De Medicina

Celsus, Aulus Cornelius

Celsus, Aulus Cornelius. De Medicina. Spencer, Walter George, translator. Cambridge, MA: Harvard University; London, England: W. Heinemann Ltd, 1935-1938.

8 It follows now that I have to explain the special signs which in any particular affection indicate either hope or danger.

When there is pain in the bladder, if purulent urine is discharged which has in it a sediment slimy and white, it allays apprehension.

In pulmonary disease a patient may possibly regain health, if expectoration, although purulent, relieves pain, so long as he breathes and expectorates freely, and bears the disease without difficulty. Nor is there cause for alarm at an early stage, if the expectoration is mixed with something reddish and with blood, so long as it is expectorated at once.

Pain in the side ends if the suppuration which has arisen is cleared off within forty days.

If there is an abscess in the liver, and the pus let out is uniform and white, in that case recovery is easy, because the mischief is enclosed in a capsule.

Among suppurations too those are tolerable which point and discharge outwards. And of those which move inwards, those are the most favourable which do not affect the overlying skin, but leave it free from pain, and of the same colour as the surroundings. Pus indeed causes no fear, wherever it breaks out, when slimy and uniformly white, and if the fever subsides at once upon its discharge, and distaste for food and thirst cease to be troublesome. Also whenever suppuration descends into the legs,

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and the patient's expectoration from being reddish becomes purulent, there is less danger.

But in phthisis, he that is to recover should have his expectoration white, uniform in consistency and colour, unmixed with phlegm; and that which drips into the nose from the head should have similar characters. It is the best by far for there to be no fever; second best when the fever is so slight as not to impair the appetite or cause frequent thirst. In this affection the patient's state is favourable: when the bowels are moved once a day, the motions being formed and in amount corresponding to the food consumed; the body least attenuated, the chest most broad and hairy; its cartilages small, and covered with flesh. If supervening on phthisis, a woman's menses also become suppressed and pain is continuous over her chest and shoulders, a sudden eruption of blood customarily relieves the disease; for the cough becomes less, and the thirst and slight fever subside. But generally in these cases, unless the haemorrhage recurs, an abscess bursts, and the more blood comes from it the better.

Dropsy is the least alarming when it has commenced without being preceded by any disease; next when it has supervened upon a long illness, certainly if the viscera are sound, if the breathing is easy, if there is no pain, if the body is not hot, and the extremities are wasted uniformly, if the abdomen is soft, if there is no cough, no thirst, if the tongue is not much parched even after sleep; if there is desire for food, if the bowels are moved by medicaments, if the motions when spontaneous are soft and formed, if the size of the abdomen are reduced; if the urine is altered both by a change of

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the wine and of certain medicinal draughts; if there is no lassitude and the disorder is easily borne: a patient who presents all these signs is thoroughly safe, and that case is hopeful which exhibits the greater number of them.

Joint-disorders, too, such as foot and hand aches, if they attack young people and have not induced callosities, can be resolved; for the most part they are removed by dysenteries and fluid motions, whatever the sort.

Epileptic fits again are not difficult to bring to an end, when they have commenced before puberty, and whenever the sensation of the coming fit begins in some one part of the body. It is best for it to begin from the hands or feet, next from the flanks, worst of all from the head.

In such patients, also, the most favourable signs are when the disease can be discharged in the stools. Diarrhoea is itself harmless, when there is no fever, if it is quickly over, if on touching the abdomen no movements are to be felt, if wind follows the last of the motion.

Even dysenteries are not a danger although blood or shreds are passed, as long as fever and other accessories of this malady are absent, so that even a pregnant woman can not only be preserved herself, but the foetus preserved also. It is helpful in this malady if the patient's age is already mature.

Intestinal lubricity on the other hand is more easy got rid of in childhood, certainly if urine begins to be passed and the body to be nourished by the food.

The same age has the advantage in cases both of hip and shoulder pains, and of all forms of para-

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lysis; in such the hip may be cured easily and early, if it is not numbed, if slightly cool, even though the pains are severe, and a paralysed limb can be restored if its nutrition is not at all impaired. Paralysis of the face may be even ended by a quick motion; and any purging benefits runnings of the eyes. But madness is relieved rather by the formation of varicose veins or by a sudden effusion of blood from haemorrhoids or by dysentery.

Shoulder pains spreading to the shoulder-blades or hands are relieved by a vomit of black bile; and pain of any kind which moves downwards is the more curable.

Sneezing puts an end to hiccough.

Prolonged diarrhoeas are suppressed by vomiting.

In a woman a vomiting of blood is relieved by menstruation; when not cleared up by menstruation, nose-bleeding removes all danger. A woman in trouble with her womb or labour difficulty is relieved by sneezing.

Quartan fever in summer is mostly short. In a case of ardent fever with a tremor, delirium is salutary. For enlargement of the spleen dysenteries are good.

Then again fever itself is in the end often a protection, which may appear very strange. For it brings to an end pains over the heart if there is no inflammation; and it also relieves a painful liver; and if it begins after spasm and rigor, it gives entire relief; and it removes the disease of the small intestine arising from urinary difficulty, if by its heat it promotes urination.

Now pains in the head, accompanied by dimness of vision and redness of the eyes, along with some

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itching of the forehead, may be relieved by a haemorrhage, whether fortuitous or procured. Pains in the head and forehead due to wind or to cold or to heat are terminated by running from the nose and sneezings.

The ardent fever, however, which the Greeks call causodes, is got rid of by a sudden shivering. During a fever, if the ears have become dulled, that trouble is entirely removed by a flux of blood from the nose, or by loose motions from the bowel. Against deafness nothing can be more efficacious than a bilious stool. Those who have begun to suffer from the smaller kinds of abscesses in the urethra which they call phumata, get well when pus has come away from that part.

. . . and since they mostly arise of themselves, we may know that even where the resources of art are applied, nature can do the most.

On the other hand, pain in the bladder with persistent fever, when nothing is passed by the bowel, is a fatal evil; the danger is greatest in boys from the seventh to the fourteenth year.

In pulmonary disease, if there was no expectoration during the first days, if it then begins from the seventh day and persists beyond a further seven days, it is dangerous. And the more the sputum has an undistinguishable admixture of colours, the worse it is. But nevertheless nothing is worse than for the expectoration emitted to be homogeneous, whether reddish, or clotted, or white, or glutinous, or pallid,

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or frothy; worst of all, however, is the black. In this same disease the following are signs of danger: cough, catarrh, and even sneezing, which in other maladies is held salutary; and a sudden diarrhoea following upon the above is a most dangerous sign.

Generally too the same signs hold good for pain in the side as for that in the lung, both the more favourable as well as the graver signs.

If the pus discharged from the liver is bloody, it is a deadly sign.

Now of suppurations the worst are those which tend inwards, whilst also discolouring the overlying skin: of those again which burst externally, the worst are those which are largest and most widespread. But even after the abscess has ruptured, or the pus has been let outwards, there is danger for certain if the fever does not subside, or although it subsides, nevertheless recurs; or further if there is thirst, if distaste for food, if liquid motions, if the pus is livid and pallid, if the patient expectorates nothing but frothy phlegm. And of such suppurations, old people die mostly of those excited by lung diseases; younger people of other kinds.

But that in phthisis danger threatens a thin man is signified as follows: the expectoration is purulent with admixtures, a persistent fever robs him of his appetite at meal-times and afflicts him with thirst. Death is at hand if, after the patient has dragged on for a long while, the hair falls out, the urine exhibits sediment like cobwebs and has a foul odour, and most of all when upon the above diarrhoea supervenes; especially if it is the autumn season, when patients who have lasted through the rest of the year are generally undone. Moreover, in this

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disease, after pus has been expectorated, it is fatal for there to be an entire cessation of spitting. In the course of phthisis, even in adolescents, abscesses followed by fistulae arise in the lung; and unless numerous signs of convalescence follow, they do not readily heal. But as regards others, the least easily cured are girls, or those women in whom suppression of menses has supervened upon the phthisis. When again in a man who has been healthy there arises suddenly pain in the head, next he is so overcome by sleep that he snores and cannot be awaked, he will die by the seventh day; the more so, if a loose motion has not preceded, if the eyelids of the sleeper are unclosed and the whites of the eyes show. And in these cases death follows except if the malady has been dispersed by fever.

Again dropsy, if caused by an acute disease, is seldom conducted to a cure, at any rate when signs supervene the reverse of those noted above. Likewise too in this disease a cough takes away hope as is also the case if there is an outburst of blood whether upwards or downwards and water fills the middle of the body. In some also in this disease swellings arise, then subside, and again recur: such patients are in a somewhat safer state than those mentioned above, if they give attention; but generally they are undone by over-confidence in their health. Here we may wonder with good reason why there should be occurrences which cause our bodies harm, and yet at the same time in a measure are beneficial: for whether it is dropsical fluid which has filled a patient up, or whether it is a quantity of pus which has collected in a large abscess, evacuation all at once is as fatal to him, as if a healthy man loses blood by a wound.

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Those too who suffer in their joints, so that growths of hard stuff are formed upon them, are never relieved entirely: all these damages, whether they have begun in old age, or have lasted from youth up to old age, although there is a possibility of some alleviation, are never entirely cured.

Also fits which have arisen after the twenty-fifth year are hard to relieve, much harder when they begin after the fortieth; hence at this age, whilst there may be some hope from nature, there is scarcely any from the Art of Medicine. In this affection, if the whole body is affected all together, and there has not been beforehand in any part some feeling of an oncoming ill, but the patient falls down unexpectedly, he scarcely ever gets well, be his age what it may: further, if either the mind is diseased, or paralysis has been set up, there is no opportunity for the Art of Medicine.

Again in cases of diarrhoea, danger of death is at hand: if there is fever in addition, if there is inflammation of the liver or of the parts over the heart or of the stomach, if excessive thirst, if the affection is prolonged; if the stools are varied and passed with pain, and especially if with these signs true dysenteries set in; and this disease carries off mostly children up to the age of ten; other ages bear it more easily. Also a pregnant woman can be swept away by such an event, and even if she herself recovers, yet she loses the child. Dysenteries are fatal, moreover, when originated by black bile, or if a black motion suddenly issues from a body already wasted by dysentery.

Now intestinal lubricity is the more dangerous, if there is a frequent motion, if there is a flux from

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the bowel at all hours, with or without noise, if the same condition continues by night and in the day-time, if what is passed is either undigested or black, and besides that also slimy and foul; if there is urgent thirst, if urine is not passed after a drink (which happens because then all fluid passes down, not into the bladder, but into the intestine); if the mouth becomes ulcerated, the face reddened and marked as if by kinds of spots of all colours; if the belly is as though in a state of fermentation, fatty and wrinkled, also if there is no desire for food . . . ; while death is imminent in these circumstances, it is much more imminent if also this disease has already lasted a long while, especially if it be in an old patient.

If again there is disease in the smaller intestine, vomiting, hiccough, spasm, delirium are bad signs.

In jaundice again it is most pernicious for the liver to become hard.

If dysentery has seized upon those with disease of the spleen which has then turned into dropsy or into leientery, scarcely any medical treatment can save them from danger.

The disease of the smaller intestine, unless resolved, kills within seven days.

A woman after childbirth is in danger of death, if

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also oppressed by violent and persistent pain in the head along with fever.

To breathe rapidly is a bad sign if there is pain and inflammation in those parts which contain viscera.

A prolonged pain in the head, if without cause it shifts to the neck and shoulders, and again returns to the head, or if it spreads from the head to reach the neck and shoulders, is most pernicious, unless it induces some abscess so that pus is coughed up, or unless there is an outburst of blood from some part, or unless there is upon the head an eruption of much scurf or of pimples all over the body. Equally severe is this malady when a numbness or an itching wanders, now all over the head, now over part of it, or there is felt there a sensation as of something cold, and when these symptoms extend to the tip of the tongue. And since the abscesses described above are beneficial, recovery is more difficult, in proportion as they supervene less often upon such maladies.

When there are pains in the hips, if there is great numbness, and both the leg and hip become cold, if there is no movement of the bowel except forced, and the stool passed is mucous, and if the patient is already over forty, there will be a very prolonged illness, lasting at least a year, nor will it possibly come to an end except either in spring or in autumn.

Treatment is likewise difficult at that age when pain in the shoulders either spreads to the hands or extending to the shoulder-blades gives rise to numbness and pain there, which is not relieved by a vomit

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of bile.

Whatever too the part of the body, any limb which becomes paralysed if it is not moved and wastes, will not be restored to its former state, and the less so the longer the paralysis has been, and the older the patient. And for the cure of all cases of paralysis, winter and autumn are not favourable seasons; there is possibly hope in spring and summer; even when mild this disease is scarcely curable, a severe attack cannot be cured.

All pain also becomes less amenable to treatment as it spreads upwards.

In a pregnant woman, if the breasts suddenly shrivel up, there is danger of abortion. A woman has a defective menstruation who has milk in her breasts, not having just borne a child, or being pregnant.

Quartan fever, whilst brief in summer, is generally prolonged in autumn, and especially so when beginning at the approach of winter. There is danger of death if haemorrhage is followed by dementia and by spasm; the same is the case when, after purgation by medicaments, and, with the bowel still empty, there is an attack of spasm, as also if with great pain in the bowel the extremities become cold.

He does not return to life who has been taken down from hanging with foam around the mouth.

A black stool resembling black blood, passed suddenly, whether accompanied by fever, or even without fever, is dangerous.

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9 Having recognized the indications which either console us with hope, or terrify us with fear, we must pass to the methods of treating Diseases. Of these some are general aids, some special. General Aids are those which are beneficial in most diseases, Special Aids in particular ones. I shall speak first of the general, some of which, however, sustain not alone the sick but also those in health; some are applied against illness only.

Now every corporeal aid either diminishes substance or adds to it, either draws it out or represses it, either cools or warms, either hardens or softens; some act, not merely in one way, but even in two ways, not contrary the one to the other. Substance is withdrawn by blood-letting, cupping, purging, vomiting, rubbing, rocking, and by bodily exercises of all kinds, by abstinence, by sweating; of these I shall now speak.

10 To let blood by incising a vein is no novelty; what is novel is that there should be scarcely any malady in which blood may not be let. Again, to let blood in young women who are not pregnant is an old practice; but it is not an old practice for the same to be tried in children and in the elderly and also in pregnant women: for indeed the ancients were of opinion that the first and last years could not sustain this kind of treatment, and they were persuaded that a pregnant woman, so treated, would abort. Practice subsequently showed indeed that in these matters there is no unvarying rule, and that other observations are rather to be made, to which the consideration of the practitioner ought to be directed. For

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it matters not what is the age, nor whether there is pregnancy, but what may be the patient's strength. So, then, if a youth is weakly, or a woman, although not pregnant, has little strength, it is bad to let blood; for any remaining strength dies out if it is thus stripped away. But a strong child, or a robust old man, or a pregnant woman in good health, may be so treated with safety. It is mostly, however, in such cases that an inexperienced practitioner can be deceived, because at the above ages there is usually a less degree of strength; and a pregnant woman has need also, after the blood-letting, of forces to sustain, not merely herself, but also her unborn child. Not that we should be in a hurry to do anything that demands anxious attention and care; for in that very point lies the art of medicine, which does not count years, or regard only the pregnancy, but calculates the strength of the patient, and infers from that whether possibly or no there is a superfluity, enough to sustain either a child or an old man or simultaneously two beings within one woman. There is a difference between a strong and an obese body, between a thin and an infirm one: thinner bodies have more blood, those of fuller habit more flesh. The more easily, therefore, do the former sustain this sort of depletion; and the more quickly is he who is over-fat distressed by it; hence it is that the body's strength may be estimated better by its blood-vessels than by its actual appearance. And the foregoing are not the sole considerations, but there is also the kind of disease, whether a superabundance or a deficiency of bodily material has done the harm, whether the body is corrupted or sound. For if the material

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of the body is either deficient, or is sound, blood-letting in unsuitable; but if the harm is its copiousness, or the material has become corrupted, there is no better remedy. Therefore severe fever, when the bodily surface is reddened, and the blood-vessels full and swollen, requires withdrawal of blood; so too diseases of the viscera, also paralysis and rigor and spasm of sinews, in fact whatever strangulates the throat by causing difficulty of breathing, whatever suppresses the voice suddenly, whenever there is intolerable pain, and whenever there is from any cause rupture and contusion of internal organs; so also a bad habit of body and all acute diseases, provided, as I have stated above, they are doing harm, not by weakness, but by overloading. But it may happen that some disease demands blood-letting, although the body seems scarcely able to bear it; if, however, there appears to be no other remedy, and if the patient is likely to die unless he be helped even at some risk — that being the position, it is the part of a good practitioner to show that without the withdrawal of blood there is no hope, and to confess how much fear there may be in that step, and then at length, if the attempt is demanded, to let blood. In such a case there should be no hesitation about it; for it is better to try a double-edged remedy than none at all; and in particular it should be done: when there are paralyses; when a man becomes speechless suddenly; when angina causes choking; when the preceding paroxysm of a fever has been almost fatal, and it is very probable that a like paroxysm is about to set in which it seems impossible for the patient's strength to sustain. Further although it is least proper to let blood whilst food is

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undigested, yet that is not an invariable precept; for the case will not always wait for digestion. Thus if a man falls from a height, if there is contusion, or something else happening suddenly has caused vomiting of blood, although food may have been taken but a short while before, yet at once the bodily material should be depleted, lest, if it forms a congestion, it should harm the body; and the same rule will hold good also in other sudden accidents which cause suffocation. But if the character of the affection permits, it should be done then only when there remains no suspicion of undigested food; and therefore the second or third day of the illness may seem the most fitting for the procedure. But whilst there is sometimes a necessity for blood-letting even on the first day, it is never of service after the fourth day, for within that interval the material itself has both been sucked up and corrupted the body, so that then depletion can make it weak but cannot make it sound. But if there is the oppression of a vehement fever, to let blood during the actual paroxysm is to cut the man's throat; the remission is therefore to be awaited: if the fever does not decrease, but merely stops increasing, and there is no hope of remission, then also the opportunity, bad as it is, as it is the only one, should not be missed. When the measure is necessary it should generally be divided between two days; on the first it is better to relieve, and later to deplete the patient, rather than perchance to precipitate his end by dissipating his strength all at once. But if this answers in the case of pus, or of the water in dropsy, all the more necessarily should it answer in the letting out of blood. If the cause affects the body as a whole, blood should be let from the arm;

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if some part, then actually from that part, or at any rate from a spot as near as may be, for it is not possible to let blood from everywhere, but only from the temples, arms and near the ankles. Nor am I ignorant that some say blood should be let from a place the furthest away from the damaged part, for that thus the course of the material of the disease is diverted, but that otherwise it is drawn into the very part which is damaged. Yet this is erroneous, for blood-letting draws blood out of the nearest place first, and thereupon blood from more distant parts follows so long as the letting out of blood is continued; when put a stop to, no more blood comes to the part diseased, because it is no longer drawn to the opened vein. Practice itself, however, seems to have taught that for a broken head blood should be let preferably from the arm; when the pain is situated in one upper limb, then from the arm opposite; I believe because, if anything goes wrong, those parts are more liable to take harm which are already in a bad state. Blood is also at times diverted when, having burst out at one place, it is let out at another. For bleeding from a place where it is not desired ceases after something is applied to stop it there, when the blood is given another exit. Now blood-letting, whilst it may be very speedily done by one practised in it, yet for one without experience is very difficult, for to the vein is joined an artery, and to both sinews. Hence should the scalpel strike a sinew, spasm follows, and this makes a cruel end to the patient. Again, when an artery is cut into, it neither coalesces nor heals; it even sometimes happens that a violent outburst of blood results. As to the actual vein, when completely divided by a forceful cut, its two ends

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are pressed together, and do not let out the blood. Yet if the scalpel is entered timidly, it lacerates the skin but does not enter the vein; at times, indeed, the vein is concealed and not readily found. Thus many things make difficult to one who is unskilled what to one experienced is very easy. The vein ought to be cut half through. As the blood streams out its colour and character should be noted. For when the blood is thick and black, it is vitiated, and therefore shed with advantage, if red and translucent it is sound, and that blood-letting, so far from being beneficial, is even harmful; and the blood should be stopped at once. But this cannot happen under that practitioner who knows from what sort of body blood should be let. It more often happens that the flow of blood continues as black as on the first day; although this be so, nevertheless, if enough has flowed out, blood-letting should be stopped, and always an end should be put to it before the patient faints, and the arm should be bandaged after superimposing a pad squeezed out of cold water, and the next day the vein is to be flicked open by the tip of the middle finger so that, its recent coalescence being undone, it may again let out blood. Whether it be on the first or on the second day that the blood, which has at first flowed out thick and black, begins to become red and translucent, a sufficient quantity has been withdrawn, and the rest of the blood is pure; and so at once the arm should be bandaged and kept so until the little scar is strong, and this, in a vein, becomes firm very quickly.

11 Now there are two kinds of cups, one made of bronze, the other of horn. The bronze cup is open at one end, closed at the other; the horn one, likewise

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at one end open, has at the other a small hole. Into the bronze cup is put burning lint, and in this state the mouth is applied and pressed to the body until it adheres. The horn cup is applied as it is to the body, and when the air is withdrawn by the mouth through the small hole at the end, and after the hole has been closed by applying wax over it, the horn cup likewise adheres. Either form of cup may be made, not only of the above materials, but also of anything else suitable; when others are lacking, a small drinking-cup or porridge bowl with a narrowish mouth may be adapted conveniently for the purpose. If the skin upon which the cup is to be stuck is cut beforehand with a scalpel, the cup extracts blood; when the skin is intact, wind. Therefore when it is some matter inside which is doing the harm, the former method of cupping should be employed, when it is flatulency, then the latter. Now the use of a cup is the rule for a disease, not of the body as a whole, but of some part, the sucking out of which suffices for the re-establishment of health. And this same fact is a proof that with a scalpel, when a part is being relieved, blood must be let from that very part where the injury already exists; since unless it be to divert haemorrhage in that direction, nobody applies a cup to a part distant from the disease, but to that which is actually affected and has to be relieved. Further there may be need for cupping in chronic maladies, although already of somewhat long duration, if there is corrupted material or an unhealthy condition of wind; in certain acute cases also, if the body ought to be depleted and at the same time the patient's strength does not admit of cutting a vein; and cupping, as it is a less severe remedy, so it is a safer

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one; nor is it ever dangerous, even if adopted in the midst of the attack of a fever, or even with food undigested. Therefore, when blood-letting is needed, if cutting a vein is an instant danger, or if the mischief is still localised, recourse is to be had rather to cupping, not forgetting that whilst we recognize the absence of danger, its efficacy is thus the less, and it is impossible to remedy a severe malady unless by a remedy likewise severe.

12 Now purging was promoted by the ancients in almost all diseases by various medicaments, and by frequent clysters; they administered either black hellebore root, or polypody fern root, or the copper scales which the Greeks call lepida chalkou, or the milky juice of seaside spurge, of which one drop on bread purges freely, or milk, whether from an ass or cow, or goat, to which a little salt was added, which they boiled, and having removed the solidified skin, they obliged their patients to drink the whey-like remainder. But medicaments generally irritate the stomach; a motion when excessively liquid, or a clyster often repeated, weakens the patient. Never, therefore, in illness is a medicament which causes such a motion rightly given, unless when that malady is without fever, as when black hellebore root is given either to those with black bile and to those suffering from insanity with melancholy, or to those who have their sinews in some part paralysed. But in the presence of fevers, it suffices for the purpose of a purge to take such food and drink as both nourish and at the same time soften the belly; and there are sorts of illness in which purgation by milk is suitable.

Still, for the most part the bowel preferably is to be clystered; the practice was limited by Asclepiades

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though still kept, but I see that in our time it is usually neglected. But the limitation which he seems to have adopted is most fitting: that this remedy should not be tried often, and yet we should not omit to use it once, or at most twice: if the head is heavy; if the eyes are dim; if the disease is in the larger intestine, which the Greeks call colon; if there are pains in the lower belly or in the hips; if bilious fluid collects in the stomach, or even phlegm or other water-like humor forms there; if wind is passed with undue difficulty; if there is no spontaneous motion, and especially if the faeces remain inside although close to the anus, or if the patient who fails to pass anything perceives a foul odour in his breath, or if the motions have become corrupted; or if abstinence does not at once get rid of the fever; or if the patient's strength does not allow of blood-letting when it is needed, or the time for that measure has passed; or if previous to the malady the patient has been drinking freely; or if a patient who has been purged repeatedly, whether that has been intentional or casual, has suddenly a suppression of motions. However, the following rules are to be observed: that the clyster is not to be administered before the third day, nor whilst there is any undigested food; nor in a case of weakness due to exhaustion by a long illness; nor to a patient who has daily a sufficient motion, nor to one whose stools are liquid; nor during the acme of the paroxysm of a fever, for what is then injected is retained in the bowel and mounting up into the head brings about a much graver danger. On the day too before the clyster the patient ought to fast, in order to fit himself for such a treatment, and on the actual day, some hours

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beforehand, he should drink warm water to moisten his upper parts; there should then be introduced into the bowel simply water when we are content with a gentle remedy, or hydromel as one a little stronger; or as a soothing enema a decoction of fenugreek, or of pearl barley, or of mallow, or as an astringent clyster a decoction of vervains, but a drastic one is sea-water or ordinary water with salt added; and the better in both instances for boiling. A clyster is made more drastic by the addition of olive oil, or soda, or honey: the more drastic the clyster, the more it extracts, but the less easily it is borne. The fluid injected should be neither cold nor hot, lest either way it should do harm. Following upon the injection the patient ought to keep in bed as long as he can, and not give way to his first desire to defaecate; then go to stool only when he must. In this way generally when the material is extracted, and the upper parts relieved, the disease itself is mollified. But when the patient has become exhausted owing to forced calls to stool, he ought for a while to keep quiet; and lest his strength fail, he should certainly take food that day, but whether it should be abundant or scanty, should be regulated according to the strength of the paroxysm anticipated, or the absence of such apprehension.

13 Again, a vomit, as it is often quite a necessity for one who in health is bilious, so is it also in those diseases which bile has occasioned. It is the more necessary, therefore, for all who are troubled by shivering and trembling before fevers, for all suffering from cholera, even for all suffering from insanity accompanied by a kind of hilarity, and also for those afflicted by epilepsy. But if the disease is an acute one,

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as in the case of cholera, if there is fever, during the shivering fits, then the sharper medicaments are out of place, as mentioned above in relation to purgations, and for the purpose of a vomit it is sufficient to take the emetics which I have prescribed to be taken by those in health. But when there are chronic and violent diseases without fever, such as epilepsy and insanity, white hellebore root should also be used. But it is not right to give it either in winter or in summer; the spring is the best time, and autumn tolerably good. Whoever is going to administer it ought to take care beforehand that the body of the prospective recipient is rendered more humid. This should be recognized, that all such medicaments given as a drink do not always benefit the sick, and are always harmful to those in health.