De Medicina

13 Again, a vomit, as it is often quite a necessity for one who in health is bilious, so is it also in those diseases which bile has occasioned. It is the more necessary, therefore, for all who are troubled by shivering and trembling before fevers, for all suffering from cholera, even for all suffering from insanity accompanied by a kind of hilarity, and also for those afflicted by epilepsy. But if the disease is an acute one,

as in the case of cholera, if there is fever, during the shivering fits, then the sharper medicaments are out of place, as mentioned above in relation to purgations, and for the purpose of a vomit it is sufficient to take the emetics which I have prescribed to be taken by those in health. But when there are chronic and violent diseases without fever, such as epilepsy and insanity, white hellebore root should also be used. But it is not right to give it either in winter or in summer; the spring is the best time, and autumn tolerably good. Whoever is going to administer it ought to take care beforehand that the body of the prospective recipient is rendered more humid. This should be recognized, that all such medicaments given as a drink do not always benefit the sick, and are always harmful to those in health.

14 Now concerning rubbing, Asclepiades as if he were the inventor of the practice has treated it in his volume, entitled "Common aids," at such great length, that, though making mention only of three such aids, namely, Rubbing, Water-drinking, and Rocking, yet he has taken up the greatest part with the first-named subject. Now on such matters recent writers ought to have credit where they have made discoveries, or where they have rightly followed others; yet we must not omit to attribute to their true authors teaching found among the more ancient writers. And it cannot be disputed that Asclepiades has taught when and how rubbing should be practised, with a wider application, and in a clearer way, although he has discovered nothing which had not been comprised in a few words by that most ancient writer Hippocrates, who said that rubbing, if strenuous, hardens the body, if gentle,

relaxes; if much, it diminishes, if moderate, fills out. It follows, therefore, that in the following cases rubbing should be employed, when either a feeble body has to be toned up, or one indurated has to be softened, or a harmful superfluity is to be dispersed, or a thin and infirm body has to be nourished. Yet when examined with attention (although this no longer concerns the medical man) the various species of rubbing may be easily recognized as all dependent on causing one thing, depletion. For an object is toned up when that is removed, which, by its presence was the cause of the laxness; and is softened when that which has been producing induration is abstracted; and it is filled up, not by the rubbing itself, but by the nutriment, which subsequently penetrates by some sort of dispersal to the very skin itself after it has become relaxed. The cause of the different results lies in the degree.

Now there is a great difference between anointing and rubbing. For it is desirable that even in acute and recent diseases the body should be anointed and then gently stroked, but only during remissions and before food. But prolonged rubbing is unsuitable in acute and increasing troubles, unless it be in madness to procure sleep. Yet a prolonged illness and one declining from its primary vehemence loves this aid. I am quite aware that some say that the need for any aid is during the increase of diseases, not when diseases are tending to end of themselves. But this is not the case. For a disorder, even although it will end of itself, may be expelled yet more speedily by adopting the aid. An aid is necessary on two accounts, both that health may be regained at the earliest possible

moment, and that what remains of the disease may not again become exacerbated from however slight a cause. Possibly the disease may have become less grave than it had been, yet is not completely got rid of, but some remnants of it persist, which the application of a remedy disperses. But while rubbing is rightly applied after a disorder has been lessened, yet it should never be applied whilst a fever is increasing: but if possible after the fever has entirely left the body, or if not, at least when it has remitted. Sometimes, moreover, rubbing should be applied to the body all over, as when a thin man ought to put on flesh; sometimes to a part only, either because weakness of the limb actually rubbed demands it, or that of some other part. For both prolonged headaches are relieved by rubbing of the head, although not at the height of the pain, and any partially paralysed limb is strengthened by itself being rubbed. Much more often, however, some other part is to be rubbed than that which is the seat of the pain; and especially when we want to withdraw material from the head or trunk, and therefore rub the arms and legs. Neither should we listen to those who would fix numerically how many times a patient is to be stroked; for that is to be regulated by his strength; and if he is very infirm fifty strokes may possibly be enough, if more robust possibly two hundred may be made; then an intermediate number according to his strength. Hence it is that the hand is to be passed even fewer times over a woman than over a man, fewer over a child or old man, than over a young adult. Finally, if particular limbs are rubbed, many strokes are re-quired and forcible rubbing; both because the body cannot be as a whole quickly rendered weak through a part, and it is necessary that as much as possible of the diseased matter should be dispersed, whether our aim is to relieve the limb actually rubbed, or through it another limb. When, however, general bodily weakness requires that the rubbing should be applied all over, it should be shorter and more gentle, just to the extent of softening the skin, so that the body may be more easily capable of forming new material from food recently consumed. As I have stated above (II.6.7), a patient is already in a bad way, when the exterior of the body is cold, whilst his interior is hot and there is thirst. But even then rubbing is the only remedy; if it draws the heat outwards into the skin, it makes possible an opportunity for other treatment.

15 Rocking also is very suitable for chronic maladies which are already abating; it is also of service both for those who are now entirely free from fever, but cannot as yet themselves take exercise, and also for those in whom persist sluggish remnants of maladies, not otherwise to be got rid of. Asclepiades has stated that use is to be made of rocking even for dispersal of a recent and severe fever, especially an ardent fever. But that gives rise to danger; an attack of that sort is better sustained by keeping quiet. If anyone, however, wants to give it a trial, let him try it when the tongue is not furred, when there is no swelling, no induration, no pain, either in the viscera or head or about the heart. And on the whole a body in pain should never be rocked, whether the pain be general or local, except, however, when sinews alone are in

pain, and never during the rise of a fever, but only during its remission. But there are many sorts of rocking, and they are to be regulated both by the patient's strength and by his resources, lest either a weak patient undergo overmuch depletion, or a poor man come short. The gentlest rocking is that on board ship either in harbour or in a river, more severe is that aboard ship on the high seas, or in a litter, even severer still in a carriage: but each of these can either be intensified or mitigated. Failing any of the above, the bed should be so slung as to be swayed; if not even that, at any rate a rocker should be put under its foot so that the bed may be moved from side to side by hand.

And this sort of exercise of the lighter kinds suits the infirm, the stronger kinds again those who have already become free from fever for several days, or those who, whilst feeling the commencement of grave disorders, as yet are free from fever (which happens in the case both of phthisis and of stomach disease, and of dropsy, also, at times, of jaundice), or when certain diseases such as epilepsy and madness persist without fever, for however long. In which affections also those kinds of exercises are necessary, which we have included in the passage where we prescribed what healthy, yet not strong, men should carry out.

16 Now Abstinence is of two kinds, in one of which the patient takes nothing at all, in the other only what he must. The beginnings of diseases require at first hunger and thirst, the actual diseases then moderation, so that nothing but what is expedient, and not too much of that, may be consumed; for it is not at all proper to have surfeit at once after a fast.

But if this be not good even in healthy bodies, when some necessity has imposed fasting, how much worse it is in a sick body! To a sufferer nothing is more advantageous than a timely abstinence. Among us intemperate men with regard to their food themselves . . . the times are left to the doctors; again others make a present of the times to their medical men, but reserve to themselves as to quantity. They think that they are generous, when they leave them to decide as to all else, and keep free as to the kind of food; as if it were a question of what may be yielded to the doctor, not what may be good for the patient, who suffers grievous harm, as often as he transgresses in what he consumes, whether as to the time of the meal, its quantity or its quality.