                                     400 BC
                          ON REGIMEN IN ACUTE DISEASES
                                 by Hippocrates
                          Translated by Francis Adams
                  ON REGIMEN IN ACUTE DISEASES

  THOSE who composed what are called "The Cnidian Sentences" have
described accurately what symptoms the sick experience in every
disease, and how certain of them terminate; and in so far a man,
even who is not a physician, might describe them correctly, provided
he put the proper inquiries to the sick themselves what their
complaints are. But those symptoms which the physician ought to know
beforehand without being informed of them by the patient, are, for the
most part, omitted, some in one case and some in others, and certain
symptoms of vital importance for a conjectural judgment. But when,
in addition to the diagnosis, they describe how each complaint
should be treated, in these cases I entertain a still greater
difference of opinion with them respecting the rules they have laid
down; and not only do I not agree with them on this account, but
also because the remedies they use are few in number; for, with the
exception of acute diseases, the only medicines which they give are
drastic purgatives, with whey, and milk at certain times. If,
indeed, these remedies had been good and suitable to the complaints in
which they are recommended, they would have been still more
deserving of recommendation, if, while few in number, they were
sufficient; but this is by no means the case. Those, indeed, who
have remodeled these "Sentences" have treated of the remedies
applicable in each complaint more in a medical fashion. But neither
have the ancients written anything worth regimen, although this be a
great omission. Some of them, indeed, were not ignorant of the many
varieties of each complaint, and their manifold divisions, but when
they wish to tell clearly the numbers (species?) of each disease
they do not write for their species would be almost innumerable if
every symptom experienced by the patients were held to constitute a
disease, and receive a different name.
  2. For my part, I approve of paying attention to everything relating
to the art, and that those things which can be done well or properly
should all be done properly; such as can be quickly done should be
done quickly; such as can be neatly done should be done neatly; such
operations as can be performed without pain should be done with the
least possible pain; and that all other things of the like kind should
be done better than they could be managed by the attendants. But I
would more especially commend the physician who, in acute diseases, by
which the bulk of mankind are cut off, conducts the treatment better
than others. Acute diseases are those which the ancients named
pleurisy, pneumonia, phrenitis, lethargy, causus, and the other
diseases allied to these, including the continual fevers. For,
unless when some general form of pestilential disease is epidemic, and
diseases are sporadic and [not] of a similar character, there are more
deaths from these diseases than from all the others taken together.
The vulgar, indeed, do not recognize the difference between such
physicians and their common attendants, and are rather disposed to
commend and censure extraordinary remedies. This, then, is a great
proof that the common people are most incompetent, of themselves, to
form a judgment how such diseases should be treated: since persons who
are not physicians pass for physicians owing most especially to
these diseases, for it is an easy matter to learn the names of those
things which are applicable to persons laboring under such complaints.
For, if one names the juice of ptisan, and such and such a wine, and
hydromel, the vulgar fancy that he prescribes exactly the same
things as the physicians do, both the good and the bad, but in these
matters there is a great difference between them.
  3. But it appears to me that those things are more especially
deserving of being consigned to writing which are undetermined by
physicians, notwithstanding that they are of vital importance, and
either do much good or much harm. By undetermined I mean such as
these, wherefore certain physicians, during their whole lives, are
constantly administering unstrained ptisans, and fancy they thus
accomplish the cure properly, whereas others take great pains that the
patient should not swallow a particle of the barley (thinking it would
do much harm), but strain the juice through a cloth before giving
it; others, again, will neither give thick ptisan nor the juice,
some until the seventh day of the disease, and some until after the
crisis. Physicians are not in the practice of mooting such
questions; nor, perhaps, if mooted, would a solution of them be found;
although the whole art is thereby exposed to much censure from the
vulgar, who fancy that there really is no such science as medicine,
since, in acute diseases, practitioners differ so much among
themselves, that those things which one administers as thinking it the
best that can be given, another holds to be bad; and, in this respect,
they might say that the art of medicine resembles augury, since augurs
hold that the same bird (omen) if seen on the left hand is good, but
if on the right bad: and in divination by the inspection of entrails
you will find similar differences; but certain diviners hold the
very opposite of these opinions. I say, then, that this question is
a most excellent one, and allied to very many others, some of the most
vital importance in the Art, for that it can contribute much to the
recovery of the sick, and to the preservation of health in the case of
those who are well; and that it promotes the strength of those who use
gymnastic exercises, and is useful to whatever one may wish to apply
it.
  4. Ptisan, then, appears to me to be justly preferred before all the
other preparations from grain in these diseases, and I commend those
who made this choice, for the mucilage of it is smooth, consistent,
pleasant, lubricant, moderately diluent, quenches thirst if this be
required, and has no astringency; gives no trouble nor swells up in
the bowels, for in the boiling it swells up as much as it naturally
can. Those, then, who make use of ptisan in such diseases, should
never for a day allow their vessels to be empty of it, if I may say
so, but should use it and not intermit, unless it be necessary to stop
for a time, in order to administer medicine or a clyster. And to those
who are accustomed to take two meals in the day it is to be given
twice, and to those accustomed to live upon a single meal it is to
be given once at first, and then, if the case permit, it is to be
increased and given twice to them, if they appear to stand in need
of it. At first it will be proper not to give a large quantity nor
very thick, but in proportion to the quantity of food which one has
been accustomed to take, and so as that the veins may not be much
emptied. And, with regard to the augmentation of the dose, if the
disease be of a drier nature than one had supposed, one must not
give more of it, but should give before the draught of ptisan,
either hydromel or wine, in as great quantity as may be proper; and
what is proper in each case will be afterward stated by us. But if the
mouth and the passages from the lungs be in a proper state as to
moisture, the quantity of the draught is to be increased, as a general
rule, for an early and abundant state of moisture indicates an early
crisis, but a late and deficient moisture indicates a slower crisis.
And these things are as I have stated for the most part; but many
other things are omitted which are important to the prognosis, as will
be explained afterwards. And the more that the patient is troubled
with purging, in so much greater quantity is it to be given until
the crisis, and moreover until two days beyond the crisis, in such
cases as it appears to take place on the fifth, seventh, or ninth day,
so as to have respect both for the odd and even day: after this the
draught is to be given early in the day, and the other food in place
is to be given in the evening. These things are proper, for the most
part, to be given to those who, from the first, have used ptisan
containing its whole substance; for the pains in pleuritic
affections immediately cease of their own accord whenever the patients
begin to expectorate anything worth mentioning, and the purgings
become much better, and empyema much more seldom takes place, than
if the patients used a different regimen, and the crises are more
simple, occur earlier, and the cases are less subject to relapses.
  5. Ptisans are to be made of the very best barley, and are to be
well boiled, more especially if you do not intend to use them
strained. For, besides the other virtues of ptisan, its lubricant
quality prevents the barley that is swallowed from proving
injurious, for it does not stick nor remain in the region of the
breast; for that which is well boiled is very lubricant, excellent for
quenching thirst, of very easy digestion, and very weak, all which
qualities are wanted. If, then, one do not pay proper attention to the
mode of administering the ptisan, much harm may be done; for when
the food is shut up in the bowels, unless one procure some
evacuation speedily, before administering the draught, the pain, if
present, will be exasperated; and, if not present, it will be
immediately created, and the respiration will become more frequent,
which does mischief, for it dries the lungs, fatigues the
hypochondria, the hypogastrium, and diaphragm. And moreover if,
while the pain of the side persists, and does not yield to warm
fomentations, and the sputa are not brought up, but are viscid and
unconcocted, unless one get the pain resolved, either by loosening the
bowels, or opening a vein, whichever of these may be proper;- if to
persons so circumstanced ptisan be administered, their speedy death
will be the result. For these reasons, and for others of a similar
kind still more, those who use unstrained ptisan die on the seventh
day, or still earlier, some being seized with delirium, and others
dying suffocated with orthopnoee and riles. Such persons the
ancients thought struck, for this reason more especially, that when
dead the affected side was livid, like that of a person who had been
struck. The cause of this is that they die before the pain is
resolved, being seized with difficulty of respiration, and by large
and rapid breathing, as has been already explained, the spittle
becoming thick, acid, and unconcocted, cannot be brought up, but,
being retained in the bronchi of the lungs, produces riles; and,
when it has come to this, death, for the most part, is inevitable; for
the sputa being retained prevent the breath from being drawn in, and
force it speedily out, and thus the two conspire together to aggravate
the sputa being retained renders the respiration frequent, while the
respiration being frequent thickens the sputa, and prevents them
from being evacuated. These symptoms supervene, not only if ptisan
be administered unseasonably, but still more if any other food or
drink worse than ptisan be given.
  6. For the most part, then, the results are the same, whether the
patient have used the unstrained ptisan or have used the juice
alone; or even only drink; and sometimes it is necessary to proceed
quite differently. In general, one should do thus: if fever
commences shortly after taking food, and before the bowels have been
evacuated, whether with or without pain, the physician ought to
withhold the draught until he thinks that the food has descended to
the lower part of the belly; and if any pain be present, the patient
should use oxymel, hot if it is winter, and cold if it is summer; and,
if there be much thirst, he should take hydromel and water. Then, if
any pain be present, or any dangerous symptoms make their
appearance, it will be proper to give the draught neither in large
quantity nor thick, but after the seventh day, if the patient be
strong. But if the earlier-taken food has not descended, in the case
of a person who has recently swallowed food, and if he be strong and
in the vigor of life, a clyster should be given, or if he be weaker, a
suppository is to be administered, unless the bowels open properly
of themselves. The time for administering the draught is to be
particularly observed at the commencement and during the whole
illness; when, then, the feet are cold, one should refrain from giving
the ptisan, and more especially abstain from drink; but when the
heat has descended to the feet, one may then give it; and one should
look upon this season as of great consequence in all diseases, and not
least in acute diseases, especially those of a febrile character,
and those of a very dangerous nature. One may first use the juice, and
then the ptisan, attending accurately to the rules formerly laid down.
  7. When pain seizes the side, either at the commencement or at a
later stage, it will not be improper to try to dissolve the pain by
hot applications. Of hot applications the most powerful is hot water
in a bottle, or bladder, or in a brazen vessel, or in an earthen
one; but one must first apply something soft to the side, to prevent
pain. A soft large sponge, squeezed out of hot water and applied,
forms a good application; but it should be covered up above, for
thus the heat will remain the longer, and at the same time the vapor
will be prevented from being carried up to the patient's breath,
unless when this is thought of use, for sometimes it is the case.
And further, barley or tares may be infused and boiled in diluted
vinegar, stronger than that it could be drunk, and may then be sewed
into bladders and applied; and one may bran in like manner. Salts or
toasted millet in woolen bags are excellent for forming a dry
fomentation, for the millet is light and soothing. A soft
fomentation like this soothes pains, even such as shoot to the
clavicle. Venesection, however, does not alleviate the pain unless
when it extends to the clavicle. But if the pain be not dissolved by
the fomentations, one ought not to foment for a length of time, for
this dries the lungs and promotes suppuration; but if the pain point
to the clavicle, or if there be a heaviness in the arm, or about the
breast, or above the diaphragm, one should open the inner vein at
the elbow, and not hesitate to abstract a large quantity, until it
become much redder, or instead of being pure red, it turns livid,
for both these states occur. But if the pain be below the diaphragm,
and do not point to the clavicle, we must open the belly either with
black hellebore or peplium, mixing the black hellebore with carrot
or seseli, or cumin, or anise, or any other of the fragrant herbs; and
with the peplium the juice of sulphium (asafoetida), for these
substances, when mixed up together, are of a similar nature. The black
hellebore acts more pleasantly and effectually than the peplium,
while, on the other hand, the peplium expels wind much more
effectually than the black hellebore, and both these stop the pain,
and many other of the laxatives also stop it, but these two are the
most efficacious that I am acquainted with. And the laxatives given in
draughts are beneficial, when not very unpalatable owing to
bitterness, or any other disagreeable taste, or from quantity,
color, or any apprehension. When the patient has drunk the medicine,
one ought to give him to swallow but little less of the ptisan than
what he had been accustomed to; but it is according to rule not to
according to rule not to give any draughts while the medicine is under
operation; but when the purging is stopped then he should take a
smaller draught than what he had been accustomed to, and afterwards go
on increasing it progressively, until the pain cease, provided nothing
else contra-indicate. This is my rule, also, if one would use the
juice of ptisan (for I hold that it is better, on the whole, to
begin with taking the decoction at once, rather than by first emptying
the veins before doing so, or on the third, fourth, fifth, sixth, or
seventh day, provided the disease has not previously come to a
crisis in the course of this time), and similar preparations to
those formerly described are to be made in those cases.
  8. Such are the opinions which I entertain respecting the
administering of the ptisan; and, as regards drinks, whichsoever of
those about to be described may be administered, the same directions
are generally applicable. And here I know that physicians are in the
practice of doing the very reverse of what is proper, for they all
wish, at the commencement of diseases, to starve their patients for
two, three, or more days, and then to administer the ptisans and
drinks; and perhaps it appears to them reasonable that, as a great
change has taken place in the body, it should be counteracted by
another great change. Now, indeed, to produce a change is no small
matter, but the change must be effected well and cautiously, and after
the change the administration of food must be conducted still more so.
Those persons, then, would be most injured if the change is not
properly managed, who used unstrained ptisans; they also would
suffer who made use of the juice alone; and so also they would
suffer who took merely drink, but these least of all.
  9. One may derive information from the regimen of persons in good
health what things are proper; for if it appear that there is a
great difference whether the diet be so and so, in other respects, but
more especially in the changes, how can it be otherwise in diseases,
and more especially in the most acute? But it is well ascertained that
even a faulty diet of food and drink steadily persevered in, is
safer in the main as regards health than if one suddenly change it
to another. Wherefore, in the case of persons who take two meals in
the day, or of those who take a single meal, sudden changes induce
suffering and weakness; and thus persons who have not been
accustomed to dine, if they shall take dinner, immediately become
weak, have heaviness over their whole body, and become feeble and
languid, and if, in addition, they take supper, they will have acid
eructations, and some will have diarrhoea whose bowels were previously
dry, and not having been accustomed to be twice swelled out with
food and to digest it twice a day, have been loaded beyond their wont.
It is beneficial, in such cases, to counterbalance this change, for
one should sleep after dinner, as if passing the night, and guard
against cold in winter and heat in summer; or, if the person cannot
sleep, he may stroll about slowly, but without making stops, for a
good while, take no supper, or, at all events, eat little, and only
things that are not unwholesome, and still more avoid drink, and
especially water. Such a person will suffer still more if he take
three full meals in the day, and more still if he take more meals; and
yet there are many persons who readily bear to take three full meals
in the day, provided they are so accustomed. And, moreover, those
who have been in the habit of eating twice a day, if they omit dinner,
become feeble and powerless, averse to all work, and have heartburn;
their bowels seem, as it were, to hang loose, their urine is hot and
green, and the excrement is parched; in some the mouth is bitter,
the eyes are hollow, the temples throb, and the extremities are
cold, and the most of those who have thus missed their dinner cannot
eat supper; or, if they do sup, they load their stomach, and pass a
much worse night than if they had previously taken dinner. Since,
then, an unwonted change of diet for half a day produces such
effects upon persons in health, it appears not to be a good thing
either to add or take from. If, then, he who was restricted to a
single meal, contrary to usage, having his veins thus left empty
during a whole day, when he supped according to custom felt heavy,
it is probable that if, because he was uneasy and weak from the want
of dinner, he took a larger supper than wont, he would be still more
oppressed; or if, wanting food for a still greater interval, he
suddenly took a meal after supper, he will feel still greater
oppression. He, then, who, contrary to usage, has had his veins kept
empty by want of food, will find it beneficial to counteract the bad
effects during that day as follows: let him avoid cold, heat, and
exertion, for he could bear all these ill; let him make his supper
considerably less than usual, and not of dry food, but rather
liquid; and let him take some drink, not of a watery character, nor in
smaller quantity than is proportionate to the food, and on the next
day he should take a small dinner, so that, by degrees, he may
return to his former practice. Persons who are bilious in the
stomach bear these changes worst, while those who are pituitous,
upon the whole, bear the want of food best, so that they suffer the
least from being restricted to one meal in the day, contrary to usage.
This, then, is a sufficient proof that the greatest changes as to
those things which regard our constitutions and habits are most
especially concerned in the production of diseases, for it is
impossible to produce unseasonably a great emptying of the vessels
by abstinence, or to administer food while diseases are at their acme,
or when inflammation prevails; nor, on the on the whole, to make a
great change either one way or another with impunity.
  10. One might mention many things akin to these respecting the
stomach and bowels, to show how people readily bear such food as
they are accustomed to, even if it is not naturally good, and drink in
like manner, and how they bear unpleasantly such food as they are
not accustomed to, even although not bad, and so in like manner with
drink; and as to the effects of eating much flesh, contrary to
usage, or garlic, or asafoetida, or the stem of the plant which
produces it, or things of a similar kind possessed of strong
properties, one would be less surprised if such things produce pains
in the bowels, but rather when one learned what trouble, swelling,
flatulence, and tormina the cake (maza) will raise in the belly when
eaten by a person not accustomed to it; and how much weight and
distention of the bowels bread will create to a person accustomed to
live upon the maza; and what thirst and sudden fullness will be
occasioned by eating hot bread, owing to its desiccant and
indigestible properties; and what different effects are produced by
fine and coarse bread when eaten contrary to usage, or by the cake
when usually dry, moist, or viscid; and what different effects polenta
produces upon those who are accustomed and those who are
unaccustomed to the use of it; or drinking of wine or drinking of
water, when either custom is suddenly exchanged for the other; or
when, contrary to usage, diluted wine or undiluted has been suddenly
drunk, for the one will create water-brash in the upper part of the
intestinal canal and flatulence in the lower, while the other will
give rise to throbbing of the arteries, heaviness of the head, and
thirst; and white and dark-colored wine, although both strong wines,
if exchanged contrary to usage, will produce very different effects
upon the body, so that one need the less wonder that a sweet and
strong wine, if suddenly exchanged, should have by no means the same
effect.
  11. Let us here briefly advert to what may be said on the opposite
side; namely, that a change of diet has occurred in these cases,
without any change in their body, either as to strength, so as to
require an increase of food, or as to weakness, so as to require a
diminution. But the strength of the patient is to be taken into
consideration, and the manner of the disease, and of the
constitution of the man, and the habitual regimen of the patient,
not only as regards food but also drink. Yet one must much less resort
to augmentation, since it is often beneficial to have recourse to
abstraction, when the patient can bear it, until the disease having
reached its acme and has become concocted. But in what cases this must
be done will be afterwards described. One might write many other
things akin to those which have been now said, but there is a better
proof, for it is not akin to the matter on which my discourse has
principally turned, but the subject-matter itself is a most seasonable
proof. For some at the commencement of acute diseases have taken
food on the same day, some on the next day; some have swallowed
whatever has come in their way, and some have taken cyceon. Now all
these things are worse than if one had observed a different regimen;
and yet these mistakes, committed at that time, do much less injury
than if one were to abstain entirely from food for the first two or
three days, and on the fourth or fifth day were to take such food; and
it would be still worse, if one were to observe total abstinence for
all these days, and on the following days were to take such a diet,
before the disease is concocted; for in this way death would be the
consequence to most people, unless the disease were of a very mild
nature. But the mistakes committed at first were not so irremediable
as these, but could be much more easily repaired. This, therefore, I
think a strong proof that such or such a draught need not be
prescribed on the first days to those who will use the same draughts
afterwards. At the bottom, therefore, they do not know, neither
those using unstrained ptisans, that they are hurt by them, when
they begin to swallow them, if they abstain entirely from food for
two, three, or more days; nor do those using the juice know that
they are injured in swallowing them, when they do not commence with
the draught seasonably. But this they guard against, and know that
it does much mischief, if, before the disease be concocted, the
patient swallow unstrained ptisan, when accustomed to use strained.
All these things are strong proofs that physicians do not conduct
the regimen of patients properly, but that in those diseases in
which total abstinence from food should not be enforced on patients
that will be put on the use of ptisans, they do enforce total
abstinence; that in those cases in which there should be no change
made from total abstinence to ptisans, they do make the change; and
that, for the most part, they change from abstinence to ptisans,
exactly at the time when it is often beneficial to proceed from
ptisans almost to total abstinence, if the disease happen to be in the
state of exacerbation. And sometimes crude matters are attracted
from the head, and bilious from the region near the chest, and the
patients are attacked with insomnolency, so that the disease is not
concocted; they become sorrowful, peevish, and delirious; there are
flashes of light in their eyes, and noises in their ears; their
extremities are cold, their urine unconcocted; the sputa thin,
saltish, tinged with an intense color and smell; sweats about the
neck, and anxiety; respiration, interrupted in the expulsion of the
air, frequent and very large; expression of the eyelids dreadful;
dangerous deliquia; tossing of the bed-clothes from the breast; the
hands trembling, and sometimes the lower lip agitated. These symptoms,
appearing at the commencement, are indicative of strong delirium,
and patients so affected generally die, or if they escape, it is
with a deposit, hemorrhage from the nose, or the expectoration of
thick matter, and not otherwise. Neither do I perceive that physicians
are skilled in such things as these; how they ought to know such
diseases as are connected with debility, and which are further
weakened by abstinence from food, and those aggravated by some other
irritation; those by pain, and from the acute nature of the disease,
and what affections and various forms thereof our constitution and
habit engender, although the knowledge or ignorance of such things
brings safety or death to the patient. For it is a great mischief if
to a patient debilitated by pain, and the acute nature of the disease,
one administer drink, or more ptisan, or food, supposing that the
debility proceeds from inanition. It is also disgraceful not to
recognize a patient whose debility is connected with inanition, and to
pinch him in his diet; this mistake, indeed, is attended with some
danger, but much less than the other, and yet it is likely to expose
one to much greater derision, for if another physician, or a private
person, coming in and knowing what has happened, should give to eat or
drink those things which the other had forbidden, the benefit thus
done to the patient would be manifest. Such mistakes of
practitioners are particularly ridiculed by mankind, for the physician
or nonprofessional man thus coming in, seems as it were to resuscitate
the dead. On this subject I will describe elsewhere the symptoms by
which each of them may be recognized.
  12. And the following observations are similar to those now made
respecting the bowels. If the whole body rest long, contrary to usage,
it does not immediately recover its strength; but if, after a
protracted repose, it proceed to labor, it will clearly expose its
weakness. So it is with every one part of the body, for the feet
will make a similar display, and any other of the joints, if, being
unaccustomed to labor, they be suddenly brought into action, after a
time. The teeth and the eyes will suffer in like manner, and also
every other part whatever. A couch, also, that is either softer or
harder than one has been accustomed to will create uneasiness, and
sleeping in the open air, contrary to usage, hardens the body. But
it is sufficient merely to state examples of all these cases. If a
person having received a wound in the leg, neither very serious nor
very trifling, and he being neither in a condition very favorable to
its healing nor the contrary, at first betakes himself to bed, in
order to promote the cure, and never raises his leg, it will thus be
much less disposed to inflammation, and be much sooner well, than it
would have been if he had strolled about during the process of
healing; but if upon the fifth or sixth day, or even earlier, he
should get up and attempt to walk, he will suffer much more then
than if he had walked about from the commencement of the cure, and
if he should suddenly make many laborious exertions, he will suffer
much more than if, when the treatment was conducted otherwise, he
had made the same exertions on the same days. In fine, all these
things concur in proving that all great changes, either one way or
another, are hurtful. Wherefore much mischief takes place in the
bowels, if from a state of great inanition more food than is
moderate be administered (and also in the rest of the body, if from
a state of great rest it be hastily brought to greater exertion, it
will be much more injured), or if from the use of much food it be
changed to complete abstinence, and therefore the body in such cases
requires protracted repose, and if, from a state of laborious
exertion, the body suddenly falls into a state of ease and
indolence, in these cases also the bowels would require continued
repose from abundance of food, for otherwise it will induce pain and
heaviness in the whole body.
  13. The greater part of my discourse has related to changes, this
way or that. For all purposes it is profitable to know these things,
and more especially respecting the subject under consideration,-
that in acute diseases, in which a change is made to ptisans from a
state of inanition, it should be made as I direct; and then that
ptisans should not be used until the disease be concocted, or some
other symptom, whether of evacuation or of irritation, appear in the
intestines, or in the hypochondria, such as will be described.
Obstinate insomnolency impairs the digestion of the food and drink,
and in other respects changes and relaxes the body, and occasions a
heated state, and heaviness of the head.
  14. One must determine by such marks as these, when sweet, strong,
and dark wine, hydromel, water and oxymel, should be given in acute
diseases. Wherefore the sweet affects the head less than the strong,
attacks the brain less, evacuates the bowels more than the other,
but induces swelling of the spleen and liver; it does not agree with
bilious persons, for it causes them to thirst; it creates flatulence
in the upper part of the intestinal canal, but does not disagree
with the lower part, as far as regards flatulence; and yet
flatulence engendered by sweet wine is not of a transient nature,
but rests for a long time in the hypochondria. And therefore it in
general is less diuretic than wine which is strong and thin; but sweet
wine is more expectorant than the other. But when it creates thirst,
it is less expectorant in such cases than the other wine, but if it do
not create thirst, it promotes expectoration better than the other.
The good and bad effects of a white, strong wine, have been already
frequently and fully stated in the disquisition on sweet wine; it is
determined to the bladder more than the other, is diuretic and
laxative, and should be very useful in such complaints; for if in
other respects it be less suitable than the other, the clearing out of
the bladder effected by it is beneficial to the patient, if properly
administered. There are excellent examples of the beneficial and
injurious effects of wine, all which were left undetermined by my
predecessors. In these diseases you may use a yellow wine, and a
dark austere wine for the following purposes: if there be no heaviness
of the head, nor delirium, nor stoppage of the expectoration, nor
retention of the urine, and if the alvine discharges be more loose and
like scrapings than usual, in such cases a change from a white wine to
such as I have mentioned, might be very proper. It deserves further to
be known, that it will prove less injurious to all the parts above,
and to the bladder, if it be of a more watery nature, but that the
stronger it is, it will be the more beneficial to the bowels.
  15. Hydromel, when drunk in any stage of acute disease, is less
suitable to persons of a bilious temperament, and to those who have
enlarged viscera, than to those of a different character; it increases
thirst less than sweet wine; character;the lungs, is moderately
expectorant, and alleviates a cough; for it has some detergent quality
in it, whence it lubricates the sputum. Hydromel is also moderately
diuretic, unless prevented by the state of any of the viscera. And
it also occasions bilious discharges downwards, sometimes of a
proper character, and sometimes more intense and frothy than is
suitable; but such rather occurs in persons who are bilious, and
have enlarged viscera. Hydromel rather produces expectoration, and
softening of the lungs, when given diluted with water. But unmixed
hydromel, rather than the diluted, produces frothy evacuations, such
as are unseasonably and intensely bilious, and too hot; but such an
evacuation occasions other great mischiefs, for it neither
extinguishes the heat in the hypochondria, but rouses it, induces
inquietude, and jactitation of the limbs, and ulcerates the intestines
and anus. The remedies for all these will be described afterwards.
By using hydromel without ptisans, instead of any other drink, you
will generally succeed in the treatment of such diseases, and fall
in few cases; but in what instances it is to be given, and in what
it is not to be given, and wherefore it is not to be given,- all
this has been explained already, for the most part. Hydromel is
generally condemned, as if it weakened the powers of those who drink
it, and on that account it is supposed to accelerate death; and this
opinion arose from persons who starve themselves to death, some of
whom use hydromel alone for drink, as fancying that it really has this
effect. But this is by no means always the case. For hydromel, if
drunk alone, is much stronger than water, if it do not disorder the
bowels; but in some respects it is stronger, and in some weaker,
than wine that is thin, weak, and devoid of bouquet. There is a
great difference between unmixed wine and unmixed honey, as to their
nutritive powers, for if a man will drink double the quantity of
pure wine, to a certain quantity of honey which is swallowed, he
will find himself much stronger from the honey, provided it do not
disagree with his bowels, and that his alvine evacuations from it will
be much more copious. But if he shall use ptisan for a draught, and
drink afterward hydromel, he will feel full, flatulent, and
uncomfortable in the viscera of the hypochondrium; but if the hydromel
be taken before the draught, it will not have the same injurious
effects as if taken after it, but will be rather beneficial. And
boiled hydromel has a much more elegant appearance than the
unboiled, being clear, thin, white, and transparent, but I am unable
to mention any good quality which it possesses that the other wants.
For it is not sweeter than the unboiled, provided the honey be fine,
and it is weaker, and occasions less copious evacuations of the
bowels, neither of which effects is required from the hydromel. But
one should by all means use it boiled, provided the honey be bad,
impure, black, and not fragrant, for the boiling will remove the
most of its bad qualities and appearances.
  16. You will find the drink, called oxymel, often very useful in
these complaints, for it promotes expectoration and freedom of
breathing. the following are the proper occasions for administering
it. When strongly acid it has no mean operation in rendering the
expectoration more easy, for by bringing up the sputa, which
occasion troublesome hawking, and rendering them more slippery, and,
as it were, clearing the windpipe with a feather, it relieves the
lungs and proves emollient to them; and when it succeeds in
producing these effects it must do much good. But there are cases in
which hydromel, strongly acid, does not promote expectoration, but
renders it more viscid and thus does harm, and it is most apt to
produce these bad effects in cases which are otherwise of a fatal
character, when the patient is unable to cough or bring up the
sputa. On this account, then, one ought to consider beforehand the
strength of the patient, and if there be any hope, then one may give
it, but if given at all in such cases it should be quite tepid, and in
by no means large doses. But if slightly acrid it moistens the mouth
and throat, promotes expectoration, and quenches thirst; agrees with
the viscera seated in the hypochondrium, and obviates the bad
effects of the honey; for the bilious quality of the honey is
thereby corrected. It also promotes flatulent discharges from the
bowels, and is diuretic, but it occasions watery discharges and
those resembling scrapings, from the lower part of the intestine,
which is sometimes a bad thing in acute diseases, more especially when
the flatulence cannot be passed, but rolls backwards; and otherwise it
diminishes the strength and makes the extremities cold, this is the
only bad effect worth mentioning which I have known to arise from
the oxymel. It may suit well to drink a little of this at night before
the draught of ptisan, and when a considerable interval of time has
passed after the draught there will be nothing to prevent its being
taken. But to those who are restricted entirely to drinks without
draughts of ptisan, it will therefore not be proper at all times to
give it, more especially from the fretting and irritation of the
intestine which it occasions, (and these bad effects it will be the
more apt to produce provided there be no faeces in the intestines
and the patient is laboring under inanition,) and then it will
weaken the powers of the hydromel. But if it appears advantageous to
use a great deal of this drink during the whole course of the disease,
one should add to it merely as much vinegar as can just be perceived
by the taste, for thus what is prejudicial in it will do the least
possible harm, and what is beneficial will do the more good. In a
word, the acidity of vinegar agrees rather with those who are troubled
with bitter bile, than with those patients whose bile is black; for
the bitter principle is dissolved in it and turned to phlegm, by being
suspended in it; whereas black bile is fermented, swells up, and is
multiplied thereby: for vinegar is a melanogogue. Vinegar is more
prejudicial to women than to men, for it creates pains in the uterus.
  17. I have nothing further to add as to the effects of water when
used as a drink in acute diseases; for it neither soothes the cough in
pneumonia, nor promotes expectoration, but does less than the others
in this respect, if used alone through the whole complaint. But if
taken intermediate between oxymel and hydromel, in small quantity,
it promotes expectoration from the change which it occasions in the
qualities of these drinks, for it produces, as it were, a certain
overflow. Otherwise it does not quench the thirst, for it creates bile
in a bilious temperament, and is injurious to the hypochondrium; and
it does the most harm, engenders most bile, and does the least good
when the bowels are empty; and it increases the swelling of the spleen
and liver when they are in an inflamed state; it produces a gurgling
noise in the intestines and swims on the stomach; for it passes slowly
downwards, as being of a coldish and indigestible nature, and
neither proves laxative nor diuretic; and in this respect, too, it
proves prejudicial, that it does not naturally form does in the
intestines: and, if it be drunk while the feet are cold, its injurious
effects will be greatly aggravated, in all those parts to which it may
be determined. When you suspect in these diseases either strong
heaviness of the head, or mental alienation, you must abstain entirely
from wine, and in this case use water, or give weak, straw-colored
wine, entirely devoid of bouquet, after which a little water is to
be given in addition; for thus the strength of the will less affect
the head and the understanding: but in which cases water is mostly
to be given for drink, when in large quantity, when in moderate,
when cold, and when hot; all these things have either been discussed
already or will be treated of at the proper time. In like manner, with
respect to all the others, such as barley-water, the drinks made
from green shoots, those from raisins, and the skins of grapes and
wheat, and bastard saffron, and myrtles, pomegranates, and the others,
when the proper time for using them is come, they will be treated of
along with the disease in question, in like manner as the other
compound medicines.
  18. The bath is useful in many diseases, in some of them when used
steadily, and in others when not so. Sometimes it must be less used
than it would be otherwise, from the want of accommodation; for in few
families are all the conveniences prepared, and persons who can manage
them as they ought to be. And if the patient be not bathed properly,
he maybe thereby hurt in no inconsiderable degree, for there is
required a place to cover him that is free of smoke, abundance of
water, materials for frequent baths, but not very large, unless this
should be required. It is better that no friction should be applied,
but if so, a hot soap (smegma) must be used in greater abundance
than is common, and an affusion of a considerable quantity of water is
to be made at the same time and afterwards repeated. There must also
be a short passage to the basin, and it should be of easy ingress
and egress. But the person who takes the bath should be orderly and
reserved in his manner, should do nothing for himself, but others
should pour the water upon him and rub him, and plenty of waters, of
various temperatures, should be in readiness for the douche, and the
affusions quickly made; and sponges should be used instead of the comb
(strigil), and the body should be anointed when not quite dry. But the
head should be rubbed by the sponge until it is quite dry; the
extremities should be protected from cold, as also the head and the
rest of the body; and a man should not be washed immediately after
he has taken a draught of ptisan or a drink; neither should he take
ptisan as a drink immediately after the bath. Much will depend upon
whether the patient, when in good health, was very fond of the bath,
and in the custom of taking it: for such persons, especially, feel the
want of it, and are benefited if they are bathed, and injured if
they are not. In general it suits better with cases of pneumonia
than in ardent fevers; for the bath soothes the pain in the side,
chest, and back; concocts the sputa, promotes expectoration,
improves the respiration, and allays lassitude; for it soothes the
joints and outer skin, and is diuretic, removes heaviness of the head,
and moistens the nose. Such are the benefits to be derived from the
bath, if all the proper requisites be present; but if one or more of
these be wanting, the bath, instead of doing good, may rather prove
injurious; for every one of them may do harm if not prepared not
prepared by the attendants in the proper manner. It is by no means a
suitable thing in these diseases to persons whose bowels are too
loose, or when they are unusually confined, and there has been no
previous evacuation; neither must we bathe those who are
debilitated, nor such as have nausea or vomiting, or bilious
eructations; nor such as have hemorrhage from the nose, unless it be
less than required at that stage of the disease (with those stages you
are acquainted), but if the discharge be less than proper, one
should use the bath, whether in order to benefit the whole body or the
head alone. If then the proper requisites be at hand, and the
patient be well disposed to the bath, it may be administered once
every day, or if the patient be fond of the bath there will be no
harm, though he should take it twice in the day. The use of the bath
is much more appropriate to those who take unstrained ptisan, than
to those who take only the juice of it, although even in their case it
may be proper; but least of all does it suit with those who use only
plain drink, although, in their case too it may be suitable; but one
must form a judgment from the rules laid down before, in which of
these modes of regimen the bath will be beneficial, and in which
not. Such as want some of the requisites for a proper bath, but have
those symptoms which would be benefited by it, should be bathed;
whereas those who want none of the proper requisites, but have certain
symptoms which contraindicate the bath, are not to be bathed.
APPENDIX
                        APPENDIX

  Ardent fever (causus) takes place when the veins, being dried up
in the summer season, attract acrid and bilious humors to
themselves; and strong fever seizes the whole body, which
experiences aches of the bones, and is in a state of lassitude and
pain. It takes place most commonly from a long walk and protracted
thirst, when the veins being dried up attract acrid and hot defluxions
to themselves. The tongue becomes rough, dry, and very black; there
are gnawing pains about the bowels; the alvine discharges are watery
and yellow; there is intense thirst, insomnolency, and sometimes
wandering of the mind. To a person in such a state give to drink water
and as much boiled hydromel of a watery consistence as he will take;
and if the mouth be bitter, it may be advantageous to administer an
emetic and clyster; and if these things do not loosen the bowels,
purge with the boiled milk of asses. Give nothing saltish nor acrid,
for they will not be borne; and give no draughts of ptisan until the
crisis be past. And the affection is resolved if there be an
epistaxis, or if true critical sweats supervene with urine having
white, thick, and smooth sediments, or if a deposit take place
anywhere; but if it be resolved without these, there will be a relapse
of the complaint, or pain in the hips and legs will ensue, with
thick sputa, provided the patient be convalescent. Another species
of ardent fever: belly loose, much thirst, tongue rough, dry, and
saltish, retention of urine, insomnolency, extremities cold. In such a
case, unless there be a flow of blood from the nose, or an abscess
form about the neck, or pain in the limbs, or the patient
expectorate thick sputa (these occur when the belly is constipated),
or pain of the hips, or lividity of the genital organs, there is no
crisis; tension of the testicle is also a critical symptom. Give
attractive draughts.
  2. Bleed in the acute affections, if the disease appear strong,
and the patients be in the vigor of life, and if they have strength.
If it be quinsy or any other of the pleuritic affections, purge with
electuaries; but if the patient be weaker, or if you abstract more
blood, you may administer a clyster every third day, until he be out
of danger, and enjoin total abstinence if necessary.
  3. Hypochondria inflamed not from retention of flatus, tension of
the diaphragm, checked respiration, with dry orthopnoea, when no pus
is formed, but when these complaints are connected with obstructed
respiration; but more especially strong pains of the liver,
heaviness of the spleen, and other phlegmasiae and intense pains above
the diaphragm, diseases connected with collections of humors,- all
these diseases do not admit of resolution, if treated at first by
medicine, but venesection holds the first place in conducting the
treatment; then we may have recourse to a clyster, unless the
disease be great and strong; but if so, purging also may be necessary;
but bleeding and purging together require caution and moderation.
Those who attempt to resolve inflammatory diseases at the commencement
by the administration of purgative medicines, remove none of the
morbific humors which produce the inflammation and tension; for the
diseases while unconcocted could not yield, but they melt down those
parts which are healthy and resist the disease; so when the body is
debilitated the malady obtains the mastery; and when the disease has
the upper hand of the body, it does not admit of a cure.
  4. When a person suddenly loses his speech, in connection with
obstruction of the veins,- if this happen without warning or any other
strong cause, one ought to open the internal vein of the right arm,
and abstract blood more or less according to the habit and age of
the patient. Such cases are mostly attended with the following
symptoms: redness of the face, eyes fixed, hands distended, grinding
of the teeth, palpitations, jaws fixed, coldness of the extremities,
retention of airs in the veins.
  5. When pains precede, and there are influxes of black bile and of
acrid humors, and when by their pungency the internal parts are
pained, and the veins being pinched and dried become distended, and
getting inflamed attract the humors running into the parts, whence the
blood being vitiated, and the airs collected there not being able to
find their natural passages, coldness comes on in consequence of
this stasis, with vertigo, loss of speech, heaviness of the head,
and convulsion, if the disease fix on the liver, the heart, or the
great vein (vena cava?); whence they are seized with epilepsy or
apoplexy, if the defluxions fall upon the containing parts, and if
they are dried up by airs which cannot make their escape; such persons
having been first tormented are to be immediately bled at the
commencement, while all the peccant vapors and humors are buoyant, for
then the cases more easily admit of a cure; and then supporting the
strength and attending to the crisis, we may give emetics, unless
the disease be alleviated; or if the bowels be not moved, we may
administer a clyster and give the boiled milk of asses, to the
amount of not less than twelve heminae, or if the strength permit,
to more than sixteen.
  6. Quinsy takes place when a copious and viscid defluxion from the
head, in the season of winter or spring, flows into the jugular veins,
and when from their large size they attract a greater defluxion; and
when owing to the defluxion being of a cold and viscid nature it
becomes enfarcted, obstructing the passages of the respiration and
of the blood, coagulates the surrounding blood, and renders it
motionless and stationary, it being naturally cold and disposed to
obstructions. Hence they are seized with convulsive suffocation, the
tongue turning livid, assuming a rounded shape, and being vent owing
to the veins which are seated below the tongue (for when an enlarged
uvula, which is called uva, is cut, a large vein may be observed on
each side). These veins, then, becoming filled, and their roots
extending into the tongue, which is of a loose and spongy texture, it,
owing to its dryness receiving forcibly the juice from the veins,
changes from broad and becomes round, its natural color turns to
livid, from a soft consistence it grows hard, instead of being
flexible it becomes inflexible, so that the patient would soon be
suffocated unless speedily relieved. Bleeding, then, in the arm, and
opening the sublingual veins, and purging with the electuaries, and
giving warm gargles, and shaving the head, we must apply to it and the
neck a cerate, and wrap them round with wool, and foment with soft
sponges squeezed out of hot water; give to drink water and hydromel,
not cold; and administer the juice of ptisan when, having passed the
crisis, the patient is out of danger. When, in the season of summer or
autumn, there is a hot and nitrous defluxion from the head (it is
rendered hot and acrid by the season), being of such a nature it
corrodes and ulcerates, and fills with air, and orthopnoea attended
with great dryness supervenes; the fauces, when examined, do not
seem swollen; the tendons on the back part of the neck are contracted,
and have the appearance as if it were tetanus; the voice is lost,
the breathing is small, and inspiration becomes frequent and
laborious. In such persons the trachea becomes ulcerated, and the
lungs engorged, from the patient's not being able to draw in the
external air. In such cases, unless there be a spontaneous
determination to the external parts of the neck, the symptoms become
still more dreadful, and the danger more imminent, partly owing to the
season, and the hot and acrid humors which cause the disease.
  7. When fever seizes a person who has lately taken food, and whose
bowels are loaded with faces which have been long retained, whether it
be attended with pain of the side or not, he ought to lie quiet
until the food descend to the lower region of the bowels, and use
oxymel for drink; but when the load descends to the loins, a clyster
should be administered, or he should be purged by medicine; and when
purged, he should take ptisan for food and hydromel for drink; then he
may take the cerealia, and boiled fishes, and a watery wine in small
quantity, at night, but during the day, a watery hydromel. When the
flatus is offensive, either a suppository or clyster is to be
administered; but otherwise the oxymel is to be discontinued, until
the matters descend to the lower part of the bowels, and then they are
to be evacuated by a clyster. But if the ardent fever (causus)
supervene when the bowels are empty, should you still judge it
proper to administer purgative medicine, it ought not be done during
the first three days, nor earlier than the fourth. When you give the
medicine, use the ptisan, observing the paroxysms of the fevers, so as
not to give it when the fever is setting in, but when it is ceasing,
or on the decline, and as far as possible from the commencement.
When the feet are cold, give neither drink nor ptisan, nor anything
else of the kind, but reckon it an important rule to refrain until
they become warm, and then you may administer them with advantage. For
the most part, coldness of the feet is a symptom of a paroxysm of
the fever coming on; and if at such a season you apply those things,
you will commit the greatest possible mistake, for you will augment
the disease in no small degree. But when the fever ceases, the feet,
on the contrary, become hotter than the rest of the body; for when the
heat leaves the feet, it is kindled up in the breast, and sends its
flame up to the head. And when all the heat rushes upwards, and is
exhaled at the head, it is not to be wondered at that the feet
become cold, being devoid of flesh, and tendinous; and besides, they
contract cold, owing to their distance from the hotter parts of the
body, an accumulation of heat having taken place in the chest: and
again, in like manner, when the fever is resolved and dissipated,
the heat descends to the feet, and, at the same time, the head and
chest become cold. Wherefore one should attend to this; that when
the feet are cold, the bowels are necessarily hot, and filled with
nauseous matters; the hypochondrium distended: there is jactitation of
the body, owing to the internal disturbance; and aberration of the
intellect, and pains; the patient is agitated, and wishes to vomit,
and if he vomits bad matters he is pained; but when the heat
descends to the feet, and the urine passes freely, he is every way
lightened, even although he does not sweat; at this season, then,
the ptisan ought to be given; it would be death to give it before.
  8. When the bowels are loose during the whole course of fevers, in
this case we are most especially to warm the feet, and see that they
are properly treated with cerates, and wrapped in shawls, so that they
may not become colder than the rest of the body; but when they are
hot, no fomentation must be made to them, but care is to be taken that
they do not become cold; and very little drink is to be used, either
cold water or hydromel. In those cases of fever where the bowels are
loose, and the mind is disordered, the greater number of patients pick
the wool from their blankets, scratch their noses, answer briefly when
questions are put to them, but, when left to themselves, utter nothing
that is rational. Such attacks appear to me to be connected with black
bile. When in these cases there is a colliquative diarrhoea, I am of
opinion that we ought to give the colder and thicker ptisans, and that
the drinks ought to be binding, of a vinous nature, and rather
astringent. In cases of fever attended from the first with vertigo,
throbbing of the head, and thin urine, you may expect the fever to
be exacerbated at the crisis; neither need it excite wonder,
although there be delirium. When, at the commencement, the urine is
cloudy or thick, it is proper to purge gently, provided this be
otherwise proper; but when the urine at first is thin, do not purge
such patients, but, if thought necessary, give a clyster; such
patients should be thus treated; they should be kept in a quiet state,
have unguents applied to them, and be covered up properly with
clothes, and they should use for drink a watery hydromel, and the
juice of ptisan as a draught in the evening; clear out the bowels at
first with a clyster, but give no purgative medicines to them, for, if
you move the bowels strongly, the urine is not concocted, but the
fever remains long, without sweats and without a crisis. Do not give
draughts when the time of the crisis is at hand, if there be
agitation, but only when the fever abates and is alleviated. It is
proper to be guarded at the crises of other fevers, and to withhold
the draughts at that season. Fevers of this description are apt to
be protracted, and to have determinations, if the inferior extremities
be cold, about the ears and neck, or, if these parts are not cold,
to have other changes; they have epistaxis, and disorder of the
bowels. But in cases of fever attended with nausea, or distention of
the hypochondria, when the patients cannot lie reclined in the same
position, and the extremities are cold, the greatest care and
precaution are necessary; nothing should be given to them, except
oxymel diluted with water; no draught should be administered, until
the fever abate and the urine be concocted; the patient should be laid
in a dark apartment, and recline upon the softest couch, and he should
be kept as long as possible in the same position, so as not to toss
about, for this is particularly beneficial to him. Apply to the
hypochondrium linseed by inunctions, taking care that he do not
catch cold when the application is made; let it be in a tepid state,
and boiled in water and oil. One may judge from the urine what is to
take place, for if the urine be thicker, and more yellowish, so much
the better; but if it be thinner, and blacker, so much the worse;
but if it undergo changes, it indicates a prolongation of the disease,
and the patient, in like manner, must experience a change to the worse
and the better. Irregular fevers should be let alone until they become
settled, and, when they do settle, they are to be treated by a
suitable diet and medicine, attending to the constitution of the
patient.
  9. The aspects of the sick are various; wherefore the physician
should pay attention, that he may not miss observing the exciting
causes, as far as they can be ascertained by reasoning, nor such
symptoms as should appear on an even or odd day, but he ought to, be
particularly guarded in observing the odd days, as it is in them, more
especially, that changes take place in patients. He should mark,
particularly, the first day on which the patient became ill,
considering when and whence the disease commenced, for this is of
primary importance to know. When you examine the patient, inquire into
all particulars; first how the head is, and if there be no headache,
nor heaviness in it; then examine if the and sides be free of pain;
for if the hypochondrium be painful, swelled, and unequal, with a
sense of satiety, or if there be pain in the side, and, along with the
pain, either cough, tormina, or belly-ache, if any of these symptoms
be present in the hypochondrium, the bowels should be opened with
clysters, and the patient should drink boiled hydromel in a hot state.
The physician should ascertain whether the patient be apt to faint
when he is raised up, and whether his breathing be free; and examine
the discharges from the bowels, whether they be very black, or of a
proper color, like those of persons in good health, and ascertain
whether the fever has a paroxysm every third day, and look well to
such persons on those days. And should the fourth day prove like the
third, the patient is in a dangerous state. With regard to the
symptoms, black stools prognosticate death; but if they resemble the
discharges of a healthy person, and if such is their appearance
every day, it is a favorable symptom; but when the bowels do not yield
to a suppository, and when, though the respiration be natural, the
patient when raised to the night table, or even in bed, be seized with
deliquium, you may expect that the patient, man or woman, who
experiences these symptoms, is about to fall to fall into a state of
delirium. Attention also should be paid to the hands, for if they
tremble, you may expect epistaxis; and observe the nostrils, whether
the breath be drawn in equally by both; and if expiration by the
nostrils be large, a convulsion is apt to take place; and should a
convulsion occur to such a person, death may be anticipated, and it is
well to announce it beforehand.
  10. If, in a winter fever, the tongue be rough, and if there be
swoonings, it is likely to be the remission of the fever. Nevertheless
such a person is to be kept upon a restricted diet, with water for
drink, and hydromel, and the strained juices, not trusting to the
remission of the fevers, as persons having these symptoms are in
danger of dying; when, therefore, you perceive these symptoms,
announce this prognostic, if you shall judge proper, after making
the suitable observations. When, in fevers, any dangerous symptom
appears on the fifth day, when watery discharges suddenly take place
from the bowels, when deliquium animi occurs, or the patient is
attacked with loss of speech, convulsions, or hiccup, under such
circumstances he is likely to be affected with nausea, and sweats
break out under the nose and forehead, or on the back part of the neck
and head, and patients with such symptoms shortly die, from stoppage
of the respiration. When, in fevers, abscesses form about the legs,
and, getting into a chronic state, are not concocted while the fever
persists, and if one is seized with a sense of suffocation in the
throat, while the fauces are not swelled, and if it do not come to
maturation, but is repressed, in such a case there is apt to be a flow
of blood from the nose; if this, then, be copious, it indicates a
resolution of the disease, but if not, a prolongation of the
complaint; and the less the discharge, so much worse the symptoms, and
the more protracted the disease; but if the other symptoms are very
favorable, expect in such a case that pains will fall upon the feet;
if then they attack the feet, and if these continue long in a very
painful, and inflamed state, and if there be no resolution, the
pains will extend by degrees to the neck, to the clavicle, shoulder,
breast, or to some articulation, in which an inflammatory tumor will
necessarily form. When these are reduced, if the hands are contracted,
and become trembling, convulsion and delirium seize such a person; but
blisters break out on the eyebrow, erythema takes place, the one
eyelid being tumefied overtops the other, a hard inflammation sets in,
the eye become strongly swelled, and the delirium increases much,
but makes its attacks rather at night than by day. These symptoms more
frequently occur on odd than on even days, but, whether on the one
or the other, they are of a fatal character. Should you determine to
give purgative medicines in such cases, at the commencement, you
should do so before the fifth day, if there be borborygmi in the
bowels, or, if not, you should omit the medicines altogether. If there
be borborygmi, with bilious stools, purge moderately with scammony;
but with regard to the treatment otherwise, administer as few drinks
and draughts as until there be some amendment, and the disease is past
the fourteenth day. When loss of speech seizes a person, on the
fourteenth day of a fever, there is not usually a speedy resolution,
nor any removal of the disease, for this symptom indicates a
protracted disease; and when it appears on that day, it will be
still more prolonged. When, on the fourth day of a fever, the tongue
articulates confusedly, and when there are watery and bilious
discharges from the bowels, such a patient is apt to fall into a state
of delirium; the physician ought, therefore, to watch him, and
attend to whatever symptoms may turn up. In the season of summer and
autumn an epistaxis, suddenly occurring in acute diseases, indicates
vehemence of the attack, and inflammation in the course of the
veins, and on the day following, the discharge of thin urine; and if
the patient be in the prime of life, and if his body be strong from
exercise, and brawny, or of a melancholic temperament, or if from
drinking has trembling hands, it may be well to announce beforehand
either delirium or convulsion; and if these symptoms occur on even
days, so much the better; but on critical days, they are of a deadly
character. If, then, a copious discharge of blood procure an issue
to the fullness thereof about the nose, or what is collected about the
anus, there will be an abscess, or pains in the hypochondrium, or
testicles, or in the limbs; and when these are resolved, there will be
a discharge of thick sputa, and of smooth, thin urine. In fever
attended with singultus, give asafoetida, oxymel, and carrot,
triturated together, in a draught; or galbanum in honey, and cumin
in a linctus, or the juice of ptisan. Such a person cannot escape,
unless critical sweats and gentle sleep supervene, and thick and acrid
urine be passed, or the disease terminate in an abscess: give
pine-fruit and myrrh in a linctus, and further give a very little
oxymel to drink; but if they are very thirsty, some barley-water.
  11. Peripneumonia, and pleuritic affections, are to be thus
observed: If the fever be acute, and if there be pains on either side,
or in both, and if expiration be if cough be present, and the sputa
expectorated be of a blond or livid color, or likewise thin, frothy,
and florid, or having any other character different from the common,
in such a case, the physician should proceed thus: if the pain pass
upward to the clavicle, or the breast, or the arm, the inner vein in
the arm should be opened on the side affected, and blood abstracted
according to the habit, age, and color of the patient, and the
season of the year, and that largely and boldly, if the pain be acute,
so as to bring on deliquium animi, and afterwards a clyster is to be
given. But if the pain be below the chest, and if very intense,
purge the bowels gently in such an attack of pleurisy, and during
the act of purging give nothing; but after the purging give oxymel.
The medicine is to be administered on the fourth day; on the first
three days after the commencement, a clyster should be given, and if
it does not relieve the patient, he should then be gently purged,
but he is to be watched until the fever goes off, and till the seventh
day; then if he appear to be free from danger, give him some
unstrained ptisan, in small quantity, and thin at first, mixing it
with honey. If the expectoration be easy, and the breathing free, if
his sides be free of pain, and if the fever be gone, he may take the
ptisan thicker, and in larger quantity, twice a day. But if he do
not progress favorably, he must get less of the drink, and of the
draught, which should be thin, and only given once a day, at
whatever is judged to be the most favorable hour; this you will
ascertain from the urine. The draught is not to be given to persons
after fever, until you see that the urine and sputa are concocted (if,
indeed, after the administration of the medicine he be purged
frequently, it may be necessary to give it, but it should be given
in smaller quantities and thinner than usual, for from inanition he
will be unable to sleep, or digest properly, or wait the crisis);
but when the melting down of crude matters has taken place, and his
system has cast off what is offensive, there will then be no
objection. The sputa are concocted when they resemble pus, and the
urine when it has reddish sediments like tares. But there is nothing
to prevent fomentations and cerates being applied for the other
pains of the sides; and the legs and loins may be rubbed with hot oil,
or anointed with fat; linseed, too, in the form of a cataplasm, may be
applied to the hypochondrium and as far up as the breasts. When
pneumonia is at its height, the case is beyond remedy if he is not
purged, and it is bad if he has dyspnoea, and urine that is thin and
acrid, and if sweats come out about the neck and head, for such sweats
are bad, as proceeding from the suffocation, rales, and the violence
of the disease which is obtaining the upper hand, unless there be a
copious evacuation of thick urine, and the sputa be concocted; when
either of these come on spontaneously, that will carry off the
disease. A linctus for pneumonia: Galbanum and pine-fruit in Attic
honey; and southernwood in oxymel; make a decoction of pepper and
black hellebore, and give it in cases of pleurisy attended with
violent pain at the commencement. It is also a good thing to boil
opoponax in oxymel, and, having strained it, to give it to drink; it
answers well, also, in diseases of the liver, and in severe pains
proceeding from the diaphragm, and in all cases in which it is
beneficial to determine to the bowels or urinary organs, when given in
wine and honey; when given to act upon the bowels, it should be
drunk in larger quantity, along with a watery hydromel.
  12. A dysentery, when stopped, will give rise to an aposteme, or
tumor, if it do not terminate in fevers with sweats, or with thick and
white urine, or in a tertian fever, or the pain fix upon a varix, or
the testicles, or on the hip-joints.
  13. In a bilious fever, jaundice coming on with rigor before the
seventh day carries off the fever, but if it occur without the
fever, and not at the proper time, it is a fatal symptom.
  14. When the loins are in a tetanic state, and the spirits in the
veins are obstructed by melancholic humors, venesection will afford
relief. But when, on the other hand, the anterior tendons are strongly
contracted, and if there be sweats about the neck and face, extorted
by the violent pain of the parched and dried tendons of the sacral
extremity (these are very thick, sustaining the spine, and giving rise
to very great ligaments, which terminate in the feet,) in such a case,
unless fever and sleep come on, followed by concocted urine and
critical sweats, give to drink a strong Cretan wine, and boiled
barley-meal for food; anoint and rub with ointments containing wax;
bathe the legs and feet in hot water, and then cover them up; and so
in like manner the arms, as far as the hands, and the spine, from
the neck to the sacrum, are to be wrapped in a skin smeared with
wax; this must extend to the parts beyond, and intervals are to be
left for applying fomentations, by means of leather bottles filled
with hot water, then, wrapping him up in a linen cloth, lay him down
in bed. Do not open the bowels, unless by means of a suppository, when
they have been long of being moved. If there be any remission of the
disease, so far well, but otherwise, pound of the root of bryonia in
fragrant wine, and that of the carrot, and give to the patient fasting
early in the morning, before using the affusion, and immediately
afterwards let him eat boiled barley-meal in a tepid state, and as
much as he can take, and in addition let him drink, if he will, wine
well diluted. If the disease yield to these means, so much the better,
but, if otherwise, you must prognosticate accordingly.
  15. All diseases are resolved either by the mouth, the bowels, the
bladder, or some other such organ. Sweat is a common form of
resolution in all these cases.
  16. You should put persons on a course of hellebore who are troubled
with a defluxion from the head. But do not administer hellebore to
such persons as are laboring under empyema connected with abscesses,
haemoptysis, and intemperament, or any other strong cause, for it will
do no good; and if any thing unpleasant occur the hellebore will get
the blame of it. But if the body have suddenly lost its powers, or
if there be pain in the head, or obstruction of the ears and nose,
or ptyalism, or heaviness of the limbs, or an extraordinary swelling
of the body, you may administer the hellebore, provided these symptoms
be not connected with drinking, nor with immoderate venery; nor with
sorrow, vexation, nor insomnolency, for, if any of these causes exist,
the treatment must have respect to it.
  17. From walking arise pains of the sides, of the back, of the
loins, and of the hip-joint, and disorder of the respiration has often
been from the same cause, for, after excesses of wine and flatulent
food, pains shoot to the loins and hips, accompanied with dysuria.
Walking is the cause of such complaints, and also of coryza and
hoarseness.
  18. Disorders connected with regimen, for the most part, make
their attack accordingly as any one has changed his habitual mode of
diet. For persons who dine contrary to custom experience much swelling
of the stomach, drowsiness, and fullness; and if they take supper over
and above, their belly is disordered; such persons will be benefited
by sleeping after taking the bath, and by walking slowly for a
considerable time after sleep; if, then, the bowels be moved, he may
dine and drink a small quantity of wine not much diluted; but if the
bowels are not opened, he should get his body rubbed with hot oil,
and, if thirsty, drink of some weak and white wine, or a sweet wine,
and take repose; if he does not sleep he should repose the longer.
In other respects he should observe the regimen laid down for those
who have taken a debauch. With regard to the bad effects of drinks,
such as are of a watery nature pass more slowly through the body, they
regurgitate, as it were, and float about the hypochondria, and do
not flow readily by urine; when filled up with such a drink, he should
not attempt any violent exertion, requiring either strength or
swiftness, but should rest as much as possible until the drink has
been digested along with the food; but such drinks as are stronger
or more austere, occasion palpitation in the body and throbbing in the
head, and in this case the person affected will do well to sleep,
and take some hot draught for which he feels disposed; for
abstinence is bad in headache and the effects of a surfeit. Those who,
contrary to usage, restrict themselves to one meal, feel empty and
feeble, and pass hot urine in consequence of the emptiness of their
vessels; they have a salt and bitter taste in the mouth; they
tremble at any work they attempt; their temples throb; and they cannot
digest their supper so well as if they had previously taken their
dinner. Such persons should take less supper than they are wont, and a
pudding of barley-meal more moist than usual instead of bread, and
of potherbs the dock, or mallow, and ptisan, or beets, and along
with the food they should take wine in moderation, and diluted with
water; after supper they should take a short walk, until the urine
descend and be passed; and they may use boiled fish.
  Articles of food have generally such effects as the following:
Garlic occasions flatulence and heat about the chest, heaviness of the
head, and nausea, and any other habitual pain is apt to be exasperated
by it; it is diuretic, which, in so far, is a good property which it
possesses; but to eat it when one means to drink to excess, or when
intoxicated. Cheese produces flatulence and constipation, and heats
the other articles of food; and it gives rise to crudities and
indigestion, but it is worst of all to eat it along with drink after a
full meal. Pulse of all kinds are flatulent, whether raw, boiled, or
fried; least so when macerated in water, or in a green state; they
should not be used except along with food prepared from the
cerealia. Each of these articles, articles, however, has bad effects
peculiar to itself. The vetch, whether raw or boiled, creates
flatulence and pain. The lentil is astringent, and disorders the
stomach if taken with its hull. The lupine has the fewest bad
effects of all these things. The stalk and the juice of silphium
(asafoetida), pass through some people's bowels very readily, but in
others, not accustomed to them, they engender what is called dry
cholera; this complaint is more especially produced by it if mixed
with much cheese, or eaten along with beef. Melancholic diseases are
most particularly exacerbated by beef, for it is of an unmanageable
nature, and requires no ordinary powers of stomach to digest it; it
will agree best with those who use it well boiled and pretty long
kept. Goat's flesh has all the bad properties of beef; it is an
indigestible, more flatulent and engenders acid eructations and
cholera; such as has a fragrant smell, is firm, and sweet to the
taste, is the best, when well baked and cooled; but those kinds
which are disagreeable to the taste, have a bad smell, and are hard,
such are particularly bad, and especially if very fresh; it is best in
summer and worst in autumn. The flesh of young pigs is bad, either
when it is too raw or when it is over-roasted, for it engenders bile
and disorders the bowels. Of all kinds of flesh, pork is the best;
it is best when neither very fat, nor, on the other hand, very lean,
and the animal had not attained the age of what is reckoned an old
victim; it should be eaten without the skin, and in a coldish state.
  19. In dry cholera the belly is distended with wind, there is
rumbling in the bowels, pain in the sides and loins, no dejections,
but, on the contrary, the bowels are constipated. In such a case you
should guard against vomiting, but endeavor to get the bowels
opened. As quickly as possible give a clyster of hot water with plenty
of oil in it, and having rubbed the patient freely with unguents;
put him into hot water, laying him down in the basin, and pouring
the hot water upon him by degrees; and if, when heated in the bath,
the bowels be moved, he will be freed from the complaint. To a
person in such a complaint it will do good if he sleep, and drink a
thin, old, and strong wine; and you should give him oil, so that he
may settle, and have his bowels moved, when he will be relieved. He
must abstain from all other kinds of food; but when the pain remits,
give him asses milk to drink until he is purged. But if the bowels are
loose, with bilious discharges, tormina, vomitings, a feeling of
suffocation, and gnawing pains, it is best to enjoin repose, and to
drink hydromel, and avoid vomiting.
  20. There are two kinds of dropsy, the one anasarca, which, when
formed, is incurable; the other is accompanied with emphysema
(tympanites?) and requires much good fortune to enable one to
triumph over it. Laborious exertion, fomentation, and abstinence
(are to be enjoined). The patient should eat dry and acrid things, for
thus will he pass the more water, and his strength be kept up. If he
labors under difficulty of breathing, if it is the summer season,
and if he is in the prime of life, and is strong, blood should be
abstracted from the arm, and then he should eat hot pieces of bread,
dipped in dark wine and oil, drink very little, and labor much, and
live on well-fed pork, boiled with vinegar, so that he may be able
to endure hard exercises.
  21. Those who have the inferior intestines hot, and who pass acrid
and irregular stools of a colliquative nature, if they can bear it,
should procure revulsion by vomiting with hellebore; but if not,
should get a thick decoction of summer wheat in a cold state, lentil
soup, bread cooked with cinders, and fish, which should be taken
boiled if they have fever, but roasted if not feverish; and also
dark-colored wine if free of fever; but otherwise they should take the
water from medlars, myrtles, apples, services, dates, or wild vine. If
there be no fever, and if there be tormina, the patient should drink
hot asses' milk in small quantity at first, and gradually increase it,
and linseed, and wheaten flour, and having removed the bitter part
of Egyptian beans, and ground them, sprinkle on the milk and drink;
and let him eat eggs half-roasted, and fine flour, and millet, and
perl-spelt (chondrus) boiled in milk;- all these things should be
eaten cold, and similar articles of food and drink should be
administered.
  22. The most important point of regimen to observe and be guarded
about in protracted diseases, is to pay attention to the exacerbations
and remissions of fevers, so as to avoid the times when food should
not be given, and to know when it may be administered without
danger; this last season is at the greatest possible distance from the
exacerbation.
  23. One should be able to recognize those who have headache from
gymnastic exercises, or running, or walking or hunting, or any other
unseasonable labor, or from immoderate venery; also those who are of a
pale color, or troubled with hoarseness; those who have enlarged
spleen, those who are in a state of anaemia, those who are suffering
from tympanites, those having dry cough and thirst, those who are
flatulent, and have the course of the blood in their veins
intercepted; those persons whose hypochondria, sides, and back are
distended: those having torpor; those laboring under amaurosis, or
having noises in their ears; those suffering from incontinence of
urine or jaundice, or whose food is passed undigested; those who
have discharges of blood from the nose or anus, or who have flatulence
and intense pain, and who cannot retain the wind. In these cases you
may do mischief, but cannot possibly do any good by purging, but may
interrupt the spontaneous remissions and crises of the complaints.
  24. If you think it expedient to let blood, see that the bowels be
previously settled, and then bleed; enjoin abstinence, and forbid
the use of wine; and complete the cure by means of a suitable regimen,
and wet fomentations. But if the bowels appear to be constipated,
administer a soothing clyster.
  25. If you think it necessary to give medicines, you may safely
purge upwards by hellebore, but none of those should be purged
downwards. The most effectual mode of treatment is by the urine,
sweats, and exercise; and use gentle friction so as not to harden
the constitution; and if he be confined to bed let others rub him.
When the pain is seated above the diaphragm, place him erect for the
most part, and let him be as little reclined as possible; and when
he is raised up let him be rubbed for a considerable time with
plenty of hot oil. But if the pains be in the lower belly below the
diaphragm, it will be useful to lie reclined and make no motion, and
to such a person nothing should be administered except the friction.
Those pains which are dissolved by discharges from the bowels, by
urine, or moderate sweats, cease spontaneously, if they are slight,
but if strong they prove troublesome; for persons so affected either
die, or at least do not recover without further mischief, for they
terminate in abscesses.
  26. A draught for a dropsical person. Take three cantharides, and
removing their head, feet, and wings, triturate their bodies in
three cupfuls (cyathi) of water, and when the person who has drunk the
draught complains of pain, let him have hot fomentations applied.
The patient should be first anointed with oil, should take the draught
fasting, and eat hot bread with oil.
  27. A styptic. Apply the juice of the fig inwardly to the vein; or
having moulded biestings into a tent, introduce up the nostril, or
push up some chalcitis with the finger, and press the cartilages of
the nostrils together; and open the bowels with the boiled milk of
asses: or having shaved the head apply cold things to it if in the
summer season.
  28. The sesamoides purges upwards when pounded in oxymel to the
amount of a drachm and a half, and drunk; it is combined with the
hellebores, to the amount of the third part, and thus it is less apt
to produce suffocation.
  29. Trichiasis. Having introduced a thread into the eye of a
needle push it through the upper part of the distended eyelid, and
do the same at the base of it; having stretched the threads tie a knot
on them, and bind up until they drop out: and, if this be
sufficient, so far well; but if otherwise, you must do the same
thing again. And hemorrhoids, in like manner, you may treat by
transfixing them with a needle and tying them with a very thick and
large woolen thread; for thus the cure will be more certain. When
you have secured them, use a septic application, and do not foment
until they drop off, and always leave one behind; and when the patient
recovers, let him be put upon a course of hellebore. Then let him be
exercised and sweated; the friction of the gymnasium and wrestling
in the morning will be proper; but he must abstain from running,
drinking, and all acrid substances, except marjoram; let him take an
emetic every seven days, or three times in a month; for thus will he
enjoy the best bodily health. Let him take straw-colored, austere, and
watery wine, and use little drink.
  30. For persons affected with empyema. Having cut some bulbs or
squill, boil in water, and when well boiled, throw this away, and
having poured in more water, boil until it appear to the touch soft
and well-boiled; then triturate finely and mix roasted cumin, and
white sesames, and young almonds pounded in honey, form into an
electuary and give; and afterwards sweet wine. In draughts, having
pounded about a small acetabulum of the white poppy, moisten it with
water in which summer wheat has been washed, add honey, and boil.
Let him take this frequently during the day. And then taking into
account what is to happen, give him supper.
  31. For dysentery. A fourth part of a pound of cleaned beans, and
twelve shoots of madder having been triturated, are to be mixed
together and boiled, and given as a linctus with some fatty substance.
  32. For diseases of the eyes. Washed spodium (tutty?) mixed with
grease, and not of a thinner consistence than dough, is to be
carefully triturated, and moistened with the juice of unripe
raisins; and having dried in the sun, moisten until it is of the
consistence of an ointment. When it becomes again dry, let it be
finely levigated, anoint the eyes with it, and dust it upon the angles
of the eyes.
  33. For watery eyes. Take one drachm of ebeny and nine oboli of
burnt copper, rub them upon a whetstone, add three oboli of saffron;
triturate all these things reduced to a fine powder, pour in an
Attic hemina of sweet wine, and then place in the sun and cover up;
when sufficiently digested, use it.
  34. For violent pains of the eyes. Take of chalcitis, and of raisin,
of each 1 dr., when digested for two days, strain; and pounding
myrrh and saffron, and having mixed must, with these things, digest in
the sun; and with this anoint the eyes when in a state of severe pain.
Let it be kept in a copper vessel.
  35. Mode of distinguishing persons in an hysterical fit. Pinch
them with your fingers, and if they feel, it is hysterical; but if
not, it is a convulsion.
  36. To persons in coma, (dropsy?) give to drink meconium
(euphorbia peplus?) to the amount of a round Attic leciskion (small
acetabulum).
  37. Of squama aeris, as much as three specilla can contain, with the
gluten of summer wheat: levigate, pound, form into pills, and give; it
purges water downwards.
  38. A medicine for opening the bowels. Pour upon figs the juice of
spurge, in the proportion of seven to one: then put into a new
vessel and lay past when properly mixed. Give before food.
  39. Pounding meconium, pouring on it water, and straining, and
mixing flour, and baking into a cake, with the addition of boiled
honey, give in affections of the anus and in dropsy; and after
eating of it, let the patient drink of a sweet watery wine, and
diluted hydromel prepared from wax: or collecting meconium, lay it
up for medicinal purposes.


                            -THE END-
