De Medicina

Celsus, Aulus Cornelius

Celsus, Aulus Cornelius. De Medicina. Spencer, Walter George, translator. Cambridge, MA: Harvard University; London, England: W. Heinemann Ltd, 1935-1938.

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

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and there corrupted, rather than for the harmful material to be diverted thence to another part of more importance. Hence it is more beneficial from time to time to clear the scalp by combing, than to repress the disorder altogether. But if this condition is too troublesome, which may happen when a discharge of humour has set in, and especially if this is malodorous, the head is to be shaved often, after which one of the mild repressants is applied, such as soda in vinegar, or ladanum in myrtle oil and wine, or bennut oil with wine. If there is little benefit from these measures it is permissible to use stronger ones, whilst bearing in mind that, at any rate when the disease is of recent origin, this is not a good thing.

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,

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owing to the dying of the surface pellicle, hairs are at first rendered thin, and then they fall out; and when the place is cut into, the blood which flows is thin and malodorous. Both kinds spread, in some quickly, in others slowly; the worse kind is that in which the skin has become thick, somewhat fatty, and quite smooth. But that which is named alopecia spreads without defined configuration. It occurs in the hairy scalp or in the beard. That again which is called from its shape ophis, commences at the back of the head, and without exceeding two fingers in breadth, creeps forward to the ears with two heads, in some even to the forehead, until the two heads join one another in front. The former affection occurs at any age, the latter generally in young children. The former scarcely ever terminates, such under treatment, the latter often by itself. Some scarify these bald patches with a scalpel; some smear on caustics mixed with oil, and especially burnt papyrus; some apply turpentine-resin with fennel. But there is nothing better than to shave the part daily with a razor, because as the surface skin is gradually removed, the hair roots become exposed; and the treatment should continue until a number of hairs are seen to be growing up. Following upon the shaving it is sufficient to smear on Indian ink.

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

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rather red and irregular. Freckles are, in fact, ignored by most; they are nothing more than a roughened and indurated discoloration. Whilst the others occur only on the face, a spot sometimes also appears on other parts of the body; of that by itself I do not think it worth while to write elsewhere. But pimples are best removed by the application of resin to which not less than the same amount of split alum and a little honey has been added. A spot is removed by equal quantities of galbanum and soda pounded in vinegar to the consistency of honey. With this the part is to be smeared, and after the lapse of several hours, the next morning, it is washed off, and the place anointed lightly with oil. Freckles are removed by resin to which a third part of rock-salt and a little honey has been added. For all the above and also for colouring scars that composition is useful which is said to have been invented by Trypho the father. In this are equal parts of the dregs of bennut oil, bluish Cimolian chalk, bitter almonds, barley and vetch meal, along with white soapwort and mellilot seeds. These are all rubbed up together with very bitter honey, smeared on at night and washed away in the morning.

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-

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tion swelling of the eyelids and a thick rheum appear all at once; if that rheum is mixed with tears, if the tears are not hot, but the rheum is white and bland, and the swelling is not hard, there is then no apprehension of a prolonged illness. But if lacrimation is profuse and hot, rheum scanty, swelling moderate, and that in one eye only, the case will be a prolonged one, but without danger. And that kind of ophthalmia is the least painful, but is seldom relieved before the twentieth day, and at times lasts two months. As it subsides, the rheum begins to be white and bland, mixed with tears. But if both eyes are attacked simultaneously, the duration may possibly be shorter, but there is danger of ulceration. Now rheum, when it is dry and sticky, gives rise to some pain, but subsides sooner unless ulceration is set up. If there is great swelling without pain and dryness, there is no danger; if there is dryness, accompanied by pain, there is generally ulceration, and at times the result is that the eyelid sticks to the eyeball. There is danger of similar ulceration in the eyelids or in the pupils when, in addition to great pain, the tears are salt and hot; or if, even after the swelling has subsided, there continues for some time a flow of tears mixed with rheum. The case is worse still when the rheum is pallid or livid, the tears hot and profuse, the head hot, and pain shoots from the temples to the eyes, causing wakefulness at night; in these circumstances generally the eyeball ruptures, and we must pray that there may be ulceration only. When the eyeball has ruptured inwards a touch of fever is beneficial. If the eyeball protrudes after rupturing outwards, there is no remedy. If something white
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has developed from the dark part of the eye, it persists for a long while; but if it is rough and thick, some vestige remains even after treatment. According to Hippocrates, the oldest authority, the treatment of the eyes includes bloodletting, medicaments, the bath and wine; but he gave little explanation of the proper times and reasons for these remedies, things of the highest importance in the art of medicine. There is no less help, often, in abstinence and clysters. Now at times inflammation seizes the eyes, and there is pain in them together with swelling, and there follows a flow of rheum, sometimes rather profuse or acrid, sometimes in both respects rather moderate. In such a case, rest in bed and abstinence are the chief remedies. From the first day, therefore, the patient should lie in bed in a dark room, and at the same time he should refrain even from talking; take no food at all, and if feasible not even water, or at any rate the least possible amount. If the pains are severe, it is better that he should be bled on the second day, but when urgent this may be done even on the first day, at any rate if the veins on the forehead are swollen, and if there is superfluity of matter in a robust patient. But if the attack is less violent, it requires less drastic treatment: the bowel should be clystered, but only on the second or third day. But moderate inflammation requires neither blood-letting nor clystering, it is sufficient for the patient to stay in bed and fast. A prolonged abstinence, however, is not necessary in patients with ophthalmia, for it may render the rheum thinner, and more acrid; hence some of the lightest kind of food should be given on the second day, such as seems likely to
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render the rheum thicker; for instance, raw eggs; in a less severe case, porridge also or bread soaked in milk. On the following days, according as the inflammation subsides, additional food may be taken, but of the same class; certainly nothing salted, or acrid, or likely to make the rheum thinner should be consumed, and nothing but water drunk. Such a dietetic regimen is exceedingly necessary. But from the first day, saffron 4 grams and the finest wheat flour 8 grams should be made up with white of egg to the consistency of honey, then spread on lint and stuck on the forehead, in order that by compressing the veins the flow of rheum may be checked. If saffron is not at hand, frankincense has the same effect. Whether it is spread on linen, or on wool, makes no difference. There should be smeared over the eyeball, of saffron as much as can be taken up in three fingers, of myrrh in amount the size of a bean, of poppy-tears the size of a lentil: these are pounded up in raisin wine, and applied on a probe to the eyeball. Another composition having the same efficacy is made up of: myrrh 0.33 grams, mandragora juice 4 grams; poppy-tears 8 grams; rose-leaves and hemlock seeds 12 grams each; acacia 16 grams; gum 32 grams. These applications are made by day; at night, in order better to assure sleep, it is not inappropriate to apply above the eye, the crumb of white bread soaked in wine; for this at once represses rheum, and absorbs any flow of tears, and prevents the eye from becoming glued up. If this application, owing to the great pain in the eye, seems oppressive and hard,
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eggs, both the white and the yolk, are poured into a vessel, a little honey-wine added, and the mixture stirred with the finger. When thoroughly mixed, soft well-combed wool is soaked in it and the wool then applied over the eyes. This is both a light application and one which by cooling checks rheum, yet does not quite dry it up, and so the eye is not allowed to become glued up. Boiled barley-meal, mixed with boiled quinces, is also a suitable application; nor is it inconsistent with the treatment, even to put on a pad of wool wrung as hard as possible out of water, if the attack is a lighter one, or out of vinegar and water, if it is more severe. The former applications are to be bandaged on, so that they do not fall off during sleep; the latter it suffices to lay one because it can be changed readily by the patient himself, and when it becomes dry, it must be wetted again. If the affection is so severe as to prevent sleep, for a time one of the remedies which the Greeks call anodyna should be administered, an amount the size of a vetch to a child, that of a bean to a man. For the eyeball itself there is no appropriate application on the first day, unless the inflammation is only moderate, for by such the flow of rheum is often stimulated rather than lessened. From the second day, even when the disease is severe, the direct application of medicaments is proper, when blood has been let or clystering applied, or after it has become evident that neither is needed.

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.

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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,

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washed white lead and lign-aloes 12 grams of each; cluster-shaped oxide of zinc, washed and roasted copper scales 32 grams each; gum 72 grams; acacia juice 80 grams; the same amount of antimony sulphide, to which is added rain-water.

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

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by tepid water; after the bath he must take care that he is not harmed by cold or draught: subsequently he should use a diet rather fuller than had been customary for those days, whilst avoiding everything which may render the rheum thinner. He should drink mild wine, not too dry, and moderately old, taking it neither too freely nor too sparingly, so that, without causing indigestion, it may nevertheless induce sleep, and mollify the internal latent acrid humour. If at the bath the patient feels the trouble in the eyes becoming worse than before he entered, which often happens to those who have hurried on to this course of treatment whilst there is still a discharge of rheum, he ought immediately to leave the bath, take no wine that day, and less food even than on the previous day. Afterwards, as soon as the flow of rheum has subsided sufficiently, he may return again to the use of the bath. Nevertheless, from the fault of the weather, or of the patient's constitution, if on happens that for many days neither the pain nor inflammation is checked, and least of all the discharge of rheum. When this occurs and the affection is now established by reason of its long standing, recourse must be had to these same remedies that is, the bath and wine. For whilst they unsuitable early in the complaints because they can then irritate and stir up inflammation, yet in inveterate cases which have not yielded to other remedies, they are quite effectual, that is to say, in this as in other instances, when ordinary remedies have proved useless, contrary ones are beneficial. But beforehand the patient should be shaved down to the scalp, then in the bath he should foment both his head and eyes with plenty of hot water, next
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clean both with a little roll of lint, and anoint the head with iris ointment: and he should keep to his bed until all the heat so produced has ended, and the sweat which of necessity has collected in the head has passed off. He is then to take food and wine of the same sort as above, drinking the wine undiluted; and he must rest with the head wrapped up. For often after these measures a sound sleep, or a sweat, or a clearance of the bowel, terminates the discharge of rheum. If, as more often happens, the malady is in some measure relieved, the same regimen is pursued for a number of days until recovery is completed. If, meanwhile, the bowels do not act, clysters are given to relieve the upper parts of the body. But occasionally a violent inflammation breaks out with so much force as to push forwards the eyes out of their place: the Greeks call this proptosis, because the eyes drop forwards. In this cases especially, if the strength allows of it, blood is to be let; if that is impracticable, then a clyster and prolonged abstinence should be prescribed. The blandest medicaments are required; hence some use that salve of Cleon's which has been noted above, as consisting of two ingredients, poppy-tears and gum, but the best is the salve of Nileus, and this point is agreed on by all authorities.

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,

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or hyoscyamus leaves with the yolk of a boiled egg, or flour with acacia juice and raisin wine or honeyed wine; if poppy-tears too be added to these, they are rendered somewhat more active. Having prepared one of the above, the eyes should be swabbed with a small screw of lint, wrung out in a hot decoction of myrtle or rose leaves and then one of the salves placed in them. Furthermore, after incising the skin of the occiput, a cup is to be applied there. But if the eye is not restored into position by the above remedies, but remains pushed forward as before, it should be recognized that its sight is lost; and that the eyeball will harden or will be converted into pus. If suppuration shows itself in the corner nearest the temple, the eyeball should be cut into, in order that by letting out the pus, both inflammation and pain may be ended, and the coats of the eyeball may recede, so that the patient's looks afterwards may be less disfigured. There should then be applied either one of the above salves with milk or egg, or saffron, either by itself or mixed with white of egg. But if the eyeball has grown hard and is dead, but not converted into pus, so much of it is to be cut out as projects in an ugly fashion; for this purpose the sclerotic coat is seized with a hook, and the scalpel cuts under it; then the same medicaments are to be inserted until all pain has stopped. Use is to be made of the same medicaments for an eye which has first prolapsed, and then has split open in several places.

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

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patient should be clystered, the food diminished, and milk given as a drink, in order to mollify the acrid matter which is doing harm. As regards poultices and medicaments, what has been prescribed for inflammation must be used. And here again the salve of Nileus is best: but when the carbuncle is on the outer surface of the eyelid, the most suitable poultice is one of linseed boiled in honeyed wine, or, if that is not at hand, flour boiled in the same.

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

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each; washed zinc oxide, frankincense, roasted and washed, antimony sulphide, myrrh, and gum 8 grams each.

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;

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other medicaments too are put upon the lice themselves in order to kill them and prevent any more from being born. For this purpose soda-scum 0.33 gram, sandarach 0.33 gram and black bryony berries 4 grams are pounded up together, with equal proportions of old oil and vinegar, until of the consistency of honey.

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

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I do not name the kind of fluid to be added, I would have water to be understood.

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.

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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

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depressed, new flesh may be grown by applying that salve called sphaerion, or that named Asclepios, which contains: poppy-tears 8 grams; sagapenum and all-heal 12 grams each; verdigris 16 grams; gum 32 grams; pepper 48 grams; washed oxide of zinc and cerussa 64 grams each. But thick scars are thinned either by the smilion, or by the salve of Canopus which contains: cinnamon and acacia 4 grams each; washed oxide of zinc, saffron, myrrh, poppy-tears and gum 8 grams each; white pepper and frankincense 12 grams each; roasted copper 32 grams. Or the pyxinum of Euelpides, which consists of: rock-salt 16 grams; ammoniacum used for incense, 32 grams; poppy-tears 48 grams; cerussa 60 grams; white pepper and Sicilian saffron 128 grams each; gum 52 grams; washed zinc oxide 36 grams. However, the best for elevating a scar seems to be: gum 0.66 gram; verdigris 4 grams; dregs of saffron 16 grams.

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

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of the eyes; sometimes it is more serious, sometimes less so. Often too, as the result of trachoma, inflammation is set up, which in its turn increases the trachoma, and sometimes lasts a short time, sometimes long, and then it is scarcely ever terminated. In this class of affection, some scrape the thick and indurated eyelids with a fig-leaf and a rasp and sometimes with a scalpel, and every day rub medicaments into the under surface of the eyelid; such things should only be done when there is marked and inveterate hardness, and not often; for the same result is better attained by dieting and proper medicaments. Therefore we shall make use of exercise and frequent baths, and foment the eye-lids freely with hot water, and the food we give will be acrid and attenuating, and the medicine the salve called caesarianum. This contains: shoemaker's blacking 1.33 grams; antimony sulphide 1.66 grams; white pepper 1.33 grams; poppy-tears and gum 8 grams each; washed oxide of zinc 16 grams; antimony sulphide 24 grams. And this preparation will do for all kinds of eye-inflammations, except such as are relieved by bland remedies.

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

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and heavy and painful, and at night the lids get stuck together by very troublesome rheum; the less violent the onset of this kind of trouble is, the less readily it is terminated. In this lesion there is need for much walking, much exercise, frequent bathing, sitting in the bath and sweating, and much rubbing. The food should not be too flesh-making, neither is acrid food suitable, but a mean between the two. In the morning, when it is plain that all food has been digested, it is not inappropriate to gargle with mustard, then next to rub the head and face for a considerable time.

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,

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and this is placed in an earthenware jar and covered over with fig-leaves and is buried underground; after twenty days it is taken up, and again pounded, when it is given this name. It is generally agreed that the salve basilicum is suitable for all affections of the eyes which are not treated by bland medicaments. But when such compositions are not at hand, honey and wine relieve the scabrous angles of the eyes; in this and in dry ophthalmia relief is afforded by soaking bread in wine, and applying it over the eyes. For since there is generally some humour which is irritating either the eyeball itself, or the eyelids, by this application any humour on the surface is drawn out and any near at hand driven back.

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

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for dim vision and previously for thinning scars. If anyone finds his eyes becoming dim he must walk and exercise a great deal; also bathe frequently, and in the bath he is to be rubbed all over, especially, however, on his head, with iris unguent, until he sweats; and he should then be wrapped up, and not uncover, until after reaching home the sweating and heat have passed off. Then he should take acrid foods which will make him thin and some days afterwards gargle with mustard.

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.

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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

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eyeballs. The same exercises, baths, rubbings, and gargles are also to be used for these patients.

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-

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sight as Nature's gift to us. But in the case of the ears still a somewhat greater danger; for whereas lesions of the eyes keep the mischief to themselves, inflammations and pains in the ears sometimes even serve to drive the patient to madness and death. The makes it more desirable to apply treatment at the very beginning, that there may be no opening for the greater discovering. As soon, therefore, as the pain is first felt, the patient should fast and keep quiet; the next day, if the pain is still severe, the head should be shaved, and after it has been anointed with hot iris unguent, covered up. But great pain with fever and sleeplessness require also that blood should be let; if anything prevents this, the bowels are to be moved. Hot poultices also, frequently changed, are of service, whether composed of fenugreek or linseed or other meal boiled in honey wine, and sponges also wrung out of hot water, applied at intervals, are appropriate. Then, when the pain is relieved, iris or cyprus unguent should be spread around the ears; in some cases, however, the rose unguent is more advantageous. If severe inflammation entirely prevents sleep, there should be added to the poultice half its quantity of toasted and pounded poppy-head rind, and this should be boiled down with the rest in diluted raisin wine. It is desirable also to pour some medicament into the ear, and this should always be made lukewarm beforehand; and is best dropped in from a strigil. When the ear is full, soft wool is applied over it to keep in the fluid. And these are the medicaments generally used for this purpose: but also there is rose oil and arundo-root juice and oil in which worms have been boiled, juice expressed from bitter almonds or
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from peach-kernels. But the compositions for relieving inflammation and pain generally employed are: castoreum and poppy-tears in equal amounts, pounded together; then to these there is added raisin wine. Or poppy-tears, saffron and myrrh in equal quantities pounded, while rose oil and raisin wine are dropped in by turns. Or the bitter part of the Egyptian bean pounded up with rose oil added; with these some mix a little myrrh or poppy-tears, or frankincense in woman's milk, or the juice of bitter almonds with rose oil. Or castoreum, myrrh and poppy-tears, equal parts, with raisin wine. Or saffron 1 gram; myrrh and shredded alum 0.66 gram of each; ;whilst this is being pounded there is slowly added to it 125 cc. of raisin wine, of honey rather less than 40 cc., and this is one of the best remedies. Or poppy-tears in vinegar. Themison's compound may also be used; it contains: castoreum, opopanax and poppy-tears 8 grams each, buckthorn scum 16 grams. These are pounded and made up in raisin wine, until they have the consistency of a wax salve and are so preserved. When required for use, this composition is again stirred with a probe whilst adding raisin wine. The rule is general, that when a composition has become too thick to be dropped into the ear, some of the fluid with which it was made up is added until it become sufficiently liquid.

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

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stacte 4 grams; the same amount of saffron; 25 bitter almonds; of honey 250 cc.; these are pounded together, and when they are to be used, are warmed in a pomegranate rind. The medicaments which are compounded for ulcerations of the mouth are equally healing for ulcerations of the ear. If the disease is of longer standing, and much matter is discharged, the composition said to have been invented by Erasistratus is suitable: pepper 0.66 gram; saffron 0.66 gram; myrrh and cooked antimony sulphide 4 grams each; roasted copper 8 grams. These are pounded up in wine, and when the mixture has become dry, 750 cc. of raisin wine are added, and are boiled up with it. When it is to be used, wine and honey are added to these ingredients. There is also the medicament of the surgeon Ptolemaeus, which contains: mastich 0.66 gram, oak galls 0.66 gram, omphacium 4 grams; and pomegranate juice. There is the very active remedy of Menophilus, which consists of: long pepper 4 grams; castoreum 8 grams; myrrh, saffron, poppy-tears, Syrian nard, frankincense, pomegranate rind, the embryo of an Egyptian bean, bitter almonds, and the best honey 16 grams each. These are pounded together with the addition of very sour vinegar until of the consistency of raisin wine. The prescription of Craton is the following: cinnamon and casia 0.66 grams, boxthorn juice, nard and myrrh 4 grams each, lign-aloes 8 grams, honey 125 cc., wine half a litre. The lycium is first boiled in the wine, and the rest added. But when there is much pus, and the odour bad, verdigris scrapings and frankincense 8 grams each, honey 85 cc.; vinegar 170 cc. are boiled together. For use, it is mixed with sweet
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wine. Or equal weights of shredded alum, poppy-tears and acacia juice are mixed together, and to these is added of hyoscyamus juice less than half the quantity of each one of the above; and these are pounded together and diluted with wine. Also hyoscyamus juice is sufficiently beneficial by itself.

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

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juice should be poured in mixed with milk, or with water in which rose leaves have been boiled, with polygonum juice or that of acacia added. If flesh has formed over the ulcerations and there is a malodorous discharge, the ear should be washed out with tepid water, then that composition poured in which contains frankincense, verdigris, vinegar and honey; or honey boiled with verdigris. Copper scales also pounded up with sandarach may be instilled through a tube with advantage.

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.

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If a crust, hot oil is poured in, or verdigris mixed with honey or leek juice or a little soda in honey wine. And when the crust has been separated from the ulceration, the ear is irrigated with tepid water, to make it easier for the crusts now disengaged to be withdrawn by the ear scoop. If it be wax, and if it be soft, it can be extracted in the same way by the ear scoop; but if hard, vinegar containing a little soda is introduced; and when the wax has softened, the ear is washed out and cleared as above. When the heaviness of the head persists it should be shaved; the head rubbed over gently and for some time with castoreum to which either iris or laurel oil has been added with either of which a little vinegar has been mixed; then the patient must take a long walk, and after the rubbing his head is to be fomented with hot water. And the food should be of the lightest and of the middle class, and the drinks especially diluted; he should occasionally gargle. Further, the ear should be syringed with castoreum mixed with vinegar and laurel oil and the juice of young radish rind, or with cucumber juice, mixed with crushed rose leaves. The dropping in of the juice of unripe grapes mixed with rose oil is also fairly efficacious against deafness.

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

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and the breath held until some humour froths out from it. If it arises from disease and pain in the head, the prescriptions as to exercise, rubbing, affusion and gargling should be carried out. Only foods that make thin are to be used. Into the ear radish juice should be dropped with oil of roses or with the juice of wild cucumber root; or castoreum with vinegar and laurel oil. Also veratrum is pounded up for this purpose in vinegar, then mixed with boiled honey, and a slave made of it and introduced into the ear.

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

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round; for that will certainly catch it. If it is some inanimate object, it is to be withdrawn by an ear scoop or by a small blunt hook slightly bent. If these are ineffectual it is possible to extract it by means of resin as above. Also if a sneezing fit is induced, this easily moves it away or a forcible injection of water through an ear syringe. Again, a plank may be arranged, having its middle supported and the ends unsupported. Upon this the patient is tied down, with the affected ear downwards, so that the ear projects beyond the end of the plank. Then the end of the plank at the patient's feet is struck with a mallet, and the ear being so jarred what is within drops out.

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

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exercise, and a moderate amount of food, neither sour nor very nutritious. Further, into the nostril itself may be inserted honey to which a very small quantity of turpentine resin has been added (this is done on a probe wrapped round with wool), and this juice is drawn inwards by the breath until it can be tasted in the mouth. For in this way the crusts are loosened, and they should then be blown out by sneezing. The ulcerations having been cleaned are steamed over hot water; then there should be applied either boxthorn-juice diluted with wine or wine lees or omphacium or the juice of mint or horehound or blacking made glowing hot and then pounded, or the interior part of a squill crushed; provided that to any of these honey is added. The honey should be a very small part in all these mixtures, except with the blacking, when there should be just enough to make the mixture liquid, whilst with the squill certainly the honey should form the larger part; a probe should be wrapped round with wool, and dipped into this medicament, and with it the ulcers are filled. And further, a strip of linen is folded into a long roll, smeared with the same medicament, and inserted into the nostril, and is lightly bandaged on below. This should be done in winter and spring twice a day, in summer and autumn three times a day.

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

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sometimes towards the lips, sometimes backwards through that passage by which the breath goes from the nose to the throat. In this direction it may grow until it can be seen behind the uvula; it chokes the patient, especially when the south or east wind blows; generally it is soft, rarely hard, and the latter sort hinders breathing more and dilates the nose; it is then generally cancerous, and so should not be touched. But the other kind can generally be removed by the knife; sometimes, however, it dries up, if the following composition is inserted into the nostril on lint or on a feather: minium from Sinope, copper ore, lime, and sandarach 4 grams each, blacking 4 grams.

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

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appropriately used for the same purpose, and stag's horn shavings boiled in vinegar, and catmint together with a torch rich in resin and a fig equally rich boiled either in honey wine or in vinegar and honey. When the fig has been boiled down with these, this fluid is strained. Also a prove wrapped round with wool is dipped in hot oil, and the tooth itself fomented with this. Moreover, some applications, like poultices, are smeared on the tooth itself, and for this purpose the inside rind of an unripe dry pomegranate is pounded up with equal parts of oak-galls and pine bark, with which minium is mixed; and these when pounded together are made up with rain-water. Or equal quantities of all-heal, poppy-tears, sulphur wort, and black bryony berries without the seeds are pounded together. Or three parts of galbanum to one of poppy juice. Whatever is applied to the teeth directly, none the less the ointment mentioned above must also be put on the jaws and covered over with wool. Some rub up together myrrh and cardamoms, 4 grams each; saffron chamomile figs and broom 16 grams each; and mustard 32 grams; spread it on lint and apply to the shoulder on the side of the painful tooth; over the shoulder-blade, if it is an upper tooth; on the chest if a lower one; and this relieves the pain, and as soon as it has relieved it, must be at once taken off. When a tooth decays, there is no hurry to extract it, unless it cannot be helped, but rather to the various applications described above, we must add more active compositions for the relief of pain, such as that of heras. This has poppy juice 4 grams; pepper 8 grams; sory 40 grams, pounded, taken up in galbanum, and
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applied round the tooth; or that of Menemachus, especially for molar teeth, containing saffron 0.66 gram, cardamons, frankincense root, figs, broom and pellitory 16 grams each; mustard 32 grams. Again, some mix chamomile, pepper, elaterium and broom 4 grams each; shredded alum, poppy juice, black bryony berries, crude sulphur, bitumen, laurel berries and mustard 8 grams each. But if pain compels its removal, a peppercorn without the tegument, or an ivy berry without the tegument is inserted into the cavity of the tooth, which it splits, and the tooth falls out in bits. Also the tail spine of the flat fish which we call pastinaca, and the Greeks trygon, is roasted, pounded and taken up in resin, and this, when applied around the tooth, loosens it. Also shredded alum and . . . put into the cavity loosens the tooth. However, it is better to insert this wrapped up in a flake of wool, for it thus relieves the pain whilst preserving the tooth. These are the remedies recognized by medical practitioners, but country people have found out by experience that if a tooth aches, catmint should be pulled up with its roots, and put into a pot, and water poured over it, and placed beside the patient as he sits all covered by clothes; then red-hot stones are thrown in so as to be covered by the water; the patient inhales the steam with his mouth open, whilst, as stated above, he is completely covered over. For profuse sweating follows, and also a steady stream of phlegm flows from the mouth, and this ensures good health always for a year, and often for longer.

10 Again, if the tonsils owing to the inflammation

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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.
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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.

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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

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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.

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.