De Medicina

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.

2 But the condition is called porrigo, when between the hairs something like small scales rise up and become detached from the scalp: and at times they are moist, much more often dry. Sometimes this happens without ulceration, sometimes there is a localized ulceration, and from this comes sometimes a foul odour, sometimes none. This generally occurs on the scalp, more seldom on the beard, occasionally even on the eyebrow. It does not arise only there is some general bodily lesion, so that it is not entirely without its use; for it does not exude from a thoroughly sound head. When there is present some lesion in the head, it is not disadvantageous for the surface of the scalp to become here

3 There is also an ulceration, called sycosis by the Greeks from is resemblance to a fig; a sprouting up of flesh occurs. That is the general description: but there are two subordinate species; in one the ulceration is indurated and circular, in the other moist and irregular in outline. From the hard species there is a somewhat scanty and glutinous discharge; from the moist the discharge is abundant and malodorous. Both occur in those parts which are covered by hair; but the callous and circular ulceration mostly on the beard, the moist form, on the other hand, chiefly on the scalp. In both it is good to apply elaterium, or pounded linseed worked up in water, or a fig boiled in water, or the plaster tetrapharmacum moistened with vinegar; also Eretrian earth dissolved in vinegar is suitable for smearing on.

4 Bald spots also are of two kinds. In both,

5 To treat pimples and spots and freckles is almost a waste of time, yet women cannot be torn away from caring from their looks. But of these just mentioned, pimples and spots are commonly known, although that species of spot is more rare which is called by the Greeks semion, since it is

6 Now the foregoing are subjects of minor importance. But there are grave and varied mishaps to which our eyes are exposed; and as these have so large a part both in the service and the amenity of life, they are to be looked after with the greatest care. Now directly ophthalmia sets in, there are certain signs by which it is possible to foretell the course of the disease. For if lacrima-

Now for this disease there are many salves devised by many inventors, and these can be blended even now in novel mixtures, for mild medicaments and moderate repressants may be readily and variously mingled. I will mention the most famous.

There is then the salve of Philo, which contains: washed cerussa, spode and gum 4 grams each; poppy-tears toasted 8 grams. It is important to know that each of these ingredients should be pounded separately, than mixed together, gradually adding water, or some other fluid. Gum, amongst other properties, has this particular advantage, that when salves made of it have become dry, they stick together and do not break up.

The salve of Dionysius consists of: poppy-tears toasted until they soften 4.66 grams, toasted frankincense and gum 2 grams each, and zinc oxide 16 grams.

The salve of Cleon is quite famous: poppy-tears toasted 4 grams, saffron 0.66 grams, gum 4 grams, to which after being pounded is added rose juice. The same man prescribed another more active salve: scales of the copper which is called stomoma 4 grams; saffron 8 grams; zinc oxide 16 grams; lead washed and roasted 24 grams; with a like quantity of gum. There is also for the same complaint the salve of Attalus especially when the rheum is profuse: castoreum 0.33 grams; lign-aloes 0.66 grams; saffron 4 grams; myrrh 8 grams; lycium 12 grams; prepared zinc oxide 32 grams; a like quantity of antimony sulphide and acacia juice 48 grams. And when no gum is added it is preserved liquid in a small receptacle. Theodotus added to the above mixture: poppy-tears toasted 0.33 grams; copper scales roasted and washed 8 grams; toasted date kernels 40 grams; gum 48 grams.

The salve of Theodotus himself, which by some is called achariston, is composed of: castoreum and Indian nard 4 grams each; lycium 0.66 gram; an equal amount of poppy-tears; myrrh 8 grams; saffron,

Besides the above, among the most commonly used salves is that which some call cycnon, others from its ashen colour tephron, which contains: starch, tragacanth, acacia juice, gum 4 grams each; poppy-tears 8 grams; washed cerussa 16 grams; washed litharge 32 grams. These ingredients likewise are compounded with rain-water.

Euelpides, the most famous oculist of our time, used a salve of his own composition called trygodes: castoreum 1.33 grams; lycium, nard and poppy-tears 4 grams each; saffron, myrrh and lign-aloes 16 grams each; roasted copper scales 36 grams; oxide of zinc and antimony sulphide 48 grams; acacia juice 144 grams; the same amount of gum.

The more severe the inflammation, the milder should the application be made, by adding to it white of egg or woman's milk. But if neither doctor nor medicine is at hand, either of the above, dropped into the eye with a little screw of lint prepared for the purpose, often relieves the trouble. But when the patient has been relieved and the discharge of rheum is already checked, any slight symptoms which remain may be got rid of by making use of the bath and of wine. Therefore when at the bath the patient should be first rubbed over gently with oil, especially over the legs and thighs, and he should bathe his eyes freely with hot water, next hot water should be poured over his head, followed

This salves consists of Indian nard and poppy-tears 0.33 gram each; gum 4 grams; saffron 8 grams; fresh rose leaves 16 grams, which are mixed up in rain-water or in a rather mild wine. And it is not out of place to boil pomegranate rind or melilot in wine and then pound it; or to mix black myrrh with rose leaves,

It is also customary for inflammation to give rise to carbuncles, sometimes upon the actual eyeballs, sometimes upon the eyelids, either on the inner or on the outer surface of these. When this occurs, the

Pustules are also an occasional consequence of inflammation. If this happens early during the first stage, the blood-letting and rest prescribed above should be even more strictly enforced; if later than the stage when blood-letting is possible, the bowels, nevertheless, should be clystered; and if anything should prevent this also, at any rate the regimen as to diet should be followed. For this condition also soothing medicaments are necessary, such as those of Nileus and Cleon.

Also the salve named after Philalethus is suitable, consisting of: myrrh and poppy-tears 4 grams each; washed lead, Samian earth called aster, and tragacanth 16 grams each; boiled antimony sulphide and starch 24 grams each; washed oxide of zinc and washed cerussa 32 grams each. These are made up with rain-water. The salve is used either with white of egg or milk.

From pustules ulcerations sometimes arise. These when recent are likewise to be treated by mild applications, generally by the same as I have prescribed above for pustules. That which is called 'dia libanu' is specially prepared for the above condition. It is composed of roasted and washed copper, and parched poppy-tears 4 grams

It happens too that the eyeballs, either both or one, become smaller than naturally they ought to be. An acrid discharge of rheum in the course of ophthalmia causes this, also continuous weeping, and an injury improperly treated. In these cases the same mild applications mixed with woman's milk should also be used, and for food, that which is most nourishing and body-building. In every way any cause which may excite tears must be avoided, and anxiety about home affairs also, knowledge of which, if anything of that sort has arisen, must be kept from the patient. And acrid medicaments and sour food do harm in these cases, chiefly because of the tears which they excite.

There is also a kind of disorder in which lice are born between the eyelashes; the Greeks call it phthiriasis. Since this comes from a bad state of health it seldom fails to get worse; but usually in time a very acrid discharge of rheum follows, and if the eyeballs become severely ulcerated, it even destroys their vision. In these cases the bowel should be clystered, the head shaved to the scalp, and rubbed for a good while daily whilst the patient fasts; walking and other exercises should be diligently practised; he should gargle honey wine in which mint and ripe figs have been boiled; at the bath the head should often be freely fomented with hot water, acrid food avoided, milk and sweet wine should be taken, with more drink than food. Medicaments administered internally should be bland lest they stimulate the acridity of the rheum;

The preceding diseases of the eyes are treated with bland applications. Next come other classes which require a different treatment, and they usually originate from inflammation, but also persist after the inflammation has subsided. And first in some cases there is a thin discharge of rheum which persists; in these the bowel is to be clystered, and the amount of food somewhat reduced. And it is not inappropriate to smear the forehead with the composition of Andrias; this consists of gum 4 grams, cerussa and antimony sulphide 8 grams each, litharge heated and washed 16 grams. But the litharge must be boiled in rain-water, and the dry ingredients pounded up in myrtle juice. When the forehead has been smeared with this, a poultice is put on of flour mad eio a paste with cold water, to which is added acacia juice or cypress oil. It is also useful to apply a cup to the top of the head after making an incision, or blood may be let from the temples. The following ointment should be used: copper scales and poppy-tears 4 grams each; stag's horn calcined and washed, washed lead, and gum, 16 grams each; frankincense, 48 grams. This slave, because it contains horn, is called dia tu keratos. Whenever

For the same purpose there is the salve of Euelpides, which he called memigmenon, containing poppy-tears and white peppercorns 28 grams each; gum 336 grams; roasted copper 6 grams. However, in the course of the treatment, after a subsidence of the disease, the bath and wine are of some service. In all cases of ophthalmia food that makes thin should be avoided, but especially in those who have had for long a discharge of thin humour. But if food which renders the rheum thicker comes to be disliked, which very readily happens with this kind of diet, recourse should be had to those foods which, in bracing up the bowels, do the same to the body in general.

Again, ulcerations which do not heal after inflammation has ended, tend to become fungous or foul or excavated, or at any rate chronic. Such as are fungous are best repressed by the salve called menigmenon; those which are foul are cleaned both by the same and by that called zmilion. This contains: verdigris 16 grams; gum the same; ammoniacum and Sinopic minium 64 grams; some pound up these with water, others with vinegar, in order to make it more active.

The salve of Euelpides also which he called pyrron is of use for this: saffron 4 grams; poppy-tears and gum 8 grams; roasted and washed copper and myrrh 16 grams each; white pepper 24 grams. But the eyes are first smeared with a mild ointment, then with the above.

That salve of his which he named sphaerion has the same effect: washed haematite stone 4.66 grams; 6 peppercorns; washed zinc oxide, myrrh and poppy-tears 8 grams; saffron 16 grams; gum 32 grams; these are pounded up in Aminean wine.

For the same purpose he prepared a liquid salve, containing verdigris 0.66 gram; roasted antimony sulphide, shoemakers-blacking, and cinnamon 4 grams each; saffron, nard and poppy-tears 4.66 grams each; myrrh 8 grams; roast copper 12 grams; ash of aromatic herbs 16 grams; 15 peppercorns. These are pounded up in dry wine, then boiled in 750 cc. of raisin wine until of uniform consistency. This is rendered more efficacious by age.

Excavated ulcerations, too, are most readily replenished with flesh by the compositions mentioned above, sphaerion, and that called Philalethus. Sphaerion is the best remedy for old-standing ulcerations, and those that are difficult to heal.

There is also a salve, which whilst efficacious in many ways seems to be specially so in the case of ulcerations. It is said to have been invented by Hermon. It contains: long pepper 4.66 grams; white pepper 0.33 gram; cinnamon and costmary 4 grams each; shoemaker's blacking, nard, casia and castoreum 8 grams each; gall 20 grams; myrrh, saffron, frankincense, lycium and cerussa, 32 grams each; poppy-tears 48 grams; lign-aloes, roasted copper and oxide of zinc 64 grams each; acacia, antimony sulphide and gum 100 grams each.

Scars resulting from ulcerations are liable to two defects, they are either depressed or thick. If

There is also a class of inflammation in which, if the eyes swell and become tense with pain, it is necessary to let blood from the forehead, and to foment the head and eyes frequently with hot water; also to gargle, using a decoction of lentils, or the cream of figs; to apply as an ointment acrid medicaments, such as have been noted above, especially that named sphaerion, and that containing haematite stone. There are also other salves of use for softening trachoma of which I am just going to speak.

Now this condition generally follows inflammation

That called after Hierax is also efficacious for trachoma. It contains: myrrh 4 grams; ammoniacum used for incense 8 grams; copper filings 16 grams. For the same purpose there are also those called respectively Canopite, smilion, pyxinum, and sphaerion. But when none of these made up medicaments is at hand, then goat's bile or honey of the best is suitable enough for the treatment of trachoma.

There is a kind of dry inflammation of the eyes called by the Greeks xerophthalmia. The eyes neither swell nor run, but are none the less red

Again, a most suitable salve is that called rhinion. It contains: myrrh 0.66 gram; poppy-tears, acacia juice, pepper and gum 4 grams each; haematite stone, Phrygian and Lycian stone, and split stone, 8 grams each; roasted copper 16 grams. The salve pyxinum is also fitting for this same purpose.

When the eyes are scabrous, which mostly occurs at their angles, the rhinion slave noted above may do good; that one may also serve which contains: copper filings, long pepper and poppy-tears 8 grams each; white pepper and gum 16 grams each; washed oxide of zinc and cerussa 64 grams each. Nothing, however, is better than that named by Euelpides basilicon. It contains: poppy-tears cerussa and Assos stone, 8 grams each; gum 12 grams; white pepper 16 grams; saffron 24 grams; psoricum 42 grams. Now there is no drug called psoricum, but some copper ore and a little more than half as much oxide of zinc are pounded up together in vinegar,

Again the eyes tend at times to become dim from ophthalmia, but also apart from that, on account of old age, or other weakness. If the disorder is owing to the remnants of an ophthalmia, the salve called Asclepios is of service and that which is composed of saffron dregs.

Also there is a special preparation for this purpose called dia crocu. It contains pepper 4 grams; Cilician saffron, poppy-tears and cerussa 8 grams each; psoricum and gum 16 grams each.

But if the eyes are dim from old age or other weakness, it is good to anoint with best honey, cyprus oil, and old olive oil. The most suitable unguent, however, is made of balsam one part, and old olive or cyprus oil two parts, and three parts of the sharpest honey. Here too those applications are suitable which were noted just above

Cataract also, which the Greeks call hypochysis, sometimes interferes with the vision of the eye. When it has become long established it is to be treated surgically. In its earliest stages it may be dispersed occasionally by certain measures: it is useful to let blood from the forehead or nostrils, to cauterize the temporal blood vessels, to bring out phlegm by gargling, to inhale smoke, to anoint the eyes with acrid medicaments. That regimen is best which makes phlegm thin.

Again, even the relaxation of the eyes which the Greeks call paralysis is not to be treated by any different regimen or by any different medicaments. It is sufficient to explain just the kind of lesion it is. It happens then sometimes in the case of one eye, sometimes of both, from some blow, or from epilepsy, or from a spasm, by which the eyeball itself is violently shaken, that it cannot be directed at any object, or be held at all steady, but with no reason it turns now this way, now that, and so does not even afford a view of objects.

The malady the Greeks call mydriasis is not very different from the above. The pupil spreads out and is dilated, and its vision becomes dimmed and almost lost. This kind of weakness is most difficult to relieve. Both of these paralysis and mydriasis are to be countered by all the same prescriptions as mistiness of the eyes, but with a few alterations such as the addition sometimes of vinegar, sometimes of soda, to the iris unguent for the head; while honey is sufficient for the eye inunctions. In the case of mydriasis, some patients have been relieved by the use of hot water, some without any obvious cause have suddenly become blind. Some of these after seeing nothing for some time have suddenly regained vision following a profuse stool. Hence it seems not inappropriate, whether in a recent case or in one of some standing, by the use of medicaments to force stools in order to drive downwards all noxious matter.

There is besides a weakness of the eyes, owing to which people see well enough indeed in the daytime but not at all at night; in women whose menstruation is regular this does not happen. But success sufferers should anoint their eyeballs with the stuff dripping from a liver whilst roasting, preferably of a he-goat, or failing that of a she-goat; and as well they should eat some of the liver itself. But, we may also use with advantage the same remedies which dry up scars and trachoma. Some add honey to pounded purslane seed until the mixture no longer drops from the end of a probe, and with it anoint the

All the foregoing disorders arise within the body; but a blow from without at times so inures the eye that it is suffused with blood. Nothing is then better than to anoint the eyeball with the blood of a pigeon, dove, or swallow. There is some reason for this, because the vision of these birds, when indicate from without, returns after an interval to its original state, most speedily in the case of the swallow. This also has given rise to the fable that the old birds restore the vision by a herb, when it really returns spontaneously. Hence the blood of these birds most properly protects our eyes too after an external injury, and in the following order: swallows' blood is best, next that of the pigeon, and the dove's is the least efficacious, both as regards the birds themselves and us. In order to relieve inflammation, it is not unfitting to apply a poultice over the injured eye. The best salt from Ammon, or some other salt, is pounded, and oil gradually added until it is of the consistency of strigil scrapings. Then this is mixed with barley-meal which has been boiled in honey wine. But it is easy, after looking through all that medical practitioners have written, for anyone to see that there is scarcely any one of the eye disorders among those included above which it may not be possible to clear up by simple and readily procured remedies.

7 So much, then, for those classes of eye disease, for which medicaments are most successful; and now we pass to the ears, the use of which comes next to eye-

If again the ears have pus in them as well, it is proper to pour in boxthorn juice by itself, or iris unguent or leek juice or the juice of a sweet pomegranate warmed in its rind, to which a little myrrh is added. It is useful to mix together myrrh of the sort called

A general remedy for all ear cases, and one approved by experience, was composed by Asclepiades. This contains: cinnamon and casia 4 grams each; flowers of round cyperus, castoreum, white pepper, long pepper, cardamomum and bennut, 8 grams each; male frankincense, Syrian nard, fatty myrrh, saffron, soda-scum, 12 grams each. These are pounded separately, then mixed with vinegar and again pounded, and so preserved; when for use they are diluted with vinegar. In the same way a general remedy for all ear disorders is the tablet of Polyidus, dissolved in sweet wine, the prescription for which is given in the last book. But if there is both a discharge of matter and a swelling, it is not unfitting to ash out the ear with diluted wine through an ear syringe, and then pour in dry wine mixed with rose oil, to which a little oxide of zinc has been added, or boxthorn juice with milk, or polygonum juice with rose oil, or pomegranate juice with a very little myrrh.

If there is also foul ulceration, it is better to wash out with honey wine, and then pour in some one of the compositions described above which contain honey. If there is a great discharge of pus the head is to be shaved, and hot water poured freely over it, also the patient should gargle with the same, walk until tired, and take food sparingly. If there is bleeding from the ulcerations, boxthorn

When maggots have appeared, if they are near the surface, they must be extracted by an ear scoop; if further in they must be killed by medicaments, and afterwards care taken that they do not breed. White veratrum pounded up in vinegar serves for both these purposes. The ear should also be washed out with a decoction of horehound in wine. By this procedure dead maggots will be driven forwards into the outer part of the ear, whence they can be readily withdrawn.

But if the ear-passage has been narrowed and thick matter collects within, honey of the best ought to be introduced. If this does not help, there must be added to 65 cc. of honey 8 grams of verdigris scrapings; they must be boiled together and so used. Iris root with honey has the same efficacy. So also has galbanum 8 grams, myrrh and ox bile 1.33 grams each, and of wine a sufficient quantity to dissolve the myrrh.

When a man is becoming dull of hearing, which happens most often after prolonged headaches, in the first place, the ear itself should be inspected: for there will be found either a crust such as comes upon the surface of ulcerations, or concretions of wax.

Another class of lesion is that in which the ears produce a ringing noise within themselves: and this also prevents them from perceiving sounds from without. This is least serious when due to cold in the head; worse when occasioned by diseases or prolonged pains of the head; worst of all when it precedes the onset of serious maladies, and especially epilepsy.

If it is due to a cold, the ear should be cleaned

If the noise begins without these reasons and so causes dread of some new danger, there should be inserted into the ear castoreum in vinegar or with either iris oil or laurel oil; or castoreum is mixed with this together with the juice of bitter almonds; or myrrh and soda with rose oil and vinegar But in this case also, there is more benefit from regulation of the diet, and the same is to be done as was prescribed above, with even greater care. And, besides, until the noise has ceased the patient must abstain from wine. But if there is at the same time both ringing and inflammation, laurel oil should be freely inserted, or the oil expressed from bitter almonds with which some mix myrrh or castoreum.

It happens also occasionally that something slips into the ear, such as a small stone, or some living thing. If a flea has got in, a little wool is introduced in which it becomes engaged and so is extracted. If it does not come out, or if it is some other creature, a probe is wrapped round with a little wool, soaked in very sticky resin, especially turpentine resin, which after being passed in the ear is there twisted

8 Now ulcerated nostrils should be fomented with steam from hot water; that is done either by applying a sponge after squeezing it ou, or by holding the nose over a narrow-mouthed vessel filled with hot water. After this fomentation the ulcerations should be smeared with lead slag, white lad or litharge; with any of these a kind of poultice is compounded, and to this, while it is being pounded up, wine and myrtle oil are added alternately, until it becomes of the consistency of honey. But if these ulcerations involve bone, and have numerous crusts with a foul odour, which kind the Greeks call ozaena, it ought to be understood that it is scarcely possible to afford relief in that disease. The following measures, none the less, can be tried: the head may be shaved to the scalp, rubbed frequently and vigorously, and sluiced with quantities of hot water; then the patient is to take a great deal of

Again, inside the nostrils there are sometimes formed little lumps like women's nipples, and these are fixed by their deepest and most fleshy parts. These should be treated by caustics, under which they are completely eaten away. A polypus, in fact, is a lump of this sort, sometimes white, sometimes reddish, which is attached to the bone of the nose, and fills the nostril, being directed

9 Now in the case of pain in the teeth, which by itself also can be counted among the greatest of torments, wine must be entirely cut off. At first the patient must fast, then take sparingly of soft food, so as not to irritate the teeth when masticating; then externally steam from hot water is to be applied by a sponge, and an ointment put on made from cyprus or iris oil, with a woollen bandage over it, and the head must be wrapped up. For more severe pain a clyster is useful, with a hot poultice upon the cheeks, and hot water containing certain medicaments held in the mouth and frequently changed. For this purpose cinquefoil root may be boiled in diluted wine, and hyoscyamus root either in vinegar and water, or in wine, with the addition of a little salt, also poppy-head skins not too dry and mandragora root in the same condition. But with these three remedies, the patient should carefully avoid swallowing the fluid in the mouth. The bark of white poplar roots boiled in diluted wine may be

10 Again, if the tonsils owing to the inflammation

11 Now ulcerations of the mouth if accompanied by inflammation, and if they are foul and reddish, are best treated by the medicaments made from pomegranates mentioned above. And, as a repressant, pearl barley gruel to which a little honey has been added is to be often held in the mouth; the patient must walk and not take acrid food. As soon as the ulcerations begin to clean, a bland liquid, at times even the purest water, is held in the mouth. It is then beneficial to eat a pear of the softer sort, and more food along with sharp vinegar; then the ulcers should be dusted over with split alum, to which about half as much again of unripe oak-galls has been added. If the ulcers are alar encrusted, as happens after cauterization, those compositions are to be applied which the Greeks call antherae: equal portions of galingale, myrrh, sandarach, and alum. Or saffron and myrrh 4 grams each; iris, split alum and sandarach 16 grams each; galingale 32 grams. Or oak-galls and myrrh 4 grams each; split alum 8 grams; rose leaves 16 grams. But some mix saffron 0.66 gram; split alum and myrrh 4 grams each; sandarach 8 grams; galingale 16 grams.

But by far the most dangerous are those ulcers which the Greeks call aphtae, certainly in children; in them they often cause death, but there is not the same danger for men and women. These ulcers begin from the gums: next they invade the palate and the whole mouth; then they pass downwards to the uvula and throat, and if these are involved, it is not easy for the child to recover. But the disease is even worse in a suckling, for there is then less possibility of its conquest by any remedy. But it is most important that the nurse should be made to take exercise both by walking and by doing work which moves her arms; she should be sent to the bath, and ordered when there to have hot water poured over her breasts; moreover, she should have bland, easily digestible food; and for drink, if the infant is feverish, water; if free from fever, diluted wine. And if the nurse is constipated, her bowels are to be moved by a clyster. If there is clotted phlegm in her mouth, she must vomit. Then the child's ulcers are to be anointed with honey, to which is added sumach, which they call Syrian, or bitter almonds; or a mixture of dried rose leaves, pinecone seeds, mint, young stalks, and honey, or that medicament which is made of mulberries, the juice of which is concentrated in the same way as pomegranate juice to the consistency of honey; similarly too there is mixed with it saffron, myrrh, alum, wine and honey; nothing should be given which can provoke spittle. If it is an older child he should

12 Ulcerations of the tongue need no other treatment than that noted in the first part of the previous chapter. But those which arise at the side of the tongue last the longest; and it should be looked to, whether some tooth opposite the ulcer is too pointed, which often keeps an ulceration in that position from healing, in which case the tooth must be smoothed down.

13 There often occur on the gums adjacent to the teeth certain painful swellings: the Greeks call them parulides. These at first should be gently rubbed over with powdered slat; or with a mixture of powdered rock-salt, cyprus oil and catmint; then the mouth is washed out with lentil gruel, and the mouth is held open at intervals until there has been a sufficient flow of phlegm.

When there is still more severe inflammation, the same medicaments are to be used as noted above for ulcerations of the mouth: and between the tooth and gum should be inserted a little roll of soft lint soaked in one of the compositions which I said are called antherae. If the hardness of the gum prevents this, then hot steam by means of a sponge