De Medicina

22 The most akin to the above among intestinal maladies are gripings, called by the Greeks dysenteria. The insides of the intestines ulcerate; from these blood trickles and at times is excreted with some faeces which are always liquid, at times with a sort of mucus, sometimes at the same time something fleshlike comes down; there is frequent desire to stool and pain in the anus. Along with this

pain a scanty motion is discharged, and by this too the griping pain is intensified: and after a while there is some relief and a short interval of ease; sleep is broken, feverishness comes; when the disorder has continued for a long while, it either carries off the patient, or even, although it come to an end, puts him to torture. Rest must be adopted from the first, since any shaking sets up ulceration; next on an empty stomach he is to sip a cupful of wine to which has been added powdered cinquefoil root; then repressant plasters are put upon the abdomen, which in the case of disorders of the upper abdomen is not expedient; whenever the patient goes to stool, he should bathe the anus with hot water in which vervains have been boiled; purslane should be eaten, whether cooked or pickled in strong brine; also such foods and drink as are astringent to the bowel. If the distemper is of longer standing, there should be injected into the rectum either a tepid cream of pearl barley, or milk, or melted fat, or deer marrow, or olive oil, or rose oil with butter or with raw white of egg, or a decoction of linseed, or if sleep does not occur, yolk of eggs in a decoction no rose-leaves: for such remedies relieve pain and mitigate ulceration, and are of special utility if loss of appetite has ensued. Themison has stated in writing that the strongest brine should be used in these cases. Food too should be of the kind which will act as mild astringents. But diuretics if they take effect are beneficial by directing humour to another part: if they do not take effect, they increase the trouble; so unless for those on whom they act promptly, they should not be used. If there is feverishness, the drink should be hot water, either plain or with some astringent in it; if none, then light dry wine. If for several days other remedies have done no good, and the disease is now of long standing, drinking of very cold water acts as an astringent upon the ulcerations and starts recovery. But as soon as the movement of the bowels is under control, there should forthwith be a return to warm drinks. Sometimes also there is discharged a putrid sanies having a foul odour, sometimes unmixed blood escapes. If the former occurs, a hydromel clyster should be given, and then the other things mentioned above injected. An effective remedy even for intestinal canker is a lump of minium rubbed up with 250 grams of salt, dissolved in water, and administered as a clyster. But if there is a flux of blood, food and drink should be astringent.

23 From dysentery there proceeds sometimes leienteria, when the intestines cannot retain anything, and whatever is swallowed is straightway excreted imperfectly digested. Sometimes in the patients this drags on, sometimes it hurries them off. In this affection especially astringents should be put on the chest, and when the skin becomes ulcerated, then an emollient to draw out humour; and the patient should sit in a decoction of vervains; take both food and drink which control the bowel: and have cold water poured over him. Nevertheless, care should be taken lest with all these remedies there be an opposite trouble

set up by excessive flatulence. Consequently, little by little, the intestines should be strengthened by some additions daily. As in the case of any abdominal flux, so in this, it is particularly necessary that the patient should go to stool, not as often as inclined, but as often as compelled, so that by such delay the intestines may be got into the habit of holding up their contents. There is another thing which, whilst applicable equally to all similar affections, is to be specially observed in this, that as many beneficial medicaments are disagreeable to the taste, such as the mixture containing plantain and blackberries and any mixture containing pomegranate rind, that shall be chosen which the patient likes most. Moreover, if he loathes all of them, something to excite his appetite should be interposed, less useful, perhaps, but most pleasant. Exercise and rubbing are needed in this disease also, as well as heat, whether of the sun, or a fire, and baths; and according to Hippocrates, a vomit even by white hellebore, when other measures prove of little avail.

24 Again, worms also occasionally take possession of the bowel, and these are discharged at one time from the lower bowel, at another more nastily from the mouth: and we observe them sometimes to be flattened, which are the worse, at times to be rounded. For the flat worms there should be given as draughts, a decoction of lupins, of or of mulberry bark, to which may be added, after pounding, either hyssop or a vinegar cupful of pepper, or a little scammony. Alternatively on one day let him eat a quantity of garlic and vomit, then on the next day take a handful of fine pomegranate roots, crush them and boil them in a litre and a half of water down to one-

third, to this add a little soda, and drink it on an empty stomach. At three hours' interval, let him take two further draughts; but with the addition of half a pint of sea water or strong brine; then on going to stool, sit over a basin of hot water. Again, for the round worms which especially trouble children, both the same remedies may be given and some milder ones, such as pounded-up seeds of nettles or of cabbage or of cummin in water, or mint in the same or a decoction of wormwood or hyssop in hydromel or cress seeds pounded up in vinegar. It is also of service either to eat lupin or garlic, or administer into the lower bowel a clyster of olive oil.

25 There is, again, another affection which the Greeks call tenesmos, slighter than all those last spoken of. It should be counted neither with acute nor with chronic diseases, since it is readily relieved, and never by itself fatal. As in the case of dysentery, there is equally the frequent desire for stool, and equally the pain when anything is passed. There is a discharge resembling phlegm and mucus; sometimes it is even slightly bloodstained; but mingled with properly formed faeces derived from food. The patient should sit in hot water, and make application frequently to his anus. For this there are several suitable medicaments; butter in rose oil, gum acacia dissolved in vinegar; that wax-salve which the Greeks call tetrapharmacon, made liquid with rose oil; alum wrapped up in wool and so applied; the same clysters as are beneficial in dysentery; the same decoction of vervains to foment the lower parts. He should drink on alternate days water and a thin dry wine

lukewarm or better cold. The diet should be the same as prescribed above 922) for dysentery.

26 Even slighter, while recent, is diarrhoea, in which the stool is liquid and more frequent than ordinary; and sometimes the pain is bearable, at times very severe, when it is a worse affair. But a flux from the bowel for one day is often salutary, and even for several days, provided that fever is absent and it subsides within seven days. For the body is purged, and whatever is about to cause a complaint inside is evacuated with advantage. But persistence is the danger; for it excites at times dysentery and feverishness and exhausts strength. It is sufficient on the first day to rest, and not to check the movement of the bowels. If it stops of itself, the patient should make use of the bath, and take a little food; if it persists, he should abstain, not only from for, but even from drink. If on the day following, in spite of all, the stool is still liquid, he should rest as before and take a little astringent food. On the third day he should go to the bath; be rubbed all over vigorously except the abdomen, sit with his loins and shoulder-blades before a fire; take food of an astringent kind, and a little undiluted wine. If on the fourth day the flux persists, he should eat more but provoke a vomit afterwards, and counter in a general way the diarrhoea by thirst, hunger and vomiting, until it subsides for it is scarcely possible that after so attending to it, the bowel will not be controlled. Another method to suppress the diarrhoea is to dine and then vomit; the next day to rest in bed, in the evening to be anointed, but lightly, then to eat about half a pound of bread soaked in undiluted Aminaean wine; after that something roasted, poultry in par=

ticular, and lastly to drink the same wine mixed with rain-water; and to do so until the fifth day, then vomit again. Now Asclepiades, against the opinion of previous writers, affirmed that the drink should be kept constantly cold, indeed as cold as possible. I myself hold that each should trust in his own experiences, whether hot than cold drink should be made us of. It sometimes happens also that this disorder, having been neglected for several days, is more difficult to relieve. Such a patient should commence with an emetic; then the following day at evening be anointed in a warm room; take food in moderation, and the sourest wine undiluted; a wax-salve with rue should be applied to the abdomen. In this affection neither walking nor rubbing is of benefit; sitting in a carriage and even more riding on horseback is advantageous; for nothing strengthens the intestines more. But if use is to be made of medicaments as well, the most suitable is that made from orchard fruit. At the time of the vintage, pears and crab apples are thrown into a large vessel; and if the latter are not to be had, green Tarentine or Signine pears, Scaudian, or Amerian apples, sweet-scented. To these are added quinces and pomegranates with their rind, service fruit, and those that are called torminalia, which we use by preference, so that these occupy one-third of the jar; then this is next to be fille up with must, and boiled until all the ingredients have become resolved into a uniform mass. It is not unpleasant to the taste, and taken as needed, it controls the bowel gently, without any harm to the stomach. It is enough to take in one day two or three spoonfuls. Another composition is stronger: myrtle berries are gathered, and wine expressed from them is boiled down to one-tenth, of which a cup is sipped. A third can be prepared at any time by scooping out the inside of a pomegranate, removing all the seeds, and returning the pulp into the cavity, than raw eggs are pounded in, and stirred round with a small rod; next the fruit itself is heated over charcoal, for it does not burn so long as the inside is liquid; when the inside begins to dry the pomegranate is taken off the brazier and with a spoon the inside is scooped out and eaten. By certain acrid additions this remedy can be made more active; thus also it may be stirred up in peppered wine and mixed with salt and pepper, and so eaten. Pease porridge, with which a little of an old honeycomb has been boiled, also lentil porridge boiled with pomegranate rind, also a decoction of bramble tops eaten with oil and vinegar, are efficacious, as also draughts of a decoction of dates or quinces or dried service fruits or brambles. Such are the kind I refer to whenever I say an astringent draught should be administered. Also a half-pint of wheat is boiled in dry Aminaean wine, and first the wheat is eaten on a stomach empty both of food and drink, afterwards the wine itself is drunk and can be justly counted amongst the most active remedies. Also there can be given to drink Signian wine, or dry and resinated wine, or any other dry wine. And a pomegranate may be pounded up along with its rind and seeds, and mixed with wine of the above sort; the patient either sips it undiluted, or drinks it mixed with water. But it is superfluous except in bad cases to make use of medicaments.

27 From the womb of a woman, also, there arises a violent malady; and next to the stomach this organ is affected the most by the body, and has the most influence upon it. At times it makes the woman so insensible that it prostrates her as if by epilepsy. The case, however, differs from epilepsy, in that the eyes are not turned nor is there foaming at the mouth nor spasm of sinews; there is merely stupor. In some women this attack recurs at frequent intervals and lasts throughout life. When this happens, if there is sufficient strength, blood-letting is beneficial; if too little, yet cups should be applied to the groins. If she lies prostrate for a long while, or if she has done so at other times, hold to her nostrils an extinguished lamp wick, or some other of these materials which I have referred to as having a specially foetid odour (III.20, 1), to arouse the woman. For the same end, affusion with cold water is also effectual. And there is benefit from rue pounded up with honey, or from a wax-salve made up with cyprus oil or from hot moist plasters of some sort applied to the external genitals as far as the pubes. At the same time also the hips and the backs of the knees should be rubbed. Then when she has come to herself, she should be cut off from wine for a whole year, even if a similar attack does not recur. Friction should be applied daily to the whole body, but particularly to the abdomen and behind the knees. Food of the middle class should be given: every third or fourth day mustard is to be applied over the hypogastrium until the skin is reddened. If induration

persists, a convenient emollient appears to be bitter sweet steeped in milk, then pounded and mixed with white wax and deer marrow in iris oil, or suet of beef or goat mixed with rose oil. Also there should be given in draught either castory, or git, or dill. If the womb is not healthy, it is cleaned with square rushes; but if it is actually ulcerated a wax-salve is made with rose oil, with pounded rose-leaves added to give it consistence. When painful the womb should be fumigated from below with sulphur. But if excessive menstruation is doing harm to the woman, the remedy is to scarify and cup the groins, or even to apply cups under the breasts. If the menstrual discharge is bad, the following medicaments are to be applied to evoke blood: costmary, pennyroyal, white violet, parsley, catmint and savory and hyssop. Let her include what is suitable in her diet: leeks, rue, cummin, onion, mustard, or any other acrid vegetable. If blood bursts out from the nose at a time when it should do so from the genitals, the groins are to be scarified and cupped, repeating this every thirtieth day for three or four months, then you may be sure that this affection has been cured. But if there is no show of blood, you may be sure that there are pains coming in the head. Then blood is to be let from the arms, and you have given relief at once.

. . . constricting remedies. White olives also produce the same effect, also black poppy seeds, taken

with honey, and liquid gum, mixed with pounded celery seeds, and given in a cupful of raisin wine. Besides the above, draughts suited for all bladder pains are made from aromatics, such as spikenard, saffron, cinnamon, cassia, and such like, also decoction of mastic does good. If in spite of these pain becomes intolerable and there is blood in the urine, venesection is proper, or at any rate wet cupping over the hips.

But when the urine exceeds in quantity the fluid taken, even if it is passed without pain, it gives rise to wasting and danger of consumption; if it is thin, there is need for exercise and rubbing, particularly in the sun and before a fire. The baths should be taken but seldom, and the patient should not stay in it for long; the food should be astringent, the wine dry and undiluted, cold in summer, lukewarm in winter, and in quantity the monument required to allay thirst. The bowels also are to be moved by a clyster or by taking milk. If the urine is thick, exercise and rubbing should be more though, and the patient should stay longer in the bath; food and wine should be of the lighter kind. In both affections, everything that promotes urine should be avoided.

28 There is also a complaint about the genitals, an excessive outflow of semen; which is produced without coition, without nocturnal apparitions, so that in course of time the man is consumed by wasting. Salutary remedies in this affection are: vigorous rubbings, affusions, swimming in quite cold water; no food and drink taken unless cold. He should, moreover, avoid everything

indigestible, everything flatulent; nothing should be taken of those things which appear to collect the semen, such things are siligo, simila, eggs, spelt, starch, all glutinous flesh, pepper, colewort, bulbs, pine kernels. It is not inexpedient to bathe the lower extremities in a decoction of astringent vervains, to cover the hypogastrium and groins with plasters prepared from the same decoction, and in particular from rue preserved in vinegar: also the patient should avoid sleeping on his back.