BOOK III.

CHAP. I. GENERAL DIVISION OF DISTEMPERS.

Having already considered all that relates to distempers in general, I come to treat of the cure of each distinctly. Now the Greeks divided them into two kinds, the one they called acute, the other chronic. And because their process was not always the same, for this reason some ranged the same distempers among the acute, which others reckoned in the number of the chronic. From whence it is plain, that there are more kinds of them. For some are short and acute, which either carry off a person quickly, or are themselves soon terminated. Others are of long continuance, from which there is neither a speedy recovery, nor speedy death. And the third kind are those, which are sometimes acute, and sometimes chronic; and this happens not only in fevers, where it is most frequent; but also in other diseases. And besides these, there is a fourth kind; which can neither be called acute, because they are not mortal; nor yet chronic, because if remedies are used, they are easily cured. When I come to treat of each, I shall point out to what kind they belong.

Now I shall divide all of them into those, that seem to affect the whole body, and those, which occur in particular parts. After a few general observations upon them all, I shall begin with the first. Though there is no distemper in which fortune can pretend to more power than art, or art than nature; since medicine can do nothing in opposition to nature: yet a physician is more excusable for want of success in acute, than in chronic disorders. For in the first, there is but a small space, within which, if the remedies do not succeed, the patient dies: in the other case, there is time both for deliberation, and a change of medicines; so that very seldom, where a physician is called at its beginning, an obedient patient is lost without his fault. Nevertheless, a chronic distemper, when it is firmly rooted, becomes equally difficult with an acute one. And indeed the older an acute distemper is, so much the more easily it is cured; but a chronic one, the more recent it is.

There is another thing we ought not to be ignorant of; that the same remedies don’t agree with all patients. Whence it happens, that the greatest authors extol some one remedy, some another, each recommending his own as the only one, according as they had succeeded with themselves. It is fit therefore, when any thing does not answer, not to pay so much regard to the author of it, as to the patient, and to make trial of one thing after another. Remembering however, that in acute distempers, what does not relieve, must be quickly changed: in the chronic, which time both causes, and removes, whatever has not immediately done service, is not to be hastily condemned; much less must that be discontinued, which does but give a small relief, because its good effects are completed by time.

CHAP. II. GENERAL DIAGNOSTICS OF ACUTE AND CHRONIC, INCREASING AND DECLINING DISEASES; THE DIFFERENCE OF REGIMEN IN EACH; AND PRECAUTIONS NECESSARY UPON THE APPREHENSION OF AN APPROACHING ILLNESS.

It is easy to know in the beginning, whether a distemper be acute, or chronic: not in those only, that are always the same; but in those also, that vary. For when the paroxysms and violent pains without intermissions distress, the disease is acute. When the pains are gentle, or the fever slow, and there are considerable intervals betwixt the fits, and those symptoms accede, which have been explained in the preceding book, it is plain, that the distemper will be of long continuance.

It is necessary also to observe, whether the distemper increases, or is at a stand, or abates: because some remedies are proper for disorders increasing, more for those, that are upon the decline. And those, which are suitable to increasing disorders, when an acute distemper is gaining ground, ought rather to be tried in the remissions. Now a distemper increases, while the pains and paroxysms grow more severe; when the paroxysms return after a shorter interval, and last longer than the preceding did. And even in chronic disorders, that have not such marks, we may know them to be increasing, if sleep is uncertain, if concoction grows worse, if the intestinal excretion is more fetid, if the senses are more heavy, the understanding more slow, if cold or heat runs over the body, if the skin grows more pale. But the contrary symptoms to these are marks of its decrease.

Besides in acute distempers, the patient must not be allowed nourishment so soon, not till they be upon the decline; that fasting by a diminution of matter may break its violence; in chronic disorders, sooner, that he may be able to endure the continuance of the disease. But if the distemper happens not to be in the whole body, but only in a particular part, yet it is more necessary to support the strength of the whole body, than of the part; since by means of that strength the diseased parts may be cured. It also makes a great difference, whether a person has been properly or wrong treated from the beginning: because a method of cure is less successful, where it has been often applied unsuccessfully. If one has been injudiciously treated, but still possesses his natural strength, he is quickly restored by a proper management.

But since I began with those symptoms, which afford marks of an approaching illness, I shall commence the methods of cure from the same period. Wherefore if any of those things(1), which have been mentioned, happen, rest and abstinence are best of all: if any thing is drunk, it should be water; and sometimes it is sufficient to do that for one day; sometimes for two days, if the alarming symptoms continue; and immediately after fasting, very little food must be taken, water must be drunk; the day after, wine; then every other day by turns water and wine, till all cause of fear be removed. For by these means often a dangerous distemper impending is averted. And a great many are deceived, while they hope upon the first day immediately to remove a langour either by exercise, or bathing, or a gentle purge, or vomiting, or sweating, or drinking wine. Not but this may sometimes happen, or answer their expectations, but that it more frequently fails; and abstinence alone may cure without any danger. Especially as that may be regulated according to the degree of one’s apprehensions: and if the symptoms are slight, it is sufficient only to abstain from wine; a diminution of which assists more than lessening the quantity of food: if they are somewhat more dangerous, it may serve the turn not only to drink water (as in the first case), but to forbear flesh too: and sometimes to take less bread than ordinary, and confine one’s self to moist food, especially greens. And it may be sufficient then only to abstain entirely from food, wine and all motion, when violent symptoms give the alarm. And without doubt scarce any body will fall into a distemper, who does not neglect it, but takes care by these means to oppose its beginning in due time.

CHAP. III. OF THE SEVERAL KINDS OF FEVERS.

These are the rules to be observed by such as are in health, that are only apprehensive of the cause. We next proceed to the cure of fevers, which is a kind of disease, that affects the whole body, and is the most common of all. Of these one is a quotidian, another a tertian, and a third a quartan. Sometimes some fevers also return after a longer period, but that seldom occurs. With regard to the former, they are both diseases in themselves, and a cure for others.

But quartan fevers are more simple. They begin commonly with a shuddering; then a heat breaks out; after the paroxysm is over, the patient is well for two days. So that it returns upon the fourth day.

Of tertians again there are two kinds. One of them both beginning and ending like the quartan; with this difference only, that there is one day’s intermission, and it returns upon the third. The other kind is much more fatal, which indeed returns upon the third day, but of forty-eight hours, thirty-six are occupied by the fit (and sometimes either less or more,) nor does it entirely cease in the remission; but is only mitigated. This kind most physicians call semitertian[ BB ].

But quotidians are various, and different in their appearances. For some of them begin with a heat, others with a coldness, others with a shuddering. I call that a coldness, when the extremities of the limbs are chilled; a shuddering, when the whole body trembles. Again, some end, so as to be followed by an interval quite free from indisposition; others so, as that though the fever somewhat abates, yet some relicks remain, till another paroxysm comes on; and others often remit little or nothing, but continue as they began. Some again are attended with a very vehement heat, others more tolerable; some are equal every day, others unequal, and alternately milder one day and more severe another: some return at the same time the following day, others either later or sooner: some by the fit and the intermission take up a day and a night, some less, others more: some, when they go off, cause a sweat, others do not; and in some a sweat leaves the patient well, in others it only renders the body weaker: sometimes also one fit comes on each day, sometimes two or more. Whence it frequently happens, that every day there are several both paroxysms and remissions; yet so as that each of them answers to some preceding one. Sometimes too the fits are so irregular, that neither their durations nor intermissions can be observed. Nor is it true, which is alledged by some, that no fever is irregular, unless it arise from a vomica, or an inflammation, or an ulcer. For the cure would always be easier, if this were fact. For what is occasioned by the evident causes, may also proceed from the occult. Nor do those dispute about things, but words, who alledge, that when feverish paroxysms come on in different manners in the same distemper, these are not irregular returns of the fever, but new and different fevers successively arising. Which however would have no relation to the method of cure, though it were true. The intervals also are sometimes pretty long, at other times scarce perceptible.

CHAP. IV. OF THE DIFFERENT METHODS OF CURE.

This then is the general nature of fevers. But the methods of cure differ, according to their different authors. Asclepiades says, that it is the duty of a physician to effect the cure safely, speedily, and with ease to the patient. This is to be desired: but generally too great haste and too great indulgence both prove dangerous. What moderation must be used in order to obtain all these ends as far as possible, the principal regard being always had to the safety of the patient, will come into consideration, when we treat of the particulars of the cure.

And the first inquiry is, how the patient is to be treated in the beginning of the distemper. The ancients by the use of some medicines endeavoured to promote concoction; for this reason, that they were extremely afraid of crudity: next they discharged by frequent clysters that matter, which seemed to hurt. Asclepiades laying aside the use of medicines, ordered clysters not so frequently as they, but in almost every distemper. And he professed his principal cure for a fever was the disease itself. He thought also, that the strength of the patient was to be worn out by light, watching, and great thirst: insomuch that he would not even allow the mouth to be washed in the first days. So much are those mistaken, who imagine the whole of his regimen to be agreeable. For indeed in the advance of the distemper he even administered to the luxury of the patient; but at the beginning he acted the part of a tormentor.

Now I grant that medicinal potions and clysters, ought to be used but sparingly. And yet I do not think these are to be administered with a view to destroy the patient’s strength: because the greatest danger arises from weakness. Wherefore it is proper only to diminish the redundant matter; which is naturally dissipated, when there is no new accession to it. For this reason the patient must abstain from food in the beginning, and in the day-time be kept in the light, unless he be weak, because even that contributes to the discharge. And he ought to lye in a very large room.

As to thirst and sleep, the best mean is, that he be awake in the day-time, and rest in the night, if possible; and neither drink plentifully, nor be too much tormented with thirst. His mouth also may be washed, when it is both dry, and has a fetid taste; although such time is not seasonable for drinking. And Erasistratus very justly observed, that often the mouth and fauces require moisture, when there is no want of it in the internal parts; and that it is of no consequence, that the patient is uneasy. Such then ought to be the treatment at first.

Now the best medicine is food seasonably administered: when that must be given first, is a question. Most of the ancients were slow in giving it; often on the fifth or sixth day: and that perhaps the nature of the climate in Asia or in Egypt admits of. Asclepiades, after he had for three days fatigued the patient in every way, appointed the fourth for food. But Themison of late considered, not when the fever had begun, but when it had gone off, or at least was abated; and waiting for the third day from that time, if the fever had not returned, he gave food immediately; if it did come on, when it had ceased; or if it continued constantly, when at least it was mitigated.

Now none of these rules is always to be followed. For it may be proper to give food on the first day, it may on the second, it may on the third, it may not before the fourth or fifth; it may after one fit, it may after two, it may after several. For the qualities of the distemper, constitution, air, age, and season of the year make some difference. And no time can be universally fixed in things so widely different from each other. In a distemper that weakens more, food must be sooner allowed; also in an air that is more dissipating. Upon this account in Africa for no day it seems proper to prescribe fasting. It should be given also sooner to a boy, than a young man; more quickly in summer, than winter. This one thing must be practised always and every where, that a physician sitting by should now and then observe the strength of the patient, and as long as that continues, encounter the disease by abstinence; if he begins to apprehend weakness, support him by food. For it is his business to be careful neither to load the patient by superfluous matter, nor when he is weaker, to kill him by fasting. And this I find in Erasistratus, who though he did not direct, when the belly, when the body itself was to be evacuated, yet by saying that these were to be regarded, and that food was to be given, when the body stood in need of it, has plainly enough shewn, that it ought not to be given, while there w as a sufficient quantity of strength, and that care should be taken, that it was not too much exhausted.

From these things it may be inferred, that many people cannot be attended by one physician; and that the man to be trusted is he, that knows his profession, and is not much absent from the patient. But they, that practise only from views of gain, because their profits arise in proportion to the number of patients, readily fall in with such rules, as do not require close attendance; as in this very case. For it is easy even for such, as seldom see the patient, to count the days and the fits: but it is necessary for him to sit by his patient, who would form a true judgment what is alone fit to be done; when he will be too weak unless he get food. In most people however the fourth day is usually the most proper for beginning to give food.

But there is still another doubt about the days themselves, because the ancients chiefly regarded the odd days, and called them critical[ BC ], as if on these a judgment was to be formed concerning the patients. These days were the third, fifth, seventh, ninth, eleventh, fourteenth, and twenty-first; so that the greatest influence was attributed to the seventh, next to the fourteenth, and then to the twenty-first. And therefore with regard to the nourishment of the sick, they waited for the fits of the odd days: then afterwards they gave food, expecting the approaching fits to be easier; insomuch that Hippocrates, if the fever had ceased on any other day, used to be apprehensive of a relapse.

This Asclepiades justly rejected as idle, and said that no day was more or less dangerous to the patients, by its being either even or odd. For sometimes the even days are worse; and food is given more properly after the paroxysm of the fevers: sometimes also in the same distemper the quality of the days is changed: and that becomes more severe, which had used to be more mild: and the fourteenth day itself is even, upon which the ancients laid a great stress. And when they maintained, that the eighth was of the same nature with the first, because the second number of seven began from it, they were inconsistent with themselves in not taking the eighth, or tenth, or twelfth day, as the more important: for they attributed more to the ninth and eleventh. When they had done this without any plausible reason, they passed on from the eleventh, not to the thirteenth, but to the fourteenth. It is a remark of Hippocrates too, that the fourth day is worst to him, that is to be relieved on the seventh. So that even by his own account, upon an even day both the fever may be more violent, and a sure indication given of what is to follow. And the same author elsewhere takes every fourth day to have the strongest influence with regard to both events; that is the fourth, seventh, eleventh, fourteenth, seventeenth: in which he passes from the odd to the even reckoning. Neither in this indeed has he kept to his point: since the eleventh is not the fourth, but the fifth day after the seventh. Whence it appears, in whatever light we consider the number, no true reasoning can be found in his doctrine. But with regard to these the ancients were misled by the Pythagoric numbers at that time in great vogue: whereas here as well as in other cases a physician ought not to count the days, but to consider the paroxysms themselves; and upon them to found his conjecture when food is to be given.

But this is of more importance, to know whether the proper time for giving food be, when the tumultuous motion of the vessels has pretty much subsided, or while some relicks of the fever still remain. For the ancients prescribed nourishment, when the body was in the soundest state: Asclepiades, upon the decline of the fit, but before it was over; his reason for which was weak; not but that food is to be given sometimes more quickly, if another paroxysm is apprehended soon; but because certainly it ought not to be given, but when the body is in its best condition: for what is received by a body free from disorder is less liable to corruption. Neither is it true, which Themison imagined, if a patient was to be well for two hours, that it would be better to give it then, that it might be digested(2), while the body was in health. Indeed if it could be so speedily digested, that would be best. But as so short a time is not sufficient, it is better that the beginning of food should be upon the end of one paroxysm, than that any of it should lie in the stomach, when another begins. Thus if a pretty long interval is to follow, it is to be given, when the person is freest of all indisposition; if but a short one, before the patient be quite well. What has been said of the sound state during an intermission, holds likewise with respect to the greatest remission we find in a continued fever. But it is also a question, whether it is necessary to wait so many hours, as use to be taken up by the fit; or whether it is sufficient to pass over the first part of them, that those patients may be more easy, who sometimes have not a perfect intermission. But it is most safe to suffer the whole time of the fit to be over first: although when the paroxysm has been long, the patient may be indulged sooner; nevertheless so that at least the one half be suffered to elapse first. And this is not only to be observed in the kind last mentioned, but in all fevers.

CHAP. V. PARTICULAR DIRECTIONS FOR THE GIVING OF FOOD IN THE DIFFERENT SPECIES OF FEVERS.

These observations are of a more general nature belonging to all kinds of fevers: I shall now descend to the particular species of them. Wherefore if there has been only one fit, which has gone off, and that arose either from the inguen(3), or from fatigue, or from heat, or from some such accident, so that there is no reason to apprehend danger from any internal cause, the following day, when the time of the fit has passed without any disorder, food may be given. But if the heat come from within; and a heaviness of the head or præcordia has followed; and there is no apparent cause for the disturbance of the body; although health has followed one fit, yet because a tertian may be apprehended, the third day is to be expected; and when the time for the fit is over, food is to be given, but very little of it; because a quartan may also be feared. But upon the fourth day, if the body is well, it may be freely used. If indeed the paroxysm has followed upon the second, third, or fourth day, then we may conclude it to be a disease. But the method of cure in tertians and quartans (whose periods are certain, whose fits leave no indisposition, and the intervals are in a good measure calm) is easier: of which I shall speak in their proper place.

At present I shall treat of those, which distress every day. Wherefore it is most convenient to give food to the patient every third day; that the abstinence of one day may lessen the fever, on the other nourishment may recruit the strength. But when the fever is quotidian, and goes entirely off, it ought to be given as soon as the body becomes well. But if though there are not distinct fits immediately succeeding each other, yet there are feverish heats without intermission, and these daily increase without going entirely off, then it is to be allowed at that point of time, when a greater remission is not to be expected: if on one day the fit is more severe, and on another milder, after the most severe. Now commonly a more severe fit is followed by an easier night: whence it happens also, that a more troublesome night precedes a severer fit.

But if the fever is continued, and is never mitigated, and there is a necessity for giving food, the proper time for doing this is much disputed. Some, because patients are commonly easier in the morning, think that the opportunity. Which if it be so, is a proper time, not because it is the morning, but because the patients then have a remission. If even at that time the patient has no ease, since upon this very account that time is worse, that whereas from its own nature it ought to be better, from the force of the distemper it is not so; and likewise because the middle of the day follows, after which as almost every patient grows worse, there is room to fear, lest he be then more distressed, than he used to be: therefore, some give food to such a patient in the evening. But since at that time sick people are commonly worst, there is cause to be afraid, lest if we raise any commotion then, the disorder may be increased. For these reasons others defer it(4) till midnight, when the severest is just over, and while the same is at the greatest distance. It is more safely given before day-light, when most sick people get the quietest sleep; next to that in the morning, the time which is naturally the easiest of all.

But if the fits are irregular, because in such a case there is room to fear, that they may follow immediately after food; whenever a patient is relieved from the paroxysms he ought to eat. But if several paroxysms come on the same day, it is necessary to consider, whether these be in all respects equal (which can scarcely happen) or unequal. If they be in every point equal, food ought rather to be given after that fit, the end of which does not fall betwixt mid-day and the evening. If they are unequal, it must be considered what the difference is. For if one is more severe, and the other more mild, it ought to be given after the more severe fit: if the one is longer, and the other shorter, after the longer: if one is more severe, and the other of longer continuance, it must be examined, which of the two distresses most, the one by its violence, or the other by its continuance; and it must be given after the most weakening. But it is plainly the most important point of all, how great the remissions are, and of what nature, which happen between the fits. For if an uneasiness remains after one paroxysm, and the body feels no indisposition after the other; when the body is well, it is the fitter time for food.

If a feverishness always continues, but yet one remission is longer than the other, that is rather to be chosen: so that when the fits are continued, food may be administered immediately upon the decline of the first. For this is an universal rule, and may serve for directing all our measures in this article, to give food at the greatest distance always from a future fit; and with this caution to give it in the best state of the body. Which must be observed not only between two fits, but also amongst several. But whereas it is most generally proper to give food every third day, yet if the body is weak it must be given every day: and much more so, if the fevers are continued without any remission: and it is the more needful, the more they weaken the body; or if two or more fits attack on the same day. Which occurrence also requires the giving of food every day immediately from the first, if the pulse has presently sunk; and oftener on the same day, if in the midst of several fits the strength of the body now and then fails. Yet in these this observation must be regarded; that after such fits less food be given, where if the strength of the body would admit, none would be given at all. Now as a paroxysm must either be instantly expected, or beginning, or increasing, or at its height, or abating; and again in its abatement either at a stand, or entirely gone off; it is certain the best season for food is, when the fever is ended; next to that, when in its abatement it stops; thirdly, if there be a necessity, whenever it begins to abate: all other times are dangerous. But if upon account of weakness there is an absolute necessity for it, it is better to give somewhat, when its increase is at a stand, than while it still increases; better when it is instantly expected, than when it is beginning. Nevertheless no time is improper for supporting one, who faints for want.

Nor indeed is it sufficient for a physician to regard only the fevers, but also the state of the whole body, and direct his cure by that; whether the patient has a sufficient measure of strength or not, whether some troublesome passions affect the mind. And as the sick should always be in a state of tranquillity, that they be distressed in body only, and not in mind at the same time; so it is more especially necessary immediately after food; so that if there be any thing, which would render them uneasy, it is the best way, while they are sick, to conceal it from them; if that cannot be done, at least to forbear after food; and after their time of sleep, and when they have awaked, then to communicate it.

CHAP. VI. THE PROPER TIMES FOR GIVING DRINK TO PERSONS IN FEVERS, AND THE KINDS OF ALIMENT SUITED TO THE SEVERAL STAGES OF THE DISTEMPER, TOGETHER WITH SOME GENERAL OBSERVATIONS.

But patients are more easily managed with regard to food; because in spite of some inclination of their own, the stomach then refuses it. But in the article of drink the struggle is hard; and the more violent, the higher the fever is: for this inflames the thirst, and demands water most importunately, when it is most dangerous. But the patient is to be informed, that when the fever has abated, the thirst also will immediately decline; and that the paroxysm will be longer, if any nourishment be given to him: and that he that drinks none, is sooner freed from the thirst. However as even people in health can bear hunger a good deal easier than thirst, it is necessary to indulge the sick more with regard to drink than food. But on the first day no moisture ought to be given, unless the pulse has suddenly sunk so low, that there is a necessity for giving food also; but on the second and following days likewise, where food is not to be allowed, yet if the thirst be violent, drink may be given.

What was said by Heraclides of Tarentum is not altogether without reason; that when either bile or crudity make a patient uneasy; it is expedient by a moderate quantity of a drink to mix new matter with the corrupted. This rule ought carefully to be observed, that the same times be chosen for drink as for food: when it is to be given without the other, let it be at a time, when we would desire the patient to sleep, which commonly thirst prevents. It is generally allowed, that as too much moisture is hurtful to every person in a fever, it is especially so to such women, as have fallen into fevers after child-bearing.

But as the fever and the manner of its remission direct to the proper seasons for food and drink, so it is not very easy to know, when the patient has a fever upon him, when he is better, or when his strength fails; without which these cannot be properly administered. For we principally trust the pulse, a most fallacious mark; because this is often slower or more quick from the age, and sex, and difference of constitutions. And generally when the body is in good enough health, if the stomach be weak, sometimes also in the beginning of a fever, it rises and sinks; so that the person may seem to be weak, when he can very well stand a severe fit that is just approaching. On the other hand, the pulse is often raised, and the vessels relaxed by the influence of the sun, and the bath, and exercise, and fear, and anger, and any other passion of the mind. So that, when a physician first comes in, the anxiety of the patient, doubtful how he may think him, accelerates the pulse. For this reason it is the business of a skilful physician not to take hold of the patient’s arm with his hand, as soon as he comes in; but first to sit down with a cheerful countenance, and ask him how he does; and if he has any apprehension, to encourage him with plausible discourse: then to apply his hand to his wrist(5). Now if the sight of the physician quickens the pulse, how easily may a thousand other accidents disorder it! Another mark, to which we trust, is heat, equally deceitful; for this is excited by warmth, labour, sleep, fear, and anxiety.

Wherefore it is fit to consider those things; but not to trust entirely to them. And we may at once assure ourselves that a person has no fever, whose pulse moves regularly, and who has such a heat as is common to people in health; and that a fever is not necessarily breeding, when there is heat and motion; but only with these circumstances, if the surface of the skin, be unequally dry; if there be a heat in the forehead, and at the same time arising from the internal part of the præcordia; if the breath rushes out of the nostrils very hot; if the colour be changed either for a redness or an unusual paleness; if the eyes are heavy, and either very dry or somewhat moist; if when a sweat comes on, it is partial; if the pulse does not beat at equal intervals. Upon this account the physician ought to sit down neither in the dark, nor at the patient’s head, but in a light place opposite to him, that he may take all the marks from the countenance of the patient as he lies.

Now where there has been a fever, and it has decreased, it is, proper to take notice, whether the temples or other parts of the body grow a little moist, so as to portend an approaching sweat. And if there is any prognostic of it, upon that to give warm water to drink, the effect of which is salutary, if it diffuse a sweat over the whole body. For this purpose the patient ought to keep his hands under a good quantity of clothes; and to cover his legs and feet in the same manner. By laying on such a load many people mismanage patients in the very height of the fever, and especially where it is of the ardent kind. If the body begins to sweat, it is necessary to warm a linen cloth, and slowly to wipe every part. But when the sweat is entirely off, or if it have not come on, when the patient is warmest, and seems fit for food, he is to be gently anointed under the clothes, then wiped, and after that food is to be given him.

Liquid food is most proper for persons in fevers, at least as near as possible to liquids, and that of the lightest kind, particularly gruel; and even this, if the fever be violent, ought to be very thin. Clarified honey also is properly added to it, that the body may be more nourished: but if that offends the stomach, it should be omitted; and so should the gruel itself in like case. Instead of it may be given either intrita,(6) mixed with hot water, or washed alica; if the stomach is firm, and the belly bound, with hydromel; or if the first is weak, and the other loose, with vinegar and water. And this kind of food is sufficient for the first day: but on the second day something may be added, yet of the same nature, either greens, or conchylia, or apples. And while fevers are increasing, this is the only proper food. But when they either go off, or abate, we must always begin with something of the lightest nature, and make an addition of the middle kind, having in the mean time a regard both to the strength of the patient, and of the disease.

To set a variety of food before a patient (as Asclepiades directs) is never proper, but when he is oppressed with a nausea, and his strength fails; that by tasting a little of each he may escape being famished. But if the patient wants neither strength nor appetite, he must be tempted by no variety; lest he take more than he is able to concoct. Neither is that true, which he alleges, that food of various kinds is more easily concocted; it is indeed taken in more easily; but to concoction the genus and quantity of the food are material. Neither is it safe during great pains, nor in an encreasing distemper, for a patient to fill himself with food; but when there is already a turn towards recovery.

There are also other observations necessary to be made in fevers: and that indeed must be considered, which some regard solely, whether the body be bound or loose: the one of which suffocates, and the other dissipates. For if it is bound, the belly must be opened by clysters, urine promoted, and a sweat sollicited by every method. In this kind of disorder it is serviceable even to let blood, to agitate the body by strong gestations, to keep the person in the light, to enjoin fasting, thirst, and watchfulness. It does good also to take the person into the bath, first to plunge him into the warm bath, then anoint him. Then he should return to the warm bath, and foment his groin plentifully with water; sometimes mix oil in the bath with warm water; take food more seldom, and at greater distances than ordinary, and such as is slight, simple, soft, warm, and small in quantity; especially greens, such as dock, nettles, mallows, or the broth of shell-fish, or muscles, or locustae; and eat no flesh, but what is boiled. But the quantity of drink ought to be more liberal, both before meat, and after it, and while eating too, beyond what thirst will require. And after the bath may be given even fat broth, or wine of the sweeter kind: during which course once or twice salt Greek wine may be used.

But on the contrary, if the body incline to discharge excessively, then sweat must be restrained, and rest enjoined; and the patient may have his room darkened, and go to sleep, whenever he shall chuse it; the body is not to be agitated, unless by a gentle gestation, and to be relieved according to the nature of its disorder. For if the belly is loose, or the stomach does not retain, when the fever has abated, it is proper to give warm water to drink plentifully, and make him vomit; unless there is a pain either in the fauces, or praecordia, or side, or the distemper be inveterate.

If again a sweat prevails, the skin must be hardened, either by nitre or salt, mixed with oil. But if that disorder is more slight, the body must be anointed with pure oil: if more violent, with oil of roses, or of quinces, or of myrtles, with an addition of austere wine.

Whoever is disordered by any discharge, upon coming to the bath, must first be anointed, and then go in. If the disorder is in the skin, it will be better for him to use cold water than warm. As to his meals, his food should be substantial, cold, dry, simple, and the least liable to corruption, toasted bread, roasted flesh, austere wine, or at least inclining to austerity; and if the belly is loose, let him drink it hot; if sweating be the disorder, or vomiting, it must be cold.

CHAP. VII. OF THE CURE OF PESTILENTIAL AND ARDENT FEVERS.

The case of pestilential fevers demands attention and a peculiar treatment. In this it is by no means good to try fasting, or medicines, or clysters. If the strength will admit, it is best to let blood; especially if the fever be attended with a burning heat. If that is not safe, when the fever is either abated, or less violent, to cleanse the breast by a vomit. But there is a necessity to order the bath sooner in this than in other distempers; to give wine strong and hot, and every thing glutinous; amongst which flesh of the same kind. For the more quickly that such constitutions of the air destroy, so much the sooner must remedies be laid hold of, even with a degree of rashness. But if he be a boy, that labours under it, and have not sufficient strength for bleeding, he must be cupped, and have a clyster either of water, or the cream of ptisan; then lastly he is to be nourished by light food. It is a general rule, that boys ought to be treated altogether in a different method from men. Wherefore in this, as well as in every other kind of distemper, greater caution must be used at that age in the following articles: not to bleed, not to give a clyster without necessity, nor to torment by watching, or fasting, or excessive thirst, nor to attempt the cure by wine. The patient must vomit after the fever: then the lightest kind of food is to be given; after that he is to sleep: the day following, if the fever continue, he must fast; on the third day return to the same diet. And we must endeavour, as much as possible in the midst of a seasonable abstinence to nourish him by food at proper times, laying aside every thing else.

Of an Ardent fever.

If an ardent fever is very violent, no medicinal potion is to be given; but during the paroxysms the patient must be cooled by water and oil: which are to be agitated together, till they grow white. He is also to be kept in a spacious room, where he can draw a great deal of pure air; and not be suffocated by many cloaths, but be covered very lightly. Vine leaves also dipped in cold water may be put upon his stomach. And he is not to be tormented with excessive thirst. He is to be allowed nourishment sooner; that is after the third day: and before meat he must be anointed all over with the above-mentioned liquor. If there is a collection of phlegm in his stomach, upon the decline of the paroxysm he must be forced to vomit; and then he must eat cold greens, or fruit of the apple kind, such as agrees with the stomach. If the stomach remains dry, there must be immediately given the cream either of ptisan, or alica, or rice, boiled with recent fat. When the distemper is at the height, but not before the fourth day, after a great thirst preceding, cold water is to be given copiously, that he may drink even beyond satiety; and when the belly and praecordia are filled above measure, and sufficiently cooled, he ought to vomit. Some indeed do not insist upon vomiting; but make use of cold water as a medicine, given only to satiety. After either of these methods he is to be well covered with cloaths, and laid so as to go to sleep. And commonly after long thirst and wakefulness, after being satiated with full draughts, after a remission of the heat, a sound and long sleep comes on; by means of which a great sweat breaks out, and that is a most immediate relief; but only in those, who have the burning heat, but no pains, nor tumour of the praecordia, and nothing to prevent it in the lungs, or fauces; or have had no ulcer, nor faintings, nor looseness of the belly. But if one in such a fever as this coughs gently(7), he ought neither to struggle with a violent thirst, nor drink cold water; but to be treated in the same manner, as is directed in other fevers.

CHAP. VIII. THE CURE OF A SEMITERTIAN.

But where there is that kind of tertian, which the physicians call semitertian, it requires careful observation to prevent being deceived. For it has generally more frequent paroxysms and intervals, so as it may seem a different kind of distemper; and the fit is protracted to twenty-four hours(8) and thirty-six: that what is really the same, does not seem to be so. And it is highly necessary both that food should not be given, unless in that remission, which is certain: and as soon as that comes, to give it immediately. And many patients die suddenly by the mistake of their doctor either way. And unless there is some important reason against it, blood ought to be let in the beginning; and then food should be given, such as will not raise the fever, and yet support under its long continuance.

CHAP. IX. THE CURE OF SLOW FEVERS.

Sometimes too we find slow fevers continuing without remission, and no room left either for food or any remedy. In this case it ought to be the care of the physician to change the distemper: for perhaps it may become more easy to cure. For this reason the body of the patient is often to be gently rubbed with cold water with oil infused, because sometimes it thus happens, that a shuddering arises, which may be some beginning of a new commotion; after that, when the body has grown hotter, a remission may follow too. In these cases friction with oil and salt seems to be a useful method.

But if coldness of the extremities, and numbness, and restless changes of postures continue long, it is not amiss, even during the fever, to give three or four cyathi of mulse, or well diluted wine together with food. For the fever is often encreased by it; and a greater heat arising at the same time both removes the former disorders, and affords hope of a remission, and from that of a cure.

And indeed the method of cure is not new, to make use of contrary medicines, by which at this time some recover patients committed to their charge, who were long under the care of more cautious physicians. For even amongst the ancients before Herophilus and Erasistratus, but after Hippocrates, was one Petron, who, as soon as he was called to a person in a fever, laid a great many cloaths upon him, that he might at once excite a great heat and thirst. After that, when the fever began to be a little abated, he gave cold water to drink; and if it once raised a sweat, he pronounced the patient to be out of danger: if it had not procured that discharge, he gave still more cold water, and then obliged him to vomit. If by either method he freed the person from the fever, he immediately gave him roast pork and wine. If it did not give way to these methods, he boiled water with salt, and obliged him to drink it, that by vomiting he might cleanse his belly(9).

And these particulars made up his whole practice. Which was not less acceptable to those, whom the successors of Hippocrates had not recovered, than it is to those in this age, who have been long unsuccessfully treated by the followers of Herophilus or Erasistratus. Nor is this kind of medicine upon this account not to be esteemed rash; because if it has been pursued from the beginning, it kills more, than it cures. But since the same things cannot agree with every body, those commonly, who are not restored by a rational method, are relieved by temerity; and for that reason physicians of that class manage another’s patients better than their own. But it is a practice not unbecoming even the man of circumspection, at times both to change a distemper, and to increase one, and to inflame fevers; because where the disorder, that is present, does not admit of a cure, another may, which is to succeed in its place.

CHAP. X. REMEDIES FOR THE CONCOMITANT SYMPTOMS OF FEVERS.

It is necessary also to consider, whether fevers are simple, or whether other disorders are not likewise concomitant; that is, whether the head be pained, the tongue rough, or the præcordia tense. If there be pains in the head, it is proper to mix oil of roses with vinegar, and to apply that(10); then to have two pieces of cloth, which are as broad and as long as the forehead; to have one of these alternately in the vinegar and rose-oil, and the other on the forehead; or to put on sordid wool dipped in the same. If vinegar is offensive, pure oil of roses must be used. If even the rose-oil is offensive, bitter oil. If these do little service, dry iris, or bitter almonds, or any of the cooling herbs may be powdered. Any of them mixed with vinegar and laid upon the part lessens the pain: but in some one of these is more successful, and in others another. Relief is also procured by bread laid on with poppies, or with oil of roses, cerus, or litharge. It is also not improper to smell at either serpyllum or dill.

But if there is an inflammation and pain in the præcordia, in the first place restringent cataplasms must be applied; and not the hotter kind, lest there should be a greater flux of matter thither. After that, as soon as the inflammation has abated, recourse must be had to hot and moist, in order to discuss what remains. Now the marks of inflammation are four, redness, and swelling, together with heat, and pain. So much was Erasistratus mistaken, when he declared there was no fever without it.

Wherefore if there is pain without inflammation, nothing is to be applied at all; for the fever itself will presently remove that. But if there is neither an inflammation, nor fever, but only a pain of the præcordia, warm and dry fomentations may be immediately used. If the tongue is dry and scabrous, it is first to be wiped with a penecillum dipped in hot water; and then anointed with a mixture of rose-oil and honey. The honey cleanses, and the oil of roses restringes, and at the same time does not suffer it to grow dry. But if it is not rough, but only dry, after wiping it with the penecillum it ought to be anointed with rose-oil mixed with a little wax.

CHAP. XI. REMEDIES AGAINST A COLDNESS OF THE EXTREMITIES PRECEDING A FEVER.

It is common also for a coldness to precede fevers, which of itself is a very troublesome kind of disorder. When it is expected, the patient must be forbid all drink: for giving this a little before much increases the malady. He is also to be timely covered with many cloaths. Dry and hot fomentations are to be used to those parts, for which we are apprehensive; in such a manner that the most violent heat may not begin immediately, but increase gradually. And those parts are to be rubbed with the hands anointed with old oil, and some of the warming medicines may be added to it. And some physicians are content with one friction with any kind of oil. In the remissions of such fevers some give three or four cyathi of gruel, while the fever still continues; and then, when it is quite over, refresh the stomach with cold and light food. I think this ought to be then tried, when food once given, and that after the fever, does little service.

But great care must be taken, that we be not deceived as to the time of the remission; for even in this kind of distemper, often the fever seems to abate, and again increases. Wherefore we must trust no remission, but that, which both continues, and lessens the restlessness, and excessive heat of the body, which the Greeks call(11) zesis[ BD ]. This is a rule generally received, if every day the fits are equal, to give a little food every day: if unequal, food must be given after the most severe; after the milder hydromel.

CHAP. XII. THE CURE OF A SHUDDERING BEFORE FEVERS.

A shuddering commonly precedes those fevers, that have a certain period, and a perfect remission, and for this reason are the most safe, and most easily admit of a cure: for where the periods are uncertain, neither clysters, nor the bath, nor wine, nor any other remedy can be duly administered. For it is uncertain when the fit will come: so that if it come on suddenly, the greatest detriment may happen to accrue from that, which was intended to give relief. And nothing else can be done, than that the patient practise a strict abstinence in the first days of the disease: then upon the decline of that fit, which is most severe, let him take food.

But where the period is certain, all these things are more easily tried; because we can more readily inform ourselves of the succession both of the fits and the intervals. Now in this kind, when they are of long standing, fasting is not good: in the first days only we are to make use of it to oppose the distemper; after that the cure is to be divided, and first the shuddering, then the fever is to be removed. Wherefore as soon as a person has shuddered, and after the shuddering has grown hot, it is fit to give him warm water to drink a little salt, and force him to vomit: for generally such a shuddering arises from something bilious oppressing the stomach. The same method is to be pursued, if at the next period also it has again appeared: for thus it is often removed. And by this time one may find out the species of the fever.

Wherefore when the third fit is expected, which may possibly come on, the patient must be brought to the bagnio, and care must be taken that he be in the bath at the time of shuddering. If he have felt it there also, let him do the same nevertheless, when the fourth fit is expected: for by this repetition it is often removed. If the bath proves unsuccessful, before the fit let him eat garlick, or drink hot water with pepper: for these too raise a heat, which repels the shuddering. After that, before the shuddering has time to come on, let him cover himself up in the manner above directed under the article of coldness: and it is proper immediately to apply all round his body pretty hot fomentations, and chiefly extinguished tiles, and coals wrapped up in cloths.

If notwithstanding the shuddering has broke out, he must be anointed within the cloaths plentifully with hot oil; to which also may be added some of the warming substances: and friction may be used, to as great a degree as he is able to bear, and especially in his hands and feet, and let him hold in his breath. And it must not be given over, although the shuddering do return: for often the perseverance of the physician overcomes the distemper of the body.

If he has vomited, warm water must be given, and he obliged to vomit again; and the same methods must be repeated, till the shuddering is removed. But beside these a clyster must be given, if the shuddering gives way slowly: for that has a good effect by exonerating the body. The last remedies after these are gestation and walking. Now in distempers of this kind, the fittest food is such as may prove laxative, and glutinous flesh. When wine is given, let it be austere.

CHAP. XIII. THE CURE OF A QUOTIDIAN FEVER,

Now these observations relate to the periodical returns of all fevers: but the several species of them are to be distinctly treated, according to their different natures. If it be a quotidian, for the first three days by all means abstinence should be observed; then food be taken every other day. If the distemper has become inveterate, after the fit it is proper to try the bath and wine, especially if, when the shuddering is removed, the fever remains.

CHAP. XIV. THE CURE OF A TERTIAN FEVER.

But if the fever be either a tertian, which has a perfect intermission, or a quartan, on the intermediate days, it is proper to walk, and make use of other exercises and unctions. Cleophantus, one of the more ancient physicians, in these distempers used to pour a great quantity of hot water upon the head of the patient long before the fit, and then to give him wine. Yet Asclepiades, though he adopted most of his precepts, has justly omitted this: for it is of doubtful effect.

When there is a tertian fever, he says it is proper to administer a clyster the third day after the fit; on the fifth, after the shuddering to procure a vomiting; then after the fever, according to Cleophantus’s practice, to give the patients food and wine, while they are yet hot; on the sixth day to keep them in bed: for thus it will happen, that the fit will not return on the seventh day. That this may often answer is very probable. Yet it is safer in this order to make trial of these three remedies, vomiting, purging by clysters, and drinking of wine, for three days, that is, on the third, and fifth, and seventh; and not to drink wine, till after the fit upon the seventh day.

But if the distemper is not removed in these first days, and it grows inveterate, on the day the fit is expected, let the patient keep his bed; after the fit be rubbed; and after eating let him drink water: the day following, when he takes no food, let him intermit his exercise and unction, and rest content with water alone. And this indeed is best. But if his weakness bear hard upon him, he ought both to take wine after the fit, and a little food on the intermediate day.

CHAP. XV. THE CURE OF A QUARTAN FEVER.

The same method is to be followed in a quartan. But since this is very slowly terminated, unless it have been removed in the beginning, greater accuracy must be observed in prescribing from its first appearance, what ought to be done it. Wherefore if a person is attacked with a fever and shuddering, and it has gone off, all that day and the following, and the third, he ought to confine himself to a stricter regimen, and on the first day drink only warm water after the fever; the two following days to abstain from that as much as possible; on the fourth day, if the fever returns with the shuddering, to vomit, as has been directed before; then after the fit, to eat sparingly, and drink a quadrans of wine; the day after that, and the third to abstain; taking only warm water if he be thirsty. On the seventh day he should prevent the coldness, by going into the bath before its time, fast and observe the former regimen strictly(12); if the fever has returned, have a clyster: when the body has rested after that, he should be anointed and brushed briskly; take food and wine in the same way, and for the two following fast, not neglecting the friction. On the tenth day he must try the bath again; and if the fit has come on after, brush in the same manner, and drink wine more plentifully. And thus the consequence is, that a rest of so many days, and abstinence, with the practice of the other injunctions, may remove the fever.

If notwithstanding these it continues, another method of cure entirely different is to be pursued; and all our measures must be directed to this point, that the body may easily bear what is to be long endured. For this reason the practice of Heraclides of Tarentum ought to be less approved, who prescribed clysters in the beginning, after that fasting to the seventh day. Which course though a person should be able to undergo, yet when he is even freed of the fever, he will scarcely have strength to recruit; and so if the fever frequently returns, he must sink under it. Wherefore if the distemper shall continue upon the thirteenth day, the bath must neither be tried before the fever nor after it, unless sometimes when the shuddering is already removed. Now the shuddering is to be repelled by the same means, as have been directed before. Then after the fever it is proper to be anointed, and rubbed briskly; to eat heartily of substantial food; to take as much wine as he inclines; the day following, when he has rested sufficiently, to walk, take exercise, be anointed, and stoutly brushed; to take food without wine; on the third day to abstain.

On the day that he shall expect the return of the fever, it is proper for him to rise before its hour, and exercise himself, and to endeavour to have its time coinciding with his exercise: for thus it is often dispelled. But if it has seized him in the midst of his exercise, in that case to give over. In a disorder of this kind the remedies are unction, friction, exercise, food and wine. If the belly is bound, it must be opened.

Now these things are easily performed by the more robust; but if the patient be grown weak, gestation must stand instead of exercise. If he cannot even bear this, yet friction must be used. If this also when vehement distresses him, the cure must be confined to rest, unction, and diet: and care must be taken, lest any crudity change the distemper into a quotidian. For a quartan kills no body: but if it be changed into a quotidian, the patient is in a bad way: which however never happens, unless by the fault either of the patient or the physician.

CHAP. XVI. THE CURE OF A DOUBLE QUARTAN.

But if there are two quartans, and those exercises, which I have prescribed cannot be used, there is a necessity either entirely to rest, or if that is difficult, to walk gently, then sit down, with the feet and head carefully wrapped up; as often as the fit has come on, and gone off, to eat sparingly, and drink a little wine; at other times, unless the weakness be very great, to abstain. But if there is hardly any intermission between two fits, to take food after both are over: then in the interval both to move a little, and after unction to eat. Now since an inveterate quartan is very seldom cured unless in the spring, in that season especially attention must be given, that nothing be done, which may obstruct the recovery of health. And it is of service in an old quartan to alter now and then the manner of living, to change from wine to water, from water to wine, from mild food to such as is acrid, and on the contrary; to eat radish, then vomit, or open the belly by chicken broth; to add warming medicines to the oil for friction; before the fit to take two cyathi of vinegar, or one of mustard, with three of Greek salt wine; or pepper, castor, laser(13), and myrrh, mixed in equal proportions, and diluted with water; for by these, and such like the body must be agitated, that so a change may be made from its present state.

If the fever has disappeared, it is proper to be long mindful of its periodical day; and on that day to guard against cold, heat, crudity, and fatigue: for it easily returns, unless it be feared for some time after the recovery of health.

CHAP. XVII. THE CURE OF A QUOTIDIAN ARISING FROM A QUARTAN.

But if a quotidian is formed from a quartan, when that has happened in the beginning(14), it is proper to abstain for two days; in the evening to make use of friction, and give only water to drink. On the third day it often happens, that the fit does not come. But whether it has appeared or not, food must be given after the time for the fit: and if it continue, the strictest abstinence possible must be enjoined for two days, and friction used every day.

CHAP. XVIII. OF THE SEVERAL KINDS OF MADNESS AND THEIR CURE.

I have now gone through the treatment of fevers. There remain other disorders of the body, which come on after them: some of which, that cannot be assigned(15) to any certain part, I shall immediately subjoin. I shall begin with madness, and treat of the first kind of it, which is both acute, and happens in a fever; the Greeks call it phrenitis[ BE ].

First of all it is necessary to know, that sick people sometimes in a febrile paroxysm lose their judgment, and talk incoherently. Which, though it be not trifling, and cannot happen unless in a violent fever, yet is not equally dangerous; for it is commonly of short continuance: and when the violence of the fit is abated, the judgment presently returns. Nor does this kind of distemper require any other remedy, than what has been already directed for curing a fever.

It becomes then a phrenitis, when the delirium begins to continue without interruption; or when the patient, though he still have his reason, yet forms to himself some vain images: it is perfect, when the mind gives itself up to these images. Now there are several kinds of it: for amongst phrenitic people some are merry, others sad; some are more easily commanded, and their disorder goes no farther than words; others grow outrageous, and do acts of violence; and of these last again some only employ force, others even make use of cunning, and present a specious appearance of judgment, while they are catching at opportunities of doing mischief; but they are discovered by the issue.

Such of them as only rattle, or do no harm but in trifles, it is needless to load with severe restraints. Those, who are more violent in their actions, it is proper to bind, lest they should hurt either themselves or any other person. Nor should we trust any of them, if in order to get rid of his chains he pretends to be well, though he speak sensibly, and make lamentable complaints; because this is nothing else but the cunning of a mad person.

Generally the ancients kept such patients in the dark; for this reason, that it hurts them to be terrified: and they judged, that darkness of itself contributed something to the quiet of the mind. But Asclepiades, alleging that darkness itself strikes terror, ordered them to be kept in the light. But neither of these holds always. For one person is more disturbed by the light, and another by darkness: and some are to be met with, in whom no difference can be found either the one way or the other. Therefore it is best to try both methods; and to keep him, that has a horror at darkness, in the light; and him, that is afraid of light, in darkness. But where there is no such difference, if the patient have strength, he must be confined in a light place; if not, in a dark one.

To make use of remedies in the greatest violence of the phrenzy is needless: for at the same time the fever also increases. Wherefore nothing is to be done then, besides confining the patient. But when the circumstances allow, speedy help must be administered. Asclepiades asserted, that to bleed such was just the same as to murder them: upon this principle, that there was no madness, but when the fever was very high; and that bleeding could not be properly performed, unless in its remission. He himself endeavoured to procure sleep in such cases by much friction. But since both the violence of the fever prevents sleep, and friction is not useful unless in its remission, he ought to have omitted this remedy too. What then is to be said to this case? Many things are properly done in imminent danger, which should not be practised on any other occasion. And even a continued fever has times, in which, though it does not remit, nevertheless it does not increase. And this though not the best, yet is a pretty favourable season for the application of remedies. And if the strength of the patient admits of it, he may also lose blood.

There may be the same reason(16) for doubting whether a clyster should be administered. Then after the interval of a day, it is fit to clip the hair of the head close to the skin; then to foment it with a decoction of some of the restringent herbs; or to foment it first, after that clip, and foment it again; and lastly to embrocate the head and nostrils with oil of roses; to hold also to the nostrils rue bruised with vinegar, and to provoke sneezing by medicines efficacious for that purpose. These things however are to be done only to persons, who don’t want strength. If there be a weakness, the head is only to be moistened with oil of roses, adding to it serpyllum or something of the like nature. Also whatever be the degree of strength, two herbs are useful, nightshade and the wall-herb, if the head be bathed with the expressed juice of them both. When the fever has remitted, friction must be used; but more sparingly in those, that are too merry, than in those, that are too sad.

It is necessary to apply to the minds of people thus mad in a manner suitable to the temper of each. For the groundless apprehensions of some are to be alleviated: as was done to a very rich man in fear of starving, whom they relieved by frequent accounts of estates bequeathed to him. The audaciousness of others must be restrained, as is practised in the case of those, who require even stripes to keep them under government. The unseasonable laughter of some must be checked by chiding and threats. The sorrowful thoughts of others must be dispelled: for which purpose concerts of music, and cymbals and noise are useful. Yet these patients must be oftener humoured than contradicted: and the mind is to be led by slow degrees, and not evidently, from their irrational assertions to better notions. Sometimes also the attention of the person must be strongly engaged; a method taken with studious men, to whom a book is read, either with propriety of accent, if they be pleased with it, or with an improper tone of voice, if that offends them: for by correcting they begin to give their attention. Moreover they must be obliged to repeat any thing they may remember. Some also have brought those to eat, that had no inclination for it, by placing them in the midst of people at a feast.

To every body thus affected, sleep is both hard to be obtained, and highly necessary; for by this most of them recover. For this purpose, and at the same time for composing the mind, the ointment of saffron(17) with that of iris rubbed upon the head is useful. If notwithstanding they continue wakeful, some endeavour to procure them sleep by giving them to drink a decoction of poppies or henbane; others put mandrake apples under their pillow: others apply to their forehead either amomum or sycamine tear. This name I find among the physicians. But why do the Greeks call the mulberry-tree sycaminus[ BF ], when there is no tear of the mulberry-tree? But this name they give to the tear of a tree growing in Egypt, which they call sycomorum[ BG ]. Many physicians now and then foment the face and head with a sponge dipt in a decoction of poppy-heads.

Asclepiades affirmed these things to be hurtful: because they often change the distemper into a lethargy. His advice is, that the first day the patient should abstain from meat, drink, and sleep; on the evening water should be given him to drink; then friction should be used so gentle, that even the hand that rubbed, should not press strongly; the day after, all these things being repeated, on the evening gruel and water should be allowed him, and the friction again repeated: for by this we would procure sleep. This sometimes happens; insomuch that by his own confession, too much friction may even endanger a lethargy. But if by these means sleep is not obtained, then at last it must be procured by the medicines above-mentioned: still with the same moderation, which is also necessary in this case; lest it be not in our power afterwards to wake the person, whom we desire to sleep. A fall of water near is also some help to sleep; or gestation after meat, and in the night time; especially the motion of a suspended bed.

Nor is it improper, if bleeding has not gone before, and the understanding be still disturbed, and there be no sleep, to make an incision in the occiput, and apply a cucurbital: because this, by lessening the distemper, may bring on sleep. Moderation must also be used as to his diet: for the patient must neither be full-fed, lest he grow outrageous, nor must he be tormented with hunger, lest from his weakness he fall into a cardiac disorder. He must use weak food, and especially gruel, and drink hydromel, three cyathi of which are sufficient in winter, and four in summer.

There is another kind of madness, which continues a longer time; because generally it begins without a fever, afterwards excites slight feverish fits; and goes no farther than a sadness, which seems to proceed from atrabilis. In this bleeding is useful. If there be any reason against that, the first remedy is abstinence; the second to purge by white hellebore and vomiting: after either of these friction is to be used twice a day; if the patient be pretty strong, frequent exercise too, a vomit fasting, food of the middle kind is to be given without wine. As often as I mention this kind of food, I would be understood, that it may be given even of the weakest, provided one be not confined to that alone: that only the strongest is to be refrained. Besides, the belly is to be kept as soft as possible: terrors are to be dispersed, and rather good hopes are to be given. Entertainment must be sought in amusing stories and diversions, such as the person in health used to be most pleased with. If there are any works of his performing, they must be commended, and placed before his eyes. His groundless sorrow is to be mildly reprimanded. Arguments must be offered now and then to persuade him, that in those very things, which disturb him, there is more matter for joy than anxiety. If a fever has also come on, it must be cured in the same manner as other fevers.

The third kind of madness is the longest of all; insomuch that it does not shorten life. Which kind is most incident to people of strong constitutions. Now there are two species of this: for in some the deception arises from false images, not from the understanding: such a madness the fables of the poets represent that of Ajax, or Orestes(18): others are disordered in their judgment. If imaginations mislead, first of all it must be observed, whether they be melancholy or merry. If melancholy, black hellebore ought to be given as a purge; in the merry kind, the white as an emetic. And if the patient will not take it in a potion, it must be added to bread, that it may the more easily deceive. For if he be thoroughly purged, it will in a great measure lessen the distemper. And therefore if hellebore once given has done little service, after a proper interval it ought to be repeated. And it should be known that this distemper is more mild, when attended with laughter, than with gravity. And this rule also is universal in all diseases, when any person is to be purged in the inferior parts(19), that the belly be first opened; when the superior parts, it must be bound.

But if the madness affect the judgment, the patient is best treated by some kind of tortures. When he has said or done any thing wrong, he is to be punished by hunger, chains, and stripes: he must be forced both to attend and get something by heart, and retain it in his memory. For thus it will happen, that gradually by fear he may be obliged to consider, what he does. It is also serviceable in this disorder to be put into sudden consternation and fear; and the same tendency commonly has every thing, that disturbs the mind greatly; for some change may be brought about, when the mind is withdrawn from that state, in which it was before. It likewise makes a difference, whether the patient laugh now and then without cause, or be sorrowful and dejected. For the merriment of a mad person is better cured by those terrours, which I mentioned above. If sadness be his extreme, gentle, but long friction twice a day is useful; also pouring of cold water upon the head, and dipping the body in water and oil.

The following are general rules: that mad people ought to be strongly exercised; to make much use of friction; to take neither fat flesh nor wine; to take food, after purging, of the middle kind, and as light as possible; that they should neither be alone, nor amongst strangers, nor those which they either despise, or look upon with indifference: they ought to go into other countries, and, if their judgement returns, to take a journey into distant parts once a year.

Sometimes, though seldom, a delirium arises from fear; which kind of madness is of a similar species, and is to be cured by a like diet: except that in this kind of madness alone wine is properly given.

CHAP. XIX. OF THE CARDIAC DISORDER AND ITS CURE.

That kind of distemper, which by the Greeks is called cardiacus[ BH ], is directly contrary to the last mentioned; although phrenitic people often fall into it: for the mind in that is disordered, in this it is sound. This is nothing else but an excessive weakness of the body; which from a languishing stomach is dissipated by immoderate sweating. And one may immediately know that this is the disease, when the pulsations of the arteries are small and weak, and sweat uncommon both in degree and continuance, breaks out from the whole breast, and neck, and even from the head, the feet only and legs being more dry and cold. This distemper is of the acute kind.

The first step in the cure is to apply restringent cataplasms to the præcordia; the second to restrain the sweat. That is accomplished by bitter oil, or that of roses, or quinces, or myrtles. With any of these the body is to be gently anointed; and then a cerate of some one of them is to be applied.

If the sweat nevertheless prevails, the person is to be rubbed over with gypsum, or litharge, or Cimolian chalk, or to be sprinkled now and then with the powder of these. The same purpose is answered by the powder of dry myrtle or bramble-leaves, or the dried lees of austere and strong wine. And there are a great many more things of the same nature, which if they cannot be had, sprinkling of common dust will have a good effect. And besides these, that the body may sweat less, the person ought to be covered with a light garment, and set in a place not hot, with the windows open, so that he may be even sensible of the stream of air.

The third remedy is to succour the weakness of the patient by eating and wine. Food is not to be given in great quantity indeed, but often, both in the night and day; so as it may nourish, and not load. It ought to be of the weakest kind, and agreeable to the stomach: and unless there be a necessity, we ought not to be in haste to give wine. If there is reason to fear the person is fainting, then both intrita with wine, and wine itself, austere but small, and somewhat diluted, with the cold taken off it, may be given pretty frequently and freely; with the addition of polenta(20), provided the patient takes little food. And the wine ought to be neither very weak nor very strong: and the patient in a day and a night may very well drink two or three heminæ; if it be a person of a large make, even more: if he has no appetite for food, it is fit first to anoint him, then to pour cold water all over him, and then give it him.

But if his stomach be so relaxed, that it hardly retains, both before meat and after it, he ought to vomit spontaneously(21); and again after vomiting to take food. If even that do not stay, to sup a cyathus of wine, and at the distance of an hour to eat again. If the stomach return that too, the whole body must be rubbed over with bruised bulbous roots(22): when these have grown dry, the effect is, that the wine may be retained in the stomach, and from that, the heat may return to the whole body, and the tone of the vessels be restored.

The last remedy is to inject by way of clyster(23) the cream either of ptisan or alica, for that also will support the strength. Nor is it amiss to hold something refreshing, such as rose oil and wine, to the nose of the person, when he is restless and hot: and if there is any coldness in the extremities, to cherish them with hands anointed and warm. By which means if we have been able to gain these points, that the violence of the sweat abates, and life is prolonged, time itself now begins to work a cure. When he seems to be out of danger, yet we must be cautious, that he do not relapse quickly into the same weakness. Therefore omitting only the wine, he ought every day to take more substantial food, till his body recover sufficient strength.

CHAP. XX. OF THE LETHARGY, AND ITS CURE.

There is also another distemper, which in a different way is opposite to the phrenitic one. In phrensies sleep is hardly obtained, there is a disposition to fool-hardy enterprises: in this there is a languor, and an almost invincible necessity of sleeping. The Greeks call it lethargus[ BI ]. This too is of the acute kind, and unless it is cured, kills quickly.

Therefore some endeavour to rouse such patients by holding to their nose those things, which provoke sneezings, and such as excite by their offensive smell; for instance, burnt pitch, sordid wool, pepper, hellebore, castor, vinegar, garlick, onion. They also burn galbanum by them, or hartshorn; if this is not to be got, any other horn; for when these are burnt, they stimulate by their offensive smell.

But a certain author, Tharrias, affirmed, that this disposition to sleep is concomitant upon a febrile paroxysm, and that it abates, when the latter is gone off: and therefore that such practitioners, as rouse them frequently, give them unnecessary pain. Now it makes a considerable difference whether the patient awakes upon the termination of the fit, or whether the weight of sleep oppresses him, when the fever is abating, or even after its going off. For if he awakes, it is needless to treat him as one asleep: for he is not made better by being awake; but if he be better, he will keep awake of himself. If his sleep is continual, he must in such a case be roused; but at those times, when the fever is lowest, that he may discharge somewhat, and take food. Cold water suddenly poured on excites more powerfully than any thing. After the remission therefore the whole body must be anointed over with a great quantity of oil, and three or four amphorae of water must be poured upon the head, so as to stream over all the body. But this we shall make use of, if the patient’s breathing be equal, if the præcordia be soft. But if the case shall be different, the other remedies are preferable, which were mentioned before. And as to the sleep, this method is the most suitable.

With regard to the cure of the distemper, the head must be shaved; then fomented with a decoction of bay-leaves, or of rue in vinegar and water. And the day after, castor must be applied, or rue bruised with vinegar, or bay-berries, or ivy with rose-oil and vinegar. And mustard is of singular use, both held to the nostrils in rouzing the patient, and if applied to the top of the head or forehead, in removing the distemper itself. Gestation is also useful in this distemper, and especially food seasonably given, that is, in the greatest remission, that can be found. Now gruel is most proper till the distemper begins to decline. And if every day there is a severe fit, this may be given daily: if every other day, gruel after the most severe; after the milder hydromel. Wine also given with seasonable food is of no small use.

But if such a torpor has come after long fevers, all the other rules are to be observed: but three or four hours before the fit, if the belly be bound, castor with a mixture of scammony must be given; if that is not the case, castor alone must be given with water. If the præcordia are soft, the diet must be pretty full; if hard, we must keep to the gruels above-mentioned; something being applied to the præcordia, which can at once repel and soften.

CHAP. XXI. OF THE SEVERAL SPECIES OF THE DROPSY AND THEIR CURE.

The foregoing is an acute distemper; but the case of those, who are troubled with water under the skin, may turn to a chronical disease: for unless it is speedily cured, such patients fall into what the Greeks call hydrops[ BJ ] (dropsy). There are three species of it; for at times the belly is very tense, and there is a frequent rumbling within from the motion of the air: sometimes the surface of the body is unequal, with tumours of different sizes rising over the whole: sometimes water is confined within the abdomen, and upon the body’s being moved, it moves in such a manner, that the course of it may be seen. The first the Greeks call tympanites[ BK ]; the second leucophlegmatia, or hyposarca[ BL ]; the third ascites[ BM ]. An excess of moisture however is common to them all: for which reason ulcers in such patients are not easily healed. This disease often begins of itself; and often succeeds another distemper of long standing, and especially a quartan.

It is more easily cured in slaves, than in free people; because as it requires fasting, enduring of thirst, and a thousand other hardships, and long patience, such are more readily relieved, that are easily commanded, than those, whose liberty is hurtful to them. But even those, that are under the authority of another, if they cannot entirely command themselves, are not to be recovered. And upon this account no inconsiderable physician, a disciple of Chrysippus, residing with king Antigonus, declared that a certain friend of that prince, of known intemperance, though not very ill of this disease, could not possibly be cured: and when another physician, Philip of Epirus, undertook to cure him, he answered, that the other considered only the distemper of the patient; he, his dispositions. And he was not deceived; for though he was watched with the greatest diligence not only by the physician, but even by the king too, yet by devouring his malagmas(24), and drinking his own urine, he quickly killed himself.

However at the beginning the cure is not very difficult, if rest, thirst, and fasting be strictly enjoined. But if the disease has continued long, it is not removed without great trouble. Yet they tell us, that Metrodorus, a disciple of Epicurus, when he was afflicted with this distemper, and could not patiently endure the necessary thirst, after refraining long, used to drink, and then vomit it again. Now if whatever has been taken, be brought up again, it lessens the uneasiness considerably: if it is retained in the stomach, it increases the disorder; therefore it must not be attempted in every one.

But if it be attended with a fever, that in the first place must be removed by such means as have been prescribed for the cure of that distemper. When the patient is free of a fever, then we may apply the usual remedies of the dropsy. And with regard to this, whatever species it is, if it has not got too deep root, the very same remedies are necessary. The person must walk much, run sometimes, and his superior parts especially must be rubbed, so as to bring a warmth into the skin. In the mean time he must keep in his breath. Sweat is likewise to be procured, not by exercise only, but also by hot sand, or the laconicum, or clibanum, and such like means: and natural and dry sweating places are very beneficial: such as we have at Bajæ amongst the groves of myrtles. The bath and all moisture is hurtful. Catapotia(25), composed of two parts of wormwood and one of myrrh, are properly given to the patient fasting.

The food ought to be of a middle nature, but of the harder kind of it. No more drink given than to support life: and that is best, which provokes urine. It is better to attempt that by diet(26), than medicine. However, if there is a necessity, some of the things, which have that effect, must be boiled, and the decoction of them given to drink. This faculty seems to be possessed by the iris, nard(27), saffron, cinnamon, cassia, myrrh, balsam(28), galbanum, labdanum, flower of the wild vine, panaces(29), cardamom(30), ebony, cypress seed, stavesacre, which the Greeks call staphis agria[ BN ], southernwood, rose-leaves, acorum(31), bitter almonds, goat’s marjoram, storax, costus, the flower of long and round cyperus(32); the first of these the Greeks call cyperus[ BO ], and the other schœnus[ BP ]. Whenever I mention these, I intend not such as grow here, but those that are imported amongst the spices. However the mildest of these must be tried first, that is the rose-leaves, or spikenard. Austere wine also, but very weak, is good.

It is convenient likewise to measure the belly every day with a thread, and to put a mark upon this, where it meets: and each succeeding day to observe, whether the bulk be enlarged or diminished; for that which lessens, feels the effect of the medicine. And it is not improper to measure the patient’s drink, and his urine; for if more moisture is excreted, than is taken, in such a case there is hope of recovery. Asclepiades tells us in his writings, that to a person, who had fallen into a dropsy after a quartan, he prescribed abstinence for two days, and friction; on the third he gave him food and wine, finding him free both of the fever and dropsy. Thus far general rules may be laid down for all the species of the distemper: if the malady rises to a greater height, different methods of cure are required in each.

Wherefore if there is a flatulency, and from that frequent pain, a vomit after meat every day, or every other day, is of service. After that dry and warm fomentations must be used. If the pain is not removed by these means, cupping without scarification is necessary. If the pain does not even yield to that, the skin must be cut, and the cucurbitals applied again. The last remedy, if the cupping has done no service, is to inject into the belly plenty of warm water, and to take it back again. Moreover it is necessary to make use of friction three or four times a day, with oil and some heating medicines. But in this friction the belly must be avoided; mustard must be applied to it frequently, till it corrode the skin; and several ulcers must be made in the belly with hot irons, and these kept open for some time. Boiled squils also bound upon the skin(33) are good. But for a long time after these flatulencies all windy food must be avoided.

But if the distemper be what is called leucophlegmatia, it is fit to expose the swelled parts to the sun; but not too much, lest it inflame the fever. If the sun is too powerful, the head must be covered, and friction made use of, the hands being only moistened with water mixed with salt, and nitre, and a little oil; and that by the hands either of a child or a woman, as their touch is softer: and if the strength will allow, it may be continued a whole hour in the forenoon; in the afternoon for half an hour. Restringent cataplasms also are good; especially if the body be pretty tender. An incision must likewise be made on the inside of the leg, about four fingers breadth above the ancle; from which for some days a good quantity of water may be discharged, and it is proper also to make deep gashes in the tumours: and the body must be well agitated by frequent gestation; and when the wounds are cicatrized, the exercise and food must be increased, till the body return to its former habit. The food ought to be strong and glutinous, and chiefly flesh. The wine pretty sweet, if the stomach will bear it; but in this course, that alternately for two or three days together, sometimes water and sometimes wine be drunk. It is proper also to give the seed of sea spurge, which grows large near the sea, to drink with water. If the person be strong, boiled squills may be tied upon his belly at the same time. And many authors advise, that the tumours be beat with inflated bladders.