De Medicina

10 Again, if the tonsils owing to the inflammation

are swollen but not ulcerated, the head is to be kept covered; externally the painful part should be fomented by steam; the patient is to take walking exercise freely; when in bed his head should be raised repressive gargles should be used. Also that root which they call sweet, crushed and boiled in raisin wine or honey wine, has the same beneficial effect. It is useful to anoint them gently with certain medicaments prepared as follows: the juice is squeezed out of sweet pomegranates, and of this half a litre is boiled over a slow fire until of the consistency of honey; then saffron, myrrh, and shredded alum 8 grams each are pounded together, and to this is added a little at a time 85 cc. of mild wine and 42 cc. of honey; next these latter are mixed with the pomegranate juice aforesaid, and all gently boiled again. Or half a litre of the pomegranate juice is boiled in the same way, and the following after being pounded in like manner are added: nard 0.33 gram; omphacium 4 grams; cinnamon, myrrh and casia 0.33 gram each; these same compositions are also appropriate both for purulent ears and nostrils. Food too in this affection should be bland that it may not irritate. If the inflammation is so severe that breathing is hindered, the patient should keep in bed, abstaining from food, and take nothing else except hot water; the bowels should be moved by a clyster, and the gargle of fig and honey wine used; the tonsils are to be smeared with honey and omphacium; internally steam is to be inhaled somewhat longer until the tonsils suppurate and spontaneously open. If after pus has formed these swellings do not burst, they are to be cut into; then the patient must gargle with warm honeyed wine. But if with only moderate swelling there is ulceration as well, the throat is to be gargled with bran gruel to which a little honey should be added; and the ulcers smeared with the following composition: 750 cc. of the sweetest raisin wine are boiled down to one-third, then are added: frankincense 4 grams; garlic 4 grams; saffron and myrrh 0.66 gram each; and all are then gently heated together. When the ulcers have cleaned, the throat is gargled with bran gruel or milk. And here also bland food is necessary, and in addition sweet wine can be taken.

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.

The first compositions are dried and then dusted on; the last one is smeared on with honey added, and used not only for ulcerations of the mouth, but also of the tonsils.

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

generally gargle as described above. If the milder medicaments do little good, the caustic materials which induce crusts upon the ulcers should be applied, such as split alum or copper ore or blacking. Even hunger is beneficial and the greatest possible abstinence is to be ordered. The food ought to be bland; for cleansing the ulcers, however, sometimes cheese with honey is appropriately given.