First draft. This English translation was generated by
Claude Sonnet 4.6, critiqued by Claude Haiku 4.5, and adjudicated/corrected
once by Claude Sonnet 4.6. It is published for reading and review, not as a
final scholarly edition. Hippocratic medical recipes and treatments are
historical text, not medical advice.
ON DISEASES. THE FIRST BOOK.
Whoever wishes to inquire correctly in matters of healing, and to answer correctly one who inquires, and to argue correctly against views, must attend to the following things: first, from what sources all diseases arise in human beings; then, which of the diseases carry necessities such that, whenever they arise, they are either prolonged or brief, or deadly or not deadly, or such that some incapacitation of the body will come about or will not; and which diseases, once they have arisen, are doubtful as to whether bad outcomes will follow from them or good ones; and from what sorts of diseases they shift into what other sorts; and how many things healers accomplish by chance in treating the sick; and what good or bad things the sick suffer in the course of their diseases; and how many things are said or done by the healer toward the sick person, or by the sick person toward the healer, by conjecture; and how many things are done and said with exactness in the craft, and what within it is correct and what is not correct; and what is the beginning, end, middle, or some other such part of it, and what has been correctly demonstrated to belong within it or not; and the small things and the great, the many and the few; and the fact that everything in the craft is one, and that one thing is all; and the things that are achievable — both to understand and to say, and if need be also to do — and the things that are not achievable — neither to understand, nor to say, nor to do; and what in the craft is ease of hand and what is difficulty of hand; and what is the right moment and what is untimeliness; and which other crafts it resembles and which it resembles not at all; and what in the body is hot or cold, or dry or wet, and what is strong or weak, or dense or open in texture; and how many of the many things occur in small measure, whether for the worse or for the better; and what is done finely or poorly, slowly or quickly, correctly or not correctly; and what bad thing occurring on top of a bad thing produces a good outcome; and what bad thing of necessity occurs on top of a bad thing.
Chapter 1
Having attended to these things, one must keep watch over them in discussions. If anyone goes wrong in any of these — whether in speaking, in questioning, or in answering — and whether he says that things which are many are few, or that things which are great are small, and whether he says that things which are impossible are possible, or whatever other error he makes in speaking, it is there that one must press one's attack in argument, watching for that point. Now all diseases arise — among the things present within the body, from bile and phlegm; and among things coming from without, from exertions and wounds, and from heat that overheats, and cold that overcools, and dryness that over-dries, and moisture that over-moistens.
Chapter 2
Bile and phlegm are present together with people from birth, and are always in the body in greater or lesser quantity. They bring about diseases — some from foods and drinks, others from heat that overheats and cold that overcools. These things necessarily come about whenever they do: among wounds, when the thick sinews are wounded, the patients become lame, and so too the heads of the muscles, especially those in the thighs; and death necessarily follows if someone is wounded in the brain, or the spinal marrow, or the liver, or the diaphragm, or the bladder, or a bleeding vessel, or the heart; but one who is wounded in parts of the body in which none of these things are present, and which are farthest from them, does not die.
Chapter 3
Of the diseases, the following necessarily bring death to those who have them whenever they arise: phthisis (wasting-disease); sub-flesh dropsy; and a woman who is carrying a foetus when she is seized by lung-inflammation, or burning fever, or pleuritis, or phrenitis, or erysipelas occurring in the womb. Doubtful as to whether they kill or not are the following: lung-inflammation, burning fever, phrenitis, pleuritis, throat-strangulation, uvula-disease, liver-inflammation, spleen-inflammation, kidney-inflammation, dysentery, a bloody flux in a woman. The following are not deadly, unless something is added to them: kedmata, black-bile disease, foot-gout, hip-joint pain, tenesmos, quartan fever, tertian fever, strangury, eye-inflammation, scaly-skin, lichen, joint-disease. But often many people become disabled from the following: struck in hands and feet, and without control of voice, and paralyzed by black bile; lame from hip-joint pains; and eyes and hearing are disabled by phlegm that has become fixed. The following of necessity are prolonged: phthisis, dysentery, foot-gout, kedmata, white phlegm, hip-joint pain, strangury, and for the elderly, kidney-inflammation, and for women, bloody flux, haemorrhoids, fistulas. Burning fever, phrenitis, lung-inflammation, throat-strangulation, uvula-disease, pleuritis — these come to crisis quickly. The following shift: from pleuritis into burning fever, and from phrenitis into lung-inflammation; but from lung-inflammation, burning fever would not arise; tenesmos shifts into dysentery; from dysentery, smooth-bowel; from smooth-bowel into dropsy; and from white phlegm into dropsy; and from lung-inflammation and pleuritis into empyema. The following of necessity turn out badly when compounded with bad things: if shivering seizes, fever must follow; if a sinew is cut through, convulsion follows; and a severed sinew will neither knit together nor fail to become greatly inflamed; and if the brain is shaken and injured when someone is struck, he must at once be rendered speechless, and unable to see or hear; and if wounded, fever and vomiting of bile must follow, and some part of the body must be struck apoplectically, and death follows; if the caul falls out, it must of necessity rot; and if blood flows from a wound or a vessel into the upper cavity, that must necessarily become pus.
Chapter 5
Right moments, to speak of them at once in general, are many and of every kind in the craft, just as the diseases and affections and their treatments are many and various. The most acute moments are those in which one must help either someone who is on the point of dying, or someone unable to urinate or pass stool, or someone being suffocated, or to deliver a woman in labour or one who is wounded, or whatever such cases there are. These are the acute right moments, and a little later is not enough, for most of such patients die a little later. The right moment is, however, this: whenever something like this has befallen a person, whatever aid is given before the psyche departs — before the life-breath leaves the body — all of that help came at the right moment. This is indeed very nearly the nature of the right moment in the other diseases as well, for whenever someone provides benefit, the benefit came at the right moment. But for all those diseases or wounds that do not lead to death and yet are critical — pains arise in them, and it is possible, if one treats correctly, for them to cease — for these, the benefits that come from the healer when they come are sufficient; for even without the healer present, they would have ceased. But there are other diseases for which the right moment of treatment is in the early morning, and whether it is very early or a little later makes no difference; and there are other diseases for which the right moment is to be treated once in the day, and at what hour makes no difference at all; and others, every third or fourth day; and others once a month; and others every three months, and whether at the beginning or the waning of the third month makes no difference. Such are the right moments in some cases, and they have no precision other than this. Untimeliness is as follows: those things that need to be treated in the early morning, if treated at midday, are treated at the wrong time; and at the wrong time in this sense: those things that quickly incline toward the worse owing to treatment not at the right moment — whether the treatment is at midday, late in the day, or at night — are treated at the wrong time; and if treatment is needed in spring but given in winter, or if it is needed in winter but given in summer; or if what already needs to be treated is put off, or what needs to be put off is treated now — these things are treated at the wrong time. What is correct and not correct in the craft is as follows: not correct — to call a disease other than what it is when it is one thing, and to call a great one small and a small one great; and to say that one who will survive will not survive, and to say that one who is going to perish will not perish; and not to recognize that someone has an empyema; and not to recognize that a great disease is growing in the body; and not to recognize that one needs a drug of any kind; and not to know how to treat what is treatable, and to say one will treat what is not treatable.
Chapter 6
Those are errors according to judgment. Errors according to hand-craft are these: not to recognize pus present in a wound or in a growth; not to recognize fractures and dislocations; when probing a skull, not to recognize whether the bone is fractured; not to be able, when passing a small tube into the bladder, to pass it; not to recognize a stone present in the bladder; not to recognize by shaking that someone has an empyema; and when cutting or burning, to fall short either in depth or in length; or to burn and cut what one ought not. These are errors. What is correct is: to recognize the diseases — what they are and from what they come — and their prolonged and their brief, and their deadly and not deadly, and those that shift and those that grow and those that diminish, and the great and the small; and in treating them, to treat fully those that are treatable, and for those not treatable, to know why they are not treatable, and in treating those who have such conditions, to give benefit from the treatment to the extent that is achievable. What is applied to the sick should be watched over in this way, for what is correct and not correct: if one dries what needs to be moistened, or moistens what needs to be dried, or does not apply what would thicken when thickening is needed, or does not thin when thinning is needed, or does not cool when cooling is needed, or does not warm when warming is needed, or does not putrefy when putrefaction is needed, and so on according to the same principle. The following things arise of themselves in diseases in human beings, both good and bad: in someone feverish and full of bile — bile dispersed outward at the right moment is good, spreading and being scattered under the skin, both easier for the one who has it to bear and easier for the one treating him to treat; but when dispersed and scattered it falls upon a single part of the body — that is bad.
Chapter 7
The bowel disturbed in someone suffering from pleuritis or lung-inflammation, or in someone with an empyema — bad. In someone feverish or wounded, the bowel dried out — bad. In someone dropsical and suffering from spleen-disease and affected by white phlegm, the bowel strongly disturbed — good. Erysipelas: if it is spread externally and turns inward — bad; if spread internally and turns outward — good. In someone held by a strong diarrhoea, vomiting coming on — good. In a woman vomiting blood, the monthly periods breaking through — good; in one pressed by a flux, the flux shifting to the nostrils or to the mouth — good. In a woman held by convulsion from childbirth, fever supervening — good; and in one who has tetanus and convulsion, fever supervening — good. For such things come about and do not come about through no ignorance or wisdom of healers, but of themselves and by chance, and when they come about they benefit or harm, and when they do not come about they benefit or harm in the same way. By chance, healers bring about the following good things in treatment: giving an emetic drug, they purge both upward and downward well; and giving a woman a downward drug for bile or phlegm, they have broken open monthly periods that were not occurring; and to someone with an empyema in the spleen, giving a downward drug to purge bile and phlegm downward through the bowel, they purged the pus downward from the spleen and released him from the disease; and to someone with stone-disease giving a drug, the force of the drug pushed the stone into the ureter so that it was expelled in urine; and to someone with pus in the upper cavity in a growth, not knowing what he had, giving an upward drug that purges phlegm, the patient vomited the pus and became healthy; and treating someone purged excessively upward by a drug, when the lower bowel broke through of itself, they made him healthy of the vomiting.
Chapter 8
The bad things they bring about from ill chance are these: giving an upward drug for bile or phlegm, they have ruptured a vessel in the chest through the vomiting — the patient having had no conspicuous pain in the chest before — and a disease resulted; and giving an upward drug to a woman with child, the lower bowel broke downward and she miscarried the foetus; and in treating someone with an empyema, the bowel flowing has destroyed him; and in treating eyes and applying salve, sharper pains set in, and if it falls out so, the eyes are ruptured and grow dim, and they blame the healer because he applied the salve; and in the case of a woman recently delivered, with abdominal pain, if the healer administers something and the patient worsens or dies, the healer is held responsible. And broadly, whatever things necessarily bring bad outcomes upon bad conditions in diseases and wounds — when these happen they blame the healer, and they do not recognize the necessity that compels such things to come about. And if he enters and administers to someone feverish or wounded, and the first treatment gives no benefit, but the next day the patient is worse, they blame the healer; yet if he does give benefit, they do not praise him equally, for they think it was his duty to have done so; but that wounds should be inflamed, and pains should arise in diseases in some cases — they do not think that these things need to happen to them, nor such things as these: that a sinew once severed will not knit together again, nor the bladder, nor the intestine if it be one of the thin ones, nor a bleeding vessel, nor the thin part of the jaw, nor the skin upon the genitals. Now a demonstrated beginning of healing has not been established — one that is rightly the beginning of the whole craft — nor any second thing, nor middle, nor end; but we enter upon it, sometimes by speaking, sometimes by working, and we end it in the same way; and when we speak we do not begin from the same starting-points, not even if we are speaking about the same things, nor do we end at the same points; and when working, in the same way we neither begin from the same actions nor end at the same ones.
Chapter 10
Ease of hand is the following: when one cuts or burns, not to cut or burn a sinew or a vessel; and when burning for an empyema, to hit upon the pus, and likewise when cutting; and to set fractures correctly; and whatever part of the body has fallen out of its natural position, to restore it correctly to its natural position; to grasp what needs to be grasped firmly and, having grasped it, to compress; and to grasp gently what needs gentle grasping and, having grasped it, not to compress; and when bandaging, not to make straight things crooked, and not to press what should not be pressed; and when touching wherever one touches, not to cause unnecessary pain. These things are ease of hand. But taking hold elegantly with the fingers, whether finely or not, with long fingers or short; and bandaging finely and all kinds of bandagings — these are not judged in relation to the craft in the matter of ease of hand, but separately. Those who have an empyema in the lung, or in the upper or lower cavity, or have growths either in the upper or lower cavity, or in the lung, or internal ulcers, or are spitting or coughing blood, or have some pain either in the chest or in the back behind — all of these conditions arise, in what comes from within the body, from bile and phlegm, and in what comes from without, from air mingling with the innate heat, and also from exertions and wounds.
Chapter 12
Those who become empyemic in the lung come to this condition from the following: if someone seized by lung-inflammation is not purged in the critical days but sputum and phlegm are left behind in the lung, he becomes empyemic; and if he is treated at once, he mostly escapes; but if neglected, he is destroyed, and he is destroyed in this way: the phlegm that settles in the lung and putrefies causes the lung to become ulcerated and completely suppurated, and it no longer draws into itself what is of any account from nourishment, nor is anything cleared out from it upward, but he chokes and breathes with ever more difficulty, and wheezes when breathing, and breathes only from the chest upward, and at last is stopped up by the sputum and dies. A person also becomes empyemic if phlegm runs down from the head into the lung; and at first it mostly flows down unnoticed, and produces a thin cough, and the saliva is somewhat more bitter than usual, and now and then there is a slight heat; but when time goes on, the lung is roughened and becomes ulcerated inside by the phlegm that settles in it and putrefies, and it produces heaviness in the chest and sharp pain forward and backward, and more acute fevers fall upon the body; and the lung under the influence of the heat draws phlegm into itself from the body, especially from the head; and the head when it heats up draws from the body; and this putrefying he spits up somewhat thick; and as time goes on he spits pure pus; and the fevers become more acute, and the cough dense and strong, and the loss of appetite wastes him; and at the end the lower bowel is disturbed, disturbed by the phlegm; and the phlegm comes down from the head; this person, when he reaches this point, perishes, as was said in what precedes, when the lung has become fully suppurated and rotten, or when the lower belly flows.
Chapter 14
The lung also becomes empyemic from the following: when one of the small vessels within it ruptures — it ruptures from exertions — and when it ruptures, the small vessel bleeds; and if it is rather thick, more; if rather thin, less; and in the one case, it spits blood right away; in the other, if the vessel is not sealed, the blood pours into the lung and putrefies in it, and when it has rotted he spits pus; and as time goes on, sometimes pure pus, sometimes blood-tinged pus, sometimes blood; and if the small vessel becomes more filled, it casts off from itself the excess of the blood, and the pus is spat up thick owing to the phlegm that comes in addition and putrefies. If this person is caught at the beginning of the disease before the vessel bleeds greatly or relaxes greatly, before he has grown thin and become bedridden, and before the head has begun to waste and the rest of the body to melt away, he escapes this disease; but if he is neglected and these things overtake him so that he suffers all or most of them, he perishes; and he perishes either from the same things I mentioned before, or from the vomiting of much blood vomited many times. But if the small vessel is not completely ruptured but a strain develops within it — and it most often becomes something like a varix — which at once, when it arises, causes a slight pain and a dry cough; and if it becomes prolonged and is neglected, it distributes blood, at first little and somewhat dark, then more and purer, then pus, and he suffers all that was described in the foregoing. For such cases it is beneficial, if you take them at the start so as to treat them, to open veins in the arms, and a diaita — regimen — by which the patient will be as dry and as bloodless as possible. In the same way the small vessels in the side that are superficial on the inner surface are affected; so when they are strained, they become varix-like and raised inside; and if neglected, they suffer the following: they rupture, and the patients spit blood from them, and sometimes vomit blood as well, and they become empyemic, and in most cases they perish; but if treated at the beginning of the disease, the small vessels settle back into place against the side and become flat. The lung becomes empyemic from these causes, and patients suffer such things from it and end in this way. The upper cavity becomes empyemic in many ways: when phlegm flows from the head in abundance into the upper cavity, it putrefies and becomes pus; it putrefies when spread out over the diaphragm; it putrefies most often in twenty-two days; then this is shaken and the pus sloshes against the sides; if this person is cauterized or incised before the pus has lingered long, he mostly becomes healthy.
1 15 [55]
Empyema of the upper cavity also arises from pleuritis, whenever it becomes severe and on the critical days neither putrefies nor is expectorated, but instead the side is ulcerated by the phlegm and bile that have stuck to it. And when the ulcer forms, it gives off pus from itself, and by means of heat it draws phlegm to itself from the neighboring regions; and when this putrefies, pus is expectorated. Sometimes too blood passes from the small vessels into the ulcer, and through putrefaction becomes pus. If this patient is attended to promptly, he generally recovers; but if neglected, he perishes.
Empyema also arises when phlegm flowing down from the head adheres to the side and putrefies; for then the side is in most cases inflamed, and it undergoes the same things as in pleuritis when empyema develops.
Empyema also arises when, through exertion, or from exercise, or otherwise, the chest is torn—whether in front or behind—yet not so as to spit blood immediately, but a tear occurs in the flesh, and the flesh, being torn, draws in a little moisture and becomes somewhat livid; and when the affected person does not notice it immediately on account of his strength and good condition, or if he does notice it, regards it as nothing serious. In this way, when fever, or drinking, or sexual activity, or something else reaches a point where it wastes him away, the wounded flesh becomes somewhat dried out and somewhat heated, and draws moisture to itself from the neighboring vessels and flesh. When it draws this in, it swells and becomes inflamed, and at first causes a slight pain and an infrequent and dry cough; then it draws still more to itself and causes stronger pain and a more frequent cough; and the patient spits first something somewhat purulent, sometimes somewhat livid and tinged with blood. As time advances, the flesh draws more to itself and causes putrefaction; and all of the flesh that was livid from the beginning becomes one ulcer, causing sharp pain and fever and a heavy and frequent cough, and the expectoration spat out is pure pus.
If the pus remains long in the cavity, the whole body is heated through, and especially the parts nearest to it; and as the body heats, the fluid in it is melted away. That coming from the upper parts flows mostly into the upper cavity and becomes pus in addition to what is already there; and some flows also into the lower cavity, and sometimes the bowel is disturbed by it, which has destroyed the patient. For the food that enters passes through undigested—pepsis (digestive concoction) does not take place—and the body gains no nourishment from it. And the upward clearance of the expectoration does not proceed smoothly, since the cavity has grown heated and draws everything downward toward itself; and the patient is suffocated and wheezes from the expectoration that is not cleared, and he is exhausted by the flowing of the belly, and in most cases perishes.
In such diseases it is chiefly the head that supplies this flux, since it is hollow and lies above; for when it is heated by the cavity, it draws from the body the thinnest part of the phlegm; and when this has collected within it, it releases it again—collected and thick—and, as has been said, some of it flows down into the upper cavity, some into the lower. When, therefore, the head begins to flow and the rest of the body begins to waste away, they no longer survive regularly, not even when cauterized; for the harmful influxes or effluxes overcome the pus, and the flesh wastes away more under the harmful influences than it is nourished by what enters.
1 16 [5]
Of those who have diseases of this kind and arising from these causes, some perish in a short time, while others drag on for a long while; for body differs from body, age from age, and affection from affection; and some are more capable of withstanding hardship in their diseases, while others are altogether unable to endure hardship. It is therefore not possible to know precisely and to declare in a single pronouncement the time in which they perish, whether it be long or short; for neither is the time that some state as a general rule precise, nor does that very thing accomplish it; for year differs from year, and season from season in which they fall ill. But if one wishes to understand and speak about these matters correctly, he will know in this way: that in every season there are those dying, those surviving, and those experiencing whatever they happen to experience.
Empyema of the lower cavity arises most of all when phlegm or bile accumulates between the flesh and the skin; it also arises from tears, and when a small vessel is torn and ruptures—the blood poured out putrefies and suppurates. And if the flesh is torn or crushed, it draws blood from the small vessels nearby, and this putrefies and suppurates.
1 17 [5]
For these patients, if the pus signals outward and comes out, they recover; but if it bursts spontaneously inward, they perish. Pus spread throughout the lower cavity, such as was said to form in the upper cavity, could not accumulate there in the same fashion; but as I have said, it occurs in membranous sheaths and in tumorous swellings. And if it signals inward, it is difficult to know; for one cannot determine it even by shaking. It is recognized chiefly by the pain at the location where it is, and if you apply a poultice of clay tile or something similar, it dries up in a short time.
Erysipelas occurs in the lung when the lung becomes excessively dried out. It becomes excessively dried out both from intense heat and from fevers and from exertion and from intemperance. And when it becomes excessively dried out, it draws blood to itself—most of all and in greatest quantity from the large vessels, for these are nearest to it and lie upon it—and it also draws from the other neighboring parts; and it draws what is thinnest and weakest.
1 18 [10]
When it has drawn this in, an acute fever arises from it, and a dry cough, and a sense of fullness in the chest, and sharp pain both in front and behind—especially along the spine, since the large vessels are heated through—and the patients vomit sometimes something tinged with blood, sometimes something livid; and they vomit also phlegm and bile; and they faint frequently. They faint through the sudden shifting of the blood. This condition is most clearly evident when erysipelas supervenes on the lung and the seizure of fever is continuous.
For this patient, if within two or three or at most four days the condition within is dispersed and shifted outward, he generally recovers; but if it is not dispersed and shifted, it putrefies and empyema develops, and he perishes—perishes quickly, the entire lung being suppurated and putrid. But if what was spread outward turns inward and seizes the lung, there is no hope of survival; for when the lung, already previously dried out, draws into itself, the condition cannot be shifted again, but immediately, from the burning heat and the dryness, the lung no longer receives anything nor transmits anything upward, and the patient has perished.
A tumorous swelling (phuma) forms in the lung in this way: when phlegm or bile is massed together, it putrefies; and as long as it is still somewhat raw, it causes slight pain and a dry cough; but when it ripens, there is sharp pain both in front and behind, fevers take hold, and the cough is severe. And if it ripens as quickly as possible and bursts and the pus turns upward and is all expectorated, and the cavity in which the pus was contained collapses and dries out, the patient recovers entirely. But if it bursts quickly enough and ripens and is being cleansed, yet cannot be dried out entirely, but the phuma itself keeps giving off pus from itself—this is fatal; and the phlegm flowing down from the head and the rest of the body into the phuma putrefies and becomes pus and is expectorated, through which the patient has perished.
1 19 [5]
He perishes from the looseness of the bowel, for the same reasons as have been stated in the earlier cases. While he talks and thinks clearly about all matters just as before, he dries out and grows cold, and all the small vessels in the body draw together, as the blood has been burnt out of them by fever—sometimes also by the length of time and the magnitude of the disease and the harmful elements already present and those that subsequently develop. And if for a long time the swelling cannot burst, either spontaneously or under the action of drugs, the patient wastes away from severe pains and from lack of food and cough and fevers, and in most cases perishes.
And if the pus bursts when the patient is already wasted and bedridden, not even then do they generally recover, but perish by the same manner. And if the swelling bursts as quickly as possible and ripens, and once ripened the greater part of it is poured out onto the diaphragm, the patient seems easier immediately; but as time proceeds, if he expectorates it all and the cavity in which the pus was contained collapses and dries out, he recovers. But if the time becomes too long and he becomes weaker and is unable to expectorate, but is cauterized or cut and the pus comes out—even so he seems somewhat easier immediately, but as time proceeds he perishes from the same causes as have been stated in the earlier account.
In the side, tumorous swellings arise from phlegm and from bile by the same reasoning as in the lung; they also arise from exertions, when one of the small vessels is torn and ruptures, or is torn but does not rupture entirely, but a tear forms in it. If it ruptures immediately, the blood poured out from the small vessel putrefies and suppurates; but if a tear forms in the small vessel, this at first causes pain and throbbing, and as time progresses the vessel releases blood into the flesh, and this, putrefying in the flesh, becomes pus.
1 20 [5]
By the same reasoning, the flesh too, if it is more severely strained, draws more blood to itself from the nearest vessels and suppurates quickly; if it is less severely strained, it draws more slowly and suppurates more slowly. In some cases, when the tears in the flesh or in the vessels are slight, there is no suppuration, but long-lasting pains develop, which they call rupture-pains (rhēgmata).
The cases occurring in the flesh arise as follows: when the flesh undergoes some injury—whether by tearing, or being struck, or some other suffering—it becomes livid, as I said before, not with pure blood, but with blood that is thin and watery and scant. When it then becomes more dried than is customary, it grows heated and causes pain, and draws the fluid to itself from the neighboring vessels and flesh. And when it becomes overly moistened, and this moisture is itself overly heated by the flesh itself, it is dispersed throughout the whole body in the same way it was drawn in, and it disperses somewhat more into the vessels than into the flesh; for the vessels draw more strongly than the flesh, though the flesh draws too. But when a little of the fluid from the flesh comes into the large amount of fluid already in the body, it becomes imperceptible and painless, and instead of being diseased the part becomes healthy with time. But if the flesh becomes more heated and draws in more fluid, it causes pain; and wherever in the body it sets out from the flesh and settles, it causes sharp pain, and some patients think the rupture-pain has shifted to a new location; but that is impossible, for it is impossible for an ulcer to shift. Rather, such conditions are very close to ulcer; but the fluid from the flesh rushes through the small vessels. When it becomes heated and thickened and increases in quantity, it causes pain until it comes to resemble the rest of the fluid in thinness and coolness.
In the cases occurring in the small vessels, the small vessel itself, to whatever extent it is torn, remains in place; and when it is torn—being torn by strain and force—it becomes like a varix; it grows heated and draws to itself a certain moist dampness; this dampness comes from bile and phlegm. And when the blood and the fluid from the flesh are mixed together, the blood thickens in that part where the vessel happens to be torn—many times its own quantity—and becomes more morbid, more stagnant, and more abundant. And when it becomes more abundant, the fullness has shifted to wherever it happens to, and causes sharp pain, so that some patients think the rupture-pain has shifted within them. And if it happens to shift to the shoulder, it causes heaviness and numbness and sluggishness in the arm. And if it presses into the vessel that runs toward the shoulder and the back, the pain generally ceases immediately.
Tears arise from exertions and falls, from blows, from lifting too great a weight, from running and wrestling, and from all such things.
Of those who develop empyema from wounds—whether wounded internally by a spear, or a dagger, or an arrow—as long as the wound has an open outlet for breathing through the original wound, through this the cold is drawn in and the heat is released, and the pus and whatever else is present is easily cleansed.
1 21 [5]
And if both the interior and exterior heal together, the patient recovers entirely. But if the exterior heals while the interior does not heal, he becomes empyematous. And if both interior and exterior heal together, but the inner scar forms weak and rough and livid, it sometimes ulcerates again, and empyema develops in this way too. It ulcerates again if there is excessive exertion, or if the patient becomes emaciated, or if phlegm or bile adheres to the scar, or if the patient is seized by another disease and becomes emaciated.
When an ulcer forms—whether in this way, or when the exterior grows together with the interior—it causes sharp pain and cough and fever. The ulcer draws coolness to itself because it is more than what is normal and hotter; and it gives off its heat from itself, and the pus is cleansed, and the treatment proceeds over a longer time, and recovery is slower. Sometimes, indeed, there is no recovery at all; for the flesh of the ulcer is cooked by the internal heat of the body and becomes excessively moistened, so that it can neither be dried, nor grow new flesh, nor heal. But as time advances the patient ends by undergoing the same things that have been stated before.
If one of the thicker small vessels happens to be wounded, and the blood flows inward and putrefies there, the patient becomes empyematous. And if all of this pus is expectorated and the wounded vessel is closed and the ulcer heals—both interior and exterior—he recovers entirely. But if the ulcer cannot grow together nor the vessel be closed, but instead gives off blood now and again, which is either vomited immediately or expectorated, or putrefies and is expectorated as pus, the patient in most cases perishes—either immediately by vomiting blood, or at a later time—from the same causes as were stated before.
Often those in whom some small vessel is wounded internally, whether from wounds or from certain exertions, or exercises, or from something else—when the vessel has healed and seems to be sound, it bursts again later; it bursts again from the same causes as before. And when it bursts, it hemorrhages, and they perish immediately vomiting much blood and repeatedly; or at intervals they vomit fresh blood and expectorate pus daily in large quantity and thickness, and have perished by such or a similar manner as has been described in the other diseases.
In those who have these diseases and all such conditions, it makes a difference to easier or harder recovery: man versus woman, the younger versus the older, the younger woman versus the older woman; and besides these, the season of the year in which they fall ill, and whether they fall ill from another disease or not. It makes a difference also whether affection is greater or lesser in severity, and constitution against constitution, and treatment against treatment.
1 22 [45]
With these things differing in these ways, the duration must necessarily differ too: for some it is longer, for others shorter; some die, others do not; for some the conditions are persistent and more severe, for others lesser and brief; for some the diseases persist into old age and die with them, and some are destroyed quickly by them.
Those who are younger and suffer any of the affections said to arise from exertions suffer them more severely and more intensely and feel more pain than others, and the symptoms are immediately evident in them, so that they either spit blood or vomit it; yet some of these occurring conditions escape their notice on account of the body's good condition. Older patients suffer them less frequently, and when they do suffer them, they suffer them in a weaker form, being weaker themselves, and they are more perceptive and attend more carefully to their affections. So from the outset the condition arises less readily in the older than in the younger; and when it does arise, in the older it is weaker, in the younger more severe.
In the younger, since the body has tone and dryness and the flesh is dense and strong and sits close to the bones, and the skin is drawn tightly around it, whenever there is more exertion than is customary, stronger and more sudden spasms occur, and many and various ruptures of the vessels and the flesh; and of these some become immediately evident, others appear later.
In older patients there is no strong tone, the flesh flows loosely around the bones, and the skin around the flesh, and the flesh itself is loose and weak; and they would not suffer such a thing to the same degree as the younger, and if they do suffer it, they suffer it weakly and the signs are immediately evident. To this extent, then, at the outset of the affections younger patients have a harder time recovering than older ones.
When the disease becomes manifest and they spit or vomit pus or blood or both: those who are younger, since the body is well-toned and dense, cannot be cleansed evenly of the pus from the ulcers in the upper cavity—for the lung, being denser, does not strongly draw toward the airways, and the airways, being narrow and constricted, do not admit the pus except in small amounts and rarely, so that the pus necessarily accumulates and thickens in the thorax and upon the ulcers. In the older patient the lung is more porous and more hollow, and the airways are wider, so that the pus does not linger in the cavity and upon the ulcers, and whatever accumulates must all be drawn up by the lung into the airways and immediately expectorated.
For the younger patient, then, since the affections are more severe and the clearance of the expectoration does not keep pace, the fevers are more acute and more frequent, and sharp pains strike both at the affected part itself and throughout the rest of the body, since the small vessels are taut and full of blood. When these are heated through by themselves, pains shoot through different parts of the body at different times, and these patients in most cases perish quickly.
1 22 (50) [5]
For older patients, since the affections are weaker and the expectoration is being cleansed from them, the fevers are slighter and less frequent, and pains are present, but present in mild form. Yet older patients too do not entirely free themselves of such affections, but carrying them for a long time they are worn away, spitting pus at one time, blood at another, and at another time neither, until at last they die along with their disease. They die most often in this way: when a disease similar to the one they already have seizes them, so that they suffer both this and the condition they already have, which becomes more severe, and in most cases they perish.
The diseases that most of all bring this about are pleuritis and peripneumonia.
Fever arises from the following: when bile or phlegm is heated, the whole rest of the body is heated from them, and this is called fever. Bile and phlegm are heated internally from food and drink—from which they are also nourished and increased—and externally from exertions and wounds, and from excessive heat overheating, and from excessive cold overcooling. They are also heated from sight and from hearing, but least of all from these.
1 24 [5]
Rigor occurs in illnesses, arising partly from external winds, water, clear sky, and other such things, and partly from food and drink that are taken in. It becomes most intense, however, when bile and phlegm are mixed together into the blood, whether one or the other, or both; and more so if phlegm alone is mixed in — for phlegm is the coldest by nature, blood the warmest, and bile somewhat colder than blood. When these — either both or one of them — are mixed into the blood, they cause the blood to congeal, but not entirely; for a person could not go on living if the blood became many times denser and colder than itself. As the blood is chilled, the rest of the whole body must necessarily be chilled as well, and this is called rigor, whenever such a state comes about. If it happens with great intensity, there is violent rigor and trembling, for the vessels, as they contract and as the blood converges and congeals, draw the body together and cause it to tremble. If the convergence of the blood is somewhat less severe, this is called rigor; and phrikē (frisson) is the weakest form. That fever must follow rigor, greater or lesser, stands thus: when the blood heats through and is forced back and returns again to its own nature, whatever of the phlegm and bile that has been mixed into the blood is heated through along with it, and the blood becomes many times hotter than itself. When these have been thoroughly heated, fever must necessarily supervene after the rigor, owing to the heat of the blood. Sweat arises for the following reason: in those whose illnesses reach their crisis on the critical days, and whose fever lets up, the finest part of the phlegm and bile in the body is melted off, and is separated out; the part that travels outside the body passes outward; what remains inside stays within the body itself; and what is thinned by the heat becomes vapor, and mingling with the pneuma (breath / moving air), passes out.
1 25 [15]
Those, then, are the facts, and from these processes sweat is generated. Why it is sometimes hot and sometimes cold is as follows: hot sweat issues when the bad matter has been thoroughly heated, burned through, thinned, and is weak and not very abundant; it must be excreted from the body in a warmer state. Cold sweat issues when more of the bad matter is being separated off — matter that remains, still retains its force, is not yet putrified, not yet thinned, not yet burned through — and it passes out colder, thicker, and more foul-smelling. This is evident from the following: those who sweat with cold sweat generally suffer long illnesses, since the bad matter remaining in the body still retains its force; while those who sweat with hot sweat are freed from their illnesses more quickly.
Pleuritis and peripneumonia arise as follows. Pleuritis arises when a person takes very warm and very strong potions; for the whole body is heated through by the wine and moistened, and above all the bile and phlegm are heated through and moistened.
1 26 [15]
When, then, these have been set in motion and thoroughly moistened, and it happens that the person shivers — whether drunk or sober — since the side is by nature more bare of flesh than any other part of the body, and has nothing within to brace against it except the cavity, he feels the rigor there most acutely. And when he shivers and is chilled, the flesh over the side and the small vessels contract and are drawn together; and however much bile and phlegm is within the flesh itself or in the small vessels within it, the greater part or all of it is separated off inward toward the warmth, as the flesh thickens from outside, and it adheres to the side, and causes intense pain, and becomes heated through; and by means of this heat it draws toward itself from the neighboring vessels and flesh both phlegm and bile. This, then, is how it arises. When what has adhered to the side putrefies and is expectorated, recovery follows; but if the original matter has adhered to the side in large quantity and more accrues on top of it, they perish at once, unable to spit it up because of the abundance of the matter, or they become suppurative (empyoi); and some perish, some survive. This is made clear within seven days, or nine, or eleven, or fourteen. Pain is referred to the shoulder, the collar-bone, and the armpit for the following reason: the vessel called the splenitid extends from the spleen to the side, and from the side to the shoulder and to the left arm; the hepatic vessel does the same on the right side. And when the portion of this vessel over the side is contracted by the rigor and the blood within it is made to shudder, it converges and pulls toward the armpit, the collar-bone, and the shoulder, and causes pain. By the same reasoning the areas around the back are also heated through by the fluid — phlegm and bile — that has adhered to the side. Sometimes it also causes pain in the regions below the side; and often, if the pain turns downward, it transmits through the small vessels to the bladder, and the person passes urine that is copious and bilious. People regard the rigor as the cause and beginning of this illness. Peripneumonia arises when, with phlegm and bile already set in motion and heated, the lung draws toward itself by heat from the neighboring regions, in addition to what is already present within it; it heats the whole body through and causes pain, especially in the back, the sides, the shoulders, and the spine, since it draws the greater part of the moisture from these parts into itself, and overdries and overheats them. When the bile and phlegm have been drawn into it and have settled in the lung, they putrefy and suppurate; and if on the critical days they are expectorated after putrefying, the patient survives; but if the lung both receives what has come in from the start and more keeps accruing, and neither by coughing nor by putrefying does the patient gain mastery over the abundance of what keeps accruing, they generally perish. But if they hold out through twenty-two days and the fever lets up, yet within these days the matter has not been coughed out, they become suppurative (empyoi); and this happens most with those in whom pleuritis and peripneumonia are most severe.
1 28 [15]
There is also a form of peripneumonia and pleuritis without expectoration, both caused by the same thing: dryness. Heat dries when it overheats, and cold dries when it overcools. The side and the small vessels within the side itself are congealed and contract; and whatever phlegm and bile is within it has been hardened by the dryness and causes pain, and from the pain causes fever. For this condition it is beneficial to incise the vessel in the arm — the one called the splenitid, or the hepatic vessel, depending on which side the illness lies. In this way the pain of the side and the rest becomes more gentle; for the vessel releases outward, along with the blood that has itself been diseased, most of the bile and phlegm that is in it. What is in the flesh is dispersed by drugs and potions and by warm applications placed externally, so that the illness is scattered throughout the whole body. This is called pleuritis without expectoration. As for peripneumonia, it arises when the lung itself also becomes excessively dried out; and however much bile or phlegm is within it, it neither putrefies evenly nor delivers up the spittle; and whatever moisture is in it — whether from drink, or broth, or from the neighboring regions — all this it burns off by excessive dryness and heat. For this condition it is beneficial to drink potions by which the lung is moistened and expectorates; for if expectoration does not occur, the lung becomes harder and is parched up and destroys the person. Causus (burning fever) seizes those of a bilious constitution more readily, though it also seizes the phlegmatic. It seizes in this way: when bile is set in motion throughout the body, and it happens that the vessels and the blood draw bile, and draw the greater part of it from the flesh and from the gut where it was previously present — since blood, being the hottest by nature in the body, when heated through from the flesh and the gut in addition to what was already present, is yet further heated by the bile — it heats the whole rest of the body as well. The parts within cannot be completely dried out because of the great amount of moisture; if they were dried out completely, the person would die. But the parts at the extremities of the body, being dry by nature, are dried out and the greater part of the moisture is burned off from them; and if you were to touch them, you would find them cold and dry. This is why those who are seized by causus burn within from the fire, while outwardly they are cold; and the tongue and throat become roughened and parched by the internal pneuma and the heat.
1 29 [5]
As much bile as accumulates in the gut and in the bladder: what is in the gut is sometimes disturbed downward, but is for the most part vomited up in the first days — four or five. It is vomited up for this reason: when the upper gut is overheated, it draws toward itself and vomiting results. For this same reason, illnesses also shift most readily from causus and pleuritis into peripneumonia; for when the upper gut is overheated, it draws to itself and the lung receives it, and peripneumonia results, and they generally perish, being already weakened and, with a new additional illness having arisen, unable to endure the days until the spittle in the lung is concocted, but for the most part perishing from weakness. Some, however, survive. As much bile as flows into the bladder, they pass as thick urine; and it passes thick, from a mixture of phlegm and bile, when it does pass, because of the burning up of what was present in the gut. Phrenitis (mind-fever) is as follows: the blood in a person contributes the greatest part toward understanding; some say it contributes everything. When bile, set in motion, enters the vessels and the blood, it disturbs and disarranges the blood from its accustomed consistency and motion, and overheats it; and when it is overheated, it heats the whole rest of the body as well, and the person becomes disordered in mind and is not in possession of himself, owing to the abundance of the fever and the disarrangement and motion of the blood that has arisen, which is not the accustomed one.
1 30 [5]
Those in the grip of phrenitis most closely resemble those suffering from melancholy in their mental disorder; for those with a melancholic constitution, when their blood is corrupted by bile and phlegm, have the disease and become mentally disordered, and some are even seized by madness. It is the same in phrenitis. The madness and the mental derangement are less severe to the degree that the bile is weaker than the bile of the other condition. In pleuritis and peripneumonia, the spittle is blood-tinged and livid for the following reason: at the outset they are mostly expectorating neither livid nor blood-tinged matter; one should recognize the illness as severe when they begin to cough up spittle that is somewhat thick and are most copiously evacuating at that time.
1 31 [5]
Expectoration arises from the distension of the vessels — in pleuritis from those in the side, in peripneumonia from those in the lung — and draws heat toward itself. If the person with the illness is given to ruptures and is lax in constitution (σαβακός), he expectorates blood and blood-tinged and livid matter along with spittle from the first day. The livid color comes from the blood, when a small amount is mixed into a large quantity of spittle and is not immediately expectorated, but remains in the body in a half-putrified and degenerated state. Death from pleuritis occurs when a large amount of phlegm and bile has adhered to the side from the outset, and a large amount flows on additionally from the rest of the body, and the patient can master neither the expectorating of it — owing to its abundance — nor the putrefaction of it; the airways fill up from the matter present — phlegm and pus — and then the patient rattles and breathes rapidly and only from the upper part, until finally everything is obstructed, and he dies.
1 32 [5]
In the same manner they also perish from peripneumonia. Those who die from causus all die from dryness: first the extremities are dried out — feet and hands — then the parts that are more prone to dryness. When all the moisture from the body is completely burned off and dried out, the blood congeals entirely and becomes cold, and the rest of the body is dried out, and thus the person dies.
1 34 [10]
Those who perish from phrenitis do so in this way: they are mentally disordered throughout the illness, since the blood has been corrupted and moved in a manner not its accustomed one; and because they are mentally disordered, they no longer accept any of what is offered to them that is worth mentioning. As time advances, they waste and diminish, from the fever and from taking no nourishment. The parts at the extremities diminish and grow cold first, then the parts nearest to them. And of cold, fire, and pain, this is the beginning: when the blood in the vessels is chilled by the phlegm, it shifts and is convulsed in clusters now one way, now another, and shakes; finally everything is chilled, and the person dies.
ON DISEASES, THE SECOND BOOK.
2 1 [15]
Copious urination occurs when the head is overheated; for the phlegm in it melts, and as it melts, part of it passes into the nostrils, part into the mouth, and part through the vessels that lead to the genitals; when it reaches the genitals, the person urinates and is affected as though by strangury. Dimness of vision occurs when phlegm enters the small vessels in the eyes; for vision becomes more watery and more turbid, and the bright spot in the eye is not equally bright, nor does it appear in it when one wishes to see, as it did when it was bright and clear. This condition is generally resolved in forty days. If the illness recurs much later, the skin of the head thickens, and the rest of the body swells, thickens, and becomes of good color. In this person the phlegm turns into the flesh, and he seems fat because of it; for the flesh, being thoroughly soaked and swollen and more porous, draws blood from the vessels, and this is why they appear to have a good color. Another illness: the head fills with sores, the body swells, the complexion is jaundiced, sores break out now one place now another in the body, fever seizes intermittently, and water flows from the ears.
2 2 [10]
In this person, when a bile-tinged phlegm has grown within the head, the sores arise when the crown of the head becomes soaked with the phlegm and bile, and the phlegm and bile become porous and spread in clusters; for this collects and putrefies and ulcerates; while into the ears the phlegm makes its way in a thinned state. In the rest of the body the sores arise by the same reasoning as those in the head, with blood and bile co-putrefying wherever they chance to collect; for there the flesh putrefies and ulcerates, and the phlegm and bile that has entered putrefies along with it, and pus is formed. Another illness: pain grips the head throughout, the patient vomits bile, urinates with difficulty, and becomes disordered in mind.
2 3 [5]
This person is in severe pain because of the overheating of the head; he becomes disordered in mind when the blood in the head is overheated and moved more than usual by bile or phlegm; he vomits bile because it has been set in motion in the body, and the head by its heat draws toward itself, and expels the thickest part by vomiting while drawing the finest into itself; he urinates with difficulty in this illness for the same reasons as in the one described before. Another illness: if the small vessels around the brain are said to overvomit — the name given to this condition is not correct, for it is not possible for any vessel, whether smaller or larger, truly to overvomit; but people name it and call it overvomiting. Even if the vessels overvomited to the greatest extent, illness does not seem likely to result from that; for from what is good, harm cannot come, nor can a good thing become more than it need be; rather, what seems to be overvomiting is in fact when bile or phlegm enters the vessels.
2 4 [25]
For the vessels are distended and pulsate, and pain arises throughout the whole head, and the ears ring, and the person hears nothing. The ringing is because the small vessels pulse and throb — for then there is a sound in the head — and hard-hearing arises partly from the inner noise and ringing, and partly when the brain and the vessels around it are swollen. For under the overheating the brain fills its own mass into the space adjacent to the ear, and since the air is not as abundant as it was before, nor producing an equal resonance, what is spoken does not register in him uniformly, and from this comes hard-hearing. This person, if water and phlegm break out to him through the nostrils or through the mouth, recovers; if it does not break out, he dies mostly on the seventh day. If the vessels in the head overvomit, they overvomit for the same reasons as stated before. The sign that they overvomit in such a manner is this: when one cuts a hand, head, or any other part of the body of such a person, the blood flows dark, turbid, and diseased — though by right it ought to flow red and unmixed. When they do overvomit for these same reasons, pain, dizziness, and heaviness seize the head; pain from the overheating of the blood, dizziness when the blood rushes in a mass to the face, and heaviness because the blood present in the head is more abundant and more turbid and more diseased than it is accustomed to be. Gangrene of the brain: if the brain gangrenes, pain seizes the spine from the head and recurs at the heart, and there is swooning and sweat, and wakefulness, and blood flows from the nostrils, and often blood is also vomited.
2 5 [15]
The brain gangrenes in this manner: when it is either overheated or overcooled, or becomes more bilious or more phlegmatic than usual; and whenever any of these things befalls it, it becomes overheated, and heats the spinal marrow through, and this causes pain in the spine. There is swooning when phlegm or bile presses upon the heart; it must press upon it when they have been set in motion and made fluid. Sweat arises from distress. Blood is vomited when the vessels in the head are heated by the brain, those alongside the spine by the spine, the spine by the spinal marrow, and the marrow by the brain, from which it takes its origin. When the vessels are heated and the blood in them boils, those from the head deliver it to the nostrils, while the blood-bearing vessels alongside the spine deliver it into the body. This person dies on the third or fifth day for the most part. Another illness: pain suddenly seizes the head, and at once the person is rendered speechless and loses self-control.
2 6 [15]
This person dies within seven days, unless fever seizes him; for if fever seizes him, he recovers. He is affected in these ways when black bile set in motion in the head flows out, and most of all in the region where the vessels are most numerous — in the neck, I mean, and in the chest; and then on the following day he becomes stricken with apoplexy (sudden incapacitation) and loses self-control, since the blood has grown cold. And if it prevails so that the blood is warmed — whether by what is administered or by itself — it is lifted and dispersed, and moves, and draws in breath, and foams, and separates from the bile, and the person recovers. But if it does not prevail, it grows colder still; and when it is wholly chilled and the warmth departs from it, it congeals and cannot move, and the person dies. If this befalls someone from drinking, he is affected by the same causes, perishes by the same causes, and escapes by the same causes. Boring of the bone: when boring occurs in the bone, pain seizes from the bone, and over time the skin separates from the head here and there.
2 7 [5]
This person is affected in these ways when phlegm that has formed in the diploe (the double layer) of the bone dries up within it; for the bone becomes porous there, and all the moisture departs from it, and since it is dry, the skin separates from it. This illness is not fatal. Another illness: if a person is struck (βλητός), he has pain in the front of the head, his vision is not uniform in both eyes, his hair grows thick, his vessels pulsate, a faint fever seizes him, and there is loss of control of the body.
2 8 [15]
This person suffers these things when the veins in the head become heated and, once heated, draw phlegm into themselves. The origin of the disease comes from this. The front of the head aches for this reason: because the veins there are the thickest, and the brain lies more toward the front of the head than toward the back; and vision through the eyes is impaired for this reason, because the brain lies in front and is inflamed. The body is seized by loss of control for this reason: when the veins draw phlegm into themselves, the blood must, under the coldness of the phlegm, stand more still now than it did before, and be chilled; and when the blood is not moving, it is not possible for the body to do otherwise than become immobile and numbed. And if the blood and the rest of the body prevail so as to be warmed through, the patient escapes; but if the phlegm prevails, the blood is further chilled and congeals; and if this condition progresses, the blood continuing to cool and congeal, it congeals completely and the person is chilled through and dies.
Kynanchē: Kynanchē (throat-strangling) arises when phlegm set in motion in the head flows all at once downward and settles in the jaw-bones and around the neck.
2 9 [5]
This person can neither swallow saliva, nor breathes except with force and with rattling, and sometimes fever seizes him as well. The condition originates from this, sometimes beneath the tongue itself, sometimes a little above the chest.
Staphylē: Staphylē (the uvula-swelling) arises when phlegm descends from the head into the uvula; it hangs down and becomes red; and if a longer time passes, it turns black. It turns black in this way: the uvula sits upon a thick vein, and when it becomes inflamed it grows warm, and by the heat draws blood also from the vein, and is blackened by it.
2 10 [5]
For this reason also, if you cut it when it is not yet turgid, they immediately go into convulsions; for the vein warms through and by the heat fills the region around the uvula with blood, and they are choked through entirely.
Antiades: The antiades (tonsils), the sublingual glands, the gums, the tongue, and all such things that grow in that region — all of these fall sick from phlegm. The phlegm descends from the head, and the head draws from the body; it draws when it is warmed through; it is warmed through by food, by sun, by exertion, and by fire. When it is warmed through, it draws the thinnest part into itself from the body; and when it has drawn it, it descends and passes back into the body again.
2 12 [5]
Diseases arising from the head: when the head becomes replete and happens to be warmed through by any one of these things, torpor seizes the head, and the patient urinates frequently, and suffers the other things that accompany strangury. This person suffers these things for nine days; and if fluid and mucus burst out through the nostrils or through the ears, he is released from the disease and the strangury ceases, and he urinates without pain, copiously, and with white urine for up to twenty days, and the pain from the head departs, and as he looks out through his eyes the light is stolen from him, and he seems to see only half of faces. This person is fully well by the fortieth day. Sometimes, however, the disease has returned in many cases in the seventh or fourteenth year; and the skin of his head thickens, and when touched it gives way, and from little food he appears soft-skinned and of good color, and does not hear acutely.
When you encounter such a person at the start of the disease, before the fluid bursts through the nostrils and ears, while the severe pain holds him, you should shave his head, bind a leather wineskin around his forehead, fill it with the hottest water he can bear, let it warm him, and when it cools, pour in another; if he weakens, stop, and after an interval do the same things again until the severe pain relaxes. If the belly does not move, give him an enema; and giving him diuretic drinks, have him drink dilute mead as well; let him be kept warm as much as possible; let him sip the thin juice of ptisanē.
If the belly does not move, boil mercury-plant (linozōstis) in water, crush it, strain off the juice, mix equal parts of this with the juice of the barley-gruel, add a little honey to the juice; let him sip this three times a day, and drink in addition a honeyed wine, dilute, white, and small in quantity, after the sip. When the mucous matter has burst through his nostrils, and he urinates thick, and has been freed from the pain in the head, let him no longer use the wineskin, but washing with much hot water let him drink the diuretics and dilute mead. For the first days let him lick millet and eat gourd or beet for three days; then let him use foods as soft and as laxative as possible, always adding a little more food. When forty days have passed — for the disease mostly settles in this much time — purge his head first by giving him a drug from below to purge downward; then, if the season of the year is right, let him drink whey for seven days; if he is weak, fewer. If the disease should relapse, after steaming him all over, give him hellebore to drink on the next day; then let an interval pass for as long as seems right to you, and at that point, after purging the head, giving the downward-acting drug, burn the head with eight escharae — two beside the ears, two at the temples, two behind the head on either side at the occiput, two at the nose beside the canthi; burn the veins beside the ears until they stop pulsing; and making wedge-shaped irons, burn through the veins crosswise. If you do these things, recovery comes about.
Another disease: the head fills with sores, and the legs swell as if from water, and it presses in at the shins, and if you press them the color is jaundiced, and sores break out now here now there, most of all around the shins, and they look bad to see, but once the inflammation clears they heal quickly; and fever seizes him now and then; the head is always hot, and fluid flows from the ears.
2 13 [5]
When this is the condition, give him a drug by which phlegm and bile are purged upward; if it is cold weather, first steam him and wash him with warm water; then, leaving an interval of three days, purge the head; after this, give a drug to drink downward; if the season allows, let him also drink whey; if not, ass's milk. After the purgings let him use foods as few and as laxative as possible, and let him abstain from bathing. If the head has become ulcerated, burn wine-lees to ash, making a cleansing paste, and mix in the pulp of the suppository-fruit, grinding smooth, mixing in an equal quantity of soda; after rubbing with these, let him wash with much hot water. Let him anoint the head with a mixture of crushed bay-berries, oak-galls, myrrh, frankincense, flower of silver, pig's fat, and bay-oil; mix these and apply. From then on let him use emetics three times a month, take exercise, and bathe in warm water. If doing these things the disease has departed from the rest of the body but sores are still forming in the head, purge the head again, and give a drug to drink downward; then shaving the head, make sparse incisions, and when the blood flows off, rub; then dipping fleece in wine, bind it on, and when you undo it, sponge around and do not soak; then sprinkle cypress-wood powder, daubing oil under it; use woolen bandages until he is well.
Another disease: severe pain seizes the head, and when someone moves him — whether more or less — he vomits bile; sometimes he also has difficulty urinating and becomes delirious; when the seventh day arrives he sometimes dies; but if he passes the seventh day, on the ninth or eleventh, unless fluid bursts through his nostrils or ears.
2 14 [5]
If it bursts through, he escapes; what flows is water somewhat bilious, and in time it becomes pus, having undergone putrefaction. When this is the condition: so long as the severe pain holds in the beginning, before the burst through the nostrils and ears, apply sponges soaked in hot water, pressing them to the head while warm; if it does not relax with such means, use the wineskin in the same manner as in the previous case; let him drink dilute mead; if that gives no relief either, let him drink water strained from barley grits; let him sip the juice of ptisanē, and drink white wine diluted. When the burst occurs through the ears and the fever relents and the pain is gone, let him use laxative foods, starting from small amounts, always adding more; let him wash with warm water over the head; rinse the ears with clean water; and insert a small sponge dipped in honey. If the ear does not dry up in this way but the flux becomes prolonged, rinse it out, then put in flower of silver, sandarach, and white lead, equal parts of each, ground fine; filling the ear, pack it in, and if it leaks alongside, put in more of the drug; when the ear has become dry, clean it out and rinse out the drug; then — for the ear, when it first dries out, becomes deaf — apply mild steam-heat to the ears; for it will come right in time.
They also die if a severe pain that has arisen in the ear does not burst within seven days. For this one: wash with much hot water, and soaking sponges in hot water, wring them and apply them warm to the ear. If it does not burst even so, apply steam-heat to the ear; and let him use the same sips and drinks as those before.
Another disease: if fluid has formed over the brain, a sharp pain seizes him through the bregma and temples now in one place now in another, and there is shivering and fever now and then, and he aches at the sockets of the eyes, and his sight is blurred, and the pupil splits, and he seems to see two from one, and if he stands up dizziness seizes him, and he cannot bear wind or sun, and his ears ring, and he is distressed by sound when hearing it, and he vomits saliva and phlegm-matter, and sometimes food also, and the skin of the head grows thin, and he is pleased when touched.
2 15 [5]
When he is in this condition, first give him a drug to drink upward, one that will bring up phlegm, and after this purge the head; then after an interval give a drug to drink downward; then restore him with foods as laxative as possible, always adding a little; when he is eating adequate food already, let him use emetics on an empty stomach, mixing honey and vinegar into the lentil preparation, eating some greens first, and on that day on which he vomits, first let him drink a thin kukeōn; then toward evening let him use few foods; let him abstain from bathing and walk after meals and at dawn, guarding against wind and sun and not going near fire. And if, doing such things, he becomes well; but if not, first purge him upward, first with hellebore, then pour a drug into the nostrils, and after a short interval purge downward; then restore him with foods; then, cutting open the head at the bregma, bore toward the brain, and treat as a saw-wound.
Another disease: shivering and pain and fevers through the head, most of all into the ear and the temples and the bregma, and he aches at the sockets of the eyes, and the eyebrows seem to him to press upon him, and the head feels heavy, and if anyone moves him he vomits, and vomits copiously and easily, and the teeth are numb and he has a sour-tooth feeling, and the veins in the head rise and throb, and he cannot bear to stay still but is restless and out of his mind from the pain.
2 16 [5]
For this one, if a burst occurs through the nostrils or the ears, hydrops flows mixed with pus, and he becomes well; but if not, he dies in seven days for the most part. This disease arises most often from a lingering fever: when the patient, on being released from the fever while still uncleared, either fills himself with food, or gets drunk, or labors in the sun. When this is the condition, first let blood from the head from wherever seems right to you; once you have let it, shave the head and apply cold applications, and if the belly does not move, give an enema; let him drink the juice of ptisanē cold and drink water in addition; if his condition does not relax with the cold applications, change course and use the wineskin and warm him. When the pain has ceased, let him use laxative foods and not fill himself; when twenty days have passed from the cessation of pain, steam his head and apply a drug to the nostrils, and after leaving an interval of three days, give a drug to drink downward.
Another disease: if the small blood-carrying vessels around the brain overflow and warm the brain, a strong fever seizes, and pain into the temples and the bregma and the back of the head, and the ears ring, and he fills with pneuma, and he hears nothing, and is restless, and tosses himself about from the pain; this person dies on the fifth or sixth day.
2 17
When this is the condition, warm his head; for if fluid bursts through the ears or nostrils he thus escapes destruction; and if he gets past the six days, manage his diaita as in the previous case.
Another disease: if the veins in the head overflow, a mild pain holds the whole head and the neck, and it shifts now here now there in the head, and when he stands up dizziness seizes him, but fever does not take hold.
2 18 [5]
When this is the condition: shave the head; if it does not respond to warm applications, split the skin from the head at the forehead, where the hair ends; when you have cut, spread the skin apart; when the blood has flowed off, sprinkle with fine salt; when the blood has run off for you, bring the incision together and wrap it all in doubled saffron-bandage; then, having smeared a small pad with wax-pitch, lay it down below on the wound, place greasy fleece on top, bind it down, and do not loosen for seven days unless pain holds; if it does hold, loosen it. Give him, until he is well, water from groats to drink, and sip the juice of ptisanē, and drink water.
Another disease: if the brain is bilious, a mild fever seizes and shivering and pain through the whole head, most of all into the temples and the bregma and the sockets of the eyes, and the eyebrows seem to hang down over him, and pain enters the ears at times, and bile flows through the nostrils, and there is blurring of vision; and in most cases the pain enters into half the head, though it also occurs in the whole head.
2 19 [15]
When this is the condition, apply cold applications to the head, and when both the pain and the flux have ceased, drip juice of celery into the nostrils; let him abstain from bathing so long as the pain holds; let him sip thin millet gruel with a little honey poured in, and drink water; if the belly does not move, let him eat cabbage and sip the juice; if still not, the juice of elder leaves in the same way; and when the time seems right to you, give him food as laxative as possible; and if, after the flux and pain have been cleared away, there is heaviness above the eyebrow or thick and putrid mucus, steam him with vinegar and water and oregano, then wash with warm water, and apply flower of copper and myrrh to the nostrils. Doing these things, he becomes well for the most part; the disease is not deadly.
Another disease: if the brain undergoes sphakelismos (mortification), pain takes hold from the occiput into the spine, and cold comes down toward the heart, and sudden sweating, and he becomes without breath, and blood flows through the nostrils; and many also vomit.
2 20 [15]
This person dies within three days; but if he survives seven days — and most do not — if he is vomiting blood or it flows from the nostrils, do not wash him with warm water nor apply warm applications, but give him white wine diluted with water to drink, and if he is weak, let him sip ptisanē. If it seems to you that he is vomiting more blood than is right, or if it flows from the nostrils, from the vomiting let him drink fine wheat-flour shaken onto water; if it flows from the nostrils, also bind the veins in the arms and at the temples, placing a piece of spleen beneath. If neither of these is available to him, and he aches in the occiput and the neck and the spine, and cold makes its way toward the heart, warm the chest and back and occiput and neck with bitter-vetch poultice. Doing these things you would help most; but few escape such a disease.
Another disease: a person in good health is suddenly seized by pain in the head, and immediately becomes speechless and rattles in the throat, and his mouth gapes, and if someone calls or moves him he groans only, and understands nothing, and urinates copiously, and is unaware that he is urinating.
2 21 [10]
This person, if fever does not take hold of him, dies within seven days; but if it does take hold, he becomes well for the most part; the disease occurs more in older people than in younger. When he is in this condition one must wash him with much warm water, warm him as much as possible, and drip warm mead into his mouth. If he comes to himself and escapes the disease, restore him with food; when it seems to you that he has strength, put a drug into his nostrils, and after leaving a few days' interval, give a downward-acting drug to drink; for if you do not purge, there is fear of the disease recurring; but they do not readily escape from the first attack.
Another disease: if a person becomes speechless after heavy drinking — if fever seizes him at once and immediately, he becomes well; if it does not seize him, he dies on the third day.
2 22 [15]
If you do not find him in that condition, wash him with much warm water, apply sponges dipped in hot water to his head, and insert onions, peeled, into his nostrils. If, lifting his eyes and uttering a sound, he comes to himself and is not rambling, he lies that day in a heavy stuporous sleep and becomes well on the next day; but if on rising he vomits bile, he becomes delirious, and dies most often within five days, unless he falls asleep. For this one you must do the following: wash him with much warm water until he comes back to himself; then, anointing him with much oil, lay him down gently in soft bedding, cover him with garments, and neither light a lamp beside him nor speak; for as a rule he falls asleep from the bath, and if he sleeps, he becomes well. When he comes to himself, hold him back from food for the first days — three or four days — giving him thin millet gruel to sip or juice of ptisanē, and a honeyed wine to drink; then let him use foods as soft as possible and in small quantities at first.
Sphakelismos of the brain: if sphakelismos (mortification) takes hold, pain seizes most strongly the front of the head gradually, and it swells up and becomes livid, and fever and shivering come on.
2 23 [5]
When this is the condition, one must cut where it is swelling, and after thoroughly cleaning the bone, scrape until one reaches the diploē (the spongy layer between the skull-tables); then treat as a fracture.
Teredo: when a teredo (gnawing worm / caries) forms in the bone, pain seizes from that bone; and in time it grows thin, and puffs up, and a fracture forms in it, and if you cut it open like this you will find the bone bloodless and rough and reddish, and in some cases gnawed through toward the brain.
2 24
When you find someone in this condition, if it has been gnawed through to the other side, it is best to remove it and treat the wound as swiftly as possible; but if it has not been perforated but is rough, after scraping down to the diploē, treat as the previous case.
Another disease: if a person is struck (blytos), the front of the head aches, and through the eyes he cannot see, but stupor holds him, and the veins in the temples throb, and a mild fever holds, and there is loss of control and wasting of the whole body.
2 25 [5]
When this is the condition, heat him with much warmth, and apply warm applications to the head; from the steam-treatment put myrrh and flower of copper into the nostrils; let him sip the juice of ptisanē and drink water. And if, doing these things, he improves; but if not — for in this way alone is there hope — split his bregma, and when the blood has flowed off, bring the edges together, treat and bind; if you do not split it, he dies on the eighteenth day, or the twentieth for the most part.
Kynanchē: fever seizes and shivering and pain in the head, and the jaw-bones swell, and he swallows saliva with difficulty, but spits out saliva hard and in small amounts, and rattles below in the throat; and if, holding down the tongue, you examine him, the uvula is not large but slack; the pharynx is full inside of sticky saliva, and he cannot cough it up, and he cannot bear to lie down, but if he lies down he is choked.
2 26 [30]
When you find him in this condition, do the following: first, apply cupping-vessels to the neck vertebra, on each side, having first shaved the head beside the ear on each side; and when you have drawn off the cup, allow it to remain attached as long as possible. Then foment him with vinegar, natron, marjoram, and cress-seed, having ground them fine and mixed the vinegar in equal measure with water and having dripped in a little oil, dissolving the mixture in this; then pour it into a small earthen pot, put on a lid and cover it, pierce the lid, and insert a hollow reed; then set it over coals, bring it to a boil, and when the steam rises through the reed, let him gape over it and draw the steam inward, taking care not to scorch the throat. Outside, let him apply sponges dipped in hot water to the jaws and cheeks. Prepare for him a gargle of marjoram, rue, savory, celery, mint, and a little natron; mix a dilute hydromel, add a little vinegar; grind the leaves and the natron fine, dissolve them in this, warm it, and let him gargle. If the saliva is held back, take a myrtle twig, smooth it, bend the soft tip, wrap it in soft wool, and looking into the throat, clear out the saliva. If the belly does not evacuate, apply a suppository or give a clyster. Let him drink barley-water and drink water after. If a swelling develops externally and the swelling turns toward the chest and becomes red and hot, there are greater hopes of survival. Do the following for him: when the inflammatory matter turns outward, dip beets in cold water and apply them; let him gargle with warm things, and let him abstain from bathing. By doing these things he would most likely escape. The disease is deadly, and few escape. Another form of cynanche: fever and pain seize the head, the throat becomes inflamed along with the jaws, he cannot swallow the saliva, but spits thickly and copiously, and speaks with difficulty.
2 27 [25]
When he is in this condition, first apply a cup in the same manner as described above; then apply a sponge soaked in hot water to the neck and jaws; give him sun-warmed leaf-water to gargle; give dilute hydromel to drink; and compel him to drink down barley-water. If, with these measures, the saliva does not come out, foment in the same manner as in the previous case. If the inflammatory matter turns toward the chest or the neck, let him apply chopped beets or gourds soaked in cold water, and let him drink cold water, so that the saliva may be brought up more easily; when the swelling has moved outward toward the chest, the majority escape. But if, when the throat has settled and the swellings have subsided, the disease turns to the lung, fever immediately resumes, along with pain in the side, and for the most part he dies when this happens; but if he survives five days, he becomes empyic, unless cough seizes him at once; but if it does seize him, after bringing up matter and being cleared, he becomes healthy. For this patient, as long as pain holds the side, warm the side and apply whatever you would apply for peripneumonia. If he survives the five days and the fever abates but the cough persists, use liquid gruels for the first days; when he begins on solid food, let him eat as fatty and salty as possible. But if there is no cough, and you recognize that empyema is forming, after supper, when he is about to sleep, let him eat as many raw garlic as possible and drink undiluted wine that is as strong as possible; and if the pus thus breaks through — if not, on the following day bathe him in hot water, fumigate him, and if it breaks, treat as for empyema. Another form of cynanche: the back of the tongue becomes inflamed, and the closure beneath the windpipe, and he cannot swallow the saliva or anything else; if forced to try, it flows out through the nostrils.
2 28 [5]
When he is in this condition, grind fresh mint, celery, marjoram, natron, and red sumac, mix with honey to make a thick preparation, and anoint the tongue on the inside wherever it is swollen; then boil figs, pour off the water, grind some sumac, dissolve a little in the fig liquid, and let him gargle with this if he can; if not, let him use it as a mouthwash. Give him the water from groats to drink. Outside, poultice the neck and jaws with flour boiled in wine and oil, warm; and apply warm bread. For it usually suppurates at the closure, and if it ruptures on its own, he becomes healthy; if it does not rupture, feel with the finger whether it is soft, and if so, bind a sharp iron instrument to the finger and lance it. By doing these things patients recover; this disease is least likely to be deadly. Uvula-grape: if a grape-like condition arises in the throat, the tip of the uvula fills with fluid and its tip becomes round and transparent, it catches the breath, and if the jaws are inflamed on either side, the patient suffocates; if it arises on its own, without those becoming inflamed, he is less likely to die.
2 29
When he is in this condition, take hold of the uvula with the finger, press it upward against the palate, and cut off the tip; then give gargling of leaf-water; let him lick cold flour and drink water after, and not bathe. Tonsils: if the tonsils are affected, the area beneath the jaw swells on both sides, it feels hard on the outside, and the whole uvula is inflamed.
2 30 [5]
When he is in this condition, insert the finger and push the tonsils aside; apply dry copper-flower to the uvula, and let him gargle with sun-warmed leaf-water; and outside, poultice wherever it is swollen with raw-ground flour cooked in wine and oil, warm. When the swellings seem to you to be soft on internal palpation, lance them with a lancet; some subside on their own. Sublingual abscess: if a sublingual abscess forms, the tongue swells, as does the area beneath it; on external palpation it feels hard, and he cannot swallow the saliva.
2 31 [5]
When he is in this condition, dip a sponge in hot water and apply it; poultice outside wherever it is swollen with raw-ground flour cooked in wine and oil; let him gargle with fig-water and not bathe. When it becomes full of pus, cut it; sometimes it ruptures on its own and subsides without being cut; when it suppurates outward, cauterize thoroughly. Phlegm collected in the palate: if phlegm collects in the palate, it swells and suppurates.
2 32 [5]
When he is in this condition, cauterize the swelling; when the pus comes out, wash the remainder, first with natron and warm water, then with wine; when the washing is done, grind white raisins having removed the seeds, and insert them into the cauterized area; when it has discharged, let him wash it out with warm undiluted wine, and whenever he is about to eat or drink gruel, insert a small sponge. Do these things until he is healthy. Polyp: if a polyp forms in the nose, it hangs down from the middle of the cartilages like a uvula, and when he forces breath out it comes forward and is soft, and when he breathes in it goes back, and he speaks with a hollow sound, and when he sleeps, he snores.
2 33 [15]
When he is in this condition, cut a sponge round, form it into a coil, wrap it with Egyptian linen and make it firm; it should be of a size to fit into the nostril; tie the sponge with linen thread in four places, each thread being the length of a cubit; then making one point of attachment among them, take a thin tin rod with an eye at one end, thread the rod into the mouth at the sharp end, and when it catches, thread the linen through the eye and draw it until it takes hold at the point of attachment; then placing a forked instrument beneath the uvula as a counterhold, pull until you draw out the polyp. When you have extracted it and the blood has stopped flowing, wind a dry linen strip around a probe, pack it, and boil the rest of the copper-flower in honey, and anointing the strip introduce it into the nostril; and when the wound is already healing, make a lead plug sized to reach the wound, anoint it with honey, and apply it until he is healthy. Another polyp: the nose fills with fleshy tissue, and on palpation the flesh seems hard, and he cannot breathe through the nose.
2 34 [5]
When he is in this condition, one must insert a tube and cauterize with three or four irons; after cauterizing, insert ground black hellebore; and when the flesh has become rotten and fallen away, apply linen strips anointed with honey together with the copper-flower; when it is healing, insert lead plugs anointed with honey until he is healthy. Another polyp: from inside, growing from the cartilage, round fleshy tissue protrudes; on palpation it is soft.
2 35 [10]
When he is in this condition, take a sinew-cord, make a small loop on it, and wrap it with fine linen; then pass the other end through the loop, making the loop larger; then thread the end through the tin rod; then introduce the loop into the nostril, and using the notched probe, stretch the loop around the polyp; when it is placed around, thread the rod into the mouth, grasp it and pull in the same manner, with the forked instrument as a counterhold; when you have drawn it out, treat as the previous one. Another polyp: it grows on the inside beside the cartilage from something hard, and it seems to be fleshy tissue; but if you touch it, it makes a sound like a stone.
2 36 [5]
When he is in this condition, split the nose with a scalpel and clean it out, then cauterize; having done this, sew the nose together again and treat the wound by applying ointment, insert a strip of cloth, and when it has rotted off, apply the copper-flower in honey; bring to healing with the lead. Another: it grows from the side of the cartilage at the tip like small crabs; all of these must be cauterized; when you have cauterized, sprinkle hellebore on them; when it has rotted, clean it with the copper-flower in honey; bring to healing with the lead.
2 38 [15]
Jaundice: the complexion becomes dark on the face, especially the shaded parts, and the eyes are yellow-green, as is the underside of the tongue, and the veins beneath the tongue are thick and dark, and the patient is without fever, and he passes thick bilious urine. When he is in this condition, first bleed the veins beneath the tongue, then bathe him with much hot water, and give him to drink, fasting, the roots of asphodel — having cleaned them and boiled them in wine, about five roots — mixing in celery leaves, as many as a handful; pour on three half-kotylai of Aeginetan sweet wine and reduce to one half-kotyle; mix this and give him a sixth of it to drink; when he has urinated, use solid foods that promote evacuation, and after the food let him eat white chickpeas, and drink white wine, plentiful and dilute, and let him eat celery and leeks with his food. Let him do these things for seven days, and if the complexion seems to him to have been sufficiently cleared in that time — if not, let him do these things for three more days; after that, wait one or two days, then apply a drug to the nostrils; after that, give a purging drug below, by which the bile will be purged, and if he is not of a splenic nature, give him afterwards donkey's milk or whey. By doing these things he becomes healthy. Another jaundice: a mild fever seizes him, the head is heavy, and the fevers have stopped in some cases; he himself becomes yellow-green, the eyes most of all, and there is weakness and loss of bodily control, and he passes thick and yellow-green urine.
2 39 [5]
Bathe this patient in hot water, and give him diuretics to drink; when he seems to you to be cleaner and the complexion has improved, apply a drug to the nostrils, and give a purging drug below; use solid foods as soft as possible; let him drink white wine, sweet and dilute. By doing these things he becomes healthy. Fevers from bile: if a person has an excess of bile, fever seizes him daily and releases him, holding most strongly at midday, and his mouth is bitter, and when he is without food it distresses him; but when he eats, he feels suffocated, and he is filled by small amounts, and is nauseated, and bouts of vomiting seize him, and heaviness falls into the lower back and the legs, and he is very sleepy.
2 40 [5]
With this patient, if after the fever he sweats copiously and the sweat is cold and profuse, and he is not rid of the fever, the disease becomes chronic; if he does not sweat, it is resolved more quickly. When he is in this condition, when he has reached the ninth day, give him a drug; for if you give it at the very beginning when the fever starts, when he has been purged, the fever resumes and he needs a drug again. When the mouth is no longer in pain but cramping falls into the lower belly, give a purging drug below, and give donkey's milk or whey or some of the juices to drink after; if he is weak, give a clyster. Before the drug-drinking, if he has fever, give dilute hydromel in the morning; for the rest of the day when the fever holds, give as much cold water to drink as he wishes; when the fever abates, give him barley-water gruel or fine millet to drink, and let him drink dilute white wine, full-bodied. If he is afire internally and the fever does not lift either night or day, and on palpation the upper parts are hot but the belly and feet are cold and the tongue rough, do not give this patient a drug, but give a gentle clyster, and give him cold barley-water gruel to drink down twice a day, and let him drink dilute wine; at other times let him drink water as cold as possible. This patient, if he sweats on the seventh day and the fever releases him — if not, he dies on the fourteenth day for the most part. Another fever: to outward touch it is mild, but inside he burns, and his tongue is rough, and he breathes hot air through the nostrils and the mouth; when the fifth day arrives, the hypochondria are hard and there is pain in them, and the complexion appears as if under the grip of jaundice, and he passes thick and bilious urine.
2 41 [15]
This patient, if on the seventh day a chill seizes him, a strong fever, and he sweats — if not, he dies on the seventh or ninth day; this disease takes hold most when the year is not dry. When he is in this condition, bathe him in hot water each day, give him plentiful dilute hydromel to drink, and give him cold barley-water gruel to drink twice a day; after the gruel, let him drink a little dilute white wine; if the belly does not evacuate, give a clyster or apply a suppository; give no solid food until the fever abates; when it ceases, give a purging drug below, for the disease sometimes returns if the patient goes through without being purged. This disease takes hold when bile becomes excessive. If a tertian fever holds: if it does not skip three seizures but takes hold on the fourth day, give a purging drug below; if you think a drug is not needed, grind the roots of five-leaf plant, as much as one oxybaphon-measure, in water and give it to drink.
2 42 [5]
If it does not cease even with this, bathe him in much hot water, give him trefoil and silphium-juice to drink in wine of equal mixture, lay him down and pile on many blankets until he sweats; when he has sweated, if he is thirsty, give him barley-groat water to drink; toward evening let him drink fine boiled millet-gruel and wine after; as long as there is a remission, let him use solid foods as soft as possible. Quartan fever: when quartan fever holds, if it seized him while impure from another disease, give a purging drug below; then purge the head; then give a purging drug below; if it does not cease even after doing these things, skipping two seizures after the lower purging, bathe him in much hot water, and give to drink as much henbane-seed as a millet-grain, and an equal measure of mandrake, and three bean-measures of opium-juice, and an equal measure of trefoil, in undiluted wine.
2 43 [15]
If he is strong and seeming healthy, but after exertion or a journey develops fever that settles into a quartan, foment him, and give garlic dipped in honey; then let him drink lentil-water mixed with honey and vinegar; when he is full, let him vomit; then, having bathed in hot water and cooled off, let him drink kykeon in water; in the evening let him use soft and not plentiful solid foods. At the next seizure, bathe him in much hot water, pile blankets on him until he sweats, then give immediately to drink white hellebore-roots of the length of three fingers, and trefoil of one drachma's measure, and two bean-measures of juice, in undiluted wine; and if bouts of vomiting seize him, let him vomit; if not, similarly, and after that purge the head; let him use solid foods as soft as possible; when the seizure holds him, let him not take the drug while fasting. Pleuritis: when pleuritis seizes him, fever and chill hold, and pain runs through the spine into the chest, and there is orthopnoea, and cough, and the saliva is thin and somewhat bilious, and it is not coughed up easily, and there is pain through the groin, and he passes blood-tinged urine.
2 44 [20]
When he is in this condition, if the fever abates on the seventh day, he becomes healthy; if it does not abate, the disease reaches eleven days or fourteen; most perish within these; if he passes the fourteenth, he escapes. When the pain holds in this way, apply warm fomentations; let him drink honey — having boiled it and poured in vinegar equal in measure to the honey, then poured water nineteen times the combined measure of the boiled honey and vinegar — give this to drink in small amounts frequently, and mix in water, adding a little vinegar; let him also drink gruel of millet, dripping in a little honey, cold, about a quarter-kotyle at each meal, and let him drink white wine, full-bodied and dilute, a little; the wine should be as smooth as possible and without a strong smell. When the fever releases, for two days let him drink millet-gruel twice a day, and eat the sweetest beets; then after these things, having made a puppy or a young fowl well-boiled, let him drink the broth and eat a little of the meat; for the remaining time, especially as long as the disease holds, let him take millet at midday, and in the evening use as little and as soft solid food as possible. Another pleuritis: fever holds, and gnashing, and dry cough, and he coughs up yellow-green material, sometimes also livid, and pain seizes the side, and the upper back becomes somewhat red, and warmth is felt in the head and chest, sometimes also in the belly and the feet and legs, and sitting upright he coughs more, and the belly is disturbed, and the stool is quite yellow-green and foul-smelling.
2 45 [5]
For this patient, apply warm fomentations wherever the pain holds most, and bathe him in hot water if the fever is not intense; if it is, do not. Give him honeycomb soaked in water to drink, making it just barely sweet, and mix in water; give millet-water gruel to drink twice a day, and let him drink dilute white wine after; and if he survives the fourteen days, he becomes healthy. [The following description of symptoms appears to repeat the account of 'Another pleuritis' given at the close of 2 44; it is translated here as it stands in the text, without emendation.] Another pleuritis: fever holds, and gnashing, and dry cough, and he coughs up yellow-green material, sometimes also livid, and pain seizes the side, and the upper back becomes somewhat red, and warmth is felt in the head and chest, sometimes also in the belly and the feet and legs, and sitting upright he coughs more, and the belly is disturbed, and the stool is quite yellow-green and foul-smelling.
2 46 [10]
This patient dies within twenty days; if he escapes these, he becomes healthy. For this patient, until fourteen days have passed, give the groat-water to drink, and let him drink after it dilute white wine, full-bodied; let him drink cold barley-water gruel twice a day; in place of honey mixed into the gruel, mix the juice of wine-like pomegranate when the gruel is already cooked; bathe him, but not with much water. When fourteen days have passed, then let him take millet at midday, and in the evening use fowl-meat and broth and small amounts of solid food. Few escape from such a disease. Peripneumonia: fever holds for at least fourteen days, at most for eighteen, and he coughs strongly all these days, and at first, on the seventh and eighth day, he brings up thick and clear saliva; when the fever takes hold, on the ninth and tenth day, what he brings up is somewhat sweet and purulent, until the fourteen days have passed; and if on the fifteenth day the lung dries out and he coughs it clear, he is restored to health; if not, watch for eighteen days; and if in these days the coughing ceases, he escapes; if it does not cease, ask him whether the saliva is sweeter, and if he says yes, the disease becomes a year-long affair; for the lung becomes empyic.
2 47 [45]
For this patient, during the first days one should give sweet white wine, well-diluted, to be drunk in small amounts at close intervals; and give barley-water gruel to drink, mixing in honey, three times a day, until the eighteen days have passed and the fever has ceased. The greatest danger is during the seven or the fourteen days; but once he survives the eighteen days, he no longer dies, though he spits pus, and the chest is painful, and he coughs. When he is in this condition, give him to drink on an empty stomach the preparation made with sage, and give him pulse-pottage to eat, mixing in a good deal of fat — provided it is not the hot season; if it is the hot season, he should not eat the pottage, but should use foods that are salty, fatty, and of the sea rather than meats. And if it does not seem to you that he is being cleansed in proportion, instill fluid and apply steam-fomentation: if the pus is thick, apply steam-fomentation; if it is thin, instill. Hold to food as much as possible, and abstain from sharp foods and from beef, mutton, and pork. When a patient has become pus-filled from peripneumonia, fever holds him and there is a dry cough and difficulty breathing, and the feet swell, and the nails of the hands and feet are drawn in. For this patient, when he is in this condition, on the tenth day from the onset of the pus formation, having bathed him in a large quantity of warm water, grind root of wild arum the size of an ankle-bone, and a lump of salt, and honey and water, and a little oil; then drawing out the tongue, pour the preparation in while lukewarm; then shake the shoulder, and if the pus bursts from this — if it does not, make another preparation: squeeze out the juice of sharp pomegranate rinds and of cyclamen, of each an amount equal to a small vinegar-saucer; then grind silphium-juice the size of a bean, dilute it, and mix in goat's milk or donkey's milk, an amount equal to a vinegar-saucer, and pour this in lukewarm. If the pus does not burst from this, grind radish-rind and flower of copper, the equivalent of three beans, finely — the radish being twice as much — dilute with oil equal to a quarter cotyle, pour this in lukewarm. If the pus bursts, use foods as salty and as fatty as possible; and if the pus does not come out, apply steam-fomentation little by little through the mouth with water-parsley juice, with unblended wine, and with cow's or goat's milk, mixing equal parts of each; the total should be about three cotylae; then throw in heated pottery-sherds from a kiln, letting him draw this through a tube, taking care that he is not burned. Once he is spitting more cleanly, instill for him nettle-seed, frankincense, and marjoram in white wine, honey, and a little oil, instilling every third day; after this, dissolve butter and resin in honey; and let him no longer use salty or fatty foods. Let him drink, fasting, on the days between the instillations: sage, rue, savory, and marjoram in equal portions in undiluted wine, each sprinkled in equal measure to fill a vinegar-saucer. If the pus does not burst from the instillations, there is nothing surprising in this; for often it bursts into the body-cavity, and immediately he seems to be better, since it has passed from a narrow space into a wide one.
2 47 (50) [5]
When more time passes, the fever becomes stronger and the coughing comes on, and the side is painful, and he cannot lie on the healthy side but only on the painful one, and the feet swell, as do the hollows of the eyes. For this patient, when it is the fifteenth day from the rupture, having bathed him in a large quantity of warm water, seat him on a stool that will not rock; let one person hold his hands while you, shaking him by the shoulders, listen on which side the sound is heard; and prefer to make the incision on the left side, for it is less fatal. But if, because of the thickness and volume, no sound is heard — for this sometimes happens — whichever side is more swollen and more painful, cut that side as low as possible toward the back of the swelling rather than toward the front, so that the outflow of pus may be easy for you. Cut between the ribs with a scalpel shaped like a chest-knife, first through the skin, then with a sharp-pointed blade, having bound it with a rag, leaving the tip of the scalpel exposed no more than the nail of the big toe, and push it in. Then, having released as much pus as seems right to you, pack with raw-linen fibers, having tied a thread to the linen; release the pus once each day. When the tenth day comes, having released all the pus, pack instead with a woven linen cloth. Then pour in wine and oil, warming them through a small tube, so that the lung, being accustomed to being bathed in pus, may not suddenly be dried out. Let the instilled fluid that is put in at dawn flow out by evening, and what is put in at evening by dawn. When the pus has become thin like water, and sticky to the touch of the finger, and scanty, insert a hollow tin plug; and when the cavity has dried up entirely, cutting the plug little by little, let the wound grow together, until you remove the plug entirely. The sign that the patient will escape: if the pus is white and clear and blood-fibers are mixed through it, he usually recovers; but if what flows out on the first day is like the yolk of an egg, or if on the following day what flows out is thick, pale-greenish, and foul-smelling, they die when the pus ruptures.
[Another disease:] When the lung suppurates, the sputum is coughed up thick, pale-greenish, and sweet; there is gnashing of teeth, and pain into the chest and into the back, and a thin whistling in the throat, and the throat becomes dry, and the orbital rings are red, and the voice is heavy, and the feet swell slightly, and the nails are drawn in, and the upper parts of the body waste away, and the patient diminishes, and he is disgusted by the sputum when he holds it in his mouth after coughing it up; he coughs especially at dawn and at midnight, but also at other times; and this disease takes hold of younger women more than older ones.
2 48 [5]
For this patient, if the hairs are already falling from the head and the head is already going bare as from disease, and when the patient spits on coals the sputum smells strongly foul, declare that he will die within a short time, and that the thing that will kill him will be diarrhea; for when the pus around the heart has already putrefied, it smells like burnt fat on coals, and the brain, being heated along with it, runs down a brine-fluid that disturbs the lower belly; and the sign of this is that the hairs fall from the head. Do not try to treat him when he is in this condition. But if you encounter the disease at its beginning, give him lentil-broth to drink; then, after allowing one day's interval, give hellebore blended so as not to move the lower belly; and when brine flows into his mouth during the night, apply medications to the nostrils more frequently; if no brine flows, apply them, but at longer intervals; and once a month have him drink hellebore in the quantity that can be lifted with two fingers, blended in sweet wine; then immediately give him lentil-broth to drink after. Let him drink as few drug-preparations as possible. If sharper fevers come on, give the white root and hellebore to lick in honey; for in this way it will least disturb the lower belly. If colic arises in the lower belly, first give an enema into which the grain is mixed; if it still does not stop, purge with boiled donkey's milk; do not give a downward-purging drug. If before the drug-preparation he vomits bile when drinking the hellebore, let him vomit with the lentil-broth itself. As for foods, unless sharp fevers hold him, let him use boiled sheep's meat and poultry, and gourd, and beet; but let him not drink up broth, nor dip in it; let him use scorpion-fish and cartilaginous fish, boiled; let him eat nothing hot; let him not bathe if heavy fever holds him; let him not use sharp vegetables, except savory or marjoram; let him drink white wine. If he is without fever but heats come on him from time to time, let him eat the best and fattest fish, and fatty, sweet, and salty things as much as possible, and let him take walks neither in wind nor in sun, and let him vomit after meals when it seems to him the right moment, and bathe in lukewarm water except for the head. Of foods, bread is better for those who are not barley-cake eaters; for those who are, mix both.
[Another disease, which is called phthisis (wasting-consumption):] There is coughing, and the sputum is copious and moist, and sometimes it is easily coughed up, and the pus is like hailstones, and when rubbed between the fingers it becomes hard and foul-smelling; but the voice is clear and the condition is painless, and fevers do not come on — only warmth sometimes, and that also is slight.
2 49 [5]
For this patient, one must give hellebore and lentil-broth to drink, and feed him as well as possible, while abstaining from sharp foods, from beef, pork, and mutton; and take moderate exercise and walk, and use vomiting after meals, and abstain from sexual intercourse. This disease lasts seven or nine years; if the patient is treated from the beginning, he recovers. If the tube (σύριγξ) of the lung becomes ulcerated, a mild fever holds him, and pain in the middle of the chest, and itching of the body, and the voice is hoarse, and he spits moist and thin sputum, sometimes thick and like barley-water gruel; and a heavy smell like that of raw fish arises in his mouth; and from time to time hard things appear in the sputum, like a fungus from a sore; and the upper parts of the body waste away, most of all the whole body; and the orbital rings of the face become red, and over time the nails are drawn in and become dry and pale-greenish.
2 50 [5]
He ends up dying quickly, if not treated, spitting blood and pus; then strong fevers coming on killed him in the end. If he is treated, he escapes from this phthisis (wasting-consumption). The treatment should be: give lentil-broth preparations to make him vomit. And if it seems to you the right moment to drink hellebore: if the man is strong enough, give it directly; if not, mix in half a dose with the lentil-broth, at every fifth or sixth dose; do not move the lower belly with a drug, unless strong fevers come on; if they do, use donkey's milk to cleanse downward. If he is too weak to drink, give an enema; but be more sparing with the head. And if much salty saliva comes into the mouth, apply to the nostrils something that will not bring up bile; if the flux does not go to the mouth, do not apply anything to the head. When the sputum is foul-smelling, between the lentil-broth doses instill a drug into the lung; and allowing one day's interval when you have the opportunity, apply fumigation. As for food, use sheep's meat and poultry, and cartilaginous fish and scorpion-fish, boiled; every fourth day let him eat the best and fattest salted fish; let him breakfast on barley-cake, and dine mixing in bread as well; and let him neither eat pottage nor drink mixed-grain drink if he is able to eat solid food. Season the relishes with sesame in place of cheese, and with coriander and dill; use nothing of silphium nor of any other sharp vegetable, except marjoram, thyme, or rue. Let him take walks both before and after meals, guarding against wind and sun; let him abstain from strenuous exertion and from sexual intercourse. Let him bathe in lukewarm water, except for the head, which should be washed as infrequently as possible.
[Dorsal phthisis (wasting-consumption):] Dorsal phthisis arises from the marrow; it takes hold especially of the newly-wed and the lust-loving. They are without fever, and have a good appetite, yet they waste away; and if you question him, he will say it seems to him as though ants are moving down from above, from the head along the spine; and when he urinates or defecates, much moist seed comes out of him, and no children are conceived; and he has erotic dreams, whether or not he sleeps with a woman; and when he walks or runs, especially uphill, shortness of breath and weakness take hold of him, and heaviness of the head, and the ears ring.
2 51 [20]
For this patient, in time when strong fevers come on, he died in the end from smoldering fever. When he is in this condition, if you take him in hand from the start, having steam-fomented his whole body, give him a drug to drink upward, and after this purge the head, and after that give a downward drug; prefer to attempt this especially in spring. After this give whey or donkey's milk to drink; give cow's milk to drink for forty days; in the evenings, as long as he is drinking milk, give groats to eat as pottage; let him abstain from solid food. When he has ceased drinking milk, restore him on soft foods beginning with a small amount, and fatten him as much as possible; and for a year let him abstain from strenuous exertion, from sexual intercourse, and from bodily exertion except for walking, guarding against cold and sun; let him bathe in lukewarm water.
[A disease of the lung:] The sputum is thick and sooty when coughed up, and the complexion is dark and somewhat swollen, and there are dull pains under the chest and under the shoulder-blades, and such patients become hard to heal.
2 52 [10]
This one is less dangerous than the other, and more of them escape. For this patient one must give hellebore to drink, both by itself and mixed into the lentil-broth preparations, and instill into the lung, and apply fumigation, and feed him well while abstaining from beef, mutton, pork, and sharp vegetables, except marjoram or savory; and let him take walks; let him journey uphill at dawn on an empty stomach; then drink a preparation of leaves sprinkled onto blended wine. For the rest, let him use the foods described.
[A wounded windpipe:] If the windpipe is wounded, coughing holds him, and he coughs up blood, and the throat fills with blood without his realizing it, and he throws out clots; and there is a sharp pain from the chest into the back, and the sputum is sticky and copious, and the throat is dry, and fever and shivering take hold, and the throat is rough as if from something fatty; and he suffers such things for up to fifteen days; after this he spits pus, and things like ticks from a sore, and again coughing; and so the blood has burst, and after the pus he spits something thicker, and the fever grows stronger, and it ends in lung disease and is called rupture-sickness of the lung.
2 53 [15]
But if after the first blood he does not spit pus, once it has stopped, he must cease from physical exertion and exercise, not mount a vehicle, abstaining from salty, fatty, and rich foods and sharp vegetables; and when he himself seems to be in the best condition of his body, cauterize the chest and the back, each in its proper portion; and when the wounds have healed, for a year let him abstain from strenuous exertion, and not over-fill himself, and not labor with his hands, and not mount a vehicle, but fatten his body as much as possible.
[Stretched ligaments of the lung:] When a ligament of the lung is stretched, he spits thin sputum, sometimes bloodied; he froths and fever holds him, and there is pain in the chest, the back, and the side; and if he turns, he coughs and sneezes.
2 54 [10]
For this patient, wherever pain holds him, apply warm fomentations, and give him centaury and wild carrot to drink beforehand as pottage, and grind sage leaves with honey and vinegar and water poured over, and give him this to sip; and let him first sip barley-water gruel, and afterwards drink diluted wine. When the pain has stopped, pound and sift sage, and St. John's wort and hedge-mustard finely and barley-flour, equal parts of each; mix these into blended wine and give to drink on an empty stomach; and if he is not fasting, give him unsalted pulse-pottage to eat as pottage. If it is the hot season, use foods as soft as possible, unsalted and without cooking-smells, when the body and chest and back are already in reasonable condition. If both ligaments are stretched, coughing holds him, and the sputum is spat up thick and white, and a sharp pain holds him in the chest and under the shoulder-blades and in the side, and heat holds him, and he is filled with blisters, and itching holds him, and he cannot remain seated, lying down, or standing, but is in distress. This patient dies most often on the fourth day; if he survives these, the hopes are not many; there is danger also in the seven days; but if he escapes these too, he recovers. For this patient, when he is in this condition, bathe him in a large quantity of warm water twice a day; and when pain holds him, apply warm fomentations; and give him honey and vinegar to drink, and barley-water gruel to sip, and white, full-bodied wine to drink after. But if he is distressed by the bathing and the warm fomentations and cannot bear them, apply to him rags of half-finished linen, and dipping them in water, lay them on the chest and on the back; and give him to drink honeycomb soaked in water as cold as possible, and the cold gruel and water to drink after, and let him lie in a cool place. Do these things; but the disease is fatal.
[Erysipelas in the lung:] If erysipelas arises in the lung, coughing holds him, and he spits up much moist sputum, like something from a bronchial infection, and it is not bloodied; and pain holds the back, the flanks, and the loin-areas, and the viscera gurgle, and he vomits clear fluid and something like vinegar, and his teeth are set on edge, and fever, shivering, and thirst take hold; and when he eats something, his viscera gurgle, and he belches sharply, and the belly rumbles, and the body becomes numb; and when he has vomited, he seems to be better; but when he has not vomited, as the day passes, colic and pain arise in the stomach, and loose stool passed through.
2 55 [5]
This disease arises most often from strenuous exertion and from meat-eating and from change of water; but it also comes on otherwise. For this patient, give a downward drug to drink, and afterwards give donkey's milk to drink, unless he is naturally disposed to spleen-trouble; if he is spleen-prone, do not purge with juices or milk or whey, but with something that, entering in small quantity, will draw out much; give enemas to the belly, and apply suppositories if the belly is not moving — this applies in all diseases — and in this disease use cold bathing and exercise, when the fevers remit and the patient seems to be in reasonable bodily condition; and in spring and autumn induce vomiting. Boil three heads of garlic and an amount of marjoram that can be grasped between three fingers, having poured over them two cotylae of sweet wine, a cotyle of the sharpest vinegar, and honey equal to a quarter-measure; boil until one third is left; then, having exercised the man and bathed him in lukewarm water, give this warm to drink, and give him lentil-broth to drink, mixing in honey and vinegar, until he is full; then let him vomit; and on that day, having drunk barley-flour and water, let him fast; toward evening let him eat beet and a little barley-cake, and drink diluted wine. For the rest of the time let him vomit with the lentil-broth preparations and after meals. And if the pain settles under the shoulder-blades, apply a cupping-vessel, and bruise the veins in the arms; use foods that are unsalted, not fatty, and not rich; let him eat sharp, sour, and cold things of all kinds, and take walks. If he does these things, he would manage his diaita (regimen / ordering of life) best, and the disease would recur least often; and it is not fatal, but leaves the patient when he reaches old age. But if you wish to release a younger person from the disease more quickly, having purged him, cauterize both the chest and the back.
[Dorsal disease:] Shivering and fever and cough and difficulty breathing take hold of him, and he spits pale-greenish sputum, sometimes also tinged with blood, and he suffers most in the back and in the groin-regions, and on the third or fourth day he urinates blood-tinged fluid, and he dies on the seventh day; but if he escapes the fourteen days, he recovers; he does not often escape.
2 56 [5]
For this patient, give mead boiled in a new pot, cooling it, soaking in celery-rind or fennel; give this to drink, and barley-water gruel twice a day, and white wine well-diluted to drink after; wherever pain is present, apply warmth; and bathe in warm water, if the fever does not hold strongly. When the fourteen days have passed, let him eat millet at breakfast, and in the evening eat boiled puppy-meat or poultry, and sip the broth; and use as little solid food as possible in the first days.
[A growth in the lung:] When a growth develops in the lung, coughing holds him, and inability to breathe except when upright, and sharp pain into the chest and into the sides; and he suffers these things until the fourteen days; for in most patients the inflammation of the condition of the growth lasts that many days most of all; and the head and the eyelids ache through, and he cannot see, and the body becomes somewhat reddish and fills with blisters.
2 57 [5]
Bathe this patient in much warm water, give him diluted melikraton to drink, and have him sip the juice of ptisane, with watered wine to drink after; if the pain presses hard, apply warmth; once it has ceased, let him use the softest possible foods. If, when he has been freed of the disease, difficulty of breathing seizes him whenever he goes to an uphill place or hurries along somehow otherwise, give a medicinal draught that will not move the lower bowel; and if pus follows along with the vomited matter, then if the pus is white and there are bloody-tinged fibres in it, he escapes; but if it is livid and green and foul-smelling, he dies. They are purged within forty days from when it ruptures, but in many the disease lasts a full year; one should manage this patient exactly as one manages the empyic. If it does not rupture — for in some cases it withdraws in time toward the side and swells outward — in such a case one must cut or cauterize.
The lung filled with fluid: if the lung is filled, cough takes hold, and orthopnoia, and gasping, and he thrusts out his tongue, and he fills with wheals, and itching takes hold, and sharp pain holds him in the chest and along the shoulder-blades, and he can bear neither sitting nor lying down nor standing, but is without strength.
2 58 [5]
This patient dies most often on the fourth day; and if he survives even those, hope is not great; he is in danger also during the seventh; but if he survives beyond those, he recovers. When he is in this condition, bathe him in much warm water twice a day, and when pain holds him, apply warming applications, and give him boiled honey and vinegar to drink, and have him sip the juice of ptisane and drink wine after; but if he suffers under the bathing and the warming applications and cannot bear them, apply cold compresses to him, and give him honeycomb steeped in water as cold as possible to drink, and let him lie in a cool place — do these things; the disease is grievous and deadly.
The lung collapsed against the side: if the lung falls against the side, cough takes hold and orthopnoia, and he coughs up white saliva, and pain holds the chest and the back, and it presses as it lies against, and it seems as though something heavy is placed in the chest, and sharp pains stab, and it creaks like leather, and it holds back the breath; and lying down on the ailing side he can bear, but not on the sound side — rather it seems to him as though something heavy hangs from the side, and he seems to breathe through the chest.
Also, often it seems to shift as if toward peripneumonia, and he becomes delirious — by this you would know that peripneumonia is coming on.
2 59 [5]
Bathe this patient in much warm water twice a day, give him melikraton to drink, and from the bath, mixing white wine with a little honey, and pounding the seed of wild carrot and of centaury, dissolving these in the mixture, give it him warm to sip down; and apply to the side a skin or ox-bladder filled with warm water poured in, and bind the chest with a bandage, and let him lie on the sound side, and give him the juice of ptisane warm, with watered wine to drink after. If this has come about from a wound, or in a patient cut for empyema — for it can happen — bind a bladder to a tube for him, fill it with air and let it enter inside, and insert a firm tin plug, and push it forward. Treating him thus you will most likely succeed.
A growth on the side: when a growth is in the side, a hard cough takes hold, and pain, and fever, and something heavy is lodged in the side, and sharp pain seizes always the same spot, and strong thirst, and the drink is belched back warm, and lying on the painful side he cannot bear it, but on the sound side; yet when he lies down, it seems as though a stone is hanging there, and it swells and reddens, and the feet swell.
2 60 [5]
This patient must be cut or cauterized; then let the pus out until the patient reaches the tenth day, and plug with raw linen; when the tenth day comes, letting out all the pus, introduce wine and oil warmed together, so that it does not suddenly dry out, and plug with a linen cloth; letting out what has been poured in, pour in another lot; do this for five days. When the pus flows out thin like the juice of ptisane and in small quantity, and is glutinous when touched by the hand, insert a tin plug, and when it has dried out entirely, cutting off a little of the plug at a time, always allow the wound to grow together toward the plug.
Dropsy of the lung: if dropsy forms in the lung, fever and cough take hold, and he breathes in gasps, and the feet swell, and all the nails are drawn in, and he suffers just as one who has become empyic, but more sluggishly and over a longer time; and if you pour in, or apply steam, or fumigate, pus does not follow — by this you would know that it is not pus but water; and if you hold your ear pressed against the sides for a long time listening, it seethes within like vinegar.
2 61 [5]
For a time he suffers these things, then it ruptures toward the belly-cavity; and immediately he seems to be well and to have been freed of the disease, but in time the belly becomes inflamed, and he suffers those same things and worse; some also swell in the belly and the scrotum and the face, and some seem to be suffering from the lower belly, seeing the belly large and the feet swelling — and these things swell if you have missed the right time for cutting. This patient, if it has swollen outward, must be treated by cutting through the sides; if it has not swollen outward, bathe him in much warm water, seat him as one seats the empyics, and wherever there is a sound, there cut; aim as low as possible, so that drainage flows freely for you. When you have cut, plug with raw linen, making the plug thick and tapering to a point, and let out the water sparingly, as little as possible. And if on the fifth or sixth day some pus appears on the plug, in most cases he escapes; but if it does not appear, when you have drained off the water, thirst seizes him and cough, and he dies.
Rupture of the chest or back: if the chest or the back ruptures, pains hold the chest and the back through and through, and heat seizes him now and then, and he coughs up blood-tinged saliva, while something like a hair runs through the saliva, blood-stained; and he suffers these things especially if he does any labor with his hands or mounts a wagon or a horse.
2 62 [5]
This patient must be cauterized both in front and behind, each side equally, and thus he recovers; he must refrain from labors for a year, and build up flesh from the cauterization.
Kauson fever: fever takes hold and strong thirst, and the tongue is rough and black and greenish-yellow and dry and deeply flushed, and the eyes are greenish-yellow, and he passes reddish and greenish-yellow stools, and urinates the same, and spits much; often it also seems to shift as if toward peripneumonia, and he becomes delirious — by this you would know that peripneumonia is coming on.
2 63 [5]
This patient, if he becomes peripneumonic, recovers if he survives fourteen days; but if within eighteen days he has not been purged and becomes empyic, he must drink the liquid from crushed grain, and drink after it white vinegar as fragrant as possible, and sip the juice of ptisane twice a day — if he is weak, three times — and drink after it wine that is full-flavored, white, and watered, and bathe as little as possible; if he becomes empyic, manage him as an empyic.
Hiccup fever: fever seizes urgently, and rigor, and cough, and hiccup, and he coughs up clots of blood along with the saliva, and dies on the seventh day; if he survives ten days, he becomes easier; on the twentieth day he becomes empyic, and coughs up at first a little pus, then more; and he is purged within forty days.
2 64 [20]
During the first days give him boiled vinegar and honey to drink, mixing vinegar and water, making it dilute; have him sip the juice of ptisane mixing in a little honey, and drink white full-flavored wine after; when ten days have passed, if the fire has ceased and the sputum is clear, let him sip whole ptisane or millet; if on the twentieth day he spits pus, let him drink the following: pound and sift sage, rue, savory, oregano, and St. John's wort, equal portions of each, the whole amounting to a small cup, and the same amount of barley-meal in sweet wine blended, to be drunk on an empty stomach; and let him sip this if it is winter or late autumn or spring; if it is summer, not that — but instead grind almonds and roasted cucumber seed and sesame in equal portions, the whole a cupful, pour over it water amounting to an Aeginetan kotyle, sprinkle flour and honeycomb, and let him sip this after the drink; let him use fatty and salty and sea-food rather than meats; let him bathe in warm water, washing the head as little as possible. Doing these things he is freed from the disease.
The disease called lethargos: cough takes hold, and he spits much watery saliva, and he talks nonsense, and when he ceases talking nonsense, he sleeps, and he passes foul-smelling stools.
2 65 [5]
Give this patient the liquid from crushed grain to drink, and give him white full-flavored wine to drink after, and have him sip the juice of ptisane; mix in the juice of pomegranate rind; and drink white full-flavored wine after, and do not bathe him. This patient dies within seven days; if he survives those, he recovers.
Another disease called the withering disease: he cannot bear either fasting or having eaten; when he is fasting, the viscera draw inward and he has heartburn, and he vomits now one thing now another — bile and saliva and watery matter and something sharp — and when he has vomited, he seems to be easier for a short time; when he has eaten, belchings come on him, and he burns, and he constantly thinks he is about to pass a large stool; when he sits down, wind passes; and pain holds the head, and the whole body seems to be pierced as by a needle now in one place now another, and the legs are heavy and weak, and he wastes and becomes feeble.
2 66 [5]
Give this patient a medicinal draught, first downward, then upward, and purge the head; abstain from sweet and oily and rich foods and from strong drink; induce vomiting with vegetable juices and from solid foods, and in season give him ass's milk or whey to drink, giving beforehand a medicinal draught, whichever you think he more needs; let him take cold baths in summer and spring, but in autumn and winter use anointing with oil, and walk, and take a little exercise; if he is too weak to exercise, let him use walking; and let him use cold and laxative foods; and if the belly does not move, flush with a gentle enema. The disease is a chronic one and leaves those who are aging, if it is going to leave; otherwise it perishes with them.
The so-called murder fever: fever and rigor take hold, and the eyebrows seem to be hanging down, and he has pain in the head, and he vomits warm saliva and much bile; sometimes it also passes downward; and the orbits do not contain the eyes, and pain holds the neck and the groin; and he is without strength and talks nonsense.
2 67 [5]
This patient dies on the seventh day or even sooner; if he survives those days, he is for the most part well; the disease is deadly. For this patient one must apply cold compresses to the viscera and to the head, and give him to drink water in which parched barley with its husks has been steeped, and the water strained off, making melikraton in this water, giving it diluted; bring him no food and no gruel for seven days, unless he seems weak to you; if he is weak, give him a little thin cold juice of ptisane twice a day, with water to drink after; when seven days have passed and the fire has let up, let him lick millet; toward evening give him a little gourd or beet, and have him drink white watered wine after, until the ninth day has come; then let him use food as sparingly as possible, breakfasting on millet; as for bathing, while pain holds and fever, let him not use it; when it has ceased, let him bathe in much water; if the belly does not pass, flush with a gentle enema, or apply suppositories. When he has grown strong, applying a gentle medicinal draught to the nostrils, purge the lower bowel; then give him ass's milk to drink after.
The livid disease: a dry fever takes hold and shivering now and then, and he has pain in the head, and pain holds the viscera, and he vomits bile, and when the pain holds him, he cannot look steadily but feels heaviness; and the belly becomes hard, and the skin-color livid, and the lips and the whites of the eyes livid, and he stares as though being strangled; sometimes he also changes color, and from livid becomes somewhat greenish-yellow.
2 68 [5]
Give this patient medicinal draughts both downward and upward, and flush with an enema, and purge from the head, and bathe in warm water as little as possible, but when he does bathe, let him take sun, and in season give him whey and ass's milk to drink, and let him use the softest and coldest foods, avoiding sharp and salty things; let him use richer and sweeter and fattier foods. The disease for the most part perishes together with the patient.
The belching disease: sharp pain seizes him, and he suffers intensely, and tosses himself about, and shouts, and belches frequently, and when he has belched, he seems to be easier; often he also vomits up a little bile, about a mouthful; and pain seizes him from the viscera down to the lower belly and the flank, and when this happens, he seems to be easier, and the belly is distended with wind and becomes hard and makes sounds, and the wind does not pass through nor does the stool.
2 69 [5]
If pain holds this patient, bathe him in much warm water, and apply warming applications; when the pain and wind are in the belly, flush with an enema, and boiling the juice of mercury-herb mix it with the juice of ptisane, and have him drink sweet watered wine after; bring him no food until the pain eases; let him drink for six days, steeping sweet grape-pressings overnight, the water from these; if he has no grape-pressings, honey and boiled vinegar; when he is moved from the pain, purge the bowel downward with a medicinal draught; let him use soft and laxative foods, and sea-food rather than meats, and among meats boiled fowl and boiled mutton, and beet and gourd, and abstain from the rest. The disease, when it takes a young person, leaves in time; if an older person, it perishes with them.
The phlegmatic disease: it takes men too, but more often women; she is plump and of good color, but grows weak when walking, especially when going uphill; a slight fever takes hold, sometimes also a sense of choking; she vomits, when fasting, bile and much saliva, often also after eating, but none of the food; and when she exerts herself, she has pain now in one place now another in the chest and the back, and she fills with blisters as if from nettles.
2 70 [5]
Give this patient a medicinal draught, and let him drink whey and ass's milk; if he is to drink whey, give a medicinal draught downward beforehand for as many days as possible; and when the whey-drinking ends, let him drink ass's milk after; while drinking, let him abstain from foods; let him drink wine as pleasant as possible, when purging has ceased; when the drinking course ends, let him breakfast on millet, and toward evening use food as soft as possible and as little as possible; abstain from rich and sweet and oily things; now and then, especially in winter, let him vomit by means of the lentil-herb, eating raw vegetables first; and let him bathe in warm water as little as possible, but take sun instead. The disease perishes together with the patient.
White phlegm: the whole body swells with a white swelling, and the belly is thick to the touch, and the feet and thighs swell and the shins and the scrotum, and he breathes in gasps, and the face is reddish, and the mouth dry, and thirst holds him, and when he has eaten, the pneuma comes on dense; this patient sometimes on the same day becomes easier, sometimes worse.
2 71 [5]
For this patient, if the belly is disturbed spontaneously at the outset of the disease, he comes closest to recovery; if it is not disturbed, give a medicinal draught downward that will purge water, and do not bathe in warm water, and bring him into the open air, and strike the scrotum when it is inflamed; let him use for food clean cold bread and beet and boiled scorpion-fish and sea-creatures and boiled minced mutton; use the broth as little as possible, and everything cold, and not sweet or fatty, but minced and sharp and pungent, except garlic or onion or leek; eat much oregano and savory, and drink full-flavored wine after, and walk before food. If he swells under the medicines, flush with an enema, and press with food and walks and refraining from bathing; give medicines as little as possible, and nothing upward before the swellings have descended to the lower part; if, when he has now become thin, a choking sensation arises in the chest, give hellebore to drink and purge the head, and then give a downward draught. The disease mostly comes to no definite crisis.
The distressing anxiety disease: it seems as though a thorn is in the viscera stabbing them, and nausea seizes him, and he shuns the light and other people, and loves the dark, and fear takes hold, and the midriff swells outward, and it is painful to the touch, and he is frightened, and he sees terrors and fearful dreams and sometimes the dead; and the disease sometimes takes hold of the most people in spring.
2 72 [10]
Give this patient hellebore to drink, and purge the head, and after the purging of the head give a medicinal draught downward, and after these have him drink ass's milk; let him use food as sparingly as possible, unless he is weak, and cold and laxative food, and not sharp nor salty nor fatty nor sweet; let him not bathe in warm water nor drink wine, but preferably water; if not, watered wine; let him not exercise nor walk. Doing these things he is freed from the disease in time; if he is not attended to, it perishes with him.
The black disease: he vomits black matter like wine-lees, sometimes blood-like, sometimes like second-pressing wine, sometimes like the ink of an octopus, sometimes sharp like vinegar, sometimes saliva and watery matter, sometimes green bile; and when he vomits the black blood-like matter, it seems to smell like slaughter, and the throat and the mouth burn from the vomited matter, and the teeth are set on edge, and the vomit lifts off the ground, and when he has vomited, he seems easier for a short time; and he can bear neither fasting nor having eaten too much — when he is fasting, the viscera draw inward, and the saliva is sharp; when he has eaten something, there is heaviness on the viscera, and the chest and the back seem to be pierced as by needles, and the sides hold pain, and there is a sluggish fever, and he has pain in the head, and he cannot see with his eyes, and the legs are heavy, and the skin-color is dark, and he wastes.
2 73 [5]
Give this patient a medicinal draught frequently and whey and milk in season, and keep him from sweet and oily and rich foods, and have him use foods as cold and as laxative as possible, and purge the head, and after the upper medicinal draughts let blood from the arms, if he is not weak; if the bowel does not pass, flush with a gentle enema, and abstain from strong drink and sexual intercourse; if he engages in intercourse, let him be steamed on an empty stomach; and keep from the sun, and do not exercise much, and do not walk much, and do not take warm baths, and do not eat sharp or salty things. Doing these things, he escapes along with his age, and the disease grows old together with the body; if he is not cared for, it perishes with him.
Another black disease: he becomes somewhat reddish and thin and somewhat greenish-yellow in his eyes, and becomes thin-skinned and weak; and the longer the time goes on, the more the disease afflicts; and he vomits at every hour something like a small drop, about two mouthfuls, and the food frequently, and along with the food bile and phlegm, and after the vomiting the whole body aches, and sometimes even before vomiting; and slight chills and fever take hold, and he vomits most especially in response to sweet and oily things.
2 74 [10]
This patient must be purged with medicinal draughts both downward and upward, and given ass's milk to drink after, and use food as soft as possible and cold — coastal fish and sea-creatures and beet and gourd and minced meats — and drink white full-flavored wine somewhat diluted; use exertion in walking, and do not take warm baths, and keep from the sun. Do these things; the disease is not deadly, but it grows old alongside the patient.
The gangrene-like disease: the patient suffers the same things in other respects, but vomits clotted congealed masses of bile, and likewise passes them downward when he has passed the food.
2 75
One must do the same things as were said in the case of the preceding disease, and flush with an enema.
[Colophon: On Diseases, the Third Book]
3 1
I have now spoken of all fevers; I will now speak concerning the remaining conditions. Swelling of the brain: whenever the brain swells from phlegmasia, pain grips the whole head, and most of all where the phlegmasia settles — it settles in the temple. The ears become full of ringing, hearing grows dull, the veins are stretched taut and throb, fever and shivering sometimes take hold, and the pain never leaves off but at times relents, at times presses harder. The patient cries out and starts up from the pain; and when he rises, he immediately rushes back to fall upon the bed, and throws himself about. This condition is deadly; on how many days the patient will die there is no fixed determination, for different patients perish differently — yet for the most part they die within seven days; those who survive twenty-one days recover. When there is great pain, one must cool the head — preferably after shaving it — by pouring something cooling into a bladder or intestine, such as juice of nightshade and potter's clay, applying it and removing it before it grows lukewarm; and one must draw off blood, and purge the head by mixing juice of celery with fragrant things; and abstain wholly from wine, drink cold barley-gruel, and loosen the lower gut.
Painful fullness of the brain: when the head is in great pain from a fullness of the brain, it signals uncleanness; pains seize the entire head, the patient becomes deranged, and dies on the seventh day — and will not escape unless the fluid bursts out through the ears on the seventh day; in that case the pain ceases and the patient regains his reason. The discharge is copious and without odor.
3 2
For this condition, above all do not treat the ears before you see the pus has burst; but if you wish to purge the upper and lower cavity, loosen each separately. Then apply fomentation to the entire head, especially through the ears and through the nostrils. Have the patient drink barley-gruel, and abstain wholly from wine. When the pus has burst, hold back until the greater part of the discharge has ceased; then irrigate the ears with sweet wine, or with woman's milk, or with old olive oil — irrigating with these warm — and apply fomentation to the head frequently with gentle and fragrant steam-baths, so that the brain is cleansed more quickly. At first the patient hears nothing; but as time advances the discharge lessens, and hearing, returning together with the cessation of the discharge, comes back fully, and the patient becomes most like his usual self. One must guard against sun, wind, fire, smoke, sharp odors, and the like; the patient should remain quiet and follow a gentle diaita (regimen / way of living), and the lower gut should be kept loose by evacuant means.
Those called 'struck' (blêtoi): those said to be 'struck' — whenever the brain is filled with much uncleanness — first produce pain in the front of the head; the patients cannot look upward, some with both eyes, some with one; stupor (kôma) seizes them, they are out of their minds, the temples throb, a slight fever holds them, and there is loss of control of the body.
3 3
Such a patient dies on the third or fifth day; he does not reach the seventh; but if he does reach it, he recovers. If you wish to treat him, apply fomentation to the head and make an incision to create an opening for breathing; if the pain is fixed in place, sneezing must also be induced, the head must be purged with light and fragrant things, the lower gut must be purged, and wine must be entirely avoided; barley-gruel is to be used.
Gangrene of the brain (sphakhelismos): if the brain gangrenes, pain grips the head and travels through the neck into the spine; deafness seizes the patient, a cold comes over the head, he sweats all over, is suddenly found to be voiceless, blood flows from the nostrils, and he becomes livid.
3 4
If the disease has taken a loose hold, with the blood having passed off the patient improves; if he is severely seized, he dies quickly. For this patient, induce sneezing through fragrant things, purge both cavities in turn each separately, hold light-scented things to the nostrils, and give thin, warm gruel; abstain wholly from wine.
Lethargics (lêthargoi): the lethargics — the seat of the trouble is the same as in pneumonia, but more severe, and not entirely distinct from wet pneumonia; yet the disease is much slower.
3 5
The patient suffers as follows: cough and stupor seize him, he brings up saliva that is fluid and copious, is very weak, and when he is about to die he passes downward in great amount and fluid matter. For this patient hope of survival is very slight; nonetheless, one must make him expectorate as much as possible, keep him warm, and abstain from wine; if he escapes, he becomes empyic.
The so-called ardent (kausôdês): the so-called ardent fever — great thirst grips the patient; the tongue is roughened, and its color at first is as usual, but it is very dry; as time advances it hardens, roughens, thickens, and becomes blackened.
3 6
If these things happen at the beginning, crises come quicker; if later, more slowly. The tongue signals the release of the disease from all these signs, just as likewise in pneumonia. The urine, when bilious or bloody, signals distress; when yellow, less distress. The sputum is burnt together and thick from heat and dryness; often the disease shifts to pneumonia, and if it shifts, the patient dies quickly. One must treat this condition as follows: bathe with warm water twice or three times each day, except the head; during crises do not bathe. In the first days give gentle purging and let the patient drink water, for water for the most part induces vomiting; in the later days after purging, moisturize, and use gruel and sweet wines. But if you do not take the patient from the beginning, but are called when the signs in the tongue are already present, leave things until the crises have passed and the signs of the tongue have become milder, and give neither drug nor clyster for purging until the crises have passed.
The lung swollen from heat: whenever the lung swells, filled with heat, a strong and hard cough seizes him, orthopnea, he breathes in gulps, pants rapidly, sweats, flares the nostrils like a horse from a race, frequently protrudes the tongue, and the chest seems to him to be singing and to have weight inside, so that the chest cannot expand but bursts apart and is disabled; sharp pain grips him; the back, the chest, and the sides are pricked as by needles, and these parts burn as if sitting by a fire; flame-like reddened patches break out on the chest and back; intense biting pain falls upon him; he is at a loss — he can neither stand nor sit nor lie down — and helpless in this way he tosses himself about and thinks he is already going to die. He dies most often on the fourth or seventh day; if he survives these, he rarely dies.
3 7
If you are treating him, you must purge the lower gut as quickly as possible with clysters, thoroughly; draw off blood from the elbows, the nose, the tongue, and from everywhere on the body; give cooling drinks and gruel with the same power, and give diuretics frequently — but not warming ones. For the pains themselves, when they storm, apply light, moist warm compresses, warming and moistening the place where the pain is; for the rest apply cooling agents, alternately removing and reapplying, and apply cold to where there is burning; abstain wholly from wine.
Pain of the head: when a sharp pain beginning in the head at once makes the patient voiceless — especially if from drunkenness — this patient dies on the seventh day.
3 8
Those who suffer such a thing from drunkenness and remain voiceless are less often fatal; for if they recover their voice the same day, or the next, or the third, they become well; some do this from drunkenness, others perish. For these patients: induce strong sneezing; give a clyster that will draw bile forcefully; and if the patient is conscious, give juice of thapsia in a large quantity of warm fluid, so that he vomits it up as quickly as possible. Then reduce him and keep him from wine for seven days; and draw blood from the tongue as well, if you can catch a vein.
Phrenitides: phrenitides arise also from other diseases.
3 9
The patients suffer as follows: they suffer pain in the phrenes (the region of the diaphragm/midriff), so as not to permit touching; fire grips them; they are out of their minds; they stare fixedly; and in other ways they behave like those in pneumonia when pneumonia patients are delirious. For this patient one must apply warm, moist compresses and drinks other than wine; and if he is able, purge upward — one must bring up material by coughing and expectoration, as in pneumonia; if not, prepare the lower gut so that it moves; and moisten with drink, for this is good. The disease is deadly; patients die on the third, fifth, or seventh day; if the seizure is mild, it resolves like pneumonia.
Kynanchê: under what is called kynanchê (dog-strangling), the person is choked; it seems to him that it is seized especially in the throat, and he swallows neither saliva nor anything else; the two eyes are in pain and protrude as in people being hanged; he stares fixedly with them and cannot turn them; he hiccups, starts up frequently, and the face and the throat are inflamed, as also the neck. Below the ears there seems to be nothing bad; sight and hearing are more dull; from the choking he is not in possession of his mind — neither if something is said to him, nor if he hears or does anything; instead he lies there gaping, drooling. Doing such things as these, this patient dies on the fifth, seventh, or ninth day.
3 10
When any one of these signs is absent, it indicates a milder disease, and they call it a lesser kynanchê (parakynanchê). For this patient one must do phlebotomy, preferably under the nipple, for warm pneuma (breath / moving air) follows along from the lung through that path; the lower parts must be purged with a drug or clyster; small tubes must be pushed into the throat along the cheeks so that pneuma is drawn into the lung; the patient must be made to expectorate as quickly as possible; the lung must be thinned; Cilician hyssop, sulfur, and asphalt must be fumigated beneath, and the fumes drawn through the tubes and through the nostrils so that phlegm goes out; the throat and tongue must be rubbed with things that draw phlegm; the veins under the tongue must be cut; blood must be let also from the elbows, if the patient has strength. Abstain from wine; drink thin barley-gruel. When the disease releases and the patient tastes food, purge with fresh elaterion, so that he does not fall into another trouble.
The jaundice disease (ikteros): the acute kind of jaundice that kills quickly is this: the entire complexion is intensely pomegranate-rind colored, or greener, like green lizards; the skin is similar in color; in the urine there settles something like a reddish vetch-seed; fever and a faint shivering grip him; sometimes he cannot bear to have a garment on, but is bitten by it and scratches; and being without food he is mostly gnawed in the morning in the viscera, and when someone wakes him or speaks to him, he cannot bear it.
3 11
For the most part this patient dies within fourteen days; if he survives these, he recovers. One must give warm baths; and let him drink mêlikrêton (honey-water) together with peeled Thasian walnuts and an equal amount of the top of wormwood, and half as much sifted anise — drinking a three-obol weight of this fasting; and again at bedtime, this mêlikrêton, and old thin wine, and gruel; but not to go without food.
Tetanos: when tetanos (tetanic spasm) seizes them, the jaws are locked like wood, they cannot open the mouth, the eyes water and squint, the back is locked rigid, the legs cannot be brought together, nor likewise the hands; the face reddens, the patient is in great pain, and when about to die, he vomits up through the nostrils his drink, his gruel, and his phlegm.
3 12
This patient perishes on the third, fifth, seventh, or fourteenth day; surviving these, he recovers. Give him tablets to swallow: pepper and black hellebore; give him rich, warm chicken broth; induce many strong sneezes; apply fomentation; and when not being fomented, apply warm moist and greasy compresses in bladders and wineskins from all sides — especially over the painful areas — and anoint with warm oil, copiously and often.
Opisthotonos: when opisthotonus seizes a patient, for the most part the other things are the same, but he is drawn backward; he cries out at times; strong pains grip him; at times he is not permitted to draw the legs together nor to extend the arms — for the elbows become bent; he holds his fingers in a fist, and for the most part presses the great toe under the rest; he talks nonsense at times; he cannot control himself but starts up at times when the pain grips him; when the pain lets go, he is quiet. At times they also become voiceless at the moment of seizure, or become raving and melancholic.
3 13
These patients die on the third day when the voice is released and they vomit up through the nostrils; but if they manage to escape fourteen days, they recover. Treat as the patient above. If you wish, you may also do as follows: pour as much cold water as possible over the patient, then throw on thin, clean, warm garments, but do not apply fire at that point. This is how one must treat both tetanos patients and opisthotonus patients.
Eileos: eileos (intestinal obstruction / ileus) arises when the upper gut heats while the lower cools; for the intestine dries up and is packed together by the phlegmasia, so that neither pneuma nor food can pass through; instead the belly becomes hard; the patient vomits at times — first phlegm-like material, then bilious material, and finally feces; thirst grips him; pain grips him most around the hypochondria, but he aches through the whole belly; it is distended; he hiccups; and fevers take hold.
3 14
This arises most often in autumn; the patient dies most often on the seventh day. One must treat these patients as follows: purge the upper gut as quickly as possible; draw blood from the head and elbows, so that the upper gut stops heating; cool the parts above the phrenes (midriff) except the heart; warm the lower parts by seating the person in a tub of warm water and anointing continuously, and apply moist warm compresses; and make a honey suppository alone, about ten fingers in length, smearing ox-bile on the front end, and insert it two or three times until you bring out all the dried matter around the anus. If the bowel responds to this, then follow it with a clyster; if not, take a smith's bellows, insert the air-tube into the gut so as to open up the gut and the compaction of the intestine; then draw the tube out again and immediately give a clyster — the clyster should be ready, not strongly heating, but of the kind that dissolves and melts the feces. Then, stopping the anus with a sponge, let the patient sit in warm water retaining the clyster; and if he takes in the clyster and then lets it go, he recovers. In the meantime let him lick the best honey possible and drink undiluted new wine. If after the eileos releases, fever seizes him, he is without hope — for perhaps even the loosened lower gut may kill him along with the rest.
Pneumonia (peripleumoniê): pneumonia produces the following: acute fever grips him; the breathing is frequent; he breathes out warmly; there is helpless distress, weakness, tossing about, pain under the shoulder-blade, into the clavicle and into the nipple, and heaviness in the chest; and sometimes also derangement of mind.
3 15
In some cases there is no pain until they begin to cough; and the disease is more prolonged and more difficult than that one. At first the patient expectorates thin, frothy saliva. The tongue is yellow; as time advances it turns black; if it blackens at the beginning, resolution comes sooner; if later, more slowly. In the end the tongue also cracks, and if you press your finger on it, it sticks; and the tongue signals the release of the disease, just as likewise in pleuritis. The patient suffers these things for at least fourteen days and at most twenty-one; and he coughs hard throughout this time; and is purged together with the coughing — first much frothy saliva; on the seventh and eighth days, when the fever is at its peak, thicker, if the pneumonia is of the wet kind; if not, not so; on the ninth and tenth days, pale-greenish and tinged with blood; from the twelfth through to the fourteenth day, copious and purulent. Those whose natures and bodily conditions are wet — and the disease itself is severe in these cases; those whose nature and the constitution of the disease is dry, less so. If then on the fifteenth and sixteenth days it dries out and the patient no longer coughs up pus, he is well; if not, watch carefully toward the nineteenth and twenty-first days, and if the sputum ceases there — if it does not, ask the patient whether the saliva is sweeter, and if he says yes, know that the lung is empyic and the disease is settling in for a year, unless he manages with urgency to bring up the pus within forty days; if he says the saliva is unpleasant, the established position of the disease is deadly. But in the first days it shows most clearly: if he spits up the rotten and pus-like matter within twenty-two days and is not ulcerated, he escapes; if not, he does not. This pneumonia lacks nothing of the evils that come from pneumonia; if therefore any of these evils is absent, one must know that the patient has that much less of it to bear and the healer has that much less to manage; but if the patient has few of these signs, let it not deceive you that it is not pneumonia — for it is a mild form. One must treat pneumonia as follows — and you will not go wrong by managing pleuritis and phrenitis in the same way: begin first by lightening the head so that nothing flows down toward the chest. In the first days let the gruels be sweetened, for in this way you would best wash away and move what has settled and congealed. On the fourth, fifth, and sixth days no longer sweet, but fatty, for this is beneficial toward expectoration upward by clearing the throat; if the patient is unable to expectorate in proportion, give the drug remedies that bring things up. The guts: in the first four or five days they must move, and a little more than that, so that the fevers may be duller and the pains lighter; but when the patient has been emptied and the body is weak, move the lower gut every third day, so that the body may not be disabled and the upper regions may remain moist — for if much fluid passes down from the fifth day on, it causes death; for with the fluid passing down, the upper parts dry out, and the purification of the sputum does not proceed upward.
3 15 (50)
The lower gut must, then, neither stand quite still (lest the fevers be acute) nor pass too freely (lest the sputum cannot rise and the patient be without strength). Give the drugs for bringing up on the sixth, seventh, ninth days and still further along in the disease, rather than earlier; let the drug be white hellebore, thapsia, fresh elaterion — equal amounts of each. If the sputum is not purging well, the breathing is frequent, and purging is not prevailing, declare in advance that there is no hope of his living, unless he is able to cooperate with the purging. Also do what is prescribed in the pneumonia section, if the conditions of the lower gut are serving you well. And there is also another method beginning from the first day: give a heaped shell-measure of great arum-root, one each of dill and nettle, and as much mustard and rue as one can take with three fingers, and as much juice of silphium as a bean; mixing these in oxymeli (vinegar-honey) and water and straining, give warm to the fasting patient. When the patient begins to expectorate cleanly, give a shell-measure of arum, sesame, and blanched almonds in diluted oxymeli to drink; and if you wish to drive more, mix in the bark of the caper-root with these.
Pleuritis: when pleuritis seizes a patient, the following happens: pain grips the side, and fever and shivering; he breathes rapidly; orthopnea grips him; he coughs up bilious matter like pomegranate-rind color, unless there are ruptures; if there are ruptures, also blood from the ruptures; and in the bloody kind it is tinged with blood.
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The bilious type is milder, provided the patient has no internal ruptures; if he does, it is more painful but not more lethal. The bloody type is severe, painful, and deadly. When hiccup is present along with this, and the patient coughs up dark clots of blood together with the sputum, he dies on the seventh day; but if he survives ten days, he recovers from the pleurisy, then on the twentieth day suppuration sets in, and he coughs up pus, and finally vomits it up as well, and he does not recover easily. There are also dry pleurisies without expectoration; these are difficult. Their crises resemble those of the other types, but they require more moisture in drink than the others. The bilious and the bloody types reach their crisis on the ninth and eleventh days, and these patients recover more often. If at the outset the pains are soft but become sharp from the fifth and sixth day, they run their course by the twelfth day, and patients do not much die; the danger is greatest through the seventh day, yet extends also to the twelfth, and after these days they recover. Those that are soft at the outset but become sharp from the seventh and eighth day reach their crisis by the fourteenth day and the patients recover. The pleurisy of the back differs from the others in this: the back aches as though struck, and the patient groans and breathes in gasps; he spits a little immediately, and the body is fatigued; on the third or fourth day he passes urine that is serum-like and tinged with blood; he dies most often on the fifth day; if not by then, on the seventh; having survived these, he lives, and the disease is milder and less deadly; one must watch until the fourteenth day; after that he recovers. In some pleurisy patients the sputum is clear but the urine is bloody, like the serum from roasted meat; sharp pains extend through the spine to the chest and to the groin; such a patient, having survived the seventh day, recovers. Whenever any of these pleurisy patients additionally shows redness of the back, heating of the shoulders, heaviness when sitting up, and the belly is violently disturbed with a greenish and very foul-smelling discharge, this patient dies on the twenty-first day because of the bowel discharge; having survived this, he recovers. Those whose sputa are immediately varied in character and whose pains are very sharp die on the third day; having survived these, they recover. One who is not recovered by the seventh, ninth, or eleventh day begins to suppurate; it is better to suppurate, for it is less deadly, though painful. In addition to the signs mentioned in each type of pleurisy, one must also examine the tongue: when a bubble appears on the tongue that is somewhat livid, like what happens when an iron implement is dipped into oil — if this forms while rough at the beginning, recovery from the disease is more difficult, and there is a necessity to cough up blood on the days when this is required; but if it forms when the disease has already advanced, the crises fall on the fourteenth day, and there is a necessity to spit blood. The situation concerning recovery is as follows: if ripening and expectoration begin by the third day, recovery is quicker; if ripening occurs later, the crises also come later, as with the signs in cases involving the head. The pains in all the pleurisies are for the most part relieved more by day than by night.
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The pleurisies should be treated as follows: for the most part as in phrenitis and peripneumonia, except that warm baths and sweet wines are to be used. If you take charge on the first day or the next after the onset, and the stool has already passed clean or mildly bilious and scanty, administer a clyster of thapsia; if the bowel, once moved, relaxes during the night but pain and cramping are present the next day, administer the clyster again. If the patient is bilious by nature and is seized by the disease when uncleared, purge the bile thoroughly with a drug before the sputum becomes bilious; but when he is already coughing up bilious matter, do not give the drug, for if you do, the sputum will not be able to come up, and on the seventh or ninth day he will be choked; if in addition to the pains in the sides the hypochondria also hurt, a clyster must be given, and on an empty stomach give him to drink aristolochia, hyssop, cumin, silphion, white poppy, flower of copper, honey, vinegar, and water. These first treatments with drugs must be conducted in this way; the other measures are as follows: bathe with much warm water according to the patient's strength, except for the head; and when the crises are at hand, warm the painful parts with moist fomentations, rubbing on olive oil. Whenever the diseases are at their most violent, both the patient and the physician should hold back from treatments, so that nothing harmful is done; give well-boiled barley-gruel juice, slightly thicker, making it honey-sweet. After the baths, also offer sweet diluted wine to drink before meals, not cold, a little from a flask with a narrow mouth; and when fits of coughing come on, drink additionally and clear the throat as much as possible, and moisten with the drink, so that the lung, being moister, may discharge the sputum more easily and quickly, and the coughing may give less distress. Also the juice of sweet or wine-dark pomegranate, mixed with a little goat's milk and honey, give in small amounts frequently both at night and during the day. And prevent sleep as much as possible, so that the cleansing may be quicker and more copious. The bloody pleurisy must be treated as follows: after the crises, restore the patient with light foods, and have him rest, and guard very carefully against sun, winds, repletion, sharp foods, salty foods, fatty foods, smoke, flatulence in the belly, exertions, and sexual intercourse; for if the disease relapses, death will follow. During episodes of spitting, if pain is present and the patient cannot expectorate, give on an empty stomach flower of copper in the amount of a small olive, and half as much juice of silphion, and a little fruit of trefoil in honey to lick; or give five grains of pepper and juice of silphion in the amount of a bean, with honey, vinegar, and water, warm, on an empty stomach; this also relieves the pains. If he cannot spit in due proportion but the matter is lodged in him and there is rattling in the chest, mix a root of great arum the size of a small vessel with olive oil and honey, and sip repeatedly diluted vinegar. Another strong remedy: flower of copper in the amount of a bean, double that of roasted natron, hyssop in the amount that three fingers can take up — mix with honey, add a little water and oil, warm in a small vessel, and pour in so that he is not choked. This must also be done in peripneumonia if cleansing does not proceed. If there is neither rattling nor spitting as required, take fruit of caper in the amount that three fingers can take up, with pepper, a little natron, honey, vinegar, and water mixed, and have him sip this warm in small repeated sips; on the next day boil hyssop in vinegar, honey, and water and have him sip it repeatedly.
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Give this also to those who rattle and cannot be cleared. If you wish to make it stronger, grind hyssop, mustard, and cress in the amount of a small or larger vessel, mix with honey and water, boil, strain, and give warm to sip repeatedly. These diseases, treated in this way, lead to recovery, unless some residue of sputum left in the lung turns to pus, from which dry hacking coughs arise, and fever and shivering seize the patient, and orthopnoea is present, and he breathes frequently and in gasps, and the voice is a little deeper, and the face holds a good colour along with the fever; as time goes on, the disease becomes more clearly manifest. If you take charge of such a patient within ten days, after warming him with diaita (regimen) and a warm bath, you should instil into the lung something that will bring up the pus, and use the other agents that draw up pus, and manage him as a patient with empyema, and dry out the head so that there is no flux flowing down. If in the course of instillation the pus does not putrefy and come up, it bursts from the lung into the chest cavity; and after the rupture he seems to be well, because the pus has passed from a narrow space into a wide one, and the pneuma (breath) that we breathe in has found its seat in the lung; but as time goes on, the chest fills with pus, and the coughs, fevers, and all other pains press upon him more, and the disease becomes fully manifest. After the rupture one must leave him for fifteen days, so that the pus may be ripened again; for having come into the wide space it has cooled and attracted to itself the moisture already present in the chest, so that it is half-putrefied. If spontaneous expectoration begins in this period, treat with drugs or drinks; and in the final days of the fifteen, press to have him sit up before the body is further worn down, keeping the head free of fluxes. If it is not expectorated but points to the sides, one must cut or cauterize. If it is neither expectorated nor points to the sides, wash him with much warm water while he is fasting and has drunk nothing, seat him on a steady seat, and have one person support his shoulders while you yourself shake him, putting your ear against his sides to know on which side it points; prefer the left side; for cauterizing and cutting on the right side is more deadly, since the right side is stronger, and diseases in it are correspondingly shown to be more severe. If because of the thickness the fluid does not slosh and there is no sound in the chest, but the patient draws in pneuma (breath) rapidly and the feet are swollen and there is some coughing, let this not deceive you — know well that the chest is full of pus. Dip a thin linen cloth into wet, finely ground, warm Eretrian earth and wrap it all around the chest; and where it first dries, there one must cut or cauterize as close as possible to the diaphragm, being careful of the diaphragm itself. If you prefer, rub on the Eretrian earth and observe the same way as with the cloth, with many people applying it at the same time, so that the first areas applied to do not dry out. After the incision or cauterization, use a plug of raw linen, and let the pus out little by little. Whenever you are about to cut or cauterize, mark the patient in the same position as that in which you intend to cut or cauterize, so that the skin does not deceive you by moving higher or lower in the change of position; and guard against coughs through the diaita, so that they do not draw the pus back again into the lung — for that is harmful — but let it dry out as quickly as possible; when the twelfth day has come, let out all the remaining pus, use a lint plug from the cloth, and let the pus out twice a day, and dry out the upper cavity as much as possible through the diaita.
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In this way one must also examine and treat suppurations arising from wounds, from peripneumonia, from severe catarrhs, and from the lung collapsing against the sides. The following cooling drinks give to patients with burning fever to drink when you wish; they produce many different effects: some bring on urination, some evacuation through the bowel, some both, some neither, but merely cool as a vessel of boiling water does if one pours cold water onto it or brings the vessel close to a cold current of air; give different ones to different patients, for neither sweet ones suit all, nor astringent ones, nor are they all able to drink the same.
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This one: soak about two cups of dry honeycombs in water and rub them, tasting until they are slightly sweet, then strain, add celery, and give to drink. This one: a cup of linseed, pouring on ten cups of water, boil in a new pot over coals without letting it boil fully, so that it breathes, until the juice feels oily to the touch. This one: boil down diluted mead by half, then add celery, and give this cold in small amounts. This one: dry a cup of unhulled barley, remove the awn and wash well, pour on a chous of water, boil, and leaving half, let cool and give to drink. This one: a tenth part of a cup of Ethiopian cumin, pour on three half-choes, boil sealed with hair-clay, without boiling fully, until a third remains, and giving it cooled, give this for every burning fever and remaining fever. This one: rain-water on its own. This one: pour a chous of water onto a cup of barley-gruel, boil leaving half, then strain, add celery, and give cold. This one: white raisin wines diluted. This one: diluted marc wines made from dried grapes. This one: a cup of white dried grape without seeds, and a handful of roots of cinquefoil crushed, pour on twenty cups of water, boil down leaving half, and give cold in small amounts. This one: half a choinix of coarsely ground barley groats, pour on a chous of water; when the groats swell, knead with the hands until the water becomes white, add a drachma-weight of maidenhair fern, air overnight, and give. This one: beat the whites of three or four eggs in a chous of water and let him drink it; this cools strongly and moves the bowel; if you wish it to move more, also beat in mercurywort. This one: wash half a choinix of roasted barley well, boil in a chous of water two or three times, and give cold. This one: give thin well-boiled barley-gruel juice and sweet wine; this does not move the bowel. This one: pulp of ripe cucumber without the skin, in water; this produces urination, cools, and stops thirst. This one: first boil bitter vetches in water, then set a new pot inside a larger pot full of water, pour other water onto the bitter vetches, boil a short time, then pour off a third; when the bitter vetches are well boiled, let cool and give, sprinkling a cyathus of cucumber pulp onto the vetch pulp; this reliably stops thirst. This one: old Thasian wine, give twenty-five parts water to one of wine. This one: soak trefoil — the cucumber-like variety — with barley groats in water and give to drink. This one: boil celery, enough to grasp three times in the hand, and two drachma-weights of pennyroyal in ten cups of vinegar until a third remains; mix this with honey and water, making it diluted, add a drachma-weight of maidenhair fern, and let him drink; this brings on urination and loosens the bowel.
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This one, and preparations similar to these, follow in this way. Give everything to the fevered patient aired overnight, except for those whose bowels are running more than they should. This one: boil three drachma-weights of pennyroyal, double that amount of celery, in diluted wine, and give; this both produces urination and drives bile through the bowel.