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.

29 It remains for me to come to the extremities of the body which are interconnected by joints. I begin with the hips. In these severe pain is wont to occur, and this often weakens the patient, and some it never leaves: and on this account it is a difficult class to treat, for it is generally after chronic diseases that a pestiferous force directs itself to the hip; which, as it releases other parts, seizes upon this, which now becomes the seat of the disease. The hip is to be first fomented with hot water, after which hot plasters are applied. Those which appear to be especially beneficial are these: caper bark chopped up and mixed either with barley meal or with fig decoction, or darnel meal boiled in diluted wine and mixed with sour wine lees: since these are apt to grow cold, by night it is better to put on emollients. Inula root also pounded and afterwards boiled in dry wine and applied widely of the hip is among the most efficacious of remedies. If these do not resolve the trouble, then hot moist salt is to be employed. If even these measures do not end the pain, and a swelling supervenes, the skin is incised and cups are to be applied; diuretics are given; and the bowels if costive are to be clystered.

v1.p.455
The ultimate measure and the most efficacious in cases of old standing, is to set up issues in three or four places over the hip by burning the skin with cauteries. But rubbing is also to be employed, particularly in the sun and often each day, in order that the materials of the disease, which have been doing harm by collecting, may be the more readily dispersed; and the rubbing is applied actually over the hips in the absence of ulceration; if there is any, then to other parts. Since now some issue often has to be set up by the hot cautery, in order that matter may be extracted, it is the general rule not to let ulcerations of this kind heal offhand, but to let them drag on until the complaint which we aim to relieve has quieted down.

30 Next to the hips come the knees, in which pain now and again occurs, and these same plasters and cuppings are a safeguard, as also when any pain arises in the shoulder or other joints. Riding on horseback is of all things the most injurious to anyone with painful knees. All such pains, when of long standing, are hardly ever ended except by cauterization.

31 Joint troubles in the hands and feet are very frequent and persistent, such as occur in cases of podagra and cheiragra. these seldom attack eunuchs or boys before coition with a woman, or women except those in whom the menses have become suppressed. Upon the commencement of pain blood should be let; for when this is carried out at once in the first stages it ensures health, often for a year, sometimes for always. Some also, when they have washed themselves out by drinking asses' milk, evade this disease in perpetuity; some have obtained lifelong

v1.p.457
security by refraining from wine, mead and venery for a whole year; indeed this course should be adopted especially after the primary attack, even although it has subsided. But if the malady has already become established, it may be possible to act with more freedom in those seasons in which the pain tends to remit; but he should adopt more careful treatment at those times in which it recurs, which is generally in spring or autumn. Now when the pain requires it, in the morning the patient should be rocked; then carried to a promenade; there he should move about, and in the case of podagra he should take short turns at sitting down and walking about: next before taking food and without entering the bath itself, but in a hot room, he should be gently rubbed, sweated, and then douched with lukewarm water: the food following should be of the middle class; diuretics are given with it, and an emetic whenever he is of a fuller habit. When the pain is very severe, it makes a difference whether there is an absence of swelling, or a swelling with heat, or swellings which already hardened. For if there is no swelling, hot foments are needed. Either sea-water, or strong brine should be heated, then poured into a vessel; and as soon as he can bear it, the man puts his feet in, over the vessel is spread a cloak, and over him a blanket; after that hot water is poured over the lip of the vessel, a little at a time, to prevent the contents from losing heat: and then at night heating plasters are applied, especially mallow root boiled in wine. But if there is swelling and heat, refrigerants are more useful, and the joints may be rightly held in very cold water, but not every day, nor for long, lest the sinews become hardened. There is to be applied
v1.p.459
also a cooling plaster; this, however, is not to be kept on for long, but a change made to those which soothe as well as repress. If pain is greater, rind of poppy-heads is to be boiled in wine, and mixed with wax-salve made up with rose oil; or wax and lard, equal parts, are melted together, and then the wine mixed with these; and as soon as this application becomes hot, it is to be removed and another immediately put on. But if the swellings have grown hard and are painful, the application of a sponge frequently squeezed out of oil and vinegar, or out of cold water, or the application of pitch, wax and alum, equal parts mixed, gives relief. There are also several emollients suitable alike for the hands and feet. But if the pain does not allow of anything being put on, when there is no swelling, the joint should be fomented with a sponge which has been dipped in a warm decoction of poppy-head rind, or of wild cucumber root, next the joints are smeared with saffron, poppy-juice and ewe's milk. But if there is a swelling, this ought to be bathed with a tepid decoction of mastic or some other repressant vervain, and then covered with a medicament composed of bitter almonds pounded up in vinegar, or of white lead, to which has been added the juice of pounded pellitory. The stone, too, which corrodes flesh, which the Greeks call sarcophagos, is carved out so as to admit the feet; when these are painful, they are inserted and held there, and are usually relieved. In Asia Minor Assian limestone is held in esteem for this purpose. When pain and inflammation have subsided, which should happen within forty days, unless the patient is in fault, gentle exercise, spare diet, soothing anoint-
v1.p.461
ings, are to be employed, provided that also then the joints may be rubbed with an anodyne salve or with a liquid wax-salve of cyprus oil. But riding on horseback is harmful for those with podagra. Those, too, in whom joint-pains tend to recur at certain seasons ought both to take precautions beforehand as to their diet, lest there should be a surfeit of harmful material in the body, and to use an emetic the most frequently; and those in any anxiety as to their body should make use of clystering, or of purgation by milk. This treatment for those with podagra was rejected by Erasistratus, lest a flux directed downwards might fill up the feet, though it is evident that any purgation extracts, not only from the upper parts, but also from the lower as well.

32 Now from whatever disease he is recovering, if his convalescence is slow, the patient ought to keep awake from dawn, but nevertheless stay at rest in bed: about nine o'clock he should be gently stroked over with anointed hands, after that by way of amusement, and as long as he pleases, walk, all business being omitted: then he should use conveyances for a good while, be rubbed much, often change his residence, climate and diet. Having taken wine for three or four days, he should for one or two days drink water only. For thus he will ensure that he does not lapse into a complaint which causes wasting, but soon gets back his full strength. When he has, in fact, completely recovered, it will be dangerous for him suddenly to change his way of life and to act without restraint. Therefore he should only little by little leave off what has been prescribed, and pass to a way of life of his own choosing.

p.3

I have spoken of those maladies of the body in which the regulation of the diet is most helpful: now I pass on to that part of medicine which combats rather by medicaments. These were held of high value by ancient writers, both by Erasistratus and those who styled themselves Empirics, especially how by Herophilus and his school, insomuch that they treated no kind of disease without them. A great deal has also been recorded concerning the powers of medicaments, as in the works of Zeno or of Andreas or of Apollonius, surnamed Mys. On the other hand, Asclepiades dispense with the use of these for the most part, not without reason; and since nearly all medicaments harm the stomach and content bad juices, he transferred all his treatment rather to the management of the actual diet. But while in most diseases that is the more useful method, yet very many illnesses attack our bodies which cannot be cured without medicaments. This before all things it is well to recognize, together, that it is impossible to separate off any

p.5
one part completely, but each gets its name from the treatment which it uses most. Therefore, both that which treats by dieting has recourse at times to medicaments, and that which combats disease mainly by medicaments ought also to regulate diet, which produces a good deal of effect in all maladies of the body.

But since all medicaments have special powers, and afford relief, often when simple, often when mixed, it does not seem amiss beforehand to state both their names and their virtues and how to compound them, that there may be less delay when we are describing the treatment itself.

1 The following suppress bleeding: Blacking with the Greeks call chalcanthon, copper ore, acacia, and lycium with water, frankincense, lign-aloe, gums, lead sulphide, leek, polygonum; Cimolian chalk or potter's clay, antimony sulphide; cold water, wine, vinegar; alum from Melos, iron and copper scales and of this last there are two kinds, one from ordinary copper, the other from red copper.

2 The following agglutinate a wound: myrrh, frankincense, gums, especially gum arabic; fleawort, tragacanth, cardamon, bulbs, linseed, nasturtium; white of egg, glue, isinglass; white vine, snails pounded with their shells, cooked honey, a sponge squeezed out of cold water or out of wine or out of vinegar; unscoured wool squeezed out of the same; if the wound is slight, even cobwebs.

The following subdue inflammation: alum, both split alum called schiston, and alum brine; quince oil, orpiment, verdigris, copper ore, blacking.