Chapter XIII: Preface (3)

And these above-mentioned are not the only distinctions; but some things afford good juices, others bad, which two kinds the Greeks term euchyma and cacochyma[AY]; some are mild, others acrid; some generate in us a thicker phlegm, others a more fluid; some agree with the stomach, others not; likewise some produce flatulencies, others have not that property; some heat, others cool; some readily turn sour in the stomach, others are not easily corrupted there; some open the belly, others bind it; some promote urine, others retard it; some are soporiferous, others excite the senses. Now all these must be known for this reason, that different things are proper in different constitutions or states of health.

[AY] εὔχυμα et κακόχυμα.

CHAP. XX.

OF THINGS CONTAINING GOOD JUICES.

Good juices are afforded by wheat, siligo, alica, rice, starch(47), tragum(48), milk, soft cheese, all venison, all birds of the middle class; of the larger kind also, those that we mentioned above; the middle kind betwixt tender and hard fishes, as the mullus, and lupus; pot-herbs, lettuce, nettle, mallows, cucumber, gourd, purslane, snails, dates; any of the apple kind, that are neither bitter, nor acid; wine sweet or mild, passum, defrutum, olives, or any of this fruit preserved in either of the two last mentioned liquors; the wombs(49), cheeks, and legs of hogs, all fat flesh, and glutinous, all livers, and a sorbile egg.

CHAP. XXI.

OF FOODS CONTAINING BAD JUICES.

Of bad juices are millet, panick, barley, leguminous vegetables, the flesh of tame animals very lean, and all salt meat, all salt fish and garum(50), old cheese, skirret, radish, turneps, navew gentle, bulbusses(51), cabbage, and more especially its sprouts, asparagus, betes, cucumber, leek, rocket, cresses, thyme, catmint, savory, hyssop, rue, dill, fennel, cumin, anise, dock, mustard, garlick, onion, spleens, kidneys, intestines, every kind of apple, that is acid or bitter, vinegar, every thing, that is acrid, acid, or bitter, oil, also rock-fish, and those, that are of the tenderest kind, or those again, which are either too hard and strong tasted, as those found in ponds, lakes, or muddy rivers generally are, or those, that have grown to an excessive bulk.

CHAP. XXII.

OF MILD AND ACRID THINGS.

The following are mild; gruel, pulse, pancake(52), starch, ptisan, fat flesh, and all glutinous flesh, such as we have in all tame animals, but especially in the heels, and legs of swine, the petty-toes, and heads of kids, calves, and lambs, and the brains of them all. Also milk, and what are properly called sweets, defrutum, passum, pine-nuts.

Things acrid are, whatever is too austere, all acids, all salt provisions; and even honey, which is the more so, the better it is: likewise garlick, onion, rocket, rue, cresses, cucumber, bete, cabbage, asparagus, mustard, radish, endive, basil, lettuce, and the greatest part of pot-herbs.

CHAP. XXIII.

OF THOSE THINGS WHICH GENERATE A THICK AND A FLUID PHLEGM.

A thick phlegm is generated by sorbile eggs, alica, rice, starch, ptisan, milk, bulbous roots, and almost every thing that is glutinous.

The contrary effect is produced by all salted, and acrid, and acid substances.

CHAP. XXIV.

OF WHAT AGREES WITH THE STOMACH.

Whatever is austere or acid, or whatever is moderately sprinkled with salt, is agreeable to the stomach: also un-leavened bread, and washed alica, or rice, or ptisan; and all birds, and all venison; and both of these either roasted or boiled: amongst the tame animals, beef; if any of the rest is made use of, rather lean than fat; in a swine the heels, cheeks, ears, and barren wombs; amongst pot-herbs endive, lettuce, parsnip, boiled gourd, skirret; of the apple kind, the cherry, mulberry, service fruit, mealy pears, such as are either those called crustumina(53) or næviana, also those called tarentina, or signina; the round apples, or scandiana, or amerina, or quinces, or pomegranates, wormwood(54), jar raisins, soft eggs, dates, pine-nuts, white olives preserved in strong brine or tinctured with vinegar, or the black kind, which have grown thoroughly ripe upon the tree, or been kept in passum or defrutum; austere wine, although it be grown rough, also resinated(55); hard fish of the middle class, oysters, pectines(56), murex and purpura(57), periwinkles; food and drink either cold or hot.

CHAP. XXV.

OF THINGS HURTFUL TO THE STOMACH.

The stomach is offended by every thing tepid, all salt provisions, all meat stewed into broth, every thing too sweet, all fat substances, gruel, leavened bread, and the same made either from millet or barley, oil, roots of pot-herbs, and whatever greens are eaten with oil or garum, honey, mulse, defrutum, passum, milk, all cheese, fresh grapes, figs both green and dry, all leguminous vegetables, and things, that usually prove flatulent; also thyme, catmint, savory, hyssop, cresses, dock, nipplewort, and walnuts. From this account it may be inferred, that it is no rule that what affords a good juice, agrees with the stomach; nor that what agrees with the stomach, is for that reason of good juice.

CHAP. XXVI.

OF THOSE THINGS, WHICH OCCASION FLATULENCIES, AND THE CONTRARY.

Flatulencies are generated by almost all the leguminous vegetables, every thing fat, or over sweet, all stewed meat; must, and even any wine, that has not got age: amongst pot-herbs, garlick, onion, cabbage, and all roots (except skirret and parsnip) bulbusses, dry figs too, but more especially the green, fresh grapes, all nuts, except pine-nuts, milk, and all cheese, and lastly, whatever is too crude.

Little or no flatulency is occasioned by venison, wild fowl, fish, apples, olives, conchylia, eggs either soft or sorbile, old wine. But fennel and dill even relieve flatulencies.

CHAP. XXVII.

OF THOSE THINGS WHICH HEAT AND COOL.

Heat is excited by pepper, salt, all flesh stewed into soup, garlick, onion, dry figs, salt fish, wine which is the more heating, the stronger it is.

Those greens are cooling, whose stalks are eaten without boiling, as endive, and lettuce: likewise coriander, cucumber, boiled gourd, bete, mulberries, cherries, austere apples, mealy pears, boiled flesh, and especially vinegar mixed either with meat or drink.

CHAP. XXVIII.

OF WHAT IS EASILY CORRUPTED IN THE STOMACH, AND THE CONTRARY.

The following kinds easily corrupt in the stomach, leavened bread, and such as is made of any other grain than wheat, and all kinds of the sweet bread mentioned before(58), milk, honey, also sucking animals, and tender fish, oysters, greens, cheese both new and old, coarse or tender flesh, sweet wine, mulse, defrutum passum; lastly, whatever is either juicy, or too sweet, or over thin.

But unleavened bread, birds, especially the harder, hard fish, and not only the aurata for instance, or scarus(59), but even the lolligo, locusta, polypus, do not easily corrupt; also beef and all hard flesh: the same is preferable if it be lean, and salted; and all salt fish; periwinkles, the murex and purpura, austere wine, or resinated.

CHAP. XXIX.

OF WHAT OPENS THE BELLY.

The belly is opened by leavened bread, and the more so if it be coarse, or made of barley; cabbage if it be not well boiled, lettuce, dill, cresses, basil, nettle, purslane, radishes, capers, garlick, onion, mallows, dock, bete, asparagus, gourd, cherries, mulberries, all mild apples, figs even dry, but more especially green, fresh grapes, fat small birds, periwinkles, salt fish and garum, oysters, pelorides(60), sea-urchins, muscles, and almost all shell fish, and chiefly the liquor of them, rock fish, and all tender fish, blood of the cuttle fish; and any fat meat, and the same stewed, or boiled; birds that swim; crude honey, milk, all sucking animals, mulse, sweet or salt wine, soft water(61), every thing tepid, sweet, fat, boiled, stewed, salt, or diluted.

CHAP. XXX.

OF WHAT BINDS THE BELLY.

On the contrary the belly is bound by bread made of the siligo, or flour of wheat; especially if it be unleavened; and more so if it be also toasted: and this virtue is even increased, if it be twice baked: pulse made either from alica, or panick, or millet; also gruel prepared from the same; and more so, if these have been toasted first. Lentils with the addition of betes, or endive, or cichory, or plantain, and more so, if these have been toasted before: endive also by itself or cichory toasted, with plantain; small greens, cabbage twice boiled; hard eggs, and more so if roasted; small birds, black bird, ring-dove, especially boiled in vinegar and water, crane and all birds that run, more than they fly; hare, wild goat; the liver of those animals, that have suet, especially that of beef, and the suet itself; cheese, which is grown strong by age, or by that change, which we observe in the foreign kind; or if it be new, boiled with honey or mulse; also boiled honey, unripe pears, fruit of the service-tree, more especially those that they call torminalia(62), quinces and pomegranates, olives either white or early ripe, myrtle-berries, dates, the purpura and murex, wine either resinated or rough, and wine undiluted, vinegar, mulse, that has been boiled, also rough defrutum, passum, water either tepid or very cold, and hard, that is, such as keeps long without stinking, therefore particularly rain water, every thing hard, lean, austere, rough, and scorched, and the same flesh rather roasted, than boiled.

CHAP. XXXI.

OF DIURETIC MEATS AND DRINKS.

The urine is promoted by whatever grows in the garden of a good smell, as smallage, rue, dill, basil, mint, hyssop, anise, coriander, cresses, rocket, fennel. Besides these, asparagus, caper, catmint, thyme, savory, nipplewort, parsnip, especially the wild kind, radish, skirret, onion; of venison principally the hare; small wine, pepper both round and long, mustard, wormwood, pine-nuts.

CHAP. XXXII.

OF SOPORIFEROUS AND EXCITING THINGS.

Sleep is procured by the poppy, lettuce, especially the summer kind, when its stalk is replete with milk, mulberries, and leeks.

The senses are excited by catmint, thyme, savory, hyssop, particularly pennyroyal, rue and onion.

CHAP. XXXIII.

OF THOSE THINGS, WHICH DRAW, REPEL, OR COOL, OR HEAT, OR HARDEN, OR SOFTEN.

Many things are powerful in drawing out matter: but as these consist principally of foreign medicines, and not so much adapted to the cases of those who are to be relieved by diet, I shall postpone the mention of them for the present: and shall only name those things, which are commonly at hand, and are fit for corroding, and thus extracting whatever is hurtful in those distempers, concerning which I am presently to treat. This virtue resides in the seeds of rocket, cresses, radish; but most of all mustard. The same power is also found in salt, and figs.

Sordid wool(63) dipt either in vinegar, or wine, with an addition of oil; bruised dates, bran boiled in salt water or vinegar, are all at the same time both restringent and emollient.

But the following things both restringe and cool, the wall herb (which they call parthenium or perdicium, _feverfew_) serpyllum, pennyroyal, basil, the blood herb (which the Greeks call polygonon[AZ],) purslane, poppy-leaves, and clippings of vines, coriander-leaves, henbane, moss, skirret, smallage, nightshade (which the Greeks call struchnos)[BA], cabbage-leaves, endive, plantain, fenel-seed, mashed pears or apples, chiefly quinces, lentils; cold water, especially rain water, wine, vinegar; and bread, or meal, or sponge, or pieces of cloth, or sordid wool, or even linen, moistened in any of these liquors; Cimolian chalk(64), tarras(65), oil of quinces(66), or myrtles(67), or of roses(68), bitter oil(69), leaves of vervains bruised with their tender stalks; of this kind are olive, cypress, myrtle, mastich-tree, tamarisk, privet, rose, bramble, laurel, ivy, pomegranate.

[AZ] πολύγονον.

[BA] στρύχνος.

Boiled quinces, pomegranate bark, a hot decoction of vervains, which I mentioned before, powder from the lees of wine, or myrtle-leaves, bitter almonds, all restringe without cooling.

A cataplasm made from any meal is heating, whether it be of wheat, or of far(70), or barley, or bitter vetch, or darnel, or millet, or panick, or lentil, or beans, or lupines, or lint, or fenugreek; the meal after being boiled is laid on hot. But every kind of meal boiled in mulse is more effectual for this purpose, than the same prepared with water. Besides these, Cyprine oil(71), or iris(72), marrow, fat of a cat, mixed with oil, especially if it be old, salt, nitre(73), git, pepper, cinquefoil.

And _we may observe_ in general, that those things, which both restringe violently and cool, are hardening: and those which heat and dissipate, are softening: but the most powerful cataplasm for softening is made from the seeds of lint or fenugreek.

Now physicians make use of all these things variously, both by themselves, and mixed; so that we rather see what each of them was strongly persuaded of, than what upon certain trial he found to be useful.

A. CORNELIUS CELSUS

OF

MEDICINE.

_BOOK III._

CHAP. I.

GENERAL DIVISION OF DISTEMPERS.

Having already considered all that relates to distempers in general, I come to treat of the cure of each distinctly. Now the Greeks divided them into two kinds, the one they called acute, the other chronic. And because their process was not always the same, for this reason some ranged the same distempers among the acute, which others reckoned in the number of the chronic. From whence it is plain, that there are more kinds of them. For some are short and acute, which either carry off a person quickly, or are themselves soon terminated. Others are of long continuance, from which there is neither a speedy recovery, nor speedy death. And the third kind are those, which are sometimes acute, and sometimes chronic; and this happens not only in fevers, where it is most frequent; but also in other diseases. And besides these, there is a fourth kind; which can neither be called acute, because they are not mortal; nor yet chronic, because if remedies are used, they are easily cured. When I come to treat of each, I shall point out to what kind they belong.

Now I shall divide all of them into those, that seem to affect the whole body, and those, which occur in particular parts. After a few general observations upon them all, I shall begin with the first. Though there is no distemper in which fortune can pretend to more power than art, or art than nature; since medicine can do nothing in opposition to nature: yet a physician is more excusable for want of success in acute, than in chronic disorders. For in the first, there is but a small space, within which, if the remedies do not succeed, the patient dies: in the other case, there is time both for deliberation, and a change of medicines; so that very seldom, where a physician is called at its beginning, an obedient patient is lost without his fault. Nevertheless, a chronic distemper, when it is firmly rooted, becomes equally difficult with an acute one. And indeed the older an acute distemper is, so much the more easily it is cured; but a chronic one, the more recent it is.

There is another thing we ought not to be ignorant of; that the same remedies don’t agree with all patients. Whence it happens, that the greatest authors extol some one remedy, some another, each recommending his own as the only one, according as they had succeeded with themselves. It is fit therefore, when any thing does not answer, not to pay so much regard to the author of it, as to the patient, and to make trial of one thing after another. _Remembering_ however, that in acute distempers, what does not relieve, must be quickly changed: in the chronic, which time both causes, and removes, whatever has not immediately done service, is not to be hastily condemned; much less must that be discontinued, which does but give a small relief, because its good effects are completed by time.

CHAP. II.

GENERAL DIAGNOSTICS OF ACUTE AND CHRONIC, INCREASING AND DECLINING DISEASES; THE DIFFERENCE OF REGIMEN IN EACH; AND PRECAUTIONS NECESSARY UPON THE APPREHENSION OF AN APPROACHING ILLNESS.

It is easy to know in the beginning, whether a distemper be acute, or chronic: not in those only, that are always the same; but in those also, that vary. For when the paroxysms and violent pains without intermissions distress, the disease is acute. When the pains are gentle, or the fever slow, and there are considerable intervals betwixt the fits, and those symptoms accede, which have been explained in the preceding book, it is plain, that the distemper will be of long continuance.

It is necessary also to observe, whether the distemper increases, or is at a stand, or abates: because some remedies are proper for disorders increasing, more for those, that are upon the decline. And those, which are suitable to increasing disorders, when an acute distemper is gaining ground, ought rather to be tried in the remissions. Now a distemper increases, while the pains and paroxysms grow more severe; when the paroxysms return after a shorter interval, and last longer than the preceding did. And even in chronic disorders, that have not such marks, we may know them to be increasing, if sleep is uncertain, if concoction grows worse, if the intestinal excretion is more fetid, if the senses are more heavy, the understanding more slow, if cold or heat runs over the body, if the skin grows more pale. But the contrary symptoms to these are marks of its decrease.

Besides in acute distempers, the patient must not be allowed nourishment so soon, not till they be upon the decline; that fasting by a diminution of matter may break its violence; in chronic disorders, sooner, that he may be able to endure the continuance of the disease. But if the distemper happens not to be in the whole body, but only in a particular part, yet it is more necessary to support the strength of the whole body, than of the part; since by means of that _strength_ the diseased parts may be cured. It also makes a great difference, whether a person has been properly or wrong treated from the beginning: because a method of cure is less successful, where it has been often applied unsuccessfully. If one has been injudiciously treated, but still possesses his natural strength, he is quickly restored by a proper management.

But since I began with those symptoms, which afford marks of an approaching illness, I shall commence the methods of cure from the same period. Wherefore if any of those things(1), which have been mentioned, happen, rest and abstinence are best of all: if any thing is drunk, it should be water; and sometimes it is sufficient to do that for one day; sometimes for two days, if the alarming symptoms continue; and immediately after fasting, very little food must be taken, water must be drunk; the day after, wine; then every other day by turns water and wine, till all cause of fear be removed. For by these means often a dangerous distemper impending is averted. And a great many are deceived, while they hope upon the first day immediately to remove a langour either by exercise, or bathing, or a gentle purge, or vomiting, or sweating, or drinking wine. Not but this may sometimes happen, or answer their expectations, but that it more frequently fails; and abstinence alone may cure without any danger. Especially as that may be regulated according to the degree of one’s apprehensions: and if the symptoms are slight, it is sufficient only to abstain from wine; a diminution of which assists more than lessening the quantity of food: if they are somewhat more dangerous, it may serve the turn not only to drink water (_as in the first case_), but to forbear flesh too: and sometimes to take less bread than ordinary, and confine one’s self to moist food, especially greens. And it may be sufficient then only to abstain entirely from food, wine and all motion, when violent symptoms give the alarm. And without doubt scarce any body will fall into a distemper, who does not neglect it, but takes care by these means to oppose its beginning in due time.

CHAP. III.

OF THE SEVERAL KINDS OF FEVERS.

These are the rules to be observed by such as are in health, that are only apprehensive of the cause. We next proceed to the cure of fevers, which is a kind of disease, that affects the whole body, and is the most common of all. Of these one is a quotidian, another a tertian, and a third a quartan. Sometimes some fevers also return after a longer period, but that seldom occurs. With regard to the former, they are both diseases _in themselves_, and a cure _for others_.

But quartan fevers are more simple. They begin commonly with a shuddering; then a heat breaks out; after the paroxysm is over, the patient is well for two days. So that it returns upon the fourth day.

Of tertians again there are two kinds. One of them both beginning and ending like the quartan; with this difference only, that there is one day’s intermission, and it returns upon the third. The other kind is much more fatal, which indeed returns upon the third day, but of forty-eight hours, thirty-six are occupied by the fit (and sometimes either less or more,) nor does it entirely cease in the remission; but is only mitigated. This kind most physicians call semitertian[BB].

[BB] ἑμιτριτα̃ιος.

But quotidians are various, and different in their appearances. For some of them begin with a heat, others with a coldness, others with a shuddering. I call that a coldness, when the extremities of the limbs are chilled; a shuddering, when the whole body trembles. Again, some end, so as to be followed by an interval quite free from indisposition; others so, as that though the fever somewhat abates, yet some relicks remain, till another paroxysm comes on; and others often remit little or nothing, but continue as they began. Some again are attended with a very vehement heat, others more tolerable; some are equal every day, others unequal, and alternately milder one day and more severe another: some return at the same time the following day, others either later or sooner: some by the fit and the intermission take up a day and a night, some less, others more: some, when they go off, cause a sweat, others do not; and in some a sweat leaves the patient well, in others it only renders the body weaker: sometimes also one fit comes on each day, sometimes two or more. Whence it frequently happens, that every day there are several both paroxysms and remissions; yet so as that each of them answers to some preceding one. Sometimes too the fits are so irregular, that neither their durations nor intermissions can be observed. Nor is it true, which is alledged by some, that no fever is irregular, unless it arise from a vomica, or an inflammation, or an ulcer. For the cure would always be easier, if this were fact. For what is occasioned by the evident causes, may also proceed from the occult. Nor do those dispute about things, but words, who alledge, that when feverish paroxysms come on in different manners in the same distemper, these are not irregular returns of the fever, but new and different fevers successively arising. Which however would have no relation to the method of cure, though it were true. The intervals also are sometimes pretty long, at other times scarce perceptible.

CHAP. IV.

OF THE DIFFERENT METHODS OF CURE.

This then is the general nature of fevers. But the methods of cure differ, according to their different authors. Asclepiades says, that it is the duty of a physician to effect the cure safely, speedily, and with ease _to the patient_. This is to be desired: but generally too great haste and too great indulgence both prove dangerous. What moderation must be used in order to obtain all these ends as far as possible, the principal regard being always had to the safety _of the patient_, will come into consideration, when we treat of the particulars of the cure.

And the first inquiry is, how the patient is to be treated in the beginning of the distemper. The ancients by the use of some medicines endeavoured to promote concoction; for this reason, that they were extremely afraid of crudity: next they discharged by frequent clysters that matter, which seemed to hurt. Asclepiades laying aside the use of medicines, ordered clysters not so frequently as they, but in almost every distemper. And he professed his principal cure for a fever was the disease itself. He thought also, that the strength of the patient was to be worn out by light, watching, and great thirst: insomuch that he would not even allow the mouth to be washed in the first days. So much are those mistaken, who imagine the whole of his regimen to be agreeable. For indeed in the advance of the distemper he even administered to the luxury of the patient; but at the beginning he acted the part of a tormentor.

Now I grant that medicinal potions and clysters, ought to be used but sparingly. And yet I do not think these are to be administered with a view to destroy the patient’s strength: because the greatest danger arises from weakness. Wherefore it is proper only to diminish the redundant matter; which is naturally dissipated, when there is no new accession to it. For this reason the patient must abstain from food in the beginning, and in the day-time be kept in the light, unless he be weak, because even that contributes to the discharge. And he ought to lye in a very large room.

As to thirst and sleep, the best mean is, that he be awake in the day-time, and rest in the night, if possible; and neither drink plentifully, nor be too much tormented with thirst. His mouth also may be washed, when it is both dry, and has a fetid taste; although such time is not seasonable for drinking. And Erasistratus very justly observed, that often the mouth and fauces require moisture, when there is no want of it in the internal parts; and that it is of no consequence, that the patient is uneasy. Such then ought to be the treatment at first.

Now the best medicine is food seasonably administered: when that must be given first, is a question. Most of the ancients were slow in giving it; often on the fifth or sixth day: and that perhaps the nature of the climate in Asia or in Egypt admits of. Asclepiades, after he had for three days fatigued the patient in every way, appointed the fourth for food. But Themison of late considered, not when the fever had begun, but when it had gone off, or at least was abated; and waiting for the third day from that time, if the fever had not returned, he gave food immediately; if it did come on, when it had ceased; or if it continued constantly, when at least it was mitigated.

Now none of these rules is always to be followed. For it may be proper to give food on the first day, it may on the second, it may on the third, it may not before the fourth or fifth; it may after one fit, it may after two, it may after several. For the qualities of the distemper, constitution, air, age, and season of the year make some difference. And no time can be universally fixed in things so widely different from each other. In a distemper that weakens more, food must be sooner allowed; also in an air that is more dissipating. Upon this account in Africa for no day it seems proper to prescribe fasting. It should be given also sooner to a boy, than a young man; more quickly in summer, than winter. This one thing must be practised always and every where, that a physician sitting by should now and then observe the strength of the patient, and as long as that continues, encounter the disease by abstinence; if he begins to apprehend weakness, support him by food. For it is his business to be careful neither to load the patient by superfluous matter, nor when he is weaker, to kill him by fasting. And this I find in Erasistratus, who though he did not direct, when the belly, when the body itself was to be evacuated, yet by saying that these were to be regarded, and that food was to be given, when the body stood in need of it, has plainly enough shewn, that it ought not to be given, while there w as a sufficient quantity of strength, and that care should be taken, that it was not too much exhausted.

From these things it may be inferred, that many people cannot be attended by one physician; and that the man to be trusted is he, that knows his profession, and is not much absent from the patient. But they, that practise only from views of gain, because their profits arise in proportion to the number of patients, readily fall in with such rules, as do not require close attendance; as in this very case. For it is easy even for such, as seldom see the patient, to count the days and the fits: but it is necessary for him to sit by his patient, who would form a true judgment what is alone fit to be done; when he will be too weak unless he get food. In most people however the fourth day is usually the most proper for beginning to give food.

But there is still another doubt about the days themselves, because the ancients chiefly regarded the odd days, and called them critical[BC], as if on these a judgment was to be formed concerning the patients. These days were the third, fifth, seventh, ninth, eleventh, fourteenth, and twenty-first; so that the greatest influence was attributed to the seventh, next to the fourteenth, and then to the twenty-first. And therefore with regard to the nourishment of the sick, they waited for the fits of the odd days: then afterwards they gave food, expecting the approaching fits to be easier; insomuch that Hippocrates, if the fever had ceased on any other day, used to be apprehensive of a relapse.

[BC] κρισίμοι.

This Asclepiades justly rejected as idle, and said that no day was more or less dangerous to the patients, by its being either even or odd. For sometimes the even days are worse; and food is given more properly after the paroxysm of the fevers: sometimes also in the same distemper the quality of the days is changed: and that becomes more severe, which had used to be more mild: and the fourteenth day itself is even, upon which the ancients laid a great stress. And when they maintained, that the eighth was of the same nature with the first, because the second number of seven began from it, they were inconsistent with themselves in not taking the eighth, or tenth, or twelfth day, as the more important: for they attributed more to the ninth and eleventh. When they had done this without any plausible reason, they passed on from the eleventh, not to the thirteenth, but to the fourteenth. It is a remark of Hippocrates too, that the fourth day is worst to him, that is to be relieved on the seventh. So that even by his own account, upon an even day both the fever may be more violent, and a sure indication given of what is to follow. And the same author elsewhere takes every fourth day to have the strongest influence with regard to both events; that is the fourth, seventh, eleventh, fourteenth, seventeenth: in which he passes from the odd to the even reckoning. Neither in this indeed has he kept to his point: since the eleventh is not the fourth, but the fifth day after the seventh. Whence it appears, in whatever light we consider the number, no true reasoning can be found in his doctrine. But with regard to these the ancients were misled by the Pythagoric numbers at that time in great vogue: whereas here as well as in other cases a physician ought not to count the days, but to consider the paroxysms themselves; and upon them to found his conjecture when food is to be given.

But this is of more importance, to know whether the proper time for giving food be, when the tumultuous motion of the vessels has pretty much subsided, or while some relicks of the fever still remain. For the ancients prescribed nourishment, when the body was in the soundest state: Asclepiades, upon the decline of the fit, but before it was over; his reason for which was weak; not but that food is to be given sometimes more quickly, if another paroxysm is apprehended soon; but because certainly it ought not to be given, but when the body is in its best condition: for what is received by a body free from disorder is less liable to corruption. Neither is it true, which Themison imagined, if a patient was to be well for two hours, that it would be better to give it then, that it might be digested(2), while the body was in health. Indeed if it could be so speedily digested, that would be best. But as so short a time is not sufficient, it is better that the beginning of food should be upon the end of one paroxysm, than that any of it should lie in the stomach, when another begins. Thus if a pretty long interval is to follow, it is to be given, when the person is freest of all indisposition; if but a short one, before the patient be quite well. What has been said of the sound state during an intermission, holds likewise with respect to the greatest remission we find in a continued fever. But it is also a question, whether it is necessary to wait so many hours, as use to be taken up by the fit; or whether it is sufficient to pass over the first part of them, that those patients may be more easy, who sometimes have not a perfect intermission. But it is most safe to suffer the whole time of the fit to be over first: although when the paroxysm has been long, the patient may be indulged sooner; nevertheless so that at least the one half be suffered to elapse first. And this is not only to be observed in the kind last mentioned, but in all fevers.

CHAP. V.

PARTICULAR DIRECTIONS FOR THE GIVING OF FOOD IN THE DIFFERENT SPECIES OF FEVERS.

These observations are of a more general nature belonging to all kinds of fevers: I shall now descend to the particular species of them. Wherefore if there has been only one fit, which has gone off, and that arose either from the inguen(3), or from fatigue, or from heat, or from some such accident, so that there is no reason to apprehend danger from any internal cause, the following day, when the time of the fit has passed without any disorder, food may be given. But if the heat come from within; and a heaviness of the head or præcordia has followed; and there is no apparent cause for the disturbance of the body; although health has followed one fit, yet because a tertian may be apprehended, the third day is to be expected; and when the time for the fit is over, food is to be given, but very little of it; because a quartan may also be feared. But upon the fourth day, if the body is well, it may be freely used. If indeed the paroxysm has followed upon the second, third, or fourth day, then we may conclude it to be a disease. But the method of cure in tertians and quartans (whose periods are certain, whose fits leave no indisposition, and the intervals are in a good measure calm) is easier: of which I shall speak in their proper place.

At present I shall treat of those, which distress every day. Wherefore it is most convenient to give food to the patient every third day; that the abstinence of one day may lessen the fever, on the other nourishment may recruit the strength. But when the fever is quotidian, and goes entirely off, it ought to be given as soon as the body becomes well. But if though there are not distinct fits immediately succeeding each other, yet there are feverish heats without intermission, and these daily increase without going entirely off, then _it is to be allowed at that point of time_, when a greater remission is not to be expected: if on one day the fit is more severe, and on another milder, after the most severe. Now commonly a more severe fit is followed by an easier night: whence it happens also, that a more troublesome night precedes a severer fit.

But if the fever is continued, and is never mitigated, and there is a necessity for giving food, the proper time for doing this is much disputed. Some, because patients are commonly easier in the morning, think that the opportunity. Which if it be so, is a proper time, not because it is the morning, but because the patients then have a remission. If even at that time the patient has no ease, since upon this very account that time is worse, that whereas from its own nature it ought to be better, from the force of the distemper it is not so; and likewise because the middle of the day follows, after which as almost every patient grows worse, there is room to fear, lest he be then more distressed, than he used to be: therefore, some give food to such a patient in the evening. But since at that time sick people are commonly worst, there is cause to be afraid, lest if we raise any commotion then, the disorder may be increased. For these reasons others defer it(4) till midnight, when the severest is just over, and while the same is at the greatest distance. It is more safely given before day-light, when most sick people get the quietest sleep; next to that in the morning, the time which is naturally the easiest of all.

But if the fits are irregular, because in such a case there is room to fear, that they may follow immediately after food; whenever a patient is relieved from the paroxysms he ought to eat. But if several paroxysms come on the same day, it is necessary to consider, whether these be in all respects equal (which can scarcely happen) or unequal. If they be in every point equal, food ought rather to be given after that fit, the end of which does not fall betwixt mid-day and the evening. If they are unequal, it must be considered what the difference is. For if one is more severe, and the other more mild, it ought to be given after the more severe fit: if the one is longer, and the other shorter, after the longer: if one is more severe, and the other of longer continuance, it must be examined, which of the two distresses most, the one by its violence, or the other by its continuance; and it must be given after the most weakening. But it is plainly the most important point of all, how great the remissions are, and of what nature, which happen between the fits. For if an uneasiness remains after one paroxysm, and the body feels no indisposition after the other; when the body is well, it is the fitter time for food.

If a feverishness always continues, but yet one remission is longer than the other, that is rather to be chosen: so that when the fits are continued, food may be administered immediately upon the decline of the first. For this is an universal rule, and may serve for directing all our measures in this article, to give food at the greatest distance always from a future fit; and with this caution to give it in the best state of the body. Which must be observed not only between two fits, but also amongst several. But whereas it is most generally proper to give food every third day, yet if the body is weak it must be given every day: and much more so, if the fevers are continued without any remission: and it is the more needful, the more they weaken the body; or if two or more fits attack on the same day. Which occurrence also requires the giving of food every day immediately from the first, if the pulse has presently sunk; and oftener on the same day, if in the midst of several fits the strength of the body now and then fails. Yet in these this observation must be regarded; that after such fits less food be given, where if the strength of the body would admit, none would be given at all. Now as a paroxysm must either be instantly expected, or beginning, or increasing, or at its height, or abating; and again in its abatement either at a stand, or entirely gone off; it is certain the best season for food is, when the fever is ended; next to that, when in its abatement it stops; thirdly, if there be a necessity, whenever it begins to abate: all other times are dangerous. But if upon account of weakness there is an absolute necessity for it, it is better to give somewhat, when its increase is at a stand, than while it still increases; better when it is instantly expected, than when it is beginning. Nevertheless no time is improper for supporting one, who faints for want.

Nor indeed is it sufficient for a physician to regard only the fevers, but also the state of the whole body, and direct his cure by that; whether the patient has a sufficient measure of strength or not, whether some troublesome passions affect the mind. And as the sick should always be in a state of tranquillity, that they be distressed in body only, and not in mind at the same time; so it is more especially necessary immediately after food; so that if there be any thing, which would render them uneasy, it is the best way, while they are sick, to conceal it from them; if that cannot be done, at least to forbear after food; and after their time of sleep, and when they have awaked, then to communicate it.

CHAP. VI.

THE PROPER TIMES FOR GIVING DRINK TO PERSONS IN FEVERS, AND THE KINDS OF ALIMENT SUITED TO THE SEVERAL STAGES OF THE DISTEMPER, TOGETHER WITH SOME GENERAL OBSERVATIONS.

But patients are more easily managed with regard to food; because in spite of some inclination of their own, the stomach then refuses it. But in the article of drink the struggle is hard; and the more violent, the higher the fever is: for this inflames the thirst, and demands water most importunately, when it is most dangerous. But the patient is to be informed, that when the fever has abated, the thirst also will immediately decline; and that the paroxysm will be longer, if any nourishment be given to him: and that he that drinks none, is sooner freed from the thirst. However as even people in health can bear hunger a good deal easier than thirst, it is necessary to indulge the sick more with regard to drink than food. But on the first day no moisture ought to be given, unless the pulse has suddenly sunk so low, that there is a necessity for giving food also; but on the second and following days likewise, where food is not to be allowed, yet if the thirst be violent, drink may be given.

What was said by Heraclides of Tarentum is not altogether without reason; that when either bile or crudity make a patient uneasy; it is expedient by a moderate quantity of a drink to mix new matter with the corrupted. This rule ought carefully to be observed, that the same times be chosen for drink as for food: when it is to be given without the other, let it be at a time, when we would desire the patient to sleep, which commonly thirst prevents. It is generally allowed, that as too much moisture is hurtful to every person in a fever, it is especially so to such women, as have fallen into fevers after child-bearing.

But as the fever and the manner of its remission direct to the proper seasons for food and drink, so it is not very easy to know, when the patient has a fever upon him, when he is better, or when his strength fails; without which these cannot be properly administered. For we principally trust the pulse, a most fallacious mark; because this is often slower or more quick from the age, and sex, and difference of constitutions. And generally when the body is in good enough health, if the stomach be weak, sometimes also in the beginning of a fever, it rises and sinks; so that the person may seem to be weak, when he can very well stand a severe fit that is just approaching. On the other hand, the pulse is often raised, and the vessels relaxed by the influence of the sun, and the bath, and exercise, and fear, and anger, and any other passion of the mind. So that, when a physician first comes in, the anxiety of the patient, doubtful how he may think him, accelerates the pulse. For this reason it is the business of a skilful physician not to take hold of the patient’s arm with his hand, as soon as he comes in; but first to sit down with a cheerful countenance, and ask him how he does; and if he has any apprehension, to encourage him with plausible discourse: then to apply his hand to his wrist(5). Now if the sight of the physician quickens the pulse, how easily may a thousand other accidents disorder it! Another mark, to which we trust, is heat, equally deceitful; for this is excited by warmth, labour, sleep, fear, and anxiety.

Wherefore it is fit to consider those things; but not to trust entirely to them. And we may at once assure ourselves that a person has no fever, whose pulse moves regularly, and who has such a heat as is common to people in health; and that a fever is not necessarily breeding, when there is heat and motion; but only with these circumstances, if the surface of the skin, be unequally dry; if there be a heat in the forehead, and at the same time arising from the internal part of the præcordia; if the breath rushes out of the nostrils very hot; if the colour be changed either for a redness or an unusual paleness; if the eyes are heavy, and either very dry or somewhat moist; if when a sweat comes on, it is partial; if the pulse does not beat at equal intervals. Upon this account the physician ought to sit down neither in the dark, nor at the patient’s head, but in a light place opposite to him, that he may take all the marks from the countenance of the patient as he lies.

Now where there has been a fever, and it has decreased, it is, proper to take notice, whether the temples or other parts of the body grow a little moist, so as to portend an approaching sweat. And if there is any prognostic of it, upon that to give warm water to drink, the effect of which is salutary, if it diffuse a sweat over the whole body. For this purpose the patient ought to keep his hands under a good quantity of clothes; and to cover his legs and feet in the same manner. By laying on such a load many people mismanage patients in the very height of the fever, and especially where it is of the ardent kind. If the body begins to sweat, it is necessary to warm a linen cloth, and slowly to wipe every part. But when the sweat is entirely off, or if it have not come on, when the patient is warmest, and seems fit for food, he is to be gently anointed under the clothes, then wiped, and after that food is to be given him.

Liquid food is most proper for persons in fevers, at least as near as possible to liquids, and that of the lightest kind, particularly gruel; and even this, if the fever be violent, ought to be very thin. Clarified honey also is properly added to it, that the body may be more nourished: but if that offends the stomach, it should be omitted; and so should the gruel itself in like case. Instead of it may be given either intrita,(6) mixed with hot water, or washed alica; if the stomach is firm, and the belly bound, with hydromel; or if the first is weak, and the other loose, with vinegar and water. And this kind of food is sufficient for the first day: but on the second day something may be added, yet of the same nature, either greens, or conchylia, or apples. And while fevers are increasing, this is the only proper food. But when they either go off, or abate, we must always begin with something of the lightest nature, and make an addition of the middle kind, having in the mean time a regard both to the strength of the patient, and of the disease.

To set a variety of food before a patient (as Asclepiades directs) is never proper, but when he is oppressed with a nausea, and his strength fails; that by tasting a little of each he may escape being famished. But if the patient wants neither strength nor appetite, he must be tempted by no variety; lest he take more than he is able to concoct. Neither is that true, which he alleges, that food of various kinds is more easily concocted; it is indeed taken in more easily; but to concoction the genus and quantity of the food are material. Neither is it safe during great pains, nor in an encreasing distemper, for a patient to fill himself with food; but when there is already a turn towards recovery.

There are also other observations necessary to be made in fevers: and that indeed must be considered, which some regard solely, whether the body be bound or loose: the one of which suffocates, and the other dissipates. For if it is bound, the belly must be opened by clysters, urine promoted, and a sweat sollicited by every method. In this kind of disorder it is serviceable even to let blood, to agitate the body by strong gestations, to keep the person in the light, to enjoin fasting, thirst, and watchfulness. It does good also to take the person into the bath, first to plunge him into the warm bath, then anoint him. Then he should return to the warm bath, and foment his groin plentifully with water; sometimes mix oil in the bath with warm water; take food more seldom, and at greater distances than ordinary, and such as is slight, simple, soft, warm, and small in quantity; especially greens, such as dock, nettles, mallows, or the broth of shell-fish, or muscles, or locustae; and eat no flesh, but what is boiled. But the quantity of drink ought to be more liberal, both before meat, and after it, and while eating too, beyond what thirst will require. And after the bath may be given even fat broth, or wine of the sweeter kind: during which course once or twice salt Greek wine may be used.

But on the contrary, if the body incline to discharge excessively, then sweat must be restrained, and rest enjoined; and the patient may have his room darkened, and go to sleep, whenever he shall chuse it; the body is not to be agitated, unless by a gentle gestation, and to be relieved according to the nature of its disorder. For if the belly is loose, or the stomach does not retain, when the fever has abated, it is proper to give warm water to drink plentifully, and make him vomit; unless there is a pain either in the fauces, or praecordia, or side, or the distemper be inveterate.

If again a sweat prevails, the skin must be hardened, either by nitre or salt, mixed with oil. But if that disorder is more slight, the body must be anointed with pure oil: if more violent, with oil of roses, or of quinces, or of myrtles, with an addition of austere wine.

Whoever is disordered by any discharge, upon coming to the bath, must first be anointed, and then go in. If the disorder is in the skin, it will be better for him to use cold water than warm. As to his meals, his food should be substantial, cold, dry, simple, and the least liable to corruption, toasted bread, roasted flesh, austere wine, or at least inclining to austerity; and if the belly is loose, let him drink it hot; if sweating be the disorder, or vomiting, it must be cold.

CHAP. VII.

OF THE CURE OF PESTILENTIAL AND ARDENT FEVERS.