De Medicina

19 Among the plasters none render greater service than those for immediate application to bleeding wounds, which the Greeks call enhaema. For these repress inflammation, unless a severe cause excites it, and even then they lessen its attack; further, they agglutinate wounds which allow of it, and induce a scar in them. But as the plasters consist of medicaments which are not greasy, they are named alipe.

The best of these is the plaster called barbarum. It contains scraped verdigris 48 grams, litharge 80 grams, alum, dried pitch, dried pine-resin, 4 grams each, to which is added oil and vinegar 250 cc. each.

Another one called Coacon, used for the same purpose, consists of litharge 400 grams, dried resin the same, but the litharge should be first boiled in three-quarters of a litre of oil. In these two plasters the colour is black, which is the colour generally produced by the pitch-resin, but the blackest is from bitumen, green from verdigris or copper scales, red from minium, white from white-lead.

There are very few compositions in which diversity of ingredients makes any change. Hence that plaster which is called basilicon is also black. It consists of all-heal 4 grams, galbanum 8 grams, pitch and resin, 40 grams each, oil 20 cc.

But, because it is bright green, a plaster is called emerald-like which contains pine-resin 12 grams, wax 4 grams, verdigris 168 grams, frankincense soot 56 grams, oil the same, and vinegar enough to combine into one the soot and the verdigris.

There is also one, almost red in colour, which is found to bring wounds rapidly to a scar. It contains incense 4 grams, resin 8 grams, copper scales 16 grams, litharge 80 grams, wax 400 grams, oil 250 cc.

As well, there is one called rhaptousa, because it agglutinates, consisting of bitumen and split alum 16 grams, litharge 160 grams, and 250 cc. of old oil.

There are also some plasters of the same class, called by the Greeks cephalica, because they are especially suitable for broken heads. That of Philotas has the following composition: Eretrian earth and chalcitis, 16 grams each, myrrh and calcined copper 40 grams each, isinglass 24 gram each, scraped verdigris, round alum, crude antimony sulphide and aristolochia, 32 grams each, copper scales 40 grams, male frankincense 8 grams, wax 336 grams, rose-oil and bitter olive-oil, 125 cc. each, and sufficient vinegar to rub up the ingredients while keeping them dry.

A green plaster for the same purpose consists of calcined copper, copper scales, myrrh and isinglass 24 grams each, crude antimony sulphide, scraped verdigris, aristolochia and alum, 32 grams each, wax 4 grams, oil 250 cc., and as much vinegar as is required.

But for promoting suppuration there is nothing better than the plaster called by the Greeks tetrapharmacon, which acts very quickly. It contains wax, pitch, resin and bull's suet, or, if that is not at hand, veal-suet, in equal proportions.

Another for the same purpose is named enneapharmacum, which is more for cleaning wounds. It has nine ingredients: wax, honey, suet, resin, myrrh,

Now there are certain plasters which produce both effects which if . . . they are to be applied for both purposes are better; but if there is a choice these are to be rejected, and those plasters rather are to be selected which especially effect what is needed at the time. I will mention two as examples.

There is the plaster of Attalus for wounds, which contains copper scales 64 grams, frankincense soot 60 grams, ammoniacum the same; liquid turpentine 100 grams, bull-suet this amount; vinegar three-quarters of a litre, oil half a litre.

But among those suitable for broken heads, some include the one which is ascribed to Iudaeus. It is composed of salt 16 grams, red copper scales and calcined copper, 48 grams each, ammoniacum for fumigation, frankincense soot and dried resin, 64 grams each, Colophon resin, wax and prepared calf's suet, 80 grams each, vinegar 65 cc., less than 40 cc. of oil. The Greeks call tetherapeumena, what we call prepared, when, for instance, from suet all membranous particles are carefully removed, and so in the case of other medicaments.

There are besides certain plasters noteworthy for extracting, and these too are named epispastic; for instance, that called dia daphnidon, because it contains laurel berries. In it there are terebinth-resin

Another of the same name which also promotes suppuration, contains calf-suet, ammoniacum for fumigation, pitch, wax, soda, laurel-berries, dried resin, aristolochia and pellitory, equal parts.

There is also that of Philocrates, which consists of ammoniac salt 28 grams, aristolochia 32 grams, wax, turpentine resin, frankincense soot, 60 grams each, litharge 128 grams, to which is added, in order to promote suppuration, iris 16 grams, and galbanum 24 grams.

The best as an extractive, however, is that called by the Greeks rhypodes, from its resemblance to dirt. It contains myrrh, crocus, iris, propolis, bdellium, pomegranate heads, alum both split and round, antimony sulphide, copper ore, boiled blacking, all-heal, ammoniacum salt, mistletoe juice, 16 grams each, aristolochia 32 grams, copper scales 56 grams, turpentine resin 300 gams, wax and ox or he-goat's suet, 400 grams each.

The plaster invented by Hecataeus is of the same class, and is composed of galbanum 8 grams, frankincense soot 16 grams, pitch 24 grams, wax and turpentine-resin, 32 grams each, with which is mixed a little iris ointment.

Efficacious for the same purpose is the green Alexandrian plaster. It consists of split alum 32 grams, ammoniac salt 32·66 grams, copper scales 64 grams, myrrh and frankincense 72 grams, wax 600 grams, Colophon or pine resin 800 grams, oil 250 cc., vinegar half a litre.

Some plasters, called by the Greeks septa, eat away flesh; one such contains turpentine-resin and frankincense soot, each 56 grams, copper scales 4 grams, ladanum 8 grams, alum the same amount, litharge 16 grams.

The following prescription is even violent in its action on soft tissue, and also causes exfoliation of bone and keeps down fungating flesh: litharge and copper scales 28 grams each, unheated soda, Assos stone, aristolochia, 56 grams each, wax, turpentine resin, incense and old oil, blacking and ammoniac salt, 168 grams each, scraped verdigris 224 grams, vinegar of squills 250 cc., Aminaean wine the same amount.

There are also some suitable for bites; one of these is the black paste of Diogenes, which contains bitumen, wax, dried pine-resin, each 80 grams, litharge 400 grams, oil half a litre. Another consists of copper scales 16 grams, white-lead and scraped verdigris, each 32 grams, ammoniacum 48 grams, wax and pine resin, each 100 gams, litharge 400 grams, oil half a litre. Or there is that in which there are copper scales 56 grams, galbanum 24 grams, white-lead and scraped verdigris, a 32 grams, ammoniacum 48 grams, wax and pine-resin, each 140 grams cooked with litharge.

The red plaster called Ephesian is likewise suited for this purpose. It contains turpentine-resin 8 grams, galbanum 16 grams, minium for Sinope 24 grams, frankincense soot 24 grams, wax 32 grams, litharge 144 grams, old olive-oil 250 cc.

There is another similar one which consists of copper scales and frankincense soot, each 16 grams, galbanum 24 grams, ammoniac salt 48·66 grams, wax 100 grams, olive-oil 750 cc. These plasters, however, may be also usefully applied to more erect wounds.

There are also soothing white plasters, called by the Greeks leuca, fitted in general for wounds which are not severe, especially in old people. Such is that containing white-lead 128 grams, prepared calf's suet, and wax, each 192 grams, olive-oil 750 cc., with which the white-lead is boiled.

Another consists of white-lead 80 grams, wax 140 grams, olive-oil 250 cc., water half a litre. Whatever these liquids are added to white lead or litharge, it is understood that those drugs are to be boiled up in the liquids. But the above composition being of a glistening white appearance is called ivory plaster.

There are also some soothing plasters, commonly called liparae by the Greeks, such as that containing minium 16 grams, litharge 100 grams, wax and lard, each 148 grams, with the yolk of 4 eggs.

Another composition of the same sort contains wax and turpentine-resin, each 24 grams, white-lead 32 grams, litharge and lead-slag, called by the Greeks σκωρία μολύβδου, each 80 grams, castor-oil and myrtle-oil, a 250 cc.

A third, said to have been invented by Archagathus, contains boiled antimony sulphide and calcined copper, each 16 grams, boiled white-lead 32 grams, turpentine-resin 40 grams, litharge 24 grams.

Yet another of the same class consists of litharge, wax and lard, each 108 grams, yolk of 4 eggs boiled, rose-oil 250 cc. Another consists of a cerate made with myrtle-oil three parts, lard a fourth part, and a small quantity of lead-slag. Alternatively: litharge 168 grams, olive-oil 250 cc., and an equal quantity of sea water, boiled, to which, when off the boil, a little wax may be added. Or: wax, suet, antimony sulphide, litharge and white-lead, equal parts.

20 Pastils have also dives faculties. For some are suitable for agglutinating and making the scar upon recent wounds: such as that containing copper ore, antimony sulphide, soda-scum, flowers of copper, oak-galls, split alum moderately boiled, each 4 grams, calcined copper and pomegranate-heads, each 12 grams. It should be dissolved with vinegar, and so smeared on for agglutinating a would. But if the part wounded involves sinews or muscles, it is better to mix the pastil with a cerate, eight parts of the former to nine of the latter.

Another for the same purpose is composed of bitumen and split alum, each 4 grams, calcined copper 16 grams, litharge 44 grams, oil half a litre.

But the pastil of Polyides called the "seal" is by far the most celebrated. It contains split alum 4·66 grams, blacking 8 grams, myrrh 20 grams, ling aloes the same, pomegranate heads and ox-bile, 24 grams each; these are rubbed together and taken up in dry wine.

For foul ulcerations and gangrene in the ears, nostrils and genitals, and their inflammatory complications, take chrysocolla 4 grams, blacking and split alum 8 grams each, winter cherry bark 16 grams, minium 24 grams, litharge 48 grams, white lead 64 grams; these are both compounded with vinegar and dissolved for use with the same.

The pastil of Andron is for inflammation of the uvula, and for the genitals when foul, and even when affected by canker. It contains oak-galls, blacking, and myrrh, 4 grams each, aristolochia and split

But the following is appropriate for anal fissures, for bleeding piles, or for canker, verdigris 8 grams, myrrh 16 grams, gum 32 grams, frankincense 48 grams, antimony sulphide, poppy tears and acacia, 64 grams each. These are both pounded up in wine and for actual use are dissolved in the same.

The following present is efficacious to expel stones from the bladder along with the urine; casia, crocus, myrrh, costmary, nard, cinnamon, liquorice root, balsamum and hypericum juice, equal parts; these are rubbed together, then mild wine is poured on, and pastils are made, each weighing 0·66 gram; one of them is given every morning on an empty stomach.

21 These three classes of compositions —emollients, pastils and plasters — have very wide and varied uses. But there are other useful compositions, such as those which are introduced into women from below: the Greeks call them pessoi. Their characteristic is that the component medicaments are taken up in soft wool, and this wool is inserted into the genitals.

A pessary for inducing menstruation contains soda 2·65 grams, added to two Caunean figs; or garlic seeds are pounded, a little myrrh added, and these are mixed with Susine lily ointment; or the pulp of a wild cucumber is diluted in woman's milk.

To mollify the womb a yolk of egg, fenugreek, rose-oil and saffron are mixed together. Or elaterium 0·66 gram, the same quantity of salt, and black bryony berries 24 grams are taken up with honey.

The pessary invented by Boethus consists of saffron and turpentine resin, 16 grams each, myrrh 1·33 grams, rose-oil 4 grams, calf's suet 4·66 grams, wax 8 grams, mixed together.

But against inflammations of the womb, the composition of Numenius is the best; it consists of saffron 1 gram, wax 4 grams, butter 32 grams, goose-fat 48 grams, 2 yolks of egg boiled, and of rose-oil less than 40 cc.

If the foetus is dead, to render its expulsion more easy, pomegranate rind should be rubbed up in water and so used.

If a woman is liable to fits owing to genital disease, snails are to be burnt with their shells, and pounded up together; then honey added to them.

If a woman does not conceive, lion's fat is to be softened by rose-oil.

22 Now, some mixtures of medicaments are used dry, without being combined, so that they are dusted or smeared on after some liquid has been mixed with them. Such is the present to eat away fungous flesh, which contains copper scales and frankincense soot, 4 grams each, verdigris 8 grams. But when combined with honey this compound cleans ulcers, when with wax it fills them up. Also antimony

Honey mixed with lentils or with horehound or with olive leaves previously boiled in wine holds in check putrid flesh, prevents its further spread, and is a mild corrosive. The same is the action of melilot, boiled in honey wine, then pounded up; or lime with cerate; or bitter almonds with garlic in the proportion of three to one, with the addition of a little saffron. Or the composition containing litharge 24 grams, burnt ox-horn 48 grams, myrtle-oil and wine, 125 cc. of each. Or that mixture which consists of pomegranate flowers, blacking and lign-aloes, 8 grams each, split alum and frankincense 16 grams, oak-galls 32 grams, aristolochia 40 grams. Stronger as a corrosive is that compounded by calcining orpiment with copper ore, and with either soda or lime or burnt papyrus; salt with vinegar is similar. Or that composition which contains copper ore, pomegranate heads, lign-aloes, 8 grams each, split alum and frankincense, 16 grams each, oak-galls 32 grams, aristolochia 40 grams, with sufficient honey to combine them. An alternative is the composition containing cantharides 4 grams, sulphur 4 grams, darnel 12 grams, to which is added enough liquid pitch to combine them. Or also that composed of copper ore mixed with resin and rue; or slag similarly with resin; or black bryony berries with liquid pitch. The same property too belongs both to burnt wine-lees and lime and soda, equal parts, or to split alum, 1·33 grams, frankincense, sandarach and soda, 4 grams each, oak-galls 32 grams, aristolochia 40 grams, and as much honey as is required.

There is also the compound of Heras which contains myrrh and copper ore, 8 grams each, lign-aloes, frankincense, split alum, 16 grams, aristolochia and immature oak-galls, 32 grams each, pomegranate rind pounded 40 grams.

The compound of Iudaeus contains lime two parts; the reddest soda one part, mixed with the urine of a young boy to the consistency of strigil scrapings. But the place on which it is smeared should from time to time be moistened.

Then the compound of Iollas consists of burnt papyrus and of sandarach, 4 grams each, lime 8 grams, mixed with the same quantity of orpiment.

But if there is haemorrhage from the membrane covering the brain, a yolk of egg which has been charred and then pounded should be scattered on; for haemorrhage elsewhere orpiment and copper scales, 4 grams each, sandarach 8 grams, calcined marble 16 grams, should be dusted on. The same also checks canker. To induce scarifying, copper scales and frankincense soot, 8 grams each, lime 16 grams. The same also counters fungous flesh.

Also Timaeus used the following for ignis sacer and for canker: myrrh 8 grams, frankincense and blacking, 12 grams each, sandarach, orpiment, copper scales, 16 grams each, oak-galls 24 grams, burnt white-lead 32 grams. This is either scattered on dry or has the same effect when taken up in honey.

Sneezing too is excited by putting up the nose either white veratrum or soapwort; or the following mixture: pepper and white veratrum, 0·66 gram each, castoreum 1 gram, soda-scum 4 grams, soapwort 16 grams.

Now gargles are used as emollients or as repres-

23 Antidotes are seldom needed, but are at times important because they bring aid to the gravest cases. They are appropriately administered for bodily contusions, either from blows or in cases of a fall from a height, or for pain in the viscera, sides, fauces, or internal parts. But they are chiefly necessary against poisons introduced into our bodies through bites or food or drink.

One consists of poppy-tears 0·66 gram, sweet flag and malabathrum, 20 grams each, Illyrian iris and gum, 8 grams each, anise 12 grams, Gallic nard, dried rose-leaves and cardamons, 16 grams each, parsley 16·66 grams (or trifolium 20 grams), black casia, seseli, bdellium, balsam seed, white pepper, 20·66 grams each, storax 20·66 grams, myrrh, opopanax, Syrian nard, male frankincense and hypocistis juice, 24 grams each, castoreum 24 grams, costmary, white pepper, galbanum, turpentine resin, crocus, flowers of round rush 25 grams, liquorice root 33 grams, which are taken up in honey or in raisin wine.

Alternatively there is that which Zopyrus is said to have compose for a King Ptolemy, and to have called it ambrosia, consisting of the following: costmary and male frankincense, 1·33 grams each, white pepper 1 gram, flowers of round rush 8 grams,

But the most famous antidote is that of Mithridates, which that king is said to have taken daily and by it to have rendered his body safe against danger from poison. It contains costmary 1·66 grams, sweet flag 20 grams, hypericum, gum, sagapenum, acacia juice, Illyrian iris, cardamon, 8 grams each, anise 12 grams, Gallic nard, gentian root and dried rose-leaves, 16 grams each, poppy-tears and parsley, 17 grams each, casia, saxifrage, darnel, long pepper, 20·66 grams each, storax 21 grams, castoreum, frankincense, hypocistis juice, myrrh and opopanax, 24 grams each, malabathrum leaves 24 grams, flower of round rush, turpentine-resin, galbanum, Cretan carrot seeds, 24·66 grams each, nard and opobalsam, 25 grams each, shepherd's purse 25 grams, rhubarb root 28 grams, saffron, ginger, cinnamon, 29 grams each. These are pounded and taken up in honey. Against poisoning, a piece the size of an almond is given in wine. In other affections an amount corresponding in size to an Egyptian bean is sufficient.

24 Acopa again are useful for neuralgia. Of these there is one which consists of the flower of the round rush, 9·33 grams each, costmary, square rush, laurel berries, ammoniacum, cardamons, 17 grams each, myrrh and calcined copper 28 grams, Illyrian iris and wax 56 grams, Alexandrian flag,

Another called euodes is prepared as follows: wax 84 grams, oil this quantity, and turpentine-resin, the size of a walnut, are boiled together, then pounded in a mortar, and into this is gradually dropped 63 cc. of the best honey, and then iris ointment and rose-oil, 125 cc. of each.

Now enchrista is the Greek name for liquid applications. Of these one is used for cleaning and filling up ulcers, especially about sinews. It is composed of a mixture of each parts of butter, calf's marrow, calf's suet, goose-fat, wax, honey, turpentine-resin, rose-oil and castor-oil. This are all liquefied separately, then the liquids are mixed and stirred up together. And the above is more for cleaning up wounds; it is more of an emollient if instead of the rose-oil, cyprus-oil is poured in.

And for ignis sacer litharge 24 grams, burnt ox-horn 48 grams, are rubbed together, adding by turns wine, especially that which is called sil, and myrtle-oil until 125 cc. of each is mixed in.

25 Pills are also numerous, and are made for various purposes. Those which relieve pain through sleep are called anodynes; unless there is overwhelming necessity, it is improper to use them; for they are composed of medicaments which are very active and alien to the stomach. There is one, however, which actually promotes digestion; it is composed of poppy-tears and galbanum, 4 grams each, myrrh, castory, and pepper, 8 grams each. Of this it is enough to swallow an amount the size of a vetch.

Another, worse for the stomach, but more soporific, consists of mandragora 1 gram, celery-seed and hyoscyamus seed, 16 grams each, which are rubbed up after soaking in wine. One of the same size mentioned above is quite enough to take.

But whether there is headache or ulceration or ophthalmia or toothache or difficulty in breathing or intestinal gripings or inflammation of the womb or pain in the hips of liver or spleen or ribs, or, whether owing to genital trouble, a woman collapses speechless, a pillar of the following kind counteracts pain by producing sleep: saxifrage, sweet flag, wild rue seed, 4 grams each, castory and cinnamon 8 grams, poppy-tears, panax root, dried mandrake apples, flowers of the round rush, 9 grams each, and 56 peppercorns. These are first pounded separately, then rubbed up all together, whilst gradually adding raisin wine until the mixture is either swallowed or dissolved in water and taken as a draught.

Or take a good handful of wild poppy-heads when just ripe for collecting the juice and put into a vessel and boil with water sufficient to cover it. When this handful has been well boiled there, after being squeezed out it is thrown away; and with its juice is mixed an equal quantity of raisin wine, and heated until to consistency of sordes. When the mixture has cooled, pills are formed, the size of our beans; they are used in many ways. For they procure sleep

Again if inflammation of the womb prevents sleep take saffron 1·33 grams, anise and myrrh, 4 grams each, poppy-tears 12 grams, hemlock seed 32 grams. These are mixed together, and taken up in old wine, and a pill the size of a lupin is dissolved in 125 cc. of water. It is dangerous, however, to give it when there is fever.

For the relief of pain in the liver soda 1 gram, saffron, myrrh, Gallic nard, 4 grams each, are taken up in honey, and a pill the size of an Egyptian bean administered.

A pill to stop pain in the side is made of pepper, aristolochia, nard, and myrrh in equal parts.

A pill for pain in the chest is made from nard 4 grams, frankincense and casia, 12 grams each, myrrh and cinnamon, 24 grams each, saffron 32 grams, turpentine-resin 1 gram, honey three-quarters of a litre.

The pill of Athenion for cough contains myrrh and pepper, 0·66 gram each, castory and poppy-tears, 4 grams each; these are rubbed down separately, then together, and two pills, the size of our bean, are given in the morning and two at bed-time.

If cough prevents sleep the pill of Heracleides of Tarentum relieves both; it contains saffron 0·66 gram, myrrh, long pepper, costmary, galbanum, 1 gram each, cinnamon, castor and poppy-tears, 4 grams each.

But if ulcers of the throat causing cough are to be cleaned, panax, myrrh and turpentine-resin, 28 grams each, galbanum 0·66 gram, hyssop 1 gram are rubbed together, and 250 cc. of honey added to them and as much swallowed as can be taken up on the finger.

The pill of Cassius for colic contains saffron, anise, castory, 12 grams each, parsley 16 grams, pepper both long and round, 20 grams each, poppy-tears, round rush, myrrh, nard, 24 grams each; these are taken up in honey. It may be either swallowed as it is or dissolved in hot water.

A draught for the expulsion of a dead foetus or placenta consists of ammoniac salt 4 grams, or of Cretan dittany 4 grams in water.

In difficult labour hedge mustard in tepid wine should be administered on an empty stomach.

The voice is strengthened by frankincense 4 grams in two cups of wine.

For difficult micturition long pepper, castory, myrrh, galbanum, poppy-tears, saffron, costmary, 28 grams each; storax and turpentine-resin, 56 grams each, honey with absinth 42 cc. Of this an amount the size of an Egyptian bean should be taken in the morning and after dinner.

A medicine for the windpipe is prepared as follows: casia, iris, cinnamon, nard, myrrh, frankincense, 4 grams each; saffron 1 gram; and 30 peppercorns boiled in a litre and a half of raisin

26 Now that I have set out the properties of the medicaments, I will explain the classes of lesions harmful to the body: there are five; when something from without causes the lesion, as in the case of wounds; when some internal part has become corrupted, as in the case of canker; when some new formation has occurred, such as a stone in the bladder; when something has grown bigger, as when a vein swells up and is converted into a varix; when there is some defect, as when some part has been mutilated.

In some of these medicaments are more effectual, in others surgery. Postponing those conditions which demand in particular the scalpel and surgical treatment, I will speak now of those which chiefly require medicaments. As I have done before, I shall divide this part of treatment, and speak first of those lesions which may occur in any part of the body, then of those which attack particular parts. I shall begin with wounds.

In this connexion, however, a practitioner should know above all which wounds are incurable, which may be cured with difficulty, and which more readily. For it is the part of a prudent man first not to touch a case he cannot save, and to the risk the appearance of having killed one whose lot is but to die; next, when there is grave fear without, however, absolute

It is impossible to save a patient when the base of the brain, the heart, the gullet, the porta of the liver, or the spinal marrow has been pierced; when the middle of the lung, or the jejunum, or the small intestine, or the stomach, or kidneys have been wounded; or when the large blood-vessels and arteries in the region of the throat have been cut.

Again, there is hardly ever recovery when either the lung or the thick part of the liver or the membrane enclosing the brain, or the spleen, womb, bladder, any of the intestines or diaphragm has been wounded in any part. There is also grave danger when the point of a weapon has gone down to the large blood-vessels deeply seated in the armpits or hams. Also wounds are dangerous wherever the blood-vessels are larger, because they may exhaust the patient by profuse bleeding. This occurs not only in the armpits and hams, but also in those blood-vessels which go to the anus and testicles. Moreover, a wound is a bad one whenever it is in the armpits or in the thighs or in hollow places or in joints or between the fingers; also whenever a muscle

The above wounds are severer or slighter according to their situations. Still, whenever it is large, a wound makes for danger.

The class of wound and its shape are also important. For a contused would is worse than one simply incised, hence it is better to be wounded by a sharp weapon than by a blunt one. A wound is worse also if a piece is cut out, or if the flesh is cut away in one part and hanging free in another. A curved wound is worst, a straight linear one safest; hence a wound is more or less serious, according as it approximates to the former or to the latter shape.

Again, both age and constitution and mode of life and the season have also some influence; for a boy or young adult heals more readily than does an old man; one who is strong than a weak man; a man who is not too thin or too fat than one who is either of these; one of sound habit than of unsound; one who takes exercise than a sluggard; one who is sober and temperate than one addicted to wine and venery. And the most opportune time for healing is the spring, or at any rate when the weather is neither cold nor hot, for wounds are harmed by excessive heat and excessive cold, but most of all by variations of these; hence autumn is the most pernicious season.

Now most wounds are open to view; some are inferred from their situation, which we have pointed out elsewhere when indicating the positions of the internal parts. Since, however, some of these wounds are near at hand, and it is of importance whether the wound is superficial or has penetrated inwards,

Now when the heart is penetrated, much blood issues, the pulse fades away, the colour is extremely pallid, cold and malodorous sweats burst out as if the body had been wetted by dew, the extremities become cold and death quickly follows.

But when the lung is pierced there is difficulty in breathing; frothy blood escapes from the mouth, red blood from the wound; and at the same time breath is drawn with a noise; to lie upon the wound affords relief; some stand up without any reason. Many speak if they have been laid upon the wound; if upon the opposite side they become speechless.

Symptoms that the liver should have been wounded are that considerable haemorrhage occurs from under the right part of the hypochondria; the hypochondria are retracted towards the spine; the patient is eased by lying on his belly; stabbing pains spread upwards as high as the clavicle and its junction with the scapula; to which, not infrequently, also bilious vomiting is added.

When the kidneys have been penetrated, pain spreads down to the groin and testicles; urine is passed with difficulty, and it is either bloodstained or actual blood clot is passed.

But when the spleen has been pierced, black blood flows out from the left side; the hypochondria on that side together with the stomach become hard; great thirst comes on; pain extends to the clavicle as when the liver has been wounded.

But when the womb has been penetrated, there is

When the brain or its membrane has been wounded, blood escape through the nostrils, in some also through the ears; and generally bilious vomiting follows. Some lose their senses and take no notice when spoken to; some have a wild look; in some the eyes move from side to side as if they were out of control; generally on the third or fifth day delirium supervenes; many have also spasm of sinews. Again, before death many tear off the bandages with which their head has been bound up, and expose the bared wound to cold.

But when the gullet has been penetrated, hiccough and bilious vomiting follow; if any food or drink is swallowed, it is returned at once; pulsation of the blood-vessels fades away; thin sweat breaks out, following which the extremities become cold.

The signs when the small intestine and the stomach have been wounded are the same; for food and drink come out through the wound; the hypochondria become hard, sometimes bile is regurgitated through the mouth. Only in the case of the intestine the situation of the wound is lower down. All other intestinal wounds cause the emission of faeces or a faecal odour.

When the marrow which is within the spine has been crushed, there is

But if the diaphragm has been penetrated, the praecordia are contracted upwards; the spine is painful; breathing is laboured; frothy blood escapes.

When the bladder has been wounded, the groins are painful; the hypogastrium becomes tense; blood is passed, instead of urine, the urine being discharged from the actual wound. The gullet is affected, and so the patients either vomit bile or hiccough. Coldness and after that death follows.

Even when these facts are known, there are still some other things to be learnt about wounds and ulcerations in general, of which we will now speak. From wounds, then, there comes out blood, or sanies, or pus. Blood everybody knows; sanies is thinner than blood, varying both in thickness and stickiness and colour. Pus is the thickest and whitest, more sticky than either sanies or blood. Now blood comes out from a fresh wound or from one which is already healing, sanies between these two periods, pus from an ulceration already beginning to heal. Again, the Greeks distinguish by name different kinds of sanies and pus. For there is a kind of sanies which is named either hidros or melitera; there is pus which is called alaeodes. Hidros is thin, whitish, and comes from a bad ulceration, especially when inflammation has followed upon a wound of a sinew. Melitera is thicker, stickier and whitish, something like honey. It is likewise discharged from bad ulcerations, when sinews near to joints have been wounded, and among such places especially from the knees. Elaeodes is thin, whitish, fatty, in colour and fattiness not unlike olive-oil; it appears

After these matters have been investigated, when a man has been wounded who can be saved, there are in the first place two things to be kept in mind: that he should die from haemorrhage or inflammation. If we are afraid of haemorrhage which can be judged both from the position and size of the wound and from the force of the flowing blood, the wound is to be filled with dry lint, and over that a sponge applied, squeezed out of cold water, and pressed down by the hand. If the bleeding is not checked thus, the lint must be changed several times, and if it is not effective when dry, it is to be soaked in vinegar. Vinegar is powerful in suppressing a flow of blood; and some, therefore, pour it into wounds. But then there is an underlying fear of another kind, that if too much diseased matter is forcibly retained in the wound it will afterwards cause great inflammation. It is on this account that no use is made, either of corrosives or of caustics, owing to the crust they induce, although most of these medicaments suppress bleeding; but if for once recourse is had to them, choose those which have a milder action. But if even these are powerless against the profuse bleeding, the blood-vessels which are pouring out blood are to be seized, and round the wounded spot they are to be tied in two places and cut across between so that the two ends coalesce each on itself and yet have their orifices closed. When circumstances do not even admit of this, the blood-vessels can be burnt with a red-hot iron. But even when there has been a considerable bleeding from a place where there is neither sinew nor muscle, such as the forehead or top of the head, it is perhaps best to apply a cup to a distant part, in order to divert thither the course of the blood.

Against bleeding there is help in the foregoing measures, but against inflammation it lies simply in the bleeding itself. Inflammation is to be feared when a bone is injured or sinew or cartilage or muscle, or whenever there is little outflow of blood compared to the wound. Therefore, in such cases, it will not be desirable to suppress the bleeding early, but to let blood flow as long as it is safe; so that if there seems too little bleeding, blood should be let from the arm as well, at any rate when the patient is young and robust and used to exercise, and much more so when a drinking bout has preceded the wound. But if a muscle is seen to be wounded, it will be best to cut it right through; for when stabbed it causes death, when cut through it admits of cure.

Now, when bleeding has been suppressed if excessive, or encouraged when not enough has escaped of itself, then by far the best thing is for the wound to become agglutinated. But this is possible for a wound in the skin, or even in the flesh, if nothing else has occurred to do it harm. Agglutination is possible if the flesh is hanging free at one part, whilst attached at another, provided, however, that the flesh is still sound, and has a connexion with the body to feed it. But with wounds which are being agglutinated, there are two treatments. For if the wound is in a soft part, it will be stitched up, and particularly when the cut is in the tip of the ear or the point of the nose or forehead or cheek or eyelid or lip or the skin over the throat or abdomen. But if the wound is in the flesh, and gapes, and its margins are not easily drawn together, then stitching in unsuitable; fibulae (the Greeks call them ancteres) are then to be

The bandage too for binding up a wound is best made of linen, and it should be so wide as to cover it in a single turn, not the wound alone but somewhat of its edges on either side. If the flesh has receded more from one edge, the traction is better made from that side. If equally from both, the bandage, put crosswise, should press the margins together; or if the character of the wound does not admit of that, the middle of the bandage is to be applied first, so that it may then be drawn to either side. Moreover, the wound is to be bandaged so that it is held together, yet not constricted. When it is not so held, it gapes; if it is constricted too much, there is a risk of canker. In winter there should be more turns of the bandage, in summer just those necessary; finally, the end of the bandage is to be stitched by means of a needle to the deeper turns; for a knot hurts the wound, unless, indeed, it is at a distance from it.

On the following point no practitioner should be ignorant so that he has to enquire as to the special treatment required for the internal organs, which I have spoken of above. For whilst an external wound is to be treated either by suture, or by some sort of medicine; in the case of the internal organs, nothing is to be moved, unless it be to cut away some bit of liver or spleen or lung which hangs outside. Otherwise internal wounds will be cured by the regulation of diet, and by those medicaments which I have stated in the preceding book to suit each individual organ.

So then, after this has been done on the first day,

It is dangerous when a wound swells overmuch; no swelling at all is the worst danger: the former is an indication of severe inflammation; the latter that the part is dead. And from the first if the patient retains his senses, if no fever follows, we may recognize that the wound will soon heal. And even fever should not cause alarm in the case of a large wound, if it persists while there is inflammation. That fever is harmful which either supervenes upon a slight wound, or lasts beyond the inflammatory period, or excites delirium; or which does not put an end to the rigor or spasm of sinews which has originated from the wound. Also involuntary bilious vomiting either immediately after the injury, or during the inflammatory period, is a bad sign only when sinews or even the neighbourhood of sinews have been wounded. The induction of a vomit, however, is not inappropriate, especially in those habituated to it; provided that this is not done immediately after food, or just when the inflammation has arisen, or

When the wound has been so treated for two days, on the third it should be uncovered, sanies washed away with cold water, and then the same dressing applied again. By the fifth day the extent of inflammation in prospect is apparent. And on that day, when the wound has been uncovered again, its colour must be considered. If it is livid or pallid or patchy or dusky, it can be recognized that the wound is a bad one, and whenever this is observed, it should alarm us. It is best for the wound to be white or rubicund; also if the skin is hardened, thickened, or painful, danger is indication. Good signs are for the skin to be thin and soft without pain. But if the wound is agglutinating or swollen slightly, the same dressings as at first are to be applied; if there is severe inflammation and no hope of agglutination, then such applications are to be made as promote suppuration. And now the use of hot water as well is a necessity, in order to disperse diseased matter and to soften hardening and bring out pus. The temperature of the water must be pleasant to the hand when put into it, and the affusion is to be continued until the swelling is seen to have diminished and a more natural colour to have returned to the wound. After this fomentation, if the wound is not gaping widely, a plaster should be put on at once, particularly that tetrapharmacum if it is a large wound; in the case of wounds of joints, fingers, cartilaginous places, the plaster rhypodes; if the wound gapes more widely, that same plaster should be liquefied by iris unguent, and lint smeared with this laid all over the wound; upon this put the plaster, and above that greasy wool.

As to joints, there are certain special points to be noticed as, if the controlling sinews have been divided, weakness of the part concerned follows. If this is in doubt, and the wound has been made by a sharp weapon, a transverse wound is the more favourable; if by a blunt and heavy weapon, the shape of the wound makes no difference. But it is to be observed whether pus is being formed above the joint or beneath. If it is produced underneath, and thick and white discharge continues for some time, it is probable that a sinew has been cut, and the more so the greater the pains and inflammation, and the earlier these occur. But even though no sinew is divided, yet, if a hard swelling persists for a long while round about, the wound will last a long time and even after healing a swelling will persists; and in future that limb will be bent or stretched out slowly. There is, however, more delay in extending a limb which has been kept bent while treated, than in bending a limb which has been kept straight. Also there should be a definite rule as to position for a limb which has been wounded. If the wound is seem to be agglutinated, the limb is kept raised; it must not be bent either way if there is still inflammation; if pus is already being discharged it should be hanging down. The best medicament too is rest; movement and walking before healing are adverse. The danger, however, from movement is less for wounds of the head and arms than for the lower limbs. Walking about is least of all suited to an injured thigh or leg or foot. The patient's room should be kept warm.

When the inflammation has ended, the wound must be cleaned. And that is best done by putting on lint soaked in honey, and over it the plaster called tetrapharmacum or that called enneapharmacum. Then at length the wound is really clean when it is red, and neither too dry nor too moist. But a wound is not clean when it lacks sensation, when there is sensation which is not natural, when it is either too dry or too wet, when it is either whitish or pallid or livid or blackish.

When the wound is clean, there follows the growth of new flesh; and now warm water is necessary in order to remove sanies. The use of unscoured wool is superfluous; scoured wool is the better wrapping. But for filling up a wound certain medicaments also are useful; therefore it is not inappropriate to make use of such things as butter with rose-oil and a little honey; or the tetrapharmacum with the said rose-oil, or lint soaked in rose-oil. More beneficial, however, is an occasional bath, a nourishing diet, while avoiding everything acrid, but now somewhat fuller, for both poultry and venison and boiled pork can be given. In all cases, while fever and inflammation are present, wine is inappropriate; also, until the scar is formed, if either sinews or muscles have been wounded; or even if there is a deep flesh wound. But when the wound is of the safer kind, only skin deep, wine if

Such is the procedure of a successful treatment; dangerous complications, however, are wont to occur. Sometimes the wound becomes the seat of chronic ulceration, and it becomes hardened, and the thickened margins are a livid colour; after which whatever medicament is applied is of little service; and this commonly occurs when the wound has been carelessly treated. At times, whether owing to excess of inflammation, or to unusually hot weather, or to excessively cold weather, of because the wound has been bandaged too tightly, or on account of old age, or of a bad habit of body, canker sets in. The Greeks divided this genus into species for which there are no terms in our language.

Now canker, whatever its species, corrupts not only the part it attacks, but it also spreads; next it is distinguished by differing signs. For sometimes a redness, over and above the inflammation, surrounds the wound, and this spreads with pain (the Greeks term it erysipelas); at times the wound is black because its flesh has become corrupted, and this is still more intensified by putrefaction when the wound is moist, and from the black wound is discharged a

And such are the dangers following upon wounds. Now a wound when of long standing should be cut with a scalpel, its margins excised, and incisions made at the same time into any livid area surrounding the margins. If there is a small varix inside the wound which hinders healing, it also is to be excised.

But what I have said is called erysipelas, not only follows upon a would, but is wont also to arise without a wound, and sometimes brings with it some danger, especially when it sets in about the neck or head. If strength permits, blood should be let; then repressives and refrigerants applied together, particularly white-lead with nightshade juice, or Cimolian chalk with rain-water as an excipient; or flour made into a paste with the same, with cyprus shoots added, or lentil meal if the skin is more delicate. Whatever is put on is to be covered over with beet leaves, and over that with lint wetted with cold water. If refrigerants by themselves have little effect, they are to be combined with the following: sulphur 4 grams, white-lead and saffron, 50 grams each; and these are pounded up with wine and the place smeared with them: or when the skin is more hardened, nightshade leaves are pounded, mixed with lard, and applied spread on lint.

But if there is a blackening which is not yet spreading, the milder corrosives of putrid flesh are to be put on, and the wound having been thus cleaned out, is cared for like other wounds. If there is more corruption, and it is already spreading, stronger corrosives are needed. If even these are not effective,

But gangrene, when not yet widespread, but only beginning, is not very difficult to cure, at any rate in a young subject; and even more so if muscles are intact, sinews uninjured or but slightly affected, and no large joint opened, or if there is little flesh in the part, and so not much to putrefy, and if the lesion is limited to one place; and this mostly happens in a finger. In such a case the first thing to be done, when strength permits, is to let blood; then whatever has become dry, and by stretching out, as it were, in injuring also what is next to it, is cut away up to this point the sound tissue. Whilst the gangrene is spreading, medicaments which tend to promote suppuration are not to be applied; and therefore not even hot water. Weighty dressings also, although repressant, are unsuitable; but the lightest are needed; and over the parts which are inflamed refrigerants are to be used. If the malady is still not checked, the part between what is sound and diseased ought to be cauterized; and in such a case especially assistance is to be sought, not only from medicaments, but also from a system of diet; for this malady only occurs in a corrupt and diseased body. Therefore at first, unless weakness prohibits

Such are the treatments of the gravest wounds. But there should be no neglect of those in which the skin is intact, but some inner part has been contused; or where something has been scraped or rubbed off: or what a splinter has become fixed in the body, or where the wound is small but deep.

In the first case the best thing is to cook the rind of a pomegranate in wine, and pound up its interior and mix with rose-oil cerate, and so apply it: next, when the skin has been actually abraded, to lay on a soothing medicament such as lipara.

When the skin has been scraped and rubbed off, the plaster tetrapharmacum is to be applied, the food reduced and wine withdrawn. Such wounds are not to be disregarded because deeper structures are uninjured; for often from injuries of this kind

A splinter too, whenever possible, should be extracted either by the hand or even by the help of an instrument. But if the splinter has been broken off or has penetrated too deeply for this to be done, it must be drawn towards the surface by a medicament. The best thing to draw it out is an application of pole-reed root pound up straight away if soft, but if already rather hard, boiled first in honey wine; to which honey should always be added, or birthwort also with honey. Of splinters the pole-reed is the worst because it is rough; there is the same harmfulness in fern. But by experience it has been learnt that either, when pounded up and applied, serves as a medicament against the other. Any medicament which has an extractive property has the same effect on splinters of all kinds.

The same treatment is best for deep and narrow wounds. The plaster of Philocrates is especially good for the former, that of Hecataeus for the latter.

Whatever the kind of wound, when the time has come for inducing the scar, which must be after the wound has cleaned and filled with new flesh, first lint is applied, wetted by cold water while the flesh is being nourished; afterwards, when it has to be checked, dry lint must be applied until the scar is induced. Then plumbum album should be bandaged on in order to keep down the scar, and to give it a colour as much as possible like sound skin. Wild cucumber root has the same property, so has the present contain in: elaterium 4 grams, litharge

27 I have spoken of those wounds which are mostly inflicted by weapons. My next task is to speak of those which are caused by the bite, at times of a man, at times of an ape, often of a dog, not infrequently of wild animals or of snakes. For almost every bite has in it poison of some sort. Therefore if the wound is severe, a cup should be applied straightway of it; if slighter a plaster, especially that of Diogenes. If that is not at hand, then one of the others I have recommended against bites; failing such, the green plaster called Alexandrian; if not even that is to be had, then any one which suits recent wounds, so long as it is not greasy. Salt is also a remedy for bites, especially dog-bite, if a hand is then placed over the bite and struck by two

But especially if the dog was mad, the poison must be drawn out by a cup; next, if the wound is not among sinews and muscles, it must be cauterized; if it cannot be cauterized, it is not amiss to bleed the man. After cauterizing, applications are to be put on as for other burns; if the wound is not cauterized, such medicaments as are powerful corrosives. After this the wound should be filled in and brought to healing, not by any new method, but as already described above. After the bite of a mad dog some send the patients at once to the bath, and there let them sweat as much as their bodily strength allows, the wound being kept open in order that the poison may drop out freely from it; then follows the administration of much wine, undiluted, which is an antidote to all poisons. And when this has been carried out for three days, the patient is deemed to be out of danger.

But when too little has been done for such a wound, it usually gives rise to a fear of water which the hands call hydrophobia, a most distressing disease, in which the patient is tortured simultaneously by thirst and by dread of water. In these cases there is very little help for the sufferer. But still there is just one remedy, to throw the patient unawares into a water tank which he has not seen beforehand. If he cannot swim, let him sink under and drink, then lift him out; if he can swim, push him under at intervals so that he drinks his fill of water even against his will; for so his thirst and dread of water are removed at the same time. Yet this

Serpents' bites again need a not very different treatment, although in this the ancients had very various methods so that for each kind of snake some prescribed one special kind of remedy, some another; but in all it is the same measures which are the most efficacious. Therefore first the limb is to be constricted above this kind of wound, but not too tightly, lest it become numbed; next, the poison is to be drawn out. A cup does this best. But it is not amiss beforehand to according to incisions with a scalpel around the wound, in order that more of the vitiated blood may be extracted. If there is no cup at hand, although this can hardly happen, use any similar vessel which can do what you want; if there is not even this, a man must be got to suck the wound. I declare there is no particular science in those people who are called Psylli, but a boldness confirmed by experience. For serpent's poison, like certain hunter's poisons, such as the Gauls in particular use, does no harm when swallowed, but only in a wound. Hence the snake itself may be safely eaten, whilst its stroke kills; and if one is stupefied, which mountebanks effect

Such are the general remedies against bites of any kind. Experience has taught, however, that anyone bitten by an asp should in particular drink

There are also against certain other reptiles remedies which are well enough known. For the scorpion is itself the best remedy against itself. Some pound up a scorpion and swallow it in wine; some pound it up in the same way and put it upon the wound; some put it upon a brazier and fumigate the wound with it, putting a cloth all round to prevent the escape of the fumes, afterwards they bandage its ash upon the wound. The patient should also drink wine in which have been steeped the seeds, or at any rate the leaves, of the herba solaris, which the Greeks call heliotropion. It is good also to apply to the wound bran soaked in vinegar, or wild rue, or roasted salt with honey. I have known, however, practitioners who merely let blood from the arm of those stung by a scorpion, that and nothing more.

For the sting of a scorpion also, or for that of a spider, it is good to put on garlic mixed with rue and pounded up with oil.

But when cerastes, or dipsas, or haemorrhois has

For the bite of a chelydrus, allheal-juice or laser 4 grams, or leek-juice in 250 cc. of wine, may be taken, and a quantity of savory eaten. Over the bite either goat's dung, or barley-meal boiled with vinegar should be applied, or rue, or catnip pounded with salt, with honey added. This last is equally efficacious for the bite of a cerastes.

But when a venomous spider has done the harm, in addition to the surgical treatment, the patient should be plunged often into the hot bath; and take equal quantities of myrrh and bryony berries in 250 cc. of raisin wine; or radish seeds or darnel root in wine; bran boiled in vinegar is to be put on the wound, and the patient is kept in bed.

But the foregoing classes of reptiles belong to foreign countries, and are especially poisonous, and they are mostly generated in hot countries. Italy and colder countries are healthier in this respect too, for the reptiles they produce are less dangerous. Against them sufficient remedies are betony or convolvulus or centaury or agrimony or germander or burdock or sea parsnip; any one or two of these is pounded up and taken in wine . . . and applied to the bite. It must be remembered that all snake-bites are more harmful when either the reptile or the man is hungry. Hence snakes are most injurious when

It is not so easy to render assistance when poison has been taken in food or drink, first because patients do not perceive it at once as when bitten by a snake; and so are unable to afford themselves any help immediately. Moreover, the mischief starts, not from the skin, but from within. But the best thing, as soon as any one has perceived it, is to swallow a quantity of oil at once and vomit; then, when the praecordia have been emptied, to drink an antidote; or failing that undiluted wine.

There are, nevertheless, certain remedies proper for particular poisons, especially for the milder ones. If a potion of cantharides has been swallowed, all-heal pounded in milk should be given or galbanum with the addition of wine, or milk by itself.

If it be hemlock, hot undiluted wine with rue should be taken in a large quantity, then the patient should be made to vomit; and after that laser is given in wine; and if free from fever he should be put into a hot bath; if not free, he should be anointed with heating remedies. After this, rest is necessary.

If it be hyoscyamus, honey wine should be drunk hot, or milk of any kind, especially asses' milk.

If it be white-lead, mallow or walnut juice rubbed up in wine is best.

If a leech has been swallowed, vinegar with salt is to be drunk. When milk has curdled inside, either raisin wine or rennet or laser with vinegar.

If any one has eaten fungi that are not used, a

Burns are likewise the product of external violence, and so it seems to follow that I should speak of them here. Now they are best treated by leaves either of lily or of hound's tongue or of beet, boiled in old wine and oil; any one of the above applied at once brings healing. But the treatment can also be divided into: first, a stage of moderately exedent and repressant applications both to check blisters and to roughen the skin; next, a stage of soothing applications for healing. Among the former is lentil meal with honey, or myrrh with wine, or Cimolian chalk pounded up with frankincense bark and mixed with water, and when it has to be used, diluted with vinegar. Subsequent applications include anything that is greasy; but the most suitable is that containing lead slag or yolk of egg. There is also another treatment of burns, namely, while the inflammation lasts, to keep lentil meal and honey on the wound; next, when the inflammation has subsided, flour with rue or with leek or with horehound, until the crusts fall off; then vetch meal with honey, or iris ointment or turpentine-resin, until the ulceration is clean, and finally dry lint.

28 From those lesions which are due to something from without we come to those which originate from within, when some bodily part has become corrupted. Of these none are worse than carbuncles, the signs of which are: redness, with a few pustules projecting

A carcinoma does not give rise to the same danger unless it is irritated by imprudent treatment. This disease occurs mostly in the upper parts of the body, in the region of the face, nose, ears, lips, and in the breasts of women, but it may also arise in an ulceration, or in the spleen. Around the spot is felt a sort of pricking; there is a fixed, irregular swelling, sometimes there is also numbness. Around it are dilated tortuous veins, pallid or livid in hue; sometimes in certain cases they are even hidden from view; and in some the part is painful to the touch, in others there is no feeling. And at times the part becomes harder or softer than natural, yet without ulcerating; and sometimes ulceration supervenes on all the above signs. The ulceration at times has no special characteristic; at times it resembles what the Greeks call condylomata, both in a sort of roughness and in size; its colour is either red or like that of lentils. It is not safe to give it a blow; for either paralysis or spasm of the sinews follows at once. Often from a blow on it a man loses speech and faints; in some also, if the place is pressed, the parts around become tense and swollen. Then it is the worst kind. And generally the first stage is what the Greeks call cacoethes;

There is also an ulceration which the Greeks call therioma. This may arise spontaneously, and at times it may supervene upon ulceration from another cause. It has either a livid or black colour, a foul odour, and an abundant mucus-like discharge. The ulcer itself is insensitive to touch and applications; there is just disturbance by itching. But around there is pain and inflammation; sometimes even fever is set up, occasionally blood is discharged from the ulceration. This also is a spreading disease. And all these signs often extend, and there results from them an ulcer which the Greeks call phagedaena, because it spreads rapidly and penetrates down to the bones and so devours the flesh. This ulceration is uneven, bog-like; there is a large amount of glutinous discharge; the stench is intolerable, and the inflammation is greater than accords with the extent of the ulceration. Both therioma and phagedaena, like all canker, occur for the most part in the aged or those of a bad habit of body. Both are treated in the same way, but treatment is more necessary in the severer form. Firstly, a regimen must be enforced, so that the patient rests in bed, abstains from food for the first days, drinks very freely of water; also has the bowels moved by a clyster; then, on the subsidence of the inflammation, takes digestible food, avoiding everything acrid; drinks as much as he likes, but for the time being contents himself with water, except that at dinner he may drink a little dry wine. But fasting is not to be used for patients with phagedaena

Ignis sacer should be counted also among the bad ulcerations. Of this there are two kinds; one is reddish or partly red, partly pale and roughened by a chronic pustulation, the pustules all of about equal size, but mostly very small: in them there is nearly always pus and often there is redness with heat. And sometimes the disease spreads while the first part attacked is healing; sometimes even after this is ulcerated, when the pustules have ruptured and the ulcer continues and a humour is discharged which appears to be continuing between sanies and pus. It attacks chiefly the chest or flanks or

Again, the ulcer called chironean is large and has hard, callous, swollen margins. A sanies exudes, which is not copious, but thin. There is no bad odour, either in the ulcer or in its discharge; no inflammation; pain is moderate; it does not spread, so it brings no design, but it does not heal rapidly. At times a thin scab is produced, then in turn it is broken down and the ulceration is renewed. It occurs chiefly on the feet and legs. On it should be applied something which is at once soothing, and active and repressant, such as the following: copper scales, washed lead calcined, 16 grams each, cadmia and wax, 32 grams each, along enough rose-oil to give the wax together with the other materials a soft consistence.

Ulcers are also produced in winter by the cold, mostly in children, and particularly on their feet and toes, sometimes also on the hands. There is redness with moderate inflammation; some pustules arise followed by ulceration; the pain is

Struma, again, is a swelling, in which there occur underneath certain concretions of pus and blood like little glands; they are specially embarrassing to medical men, for they set up fever and yet do not quickly come to a head; and whether they are treated by incision or by medicaments, they are generally prone to recur in the neighbourhood of their scars, and this happens much more often after the application of medicaments; and in addition to all this, they are of long duration. These swellings arise particularly in the neck, but also in the armpits and groins and in the flanks. The surgeon Meges stated that he had met with them also in the breasts of women.

For these white hellebore is an appropriate remedy, and this must be taken frequently until they are dispersed; and also the medicaments which have been mentioned above are applied in order to draw out or disperse the humour. Some also use caustics

The boil, again, is a pointed swelling attended by inflammation and pain, and especially so when it is being converted into pus. When it has opened and the pus gone out, it is seen that part of the flesh has been turned into pus, part into a greyish-reddish core which some call the sac of the boil. There is no danger in it, even although no treatment is adopted; for it ripens of itself, and bursts; but the pain renders treatment preferable in order to afford earlier relief. The special medicine for this is galbanum; but there are others also which have been mentioned above. If none of these are available a plaster that is not greasy should first be applied to disperse it; next, if this is not effective, something adapted to promote suppuration; if even that is not to be had, either raisin wine or yeast. When the pus has been squeezed out, no further treatment is needed.

A phyma is a swelling which resembles a boil, but is rounder and flatter, often also larger. For a boil rarely reaches the size of half an egg, and never exceeds it; a phyma commonly extends even over a wider area, but the pain and the inflammation in it are less. When it has been opened, pus appears in the same way; no core is found as in a

Phygetron, again, is a wide swelling, not much raised up, in which there is a certain resemblance to a pustule. The pain and tension is severe, and more than would be expected from the size of the swelling; at times there is also feverishness. The ripening takes place slowly, and not much pus is formed. It occurs particularly on the top of the head, or in the armpits or groins. Our people call it panus, from its spindle-shape. And I have pointed out above by what medicament this should be relieved.

But although all these diseases are really only minute abscesses, that name implies in general a more extensive lesion, tending to suppuration; and it occurs usually either after fevers or after pains in some part, and particularly after those which have attacked the abdomen. And generally it is visible, since there is some rather widespread swelling, like that which I have previously described as called phyma, and it grows red and hot and shortly afterwards hard as well, and becomes more painful as it increases and occasions both thirst and insomnia: sometimes, however, there may be none of these signs to note in the skin, and especially when pus is forming more deeply; but along with the thirst and insomnia some stabbing pains are felt internally.

Now a swelling is immature when the blood-vessels throb more as if they were bubbling and there is weight and heat and tension and pain and redness and hardening and, if the abscess is larger, shivering or even persistent feverishness; and a

Sometimes, again, fistulae arise, both from abscesses of this kind and from other sorts of ulceration. A fistula occurs in almost any part of the body, but in each place it has some peculiarities. I shall speak first of its general characteristics. There are many kinds of fistulae, then, and whilst some are short, others penetrate deeper; some run straight

There is besides a class of ulceration which the Greeks call κηρίον from its resemblance to honeycomb, and of this there are two kinds. One is greyish, like a boil, but larger and more painful. As it is maturing, holes appear through which is discharged a glutinous and purulent humour; yet it does not properly mature. If it is cut into, there appears much more corruption than in a boil, and it penetrates deeper. It is rare except in the scapular region. The other kind is found only in the head; it projects less above the surface, is hard, broad, greenish or greyish-green in colour, more ulcerated; there are holes at the root of each hair, through which is discharged a glutinous greenish-white humour, in consistency like honey or mistletoe-juice, or at times like olive-oil. If it is cut into, the flesh within appears green. The pain also and inflammation are so severe that they generally cause acute fever. On a case which is only irritated by a few openings, suitable applications are a dry fig and linseed boiled in honey wine or plasters or emollients which draw out diseased matter, or the medicaments noted above for such purposes. For the other form of this, the same medicaments are good, also flour boiled in honey wine mixed with half its quantity of turpentine-resin;

Of these the acrochordon and thymion often end of themselves, and the more so the smaller they are. The myrmecia and corns scarcely ever subside without treatment. The acrochordon, if cut off, leaves no trace of a root behind, and so does not sprout again. When the thymion and clavus have been cut off, a small rounded root is formed underneath, which penetrates right down into the flesh, and if this is left behind it sprouts up again. The myrmecia are held by very broad roots, and so cannot be excised without causing a large wound. A corn is best scraped down from time to time; for thus, without any violence, it softens, and if also a little blood is let out, it often dies away. It is also removed if we clean the part round it and then put on resin mixed with a little powdered millstone. All the other varieties are to be burnt away by medicaments: for some the ash of wine-lees is best; for myrmecia the application made of alum and sandarach. But the skin all round should be covered with leaves that it also may not become ulcerated; afterwards lentil meal is put on. Even a fig in boiled water removes a thymium.

Pustules arise chiefly in the spring; there are many kinds. For at times a sort of roughness comes all over the body, or a part of it, resembling the pustules which are set up by nettles or by sweating; exanthemata the Greeks call them. At times

But scabies is harder: the skin is ruddy, from which the pustules grow up, some moist, some dry. From some of these sanies escapes; and from them comes a persistent itching ulceration, which in some cases rapidly spreads. And whilst in some persons it vanishes completely, in others it returns at a definite time of the year. The rougher the skin, and the more the itching, the more difficult is its relief. Hence the Greeks call such scabies, agria that is, savage. In this case also the same regimen as that given above is necessary; at the beginning a suitable application is that composed of sublimed zinc oxide, saffron, verdigris 1· 16 grams each; white pepper and omphacium 4 grams; zinc oxide ore 9· 3 grams. But when ulceration already exists that com-

Impetigo, again, has four species. The least bad is that which presents a semblance to scabies; for there is redness and some hardness and ulceration and erosion. But it is distinguished from scabies because there is more ulceration and there are pustules like pimples, and in it is seen an appearance as of small bubbles from which after a time little scales are detached; and this recurs at fixed seasons. The second kind is worse, almost like a pimple, but rougher and redder; it has various shapes; small scales are detached from the skin surface; there is more erosion; it spreads more rapidly and widely, and both comes and goes at fixed seasons even more markedly than the previous sort; it is called rubrica. The third kind is worse still; for it is thicker, harder and there is more swelling; there are cracks in the skin and more active erosion. This form also is scaly,

Of papules again there are two kinds. There is one in which the skin is roughened by very small pustules, and is reddened and slightly erodes; in the middle it is a little smoother; it spreads slowly. This disease generally has a round shape at its beginning, and in the same fashion it spreads in a circle. But the other variety is that which the Greeks call agria that is, savage; and in this there is a similar but greater roughness of the skin with ulceration, more severe erosion, and redness; sometimes it even loosens the hair. It is less round in shape, heals with more difficulty, and unless it is got rid of, turns into an impetigo. But in fact a slight papule heals if it is rubbed daily with spittle before eating; a more severe one is got rid of best by an application of pounded pellitory. But turning to compound medicaments, that same one of Protarchus is efficacious in these cases, when the disorder is less severe. An alterna-

Vitiligo also, though not dangerous in itself, is still ugly and is due to a bad habit of body. There are three species. It is called alphos when it is white in colour, generally rather rough, and not continuous, so that it looks as if drops of some sort had been sprinkled about. Sometimes also it spreads still more widely with certain gaps. That called melas differs from it in being of a black colour and like a shadow; otherwise it is similar. Leuce is somewhat like alphos, but is whiter and extends deeper; there are hairs on it, white, and like down. All these spread, but more quickly in some people than in others. The alphos and melas come and go at various seasons; the leuce, once established, is not easily got rid of. The two former are not difficult to treat, the latter is scarcely ever cured, for even if the discoloration is mitigated, the colour of health does not right altogether. But whether any one of these is curable or not is easily learnt by this test. The skin should be cut into or pricked with a needle: if blood escapes, which it usually does in the first two species, there is place for a remedy; if a whitish humour, cure is impossible, and then we should even refrain from treating it. But to the species which admits of treatment we should apply lentil meal, mixed with sulphur and frankincense, pounded

1 I have spoken of those lesions which affect the whole body and require the aid of medicaments; now I come to those which customarily occur only in particular parts, beginning with the head.

In the head, then, when the hair falls out, the principal remedy is frequent shaving. Ladanum mixed with oil, however, is some help in preserving it. I am now referring to the falling out of hair after illness; for no kind of remedy can be given to stop the head of some people from becoming bald through age.