On Internal Affections — First Draft Translation

ON INTERNAL AFFECTIONS. If the airway (arteria) of the lung is ulcerated, or one of the small vessels hanging down into the lung ruptures, or one of the channels (syringes) stretched through the lung, and they break into one another and fill with blood — they are torn apart and burst chiefly for these reasons: from hard labor, from running, from falls, from blows, from violent vomiting, from fevers. The following then happens to the patient: at first a dry cough takes hold; then, a little later, he spits out saliva — sometimes tinged with blood, sometimes clear. [Section 1] If he recovers quickly from the disease — well and good. But if not, as time goes on the blood flows more copiously, sometimes clear, sometimes somewhat putrid. Often the throat fills with blood unnoticed; then he coughs up clots of blood a little at a time in rapid succession. Sometimes a heavy odor rises from these, and the throat is at times filled with a kind of frothy film; shivering and fever take hold — intensely at the outset of the disease, but as it progresses more feebly, and they seize him at irregular intervals. Pain sometimes settles in the chest, in the upper back, and in the sides. And when he stops spitting blood, he spits out much saliva, moist and sometimes viscous. These things he suffers in this way until fourteen days have passed. After these days, if the disease has not ceased, he coughs up and tears away scales from the airway, like those from small blisters; and pain falls into the chest, the upper back, and the side; and the region of the hypochondria is painful to the touch, as if it were a wound. For this patient it is advantageous to keep the disease as quiet as possible within, if he is in this condition. For if he exerts himself at all, both the pain becomes sharper and the cough presses harder than before, and the shivering and fever take hold more strongly; and if he sneezes, sharp pain strikes; and he aches in bed as well, whenever he turns over. For this patient one must offer foods — the same as for the patient with suppuration within (empyos) — though not in great quantity. Of relishes, use these: fish of rhinē or phagros or the large blue shark (galeōs megas glaukos), or others of this kind, all seasoned with pomegranate juice and marjoram. Let him eat roasted unsalted cock's flesh, or alternatively boiled goat's flesh; and let him use wine as austere, as old, and as pleasantly dark as possible; and take moderate walks — but only when there is no fever. If fever holds, let him use gruel of flour or millet. If he takes solid food, let him take it in small amounts, along with relishes that promote passage. If you judge that he needs a purgative, purge him downward with the Knidian grain (kokkon Knidion) or with tithymallid spurge (tithymalis); and after the purging, give him two bowls of boiled flour to drink down, rich and fatty. Then build him up as much as possible, so that he remains as far from thinness as possible — for it is not advantageous to be thin against this disease. And let him take short walks at first, so that fatigue does not seize him. Apply fomentations from time to time; and on the day he is fomented, let him eat nothing except boiled flour — let him drink down a bowl of that — and let him drink water. On the following day let him eat less than he has been accustomed to, and drink dark, sweet, austere wine in small quantity. Thereafter give this man his food two or three times a day until you have settled the belly, giving it a little at a time. For coming out of fevers and fasting, if the mouth seeks food but the belly is unwilling to receive it, the belly, receiving in a mass, becomes inflamed. So one must give by small amounts; for if you give all at once and he exerts himself a little in walking, the belly is not cooled, given that the food substances sit still without moving — and so fever tends to come on; and in winter the danger is less, but in summer there is greater risk of going wrong. [Section 1 (50)] This patient must be built up as much as possible, so that he is as stout as possible. Let him use moderate walks, and wrestle less than he is accustomed, and exert himself little at first, then more, but never much. If he does these things, he will recover most quickly. But if he grows thin from the hard labor, let him ease off and keep still. Let this man — even when healthy — not run quickly into the wind, nor mount a horse, nor ride in a yoked carriage; and let him guard against shouting and sharp-tempered outbursts; for there is danger of taking up the disease again. He must guard against all of these things. If he is shut off from grain-food: roast bitter vetches (orobioi), clean off the husks, then soak them in water for three days, pouring off the water each day and pouring on fresh; then on the fourth day strain and dry them; then grind them very fine and sift. And roast linseed and pound smooth; and roast sesame and pound smooth; and use unsalted clean fine barley-meal. Let the measure of vetches and barley-meal be equal to each other, a third part of sesame, and half a portion of linseed. Cook these in goat's milk and drink them as liquid as possible. After these things, give him at lunch clean foods and stronger relishes; let him drink the same wine. Also give him — shaving it into wine — the root of centaury (kentauriē), which is among the roots for these ruptures; and also give him dragon-wort (drakontion), shaving it into wine; and also for the sake of the cough, give him dragon-wort shaved into honey to lick. And if he says he is unable to drink the decoction in milk, let him drink as much cow's milk as possible, mixing in a third part of melikraton (honey-water). And so he will recover most quickly; but the disease requires much treatment, for it is difficult. And if, being treated and becoming well, he does not keep himself under guard, in most cases the disease relapsing has proven the cause of destruction. If he is healed by this treatment, good. But if not, fatten him on milk and cauterize the chest and the upper back; for if you succeed in the cauterization, there is hope of escaping the disease. If the airway (arteria) is convulsed or one of the vessels stretching into the lung is torn, the following happens: at the outset of the disease a sharp cough takes hold, and shivering, and fever; and he spits out saliva — abundant, white, and foamy, and at other times tinged with blood; and pain grips the head and the neck. [Section 2] This disease is more severe than the former. During the first ten days the patient suffers in this way; then most patients by the eleventh day spit up thick pus violently. On the fourteenth day the sputum is cleaner, if the patient is to escape, and he suffers less from the pain and quickly becomes well. But if the disease is going to be prolonged, far more pus is expectorated, and the other suffering in the body is far greater; the fevers hold more feebly than before. If you take this patient at the outset, purge him downward with scammony juice, if he is without fever. After the purging let him take the same things as before, and let him take the same other measures, keeping the body as quiet as possible, and sleeping softly. Let him do these things at the outset for up to ten days. If he becomes one with suppuration within (empyos), let him do the same things as the former patient. If he becomes well, he must abstain from these: foods and drinks that are sour, sharp, salty, and fatty; and from hard labor — abstain from the same things as the former patient. If he does these things, he will be rid of the disease most quickly. But if he fails to do any of these things, he will be in danger of relapse, and the disease will go worse. For most who have burst vessels in the lung (pleumorrhōgees) continue in that condition until they die. If one does not heal this patient immediately, and the disease has relapsed, one could not afterwards help him unless one does the following: having fattened him on cow's milk, cauterize the chest and the upper back. For if you succeed in cauterizing, the same benefit would come about. This disease arises from the same faults as the one before. Pneumonitis (Pleumonís) arises chiefly from the following: whenever the lung draws blood or salty phlegm into itself and does not release it again, but it gathers and congeals within — by these things abscesses (phymata) tend to form in the lung and it becomes suppurated. [Section 3] The following things happen to this patient from the outset and throughout the disease: a sharp dry cough takes hold, and shivering, and fever; and pain settles in the chest and in the upper back, and sometimes also in the side; and severe orthopnoia strikes suddenly. He continues to suffer these things for up to fourteen days — often for more — and then pus bursts and he spits out much; often he spits out what looks like cobweb-membranes, and often also something blood-tinged. If the lung is quickly cleared and dried out, there is hope of escaping. But if it holds on, the disease extends for a year, and it shifts, with the patient suffering in different ways at different times. For this patient at the outset, before the pus bursts, one must apply the following: whenever the fever lets up, bathe him in much hot water, and use many gruels; pour honey into well-boiled barley-water after it is cooked through, and let him drink it down; and let him drink sweet white wine or cooked melikraton. When he has once begun to spit pus, let him drink the same things as the former empyos (patient with suppuration within), and let him use the same foods and drinks and relishes, abstaining from sour, sharp, salty, and fatty things, and from sexual intercourse and heavy drinking (thōrēxiōn), unless these are advantageous for the disease. Watching the color, practice your judgment as to what he seems to need. Let him do the rest in the same way. Let him drink both cow's milk and goat's milk in season; but first let him be purged downward with boiled ass's milk; and let him also drink horse's milk — strained, each day at dawn — a three-kotyle cup, if he is able. If then, being cared for in this way, he improves and the pus does not burst into the chest cavity, let him attend to himself — keeping the body as quiet as possible and applying to himself what is beneficial. But if the pus bursts into the chest cavity, in the place where it seems to you to be pointing most clearly, cutting or cauterizing there, let out the pus little by little at first. Do the rest in the same way as has been written in the case of the former patient who became suppurated. If a varix (kirsos) forms in the lung, a dry cough seizes, and shivering, and fever — at the outset of the disease very intensely. There is also orthopnoia; pain has settled in the head; the eyebrows seem to hang down heavy; and swelling comes down into the face, the chest, and the feet; often it presses also into the head; and under the pain, when the distress holds, he cannot look upward. The body is somewhat pallid, and the vessels run through it either flame-colored or black. [Section 4] This patient, when he is in this condition and the distress presses hardest — first draw blood; then bathe him in much hot water; and when thirst holds, give him a kykeōn (mixed drink) to drink in dark austere wine, as pleasant as possible, mixed equal with equal. It is best to drink it cold. Use gruels of well-boiled barley-water, pouring in good honey. These things must be provided in the first fourteen days. If the disease holds on longer, and the suffering in the body is greater and weakness is present, then in this condition apply the same things as in the case of the patient with pus running from the lung, once the fourteen days have passed. This disease arises from hard labor and from black bile (cholē melaina). When the hollow small vessels running through the lung are filled with blood or black bile, and the small vessels burst into one another — since they are in narrow places and are caught there and have no outlet — they produce pain and wind (physa) in the lung. [Section 5] This disease is difficult and requires much treatment; if it does not receive this, it does not willingly leave the sick person, and for the most part it dies together with most of them. If inflammation (phlegmonē) occurs in the lung — and it arises most of all from wine-sodden excess and from gluttony on fish-heads and eels, for these have a fat most hostile to the nature of the human being — the disease has also arisen from phlegm, when it mixes with the blood and flows onto the lung. It also comes on from eating too much meat and from a change of water. [Section 6] The following things then happen: he coughs hard, and spits out saliva — moist and copious, often also thick and white, like that from laryngeal swelling (branchos); sharp pain presses into the chest and the upper back, the hollows of the flanks, and the sides; he belches sharply; and from the chest and lungs a sound of gurgling arises as from a stomach; he vomits sharp bile-matter (lapē), and if you pour the vomit onto the ground it etches the earth as when you pour vinegar; and his teeth are set on edge; shivering and fever hold, and strong thirst; and if he wishes to eat anything fatty it draws inward toward the viscera (splanchna) and brings on vomiting; and the whole body is seized by numbness. When he has vomited, for a short time he seems easier; then as the day grows later the belly rumbles and twists and gurgles. When this patient is in such a condition and it seems the moment is right, take up the treatment as follows: mix honey, milk, vinegar, and water; pour these into a small pot and warm them; stir with sprigs of headed marjoram; when lukewarm, give it to drink — or taking hold of the tongue, pour it in gently through a tube; then bid him curl up and keep still; then if vomiting comes on, let him vomit eagerly; if it does not come on, let him tickle himself with a feather and vomit; and if he vomits any phlegm, let him do the same thing for five days — for he will be easier doing this. Let him drink this after exercising if he is able, and after bathing in much hot water; if not, at least after bathing. When the five days have passed, let him drink early while fasting — in melikraton or wine-honey — silphion juice in the amount of a bitter vetch seed; and let him eat garlic and radishes while fasting, and drink down unmixed wine — dark or white austere — as a chaser; let him drink also with food and after food. Let him use dry solid foods and boiled ass's flesh or dog's flesh, if shivering and fever do not seize him. If he is purged somewhat by this kind of infusion — well and good. If not, purge him upward with hellebore; after the purging give him two bowls of boiled flour to drink, with honey poured in; let him drink the same wine diluted with water. But if you are not present at the outset of the disease, fatten him on milk and cauterize the chest and the upper back; for so he would be most freed from the disease. If he is not cauterized, it stays on and does not readily leave, but persists until old age; and often it dies along with him — unless he dies in the first forty days. But great and constant vigilant care (meledōnē) is required: let him drink whey and milk in season — cow's, goat's, ass's, and horse's — for so he would live most easily; but the disease is difficult. If the lung swells from erysipelas — this swelling arises chiefly from blood, when the lung draws blood into itself and retains it — the disease arises most in summer in its season. [Section 7] The following then happen from it: a dry cough comes on, and shivering, and fever, and orthopnoia, and strong pain in the chest; he opens his nostrils wide like a horse that has been running; he thrusts out his tongue like a dog in summer that is being scorched by the pneuma (breath / moving air) in the heat; swelling holds the chest; his voice is faint; redness and itching afflict the body; and because of the pain he cannot lie down, but throws himself about in distress. This patient dies most often within seven days. But if he escapes these, he does not readily die. This patient, when in this condition, treat as follows: cool the body — dipping beet-leaves in cold water and laying them on the body, especially against a fresh pain; or dipping rags in cold water and wringing them out and applying them. If he improves in this way — good. If not, plaster with cold potter's earth, and let him sleep in the open air. For if he is treated in this way, he will often escape the seven days. When the seven days have passed and the pain persists, be present — anointing the painful part with oil — and apply warm compresses, especially the same ones as for pleuritis; and give him to drink, for downward purging, the juice of peplos, and of poppy, and of the Knidian grain; and after the purging give him a bowl of lentils to drink down, and let him drink water. On the following day bathe him in much hot water, except for the head; then give him marjoram soaked in melikraton to drink; let him use drinks as hot as possible; let him take the same foods as the man seized by pleuritis, provided fever does not persist. This disease is difficult, and few escape it. If the chest and the upper back rupture — and it ruptures most from hard labor — the following things then happen. [Section 8] A sharp cough takes hold, and sometimes he spits out saliva tinged with blood; shivering and fever seize him most often; and sharp pain is in the chest and the upper back; and in the side it seems as though a stone lies within; and he is stabbed through by the pain as if a needle were pricking him. This patient, when in this condition, fatten at once on milk, cauterize the chest and the upper back, and so he will recover most quickly. For the rest, let him order his life (diaita) keeping the body as quiet as possible. For if he exerts himself — mounting a wagon or a horse, or laboring hard under a burden on his shoulders — the disease will be in danger of relapsing; and if it does, there is danger of destruction. For the disease when it turns back presses harder than at the start. If he is not cauterized, treat him with the same means as the empyos — gruels, drinks, and foods. In sum: let him feed well on suitable things while keeping quiet. For if he is treated in this way, he will recover most quickly; but the disease is difficult. If an abscess (phyma) grows in the side and there is internal suppuration, the following happens: shivering takes hold and fever, and a dry cough for many days; the side aches; and shooting pain runs to the nipple, the collarbone, and the shoulder-blades. [Section 9] When this patient is in this condition, in the first eleven days let him use gruels — well-boiled barley-water with honey poured in when the gruel is cooked through. Let him use white wine — sweet or austere and well-diluted — and when taking repeated drinks of wine, bid him spit it out; and keep him from sleep until the eleven days have passed. After these days let him use food in as small amounts as possible — puppy-flesh or cock's-flesh while hot; he should be well-broth-fed, and let him drink down the broth; and let him use the gruels before the solid food, and not be thirsty — until the side becomes suppurated. Suppuration comes about most often in forty days or a little before. You will know when the side has become suppurated by this: pus is not expectorated nor vomited up. When this patient is in this condition, wherever the swelling points out, cut or cauterize; then let the pus out a little at a time; and when you have drawn it off, insert a plug (motos) of unspun linen; and again on the following day, drawing it out, drain off the pus a little at a time; then plug again; and again on the third and the following days drain off twice a day until it dries up. Give him also foods and relishes when he accepts them; let him drink a little — not much — whether wine or water. Let him eat as much tender marjoram as possible, dipping it in honey; and if he does not have tender marjoram, use dried — making it fine, mixing it in honey — give as much as possible in a smooth paste; and bathe him in baths; let him not shiver; and let him sleep softly. Treating this disease in this way, you will make him well most quickly. When he becomes well, let him guard against cold, heat, the sun; let him use only short walks after food, so that fatigue does not seize the body. Doing these things, he will be well. For whichever of these diseases you cauterize: on the burns, crush many leeks and plaster them on immediately after the cauterization, and leave them on for one day. There are three phthiseis (wasting-conditions, phthisis). The first: this arises from phlegm — when the head, having filled with phlegm, becomes diseased and fever arises, the phlegm becomes corrupt in place in the head, being unable to move and drain away. Then when it thickens, and becomes putrid, and overfills the small vessels, a flux comes onto the lung; and when the lung takes it up, it falls ill immediately, being gnawed (daknomenos) by the phlegm, which is salty and putrid. 10 [35] The following is what he suffers: a sluggish fever begins to take hold, and shivering, and he has pain in the chest and the upper back; sometimes also a sharp cough presses upon him, and he spits out much saliva, watery and salty. These are what he suffers at the outset of the disease. As it advances, the body wastes thin, except for the legs—these swell, and the feet too, and the nails are drawn in; from the shoulders upward he is thin and weak; the throat fills as though with down, and it whistles as though through a reed, and he is intensely thirsty throughout the whole disease, and great powerlessness grips the body. When he is in this condition, over the course of a year he wastes away and dies wretchedly. One must attend to him as carefully as possible and try to bring him back. First, give hellebore to drink; purge downward with dodder, or peplis, or Cnidian berry, or spurge-juice. These purges must be given four times in the year: twice upward, twice downward. Also give boiled ass's milk as a downward purge, or cow's or goat's milk. Let him drink raw cow's milk, mixing in one-third part of honey-water, for forty-five days, mixing in also the origanum. The head must first be purged by applying a medicinal drug to the nostrils. Give foods and dishes that are neither fatty nor greasy-smoky nor too sharp. One must do these things judging the disease, and use walks before meals, judging so that he does not shiver; in winter let him take up his lodging by a fire. Let him drink wine—austere, dark, as old and as pleasant as possible—but little. And if it seems good to you to give a vapor-bath before the drug and then administer the drug in this way; or if you do not wish to give the drug, after a vapor-bath, force him to bring up vomit from his food, as has been written before. If walks benefit this man, let him use them; if they do not benefit him, let him keep the body as much at rest as possible. Tended in this way, he will best get through the disease; but the disease is deadly, and few escape it. Second phthisis (wasting / consumption): this arises from hard labor. He suffers mostly the same things as the one before; but this disease gives more remissions than the former, and lets up in summer. 11 [10] The saliva he spits out is thicker than in the former case, and a cough presses especially on the elderly, and the pain in the chest is stronger, and it seems as though a stone is lodged in it; the upper back also pains him; his skin color is watery, and if he exerts himself at all, he is seized with flatulence and labored breathing. This man dies from this disease chiefly within three years. One must attend to him with the same things as the one before. This disease holds on for most people up to three years, but they die; for the disease is severe. Third phthisis (wasting / consumption): from this he suffers the following: his spinal marrow becomes full of blood and bile. 12 [55] Wasting occurs similarly also from the hollow vessels; these become filled with watery-dropsical phlegm and bile. They suffer the same things, from whichever source the wasting comes, and the person immediately becomes dark and slightly swollen, and the patches under the eyes are pale-yellow, and the vessels in the body are stretched pale, some of them very red; most visible are those under the armpits. He spits up yellow matter, and when it comes upon him he is choked and sometimes cannot cough even when he wants to; and sometimes under the choking and the urgency of the coughing he vomited bile all at once, sometimes foam, and often his food when he has just eaten; and when he has vomited, he seems to be lighter; then after a short interval he again lies in the same pains. This man also speaks in a higher voice than when healthy, and an intermittent shivering and fever take hold of him along with sweating. When he is in this condition, attend to him with foods and gruels and drinks and drugs and everything else, just as the foregoing patients. The disease extends for the most part nine years, then he wastes further while perishing; few escape from it, for the disease is severe. If you wish, treat him thus: first give a vapor-bath, and when he has been vapor-bathed, on the following day give him to drink a half-chous of honey-water and pour in a little vinegar, and instruct him to drink this without breathing; then wrap him in many garments for as long as possible. If he cannot bear it but wishes to vomit, let him vomit. But if vomiting has not taken hold when time has passed, let him drink a large cup of warm water and vomit by tickling with a feather; when he has vomited sufficiently and is well, let him keep quiet that day. When the dinner hour comes, let him dine on a small barley-cake, and let his relish be salted fish and leeks—of these let him eat as much as possible—and let him drink sweet wine. For the remaining time, let him bathe every day at dawn in much hot water, and after the bath care must be taken that he does not shiver, but let him lie down and sleep as long as possible. When he rises from sleep, let him walk at least twenty stades on that day; on the other days let him walk five stades more in succession, adding each day, until he reaches one hundred stades. The belly must be purged by day with juice of beets and from cabbage, cooking each separately and straining off a chous of each; then mixing them together, cook together; and the sheep's kidney-fat, one quarter of a mina, divide and cook in both juices; when it is about to be drunk, add salt alongside the cabbage juice, and pour honey into the beet juice; it is also possible to drink each separately, or pouring honey alongside one cup and salt alongside the other; all the juice must be drunk. These things must be done for thirty days. In the second month let him eat bread and fat boiled pork, nothing else; let him drink white austere wine, and walk no less than thirty stades before dinner, ten after dinner, and not shiver but be well covered. If he does these things, he will bear the disease more easily. In the third month let him drink a mixed drink made from flowers: roots of celery, dill, rue, mint, coriander, tender poppy-heads, basil, lentil, and juice of sweet and wine-dark pomegranate—the sweet ones must be double; there must be half a kotyle of the combined juice and half a kotyle of sweet, austere, dark wine and half a kotyle of water; then grind the flowers fine, dissolve in this already-mixed preparation, and pour into a cup; then add a saucer-measure of bitter-vetch flour, and an equal amount of barley-meal, and grate aged goat's cheese equal in amount to the bitter-vetch; having stirred these together, let him drink; then after a short interval let him breakfast on bread, and let his relish be a slice of torpedo-fish or skate or dogfish or ray, and let him eat boiled pork, and let him fatten himself, keeping as much at rest as possible, and use a vapor-bath every tenth day, gently, breathing it in. 12 (50) [75] In the fourth month let him use a vapor-bath every fifth day, gently, and eat as much relish as possible; let his relish be cheeses and a little meat, boiled mutton. Let him also walk the stades as stated before, starting from the first day of the fourth month walking ten stades, adding each day until he reaches eighty stades; let him walk eighty stades per day—[thirty before dinner,] twenty after dinner, thirty at dawn. For the remainder of the time let him follow a diaita (regimen / way of living) eating both barley-cake and bread, and have cartilaginous fish as his relish, and let him eat all meats except beef and pork; of fish let him abstain from these: mullet, eel, and black-tail; let him eat torpedo-fish, skate, ray, dogfish, stingray, and frogs, and nothing else. And if it seems harmless, also let him drink a mixed drink when he wishes to sleep—a two-kotyle cup from sweet, pleasant, old dark wine—and during the day use the same wine with his food. And let him walk in the day one hundred and fifty stades—[ninety before dinner,] twenty after dinner, forty at dawn. Treated in this way he recovers within a year. The spinal marrow dries out most when the small vessels reaching to the marrow are blocked, and also the passage from the brain. 13 [5] From abuse of the body he suffers and falls ill as follows: he wastes most especially also from sexual intercourse. The following, then, is what he suffers: a sharp pain falls upon him in the head, and in the neck, and in the lower back, and in the muscles of the lower back, and in the joints of the legs, so that sometimes he cannot bend them; and the stool does not pass through but stands still, and he has difficulty urinating. At the outset of the disease this man gets on in relative quiet; but as time is prolonged by the disease, he suffers everything more, and the legs swell as from dropsy, and ulcers erupt from the lower back, and some of them heal while others keep coming up alongside. When he is in this condition, after vapor-bathing the head, purge the body thoroughly first with the juice of horse-fennel or the Cnidian berry; in the evening after the purge let him drink two bowls of barley-gruel, pouring in honey; and let him drink soft white wine. On the following day give him eight kotylai of boiled ass's milk to drink, pouring in honey; if you do not have ass's milk, three half-choes of boiled cow's or goat's milk, pouring in honey; and let him drink milk in season with whey and milk for forty-five days. Let him use foods and dishes of the most laxative kind; and let him drink white, soft, Mendesian wine. When he is at his fattest, cauterize him in the lower back on each side of the vertebrae with four burn-marks, and in the upper back fifteen on each side, and in the neck two between the sinews; for if you succeed in burning, you will make him healthy; but the disease is severe. The four diseases arising from the kidneys: from the first he suffers the following: a sharp pain falls into the kidney and into the lower back and into the flank and into the testicle on the side of the kidney, and he urinates frequently, and the urine is passed with straining and little at a time, and along with the urine comes sand, and when the sand passes through the urethra it causes strong pain in the urethra; when it has passed through in urination, the pain lets up; then again he lies in the same pains; and when he urinates, he also rubs his penis because of the pain. 14 [20] Many physicians who do not understand the disease, when they see the sand, think the bladder is forming stone—not the bladder, but the kidney forms stone. This disease arises from phlegm, when the kidney takes phlegm into itself and does not release it again but it solidifies there; this becomes fine stones like sand. When he is in this condition, purge him downward with the juice of scammony or with the root itself, first vapor-bathing the whole body; on the following day purge him downward with the juice of white chickpeas, two choes' worth, adding salt and giving it to drink; after this, attend to him with drinks and foods and baths, giving the same drugs that are given to one suffering from strangury. When the pain presses, wash with much hot water, and apply warm fomentations where the pain is greatest. When it has swollen up and protruded, at about that time cut toward the kidney, and drawing out the pus, treat the sand with diuretics; for if it is cut, there is hope of escape; if not, the disease dies with the person. Second disease of the kidneys: the pains press strongly as in the former case. 15 [15] The disease arises from hard labor, when the small vessels reaching to the kidney rupture and then the kidney fills with blood. When this happens to him, he passes blood along with his urine at the outset of the disease, then pus as time advances. If this man keeps the body at rest, he will recover most quickly; for if he exerts himself at all, the pains will grip him much more. When the kidney is suppurated, it swells up along the spine; when he is in this condition, cut at the swelling, making as deep an incision as possible toward the kidney; and if you succeed in cutting, you will make him well immediately; if you miss, there is danger of a plugged wound developing. If the wound closes, the cavity from the kidney suppurates internally; and if it breaks inward and the pus passes through the rectum, there is hope of escape; but if it touches the other kidney, there is danger of utter destruction. Attend with drugs and with all the same things as the former patient, and let him follow the same diaita (regimen); this disease is severe, and many from this disease have fallen into phthisis of the kidneys (kidney-wasting). Third disease of the kidneys: the urine that comes out is like the juice of roasted beef. 16 [15] The disease arises from black bile, when bile flows together into the small vessels reaching to the kidney, and when it stands still it ulcerates the vessels and the kidney; under the ulceration, therefore, such matter passes with the urine. The pains are located in the lower back and in the bladder and in the perineum and in the kidney itself, for a short time; then the pain lets up and again seizes sharply after a short interval; and sometimes pain falls into the thin part of the belly. When he is in this condition, purge the belly downward with dodder or the root of scammony; give him to drink the same things as the one suffering from strangury; and when the pain grips, wash with much hot water, applying warm fomentations where the pain is greatest, and let him use a gruel of boiled meal with honey poured in, and in other respects follow a diaita (regimen) of the most laxative kind, and let him drink white honey-colored Mendesian wine, or another white wine of the most pleasant kind well blended. This disease does not readily leave off; and in season let him drink whey and let him drink milk—using the whey for purging, and drinking milk in season for forty-five days. If you do these things in this way, you will bring the disease to a better state. Fourth disease of the kidneys: the disease arises from bile and phlegm, and chiefly at the season of summer; the disease also arises from sexual intercourse. 17 [40] He suffers the following: pains press upon him in the flank and in the groin and in the lower back and in the muscles of the lower back, and he suffers as a woman in labor, and he cannot lie on his healthy side but is in great pain, and the parts of the groin seem to hang as though they will tear away; but if he lies prone, he feels no pain; his feet and shins are always cold; the urine comes out with difficulty on account of the heat and thickness of the urine; and if you let it stand a short time, setting it down until it settles, you will see the sediment thick, like flour; if bile predominates, you will see it reddish; if the disease is from phlegm, it will be white and thick. At first he continues to suffer these things for a year, or a little more or a little less; but if the disease extends in duration, he suffers more and suppuration forms, and when it has suppurated and swells, wherever it chiefly swells, cut toward the kidney and let out the pus; and if you succeed in cutting, you will make him well immediately. When he is in this condition, treat him with all the same things as before; and at the outset of the disease one must purge, and vapor-bathe before the downward purge; and with baths let him not bathe frequently but be anointed rather, and not shiver, and let him keep away from the sun, and not have sexual intercourse. If he does these things and does not recover quickly, that is not surprising; for the disease is severe. If you wish to treat him without drugs, one must fatten him by means of diaita (regimen)—whether he is suffering this disease or one of the former ones—dividing the food he had been accustomed to eat into, say, ten portions; then taking away one portion, let him eat the rest, and let his relish be minced pork, and let him walk ten stades on that day; on the following day and the third day up to ten days, taking away a portion each time, let him eat less, and walk ten stades more each day in succession; when he arrives at the last food-portion and at one hundred stades, let him eat that one portion only, and on that day let him walk the one hundred stades—forty before dinner, twenty after dinner, forty at dawn; and let him drink Mendesian wine, white, austere. Let him do these things for three days; then for the remaining time, reducing the walks, let him eat more food, adding in the same way as he had taken away; and let him reduce the walks over ten days; then let him keep as quiet as possible, and feast on clean foods and as rich relish as possible, and all sweet things are beneficial for him; let him abstain from all vegetables and all sour and sharp things, and from whatever produces flatulence; let him wash in much hot water, and not shiver. If he does these things, he will recover most quickly. Following on kidney disease, this great disease of the hollow vessels takes hold—those that extend from the head along the jugular veins through the spine to the outer ankle of the foot and to the space between the great toe. 18 [5] The disease arises from phlegm and bile, when they flow together into the vessels; these vessels are full of blood; if therefore anything of a different sort enters them, they fall ill. The following, then, is what he suffers: if the disease is on the right side, the pain begins to arise from the cup-shaped cavity of the hip at the outset; and as more time passes and is prolonged, the pain grows sharper and descends lower, and when it arrives at the outer ankle of the foot and the space between the great toe, it begins to travel back up to the head, and when the pain settles in the head it presses strongly, and the man feels as though his head is being torn apart, and the eyes fill with phlegm and so does the whole body. When he is in this condition, give him elaterium to drink, or root of thapsia, or hellebore, or juice of scammony; after the purging apply the same things as to those before. But if it does not cease under this treatment, after fattening him with milk, cauterize below the right shoulder-blade four burn-marks, and in the cup-shaped cavity of the right hip three, and under the buttock two, and in the middle of the thigh two, and above the knee one, and above the ankle one. If he is cauterized in this way, the disease will not pass through either upward or downward. But if the pain happens to burst through somewhere before cauterization: if it settles in the leg, he will be lame; if in the head, deaf or blind; if into the bladder, blood passes along with the urine for as many as forty days. But if it bursts into the bladder, one must give the same drugs as to one suffering from strangury; and wherever else the pain settles, cauterize; and one must cauterize fleshy parts with irons, but bony and sinewy parts with mushroom-cautery. But one must first do the following before all these: if you are present at the outset of the disease, give to drink as much diluted white Mendesian wine as possible during the day, and let him be made drunk until he has a nosebleed; when it begins, let it flow for at least thirteen days; when these days have passed, let him no longer be made drunk, nor once it has begun to flow at all; yet let him drink a little more wine with his food, so that the blood continues to flow. In some cases already, when the blood stopped, it burst into the bladder and blood and pus moved through; if therefore it bursts, give the same drugs as to one suffering from strangury, and from the same wine give him more to drink. Attended in this way and taking laxative foods and relishes, he will recover most quickly; but the disease is severe. Another case arising from the left vessel: in most other respects he suffers the same things as the one before; but a sharp pain settles in the spleen right from the outset of the disease; and if you understand it immediately before it fixes in the spleen, cauterize with eight burn-marks using mushroom-cautery, catching the extremities of the spleen, as quickly as possible; and wherever else the pain settles, cauterize, and in this way he will recover immediately. 19 But if he has not been cauterized, yet recovers on his own, in most cases the disease returned again after twelve years; and if it takes hold of the spleen, in most cases it produced dropsy. But one must treat him immediately as before, and if it seems right, cauterize just as with the earlier patient, if the pain has settled in the same joints. If he is not attended to in this way, he wastes away and dies in the time remaining; for the disease is severe. Regarding phlegm, I hold the same views as I do regarding bile: that it has many forms. 20 The most recent form of it is epidemic, and the treatment is easiest. For one must induce vomiting after food, eating two or three days of morning meals and resting — if he had been accustomed in the preceding days to eating only once and to vigorous exertion. If not, let him follow the same diaita (regimen / way of living), but let him bathe in abundant hot water when he is about to make himself vomit. Let him eat barley-cake crumbled and dry-baked stale bread; for these draw the phlegm more. Let him use pungent relishes and vegetables; and the fatty, the sweet, and the sour things — all these are suitable to take combined together. Let him use all green vegetables, and let him drink sweet wine in small amounts frequently with his food; and at the end let him eat some cake and honey and figs; and when he has dined, let him drink the cups freely, and when he is already full, let him lie down a little, then rousing himself let him vomit after drinking a large cup of wine mixed in lukewarm water; for this draws the phlegm more from the flesh and the veins and dries the body more. Let him vomit until he vomits up the figs, for these are expelled last. So much for that day. On the following day let him restrain himself until dinner, and let him dine on whole-wheat bread; the relish should be from the more robust sorts; let him drink dark, astringent wine. This then is the treatment for epidemic phlegm. But if a man is capable of eating and drinking and takes pleasure in his food, yet then has his legs grow heavy and his complexion is altered, say to him that the phlegm troubling him is in the belly. But when he is in this state, one must give a clyster of honey, sweet wine, and oil, mixing in as much natron as an astragalus-bone of a sheep; for these are most favorable to the nature of a man for the clyster. The measure for each should be: one kotyle of wine, half a kotyle of oil, and an equal amount of honey. If you do not wish to give a clyster, you must make the man thoroughly moist by steaming him in a wet steam-bath; for in this way too his stool might be somewhat evacuated; since he is in this condition owing to the over-drying of his food. If someone eats foods that are sufficiently juicy, he would perhaps not suffer these things so severely; and if he did suffer them at some time, he would need only slight treatment. Treating him in this way you would restore him to health most quickly. If it happens that the phlegm is of longer standing — this is called white phlegm — the following things occur: it weighs the man down more and seems to present a different appearance from the epidemic kind; he is more pallid, and the whole body swells with swelling, and the face reddens, and the mouth is dry, and thirst grips him, and when he eats, rapid breathing (pneuma [breath]) comes upon him thickly. This man at one time in the same day becomes easier, at another suddenly suffers greatly and thinks he is going to die. 21 For this man, if the belly is disturbed spontaneously, he will most nearly recover. If the belly is not disturbed spontaneously, one must purge by giving kneoros (κνέωρον) or hippophaes (ἱππόφαος) or cnidian berry (κνίδιον κόκκον) or Magnesian stone (Μαγνησίη λίθος) — the botanical and mineral identities of these purgatives remain disputed — and after the purging give one or two bowls of lentil soup to sip; let garlic be cooked together in the lentil soup, and give a bowl of rich beet, unseasoned, sprinkling barley-meal over it; let him drink dark, astringent, strong wine. On the following day let him walk twenty stades in the morning; when he returns let him eat a small dry-baked loaf, and let his relish be boiled garlic; and let him drink a little of the same wine, somewhat undiluted. Then let him walk thirty stades, and when the hour comes let him dine as much as he was accustomed to eat at breakfast, and let his relish be chiefly pig's feet and heads; or if not, let him use minced chicken or pork; of fish, scorpion-fish or dragonet or cuckoo-wrasse or callionymus or goby or whatever other fish have equal potency. Let him use only garlic among vegetables and none of the other vegetables; let him eat these as much as possible, both raw and roasted and boiled, always more each day, and let him exert himself in proportion to his food, increasing gradually from a little. This disease arises most in the summer season from drinking water, and also from much sleep. It is decided in thirty days whether it is fatal or not. Let him do these things when the thirty days have passed. In the first days let him use as his broths lentil soup boiled and more liberally seasoned with vinegar, and sharp barley-water; let him drink warm mead, sprinkling in a little barley-meal, so that the body may be unworked-up in preparation for taking the drug; and let him sleep in the open air during these days. And if it seems right to you to draw blood from the lumbar region, apply a cupping-vessel, and scarify the thickest veins in the scrotum. Treated in this way he will recover most quickly. It passes from phlegm most often into dropsy in the following manner: the fat melts and becomes water under the heat that is present in the phlegm. 22 You will recognize in this case who is capable of being cured and who is not. As long as the fat still lies over the lower belly, he is capable of being cured. You will recognize most readily whether fat is present over the lower belly or not by these signs: if fever comes on and he cannot rise and the navel protrudes outward swollen, say that the fat is no longer present and that he is not curable. But if no fever comes on, and he is able to rise, and the navel does not protrude, say that fat is present and that he is curable. For him it is beneficial to dry out the belly, giving whole-wheat bread, warm, not stale, and as relish the flesh of ass and of a full-grown dog, and of sheep and pork, all roasted, and roasted chicken warm; and let him eat octopus boiled in dark astringent wine. Let him drink dark wine as thick and astringent as possible. Of fish let him use goby, dragonet, callionymus, cuckoo-wrasse, scorpion-fish and all others of this kind, boiled, day-old, and cold; for these are by far the driest, and he should not dip them in their broth, and the fish should be unsalted. Of vegetables let him use radishes and celery. Let lentils be boiled with vinegar more liberally and let him eat them, and let him walk each day, both after dinner and at dawn, and let him sleep in the evening and rise early. And if he is brought into order by these measures, enough. But if not, give him kneoros to drink, or juice of hippophaes, or cnidian berry, and after the purging let him sip two bowls of lentil soup and eat a small loaf. Let him drink dark, astringent wine, a little. Let him drink the drug twice a day until he becomes loose in the belly. If the swelling has settled in the scrotum and the thighs and the lower legs, one must scarify with a very sharp lancet, many cuts close together. If you do these things you will quickly restore him to health. Dropsy: Dropsy arises from the following: when in the summer season a man who is thirsty drinks a great quantity of water in one draught, from this it most readily tends to arise; for the lung, being filled, releases it again into the chest, and when it comes to be in the chest it produces intense heat so as to melt the fat that is present along the arteries, and once the tallow begins to melt it produces dropsy in great quantity in a short time. 23 It also arises if swellings grow in the lung and become filled with water and burst into the chest. That dropsy also arises from swellings — this is my evidence, both in the ox and in the dog and in the pig; for of four-footed animals it is in these most that swellings arise in the lung that contain water, and if you cut them open you would know it at once, for water will flow out. It also seems that such things arise in a human being far more than in sheep, inasmuch as we also follow a more disease-prone diaita (regimen / way of living). And many have also become suppurating cases when swellings developed. The following things come on at the beginning of the disease: a dry cough, and the throat seems to be rough, and shivering and fever come on, and orthopnoea, and the skin has a puffy, swollen aspect, and the feet swell, and the nails are drawn up, and as long as the dropsy is in the upper cavity (thoracic region) the pain is sharp; but when it comes into the lower cavity (abdominal region), the patient seems easier; then as time goes on he suffers the same as before, as the cavity fills up. At times there is a swelling-out toward the side, and it indicates where one must cut. But if it does not clearly indicate, wash him with much hot water, grasp him by the shoulders and shake him; then listen on which of the two sides there is more sloshing. Having determined this, cut the third rib from the lowest, down to the bone; then drill through with a perforating drill; and when it is drilled through, release a little of the water; and when you have released it, plug with raw linen, and place a soft sponge on top; then bind it so that the plug does not fall out. One must release the dropsical fluid once a day for twelve days; after the twelve days, on the thirteenth, release all the water, and in the remaining time if any water accumulates, release it, and dry out the belly with foods. The following must be given after the incision: prepare a drachma's weight of silphium juice, and scrape aristolochia to the amount of a deer's astragalus-bone, and of lentils and bitter vetches parched, having sifted their meal to a half-choinix of each, mix these with honey and vinegar; then mold sixty small loaves, and each day grinding one dissolve it in a half-kotyle of dark wine, as astringent as possible and as palatable as possible; then give it to drink on an empty stomach. For the rest, order him to follow the same diaita (regimen) and exertion as in the previous time, and if the genitals and the thighs swell, scarify with confidence. If you attend to him in this way you will restore him to health most quickly. Dropsy from the liver: Dropsy from the liver arises when phlegm comes upon the liver and the liver absorbs it and becomes thoroughly moistened. Straightway it produces heat in him and creates flatulence, and then in time becomes filled with water; and then a gnawing falls upon the body, and there is swelling in the lower legs and in the feet, and the liver is hard and swells, and the collarbones grow thin. 24 For this man, when he is in this condition, give at the outset of the disease — if the liver is painful — marjoram ground up, dissolving a quantity of silphium juice the size of a bitter vetch in half a kotyle of white wine, to drink; and goat's milk, mixing in a third part of mead, a four-kotyle cup. Let him abstain from food for the first ten days; for these decide whether it is fatal or not. Let him sip the juice of barley-water, pouring in thoroughly boiled honey; let him drink white Mendaean wine or another of the most pleasant kinds, well-watered. When the ten days have passed, let him take clean foods, and let his relish be roasted chicken meat, warm; let him also have boiled puppy-meat; of fish let him use thornback and torpedo fish, roasted. Let him drink the same wine. If he stops from these measures, enough. If not, when he himself is at his fattest and the liver at its largest, cauterize with fungi-cautery; for in this way you would restore him to health most quickly. One must burn eight escharae. If dropsy forms and bursts into the belly, treat with the same remedies as before — drugs and drinks and foods and exertions. Let him drink dark, astringent wine. If it seems to you that it is drawing away from the liver somewhere, cauterize with iron wherever it appears, and release the water a little at a time, and treat as the rest of the previous cases. If he does not recover under these measures, he wastes away and dies in time; for the disease is severe, and few escape it. Dropsy from the spleen: Dropsy from the spleen arises most from this cause: when it is the harvest season and the man himself eats a great quantity of fresh figs and apples. And many have also contracted the disease from eating many bunches of grapes and much new wine. 25 If he is about to fall into the disease, he is immediately in distress. Sharp pains settle in the spleen and shift also to the shoulder and to the collarbone and to the nipple and to the flank, and strong fevers grip him, and if he eats anything the belly is filled and the spleen is raised up and causes pain. If the disease goes on long for this man, for the rest of the time he suffers less; but when it is the harvest season and he eats of it, then he suffers most. This man, when he is in this condition, is to be attended to from the outset by giving hellebore upward, and downward kneoros or juice of hippophaes or cnidian berry; also give eight kotylai of ass's milk, pouring honey over it. If he is brought into order by these, enough. But if not, when the spleen is at its largest and swells most, cauterize with fungi-cautery, having removed their heads, or with iron instruments, with great caution and attention so that you do not cauterize through to the other side. These things are to be done from the outset of the disease, and the following diaita (regimen) is to be administered when there is no fever. Let him use wheat bread baked or a twice-baked loaf of hard wheat. Let his relish be Gaditanian salt-fish or saperde, and minced sheep's meat, and let him eat all sour and salty things, and drink astringent Coan wine as dark as possible. Let him abstain from sweet things. If he is able to get up and is strong enough, let him wrestle from the top of the shoulders and exert himself with many circuits throughout the day, and let him feast on what has been said, especially. If dropsy comes on, treat according to the same plan and with the same measures as the previous cases. Generalized dropsy: Dropsy arises from the following: in the summer season, if a traveler on a long road comes upon rain-water lying stagnant and drinks a great quantity of it in one draught, and the flesh drinks it in and retains the water within itself, with no passage-out occurring anywhere. 26 The following things then occur: if it is in the flesh, it produces heat both in the belly and in the body, so that the tallow that lies upon the belly melts. As long as this man walks, he seems to have nothing wrong; but when he stops walking and the sun sets, sharp pain grips him immediately. As the disease advances he becomes very thin; and if loss of appetite comes on as well, he becomes much thinner; and if he is unable to eat food and is incapable of exertion, he deteriorates further. In most such cases swelling also settles over the whole body, and in the thin man the complexion becomes livid and the belly large, and strong thirst grips him; for his viscera are dried out by the heat. As time advances, this man is eager to eat whatever anyone gives him and to drink, and he has no pain; but if the swelling persists, the complexion becomes pale for him, and thick dark veins are stretched throughout the body; he is irritable and distressed at everything, with no new cause; and the belly is full of water and large like a lantern, and as time goes on he does not accept food, but it seems to him to smell of wild cucumber from the nausea. For this man, when he is in this condition, give kneoros or juice of hippophaes or cnidian berry. These drugs must be given as follows: kneoros every sixth day, juice of hippophaes every eighth day, cnidian berry every tenth day. These must be given until he is thoroughly cleansed and becomes loose in the belly. The days in between let him feast on the same things as the previous patient. Most importantly, give him as much as possible of the same water by which he contracted the disease, so that it will stir up his belly and he will have a vigorous passage; for in this way you will restore him to health most effectively. If it seems right to you, also give frequent clysters: grind half a dose of kneoros, mix in a third of a kotyle of honey, and four kotylai of beet-juice, dissolve them, then give a clyster in this way; and on the following day give eight kotylai of boiled ass's milk to drink, pouring in honey or adding salt. After the purging let him use the same things as the previous patient; and on the days between let him use the same foods, drinks, and walks similarly. Treated in this way he will be freed from the disease quickly — in three months or six months. But if any neglect arises and he is not attended to at once, he dies quickly. And for the man who is wasting away, use the same things for treatment; but one must first make his body thoroughly moist by steaming, so that it may respond better to the drug. But one must attend to him at once; if not, for most people the disease grows old alongside them. The following clyster may also be given for whichever of the diseases you choose: taking two kotylai of white wine and half a kotyle of honey, and half a kotyle of oil, a quarter-measure of roasted Egyptian natron, and the leaves of wild cucumber — having pounded and pressed out one kotyle of the chymos (juice / fluid) — mixing all these together, pour them into a small new earthen pot; then bring to a boil and give as a clyster in this way. The liver disease: The disease arises from black bile, when it flows into the liver. It comes on most in autumn, at the turnings of the year. 27 The following things occur: sharp pain falls upon him in the liver, and under the lowest ribs and in the shoulder and in the collarbone and under the nipple, and a strong choking grips him, and at times he vomits up livid bile, and shivering, and fever is very strong in the first days, then afterwards grips him more feebly; and when touched the liver is painful, and his complexion is somewhat livid, and the foods he had previously eaten choke him when they press upon him and burn and twist the belly. These things happen at the outset. As the disease advances the fevers let up and he is filled by little food, and in the liver only pain remains, and that sometimes strong, sometimes lesser with remissions; and at times a sharp attack seizes him, and many times he has suddenly let go of the psyche (life-breath / living principle). For this man it is beneficial, when the pain is upon him, to apply among other things warm fomentations, the same as for pleurisy; and when the pain lets up, to bathe him in much hot water, and to give mead to drink and white wine — sweet or astringent, whichever is beneficial — and the same broths as for the one seized by pleurisy. For the pain, the following must be given to drink: grinding the yolk of a boiled hen's egg, pouring over it half a kotyle of juice of nightshade and mead made in water — half of half a kotyle — dissolving in these, give to drink; and this will stop the pain. Give it each day until the pain stops. Let him also drink silphium juice the size of a bitter vetch, and grind marjoram, dissolve in white wine, and so drink it fasting; let him also drink the drugs given in pleurisy for the pain. Let him also drink goat's milk, mixing in a third part of honey, and let the milk be four kotylai; let him drink this in the morning when he is not drinking the other things. Let him abstain from foods until the disease is decided. It is decided mostly in seven days, for during these it is shown whether it is fatal or not. If choking also comes on, the following must be given so that he may vomit: honey, water, vinegar, salt — mix these and pour into a new small earthen pot; then warm it and stir with sprigs of round-headed marjoram with its fruit; when it is warmed, give to drink lukewarm. Then wrapping him in cloaks leave him covered so that he sweats as much as possible, and when the urge to vomit has him, let him vomit eagerly, working with a feather; if he cannot vomit, let him first drink a two-kotyle cup of warm mead, then vomit; and if he vomits up anything of bile or phlegm, he must do the same again for four hours; for it will benefit him. After the crisis of the disease, attend to him giving small amounts of clean food; and if he likes to eat bread, let him eat bread as clean and as warm as possible; if barley-cake, let him eat it unkneaded, having first soaked it; let his relish be boiled puppy flesh or pigeon or chick, all boiled; of fish, thornback, torpedo, stingray, and small skates, all boiled. Let him bathe every day and guard against the cold, and let him walk a little for now, in safety. If he observes these things, there is no fear that the disease will return again; for indeed such a disease is severe and chronic. Another liver disease: The pains press in the same places in the liver, and the complexion differs from the former — for it is pomegranate-rind-colored. 28 [5] [A further hepatitis:] This condition strikes most of all at the time of summer; it arises from eating beef and from heavy drinking of wine, for all of these are most hostile to the liver at this season and cause bile to settle most against the liver. The patient suffers the following: sharp pains come on and do not leave off at any hour, but press ever harder; sometimes he vomits pale yellow bile, and when he has vomited, he seems to be somewhat easier; but if he does not vomit it up, the bile settles into the eyes, which become very yellow, and the feet swell. He suffers these things sometimes severely, sometimes less so. When the days in which the disease reaches its crisis have passed and the pain is lighter, he must conduct himself without fault in his diaita in the same way as before; for if he gets drunk at the wrong moment, or indulges in sexual intercourse, or does anything else unsuitable, the liver at once becomes hard for him, and swells, and throbs with pain, and if he makes any sudden exertion, the liver and the whole body suffer pain immediately. For this man, when he is in such a state and the first days have passed, apply steam fomentation, then purge downward with scammony; but if the belly is parched and burnt, give a clyster in the same materials as for those described before, whatever will draw well; and after the clyster, purge downward with boiled ass's milk — eight kotylai — adding honey to drink; give also goat's milk, mixing in a third part of melikraton, in the morning, a four-kotylai cup; give also two kotylai of boiled goat's milk, mixing in a third part of melikraton, or adding honey alone; give also mare's milk in the same way as the ass's milk. If the disease yields and departs under this care, that is sufficient; if not, cut the inner vein of the right elbow and let blood. If it does not seem right to you to purge downward with ass's milk, give two kotylai of raw cow's milk, mixing in a third part of melikraton, each day for ten days; then for another ten, adding a sixth part of melikraton, give to drink; and the milk itself, the remainder, give two kotylai until he is fattened up. If it does not stop even so, one must cauterize, when the liver is at its largest and projects out the most; cauterize with box-wood spindles, dipping them into boiling oil, and keep applying until it seems to you to be well done and burnt, or burn eight cautery-scars with tinder-fungus; for if you succeed in cauterizing, you will restore him to health, and for the remaining time he will manage more easily; but if the cauterization does not succeed, he fails to recover under the rest of the treatment and dies wasting away. Another hepatitis: for the most part the patient suffers the same quantity of symptoms as those before; but the color is dark — and the bile of the liver, filled with phlegm and blood as we reckon, bursts through; and when it has burst, he very quickly goes mad, and is distressed, and speaks incoherently, and barks like a dog, and the nails are crimson, and he is unable to see with his eyes, and the hairs on the head stand upright, and a sharp fever seizes him. 29 For this man one must apply the same things as for those before; but most die within eleven days, and few escape. First disease of the spleen: this kind of disease arises through the heat of the sun when bile is set in motion, whenever the spleen draws bile toward itself. 30 [5] The patient suffers the following: a sharp fever comes on at the outset; as the disease advances it lets go, except at the spleen itself — there heat persists continually; and sharp pain strikes now and again into the flank and the belly; food is taken at first, but does not pass through easily; as the disease advances, the color becomes pale, and strong pain strikes, and the collar-bones become thin, and food is not received as readily as at the outset, and the patient fills up from little; and the spleen becomes larger at one time of the same day and smaller at another. For this man, when he is in such a state, give hellebore to drink, and purge downward with the cnidian berry; in the evening after the purging, give a bowl of rather sharp lentil-broth to drink, and a bowl of well-oiled beets sprinkled with barley-groats; on the next day and the third, give a little bread; let him use lentils as a relish, and pork boiled and mashed in the lentils; let him drink austere, dark wine, rather unmixed, in small quantities, and let him rest during these days, except to walk a little indoors in the shade. For the remaining time one must administer the following: bread made of unsifted wheat as food; as a relish, let him have dog's meat — a larger dog — or goat or sheep, mashed, and Gadeiric salt-fish or the saperdēs fish, and let him take all things sharp and salty and astringent; let him drink Coan wine, somewhat astringent, as dark as possible; let him abstain from sweet and fatty and greasy things; let him not take silphion, nor garlic, nor pork, nor the mullet, neither salt-dried nor fresh, nor eel, nor any boiled vegetable without vinegar; of raw-foods, let him use radish and celery, dipping into vinegar, and let him eat barley-groats mixed with wine, and drink the wine undiluted; if he wishes, let him also eat bread broken into wine while it is warm; give also the following fish: scorpion-fish, dragonet, cuckoo-fish, goby, callionymus — give these boiled and cold. Give also each day the things that are going to thin the spleen: fruit of asphodel, or leaves of mistletoe, or carob, or fruit of chaste-tree, or rue, or root of didymaion; grind whichever of these you wish and give in a kotylē of austere wine on an empty stomach. If he is able, compel him to saw wood for thirty days, and let him exercise with his shoulders [wrestling or shoulder-work], and walk throughout the day, and sleep late and rise early, and feast on the things prescribed above. If he does not improve under these, cauterize the spleen with ten large cautery-scars when the spleen is at its largest and most elevated; for if you succeed in cauterizing as required, you will restore him to health, though not quickly. This disease requires care, for it is difficult and chronic if not treated immediately. Another disease of the spleen: it arises from the same causes as the one before; the patient suffers the following under this disease: the belly becomes distended, and then the spleen also swells and is hard, and sharp pains strike into the spleen; the color changes, and appears dark, pale-yellow, pomegranate-rind-hued, and the ear gives off a bad smell, and the gums draw back from the teeth and give off a bad smell, and sores burst from the shins, like the kind they call epinyktides; the limbs become thin and the stool does not pass. 31 [5] For this man, when he is in such a state, treat with the same medicines and foods and drink and physical exertions and all the rest; and give a clyster whenever the stool will not pass, using the following: half a kotylē of honey and as much Egyptian natron as can be held in a sheep's knuckle-bone; grind these and dissolve in four kotylai of water from boiled beets; then give the clyster thus. If the disease does not settle under these, cauterize his spleen as the one before, and if you succeed in cauterizing, you will restore him to health. Another disease of the spleen: it occurs mostly in the season of spring, and arises from blood; for when the spleen is filled with blood, it bursts into the belly, and sharp pains strike into the spleen and into the breast and into the collar-bone and into the shoulder and under the shoulder-blade. 32 [5] The color of the limb is lead-like, and he gets scratches on the shins, and large sores form from them, and the matter passing below comes up along with the stool, blood-tinged and rust-colored, the belly is hard, and the spleen is like a stone. This man is more apt to die than the previous ones, and few escape from it. For this man, when he is in such a state, treat with the same things as the one before, except do not give a medicine upward; but give downward from the cnidian berry; on the next day, eight kotylai of boiled ass's or horse's milk, adding honey; or, if not, boiled cow's or goat's milk, two choes, adding honey, alternating cup by cup; and give in the evening after the purging the same things as to the previous man after the medicine; and if it seems right to you, draw blood from the inner vein of the left elbow. For the remaining days, give each day on an empty stomach four kotylai of cow's milk, mixing in a third part of brine; treat with the same foods and drinks and the rest as those before; this man and those before must abstain from sexual intercourse and from heavy wine-drinking; and if it seems right to you, cauterize also when the spleen is at its thickest and largest; and if you succeed in cauterizing at the right moment, you will restore him to health; but if he does not become healthy under this treatment, he wastes away and dies over time; for the disease is exceedingly difficult. Another disease of the spleen: this disease also strikes most in spring, whenever the spleen takes phlegm into itself — it becomes large and hard at once; then it settles back again; and when it is raised up, sharp pains strike; and when it is slack, it is free of pain; and when time has passed in the disease, it appears dimmer, and rises up again, and quickly settles again. 33 [15] This man, when he is in such a state, at the outset of the disease cannot take food, and quickly becomes very thin, and the body has great incapacity. If the disease is not treated at once, or does not settle of itself, it recurs after an interval of five or six months; it abates most of all through winter. If you catch this man at the outset, cauterize ten scars into the spleen, and you will restore him to health immediately; but if you do not cauterize, treat with the same medicines as those before, and with foods and drinks and physical exertions; for in this way you would restore him to health most quickly. The color of this man becomes whitish, now somewhat pale, now parched-looking. Another disease of the spleen: it occurs most in autumn, from black bile; it arises from eating many raw vegetables and drinking water. 34 [10] The patient suffers the following: when the disease seizes him, he has strong pain in the spleen, and shivering and fever come on, and loss of appetite holds him, and the limb collapses quickly; the spleen does not become very large, but is hard, and slips in beside the viscera and draws inward pressing against them. For this man, when he is in such a state, treat with the same medicines and foods and drinks and physical exertions as the ones before, and if it presents the opportunity, cauterize in the same way as the others. This disease in most people, if treated at once, departs quickly. Four types of jaundice. The first strikes most in summer when bile is set in motion; bile settles beneath the skin and in the head, so that the body at once changes color and becomes yellow like a pomegranate-rind, and the eyes are yellow, and under the hair on the head there is something like down, and shivering and fever come on, and the urine passed is yellow, and a thick pale-yellow sediment settles under it, and in the morning, as long as he is fasting, it draws inward toward the heart and the viscera, and when someone speaks to him or questions him, he is nauseated and distressed, and cannot bear to listen; the stool when it comes is pale-yellow-white and foul-smelling. 35 [45] This man, when he is in such a state, most often dies within fourteen days; but if he survives these, he recovers. One must treat him in the following way: when the fever lets up, bathe him in much hot water and give him melikraton to drink; let him use as gruel the juice of ptisanē — barley-gruel — pouring in honey but not boiling the honey together with it during this period, until the fourteen days have passed; for these decide whether it is fatal or not. After this, bathe him twice a day, and nourish him at first with small amounts of whatever he takes most readily, then give more; let him drink as much white wine as possible throughout the day; and if as time goes on it seems to you that he is pale and weak, order him to perform vomiting after food, as described for the upper diseases. If he ceases from these causes, that is sufficient; if not, give hellebore to drink; after the purging in the evening let him eat soft barley-cake or the crumb of bread; as a relish let him eat a young chicken boiled twice through, with broth seasoned with onion and coriander and cheese and salt and sesame and white raisins; let him drink white wine, austere, as old as possible; purge the lower belly; on the next day use the juice from white chickpeas — one must pour honey into the juice — let him use this and drink two kotylai of the juice. Beginning on the third day, let him drink each day water boiled from the following: thin fennel-roots, a bundle as much as can be grasped in three fingers, boil in two choes of water until half remains; also boil a choinix of white chickpeas in two choes, and let half of that also remain; when these are reduced, strain them, set them out in the open air, and mix both together; blend this water with wine to drink, or let him drink the water itself alone, if he wishes, as much as possible; and let him drink no other water. If he does not accept this drink, prepare the following and give it thus: boil a choinix of white dried figs in two choes, strain, and set out in the open air; then let him drink this water, whether he wishes it plain or mixed with wine; let him not drink a large amount all at once, but at each impulse half a kotylē, so that diarrhea does not come upon him, and let him drink again after a short interval. It is also good to give the following to drink on an empty stomach each day: grinding fine and dissolving in a kotylē of old white wine — celery seed, cucumber seed, fennel fruit, Ethiopian cumin, maidenhair fern, coriander plant, white raisins; drinking these along with those things he will benefit and will recover health most quickly. The second jaundice: this one strikes in the winter season, from drunkenness and shivering; it begins first with shivering coming on, then fever also holds; and because of this the fluid in the body congeals in the skin. 36 [25] The signs that show he is in this state are: his body is livid and somewhat hard, and the veins are stretched throughout the body, yellow; they are larger and thicker than before; other veins also are stretched, darker, and if one cuts any of them, the blood will flow yellow if the veins are yellow; and if they are dark, dark blood will flow. And the garment lying next to the body cannot be tolerated because of the itching. This man is eager to walk and go about, but because of his weakness his legs give way beneath him, and he thirsts greatly. This disease is no less fatal than the previous one; it proceeds for a longer time if he does not recover in seven days; and if the disease is prolonged and becomes the eighth or ninth day, he takes to bed, and the disease and the pain press harder, and he cannot get up, and most waste away all at once at this time. For this man, when he is in such a state, if you are present at the outset of the disease, when the seven days have now passed, give hellebore to drink; purge the lower belly with juice as in the previous case, and give the other same medicines. Give also cantharides — without wings and head — four of them, ground and dissolved in half a kotylē of white wine, adding a little honey, then give thus to drink; let him drink this twice or three times a day. As the disease advances, treat with baths and steam fomentations; let him eat whatever he takes; let him drink white, austere wine, and take the same other things as those before. This disease is chronic and difficult if not well treated from the outset. The third jaundice: this one is called epidemic, because it strikes at every season; it arises most from repletion and drunkenness, and when one shivers. 37 [5] At once the body changes its character and becomes yellow, and the eyes very yellow, and the disease creeps under the hair and under the nails, and mild shivering and mild fever hold, and the body is weak, and there is pain in the head, and the urine passed is yellow and thick. This jaundice is less fatal than those before, and when attended to is treated quickly. For this man, when he is in such a state, scarify his elbows and draw off blood, then after steam fomentation give elaterion to drink; purge downward again on the third day with ass's milk. Give the same other gruels and drinks and foods as to the one before, and cleanse his head frequently, and give to drink from the charadrios bird [a folk remedy of obscure procedure], and bathe him in much hot water, and scraping the flesh in white wine give it to drink, and in all other respects use the same things, and he will be well quickly. The fourth jaundice: it arises from phlegm, and strikes most in winter; his color is white, and his chest becomes full of phlegm, and he spits out much saliva, and when he hawks up, hiccupping comes upon him, and he passes white, thick urine, and under it settles a sediment like flour. 38 [15] This jaundice is not fatal and is cured quickly when attended to. For this man, when he is in such a state, give the cnidian berry to drink, and after the purging give four kotylai of the juice of ptisanē — barley-gruel — adding honey, to be drunk up; let him keep the upper belly clean by producing vomiting as in the previous cases; for in this way one would most easily lead off the phlegm from the lung and the airways; and prepare gargling for him frequently. This man sometimes also has a mild fever, and slight shivering comes on. Treat the rest as for the previous jaundice cases, with medicines and steam fomentations and baths and foods and drinks and gruels; for in this way you would most of all restore him to health. The disease called typhos: this disease is called typhos; it strikes in summer season, when the dog-star rises, when bile is set in motion throughout the body. 39 [30] At once strong fevers hold him and sharp burning heat, and from the heaviness weakness and powerlessness of the legs, and he becomes most useless in his hands; and the belly is disturbed, and what is passed below is foul-smelling, and strong griping comes on. He suffers these things, and if someone wishes to raise him up, he cannot stand upright, nor can he look up with his eyes because of the burning heat, and if someone questions him, he hears but because of the suffering cannot answer. When he is about to die, he sees more sharply and speaks boldly, and asks for drink and food, and if someone gives it and he eats, he quickly lets go his psyche, unless he vomits it up. The disease in this man reaches its crisis in seven days or fourteen; many run through to twenty-four; if he gets through these, he will be well; for in these days it is shown whether it is fatal or not. For this man, when he is in such a state, treat in the following way: in the first days, abstain from bathing; but anoint him with wine and oil warmed toward bedtime, and abstain from food; give thin cold gruels; let him drink dark, austere wine if it benefits him; if not, white, austere, more diluted; if strong thirst presses, give a large drink of water at once and bid him vomit it up — do this two or three times in succession — and when the burning heat holds, dip rags in cold water and apply them wherever he says he burns most; if the body has shivering, ease off the coolings. When this man is suffering most, he may suddenly be in danger from the pain of letting go his psyche; but one must give him with urgency the medicines for pain, the same as for the man held by pleuritis. When he is able to get up again, restore him with food and drink and baths as quickly as possible; for the disease is difficult and few escape. Another typhos: this disease strikes at every season; it arises from moisture of the body, when the flesh absorbs moist food and large quantities of drink and becomes waterlogged; from these the disease arises most of all. 40 [5] The fever then begins, being tertian or quartan from the outset, and a severe pain settles in the head, sometimes also throughout the body at intervals; and he brings up saliva and belches frequently, and feels pain in the regions of the eyes, and the face puffs up, and swelling comes down into the feet; sometimes the whole body also swells up, and the pain sometimes runs to the chest and to the back, and the belly is disordered, and he stares with his eyes intensely, and he spits out much foamy saliva, and he seems to feel something caught in the throat, and it causes him to rasp; and frequently the throat becomes inflamed. When in this patient the pain presses thus, there sometimes also falls upon him a severe orthopnoea (upright-breathing difficulty), and often he suddenly lets his psyche (life-principle) go because of the pain within seven or fourteen days; but many carry through up to twenty-four days. Often too the disease suddenly remits and he seems to be well; but one must be watchful until the twenty-four days have passed, for if he escapes these, he does not on the whole die. For this patient, when he is in this state, one must in the first days give him a thin gruel of ground meal well boiled, pouring in light honey; and give him to drink dark wine, diluted as much as he may wish, a little at a time; and do not bring him solid foods until the days have passed; give him boiled cuttlefish in wine to eat, and let him sip the broth, and eat many radishes; and toast the seed of cress, grind and sift it fine; then, adding it to dark astringent wine with a little fine barley-flour, give it to drink in the morning; and let him abstain from bathing until the days have passed; and anoint him warmed with wine and oil at bedtime and wipe him down; and boil ten berries of glykyside in dark wine and give to drink; and make thoroughly boiled turnips and let him sip the juice, seasoning it with unsalted cheese and poppy and salt and oil and silphion and vinegar. If you also wish to give him a purging drug, give him Cnidian grain to drink, and after the purging give him two bowls of boiled rich flour to sip; and let him drink the same wine. Of these drugs and gruel-drinks and potions, whatever you give will benefit him, whether you administer them one at a time or several together, and so you will restore him to health most quickly; but the disease is difficult and few escape it. Another typhos: this one too arises from this cause — when bile, having putrefied, mingles with the blood throughout the blood-vessels and the joints, and when it comes to rest, a swelling rises up, chiefly in the joints and becomes fixed there, but sometimes also throughout the rest of the whole body, and it causes sharp pains; and many people from this disease become lame, when the bile, trapped in the joints, becomes indurated (hardened like chalk); and the pain strikes at intervals, every three or four days. 41 [35] For this patient, when he is in this state, the care should be as follows: when the pain holds in the body, one must make warm fomentations and apply them, having first rubbed with oil; and when the pain lets up, give him hellebore — but first vapor-bathe the whole body; on the following day, boil goat's whey and give two choes to drink, pouring honey into one chous and putting salt in the other; then let him drink cup by cup alternating until he has drunk it all; in the evening after the purging let him sip a bowl of lentils, and let him drink down a bowl of fatty beet-greens, sprinkling barley-flour over it; and let him eat the meat of a young chicken or a pigeon or a turtledove or of a sheep or a fat pig. Give the hellebore every sixth day; and if any of the joints swells up and is unwilling to subside, apply a cupping vessel and draw off blood, pricking with a three-cornered lancet into the knees, if the swelling is in the knees; but do not prick any of the other joints. During the days in between, let him take food: bread as well-baked as possible, and crumbly barley-cake as much as possible; as relish let him have above all unsalted roast bird; if not that, then also boiled, in broth, but without cheese or sesame or salt; and let him use the fleshiest fish, roasted in the same manner as the meats, or stewed through with oregano after being salted, rubbing them with oil; and let him drink white wine, if it agrees with him; if not, dark; and let him exercise with walks through the day and after dinner and in the early morning; and let him always drink whey and milk in season; and if it seems good to you, give him also boiled ass's milk. And when he becomes well, let him be on guard against cold and against stifling heat, and let him not fill himself too full with foods; for there is danger the disease will relapse. This disease then, when treated thus, resolves in six months; for these months decide whether it is fatal or not, even if treatment begins at once; but the disease is difficult and in most cases it carries them off with it. Another typhos: this disease arises when someone has gorged on all kinds of autumn fruit. 42 [30] In many people the disease arose also from the following: eating flatcakes and sesame-sweets and other honey-sweetened things without restraint. For cooked honey is heating and sticks to the belly-cavity; then when it has been boiled down in the belly, it seethes up, and suddenly the stomach rises and becomes inflamed, and seems about to burst; then suddenly a diarrhea supervened, and once it starts flowing it purges for many days, and many became well after this purging. When then the spontaneous purging has stopped, force him to drink three half-cotylae of the chymos (juice) of lentils, adding salt; after the purging from the chymos, in the evening let him sip a bowl of cold unsalted lentils, with much silphion scraped over it, and eat a bowl of fatty unseasoned beet, sprinkling barley-flour over it; and let him drink dark austere wine a little at a time. For the rest of the time let him do the same, and take as solid food well-baked bread and crumbly barley-cake as much as possible; in the first days let him eat well-boiled flour, cooling it and pouring honey over it; and let him drink dark astringent wine until the disease settles down — these things let him take. The one seized by the disease from autumn fruit has wind (gas) and colic and pain, and the food is unwilling to pass through, and his belly is large and hard, and he has chills and fever. For this patient, if the belly is disturbed on its own, it purges within twenty days at least, and when the purging stops he will be well at once; but if it is not disturbed on its own, purge him with the juice of hippophaes or with Cnidian grain; in the evening give him the same things as to the one who purged spontaneously; on the following day, if he has fever let him rest, and give him the same wine to drink in the coldest possible water; if he has no fever, let him follow a diaita (regimen / way of living) that is not moist but stronger, and let him walk, gauging it by his food intake. From this disease dropsy has already developed in many people, and if it seems good to you to give a clyster, use the same clyster as for the one with dropsy. If you wish, give the clyster as follows: scrape into a cotyle of hydromel the herb of thapsia, then administer it as a clyster in this way. This patient, treated thus, will most quickly become well. Another typhos: the disease arises when the moisture in the body congeals and dries out more than is fitting. 43 [5] In appearance, when he is held by the disease, he looks moisture-laden, somewhat pallid, translucent, resembling a bladder full of urine, except that he does not swell — rather he is thin and lean and weak; and chiefly the collar-bones of the body become wasted, and the face is severely emaciated, and the eyes are very hollow. These things he suffers from the disease; but if the color of his body is dark, the following are the causes: when black bile has entered the small vessels and the skin, and in addition to this when warmth supervenes, it is inevitable that under the warmth the small vessels are scorched and dried, so that the blood cannot move through the small vessels. The following things then he suffers on top of those others: he becomes thin and severely emaciated, and he blinks his eyes rarely, and he hunts flies off his clothing, and he is more ravenous for food than when well, and he takes pleasure in the smell of an extinguished lamp, and he has frequent nocturnal emissions; and often even while walking his seed (semen) is discharged. For this patient, when he is in this state, purge the belly with black hellebore — the upper way, clearly; and the lower with juice of scammony; after the purging give the same things as to the others, and give whey and the milk of a cow or goat in season; give also ass's milk for a mild purging. This patient, treated thus, most often becomes well within two years; and let him take whatever foods he wishes; let him feast as much as possible and let him walk, gauging by his food intake. This disease takes hold of those older than twenty years; and when it takes hold, if it is not treated at the outset of the disease, it does not leave off before twenty years have passed, but stays; then in some who are treated it departs; the disease is difficult. Eileoi: these diseases are called eileoi (twistings / obstructions); they arise chiefly from the following: if in winter one follows a warm and moist diaita (regimen / way of living) and neither exercises by walking, gauging it by food intake, but always sleeps on a full stomach, and then is suddenly compelled to walk a long road in cold weather, and then shivers to the bone — the following then happens to him: wind forms throughout the whole body, and his color becomes lead-colored, and he shivers constantly, so that hot water poured over him does not seem to him to be hot. 44 [40] When he bathes, his body scales from the heat, especially the scrotum; if you press with a finger anywhere on his body, you will make a dent, and it will show like a mark in dough; the denting is most pronounced in the feet. His legs are heavy, and if he moves about he trembles, and if he walks on a slope he breathes hard, and his forearms seem to hang limp, and his head aches, and his eyebrows seem to hang down, and he has thirst at night, and the food passes through raw as he has eaten it. For this patient, when he is in this state, vapor-bathe him and give him to drink the juice of kneoros or of hippophaes or of Cnidian grain; after the purging give him the same things as prescribed for the earlier patients; on the following day give him two choes of boiled ass's milk twice to drink, adding salt; in the evening let him dine on bread; as relish let him have boiled sheep's meat, and boiled cuttlefish in dark wine, and let him sip the broth; and let him have lentils prepared as follows: boil a cotyle of lentils and grind smooth, then mix in flour and scrape silphion over it and throw in salt and pour in vinegar and stew garlic with it; then pour in water and bring to the boil two or three times, stirring together; then remove and let it cool; and let it not be too thick; let pennyroyal also be steeped in it while cooking for the sake of fragrance. On the days in between let him induce vomiting every sixth day; and he should be vapor-bathed now and then before the vomiting and the drug-drinking; and let him bathe every third day if it is beneficial; if not, let him be anointed, and let him walk, if he is able, gauging by his food intake; and boil elder-leaves and the always-tender fleabane and give them to eat. For if he is cared for thus he will pass through most easily and the disease should resolve within a year; but in many who have already recovered the disease has relapsed within two years; but if it relapses, one must treat with the same treatment. If it relapses a third time, swelling does not supervene, but he becomes thin and emaciated, and he begins to waste from the face, and his color becomes whiter than before. In this patient dropsy has sometimes formed in the belly cavity; if then it forms, one must not cut him, for he will die; but treat him with the same things as for the one who has dropsy from the spleen. For this patient one should wish above all to take and treat him at the outset, and thus you will quickly make him well; the disease requires much care, for it is difficult. Another eileos with jaundice: this one seizes people chiefly in the season of summer in marshy places, and more commonly from drinking water; and many have already taken the disease after being heated in the sun, having pain in the head. 45 [10] But they suffer things similar to those of the earlier patients, except in color, for he becomes pale like a pomegranate rind, and the eyes are sometimes filled with jaundice. For this patient, when he is in this state, one must treat with the same things as the earlier patient; give him to drink the water from boiling white chickpeas, and mix it in the wine and give it; and purge his head with the tetragonon (the four-sided drug). This one is less fatal than the preceding; and he is called the jaundiced eileos. Haematites eileos: for the most part he suffers the same things as those before him; but the disease begins to arise in autumn. 46 [5] The following additionally come on in the disease: the breath from the mouth smells bad, and the gums recede from the teeth, and blood flows from the nostrils. Sometimes also ulcers break out on the legs, and some heal while others arise in turn, and the color is dark, and the skin is thin; and he is not eager to move about and exert himself. For this patient, when he is in this state, treat him with the same things as the earlier patients, and give a clyster as follows: grind smooth five leaves of wild cucumber and mix in a half-cotyle of honey and a handful of salt and a half-cotyle of oil and four cotylae of the juice from boiled beet; and give for a mild purging eight cotylae of boiled ass's milk pouring in honey; and let him drink bovine milk in season for forty days; and let him also drink in the morning two cotylae of bovine milk, mixing in a third part of hydromel on the days in between. This disease requires much treatment; if not so treated, it does not depart but dies with the person; and it is called haematites eileos. The so-called thick diseases: from the so-called thick diseases the following chiefly arises: when phlegm and bile are mixed through the body, they flow together into the belly-cavity, and when they have collected in the belly-cavity it rises up, and surges upward and downward like a wave, and chills and fever take hold, and pain has settled in the head, and when the pain settles at the viscera it causes choking; and sometimes he vomits sharp watery flux (lape), sometimes also salty, and when he has vomited, his mouth seems to him to be bitter. 47 [35] And in the sides (ribs) a redness is poured out; for since the phlegm is in the belly-cavity, the blood, collected under heat, has fallen against the sides, and redness is poured out in the sides, and heat holds most in the sides; and his back becomes hunched; and when he is suffering most, he cannot endure his body being touched, for it hurts him as though it were a wound; and the flesh quivers from the pain, and the testicles are drawn up, and into the seat and into the bladder some heat and pain fall, and he urinates thick like dropsy-fluid, and the hair falls from his head, and the legs and feet are always cold, and the pain presses most on the sides and the back and the neck; and at the skin he seems to feel something creeping. The disease at one time presses hard, at another lets up; but as the disease advances it presses more continuously, and the skin of the head is thick and red. This patient continues suffering such things for up to six years; then a copious and foul-smelling sweat pours over him; and often he also has nocturnal emissions, and the ejaculation comes out blood-tinged and livid. This disease arises through the heat of the sun and drinking water. For this patient then, when he is in this state, give kneoros to purge the lower bowel, or Cnidian grain, or hippophaes; and give him also ass's milk to drink, boiling eight cotylae and pouring in honey; on the following day after the purging bring the same things as for the other patients; in the first days let him feast on the same things as the one seized by dropsy; and let him exert himself by walks, if he is able; if he is not able because of the fevers and cannot eat the solid food, let him use lentil gruel; as drink, the darkest and most austere wine. This disease seizes people chiefly in autumn and late summer. If this patient is not treated within six years, the disease persists up to ten years; and in many it also dies with them, if it is not tended to at once. Another thick disease: it arises from bile, when bile flows over the liver and comes to rest in the head. 48 [45] The following things then happen to him: the liver swells and is pushed up against the diaphragm by the swelling, and at once pain falls into the head, especially into the temples; and his hearing with his ears is not sharp, and often he does not see with his eyes either; and shivering and fever seize him. These things happen to him at the beginning of the disease, happening at intervals, sometimes severely, sometimes less so; and the more time advances in the disease, the more pain in the body, and the pupils of the eyes dilate, and he has shadow-vision, and if you bring a finger close to the eyes he will not perceive it because of not seeing; by this you would know that he does not see: that he does not blink when the finger is brought near. And he picks fluff off his clothing when he sees it, thinking it is lice. And when the liver is further pushed up against the diaphragm, he becomes delirious; and there seem to appear before his eyes reptiles and all manner of other wild creatures and armed men fighting, and he himself seems to be fighting among them, and he speaks as one seeing battles and wars, and he goes up to people and threatens, unless someone lets him go out; and if he gets up he cannot lift his legs but falls down; and his feet are always cold; and when he is sleeping he starts up from sleep and is frightened when he sees frightening dreams. We recognize that he starts up and is frightened from dreams in this way: when he comes to his senses he describes the dreams, of the same kind as what he was doing with his body and saying with his tongue. These things he suffers thus. And sometimes he also lies voiceless the whole day and night, drawing in much pneuma (breath / moving air) in great gasps. And when he stops being delirious, he immediately comes to his senses at once, and if someone questions him he answers correctly and recognizes everything that is said; then a little time later he lies again in the same pains. This disease strikes most in foreign lands, and when one is walking a deserted road and fear seizes him from a phantom; but it also seizes in other ways. For this patient, when he is in this state, weigh out five obols of black hellebore and give him to drink in sweet wine, or give him a clyster with the following: as much Egyptian natron as a sheep's knuckle-bone, grind this smooth, and mix in a half-cotyle of the finest honey after boiling it in a mortar, and a half-cotyle of oil and four cotylae of the water from boiled beet exposed to the open air; or if you wish, instead of beet mix in boiled ass's milk; mix these together and give as a clyster whether he has fever or not. Let him use as gruel thoroughly-boiled barley-groats, pouring in honey; and let him drink honey and water and vinegar mixed together, until the disease reaches crisis; and it reaches crisis at most within fourteen days, whether it is fatal or not. In many people such a disease, having ceased, has relapsed again; and if it relapses, there is danger that he will be destroyed; and the disease reaches crisis within seven days, whether it is fatal or not; and if he escapes these, he does not on the whole die, but in most people it departs when cared for. When the disease has ceased, let him follow a fine diaita (regimen / way of living), gradually introducing as much as the belly will accept and not be scorched, nor let diarrhea supervene; for both seem to be dangerous; and let him bathe each day and walk a little after meals; and let him wear light and soft clothing; and let him drink milk in season and whey for forty-five days. 48 (50) If he does these things, he will become well most quickly; the disease is difficult and requires much care. Another thick disease: it arises from putrefied phlegm; and the sign that it is putrefied is this — he belches from it having the smell as of someone who has eaten radishes. 49 [30] This kind of disease begins from the legs, then from there rises into the belly, and when it settles in the belly it runs back up toward the viscera, and when it settles upon these, it causes a gnawing sensation and brings on vomiting — together with a sharp, somewhat putrid bile — and when the patient has vomited he cannot hold himself upright. Then there is a state of distress around the viscera, and sometimes a sharp pain fixes suddenly into the head; and he is unable to hear sharply with his ears nor to see with his eyes because of the heaviness. A great sweat pours over him, ill-smelling — most of all when the pain grips him, but it pours even when the pain both holds and relents, and most of all at night. His skin-color appears jaundiced. This disease is slightly less deadly than the preceding one. When he is in this condition, purge the belly — downward by hippophaes, and upward by hellebore — and purge the head with the tetragonon. And when he has been purged by the hellebore, on the following day give a gentle purgation below with boiled ass's milk, on the third day with boiled goat's milk, and likewise on the fourth and fifth day. For twenty other days give raw cow's milk, or also goat's milk, adding honeyed water in the proportion of one-third; let him drink a chous of the milk. After the downward purging, apply the same drugs as for those gripped by dropsy. During the remaining time, while he is drinking the milk, let him dine on well-baked bread; for his side-dish, among fish let him have scorpion-fish or callionymus or gurnard or a slice of skate boiled in seasonings, and among meats young lamb or cockerel chicks — these boiled. Let him drink white wine if it suits him, and if not, dark astringent wine. Then let him walk about after eating, so that he may not take a chill. For this patient, if solid foods suit him, give them; if they do not suit him, give gruels of barley-groats or millet. If the sick person passes thirty days with this disease, he recovers; for these are what decide whether it is deadly or not. The disease is difficult. Another thick: the disease arises from white phlegm; it collects in the belly when prolonged fevers take hold of the body. 50 [15] The disease begins from the face, and the face swells; then it comes down into the belly, and when it settles there it greatly enlarges the abdomen, and the body is weary as if from hard labor, and there is heaviness in the belly and strong pain, and the feet swell. And if rain pours upon the earth, he cannot endure the smell of the dust; and if he happens to be standing in the rain and inhales the smell of the earth, he falls suddenly. This disease, proceeding with intermissions, takes hold for a longer time than the preceding one and passes more slowly. One must attend to it with the same things as for one suffering from dropsy — namely with vapor-baths, drugs, foods, and physical labors. This disease lasts at most six years, then with good care over time it passes, even if it was not cured at the outset. This disease is difficult and requires much attention. On ischias: Ischias (hip-joint pain) arises most often in the many from the following causes — if one has been exposed to the sun for a long time and the hips have been thoroughly heated and the moisture present in the joints has been dried out by the burning heat. 51 [45] That it is dried out and congealed, this is my evidence: the sick person cannot turn or move his joints because of the pain in them and because the vertebrae have become fixed together. He suffers pain most of all in the lower back and the vertebrae along the sides of the hips and the knees. The pain settles longest in the groins together with the hips — sharp and burning. And if someone tries to raise him up or move him, he cries out in pain as loudly as he can. Sometimes convulsion also comes on, and shivering, and fever. The disease arises from bile; it also arises from phlegm and from blood, and the pains are similar from all these conditions; and shivering and a mild fever sometimes seize him. But one must attend to the person who has gotten this disease from the sun in the following way: moisten his body with vapor-baths and through foods and drinks and other things given — give them warm and moist; all these boiled. Let him use barley-cake as his grain food — soft and not kneaded down. Let him drink white wine diluted with water. Let him keep his body at rest; but if he is able to stand, let him walk a little each day. Let him not take a chill, and let him bathe, but not much. And when it seems to you that he is doing well and that the body is moist, apply a very gentle vapor-bath vigorously; for it will loosen more and re-moisten what has congealed in the joints. Then on the following day give him Cnidian berry to drink. If that does not help, one must give him this enema: grind half a kotyle of cumin, pound a whole small round cucumber in the mortar, and sieve as fine as possible a quarter-mna of roasted and finely ground red Egyptian natron; put these into a small pot, pour in a kotyle of oil, half a kotyle of honey, a kotyle of sweet white wine, and two kotylai of beet juice; boil these until you judge the thickness to be right; then strain through linen cloth and mix in a kotyle of Attic honey, if you do not wish to boil the honey together with the other ingredients; but if you do not have Attic honey, mix in a kotyle of the finest you have and boil it in a mortar. If the enema is too thick, pour in some of the same wine, judging by the thickness; use this as the enema. Then let him be purged for up to three days; but if he is purged for more days, give three kotylai of cow's or goat's milk to drink; then give him fat beet greens, sprinkled over, unsalted in seasonings, to eat. From this disease many have already become lame. If the disease arises from bile, give him hellebore to drink as a downward purge, or juice of scammony; after the purging, give him two bowls of barley-groat gruel with honey poured in to drink down; on the following or third day apply a vapor-bath and give a gentle purgation below with boiled ass's milk; toward evening let him eat two bowls of fat beet greens with barley-meal sprinkled over; let him drink white wine, diluted, sweet — both now and after the drug-purging. If the disease is from phlegm, give him Cnidian berry or hippophaes to drink after a vapor-bath; after the purging, the same things must be given — both gruels and drinks and milk-drinking. During the intervening days let him follow as light a diaita (regimen / ordering of life) as possible. 51 (50) [5] And if he is benefited by these things, well; but if not, cauterize him — the bony parts with fungus-cautery, the fleshy parts with iron instruments, making many deep eschars. If the disease is from blood, apply a vapor-bath and attach a cupping-vessel and phlebotomize the veins in the hollows of the knees; and if it seems good to you, also give him Cnidian berry to drink. Let him follow as dry a diaita as possible. Let him not drink wine, or rather not at all; but if he wants to drink, give as little as possible and as well-diluted as possible, and order him to walk a little; and if he is able, as much as possible. The same measures are also beneficial for the one sick from phlegm. If he is not able to stand, he must be moved in his bed as frequently as possible from the time he falls sick, and all things likewise, so that the cartilage may not grow together within; and if it does grow together and the joints fuse, the person is of necessity made lame. And if you wish to give an enema to the one sick from blood, so as to draw off blood and phlegm from the hips, one must give this enema: grind a drachm's weight of salt, mix in a kotyle of oil and two kotylai from boiled barley, and then give him this enema. Attending to him in this way you will restore him to health most quickly. The disease is altogether difficult and chronic. Three tetanuses. First: if tetanus (τέτανος — rigid spasm) arises from a wound, the patient suffers the following: the jaws are fixed, he cannot open his mouth, the eyes water and are drawn, the back is fixed rigid, he cannot bend his legs, nor his hands, nor his spine. When it is deadly, what the patient drank and ate before sometimes comes back up through the nostrils. 52 [5] When he is in this condition, one must apply vapor-baths, and having anointed him generously heat him from a distance at the fire, and apply warm poultices after anointing the body. And grind wormwood or bay leaves or the fruit of henbane and frankincense, then dissolve in white wine and pour into a new small pot; then pour in oil equal to the wine, and heating it anoint the body and head generously with much warm liquid; then laying him down bring it about that the flesh is soaked in it, and dress him in soft clean garments so that he may sweat copiously. Give warm honeyed water — if he is able, by mouth; if he cannot, pour it in through the nostrils. Also give him white wine to drink, as pleasant and as much as possible. These things must be done each day until he becomes well. The disease is difficult and demands attention without delay. Opisthotonos: The opisthotonus patient suffers largely the same symptoms; it arises when the tendons at the back of the neck fall sick; it falls sick either from throat-constriction (κυνάγχη), or from uvular swelling (σταφυλή), or from the gill-glands (ἀμφιβράγχια) having become suppurating; sometimes also from fevers that come on from the head, if convulsion supervenes; and also from wounds. 53 [10] This patient is drawn backward, and from the pain the back and chest are gripped, and he cries out, and is convulsed so violently that the bystanders can barely hold him to keep him from falling out of the bed. He is in distress many times during the day and passes the rest of the time in a somewhat lighter state. For this patient in such a condition the same things must be applied as for the preceding one. The disease holds on at its longest up to forty days; if he survives these, he recovers. Another tetanus: This tetanus is less deadly than the preceding ones; it arises from the same causes; and many have also gotten the disease by falling backward. 54 [10] The patient suffers the following: the whole body is convulsed; sometimes also whatever part of the body it may be is convulsed. At first he walks about; then as time advances he falls into the bed, and again the pain and convulsion let up; and having risen he might perhaps walk about for a few days, then again lies in the same pains. He suffers these things and alternates for a considerable time. And if he eats something, it does not pass downward except with difficulty, and what does pass is scorched; instead the food is retained in the chest and causes a choking sensation. Treating this patient with the same things as the preceding ones, you will restore him to health most quickly; and give an enema of thin boiled barley-groat gruel and honey.