i.e. the fevers caused by blood called synocha and synochus. Synochus comes from corrupt blood within the vessels, and synocha from an excess of blood without putrefaction. Galen ¹ says, since the blood is the friend of nature it may be corrupted and ² brought under her ruling; if it be brought on account of sharpness of choler and become corrupt, the thin part of it turns to choler and the thick part to melancholy; and the contrary of this i.e. that sanguine humour is capable of putrefaction and corruption and generates fever. The doctors agree with this statement, and it is not right to oppose their sayings, but to treat them with honour: nevertheless we have said the blood is naturally in the veins and arteries and is ruled by nature and her instruments, that is by the natural heat. When choler penetrates thither it disturbs their natural moderation, and sometimes it grows hot of itself naturally and becomes corrupted [or] the thin part is burnt and nature heats it. And when nature overcomes it, it is evacuated by crisis, or by nose-bleeding, or the haemorrhoidal or menstrual flow. At another time it cannot be evacuated from the veins, but settles in some member forming the imposthume called phlegmon.  p.21 Sometimes nature can do neither of these things, but [the matter] remains in the veins externally, and when brought under [the ruling of] nature it is corrupted and causes acute fever.

If we speak [of the forms of this fever, there are three,] ³ i.e. aumasticus which increases continually; epamasticus which decreases continually; and homotonos which remains in one state. In the first form there is {⬌} that dissipates and does not consume, and therefore it is weaker, and in the second form there is heat (?) that dissipates and is {⬌} and therefore it is stronger and is greater {⬌} according to the consumption of the matter. In the third form the dispersal and the consumption are equal, therefore it remains in one state and the judgment thereof is equal as to life or death. At another time it disperses more than it corrupts, and that is the way to health, for when the crisis comes, there is but little matter. Yet another time the putrescence is greater than the consumption, and that is bad and dangerous.

The causes of these fevers are oppilation and repletion, much resting as well as many other signs ⁴; the consumption of food that increases sanguine humour, such as eggs, salmon ⁵, and the like; avoiding accustomed work and purging, and practising laborious exercise along with repletion of the body;  p.23 the mutilation (want) of a member whitherto much blood was wont to flow; much foods ⁶ that generate watery blood, and fruit, milk and fish, for such easily turn to purely watery humours ⁷ and contract putrefaction, cause oppilation and greater heat, and give rise to the fever called synocha ⁸. And should the leech be careless in opening the obstruction or evacuating it, it readily turns to the fever called synochus. Therefore Haly ⁹ says the excess does harm in three ways: as regards quality only, as the blood when it heats and generates the fever called ephemera; ‘or he takes the blood there for the spirit, which is generated from the thinnest part thereof {Vel capit sanguinem pro spiritu, qui ex parte purioris sanguinis generatur.}’ (R. A. 811.) Or the excess is generated as regards quantity alone, when the blood increases in quantity only, its quality only being good, and not a corrupt quality ¹⁰, it then causes the fever called synocha. And the pus in the imposthume injures by reason of quality and quantity [combined].

Galen and Avicenna are against this, for Avicenna says there are but three simple fevers, a fever from phlegm, one from choler and one from sanguine humour; for when it (the blood) corrupts, it causes not a simple fever, but a compound fever; for the blood is moderate, and when it heats and putrefies, the thinner part turns to choler, and the thicker to melancholy. Avicenna ¹¹ says he found much [adverse] criticism regarding this saying of Galen's, and says [moreover] that sanguine humour generates one simple fever only. I say with regard to this briefly: if vapour arise on account of the  p.25 corruption of the blood, it turns to choler, and the blood putrefies by itself by reason of the antecedent cause of the combination. Of these Galen takes one view and Avicenna another.

These are the indications preceding this fever: heaviness of the head, and puffiness of the eyes ¹², plethora of the veins, redness of the face, fatigue of the whole body as though after labour. The concomitant symptoms ¹³ are frontal headache; the sick man imagines he sees a lighted candle before him ¹⁴; perturbation of mind; something lacking in the sight; undulating full pulse; sweetness in the mouth; urine thick, strong and leaden-coloured on top ¹⁵; itch in the nose, on the neck, and where the cupping horns are placed; shortness of breath; profound sleep; difficulty of conversation; and an imposthume at the base of the ears and the tongue. These symptoms are more pronounced in synochus than in synocha.

Item no cold or horripilation precedes this fever, because the blood giving rise to it ¹⁶ is in the veins, excepting if it be caused by the imposthume called phlegmon, situate on the liver or the midriff ¹⁷; for then come paroxysms like to tertian fever ¹⁸, because it heats as if it were choler.

Item Averroes says the signs manifesting this fever are those that signify the dominance of sanguine humour; the which are ¹⁹: heaviness in the head, the eyes, and the temples,  p.27 especially in the season of sanguine humour; sleep, yawning, perturbation of mind, sweet taste in the mouth, and a flow of blood from the nose, the anus or the womb, if the region, the season ²⁰, and the age be in agreement; and itch on the place of blood-letting ²¹; he sees red objects in dreams, blood or flowers or beautiful gardens in dreams.

These are the signs that follow this fever: swelling of the face, and flaccidity of the whole body; sometimes smallpox, or measles, or chickenpox (?) ²², or quinsy supervenes and other evil symptoms which are wont to come in time of plague and are caused oftenest by corruption of the blood. These symptoms are less pronounced in synocha than in synochus, on account of the putrescence; therefore the latter is like to ephemera.

Prognosis of aumasticus ²³; the which is a deadly kind for the most part, for it is the worst of them. The crisis comes most frequently on the seventh day, and it the fever is terminated ²⁴ sometimes by a noticeable evacuation, and at other times by an insensible one. The crisis in this species is imperfect, for it turns sometimes to causon or frenzy, and at other times to lethargy, or smallpox, or measles: sometimes to subeth ²⁵. Sometimes the belly swells and a noise is heard therein, like unto the voice of the tympan and thunder, and an “outgoing” checks not this ²⁶. It may be recognised by the signs of digestion on the third day, or the fourth, if the crisis will come on the seventh day; and sometimes it is ended on the fourth day, and sometimes later.

Item epamasticus ²⁷ is the best of these and homotonos the mean. Item should broad black pustules, or green leaden hued ones, appear on the sufferer from this fever, it is a sign of death. Item if the eyes shed involuntary tears in this fever, it is a sign of death, unless there be an imposthume or an itching on them in the lids. ²⁸ Item heaviness after sufficiency of sleep is a bad symptom and a sign of death, and likewise great difficulty in drawing breath on account of the violence of the disease. Item when small black pustules ²⁹ arise on the tongue of sufferers from this disease, or any other acute sickness, it signifies death, and especially if they desire hot things. Item if on the knee of the sufferer a little black pustule ³⁰ arise with redness round it, it is a sign of death; and though these pustules disappear suddenly, unless they were wont to be on him in health, it is a cause for fear. A red imposthume on any principal member is dangerous, more especially if it appear on a place whither that member sends its excess, ³¹ or near thereunto.

The cure of this fever demands the evacuation of the matter, alteration thereafter, and rationing of food and drink. The evacuation is ordered first here, but not so in other fevers, except those from blood, if it be pure, as in synochus. ³² Note, much purging is demanded in this fever, such as blood-letting, cupping, scarification ³³ of the small of the foot and the nose, and by the haemorrhoidal and menstrual flow: and laxative medicaments avail here, and clysters, and suppositories. The letting of a vein is the last and the best of them; and if the  p.31 force and the age and the season permit it not, let the horn be applied to him, and the blood of the small of the foot ³⁴ is best here. If he abide that not, reduce his food and drink, employ sweating, and rub the members; the which Hali teaches when he speaks of superfluous repletion. This is manifest in synocha, for Hali ³⁵ says, it has no other cause but plethora and excessive oppilation, produced by red blood, wherein the excessive quantity is at fault. ³⁶

Since we have spoken of phlebotomy, it may be asked, is it meet to let a vein here, till weakness seize the sick man? They say it is meet, for Galen says, when we bleed a patient in acute fevers, it is till weakness seizes him, for that cools the whole body at once, quenches the fever, and relaxes the bowels; the sweat breaks out, and many folk have I cured entirely thereby. Therefore it is meet to bleed a sick man usque ad syncopen. Item Avicenna says the same, but Averroes is against it, and says, the patient should not be bled to the point of faintness. Avicenna says that it is better to remain within the limit in drawing off superfluities than not to perform the letting. Item he says again, it is better to increase the number of times, than the quantity. Item he says again, in excessive repletion it is meet for the evacuating to be equable, ³⁷ by drawing off the matter gradually, and such purging does no harm to the weakened body, and therefore still less to a strong ³⁸ body. To this I say, with Averroes, that it is imprudent to continue the letting till the sick man is at the point of collapse; for Galen says: ³⁹ “See, O learned man, that weakness seize not thy patient under thy hands.” Thou mayest  p.33 continue till slight weakness of the branches lay hold of him, according to Constantine. Or as Avicenna says: “Cease not, till he be approaching faintness”; and there he speaks of the weakness of the branches and not of that of the force. ⁴⁰

However, since Nature hates a sudden change, let the matter be drawn off gradually, to evacuate that which is superfluous. If it be asked of you what amount is excessive in physic, ⁴¹ since all the blood is good here, and therefore if one part of it is rightly excessive, then the other part is excessive too, and so it should all be drawn, if one part is drawn; I say, for example as follows, that one pound only is excessive, and if it be drawn off, Nature arranges the remaining part thereof; and since she gets help from the things nearest, she makes good what is lacking. ⁴² Neither is the reasoning correct ⁴³ that all the blood is peccant and therefore it were right to draw it all off, for if some be evacuated, the other parts do not err; or else it is the parts farthest from the heart that are to blame, and the blood should be drawn from them. So the evacuation is in the branches and the deficiency likewise, and not in the root.

If it be asked what is the right time to let blood, Avicenna ⁴⁴ says, heed not the number of the days, but consider the force of the patient. If it be strong, let a vein on the fifth day, and not only on that day, but on every day thou shalt visit him. ⁴⁵ Nevertheless Avicenna says, if a vein be not opened at the outset of this sickness, there is no use in bleeding him at all, and therefore it is not right to bleed him every time thou visitest him. I reply, in the case of putrid fever that  p.35 comes to increase after inception, there is no use ⁴⁶ in bleeding; for he suffers laxatives more readily then than phlebotomy, ⁴⁷ because the matter is digesting: (as) there is no digestion at the beginning of this fever; and therefore a vein may be opened then, if the force, the age and the season permit. Open first the medial vein in the right arm, then the medial vein in the left, ⁴⁸ and thereafter that in the right. Whereupon let the Basilic vein in the right arm, and if needs must the same in the left. If that avail not, let the cupping horn and scarification be applied between his shoulders, and do the same to his calves and both sides of the hips; and let the saphenic vein be opened on both sides in these two cases, as well as the lower vein in the arm on both sides, but first from the right arm, because of the liver, which is the source of the blood.

If the sufferer be a plump infant, he may be bled a little then, for Averroes says Avenzoar bled his son at the age of three years. If it be a woman et menstrua retinentur, it may be relieved by a vein of the inner ankle, ⁴⁹ and if the haemorrhoidal flow be withheld, relieve it by the same. I say it is better to open them externally, and if the veins of the anus be so relieved, apply boiled onions to the heads thereof. To him who is constipated, give a clyster in which are boiled violets,  p.37 mallows, mercurial, great mallows, bran, cassia fistula, and a little salt.

The proper purgatives to give here are those that purge choler, and purify the blood from burnt humours, as cassia fistula, tamarind, violets, borage flowers; the juice of bugloss, of rue, and of roses ⁵⁰ (?); myrobalani citrini, chebuli, emblici, bellirici, and indi. If he have taken food previously, or be drunken ⁵¹, give him but little of these, and also if he be a person that consumes many cold things, as cold water, cold fruit and the like. The compound purgatives that avail in this case are: oxylaxativum, diaprunis, and triphera saracenica.

Let us now consider the cold things, and amongst these, cold water is most recommended for them, on the further conditions added thereto; ⁵² the matter should be digested in the intestines, and no hard imposthume present in the same: the upper and the lower part of the stomach should be neither weak, nor cold, nor any humoral putrescence therein, neither be there oppilation, nor excessive repletion. On these conditions the sick man (he) may drink as much as he please of the water, without taking breath; ⁵³ having first been purged by bloodletting, for in every case this is best, unless drunkenness, or nausea (excessive filling) prevent it, and if so a clyster is more beneficial, or diet of food and drink, or suppositories, or rubbing. ⁵⁴

Item if the blood be thin, it should be thickened by these: plantago, poppy seed, and that of coltsfoot. If thick, let it be thinned by endives, scariole, chicory, lactuca (i.e. lettuce) if the sick man cannot sleep, and burnt ivory turnings. Item the following thicken the blood: diatragacanthum ⁵⁵,  p.39 gummi arabicum, berberis, sorrel, coriandrum, and sugar of roses. Item these are the comfortatives: diatrionsantalon; and if he cannot sleep, diapapaver; and diatragacanthum frigidum if he have difficulty in drawing breath, nevertheless it is advantageous (?).

The cure of this fever called synochus is accomplished in two ways, by bleeding, and by cold water. Galen says a vein avails always if the force be strong, but it is not good as a rule to use cold water unless there be signs of digestion of food in the flux, ⁵⁶ in the pulse or in the urine, and when the fever is greatest and sharpest. And therefore it is that if the blood be choleric cold water avails before the digestion of the matter, as it digests by cooling and by checking the malice, on the before-mentioned conditions, because cold water increases oppilation at times, and when a man drinks his fill thereof; for sometimes it cures, or at other times it turns to phlegmatica. Averroes ⁵⁷ says, this is preferable to death, and therefore he says it is better and more proper to give him camphor in electuaries and foods and drinks; for a drink of barley water, and andivia mixed with camphor, is made against the thirst, because it greatly cools.

Item it is proved that it avails not in either of these (?), for Galen says it is not conceived (?) that the fulness that is in  p.41 the veins can be purged by laxatives, or it is not possible, and the veins of him who has great thirst ⁵⁸ are full. I reply absolute fulness is when all the humours increase equally in the veins, the which truly cannot be purged by any simple laxative medicament, though perchance it might by a compound one; and fulness and repletion outside of the veins is when one humour alone increases, and the name thereof is the “fulness of an evil humour”, ⁵⁹ the which may be purged by laxative medicine.

If it be said with Galen, that the increase of all the humours should be evacuated by blood-letting, and if it be only of one humour, then by laxatives, and therefore, that it follows that purgative medicine is for sanguine humour alone; I agree, but we should not use it without preparing with the following ⁶⁰: aloes, centaury, juice of honeysuckle and agaric. Regarding the word Averroes spake, that it were impossible to purge the fulness in the veins with laxative medicaments, I say this is how that should be understood: “impossible”, that is, “not easy” or “difficult”. When one humour alone increases outside the veins, it is easy to purge it with laxatives, but in the case of fulness of the body in the veins, it is not good for them. ⁶¹

These are the foods ⁶² that avail in this fever. Pottage made of oatmeal and chicken broth; barley sowens ⁶³, and bread seethed in milk of almonds; and chicken broth with lettuce, if the force be weak; fresh water fish and meat that  p.43 is close-grained and free from taint, with juice of sorrel, and acid syrup ⁶⁴, or syrup of violets or nenufar.

As we have spoken of blood-letting, note that it is most proper and avails most for persons of robust and stout habit, and from whom but little is dissipated. Not thus for the folk who have thin bodies and dominance of choler in the pit of the stomach, as for them it avails not. In cold wet weather it avails most, and for dark folk who are wont to consume much meat. ⁶⁵ It may be asked here — if there be little good blood in the body, and many crude humours, does a vein avail in that case? It is proven according to Galen that it does avail, and Hippocrates says, regarding the people that fill themselves excessively and are drunken (?), who cannot but have crude humours, and where there is little good blood and a plethora of raw humours, blood-letting is beneficial.

Item I suppose, for example, that there comes an imposthume of the breast or lungs from phlegm, along with drunkenness, and rawness of humours, and there is little good blood present then, because of the quantity of phlegm and the fever; no one denies that in such a case, letting a vein is not good nor any other sudden quenching; if any one say bloodletting avails not in this case, it is true, for the good blood would go out and leave the bad within. I say against this that Nature is wise, and there is no limit to her skill in ruling the animal, and if that is true, she will retain the good blood inside for herself, and let the bad go. Item Galen says, it is the blood that Nature purges ultimately from the superfluous substance of the humours; therefore she retains the good blood for herself at last, through her skill: the bad blood will go out and the good blood will remain within. Galen(?)  p.45 says the contrary of this in The Regimen of Health, where he says blood-letting avails not in this case. This is the reason: because a vein is only beneficial in two cases, i.e. when red blood alone has the dominance, or else all the other humours combined, according to Galen; and sanguine humour has not the dominance here, for it does not increase (?), but diminishes, nor the other humours combined, but the crude humours only hold sway; and so in this case, according to the rule of Galen, blood-letting does not avail.

Item Galen allows that it would avail, but it does not because the humours are crude and viscous, and though the aperture be big, they could not emerge because of their thickness. Therefore if there be but little good blood, that is ⁶⁶ what gets out first, because of its thinness, and the wider the opening the easier is the exit. From this it is clear that in acute putrid choleric fevers, where there is not so much thickness, if the opening be narrow, the good thin blood comes out first, and if it be increased thereafter, the corrupt blood emerges.

Item if a vein be opened in this case, it will do great harm, which Galen warns us to avoid; namely, it draws the crudeness of the humours from the little veins to the big veins, and if they be in the big veins it draws them to the members; and it were great harm to nourish the members by the crude humours; and therefore a vein avails not in this case. Nor yet lesser things, for a bath is not beneficial, nor labour, nor coition; but rather abstinence, solitude, long sleeping, light rubbing on the members, and things that comfort them.

As to the first reason, I say a thing can be over-filled in the absence of crude humours, though they be old in the filling (?); and there are people who have narrow veins and  p.47 who though they eat little food, digest it well in the stomach and the liver, and none the less do they fatten excessively. Or else we may say: there is so much matter undispersed, because of its (?) labour, that if it be not purged suddenly it would choke them: and nothing evacuates with greater suddenness than a vein; so if it avail not for its own sake, it avails for the excess. In the same way I answer the reasoning he made regarding an imposthume of the breast or lungs. As regards the other argument, that Nature is skilful in her works, I say that is true, when she is greatly troubled therein; and for the other reason, I say the comparison is not right, because there is a big opening in the veins, which the laxative medicaments have not, but they go from the big veins to the narrow veins which are at the back of the liver, and from thence to the still narrower veins called meseraic. Thus it is easy to retain it finally, and therefore at last that thing is expelled which increases most, or which nature needs least.

These are two fevers and since the cause of a species ⁶⁹ of hectica is ephemera, we should rightly speak of it first according to Averroes. Ephemera is so-called, because efemiron in Greek is the same as a certain fish in Latin, the which fish ⁷⁰ is only alive for one single day; and in the same way this fever does not continue beyond one day in its own course. Ephemera is a fever resulting from exceptional immoderation of the spirits ⁷¹ which does not last beyond twenty four hours, as regards its own nature. And therefore note, there is true ephemera, and false: the true ephemera does not continue beyond a natural day without finishing; the false continues at times till the third and at other times till the fourth day, and the cause of it is the grossness of the matter in the body, or the blocking up of the pores, the which prevents opening; or because of the oppilation of the pores from an external cause.

Gilbert ⁷² says that it is not because there is no matter in it that this fever is said to be non-material, but because it has no peccant humoral cause that precedes it, (like hectica). And ⁷³ though Avicenna puts down this fever as coming from many causes, such as excessive flux, coition, or excessive  p.51 drinking, hunger, syncope, want of sleep, and many more of the like; nevertheless these may be reduced to four causes ⁷⁴ alone. The first of these from an external cause which heats and blocks the pores actually or potentially, as is the heat of the sun or of a fire, or a bath with hot things in it, or one wherein is sulphur or cold water; briefly everything that closes the pores and prevents the escape of the vapours. Note, the diversity of fever is understood according to the diversity of the bodies and the vapours; for if the body be hot and dry, and the vapour(s) likewise, this stoppage is caused by the blocking of the pores and the like; then this fever called ephemera is easily generated. And if the body be hot and moist, the vapour is thus retained, and therein putrid fever is easily generated.

The second cause: ⁷⁵ hot food and drink; and warm dry medicines; as are strong, old, pure wine, garlic, onions, pepper and euphorbium, without being used to them. The third cause: ⁷⁶ disturbance as regards the body or the soul, such as anger, immoderate exercise and the like. Should there be causes present, they can be broken and brought hereunto.

The fourth cause ⁷⁷: imposthumes that arise in the inwards, whither are banished the surplus of the chief organs.

See now why diseases are said to be non-material. Since a humour is peccant in every sickness in the world, if the matter be harmful, the member is injured; therefore since blood is in every member, ⁷⁸ a perceptible injury cannot be made therein unless the humoral matter be infected or injured. ⁷⁹ Item Averroes says, in truth, no disease whether simple or compound is without matter ⁸⁰; no simple disease for there is no one cause in the body which is hot only or cold only, without matter; nor compound, for there are composite causes (diseases) in the body, hot and moist, hot and dry, cold and moist, cold and dry.

Item I say that the fever called ephemera injures the vital spirit first, and the animal spirit or the natural spirit thereafter, the which are in the humours; or the humours adjacent to them are infected, but the spirits are infected soonest, but not so that it is necessary to undertake some other operation against them, that was not done against the humours, or vice versa. It is sufficient to effect one change only, and ephemera heats it. Hence Avicenna says there is no fever therein, until fiery heat seizes the entire heart; the which is not material, as there  p.55 is no peccant matter ⁸¹ there in its substance to be purged by medicine. Therefore Isidorus says, in the same way purging does not necessarily avail in every sickness wherein is a peccant humour, such as causon from burnt choler.

Note ⁸² that there is an external cause ... the fault of a humour or humours, because of their quantity; the letting of a vein avails there. In one kind there is the fault of a humour on account of causon or putrid substance or quality wherein drawing avails; and in another kind it is the fault of humours, as regards their ⁸³ own sharpness and vehemence; wherein a change avails. Therefore there is the fault of a humour in every disease, nevertheless it is not material, that is it has no matter in it, which is subservient to, or necessary for, evacuation.

Avicenna says, these are the ordinary signs of this fever i.e. it comes from a primitive cause, and not from an antecedent cause, unless it be false ephemera, and it does not begin with horripilation and shivering (?), unless it be true ephemera, which is produced by oppilation of the pores through humoral matter, for this is intermediate between true ephemera and  p.57 putrid matter called putrida. And the pulse and the urine vary little from the normal and the heat neither irritated nor burning to the touch, but is like the heat of a man labouring and angry, and is terminated by natural, moderate sweat oftimes. Avicenna applies another sign to it, as follows. ⁸⁴ Let the sick man be put in a bath, and if unwonted horripilation and shivering (?) result therefrom after a space, understand that it is putrida, and if a change come not to him then but such as is wont, understand that it is ephemera.

Draw special indications of the primitive causes from the patient himself, i.e. should the head ⁸⁵ be hot from the sun to the touch; if the colour of the skin ⁸⁶ turn dark and livid, it is from cold, and if it become hard and dry, as though it were stretched, that is produced by styptics; should there be heat round the liver in the natural spirit ⁸⁷, it is caused by drink or food, and the urine is highly coloured; if it come from hard labour, the body is weaker and there is pain in the joints; if from anger, the eyes are protruding ⁸⁸ and the face red, unless the anger be mixed with depression, because he cannot wreak vengeance ⁸⁹; and in that case he turns pale, and undergoes many changes of colour. If it come from depression alone, the eyes are sucked back (sunken); and if from poison, there is great heat and dryness internally, which causes violent thirst, and they say these are the people of melancholic humour.

Prognosis of this sickness. Understand, it is difficult to recognise this fever, but once recognised the cure is so  p.59 much the easier. Thus, if the pulse be variable and the urine undigested, he passes into putrid fever, particularly ⁹⁰ if the urine be evil-smelling. If the body be dry and hard to the touch and this not resulting from styptics externally, there is danger of its turning to hectica, and for that reason let there be no delay in curing him.

Item ⁹¹ the people who fall oftenest into the disease called hectica, or tertian fever, are those who have a hot dry complexion, but they whose complexion is hot and moist, fall quicker from ephemera into the complexion of putrid fever; thereafter those in whom heat is greater, and again those in whom dryness is greater, and if the complexion be hot and dry, and the sick man suffering from hunger, want of sleep, or bodily labour, he falls swiftly ⁹² (?) into ephemera; and unless he get food at once, he passes into putrid fever.

The cure of these cases is brought about in two ways. The first of these, by changing the hot dry complexion; the other, in that something may be done against the extrinsic causes whence this fever is produced, along with a regimen of food and drink. ⁹³ The first thing is accomplished by cold moist remedies according to particular matters ⁹⁴, such as complexion, age, habit etc., and the causes it produces (?); the cooling is produced by itself or by accident. By itself i.e. cold foods or medicines that cool internally: by accident, that is by a bath of hot or tepid water. A bath avails much in this fever, for it disperses the vapour, which if it were not dissipated would throw the body into acute heat and turn to corruption;  p.61 so the bath is a common remedy for all who have this fever, and especially if it be on the decrease; and it should ⁹⁵ be avoided by those ready for the corruption of the matter (putrid fever).

The following is a special cure for this case: to do something against the external cause whence the fever comes; whether it be caused by fire or by the sun. Put the sick man in a cold place and cool the air with a linen cloth, in the same way as a bellows cools it. If the pain  ⁹⁶ be in the head, let cold water be poured thereon, for it cools quickly; and put him in a bath of hot water and let him remain long therein; thereafter let it (the cure) be accomplished by rubbing with oil of roses or water rue (?) or violets.

If the cause be styptic, a bath of hot water relieves; and let the whole body be rubbed with oils that are aperient without being styptic, and other things such as camomile oil and do not rub it in until he has had the bath. And do not give the bath more than once unless the fever return. And if it be seen that it does not avail him, understand there is plethora present or that he has an internal stoppage; then let a vein and move the bowels with laxatives, for that remedy is medial between ephemera and putrida. If the cause be cold, put him  p.63 in his bed ⁹⁷ with boiled herbs beside him, so that he sweat, for this is better than putting him in a bath of hot water, and let him be rubbed with hot things, according to hot action (?) ⁹⁸.

If the cause be produced by hot food, give him a vinegar syrup and cold things, that cool the stomach and the liver within and without; bread made with vinegar, triasandal (diatrionsan:) along with camphor. If the cause be labour or motion, let him rest and rub oil of camomile and violets to his joints; and apply fomentations thereto, of roses, violets and camomile. Give them (the patients) food that nourishes well, such as eggs, small fish, and the genitals of a cock. To escape this fever coming from fatigue ⁹⁹, know ye, whatever man may make a long journey, if he carry ragweed in his hand, the walking will not hurt him, as ¹⁰⁰ Alibertus says.

Give roots of ragweed tempered by subtle wine, or with good broth, at the end of the day, to him who is tired after walking, and the fatigue will go from him, as though it had never been — so says Dioscorides. And whoever goes a journey, if he carry a staff of tutsan ¹⁰¹ he will not stumble against a stone, or anything else, nor will walker's abrasion (?) ¹⁰² seize him; and if it do, he need only rub on oil of roses, or the yolks of eggs, raw or heated. This is useful for friars, who walk the country, or the people of pilgrimage, or for envoys, according to Serapion.

[If it be caused by want of sleep and he have constipation], ¹⁰³  p.65 give him a clyster or honey suppository; ¹⁰⁴ and if the food be swimming in the stomach, make him vomit ¹⁰⁵: let him not take food till it be digested, and thereafter pay no heed to the fever, but comfort the stomach so that it digest the superfluities. If the bowels be relaxed, apply hot wormwood juice to the mouth of the stomach, and give easily digested foods, tending to coldness with some astringency, such as rose and nutmeg, and the like. If the matter come from hunger, give him food, and especially if choler be the peccant humour, or be dominant therein, for they are unable to take any meal. ¹⁰⁶ If it be produced by imposthumes, let them be cured in the way stated in the treatise on imposthumes ¹⁰⁷: therefore the nutriment of food and drink of those suffering from these fevers should tend towards cold and moisture, except when it is caused by consuming too much food.

Since ¹⁰⁸ we have spoken much concerning water in these diseases, it may be asked whether it avails in fevers in every age. It is asserted that it avails not in any age, for it does not help youths as they need much nourishment to increase their growth, and there is not that nourishment in water; so it avails them not. Item it does not help young people, for by their like they are maintained, while water is contrary to their complexion; and so it avails them not. Item it is not good for the old, as it is like their complexion; in those immoderate people when like is put to like, it increases it, makes it vehement; and so it is not good for the old. Galen is against this in Regimen, where he says, good water avails for every age. And I say there is nothing in the world more efficacious for every age, in general, than water; and therefore we should  p.67 take much pains to find good, pure, cold water. Let us take for example food and air and the other particular matters in turn, and I say they are the moderate things that benefit moderate things, and that they are common to immoderate things. I say also, though the age be moderate or immoderate, it i.e. water (?) is not merely advantageous, but necessary or almost so; for when the food is thick in comparison with water, it cannot penetrate to the members, if it be not thinned; therefore since water is thin and fluid, it makes a way for the food to the members without doing the least harm. Neither wine nor milk nor any other simple does the like, and therefore there is nothing more beneficial to every age than good water. As to the reasons given against this part, I allow them; for in the way he gives the reasons, it does not avail; nevertheless it benefits in making a way for the food to the members, as aforesaid.

Note, these are the conditions of good water. One condition is that it heats easily and cools suddenly. Another that there be no foreign bodies visible therein. Another that it be not turbid. Another that it be not ugly and evil-tasting. Another condition is: if two waters be taken and a little lixivium  ¹⁰⁹ mixed therein, then whichever does not become turbid, is the better of them. Another condition: take two identical cloths and wet them entirely in two different waters equally, and dry them equally; whichever cloth dries quickest, that water, wherein it was wet, is the best water. Another condition: take equal quantities of two different waters, and which ever is lightest is the best. He says also not to use water that goes through pipes, for according to all true doctors it is not good.

Etica or Hectica is a non-material sickness. It is moreover a wasting fever, and they say that it is a continuous fever, ¹¹¹ without the fault of a putrescent humour, which has its origin in the heart ¹¹² and the close members; and thereof are three varieties.

The first of them is light, ¹¹³ that is, when the external heat is kindled in the natural and radical juices, and in the roots that are in the substance of the little veins, at the time the moisture called rose is kindled. The second is in the moisture which is in the flesh, and when it is dispersed, it can be cured at times by food alone, and that is when the fluid called cambium is kindled. ¹¹⁴ The third ¹¹⁵ form is the worst of them, when the external heat deepens itself in the close spermatic members; and this is when the moisture called gluten is corroded (?), for it binds the members together.

The following are the causes of hectica. Everything that heats, and dries, and burns the heart, and the close members; and it also comes from other diseases preceding it, such as ephemera and causon and their like. And especially to those to  p.71 whom abstinence is ordered in a wrong season, ¹¹⁶ or who are refused a drink of cold water at a time when they should drink it; for it is easy for them, and those of a hot dry complexion to pass into hectica; also for lean people. It comes also through the fault of the heart, the lungs, and the chest, as are phthisis, and apostema, and their like. It is produced by accidents of the soul, which are long and puissant ¹¹⁷, and especially pain and depression and oppression of mind, anger, and labour that fatigues body and soul, and long lying in prison. Therefore Avicenna says, he who leaves his usual work ¹¹⁸ passes into hectica; the which is surprising, for they who avoid labour, rest for the most part, and resting moistens the body.

Item he who does this, takes to himself a disease from fulness of humours; so it is not a wasting sickness he contracts. ¹¹⁹ Item he who forsakes his work, becomes cold thereby, therefore I say there are two hecticas: hectica that comes from old age, and that which comes accompanied by fever. He who avoids his work, contracts the hectica of old age, for the excess remains in the body, and that weakens it and the digestion, and causes diseases from fulness of humours: that being so, it throws a man into old age, the which age is cold and dry as the heat is weakened on account of the excess remaining in the body, and so the digestion is weakened, and the food is not sufficiently digested in the stomach or the liver: for the error produced in the first digestion is not corrected in the second, according to Isidorus; nor in the third, therefore the members receive neither plentiful nor sufficient nourishment, and are impoverished, and so hectica follows the  p.73 swelling. ¹²⁰ Through this we should say, the first thing to be consumed in hectica is the recent fattening surrounding the firm solid members internally (the which is not the fat bordering on the skin), and thereafter the older fattening is consumed. ¹²¹ Or the species of hectica are defined (?) ¹²², not according to the consumption ¹²³ of the various liquids, but because of that of the various members, such as the fat and flesh first, the arteries and veins thereafter, the bones and the cartilages in part. ¹²⁴ Thus he who contracts hectica passes into diseases produced by fulness of humours ¹²⁵ per accidens, into accidental flux, and moisture, such as dropsy.

Speaking of the hectica that comes (along) with fever; sometimes it comes accidentally, for he who avoids his work, retains the superfluities, which through want of windiness go to heat, and corrupt. Hectica follows every putrid fever that comes frequently, or continues and remains long. In this way, I grant that heavy labours and weak immoderate exercise produce hectica of themselves, while long lying in prison and avoiding regular occupation cause it accidentally. Excessive coitus does the same, also great flux of the belly (diarrhoea), excessive haemorrhoidal or catamenial flow, or that of urine, or excessive vomiting; constant vigil, or excessive meditation; and everything that heats and dries the body unduly. Avicenna says, fever is frequently generated by too violent purging, and especially hectica.

Signs of hectica. The pulse and the heat ¹²⁶ of the sick  p.75 man should be noted at the end of three hours after taking food, and observe whether it (the heat) is greater in the nerves (?) than in the veins ¹²⁷ or in the places nearest to them; for when the heat is equal there is no difference between them, as regards its own nature. The skin becomes withered, the which is a sign of the first form of hectica, which is hard to recognise and easy to cure, according to Avicenna; for he says, the first form may be recognised through its want of dryness. ¹²⁸ And Galen says, the heat increases in sufferers from hectica when they eat food; and Averroes says, this occurs three hours thereafter, that is, when it is digesting. ¹²⁹ And ¹³⁰ I say, when the patient consumes food, i.e. extra food, it cools the body forthwith, and when he consumes food in the natural way of digestion in the stomach, along with a kind of digestion in the liver, then it is dispersed throughout the members, so that it heats then, and thereafter heats the members as a cloth that is in the day about a man, takes heat from the body, and itself heats the body thereafter. In the second variety of hectica understand that dryness is apparent therein, and whatever time he takes food, so much the greater is the inflammation and his pulse is the less thereof, and there is no sign of hectica more certain than that. In the third form of hectica, the eyes are sunken, the skin drawn, and the belly adheres to the back, the pulse is hard and taut as it were a  p.77 cord being stretched, the urine is like oil, and should it strike against a stone it emits a dull sound. ¹³¹ Therefore when the fever sets in, it impoverishes the body, dries the skin, the face becomes deformed, and the eyes deepen. When it reaches the last stage of hectica, you will see his eyes as though there were ashes scattered on them, and the lids are drawn down like one who has spasmus; ¹³² the skin of the forehead is drawn and dry; the ears become yellow, and the skin of that part called mirach is dry and wrinkled. Mirach is the membrane that lies outside siphac on the belly, with siphac within, the which separates the nutritive organs from those of generation, and the intestines are contained therein. The pulse is stretched like a cord, weak and rapid, and the urine like oil.

Item ¹³³ the bodies called crimnodes are present in the urine from the burning of blood and flesh, in the first form of hectica, and also in its combination with the second form. The bodies come like scales from the surface of the strong members, but the bodies like bran from their centre, which is a sign of the third form of hectica, and these are the worst therein: and the smaller they are, the worse; for then they come from the strongest members. If the bodies called crimnodes should come from one member only, then the bigger they are the worse; and so Egidius was not right in saying that the bodies called crimnodes signified the third form of hectica. Sometimes the bodies like bran come from the bladder, ¹³⁴ then the urine is a good colour; and at other times should they come from the whole body, as in hectica, then it is evil-coloured.

Crimnodes are fat particles ¹³⁵ like wheat broken large or badly ground. When there is fat in the urine, if it come from the whole body, and appear slowly, it will be like a fishing net, in the first form of hectic fever. If it come suddenly, it comes from the kidneys, and the colour of fever will not be on the urine. If the sediment ¹³⁶ be as thick as a spider's web, it is a sign of the second form of hectic fever, and if it be like oil it typifies the third form. For Averroes says, it is seldom this fever comes except after the fever called ephemera; save in bodies predisposed to it, or else after a putrid fever. Therefore it is necessary to know what are the signs of the combining of this fever i.e. ephemera with hectic fever, ¹³⁷ and they are as follows: excess of vigour on the third day particularly as regards heat, as ephemera often begins to decrease after twelve hours, and when it goes beyond twelve hours with no signs of decreasing, but continues every day till the end of the third day, ¹³⁸ then it is hectic fever.

These are the signs of the combination of hectic fever with putrid fever: the urine and the faeces are fatty, and paroxysms ¹³⁹ come, accompanied by shrivelling of the skin, which remains hot and dry after the decrease of the fever and the paroxysms. Understand there is only one paroxysm ¹⁴⁰ in true hectic fever, in which are the four stages of disease. If true hectic fever come from an inflammatory imposthume ¹⁴¹ the pulse will be very rapid.

These are the signs of stasis in this fever: if hectic fever come, the nails bend and sharpen; the skin appears as  p.81 though there were dust thereon from sunburn, and dried mucus matter ¹⁴² from the eyes. The eyes are not opened because of the difficulty of raising the eyelids and the brows, but remain shut as though the patient were asleep. The nose becomes pinched, ¹⁴³ and the hair of the eyebrows grows long, the shoulders are drawn up, and then is the stasis of the second form of hectic fever; and when at the decrease the cartilages ¹⁴⁴ dissolve, then comes the third form of hectica. Item in the first form of hectic fever, the patient is better after a meal than before. In the second form, he is better before it. In the third form it is equal.

Prognostics of this fever which is called hectic. Note, it is easy to cure the first form of it after it is recognised, though its recognising is difficult. The diagnosis of the second form is easy, but its cure is difficult. And for no power in the worid can the third form be cured, ¹⁴⁵ for it is not possible to moisten the strong members, that is, especially, the spermatic, once they get dry. Item when the nails bend, and the hair falls, death will be near; and if diarrhoea come, the strength will collapse suddenly. A flux is almost always bad at the end of every long sickness; and if the calves swell, it is probable that the patient will die before the third day. When the palms are dry to the touch, and hot after food, the matter has turned to phthisis. Item if the appetite fail, and he is not able to take or swallow food, on account of the dryness of the gullet, and can only consume wet things, then death is near.

Item when hectic fever ¹⁴⁶ comes from the stomach,  p.83 Hali says it is curable: for when hiccup is produced by dryness of the same, it is likewise curable. And Galen says, the cause is the same when either hiccup or hectic fever is produced by dryness of the stomach, as ¹⁴⁷ hiccup is only an unreal spasmus of the stomach: and therefore when it comes from dryness of the nutritive juices, it is curable. The same is true in hectic fever arising from the stomach in the first form; nevertheless, when hiccup or cramp arises from inanition of the spermatic juice, it is incurable; this is not the case in the stomach, except it suffer consumption or labour (?), as in the case of hectic fever and phthisis patients.

The cure of this fever is accomplished first by cold moist things, and by cold wet foods; then by electuaries; then by baths; then unguents; and then by regimen of food and drink; and after that by things ¹⁴⁸ that correct the air, and through the cure of the accidents. These are the cold wet thin things: food and medicaments. These are the medicines: common syrups, syrup of water rue, syrup of roses, and of violets. If it be accompanied by putrid ¹⁴⁹ fever, then a vinegar syrup is good, and simple and compound oxymel. ¹⁵⁰

Item make this drink for hectic fever patients.

Take a portion of water rue roots; a fistful of each of these: andivia, liverwort, bear's-foot, and water rue (?). If inflammation of the liver or putrid fever follow, take half a fistful of scariole, dandelion and chicory; and unless the sick man suffer from a loathing of food ¹⁵¹, it is good to give a handful and a half of violets and lettuce. Since sleep greatly moistens sufferers from hectica, lettuce seed ¹⁵² is good, and lactuca therein, and lactuca itself, and white poppy seed, and coltsfoot; and the four large cold seeds, ½ ounce of each of these things, and 1/4 lb. figs; ½ quart of almonds; an ounce of roses if the stomach be too hot; ounceii of sanders, red and white, if the liver be too hot; ouncei of calcined ivory turnings if the heart be too hot, and ½ ounce of camphor. Flowers of water rue and violets are advantageous here; if he have constipation ¹⁵³, and give ½ quart of each of these and ½ ounce of cassia fistula, if it be the first form of hectic fever, and a quarter of licorice, and a pound of cleaned barley, if the lungs be too hot. A pound or two of sugar, ¹⁵⁴ or more according to the means of the patient; though the more sugar there is in it, the better. Make him this syrup, with well water or rain water or barley water, on a slow fire without smoke, to be taken at bedward, or on rising. If the stomach be cold, and the season winter, give it tepid, and if not give it cold, but not so in other fevers, as the heat is in the solid members here. Item this syrup is good for sufferers from hectic fever, and phthisis, and the cough; and for those recovering from some other long hot sickness, and especially for those who indulge in an excess of sexual intercourse and study, ¹⁵⁵ and therefore I call it “the Golden Syrup”.

The following are the thin foods ¹⁵⁶ that cure: barley water, filtered tisane, white wine, watery and sweet-tasting; broth of capons and hens; milk, barley or oaten sowens unflltered, cullis, ¹⁵⁷ and water of meat. These things are good here, for Galen says that it is easier for a man to fill himself with drink than with food, ¹⁵⁸ and this should be understood of thin food, or of fat, as the digestion in these is weak. (And) Averroes says, tisane is the best food for folk who have a warm dry complexion to take after bathing, if the weather be warm and dry, because it cools, moistens, and helps the expulsion of excess in every weather, and in every way. I say likewise, a hot, dry complexion is accidental here. And if you say there is no excess matter in this case, because it is not a material sickness, then I reply that superfluities are generated therein, through the excessive weakness of force, or the want of digestion, though they be scarce and not the matter of this disease. ¹⁵⁹

The tisane should be made of barley thus: let it be cleaned and boiled until it is broken up, and then strain it, or else put barley in a glass vessel ¹⁶⁰ full of water, and boil it without smoke. Some people put the following quantity in: 3 ¹⁶¹ lbs. barley, and 6 lbs of water, others put in 20 ¹⁶² lbs. of water, but there is nothing in it but that it must be boiled down to 2 lb.

And Averroes says, wine is good for sufferers from hectic fever, watery white wine, sweet-smelling, and every other watery wine, along with barley water, provided that it  p.89 be drunk after the digestion of the food. It will give greater relief than syrup, ¹⁶³ for the wine prevents the food from swimming about in the stomach, disperses the flatulence, provokes the urine and the sweat; and helps nature to expel excess matter, when those who have this fever suffer from want of digestion, and especially when they suffer from want of sleep and worry. Avicenna says moist things do harm in hectic fever, as they are heating, and wine should be understood here, for it is wet. But Isidorus says, wine is wet as regards melancholy, and dry as regards phlegm. It is wet according to complexion, but since it provokes the sweat and the urine, it is easily turned to choler; therefore it is dry as regards virtue, and not as regards material dominion, ¹⁶⁴ wherein it is wetter, nor as regards formal dominion, wherein it is drier; as is said, for example, that it is wet in substance, i.e. thin, or otherwise that it moistens according to its substance (substantially) because it is easily converted to red blood; nevertheless since it is dry, it is not good here, except thin watery wine taken seldom and in small quantities when the force is weak.

Bernard says ¹⁶⁵, note that new wine is hot in the first degree, old wine hot in the third degree, and medium wine in the second degree. Old wine is good {⬌} as a remedy only; ¹⁶⁶ and new wine is neither good as food nor as a remedy; but medium wine is good as food, and drink, and remedy. Wine is good for hot people, for it purges them; and for moist people, for it moderates the moisture and ripens it; and for cold people, for it brings them to moderation; and it is good for  p.91 dry people, as it moistens and cheers them. According to this it is good for every complexion — that is, good wine.

It is not good for every age as it is only adding fire to fire to give it to youths, according to Avicenna; and as much as it comforts the old, so much also it injures the young. Galen[?] says, if wine be drunk in moderation when it is required, it comforts the natural and animal forces, and gives good cheer and confidence. However much it gives relief if taken in moderation, it does still more harm if taken immoderately, for if the stomach be choleric, it turns it to choler; and if cold, it turns it to acidity and causes paralysis and cramp; and he who has a weak head gets drunk easily. Drunkenness comes from weakness of the brain, or excessive strength of the wine, or emptiness of the stomach, or from its being full of humours; therefore it is a rule that it is not right to drink wine without eating something first.

It is not proper for a man who has a weak head to drink wine, except a little with water; so anyone who is at a feast, or drinking with friends, if he cannot keep his head, let him eat pears or the stalks (?) of cabbage, or its seed after his meal. If ill hap cause him to get drunk, as he will notice first by his tongue stumbling, let him get up and vomit. If it be a man, wash his extremities and rub them and his testicles with salt; and if a woman, wash her extremities and her breasts; let water be dashed on the face, and rub the head with rose water, and let him be a day and a night without food or drink. On the following day, let him do work and bathe, and let him eat something late, avoiding things hard to digest: and I say  p.93 it is not seemly for a Christian to get drunk with his own knowledge. For though there come vomiting and sweat thereafter, yet it is very dangerous to vomit, for fear lest he fall into epilepsy, or apoplexy, or in the case of a woman, suffocatio hysterica. So there is many a way that is better than this of purging the body, and it is all against God and reason.

Let those of hot complexion drink white wine, thin, and tempered with water, for there are no comforts in wine but for moderate or cold bodies; and let no one drink wine after coition or heavy work, unless he take a rest thereafter, or unless he eat something that will bring comfort to the stomach.

Note, thin ¹⁶⁷ food is the remedy that avails most in this sickness, e.g. milk, according to Averroes. The best milk here is firstly breast milk, then ass's milk, then goat's milk, and then cow's milk, and it were better the butter be taken off it. When putrid fever is joined to hectic, Galen says, milk is no use then, for it is easy to corrupt milk, and sperm, and blood. ¹⁶⁸ He (Galen) says, indeed, sperm is not out of the vessels an hour, or a moment, till it is corrupted.

The milk should be drunk from the breast by sucking, and if this be loathsome to the patient, let him take it as hot as possible. ¹⁶⁹ Take a vessel full of hot water, and put another vessel washed with hot water on top of it, and milk the milk into the latter; let it be drunk in haste, and it should be taken fasting, as much thereof as a man will be expected  p.95 to digest, because it turns to curds easily in the stomach, and then it is nothing but poison. Therefore it is best only to give a little of it at first, and increase it by degrees until it reaches a pound, according to Averroes. Otherwise bring it to the boil, and add a little water, and honey, and salt, or else add mint, or its juice, and quench red hot river stones or hot iron therein, and thereby so much the longer it will be without corruption; it will not curdle, ¹⁷⁰ and so much the quicker will it leave the stomach; if it curdle, that will be known by the pulse, which is then weak and tight; if it does not curdle, then the pulse is strong and full, according to Galen. He says it is recognised by the smallness of the belly, that the milk is digested, and if it be ass's milk it is longer in curdling there. He teaches that the ass should be fattened with barley and lettuce and the like.

Note, these are the best broths in this sickness: broth of beef, chicken, capon, mutton (ram's meat), soup of cabbage and peas. These are good for those who have hectic fever, or whatever fever they have, except ague (sharp trembling). ¹⁷¹ And note, though people say that meat water and broth ¹⁷² are the same, yet that is not true. Meat water consists in cutting the meat fine, and boiling it, bruising it and squeezing and extracting the juice therefrom: it is generally known what  p.97 the broth of meat is ... (?) Do not give soup of cabbage or peas in this fever if there be flux.

Two remedies are ordered here, called ordeatum and avenatum; one made from barley and one from oats. To make ordeatum, take the husks off the barley, and wash it well in frequent changes of water, and boil it as long as you would boil beef. ¹⁷³ Then bruise it well in a mortar, and add almond milk to it, strain it through a cloth, and boil till it begins to thicken; it is improved by boiling meat with it. In the same way avenatum ¹⁷⁴ proper is made, the which is naught but a kind of pottage, of oatmeal along with water and meat, and that forms the gruel that the English make with gross oatmeal and water and meat, which is a good thin pottage with ale. It is good for hectic patients and people going into a decline, and for almost all people.

An electuary ¹⁷⁵ is good in these fevers, early, called violet sugar {⬌} rose sugar, given after a meal and made as follows: ℞ 1 lb. of sugar; drachm i ¹⁷⁶ of pearls; and drachm i t of white and red coral; make a powder of them, and mix with sugar of roses, to be taken with rosewater. Give this electuary at bedward ¹⁷⁷ and on rising: ℞ ounce ii of each of these: diatragacanthum frigidum, diapenidii frigidi without cinnamon. Mix them well and drink with barley water. If putrid fever ¹⁷⁸ be combined with hectica, rosata novella is good {⬌} in the first form of the combination of putrida  p.99 with hectica. If possible let a little blood then, because we ¹⁷⁹ ought to check the putrid matter first, as it kills a man quickest, and here diatriosant: and diarrhodon abatis are advantageous.

Understand, unless putrida be in conjunction, or there be an imposthume on the intestines, or the sick man have a cough, a bath is good in this fever twice a day, after the food is digested, if he be used to it; ¹⁸⁰ but it should only be tepid, because heat resolves and heats and purges, and therefore it is no use in this non-material ¹⁸¹ fever. He should also not be in the bath so long that he sweat ¹⁸² therein, but cold water should be poured on him at once, or else sprinkled, so that it hurt him not. A bath of tepid or hot water does not avail them for the purging of their bodies, so that they might endure cold ¹⁸³ water at the end of the bath, according to Galen.

Averroes says cold water is best therein, if he be able to endure it with equanimity, and rub the extremities and the spinal column afterwards with oils, compounded of oil of violets, and water rue, or of roses or some styptic thing in which is some cold, ¹⁸⁴ in order to retain the moisture of the bath inside. Let him be dried then with a soft linen cloth, and put to bed with cloths ¹⁸⁵ round him; then give milk as before mentioned. When that is digested, bathe him again as before mentioned. When that is digested, bathe him again as before, and put him and put him in an empty ¹⁸⁶ dwelling, lonely and sweet-smelling, in which is little air, and thereafter open the windows to cool the air,  p.101 for the air should be tempered ¹⁸⁷ where he has no clothes on, while he goes into the bath. Let there be a cold bright cloth in sight of his bed, on which is sprinkled rose water, after the bath and the unguents. Have a vessel full of cold water in which are sally leaves and rose and vine leaves near to his bed, and spread sally leaves round it, gathered before sunrise, whereon rose water ¹⁸⁸ is sprinkled, and let him sleep after eating. If the weather be hot, ¹⁸⁹ let the air be cooled by water violently shaken, raised up in a vessel, and let down again into a vessel that is low.

If it come from the stomach, or the chest, or the kidneys, or the intestine called jejunum, the evil complexion spreads throughout the whole body. If from the heart, give cold cordials, such as roses, camphor, flowers of water rue, bone of stag's heart and the like. If it be caused by an imposthume, let it be cured as before mentioned. ¹⁹⁰ If from heat of the liver, or from the midriff, the lungs, the womb, or the intestine called colon, or the veins called meseraie, then allay the matter whence it came first.

The following is the most appropriate and best bath here, a bath of warm milk, ¹⁹¹ and as it would be too costly for poor people, let them boil three gallons, or four of new milk, soak a sheet folded in three therein, and before it begins to cool, put it about the sick man. Have milk slightly heated, at hand ¹⁹² to pour on him for fear of his being injured by cold, and dry him  p.103 thereafter with a fine linen cloth. This is good for everyone who is in consumption, unless ¹⁹³ fever or an imposthume be present.

Note, the cold of milk does less harm to the body than the cold of water, though cold of any kind is harmful to sufferers from hectic fever, according to Galen, on account of their leanness; and as he says, no cold thing gives help without harm; ¹⁹⁴ therefore give cold things in the best order possible. Item take a large number of yolks of eggs, mix them well with new milk, and make a bath of them; it is not necessary to rub in unguents after this, as the yolks keep in the moisture of the milk.

The following plasters ¹⁹⁵ are good for the stomach, the liver, and the warm dry members: rose, mastych, sanders, and wax for the stomach; hepatica, mastych, lignum aloes, and calcined ivory ¹⁹⁶ for the liver. These are the juices ¹⁹⁷ that are good for them: juice of houseleek, liverwort, sorrel, coltsfoot, lettuce, endive, plantago, and flour of barley meal; or put the substance of these in a linen cloth, and apply them to the part in which is heat, and it should be frequently ¹⁹⁸ changed; and if you do not this (frequent changing), it will do harm.

This is the nourishment (diet) that is ordered them: milk to be drunk as aforesaid; a bath to be taken after digesting food, and let him eat a little easily-digested food with moist substance ¹⁹⁹. On digesting this he should bathe, and be anointed as above.

These are the meats best in this case: chickens ²⁰⁰ fattened on wheat, and yolks of eggs are good here, and a custard ²⁰¹ made of them with a little wine. Capons are good fattened on wheat; partridges, and pheasants, ²⁰² and lean pork. Averroes says, the latter is most nourishing, but only give a little of it, well pounded and well chewed. ²⁰³ Give especially the meat of the back, a little of which is good along with bread.

Item take barley or wheat, and boil it well in milk, or water, with many snails, ²⁰⁴ and feed the hens thereon; in this way they are good for lean people, as they fatten them. Item fatten a capon on the flowers of a tree that bears fruit in the first month ²⁰⁵ of summer; the which is good for sufferers from hectica. Item make small portions ²⁰⁶ of figs, and give to the hens to fatten them. Piglings ²⁰⁷ and flesh of kids roasted, can also be given in this sickness, on taking off the hard, outer parts (crackling) that are on them; and flesh of lambs and kids ²⁰⁸ is good here; and I do not say to give meat to them, except that which has been mentioned hitherto.

These are the herbs that are good for their pottage: liverwort, mallows, violets, lettuce, patience, but lettuce is specially good for sufferers from hectic fever, as they need it to make them sleep. As their powers are weak and they cannot eat much at a time, their food should be divided, and a little given often. The fish that is best for them is freshwater fish, on which are scales.

The best bread for them is bread of barley and wheat mixed; ²⁰⁹ and add a little salt to it, and wash it in water or wine before it is eaten. Let it not be so new that it be hot. ²¹⁰ It may be soaked in new milk, in which way it forms a good food, and very fattening. Let him not eat marrow or brains. ²¹¹ Nevertheless an ointment may be made and rubbed on the chest and joints of marrow of deer and calves, mixed with unsalted butter, fresh pig's lard, and that of hens; and add a little wax and gum arabic. This is very good, if hectic fever come from the midriff. ²¹²

These are the symptoms thereof, delirium (want of sense ²¹³) and shortness of breath; for in the delirium that is caused by the midriff, the breathing is short and quick, and in that that comes from the brain there is no great harm to the breathing, but rather to the eyes and nose, and drops of blood drip from them. Galen says, if this fever come from the midriff, the breathing ²¹⁴ is now too short, now too long, and now too slow, and sometimes when he breathes in ²¹⁵ the air, he has to draw in twice and do the same to expel it.

Item in this sickness the following are good: maidenhair, mint, pollitricum, together with liquorice and mallow flowers, also roses along with the large, cold seeds, and sugar. Rub salt and vinegar to his veins and feet, and wash them with sally and vine leaves. A laxative clyster is good in hectic fever, of violet oil and salt. Rub violet oil round the midriff,  p.109 and soak a linen cloth in cold juices and lay it thereon. It is not meet to cool that part too much, lest it provoke the cough. Put lettuce, poppy and coriander in their food. Cold air, produced naturally or artificially, is useful here, and is all but sufficient cure. In all hectic fevers where a man cannot take food, it is good to give a clyster made of cullis of chickens and capons, together with beef-tea, as ²¹⁶ the attractive force draws away from the navel. This is clear in pregnancy; that is, it draws back (?) in the intestine called jejunum, for the clyster goes so far, and not beyond, except by violence.

Concerning the accidents ²¹⁷ that come in this fever, understand that flux is dangerous in this case, as also in phthisis and dropsy. If it occur, give sugar of roses, red coral and pearls, together with mastych. Item take two handfuls of each of the following: plantago, ribwort, and shepherd's purse; ouncei of roses, and 3 handfuls of lettuce, and parched barley and make a drink thereof with water wherein is quenched red hot iron, together with sugar. Item it is possible to give a pottage of ram's flesh, and almond milk, and plantago, and liverwort, and cabbage leaves boiled in water and squeezed out.

Item take small white pullets, for those are the coldest, and feed them on barley boiled in sumach and violets: let him drink the broth of these birds and eat their substance. ²¹⁸ Item if the sick man suffer from heat or burning along with the flux, let him take pills made of camphor along  p.111 with rose water, or plantago ²¹⁹, as follows: ℞ drachm i burnt ivory; drachm i of armenian bole; drachm iii of roses, and drachm ii of coltsfoot; and make pills of them, with poppy juice, or that of plantago; add drachm ii of camphor, and red coral. Item in this flux, milk is good, wherein are quenched river stones, heated red-hot two or three times, unless putrid fever be present; nevertheless, sufferers from hectic fever ought only to take milk before food. It is meet for them to use it from the beginning of spring to the end of summer, and though it is good for them at other times, yet not as good as then.

Here it is to be noted that an astringent bath is good for them, and Averroes says it is in the decrease of flux that it avails, and not in the static condition, as it would draw the matter of the disease all over the body. This bath is good here: take young cats ²²⁰, cut their entrails out, and put their extremities with cold wet herbs, such as rose, willow, and vine leaves, and lettuce. Add plantago by reason of the flux, and ribwort, tartary, ²²¹ and leaves of the pear tree or oak, and boil them together in water, and bathe the sick man in it, as often as you wish, since it is not a material sickness, unless an imposthume, or putrid fever, be joined thereto, or raw humours, or corruption.

Regarding the hectic fever that comes from old age, following the consumption of the strong close members; note, it is found in old people and cold consumptive people, ²²² and dry people and melancholics and young people; and honey and milk avail for the most part. However, Galen says honey does great harm to those who have hectic fever resulting  p.113 from old age, and he says he saw himself an old man ²²³ of a hundred years, and the food he would take oftenest was goat's milk, and sometimes he would eat a little bread, and other times he would mix it with honey, and boil it with bread or blackberries or mint.

It ²²⁴ is asked whether milk is good for old people, and it is certain that it is not; for hot moist things are best for the old. Galen says milk is cold, and therefore is not suitabie for them. Item milk is among the foods which corrupt easiest, for it is a susceptible thing; and such is not suitable for old people; and therefore it is found that it is not right to give it to them.

There are three substances in milk: curds, whey, and butter; and that is not suitable when the strength is weak, as in the case of old people; therefore milk is not good for them. Galen is against this in his book concerning the maintaining of health. I say, according to the intellect of Galen and his mind, that milk is good for old people, and there have been people who lived a hundred years on milk as food; though it is necessary to digest it well in the stomach, without letting it form curds nor turn to windiness nor cause oppilations, hence it is not good for those who have narrow veins naturally unless salt and honey be mixed with it, that it form not curds nor oppilations nor turn to windiness and in this way it is good, for it is easy to digest, and penetrates easily and agrees, though it is not easy to eat anything else after it, till it be digested.

Regarding his first reason, when he says milk is cold, I say that there are two cold parts in milk and one hot; namely, the butter, which is more nutritive in that way, than when it is separated from it, for the whey helps it to penetrate; and the curd  p.115 stimulates the strength when it is not separated, though the danger is that it curdle in the stomach. If this be prevented, it is good, for it is hot as regards the butter, though the other two parts be cold. I say regarding the other two, that they can be saved from corruption by salt after it has been put into the body on digesting it well; for it is not good any other way. This is soon recognised by the weight, the contortions (?) and the like. With regard to the third reason, I say that there are not three substances actually present in milk, but only theoretically and potentially (i.e. in latency); and it is all the better for this, as the whey helps to penetrate before the butter, and clears the passage of urine and faeces; while the curd is present in latency ²²⁵, and helps the weak members.

Gaddesden says milk is not good for all old people, but only for those who can sleep and digest it well, and who do not feel any pain in the sides, ²²⁶ especially the right side; whose veins are wide, and who do not suffer from sour eructations or flatulence after it. Give sweet-tasting milk to them, from an animal pastured in a good meadow. ²²⁷

The following herbs are good for them: woodbine, parsley, mallows, endives, smallage, yellow-flag, not kail; ²²⁸ and fresh meat is good for them; and they should eat dried figs, ginger and cassia, ²²⁹ as these purge them well; kneaded ²³⁰ bread,  p.117 boiled well with honey or wine, is good for them; also a bath of sweet water and wine, as it moistens them well. Also moderate exercise and sleep, for Galen says, they suffer much from want of sleep, hence they should get lettuce, cinnamon, nutmeg, ginger, spikenard, and lignum aloes. Wine, new or old, is not good, but only medium wine, and let them drink plenty of it; for Galen says, to give wine to youths is naught but adding fire to fire when the fuel is weak ²³¹: and he says to give it in moderation to young folk, but to the old as much as they wish, unless the head and the nerves be weak. Those whose veins are wide should take milk along with honey and salt, and dried figs with nettle seeds the first day: good claret helps them, made from sweet-smelling spices; ²³² and let them avoid blood-letting and coition, or too much of the same, or meditation or cogitation, ²³³ though occasionally anger suits them well, as it heats them; but in moderation. Galen says no man ever died of it; and neither depression, ²³⁴ nor repression, nor work is good for them, except a little, but instead of the work let them take a bath.

If you say wine helps them, therefore milk does not, because preservation is brought about by likes, not by contraries ²³⁵; then I say it is proper to preserve healthy people in health and rule them by their likes, but old folk are not well except with complaining. Galen says they should be called neutral, and therefore they should be kept on moderate things, in which is some heat and some moisture.

Item a laxative clyster is good for them, of oil of  p.119 violets or common oil, in order that the bowels may be kept relaxed, and if necessary give a little senna, as it is good for the sight. Item if fattening ²³⁶ be desired, take pitch and soften it between your fingers beside the fire, and apply it to the sufferer after bathing, and change it often, the which draws the blood to the surface of the skin. The bath that is desired for fattening, should be taken after food, before the digestion is complete, unless the closing of the veins or an imposthume be feared. In that case, let them be rubbed with oil of roses or lilies, and again apply the pitch, and repeat often; otherwise let the body be slapped frequently with little rods, ²³⁷ and apply a poultice of pitch; and it is right to do this in order to fatten the members that have gone to wasting: and both the bath and the emplaister should be local. Note that vinegar is not suitable for lean old men to take, nor any acid things, as they reduce flesh. In the same way winelees, which people take often as a laxative, and old people should only take a little, as they are but lights ready for extinguishing. ²³⁸

Item Galen says, boiled ²³⁹ onions are good for them, and garlic, if they be used to it, and make them a sauce of ginger, mustard, and cinnamon, anise, cucumber, mint, parsley, mace, cloves, and the like; or this sauce: mint, parsley, sage, dittany and pellitory; and this is good against cold, and flatulence of the stomach, its weakness, and that of the intestines: if he suffer from hiccup, let him use anetho, and let him hold his breath, and let hot things be applied to the stomach, as for instance, ²⁴⁰ a hot hand, a hot pillow, or a hot plate {⬌}.

Cardiaca is a tremulous movement of the heart, praeter naturam which is caused by fear, or compression, or depression. ²⁴² The cardiaca that is called syncope is a movement ²⁴³ whereby motion and sensation are removed from the body for the greater part, through weakness of the heart; and syncope is synonymous with little death.

There are two causes of cardiaca, an internal, and an external. The following are the external causes: excess of heat that comes suddenly, or excess of cold, or excessive weakness of nature, such as excess of sweat; a bath made of rotten wood ²⁴⁴ as Galen says, and everything that causes nature to collapse suddenly; coitus superfluus, accidents of the soul, and everything that disperses the heat suddenly from the heart, and drives unnatural heat in suddenly to it. Poison, on being taken, has the same effect, and the bite of a poisonous reptile, ²⁴⁵ and everything that weakens the heart and its force; worms, and excess of food and drink; pestilential air, and bad time of plague, intercourse with a woman suffering from lepra, and too much meditation. ²⁴⁶

These are the internal causes: ²⁴⁷ diseases which have affinity  p.123 with the medial members, such as the heart; and therefore cardiaca comes from diseases of the brain, such as the falling sickness and apoplexy. It also comes from diseases of the stomach, such as distension and exhaustion, and stomach ache, for Galen says, the mouth of the stomach is more sensitive than any other member; and colica and iliaca have the same result. The same is true of every flux, whether it be diarrhoea; haemorrhage, either haemorrhoidal or catamenial; or sweat, if it be excessive.

Item the same effect is caused by anything that drives bad vapour to the heart, such as worms; ²⁴⁸ matrix in qua retinentur menstrua corrupta; corrupt humours in the liver, or the spleen; and it is produced by the clogging of the pores and the passages; through excessive heat of the heart, and thinness, or heat, or cold of the humours; and through excessive pains of the teeth, the head, or any other part of the body; or through ulcers, imposthumes and pus; and because of sickness that comes from ²⁴⁹ aches of the teeth, or nerves.

Galen gives manifest causes for this disease, such as diarrhoea, haemorrhage, weakness, hectic fever, and long sickness, for then the weakness is great and consumes the spirits, as those recovering from a long sickness have but little blood and heat and spirit in them, and natural heat. Therefore the heart is weak, and when a burden is put on anything weak, it trembles suddenly, and is very unsteady (?) ²⁵⁰ because of it.

For Avicenna says that the spirit is the root and the heart the branch, and when the fundament is injured, every instrument that comes from it is injured; but there is a  p.125 doubt, is it the spirit that is the root of the heart? It has been affirmed that it is not, for the spirit is engendered in the heart.

Avicenna says the heart is the prime (earliest) ²⁵¹ thing in the body, and the spirit whence it comes; therefore it is the heart that is the root, and the spirit the branch. Item the heart can be, although the spirit is not, ²⁵² prior to the existence of the spirit, for it is said in Prognostica that it is into the heart life comes first, and goes from it last; therefore the heart is the root of the spirit.

Avicenna is against this, when he says the spirit is root, and the heartis branch. Galen is against this in Prognostica, where he says the body ²⁵³ is compounded of the carrier, and the carried; the spirit or the force is the carrier, and the body the carried; and therefore the spirit is the root.

We say in this connection, that “spirit” can be understood in two ways, one with regard to the natural heat, and the other with regard to the vapour that is subtler than it. For there are two vapours in the heart: the denser vapour, that is ²⁵⁴ the natural heat, and the vapour that is subtler and hotter, which is the spirit, and it is of this that Galen speaks in Prognostica.

I say, as Isidorus says, that there are two lives: the life called nutritive, and the life called sensory. ²⁵⁵ Taking the spirit as the life force, it is said that it is the first instrument of the soul. And thus Galen says that the body consists of that which carries, and that which is carried. The force is the carrier or  p.127 the active spirit along with the force which it carries; therefore I say, the body is heavier dead than living, because of the loss of the spirit that carries and lightens it. In the same way Galen says there is erective force in the body of a man standing, for if there were not, he would fall. This is clear in the case of weak people, for through the weakness of their erective force, they cannot remain standing. He says in like wise, of the bird which when flying through the air lingers hovering by virtue of that spirit, for Avicenna says, the spirit is the carrier of the force. Having regard to these facts, we say the spirit maintains and is root, and the heart is branch.

Heart is taken in two ways: one improperly, ²⁵⁶ of the lump of flesh from which the heart proper is generated. The shape of this mass is as is the shape of a cone, a little before the soul is put in. Heart is taken properly after it has been formed in such wise, on the addition of the soul, and according to the former mode the heart is prior quoad generari to the other members of the body; but not prior quoad generatum esse, by priority of time but only by priority of nature. However, it is prior by priority of time to those other members that are required for the well-being of the body such as arms and legs. ²⁵⁷

Or it could be said, the force is in the spirit as in the root, ²⁵⁸ and in the body of the heart as in the branch, and therefore the heart is a branch of the force, for it is from the force heart is said to be heart. But spirit is spirit as long as that ²⁵⁹ vapour lasts which is called the spirit according to Galen, that is, the temperate vapour, and this statement is not amiss; ²⁶⁰ but taking the spirit as brother to the natural heat, as Damascenus says, it only lives as long as the man lives, for it then grows cold, and the natural heat corrupts, and putrescent vapour takes its place. Or I say, the spirit is the root which forms the heart and the heart is comforting branch, for when it (the spirit) helps the heart, the heart helps the members.

I say now as a first reply, ²⁶¹ that this spirit is generated in the heart, however it (the spirit) is the co-formative ²⁶² root of the instrument (i.e. the heart) coming with it (i.e. the spirit) in which it works, for it (the spirit) is generated in another place than the heart, if we mean to speak of the secondary and accidental generation, for instance the animal spirit in the head; for that takes to itself there the power on account of which it is called “animal” by which it sets in motion the animal forces which are called sensation and movement.

I reply secondly, ²⁶³ that it is into the heart that life comes soonest of all the constant members, although not of the fluid members, such as the spirit and the humours, according to Averroes. Or else I say they could come together, that is  p.131 to say, that the heart is prior as regards sovereignty, and that the spirit is prior as instrument, and is the root of the instruments ²⁶⁴ of the heart. If it be said that it is the work ²⁶⁵ of nourishing that is first used (?), and therefore the liver is prior, I answer that the liver is (merely) the first to exercise (?) the first (i.e. primary) function, and not (first) by priority of universal dominance ²⁶⁶ and dignity, for there the heart is prior, nevertheless as regards the priority of partial dominance, ²⁶⁷ the liver, the brain and the testicles are prior; that is, they are principal as regards dominance and superiority of office. There are many principal members, such as the stomach, and the lungs, for Galen says there are seven principal members, according to the number of the seven planets.

The external causes are known by the patients own indications. If cardiaca come from the defect ²⁶⁸ of another member, it is recognised by that sickness and its signs. If it come from the blood, ²⁶⁹ it will be recognised by those things, that are natural, unnatural or contrary to nature. If the urine be red and thick, the pulse undulating, the face red, and there be heat round the neck, ²⁷⁰ and the patient suffer extreme thirst, and he be young, liberal, ²⁷¹ and jolly, and favour foods that increase sanguine humour, then it is right to say the cardiaca comes from sanguine humour. If the urine be thin and yellow, the pulse rapid, accompanied by great heat, and the patient be used to hard work and running, and foods that engender  p.133 choler, then it is right to say the cardiaca comes from that humour.

If it come from phlegmatic humour, the urine will be thick, scant, the pulse irregular, ²⁷² and the patient somnolent, and if he be young, and it be winter time, the phlegmatic fluids will be seen to go to the heart, preventing its natural movement, and therefore it beats in an irregular and tremulous manner.

If the cardiaca come from melancholic humour, and the season be autumn, the patient will be low-spirited ²⁷³ and timorous, and it is not surprising that melancholics be fainthearted, for they bear the cause of fear in them, according to Galen; therefore it is seen to be caused by the melancholic vapours invading the heart. For Galen says the heart is noble ²⁷⁴ and deems it degrading to endure those loathsome vapours, and therefore it beats irregularly; and there is trembling in the head, ²⁷⁵ the hands and the feet whenever the force cannot control the matter or the member, ²⁷⁶ for it is a compound motion, as opposed to natural motion, for a limb to tremble.

If the cardiaca come from worms, it is worse before food than after, for whenever the patient begins to take food, the worms flee up before it. If it come from inanition, it is worse before food than after, and if from repletion it is worse after food. If it come from sudden flatulence, it will leave him suddenly; and if from heat, the pulse and the breathing are rapid and irregular; and if from cold, ²⁷⁷ the breathing is slow and irregular.

The following are the signs of the weakness of the heart, called syncope. The patient will have a slow, uneven pulse; the colour of the face changing; the eyes closed as if for sleep; and sweat round the neck. On seeing him thus, you may say the weakness called syncope is at hand.

There are three signs of the weakness called syncope, prognostica, demonstrativa and memorativa. These form the prognosis: trembling of the heart, the colour of the face changing to an unnatural hue, the pulse fluctuating to slowness, and cold of the extremities. These are the demonstrative symptoms of syncope: want of sensation and motion, and the hue of the face as of one dead. These are the symptoms as to memory: the things which recall and signify the internal and external causes already mentioned. If syncope come suddenly without external or internal cause, that is a sign then that it is caused by diseases proper to the heart itself, and this form is bad and is fatal. ²⁷⁸ The patient should be asked if he feel density or rarity of the heart, or heat or cold, and the causes can be recognised therefrom. If it come from poison, it is recognised by a bad taste in the mouth, and by other symptoms of poison. ²⁷⁹

If trembling of the heart continue long in this disease, it signifies death. ²⁸⁰ Item if a man suffer from continued tremor cordis in this illness, and syncope come suddenly, bleed him (?). When the evil complexion is excessive, it weakens the force, and the weakened force induces tremor, and tremor causes syncope, and syncope causes death.

Item if a man suffer prolonged syncope, and the hue of the face turn to the colour of ashes or green, or black, that is a sign of sudden death. Item when anyone has syncope,  p.137 if powder be put in (up) his nose to make him sneeze, and he does not sneeze, it is a sign that there is no manner of cure for him.

Item whether the imposthume of the heart be big or small, if it be big or if it be small, if it be cold or hot. ²⁸¹ If it be hot, it kills on the first day; if cold, on the second day; if small like a pimple, on the fourth day it causes nose-bleeding and kills. ²⁸²

Item accidental mental pain comes to the heart, weakening it, ²⁸³ such as depression, worry (mental oppression) or anger; but physical pain comes to it less; and if it come, he will not endure it long, for death intervenes before pain is confirmed in the heart.

Item if there be a wound in the heart, look whether it be in the right half or the left. If in the right half, whether it be big or small. If it is big, it kills forthwith; if it is small, it kills the first day. If in the left half, it kills the first day, or whatever time it comes, whether it be big or small. For Galen says, the split that is made in the heart is deadly undoubtedly; but not necessarily so a gash in the other organs, unless it be big; and he says (also), a split is not worse in the other organs, such as the lungs, for they are always in motion. ²⁸⁴

Item Avicenna says, the heart cannot suffer injury or imposthume, and he ²⁸⁵ says in the book De Animalibus, that the heart cannot endure heavy sickness. He  p.139 says on the other hand, the heart suffers syncope, i.e. “little death”, and it suffers imposthume, according to the reasoning of Avicenna, which is, that an imposthume can exist in every member; as everything that can be increased naturally by taking nutriment to itself, ²⁸⁶ can be increased unnaturally by excess of nourishment.

I say that the heart endures serious disease often, that is, it suffers it a short time, but not for long, as do the other members, for the heart does not suffer a heavy illness, except from a slight cause. ²⁸⁷ I say also, an imposthume can be on the heart, but it does not suffer it to be confirmed therein, for death comes without delay before the static period; and therefore, I say that pain seizes the heart for a time, but constant pain does not seize it; or it could be said that the heart suffers pain through “sympathy” with the other members, and the union (?) therewith, and not from its own proper disease. ²⁸⁸ It can be said that the heart does not contract an imposthume in its own substance, for if it did, its own function would be impeded, that is, life, and death would come. For Avicenna says, the heart contributes to every member, and does not receive from them. ²⁸⁹

Much is needed for the cure of this case. The first thing, is to comfort the heart, and then to digest the matter, then its evacuation, thereafter dieting and then particular treatment at the time of the paroxysm.

As to the first of these, understand that sweet-smelling things are meet in every case of tremor cordis. If the cause be hot, cold sweet-smelling things should be given, along with a few hot things: so that they may be the more penetrating. If the cause be cold, hot sweet-smelling things should be given, along with a few cold aromatics; unless the cause be too strong, ²⁹⁰ for in that case only contrary things should be given.

There are many {⬌} simples that are required for relieving the heart, and many compound things, and there are hot simples and cold simples and medium compounds. ²⁹¹ The following are the hot simples that relieve the heart: amber, i.e. the sperm of the whale, and storax, and calamint, lignum aloes, nutmeg, cinnamon, cloves, sweet-smelling wine, elecampane, saffron, melissa, mace and setwall.

The following are the cold simple cordials: rose, nenuphar, camphor, sorrel, vinegar, rose water, and coriander, sweet pears, peony, ²⁹² and sour milk, tisane, violets, coral, dandelion, ²⁹³ camphor, burnt ivory, tamarind, and silver.

The following are the temperate cordials: pure gold, and borage flowers, provided they make for heat, ²⁹⁴ also bugloss and its juice. The following are the temperate cordials, verging towards cold: ²⁹⁵ ivory turnings, bone of stag's heart and burnt silk, ²⁹⁶ although they incline to heat and dryness: they lit. it  p.143 can be taken thus, or raw; they lighten the sight if they are rubbed on the eyes, and refresh the memory, therefore it comforts the animal spirit, and the natural spirit also, as it fattens the body, and the life spirit, according to its property, as it illumines it.

These things are good in those two cases: coral, pure silver, ²⁹⁷ pearls, borage, bugloss, saffron, burnt ivory, melissa, lingua avis, spikenard, and lignum aloes. Of compound things, there are cold and hot; the following are the cold composites: syrup of roses, and of violets, and nenuphar; diatrionsantalon; sugar of roses, and of violets; and diadragacanthum frigidum. The following are the hot compound things: diamargariton, mithridatum, and rosata novilla. The following are the temperate composites: diaboraginatum, ²⁹⁸ diarrhodon abatis.

Give him my own electuary, ℞ drachm i ½ of cinnamon, and drachm i of each of these: spikenard, lignum aloes, sanders, anise, endive; drachm ½ of each of these: red roses, gariofil, cummin, and red sanders; a scruple of each of these: cardamomum, spodium, i.e. burnt ivory; drachm ½ of each of these: storax, calamint, borage flowers, bone of stag's heart, unbored pearls; and 1 lb. of sugar. Make this with two parts of honey and rose water and the third part of water of borage; and it is good in every weakness of the heart, whatever time it occurs; ²⁹⁹ and I have often proved its goodness myself.

Item in (cases of) weakness of the heart, drachm ii of juice of bugloss ³⁰⁰ is good regularly if the cause be cold; and it improves it to add gariofles. Item against syncope and palpitation of the heart give drachm i of gold filings; and drachm iv of these: been albi, and been rubri; drachmiii of red and white coral; drachm i of  p.145 pierced pearls; drachm ½ of bone of stag's heart; make a powder and use in food and drink. I do not know of a better cure than it for diseases of the heart, and it is called “Golden Powder”; and it is not known how often it has been approved in this case(?). ³⁰¹

Item lignum aloes is good, and good sweet-smelling wine, wherein lignum aloes is steeped for a time, and it should be given to drink in tremor cordis and syncope. The sign of trembling cardiaca is to put the hand on the left breast; and if there be tremor, then it is trembling cardiaca; and if not, it is syncope, which is called “little death”. Item bone of stag's heart is good along with good wine, in which has been put water of roses and bugloss,  ³⁰² and it avails in every kind of cardiaca, for it purges melancholy from the pericardium, and so comforts the heart.

Understand that a thing is said to comfort the force in five ways. ³⁰³ One by strengthening the spirits, and restoring them, as do sweet-smelling things. Another way by restoring the humours and strengthening them, as do wine and easily digestible foods. According to this, bread ³⁰⁴ soaked in wine or capon broth strengthens the force through nourishment. Another way, by increasing the natural heat, as do hot things. Another way, by contracting and uniting parts of the stomach and the heart moderately, as do styptics. So rose and other styptic things comfort internally and externally as emplaisters, for every force is stronger by union than by division. Another way, by evacuation of excess matter, as do laxatives; and so agaric is a cure that affects the heart, and myrobalanum, for  p.147 they purge the gross, melancholic, corrupt vapours of black bile from it. ³⁰⁵

So treacle is good against poison, for it helps the heart in fighting against it, that is, against a drink of poison, or the bite of a poisonous reptile ³⁰⁶ or of a mad dog. In the same way tormentil is good, along with a fatty broth or juice of bugloss, against every poison. The force can be comforted aiso by dilating the heart moderately, as does saffron, but it is not proper to give more than a little of it; for Avicenna says, if much of it is given, it kills him who takes it, by the excess of mirth it causes and incites. ³⁰⁷

Item let a powder be made of roses, lignum aloes, saffron and gariofles; and mix rose water with it, and soak a new linen shirt therein, and let the person who has the disease wear it, for it renews and comforts and vivifies the heart; and this is good for hectics, consumptives, melancholics, and other trist folk. ³⁰⁸ Understand that it is not proper to give a simple medicine in affections of the heart, unless some cordial be given with it.

The second thing mentioned is accomplished by the varying of digerents according to the changes of the peccant matter. If sanguine humour be responsible, ³⁰⁹ digest the matter with borage and bugloss, by making a syrup of them, and with syrup of roses, in which is put black sanders and camphor; and take their flowers, and put them in a linen bag. If choler be responsible, digest the matter with syrup of borage, bugloss, violets, and nenuphar to which is added sanders, and roses and camphor, and take the flowers of these herbs {⬌} ³¹⁰ after  p.149 putting them into a bag. If phlegm be responsible, digest it by syrup of borage and bugloss, and by oximel of squills, ³¹¹ in which is put nutmeg and marjoram; and let him smell ³¹² an apple made of the sperm of the whale, and lignum aloes, and nutmeg. If melancholy be responsible, digest it with syrup of borage and bugloss, and syrup of fumitory, and with oximel of squills in which is lignum aloes, and cinnamon, and gariofil.

If the matter come from flatulence, the member should be rubbed, and let the sick man take diagalanga, garyophyllatum, diacyminum; and avoid all things that cause flatulence, such as peas and beans and the like. If the matter come from worms, give ounceiii of juice of elecampane, along with juice of smallage, for these kill the worms, when given with vinegar syrup or sour milk; and cabbage seed and hemp seed do the same, and ounceiii of roots of elecampane kills them.

The third of the things we mentioned is fulfilled by laxatives, ³¹³ and things that purge the matter of the disease, and that bring comfort to the heart, according to their property; such are, in the case of sanguine humour: cassia fistola, violets, bugloss and borage flowers, to be given along with capon broth or whey of cow's milk after straining. A vein should be opened in this case, provided that it purge the cause, ³¹⁴ the heat, and the spirit; and though this causes greater weakness than any other purging, according to Galen, nevertheless it avails. This is how that should be understood: that purging by blood causes greater weakness than purging by any other medicament. ³¹⁵ Where he speaks of a vein, this  p.151 is how that should be understood: when a vein is let excessively it causes greater weakness than any other purging through medicine, for the vein purges every humour and the heat and the spirit, and no other purging does as much; neither is the spirit purged to the same extent by any other purging, except it be a remedy of poison which brings a man to syncope. ³¹⁶ It is of the purging that does not speak of (cause?) syncope ³¹⁷ and does not exhaust the force, that I speak. Indeed, no other purging causes the patient weakness as does letting a vein, because of the suddenness with which the blood comes out, and the heat and the spirit also. For in the other purgings, the humours, the heat and the force are purged more gradually, unless the retentive (?) force be impeded, ³¹⁸ or a laxative be given in excess.

If the matter come from choler, let it be purged with violet, tamarind and cassia fistula; for Avicenna says, tamarind comforts the heart in people of evil complexion with a tendency to choler, for it moderates the heat of choler, and cleanses it by the laxative power it has. In the same way, myrobalani comfort the heart when there is depression present or weakness from thinness of the blood. For Avicenna says, they cool according to complexion, and according to force they purge the burnt matter therein. Similarly rhubarb comforts the heart by relieving the liver first, as the heart is life to the liver, according to Aristotle. ³¹⁹ The following are the composites that purge choler: violet-sugar, diaprunus, ³²⁰ diarhabarbarum, and electuaries of juice of roses.

If the matter come from phlegm, let it be purged by agaric and turpeth, along with a little ginger, and give him a drachm or two with sweet-smelling wine. These are the compound things that purge phlegm: hiera picra Galeni, and hiera Logodion. If the matter come from melancholy, let it be purged with senna and polypody, and of the latter Avicenna says it rejoices the heart per accidens by drawing off melancholy ³²¹ from the brain, the heart and the whole body, but anise and cummin should be boiled therewith to overcome the flatulence. These are the compound things that purge it: diaboraginatum {⬌} ³²²

The fourth thing mentioned is accomplished by digestible foods, which easily turn to the nature of spirit; ³²³ and therefore Avicenna says, water of meat is good here, as it turns easily to the nature of spirit. And know, according to Avicenna, that the force is increased by wine, and subtle foods, and by sweet odour, by joy and tranquillity, and by avoiding depression and anger, and by rejoicing in pleasant things, and by remaining with friends. Therefore Constantine says, on the authority of Galen, that conversation between lovers and sages removes trouble from people, and from the interior members. ³²⁴

Item roasted chickens are good, larded and sprinkled with wine and syrup of roses, the wine to be sweet-smelling.

If the cause be cold, let him drink ³²⁵ it hot with gariofles; and if hot, let him take it cold; and if he can eat meat {⬌} ³²⁶

This is the nutriment that is good in the weakness called syncope, if the cause be hot: sour milk, when the butter has been taken off it, cold fish, sugar, ³²⁷ ripe (black)berries, good pears, and sweet-smelling apples. If the cause be cold give warm yolks of eggs, and a custard, ³²⁸ and meat, and eggs whipped up with milk, and saffron prepared with broth of capon, and beef. Squeeze the soup out of them then, and pour wine over it, the which food is very good.

Item roast chickens, partridges, or mutton, or pheasants, and put therein gariofles, and lard, and sprinkle rose water with sweet-smelling wine thereon; let the patient smell it for long; then bruise it well, and put in a linen cloth, and squeeze the juice out of it, heat it, and give to the sick man, and he will get great comfort therefrom.

Item give nutritious easily-digested foods to those who suffer from wasting of their flesh (consumptives), and give aromatics by degrees in small quantity; and give these sweet-smelling things upwards ³²⁹ to a woman suffering from syncope through suffocatio matricis, and give them downwards to the men who suffer from weakness. Give these nutritious and easily-digested foods to those who suffer from wasting of their flesh, and give a little of the sweet-smelling things by  p.157 degrees to them who are weakened by ³³⁰ inanition, not by repletion; for they err who give wine, and sweet-smelling things internally to people suffering from heart-weakness and loss of force through distention; so food should not be given in every weakness called syncope, for there is more need of purging by clysters and vomiting and abstinence, and to cure them by rubbing and by bandaging the extremities. ³³¹

The fifth thing mentioned is fulfilled by sneezing, and by rubbing ³³² the extremities, and by sweet-smelling things. Therefore when a man is in a paroxysm of this sickness, let a hen-feather soaked in strong vinegar be put up his nose; to compel him to sneeze, and it will check the paroxysm.

Item let rose water, or any other water, be poured suddenly about his face, the which avails in the paroxysm, although it does harm thereafter if it remain long on his body, as in the case of syncope caused by crude humours and by fear. ³³³ For that increases the crudity of the matter and keeps it and the spirit inside, and therefore the water shouid be poured on him suddenly and not be permitted to remain on him. Sometimes the water should be poured on gradually and allowed to remain, as in the case of syncope caused by joy, or by fiux; thereafter he should be made to vomit, and rub the nose ³³⁴ and shoulder-blades, and fumigate them, and the belly, ³³⁵ according to Galen. ³³⁶ Cold water avails poured suddenly in this case, because of the shock which excites the heat, but ³³⁷ it were better then to excite  p.159 it by rubbing and sweet odours. In a cold case, however, resulting from repletion, it is not good ³³⁸ to pour the water at first, but at the end, not on account of the complexion, but of the shock it gives. Then let sweet-smelling things be applied in this case, ³³⁹ such as sanders, violets, and nenuphar, placed in a linen cloth; but in a cold cause add lignum aloes and laudanum. If it come from phlegm, give alipta moschata, and rub the extremities, and especially when the matter comes from repletion. If the matter come from poison, give tormentil with wine or milk in it, or nuts with figs, and warm juice of milfoil. Put a broad stick between his teeth, and call him loudly by his proper name, ³⁴⁰ and give treacle to him, and diamargariton and wine.

In the case of trembling cardiaca, rubbing of the extremities and round the heart avails; and let him smell the following: ³⁴¹ ambergris, and roses, for cold things should be mixed with hot and dry here, so that they may last the longer, also hot things with cold, so that they may penetrate the easier. Let a linen cloth be soaked in rose water and put round the heart, ³⁴² and it will relieve it, and give mace and gariofles to cornfort it. A light bath is good in cardiaca or syncope.

If it come from flatulence, it is good to rub the extremities with a hot cloth, and to put reddened ³⁴³ oats round the stomach, and use dianthos (?) and diamasum, and let everything  p.161 that engenders flatulence be avoided, as peas and beans and hot bread. Hot bread ³⁴⁴ though is good on being soaked in wine, for it increases the force and the heat, and preserves a man from poison and from plague etc.

Galen says an imposthume is the same as a swelling according to the ancients ³⁴⁶ and nescoid in Gaelic is the same as apostema in Latin; apostema is the same as ‘a tumour after leaving its natural disposition. {Dicitur enim apostema a post & tumor .i. posterius tumor .i. tumor superveniens post dispositionem naturalem.}’ ([R. A. 943.]) And therefore it is called tumour, so that it might not be thought that the superfluous fat the body takes to itself because of nourishment of food and drink is imposthume.

Another doctor says apostema is the same as a swelling beyond nature. ³⁴⁷ Hali says apostema is a compound sickness, that comes from malice of the complexion, and quantity, and form. ³⁴⁸ Avicenna says apostema is a compound disease in which is found every kind of sickness, for a malicious complexion and composition are therein; and it errs ³⁴⁹ in its position and quantity, because of excess of malice and repletion (and) separating the parts one from another, ³⁵⁰ as an imposthume is never without malice of complexion, and composition, along with matter, i.e. peccant humour.

Constantine says that this is not true, for he says in the ninth book of Pantechnes that ‘a hot imposthume arises from malice of complexion, without peccant humour. {... quasdam phlegmonas nasci a mala complexione.}’ (8 Pantechnes cap. 12 [R. A. 944.]) I say  p.165 in this regard, as does Galen, that a hot imposthume ³⁵¹ may be understood in two ways; one of them regarding acute hot imposthumes, that are formed often by sanguine humour, and the other, because of excess of heat and burning; and it is thus Constantine understands it; for he says, a limb suffers heat and redness in this disease, as in fever.

And Constantine says on the eighth book of his Pantechnes, that apostema is the same as fatness or swelling, that a member suffers on account of excess of humours. And Galen says, regarding the fifth section Hippocrates wrote, that apostema is swelling and fatness beyond nature in bodies; ³⁵² therefore since unnatural swelling can be in every member, so also an imposthume can be in every member. And it is clear, according to Galen, that swelling in excess of nature can be in every member, for Avicenna says thus: every member that can be increased naturally by taking nourishment to itself, can be increased unnaturally and every member can be increased naturally by taking nourishment, because it is nourished; therefore it can also be increased unnaturally, (and) therefore, an imposthume can be in every member. ³⁵³

And Avicenna reasons in the same way with regard to the teeth and the bones; and regarding imposthumes of the brain called frenzy accordingly: ³⁵⁴ I grant that imposthumes can be on the brain, but Serapion says they can not, for it is a soft, wet, fluid member and so does not suffer matter to remain, ³⁵⁵ therefore imposthumes cannot be thereon.

To this we answer and say, there remain four things proper for an imposthume to form in a member: the first is the flowing of excess towards the member; the second the member absorbing it; the third its retention there; the  p.167 fourth fatness or swelling: ³⁵⁶ and of these the first three can be in the brain, but the fourth cannot occur there obviously, i.e. the swelling. Nevertheless I say Avicenna allows that imposthumes can be on the brain in its own substance, for it is a tough, earthy ³⁵⁷ member, and therefore it retains the matter of the imposthume; the which is true.

Still greater is the doubt as to whether an imposthume can be in the heart, for Avicenna says the heart does not suffer imposthume, and Hali says a man dies before the pain is confirmed in the heart. And I say with regard to that, that every imposthume is fatal in the substance of the heart, and therefore it does not suffer it to be stabilized therein, that is its stasis, for it is with regard to its stabilizing he says stasis, or the end of its increasing, because a man dies before he reaches the “static” period. ³⁵⁸

These are the causes ³⁵⁹ of imposthume: Firstly, matter flowing or being sent from one member to another. Secondly, excess of nourishment collecting in the same member.

The first of these is produced by six causes. First, the strength of the member that expels the matter, for Galen says, the strong members send their excess to the weak members, and the noble members to the ignoble. Second, the weakness of the evacuatory force in the member that receives the matter. Third, the quantity of the matter. Fourth, the width of the pores. Fifth, the want of nutritive force and power of ³⁶⁰ conversion in the member, to which the matter has been sent. Sixth, that the members ³⁶¹ which receive the matter are subject to the members that put it from them. Constantine puts these causes  p.169 in the eighth book of Pantechnes, and ³⁶² these two further causes may be added to them: — namely, the movement of the member to which the matter is sent, and its heat.  ³⁶³ For Galen says, it is easier to pour the matter to a member that moves and heats, than to other members; therefore the imposthumes that move and are caused by crisis are oftener formed in the joints, than in other places, because of the amount of movement and space therein.

The cause of imposthumes formed from excess of nutriment gathering in a member, ³⁶⁴ is the want of nutritive force in the member, that cannot digest perfectly the food that comes to it; and the excess matter grows gradually until it fills the member.

This is how an imposthume grows in a member when it comes from malice of complexion therein, or through excess that is sent to it from another member, stronger than itself; and it cannot expel or digest in itself: the excess remains in the member and forms an imposthume in the following manner; if sanguine humour  ³⁶⁵ or any other humour is drawn to the member in such quantity that it fills the veins entirely, then the veins are stout and full, like a vessel, and some of it flows from the pores to the space in the member surrounding it, which it fills, and separates the parts, forming the swelling there that is called imposthume.

There are six species of imposthumes in general ³⁶⁶ according to the matter ³⁶⁷ from which they are made, i.e. the four humours, wateriness and flatulence. From sanguine humour is formed the imposthume called phlegmon, i.e. great swelling; ³⁶⁸ and so there is a difference between it and the imposthume formed from choler, ³⁶⁹ for in that there is only a little swelling, and it is sharp without being broad. If therefore sanguine humour is strongest, phlegmon is its name, and if phlegm is strongest, a soft imposthume is generated there called zimia. ³⁷⁰

 ³⁷¹ If it be choler; the imposthume engendered is called erysipelas. If it be inflammatory melancholy that is strongest, the imposthume called cancer ulceratus is formed (at first?). If acid melancholic humour is strongest therein, then is formed the imposthume called sclerosis, that is a hard imposthume. If sanguine humour is strongest, the imposthume called carbuncle is formed, for it reddens like a coal of fire, the which is a compound imposthume.

Note that there are imposthumes both compound and simple, the latter from one humour only. Avicenna says: is the blood thick or thin? If it be thick, it forms an imposthume phlegmon, that affects the flesh and the skin together, accompanied by throbbing; if it be thin, it forms an imposthume that affects the skin only, without throbbing, and spina is its name. If it be formed from sanguine humour and choler, and sanguine humour be the stronger, there is  p.173 formed the imposthume called phlegmon, or erysipelas. If choler, then is formed that called erysipelas phlegmonides. ³⁷²

Avicenna also says that hot imposthumes are formed from choler ³⁷³ and that there is thin choler, thinner choler, and very thin choler. From thin choler, ³⁷⁴ the imposthume called formica corrosiva is formed; from thinner choler, that called formica miliaris, the which is more in the flesh than in the skin, and is like a big ant. From very thin choler is formed the imposthume called formica deambulativa.

Let us speak now of the cold imposthumes, and of the four things of which they are formed, i.e. of phlegm, and melancholy, flatulence, and wateriness. In the imposthumes formed by phlegm, some are made of thin phlegm along with a little choler, of such are (the) pimples that grow in the night, and they are called “daughters of the night”. ³⁷⁵ Others are formed of gross phlegm, ³⁷⁶ such as neck boils, and imposthumes of the armpit, and the groin, and of this kind are warts. Of medium phlegmatic humour is formed a soft imposthume, without pain. ³⁷⁷

From melancholic humour is formed sclerosis, that is a hard imposthume, and cancer, that is a canker, and glandules, that is imposthumes which are like acorns and which separate themselves from the member and are wrapped up in  p.175 skin; ³⁷⁸ and scrophulae ³⁷⁹ — they also adhere to the skin, and not to the member. The two other imposthumes mentioned, cancer and sclerosis, stabilize themselves in the substance of the member, and there is a difference between them, for sclerosis remains in the member without pain and hinders sensation, ³⁸⁰ while cancer is mobile and painful, and does not hinder sensation unless it be there too long, and kill the member.

These are the watery imposthumes, dropsy, hernia (i.e. the dipping), and sometimes there is a watery imposthume on the peritoneum. ³⁸¹

These are the imposthumes formed from windiness, that is one ³⁸² in which there is a swelling, as there were breath in it, and the flesh and the skin separate one from the other, and when it is seized, it so to speak gives with you: another imposthume called cachexy has windiness in it, in the substance of the member and when it is seized it does not give with you, but disperses through the pores.

And know ye, that the imposthumes formed from the four humours have four seasons, inception, increase, stasis, and decrease. ³⁸³ Inception, when the matter begins to move to the surface of the member and begins to increase. Increase, when it enlarges and swells. Stasis, when it remains and does not increase any more. Decrease, when it begins to diminish and ripen, and then turns to pus, or disperses without sensation, or becomes hard, for these are the four ³⁸⁴ ways in which imposthumes finish.

These are the signs whereby is recognised the matter from which the imposthumes arise; colour and pain and accompanying fever, speed or slowness of movement, the feel ³⁸⁵ when touched by finger or palm, as Hali says.

These are the signs of the imposthumes that are formed from sanguine humour, redness ³⁸⁶ and swelling round them, fulness of the veins, throbbing, flaccidity, and leaping. Averroes says the signs are red colour along with extreme heat, and great pain. These are the signs of the imposthumes that are formed from choler, the member becoming yellow, violent pain, and thinness of the humours; and of this kind is the imposthume called formica deambulativa. Symptoms of the imposthume formed from phlegm: the member white, without great pain even on pressure, and it is soft: and swollen with a broad base. Symptoms of the imposthume formed from melancholy; no great pain, colour black, dark and swarthy, earthy (?) and the veins round it are full of melancholic humour.

If the imposthume come from matter poured from member to member, ³⁸⁷ it comes suddenly, and if from excess of nourishment ³⁸⁸ in the member, it comes slowly, by degrees. If the imposthumes be compound, they will have compound signs, according to the humours of which they are formed. If sanguine humour be responsible, and be strongest therein, the colour of the imposthume will turn to dull red. ³⁸⁹ If choler dominate, it turns to bright red unless it become purulent. If salt phlegm be strongest therein, it will become white, with a kind of yellowness, because of the mixing of phlegm with choler, for choler is bright when it is not mixed with any other  p.179 humour: usually there is itching in the place wherein is salt phlegm. If melancholy be strongest, the colour is black and blue and heaviness, insensibility, and great hardness are present, for if there be sensation it would not be formed from pure melancholy. No imposthume is formed from pure melancholy, but from dense, black, earthy (melancholic) blood only, for Averroes assents that it does not cause fever unless it be mixed with phlegm, or red blood; therefore it does not form an imposthume, for the matter of both is the same. ³⁹⁰ And Isaac says in the treatise he himself wrote on the urine, if an imposthume were formed of corrupt burnt humours turning to the nature of poison, such as formica, carbuncle, anthrax, and noli me tangere, it will be evil-smelling, with pain and itch, a blue black colour, corruption and mortification of the member.

Note, imposthumes are generated in the internal members, as they are in the external, and some of them kill suddenly on account ³⁹¹ of the nobility of the humours, and the members and the violence of the fever and the pain; such are diseases of the heart, and its imposthume: other things kill more slowly, such as imposthumes of the liver, the spleen, the reins, and the stomach. There are other things again that have special names, such as imposthume of the ribs, called pleurisy, and this is why it is so called: — pleur in Greek is the same as easna in Latin (sic) ³⁹² and in Gaelic, and “sis” is the same as position, therefore it is called pleurisis from its position on the rib, or near if, on the midriff. Peri-pneumony,  p.181 i.e. imposthume of the lungs. Frenzy, i.e. imposthume of the brain.

And there are four signs ³⁹³ by which an internal imposthume is recognised, swelling, pain, injury to the functions, and the things we have mentioned, as are urine, faeces, and their like. And there are five special signs of true pleurisy, that cannot be separated from it, as are difficulty of drawing breath, continuous fever, cough (and) pain in the side; and Avicenna adds the fifth sign to these, a serrated pulse, like the teeth of a saw, ³⁹⁴ striking at long intervals with a pause between.

Note, a hot imposthume is said to arise in two ways, i.e. it may come from hot matter naturally, or it may assume heat accidentally, through putrefaction, as Avicenna says.

These are the symptoms of imposthumes on the lungs, undulating pulse, heat between the shoulders, redness of the cheeks, puffiness of the eyes, very high fever, and difficulty in drawing breath, as though “he” were being suffocated.

Symptoms of imposthume on the liver: the pulse ³⁹⁵ less than that above mentioned, pain along with heaviness, dry cough, frequent change of appearance, blood in faeces, and the patient does not lie on his right side; the urine turbid, like water that meat has been washed in; the shape of the imposthume is like the new moon, and the body is lean.

Symptoms of imposthume of the spleen: swelling, and hardness ³⁹⁶ in the left side only; it is otherwise as regards oppilation and hardness if no imposthume be present, for then  p.183 there is hardness in them both; for the spleen is a long loose member situate in the left side, and ordained to purify sanguine humour, though Averroes says, the spleen is sometimes found on the right side, and the liver on the left (side), but since it is seldom found physicians pay no heed to it. ³⁹⁷

Symptoms of imposthumes of the reins: — pain, heaviness, steady fever; and if it be in the right kidney, the pain rises till it reaches the liver; and if in the left, it sinks to the bladder. ³⁹⁸ If the cause be hot, the pain is acute and darting; if cold, the pain is heavy, unless the cause be windy, for in that case the pain is light, and moves about from one place to another.

Symptoms of imposthumes formed through crisis, ³⁹⁹ that turn to pus: when the sickness ⁴⁰⁰ is not acute, without hot matter present from hot humours, and the force is neither strong nor weak, but between them. These imposthumes come out in medial diseases ⁴⁰¹ that do not cause death suddenly, nor quick recovery; for it is necessary where this imposthume arises, that the disease be of long (chronic) ⁴⁰² duration, and the humours gross and hard to digest, and that the matter be not wholly purged, as Galen says in the second book of Prognostica, for then the matter is terminated through the imposthume or by degrees ⁴⁰³ or through an insensible dissolution. Galen says in the third book of Prognostica, when the humours are hot, the  p.185 force cannot be strong, and this is how that should be understood: in a disease that comes from hot humours, and finishes by this imposthume; the force cannot be strong, but weak, for if ⁴⁰⁴ it were weak, it would be bad, and ⁴⁰⁵ if it were strong it would finish the matter by diarrhoea or sweat, or insensibly (?) and that is the way in cold humours. ⁴⁰⁶

If the disease come in winter or ⁴⁰⁷ on an old person, and if no crisis or other purging come to him, by the end of twenty days, and the sick man improving, then it is a sign that it will finish in an imposthume, ⁴⁰⁸ and where most sweat comes, there the imposthume will form. If the veins of the temples dilate ⁴⁰⁹ and beat, and the breath be quick, it is certain there will come an imposthume at the base of the ear, or the cheek, or in the throat. If there be strong tension below the midriff, or in the groin, or in the thighs, ⁴¹⁰ accompanied by pain and inflammation, that is a sign that the imposthume is in the lower members.

Galen says in ⁴¹¹ laborious fevers the imposthume is formed chiefly in the joints and in the cheeks because of the weakness, the movement, and the looseness of the members, and their flaccidity. For the movement draws the excess matter to itself, and the fever sends it to the weak members; as the doctor says, ⁴¹² nature readily sends the matter and the excess of the humours, towards the weak members.

Let us speak now of the urine, that is, of the urine of those who have this disease, i.e. imposthumes. Note, if there be two colours on the urine, the colour of camel ⁴¹³ wool on top, and the lower part of the colour of inopus, that is the sign of an imposthume. If the urine be like that of a brutish beast, that is a sign ⁴¹⁴ of frenzy; if the matter be dense and watery, it signifies lethargy.

Item if the urine be red-brown, ⁴¹⁵ turning one day to the colour of inopus, and leaden on top, with saffron-coloured foam; that is a sign of a hot imposthume on the liver. Item if the urine be turbid, scant, and raw, that is a sign of a cold imposthume on the liver. Item if the urine be thick in substance, and somewhat high (?) coloured, ⁴¹⁶ together with many little bright granules in its midst, that is a sign of an imposthume of the stomach, from phlegm.

Item if the urine be low ⁴¹⁷ in colour, according to Egidius, and thin in substance, and much radiance in it like a sunbeam, with little bodies like ashes underneath; that is a sign of imposthume or stoppage of the spleen. Item if the urine be black in colour like the hue inopus, at the beginning of the disease, that is a sign that death will result ⁴¹⁸ therefrom; at other times it typifies an imposthume on the kidneys, if it be scant.

Item if the urine be of the colour called cyanose, ⁴¹⁹ which is a composite colour of white, black, and red along  p.189 with fatty corpuscles, that signifies an ulcer in the bladder arising from an imposthume therein. If there be red sand in it, that shows the kidneys ⁴²⁰ are not sound; sometimes this sand comes from the burning of sanguine humour in the veins, and then the urine is high-coloured: if it come from the kidneys it is not high-coloured, but whitish, being drawn from them before it is digested: in this way the sand results from the burning of blood, ⁴²¹ and is soft; at other times it signifies a stone in the kidneys, and is not soft, but hard, as is generally clear in the matter of stone.

Let us speak now of the prognosis of this disease of imposthumes. Hippocrates says, the pain is stronger when ripening, than when they are matured; Galen says this is true, especially if the pus be expelled. ⁴²² Note, some imposthumes are terminated by the end of twenty days, others by the end of twice twenty, and others by the end of three times twenty days. If the matter be hot and the member hot, it is finished by the end of twenty days: if the matter be hot and the member cold, or the matter cold and the member hot, it is finished by the end of twice twenty days; and if the matter and the member be both cold, that finishes by the end of three times twenty days. Let that be counted from the day on which these accidents appear, and become stronger or more serious than they were at first; i.e. shivering, ⁴²³ and horripilation, and sharp fever. Expect that the imposthume will break by the end of twenty days or twice twenty days from then, or by the end of three times twenty.

Item if the matter of an imposthume on the surface (?) ⁴²⁴ disappear suddenly, it means one of two things: the  p.191 matter resolves itself imperceptibly, or else it goes back inside to gather again in the entrails, ⁴²⁵ and that is bad and dangerous; for if the matter turn in again, the fever continues together with the other accidents, ⁴²⁶ that the matter gave rise to at first, and the sick man is none the easier; but when the matter is dispersed imperceptibly, the fever ceases and the sick man gets relief.

Note that there are five causes by which the matter of the disease disperses imperceptibly (i.e. the matter of the imposthume). These are, the thinness of the humours, the rarity of the member, the heat of the air, the virtue of the remedy, and the strength of the patient's vigour, as Galen says in the second book of Prognostica.

Item all imposthumes occur more frequently in winter, than at any other time, and remain longer, and if they be relieved they do not come back again, as Hippocrates says in the third book of Prognostica; and it is of the imposthumes occurring in crisis, ⁴²⁷ caused by cold humours, that he speaks; for those humours are more numerous in winter, and it is then these imposthumes are most frequent and most plentiful.

Item an imposthume that is in a principal member, and is without pain, signifies that nature has lost the guiding force ⁴²⁸ there and especially if it be formed of sanguine humour or choler. And Damascenus says, ⁴²⁹ a painful imposthume is seldom caused, except by hot humours, and Hippocrates says in the first book of Prognostica that the hard imposthume which is formed painlessly, is not dangerous, but if it be formed  p.193 with acute pain, it is dangerous; excepting such imposthumes formed from a humour in which are hardness and dull pain. Item ⁴³⁰ the imposthume that does not turn to running does not cause unnatural external heat ⁴³¹ such as that formed by flatulence which ⁴³² becomes hard. The imposthumes that are on the noble internal members cause fever, and some of them cannot be easily felt, as are imposthumes of the chest, or lungs; and there are others hard to take hold of, such as imposthumes of the liver, the spleen, the stomach, the small intestines, the kidneys and the bladder, as says Averoes.

Item the imposthume that appears below the navel, seldom turns to running, because of the coldness of the place wherein it is. Item the imposthume that has a sharp head, and is not broad below is better than the imposthume that has a broad base without a pointed head; ⁴³³ for the former shows the strength of the force that expels the running (pus).

Item when an imposthume of the side ⁴³⁴ turns to one of the lungs, or frenzy to lethargy it is bad; but it is less harmful if it be an imposthume of the lungs that turns to one of the side, or lethargy to frenzy — as Avicenna says. He says also, when the matter goes from a noble member to an ignoble member, that it is a good sign; but when it goes from an ignoble member to a noble member, or to a member that cannot digest it properly, it is a bad sign. Note, fever and trembling, come often when the pus is formed, because of the matter breaking and burning the skin. ⁴³⁵

Item hard imposthumes that are on the liver ⁴³⁶ can be cured at the beginning of the matter, with great difficulty;  p.195 thereafter it is not possible, for it turns to dropsy within fifteen days; and then the hardness is not apparent to the touch, and that is the dropsy that cannot be cured. Note, the imposthume that is at the back ⁴³⁷ of the liver is usually cleared up by three things, by urine, by sweat, and by nose-bleeding; and an imposthume inside the liver is most ⁴³⁸ times terminated by flux, by sweat, or by vomiting.

Item a hot imposthume, that is in fleshy places ⁴³⁹ is occasionally terminated by dissolution, for the nature of the flesh is weak and loose, and it is near to moisture: ⁴⁴⁰ an imposthume that is in a sinewy member ⁴⁴¹ gathers slowly, and disperses more slowly; for the gathering is slow there, and the harder it is, the slower does it disperse, as Galen ⁴⁴² says on the 3rd section that Hippocrates wrote, and Isidorus ⁴⁴³ says in the 3rd part that Damascenus made “that which comes easily goes easily”.

Item every imposthume that is formed from contraries, the more direct it is the worse it is, for it shows the amount and the badness of the matter which nature cannot control or endure, because of its contrariety. For Galen says the disease in which are many and diverse kinds of matter is longer than the disease in which is one kind of matter only, though it be much, for nature cannot digest much and diverse matter, in a short time. This is how that should be understood, of compound diseases caused by heat and cold, as compared with diseases caused by heat only; and it is not right to take it of diseases compounded of heat and cold, as compared with  p.197 those caused by cold ⁴⁴⁴ only, for simple quotidian fever is longer than hybrid (?) tertian, caused by choler and phlegm.

All imposthumes caused by burnt matter, ⁴⁴⁵ such as anthrax, formica, carbuncle and the like are worst and deadliest, and if accompanied by fever, the patient seldom recovers; and therefore they greatly err who open the black pustules, before they are ripe: if they are opposite the heart or near it, it is fatal, and if they vanish suddenly without relieving the patient, it is a sign of death.

Item every imposthume, out of which blood or yellow matter comes before the seventh day, unless it be broken by force, is fatal; for nature cannot evacuate the matter (of the imposthume) suddenly, by the digestion of a certain thing outside of nature, for the digestion that nature does at the beginning of the matter does not avail. Nevertheless if many good signs come from it afterwards, there is a chance (?) that he will not die quickly. ⁴⁴⁶

Note, moreover these are good signs in every disease; the sick man's force strong and he himself constant ⁴⁴⁷ and the breathing good, and he evacuates easily and entirely the matter of the disease; equal heat in the body; and no violent thirst; that he be right as regards urine, faeces, sweat and sleep. And whoever is thus, will get over any material sickness. The author of this treatise puts that into Latin verse; and these are his words in Gaelic, ⁴⁴⁸ (i.e.) force, mind, lightness, spirit, sleep, and beating. Gaddesden says, these signs are good in  p.199 this disease, and this is how he explains them: the force to be strong and powerful; lightness, ⁴⁴⁹ that is, the patient finds relief from the sickness after the signs of digestion;  ⁴⁵⁰ and speaks with reason; spirit (?) i.e. the species of heat or cold evenly balanced; of sound mind i.e. he should be sane with no ravings arising therefrom; sleep, i.e. to be good, and untroubled by imaginings or ugly visions; beating, i.e. a strong beat apparent in the pulse, for unless it were thus the symptoms would be bad. ⁴⁵¹ But although Avicenna says we did not know how many good signs we viewed with horror, such as the heaviness of sleep, the exhaustion of the pulse, and the want of sweat; yet the patient came out of it at last to the crisis. Nevertheless that happens seldom, and therefore these signs are dubious, and therefore an accurate prophecy cannot be made here, as happens often in acute sicknesses. This word “beating” can be explained another way; i.e. the beating of food on being chewed in the mouth: for it is a good sign if the sick man can masticate his food well, and beat it hard with the teeth, and swallow it properly. ⁴⁵²

Since we spoke above of the symptoms and causes of imposthumes, let us speak now of their cure. The cure is varied according to the stages of the disease, ⁴⁵³ for it is meet in the beginning to give repercussives; and in the increase, when it grows and broadens, repercussives along with maturatives but more of the repellents. At the stasis give maturatives  p.201 only, or more of them, and less of the repercussives or an equal amount of both, and in the decrease, things that disperse the matter.

Item it is proper in the beginning to apply repellents to them (i.e. the imposthumes) except in certain cases. One case, when it is clear that the body is full of evil humours, and again when the matter is poisonous as in anthrax and carbuncle for then it should rather be drawn off than repelled, or if the imposthume be near to a principal member. Another case is if the force be weak as in those rising from a long sickness, old people, children and pregnant women, ⁴⁵⁴ for Damascenus says the repulsion is hindered in imposthumes in three ways: by a humour, if it be poisonous or raging, for there is beating ⁴⁵⁵ then according to (the) force, or by a humour that errs as regards quantity, because of its amount, so that it fills the vessels; ⁴⁵⁶ and it is not right to cause repercussion then, but to reduce ⁴⁵⁷ it according to its force, because if the force be weak, a repercussive should not be given. Another case where a repercussive should not be applied: if the imposthumes be in the groin, or the throat, or in the armpits; for it is thither the noble members send their surplus, and if the repellent be given there the matter is returned to themselves then, and that is a great danger. Another case is, if there be an imposthume on the anus, a repellent should not be given, for it is thither all expel their excess. Another case: if it be an imposthume resulting  p.203 from crisis, a repellent should not be given except if the matter flow towards a painful noble member, such as the eye for then it is meet to apply it. ⁴⁵⁸

The cure of hot imposthumes is effected in two ways: by the purging of the humour of which the imposthume is formed, and by removing the evil complexion. If the imposthume is caused by choler, it is necessary then to alter the evil complexion; if the imposthume is caused by phlegm, or corruption, then it is meet to give purgings. And Averroes adds a third method here, to remove the antecedent cause.

Note, imposthumes have antecedent causes, such as repletion ⁴⁵⁹ and primitive causes, i.e. external causes, such as a fall, a blow, or the bite of an animal. The imposthumes that are formed from primitive causes are sometimes formed with repletion of the body, and at other times without it, although there is local plethora in the member wherein is the imposthume, the which plethora is caused by the dispersal of the matter to the member. And this dispersal is caused by the repletion of the whole body, or by that of a member that is near to the imposthume, or by the strength of a member that expels its excess to another weak member, and the tying ⁴⁶⁰ of the members together helps to this end, or the wideness of the passages. Sometimes the cause of the drawing of the matter to the place of the imposthume is the hot evil complexion of the member, for attraction is the property of heat.

Another cause thereof, is the very great pain ⁴⁶¹ of the member wherein is the imposthume; and the pain is caused by the bad complexion which generates it, or because  p.205 of the bad complexion which is caused by the excessive movement of the evacuatory force, when it expels its excess from it, as Galen says. It may be said according to this, that pain draws, ⁴⁶² for it is the cause, according to Galen, whereby nature puts the matter to expel the injurious products; and so it only does harm by accident.

If repletion be the cause of that drawing, and if it come from sanguine humour, let a vein; and if it be because of the malice of another humour, purge him with a purgative or by vomiting. If both be responsible, let those three things be done; and let the drawing be done to the member that is farthest from you opposite it, such as, if there be a hot imposthume on the eye, ⁴⁶³ apply the (cupping) horn, along with scarification, to the back of the head; for this purges the matter, and draws it strongly in the opposite direction. Galen ⁴⁶⁴ says if there be an imposthume on the right hand, let the blood be drawn to the left; and vice versa, ⁴⁶⁵ regarding the right, that is, if it be the right foot let (it) be drawn to the left foot. ⁴⁶⁶

56. Regarding the cure of warts etc.

Let the patient abstain from all melancholic foods, ⁴⁶⁷ such as beef (and) duck, (and) ganders, old salt-meat, kail, peas, cheese, meat fried in fat, entrails of animals; then take hens' feet and put them under cinders until their flesh and skin separate, then rub the hot skin on them (the warts) three or four times, and then extract the blood all round, with your nail. ⁴⁶⁸

Item take burnt willow bark and mix it with vinegar; this will cure warts on being applied to them, and porrigo and ficcus i.e. soft warts near the anus; there are a number of little granules in them as are in figs, and therefore they are called ficcus, for ficcus is the same as fig; and on whomsoever they be, let him drink the juice of pipinella, and apply it whole to them as an emplaister, and it heals.

Item a thing I have proved myself often on my own body, is to rub acrimony on them ⁴⁶⁹ (the warts) frequently and bruise with salt and vinegar, and apply it to them every day as an emplaister, and rub on portulaca every other day; the juice of willow leaves has the same effect.

Item droppings of goats and vinegar applied to them ⁴⁷⁰ avails; if it is put on hot to them often, it heals. Calsidus ⁴⁷¹ says a proper common remedy for them is to rub common burdock ⁴⁷² and urine on them: if they be like acorns (glandulous) or like knots on a joint (nodular) then ashes of snails ⁴⁷³ along with stale unsalted lard helps them, and there is nothing  p.209 better for them than that, and it heals all the imposthumes that are like acorns. And Johannes de Sancto Amando says, that unripe figs mixed with vinegar cure them, and he calls this “the King's Remedy”. Item a cure in which is no deceit, is to wash them in the water in which a dead man has been washed. ⁴⁷⁴

And there are many kinds of these (warts), such as lupia, and acrochordones, and note, it is good to cut them, and cauterize the place, so that too much blood may not flow from them; or let garlic be broken together with salt, and change it between the day and the night three times, and continue using it well for nine days thus, and press them out with a plate. ⁴⁷⁵ If it be desired that blood shall not flow from them after the cutting, apply cobwebs to them, or white of egg along with the hair of a hare. And a common cure is to tie them round the base with a strand of horse hair, or a thread of silk, until they fall off. ⁴⁷⁶

And Averroes says that the imposthume called carbuncle is most frequent in time of plague when the air is corrupt, and therefore the blood boils ⁴⁷⁷ and putrefies; and an evil complexion and putrid fever composed of diverse humours come(s) thereafter. Formica is as follows: an imposthume that travels in the skin ⁴⁷⁸ and is not broad: sometimes there are broad ⁴⁷⁹ pustules, which move from one place to another, and form sores; they have wide roots and are of the colour of ashes (yellowish), and fiery choler is the cause thereof.

Anthrax ⁴⁸⁰ is a poisonous imposthume formed from  p.211 burnt humours, and felon is its name in English; the humours in this do not burn as much as in the imposthume called carbuncle. In it are many colours, such as yellow, red, blueblack, and black like a wheel (rainbow?) ⁴⁸¹ because of burnt sanguine humour ⁴⁸² and burnt choler which turn to the nature of poison and melancholy, and form ulcers. And for this it is called anthrax; antrum in Latin is the same as umha or clais ⁴⁸³ in Gaelic, for they make a furrow in the place wherein they are. Their cure is similar to the above and consists of blood-letting and purgatives, and it is necessary to purge all the humours, for they are all to blame in this case. Understand it is not proper to open them (the imposthumes) until the matter is purged, for it does not find a channel for evacuation because of the amount of matter, therefore it goes to the heart, and because of the excessive pain, it kills; ⁴⁸⁴ as I once saw a man die on whom was a black pustule of this kind, on opening it with a needle.

Item in the case of these, let cold things and strong styptic things be avoided, and repercussives that repel the matter towards the principal interior members, and do not thicken the matter too much. Item avoid over-hot dispersives so that the hot matter be not inflamed; but apply dry cold non-corrosive things to them in which are some attractives, ⁴⁸⁵ such as plantago, barley meal, and bread of bran and alum along with vinegar. Note, as a general rule, every remedy for felon, cures carbuncle.

Since ⁴⁸⁶ we are speaking of felon, these are its prognostics: vomiting, strong pulse, cold sweat, heart weakness, and if that increase it signifies death. Item the felon which has the colour of flame is not curable. Item dry some pig's gall and apply a piece the size of the opening to the ulcer, and if none of it adhere to the sore, it is a sign of death, and if it do, it heals the felon: and likewise the bite of a mad dog.

Item for the cure of felon; open a vein in the same Curatio. member, ⁴⁸⁷ for it is a common rule that the matter should not be drawn to its contrary. ⁴⁸⁸ Put then, repercussives round it, and resolvents that be not too hot, on the imposthume itself. Give things against the poison internally, such as violet, and hypericon, and scabious; let the bowels be kept constantly relaxed with senna, and cassia fistula, and violets. In order to ripen and break the felon, let yolks of eggs, with a little salt and honey well pounded together, be applied frequently during the day; or let an emplaister be made of figs, or of sour dough, with oil (spurge?) ⁴⁸⁹ and salt.

Item if peacock's droppings be applied, it breaks, ripens, and heals the anthrax. Item bruise daisies between two stones, and put them on it and raw yolks of eggs, and burnt salt mixed well, and this will break it by the end of the third day. Item bruise pimpinella, along with linaria, the which is very potent in this case. Item bruise scabious along with lard, it is approved potent in this case, and clean the spot then, with juice of smallage, and pure honey, ⁴⁹⁰ and wheaten meal. If the pain be intolerable, take lily roots bruised and boiled in water, and apply them, or roots of lily and daisy, with  p.215 white of egg, and add a healing powder of mastyche, dragon's blood, roses, and the like. If it be desired to draw the matter from a noble member to an ignoble one, rub with juice of savory, ⁴⁹¹ from the place where the felon is, to the place where it is desired it should go, and apply a resolvent poultice to it then.

Item against the Fire of God, ⁴⁹² that is, the imposthume called erysipelas, take new cheese and bruise (?) it strongly, ⁴⁹³ and mix with honey, and rub thereon. Put leaves of kail on it after that, and it heals.

Let us speak now of imposthumes of the testicles; ⁴⁹⁴ sometimes the vessels harden, and imposthumes appear on them, ⁴⁹⁵ and (from this) there is swelling in their own substance at other times there is swelling ⁴⁹⁶ in them because of rupture and this has the appearance of an imposthume, but it is not so. And the following is the cause of it: ‘Est aliquando sperma, quod est in via, non habens completum exitum; sicut accidit illis, qui loquuntur cum mulieribus, & tangunt eas, amplexantur fortiter, cupiuntque coire, & tamen desiderio non satisfaciunt. Aliquando accidit induratio propter equitationem incommodam equi succusantis, vel propter saltum super sellam ascendendo, ante vel post sellam, super lignum. Aliquando propter pollutionem nocturnam inchoatam & impeditam.’ ([R. A. 930])

If it be caused by sanguine humour, then the colour will be red: if it be from semen the colour will be swarthy.

The following are the cures: give a clyster of rue and tutsan, cummin, pellitory, lovage, walwort, oil of roses, and benedict, sharpened with vinegar, and with agaric. Item  p.217 it is good to make him vomit with the middle bark of elder, ⁴⁹⁷ and he should eat but little food, and that easily digested.

If the evil be in the right half, ⁴⁹⁸ let a vein of the right arm for him; if in the left half open a vein in the left arm likewise: mix together cummin, flower of beans, oil of walwort and pellitory, and let it be applied to them, or whole beans, and wine, and bran. Item ℞ take pellitory, rue, camomile, mallows, pansy, ⁴⁹⁹ a fistful of each, and boil in water; put a stupe about the testicles of these; to be applied fasting.

If the cause be hot, let oil of roses be rubbed on it; if cold, rub on oil of camomile. ⁵⁰⁰ If the place be red, take tepid juice of plantain and dip a linen cloth ⁵⁰¹ therein, and apply. Open the medial vein of the joint internal to it. ⁵⁰² Apply the blood of a hare, hot, to it, and cassia fistula thereon, which ripens it and every other hot or cold imposthume also.

Item henbane ⁵⁰³ boiled in wine is good for every hot imposthume of the kidneys and testicles, on being applied to them and an emplaister of mallows. Item kail ⁵⁰⁴ ripens the imposthumes of sanguine humour, and softens their hardness, and duckweed (?) does the same. If the imposthume be phlegmatic or watery, let the matter be digested with the roots of smallage and radishes, and with watercress, hyssop, calamint, liquorice, and honey; let it also be purged with agaric, and again repeat the clyster, and the vomit. Then apply to them things that penetrate, as are southernwood, boiled in wine and vinegar.

Item moss of a tree (lichen?) boiled in wine or in  p.219 oil is good for every imposthume that is in a sinewy member: the scrotum is sinewy, ⁵⁰⁵ therefore it is good for it. Item watercress with water, honey, and salt avails for swollen testicles, if the cause be cold; and for every cold watery imposthume. Item turpentine and salted pig's lard is good for hard imposthumes. Item wallwort, and rue, and bean meal, is good as a poultice in every windy imposthume.

Item ⁵⁰⁶ turpentine and flax seed, fenugreek, seed of mallows, saffron and finely sifted bran is good for every hardness and for every cold imposthume, though it be soft: ⁵⁰⁷ if there be pain in it apply anise to it, as it stops the aching. ⁵⁰⁸ Item fenugreek, ⁵⁰⁹ fried in butter or oil, is good for hard imposthumes, and it is hotter than flax seed. If you wish it to have a stronger effect, add lily leaves to them; for they stop the pain better than the roots, nevertheless there is a ripening, dispersive force in the roots, and Avicenna says lily leaves are good for hot imposthumes.

Let us speak now of the hot imposthumes ⁵¹⁰ that are in the uterus, which are formed by an external cause, such as a blow, or a fall; or from an internal cause, such as retention of the menses, or difficulty of child-birth.

These are its symptoms: weakness of the heart, syncope, pains in the head and neck, heaviness of the eyes; flaccidity of the extremities; constant thirst; ⁵¹¹ the nature of the urine {⬌} the disease called dysuria, and fever for the most part.

A cold imposthume is formed from external causes, as are a bath in cold water, a cold wind, sitting on a cold stone, and from cold viscous foods, ⁵¹² such as milk, or too much fruit. It is formed also from internal causes, such as retention of  p.221 urine, or excess of cold humours; the symptoms are, heaviness in the lower limbs, and occasional fever; and cold things afflict the person who has it. If it be a hard imposthume, there is hardness in the share, ⁵¹³ and in the mouth of the womb, heaviness in moving the members, and especially in saphena and ⁵¹⁴ veins of the ankle (?). It is not the same as mola matricis, for if a hand be placed on it hard, it moves from place to place, as though pregnancy were present.

Hot imposthume of the womb is cured ⁵¹⁵ by letting the vein of the liver, ⁵¹⁶ and the vein called saphena, for the catumenial flow is withheld therein in this tumour: cause vomiting afterwards, and make a tisane in which are boiled violets, and coltsfoot. Let the patient consume but little food and drink, and make long vigils, and place sweet-smelling things in the place wherein she is. Then put cassia fistula in her remedies; ⁵¹⁷ boil mallows, flax seed, and plantain, ⁵¹⁸ and mix oil of roses therein, then soak wool in it, and apply the wool thereto. Let it be ripened with mallows, and dactylis (?) and with gander's fat and barley meal; and put it as an emplaister on the share and the place where the pain is. If it be ripe, break it with figs and mustard, and with droppings of goats or doves, and clean the ulcer then with honey water.

Cold imposthume of the womb is cured by vomiting, by an attractive clyster, and by agaric; and digest the matter with fennel roots, smallage, maiden hair, caeterach, pollitrich, plantain roots, and scabious, a fistful of each of these; columbine, pimpernel, daisy, mulberries, fumitory, hypericon (?), half a fistful of each of these; a quart of liquorice, one ounce of fennel  p.223 seed, half an ounce of camomile seed or flowers, ⁵¹⁹ and a drachm of violet flowers. Make a syrup of this with water and let it be used early, at noonday, and at bedward, and this syrup cures every imposthume and felon in cold weather, and delivers from poison; and from the columbine it is named. It is also good in hot weather provided one thing, that the cold things be increased in hot weather and the hot lessened. Violet water is good in the case of every hot imposthume mixed with nightshade (?) ⁵²⁰ and roses, and therefore bear this in mind for the use of every imposthume, except the imposthume of the brain called phrenesis.

And if the imposthume be hard, take marrow of stag, lard of gander and duck, beef marrow, hardened yolk of egg, butter, and red wax ⁵²¹ drachm 2 of each; and take then fennel seed and flax seed, equal parts of each, and boil them in water or in wine, along with the things we said before, and let it be applied to the womb by ⁵²² a pessary.

Item, in the same case, vine leaves are good, and oil and honey water, and leaves of kail. And Avicenna says, if a hard imposthume go uncured beyond a month, and ⁵²³ the pain be not checked then, it cannot be dispersed by treatment.

Item take old pig's lard drachm i½, ⁵²⁴ and the same amount of wax; drachm i of gander's fat, and drachm iv of honey and of butter, and drachm ii of galbarnum. Break the galbarnum in a mortar, along  p.225 with drachm iv of oil; melt all these things, and pass them through a cloth, and use this against every swelling and hardness, and against every cold disease and pain of the nerves.

Note the best marrow here is stag marrow, because of the thinness of their humours, ⁵²⁵ and after that calf marrow; the best fat ⁵²⁶ is duck, because it is thin, and not sharp; and after that hen fat; and the best fat among the fourfooted animals is lions', because of its thinness, then cows' grease, ⁵²⁷ and goats' thereafter.

Item another thing for dispersing and ripening imposthumes is flax seed, fenugreek, barley meal, wheaten meal, figs, droppings of doves, and oil, and sour dough boiled along with them; and apply it as an emplaister.

Item let a powder be made of doves' droppings, and mix it with oil, and that expels every hardness and every pain. If there be windiness in the womb, make the patient to sneeze, ⁵²⁸ and give diacyminum for that is good against flatulence. ⁵²⁹

Let us speak now of Lethargy. Lethargy is an imposthume on the posterior brain, as frenzy is on the facial cranium, the which is true lethargy, for lethargia non vera is produced by vapours that confound the memory, or by choler mixed with phlegm. Lethargia vera is produced by corrupt phlegm in the posterior brain, and fever accompanies it. ⁵³⁰

These are the causes thereof: — everything that increases phlegm and choler in the body and in the brain, such as leeks, and onions, and garlic, and watery fruits, wine, plethora of food and drink, “crapula”, drunkenness, much food, great consumption of white meat, bread soaked in fatty broth, fish, pork, and much resting; and it never comes alone, but follows another sickness, such as continuous quotidian fever, ⁵³¹ which is usual. This imposthume is situated in the passages (?), and holes of the cranium (?), and seldom in the substance of the brain. ⁵³²

Its symptoms are as follows: — continuous slow fever, and little pain, forgetfulness, confusion of reason, the urine somewhat thick and turbid, as it were the urine of a brutish beast; much false sleep, and sometimes he forgets to evacuate urine and faeces. ⁵³³

If the matter be compound and phlegm be dominant,  p.229 the sleep is the heavier thereof, and the patient is taciturn, and dislikes moving, ⁵³⁴ and keeps his eyes closed as though he were devoid of life. If choler be strongest, then the patient is restless and sleepless, ⁵³⁵ and keeps his eyes open, gazing at one object for long. If both these humours be equal, the symptoms will be intermediate. If produced by phlegmatic humour only, the patient is yawnful at the beginning of the matter, and he suffers from an excess of saliva, and heavy sleep, and keeps his eyes and mouth shut, and if these be opened, he forgets to close them. The faeces are frequent, copious and moist, and the pulse and breathing scant and oppressed, ⁵³⁶ and if the sufferers from this disease be addressed in a loud voice, and called by their proper names, they answer; ⁵³⁷ but if permitted they relapse into sleep without delay, and that is not real sleep, but heaviness and stupor.

These are the symptoms of this sickness, as regards its prognosis: — blue black colour ⁵³⁸ of the face, swelling, and disorderly movements, for these things are proper thereto. ⁵³⁹ Item if he be morbid, ⁵⁴⁰ eating much, and have a voracious desire to eat more, say things that are not comely, and expel his spittle constantly, it is a sign of death; and more especially if there be cold sweat on the face and neck. If these signs do not appear, it is certain he can be cured.

Note there is a difference between this disease and the disease called suffocatio matricis, for in the former one can speak, and in suffocatio matricis one cannot, and if one attempt  p.231 to speak to anyone, one cannot. ⁵⁴¹ And there is also a difference between it ⁵⁴² and apoplexy and epilepsy, for those sicknesses come suddenly, while this comes but slowly, by degrees. There is another difference between it and the weakness called syncope, for in lethargy the face is as the face of a healthy man, and in syncope, it is as the face of one dead.

Note, it is necessary for lethargics, that people talk loudly in their presence. Tie their extremities tightly, (and) rub their palms and soles hard; and let their feet be put in salt water up to the middle of their shins, and pull the hair and nose, and squeeze the toes and fingers tightly, and cause pigs to squeal (?) ⁵⁴³ in his ears; give him a sharp clyster at the beginning of the case, in which is hiera picra Galeni, centaury, southern wood and wormwood, and the like, and open the vein of the head, or nose, or forehead, and draw blood from the nose with the bristles of a boar. ⁵⁴⁴ Put a feather, or a straw in his nose to compel him to sneeze, and do not ever desist from hindering him from sleeping; and let human hair, or other evil-smelling thing, be burnt under the nose. Apply moreover the cupping horn between the shoulders, and let a feather be put down the throat, to cause vomiting, and shave the back of the head, and rub oil of roses and vinegar, and smallage juice thereon. On the imposthumes consolidating on the third day, or the fourth, take castoreum, and juice of red mint(?), water, vinegar and smallage juice, and let them simmer together, and rub them on the back of the head, so that they,  p.233 and the matter therein, are digested, ⁵⁴⁵ or soak a cloth in it, and apply to the back of the head, and change frequently.

Item apply a poultice of pigeon's droppings, and honey, to the back of the head, which relieves it greatly. Item if he have some sense, ⁵⁴⁶ and desire to take a remedy, it is sufficient to cure if he drink mustard and beaver powder and mint juice frequently; and let galbanum and stag's horn be burnt, and let its smoke go up under his nose on waking. And if he have a little of his reason, let the matter be digested with a syrup, in which shall be put sage juice, and betony, and rue, and mint, calamint, anise, fennel seed, cummin, nettles, seed of rue, vinegar, a little honey and sugar. If the fever be acute, give him a little of the syrup in which maidenhair has been boiled. If it be slight or the matter composite, give syrup of violets, and digest with oxymel of squills.

If the matter be produced by phlegm, ⁵⁴⁷ the eyes are open, and the gaze fixed, accompanied by signs of motion (twitching?); ⁵⁴⁸ and let the matter be digested, then, by oxymel of squills, and by syrup of fumitory, and purged by hiera picra, sharpened with a little colocynthis, and with hiera logodium. If melancholy be responsible here, let it be purged with hiera ruphi and with diasene (senna). If the matter be composite, let the remedy be compounded of hiera picra and an electuary made of oil of roses. ⁵⁴⁹

Item let things be given to drink, and a gargarism, and then put treacle on the tongue, and if he can, let him swallow it. In order to restore their memory to them, make an electuary of two parts of lign aloes, and cassia linea, and the third part of euphorbium mixed with pellitory and honey,  p.235 and give them a little at a time. Shave the back of the head, then rub it hard, and scarify it and immediately rub in the same things boiled. If the cause be compound, take roses and violets, and camomile, and mellilot (?), and boil them, and let them be rubbed in briskly to the back of the head, and dry at once.

Item if frenzy turn to lethargy, it is a sign of death; and if vice versa, the sick man often recovers.

 ⁵⁵⁰Item take the heart of a robin redbreast, and put it round the neck of him who has this disease, and while it remains there he will not sleep. Item take the same heart, ⁵⁵¹ and the heart of an owl, and hang them up above the man on whom is this disease, and who has lost his memory, and it will give it back to him. Item the heart of a swallow cooked with honey, the which compels him who eats it to tell things that happened, and things that did not happen yet. ⁵⁵²

Hernia is a disease in which that part of the peritoneum called siphac breaks, or is stretched, and widened, and because of this, the intestines fall into the scrotum, or swell in the groin with pain, and prevent a man from walking. ⁵⁵³

Note that there are many varieties of this disease; a form caused by flatulence, another caused by wateriness, one produced from humours, and one from flesh, another from varicose veins, and another from the entrails. And this is true hernia, for it is that form where the peritoneum called siphac breaks, and in it the entrails fall into the scrotum: yet another form is from that part of the peritoneum called zirbus.

Note that there is on the belly, first the outer skin, inside that the peritoneum called mirach, ⁵⁵⁴ then siphac, inside that zirbus, and inside that again the intestines themselves. And as the midriff forms a wall between the digestive organs, and the respiratory organs, so does siphac between the intestines and the organs of nutrition and generation. It is like a sack which keeps up the entrails, and therefore when it is broken, they fail down; and when it is stretched, there is swelling and pain in the groin. ⁵⁵⁵ They seldom fall into the scrotum ⁵⁵⁶ then but when this happens without pain, fever, or an imposthume; that is true rupture.

Sometimes windiness penetrates into the scrotum and causes it to swell; at another time there is wateriness there, and sometimes one of the humours swells in it; another time  p.239 there is superfluous flesh present, and yet again the veins are filled with melancholic humour and they become swollen, the size of a finger. ⁵⁵⁷ Another time the peritoneum called zirbus falls, and the sinews ⁵⁵⁸ which propel the semen towards the testicles thicken when they stretch too much.

These are the external causes of rupture: — labour, much shouting, jumping, especially after food when the belly is full; excessive sexual intercourse, riding an unsafe horse immediately after food, laborious coughing and an overviolent sneeze. Another ⁵⁵⁹ cause thereof is the semen breaking away for expulsion and being prevented by some cause, and stretching the sinews by which it is propelled towards the testicles, and causing the sinews of the latter to swell, which produces the same disease: it is also caused by prolonged constipation and by the retention of flatulence, as in the disease called colica passio.

To prove whether the peritoneum is broken or stretched, ⁵⁶⁰ the patient lies supine, squeezes the swelling, and puts it in with his finger: then let him sit up, and tell him to cough, and if the viscera fall, it (the peritoneum) is broken, and if not it is stretched.

Item let a fire be made him of elder wood, and when he who suffers from this disease smells the smoke thereof, the entrails fall down, and there is great hacking pain ⁵⁶¹ and (roaring) rumbling in the abdomen and intestines, which is heard throughout the house.

If it be caused by windiness, there is flatulence in the intestines and rumbling, and the flatulence moves from one side to the other; if a finger be put on it, no undulation (?) ⁵⁶² is felt, neither is heaviness present, but lightness compared to the other varieties. If it be caused by wateriness, the scrotum increases in size, accompanied by heaviness, and brightness; ⁵⁶³ if you take hold of it with your fingers and feel the watery fluid in it, which yields to the touch, and does not yield when it is (?) flatulence then the sufferer is disposed to dropsy. If it be caused by fleshiness, the testicles increase without pain, or imposthume, together with a certain hardness, and when handled, hard flesh is felt round about them.

If it be caused by  ⁵⁶⁴ varicose veins, the veins are hard and long, as though they were crooked rods, like those seen in the calves of beggars who carry great burdens. If it be from that part of the peritoneum called zirbus, though the sufferer lie supine the matter is not returned. ⁵⁶⁵ If it be the true form it returns easily if he lie supine. If it be the sinews, by which the semen is propelled that are relaxed, because the holes in them are large and loose, it is easy for the viscera to fall into the scrotum, and the name of these sinews isdidimi. If it come from the humours, the body is full of evil humours, without pain, and if the matter be grasped, it so to speak “comes with you” i.e. yields to the touch, and there is an intermediate softness ⁵⁶⁶ between the variety caused by fleshiness, and that caused by wateriness.

Prognosis of this sickness: when the rupture is old, and the mouth of the wound blistered and hard inside, by  p.243 the end of a year, or half a year, it cannot be cured. Every form of rupture is easily cured at the beginning, especially in children, but it cannot be cured in old people, and moderately (?) in young people. ⁵⁶⁷ When it comes from the intestines, and is old, it cannot be cured,  ⁵⁶⁸ except by chirurgerie, i.e by cauterising, together with a truss, or cutting, but that incision cannot be performed on old folk, and it is seldom resorted to without causing death. And if the stretched form of rupture continue beyond six months, ⁵⁶⁹ it must be left to chirurgerie.

Many things are required for the cure of this sickness; first of these, diet: the second, to put the viscera in their proper place: the third, to keep them there; the fourth, to heal the wound; the fifth, cicatrizing and firing, or cutting. ⁵⁷⁰ The first of these is carried out by keeping the sufferer for six months without repletion of food and drink, or allowing him too much exercise; and let him not eat fresh fruit or things that cause flatulence, such as peas, and beans, and new ale; and let him not eat his fill at one time, nor rise from the place he is in after food, except he have very great need of performing the works of nature: let him not go a journey, nor go up and down stairs, nor jump, nor shout. And if he ride, let him not mount by the stirrup but ⁵⁷¹ be in a high place sloping down, so that it (the horse) be below him, and he  p.245 come down on to it. If he must walk or do work, let it be finished before food, and keep the bowels relaxed with a clyster or a laxative pottage; avoid coition, and bathing, except there be so much swelling in the entrails that they cannot be put back, for then a bath may be taken to prepare him for that.

The second thing mentioned for the cure is carried out in this manner; the patient lies supine with his hips high and his head low, and he, the doctor puts the guts up very gently with his finger, until they go in by degrees to their own place. The third stage before mentioned, i.e. the retaining of the entrails in their own place, is carried out by means of a special truss made for this case, the width of four fingers; let it be made of linen cloth (and) with many folds in it, and with cotton inserted between, sew it well, and make a tie ⁵⁷² by which it can be closed and opened, and let there be a hard wedge (?) of linen cloth attached to it, and put it between his thighs. ⁵⁷³

This is paralysis according to the author: — a disease of the nerves that comes, sometimes, after the falling sickness, or similar diseases. And “paralysis” is the same as to say the “wounding of a member”. ⁵⁷⁴ Sometimes the entire half of the body is afflicted, from the head to the foot, and ⁵⁷⁵ it affects a part of the tongue or the whole and prevents speech, and that is called general paralysis. Sometimes it affects but the tongue only, or one foot only, or the finger only, and that is called partial paralysis.

Therefore there are two kinds of paralysis, general paralysis, and partial. According to that, paralysis consists in the softening of the nerves (sinews?) by taking from them their movement and perception, the which is true paralysis; in false paralysis only the sensation is taken away, or the perception, or the movement, as though a limb were asleep, or were frozen, or suffer from excess of cold; so that the sick man cannot stretch his finger, nor close it, nor clench it.

And Avicenna says the term paralysis is used in general, ⁵⁷⁶ whereby it means the softening of any member it seizes, and therein both sides agree, with the exception  p.249 of parts of the head. For if the parts of the head agree, it is not paralysis, but apoplexy, which hinders movement and perception. Paralysis is used specially to mean softening of either side throughout the body, and so when half the body is affected with the exception of half the head, it is general paralysis. And there is a more general species than that, when it affects the whole half of the body, and half the head; for the parts of the body and the head are divided, so that one part may be affected without the other part, and for that reason nature has arranged two eyes, and two hands. There is also a most general paralysis when it affects the whole body, with the exception of the head, as we said before.

The external causes are: falling, percussion of the nerves, attrition, and cutting across of the nerves; also anger, fear and excess of cold that compresses, excess of heat that scatters; also taking hold of the fish called “tarcon”. ⁵⁷⁷ And Avicenna, with profitable briefness, calls everything paralysis which binds and compresses the end and origin of the nerves, so that the spirit cannot pass through them. It comes oftenest from the following; phlegm, and less often from melancholy, still less often from sanguine humour, and least of all from choler, except it be mixed with another humour. Also it is caused by an imposthume, or by the crisis of the four sicknesses, namely, the falling sickness, colic, suffocatio matricis, and apoplexy.

And I say briefly, there are eight general causes that hinder the passage of the spirit to the nerves. The first cause is poverty and scantiness of spirit and heat, so that they cannot increase and spread themselves to the nerves. ⁵⁷⁸ The second cause is excess of cold, which retains ⁵⁷⁹ and binds together the nerves.

The third is excess of heat, which dissipates the spirit, such as burning fevers, ⁵⁸⁰ and remaining too long in an overhot bath. The fourth cause is dryness, ⁵⁸¹ that twists the nerves, the which cause is bad. The fifth cause is moisture, without ⁵⁸² matter having come to block it up. The sixth cause is excessive tightening and binding of the member. The seventh cause, a stoppage from whatever cause it come; whether from red blood, because of its quantity, or phlegm because of its sluggishness, or melancholy because of its toughness and denseness, or from choler on account of its thinness, which causes the other humours, with which it is mixed, to proceed so that they penetrate throughout. ⁵⁸³ Therefore since melancholy causes stoppage, there is no clear passage through the nerves, except those of the eye ⁵⁸⁴ and the virga, as Galen says. The eighth cause is hardening and thickening of the nerves.

Note however that there is a difference between paralysis, and cramp; for movement and perception are prevented in paralysis, but in cramp only movement is prevented. Item in paralysis there is pain in the sick side, and in cramp in the healthy side. Item in cramp the sick side draws the healthy side towards it but not so in paralysis. Item in paralysis the oppilation is in the origin of the nerve, and in cramp it is in the whole nerve.

Signs as to which humour the paralysis is caused by. If from sanguine humour, the pulse is full, and the colour of the body ruddy; the veins full, and it will have been preceded by causes of increase of sanguine humour. If from phlegm the body will be white, and phlegmatic signs are manifest before that in the whole body, for cold afflicts it; and it is relieved by heat;  p.253 it is also a sign if the sick man use those things that increase phlegm, such as white meat, fish and fruits, and excessive drinking (crapula). If from melancholy, the body is leaden-hued, black and scabby and (he) the sick man is lean and the season favourable thereto, and if he use things that increase melancholy, ⁵⁸⁵ such as excessive meditation, and depression; beef and hare, and duck, and gander, and peas, and kail, or other things prepared with salt. If it come from choler, though that occurs ⁵⁸⁶ but seldom and then only from a mixture of other humours, its symptoms are compound, i.e. heat, and yellowness in the body, and a kind of bitterness in the mouth and spittle; and if he be wont to take roasted things prior thereto, and garlic, pepper with fish, or (with) moist things, for that produces a compound humour from choler and phlegm.

If the paralysis come from an imposthume, it is accompanied by fever, with hardness in the member, and the pulse is obscure, weak and disorderly, the urine is white, thin, and sometimes like the urine of a brutish beast; ⁵⁸⁷ another time it is high-coloured on account of disease of the reins, or fever, or other illness that accomplishes ⁵⁸⁸ it. The sick side is cold and freezing, as though it were in ice, and the other healthy side, hot as though it were on fire; sometimes the eye gets smaller, and the mouth becomes crooked; at another time the hand shakes on account of the conflict there is between nature and the disease, as Galen says; for the heaviness and matter of the disease press down and the weakened force cannot resist it altogether, but it does what it can and gives a heave upwards, but since it cannot keep the weak member  p.255 in its own proper place, forthwith it i.e. the member trembles.

Prognosis of paralysis here. If trembling come to the paralytic, it is a good sign. Item if he become feverish, is a good sign. Item if he on whom is the sickness be old, the cure is difficult, or impossible. Item if the paralysis come from the crushing of the nerves, or their cutting across, it cannot be cured.

Item if young people have fever, and have green urine, it shows that paralysis, or cramp, is coming. Item if one have a fever, with great pain in the head, and when the fever ceases the pain remain, ⁵⁸⁹ with plethora and heaviness; then paralysis often follows; for nature expels ⁵⁹⁰ the matter from the brain to the nerves, with evacuation of heaviness, but not with complete purging. Item the cold in the first stage tends to confusion ⁵⁹¹ of mind and spirit; and moisture in the second stage, after the cold, and therefore paralysis is seldom produced by heat.

Item the man who has frequent nightmares perceives ⁵⁹² it by apoplexy, or paralysis, or epilepsy. Item he who suffers from jumping ⁵⁹³ in the body (throbbing?) usually accompanied by weakness, and confusion of perception, and stupor of the members, is ripe for paralysis, unless the phlegmatic humours be purged.

The cure of paralysis is accomplished generally and specifically. The general regimen ⁵⁹⁴ is sometimes completed by  p.257 a part of the disease according to its property; and at other times by diet. The first of these ⁵⁹⁵ is carried out by putting things on the back of the head; for this disease comes mostly from the origin of the nerves which is the back of the head; and this cure is possible for other diseases of the nerves, such as tortura, cramp, and tremor.

The second thing is accomplished by medicaments possessing virtue and specific properties that comfort the nerves; as wolf's lard which comforts the cold nerves, and the dregs of oil made from flax, and agaric; and other moderate operations, such as laurel oil, and oil of costus. ⁵⁹⁶ And he says, treacle ⁵⁹⁷ is good in every disease of the nerves that comes from cold, if it be boiled in water of anise, and leaves of rue, and sage, the which avails in every season against these diseases. Mesue says, it is good at the beginning of these sicknesses, as it digests and thins the matter, and corrects the malice of the cold complexion; ⁵⁹⁸ they avail after the digestion, as they purge, and disperse the remainder of the matter, and have specific properties for comforting the nerves: the proper amount to give thereof is drachm 1½.

The third of the above-mentioned thing is carried out by a paucity of food and drink, and a diet that makes for dryness, and contains some comforting specific for the nerves, such as the brain of a hare, and thyme, hyssop, pepper, pelletory, or the broth of an old cock which shall be driven about ⁵⁹⁹ till it is buried.

The following are the things to be avoided in this case: coitus frequens, sleeping after much food, drunkenness, and drinking cold water, a drink immediately after food, and much wine when fasting, because it causes the matter to penetrate to the nerves. ⁶⁰⁰ Every sour thing should be avoided, or the letting of a vein, or remaining long in a bath; the fumes of quick-silver; vinegar, apples, or heavy work after food. Avoid cold air, and every very cold thing especially to the feet, hands, and head, and drink but little, and suffer hunger. ⁶⁰¹

The proper regimen is carried out by four things. ⁶⁰² The first of them, is the digesting of the matter; the second, its expelling; the third, the converting of the remains of the matter to its contrary; ⁶⁰³ the fourth, the correcting of the accidents. The first of these is accomplished by things that transform the matter; ⁶⁰⁴ and let this digestive syrup be made to that end. ℞ Fennel seed, parsley, wild carrot, anise, sage, mountain sage (lavendula), calament, primrose, betony, southernwood and avens: a fistful of each; ginger, pellitory, burdock, long and black pepper, dried rue, aristolochia, laurel berries, mustard, gentian; drachm i of each. Stamp, and boil, and strain them, and make thereof a syrup as is meet with honey.

Item another syrup that is good against every cold disease of the nerves, according to Johannes Mesue. ℞ ⁶⁰⁵ Foxglove drachm4&12frac;; thyme and calamint ounce i of each; anise, and pellitory, scruple6 of each; long pepper drachmiii; ginger, cinnamon, calamus aromaticus and saffron drachm1&12frac; of each. Tie up the latter ⁶⁰⁶ things in a linen cloth, and make a syrup of them, along with honey  p.261 and sugar, and the amount that is meet for him thereof is drachmii with water wherein is boiled spikenard and sage.

Item a piment, ⁶⁰⁷ which is made thus avails. Take a galon of good old wine, and 2 lbs of honey, removing its froth, sprinkle on this drachmiii. of cinnamon; spincanard drachmi; ginger drachmiv, drachmi of mace; and drachmiv (quart. i.?) lign aloes]; drachmii of dried sage; and drachm1 of saffron. Give them a little pounding; ⁶⁰⁸ and put them in a close linen cloth to strain, the which is good for cold of the stomach and liver, against their softening, and windiness, and it sweetens the breath.

If it be produced by melancholy, let it be digested in the following manner: — ℞ Take roots of radishes and water plantain, ⁶⁰⁹ lily, peony, equal quantities of each; bruise, and soak in vinegar and wine for a day and a night. Then take sage, and mountain sage, and great germander, thyme, calamint, cinquefoil, hyssop, a fistful of each; drachmi of anise and seed {⬌} fennel seed, yellow flag; ouncei of nutmeg ouncei½ of cinnamon; ounce1 of borage flowers, and ounce1½ of ashen wood bark and ounce1½ of bark of aspen; and 1½ lbs of honey; and boil in water wherein is quenched red-hot iron. If the weather be hot, and the person young, hart's-tongue may be mixed with it; and that is syrup of radishes. If it proceed from sanguine humour, let it be digested with oxymel diuretica, or pliris dianthos; diacastoreum in cold age and cold weather, after purging.

The second partial thing mentioned, is accomplished by appropriate evacuations; but administer not strong purging at the beginning of the matter, lest the force turn to weakness; nor draw off the thin things and leave the gross undrawn. Give the sick man a laxative clyster at first, if he have constipation.

℞ centaury, and the two kinds of mallows, mercurial, southernwood, rue, an equal quantity. of each: boil, and add drachmiii of common oil; drachm (?) ix, salt ⁶¹⁰ and bran; and drachm1 ½ of hiera pikra Galeni. Make of these up to a pound and a half, and the matter may be digested again separately by degrees. ⁶¹¹

Item let the matter be evacuated without injury with agaric, and turpeth, and hiera pikra Galeni, and after the purging make the following clyster for him: — ℞ primrose, and watermint (?), ⁶¹² calamint, wormwood, mustard, avens, ⁶¹³ polypody, mallows, mercurial; and make of them a clyster, together with a little salt, and butter and oil.

The third method mentioned, is carried out by a gargarism, and things that purge the head. ⁶¹⁴ A head-purging gargarism is made, by boiling mustard, and pellitory, flag flower, staphisagria, hyssop, and calamint, along with a little vinegar.

The fourth intention is accomplished by rubbing the limbs; and by ointments, emplaisters, and bathing. Rub the back of the head often, and extreme parts frequently, ⁶¹⁵ and dry ⁶¹⁶ the head with lily roots and a clean cloth.

Item when a remedy is applied to the sick limb, it is proper to observe and change it frequently; for it sometimes ulcerates and heats overmuch, but with the cold of the limb it is not noticed. If the member be red and swollen, and when lain on become white, that is a good sign, but if it do not that, and its own redness remain therein, it shows the limb has been too much ⁶¹⁷ heated, and if there be sores on it, so much  p.265 the more certain that the cure should be changed. If he can endure it, rub the limb with fenugreek, and ground ivy, together with urine, as the unnatural things should be drawn to dryness. So things roasted with spices are good for them, ⁶¹⁸ and moist meat powdered, and let them consume but little food and drink, for the space of six days. Then take calamint, and camphor, ⁶¹⁹ sage, onions, wild sage, avens, primrose, ground ivy, plenty of them, bruise them, and add gander's lard, that of a dog and a black cat; pepper, drachm1½. ⁶²⁰ Then place them in the belly of a black cat, having removed the inwards and its skin from it. Roast the whole, and collect the juice that comes out of it in this way, and rub it on the sick limb. The comfort derived therefrom is marvellous, and the ointment is named after the cat. ⁶²¹ Ointment of gander is good in a cold disease, as in cold gout. ⁶²²

Item there are members in paralysis that ointment cannot be rubbed on, such as the tongue, the womb, and the nerves ⁶²³ of the bladder; in this case they say to rub the remedy on the back of the head, and to rub ⁶²⁴ the tongue and wash frequently with usquebaugh and a gargarism. Let the usque baugh be rubbed often on the back of the head, the tongue, and the paralysed limb, and it restores the speech, as has been proved on many people. A little of this water ⁶²⁵ is meet with honey, or wine, at times to reduce the disease and at times in the middle of a meal, mixed with soup or syrop, or an electuary.

Then make an emplaister round the member, with mustard, and honey, and rue, and coarse salt; ⁶²⁶ or let it be compounded of hot gums gathered in one place; such as galbanum, opopanacum, serapinum, bdelium, myrrh, masdix, laudanum, euphorbium, castoreum, and other gums, and the like. Make a bath ⁶²⁷ for the sick man then with the following herbs: sage, and wood sage (lavendula), primrose, penny royal, yellow flag, hoarhound, fennel, nettle, camomile, and ground ivy.

And make this wet bath for him after the emplaister; and scour the body with water wherein an entire fox is boiled until its flesh separate from the bones; and with rue and flagflower, and caroway, and peony, herb of paralysis and vervain. Then let the horn ⁶²⁸ be still frequently applied to the roots of the nerves, and finally a little wine, hot, may be given, and let the member be raised and rubbed often with the hand, and hap it up well in the skin of a fox or with other skins(?). ⁶²⁹

Hydrops is an error of the unifying force in the entire body, following the change of the digestive force ⁶³⁰ in the liver {⬌} of the nutritive force ⁶³¹ this attractive force is, and the nutritive force completes its work because of these four forces; and when one of them is wanting, then all are astray, as such is the liver on account of the gall bladder; and Averroes says if one force be strong and uncorrupted, the body is in its proper state, without a doubt.

Indication of the approach of dropsy, and more especially tympanitis. Galen says on the 4th section he wrote: ⁶³² Whosoever says he, has a griping ⁶³³ pain, below the navel, and below the reins, which does not cease on going out, ⁶³⁴ or with other remedies, he passes into a dry swelling called tympanitis. Another indication that it has begun, is swelling in the stomach after food, which remains long there; and if the belly resound on being struck like a tympanon, or drum, and flux does not ease  p.271 the sick man, nor reduce the belly, according to its weakness (?), that is a sign that it (dropsy) is consolidated therein. ⁶³⁵

Item the urine in this species, is thin and sometimes high-coloured, but less often high here, than in the species called ascites; for Galen says this form is produced by heat, not by great heat, nor great cold, but by medium heat. Usually there is more heat in the liver, and the urine is thicker in ascites, because of the humours present therein. Item the pulse is rapid and hard, on account of flatulence.

Signs of the approach of that form of dropsy called ascites: an evil hue on the face, turning to yellowness; the urine frequently high-coloured, nor does he notice much inconvenience ⁶³⁶ thereby; yellowness in the eyes often, and oppression in the right side below the ribs after walking, or riding, or after food, or travelling on foot, ⁶³⁷ or any other labour.

Item a sign that the swelling called ascites has set in, is swelling in the feet, and lower limbs; the rising up of the navel; the upper members alter ⁶³⁸ i.e. the face, neck, breast and hands. Item the urine is high-coloured, thick, and scant, frequently with saffron-coloured froth on it, and is of two colours: sometimes the eyes swell through the fumes rising towards them from the liver. ⁶³⁹ The sick man has difficulty in drawing breath, a dry cough, unquenchable thirst, lack of appetite ⁶⁴⁰ for food on account of the excess of drink, and the appetite therefor. If the abdomen be struck, it resounds like a tympan, or two vessels half full.

Indications of the approach of the swelling called hyposarca: stoppage of the excess matter that is wont to flow, such  p.273 as haemorrhage, haemorrhoidal and catamenial, sweat, and urine; the face becoming paler than usual; excessive appetite for food, or lack of the same; a kind of swelling in the testicles; and plethora of humours in the whole body.

Indications that the disease known as hyposarca has set in: soft swelling thoughout the whole body, and if you take hold of it hard with your finger, it forms a furrow. ⁶⁴¹ The abdomen is not so swollen as in the other forms; the pulse undulating and broad; the first digestion ⁶⁴² whitish and excessive, whereas in the other two forms it is of the colour of blood; the urine is high-coloured at times, not from heat, but from weakness of the digestive force in the liver, which cannot separate the blood from the wateriness of the urine.

Therefore the symptoms of dropsy show but two varieties; special symptoms and general symptoms. We have spoken already of the special symptoms. ⁶⁴³ There are but three general symptoms i.e. swelling of the feet and soles, an evil colour on the whole body, swelling in the eyes from the weakness of the natural heat; and because the vapour is not expelled to the pores of the body by reason of the weakness of the evacuatory force, it is banished to the upper ⁶⁴⁴ limbs, the force being tired. ⁶⁴⁵ And because the digestion and the natural heat are weak there, it returns to the feet, and causes windiness and swelling.

If it be asked, whence it comes that the feet swell more in hydrops, than the hands, I say as does Serapion, that the hands are near the heart, and therefore the pulse is taken at  p.275 the wrist (hand); the heart is the source of the natural heat, and the feet are far off therefrom, and so they are far from the source of heat and therefore death starts from the feet, as Galen says. For this reason surplus matter is better digested and consumed in the hands than in the feet. Another cause: as it is proper and natural for gross matter to fall down, therefore swelling is more proper to the feet than to the hands.

Signs of the proper causes of dropsy, the which are not signs of the species. Dropsy produced by the stomach, the intestines, and the veins known as meseraic, is recognised by continued diarrhoea beforehand, having no colour of blood. When it comes from the liver, it is recognised by a hard cough and by the excess of the first digestion being hard. ⁶⁴⁶ The dropsy that comes from an imposthume is known by the bloody colour of the flux: that from the spleen by the colour turning livid, or ashen, and preceded by pain in the spleen. When it proceeds from the reins, the appetite is strong, ⁶⁴⁷ and there is pain and oppression round the kidneys, behind them, and just a very little above the belt of the trousers, or a little below it.

Note, Galen says tympanites commences in the stomach, with which the liver suffers jointly. Ascites is formed in the liver, and the other members are in sympathy. Hyposarca is caused by the faultiness of the third digestion, with which the liver is in sympathy, but I maintain neither of them is produced without default on the part of the liver.

Prognosis of dropsy. Averroes says tympany is the worst form, but Avicenna ⁶⁴⁸ maintains that ascites is the most  p.277 malicious, hyposarca the slightest, and tympany medium. And to this I say, tympanites is the most malicious form, and the hardest to cure of them all; for it is produced by (weak) cold that weakens the heat, and by restless ⁶⁴⁹ heat. Therefore many a time, nor leech, nor physician knows what he should do, for if he apply hot things thereunto it increases the matter in the liver and stomach, and causes extreme thirst: if cold things be applied the windiness is retained, and the limbs fatten, and if he put cold things on the liver it increases flatulence for the liver helps the stomach to digest, and if the liver be weakened, the digestion is weakened, and from this is produced flatulence. But ascites is worse than tympanites, as regards accidents, ⁶⁵⁰ or it may be said, ascites is worse as regards internal cure, and tympanites, as regards external, ⁶⁵¹ for the swelling is in the stomach, and if it be cut in the thin part, it is death without a doubt.

Item the swelling accompanied by fever ⁶⁵² is worst. Item every sickness is bad that occurs in ague or the swelling, or follows thereafter. Item Avicenna says if flux come with the swelling along with blood, it is death. Item should it come in the swelling, without relieving the sick man, it is death. ⁶⁵³ Item a bloody flux, ⁶⁵⁴ or one as it were congealed blood, is a sign of death, and more especially if the swelling be of long duration. Item if a watery bloodless flux come, it is an indication of health, but if it be immoderate it signifies death.

If a cough seize him who has the swelling, it is a hopeless sign. ⁶⁵⁵ And Serapion says, it is a bad sign, should  p.279 ill-coloured, evil-smelling sputum come with the cough. And to this I say, there are two varieties of cough, a dry cough, and a moist, according to whichever it is produced by, rheum, or the matter of the disease. If it come from rheum, it is not deadly, ⁶⁵⁶ but it is, if produced by the matter of the disorder; therefore Hippocrates says, if the cough follow the swelling it is injurious, but not if it precede it. Serapion ⁶⁵⁷ says when the matter of the disease (i.e. the swelling) has the dominance, so much that it causes constriction of the chest and breathing, it is a sign of death, before the end of the third day.

Item the dropsy that comes after a hardness in the spleen, is more a sign of health, than that which comes after a hardness in the liver; ⁶⁵⁸ for the cure is possible in the first case, but not so in the latter, unless he who performs it, be skilful and attentive, and the patient submissive to him.

Note that there is no doubt that every dropsy produced by cold can be cured, whereas Serapion ⁶⁵⁹ says no man may be cured of a hot dropsy. I say, this is true as regards its own nature, but it may be cured by skill; or else I say thus: that hot dropsy is not cured but with difficulty and great labour, the force of the patient being strong, and he having a good strong complexion. Or else I put it this way: dropsy can be cured at its inception, and when on the increase, but this is not possible ⁶⁶⁰ later than the static period. This doctor ⁶⁶¹ says, he has  p.281 seen people in every kind of dropsy who had a waist measurement of 25" more than their wont, whom God willing, he cured; but he took no one of them to cure him for certain, as it is not proper in this case to promise, except on condition. Should a man suffer from madness and dropsy befall him, it cures the causes of the madness, for the dropsy ⁶⁶² moistens it (?) according to Averroes.

Item it is better at the inception of the swelling for the belly to be dry, than moist and lax, for it shows that the force is active, unless there be a hot imposthume ⁶⁶³ in it, which dries the refuse. Item should a sore appear on the body through the evil complexion of the blood, or in the mouth, through the malice of the vapours and flatulence, that is a sign of death. Item in dropsy, should an evil odour come from the whole body, the breath, the spittle, the sweat and other things that proceed from the body, it is a sign of death; for the fetid smell signifies corruption therein.

Item Hippocrates says, if ulcers break out on the body ⁶⁶⁴ in dropsy it is not easy to cure them, for ulcers do not heal till they are dried, and it is not easy to heal these wounds, nor to dry them, as they themselves (the sufferers) are full of evil “accidental” liquid. Avicenna says if there be ulcers in a member of evil complexion, or sores, they are not curable, or if they are cured, it is long in doing, for instance, in the case of the sufferer from dropsy or lepra. ⁶⁶⁵

Item should there be two colours on the urine of him who has the swelling, it is a sign of death; that is, were  p.283 it red below ⁶⁶⁶ and leaden-coloured on top, or ruddy on top and black below. Item Hippocrates says, if in dropsy there be a pain round the liver caused by flatulence, and there come fever thereafter, it cures it. ⁶⁶⁷ So it may be said, tympanites may be cured, if fever come in its wake, ⁶⁶⁸ for there is pain under the liver, and round it, proceeding from windiness.  ⁶⁶⁹It is false to say that tympanites is cured through fever, for it increases the flatulence by weakening the digestion, and that is a dry dropsy, and the fever likewise is dry; therefore what Hippocrates said is untrue. ⁶⁷⁰

I say with regard to this, that pain is produced in the liver from a hot imposthume or by reason of oppilation or of flatulence. There ⁶⁷¹ is fever with the pain that comes from an imposthume, and little pain is caused by oppilation, as there is more heaviness therein than pain. As to ⁶⁷² the pain that comes from gross flatulence without fever, if fever supervene, without a doubt it cures it. Now as to the reason. I say there is no pain in the liver in tympanites, but only in the stomach, and in the guts, and the fever does not benefit the flatulence ⁶⁷³ in the stomach.

Item dropsy attacks the child in its mothers womb, through her eating much cold fruit, and whitemeat, the which is recognised by the size of the abdomen, and the excessive motion of the pregnancy; and when the time of birth comes  p.285 unless she be relieved, they will both die. ⁶⁷⁴ Therefore it is a great error for a pregnant woman to eat much fruit, and whitemeat. Item if the swelling seize a woman, and she get over it and later become pregnant ⁶⁷⁵ the pregnancy is wont to fall into dropsy, for the blood whereof it is formed is entirely watery, wherefore it is easy for it to fall into dropsy.

Of the cure of dropsy here, the which is twofold: proper and common. The proper consists in varying many species (spices?) ⁶⁷⁶ and herbs proper to it, and arranging meetly for the cure. The common remedy consists in drawing off the watery fluid, and drying it up. Constantine says this drawing off is done in four ways. The first, by giving things that excite the urine, such as spikenard, and cassia linea; the second by drawing off the wateriness by sweats, by vomiting, and by clysters, which are made of agaric and juice of iris. ⁶⁷⁷ The bath for drawing the sweat ⁶⁷⁸ is made with sulphurous ⁶⁷⁹ or sea water, or by the fumes of water wherein are boiled pellitory, lovage and bran, or by hot ointments, as arraton abatis and agripa. ⁶⁸⁰

The third way whereby it is purged, is for him on whom is the swelling, ⁶⁸¹ to drink his own urine, which heals it forthwith, and also jaundice when it comes from the spleen; and whey of goat's, or cow's milk clears off this same water likewise. The fourth way of drawing off the water is by making an incision of the breadth of three fingers, below the navel; or  p.287 by scarifying between the joints of the back, ⁶⁸² or on it itself, or on the soles. Nevertheless this cutting is dangerous, and does not avail but in the swelling called hyposarca; as Avicenna saith, when the belly is full of water, and the force strong, let the incision be made and let the matter be emptied by degrees, so that it be not all evacuated at the same time.

Concerning the things we said a while ago, may ye know (that) the following are the hot things which induce urine: anise, fennel seed, cumin, peony, spikenard, cassia linea, asarabacca, ⁶⁸³ balsam, squinancy, and spica Celtica. These are the hot diuretic herbs: watercress, ⁶⁸⁴ walwort, hyssop, smallage, yellow flag, lovage, mountain sage (?), ⁶⁸⁵ parsley, fennel, juniper(?), the two ragweeds, wild carrot, orchis, dittany, wormwood, and the 1ike.

Item cold things having the same effect: — sanders, endive, and its seed, dandelion (endive?), ⁶⁸⁶ scariole, liverwort, maidenhair, lettuce, coltsfoot; the four greater cold seeds, melon, citrul, cucumber and gourd; gromwell along with ivory turnings. Item things that avail in either case, the cold or the hot; spikenard, wood sage, maidenhair, endive, hart's tongue, ⁶⁸⁷ liverwort, sanders, cinnamon, mastyche, nutmeg (nux muscata), whey of goat's milk, rhubarb, agaric, and cassia linea. ⁶⁸⁸

Let the special cure be made as follows for the dropsy called ascites, which is caused by heat, for it is more dangerous than hyposarca: if he have constipation, make him laxative clysters, wherein these things shall be added to the ordinary ones: wormwood, centaury, cumin, parietary, salt, bran and common  p.289 oil. ⁶⁸⁹ Then make him this alterative digestive drink, ⁶⁹⁰ for it helps dropsical persons, while excess of thirst, and astringents kill them: ℞ take roots of fennel, smallage, and parsley, an equal portion of each: endive, scariole, lettuce, liverwort, maidenhair, a fistful of each; red and white sanders, and the four greater cold seeds, and the four lesser cold seeds, as are, the seeds of lettuce, coltsfoot, endive and scariole, ounce ½ of each; ivory turnings, roses ounce 1 of each; nutmeg, drachm 2; cinnamon drachm 3; ½ quart. of liquorice, or 4 pounds of the juice of plantago, or else mix it entire therein; ounce ½(?) of sugar, and make three or four ounces thereof, unless he have a cough; add a little vinegar thereto; and should he have diarrhoea, make it with milk, wherein a red-hot iron is quenched. If the sick man be old, add anise, and hyssop, and watercress, and let it be used every day. If a specific purgative be needed, give triphera saracenica with rhubarb in clarified whey of goat's milk, with water of endivia; or some of the syrup before mentioned; ⁶⁹¹ nevertheless I think little of every laxative medicine in this case, except clysters and rhubarb ⁶⁹² in purified whey of goat's milk, because all these things do harm, unless there be present very excessive wateriness, and constipation.

 ⁶⁹³ If the sick man be weak give him any remedy, except that boiled in whey of goat's milk. Nevertheless I maintain, rhubarb does not avail much in this case, for, if taken, it purges choler especially; therefore, only a little is meet to give thereof, unless he be jaundiced in the dropsy, or have a fever from choleric humours, or a hot imposthume, when the greatest amount may be given, and it is proper to give it, as it is said  p.291 to be life to the liver. ⁶⁹⁴ It is a clear error for cold people, unless it happen to suit them as regards complexion, and then only a little thereof. And I have often seen it, taken with whey, relax them who suffer from jaundice, because of the amount of choler in them; yet Avicenna says in the chapter on the flux called dysentery, that rhubarb is binding to the bowels. This is true when a little is roasted with fire, ⁶⁹⁵ or else it has that effect per accidens, by comforting ⁶⁹⁶ the liver, or by drawing the choler which causes the flux.

Item this electuary ⁶⁹⁷ is frequently given: ℞ sanders drachm 2 of each; ivory and charred ivory turnings, drachm 1½ of each; cubebs ounce ½: if there be great heat present, drachm 2 of each seed of the four great cold seeds, and drachm 2 of endive seed; portulaca, lignum aloes, nutmeg, drachm 1½ of each; and 1 lb. of sugar, the which to be made with water wherein is boiled andivia. Let him use a good measure of it at dawn, but not at bedward, save when he have not supped; for it is not meet to give medicine to the liver, except when the stomach is empty, as is best possible. ⁶⁹⁸ Sometimes I put in spikenard, in place of lignum aloes, the which electuary I have proved in the case of many people, ⁶⁹⁹ and it is a special secret of my own which should be neither prepared for or taught to any one but on first receiving the price of treatment, for it cures within a short space.

Then be this emplaister made for him: ℞ roses, sanders, endives, plantain, barley meal, and vinegar; and let the sick man not lie down; ⁷⁰⁰ or he may be purged with juice of plantain, solatrum or sorrel, the which warm, and add a  p.293 little vinegar; soak a linen cloth therein, and apply to the liver, but not to any other part; give him a drachm or two of spikenard every day, along with purified whey of goat's or cow's milk.

Should there be fever combined with the hydrops or an imposthume, or if it be caused by stoppage of the menses or of haemorrhoidal flux, a little blood may be let occasionally, for the wasting of blood cools the liver, and carries off the nourishment from the members. Avicenna says when there is much evil in the body, and little good, the letting of a vein steals the good with it, and leaves the evil in its own dominion, where it was at first; or understand what he says thus; when the good blood is thin, and the humours dense and viscous, and far off from the place where the vein is let, then the vein steals the good blood, and leaves the bad within.

And know ye, for all that, that it is good to let much blood often, in these sicknesses caused by plethora, in the fever caused by red blood, called synocha, and others of that ilk. It is good at times to let a vein often without drawing much blood from it, so as to maintain health; ⁷⁰¹ for Avicenna says it is better to increase the number of times rather than the quantity of blood; and at times it is good to let much seldom; as in the case of sicknesses accompanied by violent pain, such as quinsy and its like; it is good not to let much blood, neither to let it often, but in dropsy only a little and seldom.

Then make an emplaister for the stomach of these herbs: ℞ mint, wormwood, mastich, camomile flowers, cumin soaked in vinegar, betony, roots of lily, roses and sour bread. Do not apply another to him the following day, but let him do this exercise early on rising (?); ⁷⁰² — let him  p.295 lie prostrate, and turn often from one side to the other, and, let him rub himself often with his hands, ⁷⁰³ or let him mount a while on a horse that carries him gently, and when he comes down let him walk in a sandy level place. If he sweat, dry him, and put him in a place where the sun is hot, and let his head be well covered; or he may be put in hot sand, not in a hot oven, as do the people, for there were against that, that he would suffocate, unless his head were outside of it.

Then apply a poultice of these to the belly: ℞ rue, parietary, walwort, cumin, cowdung, and oyster shells; seethe them well together (?) ⁷⁰⁴ and put hot, on a thin piece of woollen cloth (?), and apply round the navel, as far as the share. When it cools, heat it and put it about him again: this is more efficacious fasting than after food.

Then of the following, make a bath ⁷⁰⁵ for the sick man, ⁷⁰⁶ but let his head be outside: ℞ rue, parietary, walwort, calament, camomile, pennyroyal, wormwood, horehound, fennel, ground ivy and tree ivy; equal parts of each. Boil in a well-closed cauldron, ⁷⁰⁷ from which is a pipe, so that it burn him not, being shut, for want of a place where the head shall go out. The sick man sits on a cushion well filled with bran, or cotton, or unwashed wool, till he sweat, and let him be rubbed with a linen cloth; nor let him consume food nor drink thereon. When the pulse shall be felt to weaken, put him in his own bed, and when cold begins to be noticed give him some of the afore-mentioned electuary.

Should any of the swelling remain till the morrow, give him a clyster, and the following day apply a partial dry bath (stupe) to his feet and testicles and if there be swelling therein, make a fomentation for him of these herbs: parietary, lovage, parsley, yellow flag, watercress, walwort and meadowsweet. Dry him lest ⁷⁰⁸ the water that rises like vapour from the stupe adhere to him, for it is not meet for those who suffer from dropsy to be washed with water. Avicenna says they should not see water, and if so still less should they drink it.

If necessary apply an emplaister to the afore-mentioned members, of cowdung, saffron and cumin seed, the which cures them: it is not proper to give them any kind of medicine ⁷⁰⁹ in this case, and many people I have cured here with drinks and digestive clysters in turn, and with partial stupes to the feet and calves, and by rubbing water of roses or andivia to these members and the liver, ⁷¹⁰ without anything further. But I was long in doing it, for the disease cannot be cured in a little time.

Item a remedy approved in a hot case. Take the juice of plantain, and liverwort, and fill it almost full in an earthen pot, the which is closed with a thin hide, and tied up tight. Put ashes on the hide, and put it in an oven, having taken the bread from out of it; make a low fire beneath the sides of the pot to keep the heat in the oven, ⁷¹¹ and open it thereafter, when it is boiled, and filter, to extract its juice from it; add sugar, and give to drink early and at bedward, which cures, as I have proved on a man whom no other remedy helped; and on giving a little spikenard with it, he passed a gallon of urine on the first day, on the second day another, and another gallon on the third day. I permitted him, not to drink during  p.299 that time, but to have a piece of candy in his mouth. ⁷¹²

Note it is not meet to drink these cold things in every case of the dropsy called ascites, ⁷¹³ nor to give hot things in all cases of the dropsy called hyposarca, without cold things mixed therewith; as Avicenna says when he speaks of dropsy, that there are varieties of hyposarca and likewise of tympanites and ascites; for he says hyposarca comes both from a hot cause and a cold, and in like wise, ascites and tympanites.

This is ascites: — when the lower limbs are swollen, and not the upper, accompanied by a watery sound in the belly. ⁷¹⁴ This is hyposarca: — when there is general swelling. This is tympanites: — when the belly and the navel rise up, and the stomach resounds like a tympanum, from whatsoever cause it come. Therefore it is necessary to look for some indication other than the swelling, ⁷¹⁵ such as the pulse, the urine, and pricking (?) ⁷¹⁶, pain, and oppression, and see if cold things harm, and hot things comfort; then the cause is cold: this the authors prescribe when they know not the cause of the disease. ⁷¹⁷ Therefore, give them weak things at first, that can do no great harm, if the cause be not recognised; when it is not known in the beginning, give common things that avail in every dropsy, as beforesaid.

The following medicine can be made up in every case of dropsy, whether it be hot, or whether it be cold, provided it be watery dropsy: ℞ Take roots of fennel and iris, a little of each, endive, maidenhair, liverwort, wood sage, a fistful of each; red and white sanders; drachm 2 of each of these: —  p.301 cinnamon and spikenard, a little wormwood leaf, as it is bitter, anise and andivia seed, drachm 3 of each; drachm 1½ of sugar, and make a pound of them. Should it be desired to make it stronger, add {⬌} ⁷¹⁸ of the limbs because of its penetration. ⁷¹⁹

Herein is smallpox little imposthumes or pustules, seen in the skin, the which are oft times of a red colour, and dig themselves into the flesh; they are produced from corruption of the catamenia, ⁷²⁰ and are often preceded by. continuous sanguine fever.

The cause of this sickness, as Hali says, is when nature expels towards the surface of the body, the excess of sanguine humour ⁷²¹ or continuous fever arising from a peccant humour, in one in whom something of the menstrual flow or corrupt boiling blood remains; therefrom results the sickness called variolae i.e. smallpox, and from the menstrual blood it is formed: and Averroes says there is no man who does not contract smallpox, and these are his words: — as an evacuatory force is in every member which sends its surplus from it to another member thence is formed smallpox, and measles, and therefore no man escapes them, and if any one be conceived ⁷²² at the time of the catamenial flow, he seldom escapes without lepra or other hateful disease.

 ⁷²³Avoiding customary exercise sometimes causes smallpox, to seize a man twice, ⁷²⁴ when the matter is not expelled  p.305 entirely the first time. Thereafter let him eat figs frequently, for they expel the matter. Smallpox occurs oftener in a hot moist complexion than in a hot dry one, and in little children and youths, rather than in maturity, or old age; for it is not produced in old age but through strength, ⁷²⁵ and in a hot moist land. Isaac says, it never seizes old folk: it comes oftener in spring than in winter, and in a south wind rather than a north wind; and staying long in the sun ⁷²⁶ disposes a man to smallpox.

And note, it does not seize the child in its mother's womb, for heat is not intense therein, and so it does not cause the blood to boil. Yet another reason; the menstrual blood is retained by the heat of the womb, therefore it is neither corrupted nor does it boil. Another reason; that nature gives her attention to the thing she is doing, that is, to creating the limbs. ⁷²⁷

So we understand there are two kinds of smallpox, proper and improper. ⁷²⁸ Smallpox proper is produced by the blood that boils, and this form occurs principally in children, and youths. Improper smallpox is caused by corrupted foods  p.307 which strong heat ⁷²⁹ draws outward from the inner members to the extremities, and this can occur at any age; and therefore Avicenna says smallpox seizes men twice, i.e. proper smallpox and improper smallpox.

If the smalipox be caused by sanguine humour, the pustules are pointed on top and broad below, ripen at once, and escape through running; ⁷³⁰ the which is a sign of health; for sanguine humour is the cause thereof, and it is subject to the digestion and is a friend of nature. ⁷³¹ If the complexion be hot and moist and the wind south in spring, it is certain that it comes from red blood.

If from choler ⁷³² the pustules are red in hue, turning to yellow; they are small and round with sharp heads, and prick as though it were a needle, because of the sharpness of the matter. Should there be signs of digestion ⁷³³ in the urine, on the day of the crisis, accompanied by a lessening of the pain, fever and the violent thirst; and the pustules define themselves (open?), and liquid come therefrom, that is a good sign, and if the contrary be the case it is bad.

If it be from phlegm the pustules are white and broad and hard to digest, the matter corrupting under the skin, causing great itching, ⁷³⁴ more especially if it be from salt phlegm. If a running begin of the colour of copper rust, ⁷³⁵ accompanied by itching, and the urine be raw, that signifies death.

If it be caused by melancholy, the pustules are leaden-hued at first becoming blackish ⁷³⁶ thereafter, and then black;  p.309 and moisture gathers not in them; they are large and hard like large warts, the which is bad, for there is no quality in them by which they could mature; ⁷³⁷ therefore they dry and split, causing heart weakness, delirium, ⁷³⁸ and lack of energy, and when this happens, the leech can say, death is at hand. And sometimes two large pustules appear so that one of them is in the middle of the other, the which is bad, for it shows the amount and toughness of the matter; so if the force be weak, it is a sign of death.

Prognosis of him on whom is smallpox. It may be said that the white pustules are best when they are few and large; for they come out easily ⁷³⁹ the fever accompanying them is low, and lessens on their being opened. If they be white, large, and dense in number and do not come one after the other, then it is less serious, than if they come by degrees. ⁷⁴⁰ If they be white, small and hard, close together, and come out with difficulty, it is bad, for they are produced by thick matter, which kills often quicker than they can be ripened. Should the pustules appear now, and go in again, and be purplish ⁷⁴¹ accompanied by weakness of the force, it typifies death; if the force be strong, there is hope of escape, ⁷⁴² and it is better that the fever ⁷⁴³ precede the pustules than that they come first and the fever after.

Item if the breathing be good, and the fever lightening, it is a good sign, but should the fever and thirst be acute, with constriction of the chest, it is a sign of death. Item if weakness of the heart supervene, it is a sign of death, for it  p.311 shows that the matter has gone to the heart. Item if the matter go to the lungs, it is an indication that death or phthisis is approaching; and if it go to the eyes, it takes away the sight, or leaves a web on them; and if they (the patients) be cured badly, it leaves ugly pits on the body.

Item smallpox pustules come out gradually, while those of measles come suddenly; if they be green or purplish, heart weakness follows. Item when the breath is evil in this case, an imposthume ⁷⁴⁴ of the chest is frequent thereafter. Item cold air ⁷⁴⁵ and cold things applied externally cause the matter to return to the guts, and so produce the flux called dysentery.

Many things are sought for the cure hereof, but first the matter must be purged by letting a vein, and with a little laxative that softens, but not one that draws or dissipates. Second: the matter must be surrounded (?) and changed internally, ⁷⁴⁶ with acids, unless tightness of the chest prevent it. Third: it is meet to give comfortatives that relieve the sick man, so that they ⁷⁴⁷ be evacuated, i.e. the peccant matter. Fourth: things should be applied to them to dry them, before they are entirely ripened. ⁷⁴⁸

If it be from the first thing mentioned, may ye know, should the body be full of humours, or excessive blood, or the force puissant, and the age and other local matters agreeing, then it is meet to let a vein at the inception of the matter, that is, the medial vein, and that at the top of the nose thereafter, (especially in the case of youths) for they preserve the upper members from the malice of the pustules. There is no danger in letting them (i.e. the veins) in children. If it  p.313 come from plethora of blood, a vein may be let, from the fourth day till the seventh; then let the bowels be moved with cassia fistula and violets along with sugar of roses and their juice, and do not give a laxative there, the which is puissant, as in this case it easily turns to flux.

As regards the second thing we mentioned, know ye that cold things and styptics are good in this case, and bitters at the outset; therefore sorrel juice is good, and juice of garlic, and of apples, and juice of bitter sloes; but do not give very cold things internally, for they do not avail given later than the second day after the appearance of the pustules.

The diet of smallpox patients should be increasingly cold, ⁷⁴⁹ composed of barley and oats; and let the sick man take milk of almonds. If the fever be strong, make this pottage, wherein is put liverwort, lactuca, and scariole; and if the bowels be relaxed, mix with a little plantain. Then a pottage of bugloss may be made, which cleans the blood well, and he may eat figs and almonds, on removing their skins.

If it be caused by sanguine humour, violet syrup may be taken, ⁷⁵⁰ and still more syrup of fumitory. If it be produced by choler, increase the violet syrup, and lessen that of fumitory, as that syrup (of fumitory) is common to them both. Sometimes these syrups are thick and hard to drink; if that be so, make this drink to digest them. ℞ take sorrel juice, liverwort and sampsuchine, a fistful of each; a quarter pound of fumitory juice; borage flowers, violets, roses ounce 1 of each; a quarter and a half of sugar, and a quarter of dried figs; ⁷⁵¹ make therefrom a syrup and use, the which digests the matter, whether it be from sanguine humour or choler.  p.315

It if be caused by phlegm, ⁷⁵² the matter may be digested with syrup of fumitory and oxysacchara, ⁷⁵³ and thus it is prepared. ℞ take ounce 1 (?) of sugar, 8 lbs of sour apple juice, drachm 3(?) of vinegar, and put in a tin vessel on a fire. Mix well till they come to the quantity of the sugar; then put them in a pipkin: this decoction to be used as an electuary; and is good in quotidian fever, quartan, tertian, and ague. It purges the choler in the stomach; and give it early with wine in hot water.

As to the third thing mentioned, know ye, that the following drink serves to expel them. ℞ ounce 1½ of dried figs, 2 of fennel seed, and saffron, if you fear syncope; boil in 2 lb. of water until it reach the half, ⁷⁵⁴ sweeten with honey and use: Avicenna says it expels the unnatural heat from the heart.

Item the following expel the matter to the surface of the body, fennel, smallage with sugar, and their juice, roots and seed, together with scented saffron, ⁷⁵⁵ and elm (?) wherein are boiled dried figs. Then take a scarlet or other red cloth, and put it about the pox; as I did to the King of England's ⁷⁵⁶ son when this disease seized him, and I permitted only red things to be about his bed, by the which I cured him, without leaving a trace of the smallpox pustules on him.

It is necessary to take care not to apply ointments to them, as these would clog the pores; nor to let cold air get at them, unless the weather be warm. If it be,  p.317 then let the  ⁷⁵⁷ air be moderated within by sally leaves, and by sprinkling water throughout the house. Tie the sick mans hands or let him have g1oves ⁷⁵⁸ on regularly, nor let him scratch them (i.e. the pox,) nor touch them with his nails, for that makes the skin ugly. Then take smallage and fennel, warm them by the fire, dip a linen cloth therein, and wrap it round the whole body, for that draws all the matter out and consumes it(?); ⁷⁵⁹ or else boil fennel and smallage in water with dried figs.

If the matter come from melancholy, let it be digested with oxymel diureticum, syrup of fumitory, and borage. ⁷⁶⁰

Arthritica is a grief of the binding of the limbs, the which sickness the country folk call “the pangs”, ⁷⁶² because it drips to the joints of the members, in the same way that rheum falls, for the passage is narrow through which the matter passes to the members, although there is a kind of rarity therein.

There are three varieties of this sickness called arthritica: — sciatica, podagra, and, cheiragra. Sciatica is a grief in the haunch, ⁷⁶³ and therefore it is called sciatica, because scia in Latin is the name of that sinew, and that is the same ⁷⁶⁴ as the sinew of the hip; this sickness keeps this sinew taut or painful. Therefore is it called sciatica (i.e. hip cramp) and the upper end of the thigh-bone moves in the hollow of the upper bone. ⁷⁶⁵ The name of this bone in Latin is ancha, and vertebrum is the other name of the bone, from the turning it does in the upper bone, and the sinew mentioned binds these two bones together: though the doctors say that this sinew (?) ⁷⁶⁶ is insensible to pain, yet it spreads to the empty (?) places nearest it, and causes pain therein, and the disease  p.321 called sciatica is said of this pain. If this sinew were not insensible to pain, there would be pain therein constantiy, from the continuous rubbing together of these parts, and therefore the healthiest man in the world when he moved, would have pain in that member, the which is a lie, for where pain is, there it indicates disease, according to the author. ⁷⁶⁷

Podagra is a pain in the joints of the feet, and in the soles, ⁷⁶⁸ and from the foot it takes its name, for it is to the foot it goes. ⁷⁶⁹ And there is swelling in the member in which it is, but not so in the one wherein is sciatica, for it becomes emaciated.

Cheiragra is a pain in the joints of the hands, and the fingers, along with swelling, from the mobility of the matter, and its rarity, and the movement of the hands. And therefore it is called cheiragra, as cheiros in Greek is the same as “hand”, ⁷⁷⁰ and it is in the hands it occurs. If there be pain in another member of the body, or in a joint apart from these, such as the back, or the neck, it has no special name, but pang of that member.

This is the definition by the author of the disease called sciatica: a pain commencing at the two bone-binds (joints) mentioned and descending behind to the buttocks, ⁷⁷¹ preventing due movement, and it comes from matter falling in drops. When it is of long standing, it falls (extends) to the knees, to the feet, and to the joints thereof, emaciating the member more than is wont, and causing greater pain therein than the pain of any other joint.

The description of that disease which is called podagra  p.323 here: i.e. pain in the lower joints, the feet and the toes, the which spreads to the soles, and increases upward to the hips. It causes swelling in the feet, impeding walking and standing, and softens the soles overmuch; and disposes a man to dropsy.

Cheiragra is thus described: — pain in the joints of the hands from the fingers to the wrists, spreading till it reach the elbow, accompanied by swelling, the which causes difficulty in bending the fingers. And in my opinion, cheiragra and podagra are of that species of lepra which is called elephantia; and it is the more fitting that their healing should be difficult ⁷⁷² seeing that they are all caused for the most part by rheum.

There are two causes of this sickness, one external and one internal. ⁷⁷³ The passive cause of the disease is: the member takes the sickness to itself by reason of its own weakness, or through the malice of a cold, evil complexion, or through excessive heat, caused by movement ⁷⁷⁴ or by some external cause that heats the member. As Galen says in the second book of Prognostica, it is easy (easier) for the humours to move and flow to members that are moved and heated (?). ⁷⁷⁵

Another cause is for the member that contracts the disease to be situate below the others, ⁷⁷⁶ whereby the matter increases in the hips and the feet. Another cause is the weakness of the member whence it arises, not on the part of the complexion, but on the part of its weak, rare composition. Another cause is the width and laxity of the passages. The cause whereby the matter runs to the joints, is by reason of their wideness and emptiness, whereby they take the matter to themselves. ⁷⁷⁷

This sickness is also ⁷⁷⁸ caused by sanguine humour or choler, or melancholy; but most often by phlegm, mixed with choler, ⁷⁷⁹ for otherwise it would not penetrate well. Then, it is also caused by crude humours, and then by choler, rarely by melancholy, the which by reason of its paucity, compared with the other humours, cannot penetrate to the joints because of its hardness, nor to the passages approaching them because of its grossness.

The general causes thereof ⁷⁸⁰ are {⬌} the consuming of viscous foods, such as eels, for these when they are handled cause the fingers to stick together; and windy things, such as peas and beans, for the windiness draws the matter to the veins. Another cause, figs and fried foods, such as rice ⁷⁸¹ and boiled wheat; things that give rise to vapours, ⁷⁸² such as leeks, and onions, and garlic; and every fat indigestible food, such as beef, hard-boiled eggs, and inwards of animals, and every water-fowl possessing web-feet ⁷⁸³: and things that cause eructations, such as new ale, fruits and watery things; lack of evacuation, repletion of food, especially at supper, and a late drink with food. ⁷⁸⁴ A great cause of this sickness is bad order of meals, that is to eat gross food first, then subtle food, and finally gross food again; ⁷⁸⁵ for the alternation is harmful to them, as also eating to excess.

Another cause is much resting, and avoiding customary exercise, coition on the top of much food: hence Galen says  p.327 eunuchs ⁷⁸⁶ do not suffer from podagra, neither do they become bald. And it is proved that doing this is a great cause of this disease, for podagra does not seize youths, until they reach the age of manhood. Another cause thereof is the retention of those superfluities that are wont to be expelled, such as, the catamenia in the case of women, and flux, and avoiding wonted bloodletting. Amongst its causes are running or jumping, excessive horse-riding, or violent walking after repletion, and much wine on an empty stomach, for Avicenna says that that injures the nerves.

Another cause is when there are crude humours in the body, and they are not expelled by the urine, the faeces, or other arts ⁷⁸⁷ whereby a man evacuates his excess matter from the body; and if they be expelled to the joints and remain therein, they putrefy. ⁷⁸⁸ If they be evacuated in the urine, it will have a crude gross deposit; ⁷⁸⁹ and the man who has this, will not contract the disease, for Avicenna and Galen say, those who fear an imposthume of the joints, if they give copious crude, raw urine, it saves them therefrom.

These are the external causes: violent walking, falling, beating (percussion), sitting long in an over-cold spot, compression of long standing, and custom of overheavy loads ⁷⁹⁰ and other similar things, the which turn the force to weakness, such as anger and want of sleep. It is a cause thereof when the excess of the second digestion or the third remains in the  p.329 body, until expelled. Age (too) helps in generating this sickness, for old folk are more susceptible to it, than the young. Another cause is weakness of the digestion, for when folk arise from a long sickness (are convalescing), they make the error in regimen, also when the disease is checked before enough has been evacuated; for people whose forces are weak on account of long sickness are wont to fall into this disease. ⁷⁹¹

Item the seasons of the year aid in the generating of this sickness, for it ⁷⁹² often comes in the autumn through malice of digestion, and the humours, on account of dilation of the pores in the summer preceding it; and through the violence of the heat in mid-summer at mid-day, ⁷⁹³ and the excessive cold at the beginning and end thereof. It comes in the summer through the dissolution of the humours, and in the winter through the strength of the cold humours shutting in the matter, and by reason of the paucity of evacuation of excess then from the body. So it is clear that these sicknesses come from changes in the weather, ⁷⁹⁴ and the people of the pangs (gouty subjects) can tell then, that rain and foul weather will come before it does. The cause thereof is frequently sought of leeches, and this is the answer, as Philaretus says: wherever there is anything, ⁷⁹⁵ that that is there, changes to the complexion of the place wherein it is, and therefore when wet turbid weather is at hand, the air becomes moist, gross, cold and turbid, by reason of the higher cause. ⁷⁹⁶ The sign that  p.331 the which is true, is that walls and stones drip, as they were sweating, not from themselves, but from the air becoming gross; and this air goes into the mouth and the nose and through the pores of the body, and, as Galen says, it changes the body to its own disposition. For the active thing equates ⁷⁹⁷ the passive to itself; ⁷⁹⁸ and this is clear in the joints, as it is easier for the air to go into them on account of their emptiness, dilatation, and looseness than into any other part; this ⁷⁹⁹ is the reason they ache soonest.

Item amongst the causes of this sickness is pain ⁸⁰⁰ in another part of the body, such as the griefs of childbed, and menstrual pains; stone in the kidneys, torsio (hacking), rugitus (wounding) and tenesmus (piles), ⁸⁰¹ for when the matter disperses, and resolvent medicaments are applied thereto, they consume part of the matter, and the other part becomes attenuated and mobile, and when the pain is not permitted to remain in that spot, it passes to the empty place nearest to itself, that is it penetrates the joint. ⁸⁰² Item rheum dripping is a cause thereof, and a wrong habit of lying, ⁸⁰³ that is one part up and the other part down, or lying on an over-hard place.

Let us speak now of the signs of this sickness. Avicenna says it is necessary where there is this disease, to find out whether it arise from an evil complexion along with matter, or without it; though it is rarely caused without matter, and without evil humours. If it be produced without matter, it  p.333 will be accompanied by pain, but no heaviness or swelling, nor discoloration of the skin; and if caused by matter it is meet to look whether it be simple or composite. If it come from simple matter, then see whether it be caused by phlegm, or choler, or melancholy, or sanguine humour, or by flatulence.

If it be caused by sanguine humour, there is great pain in the head, and heaviness according to the amount of the matter; the skin ruddy, except the pain be deep-seated, and therefore [Galen] says, the pain ⁸⁰⁴ of the body signifies excess of humours, unless it be too deep-seated; the urine is red and thick; the pulse rapid and full; and the pain is greater at the time of red blood, than at any other season. If it be spring time, the same is the more certain; ⁸⁰⁵ and if the sick man favour foods that increase sanguine humour, and be wont to be jolly ⁸⁰⁶ with a cheery laugh (?), have a plump body without being fat, and see red objects in dreams, and the age agree with red blood, then it is evident that the matter is caused by sanguine humour. The hip cramp (sciatica) produced by sanguine humour, causes pain as far as the knee, and some times to the soles of the feet, the which the letting of a vein helps, provided it be done straightway.

If the matter be caused by choler, there is great heat (?) ⁸⁰⁷ present, and acute tingling pain, though not of long duration, neither is there great heaviness, as the humour whence it arises is light. The colour of the skin tends to yellowness or a clear red; for in the grief caused by red blood, the colour of the skin is darker red than the hue of the body prior thereto, and is relieved by applying cold things, and aggravated by hot.  p.335 If the urine be high-coloured and thin, the pulse swift, the faeces yellow, and the season summer, the patient young with a choleric complexion, i.e. lean, brown (?) ⁸⁰⁸ and light, and make use of foods that increase red bile (i.e. eat choleric foods)  ⁸⁰⁹ and be more afflicted at the hour of choler than at any other [then it is evident that choleric matter is at fault].