Chapter XII: Preface (2)

On the contrary, when there is a pain in the head in a continued fever, and it does not at all remit, it is a bad and mortal symptom: and boys from the seventh to the fourteenth year are most liable to this danger. In a peripneumony, if the spitting did not come on in the beginning, but after the seventh day, and has continued above other seven days, it is dangerous: and the more mixed and less distinct the colours are, so much the worse. And yet nothing is worse, than for it to be excreted entirely homogeneous, whether it be reddish, or bloody, or white, or glutinous, or pale, or frothy: but the worst of all colours is black. A cough and catarrh are dangerous in the same disease; also a sneezing, which in other cases is reckoned salutary; and there is the greatest danger of all, if these things have been followed by a sudden purging. Now generally the symptoms, which are either good or bad in peripneumonies, are so in pleurisies too. A discharge of bloody pus from the liver is mortal. These are the worst kinds of suppurations, which tend inward, and discolour the external skin at the same time. Of that kind, that breaks outward(14), the worst are those, that are largest and flattest. But if the fever has not gone off, when the vomica is broke, or the pus evacuated, or after its ceasing returns again; also if there be a thirst, or a nausea, or a loose belly, or livid and pale pus, if the patient expectorates nothing but frothy phlegm; then there is certain danger. And of these kinds of suppurations, which have been produced by diseases of the lungs, old men commonly die: but those; those that are younger, by the other kinds. But in a consumption, a mixed and purulent spitting, a continued fever, which also destroys the appetite, and torments with thirst, in a slender body are sure prognosticks of immediate danger. If one has lasted under this distemper even for a considerable time, when the hairs first fall off, when the urine has something floating upon it like cobwebs, and the spittle has a fetid smell, and particularly when after these a purging has appeared, he will die soon: and more especially if it be autumn: in which season commonly those, that have got over the other part of the year, come to the close of their life. It is also mortal in this distemper to have expectorated pus, and afterwards for that to have entirely disappeared. It is likewise common for this disease in young people to arise from a vomica or fistula; and they do not readily recover, unless many salutary symptoms have ensued. With regard to others, virgins are the hardest to cure, or those women, that fall into a consumption from a suppression of the menses. A healthy person who has been taken with a sudden pain of his head, and then fallen into a deep sleep, so as to snore, and does not awake, will die before seven days are expired: and more especially if, when a looseness has not preceded, his eyelids are not closed in sleep, but the white of his eyes appears. Death however is not the certain consequence, if a fever comes on, which may remove the distemper. A dropsical disorder occasioned by an acute distemper, is seldom cured: especially if followed by the opposite symptoms to those above-mentioned. A cough likewise is equally destructive of hope in this distemper: also an hæmorrhage either upward or downward, and a collection of water in the middle of the body(15). Some people too in this disease have swellings, which afterwards subside, and then appear again. Such indeed are more safe than those mentioned before, if they take the proper care: but they commonly perish from a persuasion of their being well. Some people with good reason will wonder, how any thing can at once both be hurtful to our bodies, and in part conduce to their preservation. For whether a dropsy has filled one with water, or a great quantity of pus has been collected in a large abscess, for the whole to be discharged at once is equally mortal, as for a sound person to lose all his blood by a wound. If the joints of any person are pained, so that some tubercles from a callus grow upon them, they are never cured: and the disorders of those parts, which have either begun in old age, or have continued from youth to that time of life, though they may be sometimes mitigated, yet are never entirely removed. An epilepsy also, that begins after the twenty-fifth year, is difficult to cure: and much more so that, which has begun after the fortieth; so that, although there may be some hope from nature, scarce any thing is to be expected from medicine at that age. In the same disease if the whole body is affected at once, and the patient is not sensible of the fit beginning in any part, but falls down suddenly, whatever his age be, he rarely gets free of the distemper: but if his intellects be injured, or a palsy has come on, there is no room for medicine. In purgings too, if attended with a fever; if with an inflammation of the liver, or præcordia, or belly; if with an intolerable thirst; if the disease has continued long; if the discharge of the belly is variegated; if it is expelled with pain, there is danger even of death: and more especially if with these _symptoms_ a dysentery has grown inveterate. And this distemper sweeps off children chiefly to their tenth year: at other times of life, it is more easily endured. A pregnant woman also may be carried off by such a case: and although she herself recovers, yet she loses her child. Moreover a dysentery occasioned by atrabilis is mortal: or a sudden and black discharge from the belly, when the body is already wasted by that distemper. But a lientery is more dangerous, if the purging be frequent; if the belly is discharged at all hours, both with a rumbling, and without it; if it continues with equal violence both night and day; if what is excreted, is either crude, or black, and besides smooth and fetid; if thirst is troublesome; if urine is not made after drinking (the cause of which is, that all the liquor at that time descends, not into the bladder, but into the intestines) if the mouth is ulcerated; if the face is red, and marked with certain spots of all colours; if the belly is puffed up as it were by fermentation(16), fat and full of wrinkles; and if there is no appetite for food. And as in these circumstances death is the plain consequence; it is much more evidently so, if the disease is already of long standing; especially if withal the patient be old. In the distemper of the smaller intestine, a vomiting, hiccough, convulsion, and delirium, are bad symptoms. In the jaundice it is the most pernicious symptom for the liver to be indurated. Those, that have disorders in the spleen, if they be seized with a dysentery, which afterwards turns to a dropsy or a lientery, it is scarce in the power of medicine to save. The distemper of the smaller intestine arising from a difficulty of urine, unless it be removed by a fever, kills within seven days. If a woman after delivery is seized with a fever, and violent and constant pains of the head, she is in danger of dying. If there is a pain and inflammation in those parts, which contain the bowels, it is a bad sign to fetch the breath often. If a pain of the head continues long without a perceptible cause, and removes into the neck and shoulders, and again returns into the head; or comes from the head to the neck and shoulders, it is dangerous: unless it produce some vomica, so that the pus may be expectorated; or unless there is an hæmorrhage from some part; or scurf break out plentifully in the head, or pustules over the whole body. It is an equally formidable distemper when a numbness and itching wander about; sometimes over the whole head, sometimes in a part of it; or when there is something like a sensation of cold in the part, and these reach even to the end of the tongue. And though in these cases abscesses are beneficial, yet there is less hope of a recovery by their means, as they are seldom formed after such disorders begin. In pains of the hip, if there is a great numbness, and the leg and hip are cold, and the belly has no passage, but when assisted, and the excrements are slimy, and the age of the person exceed forty, the distemper will be very tedious, and at least of a year’s continuance; neither will it be possible to remove it, unless it be either in the spring or autumn. At the same time of life, the cure is equally difficult, when a pain of the arms removes into the hands, or reaches to the shoulders, and produces a torpor and pain, and is not relieved by a bilious vomiting. A paralytic limb in any part of the body, if it has no motion, and pines away, will not recover its former state; and the more inveterate the distemper, and the more advanced in years the patient is, so much the less probable is the cure. And in every paralytic disorder, the winter and autumn are improper seasons for medicine: some benefit may possibly be hoped for in the spring and summer. And this distemper, when moderate, is cured with difficulty; when violent, it cannot be cured at all. Every pain also, which moves upward, yields less to medicine. If the breasts of a pregnant woman have shrunk suddenly, there is danger of a miscarriage. In a woman that has milk, and has neither had a child, nor is pregnant, the menses are suppressed. A quartan ague in the summer is short, but in the autumn commonly long; especially that, which has come on, when the winter was approaching. If there has been an hæmorrhage followed with madness and convulsions, there is danger of death. Also if a convulsion has seized a person purged by medicines and still empty; or if the extremities are cold in the time of great pain. Nor does a person return to life, who has been hanged, and taken down with a frothing mouth. A black and sudden discharge of the belly, like black blood, whether it be attended with a fever or not, is pernicious.

CHAP. IX.

OF THE CURE OF DISEASES.

Having considered those signs, which may give us hope or fear, we must proceed to the methods of curing diseases. Now these are divided into the general and particular: the general, which relieve several distempers, the particular, which are confined to single disorders. I shall first treat of the general. But there are some of those, that not only support the sick, but conduce to the preservation of the healthy, others are made use of in sickness only.

Now every thing that assists the body, either evacuates somewhat, or adds, or draws, or restrains, or cools, or heats, and at the same time either hardens, or mollifies. Some things also are useful not in one way only, but even in two, that are not contrary to each other. An evacuation is made by bleeding, cupping, purging, vomiting, friction, gestation, and all exercise of the body, abstinence and sweat. Of these I shall now treat.

CHAP. X.

OF BLEEDING.

To let blood by the incision of a vein is not new: but to practise this in almost every distemper is new. Again, to bleed younger people, and women, that are not pregnant, is of ancient use. But to attempt the same in children and old people, and in pregnant women, is not an old practice. For indeed the ancients judged, that the first and last stages of life were not able to bear this kind of remedy; and they were persuaded, that a pregnant woman, who had been thus treated, would miscarry. But afterwards experience proved, that none of these rules were universal, and that some other circumstances were rather to be regarded, by which the intention of the physician was to be directed. For the material point is not, what the age may be, or what is contained within the body, but what degree of strength there is. Upon this account if a young man is valetudinary, or a woman not with child be weak, bleeding is bad: for the remaining strength, is by this evacuation destroyed. Whereas to a stout boy, and a robust old man, and a strong pregnant woman, it may be used with safety. ’Tis true an unskilful physician may be greatly deceived in such patients: because there is commonly less strength at these times of life. And a pregnant woman stands in need of strength after her cure, to support not only herself, but her fœtus also. But whatever requires either attention of mind, or prudence, is not to be immediately rejected: since the excellency of the art here consists, not in numbering the years, nor in regarding conception alone, but in considering the strength, and collecting from thence, whether there will be left sufficient to support either a boy, or an old man, or two bodies at once in one woman. There is a difference also between bodies strong, and corpulent: and those, that are slender, and infirm. In the slender, blood more abounds, but in those of a fuller habit, flesh. Wherefore the first bear this evacuation more easily: and he, that is over fat, is soonest distressed by it. For this reason the strength of the body is to be estimated rather by the state of the vessels, than from its appearance.

Nor are these the only particulars to be considered, but also what kind of distemper it is: whether a redundancy, or deficiency of matter has been hurtful; whether the body be corrupted or sound. For if there be a deficiency, or the humours be sound, this method is prejudicial. But if either the quantity of matter is hurtful, or it is corrupted, no other remedy is more successful; for this reason a violent fever, when the skin is red, and the veins are full and turgid, requires bleeding: likewise diseases of the bowels, and palsies, and the tetanus, and convulsions; in fine, whatever strangulates the fauces, so as to cause a difficulty in breathing; whatever suddenly stops the speech; any pain, that is intolerable; and any internal rupture, or bruise, from whatever cause; also a bad habit of body; and all acute distempers; provided, as I observed above, they hurt not by weakness, but by redundancy.

But it may possibly happen, that a distemper may indeed require this method, and at the same time the body may seem hardly able to bear it: but yet if there appears no other remedy, and the patient must perish, unless he shall be relieved even by a rash attempt; in this case, it is the part of a good physician to shew, that there is no hope without bleeding; and to confess what bad consequences may be apprehended even from that remedy; and after that, to bleed if desired. It is by no means proper to hesitate about it in such a situation as this: for it is better to try a doubtful remedy, than none at all. And this ought especially to be practised, when there is a palsy; when one has lost his speech suddenly; when an angina suffocates; when the preceding paroxysm of a fever has almost killed a person, and another equally severe is likely to follow, and the strength of the patient seems unable to bear it.

Though bleeding ought not to be performed in a state of crudity, yet even that does not hold always. For the circumstances will not at all times wait for concoction. So that if any person has fallen front a height, or has received a contusion, or vomits blood from some sudden accident, although he has taken food a little before, yet that evacuation is proper, lest if the matter settle, it distress the body. The same rule will hold in other sudden cases too, where there is a danger of suffocation. But if the nature of the distemper will allow a delay, it must not be done, till all remaining suspicion of crudity is removed. Upon this account, the second or third day of an illness seems most proper for this operation. But as sometimes it is necessary to bleed even on the first day, so it is never good after the fourth, when by time alone, the matter is either dissipated, or has corrupted the body; so that the evacuation may weaken, but cannot make it sound. But when a vehement fever prevails, to bleed in the time of its violence is killing the patient. Therefore an intermission(17) is to be awaited for: if it does not intermit, when it has ceased to increase: if there be no hopes even of a remission, in that case the only opportunity offered, though less favourable, is not to be neglected.

Further this remedy, where it is necessary, generally were best to be divided into two days; for it is better at the first to lighten the patient, and after that to cleanse him thoroughly, than to run any risk of his life by dissipating all his strength at once. And if this method be found to answer in the cure of a dropsy, how much more must it of necessity answer with regard to the blood?

If the disorder be in the whole body, the evacuation ought to be made from the arm: if in any particular place, from the part affected, or at least as near to it as may be; because it cannot be performed every where, but only in the temples, and in the arms, and near the ancles. I am not ignorant, that it is the opinion of some, that blood should be let at the greatest distance from the part where it does harm; for that thus the course of the matter is diverted; but in the other way it is drawn into that very place, which is distressed. But this is altogether false. For it first empties the part nearest: and the blood flows from the more remote, as long as the evacuation is continued: when this is stopt, because there is no more attraction, it then ceases to come. Yet experience itself seems to have shewn, that in a fracture of the skull blood is to be let rather from the arm: and if the disorder is in one arm, it must be performed in the other: I suppose for this reason, because if any miscarriage should happen, those parts, which are already hurt(18), are more exposed to injuries. Sometimes also an hæmorrhage breaking out in one part, is stopt by bleeding in another. For it ceases to flow, where we would not have it, when we apply what will stop its course there, and open another passage for it.

Altho’ bleeding is very easy to one, who has experience; yet it is very difficult to one, that is ignorant. For the vein lies close to the arteries; and to these the nerves. So that if the lancet has touched a nerve, a convulsion will follow, which destroys a man miserably. And then a wounded artery neither unites again, nor heals; and sometimes it occasions a violent hæmorrhage. If also the vein itself happens to be cut quite through, the two ends are compressed, and discharge no blood. Again, if the lancet is entered with fear, it lacerates the surface of the skin, and does not open the vein. Sometimes too the vein lies concealed, and is not easily found. Thus many circumstances make that difficult to an ignorant person, which is very easy to the skilful.

The vein is to be cut at the middle. And when the blood flows from it, its colour and consistence ought to be observed. For if it be thick and black, it is bad; and therefore the discharge is useful: if red and pellucid, it is sound; and that evacuation is so far from being beneficial, that it may even hurt, and is immediately to be stopt. But such an accident cannot happen to the physician, who knows in what case bleeding is to be used. It more commonly happens, that it flows on the first day equally black thro’ the operation. And altho’ it be so, yet if the discharge is sufficient, it must be stopt: and an end must always be put to it, before the person faints.

Then the arm is to be bound up, putting upon it a penecillum(19) dipt in cold water, and squeezed; and on the following day, the vein must be rubbed with the middle finger, that its recent union may be resolved, and it may again discharge blood. Whether it happens on the first or second day, that the blood, which at first flowed thick, and black, has begun to appear red and pellucid, there is then a sufficient quantity taken away, and what remains is pure: so that the arm is to be immediately bound up, and kept so, till the cicatrice is firm; which firmness it very soon acquires in a vein.

CHAP. XI.

OF CUPPING.

There are two sorts of cucurbitals: the one of copper, the other of horn. That of copper is open at the one end, and close at the other; that of horn is likewise open at one end, and at the other has a small hole. Into the copper one burning linen is put, and its mouth is clapt close to the body, and is prest down, till it adhere to it. The horn kind is only applied to the body, and after that, when a person has sucked out the air by the small hole, and that is closed with wax, it sticks, as well as the other. Both of these are made not only of these two materials, but of any thing else. Where no better can be got, a small cup with a narrow mouth is fit enough for the purpose. When it adheres, if the skin has been cut before with a scalpel, it will bring out blood: if the skin is whole, air. Wherefore when the offence is from matter contained within, the first method is to be pursued: when it is only a flatulency, the other is commonly used.

Now the principal use of a cucurbital is, when a disorder is not in the whole body, but only in a part, the emptying of which is sufficient to render it sound. And this very thing is a proof, that in the cure of any member, bleeding by a lancet too is to be performed rather in the part which is already hurt: because no body puts the cucurbital upon a different part, unless to divert the flux of blood thither, but on that, which is diseased, and which is to be relieved.

There may possibly be a necessity for using the cucurbital in chronic distempers (although they be already of some standing) if there be either corrupted matter, or a flatulency. Likewise in some acute distempers, if at the same time the body requires to be lightened, and the strength will not admit of bleeding from a vein. And this remedy, as it is less violent, so it is more safe; and is never dangerous, though it be made use of in the greatest violence of a fever, or even in the time of crudity. For this reason, when there is a necessity for bleeding, if the opening of a vein is very dangerous, or the disorder is fix’d in a noble part of the body, we must also have recourse to this instrument. We must be sensible however, that as it is attended with no danger, so it gives a feebler aid; and that is not possible to relieve a violent distemper, but by an equally violent remedy.

CHAP. XII.

OF PURGING.

In almost every distemper the ancients endeavoured to purge by various medicines and frequent clysters: and they gave either black hellebore, or polypody of the oak, or scales of copper(20), or the milk of sea-spurge(21), a drop of which taken upon bread purges plentifully; or asses, or cow’s, or goat’s milk, with the addition of a little salt; and this they boiled, and taking away what had been curdled, they obliged the patient to drink what remained like whey.

But generally _purging_ medicines injure the stomach. Wherefore aloes is to be mixed with all cathartics. If the purging be severe, or frequent clysters be administered, it weakens a man. For that reason it is never proper in an illness to give medicines with that view, unless there be no fever concomitant: as when black hellebore is given to those that labour under atrabilis, or a melancholy madness, or any paralytic disorder. But where there are fevers, it is better to take such food and drink for that purpose, as may at once both nourish, and prove laxative. And there are some kinds of disorders, with which purging by milk agrees.

[Sidenote: _Of clysters._]

But for the most part the belly is to be opened by clysters. Which method, somewhat censured, though not entirely laid aside by Asclepiades, I observe to be generally neglected in our own age. That moderation, which he seems to have followed, is most proper, that neither this remedy should be often tried, nor be entirely omitted, but used once, or at most twice, if the head is heavy, or the eyes dim; if there is a disorder of the large intestine, which the Greeks call colon; if there are pains of the lower belly, or in the hips; if any thing bilious be accumulated in the stomach, or even any flux of phlegm or a humour like water thither; if the breathing is difficult; if there is no natural discharge from the belly; especially if the excrements are near the anus, and still remain within; or if the patient, while he has no passage, nevertheless perceives the smell of excrements in his breath; or if the stools appear corrupted; or if an early abstinence has not removed a fever; or when a case may require bleeding, and the strength will not allow of it, and the time for that operation is past; or if one has drank much before an illness; or if a person, who was frequently loose, either naturally or by some accident, is suddenly bound in the belly. But the following rules are to be observed, that it be not used before the third day; nor while any crudity remains; nor in a body weak and exhausted by long sickness; nor to a person, whose belly discharges sufficiently every day, or one that is loose; nor during the paroxysm of a fever; because what is injected at this time, is retained within the belly, and being thrown upon the head, greatly increases the danger. On the day before, the patient ought to fast, that he may be prepared for this remedy. On the day of the operation to drink, some hours before, hot water, that his superior parts may be moistened; then the injection is to be performed with pure water, if we be content with a gentle medicine; if somewhat more powerful is required, hydromel(22); if a lenient, a decoction of fœnugreek, or ptisan(23), or mallows, in water: if it be intended to restringe, a decoction of vervains(24). Sea-water, or any other water with the addition of salt, is acrid: but both of these are better boiled. A greater degree of acrimony is given by adding either oil, or nitre, or honey also. The more acrid it is, it evacuates the more; but it is not so easy to bear. The injection ought neither to be cold, nor hot; lest it hurt either way. When it is injected, the patient ought to confine himself as much as possible in bed, and not yield immediately to the first stimulus he finds to go to stool; and not till necessity obliges him. And commonly this evacuation by lightning the superior parts mitigates the distemper itself. When a person has fatigued himself by going to stool, as often as he was obliged, he ought to take rest for a little time; and lest he grow faint, even on the same day to take food. The quantity of which ought to be determined by considering the nature of the paroxysm that is expected; or whether there is no danger of any.

CHAP. XIII.

OF VOMITING.

As a vomit even in health is often necessary to persons of a bilious habit; it is likewise so in those distempers, which are occasioned by bile. Upon this account it is necessary to those, that before fevers are distressed with horrors and tremors; to all those, that labour under a cholera; and all, that are attacked with madness, and a concomitant mirth; and those also, who are oppressed with an epilepsy. But if the distemper be acute, as the cholera; if it be a fever, while there are tetani, the rougher medicines are improper, as has been observed above in the article of purging; and it is sufficient to take such a vomit, as I prescribed for people in health. But when distempers are of long standing, and stubborn, without any fever, as an epilepsy or madness, we must use even white hellebore. Which it is not proper to administer in the winter, or summer; it is best in the spring: in the autumn it does tolerably well. Whoever prescribes it, ought first to take care, that the body of his patient be moist. It is necessary to know, that every medicine of this kind, which is given by way of potion, is not always beneficial to sick people, to healthy always hurtful.

CHAP. XIV.

OF FRICTION.

Concerning friction(25), Asclepiades looking upon himself as the inventor of it, has said so much in that book, which he entitled ‘of general remedies,’ that tho’ he mentions only three things, that, and wine, and gestation, yet he has taken up the greatest part of his treatise upon the first. Now as it is not fit to defraud the moderns of the merit either of their new discoveries or judicious imitations, _so it is but just_ at the same time to assign those things, which were practised among some of the ancients, to their true authors. It cannot indeed be doubted, that Asclepiades has been both fuller and clearer in his directions, when and how friction ought to be used; but he has discovered nothing, which was not comprized in a few words by the most ancient author Hippocrates; who said, that friction, if violent, hardens the body; if gentle, softens it; if plentiful, extenuates; if moderate, increases its bulk: from whence it follows, that it is to be made use of, when a lax body requires to be braced; or to soften one, that is indurated; or to dissipate where the fulness is hurtful; or to nourish that, which is slender and infirm.

Nevertheless, if a person examine more curiously into these different species (which is not here the province of a physician) he will easily understand that the effects of them all proceed from one cause; that is, the carrying off of something. For a part will be bound, when that thing is taken away, the intervention of which had caused it to be lax; and another is softened by removing that, which occasioned the hardness; and the body is filled, not by the friction itself, but by that food, which afterwards makes its way to the skin, relaxed by a kind of digestion(26). And the degree of it is the cause of these effects so widely different.

But there is a great deal of difference betwixt unction, and friction. For it is necessary for the body to be anointed, and gently rubbed even in acute and recent distempers; but this must be done in the time of their remission, and before taking food. But to make use of long friction is not proper, either in acute or increasing disorders; except when the intention of it is to procure sleep in phrenitic patients. This remedy is very agreeable to inveterate distempers, and where they have abated somewhat of their first violence. I am not ignorant that some maintain, that every remedy is necessary for distempers, while they are increasing, not when they are going off spontaneously. But this is not just; for a distemper, though it would come to a period of itself, may notwithstanding be sooner terminated by the application of remedies. The use of which is necessary upon a double account, both that the health may be restored as soon as possible; and that the disorder, which remains, be not irritated again by any slight cause: for a distemper may be less violent, than it has been, and yet not entirely removed; but there may be some remains of it, which the use of remedies may dissipate.

But though friction may be used in the decline of an illness, yet it is never to be practised in the increase of a fever; but if possible, when the body is entirely free of it; if that can’t be done, at least when there is a remission. It ought also to be performed sometimes over the whole body, as when we would have an infirm person take on flesh; sometimes in particular parts, either because the weakness of that part itself, or of some other, requires it. For both inveterate pains of the head are mitigated by the friction of it (yet not during their violence) and any paralytic limb is strengthened by rubbing it: but much more commonly, when one part is pained, a different one is to be rubbed; and particularly, when we want to make a derivation from the upper or middle parts of the body; and with this intention we rub the extremities. And these people are not to be regarded, who prescribe to a certain number, how often a person is to be rubbed: for that is to be estimated from his strength. Thus if one is very weak, fifty times may be sufficient: if of a more robust habit, it may be done two hundred times. And then _in different proportions_ betwixt these two according to the strength. Whence it also happens, that the motion of the hands in friction must be less frequent in a woman than a man; less frequent in a boy or an old man, than a young man. Lastly, if particular parts are rubbed, they require much and strong friction. For the whole body cannot be quickly weakened by a part, and there is a necessity for dissipating as much of the matter as we can, whether the intention be to relieve the part we brush, or another by means of it. But where a weakness of the whole body requires this treatment all over, it ought to be shorter and more mild; so as only to soften the surface of the skin, to render it more apt to receive new matter from fresh nourishment. A patient is known to be in a bad situation, when the surface of his body is cold, and the internal part is hot with a concomitant thirst, as I observed above. But even in this case friction is the only remedy, which, if it have brought out the heat, may make way for the use of some medicine.

CHAP. XV.

OF GESTATION.

Gestation is most proper for chronic distempers, and those that are already upon the decline. And it is useful both to those, who are quite free of a fever, but yet are not able to exercise themselves; and those, that have the slow relicks of distempers, which are not otherwise expelled. Asclepiades said, that gestation was to be used even in a recent and violent, and especially an ardent fever, in order to discuss it. But that is dangerous; and the violence of such a distemper is sustained better by remaining quiet. Yet if any person will make trial of it, he may do it under these circumstances, if his tongue is not rough, if there be no tumour, no hardness, no pain in his bowels, nor head, nor præcordia. And gestation ought never to be used at all in a body that is pained, whether in the whole, or in any part, unless the pain be in the nerves alone; and never in the increase of a fever, but upon its remission.

There are many kinds of gestation: in the use of which the strength and circumstances of the patient are to be considered; that they may neither dissipate too much a weak man, nor be out of the reach of one of small fortune. The most mild kind of gestation is in a ship, either in a port, or a river; or in a litter, or a chair; more brisk in a chariot; more violent in a ship on the ocean. And each of them may be rendered both more sharp, and more mild. If none of them can be done, the bed must be suspended and moved to and fro. If even that can’t be accomplished, at least a prop is to be put under one foot(27) of the bed, and thus the bed moved back and forward by the hand. And indeed the mild kinds of exercise agree with the weakest; the stronger with those, who have been for several days free from the fever; or those, who feel the beginnings of severe distempers, but are yet without a fever (which is the case in a consumption, and indispositions of the stomach, and a dropsical disorder, and sometimes in a jaundice) or when some distempers, such as an epilepsy or madness, continue, though for a considerable time, without any concomitant fever. In which disorders, these kinds of exercises also are necessary, which were mentioned in that place, where we prescribed rules for the conduct of sound, but weakly men.

CHAP. XVI.

OF ABSTINENCE.

There are two kinds of abstinence. One, when the patient takes no food at all: the other, when he takes only what is proper. The beginnings of diseases call for fasting and thirst: after that in the distempers themselves moderation is required, so that nothing but what is proper be taken, and not too much of that; for it is not fit after fasting, to enter immediately upon a full diet. And if this be hurtful even to sound bodies, that have been under the necessity of wanting food for some time, how much more is it so to a weak, not to say a diseased one? And there is nothing which more relieves an indisposed person, than a seasonable abstinence. Intemperate men amongst us chuse for themselves the seasons of eating, and leave the quantity of their food to the physicians. Others again compliment the physicians with the times, but reserve the quantity to their own determination. Those fancy themselves to behave very genteelly, who leave every thing else to the judgment of the physicians, but insist upon the liberty of chusing the kind of their food; as if the question was, what the physician has a right to do, not what may be salutary to the patient; who is greatly hurt as often as he transgresses either in the time, measure, or quality of his food.

CHAP. XVII.

OF SWEATING.

A sweat is procured in two ways; either by a dry heat, or a bath. A dry heat is raised by hot sand, the laconicum, and clibanum(28), and some natural sweating places, where a hot vapour exhaling out of the earth is inclosed by a building, as there is at Baiæ amongst the myrtle groves. Besides these, it is solicited by the sun and exercise. These kinds are useful, wherever an internal humour offends, and is to be dissipated. Also some diseases of the nerves are best cured by this method. And the others may be proper for weak people: the heat of the sun and exercise agree only with the more robust; when they are falling into a disorder, or even during the time of distempers not violent, provided they be free of a fever. But care must be taken, that none of these be attempted either in a fever(29), or in the time of crudity.

But the use of the bath is twofold. For sometimes after the removal of fevers, it is a proper introduction to a fuller diet and stronger wine for the recovery of health: sometimes it removes the fever itself. And it is generally used, when it is expedient to relax the surface of the skin, and solicit the evacuation of the corrupted humour, and to change the habit of the body. The ancients used it with greater caution: Asclepiades more boldly. And there is no reason to be afraid of it, if it be seasonable: before the proper time, it does harm. Whoever has been freed of a fever, as soon as he has escaped the fit for one day, on the day following, after the usual time of its coming on, may safely bathe. And if the fever used to be periodical, so as to return upon the third or fourth day, whenever it has missed, the bath is safe. And even during the continuance of fevers, if they be of the slow kind, and the patients have splenetic disorders of long standing, it is proper to make trial of this remedy: on this condition however, that the præcordia be not hard nor swelled, nor the tongue rough, and there be no pain either in the trunk of the body or in the head, and the fever be not then increasing. And in these fevers indeed, which have a certain period, there are two opportunities for bathing; the one, before the shuddering; the other, after the fit is ended. In those again, who are long distressed with slow febriculas, either when the fit is entirely off; or if that does not happen, at least when it has remitted, and the body is as sound, as it generally is in that kind of illness.

A valetudinary man, that is going into the bath, ought to be careful not to expose himself to any cold before. When he has come to the bagnio, he is to stand still a little, and try whether his temples are bound, and if any sweat breaks out: if the first has happened, and the other not followed, the bath will be improper that day: he must be anointed slightly, and carried back, and by all means avoid cold, and be abstemious. But if his temples are not affected, and a sweat begins, first there, and then elsewhere, he must wash his mouth with plenty of warm water, then go into the bath; and there he must observe, whether at the first touch of the warm water he feels a shuddering upon the surface of his skin; which can scarcely happen, if the circumstances above-mentioned were as they should be: however, this is a certain sign of the bath’s being hurtful.

One from the state of his health may know, before he go into the warm water, whether it be proper to anoint himself after it. However for the most part (except in cases where it shall be expressly ordered to be done after) upon the beginning of a sweat the body is to be anointed gently, and then to be dipped in the warm water. And in this case also regard must be had to his strength; and he must not be allowed to faint by the heat, but must be speedily removed, and carefully wrapped up in cloaths, lest any cold get to him; and there also he must sweat, before he take any food.

Warm fomentations are millet-seed, salt, sand: any of these heated, and put into a linen cloth: even linen alone, if there be less heat required; but if greater, extinguished coals, wrapt up in cloths, and applied round a person. Moreover bottles(30) are filled with hot oil: and water is poured into earthen vessels, which from their resemblance in shape are called lenticulæ(31): and salt is put into a linen bag, and dipt into water well heated, then set upon the limb that is to be fomented. And at the fire are placed two ignited pieces of iron, with pretty broad heads: one of these is put into dry salt, and water is sprinkled lightly upon it; when it begins to grow cold, it is carried back to the fire: the other is made use of in the same manner; so each of them alternately: and in the mean time, the hot and salt liquor drops down through the cloth, which relieves the nerves contracted by any disease. All of them have this property in common of dissipating that, which either loads the præcordia, or suffocates the fauces, or is hurtful in any limb. When each of these sorts of fomentations is to be used, shall be directed under the particular kinds of distempers.

CHAP. XVIII.

OF THE DIFFERENT KINDS OF FOOD AND DRINK.

Since we have treated of those things, which relieve by evacuation, we must now proceed to those, which nourish us, that is, our food and drink. Now these are not only the common supports in all distempers, but even of health too. And it is of importance to be acquainted with the properties of them all: first, that the healthy may know, in what manner they are to make use of them: secondly, that in treating of the method of curing diseases, it may suffice to mention in general the species of what is to be taken, without being under the necessity of naming each particular upon every occasion.

It is fit to know then, that all leguminous vegetables, and those grains, which are made into bread, are of the strongest kind of food (I call that the strongest, in which there is the most nourishment) also every quadruped, that is tame, all large wild beasts, such as the wild goat, deer, wild boar, wild ass; every great bird, such as the goose, peacock, and crane; all large fishes, the cetus(32), and others of a like size; also honey, and cheese. So that it is no wonder that particular kind of bread(33) should be very strong, which is made of corn, fat, honey, and cheese. Of a middle nature ought to be reckoned those pot-herbs, whose roots or bulbusses we use for food; amongst quadrupeds the hare; all birds, from the least upwards to the phœnicopter(34); also all fish, that will not bear salt, or such, as are salted whole. Of the weakest kind are all potherbs, and whatever grows on a stalk, such as the gourd, and cucumber, and caper, and all the apple kind, olives, snails(35), and also conchylia(36).

But although these are thus distinguished, yet there are great differences between things even of the same class; and one is either more substantial, or weaker than another. For instance, there is more nourishment in bread, than in any thing else. Wheat is more firm than millet: and that again than barley: and the strongest kind of wheat is the siligo(37); after that the finest flour; next, that which has nothing taken from it, which the Greeks call autopyron[AX]: still weaker than these is the second flour: the weakest is grey bread. Amongst the leguminous vegetables the bean or lentil is more substantial than pease. Amongst the potherbs, turnep and navew gentle, and all the bulbous kind (in which I rank the onion also, and garlick) are more substantial than the parsnip, or that which is particularly called radicula (garden radish.) Also cabbage, and betes, and leeks, are stronger than lettuce, or gourd, or asparagus. But amongst the fruits of the surculous tribe, grapes, figs, nuts, dates, apples properly so called, are of the firmer kind. And amongst these the juicy are stronger than the mealy(38) fruits. Also of these birds, which are of the middle kind, those are stronger, which make more use of their feet, than their wings: and of those, that trust more to flying, the larger birds are stronger than the small ones, as the beccaficos, and thrush(39). And those also, which live in the water, afford a lighter food than those, which cannot swim. Amongst the tame animals pork is lightest; beef heaviest. Also of the wild, the larger any animal is, so much the stronger food it is. And of those fishes also, which are of the middle kind, the heaviest, though we make most use of them, are first all those, that are made salsamenta(40), such as the lacertus(41); next such, as though more tender than the other, yet are in themselves hard, as the aurata, corvus, sparus, oculata; in the next rank are the plani fish, after which lighter still are lupi and mulli: and then all rock fish.

[AX] αὐτόπυρον.

And there is not only a difference in the classes of things, but also in the things themselves; which arises from their age, the different parts of their body, the soil, air, and the case they are in. For every four footed animal(42), that is sucking, affords less nourishment; also a dunghill fowl, the younger it is. In fish too, the middle age, before they have reached their greatest bulk. _For the parts_, the heels, cheeks, ears, and brain of a hog; of a lamb or kid, the whole head with the petty toes, are a good deal lighter than the other parts; so that they may be ranked in the middle class. In birds, the necks or wings are properly numbered with the weakest. As to the soil, the corn, that grows upon hilly parts, is stronger than what grows upon a plain. Fish got in the midst of rocks, is lighter than those in the sand; those in the sand, than those in the mud. Whence it happens, that the same kinds either from a pond, or lake, or river, are heavier: and that, which lives in the deep, is lighter than one in shoal water. Every wild animal also is lighter than a tame one: and whatever is produced in a moist air, than another in a dry. In the next place, all the same foods afford more nourishment, fat than lean; fresh more than salt; new than stale. Again, the same thing nourishes more, when it is stewed into broth, than roasted, more roasted than fried. A hard egg is of the strongest kind; soft, or sorbile(43) of the weakest. And though all grains, made into bread, are most firm, yet some kinds washed, as alica(44), rice, ptisan, or gruel made of the same, or pulse(45), and bread moistened with water, may be reckoned with the weakest.

With regard to drinks, whatever is prepared from grain, also milk, mulse, defrutum, passum(46), wine either sweet or strong, or must, or very old wine, are of the strongest kind. But vinegar, and wine a few years old, or austere, or oily, is of the middle kind. And therefore none of these should be given to weak people. Water is weakest of all. And the drink, that is made of grain, is stronger in proportion to the hardness of the grain itself: and that wine, which is produced in a good soil, more so than in a poor soil; or in a temperate air, than one, which is either over moist or too dry, and either over cold or too hot. Mulse, the more honey it contains, defrutum, the more it is evaporated in boiling, and passum, the drier the grape is from which it is prepared, are so much the stronger. Rain water is lightest; next spring water, then river water, then that of a well; after these snow, or ice; water of lakes is heavier than these; and that of fens heaviest of all. The trial is both easy and necessary to those, that want to know its nature. For the lightness appears from weighing it; and amongst those, that are of equal weight, the sooner any of them grows hot or cold, and the more quickly herbs are boiled in it, the better it is.

It is a general rule, that the stronger each kind is, so much the less easily it is concocted; but when once concocted, it nourishes more. Wherefore the nature of the food must be determined by the degree of one’s strength; and the quantity proportioned to the kind. Upon this account weak men must make use of the weakest things; a middle kind best supports those, that are moderately strong; and the most substantial is fittest for the robust. Lastly, A person may take a greater quantity of what is lighter: but in what is most substantial, he ought to moderate his appetite.

CHAP. XIX.

GENERAL PROPERTIES OF DIFFERENT FOODS.