0 1 I have spoken of those maladies of the body in which the regulation of the dietJJJ is most helpful: now I pass on to that part of medicine which combats rather by medicaments. These were held of high value by ancient writers, both by Erasistratus and those who styled themselves Empirics, especially how by Herophilus and his school, insomuch that they treated no kind of disease without them. A great deal has also been recorded concerning the powers of medicaments, as in the works of Zeno or of Andreas or of Apollonius, surnamed Mys. 2 On the other hand, Asclepiades dispense with the use of these for the most part, not without reason; and since nearly all medicaments harm the stomach and content bad juices, he transferred all his treatment rather to the management of the actual diet. But while in most diseases that is the more useful method, yet very many illnesses attack our bodies which cannot be cured without medicaments. This before all things it is well to recognize, together, that it is impossible to separate off any p5one part completely, but each gets its name from the treatment which it uses most. Therefore, both that which treats by dieting has recourse at times to medicaments, and that which combats disease mainly by medicaments ought also to regulate diet, which produces a good deal of effect in all maladies of the body.
But since all medicaments have special powers, and afford relief, often when simple, often when mixed, it does not seem amiss beforehand to state both their names and their virtues and how to compound them, that there may be less delay when we are describing the treatment itself.JJJ
1 1 The following suppress bleeding: Blacking with the Greeks call chalcanthon, copper ore, acacia, and lycium with water, frankincense, lign-aloe, gums, lead sulphide, leek, polygonum; Cimolian chalk or potter's clay, antimony sulphide; cold water, wine, vinegar; alum from Melos, iron and copper scales and of this last there are two kinds, one from ordinary copper, the other from red copper.
2 1 The following agglutinate a wound: myrrh, frankincense, gums, especially gum arabic; fleawort, tragacanth, cardamon, bulbs, linseed, nasturtium; white of egg, glue, isinglass; white vine, snails pounded with their shells, cooked honey, a sponge squeezed out of cold water or out of wine or out of vinegar; unscoured wool squeezed out of the same; if the wound is slight, even cobwebs.
The following subdue inflammation: alum, both split alum called schiston, and alum brine; quince oil, orpiment, verdigris, copper ore, blacking.
p7 3 1 The following mature abscessions and promote suppuration: nard, myrrh, costmary, balsam, galbanum, propolis, storax, frankincense, both the soot and the bark, bitumen, pitch, sulphur, resin, suet, fat, oil.
4 1 The following open, as it were, mouths in our bodies, called in Greek στομοῦν:JJJ cinnamon, balsam, all-heal; rush-root, pennyroyal, white violet flowers, bdellium, galbanum, turpentine and pine-resin, propolis, old olive-oil; pepper, pyrethrum, ground pine thistle, black bryony berries, sulphur, alum, rue seed.
5 1 The following have a cleaning effect: verdigris, orpiment, called by the Greeks arsenicon now this has the same property as sandarach, but copper scales are stronger, pumice; orris root, balsam, storax, frankincense, frankincense bark, pine-resin and liquid turpentine, vine-flowers; lizard dung, blood of pigeon and wood pigeon and swallow; ammoniacum, bdellium which has the same virtue as ammoniacum, but southernwood is more powerful, dry fig, Cnidian berry, powdered ivory, omphacium, radish; rennet, especially of the hare which has the same faculty as other rennet but is far more active, ox-bile, uncooked yolk of egg, burnt stagshorn, ox-glue, raw honey, antimony sulphide, copper ore; saffron, black bryony berries, southernwood, litharge, oak-gall, haematite, minium, costmary, sulphur, crude pitch, suet, fat, oil, rue, leek, lentil, bitter vetch.
6 1 The following are erodents:JJJ alum brine, especially when made from round alum, verdigris, copper p9ore, antimony sulphide, copper scales, especially from red copper, calcined copper, sandarach, minium from Sinope; oak-galls, balsam, myrrh, frankincense, frankincense bark, galbanum, liquid turpentine, pepper of both kinds but especially the round, cardamon; orpiment, lime, soda and its scum; parsley seed, narcissus root, omphacium, coral, oil of bitter almonds, garlic, uncooked honey, wine, mastich, iron scales, ox-bile, scammony, black bryony berries, cinnamon, storax, hemlock seed, omphacium, parsley seed, resin, narcissus seed, bitter almonds and their oil, blacking, chrysocolla, hellebore, ash.
7 1 The following are exedents: acacia juice, ebony, verdigris, copper scales, chrysocolla, ash, cyprus ash, soda, cadmia, litharge, hypocistis, slag, salt, orpiment, sulphur, hemlock, sandarach, salamander-ash, coral, flowers of copper, copper ore, blacking, ochre, lime, vinegar, oak-gall, alum, milk of the wild fig, or of sea spurge which the Greeks call tithymallos, coral, bile, frankincense, spode, lentil, honey, olive leaves, horehound, haematite stone, Phrygian, Assian and ironschist, antimony sulphide, wine, vinegar.
8 1 The following are caustics: orpiment, blacking, copper ore, antimony sulphide, verdigris, lime, burnt papyrus-ash, salt, copper scales, burnt wine-lees, myrrh, dung of lizard and pigeon and wood pigeon and swallow, pepper, Cnidian berry, garlic, slag, both the milks mentioned in the previous chapter, hellebore both white and black, cantharides, coral, pyrethrum, frankincense, salamander-ash, rocket, sandarach, black bryony berries, chrysocolla, ochre, split alum, sheep's dung, vine-flower buds.
p11 9 1 The foregoing generally induce scabs on ulcerations almost as when burnt by a cautery, but most of all copper ore — especially after being heated — copper flowers, verdigris, orpiment, antimony sulphide, and that also more after being heated.
11 The following, again, are most powerful to disperse whatever has collected in any part of the cody: southernwood, elecampane, marjoram, white violet, honey, lily, Cyprian marjoram, milk, melilot, thyme, oil of cypress, cedar-oil, iris, purple violet, narcissus, rose, saffron, raisin wine, angular rush, nard, cinnamon, casia, ammoniacum, wax, resin, black bryony berries, litharge, storax, dry fig, goat's marjoram, linseed, narcissus seed, bitumen, sordesJJJ from the gymnasium, pyrites or millstone, raw yolk of egg, bitter almonds, sulphur.
12 1 The following are epispastics:JJJ ladanum, round alum, ebony, linseed, omphacium, ox-bile, copper ore, bdellium, turpentine and pine resin, propolis, dried fig cooked, pigeons' dung, pumice, darnel meal, unripe figs cooked in water, elaterium, laurel berries, soda, salt.
15 1 The following are emollients: calcined copper, Eretrian earth, soda, poppy-tears, ammoniacum, bdellium, wax, suet, soft fat, oil, dried fig, sesamum, p13melilot, narcissus root and seed, rose-leaves, curd, raw yolk of egg, bitter almonds, marrow of any kind, antimony sulphide, pitch, snails boiled, hemlock seed, lead-slag which the Greeks call σκωρία μολύβδου, all-heal, cardamon, galbanum, resin, black bryony berries, storax, iris, balsam, gymnasium sordes, sulphur, butter, rue.
17 1 The powers of medicaments when unmixed having been set out, we have to say how they may be mixed together, and what are the compositions so made. Now they are mixed in various ways and there is no limit to this, since some simples may be omitted, others added, and when the same ingredients are used the proportion of their weights may be changed. Hence though there are not so very many substances having medicinal powers, there are innumerable kinds of mixtures; and, even if all of them could be included, yet this would be needless. For the same effects are produced by but a few compositions, and to vary these is easy to anyone who knows their powers. Therefore I shall content myself with those I have heard of as the best known. Now in this book I will set forth those compositions which may have been required in the previous treatments or which pertain to those treatment with which I am going shortly to mention here, so that I may bring together at the same time compositions which are more generally used: those that are applicable to a particular disease, or even to a few, I shall mention in their appropriate places. But I wish to make clear in advance that our uncia has the weight p15of seven denarii, next that I divide one denarius by weight into six parts, namely, sextantes; so that I have in the sextans of a denarius the same weight as the Greeks have in what they call an obolus. That being reduced to our weight, makes the obolus a little more than half a scripulus.JJJ
2 Now emollients and plasters and pastilsJJJ which the Greeks call trochiscoi, whilst they have much in common, differ in this, that emollients are made chiefly from essences of flowers and even from their shoots, plasters and pastils rather from certain metallic materials: again, the emollients if crushed become quite soft enough; for they are applied over intact skin; the materials out of which plasters and pastils are made are rubbed together laboriously in order that they may not irritate wounds when they are applied to them. But between a plaster and a pastil there is this difference: a plaster must contain some liquefied ingredient, in a pastil only dry materials are used, combined together by a little fluid. Then a plaster is made in this way: dry medicaments are rubbed down separately, then when they have been mixed, either vinegar is dropped in or any other liquid free from fat that is at hand, and these ingredients are rubbed together again. The materials capable of being liquefied are melted all together over the fire, and if there is to be any admixing of oil, it is then poured in. A dry ingredient is even sometimes boiled in oil beforehand: when what should be done separately has been accomplished, all are mixed together. But the making of pastils, on the other hand, is this: dry medicaments p17which have been rubbed together are mixed by the aid of a liquid free from fat, such as wine or vinegar and the mixture is dried again, and when required for use, dissolved in a liquid of the same kind. Further, a plaster is laid on, a pastil is smeared on, or is mixed with something softer such as a cerate.
Premising the above, I will speak first of emollients, almost all of which were invented, not for the purpose of cooling but for heating. There is, however, one kind which can cool, being suitable for hot podagras.JJJ It is a cupful of oak-galls, unripe or otherwise, coriander seed, hemlock, dried poppy-tears, and gum, of each 63 cc.; of washed cerate called by the Greeks πεπλυμένον,JJJ 168 grams
Almost all the rest are heating. But some disperse the diseased matter, some extract it and are called epispastic;JJJ most are designed rather for particular parts of the body.
2 If diseased matter has to be extracted, as in the case of a dropsy, pleurisy, incipient abscession, also in cases of moderate suppuration, the following emollient is suitable which contains: dried resin, soda, ammoniacum, galbanum, 336 grams, each, wax 336 grams. Or that one which contains: scrapings of verdigris and frankincense, each 8 grams, ammoniac salt 24 grams, copper scales, wax, each 32 grams, dried resin 48 grams, 42 cc of vinegar. Cumin meal with soap-wort and honey serves the same purpose.
3 If there is pain in the liverJJJ apply the emollient which consists of balsam tears 48 grams, costmary, cinnamon, casia bark, myrrh, saffron, round rush, balsam seeds, Illyrian iris, cardamon, amomum, nard, p19each 64 grams. To these is added nard ointment until the consistency is that of a cerate. And this is for use whilst fresh; but if it is to be kept, turpentine resin 64 grams, and wax 40 grams, are pounded up together in mild wine, and then mixed with the above.
4 But if there is acute pain of the spleenJJJ the rind of the nut, called by the Greeks βάλανος μυρεψική, and soda are pounded together in equal proportions and sprinkled with sharpest vinegar; when of the consistency of a cerate this is spread on lint previously moistened in cold water, and so applied, with barley-meal dusted over it; but it should not be kept on longer than six hours, lest it consume the spleen; it is better to apply it two or three times.
5 Lysias compounded an emollient equally useful the liver and spleen and for abscesses and scrofulous tumours, for parotid swellings and joints, for heels suppurating or otherwise painful, even for promoting digestion, from the following: opopanax, storax, galbanum, resin, each 8 grams, ammoniacum, bdellium, wax, beef suet, dried iris, each 16 grams, cachry, 63 cc, and 40 peppercorns, all pounded with iris ointment to the right consistency.JJJ
6 Again, for pains in the sides there is the composition of Apollophanes: turpentine-resin and frankincense root, each 16 grams, bdellium, ammoniacum, iris, calf's or goat's kidney-suet, mistletoe juice, each 16 grams. This composition relieves pain of all kinds, softens indurations, and is moderately heating.
The emollient of Andreas is for like use; and it also relaxes, draws out humour, matures pus, and p21when it is matured ruptures the skin, and brings a scar over. It is applied with advantage to abscesses, both small and large, likewise to joints and so both to the hips and feet when painful; further, it repairs any part of the body that is contused; also softens the praecordia when hard and swollen; draws outwards splinters of bone — in short, is of service in all cases which heat can benefit. It is composed of wax 4 grams, mistletoe juice, and tears of sycaminus, also called sycomorus, 4 grams each, round and long pepper, ammoniacum for fumigation, bdellium, Illyrian iris, cardamon, amomum balsam wood, male frankincense, myrrh, dried resin, 0 grams each, pyrethrum, Cnidian berries, scum of soda, ammoniac salt, Cretan aristolochia, wild cucumber root, liquid turpentine and resin, 80 grams each, to which is added a sufficiency of iris ointment to give it proper consistency.
8 A special emollient for relaxing parts constricted, for softening parts indurated, and for dispersing any collection is ascribed to Polyarchus. It contains square rush, cardamon, frankincense soot, amomum, wax and liquid resin in equal quantities.
9 Another emollient for the same purpose is that of Nileus: crocomagma,JJJ which is as it were saffron-lees, 16 grams, ammoniacum for fumigating, and wax, 80 grams each. Of these the first two are rubbed up in vinegar, the wax is liquefied by melting in rose-oil, and then all are mixed together.JJJ
10 Especially useful for softening induration is an emollient said to have been invented by Moschus. It contains galbanum 28 grams, frankincense soot 56 grams, wax and ammoniacum for fumigation, 112 grams each, dried pitch 672 grams, vinegar 750 cc.
p23 11 We have also one ascribed to medius for dispersing collections of matter. It contains wax 56 grams, panax 168 grams, copper scales, round alum, split alum, 336 grams each, calcined lead 504 grams.
12 Pantaenus used for the same purpose, quicklime 168 grams, pounded mustard, also fenugreek and alum, 336 grams each, ox-suet 840 grams.
13 For scrofulous tumour I find many emollients. Now I think that the worse this disease, and the less easy its dispersal, the most have been the remedies tried, with results varying according to the several patients. Andrias invented the following: nettle-seed 4 grams, round pepper, bdellium, galbanum, ammoniacum for fumigation, dried resin, 16 grams each, with equal parts of liquid resin, wax, pyrethrum, long pepper, seed of sea spurge, unheated sulphur, which is called apyron. Nicon's emollient contains dried vinegar lees, soda-scum, ammoniac salt, mustard, cardamon, wild cucumber root, resin, 32 grams each. These are pounded up together in mild wine.JJJ
15 A more active emollient for the same purpose contains mistletoe juice, ape's dung, resin, untreated sulphur, equal parts; another emollient contains sulphur 4 grams, the stone called pyrites 16 grams, and 63 cc of cumin. In another are pyrites one part, sulphur two parts, turpentine resin three parts.
16 An emollient, the invention of a certain Arab, serves to disperse scrofulous swelling, and the sprouting small tumours which are called phymata. It contains myrrh, ammoniac salt, incense, resin both liquid and dried, crocomagma, was, 4 grams each, p25the stone called pyrites 16 grams, to which some add sulphur 672 grams.
17 There is also an emollient efficacious for scrofulous swellings, and for those boils which are slow to come to a head, also for those which are called carcinoid.º It contains sulphur 8 grams, soda 16 grams, myrrh 24 grams, frankincense soot 3.3 grams, ammoniac salt 56 grams, wax 336 grams.
18 Protarchus, for parotid swellings, and for those small tumours which are named melicerides favi or phymata, and bad ulcerations, mixed together: pumice, liquid pine-resin, frankincense soot, soda-scum, iris, each 32 grams, along with wax 36 grams, to which are added 63 cc. of oil.
19 But against panusJJJ at any stage and when incipient, the condition called by the Greeks phygetron, and against any small tumour called phyma, the ochre named Attic is mixed with equal parts of wheat flour, and whilst these are being stirred together, honey is dropped in until the consistency is that of an emollient.
20 Also all the small tumours called phymata are dispersed by an emollient containing quicklime, soda-scum, round pepper, each 4 grams, galbanum 8 grams, salt 16 grams, which are taken up in a cerate made of rose oil.
21 Any abscessionJJJ is suppressed by galbanum and crushed beans, each 4 grams, myrrh, frankincense, caper root bark, each 16 grams. And calcined murexJJJ well pounded, with vinegar gradually added, is sufficient to disperse an abscession when forming.
p27 22 But if sufficient blood comes up,JJJ it is right to apply a remedy which is also useful against phymata. It consists of the following ingredients: bdellium, storax, ammoniacum, galbanum, pine-resin liquid and dried, also lentiscus-resin, frankincense, iris, 8 grams each.
23 But the phymata called carcinoid are relieved by the following: galbanum, mistletoe juice, ammoniacum, turpentine-resin, 4 grams each, beef suet 168 grams, of burnt wine-lees as large an amount as can be added without making the mass too dry for an emollient.
24 But after a blow on the face there is discolouration and bruising, the following prescription applied night and takes it away: aristolochia and thapsia, each 8 grams, bdellium, storax, ammoniacum for fumigation, galbanum, dried resin, liquid from lentiscus-resin, male frankincense, Illyrian iris wax, each 16 grams. The application of bean-meal also has the same effect.
25 There are certain emollients called by the Greeks anastomotica, because they have the property of opening the pores.JJJ Of these one contains long pepper and soda-scum, each 8 grams, hedge mustard 16 grams, these are mixed together with honey. They are also suitable for scrofulous tumours. Of this class is . . . a yet more powerful one of this kind is that which consists of lime 16 grams, 6 peppercorns; soda and wax, each 48 grams, honey 56 grams, and 250 cc. of oil.
p29 26 There is also a prescription of Nicon which relaxes, opens and cleans. It contains coral, sulphur, soda, and pumice, equal parts, to which pitch and wax are added to the consistency of a cerate.
27 Again, for the hard parts there is the emollient of Aristogenes made from the following: sulphur 4 grams, turpentine-resin, soda-scum, the inner part of a quill-bulb, washed lead, 8 grams each, frankincense soot 32 grams, the ripest figs and beef-suet, 32 grams each, wax 48 grams, Macedonian iris 24 grams, parched sesame 63 cc.
28 And most of all is an emollient suitable for sinews and joints. Thus still that of Euthycleus, suitable for joints and for any kind of pain, including that of the bladder, and for joints contracted by recent scarring which the Greeks call ancylae:JJJ it consists of frankincense soot 63 cc., of resin the same, galbanum without stalks 42 grams, ammoniacum and bdellium, of each 12 grams. . . . of each 56 grams, wax 168 grams. Another for similar pain in the fingers contains ammoniacum, galbanum, and soda, each 56 grams, liquid resin 24 grams, wax 64 grams.
29 The emollient of Sosagoras for pain in joints contains calcined lead, poppy tears, hyoscyamus bark, storax, sulphurwort, suet, resin and wax, equal parts.
30 That of Chrysippus contains liquid resin, sandarach, pepper, 48 grams each, to which a little wax is added.
31 That of ClesiphonJJJ consists of Cretan wax, turpentine resin, the reddest soda, 168 grams each, and p31126 cc. of oil. But this soda is pounded up beforehand over a period of three days, water being added drop by drop, and then boiled in half a litre of water until all fluid has gone. This composition too can be applied to parotid swellings, phymata, scrofulous tumours, and to soften any collection of humour.
32 Some apply to joints with good effect part of a dried fig mixed with catmint; or black bryony berries without the seeds, with pennyroyal.
33 The same are good for podagra. But for this there is also Ariston's emollient which consists of nard, cinnamon, casia, chameleon, angular rush, 32 grams each, goat's suet in liquid iris oil 80 grams, iris which should have been steeped in the sharpest vinegar for 20 days, 4 grams: this emollient also disperses recent phymata and pain of all sorts.
34 But Theoxenus for pain in the feet mixed one part of kidney-suet with two parts of salt and applied a thin membrane smeared with these, then poured over it ammoniacum for fumigation dissolved in vinegar.
35 But Numenius used to soften podagra and all cases of indurated joints with an emollient consisting of southernwood, dried rose-leaves and poppy-tears, 12 grams each, turpentine-resin 16 grams, frankincense and soda-scum, 32 grams each, iris and aristolochia, 48 grams each, wax 1 kilogram, to which is added of cedar-oil 42 cc., of laurel-oil 126 cc., of bitter olive-oil 500 cc.
36 If at any time callus has formed in joints, Dexius advised an application of lime 16 grams, white lead 32 grams, pine-resin 80 grams, 30 peppercorns, wax 56 grams. While these are being pounded together 250 cc. of mild wine is dropped in.
p33 19 1 Among the plasters none render greater service than those for immediate application to bleeding wounds, which the Greeks call enhaema.JJJ For these repress inflammation, unless a severe cause excites it, and even then they lessen its attack; further, they agglutinate wounds which allow of it, and induce a scar in them. But as the plasters consist of medicaments which are not greasy, they are named alipe.JJJ
The best of these is the plaster called barbarum.JJJ It contains scraped verdigris 48 grams, litharge 80 grams, alum, dried pitch, dried pine-resin, 4 grams each, to which is added oil and vinegar 250 cc. each.
2 Another one called Coacon,JJJ used for the same purpose, consists of litharge 400 grams, dried resin the same, but the litharge should be first boiled in three-quarters of a litre of oil. In these two plasters the colour is black, which is the colour generally produced by the pitch-resin, but the blackest is from bitumen, green from verdigris or copper scales, red from minium, white from white-lead.
3 There are very few compositions in which diversity of ingredients makes any change.JJJ Hence that plaster which is called basilicon is also black. It consists of all-heal 4 grams, galbanum 8 grams, pitch and resin, 40 grams each, oil 20 cc.
4 But, because it is bright green, a plaster is called emerald-like which contains pine-resin 12 grams, wax 4 grams, verdigris 168 grams, frankincense soot 56 grams, oil the same, and vinegar enough to combine into one the soot and the verdigris.
p35 5 There is also one, almost red in colour, which is found to bring wounds rapidly to a scar. It contains incense 4 grams, resin 8 grams, copper scales 16 grams, litharge 80 grams, wax 400 grams, oil 250 cc.
7 There are also some plasters of the same class, called by the Greeks cephalica, because they are especially suitable for broken heads. That of PhilotasJJJ has the following composition: Eretrian earth and chalcitis, 16 grams each, myrrh and calcined copper 40 grams each, isinglass 24 gram each, scraped verdigris, round alum, crude antimony sulphide and aristolochia, 32 grams each, copper scales 40 grams, male frankincense 8 grams, wax 336 grams, rose-oil and bitter olive-oil, 125 cc. each, and sufficient vinegar to rub up the ingredients while keeping them dry.
8 A green plaster for the same purpose consists of calcined copper, copper scales, myrrh and isinglass 24 grams each, crude antimony sulphide, scraped verdigris, aristolochia and alum, 32 grams each, wax 4 grams, oil 250 cc., and as much vinegar as is required.
9 But for promoting suppuration there is nothing better than the plaster called by the Greeks tetrapharmacon, which acts very quickly. It contains wax, pitch, resin and bull's suet, or, if that is not at hand, veal-suet, in equal proportions.
10 Another for the same purpose is named enneapharmacum, which is more for cleaning wounds. It has nine ingredients: wax, honey, suet, resin, myrrh, p37rose-oil, deer or calf or ox marrow, oesypum,JJJ butter; equal weights of which are mixed together.JJJ
11 Now there are certain plasters which produce both effectsJJJ which if . . . they are to be applied for both purposes are better; but if there is a choice these are to be rejected, and those plasters rather are to be selected which especially effect what is needed at the time. I will mention two as examples.
There is the plaster of Attalus for wounds, which contains copper scales 64 grams, frankincense soot 60 grams, ammoniacum the same; liquid turpentine 100 grams, bull-suet this amount; vinegar three-quarters of a litre, oil half a litre.
But among those suitable for broken heads, some include the one which is ascribed to Iudaeus. It is composed of salt 16 grams, red copper scales and calcined copper, 48 grams each, ammoniacum for fumigation, frankincense soot and dried resin, 64 grams each, Colophon resin, wax and prepared calf's suet, 80 grams each, vinegar 65 cc., less than 40 cc. of oil. The Greeks call tetherapeumena, what we call prepared, when, for instance, from suet all membranous particles are carefully removed, and so in the case of other medicaments.
12 There are besides certain plasters noteworthy for extracting, and these too are named epispastic;JJJ for instance, that called dia daphnidon,JJJ because it contains laurel berries. In it there are terebinth-resin p3940 grams, soda, wax, dried pitch, laurel-berries, 80 grams each, with a little oil. But whenever I mention a berry or nut or the like, it should be understood that the outer husk is seem to be removed before weighing.
13 Another of the same name which also promotes suppuration, contains calf-suet, ammoniacum for fumigation, pitch, wax, soda, laurel-berries, dried resin, aristolochia and pellitory, equal parts.
14 There is also that of Philocrates, which consists of ammoniac salt 28 grams, aristolochia 32 grams, wax, turpentine resin, frankincense soot, 60 grams each, litharge 128 grams, to which is added, in order to promote suppuration, iris 16 grams, and galbanum 24 grams.
15 The best as an extractive, however, is that called by the Greeks rhypodes, from its resemblance to dirt. It contains myrrh, crocus, iris, propolis, bdellium, pomegranate heads, alum both split and round, antimony sulphide, copper ore, boiled blacking, all-heal, ammoniacum salt, mistletoe juice, 16 grams each, aristolochia 32 grams, copper scales 56 grams, turpentine resin 300 gams, wax and ox or he-goat's suet, 400 grams each.
16 The plaster invented by Hecataeus is of the same class, and is composed of galbanum 8 grams, frankincense soot 16 grams, pitch 24 grams, wax and turpentine-resin, 32 grams each, with which is mixed a little iris ointment.
17 Efficacious for the same purpose is the green Alexandrian plaster. It consists of split alum 32 grams, ammoniac salt 32·66 grams, copper scales 64 grams, myrrh and frankincense 72 grams, wax 600 grams, Colophon or pine resin 800 grams, oil 250 cc., vinegar half a litre.
p41 18 Some plasters, called by the Greeks septa,JJJ eat away flesh; one such contains turpentine-resin and frankincense soot, each 56 grams, copper scales 4 grams, ladanum 8 grams, alum the same amount, litharge 16 grams.
19 The following prescription is even violent in its action on soft tissue, and also causes exfoliation of bone and keeps down fungating flesh: litharge and copper scales 28 grams each, unheated soda, Assos stone, aristolochia, 56 grams each, wax, turpentine resin, incense and old oil, blacking and ammoniac salt, 168 grams each, scraped verdigris 224 grams, vinegar of squills 250 cc., Aminaean wine the same amount.
20 There are also some suitable for bites; one of these is the black paste of Diogenes, which contains bitumen, wax, dried pine-resin, each 80 grams, litharge 400 grams, oil half a litre. Another consists of copper scales 16 grams, white-lead and scraped verdigris, each 32 grams, ammoniacum 48 grams, wax and pine resin, each 100 gams, litharge 400 grams, oil half a litre. Or there is that in which there are copper scales 56 grams, galbanum 24 grams, white-lead and scraped verdigris, a 32 grams, ammoniacum 48 grams, wax and pine-resin, each 140 grams cooked with litharge.
21 The red plaster called Ephesian is likewise suited for this purpose. It contains turpentine-resin 8 grams, galbanum 16 grams, minium for Sinope 24 grams, frankincense soot 24 grams, wax 32 grams, litharge 144 grams, old olive-oil 250 cc.
p43 22 There is another similar one which consists of copper scales and frankincense soot, each 16 grams, galbanum 24 grams, ammoniac salt 48·66 grams, wax 100 grams, olive-oil 750 cc. These plasters, however, may be also usefully applied to more erect wounds.
23 There are also soothing white plasters, called by the Greeks leuca, fitted in general for wounds which are not severe, especially in old people. Such is that containing white-lead 128 grams, prepared calf's suet, and wax, each 192 grams, olive-oil 750 cc., with which the white-lead is boiled.
24 Another consists of white-lead 80 grams, wax 140 grams, olive-oil 250 cc., water half a litre. Whatever these liquids are added to white lead or litharge, it is understood that those drugs are to be boiled up in the liquids. But the above composition being of a glistening white appearance is called ivory plaster.
26 Another composition of the same sort contains wax and turpentine-resin, each 24 grams, white-lead 32 grams, litharge and lead-slag, called by the Greeks σκωρία μολύβδου, each 80 grams, castor-oil and myrtle-oil, a 250 cc.
27 A third, said to have been invented by Archagathus, contains boiled antimony sulphide and calcined copper, each 16 grams, boiled white-lead 32 grams, turpentine-resin 40 grams, litharge 24 grams.
p45 28 Yet another of the same class consists of litharge, wax and lard, each 108 grams, yolk of 4 eggs boiled, rose-oil 250 cc. Another consists of a cerate made with myrtle-oil three parts, lard a fourth part, and a small quantity of lead-slag. Alternatively: litharge 168 grams, olive-oil 250 cc., and an equal quantity of sea water, boiled, to which, when off the boil, a little wax may be added. Or: wax, suet, antimony sulphide, litharge and white-lead, equal parts.
20 1 Pastils have also divers faculties. For some are suitable for agglutinating and making the scar upon recent wounds: such as that containing copper ore, antimony sulphide, soda-scum, flowers of copper, oak-galls, split alum moderately boiled, each 4 grams, calcined copper and pomegranate-heads, each 12 grams. It should be dissolved with vinegar, and so smeared on for agglutinating a would. But if the part wounded involves sinews or muscles, it is better to mix the pastil with a cerate, eight parts of the former to nine of the latter.
Another for the same purpose is composed of bitumen and split alum, each 4 grams, calcined copper 16 grams, litharge 44 grams, oil half a litre.
2 But the pastil of PolyidesJJJ called the "seal" is by far the most celebrated. It contains split alum 4·66 grams, blacking 8 grams, myrrh 20 grams, ling aloes the same, pomegranate heads and ox-bile, 24 grams each; these are rubbed together and taken up in dry wine.
3 For foul ulcerations and gangrene in the ears, nostrils and genitals, and their inflammatory complications, take chrysocolla 4 grams, blacking and split p47alum 8 grams each, winter cherry bark 16 grams, minium 24 grams, litharge 48 grams, white leadº 64 grams; these are both compounded with vinegar and dissolved for use with the same.
4 The pastil of Andron is for inflammation of the uvula, and for the genitals when foul, and even when affected by canker.JJJ It contains oak-galls, blacking, and myrrh, 4 grams each, aristolochia and split alum, 8 grams each, pomegranate-heads 100 grams, compounded with raisin wine, and when required for use dissolved in vinegar or wine, according as the disease to be treated is more severe or milder.
5 But the following is appropriate for anal fissures, for bleeding piles, or for canker, verdigris 8 grams, myrrh 16 grams, gum 32 grams, frankincense 48 grams, antimony sulphide, poppy tears and acacia, 64 grams each. These are both pounded up in wine and for actual use are dissolved in the same.
6 The following present is efficacious to expel stones from the bladder along with the urine; casia, crocus, myrrh, costmary, nard, cinnamon, liquorice root, balsamum and hypericum juice, equal parts; these are rubbed together, then mild wine is poured on, and pastils are made, each weighing 0·66 gram; one of them is given every morning on an empty stomach.
21 1 These three classes of compositions —emollients, pastils and plasters — have very wide and varied uses. But there are other useful compositions, such as those which are introduced into women from below: the Greeks call them pessoi.JJJ Their characteristic is that the component medicaments are taken up in soft wool, and this wool is inserted into the genitals.
p49 A pessary for inducing menstruation contains soda 2·65 grams, added to two Caunean figs; or garlic seeds are pounded, a little myrrh added, and these are mixed with Susine lily ointment; or the pulp of a wild cucumber is diluted in woman's milk.
2 To mollify the womb a yolk of egg, fenugreek, rose-oil and saffron are mixed together. Or elaterium 0·66 gram, the same quantity of salt, and black bryony berries 24 grams are taken up with honey.
3 The pessary invented by Boethus consists of saffron and turpentine resin, 16 grams each, myrrh 1·33 grams, rose-oil 4 grams, calf's suet 4·66 grams, wax 8 grams, mixed together.
4 But against inflammations of the womb, the composition of Numenius is the best; it consists of saffron 1 gram, wax 4 grams, butter 32 grams, goose-fat 48 grams, 2 yolks of egg boiled, and of rose-oil less than 40 cc.
5 If the foetus is dead, to render its expulsion more easy, pomegranate rind should be rubbed up in water and so used.
7 If a woman does not conceive, lion's fat is to be softened by rose-oil.
22 1 Now, some mixtures of medicaments are used dry, without being combined, so that they are dusted or smeared on after some liquid has been mixed with them. Such is the present to eat away fungous flesh, which contains copper scales and frankincense soot, 4 grams each, verdigris 8 grams. But when combined with honey this compound cleans ulcers, when with wax it fills them up. Also antimony p51sulphide and oak-galls, if they are mixed in equal proportions, corrode flesh. We may either sprinkle this mixture on dry or take it up in cadmianJJJ ointment and smear it on.
2 Honey mixed with lentils or with horehound or with olive leaves previously boiled in wine holds in check putrid flesh, prevents its further spread, and is a mild corrosive. The same is the action of melilot, boiled in honey wine, then pounded up; or lime with cerate; or bitter almonds with garlic in the proportion of three to one, with the addition of a little saffron. Or the composition containing litharge 24 grams, burnt ox-horn 48 grams, myrtle-oil and wine, 125 cc. of each. Or that mixture which consists of pomegranate flowers, blacking and lign-aloes, 8 grams each, split alum and frankincense 16 grams, oak-galls 32 grams, aristolochia 40 grams. Stronger as a corrosive is that compounded by calcining orpiment with copper ore, and with either soda or lime or burnt papyrus; salt with vinegar is similar. Or that composition which contains copper ore, pomegranate heads, lign-aloes, 8 grams each, split alum and frankincense, 16 grams each, oak-galls 32 grams, aristolochia 40 grams, with sufficient honey to combine them. An alternative is the composition containing cantharides 4 grams, sulphur 4 grams, darnel 12 grams, to which is added enough liquid pitch to combine them. Or also that composed of copper ore mixed with resin and rue; or slag similarly with resin; or black bryony berries with liquid pitch. The same property too belongs both to burnt wine-lees and lime and soda, equal parts, or to split alum, 1·33 grams, frankincense, sandarach and soda, 4 grams each, oak-galls 32 grams, aristolochia 40 grams, and as much honey as is required.
p53 3 There is also the compound of Heras which contains myrrh and copper ore, 8 grams each, lign-aloes, frankincense, split alum, 16 grams, aristolochia and immature oak-galls, 32 grams each, pomegranate rind pounded 40 grams.
4 The compound of Iudaeus contains lime two parts; the reddest soda one part, mixed with the urine of a young boy to the consistency of strigil scrapings.JJJ But the place on which it is smeared should from time to time be moistened.
5 Then the compound of Iollas consists of burnt papyrus and of sandarach, 4 grams each, lime 8 grams, mixed with the same quantity of orpiment.
6 But if there is haemorrhage from the membrane covering the brain, a yolk of egg which has been charred and then pounded should be scattered on; for haemorrhage elsewhere orpiment and copper scales, 4 grams each, sandarach 8 grams, calcined marble 16 grams, should be dusted on. The same also checks canker. To induce scarifying, copper scales and frankincense soot, 8 grams each, lime 16 grams. The same also counters fungous flesh.
Also Timaeus used the following for ignis sacer and for canker: myrrh 8 grams, frankincense and blacking, 12 grams each, sandarach, orpiment, copper scales, 16 grams each, oak-galls 24 grams, burnt white-lead 32 grams. This is either scattered on dry or has the same effect when taken up in honey.
8 Sneezing too is excited by putting up the nose either white veratrum or soapwort; or the following mixture: pepper and white veratrum, 0·66 gram each, castoreum 1 gram, soda-scum 4 grams, soapwort 16 grams.
9 Now gargles are used as emollients or as repressives p55or to draw out humour. As emollients, milk, pearl-barley or bran gruel; as repressants, a decoction of lentils or rose-leaves or blackberries or quinces or of dates. Mustard and pepper draw out humour.
23 1 AntidotesJJJ are seldom needed, but are at times important because they bring aid to the gravest cases. They are appropriately administered for bodily contusions, either from blows or in cases of a fall from a height, or for pain in the viscera, sides, fauces, or internal parts.JJJ But they are chiefly necessary against poisons introduced into our bodies through bites or food or drink.
B One consists of poppy-tears 0·66 gram, sweet flag and malabathrum, 20 grams each, Illyrian iris and gum, 8 grams each, anise 12 grams, Gallic nard, dried rose-leaves and cardamons, 16 grams each, parsley 16·66 grams (or trifolium 20 grams), black casia, seseli, bdellium, balsam seed, white pepper, 20·66 grams each, storax 20·66 grams, myrrh, opopanax, Syrian nard, male frankincense and hypocistis juice, 24 grams each, castoreum 24 grams, costmary, white pepper, galbanum, turpentine resin,º crocus, flowers of round rush 25 grams, liquorice root 33 grams, which are taken up in honey or in raisin wine.
2 Alternatively there is that which ZopyrusJJJ is said to have composed for a King Ptolemy, and to have called it ambrosia, consisting of the following: costmary and male frankincense, 1·33 grams each, white pepper 1 gram, flowers of round rush 8 grams, p57cinnamon 12 grams, black casia 16 grams, Cilician saffron 17 grams, myrrh called stacte 20 grams, Indian nard 21 grams. Each ingredient is ground up separately, and they are taken up in boiled honey; then at the time of using, a quantity the size of an Egyptian bean is dissolved in a draught of wine.
3 But the most famous antidote is that of Mithridates,JJJ which that king is said to have taken daily and by it to have rendered his body safe against danger from poison. It contains costmary 1·66 grams, sweet flag 20 grams, hypericum, gum, sagapenum, acacia juice, Illyrian iris, cardamon, 8 grams each, anise 12 grams, Gallic nard, gentian root and dried rose-leaves, 16 grams each, poppy-tears and parsley, 17 grams each, casia, saxifrage, darnel, long pepper, 20·66 grams each, storax 21 grams, castoreum, frankincense, hypocistis juice, myrrh and opopanax, 24 grams each, malabathrum leaves 24 grams, flower of round rush, turpentine-resin, galbanum, Cretan carrot seeds, 24·66 grams each, nard and opobalsam, 25 grams each, shepherd's purse 25 grams, rhubarb root 28 grams, saffron, ginger, cinnamon, 29 grams each. These are pounded and taken up in honey. Against poisoning, a piece the size of an almond is given in wine. In other affections an amount corresponding in size to an Egyptian bean is sufficient.
24 1 AcopaJJJ again are useful for neuralgia. Of these there is one which consists of the flower of the round rush, 9·33 grams each, costmary, square rush, laurel berries, ammoniacum, cardamons, 17 grams each, myrrh and calcined copper 28 grams, Illyrian iris and wax 56 grams, Alexandrian flag, p59round rush, aspalathus and balsam wood, 112 grams each, suet 4 grams, iris ointment 42 cc.
2 Another called euodes is prepared as follows: wax 84 grams, oil this quantity, and turpentine-resin, the size of a walnut, are boiled together, then pounded in a mortar, and into this is gradually dropped 63 cc. of the best honey, and then iris ointment and rose-oil, 125 cc. of each.
3 Now enchrista is the Greek name for liquid applications.JJJ Of these one is used for cleaning and filling up ulcers, especially about sinews. It is composed of a mixture of each parts of butter, calf's marrow, calf's suet, goose-fat, wax, honey, turpentine-resin, rose-oil and castor-oil. This are all liquefied separately, then the liquids are mixed and stirred up together. And the above is more for cleaning up wounds; it is more of an emollient if instead of the rose-oil, cyprus-oil is poured in.
4 And for ignis sacerJJJ lithargeº 24 grams, burnt ox-horn 48 grams, are rubbed together, adding by turns wine, especially that which is called sil,JJJ and myrtle-oil until 125 cc. of each is mixed in.
25 1 Pills are also numerous, and are made for various purposes. Those which relieve pain through sleep are called anodynes; unless there is overwhelming necessity, it is improper to use them; for they are composed of medicaments which are very active and alien to the stomach. There is one, however, which actually promotes digestion; it is composed of poppy-tears and galbanum, 4 grams each, myrrh, castory, and pepper, 8 grams each. Of this it is enough to swallow an amount the size of a vetch.
p61 2 Another, worse for the stomach, but more soporific, consists of mandragora 1 gram, celery-seed and hyoscyamus seed, 16 grams each, which are rubbed up after soaking in wine. One of the same size mentioned above is quite enough to take.
3 But whether there is headache or ulceration or ophthalmia or toothache or difficulty in breathing or intestinal gripings or inflammation of the womb or pain in the hips of liver or spleen or ribs, or, whether owing to genital trouble, a woman collapses speechless, a pillar of the following kind counteracts pain by producing sleep: saxifrage, sweet flag, wild rue seed, 4 grams each, castory and cinnamon 8 grams, poppy-tears, panax root, dried mandrake apples, flowers of the round rush, 9 grams each, and 56 peppercorns. These are first pounded separately, then rubbed up all together, whilst gradually adding raisin wine until the mixture is either swallowed or dissolved in water and taken as a draught.
4 Or take a good handful of wild poppy-heads when just ripe for collecting the juice and put into a vessel and boil with water sufficient to cover it. When this handful has been well boiled there, after being squeezed out it is thrown away; and with its juice is mixed an equal quantity of raisin wine, and heated until to consistency of sordes. When the mixture has cooled, pills are formed, the size of our beans; they are used in many ways. For they procure sleep p63whether taken as they are or in water; they relieve earache when a little rue-juice and raisin wine are added; when dissolved in wine they relieve gripings, and when mixed with cerate of rose-oil with the addition of a little saffron they relieve inflammation of the womb; also when smeared upon the forehead mixed with water they check the flow of phlegm into the eyes.
5 Again if inflammation of the womb prevents sleep take saffron 1·33 grams, anise and myrrh, 4 grams each, poppy-tears 12 grams, hemlock seed 32 grams. These are mixed together, and taken up in old wine, and a pill the size of a lupin is dissolved in 125 cc. of water. It is dangerous, however, to give it when there is fever.
6 For the relief of pain in the liver soda 1 gram, saffron, myrrh, Gallic nard, 4 grams each, are taken up in honey, and a pill the size of an Egyptian bean administered.
7 A pill to stop pain in the side is made of pepper, aristolochia, nard, and myrrh in equal parts.
8 A pill for pain in the chest is made from nard 4 grams, frankincense and casia, 12 grams each, myrrh and cinnamon, 24 grams each, saffron 32 grams, turpentine-resin 1 gram, honey three-quarters of a litre.
9 The pill of Athenion for cough contains myrrh and pepper, 0·66 gram each, castory and poppy-tears, 4 grams each; these are rubbed down separately, then together, and two pills, the size of our bean, are given in the morning and two at bed-time.
10 If cough prevents sleep the pill of Heracleides of Tarentum relieves both; it contains saffron 0·66 gram, myrrh, long pepper, costmary, galbanum, 1 gram each, cinnamon, castor and poppy-tears, 4 grams each.
p65 11 But if ulcers of the throat causing cough are to be cleaned, panax, myrrh and turpentine-resin, 28 grams each, galbanum 0·66 gram, hyssop 1 gram are rubbed together, and 250 cc. of honey added to them and as much swallowed as can be taken up on the finger.
12 The pillJJJ of Cassius for colic contains saffron, anise, castory, 12 grams each, parsley 16 grams, pepper both long and round, 20 grams each, poppy-tears, round rush, myrrh, nard, 24 grams each; these are taken up in honey. It may be either swallowed as it is or dissolved in hot water.
13 A draught for the expulsion of a dead foetus or placenta consists of ammoniac salt 4 grams, or of Cretan dittany 4 grams in water.
14 In difficult labour hedge mustard in tepid wine should be administered on an empty stomach.
15 The voice is strengthened by frankincense 4 grams in two cups of wine.
16 For difficult micturition long pepper, castory, myrrh, galbanum, poppy-tears, saffron, costmary, 28 grams each; storax and turpentine-resin, 56 grams each, honey with absinth 42 cc. Of this an amount the size of an Egyptian bean should be taken in the morning and after dinner.
17 A medicineJJJ for the windpipe is prepared as follows: casia, iris, cinnamon, nard, myrrh, frankincense, 4 grams each; saffron 1 gram; and 30 peppercorns boiled in a litre and a half of raisin wine until of the consistency of honey. Or, saffron, myrrh, frankincense, 4 grams each, similarly boiled in raisin wine to the same consistency. Or 750 cc. of raisin p67wine are boiled until a drop, if taken out, solidifies; thereupon pounded casia 4 grams is added.
26 1 Now that I have set out the properties of the medicaments, I will explain the classes of lesions harmful to the body: there are five; when something from without causes the lesion, as in the case of wounds;JJJ when some internal part has become corrupted, as in the case of canker;JJJ when some new formation has occurred, such as a stone in the bladder;JJJ when something has grown bigger, as when a vein swells up and is converted into a varix;JJJ when there is some defect, as when some part has been mutilated.JJJ
In some of these medicaments are more effectual, in others surgery. Postponing those conditions which demand in particular the scalpel and surgical treatment,JJJ I will speak now of those which chiefly require medicaments. As I have done before,JJJ I shall divide this part of treatment, and speak first of those lesions which may occur in any part of the body,JJJ then of those which attack particular parts.JJJ I shall begin with wounds.
In this connexion, however, a practitioner should know above all which wounds are incurable, which may be cured with difficulty, and which more readily. For it is the part of a prudent man first not to touch a case he cannot save, and to the risk the appearance of having killed one whose lot is but to die;JJJ next, when there is grave fear without, however, absolute p69despair, to point out to the patient's relatives that hope is surrounded by difficulty, for then if the art is overcome by the malady, he may not seem to have been ignorant or mistaken. But while such steps become a prudent practitioner, it is like a mountebank to exaggerate a small matter in order to enhance his own achievement. It is right to commit himself to a statement that a case is simple in order that he may examine it with even more care for fear a case slight in itself may become worse by negligence on the doctor's part.
2 It is impossible to save a patient when the base of the brain, the heart, the gullet, the porta of the liver, or the spinal marrow has been pierced; when the middle of the lung, or the jejunum, or the small intestine, or the stomach, or kidneys have been wounded; or when the large blood-vessels and arteries in the region of the throat have been cut.
3 Again, there is hardly ever recovery when either the lung or the thick part of the liver or the membrane enclosing the brain, or the spleen, womb, bladder, any of the intestines or diaphragm has been wounded in any part. There is also grave danger when the point of a weapon has gone down to the large blood-vessels deeply seated in the armpits or hams. Also wounds are dangerous wherever the blood-vessels are larger, because they may exhaust the patient by profuse bleeding. This occurs not only in the armpits and hams, but also in those blood-vessels which go to the anus and testicles. Moreover, a wound is a bad one whenever it is in the armpits or in the thighs or in hollow places or in joints or between the fingers; also whenever a muscle p71or sinew or artery or membrane or bone or cartilage is injured. The safest of all is a wound in the flesh.
4 The above wounds are severer or slighter according to their situations. Still, whenever it is large, a wound makes for danger.
5 The class of wound and its shape are also important. For a contused would is worse than one simply incised, hence it is better to be wounded by a sharp weapon than by a blunt one. A wound is worse also if a piece is cut out, or if the flesh is cut away in one part and hanging free in another. A curved wound is worst, a straight linear one safest; hence a wound is more or less serious, according as it approximates to the former or to the latter shape.
6 Again, both age and constitution and mode of life and the season have also some influence; for a boy or young adult heals more readily than does an old man; one who is strong than a weak man; a man who is not too thin or too fat than one who is either of these; one of sound habit than of unsound; one who takes exercise than a sluggard; one who is sober and temperate than one addicted to wine and venery. And the most opportune time for healing is the spring, or at any rate when the weather is neither cold nor hot, for wounds are harmed by excessive heat and excessive cold, but most of all by variations of these; hence autumn is the most pernicious season.
7 Now most wounds are open to view; some are inferred from their situation,26 which we have pointed out elsewhere when indicating the positions of the internal parts. Since, however, some of these wounds are near at hand, and it is of importance whether the wound is superficial or has penetrated inwards, p73it is necessary to state the signs by which it is possible to recognize what has happened inside, and from which follow either hope or despair.26
8 Now when the heart is penetrated, much blood issues, the pulse fades away, the colour is extremely pallid, cold and malodorous sweats burst out as if the body had been wetted by dew, the extremities become cold and death quickly follows.
9 But when the lung is pierced there is difficulty in breathing; frothy blood escapes from the mouth, red blood from the wound; and at the same time breath is drawn with a noise; to lie upon the wound affords relief; some stand up without any reason. Many speak if they have been laid upon the wound; if upon the opposite side they become speechless.
10 Symptoms that the liver should have been wounded are that considerable haemorrhage occurs from under the right part of the hypochondria;26 the hypochondria are retracted towards the spine; the patient is eased by lying on his belly; stabbing pains spread upwards as high as the clavicle and its junction with the scapula; to which, not infrequently, also bilious vomiting is added.
11 When the kidneys have been penetrated, pain spreads down to the groin and testicles; urine is passed with difficulty, and it is either bloodstained or actual blood clot is passed.
12 But when the spleen has been pierced, black blood flows out from the left side; the hypochondria on that side together with the stomach become hard; great thirst comes on; pain extends to the clavicle as when the liver has been wounded.
13 But when the womb has been penetrated, there is p75pain in the groins and hips and thighs; blood passes downwards in part through the wound, in part by the vagina; bilious vomiting follows. Some become speechless, some are mentally disturbed, others whilst composed in mind complain of pain in their sinews and eyeballs, and when dying they suffer like those wounded in the heart.
14 When the brain or its membrane has been wounded, blood escape through the nostrils, in some also through the ears; and generally bilious vomiting follows. Some lose their senses and take no notice when spoken to; some have a wild look; in some the eyes move from side to side as if they were out of control; generally on the third or fifth day delirium supervenes; many have also spasm of sinews. Again, before death many tear off the bandages with which their head has been bound up, and expose the bared wound to cold.
15 But when the gullet has been penetrated, hiccough and bilious vomiting follow; if any food or drink is swallowed, it is returned at once; pulsation of the blood-vessels fades away; thin sweat breaks out, following which the extremities become cold.
16 The signs when the small intestine and the stomach have been wounded are the same; for food and drink come out through the wound; the hypochondria become hard, sometimes bile is regurgitated through the mouth. Only in the case of the intestine the situation of the wound is lower down. All other intestinal wounds cause the emission of faeces or a faecal odour.
17 When the marrow which is within the spine has been crushed, there is either paralysis or spasm of sinews; sensation is interrupted; after some time there is p77involuntary evacuation from the parts below of either semen or urine of even faeces.
18 But if the diaphragm has been penetrated, the praecordia are contracted upwards; the spine is painful; breathing is laboured; frothy blood escapes.
19 When the bladder has been wounded, the groins are painful; the hypogastrium becomes tense; blood is passed, instead of urine, the urine being discharged from the actual wound. The gullet is affected, and so the patients either vomit bile or hiccough. Coldness and after that death follows.
20 Even when these facts are known, there are still some other things to be learnt about wounds and ulcerations in general, of which we will now speak. From wounds, then, there comes out blood, or sanies, or pus. Blood everybody knows; sanies is thinner than blood, varying both in thickness and stickiness and colour. Pus is the thickest and whitest, more sticky than either sanies or blood. Now blood comes out from a fresh wound or from one which is already healing, sanies between these two periods, pus from an ulceration already beginning to heal. Again, the Greeks distinguish by name different kinds of sanies and pus. For there is a kind of sanies which is named either hidros26 or melitera;26 there is pus which is called alaeodes.26 Hidros is thin, whitish, and comes from a bad ulceration, especially when inflammation has followed upon a wound of a sinew. Melitera is thicker, stickier and whitish, something like honey. It is likewise discharged from bad ulcerations, when sinews near to joints have been wounded, and among such places especially from the knees. Elaeodes is thin, whitish, fatty, in colour and fattiness not unlike olive-oil; it appears p79in large ulcerations when they are healing. Blood is bad when it is too thin or too thick, livid or black in colour, or mixed with phlegm or variable; it is best when hot, red, moderately thick, and not sticky. Consequently from the first the treatment is more expeditious in the case of a wound from which good blood has flowed. Also later there is more hope in the case of wounds from which all the discharges are of the better kind. Thus sanies is bad when profuse, too thin, livid, or pallid or black or sticky or malodorous or when it erodes either the ulceration itself or the skin adjoining it; it is better when not profuse, moderately thick, reddish or whitish. But hidros is worse when it is profuse, thick, somewhat livid or pallid, stick, black, hot, malodorous; it is less serious when whitish, and when all the rest of its characteristics are the opposite of the foregoing. Melitera again is bad when profuse and very thick; better for being thinner and less copious. Amongst these discharges pus is the best; but it is likewise worse when profuse, thin, watery, and the more so if it is such from the beginning; and also if it is in colour like whey, if pallid, or livid, or like wine-lees; if, besides, it is malodorous, unless, however, it is the part which causes this odour. It is better, the smaller the quantity, the thicker and whiter; also if it is bland, odourless, uniform; none the less it should correspond in quantity with the size and age of the wound. For naturally there is more discharge, the larger the wound, si more when inflammation has not yet subsided. Elaeodes also is worse when large in quantity and but little fatty, the less in quantity and the more fatty the better.
p81 21 After these matters have been investigated, when a man has been wounded who can be saved, there are in the first place two things to be kept in mind: that he should die from haemorrhage or inflammation. If we are afraid of haemorrhage which can be judged both from the position and size of the wound and from the force of the flowing blood, the wound is to be filled with dry lint, and over that a sponge applied, squeezed out of cold water, and pressed down by the hand. If the bleeding is not checked thus, the lint must be changed several times, and if it is not effective when dry, it is to be soaked in vinegar. Vinegar is powerful in suppressing a flow of blood; and some, therefore, pour it into wounds. But then there is an underlying fear of another kind, that if too much diseased matter is forcibly retained in the wound it will afterwards cause great inflammation. It is on this account that no use is made, either of corrosives or of caustics, owing to the crust they induce, although most of these medicaments suppress bleeding; but if for once recourse is had to them, choose those which have a milder action. But if even these are powerless against the profuse bleeding, the blood-vessels which are pouring out blood are to be seized, and round the wounded spot they are to be tied in two places and cut across between so that the two ends coalesce each on itself and yet have their orifices closed. When circumstances do not even admit of this, the blood-vessels can be burnt with a red-hot iron. But even when there has been a considerable bleeding from a place where there is neither sinew nor muscle, such as the forehead or top of the head, it is perhaps best to apply a cup to a distant part, in order to divert thither the course of the blood.
p83 22 Against bleeding there is help in the foregoing measures, but against inflammation it lies simply in the bleeding itself. Inflammation is to be feared when a bone is injured or sinew or cartilage or muscle, or whenever there is little outflow of blood compared to the wound. Therefore, in such cases, it will not be desirable to suppress the bleeding early, but to let blood flow as long as it is safe; so that if there seems too little bleeding, blood should be let from the arm as well, at any rate when the patient is young and robust and used to exercise, and much more so when a drinking bout has preceded the wound. But if a muscle is seen to be wounded, it will be best to cut it right through; for when stabbed it causes death, when cut through it admits of cure.JJJ
23 Now, when bleeding has been suppressed if excessive, or encouragedJJJ when not enough has escaped of itself, then by far the best thing is for the wound to become agglutinated. But this is possible for a wound in the skin, or even in the flesh, if nothing else has occurred to do it harm. Agglutination is possible if the flesh is hanging free at one part, whilst attached at another, provided, however, that the flesh is still sound, and has a connexion with the body to feed it. But with wounds which are being agglutinated, there are two treatments. For if the wound is in a soft part, it will be stitched up, and particularly when the cut is in the tip of the ear or the point of the nose or forehead or cheek or eyelid or lip or the skin over the throat or abdomen. bBut if the wound is in the flesh, and gapes, and its margins are not easily drawn together, then stitching in unsuitable; fibulaeJJJ (the Greeks call them ancteres) are then to be p85inserted, which draw together the margins to some extent and so render the subsequent scar less broad. Now from the above it can be gathered also whether flesh which is hanging free at one part and attached at another, if it is still capable of juncture, demands suture or fibula. But neither of these should be inserted until the interior of the wound has been cleansed, lest some blood-clot be left in it. For blood clot turns into pus, and excites inflammation, and prevents agglutination of the wound. Not even lint which has been inserted to arrest bleeding should be left in, for this also inflames the wound. The suture or fibula should take up, not only skin but also some of the underlying flesh, where there is any, that it may hold more firmly, and not tear through the skin. And both are best used with a strand of a soft wool not too closely twisted that it may cause less irritation to the body, and both should be inserted at intervals not too distant or too close. For if the intervals are too distant, the wound is not held together; if too close, it is very hurtful, for the more often the needle this fixes the tissues, and the more places are wounded by the inserted stitches, the worse is the inflammation set up, especially in summer. Neither procedure needs any force, but is useful just so far as the skin follows that which draws it as if of its own accord. Generally, however, fibulae leave the wound wider open, a suture joins the margins together, but these should not be brought actually into contact throughout the whole length of the wound, in order that there may be an outlet for any humour collecting within. If any wound admits of neither of these, it should none the less be cleaned. Hence, upon every p87wound there is to be applied, first a sponge squeezed out of vinegar; or out of wine if the patient cannot bear the strength of vinegar. A slight wound is even benefited if a sponge is applied wrung out of cold water. But in whatever way it is put on, it is only of service while moist; and so it must not be allowed to become dry. And a wound can be treated without foreign and far-fetched and complicated medicaments. But if any one has not confidence in this treatment, a medicament should be put on, which has no suet in its composition, chosen from those which I have stated to be suitable for bleeding wounds:JJJ and especially, if it is a flesh wound, the composition called barbarum;JJJ if a wound of sinews or of cartilage or of some projecting part, such as the ears or lips, the seal of Polyides:JJJ the green composition called AlexandrianJJJ is also suitable for sinews; and that which the Greeks call rhaptousaJJJ for parts which project. When the body is bruised it is usual also for the skin to be broken to a small extent. When this occurs, it is not improper to lay it open more widely with a scalpel, unless there are muscles and sinews near, as it is inexpedient to cut into these. When it has been sufficiently opened, a medicament is seem to be put on. But if the skin over the contusion, although broken too little, yet must not be laid open more widely on account of sinews or muscles, then such applications should be made as gently extract humour, especially that which I have said is called rhypodes.JJJ It is also not inappropriate, when the wound is severe, after putting on what is beneficial, to lay on over this, wool saturated with vinegar and oil; or a poultice, p89gently repressant if to a soft part; or emollient to a part where there are sinews or muscles.
24 The bandage too for binding up a wound is best made of linen, and it should be so wide as to cover it in a single turn, not the wound alone but somewhat of its edges on either side. If the flesh has receded more from one edge, the traction is better made from that side. If equally from both, the bandage, put crosswise, should press the margins together; or if the character of the wound does not admit of that, the middle of the bandage is to be applied first, so that it may then be drawn to either side.JJJ Moreover, the wound is to be bandaged so that it is held together, yet not constricted. When it is not so held, it gapes; if it is constricted too much, there is a risk of canker. In winter there should be more turns of the bandage, in summer just those necessary; finally, the end of the bandage is to be stitched by means of a needle to the deeper turns; for a knot hurts the wound, unless, indeed, it is at a distance from it.
On the following point no practitioner should be ignorant so that he has to enquire as to the special treatment required for the internal organs, which I have spoken of above.JJJ For whilst an external wound is to be treated either by suture, or by some sort of medicine; in the case of the internal organs, nothing is to be moved, unless it be to cut away some bit of liver or spleen or lung which hangs outside. Otherwise internal wounds will be cured by the regulation of diet, and by those medicaments which I have stated in the preceding book to suit each individual organ.JJJ
25 So then, after this has been done on the first day, p91the patient is to be put to bed; if the wound is severe, before inflammation sets in, he should abstain from food, as far as his strength permits; he should drink warm water until his thirst is quenched; or, if it is summer and he has neither fever nor pain, even cold water. There is, however, in this no standing order, for always account has to be taken of the bodily strength, since weakness may render it necessary for him to take food even from the first, light of course and scanty, just enough to sustain him; and many who are actually fainting from loss of blood must, before any treatment, be resuscitated by wine, which in other cases is most inimical to a wound.
26 It is dangerous when a wound swells overmuch; no swelling at all is the worst danger: the former is an indication of severe inflammation; the latter that the part is dead. And from the first if the patient retains his senses, if no fever follows, we may recognize that the wound will soon heal. And even fever should not cause alarm in the case of a large wound, if it persists while there is inflammation. That fever is harmful which either supervenes upon a slight wound, or lasts beyond the inflammatory period, or excites delirium; or which does not put an end to the rigor or spasm of sinews which has originated from the wound. Also involuntary bilious vomiting either immediately after the injury, or during the inflammatory period, is a bad sign only when sinews or even the neighbourhood of sinews have been wounded. The induction of a vomit, however, is not inappropriate, especially in those habituated to it; provided that this is not done immediately after food, or just when the inflammation has arisen, or p93when the wound is situated in the upper part of the body.
27 When the wound has been so treated for two days, on the third it should be uncovered, sanies washed away with cold water, and then the same dressing applied again. By the fifth day the extent of inflammation in prospect is apparent. And on that day, when the wound has been uncovered again, its colour must be considered. If it is livid or pallid or patchy or dusky, it can be recognized that the wound is a bad one, and whenever this is observed, it should alarm us. It is best for the wound to be white or rubicund; also if the skin is hardened, thickened, or painful, danger is indication. Good signs are for the skin to be thin and soft without pain. But if the wound is agglutinating or swollen slightly, the same dressings as at first are to be applied; if there is severe inflammation and no hope of agglutination, then such applications are to be made as promote suppuration. And now the use of hot water as well is a necessity, in order to disperse diseased matter and to soften hardening and bring out pus. The temperature of the water must be pleasant to the hand when put into it, and the affusion is to be continued until the swelling is seen to have diminished and a more natural colour to have returned to the wound. After this fomentation, if the wound is not gaping widely, a plaster should be put on at once, particularly that tetrapharmacum if it is a large wound;JJJ in the case of wounds of joints, fingers, cartilaginous places, the plaster rhypodes;JJJ if the wound gapes more widely, that same plaster should be liquefied by iris unguent, and lint smeared with this laid all over the wound; upon this put the plaster, and above that greasy wool. p95The bandages are to be even less tight than at first.
28 As to joints, there are certain special points to be noticed as, if the controlling sinews have been divided, weakness of the part concerned follows. If this is in doubt, and the wound has been made by a sharp weapon, a transverse wound is the more favourable; if by a blunt and heavy weapon, the shape of the wound makes no difference. But it is to be observed whether pus is being formed above the joint or beneath. If it is produced underneath, and thick and white discharge continues for some time, it is probable that a sinew has been cut, and the more so the greater the pains and inflammation, and the earlier these occur. But even though no sinew is divided, yet, if a hard swelling persists for a long while round about, the wound will last a long time and even after healing a swelling will persists; and in future that limb will be bent or stretched out slowly. There is, however, more delay in extending a limb which has been kept bent while treated, than in bending a limb which has been kept straight. Also there should be a definite rule as to position for a limb which has been wounded. If the wound is seem to be agglutinated, the limb is kept raised; it must not be bent either way if there is still inflammation; if pus is already being discharged it should be hanging down. The best medicament too is rest; movement and walking before healing are adverse. The danger, however, from movement is less for wounds of the head and arms than for the lower limbs. Walking about is least of all suited to an injured thigh or leg or foot. The patient's room should be kept warm. p97Bathing, too, while the wound is not yet clean, is one of the worst things to do; for this makes the wound both wet and dirty, and then there is a tendency for gangrene to occur. It is advantageous to apply light rubbing, but in those parts which are rather far away from the wound.
29 When the inflammation has ended, the wound must be cleaned. And that is best done by putting on lint soaked in honey, and over it the plaster called tetrapharmacum or that called enneapharmacum.JJJ Then at length the wound is really clean when it is red, and neither too dry nor too moist. But a wound is not clean when it lacks sensation, when there is sensation which is not natural, when it is either too dry or too wet, when it is either whitish or pallid or livid or blackish.JJJ
30 When the wound is clean, there follows the growth of new flesh; and now warm water is necessary in order to remove sanies. The use of unscoured wool is superfluous; scoured wool is the better wrapping. But for filling up a wound certain medicaments also are useful;JJJ therefore it is not inappropriate to make use of such things as butter with rose-oil and a little honey; or the tetrapharmacum with the said rose-oil, or lint soaked in rose-oil. More beneficial, however, is an occasional bath, a nourishing diet, while avoiding everything acrid, but now somewhat fuller, for both poultry and venison and boiled pork can be given. In all cases, while fever and inflammation are present, wine is inappropriate; also, until the scar is formed, if either sinews or muscles have been wounded; or even if there is a deep flesh wound. But when the wound is of the safer kind, only skin deep, wine if p99not too old, given in moderation, can even aid the growth of flesh. If any part is to be softened, which is necessary in the region of sinews and muscles, cerate also is to be used upon the wound. But if flesh fungates, dry lint is a moderate repressant, copper scales a more active one. If more fungation needs to be removed the still more active corrosives are to be employed.JJJ After all such applications, lycium dissolved in raisin wine or in milk, or even only an application of dry lint, is useful in inducing a scar.
31 Such is the procedure of a successful treatment; dangerous complications, however, are wont to occur. Sometimes the wound becomes the seat of chronic ulceration, and it becomes hardened, and the thickened margins are a livid colour; after which whatever medicament is applied is of little service; and this commonly occurs when the wound has been carelessly treated. At times, whether owing to excess of inflammation, or to unusually hot weather, or to excessively cold weather, of because the wound has been bandaged too tightly, or on account of old age, or of a bad habit of body, canker sets in. bThe Greeks divided this genus into species for which there are no terms in our language.
Now canker,JJJ whatever its species, corrupts not only the part it attacks, but it also spreads; next it is distinguished by differing signs. For sometimes a redness, over and above the inflammation, surrounds the wound, and this spreads with pain (the Greeks term it erysipelas); at times the wound is black because its flesh has become corrupted, and this is still more intensified by putrefaction when the wound is moist, and from the black wound is discharged a p101pallid humour, which has a foul odour, and the granulations break down: cat times also sinews and membranes undergo dissolution, and when a probe is introduced it passes to the side or downwards, and this lesion not infrequently affects the bone too; sometimes there arises what the Greeks call gangrene. The former varieties occur in any part of the body; gangrene in the extremities, that is, in the nails, armpits or groins, and generally in aged people or in those of a bad habit of body. The flesh in the wound becomes either black or livid, but dry and shrivelled; the skin near it is for the most part occupied by dusky pustules; then the skin around these becomes either pallid or livid, and usually wrinkled, deficient in sensation: farther away from the wound the skin is inflamed. dAll these things spread simultaneously, the ulceration into the pustules, the pustules into the pallid or livid part, that into the inflamed part, and that again into the sound flesh. eNow together with the above an acute fever arises and great thirst: in some also delirium: others, although in their right minds, nevertheless stammer so that they can scarcely explain their feelings; the stomach begins to be affected: even the breath gets a foul odour. This disorder at its commencement admits of treatment; but when thoroughly established it is incurable, and most patients die in a cold sweat.
32 And such are the dangers following upon wounds. Now a wound when of long standing should be cut with a scalpel, its margins excised, and incisions made at the same time into any livid area surrounding the margins. If there is a small varixJJJ inside the wound which hinders healing, it also is to be excised. p103Then when the blood has been let out and the wound made like a new one, the same treatment is to be adopted as that described for recent wounds. If any one does not want to use the scalpel, healing may be secured by using the plaster made up with ladanum,JJJ and, when that has eaten away the ulcer, by the one which induces a scar.JJJ
33 But what I have said is called erysipelas, not only follows upon a would, but is wont also to arise without a wound, and sometimes brings with it some danger, especially when it sets in about the neck or head. If strength permits, blood should be let; then repressives and refrigerants applied together, particularly white-lead with nightshade juice, or Cimolian chalk with rain-water as an excipient; or flour made into a paste with the same, with cyprus shoots added, or lentil meal if the skin is more delicate. bWhatever is put on is to be covered over with beet leaves, and over that with lint wetted with cold water. If refrigerants by themselves have little effect, they are to be combined with the following: sulphur 4 grams, white-lead and saffron, 50 grams each; and these are pounded up with wine and the place smeared with them: or when the skin is more hardened, nightshade leaves are pounded, mixed with lard, and applied spread on lint.
cBut if there is a blackening which is not yet spreading, the milder corrosives of putrid flesh are to be put on, and the wound having been thus cleaned out, is cared for like other wounds. If there is more corruption, and it is already spreading, stronger corrosives are needed. If even these are not effective, p105the place should be burnt by a cautery until no more humour escapes from it; for sound flesh is dry when it is burnt. dAfter the cauterizing of a putrid wound, such drugs are to be applied as will loosen from the living flesh the crusts which the Greeks call eschara. When these have fallen off, the wound is to be cleaned by honey and resin in particular; but it can also be cleaned by the other materials with which suppurating wounds are treatedJJJ and in the same way brought to healing.
34 But gangrene, when not yet widespread, but only beginning, is not very difficult to cure, at any rate in a young subject; and even more so if muscles are intact, sinews uninjured or but slightly affected, and no large joint opened, or if there is little flesh in the part, and so not much to putrefy, and if the lesion is limited to one place; and this mostly happens in a finger. bIn such a case the first thing to be done, when strength permits, is to let blood; then whatever has become dry, and by stretching out, as it were, in injuring also what is next to it, is cut away up to this point the sound tissue. Whilst the gangrene is spreading, medicaments which tend to promote suppuration are not to be applied; and therefore not even hot water. Weighty dressings also, although repressant, are unsuitable; but the lightest are needed; and over the parts which are inflamed refrigerants are to be used. cIf the malady is still not checked, the part between what is sound and diseased ought to be cauterized; and in such a case especially assistance is to be sought, not only from medicaments, but also from a system of diet; for this malady only occurs in a corrupt and diseased body. Therefore at first, unless weakness prohibits p107it, the patient should fast; after that he should be given light food and drink to tone up the bowels, and so also the body in general. Later if the lesion has been checked, the same things should be put on the wound which were prescribed for putrid ulceration. dAnd it is now also permissible to make use of a fuller diet — foods of the middle class, but only such as dry up the bowels and the body generally; and cold rain-water to drink. The bath is harmful until it is quite certain that soundness has returned; for a wound, if softened in the bath, is quickly again affected by the same malady. But it still happens sometimes that none of these remedies is effectual, and in spite of everything this canker spreads. In such circumstances there is one sad by solitary remedy to secure the safety of the rest of the body, that is to cut away the limb which is gradually dying.JJJ
35 Such are the treatments of the gravest wounds. But there should be no neglect of those in which the skin is intact, but some inner part has been contused; or where something has been scraped or rubbed off:JJJ or what a splinter has become fixed in the body, or where the wound is small but deep.JJJ
In the first case the best thing is to cook the rind of a pomegranate in wine, and pound up its interior and mix with rose-oil cerate, and so apply it: next, when the skin has been actually abraded, to lay on a soothing medicament such as lipara.JJJ
bWhen the skin has been scraped and rubbed off, the plaster tetrapharmacum is to be applied, the food reduced and wine withdrawn. Such wounds are not to be disregarded because deeper structures are uninjured; for often from injuries of this kind p109canker develops. But if the hurt is trifling, and of small extent, we may be content with the same soothing application.
A splinter too, whenever possible, should be extracted either by the hand or even by the help of an instrument. But if the splinter has been broken off or has penetrated too deeply for this to be done, it must be drawn towards the surface by a medicament. cThe best thing to draw it out is an application of pole-reed root pound up straight away if soft, but if already rather hard, boiled first in honey wine; to which honey should always be added, or birthwort also with honey. Of splinters the pole-reed is the worst because it is rough; there is the same harmfulness in fern. But by experience it has been learnt that either, when pounded up and applied, serves as a medicament against the other. Any medicament which has an extractive property has the same effect on splinters of all kinds.
The same treatment is best for deep and narrow wounds. The plaster of Philocrates is especially good for the former, that of Hecataeus for the latter.JJJ
36 Whatever the kind of wound, when the time has come for inducing the scar, which must be after the wound has cleaned and filled with new flesh, first lint is applied, wetted by cold water while the flesh is being nourished; afterwards, when it has to be checked, dry lint must be applied until the scar is induced. Then plumbum album should be bandaged on in order to keep down the scar, and to give it a colour as much as possible like sound skin. bWild cucumber root has the same property, so has the present contain in: elateriumJJJ 4 grams, litharge p1118 grams, unguent 16 grams.JJJ These are taken up in turpentine until the whole is of the consistency of a plaster. Further, equal parts of verdigris and washed lead mixed together with rose-oil gently clean black scars; either the scar may be anointed, as can be done on the face; or the above may be applied as a plaster, which is more convenient for other parts of the body. cBut if the scar is either elevated or depressed, it is foolish, just for the sake of appearance, to submit to pain and medicinal applications. Else both conditions can be remedied, since either scar can be made into a wound by the use of a scalpel. Or if a medicament is preferred, corrosive compositions have the same effect. After the skin has been wounded, to an elevated cicatrix corrosives are applied, to a depressed one medicaments which make flesh, until the wound, in each case, is on a level with the sound skin; and then the scar is induced.
27 1 I have spoken of those wounds which are mostly inflicted by weapons. My next task is to speak of those which are caused by the bite, at times of a man, at times of an ape, often of a dog, not infrequently of wild animals or of snakes. For almost every bite has in it poison of some sort. Therefore if the wound is severe, a cup should be applied straightway of it; if slighter a plaster, especially that of Diogenes. bIf that is not at hand, then one of the others I have recommended against bites;JJJ failing such, the green plaster called Alexandrian;JJJ if not even that is to be had, then any one which suits recent wounds, so long as it is not greasy. Salt is also a remedy for bites, especially dog-bite, if a hand is then placed over the bite and struck by two p113fingers of the other hand; for this brings out sanies; and brine-pickle may also be appropriately bandaged upon such a wound.
2 But especially if the dog was mad, the poison must be drawn out by a cup; next, if the wound is not among sinews and muscles, it must be cauterized; if it cannot be cauterized, it is not amiss to bleed the man. After cauterizing, applications are to be put on as for other burns; if the wound is not cauterized, such medicaments as are powerful corrosives. After this the wound should be filled in and brought to healing, not by any new method, but as already described above.JJJ bAfter the bite of a mad dog some send the patients at once to the bath, and there let them sweat as much as their bodily strength allows, the wound being kept open in order that the poison may drop out freely from it; then follows the administration of much wine, undiluted, which is an antidote to all poisons. And when this has been carried out for three days, the patient is deemed to be out of danger.
cBut when too little has been done for such a wound, it usually givesº rise to a fear of water which the hands call hydrophobia, a most distressing disease, in which the patient is tortured simultaneously by thirst and by dread of water. In these cases there is very little help for the sufferer. But still there is just one remedy, to throw the patient unawares into a water tank which he has not seen beforehand. If he cannot swim, let him sink under and drink, then lift him out; if he can swim, push him under at intervals so that he drinks his fill of water even against his will; for so his thirst and dread of water are removed at the same time. dYet this p115procedure incurs a good danger, that a spasm of sinews, provoked by the cold water, may carry off a weakened body. Lest this should happen, he must be taken straight from the tank and plunged into a bath of hot oil. But as an antidote we should give especially the one which I put first,JJJ when that is not at hand, another; it is to be given in a draught of water, if the patient does not dread water yet; and if the bitterness is objected to, honey is to be added; if dread of water has already seized him, the antidote can be swallowed as a pill.
3 Serpents' bites again need a not very different treatment, although in this the ancients had very various methods so that for each kind of snake some prescribed one special kind of remedy, some another; but in all it is the same measures which are the most efficacious. Therefore first the limb is to be constricted above this kind of wound, but not too tightly, lest it become numbed; next, the poison is to be drawn out. A cup does this best. But it is not amiss beforehand to according to incisions with a scalpel around the wound, in order that more of the vitiated blood may be extracted. bIf there is no cup at hand, although this can hardly happen, use any similar vessel which can do what you want; if there is not even this, a man must be got to suck the wound. I declare there is no particular science in those people who are called Psylli,JJJ but a boldness confirmed by experience. For serpent's poison, like certain hunter's poisons, such as the Gauls in particular use, does no harm when swallowed, but only in a wound. Hence the snake itself may be safely eaten, whilst its stroke kills; and if one is stupefied, which mountebanks effect p117by certain medicaments, and if anyone puts his finger into its mouth and is not bitten, its saliva is harmless. Anyone, therefore, who follows the example of the Psylli and sucks out the wound, will himself be safe, and will promote the safety of the patient. He must see to it, however, beforehand that he has no sore place on his gums or palate or other parts of the mouth. dAfter the suction, the patient should be put into a warm room, in such a position that the part bitten is inclined downwards. If there is no one at hand to suck out the wound, or to cup it, the patient should sip goose or mutton or veal broth and provoke a vomit; further a live chicken should be cut through the middle, and whilst warm applied forthwith over the wound so that its inner part is in contact with the patient's body. It will also do to slaughter a kid or lamb, and immediately to put the hot flesh upon the wound. The plasters also should be applied which have been mentioned above;JJJ the most suitable is the Ephesian plaster,JJJ or that noted next after it. eThere is ready help in one of the antidotes; if none is at hand, it is necessary to take in sips a draught of strong wine with pepper, or anything else which will stir up heat, to prevent humour from coagulating internally; for most poisons cause death by cold. All diuretics also are useful, because they dilute the diseased matter.
4 Such are the general remedies against bites of any kind. Experience has taught, however, that anyone bitten by an aspJJJ should in particular drink p119vinegar. The case of a certain boy is said to demonstrate this, for having been thus bitten, partly on account of the bite, and partly owing to excessively hot weather, he was tormented by thirst, and being in a dry place found no other fluid, so he drank the vinegar he chanced to have with him, and was saved. I believe this happened because although vinegar is a refrigerant, it has also the faculty of dissipating. Hence it is that earth sprinkled with it froths.JJJ Therefore it is likely that by the same faculty humour which is condensing inside a patient is dissipated by it, and so health is restored.
5 There are also against certain other reptiles remedies which are well enough known. For the scorpion is itself the best remedy against itself. Some pound up a scorpion and swallow it in wine; some pound it up in the same way and put it upon the wound; some put it upon a brazier and fumigate the wound with it, putting a cloth all round to prevent the escape of the fumes, afterwards they bandage its ash upon the wound. bThe patient should also drink wine in which have been steeped the seeds, or at any rate the leaves, of the herba solaris, which the Greeks call heliotropion. It is good also to apply to the wound bran soaked in vinegar, or wild rue, or roasted salt with honey. I have known, however, practitioners who merely let blood from the arm of those stung by a scorpion, that and nothing more.
6 For the sting of a scorpion also, or for that of a spider, it is good to put on garlic mixed with rue and pounded up with oil.
7 But when cerastes,JJJ or dipsas,JJJ or haemorrhoisJJJ has p121bitten a man, poley-germander roasted, equal in amount to an Egyptian bean, is divided into two draughts, a little rue being added. Trefoil also and wild mint and allheal-juice, with vinegar, are equally efficacious. Costmary, casia, and cinnamon may appropriately be taken in draughts.
8 For the bite of a chelydrus,JJJ allheal-juice or laser 4 grams, or leek-juice in 250 cc. of wine, may be taken, and a quantity of savory eaten. Over the bite either goat's dung, or barley-meal boiled with vinegar should be applied, or rue, or catnip pounded with salt, with honey added. This last is equally efficacious for the bite of a cerastes.
9 But when a venomous spider has done the harm, in addition to the surgical treatment, the patient should be plunged often into the hot bath; and take equal quantities of myrrh and bryony berries in 250 cc. of raisin wine; or radish seeds or darnel root in wine; bran boiled in vinegar is to be put on the wound, and the patient is kept in bed.
10 But the foregoing classes of reptiles belong to foreign countries, and are especially poisonous, and they are mostly generated in hot countries. Italy and colder countries are healthier in this respect too, for the reptiles they produce are less dangerous. Against them sufficient remedies are betony or convolvulus or centaury or agrimony or germander or burdock or sea parsnip; any one or two of these is pounded up and taken in wine . . . and applied to the bite. It must be remembered that all snake-bites are more harmful when either the reptile or the man is hungry. Hence snakes are most injurious when p123brooding, and it is of the greatest importance when there is danger from snakes not to go out before taking some food.
11 It is not so easy to render assistance when poison has been taken in food or drink, first because patients do not perceive it at once as when bitten by a snake; and so are unable to afford themselves any help immediately. Moreover, the mischief starts, not from the skin, but from within. But the best thing, as soon as any one has perceived it, is to swallow a quantity of oil at once and vomit; then, when the praecordia have been emptied, to drink an antidote; or failing that undiluted wine.
12 There are, nevertheless, certain remedies proper for particular poisons, especially for the milder ones. If a potion of cantharides has been swallowed, all-heal pounded in milk should be given or galbanum with the addition of wine, or milk by itself.
bIf it be hemlock, hot undiluted wine with rue should be taken in a large quantity, then the patient should be made to vomit; and after that laser is given in wine; and if free from fever he should be put into a hot bath; if not free, he should be anointed with heating remedies. After this, rest is necessary.
If any one has eaten fungi that are not used, a p125radish or purslane is to be eaten alone or with a draught of salt and vinegar. Such fungi may be distinguished from the sorts in use by their appearance, and may be rendered safe by suitable cooking; for when boiled in oil, or along with a pear-tree twig, they lose all their noxious property.
13 Burns are likewise the product of external violence, and so it seems to follow that I should speak of them here. Now they are best treated by leaves either of lily or of hound's tongue or of beet, boiled in old wine and oil; any one of the above applied at once brings healing. But the treatment can also be divided into: first, a stage of moderately exedent and repressant applications both to check blisters and to roughen the skin; next, a stage of soothing applications for healing. Among the former is lentil meal with honey, or myrrh with wine, or Cimolian chalk pounded up with frankincense bark and mixed with water, and when it has to be used, diluted with vinegar. bSubsequent applications include anything that is greasy; but the most suitable is that containing lead slag or yolk of egg.JJJ There is also another treatment of burns, namely, while the inflammation lasts, to keep lentil meal and honey on the wound; next, when the inflammation has subsided, flour with rue or with leek or with horehound, until the crusts fall off; then vetch meal with honey, or iris ointment or turpentine-resin, until the ulceration is clean, and finally dry lint.
28 1 From those lesions which are due to something from without we come to those which originate from within, when some bodily part has become corrupted. Of these none are worse than carbuncles, the signs of which are: redness, with a few pustules projecting p127a little, mostly black, sometimes livid or pallid; their contents seems to be sanies; the colour underneath is black; the actual tissue is dry, and harder than it should be naturally; and round them there is a sort of crust, and outside that an inflammatory ring; and there the skin cannot be pinched up, but is as it were fixed in the underlying flesh. bThe patient is somnolent; sometimes there is shivering or fever or both. And this lesion spreads, sometimes quickly, sometimes slowly, pushing out a sort of root underneath; on the surface too as it spreads the skin gets paler, then becomes livid, and a ring of small pustules arises; and if this occurs in the region of the gullet or fauces, often it suddenly stops the patient's breathing. The best thing is to apply a cautery at once; this is not a severe procedure, because the patient does not feel it, since the flesh is dead; and the cauterizing is topped when pain is felt all over the lesion. cAfter that the wound is to be treated like other burns; for under erodent medicaments it follows that the crust becomes separated on all sides from the liv gate flesh, and takes off with it whatever has become corrupted; and the cavity when clean can be dressed with some preparation to make flesh. But when the lesion is on the surface of the skin,JJJ it is possible to cure it simply by exedents or at any rate by caustics. dThe strength of the remedy adopted is to be proportionate to the lesion. But whatever the medicament is, if it is sufficiently effectual, it forthwith detaches the corrupted part from the living; we may be confident that wherever the application works, the diseased flesh everywhere sloughs off. If the medicament is being mastered by the disease, certainly there must be no delay in p129applying the cautery. But in such a case there should be abstinence from food and from wine; it is a good thing to drink water freely. And this should be done all the more when there is feverishness as well.
2 A carcinomaJJJ does not give rise to the same danger unless it is irritated by imprudent treatment. This disease occurs mostly in the upper parts of the body, in the region of the face, nose, ears, lips, and in the breasts of women, but it may also arise in an ulceration,JJJ or in the spleen. Around the spot is felt a sort of pricking; there is a fixed, irregular swelling, sometimes there is also numbness. Around it are dilated tortuous veins, pallid or livid in hue; sometimes in certain cases they are even hidden from view; and in some the part is painful to the touch, in others there is no feeling. bAnd at times the part becomes harder or softer than natural, yet without ulcerating; and sometimes ulceration supervenes on all the above signs. The ulceration at times has no special characteristic; at times it resembles what the Greeks call condylomata,JJJ both in a sort of roughness and in size; its colour is either red or like that of lentils. It is not safe to give it a blow; for either paralysis or spasm of the sinews follows at once. Often from a blow on it a man loses speech and faints; in some also, if the place is pressed, the parts around become tense and swollen. cThen it is the worst kind. And generally the first stage is what the Greeks call cacoethes;JJJ p131then from that follows a carcinoma without ulceration; then ulceration, and from that a kind of wart.JJJ It is only the cacoethes which can be removed; the other stages are irritated by treatment; and the more so the more vigorous it is. Some have used caustic medicaments, some the cautery, some excision with a scalpel; but no medicament has ever given relief; the parts cauterized are excited immediately to an increase until they cause death. dAfter excision, even when a scar has formed, none the less the disease has returned, and caused death; while at the same time the majority of the patients, though no violent measures are applied in the attempt to remove the tumour, but only mild applications in order to soothe it, attain to a ripe old age in spite of it. No one, however, except by time and experiment, can have the skill to distinguish a cacoethes which admits of being treated from a carcinoma which does not. eTherefore, as soon as the lesion is first noted, caustic medicaments should be applied. If the disease is relieved, if tis indications are lessened, the treatment can be advanced to the use of the knife and of the cautery. If it is irritated at once, we may recognize that it is already a carcinoma, and that all acrid and severe remedies are to be avoided. But if the place is hardened without ulceration, it is enough to put on a fig of the fattest sort or the plaster called rhypodes.JJJ fIf there is an ulceration level with the skin, the rose cerate is to be applied, to which must be added powder from a crusted earthenware pot, into which a blacksmith has been accustomed to dip red-hot iron. If there is a considerable growth upon it, copper scales, which are the mildest of the caustics, are to be tried, until they check the tendency to p133growth; but only so if it is in no wise made worse: when the growth is less prominent we ought to rest content with the rose cerate.
3 There is also an ulceration which the Greeks call therioma.JJJ This may arise spontaneously, and at times it may supervene upon ulceration from another cause. It has either a livid or black colour, a foul odour, and an abundant mucus-like discharge. The ulcer itself is insensitive to touch and applications; there is just disturbance by itching. But around there is pain and inflammation; sometimes even fever is set up, occasionally blood is discharged from the ulceration. bThis also is a spreading disease. And all these signs often extend, and there results from them an ulcer which the Greeks call phagedaena,JJJ because it spreads rapidly and penetrates down to the bones and so devours the flesh. This ulceration is uneven, bog-like; there is a large amount of glutinous discharge; the stench is intolerable, and the inflammation is greater than accords with the extent of the ulceration. Both therioma and phagedaena, like all canker, occur for the most part in the aged or those of a bad habit of body. Both are treated in the same way, but treatment is more necessary in the severer form. cFirstly, a regimen must be enforced, so that the patient rests in bed, abstains from food for the first days, drinks very freely of water; also has the bowels moved by a clyster; then, on the subsidence of the inflammation, takes digestible food, avoiding everything acrid; drinks as much as he likes, but for the time being contents himself with water, except that at dinner he may drink a little dry wine. But fasting is not to be used for points with phagedaena p135to the same extent as for those with therioma. dOver the ulceration too should be dusted dry lign-aloes pounded up or vine-flower, and if this does no good, copper ore; and if by erosion of flesh a sinew has become exposed, it must first be covered by lint, to prevent the medicament from burning it. If still stronger remedies are required, then recourse must be had to more active caustics. But whatever the medicament to be sprinkled on, it ought to be applied by means of the flat end of a probe. eOver this should be put either lint soaked in honey or olive-leaves boiled in wine or horehound; and this is to be covered over by lint well wrung out of cold water; the inflammatory swelling around is to be covered with repressant poultices. If there is no benefit from these measures, the place should be burnt with the cautery, exposed sinews being first carefully covered over. The tissue burnt, whether by caustic or by the cautery, is first to be cleaned, then to be filled up with new flesh, as is clear to anyone from what has been stated before.
4 Ignis sacerJJJ should be counted also among the bad ulcerations. Of this there are two kinds; one is reddish or partly red, partly pale and roughened by a chronic pustulation, the pustules all of about equal size, but mostly very small: in them there is nearly always pus and often there is redness with heat. And sometimes the disease spreads while the first part attacked is healing; sometimes even after this is ulcerated, when the pustules have ruptured and the ulcer continues and a humour is discharged which appears to be continuing between sanies and pus. It attacks chiefly the chest or flanks or p137putrid flesh.JJJ eWhen the inflammation is relieved and the ulcer cleaned, soothing ointment should be applied.JJJ But in the former kind,JJJ quinces, boiled in wine and pounded, may prove beneficial, as also a plaster, either that of HerasJJJ or the tetrapharmacum,JJJ with a fifth part of frankincense added, or black ivy boiled in dry wine; and if the disease is spreading rapidly there is nothing better. When the ulceration has been cleaned, the same soothing remedies which I prescribed above for the superficial variety are sufficient to induce healing.
5 Again, the ulcer called chironeanJJJ is large and has hard, callous, swollen margins. A sanies exudes, which is not copious, but thin. There is no bad odour, either in the ulcer or in its discharge; no inflammation; pain is moderate; it does not spread, so it brings no design, but it does not heal rapidly. At times a thin scab is produced, then in turn it is broken down and the ulceration is renewed. It occurs chiefly on the feet and legs. On it should be applied something which is at once soothing, and active and repressant, such as the following: copper scales, washed lead calcined, 16 grams each, cadmia and wax, 32 grams each, along enough rose-oil to give the wax together with the other materials a soft consistence.
6 Ulcers are also produced in winter by the cold,JJJ mostly in children, and particularly on their feet and toes, sometimes also on the hands. There is redness with moderate inflammation; some pustules arise followed by ulceration; the pain is p141moderate. The itching is greater; at times humour exudes, but not much; it seems to resemble either pus or sanies. In the first place, the ulcers are to be fomented freely with a hot decoction of turnips, or, if these are not to be had, some kind of repressant vervain. bIf there is not yet an open ulcer, copper scales as hot as can be borne are to be applied. If there is already an ulceration, then apply equal parts of alum and frankincense pounded together with the addition of wine, or pomegranate-rind boiled in water and then pounded. If the skin has become detached, in that case also soothing medicaments do good.
7 Struma,JJJ again, is a swelling, in which there occur underneath certain concretions of pus and blood like little glands; they are specially embarrassing to medical men, for they set up fever and yet do not quickly come to a head; and whether they are treated by incision or by medicaments, they are generally prone to recur in the neighbourhood of their scars, and this happens much more often after the application of medicaments; and in addition to all this, they are of long duration. These swellings arise particularly in the neck, but also in the armpits and groins and in the flanks. The surgeon Meges stated that he had met with them also in the breasts of women.
bFor these white hellebore is an appropriate remedy, and this must be taken frequently until they are dispersed; and also the medicaments which have been mentioned above are applied in order to draw out or disperse the humour. Some also use causticsJJJ p143which eat away, and by forming a scab harden the place; after which they dress it like an ulceration. Whatever the mode of treatment, however, after the ulcer has cleaned, the patient is to have exercise and nourishment until the scar is formed. Although these are the doctrines of the physicians; it has been found out by the experience of some country folk, that anyone with a bad struma may be freed from it by eating a snake.
8 The boil, again, is a pointed swelling attended by inflammation and pain, and especially so when it is being converted into pus. When it has opened and the pus gone out, it is seen that part of the flesh has been turned into pus, part into a greyish-reddish core which some call the sac of the boil. There is no danger in it, even although no treatment is adopted; for it ripens of itself, and bursts; but the pain renders treatment preferable in order to afford earlier relief. The special medicine for this is galbanum;JJJ but there are others also which have been mentioned above. If none of these are available a plaster that is not greasy should first be applied to disperse it; next, if this is not effective, something adapted to promote suppuration; if even that is not to be had, either raisin wine or yeast. When the pus has been squeezed out, no further treatment is needed.
9 A phyma is a swelling which resembles a boil, but is rounder and flatter, often also larger. For a boil rarely reaches the size of half an egg, and never exceeds it; a phyma commonly extends even over a wider area, but the pain and the inflammation in it are less. When it has been opened, pus appears in the same way; no core is found as in a p145boil, in fact all the corrupted flesh is turned into pus. Now in children this occurs more often and is more readily relieved; in young adults it is more rare and more difficult to treat. Where age has hardened the body, the disease does not even occur. By what medicaments it should be dispersed has been stated above.JJJ
10 Phygetron, again, is a wide swelling, not much raised up, in which there is a certain resemblance to a pustule.JJJ The pain and tension is severe, and more than would be expected from the size of the swelling; at times there is also feverishness. The ripening takes place slowly, and not much pus is formed. It occurs particularly on the top of the head, or in the armpits or groins. Our people call it panus, from its spindle-shape. And I have pointed out above by what medicament this should be relieved.JJJ
11 But although all these diseases are really only minute abscesses, that name implies in general a more extensive lesion, tending to suppuration; and it occurs usually either after fevers or after pains in some part, and particularly after those which have attacked the abdomen. And generally it is visible, since there is some rather widespread swelling, like that which I have previously described as called phyma, and it grows red and hot and shortly afterwards hard as well, and becomes more painful as it increases and occasions both thirst and insomnia: sometimes, however, there may be none of these signs to note in the skin, and especially when pus is forming more deeply; but along with the thirst and insomnia some stabbing pains are felt internally. p147bAnd it is more favourable when it does not become harder on a sudden, and although it does not redden, nevertheless changes somewhat in colour. Such are the signs which arise when pus is already forming; the swelling and redness begin long before. But if the place is soft, the gathering of the diseased matter is to be diverted by poultices which are at the same time repressant and cooling; such as I have mentioned elsewhere, and just above under erysipelas:JJJ if it has become already hard, recourse must be had to poultices for dispersing and resolving; such as a dried and crushed fig, or wine-lees mixed with cerate, made up with hog's lard, or cucumber-root to which has been added twice the weight of flour, previously boiled in honey wine. cAgain, we may mix equal part by weight of ammoniacum, galbanum, propolis, mistletoe-juice, and of myrrh half as much by weight as of the other ingredients. And the plasters and emollients which I have described aboveJJJ have the same effect. A swelling which has not been dispersed by such measures must needs mature; that it may do so more quickly, barley-meal should be put on boiled in water with which also some herb should be mixed. The same applications are appropriate also for the smaller abscesses, the names and peculiarities of which I have referred to above; treatment is the same for all, only differing in degree.JJJ
dNow a swelling is immature when the blood-vessels throb more as if they were bubbling and there is weight and heat and tension and pain and redness and hardening and, if the abscess is larger, shivering or even persistent feverishness; and a p149suppuration is completely concealed, if, instead of the signs presented by the skin in other cases, there are stabbing pains. When these signs subside, and the place begins to itch, and is either bluish or greyish, the suppuration has matured; and when it has been opened by means of these medicaments or even by the knife, the pus must be let out. eThen if there are any abscesses in the armpits or groins, they must be dressed without inserting lint. In other parts also, if there is one small opening, if there has been moderate suppuration, if it has not penetrated deeply, if there is no fever, if the patient is strong, lint is equally superfluous. In other cases lint should be applied, but sparingly, and only if the opening is large. It is beneficial, whether lint is used or not, to apply lentil meal with honey, or pomegranate rind boiled in wine; these are suitable alone or mixed together. fIf the parts are hard, they should be softened by applying either pounded mallow or fenugreek or flax seed boiled in raisin wine. Whatever dressing is afterwards applied should not be tight but bandaged on lightly. No one should be misled into applying a cerate in this sort of case. All the other directions for cleaning the ulceration, forming flesh, and inducing a scar have been described in treating of wounds.JJJ
12 Sometimes, again, fistulae arise, both from abscesses of this kind and from other sorts of ulceration. A fistula occurs in almost any part of the body, but in each place it has some peculiarities. I shall speak first of its general characteristics. There are many kinds of fistulae, then, and whilst some are short, others penetrate deeper; some run straight p151inwards, others, and by far the most numerous, crosswise; some are simple, others beginning by one opening form two or three branches inside or even divide into several passages; some go straight, others are curved and tortuous. bSome end in the flesh, others penetrate to bone or to cartilage, or, when neither of these is underneath, reach to the inner parts; some, therefore, are treated easily, others with difficulty; and some are even found to be incurable. The treatment is speedy when the fistula is simple, recent and only involving the flesh, and the body itself helps, when it is youthful and sound: contrary conditions are inimical; also if the fistula has damaged bone or cartilage or sinew or muscles; if it has involved a joint; or if it has penetrated either to the bladder of lung or womb or to large veins or arteries or to hollow regions, which as the throat, gullet or thorax. cWhen too the fistula goes towards the intestines it is always dangerous, often deadly. When the body is either sick or aged or in bad condition, the case is much worse. First of all, however, it is prisoner to pass a probe into the fistula, that we may learn both its direction and depth, and at the same time whether it is moist or rather dry. This is known when the probe is withdrawn. But if there is bone in the neighbourhood, we can also learn whether the fistula has reached and penetrated the bone or not, and how far the damage has gone. dFor if what is touched by the end of the probe is soft, the disease is still limited to the flesh; if it meets with more resistance, the fistula has reached bone. But when the probe slides smoothly, there is not yet decay; if it does not so slide, but meets with an even surface, there is some decay although p153still slight; if what underlies is uneven also and rough, the bone has become more seriously eaten away. eBut the position of the fistula shows where there is underlying cartilage, and resistance to the probe shows when this has been reached. And from these signs we may gather the situation, extent and harmfulness of fistulae; whether too they are simple, or have several branches, can be estimated from the amount of pus; for it there is more than one opening will account for, it is clear that there are several branches; and since generally flesh and sinew and sinewy tissue such as sheaths and membranes are near the fistula, the character of the pus also will show whether the several branches have eaten into other parts of the body. fFor pus derived from flesh is smooth, white and fairly plentiful; from sinewy structures it is of the same colour but thinner and less in quantity; from sinews it is fatty and not unlike oil. Further also, the bending of the body indicates whether the fistulae have penetrated in several directions, because often when a patient has changed his recumbent posture, or held a limb in a different position, pus which had previously ceased, begins to discharge again; and it then becomes evident, not only that there is another branch from which pus is being discharged, but also that it is tending into another part of the body. gBut if the fistula is in the flesh, and is recent and simple, and is not tortuous or in a cavity or joint, but in a part which remains still unless moved with the body generally, a sufficiently effective application is a plaster such as is applied to recent wounds, so long as it is composed of either salt or of alum or of copper scales or of verdigris or some other metallic p155substances; and from this a tentJJJ should be made, thinner at one end, a little thicker at the other. This should be passed into the fistula with the pointed end forwards, and be kept until pure blood shows itself. hSuch are the general rules for the use of all tents for fistulae. Next, the same plaster spread on lint is put over the place, and over that is applied a sponge dipped in vinegar; it is sufficient to change the dressing on the fifth day. The class of food to be used is that which I have prescribed for making flesh.JJJ And if the fistula is at some distance from the praecordia, the patient should eat radishes at intervals on an empty stomach, and then vomit. A fistula of long standing becomes callous. Now no one can mistake callus, for it is hard and either white or pallid. iBut there is then need for stronger medicines: such as that which has of poppy tears 4 grams, gum 12·66 grams, cadmia 16 grams, blacking 32 grams, worked up water to form a tent. Or else there is the composition containing galls 1 gram, verdigris, sandarach, Egyptian alum, 1·16 gram each, roasted blacking 2·32 grams. Or that which is compose of copper ore and limestone, with half as much orpiment as of each of the other two; and these are taken up in boiled honey. kBut the quickest remedy is that prescribed by meges; rub up verdigris scrapings 8 grams, then dissolve ammoniacum for incense 1·16 gram in vinegar, and work the verdigris into this infusion; and this is one of the best remedies. But whilst the above remedies are p157the most efficacious, when they are not at hand it is easy to eat away the callus with any of the caustic medicaments; it is enough to smear one of them on rolled papyrus, or upon a pledget of wool twisted into the shape of a tent. Squills boiled and mixed with quicklime also eat away callus. lIf, however, the fistula is longer but runs crosswise, it is best to insert a probe and to cut down upon its end; then a tent is passed into each opening. But if we deem the fistula to be double or multiple, yet only short and confined to flesh, we should not make use of a tent, because it treats one part and omits the rest; but the same medicaments, dry, are put into a writing-quill, and that having been placed against the orifice of the fistula is to be blown through, in order that these medicaments may be forced in; mor the same materials dissolved in wine, or, if the fistula is more foul, in honey wine, or, if more callous, in vinegar, are to be poured in. Whatever is introduced, refrigerants and repressants must be put on over the wound; for generally the parts surrounding the fistula are somewhat inflamed. It is not inappropriate, when changing the dressing and again before inserting fresh medicaments, to wash out the fistula, using an ear syringe; with wine if there is much pus; with vinegar if there is hard callus; if it is already clean, with honey wine or a decoction of vetch, to which also a little honey should be added. nThus it generally happens that that covering which is between the opening and the sound flesh is destroyed by the medicaments and comes quite away, and underneath is a clean ulceration; when this has occurred, agglutinants are applied, especially a sponge steeped in boiled honey. I am p159not unaware that many favour the insertion of lint formed into a tent and dipped in honey; but this agglutinates more quickly than flesh is formed. There need be no fear that clean flesh in contact with clean flesh will fail to unite: we see that there is often no need to add medicaments as well to effect this, since often when there is ulceration of the fingers, unless we have taken careful precautions, they become joined together whilst healing.
13 There is besides a class of ulceration which the Greeks call κηρίον from its resemblance to honeycomb, and of this there are two kinds. One is greyish, like a boil, but larger and more painful. As it is maturing, holes appear through which is discharged a glutinous and purulent humour; yet it does not properly mature. If it is cut into, there appears much more corruption than in a boil, and it penetrates deeper. It is rare except in the scapular region. bThe other kind is found only in the head; it projects less above the surface, is hard, broad, greenish or greyish-green in colour, more ulcerated; there are holes at the root of each hair, through which is discharged a glutinous greenish-white humour, in consistency like honey or mistletoe-juice, or at times like olive-oil. If it is cut into, the flesh within appears green. The pain also and inflammation are so severe that they generally cause acute fever. On a case which is only irritated by a few openings, suitable applications are a dry fig and linseed boiled in honey wine or plasters or emollients which draw out diseased matter, or the medicaments noted above for such purposes.JJJ cFor the other form of this, the same medicaments are good, also flour boiled in honey wine mixed with half its quantity of turpentine-resin; p161also a fig boiled in honey wine, to which a little pounded hyssop may be added; also black bryony berries, added to a fig, one part to three. If in either case medicaments are of little service, the whole ulceration ought to be cut away down to the sound flesh. When the ulceration is removed, medicaments are put on the wound, first to promote suppuration, next to clean it, and then to make flesh.
14 There are also certain wart-like ulcerations, different in name and in their ill-effects. They call one acrochordon,JJJ when some material which is rather hard and at times somewhat rough, collects under the skin: its colour is that of the skin; it is thin underneath, broadening nearer the skin; of moderate size, as it is seldom larger than a bean. It is rare to find one alone, but generally there are several, and they are mostly found in children; and sometimes they go suddenly, sometimes they cause slight inflammation, and under this they even turn into pus. bBut that which is named thymionJJJ projects above the surface like a little wart, narrow near the skin, wider above, hardish and at the top very rough. The top in colour is like flowers of thyme, whence its name, and there it is readily split and made to bleed; at times the bleeding is considerable; it is generally about the size of an Egyptian bean, rarely larger, sometimes quite small. Sometimes one is alone, generally several grow together, either on the palms or soles of the feet. The worst, however, are situated upon the genitals, and there they bleed the most. cBut those called myrmeciaJJJ are less prominent and harder than the thymion, their roots are more deeply fixed and they are more painful: they are broad underneath but thin above, they bleed less, p163and they scarcely ever exceed the size of a lupin. These also grow either on the palms or soles of the feet. The clavus,JJJ again, though occasionally found elsewhere, occurs mostly on the feet, and especially after contusions, although sometimes from other causes; it causes pain when walking, though not at other times.
dOf these the acrochordon and thymion often end of themselves, and the more so the smaller they are. The myrmecia and corns scarcely ever subside without treatment. The acrochordon, if cut off, leaves no trace of a root behind, and so does not sprout again. When the thymion and clavus have been cut off, a small rounded root is formed underneath, which penetrates right down into the flesh, and if this is left behind it sprouts up again. The myrmecia are held by very broad roots, and so cannot be excised without causing a large wound. A corn is best scraped down from time to time; for thus, without any violence, it softens, and if also a little blood is let out, it often dies away. eIt is also removed if we clean the part round it and then put on resin mixed with a little powdered millstone. All the other varieties are to be burnt away by medicaments: for some the ash of wine-lees is best; for myrmecia the application made of alum and sandarach. But the skin all round should be covered with leaves that it also may not become ulcerated; afterwards lentil meal is put on. Even a fig in boiled water removes a thymium.JJJ
15 Pustules arise chiefly in the spring; there are many kinds. For at times a sort of roughness comes all over the body, or a part of it, resembling the pustules which are set up by nettles or by sweating; exanthemata the Greeks call them. At times p165they are red, at times no redder than the colour of the skin; bsometimes a number occur resembling pimples, sometimes the pustules are larger, livid or pallid or black or otherwise changed from the natural colour; and there is humour underneath them. When these have burst the flesh below looks as if it were ulcerated; in Greek these are called phlyctaenae.JJJ They are produced either by cold or by heat or by medicaments. A phylacion is a somewhat harder pustule, whitish and pointed, from which moisture is squeezed out. But after pustules at times small ulcerations arise, either dry or moist, sometimes attended only by itching, sometimes also by inflammation and pain; the discharge is either pus or sanies or both; this generally occurs in children, selected on the trunk, often on the extremities. cThe worst kind of pustule is that called epinyctis;JJJ its colour is usually livid or black or white. And there is severe inflammation round it; and when laid open a mucous ulceration is found within, of a colour like its own humour. It gives greater pain than its size would suggest; for it is no larger than a bean. And this too grows on the extremities, and generally by night, whence also the name applied to it by the Greeks. dNow in all kinds of pustules, the treatment first is much walking and exercise; and if anything prevents these, then rockings. Next food must be diminished, all things acrid and thinning avoided; and the same treatment should be applied to nursing women, if the sucking baby is so affected. Moreover, the patient who is robust, if the pustules are small, ought to go to the bath and sweat, and at the same time to dust the pustules with soda and to mix wine with oil and anoint p167himself, after which he goes down into the hot bath. If this does no good, or if the pustules are of the larger kind, lentil meal should be applied, and after the upper skin has been detached, we must pass on to soothing medicaments. eThe epinyctis, after lentil meal application, is appropriately treated by means of polygonum or green coriander. Ulcerations caused by the pustules are relieved by litharge mixed with fenugreek seeds, rose-oil and endive juice being added in turn until the mixture becomes of the consistency of honey. For the pustules which affect infants apply: pyrite stone 9·3 grams, mixed with fifty bitter almonds, and 125 cc. of oil added. But first the pustules should be anointed with white-lead, then smeared with the above.
16 But scabiesJJJ is harder: the skin is ruddy, from which the pustules grow up, some moist, some dry. From some of these sanies escapes; and from them comes a persistent itching ulceration, which in some cases rapidly spreads. And whilst in some persons it vanishes completely, in others it returns at a definite time of the year. The rougher the skin, and the more the itching, the more difficult is its relief. Hence the Greeks call such scabies, agriaJJJ that is, savage. bIn this case also the same regimen as that given above is necessary;JJJ at the beginning a suitable application is that composed of sublimed zinc oxide, saffron, verdigris 1· 16 grams each; white pepper and omphacium 4 grams; zinc oxide ore 9· 3 grams. But when ulceration already exists that composed p169of sulphur 1·16 gram, wax 4·65 grams, liquid pitch 250 cc., oil one litre; these are heated together until they are of the consistency of honey. cThere is also the composition ascribed to Protarchus.JJJ It consists of half a litre of lupin meal, 190 cc. of soda, 250 cc. of liquid pitch, liquid resin 168 grams, and 125 cc. of vinegar. Also a suitable mixture is saffron, lycium, verdigris, myrrh, and charcoal in equal proportions boiled in raisin wine; this checks everywhere all discharge of phlegm. And when there is nothing else at hand, lees of olive-oil boiled down to one-third, or sulphur mixed with liquid pitch, as I have suggested for cattleJJJ is also of service for men suffering from scabies.
17 Impetigo,JJJ again, has four species. The least bad is that which presents a semblance to scabies; for there is redness and some hardness and ulceration and erosion. But it is distinguished from scabies because there is more ulceration and there are pustules like pimples, and in it is seen an appearance as of small bubbles from which after a time little scales are detached; and this recurs at fixed seasons. bThe second kind is worse, almost like a pimple, but rougher and redder; it has various shapes; small scales are detached from the skin surface; there is more erosion; it spreads more rapidly and widely, and both comes and goes at fixed seasons even more markedly than the previous sort; it is called rubrica.JJJ The third kind is worse still; for it is thicker, harder and there is more swelling; there are cracks in the skin and more active erosion. This form also is scaly, p171but the scales are black. It spreads widely and not slowly. It varies less in the times at which it increases or subsides, and is never quite got rid of: its name is black impetigo. cThe fourth kind, which is quite incurable, differs in colour, for it is whitish and like a recent scar, and has small pallid or whitish scales; some are like lentils, and when these are removed there is sometimes bleeding. Otherwise its humour is white, the skin hard and chapped; it spreads widely. Now all these kinds occur generally on the hands and feet; they also attack the nails. There is no more efficacious remedy than that which I have mentioned above as prescribed by Protarchus for scabies. But Serapion used soda 2·32 grams, and sulphur 4·64 grams, taken up with plenty of resin.
18 Of papules again there are two kinds.JJJ There is one in which the skin is roughened by very small pustules, and is reddened and slightly erodes; in the middle it is a little smoother; it spreads slowly. This disease generally has a round shape at its beginning, and in the same fashion it spreads in a circle. But the other variety is that which the Greeks call agria that is, savage; and in this there is a similar but greater roughness of the skin with ulceration, more severe erosion, and redness; sometimes it even loosens the hair. bIt is less round in shape, heals with more difficulty, and unless it is got rid of, turns into an impetigo. But in fact a slight papule heals if it is rubbed daily with spittle before eating; a more severe one is got rid of best by an application of pounded pellitory. But turning to compound medicaments, that same one of Protarchus is efficacious in these cases, when the disorder is less severe. An alternative p173for the same affection is the composition of Myron containing red soda and frankincense, 4 grams each, purified cantharides 8 grams, sulphur unheated, the same amount, and turpentine resin 80 grams, darnel meal a litre and a half, cumin 145 cc., and half a litre of raw pitch.
19 VitiligoJJJ also, though not dangerous in itself, is still ugly and is due to a bad habit of body. There are three species. It is called alphos when it is white in colour, generally rather rough, and not continuous, so that it looks as if drops of some sort had been sprinkled about. Sometimes also it spreads still more widely with certain gaps. bThat called melas differs from it in being of a black colour and like a shadow; otherwise it is similar. Leuce is somewhat like alphos, but is whiter and extends deeper; there are hairs on it, white, and like down. All these spread, but more quickly in some people than in others. The alphos and melas come and go at various seasons; the leuce, once established, is not easily got rid of. The two former are not difficult to treat, the latter is scarcely ever cured, for even if the discoloration is mitigated, the colour of health does not right altogether. cBut whether any one of these is curable or not is easily learnt by this test. The skin should be cut into or pricked with a needle: if blood escapes, which it usually does in the first two species, there is place for a remedy; if a whitish humour, cure is impossible, and then we should even refrain from treating it. But to the species which admits of treatment we should apply lentil meal, mixed with sulphur and frankincense, pounded p175up together in vinegar. Another application for the same purpose, ascribed to Irenaeus, is composed of coral, soda, cumin and dried fig-leaves, in equal quantities, pounded up with vinegar added. dThe vitiligo is smeared with this in the sun, then it is soon washed off, lest it corrode too much. Some find it useful to anoint the species which I have said is called alphos with the following prescription ascribed to Myron:JJJ they mix sulphur 1 gram, split alum 0·66 gram, soda 1·33 grams with a cupful of dried myrtle leaves; then at the bath they dust bean-meal over the vitiligo and afterwards apply the above remedy. That which I said was termed melas is treated by pounding up together coral, frankincense, barley and bean-meal; and these are sprinkled on, using no oil in the bath before the patient sweats; then this kind of vitiligo is rubbed off.
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