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.