ONREGIMENINACUTEDISEASES By Hippocrates TranslatedbyFrancisAdams

PART1
Thosewhocomposedwhatarecalled"TheCnidianSentences"havedescribedaccurately whatsymptomsthesickexperienceineverydisease,andhowcertainofthemterminate andinsofaraman,evenwhoisnotaphysician,mightdescribethemcorrectly,provided heputtheproperinquiriestothesickthemselveswhattheircomplaintsare.Butthose symptomswhichthephysicianoughttoknowbeforehandwithoutbeinginformedof thembythepatient,are,forthemostpart,omitted,someinonecaseandsomeinothers, andcertainsymptomsofvitalimportanceforaconjecturaljudgment.Butwhen,in additiontothediagnosis,theydescribehoweachcomplaintshouldbetreated,inthese casesIentertainastillgreaterdifferenceofopinionwiththemrespectingtherulesthey havelaiddownandnotonlydoInotagreewiththemonthisaccount,butalsobecause theremediestheyusearefewinnumberfor,withtheexception ofacutediseases,the onlymedicineswhichtheygivearedrasticpurgatives,withwhey,andmilkatcertain times.If,indeed,theseremedieshadbeengoodandsuitabletothecomplaintsinwhich theyarerecommended,theywouldhavebeenstillmoredeservingofrecommendation,if, whilefewinnumber,theyweresufficientbutthisisbynomeansthecase.Those, indeed,whohaveremodeledthese"Sentences"havetreatedoftheremediesapplicablein eachcomplaintmoreinamedicalfashion.Butneitherhavetheancientswrittenanything worthregimen,althoughthisbeagreatomission.Someofthem,indeed,werenot ignorantofthemanyvarietiesofeachcomplaint,andtheirmanifolddivisions,butwhen theywishtotellclearlythenumbers(species?)ofeachdiseasetheydonotwritefortheir specieswouldbealmostinnumerableifeverysymptomexperiencedbythepatientswere heldtoconstituteadisease,andreceiveadifferentname.

PART2
Formypart,Iapproveofpayingattentiontoeverythingrelatingtotheart,andthatthose thingswhichcanbedonewellorproperlyshouldallbedoneproperlysuchascanbe quicklydoneshouldbedonequicklysuchascanbeneatlydoneshouldbedoneneatly suchoperationsascanbeperformedwithoutpainshouldbedonewiththeleastpossible painandthatallotherthingsofthelikekindshouldbedonebetterthantheycouldbe managedbytheattendants.ButIwouldmoreespeciallycommendthephysicianwho,in acutediseases,bywhichthebulkofmankindarecutoff,conductsthetreatmentbetter thanothers.Acutediseasesarethosewhichtheancientsnamedpleurisy,pneumonia, phrenitis,lethargy,causus,andtheotherdiseasesalliedtothese,includingthecontinual fevers.For,unlesswhensomegeneralformofpestilentialdiseaseisepidemic,and diseasesaresporadicand[not]ofasimilarcharacter,therearemoredeathsfromthese diseasesthanfromalltheotherstakentogether.Thevulgar,indeed,donotrecognizethe differencebetweensuchphysiciansandtheircommonattendants,andareratherdisposed tocommendandcensureextraordinaryremedies.This,then,isagreatproofthatthe commonpeoplearemostincompetent,ofthemselves,toformajudgmenthowsuch diseasesshouldbetreated:sincepersonswhoarenotphysicianspassforphysicians owingmostespeciallytothesediseases,foritisaneasymattertolearnthenamesof

thosethingswhichareapplicabletopersonslaboringundersuchcomplaints.For,ifone namesthejuiceofptisan,andsuchandsuchawine,andhydromel,thevulgarfancythat heprescribesexactlythesamethingsasthephysiciansdo,boththegoodandthebad,but inthesemattersthereisagreatdifferencebetweenthem.

PART3
Butitappearstomethatthosethingsaremoreespeciallydeservingofbeingconsignedto writingwhichareundeterminedbyphysicians,notwithstandingthattheyareofvital importance,andeitherdomuchgoodormuchharm.ByundeterminedImeansuchas these,whereforecertainphysicians,duringtheirwholelives,areconstantlyadministering unstrainedptisans,andfancytheythusaccomplishthecureproperly,whereasotherstake greatpainsthatthepatientshouldnotswallowaparticleofthebarley(thinkingitwould domuchharm),butstrainthejuicethroughaclothbeforegivingitothers,again,will neithergivethickptisannorthejuice,someuntiltheseventhdayofthedisease,and someuntilafterthecrisis.Physiciansarenotinthepracticeofmootingsuchquestions nor,perhaps,ifmooted,wouldasolutionofthembefoundalthoughthewholeartis therebyexposedtomuchcensurefromthevulgar,whofancythattherereallyisnosuch scienceasmedicine,since,inacutediseases,practitionersdiffersomuchamong themselves,thatthosethingswhichoneadministersasthinkingitthebestthatcanbe given,anotherholdstobebadand,inthisrespect,theymightsaythattheartofmedicine resemblesaugury,sinceaugursholdthatthesamebird(omen)ifseenonthelefthandis good,butifontherightbad:andindivinationbytheinspectionofentrailsyouwillfind similardifferencesbutcertaindivinersholdtheveryoppositeoftheseopinions.Isay, then,thatthisquestionisamostexcellentone,andalliedtoverymanyothers,someof themostvitalimportanceintheArt,forthatitcancontributemuchtotherecoveryofthe sick,andtothepreservationofhealthinthecaseofthosewhoarewellandthatit promotesthestrengthofthosewhousegymnasticexercises,andisusefultowhatever onemaywishtoapplyit.

PART4
Ptisan,then,appearstometobejustlypreferredbeforealltheotherpreparationsfrom graininthesediseases,andIcommendthosewhomadethischoice,forthemucilageofit issmooth,consistent,pleasant,lubricant,moderatelydiluent,quenchesthirstifthisbe required,andhasnoastringencygivesnotroublenorswellsupinthebowels,forinthe boilingitswellsupasmuchasitnaturallycan.Those,then,whomakeuseofptisanin suchdiseases,shouldneverforadayallowtheirvesselstobeemptyofit,ifImaysayso, butshoulduseitandnotintermit,unlessitbenecessarytostopforatime,inorderto administermedicineoraclyster.Andtothosewhoareaccustomedtotaketwomealsin thedayitistobegiventwice,andtothoseaccustomedtoliveuponasinglemealitisto begivenonceatfirst,andthen,ifthecasepermit,itistobeincreasedandgiventwiceto

them,iftheyappeartostandinneedofit.Atfirstitwillbeproper nottogivealarge quantitynorverythick,butinproportiontothequantityoffoodwhichonehasbeen accustomedtotake,andsoasthattheveinsmaynotbemuchemptied.And,withregard totheaugmentationofthedose,ifthediseasebeofadriernaturethanonehadsupposed, onemustnotgivemoreofit,butshouldgivebeforethedraughtofptisan,either hydromelorwine,inasgreatquantityasmaybeproperandwhatisproperineachcase willbeafterwardstatedbyus.Butifthemouthandthepassagesfromthelungsbeina properstateastomoisture,thequantityofthedraughtistobeincreased,asageneral rule,foranearlyandabundantstateofmoistureindicatesanearlycrisis,butalateand deficientmoistureindicatesaslowercrisis.AndthesethingsareasIhavestatedforthe mostpartbutmanyotherthingsareomittedwhichareimportanttotheprognosis,aswill beexplainedafterwards.Andthemorethatthepatientistroubledwithpurging,inso muchgreaterquantityisittobegivenuntilthecrisis,andmoreoveruntiltwodays beyondthecrisis,insuchcasesasitappearstotakeplaceonthefifth,seventh,orninth day,soastohaverespectbothfortheoddandevenday:afterthisthedraughtistobe givenearlyintheday,andtheotherfoodinplaceistobegivenintheevening.These thingsareproper,forthemostpart,tobegiventothosewho,fromthefirst,haveused ptisancontainingitswholesubstanceforthepainsinpleuriticaffectionsimmediately ceaseoftheirownaccordwheneverthepatientsbegintoexpectorateanythingworth mentioning,andthepurgingsbecomemuchbetter,andempyemamuchmoreseldom takesplace,thanifthepatientsusedadifferentregimen,andthecrisesaremoresimple, occurearlier,andthecasesarelesssubjecttorelapses.

PART5
Ptisansaretobemadeoftheverybestbarley,andaretobewellboiled,moreespecially ifyoudonotintendtouse themstrained.For,besidestheothervirtuesofptisan,its lubricantqualitypreventsthebarleythatisswallowedfromprovinginjurious,foritdoes notsticknorremainintheregionofthebreastforthatwhichiswellboiledisvery lubricant,excellentforquenchingthirst,ofveryeasydigestion,andveryweak,allwhich qualitiesarewanted.If,then,onedonotpayproperattentiontothemodeof administeringtheptisan,muchharmmaybedoneforwhenthefoodisshutupinthe bowels,unlessoneprocuresomeevacuationspeedily,beforeadministeringthedraught, thepain,ifpresent,willbeexasperatedand,ifnotpresent,itwillbeimmediately created,andtherespirationwillbecomemorefrequent,whichdoesmischief,foritdries thelungs,fatiguesthehypochondria,thehypogastrium,anddiaphragm.Andmoreoverif, whilethepainofthesidepersists,anddoesnotyieldtowarmfomentations,andthesputa arenotbroughtup,butareviscidandunconcocted,unlessonegetthepainresolved, eitherbylooseningthebowels,oropeningavein,whicheverofthesemaybeproperif topersonssocircumstancedptisanbeadministered,theirspeedydeathwillbetheresult. Forthesereasons,andforothersofasimilarkindstillmore,thosewhouseunstrained ptisandieontheseventhday,orstillearlier,somebeingseizedwithdelirium,andothers dyingsuffocatedwithorthopnoeeandriles.Suchpersonstheancientsthoughtstruck,for thisreasonmoreespecially,thatwhendeadtheaffectedsidewaslivid,likethatofa

personwhohadbeenstruck.Thecauseofthisisthattheydiebeforethepainisresolved, beingseizedwithdifficultyofrespiration,andbylargeandrapidbreathing,ashasbeen alreadyexplained,thespittlebecomingthick,acid,andunconcocted,cannotbebrought up,but,beingretainedinthebronchiofthelungs,producesrilesand,whenithascome tothis,death,forthemostpart,isinevitableforthesputabeingretainedpreventthe breathfrombeingdrawnin,andforceitspeedilyout,andthusthetwoconspiretogether toaggravatethesputabeingretainedrenderstherespirationfrequent,whilethe respirationbeingfrequentthickensthesputa,andpreventsthemfrombeingevacuated. Thesesymptomssupervene,notonlyifptisanbeadministeredunseasonably,butstill moreifanyotherfoodordrinkworsethanptisanbegiven.

PART6
Forthemostpart,then,theresultsarethesame,whetherthepatienthaveusedthe unstrainedptisanorhaveusedthejuicealoneorevenonlydrinkandsometimesitis necessarytoproceedquitedifferently.Ingeneral,oneshoulddothus:iffever commencesshortlyaftertakingfood,andbeforethebowelshavebeenevacuated, whetherwithorwithoutpain,thephysicianoughttowithholdthedraughtuntilhethinks thatthefoodhasdescendedtothelowerpartofthebellyandifanypainbepresent,the patientshoulduseoxymel,hotifitiswinter,andcoldifitissummerand,iftherebe muchthirst,heshouldtakehydromelandwater.Then,ifanypainbepresent,orany dangeroussymptomsmaketheirappearance,itwillbepropertogivethedraughtneither inlargequantitynorthick,butaftertheseventhday,ifthepatientbestrong.Butifthe earliertakenfoodhasnotdescended,inthecaseofapersonwhohasrecentlyswallowed food,andifhebestrongandinthevigoroflife,aclystershouldbegiven,orifhebe weaker,asuppositoryistobeadministered,unlessthebowelsopenproperlyof themselves.Thetimeforadministeringthedraughtistobeparticularlyobservedatthe commencementandduringthewholeillnesswhen,then,thefeetarecold,oneshould refrainfromgivingtheptisan,andmoreespeciallyabstainfromdrinkbutwhentheheat hasdescendedtothefeet,onemaythengiveitandoneshouldlookuponthisseasonas ofgreatconsequenceinalldiseases,andnotleastinacutediseases,especiallythoseofa febrilecharacter,andthoseofaverydangerousnature.Onemayfirstusethejuice,and thentheptisan,attendingaccuratelytotherulesformerlylaiddown.

PART7
Whenpainseizestheside,eitheratthecommencementoratalaterstage,itwillnotbe impropertotrytodissolvethepainbyhotapplications.Ofhotapplicationsthemost powerfulishotwaterinabottle,orbladder,orinabrazenvessel,orinanearthenone butonemustfirstapplysomethingsofttotheside,topreventpain.Asoftlargesponge, squeezedoutofhotwaterandapplied,formsagoodapplicationbutitshouldbecovered upabove,forthustheheatwillremainthelonger,andatthesametimethevaporwillbe

preventedfrombeingcarrieduptothepatient'sbreath,unlesswhenthisisthoughtofuse, forsometimesitisthecase.Andfurther,barleyortaresmaybeinfusedandboiledin dilutedvinegar,strongerthanthatitcouldbedrunk,andmaythenbesewedintobladders andappliedandonemaybraninlikemanner.Saltsortoastedmilletinwoolenbagsare excellentforformingadryfomentation,forthemilletislightandsoothing.Asoft fomentationlikethissoothespains,evensuchasshoottotheclavicle.Venesection, however,doesnotalleviatethepainunlesswhenitextendstotheclavicle.Butifthepain benotdissolvedbythefomentations,oneoughtnottofomentforalengthoftime,for thisdriesthelungsandpromotessuppurationbutifthepainpointtotheclavicle,orif therebeaheavinessinthearm,oraboutthebreast,orabovethediaphragm,oneshould opentheinnerveinattheelbow,andnothesitatetoabstractalargequantity,untilit becomemuchredder,orinsteadofbeingpurered,itturnslivid,forboththesestates occur.Butifthepainbebelowthediaphragm,anddonotpointtotheclavicle,wemust openthebellyeitherwithblackhelleboreorpeplium,mixingtheblackhelleborewith carrotorseseli,orcumin,oranise,oranyotherofthefragrantherbsandwiththe pepliumthejuiceofsulphium(asafoetida),forthesesubstances,whenmixeduptogether, areofasimilarnature.Theblackhelleboreactsmorepleasantlyandeffectuallythanthe peplium,while,ontheotherhand,thepepliumexpelswindmuchmoreeffectuallythan theblackhellebore,andboththesestopthepain,andmanyotherofthelaxativesalso stopit,butthesetwoarethemostefficaciousthatIamacquaintedwith.Andthelaxatives givenindraughtsarebeneficial,whennotveryunpalatableowingtobitterness,orany otherdisagreeabletaste,orfromquantity,color,oranyapprehension.Whenthepatient hasdrunkthemedicine,oneoughttogivehimtoswallowbutlittlelessoftheptisanthan whathehadbeenaccustomedtobutitisaccordingtorulenottoaccordingtorulenotto giveanydraughtswhilethemedicineisunderoperationbutwhenthepurgingisstopped thenheshouldtakeasmallerdraughtthanwhathehadbeenaccustomedto,and afterwardsgoonincreasingitprogressively,untilthepaincease,providednothingelse contraindicate.Thisismyrule,also,ifonewouldusethejuiceofptisan(forIholdthat itisbetter,onthewhole,tobeginwithtakingthedecoctionatonce,ratherthanbyfirst emptyingtheveinsbeforedoingso,oronthethird,fourth,fifth,sixth,orseventhday, providedthediseasehasnotpreviouslycometoacrisisinthecourseofthistime),and similarpreparationstothoseformerlydescribedaretobemadeinthosecases.

PART8
SucharetheopinionswhichIentertainrespectingtheadministeringoftheptisanand,as regardsdrinks,whichsoeverofthoseabouttobedescribedmaybeadministered,the samedirectionsaregenerallyapplicable.AndhereIknowthatphysiciansareinthe practiceofdoingtheveryreverseofwhatisproper,fortheyallwish,atthe commencementofdiseases,tostarvetheirpatientsfortwo,three,ormoredays,andthen toadministertheptisansanddrinksandperhapsitappearstothemreasonablethat,asa greatchangehastakenplaceinthebody,itshouldbecounteractedbyanothergreat change.Now,indeed,toproduceachangeisnosmallmatter,butthechangemustbe effectedwellandcautiously,andafterthechangetheadministrationoffoodmustbe

conductedstillmoreso.Thosepersons,then,wouldbemostinjuredifthechangeisnot properlymanaged,whousedunstrainedptisanstheyalsowouldsufferwhomadeuseof thejuicealoneandsoalsotheywouldsufferwhotookmerelydrink,buttheseleastof all.

PART9
Onemayderiveinformationfrom theregimenofpersonsingoodhealthwhatthingsare properforifitappearthatthereisagreatdifferencewhetherthedietbesoandso,in otherrespects,butmoreespeciallyinthechanges,howcanitbeotherwiseindiseases, andmoreespeciallyinthemostacute?Butitiswellascertainedthatevenafaultydietof foodanddrinksteadilyperseveredin,issaferinthemainasregardshealththanifone suddenlychangeittoanother.Wherefore,inthecaseofpersonswhotaketwomealsin theday,orofthosewhotakeasinglemeal,suddenchangesinducesufferingand weaknessandthuspersonswhohavenotbeenaccustomedtodine,iftheyshalltake dinner,immediatelybecomeweak,haveheavinessovertheirwholebody,andbecome feebleandlanguid,andif,inaddition,theytakesupper,theywillhaveacideructations, andsomewillhavediarrhoeawhosebowelswerepreviouslydry,andnothavingbeen accustomedtobetwiceswelledoutwithfoodandtodigestittwiceaday,havebeen loadedbeyondtheirwont.Itisbeneficial,insuchcases,tocounterbalancethischange, foroneshouldsleepafterdinner,asifpassingthenight,andguardagainstcoldinwinter andheatinsummeror,ifthepersoncannotsleep,hemaystrollaboutslowly,but withoutmakingstops,foragoodwhile,takenosupper,or,atallevents,eatlittle,and onlythingsthatarenotunwholesome,andstillmoreavoiddrink,andespeciallywater. Suchapersonwillsufferstillmoreifhetakethreefullmealsintheday,andmorestillif hetakemoremealsandyettherearemanypersonswhoreadilybeartotakethreefull mealsintheday,providedtheyaresoaccustomed.And,moreover,thosewhohavebeen inthehabitofeatingtwiceaday,iftheyomitdinner,becomefeebleandpowerless, aversetoallwork,andhaveheartburntheirbowelsseem,asitwere,tohangloose,their urineishotandgreen,andtheexcrementisparchedinsomethemouthisbitter,theeyes arehollow,thetemplesthrob,andtheextremitiesarecold,andthemostofthosewho havethusmissedtheirdinnercannoteatsupperor,iftheydosup,theyloadtheir stomach,andpassamuchworsenightthaniftheyhadpreviouslytakendinner.Since, then,anunwontedchangeofdietforhalfadayproducessucheffectsuponpersonsin health,itappearsnottobeagoodthingeithertoaddortakefrom.If,then,hewhowas restrictedtoasinglemeal,contrarytousage,havinghisveinsthusleftemptyduringa wholeday,whenhesuppedaccordingtocustomfeltheavy,itisprobablethatif,because hewasuneasyandweakfromthewantofdinner,hetookalargersupperthanwont,he wouldbestillmoreoppressedorif,wantingfoodforastillgreaterinterval,hesuddenly tookamealaftersupper,hewillfeelstillgreateroppression.He,then,who,contraryto usage,hashadhisveinskeptemptybywantoffood,willfinditbeneficialtocounteract thebadeffectsduringthatdayasfollows:lethimavoidcold,heat,andexertion,forhe couldbearalltheseilllethimmakehissupperconsiderablylessthanusual,andnotof dryfood,butratherliquidandlethimtakesomedrink,notofawaterycharacter,norin

smallerquantitythanisproportionatetothefood,andonthenextdayheshouldtakea smalldinner,sothat,bydegrees,hemayreturntohisformerpractice.Personswhoare biliousinthestomachbearthesechangesworst,whilethosewhoarepituitous,uponthe whole,bearthewantoffoodbest,sothattheysuffertheleastfrom beingrestrictedtoone mealintheday,contrarytousage.This,then,isasufficientproofthatthegreatest changesastothosethingswhichregardourconstitutionsandhabitsaremostespecially concernedintheproductionofdiseases,foritisimpossibletoproduceunseasonablya greatemptyingofthevesselsbyabstinence,ortoadministerfoodwhilediseasesareat theiracme,orwheninflammationprevailsnor,ontheonthewhole,tomakeagreat changeeitheronewayoranotherwithimpunity.

PART10
Onemightmentionmanythingsakintotheserespectingthestomachandbowels,to showhowpeoplereadilybearsuchfoodastheyareaccustomedto,evenifitisnot naturally good,anddrinkinlikemanner,andhowtheybearunpleasantlysuchfoodas theyarenotaccustomedto,evenalthoughnotbad,andsoinlikemannerwithdrinkand astotheeffectsofeatingmuchflesh,contrarytousage,orgarlic,orasafoetida,orthe stemoftheplantwhichproducesit,orthingsofasimilarkindpossessedofstrong properties,onewouldbelesssurprisedifsuchthingsproducepainsinthebowels,but ratherwhenonelearnedwhattrouble,swelling,flatulence,andtorminathecake(maza) willraiseinthebellywheneatenbyapersonnotaccustomedtoitandhowmuchweight anddistentionofthebowelsbreadwillcreatetoapersonaccustomedtoliveuponthe mazaandwhatthirstandsuddenfullnesswillbeoccasionedbyeatinghotbread,owing toitsdesiccantandindigestiblepropertiesandwhatdifferenteffectsareproducedby fineandcoarsebreadwheneatencontrarytousage,orbythecakewhenusuallydry, moist,orviscidandwhatdifferenteffectspolentaproducesupon thosewhoare accustomedandthosewhoareunaccustomedtotheuseofitordrinkingofwineor drinkingofwater,wheneithercustomissuddenlyexchangedfortheotherorwhen, contrarytousage,dilutedwineorundilutedhasbeensuddenlydrunk,fortheonewill createwaterbrashintheupperpartoftheintestinalcanalandflatulenceinthelower, whiletheotherwillgiverisetothrobbingofthearteries,heavinessofthehead,andthirst andwhiteanddarkcoloredwine,althoughbothstrongwines,ifexchangedcontraryto usage,willproduceverydifferenteffectsuponthebody,sothatoneneedthelesswonder thatasweetandstrongwine,ifsuddenlyexchanged,shouldhavebynomeansthesame effect.

PART11
Letusherebrieflyadverttowhatmaybesaidontheoppositesidenamely,thatachange ofdiethasoccurredinthesecases,withoutanychangeintheirbody,eitherastostrength, soastorequireanincreaseof food,orastoweakness,soastorequireadiminution.But

thestrengthofthepatientistobetakenintoconsideration,andthemannerofthedisease, andoftheconstitutionoftheman,andthehabitualregimenofthepatient,notonlyas regardsfoodbutalsodrink.Yetonemustmuchlessresorttoaugmentation,sinceitis oftenbeneficialtohaverecoursetoabstraction,whenthepatientcanbearit,untilthe diseasehavingreacheditsacmeandhasbecomeconcocted.Butinwhatcasesthismust bedonewillbeafterwardsdescribed.Onemightwritemanyotherthingsakintothose whichhavebeennowsaid,butthereisabetterproof,foritisnotakintothematteron whichmydiscoursehasprincipallyturned,butthesubjectmatteritselfisamost seasonableproof.Forsomeatthecommencementofacutediseaseshavetakenfoodon thesameday,someonthenextdaysomehaveswallowedwhateverhascomeintheir way,andsomehavetakencyceon.Nowallthesethingsareworsethanifonehad observedadifferentregimenandyetthesemistakes,committedatthattime,domuch lessinjurythanifoneweretoabstainentirelyfromfoodforthefirsttwoorthreedays, andonthefourthorfifthdayweretotakesuchfoodanditwouldbestillworse,ifone weretoobservetotalabstinenceforallthesedays,andonthefollowingdaysweretotake suchadiet,beforethediseaseisconcoctedforinthiswaydeathwouldbethe consequencetomostpeople,unlessthediseasewereofaverymildnature.Butthe mistakescommittedatfirstwerenotsoirremediableasthese,butcouldbemuchmore easilyrepaired.This,therefore,Ithinkastrongproofthatsuchorsuchadraughtneednot beprescribedonthefirstdaystothosewhowillusethesamedraughtsafterwards.Atthe bottom,therefore,theydonotknow,neitherthoseusingunstrainedptisans,thattheyare hurtbythem,whentheybegintoswallowthem,iftheyabstainentirelyfromfoodfor two,three,ormoredaysnordothoseusingthejuiceknowthattheyareinjuredin swallowingthem,whentheydonotcommencewiththedraughtseasonably.Butthisthey guardagainst,andknowthatitdoesmuchmischief,if,beforethediseasebeconcocted, thepatientswallowunstrainedptisan,whenaccustomedtousestrained.Allthesethings arestrongproofsthatphysiciansdonotconducttheregimenofpatientsproperly,butthat inthosediseasesinwhichtotalabstinencefromfoodshouldnotbeenforcedonpatients thatwillbeputontheuseofptisans,theydoenforcetotalabstinencethatinthosecases inwhichthereshouldbenochangemadefromtotalabstinencetoptisans,theydomake thechangeandthat,forthemostpart,theychangefromabstinencetoptisans,exactlyat thetimewhenitisoften beneficialtoproceedfromptisansalmosttototalabstinence,if thediseasehappentobeinthestateofexacerbation.Andsometimescrudemattersare attractedfromthehead,andbiliousfromtheregionnearthechest,andthepatientsare attackedwithinsomnolency,sothatthediseaseisnotconcoctedtheybecomesorrowful, peevish,anddeliriousthereareflashesoflightintheireyes,andnoisesintheirears theirextremitiesarecold,theirurineunconcoctedthesputathin,saltish,tingedwithan intensecolorandsmellsweatsabouttheneck,andanxietyrespiration,interruptedinthe expulsionoftheair,frequentandverylargeexpressionoftheeyelidsdreadful dangerousdeliquiatossingofthebedclothesfromthebreastthehandstrembling,and sometimesthelowerlipagitated.Thesesymptoms,appearingatthecommencement,are indicativeofstrongdelirium,andpatientssoaffectedgenerallydie,oriftheyescape,itis withadeposit,hemorrhagefromthenose,ortheexpectorationofthickmatter,andnot otherwise.NeitherdoIperceivethatphysiciansareskilledinsuchthingsasthesehow theyoughttoknowsuchdiseasesasareconnectedwithdebility,andwhicharefurther weakenedbyabstinencefromfood,andthoseaggravatedbysomeotherirritationthose

bypain,andfromtheacutenatureofthedisease,andwhataffectionsandvariousforms thereofourconstitutionandhabitengender,althoughtheknowledgeorignoranceofsuch thingsbringssafetyordeathtothepatient.Foritisagreatmischiefiftoapatient debilitatedbypain,andtheacutenatureofthedisease,oneadministerdrink,ormore ptisan,orfood,supposingthatthedebilityproceedsfrominanition.Itisalsodisgraceful nottorecognizeapatientwhosedebilityisconnectedwithinanition,andtopinchhimin hisdietthismistake,indeed,isattendedwithsomedanger,butmuchlessthantheother, andyetitislikelytoexposeonetomuchgreaterderision,forifanotherphysician,ora privateperson,cominginandknowingwhathashappened,shouldgivetoeatordrink thosethingswhichtheotherhadforbidden,thebenefitthusdonetothepatientwouldbe manifest.Suchmistakesofpractitionersareparticularlyridiculedbymankind,forthe physicianornonprofessionalmanthuscomingin,seemsasitweretoresuscitatethe dead.OnthissubjectIwilldescribeelsewherethesymptomsbywhicheachofthemmay berecognized.

PART12
Andthefollowingobservationsaresimilartothosenowmaderespectingthebowels.If thewholebodyrestlong,contrarytousage,itdoesnotimmediatelyrecoveritsstrength butif,afteraprotractedrepose,itproceedtolabor,itwillclearlyexposeitsweakness.So itiswitheveryonepartofthebody,forthefeetwillmakeasimilardisplay,andany otherofthejoints,if,beingunaccustomedtolabor,theybesuddenlybroughtintoaction, afteratime.Theteethandtheeyeswillsufferinlikemanner,andalsoeveryotherpart whatever.Acouch,also,thatiseithersofterorharderthanonehasbeenaccustomedto willcreateuneasiness,andsleepingintheopenair,contrarytousage,hardensthebody. Butitissufficientmerelytostateexamplesofallthesecases.Ifapersonhavingreceived awoundintheleg,neitherveryseriousnorverytrifling,andhebeingneitherina conditionveryfavorabletoitshealingnorthecontrary,atfirstbetakeshimselftobed,in ordertopromotethecure,andneverraiseshisleg,itwillthusbemuchlessdisposedto inflammation,andbemuchsoonerwell,thanitwouldhavebeenifhehadstrolledabout duringtheprocessofhealingbutifuponthefifthorsixthday,orevenearlier,heshould getupandattempttowalk,hewillsuffermuchmorethenthanifhehadwalkedabout fromthecommencementofthecure,andifheshouldsuddenlymakemanylaborious exertions,hewillsuffermuchmorethanif,whenthetreatmentwasconductedotherwise, hehadmadethesameexertionsonthesamedays.Infine,allthesethingsconcurin provingthatallgreatchanges,eitheronewayoranother,arehurtful.Whereforemuch mischieftakesplaceinthebowels,iffromastateofgreatinanitionmorefood thanis moderatebeadministered(andalsointherestofthebody,iffromastateofgreatrestit behastilybroughttogreaterexertion,itwillbemuchmoreinjured),oriffromtheuseof muchfooditbechangedtocompleteabstinence,andtherefore thebodyinsuchcases requiresprotractedrepose,andif,fromastateoflaboriousexertion,thebodysuddenly fallsintoastateofeaseandindolence,inthesecasesalsothebowelswouldrequire continuedreposefromabundanceoffood,forotherwiseitwillinducepainandheaviness inthewholebody.

PART13
Thegreaterpartofmydiscoursehasrelatedtochanges,thiswayorthat.Forallpurposes itisprofitabletoknowthesethings,andmoreespeciallyrespectingthesubjectunder consideration,thatinacutediseases,inwhichachangeismadetoptisansfromastateof inanition,itshouldbemadeasIdirectandthenthatptisansshouldnotbeuseduntilthe diseasebeconcocted,orsomeothersymptom,whetherofevacuationorofirritation, appearintheintestines,orinthehypochondria,suchaswillbedescribed.Obstinate insomnolencyimpairsthedigestionofthefoodanddrink,andinotherrespectschanges andrelaxesthebody,andoccasionsaheatedstate,andheavinessofthehead.

PART14
Onemustdeterminebysuchmarksasthese,whensweet,strong,anddarkwine, hydromel,waterandoxymel,shouldbegiveninacutediseases.Whereforethesweet affectstheheadlessthanthestrong,attacksthebrainless,evacuatesthebowelsmore thantheother,butinducesswellingofthespleenandliveritdoesnotagreewithbilious persons,foritcausesthemtothirstitcreatesflatulenceintheupperpartoftheintestinal canal,butdoesnotdisagreewiththelowerpart,asfarasregardsflatulenceandyet flatulenceengenderedbysweetwineisnotofatransientnature,butrestsforalongtime inthehypochondria.Andthereforeitingeneralislessdiureticthanwinewhichisstrong andthinbutsweetwineismoreexpectorantthantheother.Butwhenitcreatesthirst,it islessexpectorantinsuchcasesthantheotherwine,butifitdonotcreatethirst,it promotesexpectorationbetterthantheother.Thegoodandbadeffectsofawhite,strong wine,havebeenalreadyfrequentlyandfullystatedinthedisquisitiononsweetwineitis determinedtothebladdermorethantheother,isdiureticandlaxative,andshouldbevery usefulinsuchcomplaintsforifinotherrespectsitbelesssuitablethantheother,the clearingoutofthebladdereffectedbyitisbeneficialtothepatient,ifproperly administered.Thereareexcellentexamplesofthebeneficialandinjuriouseffectsof wine,allwhichwereleftundeterminedbymypredecessors.Inthesediseasesyoumay useayellowwine,andadarkausterewineforthefollowingpurposes:iftherebeno heavinessofthehead,nordelirium,norstoppageoftheexpectoration,norretentionof theurine,andifthealvinedischargesbemorelooseandlikescrapingsthanusual,insuch casesachangefromawhitewinetosuchasIhavementioned,mightbeveryproper.It deservesfurthertobeknown,thatitwillprovelessinjurioustoallthepartsabove,andto thebladder,ifitbeofamorewaterynature,butthatthestrongeritis,itwillbethemore beneficialtothebowels.

PART15
Hydromel,whendrunkinanystageofacutedisease,islesssuitabletopersonsofa bilioustemperament,andtothosewhohaveenlargedviscera,thantothoseofadifferent characteritincreasesthirstlessthansweetwinecharacterthelungs,ismoderately expectorant,andalleviatesacoughforithassomedetergentqualityinit,whenceit lubricatesthesputum.Hydromelisalsomoderatelydiuretic,unlesspreventedbythestate ofanyoftheviscera.Anditalsooccasionsbiliousdischargesdownwards,sometimesof apropercharacter,andsometimesmoreintenseandfrothythanissuitablebutsuch ratheroccursinpersonswhoarebilious,andhaveenlargedviscera.Hydromelrather producesexpectoration,andsofteningofthelungs,whengivendilutedwithwater.But unmixedhydromel,ratherthanthediluted,producesfrothyevacuations,suchasare unseasonablyandintenselybilious,andtoohotbutsuchanevacuationoccasionsother greatmischiefs,foritneitherextinguishestheheatinthehypochondria,butrousesit, inducesinquietude,andjactitationofthelimbs,andulceratestheintestinesandanus.The remediesforallthesewillbedescribedafterwards.Byusinghydromelwithoutptisans, insteadofanyotherdrink,youwillgenerallysucceedinthetreatmentofsuchdiseases, andfallinfewcasesbutinwhatinstancesitistobegiven,andinwhatitisnottobe given,andwhereforeitisnottobegiven,allthishasbeenexplainedalready,forthe mostpart. Hydromelisgenerallycondemned,asifitweakenedthepowersofthosewho drinkit,andonthataccountitissupposedtoacceleratedeathandthisopinionarose frompersonswhostarvethemselvestodeath,someofwhomusehydromelalonefor drink,asfancyingthatitreallyhasthiseffect.Butthisisbynomeansalwaysthecase. Forhydromel,ifdrunkalone,ismuchstrongerthanwater,ifitdonotdisorderthe bowelsbutinsomerespectsitisstronger,andinsomeweaker,thanwinethatisthin, weak,anddevoidofbouquet.Thereisagreatdifferencebetweenunmixedwineand unmixedhoney,astotheirnutritivepowers,forifamanwilldrinkdoublethequantityof purewine,toacertainquantityofhoneywhichisswallowed,hewillfindhimselfmuch strongerfromthehoney,provideditdonotdisagreewithhisbowels,andthathisalvine evacuationsfromitwillbemuchmorecopious.Butifheshalluseptisanforadraught, anddrinkafterwardhydromel,hewillfeelfull,flatulent,anduncomfortableinthe visceraofthehypochondriumbutifthehydromelbetakenbeforethedraught,itwillnot havethesameinjuriouseffectsasiftakenafterit,butwillberatherbeneficial.And boiledhydromelhasamuchmoreelegantappearancethantheunboiled,beingclear,thin, white,andtransparent,butIamunabletomentionanygoodqualitywhichitpossesses thattheotherwants.Foritisnotsweeterthantheunboiled,providedthehoneybefine, anditisweaker,andoccasionslesscopiousevacuationsofthebowels,neitherofwhich effectsisrequiredfromthehydromel.Butoneshouldbyallmeansuseitboiled,provided thehoneybebad,impure,black,andnotfragrant,fortheboilingwillremovethemostof itsbadqualitiesandappearances.

PART16

Youwillfindthedrink,calledoxymel,oftenveryusefulinthesecomplaints,forit promotesexpectorationandfreedomofbreathing.thefollowingaretheproperoccasions foradministeringit.Whenstronglyacidithasnomeanoperationinrenderingthe expectorationmoreeasy,forbybringingupthesputa,whichoccasiontroublesome hawking,andrenderingthemmoreslippery,and,asitwere,clearingthewindpipewitha feather,itrelievesthelungsandprovesemollienttothemandwhenitsucceedsin producingtheseeffectsitmustdomuchgood.Buttherearecasesinwhichhydromel, stronglyacid,doesnotpromoteexpectoration,butrendersitmoreviscidandthusdoes harm,anditismostapttoproducethesebadeffectsincaseswhichareotherwiseofa fatalcharacter,whenthepatientisunabletocoughorbringupthesputa.Onthisaccount, then,oneoughttoconsiderbeforehandthestrengthofthepatient,andiftherebeany hope,thenonemaygiveit,butifgivenatallinsuchcasesitshouldbequitetepid,andin bynomeanslargedoses.Butifslightlyacriditmoistensthemouthandthroat,promotes expectoration,andquenchesthirstagreeswiththevisceraseatedinthehypochondrium, andobviatesthebadeffectsofthehoneyforthebiliousqualityofthehoneyisthereby corrected.Italsopromotesflatulentdischargesfromthebowels,andisdiuretic,butit occasionswaterydischargesandthoseresemblingscrapings,fromthelowerpartofthe intestine,whichissometimesabadthinginacutediseases,moreespeciallywhenthe flatulencecannotbepassed,butrollsbackwardsandotherwiseitdiminishesthestrength andmakestheextremitiescold,thisistheonlybadeffectworthmentioningwhichIhave knowntoarisefromtheoxymel.Itmaysuitwelltodrinkalittleofthisatnightbefore thedraughtofptisan,andwhenaconsiderableintervaloftimehaspassedafterthe draughttherewillbenothingtopreventitsbeingtaken.Buttothosewhoarerestricted entirelytodrinkswithoutdraughtsofptisan,itwillthereforenotbeproperatalltimesto giveit,moreespeciallyfromthefrettingandirritationoftheintestinewhichitoccasions, (andthesebadeffectsitwillbethemoreapttoproduceprovidedtherebenofaecesinthe intestinesandthepatientislaboringunderinanition,)andthenitwillweakenthepowers ofthehydromel.Butifitappearsadvantageoustouseagreatdealofthisdrinkduringthe wholecourseofthedisease,oneshouldaddtoitmerelyasmuchvinegarascanjustbe perceivedbythetaste,forthuswhatisprejudicialinitwilldotheleastpossibleharm, andwhatisbeneficialwilldothemoregood.Inaword, theacidityofvinegaragrees ratherwiththosewhoaretroubledwithbitterbile,thanwiththosepatientswhosebileis blackforthebitterprincipleisdissolvedinitandturnedtophlegm,bybeingsuspended initwhereasblackbileisfermented,swellsup,andismultipliedthereby:forvinegaris amelanogogue.Vinegarismoreprejudicialtowomenthantomen,foritcreatespainsin theuterus.

PART17
Ihavenothingfurthertoaddastotheeffectsofwaterwhenusedasadrinkinacute diseasesforitneithersoothesthecoughinpneumonia,norpromotesexpectoration,but doeslessthantheothersinthisrespect,ifusedalonethroughthewholecomplaint.Butif takenintermediatebetweenoxymelandhydromel,insmallquantity,itpromotes expectorationfromthechangewhichitoccasionsinthequalitiesofthesedrinks,forit

produces,asitwere,acertainoverflow.Otherwiseitdoesnotquenchthethirst,forit createsbileinabilioustemperament,andisinjurioustothehypochondriumanditdoes themostharm,engendersmostbile,anddoestheleastgoodwhenthebowelsareempty anditincreasestheswellingofthespleenandliverwhentheyareinaninflamedstateit producesagurglingnoiseintheintestinesandswimsonthestomachforitpassesslowly downwards,asbeingofacoldishandindigestiblenature,andneitherproveslaxativenor diureticandinthisrespect,too,itprovesprejudicial,thatitdoesnotnaturallyformdoes intheintestines:and,ifitbedrunkwhilethefeetarecold,itsinjuriouseffectswillbe greatlyaggravated,inallthosepartstowhichitmaybedetermined.Whenyoususpectin thesediseaseseitherstrongheavinessof thehead,ormentalalienation,youmustabstain entirelyfromwine,andinthiscaseusewater,orgiveweak,strawcoloredwine,entirely devoidofbouquet,afterwhichalittlewateristobegiveninadditionforthusthe strengthofthewilllessaffecttheheadandtheunderstanding:butinwhichcaseswateris mostlytobegivenfordrink,wheninlargequantity,wheninmoderate,whencold,and whenhotallthesethingshaveeitherbeendiscussedalreadyorwillbetreatedofatthe propertime.Inlikemanner,withrespecttoalltheothers,suchasbarleywater,thedrinks madefromgreenshoots,thosefromraisins,andtheskinsofgrapesandwheat,and bastardsaffron,andmyrtles,pomegranates,andtheothers,whenthepropertimefor usingthemiscome,theywillbetreatedofalongwiththediseaseinquestion,inlike mannerastheothercompoundmedicines.

PART18
Thebathisusefulinmanydiseases,insomeofthem whenusedsteadily,andinothers whennotso.Sometimesitmustbelessusedthanitwouldbeotherwise,fromthewantof accommodationforinfewfamiliesarealltheconveniencesprepared,andpersonswho canmanagethemastheyoughttobe.Andifthepatientbenotbathedproperly,hemaybe therebyhurtinnoinconsiderabledegree,forthereisrequiredaplacetocoverhimthatis freeofsmoke,abundanceofwater,materialsforfrequentbaths,butnotverylarge,unless thisshouldberequired.Itisbetterthatnofrictionshouldbeapplied,butifso,ahotsoap (smegma)mustbeusedingreaterabundancethaniscommon,andanaffusionofa considerablequantityofwateristobemadeatthesametimeandafterwardsrepeated. Theremustalsobeashortpassagetothebasin,anditshouldbeofeasyingressand egress.Butthepersonwhotakesthebathshouldbeorderlyandreservedinhismanner, shoulddonothingforhimself,butothersshouldpourthewateruponhimandrubhim, andplentyofwaters,ofvarioustemperatures,shouldbeinreadinessforthedouche,and theaffusionsquicklymadeandspongesshouldbeusedinsteadofthecomb(strigil),and thebodyshouldbeanointedwhennotquitedry.Buttheheadshouldberubbedbythe spongeuntilitisquitedrytheextremitiesshouldbeprotectedfromcold,asalsothehead andtherestofthebodyandamanshouldnotbewashedimmediatelyafterhehastaken adraughtofptisanoradrinkneithershouldhetakeptisanasadrinkimmediatelyafter thebath.Muchwilldependuponwhetherthepatient,wheningoodhealth,wasveryfond ofthebath,andinthecustomoftakingit:forsuchpersons,especially,feelthewantofit, andarebenefitediftheyarebathed,andinjurediftheyarenot.Ingeneralitsuitsbetter

withcasesofpneumoniathaninardentfeversforthebathsoothesthepainintheside, chest,andbackconcoctsthesputa,promotesexpectoration,improvestherespiration, andallayslassitudeforitsoothesthejointsandouterskin,andisdiuretic,removes heavinessofthehead,andmoistensthenose.Sucharethebenefitstobederivedfromthe bath,ifalltheproperrequisitesbepresentbutifoneormoreofthesebewanting,the bath,insteadofdoinggood,mayratherproveinjuriousforeveryoneofthemmaydo harmifnotpreparednotpreparedbytheattendantsinthepropermanner.Itisbyno meansasuitablethinginthesediseasestopersonswhosebowelsaretooloose,orwhen theyareunusuallyconfined,andtherehasbeennopreviousevacuationneithermustwe bathethosewhoaredebilitated,norsuchashavenauseaorvomiting,orbilious eructationsnorsuchashavehemorrhagefromthenose,unlessitbelessthanrequiredat thatstageofthedisease(withthosestagesyouareacquainted),butifthedischargebe lessthanproper,oneshouldusethebath,whetherinordertobenefitthewholebodyor theheadalone.Ifthentheproperrequisitesbeathand,andthepatientbewelldisposed tothebath,itmaybeadministeredonceeveryday,orifthepatientbefondofthebath therewillbenoharm,thoughheshouldtakeittwiceintheday.Theuseofthebathis muchmoreappropriatetothosewhotakeunstrainedptisan,thantothosewhotakeonly thejuiceofit,althoughevenintheircaseitmaybeproperbutleastofalldoesitsuit withthosewhouseonlyplaindrink,although,intheircasetooitmaybesuitablebut onemustformajudgmentfromtheruleslaiddownbefore,inwhichofthesemodesof regimenthebathwillbebeneficial,andinwhichnot.Suchaswantsomeoftherequisites foraproperbath,buthavethosesymptomswhichwouldbebenefitedbyit,shouldbe bathedwhereasthosewhowantnoneoftheproperrequisites,buthavecertainsymptoms whichcontraindicatethebath,arenottobebathed.

APPENDIXPART1
Ardentfever(causus)takesplacewhentheveins,beingdriedupinthesummerseason, attractacridandbilioushumorstothemselvesandstrongfeverseizesthewholebody, whichexperiencesachesofthebones,andisinastateoflassitudeandpain.Ittakesplace mostcommonlyfromalongwalkandprotractedthirst,whentheveinsbeingdriedup attractacridandhotdefluxionstothemselves.Thetonguebecomesrough,dry,andvery blacktherearegnawingpainsaboutthebowelsthealvinedischargesarewateryand yellowthereisintensethirst,insomnolency,andsometimeswanderingofthemind.Toa personinsuchastategivetodrinkwaterandasmuchboiledhydromelofawatery consistenceashewilltakeandifthemouthbebitter,itmaybeadvantageousto administeranemeticandclysterandifthesethingsdonotloosenthebowels,purgewith theboiledmilkofasses.Givenothingsaltishnoracrid,fortheywillnotbeborneand givenodraughtsofptisanuntilthecrisisbepast.Andtheaffectionisresolvediftherebe anepistaxis,oriftruecriticalsweatssupervenewithurinehavingwhite,thick,and smoothsediments,orifadeposittakeplaceanywherebutifitberesolvedwithoutthese, therewillbearelapseofthecomplaint,orpaininthehipsandlegswillensue,withthick sputa,providedthepatientbeconvalescent.Anotherspeciesofardentfever:bellyloose, muchthirst,tonguerough,dry,andsaltish,retentionofurine,insomnolency,extremities

cold.Insuchacase,unlesstherebeaflowofbloodfromthenose,oranabscessform abouttheneck,orpaininthelimbs,orthepatientexpectoratethicksputa(theseoccur whenthebellyisconstipated),orpainofthehips,orlividityofthegenitalorgans,there isnocrisistensionofthetesticleisalsoacriticalsymptom.Giveattractivedraughts.

APPENDIXPART2
Bleedintheacuteaffections,ifthediseaseappearstrong,andthepatientsbeinthevigor oflife,andiftheyhavestrength.Ifitbequinsyoranyotherofthepleuriticaffections, purgewithelectuariesbutifthepatientbeweaker,orifyouabstractmoreblood,you mayadministeraclystereverythirdday,untilhebeoutofdanger,andenjointotal abstinenceifnecessary.

APPENDIXPART3
Hypochondriainflamednotfromretentionofflatus,tensionofthediaphragm,checked respiration,withdryorthopnoea,whennopusisformed,butwhenthesecomplaintsare connectedwithobstructedrespirationbutmoreespeciallystrongpainsoftheliver, heavinessofthespleen,andotherphlegmasiaeandintensepainsabovethediaphragm, diseasesconnectedwithcollectionsofhumors,allthesediseasesdonotadmitof resolution,iftreatedatfirstbymedicine,butvenesectionholdsthefirstplacein conductingthetreatmentthenwemayhaverecoursetoaclyster,unlessthediseasebe greatandstrongbutifso,purgingalsomaybenecessarybutbleedingandpurging togetherrequirecautionandmoderation.Thosewhoattempttoresolveinflammatory diseasesatthecommencementbytheadministrationofpurgativemedicines,remove noneofthemorbifichumorswhichproducetheinflammationandtensionforthe diseaseswhileunconcoctedcouldnotyield,buttheymeltdownthosepartswhichare healthyandresistthediseasesowhenthebodyisdebilitatedthemaladyobtainsthe masteryandwhenthediseasehastheupperhandofthebody,itdoesnotadmitofacure.

APPENDIXPART4
Whenapersonsuddenlyloseshisspeech,inconnectionwithobstructionoftheveins,if thishappenwithoutwarningoranyotherstrongcause,oneoughttoopentheinternal veinoftherightarm,andabstractbloodmoreorlessaccordingtothehabitandageof thepatient.Suchcasesaremostlyattendedwiththefollowingsymptoms:rednessofthe face,eyesfixed,handsdistended,grindingoftheteeth,palpitations,jawsfixed,coldness oftheextremities,retentionofairsintheveins.

APPENDIXPART5
Whenpainsprecede,andthereareinfluxesofblackbileandofacridhumors,andwhen bytheirpungencytheinternalpartsarepained,andtheveinsbeingpinchedanddried becomedistended,andgettinginflamedattractthehumorsrunningintotheparts,whence thebloodbeingvitiated,andtheairscollectedtherenotbeingabletofindtheirnatural passages,coldnesscomesoninconsequenceofthisstasis,withvertigo,lossofspeech, heavinessofthehead,andconvulsion,ifthediseasefixontheliver,theheart,orthe greatvein(venacava?)whencetheyareseizedwithepilepsyorapoplexy,ifthe defluxionsfallupon thecontainingparts,andiftheyaredriedupbyairswhichcannot maketheirescapesuchpersonshavingbeenfirsttormentedaretobeimmediatelybledat thecommencement,whileallthepeccantvaporsandhumorsarebuoyant,forthenthe casesmoreeasilyadmitofacureandthensupportingthestrengthandattendingtothe crisis,wemaygiveemetics,unlessthediseasebealleviatedorifthebowelsbenot moved,wemayadministeraclysterandgivetheboiledmilkofasses,totheamountof notlessthantwelveheminae,orifthestrengthpermit,tomorethansixteen.

APPENDIXPART6
Quinsytakesplacewhenacopiousandvisciddefluxionfromthehead,intheseasonof winter orspring,flowsintothejugularveins,andwhenfromtheirlargesizetheyattracta greaterdefluxionandwhenowingtothedefluxionbeingofacoldandviscidnatureit becomesenfarcted,obstructingthepassagesoftherespirationandoftheblood, coagulatesthesurroundingblood,andrendersitmotionlessandstationary,itbeing naturallycoldanddisposedtoobstructions.Hencetheyareseizedwithconvulsive suffocation,thetongueturninglivid,assumingaroundedshape,andbeingventowingto theveinswhichareseatedbelowthetongue(forwhenanenlargeduvula,whichiscalled uva,iscut,alargeveinmaybeobservedoneachside).Theseveins,then,becoming filled,andtheirrootsextendingintothetongue,whichisofalooseandspongytexture,it, owingtoitsdrynessreceivingforciblythejuicefromtheveins,changesfrombroadand becomesround,itsnaturalcolorturnstolivid,fromasoftconsistenceitgrowshard, insteadofbeingflexibleitbecomesinflexible,sothatthepatientwouldsoonbe suffocatedunlessspeedilyrelieved.Bleeding,then,inthearm,andopeningthe sublingualveins,andpurgingwiththeelectuaries,andgivingwarmgargles,andshaving thehead,wemustapplytoitandtheneckacerate,andwrapthem roundwithwool,and fomentwithsoftspongessqueezedoutofhotwatergivetodrinkwaterandhydromel, notcoldandadministerthejuiceofptisanwhen,havingpassedthecrisis,thepatientis outofdanger.When,intheseasonofsummerorautumn,thereisahotandnitrous defluxionfromthehead(itisrenderedhotandacridbytheseason),beingofsucha natureitcorrodesandulcerates,andfillswithair,andorthopnoeaattendedwithgreat drynesssupervenesthefauces,whenexamined,donotseemswollenthetendonsonthe backpartoftheneckarecontracted,andhavetheappearanceasifitweretetanusthe

voiceislost,thebreathingissmall,andinspirationbecomesfrequentandlaborious.In suchpersonsthetracheabecomesulcerated,andthelungsengorged,fromthepatient's notbeingabletodrawintheexternalair.Insuchcases,unlesstherebeaspontaneous determinationtotheexternalpartsoftheneck,thesymptomsbecomestillmoredreadful, andthedangermoreimminent,partlyowingtotheseason,andthehotandacridhumors whichcausethedisease.

APPENDIXPART7
Whenfeverseizesapersonwhohaslatelytakenfood,andwhosebowelsareloadedwith faceswhichhavebeenlongretained,whetheritbeattendedwithpainofthesideornot, heoughttoliequietuntilthefooddescendtothelowerregionofthebowels,anduse oxymelfordrinkbutwhentheloaddescendstotheloins,aclystershouldbe administered,orheshouldbepurgedbymedicineandwhenpurged,heshouldtake ptisanforfoodandhydromelfordrinkthenhemaytakethecerealia,andboiledfishes, andawaterywineinsmallquantity,atnight,butduringtheday,awateryhydromel. Whentheflatusisoffensive,eitherasuppositoryorclysteristobeadministeredbut otherwisetheoxymelistobediscontinued,untilthemattersdescendtothelowerpartof thebowels,andthentheyaretobeevacuatedbyaclyster.Butiftheardentfever(causus) supervenewhenthebowelsareempty,shouldyoustilljudgeitpropertoadminister purgativemedicine,itoughtnotbedoneduringthefirstthreedays,norearlierthanthe fourth.Whenyougivethemedicine,usetheptisan,observingtheparoxysmsofthe fevers,soasnottogiveitwhenthefeverissettingin,butwhenitisceasing,oronthe decline,andasfaraspossiblefromthecommencement.Whenthefeetarecold,give neitherdrinknorptisan,noranythingelseofthekind,butreckonitanimportantruleto refrainuntiltheybecomewarm,andthenyoumayadministerthemwithadvantage.For themostpart,coldnessofthefeetisasymptomofaparoxysmofthefevercomingon andifatsuchaseasonyouapplythosethings,youwillcommitthegreatestpossible mistake,foryouwillaugmentthediseaseinnosmalldegree.Butwhenthefeverceases, thefeet,onthecontrary,becomehotterthantherestofthebodyforwhentheheatleaves thefeet,itiskindledupinthebreast,andsendsitsflameuptothehead.Andwhenallthe heatrushesupwards,andisexhaledatthehead,itisnottobewonderedatthatthefeet becomecold,beingdevoidofflesh,andtendinousandbesides,theycontractcold,owing totheirdistancefromthehotterpartsofthebody,anaccumulationofheathavingtaken placeinthechest:andagain,inlikemanner,whenthefeverisresolvedanddissipated, theheatdescendstothefeet,and,atthesametime,theheadandchestbecomecold. Whereforeoneshouldattendtothisthatwhenthefeetarecold,thebowelsare necessarilyhot,andfilledwithnauseousmattersthehypochondriumdistended:thereis jactitationofthebody,owingtotheinternaldisturbanceandaberrationoftheintellect, andpainsthepatientisagitated,andwishestovomit,andifhevomitsbadmattersheis painedbutwhentheheatdescendstothefeet,andtheurinepassesfreely,heisevery waylightened,evenalthoughhedoesnotsweatatthisseason,then,theptisanoughtto begivenitwouldbedeathtogiveitbefore.

APPENDIXPART8
Whenthebowelsarelooseduringthewholecourseoffevers,inthiscasewearemost especiallytowarmthefeet,andseethattheyareproperlytreatedwithcerates,and wrappedinshawls,sothattheymaynotbecomecolderthantherestofthebodybut whentheyarehot,nofomentationmustbemadetothem,butcareistobetakenthatthey donotbecomecoldandverylittledrinkistobeused,eithercoldwaterorhydromel.In thosecasesoffeverwherethebowelsareloose,andthemindisdisordered,thegreater numberofpatientspickthewoolfromtheirblankets,scratchtheirnoses,answerbriefly whenquestionsareputtothem,but,whenlefttothemselves,utternothingthatis rational.Suchattacksappeartometobeconnectedwithblackbile.Wheninthesecases thereisacolliquativediarrhoea,Iamofopinionthatweoughttogivethecolderand thickerptisans,andthatthedrinksoughttobebinding,ofavinousnature,andrather astringent.Incasesoffeverattendedfromthefirstwithvertigo,throbbingofthehead, andthinurine,youmayexpectthefevertobeexacerbatedatthecrisisneitherneedit excitewonder,althoughtherebedelirium.When,atthecommencement,theurineis cloudyorthick,itispropertopurgegently,providedthisbeotherwiseproperbutwhen theurineatfirstisthin,donotpurgesuchpatients,but,if thoughtnecessary,givea clystersuchpatientsshouldbethustreatedtheyshouldbekeptinaquietstate,have unguentsappliedtothem,andbecoveredupproperlywithclothes,andtheyshoulduse fordrinkawateryhydromel,andthejuiceofptisan asadraughtintheeveningclearout thebowelsatfirstwithaclyster,butgivenopurgativemedicinestothem,for,ifyou movethebowelsstrongly,theurineisnotconcocted,butthefeverremainslong,without sweatsandwithoutacrisis.Donotgivedraughtswhenthetimeofthecrisisisathand,if therebeagitation,butonlywhenthefeverabatesandisalleviated.Itispropertobe guardedatthecrisesofotherfevers,andtowithholdthedraughtsatthatseason.Fevers ofthisdescriptionareapttobeprotracted,andtohavedeterminations,iftheinferior extremitiesbecold,abouttheearsandneck,or,ifthesepartsarenotcold,tohaveother changestheyhaveepistaxis,anddisorderofthebowels.Butincasesoffeverattended with nausea,ordistentionofthehypochondria,whenthepatientscannotliereclinedin thesameposition,andtheextremitiesarecold,thegreatestcareandprecautionare necessarynothingshouldbegiventothem,exceptoxymeldilutedwithwaterno draughtshouldbeadministered,untilthefeverabateandtheurinebeconcoctedthe patientshouldbelaidinadarkapartment,andreclineuponthesoftestcouch,andhe shouldbekeptaslongaspossibleinthesameposition,soasnottotossabout,forthisis particularlybeneficialtohim.Applytothehypochondriumlinseedbyinunctions,taking carethathedonotcatchcoldwhentheapplicationismadeletitbeinatepidstate,and boiledinwaterandoil.Onemayjudgefromtheurinewhatistotakeplace,forifthe urinebethicker,andmoreyellowish,somuchthebetterbutifitbethinner,andblacker, somuchtheworsebutifitundergochanges,itindicatesaprolongationofthedisease, andthepatient,inlikemanner,mustexperienceachangetotheworseandthebetter. Irregularfeversshouldbeletaloneuntiltheybecomesettled,and,whentheydosettle, theyaretobetreatedbyasuitabledietandmedicine,attendingtotheconstitutionofthe patient.

APPENDIXPART9
Theaspectsofthesickarevariouswhereforethephysicianshouldpayattention,thathe maynotmissobservingtheexcitingcauses,asfarastheycanbeascertainedby reasoning,norsuchsymptomsasshouldappearonanevenoroddday,butheoughtto, beparticularlyguardedinobservingtheodddays,asitisinthem,moreespecially,that changestakeplaceinpatients.Heshouldmark,particularly,thefirstdayonwhichthe patientbecameill,consideringwhenandwhencethediseasecommenced,forthisisof primaryimportancetoknow.Whenyouexaminethepatient,inquireintoallparticulars firsthowtheheadis,andiftherebenoheadache,norheavinessinitthenexamineifthe andsidesbefreeofpainforifthehypochondriumbepainful,swelled,andunequal,with asenseofsatiety,oriftherebepainintheside,and,alongwiththepain,eithercough, tormina,orbellyache,ifanyofthesesymptomsbepresentinthehypochondrium,the bowelsshouldbeopenedwithclysters,andthepatientshoulddrinkboiledhydromelina hotstate.Thephysicianshouldascertainwhetherthepatientbeapttofaintwhenheis raisedup,andwhetherhisbreathingbefreeandexaminethedischargesfromthe bowels,whethertheybeveryblack,orofapropercolor,likethoseofpersonsingood health,andascertainwhetherthefeverhasaparoxysmeverythirdday,andlookwellto suchpersonsonthosedays.Andshouldthefourthdayprovelikethethird,thepatientis inadangerousstate.Withregardtothesymptoms,blackstoolsprognosticatedeathbut iftheyresemblethedischargesofahealthyperson,andifsuchistheirappearanceevery day,itisafavorablesymptombutwhenthebowelsdonotyieldtoasuppository,and when,thoughtherespirationbenatural,thepatientwhenraisedtothenighttable,oreven inbed,beseizedwithdeliquium,youmayexpectthatthepatient,manorwoman,who experiencesthesesymptoms,isabouttofalltofallintoastateofdelirium.Attentionalso shouldbepaidtothehands,foriftheytremble,youmayexpectepistaxisandobserve thenostrils,whetherthebreathbedrawninequallybybothandifexpirationbythe nostrilsbelarge,aconvulsionisapttotakeplaceandshouldaconvulsionoccurtosuch aperson,deathmaybeanticipated,anditiswelltoannounceitbeforehand.

APPENDIXPART10
If,inawinterfever,thetongueberough,andiftherebeswoonings,itislikelytobethe remissionofthefever.Neverthelesssuchapersonistobekeptuponarestricteddiet, withwaterfordrink,andhydromel,andthestrainedjuices,nottrustingtotheremission of thefevers,aspersonshavingthesesymptomsareindangerofdyingwhen,therefore, youperceivethesesymptoms,announcethisprognostic,ifyoushalljudgeproper,after makingthesuitableobservations.When,infevers,anydangeroussymptomappearson thefifthday,whenwaterydischargessuddenlytakeplacefromthebowels,when deliquiumanimioccurs,orthepatientisattackedwithlossofspeech,convulsions,or hiccup,undersuchcircumstancesheislikelytobeaffectedwithnausea,andsweats

breakoutunderthenoseandforehead,oronthebackpartoftheneckandhead,and patientswithsuchsymptomsshortlydie,fromstoppageoftherespiration.When,in fevers,abscessesformaboutthelegs,and,gettingintoachronicstate,arenotconcocted whilethefeverpersists,andifoneisseizedwithasenseofsuffocationinthethroat, whilethefaucesarenotswelled,andifitdonotcometomaturation,butisrepressed,in suchacasethereisapttobeaflowofbloodfromthenoseifthis,then,becopious,it indicatesaresolutionofthedisease,butifnot,aprolongationofthecomplaintandthe lessthedischarge,somuchworsethesymptoms,andthemoreprotractedthediseasebut iftheothersymptomsareveryfavorable,expectinsuchacasethatpainswillfallupon thefeetifthentheyattackthefeet,andifthesecontinuelonginaverypainful,and inflamedstate,andiftherebenoresolution,thepainswillextendbydegreestotheneck, totheclavicle,shoulder,breast, ortosomearticulation,inwhichaninflammatorytumor willnecessarilyform.Whenthesearereduced,ifthehandsarecontracted,andbecome trembling,convulsionanddeliriumseizesuchapersonbutblistersbreakoutonthe eyebrow,erythematakesplace,theoneeyelidbeingtumefiedovertopstheother,ahard inflammationsetsin,theeyebecomestronglyswelled,andthedeliriumincreasesmuch, butmakesitsattacksratheratnightthanbyday.Thesesymptomsmorefrequentlyoccur onoddthanoneven days,but,whetherontheoneortheother,theyareofafatal character.Shouldyoudeterminetogivepurgativemedicinesinsuchcases,atthe commencement,youshoulddosobeforethefifthday,iftherebeborborygmiinthe bowels,or,ifnot,youshouldomitthemedicinesaltogether.Iftherebeborborygmi,with biliousstools,purgemoderatelywithscammonybutwithregardtothetreatment otherwise,administerasfewdrinksanddraughtsasuntiltherebesomeamendment,and thediseaseispastthefourteenthday.Whenlossofspeechseizesaperson,onthe fourteenthdayofafever,thereisnotusuallyaspeedyresolution,noranyremovalofthe disease,forthissymptomindicatesaprotracteddiseaseandwhenitappearsonthatday, itwillbestillmoreprolonged.When,onthefourthdayofafever,thetonguearticulates confusedly,andwhentherearewateryandbiliousdischargesfromthebowels,sucha patientisapttofallintoastateofdeliriumthephysicianought,therefore,towatchhim, andattendtowhateversymptomsmayturnup.Intheseasonofsummerandautumnan epistaxis,suddenlyoccurringinacutediseases,indicatesvehemenceoftheattack,and inflammationinthecourseoftheveins,andonthedayfollowing,thedischargeofthin urineandifthepatientbeintheprimeoflife,andifhisbodybestrongfromexercise, andbrawny,orofamelancholictemperament,oriffromdrinkinghastremblinghands,it maybewelltoannouncebeforehandeitherdeliriumorconvulsionandifthese symptomsoccuronevendays,somuchthebetterbutoncriticaldays,theyareofa deadlycharacter.If,then,acopiousdischargeofbloodprocureanissuetothefullness thereofaboutthenose,orwhatiscollectedabouttheanus,therewillbeanabscess,or painsinthehypochondrium,ortesticles,orinthelimbsandwhentheseareresolved, therewillbeadischargeofthicksputa,andofsmooth,thinurine.Infeverattendedwith singultus,giveasafoetida,oxymel,andcarrot,trituratedtogether,inadraughtor galbanuminhoney,andcumininalinctus,orthejuiceofptisan.Suchapersoncannot escape,unlesscriticalsweatsandgentlesleepsupervene,andthickandacridurinebe passed,orthediseaseterminateinanabscess:givepinefruitandmyrrhinalinctus,and furthergiveaverylittleoxymeltodrinkbutiftheyareverythirsty,somebarleywater.

APPENDIXPART11
Peripneumonia,andpleuriticaffections,aretobethusobserved:Ifthefeverbeacute,and iftherebepainsoneitherside,orinboth,andifexpirationbeifcoughbepresent,and thesputaexpectoratedbeofablondorlividcolor,orlikewisethin,frothy,andflorid,or havinganyothercharacterdifferentfromthecommon,insuchacase,thephysician shouldproceedthus:ifthepainpassupwardtotheclavicle,orthebreast,orthearm,the innerveininthearmshouldbeopenedonthesideaffected,andbloodabstracted accordingtothehabit,age,andcolorofthepatient,andtheseasonoftheyear,andthat largelyandboldly,ifthepainbeacute,soastobringondeliquiumanimi,andafterwards aclysteristobegiven.Butifthepainbebelowthechest,andifvery intense,purgethe bowelsgentlyinsuchanattackofpleurisy,andduringtheactofpurginggivenothing butafterthepurginggiveoxymel.Themedicineistobeadministeredonthefourthday onthefirstthreedaysafterthecommencement,aclystershouldbegiven,andifitdoes notrelievethepatient,heshouldthenbegentlypurged,butheistobewatcheduntilthe fevergoesoff,andtilltheseventhdaythenifheappeartobefreefromdanger,givehim someunstrainedptisan,insmallquantity,andthinatfirst,mixingitwithhoney.Ifthe expectorationbeeasy,andthebreathingfree,ifhissidesbefreeofpain,andifthefever begone,hemaytaketheptisanthicker,andinlargerquantity,twiceaday.Butifhedo notprogressfavorably,hemustgetlessofthedrink,andofthedraught,whichshouldbe thin,andonlygivenonceaday,atwhateverisjudgedtobethemostfavorablehourthis youwillascertainfromtheurine.Thedraughtisnottobegiventopersonsafterfever, untilyouseethattheurineandsputaareconcocted(if,indeed,aftertheadministrationof themedicinehebepurgedfrequently,itmaybenecessarytogiveit,butitshouldbe giveninsmallerquantitiesandthinnerthanusual,forfrominanitionhewillbeunableto sleep,ordigestproperly,orwaitthecrisis)butwhenthemeltingdownofcrudematters hastakenplace,andhissystemhascastoffwhatisoffensive,therewillthenbeno objection.Thesputaareconcoctedwhentheyresemblepus,andtheurinewhenithas reddishsedimentsliketares.Butthereisnothingtopreventfomentationsandcerates beingappliedfortheotherpainsofthesidesandthelegsandloinsmayberubbedwith hotoil,oranointedwithfatlinseed,too,intheformof acataplasm,maybeappliedto thehypochondriumandasfarupasthebreasts.Whenpneumoniaisatitsheight,thecase isbeyondremedyifheisnotpurged,anditisbadifhehasdyspnoea,andurinethatis thinandacrid,andifsweatscomeoutabout theneckandhead,forsuchsweatsarebad, asproceedingfromthesuffocation,rales,andtheviolenceofthediseasewhichis obtainingtheupperhand,unlesstherebeacopiousevacuationofthickurine,andthe sputabeconcoctedwheneitherofthesecomeonspontaneously,thatwillcarryoffthe disease.Alinctusforpneumonia:GalbanumandpinefruitinAttichoneyand southernwoodinoxymelmakeadecoctionofpepperandblackhellebore,andgiveitin casesofpleurisyattendedwithviolentpain atthecommencement.Itisalsoagoodthing toboilopoponaxinoxymel,and,havingstrainedit,togiveittodrinkitanswerswell, also,indiseasesoftheliver,andinseverepainsproceedingfromthediaphragm,andin allcasesinwhichitisbeneficialtodeterminetothebowelsorurinaryorgans,when

giveninwineandhoneywhengiventoactuponthebowels,itshouldbedrunkinlarger quantity,alongwithawateryhydromel.

APPENDIXPART12
Adysentery,whenstopped,willgiverisetoanaposteme,ortumor,ifitdonotterminate infeverswithsweats,orwiththickandwhiteurine,orinatertianfever,orthepainfix uponavarix,orthetesticles,oronthehipjoints.

APPENDIXPART13
Inabiliousfever,jaundicecomingonwithrigorbeforetheseventhdaycarriesoffthe fever,butifitoccurwithoutthefever,andnotatthepropertime,itisafatalsymptom.

APPENDIXPART14
Whentheloinsareinatetanicstate,andthespiritsintheveinsareobstructedby melancholichumors,venesectionwillaffordrelief.Butwhen,ontheotherhand,the anteriortendonsarestronglycontracted,andiftherebesweatsabouttheneckandface, extortedbytheviolentpainoftheparchedanddriedtendonsofthesacralextremity (theseareverythick,sustainingthespine,andgivingrisetoverygreatligaments,which terminateinthefeet,)insuchacase,unlessfeverandsleepcomeon,followedby concoctedurineandcriticalsweats,givetodrinkastrongCretanwine,andboiledbarley mealforfoodanointandrubwithointmentscontainingwaxbathethelegsandfeetin hotwater,andthencoverthemupandsoinlikemannerthearms,asfarasthehands, andthespine,fromthenecktothesacrum,aretobewrappedinaskinsmearedwith waxthismustextendtothepartsbeyond,andintervalsaretobeleftforapplying fomentations,bymeansofleatherbottlesfilledwithhotwater,then,wrappinghimupin alinencloth,layhimdowninbed.Donotopenthebowels,unlessbymeansofa suppository,whentheyhavebeenlongofbeingmoved.Iftherebeanyremissionofthe disease,sofarwell,butotherwise,poundoftherootofbryoniainfragrantwine,andthat ofthecarrot,andgivetothepatientfastingearlyinthemorning,beforeusingthe affusion,andimmediatelyafterwardslethimeatboiledbarleymealinatepidstate,and asmuchashecantake,andinadditionlethimdrink,ifhewill,winewelldiluted.Ifthe diseaseyieldtothesemeans,somuchthebetter,but,ifotherwise,youmustprognosticate accordingly.

APPENDIXPART15
Alldiseasesareresolvedeitherbythemouth,thebowels,thebladder,orsomeothersuch organ.Sweatisacommonformofresolutioninallthesecases.

APPENDIXPART16
Youshouldputpersonsonacourseofhelleborewhoaretroubledwithadefluxionfrom thehead.Butdonotadministerhelleboretosuchpersonsasarelaboringunderempyema connectedwithabscesses,haemoptysis,andintemperament,oranyotherstrongcause, foritwilldonogoodandifanythingunpleasantoccurthehelleborewillgettheblame ofit.Butifthebodyhavesuddenlylostitspowers,oriftherebepaininthehead,or obstructionoftheearsandnose,orptyalism,orheavinessofthelimbs,oran extraordinaryswellingofthebody,youmayadministerthehellebore,providedthese symptomsbenotconnectedwithdrinking,norwithimmoderatevenerynorwithsorrow, vexation,norinsomnolency,for,ifanyofthesecausesexist,thetreatmentmusthave respecttoit.

APPENDIXPART17
Fromwalkingarisepainsofthesides,oftheback,oftheloins,andofthehipjoint,and disorderoftherespirationhasoftenbeenfromthesamecause,for,afterexcessesofwine andflatulentfood,painsshoottotheloinsandhips,accompaniedwithdysuria.Walking isthecauseofsuchcomplaints,andalsoofcoryzaandhoarseness.

APPENDIXPART18
Disordersconnectedwithregimen,forthemostpart,maketheirattackaccordinglyas anyonehaschangedhishabitualmodeof diet.Forpersonswhodinecontrarytocustom experiencemuchswellingofthestomach,drowsiness,andfullnessandiftheytake supperoverandabove,theirbellyisdisorderedsuchpersonswillbebenefitedby sleepingaftertakingthebath,andbywalkingslowlyforaconsiderabletimeaftersleep if,then,thebowelsbemoved,hemaydineanddrinkasmallquantityofwinenotmuch dilutedbutifthebowelsarenotopened,heshouldgethisbodyrubbedwithhotoil,and, ifthirsty,drinkofsomeweakandwhitewine,orasweetwine,andtakereposeifhe doesnotsleepheshouldreposethelonger.Inotherrespectsheshouldobservethe regimenlaiddownforthosewhohavetakenadebauch.Withregardtothebadeffectsof drinks,suchasareofawaterynaturepassmoreslowlythroughthebody,they regurgitate,asitwere,andfloataboutthehypochondria,anddonotflowreadilyby

urinewhenfilledupwithsuchadrink,heshouldnotattemptanyviolentexertion, requiringeitherstrengthorswiftness,butshouldrestasmuchaspossibleuntilthedrink hasbeendigestedalongwiththefoodbutsuchdrinksasarestrongerormoreaustere, occasionpalpitationinthebodyandthrobbinginthehead,andinthiscasetheperson affectedwilldowelltosleep,andtakesomehotdraughtforwhichhefeelsdisposedfor abstinenceisbadinheadacheandtheeffectsofasurfeit.Thosewho,contrarytousage, restrictthemselvestoonemeal,feelemptyandfeeble,andpasshoturineinconsequence oftheemptinessoftheirvesselstheyhaveasaltandbittertasteinthemouththey trembleatanyworktheyattempttheirtemplesthrobandtheycannotdigesttheirsupper sowellasiftheyhadpreviouslytakentheirdinner.Suchpersonsshouldtakelesssupper thantheyarewont,andapuddingofbarleymealmoremoistthanusualinsteadofbread, andofpotherbsthedock,ormallow,andptisan,orbeets,andalongwiththefoodthey shouldtakewineinmoderation,anddilutedwithwateraftersupper theyshouldtakea shortwalk,untiltheurinedescendandbepassedandtheymayuseboiledfish. Articlesoffoodhavegenerallysucheffectsasthefollowing:Garlicoccasionsflatulence andheataboutthechest,heavinessofthehead,andnausea,andanyotherhabitualpainis apttobeexasperatedbyititisdiuretic,which,insofar,isagoodpropertywhichit possessesbuttoeatitwhenonemeanstodrinktoexcess,orwhenintoxicated.Cheese producesflatulenceandconstipation,andheats theotherarticlesoffoodanditgivesrise tocruditiesandindigestion,butitisworstofalltoeatitalongwithdrinkafterafull meal.Pulseofallkindsareflatulent,whetherraw,boiled,orfriedleastsowhen maceratedinwater,orinagreenstatetheyshouldnotbeusedexceptalongwithfood preparedfromthecerealia.Eachofthesearticles,articles,however,hasbadeffects peculiartoitself.Thevetch,whetherraworboiled,createsflatulenceandpain.Thelentil isastringent,anddisordersthestomachiftakenwithitshull.Thelupinehasthefewest badeffectsofallthesethings.Thestalkandthejuiceofsilphium(asafoetida),pass throughsomepeople'sbowelsveryreadily,butinothers,notaccustomedtothem,they engenderwhatiscalleddrycholerathiscomplaintismoreespeciallyproducedbyitif mixedwithmuchcheese,oreatenalongwithbeef.Melancholicdiseasesaremost particularlyexacerbatedbybeef,foritisofanunmanageablenature,andrequiresno ordinary powersofstomachtodigestititwillagreebestwiththosewhouseitwell boiledandprettylongkept.Goat'sfleshhasallthebadpropertiesofbeefitisan indigestible,moreflatulentandengendersacideructationsandcholerasuchashasa fragrantsmell,isfirm,andsweettothetaste,isthebest,whenwellbakedandcooledbut thosekindswhicharedisagreeabletothetaste,haveabadsmell,andarehard,suchare particularlybad,andespeciallyifveryfreshitisbestinsummerandworstinautumn. Thefleshofyoungpigsisbad,eitherwhenitistooraworwhenitisoverroasted,forit engendersbileanddisordersthebowels.Ofallkindsofflesh,porkisthebestitisbest whenneitherveryfat,nor,ontheotherhand,verylean,andtheanimalhadnotattained theageofwhatisreckonedanoldvictimitshouldbeeatenwithouttheskin,andina coldishstate.

APPENDIXPART19

Indrycholerathebellyisdistendedwithwind,thereisrumblinginthebowels,painin thesidesandloins,nodejections,but,onthecontrary,thebowelsareconstipated.Insuch acaseyoushouldguardagainstvomiting,butendeavortogetthebowelsopened.As quicklyaspossiblegiveaclysterofhotwaterwithplentyofoilinit,andhavingrubbed thepatientfreelywithunguentsputhimintohotwater,layinghimdowninthebasin, andpouringthehotwateruponhimbydegreesandif,whenheatedinthebath,the bowelsbemoved,hewillbefreedfromthecomplaint.Toapersoninsuchacomplaintit willdogoodifhesleep,anddrinkathin,old,andstrongwineandyoushouldgivehim oil,sothathemaysettle,andhavehisbowelsmoved,whenhewillberelieved.Hemust abstainfromallotherkindsoffoodbutwhenthepainremits,givehimassesmilkto drinkuntilheispurged.Butifthebowelsareloose,withbiliousdischarges,tormina, vomitings,afeelingofsuffocation,andgnawingpains,itisbesttoenjoinrepose,andto drinkhydromel,andavoidvomiting.

APPENDIXPART20
Therearetwokindsofdropsy,theoneanasarca,which,whenformed,isincurablethe otherisaccompaniedwithemphysema(tympanites?)andrequiresmuchgoodfortuneto enableonetotriumphoverit.Laboriousexertion,fomentation,andabstinence(aretobe enjoined).Thepatientshouldeatdryandacridthings,forthuswillhepassthemore water,andhisstrengthbekeptup.Ifhelaborsunderdifficultyofbreathing,ifitisthe summerseason,andifheisintheprimeoflife,andisstrong,bloodshouldbeabstracted fromthearm,andthenheshouldeathotpiecesofbread,dippedindarkwineandoil, drinkverylittle,andlabormuch,andliveonwellfedpork,boiledwithvinegar,sothat hemaybeabletoendurehardexercises.

APPENDIXPART21
Thosewhohavetheinferiorintestineshot,andwhopassacridandirregularstoolsofa colliquativenature,iftheycanbearit,shouldprocurerevulsionbyvomitingwith helleborebutifnot,shouldgetathickdecoctionofsummerwheatinacoldstate,lentil soup,breadcookedwithcinders,andfish,whichshouldbetakenboilediftheyhave fever,butroastedifnotfeverishandalsodarkcoloredwineiffreeoffeverbut otherwisetheyshouldtakethewaterfrommedlars,myrtles,apples,services,dates,or wildvine.Iftherebenofever,andiftherebetormina,thepatientshoulddrinkhotasses' milkinsmallquantityatfirst,andgraduallyincreaseit,andlinseed,andwheatenflour, andhavingremovedthebitterpartofEgyptianbeans,andgroundthem,sprinkleonthe milkanddrinkandlethimeateggshalfroasted,andfineflour,andmillet,andperlspelt (chondrus)boiledinmilkallthesethingsshouldbeeatencold,andsimilararticlesof foodanddrinkshouldbeadministered.

APPENDIXPART22
Themostimportantpointofregimentoobserveandbeguardedaboutinprotracted diseases,istopayattentiontotheexacerbationsandremissionsoffevers,soastoavoid thetimeswhenfoodshouldnotbegiven,andtoknowwhenitmaybeadministered withoutdangerthislastseasonisatthegreatestpossibledistancefromtheexacerbation.

APPENDIXPART23
Oneshouldbeabletorecognizethosewhohaveheadachefromgymnasticexercises,or running,orwalkingorhunting,oranyotherunseasonablelabor,orfromimmoderate veneryalsothosewhoareofapalecolor,ortroubledwithhoarsenessthosewhohave enlargedspleen,thosewhoareinastateofanaemia,thosewhoaresufferingfrom tympanites,thosehavingdrycoughandthirst,thosewhoareflatulent,andhavethe courseofthebloodintheirveinsinterceptedthosepersonswhosehypochondria,sides, andbackaredistended:thosehavingtorporthoselaboringunderamaurosis,orhaving noisesintheirearsthosesufferingfromincontinenceofurineorjaundice,orwhosefood ispassedundigestedthosewhohavedischargesofbloodfromthenoseoranus,orwho haveflatulenceandintensepain,andwhocannotretainthewind.Inthesecasesyoumay domischief,butcannotpossiblydoanygoodbypurging,butmayinterruptthe spontaneousremissionsandcrisesofthecomplaints.

APPENDIXPART24
Ifyouthinkitexpedienttoletblood,seethatthebowelsbepreviouslysettled,andthen bleedenjoinabstinence,andforbidtheuseofwineandcompletethecurebymeansofa suitableregimen,andwetfomentations.Butifthebowelsappeartobeconstipated, administerasoothingclyster.

APPENDIXPART25
Ifyouthinkitnecessarytogivemedicines,youmaysafelypurgeupwardsbyhellebore, butnoneofthoseshouldbepurgeddownwards.Themosteffectualmodeoftreatmentis bytheurine,sweats,andexerciseandusegentlefrictionsoasnottohardenthe constitutionandifhebeconfinedtobedletothersrubhim.Whenthepainisseated abovethediaphragm,placehimerectforthemostpart,andlethimbeaslittlereclinedas possibleandwhenheisraiseduplethimberubbedforaconsiderabletimewithplenty

ofhotoil.Butifthepainsbeinthelowerbellybelowthediaphragm,itwillbeusefulto liereclinedandmakenomotion,andtosuchapersonnothingshouldbeadministered exceptthefriction.Thosepainswhicharedissolvedbydischargesfromthebowels,by urine,ormoderatesweats,ceasespontaneously,if theyareslight,butifstrongtheyprove troublesomeforpersonssoaffectedeitherdie,oratleastdonotrecoverwithoutfurther mischief,fortheyterminateinabscesses.

APPENDIXPART26
Adraughtforadropsicalperson.Takethreecantharides,andremovingtheirhead,feet, andwings,trituratetheirbodiesinthreecupfuls(cyathi)ofwater,andwhentheperson whohasdrunkthedraughtcomplainsofpain,lethimhavehotfomentationsapplied.The patientshouldbefirstanointedwithoil,shouldtakethedraughtfasting,andeathotbread withoil.

APPENDIXPART27
Astyptic.Applythejuiceofthefiginwardlytotheveinorhavingmouldedbiestings intoatent,introduceupthenostril,orpushupsomechalcitiswiththefinger,andpress thecartilagesofthenostrilstogetherandopenthebowelswiththeboiledmilkofasses: orhavingshavedtheheadapplycoldthingstoitifinthesummerseason.

APPENDIXPART28
Thesesamoidespurgesupwardswhenpoundedinoxymeltotheamountofadrachmand ahalf,anddrunkitiscombinedwiththehellebores,totheamountofthethirdpart,and thusitislessapttoproducesuffocation.

APPENDIXPART29
Trichiasis.Havingintroducedathreadintotheeyeofaneedlepushitthroughtheupper partofthedistendedeyelid,anddothesameatthebaseofithavingstretchedthethreads tieaknotonthem,andbindupuntiltheydropout:and,ifthisbesufficient,sofarwell butifotherwise,youmustdothesamethingagain.Andhemorrhoids,inlikemanner, youmaytreatbytransfixingthemwithaneedleandtyingthemwithaverythickand largewoolenthreadforthusthecurewillbemorecertain.Whenyouhavesecuredthem, useasepticapplication,anddonotfomentuntiltheydropoff,andalwaysleaveone

behindandwhenthepatientrecovers,lethimbeputuponacourseofhellebore.Thenlet himbeexercisedandsweatedthefrictionofthegymnasiumandwrestlinginthe morningwillbeproperbuthemustabstainfromrunning,drinking,andallacrid substances,exceptmarjoramlethimtakeanemeticeverysevendays,orthreetimesina monthforthuswillheenjoythebestbodilyhealth.Lethimtakestrawcolored,austere, andwaterywine,anduselittledrink.

APPENDIXPART30
Forpersonsaffectedwithempyema.Havingcutsomebulbsorsquill,boilinwater,and whenwellboiled,throwthisaway,andhavingpouredinmorewater,boiluntilitappear tothetouchsoftandwellboiledthentrituratefinelyandmixroastedcumin,andwhite sesames,andyoungalmondspoundedinhoney,formintoanelectuaryandgiveand afterwardssweetwine.Indraughts,havingpoundedaboutasmallacetabulumofthe whitepoppy,moistenitwithwaterinwhichsummerwheathasbeenwashed,addhoney, andboil.Lethimtakethisfrequentlyduringtheday.Andthentakingintoaccountwhat istohappen,givehimsupper.

APPENDIXPART31
Fordysentery.Afourthpartofapoundofcleanedbeans,andtwelveshootsofmadder havingbeentriturated,aretobemixedtogetherandboiled,andgivenasalinctuswith somefattysubstance.

APPENDIXPART32
Fordiseasesoftheeyes.Washedspodium(tutty?)mixedwithgrease,andnotofa thinnerconsistencethandough,istobecarefullytriturated,andmoistenedwiththejuice ofunriperaisinsandhavingdriedinthesun,moistenuntilitisoftheconsistenceofan ointment.Whenitbecomesagaindry,letitbefinelylevigated,anointtheeyeswithit, anddustitupontheanglesoftheeyes.

APPENDIXPART33
Forwateryeyes.Takeonedrachmofebenyandnineoboliofburntcopper,rubthem uponawhetstone,addthreeoboliofsaffrontriturateallthesethingsreducedtoafine

powder,pourinanAtticheminaofsweetwine,andthenplaceinthesunandcoverup whensufficientlydigested,useit.

APPENDIXPART34
Forviolentpainsoftheeyes.Takeofchalcitis,andofraisin,ofeach1dr.,whendigested fortwodays,strainandpoundingmyrrhandsaffron,andhavingmixedmust,withthese things,digestinthesunandwiththisanointtheeyeswheninastateofseverepain.Let itbekeptinacoppervessel.

APPENDIXPART35
Modeofdistinguishingpersonsinanhystericalfit.Pinchthemwithyourfingers,andif theyfeel,itishystericalbutifnot,itisaconvulsion.

APPENDIXPART36
Topersonsincoma,(dropsy?)givetodrinkmeconium(euphorbiapeplus?)totheamount ofaroundAtticleciskion(smallacetabulum).

APPENDIXPART37
Ofsquamaaeris,asmuchasthreespecillacancontain,withtheglutenofsummerwheat: levigate,pound,formintopills,andgiveitpurgeswaterdownwards.

APPENDIXPART38
Amedicineforopeningthebowels.Pouruponfigsthejuiceofspurge,intheproportion ofseventoone:thenputintoanewvesselandlaypastwhenproperlymixed.Give beforefood.

APPENDIXPART39

Poundingmeconium,pouringonitwater,andstraining,andmixingflour,andbaking intoacake,withtheadditionofboiledhoney,giveinaffectionsoftheanusandin dropsyandaftereatingofit,letthepatientdrinkofasweetwaterywine,anddiluted hydromelpreparedfromwax:orcollectingmeconium,layitupformedicinalpurposes.

THEEND