De Medicina

1 Thus far I have dealt with those classes of diseases which so affect bodies as a whole, that fixed situations cannot be assigned to them: I will now speak of diseases in particular parts. Diseases of all the internal parts and their treatment, however, will come under view more readily if I first describe briefly their institutions.

The head, then, and the structures within the mouth are not only bounded by the tongue and palate, but also by whatever is visible to our eyes. On the right and left sides around the throat, great blood-vessels named sphagatides, also arteries called carotids, run upwards in their course beyond the ears. But actually within the neck are placed glands, which at times become painfully swollen.

From that point two passages begin: one named the windpipe, the more superficial, leads to the lung; the deeper, the gullet, to the sm; the former takes in the breath, the latter food. Though their courses diverge, where they are joined, there is a little tongue in the windpipe, just below the fauces, which is raised when we

The lung is spongy, and so can take in the breath, and at the back it is joined to the spine itself, and it is divided like the hoof of an ox into two lobes. To the lung is attached the heart, which, muscular in nature, is placed under the left breast, and has two small stomach-like pockets. Now, under the heart and lung is a transverse partition of strong membrane, which separates the belly from the praecordia; it is sinewy, and many blood-vessels also take their course through it; it separates from the parts above not only the intestines but also the liver and the spleen. These organs are placed against it but under it, on the right and left sides respectively.

The liver, which starts from the actual partition under the praecordia on the right side, is concave within, convex without; its projecting part rest lightly on the stomach, and it is divided into four lobes. Outside its lower part the gall-bladder adheres to it: but the spleen to the left is not connected to the same partition, but to the intestine; in texture it is soft and loose, moderately long and thick; and it hardly projects at all from beneath the ribs into the belly, but is hidden under them for the most

These then are the situations of the viscera. Now the gullet, which is the commencement of the intestines, is sinewy; beginning at the seventh spinal vertebra, it makes a junction in the region of the praecordia with the stomach. And the stomach, which is the receptacle of the food, consists of two coats; and it is placed between the spleen and the liver, both overlapping it a little. There are also fine membranes by which these three are interconnected, and they are joined to that partition, which I have described above as transverse.

Thence the lowest part of the stomach, after being directed a little to the right, is narrowed into the top of the intestine. This juncture the Greeks call pylorus, because, like a gateway, it lets thru into the parts below whatever we are to excrete.

From this point begins the fasting intestine, not so much infolded; it has this name because it does not hold what it has received, but forthwith passes it on into the parts below.

Beyond is the thinner intestine, infolded into many loops, its several coils being connected with the more internal parts by fine membranes; these coils are directed rather to the right side, to end in the region of the right hip; however, they occupy mostly the upper parts.

After that spot this intestine makes a junction crosswise with another, the thicker intestine; which, beginning on the right side, is long and pervious

But that one which is pervious being widespread and winding, and less sinewy than the upper intestines, has a flexure on both sides, right and left, especially on the left side and in the lower parts and touches the liver and stomach, next it is joined to some fine membranes coming from the left kidney, and thence bending backwards and to the right, it is directed straight downwards to the place where it excretes; and so it is there named the straight intestine.

The omentum too, which overlies all these, is at its lower part smooth and compact, softer at its upper part; fat also is produced in it, which like the brain and marrow is without feeling.

Again from the kidneys, two veins, white in colour, lead to the bladder; the Greeks call them ureters, because they believe that through them the urine descending drops into the bladder.

Now the bladder, sinewy and in two layers at its bag, is at its neck bulky and fleshy; it is connected by blood-vessels with the intestine, and with that bone which underlies the pubes. The bladder itself is loose and rather free, and situated differently in men and women: for in men it is close to the straight intestine, being inclined rather to the left side; in women it is situated over the genitals, and whilst free above, is supported actually by the womb.

Again, in males, a longer and narrower urinary passage descends from the neck of the bladder into the penis; in women, a shorter and wider one presents itself over the neck of the womb. Now the womb in virgins is indeed quite small; in women, unless they are

2 Having made a sort of survey as it were of these organs, so far as it is necessary for a practitioner to know them, I shall follow out the remedies for the several parts when diseased, starting with the head; under that term I now mean that part which is covered with hair; for pain in the eyes, ears and teeth and the like will be elsewhere explained (VI.6‑9, VII.7‑12).

In the head, then, there is at times an acute and dangerous disease, which the Greeks call cephalaia; the signs of which are hot shivering, paralysis of sinews, blurred vision, alienation of the mind, vomiting, so that the voice is suppressed, or bleeding from the nose, so that the body becomes cold, vitality fails. In addition there is intolerable pain, especially in the region of the temples and back of the head. Again, there is sometimes a chronic weakness in the head, which, although neither severe nor dangerous, lasts through life; sometimes there is more severe pain, but of short duration, and not fatal, which is brought about

Of these the case that is acute, also that which surpasses ordinary limits, and that which is of sudden causation and although not deadly, is yet violent, has its primary remedy in blood-letting. But this measure is unnecessary, unless the pain is intolerable, and it is better to abstain from food; also from drink, when possible; if not possible, then to drink water. If, on the day following, pain persists, the bowels should be clystered, sneezing provoked, and nothing but water taken. For often, in this way, all the pain is dispersed within one or two days, especially if it has originated from wine of indigestion. But if there is little benefit from the above, the head should be shaved down to the scalp; then it should be considered what cause excited the pain. If the cause was hot weather, it is well to pour cold water freely over the head, to put on the

The class in which humour collects upon the head is different. In that case it is necessary to shave the head to the scalp; then to apply mustard until it causes ulcers; if this is of little avail, recourse must be had to the scalpel. The following measures are the same as for dropsical patients: exercise, sweating, smart rubbing, and such food and drink as will specially promote urination.

3 Again, about the face there originates an affection which the Greeks call "dog spasm." And it begins along with acute fever; the mouth is drawn to one side by a peculiar movement, and so it is nothing else than a distortion of the mouth. In addition there is frequent change of colour in the face as well as over all the body, also an inclination to sleep. In this case blood-letting is the best thing; if that does not end the disorder, the bowels are moved with a clyster; when not even thus dispersed, vomiting is provoked by white hellebore. It is necessary besides to avoid the sun, fatigue and wine. If it is not dispersed by these measures, use running, rubbing of the affected part gently and repeatedly, also rub other parts for less time, but smartly. It is also useful to provoke sneezing; to shave the head, to pour over it hot sea water, or at any rate salt and water, provided that sulphur is also added; after this affusion the patient should again be rubbed; should chew mustard, applying at the same time to the parts of the mouth affected a wax salve, likewise to the

4 But if there is paralysis of the tongue, which sometimes occurs of itself, sometimes is produced by some disease, so that the man's speech is not distinct, he should gargle a decoction of thyme, hyssop or mint; drink only water; have the head, face, the parts under the chin and the neck smartly rubbed; the tongue itself smeared with laser; chew very acrid materials, mustard, onion, garlic, and strive with all his force to pronounce words; hold his breath at exercise; frequently pour cold water over his head; on occasion eat a quantity of radish and then vomit.

5 Again there is dripping from the head sometimes into the nose, which is a mild affair; sometimes into the throat, which is worse, sometimes into the lung, which is worst of all. When the drip is into the nostrils, a thin phlegm is discharged from them; there is slight pain, and a feeling of weight in the head, with frequent sneezing; if the drip is into the throat, it irritates and excites a slight cough; if the drip is into the lung, besides the sneezing, cough and even weight in the head, there is lassitude, thirst, a feeling of heat, and bilious urine.

Another although not very different affection is gravedo. This closes up the nostrils, renders the voice hoarse, excites a dry cough; in it the saliva is salt, there is ringing in the ears, the blood-vessels in the head throb, the urine is turbid. Hippocrates named all the above coryza; I note that now the Greeks reserve this term for gravedo, the dripping they call catastagmus. These affections are commonly of short duration, but if neglected may last a

Whenever we feel anything of the sort, we should forthwith keep out of the sun, and abstain from the bath, wine and coition; but the use meanwhile of anointing and of customary food is allowable. The patient should walk, but only briskly and under cover; after that the head and face should be rubbed for more than fifty strokes. This complaint is generally relieved, provided that we take care of ourselves for a couple of days, or for three at the most. When the disease has been relieved so that the drip of phlegm becomes thick, or the gravedo so that the nostrils are more open, the bath may be resumed, much water, at first hot, then lukewarm, being used to foment the face and head; next, along with more food, wine may be taken. But if on the fourth day the phlegm is still thin, or the nostrils still stuffed up, the patient should take dry Aminaean wine, then for a couple of days water; after which he can return to the bath and his usual habits. Nevertheless, even during those days, when some things are to be avoided, it is not expedient to treat the patients as sick men, but they are to do everything as in health, unless these symptoms have been liable to cause more prolonged and severe trouble; for then a somewhat more careful attention is needed.

Therefore in such a case if there is a drip into the nose or into the throat, besides the treatment described above, the patient from the start should walk a good deal during the first days: have the lower limbs smartly rubbed, together with more gentle rubbing of the chest, face and head; his accustomed food should be reduced by one-half; he

But if the drip is into the lung also, there is even more need for walking and rubbing and the same regimen as to diet, and if that diet is not effective, more acrid food is to be employed; he should allow himself more sleep, and abstain from all business; but the bath should be tried at a somewhat later stage.

In the case of gravedo, he should lie in bed on the first day, neither eat nor drink, cover the head, and wrap wool around the throat; on the next day he should get up, and still abstain from drink, or, if he must have some, take not more than one tumbler-full of water; on the third day he may eat the crumb of bread, but not much, with some small fish, or light meat, and water for drink. Should the patient be unable to restrain himself from using a fuller diet, he is to provoke a vomit; when he gets to the bath, he should foment freely his head and face with hot water until he sweats, and then have recourse to wine. After the above measures it is scarcely possible for the same discomfort to persist; but if it does so, use cold, dry, light food with the least possible fluid, whilst continuing the rubbings and the exercises, such as are needed in all such sorts of illness.

6 From the head we pass to the neck, which is liable to harm from diseases of considerable

7 Whilst this kind of disease involves the region of the neck as a whole, another equally fatal and acute has its seat in the throat. We call it angina; the Greeks have names according to its species. For sometimes no redness or swelling is apparent, but the skin is dry, the breath drawn with difficulty, the limbs relaxed; this they call synanche. Sometimes the tongue and throat are red and swollen, the voice becomes indistinct, the eyes are deviated, the face is pallid, there is hiccough; that they call cynanche: the signs in common are, that the patient cannot swallow food nor drink, and his breathing is obstructed. It is a slighter case when there is merely redness and swelling, not followed by the other symptoms; this they call parasynanche. Whichever form occurs blood must be let if strength permits; if there is no surplus strength, then move the bowels by a clyster. Cups also may be applied with benefit under the chin, also outside the throat, so as to draw out the matter which is suffocating.

8 There is also in the region of the throat a malady which amongst the Greeks has different names according to its intensity. It consists altogether in a difficulty of breathing; when moderate and without any choking, it is called dyspnoea; when most severe, so that the patient cannot breathe without making a noise and gasping, asthma; but when in addition the patient can hardly draw in his breath unless with the neck outstretched, orthopnoea. Of these, the first can last a long while, the two following are as a rule acute. The signs common to them are: on account of the narrow passage by which the breath escapes, it comes out with a whistle; there is pain in the chest and praecordia, at times even in the shoulder-blades, sometimes subsiding, then returning; to these there is added a slight cough. Blood-letting is the remedy unless anything prohibits it. Nor is that enough, but also the bowels are to be relaxed by milk, the stool being rendered liquid, at times even a clyster is given; as the body becomes depleted by these measures the patient begins to draw his breath more readily. Moreover, even in bed the head is to be kept raised; the chest movement assisted by hot foments and plasters, dry or even moist, and later either emollients are to be applied or at any rate a wax-salve made with cyprus, or iris ointment. Next, on an empty stomach the patient should take a draught of hydromel, in which either hyssop or crushed caper root has been boiled.

9 But in the interior parts of the throat there is sometimes ulceration. For this most employ plasters and hot foments externally; they also order hot steam to be inhaled by the mouth. Others say that by these measures the parts are rendered more soft and more liable to the complaint already existing there. But these applications are salutary if cold can be completely avoided; if cold is to be apprehended, they are useless. But anyhow to rub the throat is dangerous; for it provokes ulceration. Nor are diuretics useful, because in the course of being swallowed they can also make thin the phlegm there, which is better suppressed. Asclepiades, who wisely advises many things, which we

10 Cough again is generally owing to ulceration of the throat. This is incurred in many ways: and so when the throat has healed the cough is ended. Nevertheless, at times cough is a trouble by itself, and when it has become chronic, is difficult to get rid of. Sometimes the cough is dry, sometimes it excites phlegm. Hyssop should be taken every other day; the patient should run whilst holding the breath, but not where there is dust; he should practise reading loudly, which may at first be impeded by the cough, but later overcomes it; next walking; then manual exercises also, and the chest should

11 When blood is spat up there is more cause for alarm, although that presents at one time less, at another more of danger. Blood sometimes comes from the gums, sometimes from the mouth, and that at times copiously, yet without cough, without ulceration, without any disease of the gums, so that there is no expectoration. But just as there is on occasion bleeding from the nostrils, so also does it

According to medical authorities blood gains exit either from some part eroded, or ruptured, or from the opened mouth of some blood-vessel; the first they call diabrosis, the second rhexis, the third anastomosis. The last is the least harmful, the first, the worst. And often indeed it happens that pus follows the blood. Now at times to stop the bleeding suffices to promote recovery; but if there follow ulcerations, or pus, or a cough, according to the situation there arise various and dangerous classes of diseases. But if only blood flows out, both the remedy and the ending are the quicker. Nor ought we to ignore that in those who are in the habit of bleeding or in whom the back or hips ache whether after hard running or walking, a limited flow of blood is not disadvantageous as long as fever is absent, and when blood is passed by the

The foregoing are general remarks: now I come to the particular points mentioned above. If blood escapes from the gums, it suffices to chew purslane; if from the mouth, undiluted wine should be held in it; if this does no good, then vinegar. If in spite of these remedies there is a severe outburst, since this may be the death of the patient, its attack is best diverted by applying a cup to the occipital region, after first incising the skin; when this happens in a woman whose menses are not forthcoming, a cup is applied to each groin, likewise after making incisions. But if the bleeding comes from the throat, or from more internal parts, there is more to fear, and a more active treatment is to be adopted. Blood should be let, and if the flow from the mouth is not lessened, the venesection should be repeated a second or a third time, and every day a little. From the first also the patient should sip either vinegar or plantain or leek juice with frankincense, and outside over the seat of pain there is to be applied unscoured wool soaked in vinegar, cooled at intervals by means of a sponge. Erasistratus used also to bind up the legs and thighs and the forearms of such patients in several places. This constricting Asclepiades declared far from being beneficial, to be even harmful. But that it often

12 Below the throat is placed the stomach, in which there tend to occur many chronic complaints. For sometimes great heat affects it, sometimes flatulence, sometimes inflammation, sometimes ulceration; at times phlegm collects, at times bile; but the most frequent malady is that in which it undergoes paralysis, nor does anything else so affect it, or,

When heated, it should be bathed externally at intervals with vinegar and rose oil, and road dust applied with oil, and those plasters which simultaneously repress and soothe. For drink, unless there is anything against it, lukewarm water is the best.

If there is flatulence, it is beneficial to apply cups, but there is no need to incise the skin; dry and hot foments do good, but not the strongest kind. At intervals there should be enjoyed abstinence from food; a draught of wormwood or hyssop or of rue on an empty stomach is useful. Exercise at first should be light, then more is to be taken, especially such as moves the upper limbs; the kind most appropriate in all complaints of the stomach. After exercise there is need of anointing, rubbing, occasionally also the bath, yet less often than usual; now and then a clyster; later, food which is hot but not flatulent, and similarly hot drinks, first water and after the flatulence has subsided, dry wine. In all complaints of the stomach this also is to be prescribed, that each should adopt in health that regimen which has cured him; for his weakness will recur unless his health is protected by the same measures as those by which it was restored.

But if there is inflammation of any kind, which is generally followed by swelling and pain, the primary remedies are rest, abstinence, a belt of sulphurated wool, and the wormwood draught upon an empty stomach. If a burning heat troubles the stomach, it should be fomented at intervals with vinegar and

But if ulcers attack the stomach, generally the same treatment should be applied as has been prescribed in the case of an ulcerated throat (IV.9). Exercise, also rubbing of the lower extremities, is to be practised; bland and glutinous foods taken short of satiety; and all pungent and sharp food withdrawn. Sweet wine is to be used if there is no fever, or if that causes flatulence at any rate light wine, but neither very cold nor too hot.

If the stomach becomes filled with phlegm an emetic is needed, sometimes on an empty stomach, sometimes after food: there is benefit in exercise, rocking, a sea-voyage, rubbing. Nothing should be eaten or drunk unless hot, whilst such things must be avoided as have tended to collect phlegm.

There is worse trouble when the stomach is vitiated by bile. Patients who are troubled with this, vomit up bile at intervals of some days, and worst of all, vomit black bile. For such a clyster is appropriate, and draughts of wormwood should be given; rocking and a sea-voyage are necessary; vomiting when possible is induced by sea-sickness; indigestion must be avoided, the food should be such as is readily swallowed, and not repugnant to the stomach, the wine must be dry.

But the commonest and worst complaint of the stomach is paralysis, when it does not retain food,