On the Diet of Acute Patients (Spurious) — First Draft Translation

ON THE DIET OF ACUTE PATIENTS (SPURIOUS) A. Causus arises whenever the small vessels, having dried out in the summer season, draw to themselves sharp and bilious ichors; and great fever seizes hold, and the body grows weary and aches as though gripped by exhaustion. 1. It arises for the most part also from a long journey and prolonged thirst, whenever the dried-out small vessels draw sharp and hot fluxes. The tongue becomes rough and dry and very black; and the patient suffers pain in the belly region with a gnawing sensation; the bowel discharges are watery and pale; violent thirsts are present, and sleeplessness, and sometimes also wandering of the mind. For such a patient give water and boiled melikraton diluted, as much as he wishes to drink; and if the mouth becomes bitter, it is beneficial to vomit, and to flush the gut; but if the condition is not resolved by these means, boil ass's milk and use it as a purge. Offer nothing salty or sharp, for he will not tolerate it; and do not give gruels until the patient is past the critical days. And if blood flows from the nostrils, the condition is resolved; and if critical, genuine sweats come on along with white, thick, and smooth urinary sediment; or if an abscess forms somewhere; but if it is resolved without these, there will be a relapse of the illness, or pain in the hips or legs will occur, and he will spit thick matter, if he is going to recover. Another form of causus. Bowels loose, full of thirst; tongue rough, dry, salty; suppression of urine; sleeplessness; extremities chilled. For such a patient, if blood does not flow from the nostrils, or an abscess does not form about the neck, or pain in the legs, and he does not spit thick sputa — and these things occur when the bowels have become constipated, or there is pain in the hip, or a livid discoloration of the genitals — there is no resolution; and a tensed testicle is a critical sign. Give drawing gruels. In acute conditions, perform phlebotomy if the disease appears severe and those affected are in their prime of age and possess bodily strength. 2. If there is quinsy, purge upward with electuaries, or in the case of any other pleuritic condition; but if patients appear weaker, or if more blood has been removed, use an enema into the gut every third day, until the patient reaches safety, and use fasting if needed. Inflamed hypochondria — not from trapping of pneuma — tensions of the diaphragm, or obstructions of pneuma, dry orthopnea: in those where no pus underlies, but where these sufferings arise from the trapping of pneuma — especially intense pains of the liver, and heaviness of the spleen, and other inflammations and severe pains above the diaphragm, and concentrated clusters of diseases — cannot be resolved if one attempts drug treatment first; rather, phlebotomy is the leading intervention for such conditions; then afterward enema, if the disease is not great and severe; if it is, drug treatment is also needed later; but phlebotomy combined with drug treatment requires safety and moderation. 3. Those who attempt to resolve inflammations at the beginning of diseases immediately by drug treatment remove nothing of what is tense and inflamed — for the condition, being raw, does not yield; but they melt down what is resisting the disease and maintaining health; and when the body becomes weak, the disease prevails; and when the disease prevails over the body, such a condition is past remedy. That a person should suddenly become voiceless — trappings of the vessels cause distress, if this happens to a healthy person without apparent cause or other strong cause; one must therefore perform phlebotomy of the inner vein of the right arm, and remove blood, calculating the larger or lesser amount according to the patient's habitual constitution and age. 4. The following things occur in most of them: redness of the face, fixity of the eyes, spreading apart of the hands, grinding of teeth, pulsations, clenching of the jaw, and chilling of the extremities, trappings of pneuma throughout the vessels. When pains come first, influxes of black bile and sharp fluxes occur; the patient suffers pain in the inner parts with a gnawing sensation; and the vessels, being gnawed and becoming very dry, become tense and, inflamed, draw in what flows toward them; wherefore, the blood being corrupted and the pneuma being unable to traverse the natural paths within it, chillings arise from the stasis, and dizziness, and loss of voice, and heaviness of the head, and convulsions, if the condition has now reached the heart or the liver or the great vessel; thence patients become epileptic or hemiplegic, if the fluxes fall into the surrounding regions and dry out because the pneuma cannot pass through. 5. But one must foment such patients first and perform phlebotomy at the very beginning, while all the troublesome pneuma and fluxes are still suspended; for they are more amenable to treatment; and resuming and keeping watch for the crises, administer drug treatment upward if there is no relief; and for the lower gut, if it does not move, give boiled ass's milk, and let the patient drink not less than twelve kotylai; but if strength is present, more than sixteen. Quinsy arises when from the head a copious and viscous flux flows in winter or spring into the jugular vessels, and they draw in more flux on account of their breadth; and when it, being cold and viscous, obstructs the passages of pneuma and of blood, it congeals what is near the blood and renders it immobile and stagnant, being by nature cold and obstructive. 6. For this reason patients choke, as the tongue becomes livid and rounded and bent back on account of the vessels beneath the tongue; for on either side of the staphule — which they also call the kionis — there is a thick vessel. When these, being full, press against the tongue which is loose and sponge-like, the tongue, receiving by force from the vessels on account of dryness the moisture from the vessels, becomes round from flat, livid from well-colored, hard from soft, unbending from flexible, so that the patient quickly chokes, unless someone aids swiftly. Performing phlebotomy from the arms, and cutting the vessels beneath the tongue, and treating with electuaries, and having the patient gargle with warm preparations, and shaving the head underneath, and applying a wax-plaster to head and neck, and wrapping with wool, and fomentation with soft sponges pressed out in warm water; and let the patient drink water and melikraton not cold; and give juice when the patient is already safe after the crisis. When in summer or autumn season a hot flux flows down from the head and is nitrous — being rendered sharp and hot by the season — such a flux gnaws and ulcerates and fills with pneuma, and orthopnea comes on and great dryness, and what is observed appears wasted, and the tendons at the back of the neck are drawn tight, and it seems to the patient that tetanus is set in, and the voice is broken, and the breath is small, and the counter-drawing of the breath comes on frequent and violent. Such patients have their windpipe ulcerated and their lung inflamed, being unable to draw in pneuma from outside. In such patients, if the flux does not willingly carry itself to the outer parts of the neck, the condition is more dangerous and harder to escape, both because of the season and because it arises from hot and sharp causes. If fever takes hold in a patient who has recently eaten, with old stool remaining, whether with pain in the side or not, keep him at rest until the food first descends into the lower gut; and let him use oxymeli as drink; when heaviness comes to the loins, flush downward with an enema, or purge with a drug; when purged, administer first a gruel as nourishment and melikraton as drink; then solid food and boiled fish and diluted wine — a little toward evening; during the day, diluted melikraton. 7. When the flatulence is foul-smelling, use a suppository or enema; if not, hold back while the patient drinks oxymeli until it descends into the lower gut, then move the gut with an enema. But if causus comes upon a patient who is already evacuated, if it seems to you that drug treatment is appropriate, do not give drugs within three days, but on the fourth. And when you have given a drug, use gruels, watching the paroxysms of the fevers carefully, so that you never administer them when fevers are about to come on, but when they are abating, indeed when they have stopped, and as far as possible from their onset. When the feet are cold, give neither drink nor gruel nor anything else of that kind; rather, consider this the most important thing to watch — until the feet become thoroughly warm; then apply what is beneficial. For in most cases, chilling of the feet is a sign that the fever is about to be exacerbated; and if in such a moment you apply anything, you will commit every error of the gravest kind; for you will increase the disease not a little. When the fever is abating, on the contrary the feet become warmer than the rest of the body; for the fever increases, chilling the feet, kindling from the chest and sending the flame upward to the head; and when all the heat has gathered together above and is exhaled upward to the head, the feet naturally become cold, since they are by nature fleshless and sinewy; and further, being at a great distance from the hottest parts, they chill as the heat is gathered into the chest; and again, correspondingly, as the fever is resolved and dispersed into fragments, it descends into the feet; and during this time the head and chest have cooled. The reason one must pay attention to this is that when the feet are cold, the gut must necessarily be hot and full of much nausea, and the hypochondrium tense, and there is tossing of the body from inner disturbance, and confusion of the mind, and pains; and the patient is drawn, and wishes to vomit, and if he vomits foul matter, he suffers; but when heat descends into the feet and urine has passed — even if there is no sweating — everything eases; and at this moment one must give the gruel; but to give it at that other time is ruin. For those in whom the gut remains moist throughout in fevers, pay special attention to warming the feet and covering them with wax-plasters and binding them with bandages so that they will not be colder than the rest of the body; and when they are warm, apply no additional warming, but watch that they do not chill; and let the patient use as little drink as possible of cold water or melikraton. 8. In those in whom during fevers the gut is moist and the mind is disturbed, most such patients pick at fluff, probe at their nostrils, and respond briefly to questions but say nothing coherent of their own accord; such conditions seem to me to be melancholic; and if in such patients the gut is moist and the patient is wasting away, it seems to me one should apply gruels that are somewhat cooler and thicker, and drinks that are styptic and more vinous or more astringent. In those whose fevers are attended from the start by dizziness and throbbing of the head and thin urines, expect the fever to be exacerbated toward the crises; and I would not be surprised if they also went out of their minds. In those whose urines at the start are cloudy and thick, purge them gently downward, if the other signs also indicate it; in those whose urines at the start are thin, do not give them drugs, but if it seems right, give an enema; it is beneficial to treat such patients thus, keeping the body at rest, anointing and covering them evenly; let them drink diluted melikraton, and take as gruel the juice of ptisane toward evening; move the gut with an enema at the start; do not apply drugs to these patients; for if you disturb anything in the gut, the urine does not mature, but the fever will continue without sweating and without crisis for a long time. Do not give gruels when the patient is near the critical days, if he is disturbed; but if he is relieved and progressing toward the better — one must also keep watch on the crises of other fevers and withhold gruels at that time. These fevers tend to be prolonged and to produce deposits: if the lower parts are cold, about the ears and neck; if not cold, other changes occur; and blood flows from the nostrils, and the guts of such patients are thrown into disorder. In those whose fevers bring nausea and the hypochondria are tense, and who cannot bear to remain lying in the same position, and whose extremities all chill — these require the greatest attention and care; manage them by applying nothing other than diluted oxymeli; do not give gruel until the fever abates and the urine is matured; lay them down in dark rooms, and let them lie as long as possible on the softest bedding, keeping to the same position, and tossing about as little as possible; for this above all benefits such patients. Apply linseed smeared on the hypochondrium, taking care that the patient does not shiver when it is applied; let it be just slightly warm, boiled in water and oil. Form a prognosis from the urines as to what is to come; for if they are thicker and more yellow-pale, they are better; if thinner and darker, worse; and if they show changes, they indicate time passing, and the patient must necessarily fluctuate — sometimes for the worse and sometimes for the better — in that unevenness. 8 (50). Unstable fevers should be left alone until they settle; when they have settled, meet them with the diaita — the regimen and care — appropriate to the situation, observing in accordance with nature. The appearances of those who are ill are many; therefore the one treating must pay attention, so as not to miss the causes — neither those knowable by reasoning, nor those that must appear on even or odd days of number; above all one must be on guard against the odd-numbered days, since these days create turning-points in patients. 9. One must therefore watch the first day on which the patient began to be ill, observing from what and why the illness began; for this is the first thing to know, as he thinks. And when you have questioned him and examined all these things, first how the head is — whether it is free of pain and not heavy in itself; then the hypochondria and sides, whether they are free of pain; for the hypochondrium, whether it is painful or raised or has some curvature or fullness, or whether there is pain in the side, and whether along with the pain there is a slight cough or colic or pain in the gut; and when any of these is present, especially in the hypochondrium, move the gut with enemas; and let the patient drink warm thoroughly boiled melikraton. Observe also in the risings from bed whether he faints, and whether ease of breath is with him; and observe the evacuation, whether anything strongly dark in color has been passed, and whether it is clean, as would be the evacuations of a healthy person; and the fever exacerbating as it comes toward the third day; having observed well those who are in such diseases on the third day, now take stock of the other signs in relation to that day; and if the fourth day has something similar to the third among these same signs, the patient becomes dangerous. The signs: a black evacuation signifies death; one similar to that of a healthy person, whenever it appears on all the days, signifies preservation; when the patient does not respond to the suppository, and there is ease of breath, and having risen to the chair or still in bed, if faintness comes on — when these are present to the patient at the start, suppose that mental disturbance will follow. One must also attend to the hands; if they are trembling, expect in such a patient that blood will drip from the nostrils; and one must observe the nostrils as well; if the breath is drawn through both equally, and if much air is carried from the nostrils, convulsion tends to arise; and if convulsion arises in such a patient, death is to be expected, and it is good to foretell it. If in a winter fever the tongue becomes rough and faintness is present, there tends to be a relaxation of the fever in such a patient; but nonetheless keep such a patient under close supervision with starvation, drinking of water, and drinking of melikraton; and keep watch with juices, putting no trust in the relaxation of the fevers, as those who show such signs are in danger of dying; and when you have recognized these things, foretell them accordingly, if it seems right to you, having observed carefully. 10. When something alarming occurs in fevers on the fifth day — the gut suddenly passes liquid, and faintness arises, or loss of voice seizes hold, or the patient becomes convulsive or hiccuping — following these things, nausea tends to arise, and sweats about the nostrils and forehead and the back of the neck of the head; and those who suffer these things die before long, blown up with pneuma. In those in whom during fevers the legs become full of nodular swellings, and these do not mature as time goes on while the fevers still continue — and if choking also falls upon the throat, with the parts about the throat being wasted, and there is no maturing but rather extinction — blood tends to flow from the nostrils in such a patient; and if much flows together, it signifies resolution of the disease; if not, a prolonged course; and the less that flows, so much worse and more protracted; and if everything else becomes easiest, expect pain in the feet in such a patient; and if it takes hold of the foot and, becoming painful, persists as a burning inflammation and is not resolved, pain will gradually come also to the neck and the clavicle and the shoulder and the chest and the joint, and this joint will need to become nodularly swollen; and when these are extinguished, if the hands become drawn or trembling, convulsion seizes such a patient and delirium; and besides, blisters appear on the eyebrow, and redness; and one eyelid grows beyond the other, and a hard inflammation takes hold, and the eye swells severely, and the delirium greatly increases; and the nights show the signs of delirium more than the days. The signs arise mostly on odd-numbered or even-numbered days; and on whichever of these numbers they arise, destruction follows. If you choose to give drugs to such patients from the beginning, give them before the fifth day, if the gut is rumbling; if not, leave them without drug treatment; but if it rumbles throughout and the evacuations are bilious, purge gently downward with scammony; and in the rest of the treatment, apply as little drink and gruel as possible, so that the patient may do better, if they do not pass the fourteenth day and relax. When loss of voice comes upon a patient who has been feverish and is on the fourteenth day, resolution does not tend to come quickly, nor does relief from the disease occur, but it signifies a prolonged course for such a patient; and when it appears on that day, the outcome tends to be more prolonged. When in a patient who is feverish and on the fourth day the tongue speaks confusedly, and the gut passes bilious watery matter, such a patient tends to be delirious; but one must keep close watch, following the outcomes. 10 (50). In summer and autumn season, in acute cases, a sudden dripping of blood shows intense tension and much disturbance in the vessels, and on the next day appearances of thin urines; and if the patient is in his prime and the body has been maintained by exercise or good flesh, or he is of melancholic character, or the hands are trembling from drinking, it is good to foretell delirium or convulsion; and if it comes on in even-numbered days, better; in critical days, fatal. If much gathered-together blood bursts forth and makes exits through excess by way of the nostrils, or when the gut has been filled, an abscess, or pains in the hypochondrium, or in the testicles, or in the legs — when these are resolved, exits occur of thick sputa, smooth white urines. For a fever with hiccup, give juice of silphion, oxymeli, daukos ground up, to drink; and galbanum in honey, and cumin as an electuary, and juice of ptisane to take as gruel after these; and such a patient is hard to escape from unless critical sweats and regular sleep come on, and thick and sharp urine runs down, or the condition settles into an abscess; coccalos and myrrh as an electuary; and give oxymeli to drink in as small an amount as possible; and if they are very thirsty, barley-water. Lung-inflammatory and pleuritic conditions must be considered thus: if the fever is acute, and the pains of one or both sides, and if when the breath is brought up there is distress, and coughs are present, and the patient spits sputa that are tawny or livid, or also thin and frothy and florid, and if there is anything else unusual beyond the typical pattern — for such patients the management is as follows: if the pain extends upward toward the clavicle or about the breast or about the arm, one must cut the inner vein in the arm, on whichever side the condition falls; and remove blood according to the patient's bodily constitution and season and age and complexion — more rather than less — and proceeding boldly, if the pain is acute, bring the patient to the point of faintness; then flush the gut afterward. 11 [45] If the pain is below the chest and pulls very hard, purge the pleuritic patient's belly downward. Give nothing in the interval between purgings. After purging, give oxymel. Give medication on the fourth day. For the first three days, use enemas; and if this brings no relief, then in that case purge downward. Let there be watchful care until the patient is fever-free and until the seventh day. Then, if the patient appears to be stable, give first a little thin gruel mixed with honey. If the patient brings it up easily, and breathes freely, and has no pain in the sides, and is without fever, give gradually something thicker and more of it, twice a day. If the patient does not clear readily, give less to drink and little to take as gruel — thin gruel, once, at whichever hour of day the patient is doing better. You will know this from the urine. One must not offer gruel to those recovering from disease before you have seen that the urine or the sputa have become concocted — (if the patient has been given medication and purged repeatedly, it is necessary to give something, though less and thinner; for he will not be able to sleep on account of the emptied vessels, nor to concoct in the same way, nor to endure the crises) — but once there is melting of the raw matters and what has been holding out begins to give way, nothing will hold firm. Concocted sputa are those that have become like pus; concocted urine is that having a reddish sediment resembling that of bitter vetch. Nothing prevents also applying warm fomentations and wax-plasters for the other pains of the sides; and anointing the legs and the loins with warm oil, rubbing fat into them; and applying a linseed poultice over the hypochondria up to the breasts. At the height of pneumonia, the patient is past all aid if not being cleared upward, and the condition is bad if there is labored breathing, the urine is thin and sharp, and sweats appear around the neck and head. Such sweats are bad signs, when the diseases are prevailing by means of suffocation and rupture and force, unless copious thick urine rushes out and concocted sputa come — whichever of these occurs of its own accord will resolve the disease. A lick-preparation for pneumonia: galbanum and kókkalos in Attic honey; and southernwood in oxymel, with pepper. Decoct black hellebore and give it at the outset to a pleuritic patient who is in severe pain. It is good also to boil up and strain all-heal in oxymel and give it to drink, and to those with liver complaints and those suffering severe pain about the diaphragm, and as much as is needed for the belly and for urination — give it in wine and honey; for matters pertaining to the belly, give more to drink with watered-down mead. 12 Dysentery, when it stops, will produce an abscess or some swelling, unless it resolves into fevers or sweats and thick white urine appears, or the pain settles into tertian fever or into varicosity or into the testis or into the legs or into the hips. In a bilious fever, jaundice appearing before the seventh day with shivering resolves the fever; but if it appears without shivering, outside the critical times, it is fatal. 14 [25] In tetanus of the loins, and when there are obstructions of pneuma through the veins of a melancholic nature, phlebotomy brings relief. But when the tendons pull strongly from the front in counter-tension, and there are sweats around the neck and face — the tendons of the urinary region being bitten and dried by the pain, those very thick ones that hold together the spine, where the greatest ligaments have grown fast down to where they end at the feet — in such a case, if fever and sleep do not supervene, and if the urine that follows does not come bearing pepsis (concoction) and critical sweats do not appear, give Cretan wine, rich in wine-character, to drink; and give boiled meal to eat; and anoint with and rub in a wax-plaster. Wrap the legs in bandages down to the feet, having first soaked them in warm water in a tub, and wrap the arms down to the fingers, and the loins from the neck down to the hips, having smeared with waxed wool so that it also holds things from outside, and at intervals apply fomentation with leather bags filled with hot water, and stretching a linen cloth over him, lay him back. Do not loosen the bowel except with a suppository, if it has been long without movement. If some improvement shows itself to you, towards the better; but if not, grind the root of modius and of daucus in fragrant wine and give it to drink in the morning on an empty stomach before the soaking, and quickly after this let him eat as much as possible of boiled meal, warm, and when he wishes let him drink well-blended wine. If improvement shows itself to you, towards the better; but if not, give a prognosis. All diseases are resolved either by way of the mouth or by way of the belly or by way of the bladder or by way of some other such outlet; and the form of sweat is common to all of these. 16 [5] One must give hellebore to those in whom a flow comes from the head. But those who become suppurated from abscesses, or from hemorrhage of the veins, or through intemperance, or through some other strong cause — do not give hellebore to such persons; for it will do no good, and if anything goes wrong, the hellebore will be thought to be the cause. But if the body is dissolving, or there is pain in the head, or the ears or the nose feel stuffed, or there is excessive salivation, or heaviness in the knees, or swelling of the body beyond the usual — whatever comes about that is due neither to drinking, nor to sexual activity, nor to grief, nor to anxieties, nor to sleeplessness — if any of these has a cause, direct the treatment toward that. As for pains from walking — of the sides, back, loins, hips — and as many as have pain on breathing with a provocation, since pains often are accustomed to come on from excess drinking and from wind-producing foods, into the loins and into the hips, and those among them who have such things also have difficulty urinating — of these, walking is the cause, and of catarrhs and of hoarseness as well. 18 [45] As regards what arises from ways of living: in most cases, each person shows signs most strongly when he departs from his accustomed habit. For those who are not used to eating a midday meal, when they do eat one, there is much fullness in the stomach, drowsiness, and repletion; and if they take an evening meal on top of it, the belly is upset. It is beneficial for such persons to take a bath and sleep; and after sleeping, to walk at a slow pace for a good circuit. If the belly has been relieved, to take supper and drink a smaller amount of wine, undiluted. If it has not been relieved, to anoint the body with warm oil, and, if thirsty, to drink a well-watered white or sweet wine and then rest. If sleep does not come, to rest longer. In other respects let such a person follow the same regimen as one recovering from excess drinking. As for what arises from drinks: watered-down drinks move more slowly, circulate around, float about the hypochondria, and do not run down into urination. When filled with such a drink, do not carry out any work quickly that involves the body being under strain of force or speed; but rest as much as possible until it has been digested along with the food. Drinks that are more undiluted or more astringent produce throbbing in the body and pulsing in the head; for these it is good to sleep on top of it and to sip something warm, whichever they find most pleasing; but fasting is bad in the case of headache and excess drinking. Those who eat only once a day are empty and weak, and urinate hot, being empty in their vessels beyond their custom; the mouth also becomes salty and bitter, and they tremble at every task, and the temples are drawn tight, and they cannot concoct the evening meal as well as if they had eaten the midday meal. Such persons should eat less for supper than they are accustomed to, and eat moister barley-cake instead of bread, and from vegetables: sorrel, or mallow, or pearl barley, or beets. Let them drink wine proportional to the food, a moderate amount, more diluted; and after supper take a short walk until the urine runs and they urinate. Let such a person also make use of boiled fish. As for foods, the following show their effects most clearly: garlic produces wind and heat around the chest, heaviness of the head, nausea, and will sharpen any other pain that was already present; it is, however, diuretic, and has that good quality; it is best eaten before drinking or when drunk. Cheese produces wind, constipation, and igniting of foods — whether raw or undigested; and it is worst to eat when one is filled with drink. All legumes are wind-producing, whether raw, boiled, or roasted — least so when soaked and fresh; do not use them except with food. Each of them also has its own particular mischief. The chick-pea produces wind, whether raw or roasted, and causes pain. The lentil is astringent and causes discomfort if taken with its husk. The lupin has the fewest of these bad qualities. Silphium and its juice: in some people especially it passes through the belly, but in those unaccustomed to it, it does not pass through the belly but is called dry cholera — a Hippocratic designation for a bile-disease with obstruction and no fluid discharge, not to be confused with modern cholera. This especially happens if it is mixed with much cheese or with beef-eating. 18 (50) [65] For the melancholic affections would also be aggravated by beef; for its nature is not to be overcome and not every belly can fully concoct it. It would be best dealt with if one used it thoroughly boiled and as old as possible. Goat meat has all the bad qualities that are in beef — indigestibility, and it is more wind-producing and belch-producing and generative of cholera. The most fragrant, firm, and most palatable pieces are best thoroughly boiled and cold; the least palatable, ill-smelling and hard, are worst, as are the freshest; best in summer, worst in autumn. Pig meat is bad when more underdone or overcooked; it would be cholera-producing and disturbing. Pork is the best of all meats; the best are those neither strongly fat nor again strongly thin, nor of the age of an old sacrifice-animal. Eat without the skin and somewhat cooled. In dry cholera the belly is distended, there are rumblings, pain in the sides and loins, nothing passes downward but it is stopped up. 19 [5] Watch over such a person so that he does not vomit, but so that the belly moves downward. Enema him as quickly as possible with something warm and as oily as possible, and lower him into water, anointing him with as much oil as possible, warm, laying him down in a tub, and pour warm water on gradually; and if when he is being warmed the belly moves downward, it is resolved. It is also beneficial for such a person to sleep, and to drink thin, old, more undiluted wine; and give oil, so that with rest the belly moves downward and it is resolved. Let him abstain from foods and other things. If the pain does not relent, give ass's milk to drink until he is purged. If the belly is loose and bile is passing downward, with cramps, vomiting, suffocation, and griping — for these it is best to keep quite still; to drink mead, and not to vomit. Of dropsies there are two natures: the one under the flesh, which once it has taken hold is inescapable; the one with distensions, which requires much good fortune. Most of all needed are hardship, fomentation, and self-control. Let the patient eat dry and sharp things; for in this way he would be most prone to urinate and would maintain the most strength. 20 [5] If there is labored breathing, and it happens to be summer, and the patient is in the prime of life, and there is bodily strength, draw blood from the arm. Then let him eat warm breads dipped in dark wine and oil; and drinking as little as possible, let him work as much as possible, and let him eat fleshy pork boiled with vinegar, so that he can hold up under uphill walks. For those who have hot lower bellies and sharp and uneven passages go through them by reason of melting, if they are capable, draw off with hellebore; if not, the thick cold juice of fine wheats, and lentil pottage, and bread baked in the embers, and fish — boiled for those with fever, roasted for those without; and dark wine for those without fever; if not, water from medlars or myrtles or apples or service-berries, or from date-palms, or from vine-blossom. 21 [5] If there is no fever and there are cramps, give warm ass's milk, a little at first, then more gradually; and linseed, and wheat-meal, and from Egyptian beans having removed the bitter parts, grinding them down, let the patient drink by sprinkling this on top. Let him eat eggs half-set, roasted; and fine wheat semolina, and millet, and spelt groats boiled in milk, boiled and cold to eat — and let him take foods and drinks similar to these. The greatest thing in the diaita (regimen / ordering of life) is to observe and watch, in lengthy illnesses, both the intensifications of fevers and the remissions, so that the critical moments are preserved — when one must not administer food, and to know safely when one must administer it; and that is when the patient is farthest from the intensification. 23 [5] One should know those with headache from exercise, running, walking, hunting, or some other untimely exertion, or from sexual activity — those who are pale, those with hoarseness, those with spleen-disease, those with deficiency of blood, those full of pneuma (breath / moving air), those with dry coughs and thirsty, those with wind, those with obstruction of the veins, those tense in the hypochondria and the sides and the back, those who have become numb, those who see dimly, and those in whose ears sounds fall, and those in a condition of incontinence of the urethra, those with a jaundiced tinge, and those whose bellies discharge raw matter, and those hemorrhaging from the nose or through the seat violently — if they are in a state of distension, or a strong pain is running through them and they are not gaining the upper hand — do not administer a drug to any such persons; for it will bring danger and you will do no good, and you will rob them of their spontaneous recoveries and crises. If it is beneficial for someone to have blood drawn, first make the belly firm, and so draw blood, and starve them, and withhold wine from them; then treat the rest of them by the fitting diaita and by moist fumigations. 24 If the belly seems to you to be very dense, purge downward with a gentle enema. If it seems good to administer a drug, purge safely upward with hellebore; but downward with none of the following kinds. 25 [5] Best of all is to lead toward urination and toward sweats and toward walking; and use gentle rubbing, so as not to pack the bodily condition tight. If the patient is bedridden, let others rub him. If the condition is giving trouble in the chest above the diaphragm, let him sit up as often as possible, and let them lean back as little as possible as long as they are able, and sit him up and rub him for a long time with much warmth. If the pains are held in the lower belly below the diaphragm, lying back is beneficial, and no movement should be made; nothing should be administered to such a body beyond the rubbing. The things resolved from the lower belly through urine and sweats — if it slips moderately of its own accord, the small things are resolved; but the violent cases are bad; for such persons either perish or do not become well without other afflictions, but it lodges and continues in the same manner. A drink for the dropsical: take three blister-beetles, removing the head, feet, and wings of each, grind the bodies in three kyathoi of water; when the drinker has pain, let him be soaked in warm water, having first anointed himself, and let him drink on an empty stomach; let him eat warm breads made with fat. 27 [5] For stanching of blood: apply the juice of the fig-tree in wool inside against the vein; or twist up rennet and insert it into the nostril; or press with the finger dusted with chalcitis, and compress the cartilages from outside on each side. Loosen the belly with boiled ass's milk, and shaving the head apply cooling applications, if it occurs in the warm season. The sesame-like plant purges upward; the dose is one-and-a-half drachmas ground up in oxymel. It is also mixed with hellebores, and the third part of the dose makes it less suffocating. 29 [10] For trichiasis: threading the suture through the needle that has an eye, pierce through from the outer point of the upper tension of the eyelid into the upper part and pass it through, and another below this one; pulling the threads taut, sew and bind, until it falls away. If it is sufficiently improved, well; if not, if it falls short, do the same again from behind. You will also push through hemorrhoids in the same manner with the needle, having tied as thick a thread of greasy wool and as large a loop as possible — for the treatment is safer this way; then pressing it off, use the caustic, and do not wet it before it falls away, and always leave one behind, and after these things taking up the patient, give hellebore treatment. Then let him take exercise and sweat it off; as exercise, rubbing and wrestling from dawn; but let him abstain from running, and from intoxication, and from sharp things except for marjoram; let him vomit every seven days or three times in the month; for in this way the body would be in the best state. Let him drink tawny astringent wine, well-watered, and the drink small. For those with suppuration: cut squill into rounds, boil in water, strain off well after boiling, pour on fresh water and boil again, until when touched it appears thoroughly boiled and soft; then grinding it smooth, mix in roasted cumin, and white sesame, and fresh almonds ground in honey, give as a lick-preparation, and after this sweet wine. For a gruel: rubbing a small Attic cup's worth of white poppy under, diluting with water from the washing of fine wheat flour, boiling, pouring honey over it, sipping warm, let the patient pass the day in this way; then reckoning from what results, give the evening meal. 31 [5] For dysentery: take a quarter measure of clean beans and twelve stalks of madder, grind fine, mix together and boil, and give in an oily preparation to lick. For the eyes: washed ash, worked with fat to a paste not wet, ground smooth, moistened with the unripe juice of the bitter unripe grape, dried in the sun, moisten to an anointable consistency; when it has dried, anoint the eyes with it ground dry and smooth, and dust the corners. 33 [5] For watery conditions: one drachma of ebony, nine obols of burnt copper ground on a whetstone, three obols of saffron — having ground these smooth, pour over them an Attic kotyle of sweet wine, and then set in the sun, covered. When it has been cooked together, use this. For severe pains: one drachma of chalcitis with grape-pulp; when it has been concocted for two days, squeeze it out, grind myrrh and saffron and mix with the must, boil in the sun, and anoint those in severe pain with this; let it be kept in a bronze vessel. 35 Diagnosis of those suffocated by uterine attacks: press with the fingers; if the patient is sensible of it, these are uterine affections; if not, they are convulsive. For those needing sleep-inducing treatment: meconium, a small round Attic dish's worth, is the dose. 37 [Uncertain passage.] Three probes' breadth of metallic scale-scraping, and a paste of fine wheat meal — having ground these smooth, rolling up as tablets for swallowing, give them; water purges downward. To empty the bowel: let juice of tithymallos drop seven times into each dried fig, then storing them together in a new vessel, keep in store; give before food. 39 [5] Also grinding the meconium, pouring water over it, straining through, kneading flour, baking pastry-cakes, pouring boiled honey over — give these to eat to those with rectal and dropsical conditions, and let them drink after sweet wine, well-watered, or watered-down mead made from the drainings of dung-heaps; or gathering meconium, keep it in store and use it therapeutically.