But although the character of the fever, and of its remission, fixes the time for giving food and drink, yet it is not very easy to know when the patient has fever, when he is better, when he is becoming worse: without which food and drink cannot be administered. For the pulse upon which we mostly rely (III.4, 16) is a very deceptive thing, because often it is rendered slower or faster by age and by sex and by constitution. And very frequently when the body is fairly healthy, if the stomach is weak, also at times when a fever is beginning, the pulse is low and quiescent, so that possibly a patient may seem weak who will yet easily support the impending severe paroxysm. On the contrary, the bath and exercise and fear and anger and any other feeling of the mind is often apt to excite the pulse; so that when the practitioner makes his first visit, the solicitude of the patient who is in doubt as to what the practitioner may think of his state, may disturb the pulse. On this account a practitioner of experience does not seize the patient's forearm with his hand, as soon as he comes, but first sits down and with a cheerful countenance asks how the patient finds himself; and if the patient has any fear, he calms him with entertaining talk, and only after that moves his hand to touch the patient. If now the sight of the practitioner makes the pulse beat, how easily may a thousand things disturb it! Another thing which we put faith in, a sensation of heat, is equally fallacious: for it may be excited by hot weather, by work, by sleep, by fear, by anxiety. Such things also should be noted indeed, but not altogether relied on. And we know at once that he is not feverish, whose pulse is of natural regularity, and his warmth such as is customary in health: we must not, however, at once assume fever if there is heat and high pulse, but under the following conditions: if also the surface of the skin is dry in patches; if both the forehead feels hot, and it feels hot deep under the heart; if the breath streams out of the nostrils with burning heat; if there is a change of colour whether to unusual redness or to pallor; if the eyes are heavy and either very dry or somewhat moist; if sweat, when there is any, comes in patches; if the pulse is irregular. On this account the practitioner should not take his seat in a dark part of the room, nor at the patient's head, but he should face the patient in a good light, so that he may note all the signs from his face as he lies in bed. Now when there has been fever and it has decreased, one should observe whether the temples or other parts of the body are becoming a little moist, which is evidence that sweating is about to set in; and if there is any sign of it, then and not before hot water should be given to drink, of which the effect is salutary if it causes a general sweating all over the body. Now to promote this the patient should keep his hands well covered under the bed-clothes, and do the same with his legs and feet. But it is a mistake to torment patients with bed-clothes, as many do, at the very paroxysm of the fever, worst of all when it is an ardent fever. If the body begins to sweat, a linen towel should be warmed, and each part gradually wiped over. But when the sweating has quite ended, or if none has come, when the patient seems in the most fit state for food, he should be anointed lightly under the bedclothes, next wiped over, and then given food. For patients in fever, liquid food is best, or whatever approximates to fluid, and that of the lightest possible kind, barley gruel in particular; and if there have been high fevers, that should be of the thinnest. Honey also which has been freed from the comb may be correctly added to give the body more nutriment; not if it upsets the stomach this is unnecessary, as also is the gruel itself. But in its place can be given either crumbled bread or washed spelt groats in hot water; in hydromel if the stomach is firm and the bowels tight, or in vinegar and water if the former is weak and the latter loose. And indeed this will suffice for food on the first day; then on the next day some addition can be made, yet from the same class of food, either pot-herbs or shell-fish or orchard fruit. And whilst fevers are on the actual increase, this is the only suitable food; but when the fevers have subsided or abated, a beginning indeed is to be made always with something of the lightest kind, then something to be added of the middle class, regard being had throughout both to the patient's strength and to his disease. A variety of food may be placed before the patient as Asclepiades prescribed, only when he is troubled by loss of appetite, and insufficiency of strength, in order that by tasting a little of each he may avoid starvation. But if there is no lack of strength nor loss of appetite, the patient should not be tempted by a variety of food, lest he take more than he can digest. And there is no truth in what Asclepiades said, that a variety of food is more easily digested; for it is eaten more readily, but digestion depends upon what the food is, and how much. Nor is it safe for the patient to be filled up with food whilst there are great pains, nor during an increase of the malady, but only after his illness has turned towards improvement.
Sed cum tempora cibo potionique febris et remissionis ratio det, non est expeditissimum scire, quando aeger febricitet, quando melior sit, quando deficiat; sine quibus dispensari illa non possunt. Venis enim maxime credimus, fallacissimae rei, quia saepe istae leniores celerioresue sunt et aetate et sexu et corporum natura. Et plerumque satis sano corpore, ⟨si⟩ stomachus infirmus est, nonnumquam etiam incipiente febr⟨e⟩, subeunt et quiescunt, ut inbecillus is uideri possit, cui facile laturo grauis instat accessio. Contra saepe eas concitare solet balneum et exercitatio et metus et ira et quilibet alius animi adfectus, adeo ut, cum primum medicus uenit, sollicitudo aegri dubitantis, quomodo illi se habere uideatur, eas moueat. Ob quam causam periti medici est non protinus ut uenit adprehendere manu brachium, sed primum desidere hilari uultu percontarique, quemadmodum se habeat, et si quis eius metus est, eum probabili sermone lenire, tum deinde eius corpori manum admouere. Quas uenas autem conspectus medici mouet, quam facile mille res turbant. Altera res est, cui credimus, calor, aeque fallax: nam hic quoque excitatur aestu, labore, somno, metu, sollicitudine. Intueri quidem etiam ista oportet, sed ⟨e⟩is non omnia credere. Ac protinus quidem scire est, non febricitare eum, cuius uenae naturaliter ordinatae sunt, teporque talis est, qualis esse sani solet: non protinus autem sub calore motuque febrem esse concipere, sed ita: si summa quoque arida inaequaliter cutis est; si calor et in fronte est et ex imis praecordiis oritur; si spiritus ex naribus cum feruore prorumpit; si color aut rubore aut pallore nouo mutatus est; si oculi graues et aut persicci aut subumidi sunt; si sudor, cum sit, inaequalis est; si uenae non aequalibus interuallis mouentur. Ob quam causam medicus neque in tenebris neque a capite aegri debet residere, sed inlustri loco aduersus, ut omnes notas ex uoltu quoque cubantis percipiat. Vbi uero febris fuit ac decreuit, expectare oportet, num tempora partesue corporis aliae paulum madescant, quae sudorem uenturum esse testentur; ac si qua nota est, tum demum dare potui aquam calidam, cuius salubris effectus est, si sudorem per omnia membra diffundit. Huius autem rei causa continere aeger sub ueste satis multa manus debet, eademque crura pedesque contegere; qua male plerique aegros in ipso febris impetu, pessimeque, ubi ardens ea est, male habent. Si sudare corpus coepit, linteum tepefacere oportet paulatimque singula membra dete⟨r⟩gere. At ubi sudor omnis finitus est, aut si is non uenit, ubi quam maxime potuit idoneus esse cibo aeger uidetur, leuiter sub ueste ungendus est, tum detergendus, deinde ei cibus dandus. Cibus autem febricitantibus umidus est aptissimus aut umori certe quam proximus, utique ex materia quam leuissima maximeque sorbitio; eaque, si magnae febres fuerint, quam tenuissima esse debet. Mel quoque despumatum huic recte adicitur, quo corpus magis nutriatur: sed id si stomachum offendit, superuacuum est, sicut ipsa quoque sorbitio. Dari uero in uicem eius potest uel intrita ex aqua calida uel halica ⟨e⟩lota; si firmus est stomachus et compressa aluus, ex aqua mulsa; si uel ille languet uel haec profluit, ex posca. Et primo quidem cibo id satis est: secundo uero aliquid adici potest, ex eodem tamen genere materiae, uel holus uel conchylium uel pomum. Et dum febres quidem increscunt, hic solus cibus idoneus est: ubi uero aut desinunt aut leuantur, semper quidem incipiendum est ab aliquo ex materia leuissima, adiciendum uero aliquid ex media, ratione habita subinde et uirium hominis et morbi. Ponendi uero aegro uarii cibi, sicut Asclepiades praecepit, tum demum sunt, ubi fastidio urgetur neque satis uires sufficiunt, ut paulum ex singulis degustando famem uitet. At si neque uis neque cupiditas deest, nulla uarietate sollicitandus aeger est, ne plus adsumat quam concoquat. Neque uerum est, quod ab eo dicitur, facilius concoqui cibos uarios: eduntur enim facilius, ad concoctionem autem materiae genus et modus pertinent. Neque inter magnos dolores neque increscente morbo tutum est aegrum cibo impleri, sed ubi inclinata iam in melius ualetudo est. Sunt aliae quoque in febribus obseruationes necessariae.
In fevers there are also other things that have to be observed. And this also must be noted, which some give as their sole precept, whether the body is constricted or relaxes; the first condition chokes it, the second wastes it away.
Atque id quoque uidendum est, quod quidam solum praecipiunt, adstrictum corpus sit an profluat; quorum alterum strangulat, alterum digerit.
For if there is constriction, the bowels are to be moved by a clyster, urination promoted, and sweating elicited in every way. In this class of maladies it is beneficial to let blood, to shake up the body by vigorous rocking, to keep the patient in the light, to impose hunger and thirst and wakefulness. It is also useful to take the patient to the bath, putting him first into the solium, next to anoint him, then to return him to the solium again and foment his groins with plenty of water; at times also oil may be mixed with the water in the solium; food is to be used later and not too often: it is to be thin, plain, soft, hot, scanty, consisting mainly of pot-herbs, such as sorrel, nettle-tops, mallow, and also of soup made from shell-fish, mussels or spiny lobsters. No meat should be given unless boiled. But as to drink, there should be more freedom, both before and after and along with food, beyond what thirst demands. Again, after the bath wine of fuller body and sweeter can also be given; once or twice Greek salted wine can be used.
Nam si adstrictum est, ducenda aluus est, mouenda urina, eliciendus omni modo sudor. In hoc genere morborum emisisse sanguinem, concussisse uehementi⟨b⟩us gestationibus corpus, in lumine habuisse, imperasse famem, sitim, uigiliam prodest. Vtile est etiam ducere in balneum, prius demittere in solium, tum ungere, iterum ad solium redire multaque aqua fouere inguina; interdum etiam oleum in solio cum aqua calida miscere; uti cibo serius et rarius, tenui, simplici, molli, calido, exiguo, maximeque holeribus, qualia sunt lapatium, urtica, malua, uel iure etiam concharum musculorumue aut lucustarum: neque danda caro nisi elixa est. At potio esse debet magis liberalis, et ante cibum et post hunc et cum hoc ultra quam sitis coget. Poteritque a balineo etiam pinguius aut dulcius dari uinum; poterit semel aut bis interponi Graecum salsum.
On the contrary, however, if the system is relaxed, sweating is to be suppressed, rest in a dark room resorted to, and sleep allowed at will; the body is to be rocked only in the lightest fashion, and helped as may suit the illness. For if the patient has loose motions, or if the stomach does not retain its contents, when the fever has subsided he should be given a large drink of tepid water, and be induced to vomit, unless the throat or the chest or the side is painful, or the disease is of long standing. But if sweating is troublesome, the skin should be hardened by nitre or salt, mixed with oil; and if the sweating is rather slight, the body is to be anointed with olive oil: if more profuse, with rose, quince, or myrtle oil, to which a dry wine should be added. But any patient with loose motions, when he reaches the bath, should be first anointed, then put into the solium. When there is anything wrong with the skin, it is better to use cold rather than hot water. Coming to the food, this should be nutritious, cold, dry, plain, with the least possible tendency to decomposition, bread toasted, meat roasted, wine dry or at any rate somewhat dry; if the bowels are loose, the wine should be hot, but cold when there is trouble from sweating or vomiting.
Contra uero si corpus profluit, sudor coercendus, requies habenda erit, tenebris somnoque, quandoque uolet, utendum, non nisi leni gestatione corpus agitandum, et pro genere mali subueniendum. Nam si uenter fluit, aut si stomachus non continet, ubi febris decreuit, liberaliter oportet aquam tepidam potui dare, et uomere cogere, nisi aut fauces aut praecordia aut latus dolet, aut uetus morbus e⟨s⟩t. Si uero sudor exercet, duranda cutis est nitro uel sale, quae cum oleo miscentur; ac si leuius id uitium est, oleo corpus ungendum; si uehementius, rosa uel melino uel murteo, cui uinum austerum sit adiectum. Quisquis autem fluore aeger est, cum uenit in balineum, prius ungendus, deinde in solium d⟨e⟩mittendus est. Si in cute uitium est, frigida quoque quam calida aqua melius utetur. Vbi ad cibum uentum est, dari debet is ualens, frigidus, siccus, simplex, qui quam minime corrumpi possit, panis tostus, caro assa, uinum austerum uel certe subausterum; si uenter profluit, calidum, si sudores nocent uomitusue sunt, frigidum.
7. 7 Among fevers the case of pestilence demands special consideration. In this it is practically useless to prescribe fasting or medicine or clysters. If strength permits of it, blood-letting is best, and especially if there is fever with pain: but if that is hardly safe, after the fever has either declined or remitted, the chest is cleared by an emetic. But in such cases the patient requires to be taken to the bath earlier than in other affections, to be given hot and undiluted wine, and all food glutinous, including that sort of meat. For the more quickly such violent disorders seize hold, the earlier are remedies to be taken in hand, even with some temerity. But if a child is the sufferer, and not robust enough for lo-letting to be possible, thirst is to be used in his case, the bowels are to be moved by a clyster whether of water or of pearl-barley gruel; then and not before he is to be sustained by light food. Indeed in general children ought not to be treated like adults. Therefore, as in any other sort of disease, we must set to work with more caution in these cases; not let blood readily, not readily clyster, not torment by wakefulness and by hunger or excess of thirst, nor is a wine treatment very suitable. After the remission of the fever a vomit is to be elicited, then food of the lightest nature is given, after which let the child sleep; next day, if the fever persists, let the child be kept without food, and on the third day return to food as above. Our aim should be, as far as possible to sustain the child, by food when suitable, with abstinence in between when suitable, omitting all else. But if an ardent fever is parching up the patient, no medicinal draught is to be given, but during the paroxysms he is to be cooled by oil and water, mixed by the hand until they turn white. He should be kept in a room where he can inhale plenty of pure air; he is not to be stifled by a quantity of bed-clothes, but merely covered by light ones. Vine leaves also which have been dipped in cold water can be laid over the stomach. He is not even to be distressed by too much thirst; he should get food fairly soon, namely from the third day, and after being anointed beforehand. If phlegm collects in the stomach, when the paroxysm has already declined he is to be made to vomit; then to be given cold salads, or orchard fruit agreeable to the stomach. If the stomach remains dry, there should be given to begin with either pearl barley or spelt or rice gruel with which fresh lard has been boiled. Whilst the fever is at its height, certainly not before the fourth day, and if there is already great thirst, cold water is to be administered copiously so that the patient may drink even beyond satiety. As soon as the stomach and chest have become replete beyond measure and sufficiently cooled, he should vomit. Some do not even insist on the vomit, but use the cold water by itself, given up to satiety, as the medicament. When either of the above has been done, the patient is to be well wrapped up and put to bed so that he may sleep; and generally, after prolonged thirst and wakefulness, after full sating with water, after making a break in the heat, there comes abundant sleep: which brings on a profuse sweat, and this is an immediate relief, but only to those who have no pains accompanying the ardent fever, no swelling of the parts below the ribs, nothing prohibitory either in the chest or in the lung or in the throat, no ulcerations, no diarrhoea, no flux from the bowel. But if in fever of this sort the patient coughs readily, he is not to be distressed by severe thirst, nor ought he to drink water cold, but he is to be treated in the way prescribed for other fevers.
7. Desiderat quoque propriam animaduorsionem in febribus pestilentiae casus. In hac utile minime est aut fame aut medicamentis uti, aut ducere aluum. Si uires sinunt, sanguinem mittere optimum est, praecipueque si cum dolore febris est: si id parum tutum est, ubi febris aut tenuata est aut leuata est, uomitu pectus purgare. Sed in hoc maturius quam in aliis morbis ducere in balineum opus est, uinum calidum et meracius dare, et omnia glutinosa; inter quae carnem quoque generis eiusdem. Nam quo celerius eiusmodi tempestates corpiunt, eo maturius auxilia etiam cum quadam temeritate rapienda sunt. Quod si puer est qui laborat, neque tantum robur eius est, ut ei sanguis mitti possit, siti ei utendum est, ducenda aluus uel aqua uel tisanae cremore, tum denique is leuibus cibis nutriendus. Et ex toto non sic pueri ut uiri curari debent. Ergo, ⟨ut⟩ in alio quoque genere morborum, parcius in his agendum est: non facile sanguinem mittere, non facile ducere aluum, non cruciare uigilia fameque aut nimia siti, non uino curare satis conuenit. Vomitus post febrem eliciendus est, deinde dandus cibus ex leuissimis, tum is dormiat; posteroque die, si febris manet, abstineatur; tertio ad similem cibum redeat. Dandaque opera est, quantum fieri potest, ut inter oportunam abstinentiam cibosque oportunos, omissis ceteris, nutriatur. Si uero febris ardens extorret, nulla medicamenti danda potio est, sed in ipsis accessionibus oleo et aqua refrigerandus est; quae miscenda manu sunt, donec albescant. Eo conclaui tenendus, quo multum et purum aerem trahere possit; neque multis uestimentis strangulandus, sed admodum leuibus tantum uelandus est. Possunt etiam super stomachum inponi folia uitis in aqua frigida tincta. Ac ne siti quidem nimia uexandus est. Alendus maturius est, id est a tertio die, et ante cibum idem perungendus. Si pituita in stomachum coit, inclinata iam accessione uomere cogendus est; tum dandum frigidum holus, aut pomum ex is, quae stomacho conueniunt. Si siccus manet stomachus, protinus uel tisanae uel halicae uel orizae cremor dandus est, cum quo recens adeps cocta sit. Cum uero in summo incremento morbus est, utique non ante quartum diem, magna siti antecedente, frigida aqua copiose praestanda est, ut bibat etiam ultra satietatem. Cum iam uenter et praecordia ultra modum repleta satisque refrigerata sunt, uomere debet. Quidam ne uomitum quidem exigunt, sed ipsa aqua frigida tantum ad satietatem data pro medicamento utuntur. Vbi utrumlibet factum est, multa ueste operiendus est, et collocandus ut dormiat; fereque post longam sitim et uigiliam, post multam satietatem, post infractum calorem plenus somnus uenit; per quem ingens sudor effunditur, idque praesentissimum auxilium est, sed in is tamen, in quibus praeter ardorem nulli dolores, nullus praecordiorum tumor, nihil prohibens uel in thorace uel in pulmone uel in faucibus, non ulcera, non deiectio, non profluuium alui fuit. Si quis autem in huiusmodi febre leuiter tussit, is neque uehementi siti conflictatur, neque bibere aquam frigidam debet, sed eo modo curandus est, quo in ceteris febribus praecipitur.
8. 8 But when the fever is that kind of tertian which the physicians call hemitritaion, great care is required to avoid a mistake, for it has a number of frequently recurring paroxysms and remissions, so that it can appear to be some other class of disease and the fever may last from twenty-four to thirty-six hours, so that what is really the same paroxysm may not seem to be the same. And it is then exceedingly important not to give food except in that remission which is a real one, and when that does come, to give it at once. Many die suddenly from error one way or the other on the part of the practitioner. And unless something strongly prohibits, blood should be let at the onset, then food is to be given, which, without exciting the fever, should yet sustain a long course of it.
8. At ubi id genus tertianae est, quod emitritaeon medici appellant, magna cura opus est, ne id fallat: habet enim plerumque frequentes accessiones decessionesque, ut aliud genus morbi uideri possit porrigique febris inter horas XXIIII et XXXVI, ut quod idem est, non idem esse uideatur. Et magnopere necessarium est neque dari cibum nisi in ea remissione, quae uera est, et ubi ea uenit, protinus dari. Plurimique sub alterutro curantis errore subito moriuntur. Ac nisi magnopere res aliqua prohibet, inter initia sanguis mitti debet, tum dari cibus, qui neque incitet febrem, et tamen longum eius spatium sustineat.
9. 9 Sometimes also slow fevers hold the body without any remission, and give no place for either food or any medicament. In that case it should be the aim of the practitioner to change the disease, for perhaps that will make it more amenable to treatment.. For this object cold water, to which oil has been added, should be sprinkled at frequent intervals over the patient's body, for it thus comes about now and again that a shivering follows, and some beginning of a fresh pulse motion, and after this when, after the body has become hotter, there may even follow a remission. Rubbing with oil and salt appears also to benefit such cases. But if for a long while there is a chill, and a numbness and a tossing of the body, it is not unfitting to administer three or four cups of honeyed wine even while the fever is present, or food along with wine well diluted. For often in this way the fever is augmented, and the increased heat which arises simultaneously both relieves the pre-existing disorders and offers hope of a remission, and through that of treatment. Assuredly that treatment is no novelty by which some nowadays at times cure by contrary remedies patients who have been handed over to them, after dragging on under more cautious practitioners. Even among the ancients, before Herophilus and Erasistratus, but especially after Hippocrates. There was a certain Petron, who on taking over a patient with fever, covered him with a quantity of clothes in order simultaneously to excite great heat and thirst. Then when the fever began to remit somewhat, he gave cold water to drink; and if this raised a sweat, he declared that the patient was recovering; if it did not, he administered even more cold water and then forced him to vomit. If by either of the above ways he had rendered the patient free from fever, he at once gave him roast pork and wine; if he had not so freed him, he boiled water with salt, and obliged the patient to drink it, in order that by moving the bowels he might cleanse the stomach. And the above formed the whole of this man's practice; and it pleased those whom successors of Hippocrates had failed to cure, no less than in our time it pleases those, who, after they have dragged on for a long while under disciples of Herophilus and Erasistratus, have not been benefited. Yet it is harsh treatment none the less, for if it is adopted forthwith at the commencement, it kills many patients. Since, however, it is impossible for the same remedies to suit everybody, rashness helps those whom the usual regimen has not made well; hence it is that practitioners of this class manage other people's patients better than their own. Yet it is the part also of a circumspect man at times to renew and increase a disease and to inflame fevers, for when the existing condition does not answer to a treatment, that which is to come may do so.
9. Nonnumquam etiam lentae febres sine ulla remissione corpus tenent, ac neque ⟨cibo neque⟩ ulli remedio locus est. In hoc casu medici cura esse debet, ut morbum mutet: fortasse enim curationi oportunior fiet. Saepe igitur ex aqua frigida, cui oleum sit adiectum, corpus eius pertractandum est, quoniam interdum sic euenit, ut horror oriatur et fiat initium quoddam noui motus exque eo, cum magis corpus incaluit, sequatur etiam remissio. In his frictio quoque ex oleo et sale salubris uidetur. At si diu frigus est et torpor et iactatio corporis, non alienum est in ipsa febre mulsi dare tres aut quattuor cyathos, uel cum cibo uinum bene dilutum. Intenditur enim saepe ex eo febris, et maior ortus calor simul et priora mala tollit et spem remissionis inque ea curationis ostendit. Neque Hercules ista curatio noua est, qua nunc quidem traditos sibi aegros, qui sub cautioribus medicis trahebantur, interdum contrariis remediis sanant. Siquidem apud antiquos quoque ante Herophilum et Erasistratum maximeque post Hippocratem fuit * * Petro quidam, qui febricitantem hominem ubi acceperat, multis uestimentis operiebat, ut simul calorem ingentem sitimque excitaret. Deinde ubi paulum remitti coeperat febris, aquam frigidam potui dabat, ac si mouerat sudorem, explicuisse se aegrum iudicabat; si non mouerat, plus etiam aquae frigidae ingerebat et tum uomere cogebat. Si alterutro modo febre liberauerat, protinus suillam assam et uinum homini dabat; si non liberauerat, decoquebat aquam sale adiecto eamque bibere cogebat, ut mouendo uentrem purgaret. Et intra haec omnis eius medicina erat: eaque non minus grata fuit is, quos Hippocratis successores non refecerant, quam nunc est is, quos Herophili uel Erasistrati aemuli diu tractos non adiuuerunt. Neque ideo tamen non est temeraria ista medicina, quia, si plures protinus a principiis excepit, interemit. Sed, cum eadem omnibus conuenire non possint, fere quos ratio non restituit, temeritas adiuuat; ideoque eiusmodi medici melius alienos aegros quam suos nutriunt. Sed est circumspecti quoque hominis et nouare interdum et augere morbum et febres accendere, quia curatio⟨nem⟩ ubi id quod est non recipit, potest recipere id quod futurum est.
10. 10 We must also take into consideration whether fevers exist alone, or whether there are additional troubles, namely whether the head aches, whether the tongue is roughened, whether the chest is tight. If there is headache, rose oil should be mixed with vinegar and poured over the head; next two strips of linen are taken, each corresponding in length and breadth to the forehead, of which in turn one is placed in the rose oil and vinegar, the other on the forehead; or unscoured wool is soaked in the same and applied. If the vinegar hurts, the rose oil alone is to be used; if rose oil itself irritates, then bitter olive oil. If there is little relief from the above, we may pound up either dried orris root, or bitter almonds, or some other from among refrigerant herbs; any one of these applied with vinegar lessens pain, one more in one case, another in another. There is benefit from the application of bread soaked in poppy head decoction, or in rose oil containing cerussa or litharge. Also it is not unsuitable to snuff up thyme or dill. But first there is inflammation and pain in the chest, the first thing is to apply to it repressing plasters, lest more diseased matter should gather there, if hotter ones were applied; next, when the primary inflammation has subsided, and not before, we must go on to hot and moist plasters, in order to disperse what remains of the matter. Now the signs of an inflammation are four: redness and swelling with heat and pain. Over this Erasistratus greatly erred, when he said that no fever occurred apart from inflammation. Therefore if there is pain without inflammation, nothing is to be put on: for the actual fever at once will dissolve the pain. But if there is neither inflammation nor fever, but just pain in the chest, it is allowable to use hot and dry foments from the first. Again if the tongue is dry and scabrous, it is to be wiped over first with a pledget of wool dipped in hot water, then to be smeared with a mixture of rose oil and honey. Honey cleans, rose oil represses and at the same time does not allow the tongue to dry. But if the tongue is not scabrous, only dry, after being wiped over with the pledget of wool, it should be smeared with rose oil to which a little wax has been added.
10. Considerandum est etiam, febresne solae sint, an alia quoque his mala accedant, id est, num caput doleat, num lingua aspera, num praecordia intenta sint. Si capitis dolores sint, rosam cum aceto miscere oportet et in id ingerere; deinde habere duo pittacia, quae frontis latitudinem longitudinemque aequent, ex his inuicem alterum in aceto et rosa habere, alterum in fronte; aut intinctam isdem lanam sucidam inponere. Si acetum offendit, pura rosa utendum est; si rosa ipsa laedit, oleo acerbo. Si ista parum iuuant, teri potest uel iris arida uel nuces amarae uel quaelibet herba ex refrigerantibus; quorum quidlibet ex aceto inpositum dolorem minuit, sed magis aliud in alio. Iuuat etiam panis cum papauere iniectus, uel cum rosa, cerussa spumaue argenti. Olfacere quoque uel serpullum uel anethum non alienum est. At si in praecordiis inflammatio et dolor est, primo superimponenda sunt cataplasmata reprimentia, ne, si calidiora fuerint, plus eo materiae concurrat; deinde si prima inflammatio se remisit, tum demum ad calida et umida ueniendum est, ut ea, quae remanserunt, discutiant. Notae uero inflammationis sunt quattuor: rubor et tumor cum calore et dolore. Quo magis errauit Erasistratus, cum febrem nullam esse sine hac dixit. Ergo si sine inflammatione dolor est, nihil imponendum est: hunc enim statim ipsa febris soluet. At si neque inflammatio neque febris sed tantum praecordiorum dolor est, protinus calidis et siccis fomentis uti licet. Si uero lingua sicca et scabra est, detergenda primum penicillo est ex aqua calida, deinde unguenda mixtis inter se rosa et melle. Mel purgat, rosa reprimit simulque siccescere non sinit. At si scabra non est sed arida, ubi penicillo detersa est, ungi rosa debet, cui cerae paulum sit adiectum.
11. 11 Generally also preceding fevers there is a chill, and that is a most troublesome class of malady. When it is expected, the patient is to be prohibited from drinking anything: for this, given a little while beforehand, adds much to the illness. Likewise he is to be covered up quite soon with a quantity of bed-clothes; to the parts about which we feel concern there are to be applied such dry and hot foments as will not immediately set up a very vehement heat, but gradually increase it. The said parts are also to be rubbed by hands anointed with cold olive oil, to which has been added one of the heating agents. And some practitioners are satisfied with one rubbing of any kind of oil. During remissions of these fevers, some give three or four cupfuls of barley water even although some fever still persists; then, the fever having definitely ended, they reinvigorate the stomach with cold and light food. This, I think, should be tried only when there has been little benefit from food given once and at the end of the paroxysm. It must be carefully looked to, however, that the time of the remission is not deceptive; for often in this class of illness the fever seems to diminish, and then again becomes intense. Some degree of trust must be placed in that remission which is prolonged, and diminishes restlessness and the foulness of the mouth which the Greeks term ozaena. This is pretty generally agreed, that if the daily paroxysms are equal, a little food should be given every day: if the paroxysms are unequal, food should be given after the more severe, after the slighter ones hydromel.
11. Solet etiam ante febres esse frigus idque uel molestissimum morbi genus est. Vbi id expectatur, omni potione prohibendus est aeger: haec enim paulo ante data multum malo adicit. Item maturius ueste multa tegendus est; admouenda partibus is, pro quibus metuimus, sicca et calida fomenta sic, ne statim uehementissimi calores incipiant, sed paulatim increscant. Perfricandae quoque eae partes manibus unctis ex uetere oleo sunt eique adiciendum aliquid ex calefacientibus. Contentique medici quidam una frictione etiam ex quolibet oleo sunt. In harum febrium remissionibus nonnulli tres aut quattuor cyathos sorbitionis etiamnu⟨m⟩ manente febre dant, deinde ea bene finita reficiunt stomachum cibo frigido et leui. Tum hoc ego puto temptandum, quo⟨m⟩ parum cibus semel et post febrem datus prodest. Sed curiose prospiciendum, ne tempus remissionis decipiat: saepe enim ⟨in⟩ hoc quoque genere ualetudinis iam minui febris uidetur, et rursus intenditur. Aliqua ei remissioni credendum est, quae etiam moratur et iactationem foetoremque quendam oris, quem ozen⟨am⟩ Graeci uocant, minuit. Illud satis conuenit, si cottidie pares accessiones sunt, cotidie paruum cibum dandum: si inpares, post grauiorem, cibum; post leuiorem, aquam mulsam.
12. 12 Now shivering usually precedes those fevers which have a fixed cycle and a complete remission; hence they are the most safe, and specially admit of treatment. For when periodicity is uncertain, neither clyster nor bath, nor wine nor other medicament, is administered at the right moment: for it is uncertain when the fever will supervene, so that if it comes on suddenly, it may happen that there is the greatest harm in what is intended to serve as an aid. And there is nothing else that can be one, except for the patient to abstain strictly for the first days, then, upon the decline of that paroxysm which is the severest, to take food. When, however, there is an assured cycle, all those remedies are more easily tried, because we are more able to inform ourselves of the alternations between paroxysms and remissions. In those fevers, however, which have become inveterate, starving is not of service; it is only in the first days that the fever is to be thus countered; later the treatment is to be divided, first to disperse the shivering, then the fever. Therefore, as soon as the patient shivers, and after the shivering grows hot, he should be given to drink tepid water with a little salt in it, and so made to vomit: for generally such shivering arises from a bilious sediment in the stomach. Likewise if shivering recurs at the next cycle, the same should be done; for often the fever is thus shaken off, and now we may learn to what class it belongs. And so in view of the possibility of the next paroxysm, the third which may be threatening, the patient should be conducted to the bath, and it should be do arranged that he is already in the solium at the moment for the shivering. If there also he feels chilled, yet none the less he should do the same again in view of a fourth paroxysm, for often in that way the shivering is shaken off. If there is no benefit even from the bath, before the paroxysm let him eat garlic, or drink hot water containing pepper; to see if these when taken excite heat which prevents the shivering. Further in the same way as prescribed for a chill before shivering can come on, the patient should be covered up, and the whole body surrounded with foments — but the stronger ones are to be used at once — and thoroughly encompassed by wraps which enclose hot tiles and cinders. If, notwithstanding, shivering breaks out, let the patient be anointed freely under the wraps with hot oil, to which add one of the heating elements: let rubbing be applied, so far as he can bear it, especially of the arms and legs, while he holds his breath. Nor should it be stopped even if he shivers; for often the pertinacity of the rubber overcomes the body's malady. If he vomits somewhat, tepid water is to be given him, and he is to be forced to vomit again; the same measures must be used until shivering comes to an end. But if the shivering is too slow in subsiding, in addition to the above, a clyster should be given; for that also is of good effect by unloading the body. The last remedies after these are rocking and rubbing. Now in such illness the food to be given is such chiefly as will secure a soft motion, meat glutinous, wine, when any is given, dry.
12. Horror autem eas fere febres antecedit, quae certum habent circuitum et ex toto remittuntur; ideoque tutissimae sunt maximeque curationes admittunt. Nam ubi incerta tempora sunt, neque alui ductio neque balineum neque uinum neque medicamentum aliud recte datur: incertum est enim, quando febris uentura sit: ita fieri potest, ut, si subito uenerit, summa in eo pernicies sit, quod auxilii causa sit inuentum. Nihilque aliud fieri potest, quam ut primis diebus bene abstineatur aeger, deinde sub decessu febris eius, quae grauissima est, cibum sumat. At ubi certus circumitus est, facilius illa omnia temptantur, quia magis proponere nobis accessionum et decessionum uices possumus. In his autem, cum inueterauerunt, utilis fames non est: primis tantummodo diebus ea pugnandum est; deinde diuidenda curatio est, et ante horror, tum febris discutienda. Igitur cum primum aliquis inhorruit, et ⟨ex⟩ horrore incaluit, dare oportet ei potui tepidam aquam subsalsam et uomere eum cogere: nam fere talis horror ab is oritur, quae biliosa in stomacho resederunt. Idem faciendum est, si proximo quoque circuitu aeque accessit: saepe enim sic discutitur, iamque, quod genus febris sit, scire licet. Itaque sub expectatione proximae accessionis, quae instare tertia potest, deducendus in balineum est, dandaque opera, ut per tempus horroris in solio sit. Si ibi quoque * senserit, nihilo minus idem sub expectatione quartae accessionis faciat: siquidem eo quoque modo saepe id discutitur. Si ne balneum quidem profuit, ante accessionem alium edat, aut bibat aquam calidam cum pipere: siquidem ea quoque adsumpta calorem mouent, qui horrorem non admittit. Deinde eodem modo, quo in frigore praeceptum est, antequam inhorrescere possit, operiatur, fomentisque, sed protinus ualidioribus, totum corpus circumdet maximeque inuolutis extinctis testis et titionibus. Si nihilo minus horror perruperit, multo oleo calefacto inter ipsa uestimenta perfundatur, cui aeque ex calfacientibus aliquid sit adiectum; adhibeaturque frictio, quantam is sustinere poterit, maximeque in manibus et cruribus; et spiritum ipse contineat. Neque desistendum est, etiamsi horret: saepe ⟨enim⟩ pertinacia iuuantis malum corporis uincit. Si quid euomuit, danda aqua tepida, iterumque uomere cogendus est; utendumque eisdem est, donec horror finiatur. Sed praeter haec ducenda aluus est, si tardius horror quiescit: siquidem id quoque exonerato corpori prodest. Vltimaque post haec auxilia sunt gestatio et fricatio. Cibus autem in eiusmodi morbis maxime dandus est, qui mollem aluum praestet, caro glutinosa: uinum, cum dabitur, austerum.
13. 13 The foregoing remarks apply to all periodic fevers: but they are to be distinguished, according to the dissimilar characters of each. If it is a daily fever, it is particularly important to abstain for the first three days, then to make use of food upon alternate days: if this fever has become inveterate, the bath and wine are to be tried at the end of the paroxysm, and especially so when the fever persists after the shivering has been removed.
13. Haec ad omnes circuitus febrium pertinent: discernendae tamen singulae sunt, sicut rationem habent dissimilem. Si cottidiana est, triduo primo magnopere abstineri oportet, tum cibis altero quoque die uti: si res inueterauerit, post febrem experiri balneum et uinum, magisque si horrore sublato haec superest.
14. 14 But if it be a tertian, when there are complete intermissions, or a quartan, on the intermediate days the patient should make use of walking and of other exercises and of anointings. In this kind of malady, well before the paroxysm, a certain Cleophantus, one of the ancient physicians, poured over the patient's head quantities of hot water; and then gave wine. Asclepiades, although he followed many of this man's precepts, rejected this one, and rightly, for it is of doubtful effect. In the case of a tertian fever, Asclepiades said that on the third day following the paroxysm, the bowels should be moved by a clyster; on the fifth day after the shivering a vomit should be elicited; then, after the paroxysm, according to the custom of Cleophantus, patients whilst still heated were to be given food and wine, on the sixth day to be kept in bed; for so he hoped to prevent a paroxysm on the seventh day. It is likely that this may often happen. It is safer, however, so that we may use the exact order laid down, to try the three remedies, vomiting, clystering, and wine-drinking, on three several days, that is, on the third, fifth and seventh days, with this proviso that on the seventh day wine is not to be drunk until after the time for the paroxysm. But if a tertian fever is not dispersed within the first days, but is becoming chronic on the day that the paroxysm is expected, the patient should keep his bed; after the paroxysm he should be rubbed, then, having taken food, drink water; on the day following, which is free from fever, the patient should keep quiet, avoid exercise and anointing, and be content with water only. And that indeed is the best procedure; but if there is urgent weakness, he may both take wine after the paroxysm and a little food on the intermediate day.
14. Si uero tertiana, quae ex toto intermittit, aut quartana est, mediis diebus et ambulationibus uti oportet aliisque exercitationibus et unctionibus. Quidam ex antiquis medicis Cleophantus in hoc genere morborum multo ante accessionem per caput aegrum multa calida aqua perfundebat, deinde uinum dabat. Quod, quamuis pleraque praecepta eius uiri secutus est Asclepiades, recte tamen praeteriit: est enim anceps. Ipse, si tertiana febris est, tertio die post accessionem dicit aluum duci oportere, quinto post horrorem uomitum elicere, deinde post febrem, sicut illi mos erat, adhuc calidis dari cibum et uinum, sexto die in lectulo detineri: sic enim fore, ne septimo die febris accedat. Id saepe posse fieri uerisimile est. Tutius tamen est, ut hoc ipso ordine utamur, tria remedia, uomitus, alui ductionis, uini per triduum, id est tertio die et quinto et septimo temptare, ne uinum nisi post accessionem die septimi bibat. Si uero primis diebus discussus morbus non est, inciditque in uetustatem, quo die febris expectabitur, in lectulo se contineat, post febrem confricetur, tum cibo adsumpto bibat aquam; postero die, qui uacat, ab exercitatione unctioneque aqua tantum contentus conquiescat. Et id quidem optimum est: si uero inbecillitas urgebit, et post febrem uinum ⟨et⟩ medio die paulum cibi debebit adsumere.
15. 15 In a quartan fever the same should be done. But seeing that unless it has been shaken off within the first days, it is a long while in terminating, we must be more careful from the very first to lay down what should be done in it. Therefore if a paroxysm has set in with shivering and has remitted, the patient ought to observe a regimen on the same day and on the following and on the third day; on the first day after the paroxysm he should take only hot water; on the next two days abstain if possible even from that;; on the fourth day, if the fever recurs with shivering, he should vomit, as was prescribed before; then after the paroxysm he should take a limited quantity of food and of wine four ounces. On the next two days he should fast, taking only hot water if thirsty. On the seventh day the cold stage should be anticipated by the bath; if a paroxysm recurs, the bowels should be moved by a clyster; having settled down after the clyster, the patient should be anointed and rubbed vigorously; then take food and wine as above; on the next two days abstain, and undergo rubbing. On the tenth day trial is again made of the bath; and if after that a paroxysm follows, he should in the same way be rubbed, and drink wine more freely. And it is likely that so many days of fasting, along with the other measures prescribed, will get rid of the fever. But if the quartan fever persists notwithstanding, a totally different line of treatment is to be pursued, the aim being that the body may easily bear what has to be borne for a long while. Therefore we cannot approve the practice of Heraclides of Tarentum, who said that in the first days the bowel was to be clystered and then there was to be abstinence until the seventh day. Even supposing a man could endure this, yet if he does become freed from fever, he will have scarcely strength enough to recover; they themselves if there be more frequent recurrences of the fever he will sink. If, therefore, the disease shall remain on the thirteenth day, the bath should not be tried, either before or after the paroxysm, except occasionally when the shivering has been thrown off. The actual shivering is to be driven off by the measures above prescribed; then after the paroxysm it will be proper that the patient be anointed, and rubbed vigorously, and take food both nourishing and abundant, with as much wine as he likes; on the day following, when sufficiently rested, he is to walk, to take exercise, to be anointed and vigorously rubbed, then to take food without wine, and on the third day to abstain. On the day that a recurrence of the paroxysm is expected, he should get up beforehand, and so arrange the performance of the exercises that the time for the onset of the fever concurs with that of the exercise; for often in this way the paroxysm is thrown off. But if attacked during the exercise, he should thereupon return home to bed. In this kind of sickness the remedies are: anointing, rubbing, exercise, food, wine. If constipated, the bowels are to be clystered. But whilst the stronger patients can easily carry out the above, if weakness has supervened, rocking should replace exercise; if even that cannot be borne, nevertheless rubbing should be applied. If this also, when vigorous, is trying to the patient, treatment should be restricted to rest and anointing and food; care being taken that indigestion does not convert the quartan into a quotidian fever. For a quartan kills no one, but when a quotidian is made out of it, the patient is in a bad way; this, however, does not happen unless through the fault either of the patient or of the practitioner.
15. Eadem in quartana facienda sunt. Sed cum haec tarde admodum finiatur nisi primis diebus discussa est, diligentius ab initio praecipiendum est, quid in ea fieri debeat. Igitur si cui cum horrore febris accessit eaque desiit, eodem die et postero tertioque continere se debebit, et aquam tantummodo calidam primo die post febrem sumere; biduo proximo, quantum fieri potest, ne hanc quidem: si quarto die cum horrore febris reuertitur, uomere, sicut ante praeceptum est; deinde post febrem modicum cibum sumere, uini quadrantem. Postero tertioque die abstineri, aqua tantummodo calida, si sitiet, adsumpta. Septimo die balineo frigus praeuenire; si febris redierit, ducere aluum; ubi ex eo corpus conquieuerit, in unctione uehementer perfricari; eodem modo sumere cibum et uinum; biduo proximo se abstinere, frictione seruata. Decimo die rursus balneum experiri; et si postea febris accessit, aeque perfricari, uinum copiosius bibere. Ac proximum est, tot dierum ut abstinentia cum ceteris, quae praecipiuntur, febrem tollant. Si uero nihilo minus remanet, aliud ex toto sequendum est curationis genus, idque agendum, ut id, quod diu sustinendum est, corpus facile sustineat. Quo minus etiam probari curatio Heraclidis Tarentini debet, qui primis diebus ducendam aluum, deinde abstinendum in septimum diem dixit. Quod ut sustinere aliquis possit, tamen etiam febre liberatus uix refectioni ualebit: adeo, si febris saepius accesserit, concidet. Igitur, si tertio decimo die morbus manebit, balineum neque ante febrem neque postea temptandum erit, nisi interdum iam horrore discusso. Horror ipse per ea, quae supra scripta sunt, expugnandus; deinde post febrem oportebit ungui et uehementer perfricari, cibum et ualidum et fortiter adsumere, uino uti quantum libebit; postero die, cum satis quieuerit, ambulare, exerceri, ungui, perfricari fortiter, cibum capere sine uino, tertio die abstinere. Quo die uero febrem expectabit, ante surgere, exerceri dareque operam, ut in ipsa exercitatione febris tempus incurrat: sic enim saepe illa discutitur. At si in opere occupauit, tum demum se recipere. In eiusmodi ualetudine medicamenta sunt oleum, frictio, exercitatio, cibus, uinum. Si uenter adstrictus est, soluendus est. Sed haec facile ualidiores faciunt: si inbecillitas occupauit, pro exercitatione gestatio est; si ne hanc quidem sustinet, adhibenda tamen frictio est. Si haec quoque [uehemens] onerat, intra quietem et unctionem et cibum sistendum est; dandaque opera est, ne qua cruditas in cotidianam id malum uertat. Nam quartana neminem iugulat: sed si ex ea cotidiana facta est, in malis aeger est; quod tamen nisi culpa uel aegri uel curantis numquam fit.
16. 16 But if there is a double quartan fever, and those exercises which I have mentioned cannot be adopted, either the patient should rest entirely, or if that is difficult walk quietly, then sit with his feet and head carefully wrapped up; as often as a paroxysm has recurred and has remitted, he should take food in moderation and wine; for the remainder of the remission, unless there is urgent weakness, he should fast. But if two paroxysms are almost continuous, he should take food after both are over; then in the intermission he should move about a little, and after being anointed take food. Now since an inveterate quartan is seldom got rid of except in the spring, it is at that season especially that attention is to be given, lest something occur to hinder recovery. And it is of advantage in an old quartan to later now and then the class of diet, and change from wine to water, from bland food to acrid, from acrid to bland; to eat radish, then to vomit; to move the bowels by shell-fish or chicken broth; to add heating agents to the oil for rubbing; before the paroxysm to sip two cups of vinegar, or one cup of mustard in three of Greek salted wine, or pepper, castoreum, laser and myrrh in equal proportions in water. For by these and such-like remedies the system is to be stirred up in order that it may be moved from the state in which it is being held. When the fever has quieted down, for a long while it is well to keep in mind the day on which it occurred, and on that day to avoid cold, heat, indigestion, fatigue: for fever readily recurs unless even a convalescent patient fears that day for some time to come.
16. At si duae quartanae sunt, neque eae, quas proposui, exercitationes adhiberi possunt, aut ex toto quiescere opus est, aut, si id difficile est, leuiter ambulare, considere diligenter inuolutis pedibus et capite; quotiens febris accessit et desiit, cibum modicum sumere et uinum, reliquo tempore, nisi inbecillitas urguet, abstinere. ⟨A⟩t si duae febres paene iunguntur, post utramque cibum sumere, deinde uacuo tempore et moueri aliquid et post unctionem cibo uti. Cum uero uetus quartana raro nisi uere soluatur, utique eo tempore attendendum est, ne quid fiat, quod ualetudinem impediat. Prodestque in uetere quartana subinde mutare uictus genus, a uino ad aquam, ab aqua ad uinum, a lenibus cibis ad acres, ab acribus ad lenes transire; esse radicem, deinde uomere; iure uel * * pulli gallinacei uentrem resoluere; oleo ad frictiones adicere calfacientia; ante accessionem sorbere uel aceti cyathos duos, uel unum sinapis cum tribus Graeci uini [salsi], uel mixta paribus portionibus et in aqua diluta piper, castoreum, laser, murram. Per haec enim similiaque corpus agitandum est, ut moueatur ex eo statu, quo detinetur. Si febris quieuit, diu meminisse eius diei conuenit, eoque uitare frigus, calorem, cruditatem, lassitudinem: facile enim reuertitur, nisi a sano quoque aliquamdiu timetur.