1. 1 Having dealt with all that pertains to whole classes of diseases taken together, I come to the treatment of diseases one by one. Now the Greeks divided these into two species, terming some acute, others chronic. But because maladies did not always respond in the same way to treatment, some of the Greek writers have placed among the acute what others have placed among the chronic; from this it is clear that there are more than two classes. For some diseases are certainly of short duration, which carry off the patient quickly, or themselves come quickly to an end; some are chronic, in which neither recovery is near at hand nor death; and there is a third class, at one time acute, at another time chronic, and that occurs not only in fevers, where it is most frequent, but in other affections also. And besides the above there is a fourth class which cannot be said to be acute, because it is not fatal, nor really chronic, because if treated it is readily cured. When I come myself to speak of diseases singly, I will point out to which class each belongs. But I shall divide all diseases into those which appear to have their seat in the body as a whole, and into those which originate in particular parts. I shall begin with the former, after a few words of preface concerning all. Whatever the malady luck no less than the art can claim influence for itself; seeing that with nature in opposition the art of medicine avails nothing. There is, however, for a practitioner who is unsuccessful, more excuse in acute than in chronic diseases: for acute diseases are of short duration, within which the patient is snuffed out, if not benefited by the treatment: chronic diseases give time for deliberation, and for change of remedies, so that when the practitioner is in attendance from the commencement, it is seldom that a docile patient should perish unless by the practitioner's default. A chronic disease, nevertheless, when it has become deep-seated, is no less difficult to deal with than an acute one. And indeed the older an acute malady, the more recent a chronic one, the more easily it is treated. There is another point which should be borne in mind, that the same remedies do not suit all patients. Hence it is that the highest authorities proclaim as if they were the only remedies, now some, now others, each in accordance with what he has found successful. It is well, then, when any one remedy fails, to look not so much to the authority as to the patient, and to make trial, now of one, now of another remedy, taking care, however, that in acute diseases what is doing no good is changed quickly; in chronic diseases which it takes time to produce as well as to remove, if a remedy does not succeed at once, it should not be condemned at once, much less should it be discontinued if it is beneficial, though only to a small extent, because the progress is completed by time.
1. Prouisis omnibus, quae pertinent ad uniuersa genera morborum, ad singulorum curationes ueniam. Hos autem in duas species Graeci diuiserunt, aliosque ex his acutos, alios longos esse dixerunt. Ide⟨m⟩que quoniam non semper eodem modo respondebant, eosdem alii inter acutos, alii inter longos rettulerunt; ex quo plura eorum genera esse manifestum est. Quidam enim breues utique sunt, qui cito uel tollunt hominem, uel ipsi cito finiuntur; quidam longi, sub quibus neque sanitas in propinquo neque exitium est; tertiumque genus eorum est, qui modo acuti, modo longi sunt, idque non in febribus tantummodo, in quibus frequentissimum est, sed in aliis quoque fit. Atque etiam praeter hos quartum est, quod neque acutum dici potest, quia non peremit, neque utique longum, quia, si occurritur, facile sanatur. Ego cum de singulis dicam, cuius quisque generis sit indicabo. Diuidam autem omnes in eos, qui IN TOTIS CORPORIBVS consistere uidentur, et eos, qui oriuntur in partibus. Incipiam a prioribus, pauca de omnibus praefatus. In nullo quidem morbo minus fortuna sibi uindicare quam ars potest: ut pote qu⟨o⟩m repugnante natura nihil medicina proficiat. Magis tamen ignoscendum medico est parum proficienti in acutis morbis quam in longis: hic enim breue spatium est, intra quod, si auxilium non profuit, aeger extinguitur: ibi et deliberationi et mutationi remediorum tempus patet, adeo ut raro, si inter initia medicus accessit, obsequens aeger sine illius uitio pereat. Longus tamen morbus cum penitus insedit, quod ad difficultatem pertinet, acuto par est. Et acutus quidem quo uetustior est, longus autem quo recentior, eo facilius curatur. Alterum illud ignorari non oportet, quod non omnibus aegris eadem auxilia conueniunt. Ex quo incidit, ut alia atque alia summi auctores quasi sola uindicarint, prout cuique cesserat. Oportet itaque, ubi aliquid non respondet, non tanti putare auctorem quanti aegrum, et experiri aliud atque aliud, sic tamen ut in acutis morbis cito mutetur quod nihil prodest in longis, quos tempus ut facit sic etiam soluit, non statim condemnetur, si quid non statim profuit, minus uero remoueatur, si quid paulum saltem iuuat, quia profectus tempore expletur.
2. 2 Now at their commencements, it is easy to recognize at once what is an acute disease, and what a chronic one, not only as regards those which take a uniform course, but also when the course is variable. For when severe paroxysms and pains are causing distress without intermission, the disease is acute: it becomes evident that the future course will be prolonged when there are but slight pains and fever, and when there are long intervals between the paroxysms, and there are in addition the signs which have been described in the preceding book. It is also to be noted whether the disease is increasing, or stationary, or lessening, because some remedies are suitable for increasing, more for declining maladies; and when an acute fever is increasing in urgency, remedies which are suitable in decreasing affections are to be tried rather during the remissions. A disease is increasing in urgency when pains and paroxysms occur with more severity, and when they both recur at shorter intervals, and desist later than before. And, in chronic diseases too, even if they do not present such characteristic signs, it may be recognized that the affection is increasing: if sleep is irregular; if digestion deteriorates; if the stools become more foul; the sense duller; the mind more sluggish; if a feeling of cold, or of heat, runs through the body, if the body becomes more pale. But opposite signs mark a decline in the disease.... In acute diseases, moreover, the patient is to be given food after more delay, and not until the paroxysm is already declining so that its force may be broken primarily by the withholding of nutriment; in chronic diseases, earlier, so that it may support the patient for the duration of his coming illness. But if sometimes, not the whole body, but a part only, is affected, still the support of the strength of the whole body rather than the curing by itself of the part diseased is of more importance. It makes a great difference also whether from the commencement the patient has been treated correctly or incorrectly, because treatment has less advantage in those cases in which a course has been persisted in without effort. If a patient lives through indiscreet treatment with his strength unimpaired, an appropriate treatment may restore him forthwith. But as I commenced (II.2) with those symptoms which show some signs of impending illness, I shall make a beginning as to treatment by noticing the same period. If, therefore, any of the signs then referred to occur, the best treatment is rest and abstinence; if anything at all is to be drunk, let it be water, and it is sufficient for this to be continued sometimes for one day, sometimes, when alarming signs persist, for two days; on the day following the fast, food should be taken sparingly, and water drunk; the next day even wine, and then in turn, on alternate days, water and wine, until all anxiety is at an end. For often in this way a severe disease is dispersed while it is impending. And many deceive themselves with the hope of getting rid of the languor straightaway on the first day, either by exercise, or by a bath, or by a purge, or by an emetic, or by sweating, or by drinking wine: not but that such a procedure may succeed or not disappoint, but more often it fails, and abstinence by itself is a remedy without any risk; especially since it also admits of being modified in accordance with the degree of apprehension, and if the indications are of the slighter kind, it is enough to abstain from wine alone, its withdrawal being more advantageous than if something were subtracted from the food; if they are of somewhat greater severity, it is easy to limit the drink to water, and at the same time to withdraw meat from the diet, sometimes also to use less bread than usual, and to be content with moist food, especially pot-herbs; and it is sufficient to abstain entirely from food and wine, and from all bodily movement, only when serious symptoms have given rise to alarm. Nor is there a doubt that scarcely anyone falls ill who has hidden nothing but has countered disease in good time by these measures.
2. Protinus autem inter initia scire facile est, quis acutus morbus quis longus sit, non in is solis, in quibus semper ita se habet, sed in is quoque, in quibus uariat. Nam ubi sine intermissionibus accessiones et dolores graues urgent, acutus est morbus: ubi lenti dolores lentaeue febres sunt et spatia inter accessiones porrigunt, acceduntque ea signa, quae priore uolumine exposita sunt, longum hunc futurum esse manifestum est. Videndum etiam est, morbus an increscat, an consistat, an minuatur, quia quaedam remedia increscentibus morbis, plura inclinatis conueniunt; eaque, quae decrescentibus apta sunt, ubi acutus increscens urget, in remissionibus potius experienda sunt. Increscit autem morbus, dum grauiores dolores accessionesque ueniunt, eaeque et ante, quam proximae, reuertuntur et postea desinunt. Atque in longis quoque morbis etiam tales notas non habentibus scire licet increscere, si somnus incertus est, si deterior concoctio, si foediores deiectiones, si tardior sensus, si pigrior mens, si percurrit corpus frigus aut calor, si id magis pallet. Ea uero, quae contraria his sunt, decedentis eius notae sunt. * * Praeter haec in acutis morbis serius aeger alendus est, nec nisi iam is inclinatis, ut primo dempta materia impetum frangat, in longis maturius, ut sustinere spatium adfecturi mali possit. Ac si quando is non in toto corpore sed in parte est, magis tamen ad rem pertinet uim totius corporis moliri quam proprie partis aegrae sanitatem. Multum etiam interest, ab initio quis recte curatus sit an perperam, quia curatio minus is prodest, in quibus adsidue frustra fuit. Si qui temere habitus adhuc integris uiribus uiuit, admota curatione momento restituitur. Sed cum ab is coeperim, quae notas quasdam futurae aduersae ualetudinis exhibent, curationum quoque principium ab animaduersione eiusdem temporis faciam. Igitur si quid ex is, quae proposita sunt, incidit, omnium optima sunt quies et abstinentia: si quid bibendum est, aqua, idque interdum uno die fieri satis est, interdum, si terrentia manent, biduo; proximeque abstinentiam sumendus est cibus exiguus, bibenda aqua, postero die etiam vinum, deinde inuicem alternis diebus modo aqua modo uinum, donec omnis [causae] metus finiatur. Per haec enim saepe instans grauis morbus discutitur. Plurimique falluntur, dum se primo die protinus sublaturos languorem aut exercitatione aut balneo aut coacta deiectione aut uomitu aut sudationibus aut uino sperant; non quo non interdum incidat aut non dec⟨e⟩per⟨i⟩t sed quo saepius fallat, solaque abstinentia sine ullo periculo medeatur: cum praesertim etiam pro modo terroris moderari liceat, et, si leuiora indicia fuerunt, satis sit a uino tantum abstinere, quod subtractum plus, quam si cibo quid dematur, adiuuat; si paulo grauiora, facile sit non aquam tantum bibere sed etiam cibo carnem subtrahere, interdum panis quoque minus quam pro consuetudine adsumere, umidoque cibo esse contentos et holere potissimum, satisque sit tum ex toto a cibo, a uino, ab omni motu corporis abstinere, cum uehementes notae terruerunt. Neque dubium est, quin uix quisquam, qui non dissimulauit sed per haec mature morbo occurrit, aegrotet.
3. 3 These then are the things to be done by those, who, being in health, have cause merely to be apprehensive. Now there follows the treatment of fevers, a class of disease which both affects the body as a whole, and is exceedingly common. Of fevers, one is quotidian, another tertian, a third quartan. At times certain fevers recur in even longer cycles, but that is seldom. In the former varieties both the diseases and their medicines are of various kinds. Now quartan fevers have the simpler characteristics. Nearly always they begin with shivering, then heat breaks out, and the fever having ended, there are two days free; this on the fourth day it recurs. But of tertian fevers there are two classes. The one, beginning and desisting in the same way as a quartan, has merely this distinction, that it affords one day free, and recurs on the third day. The other is far more pernicious; and it does indeed recur on the third day, yet out of forty-eight hours, about thirty-six, sometimes less, sometimes more, are in fact occupied by the paroxysm, nor does the fever entirely cease in the remission, but it only becomes less violent. This class most practitioners term hemitritaion. Quotidian fevers, however, vary and have many forms. For some begin straightaway with a feeling of heat, others of chill, others with shivering. I call it a chill when the extremities become cold, shivering when the whole body shakes. Again, some desist so that complete freedom follows, others so that there is some diminution of the fever, yet none the less some remnants persist until the onset of the next paroxysm; and others often run together so that there is little or no remission, but the attacks are continuous. Again, some have a vehement hot stage, others a bearable one; some are every day equal, others unequal, and the paroxysm in turn slighter one day, more severe another: some recur at the same time the day following, some either earlier or later; some take up a day and a night with the paroxysm and the remission, some less, others more; some set up sweating as they remit, others do not; and in some, freedom is arrived at through sweating, in others the body is only made the weaker. But the paroxysms also occur sometimes once on any one day, sometimes twice or more often. Hence it often comes about that daily there are several paroxysms and remissions, yet so that each corresponds to one which has preceded it. But at times the paroxysms also become so confused together, that neither their durations nor intermissions can be observed. It is not true, as some say, that no fever is irregular unless as the outcome either of an abscess or of inflammation or of ulceration; for if this were true, the treatment always would be the easier, but what evident causes bring about, hidden ones can bring about also. And men are not arguing about facts but about words if, when during the same illness fevers come on in different ways, they say that these are not irregular returns of the same fever, but other different ones arising in succession; even though it were true, it would have nothing to do with the mode of treatment. The duration of remissions also is at times considerable, at other times scarcely of any length.
3. Atque haec quidem sanis facienda sunt tantum cum causa metuentibus. Sequitur uero CVRATIO FEBRIVM quod et in toto corpore et uulgare maxime morbi genus est. Ex his una cotidiana, altera tertiana, altera quartana est. Interdum etiam longiore circuitu quaedam redeunt, sed id raro fit. In prioribus et morbi * sunt et medicina. Et quartanae quidem simpliciores sunt. Incipiunt fere ab horrore, deinde calor erumpit, finitaque febre biduum integrum est: ita quarto die reuertitur. Tertianarum uero duo genera sunt. Alterum eodem modo, quo quartana, et incipiens et desinens, illo tantum interposito discrimine, quod unum diem praestat integrum, tertio redit. Alterum longe perniciosius, quod tertio quidem die reuertitur, ex quadraginta autem et octo horis fere triginta et sex per accessionem occupat (interdum etiam uel minus uel plus), neque ex toto in remissione desistit, sed tantum leuius est. Id genus plerique medici ΗΜΙΤΡΙΤΑΙΟΝ appellant. Cottidianae uero uariae sunt et multiplices. Aliae enim protinus a calore incipiunt, aliae a frigore, aliae ab horrore. Frigus uoco, ubi extremae partes membrorum inalgescunt, horrorem, ubi corpus totum intremit. Rursus aliae sic desinunt, ut ex toto sequatur integritas; aliae sic, ut aliquantum quidem minuatur ex febre, nihilo minus tamen quaedam reliquiae remaneant, donec altera accessio accedat; ac saepe aliae * * uix quicquam aut nihil remittant sed continuent. Deinde aliae feruorem ingentem habent, aliae tolerabilem: aliae cotidie pares sunt, aliae inpares, atque inuicem altero die lenior, altero uehementior *: aliae tempore eodem postridie reuertuntur, aliae uel serius uel celerius: aliae diem noctemque accessione et decessione implent, aliae minus, aliae plus: aliae cum decedunt, sudorem mouent, aliae non mouent; atque alias per sudorem ad integritatem uenitur, alias tantum corpus inbecillius redditur. At accessiones etiam modo singulae singulis diebus fiunt, modo binae pluresue concurrunt. Ex quo saepe euenit, ut cotidie plures accessiones remissionesque sint, sic tamen, ut unaquaeque alicui priori respondeat. Interdum uero accessiones quoque confunduntur, sic ut notari neque tempora earum neque spatia possint. Neque uerum est, quod dicitur a quibusdam, nullam febrem inordinatam esse, nisi aut ex uomica aut ex inflammatione aut ex ulcere: facilior enim semper curatio foret, si hoc uerum esset: sed quod euidentes causae faciunt, facere etiam abditae possunt. Neque de re sed de uerbo controuersiam mouent, qui, cum aliter aliterque in eodem morbo febres accedunt, non easdem inordinate redire, sed alias aliasque subinde oriri dicunt; quod tamen ad curandi rationem nihil pertineret, etiamsi uere diceretur. Tempora quoque remissionum modo liberalia, modo uix ulla sunt.
4. 4 Such for the most part is the account of fevers; but there are different sorts of treatment in accordance with what is held by the several authorities. Asclepiades said that it is the office of the practitioner to treat safely, speedily, and pleasantly. That is our aspiration, but there is generally danger both in too much haste and too much pleasure. But what moderation must be shown, in order that as far as possible all those blessings may be attained, the patient's safety being always kept first, will be considered among the actual details of the treatment.
4. Et febrium quidem ratio maxime talis est: curationum uero diuersa genera sunt, prout auctores aliquos habent. Asclepiades officium esse medici dicit, ut tuto, ut celeriter, ut iucunde curet. Id uotum est, sed fere periculosa esse nimia et festinatio et uoluptas solet. Qua uero moderatione utendum sit, ut, quantum fieri potest, omnia ista contingant prima semper habita salute, in ipsis partibus curationum considerandum erit.
Before everything is the question as to what regimen the patient should keep to during the first days. The ancients tried to ensure assimilation by administering certain medicaments, because they dreaded indigestion most of all; next by the repetition of clysters they extracted the matter which appeared to be doing harm. Asclepiades did away with medicaments; he did not clyster the bowel with such frequency but still he generally did this in every disease; but the actual fever, he professed to use as a remedy against itself: for he deemed that the patient's forces ought to be reduced by daylight, by keeping awake, by extreme thirst, so that during the first days he would not allow even the mouth to be swilled out. Therefore those are quite wrong who believe that his regimen was a pleasant one in all respects; for in the later days he allowed even luxuries to his patient, but in the first days of the fever he played the part of torturer. Now in my opinion medicinal draughts and clysters should only be administered occasionally; and I consider that they should not be used as to pull to pieces the patient's strength, since the greatest danger is from weakness. There ought to be, therefore, only such a diminution of superfluous matter as is dispersed by natural processes when nothing is being added afresh. Hence for the first days there is to be abstinence from food; the patient is to keep in the light during the day unless weak, for this also clears the body; and so he ought to lie up in a room as... as possible. As regards indeed thirst and sleep, it should be so managed that he keeps awake during the day; at night as far as possible he should be at rest; and he should neither drink much nor be too much distressed by thirst; his mouth also can be swilled out when dry, if he has a bad taste in it, even though that is not the time suitable for a drink. And Erasistratus said appropriately that often whilst the inside does not require fluid, the mouth and throat require it, and it does not help to keep the patient in suffering. And for the first days, such ought to be the regimen.
Et ante omnia quaeritur, primis diebus aeger qua ratione continendus sit. Antiqui medicamentis quibusdam datis concoctionem moliebantur, eo quod cruditatem maxime horrebant: deinde eam materiem, quae laedere uidebatur, ducendo saepius aluum subtrahebant. Asclepiades medicamenta sustulit; aluum non totiens sed fere tamen in omni morbo subduxit; febre uero ipsa praecipue se ad remedium eius uti professus est: conuellendas enim uires aegri putauit luce, uigilia, siti ingenti, sic ut ne os quidem primis diebus elui sineret. Quo magis falluntur, qui per omnia iucundam eius disciplinam esse concipiunt: is enim ulterioribus quidem diebus cubantis etiam luxuriae subscripsit, primis uero tortoris uicem exhibuit. Ego autem medicamentorum dari potiones et aluum duci non nisi raro debere concedo: non ideo tamen id agendum, ut aegri uires conuellantur, existimo, quoniam ex inbecillitate summum periculum est. Minui ergo tantum materiam superantem oportet, quae naturaliter digeritur, ubi nihil noui accedit. Itaque abstinendus a cibo primis diebus est; in luce habendus aeger, nisi infirmus, interdiu est, quoniam corpus ista quoque digerit, isque cubare quam maxime * * conclaui debet. Quod ad sitim uero somnumque pertinet, moderandum est, ut uigilet interdiu. Noctu, si fieri potest, conquiescat: ac neque potet, neque nimium siti crucietur; os etiam eius elui potest, ubi et siccum est, et ipsi faetet, quamuis id tempus potioni aptum non est. Commodeque Erasistratus dixit saepe in⟨t⟩eriore parte umorem non requirente os et fauces requirere, neque ad rem male haberi aegrum pertinere. Ac primo quidem sic tenendus est. Optimum uero medicamentum eius est oportune cibus datus;
But his best medicament is food opportunely given; the question is when it should first be garden. Most of the ancients gave it late, often on the fifth, often on the sixth day of illness, which the climate of Asia or of Egypt may perchance permit. Asclepiades, after he had for three days harassed the patient in every way, destined the fourth day for food. But Themison, recently, took into account not when the fever began, but when it ceased, or at any rate was alleviated; and awaiting the third day from that time, if there was no return of the fever, gave food at once; if fever recurred, he gave food when it ceased, or if it obstinately persisted, he certainly gave it if the fever abated. But on none of these matters is there actually an invariable precept. For it may be that the first food should be given on the first day, it may be on the second, it may be on the third, it may be not until the fourth or fifth day; it may be after one paroxysm, it may be after two, it may be after several. For it all depends upon the kind of disease, the patient's body, the climate, his age, and the time of year; where circumstances differ so greatly, there cannot be an invariable rule of time by any means. In the case of a disease which takes away more of the patient's strength, food is to be given earlier, and the same in a climate in which he uses up more. Hence in Africa it seems right that a patient should never fast over a day. Food should also be given sooner to a child than to an adolescent, sooner in summer than in winter. There is one thing that should be observed, always, and everywhere, that the patient's strength should be continually under the eye of the attending practitioner; and so long as there is a superfluity, he should counter it by abstinence; if he begins to fear weakness, he should assist with food. For it is his business to see that the patient is neither burdened by superfluous material nor rendered weak by hunger. And this I find also in the writings of Erasistratus; who although he did not direct when the bowels should be emptied, or when the body in general, nevertheless, by saying that such things should be seen to, and food given when it was needed by the body, showed sufficiently that food should not be given while the strength was in excess, but that care should be taken not to let it become deficient. Hence it can be understood that it is not possible for many patients to be cared for by one practitioner, and provided that he is skilled in the art, he is a suitable one who does not much absent himself from the patient. But they who are slaves to gain, since more is to be got out of a crowd, are glad to adopt those precepts which do not exact a sedulous attendance, as in this very instance. For even those who see the patient but seldom find it easy to count days or paroxysms; a physician must always be at hand, if he is to see the one thing that matters, the point when the patient is about to become too weak unless he gets food. The fourth day, however, is generally the most suitable date for beginning to give food.
qui quando primum dari debeat, quaeritur. Plerique ex antiquis tarde dabant, saepe quinto die, saepe sexto; et id fortasse uel in Asia uel in Aegypto caeli ratio patitur. Asclepiades ubi aegrum triduo per omnia fatigarat, quartum diem cibo destinabat. At Themison nuper, non quando coepisset febris, sed quando desisset, aut certe leuata esse⟨t⟩, considerabat; et ab illo tempore expectato die tertio, si non accesserit febris, statim; si accesserat, ubi ea uel desierat, uel si adsidue inhaerebat, certe si se inclinauerat, cibum dabat. Nihil autem horum utique perpetuum est. Nam potest primo die primus cibus dandus esse, potest secundo, potest tertio, potest non nisi quarto aut quinto, potest post unam accessionem, potest post duas, potest post plures. Refert enim qualis morbus sit, quale corpus, quale caelum, quae aetas, quod tempus anni; minimeque in rebus inter se multum differentibus perpetuum esse praeceptum temporis potest. Ex morbo, qui plus uirium aufert, celerius cibus dandus est, itemque eo caelo, quo magis digerit. Ob quam causam in Africa nulla die aeger abstineri recte uidetur. Maturius etiam puero quam iuueni, aestate quam hieme dari debet. Vnum illud est, quod semper, quod ubique seruandum est, ut aegri uires subinde adsidens medicus inspiciat; et quamdiu supererunt, abstinentia pugnet; si inbecillitatem uereri coeperit, cibo subueniat. Id enim eius officium est, ut aegrum neque superuacua materia oneret, neque inbecillitatem fame prodat. Idque apud Erasistratum quoque inuenio; qui quamuis parum docuit, quando uenter, quando corpus ipsum exinaniretur, dicendo tamen haec esse uisenda et tum cibum dandum, cum corpori deberetur, satis ostendit, dum uires superessent, dari non oportere: ne deficerent, consulendum esse. Ex his autem intellegi potest ab uno medico multos non posse curari, eumque, si artifex sit, idoneum esse, qui non multum ab aegro recedit. Sed qui quaestui seruiunt, quoniam ⟨is⟩ maior ex populo est, libenter amplectuntur ea praecepta, quae sedulitatem non exigunt, ut in hac ipsa re. Facile est enim dies uel accessiones numerare is quoque, qui aegrum raro uident: ille adsid⟨e⟩at necesse est, qui quod solum opus est uisurus est, quando nimis inbecillus futurus sit, nisi cibum acceperit. In pluribus tamen ad initium cibi dies quartus aptissimus esse consueuit.
But there is another uncertainty which concerns even the days themselves, since the ancients chiefly preferred the odd days and termed them critical, as though then the fate of the sick man was decided. These were the third, fifth, seventh, ninth, eleventh, fourteenth and twenty-first days, the most importance being attached to the seventh, next to the fourteenth and then to the twenty-first. Therefore they administered food to their patients as follows: they awaited paroxysms on odd days, and after that they gave food, as though slighter paroxysms were impending, insomuch that Hippocrates, when the fever desisted on any other than an odd day, was accustomed to fear a recurrence. Asclepiades has justly repudiated this as false, and he said that no day was more or less dangerous to patients for being even or odd. For sometimes even days are the worse, and it is more suitable to give food after paroxysms on these days. Sometimes even in the course of the same fever the daily order changes, and that day becomes graver which had wont to have more of a remission; and besides, the fourteenth day itself, which the ancients confessed to be of great importance, is an even day. Since they held that the eighth day had the character of the first day, because from it began the second numbering of seven, they contradicted themselves in not giving more importance to the eighth, tenth and twelfth days, for they gave more to the ninth and eleventh. After doing this without any rational probability, they went on from the eleventh, not to the thirteenth, but to the fourteenth day. There is even in Hippocrates this statement, that the fourth day is the gravest in the case of those whom the seventh day is to liberate. So according to that very authority, there may be on an even day both a graver fever and a certain sign of what will happen. In another passage the same authority regarded each fourth day, namely, the fourth, seventh, eleventh, fourteenth, and seventeenth, as the most effective in both respects. Thus he passed from an odd system of reckoning to an even one, yet did not, even then, keep to his proposition; for the eleventh is not the fourth day after the seventh, but the fifth. It is clear enough that by whatever reasoning we view this numbering, there is to be found nothing rational in that authority at least. But in these matters indeed the Pythagorean numbers, then quite famous, deceived the ancients, since here also the practitioner ought not to count days, but observe the actual paroxysms, and from these infer when food should be given.
Est autem alia etiam de diebus ipsis dubitatio, quoniam antiqui potissimum impares sequebantur, eosque, tamquam tum de aegris iudicaretur, ΚΡΙΣΙΜΟΥΣ nominabant. Hi erant dies tertius, quintus, septimus, nonus, undecimus, quartus decimus, unus et uicesimus, ita ut summa potentia septimo, deinde quarto decimo, deinde uni et uicensimo daretur. Igitur sic aegros nutri⟨e⟩bant, ut dierum inparium accessiones expectarent, deinde postea cibum quasi leuioribus accessionibus instantibus darent, adeo ut Hippocrates, si alio die febris desisset, recidiuam timere sit solitus. Id Asclepiades iure ut uanum repudiauit, atque in nullo die, qua par inparue esset, is uel maius uel minus periculum esse dixit. Interdum enim peiores dies pares fiunt, et oportun⟨i⟩us post eorum accessiones cibus datur. Nonnumquam etiam in ipso morbo dierum ratio mutatur, fitque grauior, qui remissior esse consuerat; atque ipse quartus decimus par est, in quo magnam uim esse antiqui fatebantur. Qui cum octauum primi die naturam habere contenderent, ut ab eo secundus septenarius numerus inciperet, ipsi sibi repugnabant non octauum, neque decimum, neque duodecimum diem sumendo quasi potentiorem: plus enim tribuebant nono et undecimo. Quod cum fecissent sine ulla probabili ratione, ab undecimo non ad tertium decimum sed ad quartum decimum transibant. Est etiam apud Hippocrate⟨n⟩ eis, qu⟨os⟩ septimus dies liberaturus sit, quartum esse grauissimum. Ita illo quoque auctore in die pari et grauior febris esse potest et certa futuri nota. Atque idem alio loco quartum quemque diem ut in utrumque efficacissimum adprehendit, id est quartum, septimum, undecimum, quartum decimum, septimum decimum. In quo et ab inparis ad paris numeri rationem transit et ne hoc quidem propositum conseruauit, cum a septimo die undecimus non quartus sed quintus sit. Adeo apparet, quacumque ratione ad numerum respeximus, nihil rationis sub illo quidem auctore reperiri. Verum in his quidem antiquos tum celebres admodum Pythagorici numeri fefellerunt, cum hic quoque medicus non numerare dies debeat, sed ipsas accessiones intueri, et ex his coniectare, quando dandus cibus sit.
But it is much more pertinent to this subject to know whether food should be given when the pulse has well quieted down, or while remnants of the fever still persist. For the ancients proffered food when the bodies were as far as possible from fever: Asclepiades did so when the fever was beginning to abate although present. In this he followed false reasoning; not that food may not be given earlier sometimes, if another paroxysm is feared soon, but it certainly ought to be given when the patient is at his soundest: for food is less corrupted when introduced into a body free from fever. Nor however, is that true, which Themison held, that if the patient was likely to be free from fever for a couple of hours, it was better to give food then, in order that the food might be distributed when the body was as far as possible fever-free. For if it were possible for it to be distributed so quickly, that would be the best plan; but since that short time does not allow of it, it is better that the first food should be received by a declining fever, rather than that remnants of food should be received by a recommencing fever. In this case, if the favourable time is longer, it should be given when the body is as free as possible; if short, even before it becomes quite free. But what also holds good for a full freedom does so also for a remission, which can occur, especially in the course of a continuous fever.
Illud autem magis ad rem pertinet scire, tum oporteat dari, cum iam bene uenae conquieuerunt, an etiamnum manentibus reliquiis febris. Antiqui enim quam integerrimis corporibus alimentum offerebant: Asclepiades inclinata quidem febre sed etiamnu⟨m⟩ tamen inhaerente. In quo uanam rationem secutus est, non quo non sit interdum maturius cibus dandus, si mature timetur altera accessio, sed quo scilicet quam sanissimo dari debeat: minus enim conrumpitur quod integro corpori infertur. Neque tamen uerum est, quod Themisoni uidebatur, si duabus horis integer futurus esset aeger, satius esse tum dare, ut ab integro potissimum corpore diduceretur. Nam si diduci tam celeriter posset, id esset optimum: sed cum id breue tempus non praestet, satius est principia cibi a decedente febre quam reliquias ab incipiente excipi. Ita si longius tempus secundum est, quam integerrimo dandum est; si breue, etiam antequam ex toto integer fiat. Quo loco uero integritas est, eodem est remissio, quae maxime in febre continua potest esse.
And there is the further question, whether it is necessary to wait for the same number of hours as the fever lasted, or if it is sufficient to suffer the first part of them to elapse so that the food may settle down more comfortably for the patient, if sometimes there is no intermission. It is safest, however, first to let pass the period of the whole preceding paroxysm, although in the case of a prolonged fever the patient may be indulged earlier, provided that half at least of that time has first passed. And this is to be observed not only in the fever just mentioned but in all.
Atque hoc quoque quaeritur, utrum tot horae expectandae sint, quot febrem habuerunt, an satis sit primam partem earum praeteriri, quo[d] aegris iucundius insidat †si interdum non uacat. Tutissimum est autem ante totius accessionis tempus praeterire, quamuis, ubi longa febris fuit, potest indulgeri aegro maturius, dum tamen ante minime pars dimidia praeterea⟨tur⟩. Idque non in ea sola febre, de qua proxime dictum est, sed in omnibus ita seruandum est.
5. 5 The foregoing rules are rather of general application to fevers of all sorts: now I pass to their particular kinds. If, therefore, there has been only one paroxysm, then an intermission, and the fever arises either from the groin, or from fatigue, or from hot weather, or some other similar thing, and so that it gives no apprehension of a more internal cause, then on the day following, when the time for the recurrence of a paroxysm has elapsed without any disturbance, food can be given. But when there supervenes a deeply seated heat and a sense of weight, whether in the head or in the parts below the ribs, and it is not evident what is disturbing the system, even although freedom follows upon a single paroxysm, nevertheless the third day is to be awaited because a tertian is to be apprehended; and when the time for such a paroxysm has passed, food is to be given, but in small amount, because a quartan may yet be apprehended; and not until the fourth day, if the body is still free, may it be used with confidence. But if on the second, or third, or fourth day fever has recurred, the disease can be recognized. But tertian and quartan fever in which there is both a definite cycle ending in freedom from fever, and ample periods of quiet, are most quickly dealt with, and of these I will speak in their proper place (III.14, 15). Now, however, I will explain the treatment of those fevers which cause trouble every day. Food, therefore, is more suitably given to the patient upon alternate days, in order one day to diminish the fever, the other to recruit his strength. But if it be that sort of quotidian fever in which there is a complete intermission, food should be given immediately upon the body becoming fever-free: if, although there are no paroxysms, the fever is nevertheless continuous and daily increasing, but with remissions that are not complete, food should be given when the system is in that state that no major remission is expected; if the paroxysm on one day is more severe, on the next day milder, food is to be given after the more severe paroxysm. But if the fever continues without ever becoming milder, and it is necessary to give food, there is a great controversy as to the time when it should be given. Some, because patients generally have more of a remission early in the morning, think that food should be given then. But if this answers, the reason for giving food is not the fact that it is morning, but the fact that the patient has more of a remission. But if the patient has no relief even in the morning, it becomes all the worse time for food, just because, although by itself that time should be better, owing to the fault of the disease it is not so; and at the same time, it is followed by midday, after which generally patients become worse, and so it may be feared that the patient may become more distressed than usual. To such a patient, therefore, others give food in the evening: but since at that time those who are ill are generally at their worst, there is fear that any action we may then take may exasperate the fever somewhat. For these reasons I delay until midnight, that is, when one critical time is over, and the next furthest off, whilst the hours which follow before dawn are those during which all patients generally sleep the most; after that comes early morning, naturally a period of greatest relief. If, however, fevers are erratic, since there is apprehension that paroxysms may immediately follow food, whenever a patient begins to have relief after a paroxysm, then food ought to be taken. But if several paroxysms occur on the same day, it should be noted whether they are equal in all respects, which can scarcely ever be the case, or unequal. If they are equal in all respects, food should be given rather after any paroxysm which does not desist between midday and evening. If they are unequal, it is to be considered in what way they differ; for if one is more severe and another slighter, food should be given after the more severe; if one lasts longer, another a shorter time, after the longer; if one is more severe, another more prolonged, it is to be observed which of thetwo causes more distress, the former by its severity, or the latter by its length, and food must be given after the one which causes the most distress. But what matters almost more than anything is, how long and of what kind are the remissions between them: for if after one paroxysm shivering persists, after another the body is free from this, the more suitable time for food is when the body is free. If a slight feverishness persists all the time, but a longer period of remission occurs at one time than at another, that is the time to be selected; so that, when paroxysms are continuous, straightway, when the first one has begun to pass off, food may be given. For it is the general rule to which every pan of treatment should be directed, to give food always as long as possible before the next ensuing paroxysm, and while keeping this rule, to give the food when the body is most free from fever. This should be observed not merely with two paroxysms but also with several. But although it is most proper to give food on alternate days, yet if the system is weak, it should be given every day; and far more so if the fevers continue without remissions, inasmuch as they distress the patient more; or when two or more paroxysms occur on the same day. This occurrence renders it necessary that immediately from the first day, food must be administered daily if the pulse has immediately become weak, and several times on the same day, if in the course of several paroxysms there is progressive diminution of the bodily strength. However, in these cases we must keep to this rule, that less food is to be given after paroxysms of such a kind that no food at all would be given after them if the bodily condition allowed it. When, however, a fever threatens, begins, increases, continues stationary, declines, then persists at a low level, or terminates, it should be recognized that the best time for food is after the fever has terminated; next, when it is continuing at a diminished level; and thirdly, if need be, whenever there is a decline; all other times are dangerous. If, however, there is urgent necessity on account of weakness, it is better to give some food when the increase in the fever has become stationary, rather than whilst it is increasing, better whilst the paroxysm is as yet imminent, rather than after it has commenced, nevertheless with this proviso, that there is no time at which a patient who is failing should not be supported. Most emphatically, it is not enough for the practitioner to pay attention merely to the actual fevers, but also he must look to the habit of the body as a whole, and direct treatment to that, whether patients have superabundance or deficiency of strength, or whether there are other intervening affections. While, however, it is always of advantage for patients to be free from care, so that they may suffer in body alone, and not also in spirit, it is so especially after food has been taken. Therefore if there are any things which might exasperate their emotions, it is best to withhold these from notice whilst they are ill: if this cannot be done, nevertheless to keep all back after food, until the time of sleep, and to tell them when they wake up.
5. Haec magis per omnia febrium genera perpetua sunt: nunc ad singulas earum species descendam. Igitur si semel tantum accessit, deinde desiit, eaque uel ex inguine uel ex lassitudine uel ex aestu aliaue re simili fuit, sic ut interior nulla causa metum fecerit, postero die, cum tempus accessionis ita transiit, ut nihil mouer⟨i⟩t, cibus dari potest. At si ex alto calor uenit et grauitas uel capitis uel praecordiorum secuta est neque apparet quid corpus confuderit, quamuis unam accessionem secuta integritas est, tamen quia tertiana timeri potest, expectandus est dies tertius; et ubi accessionis tempus praeteriit, cibus dandus est, sed exiguus, quia quartana quoque timeri potest; et die quarto demum, si corpus integrum est, eo cum fiducia utendum. Si uero postero tertioue aut quarto die secuta febris est, scire licet morbum esse. Sed tertianarum uel quartanarum, ⟨quarum⟩ et certus circumitus est et finis in integritate et liberaliter quieta tempora sunt, expeditior ratio est; de quibus suo loco dicam. Nunc uero eas explicabo, quae cotidie urgent. Igitur tertio quoque die cibus aegro commodissime datur, ut alter febrem minuat, alter uiribus subueniat. Sed is dari debet, si cotidiana febris est, quae ex toto desinat, simul atque corpus integrum factum est: si quamuis non accessiones, febres tamen iunguntur et cotidie quidem increscunt sed sine integritate tamen remittunt, cum corpus ita se habet, ut maior remissio non expectetur; si altero die grauior, ⟨altero leuior⟩ accessio est, post grauiorem. Fere uero grauiorem accessionem leuior nox sequitur; quo fit, ut grauiorem accessionem nox quoque tristior antecedat. At si continuatur febris neque leuior umquam fit et dari cibum necesse est, quando dari debeat, magna dissensio est. Quidam, quia fere remissius matutinum tempus aegris est, tum putant dandum. Quod si respondet, non quia mane est, sed quia remissior aeger est, dari debet. Si uero ne tum quidem ulla requies aegris est, hoc ipso peius id tempus est, quod, cum sua natura melius esse debeat, morbi uitio non est; simulque insequitur tempus meridianum, a quo cum omnis aeger fere peior fiat, timeri potest, ne ille magis etiam quam ex consuetudine urgeatur. Igitur alii uespere tali aegro cibum dant: sed cum eo tempore fere pessimi sint qui aegrotant, uerendum est, ne, si quid tunc mouerimus, fiat aliquid asperius. Ob haec ad mediam noctem decurro, id est, finito iam grauissimo tempore eodemque longissime distante, secuturis uero antelucanis horis, quibus omnes fere maxime dormiunt, deinde matutino tempore, quod natura sua leuissimum est. Si uero febres uagae sunt, quia uerendum est, ne cibum statim subsequantur, quandocumque quis ex accessione leuatus est, tunc debet adsumere. At si plures accessiones eo⟨dem⟩ die ueniunt, considerare oportet, paresne per omnia sint, quod uix fieri potest, an inpares. Si per omnia pares sunt, post eam potius accessionem cibus dari debet, quae non inter meridiem et uesperum desinit. Si inpares sunt, considerandum est, quo distent: nam si grauior altera, altera leuior est, post grauiorem dari debet; si altera longior, altera breuior, post longiorem: si altera grauior, altera longior est, considerandum est, utra magis adfligat, illa ui, an haec tempore, et post eam dandum. Sed paene plurimum interest, quantae qualesque inter eas remissiones sint: nam si post alteram febrem motio manet, post alteram integrum corpus est, integro corpore cibo tempus aptius est. Si semper febricula manet, sed alterum tamen longius tempus remissionis est, id potius eligendum est, adeo ut, ubi accessiones continuantur, protinus inclinata priore dandus cibus sit. Etenim perpetuum est, ad quod omne consilium derigi potest, cibum quam maxime semper ab accessione futura reducere, et hoc saluo, dare quam integerrimo corpore. Quod non inter duas tantum sed etiam inter plures accessiones seruabitur. Sed cum sit aptissimum tertio quoque die cibum dare, tamen si corpus infirmum est, cotidie dandus est; multoque magis, si continentes febres sine remissione sunt, quanto magis corpus adfligunt; aut si duae pluresue accessiones eodem die ueniunt. Quae res efficit, ut et a primo die protinus cibus dari cotidie debeat, si protinus uenae conciderunt; et saepius eodem die, si inter plures accessiones subinde uis corpori deest. Illud tamen in his seruandum est, ut post eas febres minus cibi detur, post quas, si per corpus liceret, omnino non daretur. Cum uero febris instet, incipiat, augeatur, consistat, decedat, deinde in decessione consistat aut finiatur, scire licet optimum cibo tempus esse febre finita; deinde, cum decessio eius consistit; tertium, si necesse est, quandocumque decedit: cetera omnia periculosa esse. Si tamen propter infirmitatem necessitas urget, satius esse consistente iam incremento febris aliquid offerre quam increscente, satius esse instante quam incipiente, cum eo tamen, ut nullo tempore is, qui deficit, non sit sustinendus. Neque Hercules satis est ipsas tantum febres medicum intueri, sed etiam totius corporis habitum et ad eum d⟨e⟩rigere curationem, siue supersunt uires seu desunt seu quidam alii affectus interueniunt. Cum uero semper aegros securos agere conueniat, ut corpore tantum, non etiam animo laborent, tum praecipue, ubi cibum sumpserunt. Itaque si qua sunt, quae exasperatura eorum animos sunt, optimum est ea, dum aegrotant, eorum notitiae subtrahere: si id fieri non potest, sustinere tamen post cibum usque somni tempus, et cum experrecti sunt, tum exponere.
6. 6 But the rationing of patients' food is the easier because often the stomach spues it back, although the appetite is eager for it; over drink, however, there is a mighty battle, the more so the greater the fever. For fever inflames thirst, and then most demands water when it is most dangerous. But the patient is to be taught that when the fever quiets down, thirst also will become quiet at once, and that the paroxysm will be prolonged if any sustenance is given to it: thus he who does not drink will the sooner cease to be thirsty. It is necessary, however, seeing that even in health hunger is more easily borne than thirst, to indulge patients more as to drink than food. But on the first day, at any rate, no fluid at all should be given, unless the pulse sinks so suddenly that food as well ought to be given: on the second day too and even on later days upon which food is not given, yet if great thirst oppresses, drink should be given. And indeed that dictum of Heraclides of tarentum was not wanting in reason: whenever either bile or indigestion disorders the patient, it is also expedient by draughts in moderation to mingle fresh material with the decomposing. We must see that, just as times are appointed for food, so they are appointed also for drink when given apart from food,... or when we want the patient to get the sleep which thirst usually prevents. But there is sufficient agreement that for all who are feverish an excess of fluid is unsuitable, and especially for women who have lapsed into fever after childbirth.
6. Sed de cibo quidem facilior cum aegris ratio est, quorum saepe stomachus hunc respuit, etiamsi mens concupiscit: de potione uero ingens pugna est, eoque magis, quo maior febris est. Haec enim sitim accendit, et tum maxime aquam exigit, cum illa periculosissima est. Sed docendus aeger est, ubi febris quierit, protinus sitim quoque quieturam, longioremque accessionem fore, si quod ei datum fuerit alimentum: ita celerius eum desinere sitire, qui non bibit. Necesse est tamen, quanto facilius etiam sani famem quam sitim sustinent, tanto magis aegris in potione quam in cibo indulgere. Sed primo quidem die nullus umor dari debet, nisi subito sic uenae ceciderunt, ut cibus quoque dari debeat, secundo uero ceterisque etiam, quibus cibus non dabitur, tamen si magna sitis urgebit, potio dari debet. Ac ne illud quidem ab Heraclida Tarentino dictum ratione caret: ubi aut bilis aegrum aut cruditas male habet, expedire quoque per modicas potiones misceri noua⟨m⟩ materia⟨m⟩ corrupta⟨e⟩. Illud uidendum est, ut qualia tempora cibo leguntur, talia potioni quoque, ubi sine illo datur, deligantur * * *, aut cum aegrum dormire cupiemus, quod fere sitis prohibet. Satis autem conuenit, cum omnibus febricitantibus nimius umor alienus sit, tum praecipue esse feminis, quae ex partu in febres inciderunt.