De Medicina (Celsus)

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	De Medicina Author: Celsus	Translator: Walter George Spencer
57	Horror autem eas fere febres antecedit , quae certum habent circuitum et ex toto remittuntur ; ideoque tutissimae sunt maximeque curationes admittunt . Nam ubi incerta tempora sunt , neque alui ductio neque balineum neque uinum neque medicamentum aliud recte datur : incertum est enim , quando febris uentura sit : ita fieri potest , ut , si subito uenerit , summa in eo pernicies sit , quod auxilii causa sit inuentum . Nihilque aliud fieri potest , quam ut primis diebus bene abstineatur aeger , deinde sub decessu febris eius , quae grauissima est , cibum sumat . At ubi certus circumitus est , facilius illa omnia temptantur , quia magis proponere nobis accessionum et decessionum uices possumus . In his autem , cum inueterauerunt , utilis fames non est : primis tantummodo diebus ea pugnandum est ; deinde diuidenda curatio est , et ante horror , tum febris discutienda . Igitur cum primum aliquis inhorruit , et ex horrore incaluit , dare oportet ei potui tepidam aquam subsalsam et uomere eum cogere : nam fere talis horror ab is oritur , quae biliosa in stomacho resederunt . Idem faciendum est , si proximo quoque circuitu aeque accessit : saepe enim sic discutitur , iamque , quod genus febris sit , scire licet . Itaque sub expectatione proximae accessionis , quae instare tertia potest , deducendus in balineum est , dandaque opera , ut per tempus horroris in solio sit . Si ibi quoque * senserit , nihilo minus idem sub expectatione quartae accessionis faciat : siquidem eo quoque modo saepe id discutitur . Si ne balneum quidem profuit , ante accessionem alium edat , aut bibat aquam calidam cum pipere : siquidem ea quoque adsumpta calorem mouent , qui horrorem non admittit . Deinde eodem modo , quo in frigore praeceptum est , antequam inhorrescere possit , operiatur , fomentisque , sed protinus ualidioribus , totum corpus circumdet maximeque inuolutis extinctis testis et titionibus . Si nihilo minus horror perruperit , multo oleo calefacto inter ipsa uestimenta perfundatur , cui aeque ex calfacientibus aliquid sit adiectum ; adhibeaturque frictio , quantam is sustinere poterit , maximeque in manibus et cruribus ; et spiritum ipse contineat . Neque desistendum est , etiamsi horret : saepe enim pertinacia iuuantis malum corporis uincit . Si quid euomuit , danda aqua tepida , iterumque uomere cogendus est ; utendumque eisdem est , donec horror finiatur . Sed praeter haec ducenda aluus est , si tardius horror quiescit : siquidem id quoque exonerato corpori prodest . Vltimaque post haec auxilia sunt gestatio et fricatio . Cibus autem in eiusmodi morbis maxime dandus est , qui mollem aluum praestet , caro glutinosa : uinum , cum dabitur , austerum .	12 Now shivering usually precedes those fevers which have a fixed cycle and a complete remission; hence they are the most safe, and specially admit of treatment. For when periodicity is uncertain, neither clyster nor bath, nor wine nor other medicament, is administered at the right moment: for it is uncertain when the fever will supervene, so that if it comes on suddenly, it may happen that there is the greatest harm in what is intended to serve as an aid. And there is nothing else that can be one, except for the patient to abstain strictly for the first days, then, upon the decline of that paroxysm which is the severest, to take food. When, however, there is an assured cycle, all those remedies are more easily tried, because we are more able to inform ourselves of the alternations between paroxysms and remissions. In those fevers, however, which have become inveterate, starving is not of service; it is only in the first days that the fever is to be thus countered; later the treatment is to be divided, first to disperse the shivering, then the fever. Therefore, as soon as the patient shivers, and after the shivering grows hot, he should be given to drink tepid water with a little salt in it, and so made to vomit: for generally such shivering arises from a bilious sediment in the stomach. Likewise if shivering recurs at the next cycle, the same should be done; for often the fever is thus shaken off, and now we may learn to what class it belongs. And so in view of the possibility of the next paroxysm, the third which may be threatening, the patient should be conducted to the bath, and it should be do arranged that he is already in the solium at the moment for the shivering. If there also he feels chilled, yet none the less he should do the same again in view of a fourth paroxysm, for often in that way the shivering is shaken off. If there is no benefit even from the bath, before the paroxysm let him eat garlic, or drink hot water containing pepper; to see if these when taken excite heat which prevents the shivering. Further in the same way as prescribed for a chill before shivering can come on, the patient should be covered up, and the whole body surrounded with foments — but the stronger ones are to be used at once — and thoroughly encompassed by wraps which enclose hot tiles and cinders. If, notwithstanding, shivering breaks out, let the patient be anointed freely under the wraps with hot oil, to which add one of the heating elements: let rubbing be applied, so far as he can bear it, especially of the arms and legs, while he holds his breath. Nor should it be stopped even if he shivers; for often the pertinacity of the rubber overcomes the body's malady. If he vomits somewhat, tepid water is to be given him, and he is to be forced to vomit again; the same measures must be used until shivering comes to an end. But if the shivering is too slow in subsiding, in addition to the above, a clyster should be given; for that also is of good effect by unloading the body. The last remedies after these are rocking and rubbing. Now in such illness the food to be given is such chiefly as will secure a soft motion, meat glutinous, wine, when any is given, dry.
58	Haec ad omnes circuitus febrium pertinent : discernendae tamen singulae sunt , sicut rationem habent dissimilem . Si cottidiana est , triduo primo magnopere abstineri oportet , tum cibis altero quoque die uti : si res inueterauerit , post febrem experiri balneum et uinum , magisque si horrore sublato haec superest .	13 The foregoing remarks apply to all periodic fevers: but they are to be distinguished, according to the dissimilar characters of each. If it is a daily fever, it is particularly important to abstain for the first three days, then to make use of food upon alternate days: if this fever has become inveterate, the bath and wine are to be tried at the end of the paroxysm, and especially so when the fever persists after the shivering has been removed.
59	Si uero tertiana , quae ex toto intermittit , aut quartana est , mediis diebus et ambulationibus uti oportet aliisque exercitationibus et unctionibus . Quidam ex antiquis medicis Cleophantus in hoc genere morborum multo ante accessionem per caput aegrum multa calida aqua perfundebat , deinde uinum dabat . Quod , quamuis pleraque praecepta eius uiri secutus est Asclepiades , recte tamen praeteriit : est enim anceps . Ipse , si tertiana febris est , tertio die post accessionem dicit aluum duci oportere , quinto post horrorem uomitum elicere , deinde post febrem , sicut illi mos erat , adhuc calidis dari cibum et uinum , sexto die in lectulo detineri : sic enim fore , ne septimo die febris accedat . Id saepe posse fieri uerisimile est . Tutius tamen est , ut hoc ipso ordine utamur , tria remedia , uomitus , alui ductionis , uini per triduum , id est tertio die et quinto et septimo temptare , ne uinum nisi post accessionem die septimi bibat . Si uero primis diebus discussus morbus non est , inciditque in uetustatem , quo die febris expectabitur , in lectulo se contineat , post febrem confricetur , tum cibo adsumpto bibat aquam ; postero die , qui uacat , ab exercitatione unctioneque aqua tantum contentus conquiescat . Et id quidem optimum est : si uero inbecillitas urgebit , et post febrem uinum et medio die paulum cibi debebit adsumere .	14 But if it be a tertian, when there are complete intermissions, or a quartan, on the intermediate days the patient should make use of walking and of other exercises and of anointings. In this kind of malady, well before the paroxysm, a certain Cleophantus, one of the ancient physicians, poured over the patient's head quantities of hot water; and then gave wine. Asclepiades, although he followed many of this man's precepts, rejected this one, and rightly, for it is of doubtful effect. In the case of a tertian fever, Asclepiades said that on the third day following the paroxysm, the bowels should be moved by a clyster; on the fifth day after the shivering a vomit should be elicited; then, after the paroxysm, according to the custom of Cleophantus, patients whilst still heated were to be given food and wine, on the sixth day to be kept in bed; for so he hoped to prevent a paroxysm on the seventh day. It is likely that this may often happen. It is safer, however, so that we may use the exact order laid down, to try the three remedies, vomiting, clystering, and wine-drinking, on three several days, that is, on the third, fifth and seventh days, with this proviso that on the seventh day wine is not to be drunk until after the time for the paroxysm. But if a tertian fever is not dispersed within the first days, but is becoming chronic on the day that the paroxysm is expected, the patient should keep his bed; after the paroxysm he should be rubbed, then, having taken food, drink water; on the day following, which is free from fever, the patient should keep quiet, avoid exercise and anointing, and be content with water only. And that indeed is the best procedure; but if there is urgent weakness, he may both take wine after the paroxysm and a little food on the intermediate day.
60	Eadem in quartana facienda sunt . Sed cum haec tarde admodum finiatur nisi primis diebus discussa est , diligentius ab initio praecipiendum est , quid in ea fieri debeat . Igitur si cui cum horrore febris accessit eaque desiit , eodem die et postero tertioque continere se debebit , et aquam tantummodo calidam primo die post febrem sumere ; biduo proximo , quantum fieri potest , ne hanc quidem : si quarto die cum horrore febris reuertitur , uomere , sicut ante praeceptum est ; deinde post febrem modicum cibum sumere , uini quadrantem . Postero tertioque die abstineri , aqua tantummodo calida , si sitiet , adsumpta . Septimo die balineo frigus praeuenire ; si febris redierit , ducere aluum ; ubi ex eo corpus conquieuerit , in unctione uehementer perfricari ; eodem modo sumere cibum et uinum ; biduo proximo se abstinere , frictione seruata . Decimo die rursus balneum experiri ; et si postea febris accessit , aeque perfricari , uinum copiosius bibere . Ac proximum est , tot dierum ut abstinentia cum ceteris , quae praecipiuntur , febrem tollant . Si uero nihilo minus remanet , aliud ex toto sequendum est curationis genus , idque agendum , ut id , quod diu sustinendum est , corpus facile sustineat . Quo minus etiam probari curatio Heraclidis Tarentini debet , qui primis diebus ducendam aluum , deinde abstinendum in septimum diem dixit . Quod ut sustinere aliquis possit , tamen etiam febre liberatus uix refectioni ualebit : adeo , si febris saepius accesserit , concidet . Igitur , si tertio decimo die morbus manebit , balineum neque ante febrem neque postea temptandum erit , nisi interdum iam horrore discusso . Horror ipse per ea , quae supra scripta sunt , expugnandus ; deinde post febrem oportebit ungui et uehementer perfricari , cibum et ualidum et fortiter adsumere , uino uti quantum libebit ; postero die , cum satis quieuerit , ambulare , exerceri , ungui , perfricari fortiter , cibum capere sine uino , tertio die abstinere . Quo die uero febrem expectabit , ante surgere , exerceri dareque operam , ut in ipsa exercitatione febris tempus incurrat : sic enim saepe illa discutitur . At si in opere occupauit , tum demum se recipere . In eiusmodi ualetudine medicamenta sunt oleum , frictio , exercitatio , cibus , uinum . Si uenter adstrictus est , soluendus est . Sed haec facile ualidiores faciunt : si inbecillitas occupauit , pro exercitatione gestatio est ; si ne hanc quidem sustinet , adhibenda tamen frictio est . Si haec quoque onerat , intra quietem et unctionem et cibum sistendum est ; dandaque opera est , ne qua cruditas in cotidianam id malum uertat . Nam quartana neminem iugulat : sed si ex ea cotidiana facta est , in malis aeger est ; quod tamen nisi culpa uel aegri uel curantis numquam fit .	15 In a quartan fever the same should be done. But seeing that unless it has been shaken off within the first days, it is a long while in terminating, we must be more careful from the very first to lay down what should be done in it. Therefore if a paroxysm has set in with shivering and has remitted, the patient ought to observe a regimen on the same day and on the following and on the third day; on the first day after the paroxysm he should take only hot water; on the next two days abstain if possible even from that;; on the fourth day, if the fever recurs with shivering, he should vomit, as was prescribed before; then after the paroxysm he should take a limited quantity of food and of wine four ounces. On the next two days he should fast, taking only hot water if thirsty. On the seventh day the cold stage should be anticipated by the bath; if a paroxysm recurs, the bowels should be moved by a clyster; having settled down after the clyster, the patient should be anointed and rubbed vigorously; then take food and wine as above; on the next two days abstain, and undergo rubbing. On the tenth day trial is again made of the bath; and if after that a paroxysm follows, he should in the same way be rubbed, and drink wine more freely. And it is likely that so many days of fasting, along with the other measures prescribed, will get rid of the fever. But if the quartan fever persists notwithstanding, a totally different line of treatment is to be pursued, the aim being that the body may easily bear what has to be borne for a long while. Therefore we cannot approve the practice of Heraclides of Tarentum, who said that in the first days the bowel was to be clystered and then there was to be abstinence until the seventh day. Even supposing a man could endure this, yet if he does become freed from fever, he will have scarcely strength enough to recover; they themselves if there be more frequent recurrences of the fever he will sink. If, therefore, the disease shall remain on the thirteenth day, the bath should not be tried, either before or after the paroxysm, except occasionally when the shivering has been thrown off. The actual shivering is to be driven off by the measures above prescribed; then after the paroxysm it will be proper that the patient be anointed, and rubbed vigorously, and take food both nourishing and abundant, with as much wine as he likes; on the day following, when sufficiently rested, he is to walk, to take exercise, to be anointed and vigorously rubbed, then to take food without wine, and on the third day to abstain. On the day that a recurrence of the paroxysm is expected, he should get up beforehand, and so arrange the performance of the exercises that the time for the onset of the fever concurs with that of the exercise; for often in this way the paroxysm is thrown off. But if attacked during the exercise, he should thereupon return home to bed. In this kind of sickness the remedies are: anointing, rubbing, exercise, food, wine. If constipated, the bowels are to be clystered. But whilst the stronger patients can easily carry out the above, if weakness has supervened, rocking should replace exercise; if even that cannot be borne, nevertheless rubbing should be applied. If this also, when vigorous, is trying to the patient, treatment should be restricted to rest and anointing and food; care being taken that indigestion does not convert the quartan into a quotidian fever. For a quartan kills no one, but when a quotidian is made out of it, the patient is in a bad way; this, however, does not happen unless through the fault either of the patient or of the practitioner.