De Medicina |
Translator: Walter George Spencer
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| 49 |
Et febrium quidem ratio maxime talis est : curationum uero diuersa genera sunt , prout auctores aliquos habent . Asclepiades officium esse medici dicit , ut tuto , ut celeriter , ut iucunde curet . Id uotum est , sed fere periculosa esse nimia et festinatio et uoluptas solet . Qua uero moderatione utendum sit , ut , quantum fieri potest , omnia ista contingant prima semper habita salute , in ipsis partibus curationum considerandum erit . Et ante omnia quaeritur , primis diebus aeger qua ratione continendus sit . Antiqui medicamentis quibusdam datis concoctionem moliebantur , eo quod cruditatem maxime horrebant : deinde eam materiem , quae laedere uidebatur , ducendo saepius aluum subtrahebant . Asclepiades medicamenta sustulit ; aluum non totiens sed fere tamen in omni morbo subduxit ; febre uero ipsa praecipue se ad remedium eius uti professus est : conuellendas enim uires aegri putauit luce , uigilia , siti ingenti , sic ut ne os quidem primis diebus elui sineret . Quo magis falluntur , qui per omnia iucundam eius disciplinam esse concipiunt : is enim ulterioribus quidem diebus cubantis etiam luxuriae subscripsit , primis uero tortoris uicem exhibuit . Ego autem medicamentorum dari potiones et aluum duci non nisi raro debere concedo : non ideo tamen id agendum , ut aegri uires conuellantur , existimo , quoniam ex inbecillitate summum periculum est . Minui ergo tantum materiam superantem oportet , quae naturaliter digeritur , ubi nihil noui accedit . Itaque abstinendus a cibo primis diebus est ; in luce habendus aeger , nisi infirmus , interdiu est , quoniam corpus ista quoque digerit , isque cubare quam maxime * * conclaui debet . Quod ad sitim uero somnumque pertinet , moderandum est , ut uigilet interdiu . Noctu , si fieri potest , conquiescat : ac neque potet , neque nimium siti crucietur ; os etiam eius elui potest , ubi et siccum est , et ipsi faetet , quamuis id tempus potioni aptum non est . Commodeque Erasistratus dixit saepe in teriore parte umorem non requirente os et fauces requirere , neque ad rem male haberi aegrum pertinere . Ac primo quidem sic tenendus est . Optimum uero medicamentum eius est oportune cibus datus ; qui quando primum dari debeat , quaeritur . Plerique ex antiquis tarde dabant , saepe quinto die , saepe sexto ; et id fortasse uel in Asia uel in Aegypto caeli ratio patitur . Asclepiades ubi aegrum triduo per omnia fatigarat , quartum diem cibo destinabat . At Themison nuper , non quando coepisset febris , sed quando desisset , aut certe leuata esse t , considerabat ; et ab illo tempore expectato die tertio , si non accesserit febris , statim ; si accesserat , ubi ea uel desierat , uel si adsidue inhaerebat , certe si se inclinauerat , cibum dabat . Nihil autem horum utique perpetuum est . Nam potest primo die primus cibus dandus esse , potest secundo , potest tertio , potest non nisi quarto aut quinto , potest post unam accessionem , potest post duas , potest post plures . Refert enim qualis morbus sit , quale corpus , quale caelum , quae aetas , quod tempus anni ; minimeque in rebus inter se multum differentibus perpetuum esse praeceptum temporis potest . Ex morbo , qui plus uirium aufert , celerius cibus dandus est , itemque eo caelo , quo magis digerit . Ob quam causam in Africa nulla die aeger abstineri recte uidetur . Maturius etiam puero quam iuueni , aestate quam hieme dari debet . Vnum illud est , quod semper , quod ubique seruandum est , ut aegri uires subinde adsidens medicus inspiciat ; et quamdiu supererunt , abstinentia pugnet ; si inbecillitatem uereri coeperit , cibo subueniat . Id enim eius officium est , ut aegrum neque superuacua materia oneret , neque inbecillitatem fame prodat . Idque apud Erasistratum quoque inuenio ; qui quamuis parum docuit , quando uenter , quando corpus ipsum exinaniretur , dicendo tamen haec esse uisenda et tum cibum dandum , cum corpori deberetur , satis ostendit , dum uires superessent , dari non oportere : ne deficerent , consulendum esse . Ex his autem intellegi potest ab uno medico multos non posse curari , eumque , si artifex sit , idoneum esse , qui non multum ab aegro recedit . Sed qui quaestui seruiunt , quoniam is maior ex populo est , libenter amplectuntur ea praecepta , quae sedulitatem non exigunt , ut in hac ipsa re . Facile est enim dies uel accessiones numerare is quoque , qui aegrum raro uident : ille adsid eat necesse est , qui quod solum opus est uisurus est , quando nimis inbecillus futurus sit , nisi cibum acceperit . In pluribus tamen ad initium cibi dies quartus aptissimus esse consueuit . Est autem alia etiam de diebus ipsis dubitatio , quoniam antiqui potissimum impares sequebantur , eosque , tamquam tum de aegris iudicaretur , ΚΡΙΣΙΜΟΥΣ nominabant . Hi erant dies tertius , quintus , septimus , nonus , undecimus , quartus decimus , unus et uicesimus , ita ut summa potentia septimo , deinde quarto decimo , deinde uni et uicensimo daretur . Igitur sic aegros nutri ebant, ut dierum inparium accessiones expectarent , deinde postea cibum quasi leuioribus accessionibus instantibus darent , adeo ut Hippocrates , si alio die febris desisset , recidiuam timere sit solitus . Id Asclepiades iure ut uanum repudiauit , atque in nullo die , qua par inparue esset , is uel maius uel minus periculum esse dixit . Interdum enim peiores dies pares fiunt , et oportun ius post eorum accessiones cibus datur . Nonnumquam etiam in ipso morbo dierum ratio mutatur , fitque grauior , qui remissior esse consuerat ; atque ipse quartus decimus par est , in quo magnam uim esse antiqui fatebantur . Qui cum octauum primi die naturam habere contenderent , ut ab eo secundus septenarius numerus inciperet , ipsi sibi repugnabant non octauum , neque decimum , neque duodecimum diem sumendo quasi potentiorem : plus enim tribuebant nono et undecimo . Quod cum fecissent sine ulla probabili ratione , ab undecimo non ad tertium decimum sed ad quartum decimum transibant . Est etiam apud Hippocrate n eis , qu os septimus dies liberaturus sit , quartum esse grauissimum . Ita illo quoque auctore in die pari et grauior febris esse potest et certa futuri nota . Atque idem alio loco quartum quemque diem ut in utrumque efficacissimum adprehendit , id est quartum , septimum , undecimum , quartum decimum , septimum decimum . In quo et ab inparis ad paris numeri rationem transit et ne hoc quidem propositum conseruauit , cum a septimo die undecimus non quartus sed quintus sit . Adeo apparet , quacumque ratione ad numerum respeximus , nihil rationis sub illo quidem auctore reperiri . Verum in his quidem antiquos tum celebres admodum Pythagorici numeri fefellerunt , cum hic quoque medicus non numerare dies debeat , sed ipsas accessiones intueri , et ex his coniectare , quando dandus cibus sit . Illud autem magis ad rem pertinet scire , tum oporteat dari , cum iam bene uenae conquieuerunt , an etiamnum manentibus reliquiis febris . Antiqui enim quam integerrimis corporibus alimentum offerebant : Asclepiades inclinata quidem febre sed etiamnu m tamen inhaerente . In quo uanam rationem secutus est , non quo non sit interdum maturius cibus dandus , si mature timetur altera accessio , sed quo scilicet quam sanissimo dari debeat : minus enim conrumpitur quod integro corpori infertur . Neque tamen uerum est , quod Themisoni uidebatur , si duabus horis integer futurus esset aeger , satius esse tum dare , ut ab integro potissimum corpore diduceretur . Nam si diduci tam celeriter posset , id esset optimum : sed cum id breue tempus non praestet , satius est principia cibi a decedente febre quam reliquias ab incipiente excipi . Ita si longius tempus secundum est , quam integerrimo dandum est ; si breue , etiam antequam ex toto integer fiat . Quo loco uero integritas est , eodem est remissio , quae maxime in febre continua potest esse . Atque hoc quoque quaeritur , utrum tot horae expectandae sint , quot febrem habuerunt , an satis sit primam partem earum praeteriri , quo aegris iucundius insidat †si interdum non uacat . Tutissimum est autem ante totius accessionis tempus praeterire , quamuis , ubi longa febris fuit , potest indulgeri aegro maturius , dum tamen ante minime pars dimidia praeterea tur. Idque non in ea sola febre , de qua proxime dictum est , sed in omnibus ita seruandum est .
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4 Such for the most part is the account of fevers; but there are different sorts of treatment in accordance with what is held by the several authorities. Asclepiades said that it is the office of the practitioner to treat safely, speedily, and pleasantly. That is our aspiration, but there is generally danger both in too much haste and too much pleasure. But what moderation must be shown, in order that as far as possible all those blessings may be attained, the patient's safety being always kept first, will be considered among the actual details of the treatment. Before everything is the question as to what regimen the patient should keep to during the first days. The ancients tried to ensure assimilation by administering certain medicaments, because they dreaded indigestion most of all; next by the repetition of clysters they extracted the matter which appeared to be doing harm. Asclepiades did away with medicaments; he did not clyster the bowel with such frequency but still he generally did this in every disease; but the actual fever, he professed to use as a remedy against itself: for he deemed that the patient's forces ought to be reduced by daylight, by keeping awake, by extreme thirst, so that during the first days he would not allow even the mouth to be swilled out. Therefore those are quite wrong who believe that his regimen was a pleasant one in all respects; for in the later days he allowed even luxuries to his patient, but in the first days of the fever he played the part of torturer. Now in my opinion medicinal draughts and clysters should only be administered occasionally; and I consider that they should not be used as to pull to pieces the patient's strength, since the greatest danger is from weakness. There ought to be, therefore, only such a diminution of superfluous matter as is dispersed by natural processes when nothing is being added afresh. Hence for the first days there is to be abstinence from food; the patient is to keep in the light during the day unless weak, for this also clears the body; and so he ought to lie up in a room as . . . as possible. As regards indeed thirst and sleep, it should be so managed that he keeps awake during the day; at night as far as possible he should be at rest; and he should neither drink much nor be too much distressed by thirst; his mouth also can be swilled out when dry, if he has a bad taste in it, even though that is not the time suitable for a drink. And Erasistratus said appropriately that often whilst the inside does not require fluid, the mouth and throat require it, and it does not help to keep the patient in suffering. And for the first days, such ought to be the regimen. But his best medicament is food opportunely given; the question is when it should first be garden. Most of the ancients gave it late, often on the fifth, often on the sixth day of illness, which the climate of Asia or of Egypt may perchance permit. Asclepiades, after he had for three days harassed the patient in every way, destined the fourth day for food. But Themison, recently, took into account not when the fever began, but when it ceased, or at any rate was alleviated; and awaiting the third day from that time, if there was no return of the fever, gave food at once; if fever recurred, he gave food when it ceased, or if it obstinately persisted, he certainly gave it if the fever abated. But on none of these matters is there actually an invariable precept. For it may be that the first food should be given on the first day, it may be on the second, it may be on the third, it may be not until the fourth or fifth day; it may be after one paroxysm, it may be after two, it may be after several. For it all depends upon the kind of disease, the patient's body, the climate, his age, and the time of year; where circumstances differ so greatly, there cannot be an invariable rule of time by any means. In the case of a disease which takes away more of the patient's strength, food is to be given earlier, and the same in a climate in which he uses up more. Hence in Africa it seems right that a patient should never fast over a day. Food should also be given sooner to a child than to an adolescent, sooner in summer than in winter. There is one thing that should be observed, always, and everywhere, that the patient's strength should be continually under the eye of the attending practitioner; and so long as there is a superfluity, he should counter it by abstinence; if he begins to fear weakness, he should assist with food. For it is his business to see that the patient is neither burdened by superfluous material nor rendered weak by hunger. And this I find also in the writings of Erasistratus; who although he did not direct when the bowels should be emptied, or when the body in general, nevertheless, by saying that such things should be seen to, and food given when it was needed by the body, showed sufficiently that food should not be given while the strength was in excess, but that care should be taken not to let it become deficient. Hence it can be understood that it is not possible for many patients to be cared for by one practitioner, and provided that he is skilled in the art, he is a suitable one who does not much absent himself from the patient. But they who are slaves to gain, since more is to be got out of a crowd, are glad to adopt those precepts which do not exact a sedulous attendance, as in this very instance. For even those who see the patient but seldom find it easy to count days or paroxysms; a physician must always be at hand, if he is to see the one thing that matters, the point when the patient is about to become too weak unless he gets food. The fourth day, however, is generally the most suitable date for beginning to give food. But there is another uncertainty which concerns even the days themselves, since the ancients chiefly preferred the odd days and termed them critical, as though then the fate of the sick man was decided. These were the third, fifth, seventh, ninth, eleventh, fourteenth and twenty-first days, the most importance being attached to the seventh, next to the fourteenth and then to the twenty-first. Therefore they administered food to their patients as follows: they awaited paroxysms on odd days, and after that they gave food, as though slighter paroxysms were impending, insomuch that Hippocrates, when the fever desisted on any other than an odd day, was accustomed to fear a recurrence. Asclepiades has justly repudiated this as false, and he said that no day was more or less dangerous to patients for being even or odd. For sometimes even days are the worse, and it is more suitable to give food after paroxysms on these days. Sometimes even in the course of the same fever the daily order changes, and that day becomes graver which had wont to have more of a remission; and besides, the fourteenth day itself, which the ancients confessed to be of great importance, is an even day. Since they held that the eighth day had the character of the first day, because from it began the second numbering of seven, they contradicted themselves in not giving more importance to the eighth, tenth and twelfth days, for they gave more to the ninth and eleventh. After doing this without any rational probability, they went on from the eleventh, not to the thirteenth, but to the fourteenth day. There is even in Hippocrates this statement, that the fourth day is the gravest in the case of those whom the seventh day is to liberate. So according to that very authority, there may be on an even day both a graver fever and a certain sign of what will happen. In another passage the same authority regarded each fourth day, namely, the fourth, seventh, eleventh, fourteenth, and seventeenth, as the most effective in both respects. Thus he passed from an odd system of reckoning to an even one, yet did not, even then, keep to his proposition; for the eleventh is not the fourth day after the seventh, but the fifth. It is clear enough that by whatever reasoning we view this numbering, there is to be found nothing rational in that authority at least. But in these matters indeed the Pythagorean numbers, then quite famous, deceived the ancients, since here also the practitioner ought not to count days, but observe the actual paroxysms, and from these infer when food should be given. But it is much more pertinent to this subject to know whether food should be given when the pulse has well quieted down, or while remnants of the fever still persist. For the ancients proffered food when the bodies were as far as possible from fever: Asclepiades did so when the fever was beginning to abate although present. In this he followed false reasoning; not that food may not be given earlier sometimes, if another paroxysm is feared soon, but it certainly ought to be given when the patient is at his soundest: for food is less corrupted when introduced into a body free from fever. Nor however, is that true, which Themison held, that if the patient was likely to be free from fever for a couple of hours, it was better to give food then, in order that the food might be distributed when the body was as far as possible fever-free. For if it were possible for it to be distributed so quickly, that would be the best plan; but since that short time does not allow of it, it is better that the first food should be received by a declining fever, rather than that remnants of food should be received by a recommencing fever. In this case, if the favourable time is longer, it should be given when the body is as free as possible; if short, even before it becomes quite free. But what also holds good for a full freedom does so also for a remission, which can occur, especially in the course of a continuous fever. And there is the further question, whether it is necessary to wait for the same number of hours as the fever lasted, or if it is sufficient to suffer the first part of them to elapse so that the food may settle down more comfortably for the patient, if sometimes there is no intermission. It is safest, however, first to let pass the period of the whole preceding paroxysm, although in the case of a prolonged fever the patient may be indulged earlier, provided that half at least of that time has first passed. And this is to be observed not only in the fever just mentioned but in all. |
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Haec magis per omnia febrium genera perpetua sunt : nunc ad singulas earum species descendam . Igitur si semel tantum accessit , deinde desiit , eaque uel ex inguine uel ex lassitudine uel ex aestu aliaue re simili fuit , sic ut interior nulla causa metum fecerit , postero die , cum tempus accessionis ita transiit , ut nihil mouer it , cibus dari potest . At si ex alto calor uenit et grauitas uel capitis uel praecordiorum secuta est neque apparet quid corpus confuderit , quamuis unam accessionem secuta integritas est , tamen quia tertiana timeri potest , expectandus est dies tertius ; et ubi accessionis tempus praeteriit , cibus dandus est , sed exiguus , quia quartana quoque timeri potest ; et die quarto demum , si corpus integrum est , eo cum fiducia utendum . Si uero postero tertioue aut quarto die secuta febris est , scire licet morbum esse . Sed tertianarum uel quartanarum , quarum et certus circumitus est et finis in integritate et liberaliter quieta tempora sunt , expeditior ratio est ; de quibus suo loco dicam . Nunc uero eas explicabo , quae cotidie urgent . Igitur tertio quoque die cibus aegro commodissime datur , ut alter febrem minuat , alter uiribus subueniat . Sed is dari debet , si cotidiana febris est , quae ex toto desinat , simul atque corpus integrum factum est : si quamuis non accessiones , febres tamen iunguntur et cotidie quidem increscunt sed sine integritate tamen remittunt , cum corpus ita se habet , ut maior remissio non expectetur ; si altero die grauior , altero leuior accessio est , post grauiorem . Fere uero grauiorem accessionem leuior nox sequitur ; quo fit , ut grauiorem accessionem nox quoque tristior antecedat . At si continuatur febris neque leuior umquam fit et dari cibum necesse est , quando dari debeat , magna dissensio est . Quidam , quia fere remissius matutinum tempus aegris est , tum putant dandum . Quod si respondet , non quia mane est , sed quia remissior aeger est , dari debet . Si uero ne tum quidem ulla requies aegris est , hoc ipso peius id tempus est , quod , cum sua natura melius esse debeat , morbi uitio non est ; simulque insequitur tempus meridianum , a quo cum omnis aeger fere peior fiat , timeri potest , ne ille magis etiam quam ex consuetudine urgeatur . Igitur alii uespere tali aegro cibum dant : sed cum eo tempore fere pessimi sint qui aegrotant , uerendum est , ne , si quid tunc mouerimus , fiat aliquid asperius . Ob haec ad mediam noctem decurro , id est , finito iam grauissimo tempore eodemque longissime distante , secuturis uero antelucanis horis , quibus omnes fere maxime dormiunt , deinde matutino tempore , quod natura sua leuissimum est . Si uero febres uagae sunt , quia uerendum est , ne cibum statim subsequantur , quandocumque quis ex accessione leuatus est , tunc debet adsumere . At si plures accessiones eo dem die ueniunt , considerare oportet , paresne per omnia sint , quod uix fieri potest , an inpares . Si per omnia pares sunt , post eam potius accessionem cibus dari debet , quae non inter meridiem et uesperum desinit . Si inpares sunt , considerandum est , quo distent : nam si grauior altera , altera leuior est , post grauiorem dari debet ; si altera longior , altera breuior , post longiorem : si altera grauior , altera longior est , considerandum est , utra magis adfligat , illa ui , an haec tempore , et post eam dandum . Sed paene plurimum interest , quantae qualesque inter eas remissiones sint : nam si post alteram febrem motio manet , post alteram integrum corpus est , integro corpore cibo tempus aptius est . Si semper febricula manet , sed alterum tamen longius tempus remissionis est , id potius eligendum est , adeo ut , ubi accessiones continuantur , protinus inclinata priore dandus cibus sit . Etenim perpetuum est , ad quod omne consilium derigi potest , cibum quam maxime semper ab accessione futura reducere , et hoc saluo , dare quam integerrimo corpore . Quod non inter duas tantum sed etiam inter plures accessiones seruabitur . Sed cum sit aptissimum tertio quoque die cibum dare , tamen si corpus infirmum est , cotidie dandus est ; multoque magis , si continentes febres sine remissione sunt , quanto magis corpus adfligunt ; aut si duae pluresue accessiones eodem die ueniunt . Quae res efficit , ut et a primo die protinus cibus dari cotidie debeat , si protinus uenae conciderunt ; et saepius eodem die , si inter plures accessiones subinde uis corpori deest . Illud tamen in his seruandum est , ut post eas febres minus cibi detur , post quas , si per corpus liceret , omnino non daretur . Cum uero febris instet , incipiat , augeatur , consistat , decedat , deinde in decessione consistat aut finiatur , scire licet optimum cibo tempus esse febre finita ; deinde , cum decessio eius consistit ; tertium , si necesse est , quandocumque decedit : cetera omnia periculosa esse . Si tamen propter infirmitatem necessitas urget , satius esse consistente iam incremento febris aliquid offerre quam increscente , satius esse instante quam incipiente , cum eo tamen , ut nullo tempore is , qui deficit , non sit sustinendus . Neque Hercules satis est ipsas tantum febres medicum intueri , sed etiam totius corporis habitum et ad eum d erigere curationem , siue supersunt uires seu desunt seu quidam alii affectus interueniunt . Cum uero semper aegros securos agere conueniat , ut corpore tantum , non etiam animo laborent , tum praecipue , ubi cibum sumpserunt . Itaque si qua sunt , quae exasperatura eorum animos sunt , optimum est ea , dum aegrotant , eorum notitiae subtrahere : si id fieri non potest , sustinere tamen post cibum usque somni tempus , et cum experrecti sunt , tum exponere .
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5 The foregoing rules are rather of general application to fevers of all sorts: now I pass to their particular kinds. If, therefore, there has been only one paroxysm, then an intermission, and the fever arises either from the groin, or from fatigue, or from hot weather, or some other similar thing, and so that it gives no apprehension of a more internal cause, then on the day following, when the time for the recurrence of a paroxysm has elapsed without any disturbance, food can be given. But when there supervenes a deeply seated heat and a sense of weight, whether in the head or in the parts below the ribs, and it is not evident what is disturbing the system, even although freedom follows upon a single paroxysm, nevertheless the third day is to be awaited because a tertian is to be apprehended; and when the time for such a paroxysm has passed, food is to be given, but in small amount, because a quartan may yet be apprehended; and not until the fourth day, if the body is still free, may it be used with confidence. But if on the second, or third, or fourth day fever has recurred, the disease can be recognized. But tertian and quartan fever in which there is both a definite cycle ending in freedom from fever, and ample periods of quiet, are most quickly dealt with, and of these I will speak in their proper place (III.14, 15). Now, however, I will explain the treatment of those fevers which cause trouble every day. Food, therefore, is more suitably given to the patient upon alternate days, in order one day to diminish the fever, the other to recruit his strength. But if it be that sort of quotidian fever in which there is a complete intermission, food should be given immediately upon the body becoming fever-free: if, although there are no paroxysms, the fever is nevertheless continuous and daily increasing, but with remissions that are not complete, food should be given when the system is in that state that no major remission is expected; if the paroxysm on one day is more severe, on the next day milder, food is to be given after the more severe paroxysm. But if the fever continues without ever becoming milder, and it is necessary to give food, there is a great controversy as to the time when it should be given. Some, because patients generally have more of a remission early in the morning, think that food should be given then. But if this answers, the reason for giving food is not the fact that it is morning, but the fact that the patient has more of a remission. But if the patient has no relief even in the morning, it becomes all the worse time for food, just because, although by itself that time should be better, owing to the fault of the disease it is not so; and at the same time, it is followed by midday, after which generally patients become worse, and so it may be feared that the patient may become more distressed than usual. To such a patient, therefore, others give food in the evening: but since at that time those who are ill are generally at their worst, there is fear that any action we may then take may exasperate the fever somewhat. For these reasons I delay until midnight, that is, when one critical time is over, and the next furthest off, whilst the hours which follow before dawn are those during which all patients generally sleep the most; after that comes early morning, naturally a period of greatest relief. If, however, fevers are erratic, since there is apprehension that paroxysms may immediately follow food, whenever a patient begins to have relief after a paroxysm, then food ought to be taken. But if several paroxysms occur on the same day, it should be noted whether they are equal in all respects, which can scarcely ever be the case, or unequal. If they are equal in all respects, food should be given rather after any paroxysm which does not desist between midday and evening. If they are unequal, it is to be considered in what way they differ; for if one is more severe and another slighter, food should be given after the more severe; if one lasts longer, another a shorter time, after the longer; if one is more severe, another more prolonged, it is to be observed which of the two causes more distress, the former by its severity, or the latter by its length, and food must be given after the one which causes the most distress. But what matters almost more than anything is, how long and of what kind are the remissions between them: for if after one paroxysm shivering persists, after another the body is free from this, the more suitable time for food is when the body is free. If a slight feverishness persists all the time, but a longer period of remission occurs at one time than at another, that is the time to be selected; so that, when paroxysms are continuous, straightway, when the first one has begun to pass off, food may be given. For it is the general rule to which every pan of treatment should be directed, to give food always as long as possible before the next ensuing paroxysm, and while keeping this rule, to give the food when the body is most free from fever. This should be observed not merely with two paroxysms but also with several. But although it is most proper to give food on alternate days, yet if the system is weak, it should be given every day; and far more so if the fevers continue without remissions, inasmuch as they distress the patient more; or when two or more paroxysms occur on the same day. This occurrence renders it necessary that immediately from the first day, food must be administered daily if the pulse has immediately become weak, and several times on the same day, if in the course of several paroxysms there is progressive diminution of the bodily strength. However, in these cases we must keep to this rule, that less food is to be given after paroxysms of such a kind that no food at all would be given after them if the bodily condition allowed it. When, however, a fever threatens, begins, increases, continues stationary, declines, then persists at a low level, or terminates, it should be recognized that the best time for food is after the fever has terminated; next, when it is continuing at a diminished level; and thirdly, if need be, whenever there is a decline; all other times are dangerous. If, however, there is urgent necessity on account of weakness, it is better to give some food when the increase in the fever has become stationary, rather than whilst it is increasing, better whilst the paroxysm is as yet imminent, rather than after it has commenced, nevertheless with this proviso, that there is no time at which a patient who is failing should not be supported. Most emphatically, it is not enough for the practitioner to pay attention merely to the actual fevers, but also he must look to the habit of the body as a whole, and direct treatment to that, whether patients have superabundance or deficiency of strength, or whether there are other intervening affections. While, however, it is always of advantage for patients to be free from care, so that they may suffer in body alone, and not also in spirit, it is so especially after food has been taken. Therefore if there are any things which might exasperate their emotions, it is best to withhold these from notice whilst they are ill: if this cannot be done, nevertheless to keep all back after food, until the time of sleep, and to tell them when they wake up. |
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Sed de cibo quidem facilior cum aegris ratio est , quorum saepe stomachus hunc respuit , etiamsi mens concupiscit : de potione uero ingens pugna est , eoque magis , quo maior febris est . Haec enim sitim accendit , et tum maxime aquam exigit , cum illa periculosissima est . Sed docendus aeger est , ubi febris quierit , protinus sitim quoque quieturam , longioremque accessionem fore , si quod ei datum fuerit alimentum : ita celerius eum desinere sitire , qui non bibit . Necesse est tamen , quanto facilius etiam sani famem quam sitim sustinent , tanto magis aegris in potione quam in cibo indulgere . Sed primo quidem die nullus umor dari debet , nisi subito sic uenae ceciderunt , ut cibus quoque dari debeat , secundo uero ceterisque etiam , quibus cibus non dabitur , tamen si magna sitis urgebit , potio dari debet . Ac ne illud quidem ab Heraclida Tarentino dictum ratione caret : ubi aut bilis aegrum aut cruditas male habet , expedire quoque per modicas potiones misceri noua m materia m corrupta e . Illud uidendum est , ut qualia tempora cibo leguntur , talia potioni quoque , ubi sine illo datur , deligantur * * * , aut cum aegrum dormire cupiemus , quod fere sitis prohibet . Satis autem conuenit , cum omnibus febricitantibus nimius umor alienus sit , tum praecipue esse feminis , quae ex partu in febres inciderunt . Sed cum tempora cibo potionique febris et remissionis ratio det , non est expeditissimum scire , quando aeger febricitet , quando melior sit , quando deficiat ; sine quibus dispensari illa non possunt . Venis enim maxime credimus , fallacissimae rei , quia saepe istae leniores celerioresue sunt et aetate et sexu et corporum natura . Et plerumque satis sano corpore , si stomachus infirmus est , nonnumquam etiam incipiente febr e , subeunt et quiescunt , ut inbecillus is uideri possit , cui facile laturo grauis instat accessio . Contra saepe eas concitare solet balneum et exercitatio et metus et ira et quilibet alius animi adfectus , adeo ut , cum primum medicus uenit , sollicitudo aegri dubitantis , quomodo illi se habere uideatur , eas moueat . Ob quam causam periti medici est non protinus ut uenit adprehendere manu brachium , sed primum desidere hilari uultu percontarique , quemadmodum se habeat , et si quis eius metus est , eum probabili sermone lenire , tum deinde eius corpori manum admouere . Quas uenas autem conspectus medici mouet , quam facile mille res turbant . Altera res est , cui credimus , calor , aeque fallax : nam hic quoque excitatur aestu , labore , somno , metu , sollicitudine . Intueri quidem etiam ista oportet , sed eis non omnia credere . Ac protinus quidem scire est , non febricitare eum , cuius uenae naturaliter ordinatae sunt , teporque talis est , qualis esse sani solet : non protinus autem sub calore motuque febrem esse concipere , sed ita : si summa quoque arida inaequaliter cutis est ; si calor et in fronte est et ex imis praecordiis oritur ; si spiritus ex naribus cum feruore prorumpit ; si color aut rubore aut pallore nouo mutatus est ; si oculi graues et aut persicci aut subumidi sunt ; si sudor , cum sit , inaequalis est ; si uenae non aequalibus interuallis mouentur . Ob quam causam medicus neque in tenebris neque a capite aegri debet residere , sed inlustri loco aduersus , ut omnes notas ex uoltu quoque cubantis percipiat . Vbi uero febris fuit ac decreuit , expectare oportet , num tempora partesue corporis aliae paulum madescant , quae sudorem uenturum esse testentur ; ac si qua nota est , tum demum dare potui aquam calidam , cuius salubris effectus est , si sudorem per omnia membra diffundit . Huius autem rei causa continere aeger sub ueste satis multa manus debet , eademque crura pedesque contegere ; qua male plerique aegros in ipso febris impetu , pessimeque , ubi ardens ea est , male habent . Si sudare corpus coepit , linteum tepefacere oportet paulatimque singula membra dete rgere. At ubi sudor omnis finitus est , aut si is non uenit , ubi quam maxime potuit idoneus esse cibo aeger uidetur , leuiter sub ueste ungendus est , tum detergendus , deinde ei cibus dandus . Cibus autem febricitantibus umidus est aptissimus aut umori certe quam proximus , utique ex materia quam leuissima maximeque sorbitio ; eaque , si magnae febres fuerint , quam tenuissima esse debet . Mel quoque despumatum huic recte adicitur , quo corpus magis nutriatur : sed id si stomachum offendit , superuacuum est , sicut ipsa quoque sorbitio . Dari uero in uicem eius potest uel intrita ex aqua calida uel halica elota ; si firmus est stomachus et compressa aluus , ex aqua mulsa ; si uel ille languet uel haec profluit , ex posca . Et primo quidem cibo id satis est : secundo uero aliquid adici potest , ex eodem tamen genere materiae , uel holus uel conchylium uel pomum . Et dum febres quidem increscunt , hic solus cibus idoneus est : ubi uero aut desinunt aut leuantur , semper quidem incipiendum est ab aliquo ex materia leuissima , adiciendum uero aliquid ex media , ratione habita subinde et uirium hominis et morbi . Ponendi uero aegro uarii cibi , sicut Asclepiades praecepit , tum demum sunt , ubi fastidio urgetur neque satis uires sufficiunt , ut paulum ex singulis degustando famem uitet . At si neque uis neque cupiditas deest , nulla uarietate sollicitandus aeger est , ne plus adsumat quam concoquat . Neque uerum est , quod ab eo dicitur , facilius concoqui cibos uarios : eduntur enim facilius , ad concoctionem autem materiae genus et modus pertinent . Neque inter magnos dolores neque increscente morbo tutum est aegrum cibo impleri , sed ubi inclinata iam in melius ualetudo est . Sunt aliae quoque in febribus obseruationes necessariae . Atque id quoque uidendum est , quod quidam solum praecipiunt , adstrictum corpus sit an profluat ; quorum alterum strangulat , alterum digerit . Nam si adstrictum est , ducenda aluus est , mouenda urina , eliciendus omni modo sudor . In hoc genere morborum emisisse sanguinem , concussisse uehementi bus gestationibus corpus , in lumine habuisse , imperasse famem , sitim , uigiliam prodest . Vtile est etiam ducere in balneum , prius demittere in solium , tum ungere , iterum ad solium redire multaque aqua fouere inguina ; interdum etiam oleum in solio cum aqua calida miscere ; uti cibo serius et rarius , tenui , simplici , molli , calido , exiguo , maximeque holeribus , qualia sunt lapatium , urtica , malua , uel iure etiam concharum musculorumue aut lucustarum : neque danda caro nisi elixa est . At potio esse debet magis liberalis , et ante cibum et post hunc et cum hoc ultra quam sitis coget . Poteritque a balineo etiam pinguius aut dulcius dari uinum ; poterit semel aut bis interponi Graecum salsum . Contra uero si corpus profluit , sudor coercendus , requies habenda erit , tenebris somnoque , quandoque uolet , utendum , non nisi leni gestatione corpus agitandum , et pro genere mali subueniendum . Nam si uenter fluit , aut si stomachus non continet , ubi febris decreuit , liberaliter oportet aquam tepidam potui dare , et uomere cogere , nisi aut fauces aut praecordia aut latus dolet , aut uetus morbus e st . Si uero sudor exercet , duranda cutis est nitro uel sale , quae cum oleo miscentur ; ac si leuius id uitium est , oleo corpus ungendum ; si uehementius , rosa uel melino uel murteo , cui uinum austerum sit adiectum . Quisquis autem fluore aeger est , cum uenit in balineum , prius ungendus , deinde in solium d emittendus est . Si in cute uitium est , frigida quoque quam calida aqua melius utetur . Vbi ad cibum uentum est , dari debet is ualens , frigidus , siccus , simplex , qui quam minime corrumpi possit , panis tostus , caro assa , uinum austerum uel certe subausterum ; si uenter profluit , calidum , si sudores nocent uomitusue sunt , frigidum .
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6 But the rationing of patients' food is the easier because often the stomach spues it back, although the appetite is eager for it; over drink, however, there is a mighty battle, the more so the greater the fever. For fever inflames thirst, and then most demands water when it is most dangerous. But the patient is to be taught that when the fever quiets down, thirst also will become quiet at once, and that the paroxysm will be prolonged if any sustenance is given to it: thus he who does not drink will the sooner cease to be thirsty. It is necessary, however, seeing that even in health hunger is more easily borne than thirst, to indulge patients more as to drink than food. But on the first day, at any rate, no fluid at all should be given, unless the pulse sinks so suddenly that food as well ought to be given: on the second day too and even on later days upon which food is not given, yet if great thirst oppresses, drink should be given. And indeed that dictum of Heraclides of tarentum was not wanting in reason: whenever either bile or indigestion disorders the patient, it is also expedient by draughts in moderation to mingle fresh material with the decomposing. We must see that, just as times are appointed for food, so they are appointed also for drink when given apart from food, . . . or when we want the patient to get the sleep which thirst usually prevents. But there is sufficient agreement that for all who are feverish an excess of fluid is unsuitable, and especially for women who have lapsed into fever after childbirth. But although the character of the fever, and of its remission, fixes the time for giving food and drink, yet it is not very easy to know when the patient has fever, when he is better, when he is becoming worse: without which food and drink cannot be administered. For the pulse upon which we mostly rely (III.4, 16) is a very deceptive thing, because often it is rendered slower or faster by age and by sex and by constitution. And very frequently when the body is fairly healthy, if the stomach is weak, also at times when a fever is beginning, the pulse is low and quiescent, so that possibly a patient may seem weak who will yet easily support the impending severe paroxysm. On the contrary, the bath and exercise and fear and anger and any other feeling of the mind is often apt to excite the pulse; so that when the practitioner makes his first visit, the solicitude of the patient who is in doubt as to what the practitioner may think of his state, may disturb the pulse. On this account a practitioner of experience does not seize the patient's forearm with his hand, as soon as he comes, but first sits down and with a cheerful countenance asks how the patient finds himself; and if the patient has any fear, he calms him with entertaining talk, and only after that moves his hand to touch the patient. If now the sight of the practitioner makes the pulse beat, how easily may a thousand things disturb it! Another thing which we put faith in, a sensation of heat, is equally fallacious: for it may be excited by hot weather, by work, by sleep, by fear, by anxiety. Such things also should be noted indeed, but not altogether relied on. And we know at once that he is not feverish, whose pulse is of natural regularity, and his warmth such as is customary in health: we must not, however, at once assume fever if there is heat and high pulse, but under the following conditions: if also the surface of the skin is dry in patches; if both the forehead feels hot, and it feels hot deep under the heart; if the breath streams out of the nostrils with burning heat; if there is a change of colour whether to unusual redness or to pallor; if the eyes are heavy and either very dry or somewhat moist; if sweat, when there is any, comes in patches; if the pulse is irregular. On this account the practitioner should not take his seat in a dark part of the room, nor at the patient's head, but he should face the patient in a good light, so that he may note all the signs from his face as he lies in bed. Now when there has been fever and it has decreased, one should observe whether the temples or other parts of the body are becoming a little moist, which is evidence that sweating is about to set in; and if there is any sign of it, then and not before hot water should be given to drink, of which the effect is salutary if it causes a general sweating all over the body. Now to promote this the patient should keep his hands well covered under the bed-clothes, and do the same with his legs and feet. But it is a mistake to torment patients with bed-clothes, as many do, at the very paroxysm of the fever, worst of all when it is an ardent fever. If the body begins to sweat, a linen towel should be warmed, and each part gradually wiped over. But when the sweating has quite ended, or if none has come, when the patient seems in the most fit state for food, he should be anointed lightly under the bedclothes, next wiped over, and then given food. For patients in fever, liquid food is best, or whatever approximates to fluid, and that of the lightest possible kind, barley gruel in particular; and if there have been high fevers, that should be of the thinnest. Honey also which has been freed from the comb may be correctly added to give the body more nutriment; not if it upsets the stomach this is unnecessary, as also is the gruel itself. But in its place can be given either crumbled bread or washed spelt groats in hot water; in hydromel if the stomach is firm and the bowels tight, or in vinegar and water if the former is weak and the latter loose. And indeed this will suffice for food on the first day; then on the next day some addition can be made, yet from the same class of food, either pot-herbs or shell-fish or orchard fruit. And whilst fevers are on the actual increase, this is the only suitable food; but when the fevers have subsided or abated, a beginning indeed is to be made always with something of the lightest kind, then something to be added of the middle class, regard being had throughout both to the patient's strength and to his disease. A variety of food may be placed before the patient as Asclepiades prescribed, only when he is troubled by loss of appetite, and insufficiency of strength, in order that by tasting a little of each he may avoid starvation. But if there is no lack of strength nor loss of appetite, the patient should not be tempted by a variety of food, lest he take more than he can digest. And there is no truth in what Asclepiades said, that a variety of food is more easily digested; for it is eaten more readily, but digestion depends upon what the food is, and how much. Nor is it safe for the patient to be filled up with food whilst there are great pains, nor during an increase of the malady, but only after his illness has turned towards improvement. In fevers there are also other things that have to be observed. And this also must be noted, which some give as their sole precept, whether the body is constricted or relaxes; the first condition chokes it, the second wastes it away. For if there is constriction, the bowels are to be moved by a clyster, urination promoted, and sweating elicited in every way. In this class of maladies it is beneficial to let blood, to shake up the body by vigorous rocking, to keep the patient in the light, to impose hunger and thirst and wakefulness. It is also useful to take the patient to the bath, putting him first into the solium, next to anoint him, then to return him to the solium again and foment his groins with plenty of water; at times also oil may be mixed with the water in the solium; food is to be used later and not too often: it is to be thin, plain, soft, hot, scanty, consisting mainly of pot-herbs, such as sorrel, nettle-tops, mallow, and also of soup made from shell-fish, mussels or spiny lobsters. No meat should be given unless boiled. But as to drink, there should be more freedom, both before and after and along with food, beyond what thirst demands. Again, after the bath wine of fuller body and sweeter can also be given; once or twice Greek salted wine can be used. On the contrary, however, if the system is relaxed, sweating is to be suppressed, rest in a dark room resorted to, and sleep allowed at will; the body is to be rocked only in the lightest fashion, and helped as may suit the illness. For if the patient has loose motions, or if the stomach does not retain its contents, when the fever has subsided he should be given a large drink of tepid water, and be induced to vomit, unless the throat or the chest or the side is painful, or the disease is of long standing. But if sweating is troublesome, the skin should be hardened by nitre or salt, mixed with oil; and if the sweating is rather slight, the body is to be anointed with olive oil: if more profuse, with rose, quince, or myrtle oil, to which a dry wine should be added. But any patient with loose motions, when he reaches the bath, should be first anointed, then put into the solium. When there is anything wrong with the skin, it is better to use cold rather than hot water. Coming to the food, this should be nutritious, cold, dry, plain, with the least possible tendency to decomposition, bread toasted, meat roasted, wine dry or at any rate somewhat dry; if the bowels are loose, the wine should be hot, but cold when there is trouble from sweating or vomiting. |
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Desiderat quoque propriam animaduorsionem in febribus pestilentiae casus . In hac utile minime est aut fame aut medicamentis uti , aut ducere aluum . Si uires sinunt , sanguinem mittere optimum est , praecipueque si cum dolore febris est : si id parum tutum est , ubi febris aut tenuata est aut leuata est , uomitu pectus purgare . Sed in hoc maturius quam in aliis morbis ducere in balineum opus est , uinum calidum et meracius dare , et omnia glutinosa ; inter quae carnem quoque generis eiusdem . Nam quo celerius eiusmodi tempestates corpiunt , eo maturius auxilia etiam cum quadam temeritate rapienda sunt . Quod si puer est qui laborat , neque tantum robur eius est , ut ei sanguis mitti possit , siti ei utendum est , ducenda aluus uel aqua uel tisanae cremore , tum denique is leuibus cibis nutriendus . Et ex toto non sic pueri ut uiri curari debent . Ergo , ut in alio quoque genere morborum , parcius in his agendum est : non facile sanguinem mittere , non facile ducere aluum , non cruciare uigilia fameque aut nimia siti , non uino curare satis conuenit . Vomitus post febrem eliciendus est , deinde dandus cibus ex leuissimis , tum is dormiat ; posteroque die , si febris manet , abstineatur ; tertio ad similem cibum redeat . Dandaque opera est , quantum fieri potest , ut inter oportunam abstinentiam cibosque oportunos , omissis ceteris , nutriatur . Si uero febris ardens extorret , nulla medicamenti danda potio est , sed in ipsis accessionibus oleo et aqua refrigerandus est ; quae miscenda manu sunt , donec albescant . Eo conclaui tenendus , quo multum et purum aerem trahere possit ; neque multis uestimentis strangulandus , sed admodum leuibus tantum uelandus est . Possunt etiam super stomachum inponi folia uitis in aqua frigida tincta . Ac ne siti quidem nimia uexandus est . Alendus maturius est , id est a tertio die , et ante cibum idem perungendus . Si pituita in stomachum coit , inclinata iam accessione uomere cogendus est ; tum dandum frigidum holus , aut pomum ex is , quae stomacho conueniunt . Si siccus manet stomachus , protinus uel tisanae uel halicae uel orizae cremor dandus est , cum quo recens adeps cocta sit . Cum uero in summo incremento morbus est , utique non ante quartum diem , magna siti antecedente , frigida aqua copiose praestanda est , ut bibat etiam ultra satietatem . Cum iam uenter et praecordia ultra modum repleta satisque refrigerata sunt , uomere debet . Quidam ne uomitum quidem exigunt , sed ipsa aqua frigida tantum ad satietatem data pro medicamento utuntur . Vbi utrumlibet factum est , multa ueste operiendus est , et collocandus ut dormiat ; fereque post longam sitim et uigiliam , post multam satietatem , post infractum calorem plenus somnus uenit ; per quem ingens sudor effunditur , idque praesentissimum auxilium est , sed in is tamen , in quibus praeter ardorem nulli dolores , nullus praecordiorum tumor , nihil prohibens uel in thorace uel in pulmone uel in faucibus , non ulcera , non deiectio , non profluuium alui fuit . Si quis autem in huiusmodi febre leuiter tussit , is neque uehementi siti conflictatur , neque bibere aquam frigidam debet , sed eo modo curandus est , quo in ceteris febribus praecipitur .
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7 Among fevers the case of pestilence demands special consideration. In this it is practically useless to prescribe fasting or medicine or clysters. If strength permits of it, blood-letting is best, and especially if there is fever with pain: but if that is hardly safe, after the fever has either declined or remitted, the chest is cleared by an emetic. But in such cases the patient requires to be taken to the bath earlier than in other affections, to be given hot and undiluted wine, and all food glutinous, including that sort of meat. For the more quickly such violent disorders seize hold, the earlier are remedies to be taken in hand, even with some temerity. But if a child is the sufferer, and not robust enough for lo-letting to be possible, thirst is to be used in his case, the bowels are to be moved by a clyster whether of water or of pearl-barley gruel; then and not before he is to be sustained by light food. Indeed in general children ought not to be treated like adults. Therefore, as in any other sort of disease, we must set to work with more caution in these cases; not let blood readily, not readily clyster, not torment by wakefulness and by hunger or excess of thirst, nor is a wine treatment very suitable. After the remission of the fever a vomit is to be elicited, then food of the lightest nature is given, after which let the child sleep; next day, if the fever persists, let the child be kept without food, and on the third day return to food as above. Our aim should be, as far as possible to sustain the child, by food when suitable, with abstinence in between when suitable, omitting all else. But if an ardent fever is parching up the patient, no medicinal draught is to be given, but during the paroxysms he is to be cooled by oil and water, mixed by the hand until they turn white. He should be kept in a room where he can inhale plenty of pure air; he is not to be stifled by a quantity of bed-clothes, but merely covered by light ones. Vine leaves also which have been dipped in cold water can be laid over the stomach. He is not even to be distressed by too much thirst; he should get food fairly soon, namely from the third day, and after being anointed beforehand. If phlegm collects in the stomach, when the paroxysm has already declined he is to be made to vomit; then to be given cold salads, or orchard fruit agreeable to the stomach. If the stomach remains dry, there should be given to begin with either pearl barley or spelt or rice gruel with which fresh lard has been boiled. Whilst the fever is at its height, certainly not before the fourth day, and if there is already great thirst, cold water is to be administered copiously so that the patient may drink even beyond satiety. As soon as the stomach and chest have become replete beyond measure and sufficiently cooled, he should vomit. Some do not even insist on the vomit, but use the cold water by itself, given up to satiety, as the medicament. When either of the above has been done, the patient is to be well wrapped up and put to bed so that he may sleep; and generally, after prolonged thirst and wakefulness, after full sating with water, after making a break in the heat, there comes abundant sleep: which brings on a profuse sweat, and this is an immediate relief, but only to those who have no pains accompanying the ardent fever, no swelling of the parts below the ribs, nothing prohibitory either in the chest or in the lung or in the throat, no ulcerations, no diarrhoea, no flux from the bowel. But if in fever of this sort the patient coughs readily, he is not to be distressed by severe thirst, nor ought he to drink water cold, but he is to be treated in the way prescribed for other fevers. |