De Medicina

Celsus, Aulus Cornelius

Celsus, Aulus Cornelius. De Medicina. Spencer, Walter George, translator. Cambridge, MA: Harvard University; London, England: W. Heinemann Ltd, 1935-1938.

31 The following increase the urine: garden herbs of good odour, as parsley, rue, dill, basil, mint, hyssop, anise, coriander, cress, rocket, fennel; and besides these asparagus, capers, catmint, thyme, savory, charlock, parsnip, especially growing wild, radish, skirret, onion; of game especially the hare; thin wine, pepper both round and long, mustard, wormwood, pine kernels.

32 For producing sleep the following are good: poppy, lettuce, and mostly the summer kinds in which the stalk is very milky, the mulberry, the leek. For exciting the senses: catmint, thyme, savory, hyssop, and especially pennyroyal, rue and onion.

33 For drawing out the material of the disease

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certainly many things can be used, but as they are mostly composed of foreign medicaments and are more useful in other affections than in those relieved by the dietetic regimen, I will defer their consideration for the present (V. Proem., 1, 2): but I will mention here those which are at hand, and are suitable to the diseases of which I am about to speak (III, IV), since they blister the body and thus extract from it the material of disease. Now those which have this faculty are the seeds of rocket, cress, radish, and most of all mustard. The same faculty exists in salt and figs.

Those which gently both repress and mollify at the same time are greasy wool to which has been added oil with vinegar or wine, crushed dates, bran boiled in salt water or vinegar.

But those which simultaneously repress and cool are pellitory, which the Greeks call parthenion or perdeikion, thyme, pennyroyal, basil, the blood-herb which the Greeks call polygonon, purslane, poppy-leaf, vine-tendril, coriander, hyocyamus-leaves, moss, skirret, parsley, solanum, which the Greeks call strychnos, cabbage-leaves, endive, plantain, fennel-seed; crushed pears and apples and especially quinces, lentils; cold water, especially rain water, wine and vinegar, and everything soaked in these, whether bread or meal or sponge or ashes, or greasy wool or even lint; Cimolian chalk, gypsum; oil perfumed with quince, myrtle, rose; unripe olive oil; vervains, the leaves crushed along with their young twigs, of which sort are the olive, cypress, myrtle, mastic, tamarisk, privet, rose, bramble, laurel, ivy, and pomegranate.

Those which repress without cooling are cooked

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quinces, pomegranate rind, hot water in which the vervains enumerated above have been boiled, powdered wine lees or myrtle leaves, bitter almonds.

But those which are heating are poultices made of meal, whether of wheat or spelt or barley or bitter vetches or darnel or millet or panic or lentil or bean or lupin or linseed or fenugreek, when one of these has been boiled and applied hot. All forms of meal poultices, however, are rendered more efficacious by cooking in mead instead of in water. Besides there are: cyprus or iris oil, marrow, cat's fat, olive oil, especially if it is old, and there has been added to the oil salt, soda, black cummin, pepper, cinquefoil.

Generally those which are powerful to repress inflammation, and cool, harden the tissues; those which are heating, disperse inflammation and soften, and this last property belongs especially to plasters of linseed or fenugreek seeds.

But as regards all these medicaments, whether used as simples or in mixtures, their uses by medical men vary, so that it is clear that each man follows his own ideas rather than what he has found to be true by actual fact.

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1 Having dealt with all that pertains to whole classes of diseases taken together, I come to the treatment of diseases one by one. Now the Greeks divided these into two species, terming some acute, others chronic. But because maladies did not always respond in the same way to treatment, some of the Greek writers have placed among the acute what others have placed among the chronic; from this it is clear that there are more than two classes. For some diseases are certainly of short duration, which carry off the patient quickly, or themselves come quickly to an end; some are chronic, in which neither recovery is near at hand nor death; and there is a third class, at one time acute, at another time chronic, and that occurs not only in fevers, where it is most frequent, but in other affections also. And besides the above there is a fourth class which cannot be said to be acute, because it is not fatal, nor really chronic, because if treated it is readily cured. When I come myself to speak of diseases singly, I will point out to which class each belongs. But I shall divide all diseases into those which appear to have their seat in the body as a whole, and into those which originate in particular parts. I shall begin with the former, after a few words of preface concerning all.

Whatever the malady luck no less than the art can claim influence for itself; seeing that with nature

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in opposition the art of medicine avails nothing. There is, however, for a practitioner who is unsuccessful, more excuse in acute than in chronic diseases: for acute diseases are of short duration, within which the patient is snuffed out, if not benefited by the treatment: chronic diseases give time for deliberation, and for change of remedies, so that when the practitioner is in attendance from the commencement, it is seldom that a docile patient should perish unless by the practitioner's default. A chronic disease, nevertheless, when it has become deep-seated, is no less difficult to deal with than an acute one. And indeed the older an acute malady, the more recent a chronic one, the more easily it is treated.

There is another point which should be borne in mind, that the same remedies do not suit all patients. Hence it is that the highest authorities proclaim as if they were the only remedies, now some, now others, each in accordance with what he has found successful. It is well, then, when any one remedy fails, to look not so much to the authority as to the patient, and to make trial, now of one, now of another remedy, taking care, however, that in acute diseases what is doing no good is changed quickly; in chronic diseases which it takes time to produce as well as to remove, if a remedy does not succeed at once, it should not be condemned at once, much less should it be discontinued if it is beneficial, though only to a small extent, because the progress is completed by time.

2 Now at their commencements, it is easy to recognize at once what is an acute disease, and what a chronic one, not only as regards those which take a uniform course, but also when the course is variable. For when severe paroxysms and pains are causing

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distress without intermission, the disease is acute: it becomes evident that the future course will be prolonged when there are but slight pains and fever, and when there are long intervals between the paroxysms, and there are in addition the signs which have been described in the preceding book. It is also to be noted whether the disease is increasing, or stationary, or lessening, because some remedies are suitable for increasing, more for declining maladies; and when an acute fever is increasing in urgency, remedies which are suitable in decreasing affections are to be tried rather during the remissions. A disease is increasing in urgency when pains and paroxysms occur with more severity, and when they both recur at shorter intervals, and desist later than before. And, in chronic diseases too, even if they do not present such characteristic signs, it may be recognized that the affection is increasing: if sleep is irregular; if digestion deteriorates; if the stools become more foul; the sense duller; the mind more sluggish; if a feeling of cold, or of heat, runs through the body, if the body becomes more pale. But opposite signs mark a decline in the disease. . . . In acute diseases, moreover, the patient is to be given food after more delay, and not until the paroxysm is already declining so that its force may be broken primarily by the withholding of nutriment; in chronic diseases, earlier, so that it may support the patient for the duration of his coming illness. But if sometimes, not the whole body, but a part only, is affected, still the support of the strength of the whole body rather than the curing by itself of the part diseased is of more importance. It makes a great difference also
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whether from the commencement the patient has been treated correctly or incorrectly, because treatment has less advantage in those cases in which a course has been persisted in without effort. If a patient lives through indiscreet treatment with his strength unimpaired, an appropriate treatment may restore him forthwith.

But as I commenced (II.2) with those symptoms which show some signs of impending illness, I shall make a beginning as to treatment by noticing the same period. If, therefore, any of the signs then referred to occur, the best treatment is rest and abstinence; if anything at all is to be drunk, let it be water, and it is sufficient for this to be continued sometimes for one day, sometimes, when alarming signs persist, for two days; on the day following the fast, food should be taken sparingly, and water drunk; the next day even wine, and then in turn, on alternate days, water and wine, until all anxiety is at an end. For often in this way a severe disease is dispersed while it is impending. And many deceive themselves with the hope of getting rid of the languor straightaway on the first day, either by exercise, or by a bath, or by a purge, or by an emetic, or by sweating, or by drinking wine: not but that such a procedure may succeed or not disappoint, but more often it fails, and abstinence by itself is a remedy without any risk; especially since it also admits of being modified in accordance with the degree of apprehension, and if the indications are of the slighter kind, it is enough to abstain from wine alone, its withdrawal being more advantageous than if something were subtracted from the food; if they are of somewhat greater severity, it is easy to limit the drink to water, and at

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the same time to withdraw meat from the diet, sometimes also to use less bread than usual, and to be content with moist food, especially pot-herbs; and it is sufficient to abstain entirely from food and wine, and from all bodily movement, only when serious symptoms have given rise to alarm. Nor is there a doubt that scarcely anyone falls ill who has hidden nothing but has countered disease in good time by these measures.

3 These then are the things to be done by those, who, being in health, have cause merely to be apprehensive. Now there follows the treatment of fevers, a class of disease which both affects the body as a whole, and is exceedingly common. Of fevers, one is quotidian, another tertian, a third quartan. At times certain fevers recur in even longer cycles, but that is seldom. In the former varieties both the diseases and their medicines are of various kinds.

Now quartan fevers have the simpler characteristics. Nearly always they begin with shivering, then heat breaks out, and the fever having ended, there are two days free; this on the fourth day it recurs.

But of tertian fevers there are two classes. The one, beginning and desisting in the same way as a quartan, has merely this distinction, that it affords one day free, and recurs on the third day. The other is far more pernicious; and it does indeed recur on the third day, yet out of forty-eight hours, about thirty-six, sometimes less, sometimes more, are in fact occupied by the paroxysm, nor does the fever entirely cease in the remission, but it only becomes less violent. This class most practitioners term hemitritaion.

Quotidian fevers, however, vary and have many

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forms. For some begin straightaway with a feeling of heat, others of chill, others with shivering. I call it a chill when the extremities become cold, shivering when the whole body shakes. Again, some desist so that complete freedom follows, others so that there is some diminution of the fever, yet none the less some remnants persist until the onset of the next paroxysm; and others often run together so that there is little or no remission, but the attacks are continuous. Again, some have a vehement hot stage, others a bearable one; some are every day equal, others unequal, and the paroxysm in turn slighter one day, more severe another: some recur at the same time the day following, some either earlier or later; some take up a day and a night with the paroxysm and the remission, some less, others more; some set up sweating as they remit, others do not; and in some, freedom is arrived at through sweating, in others the body is only made the weaker. But the paroxysms also occur sometimes once on any one day, sometimes twice or more often. Hence it often comes about that daily there are several paroxysms and remissions, yet so that each corresponds to one which has preceded it. But at times the paroxysms also become so confused together, that neither their durations nor intermissions can be observed. It is not true, as some say, that no fever is irregular unless as the outcome either of an abscess or of inflammation or of ulceration; for if this were true, the treatment always would be the easier, but what evident causes bring about, hidden ones can bring about also. And men are not arguing about facts but about words
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if, when during the same illness fevers come on in different ways, they say that these are not irregular returns of the same fever, but other different ones arising in succession; even though it were true, it would have nothing to do with the mode of treatment. The duration of remissions also is at times considerable, at other times scarcely of any length.

4 Such for the most part is the account of fevers; but there are different sorts of treatment in accordance with what is held by the several authorities. Asclepiades said that it is the office of the practitioner to treat safely, speedily, and pleasantly. That is our aspiration, but there is generally danger both in too much haste and too much pleasure. But what moderation must be shown, in order that as far as possible all those blessings may be attained, the patient's safety being always kept first, will be considered among the actual details of the treatment.

Before everything is the question as to what regimen the patient should keep to during the first days. The ancients tried to ensure assimilation by administering certain medicaments, because they dreaded indigestion most of all; next by the repetition of clysters they extracted the matter which appeared to be doing harm. Asclepiades did away with medicaments; he did not clyster the bowel with such frequency but still he generally did this in every disease; but the actual fever, he professed to use as a remedy against itself: for he deemed that the patient's forces ought to be reduced by daylight, by keeping awake, by extreme thirst, so that during the first days he would not allow even the mouth to be swilled out. Therefore those are quite wrong who

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believe that his regimen was a pleasant one in all respects; for in the later days he allowed even luxuries to his patient, but in the first days of the fever he played the part of torturer. Now in my opinion medicinal draughts and clysters should only be administered occasionally; and I consider that they should not be used as to pull to pieces the patient's strength, since the greatest danger is from weakness. There ought to be, therefore, only such a diminution of superfluous matter as is dispersed by natural processes when nothing is being added afresh. Hence for the first days there is to be abstinence from food; the patient is to keep in the light during the day unless weak, for this also clears the body; and so he ought to lie up in a room as . . . as possible. As regards indeed thirst and sleep, it should be so managed that he keeps awake during the day; at night as far as possible he should be at rest; and he should neither drink much nor be too much distressed by thirst; his mouth also can be swilled out when dry, if he has a bad taste in it, even though that is not the time suitable for a drink. And Erasistratus said appropriately that often whilst the inside does not require fluid, the mouth and throat require it, and it does not help to keep the patient in suffering. And for the first days, such ought to be the regimen.

But his best medicament is food opportunely given; the question is when it should first be garden. Most of the ancients gave it late, often on the fifth, often on the sixth day of illness, which the climate of Asia or of Egypt may perchance permit. Asclepiades, after he had for three days harassed the patient in every way, destined the fourth day for food. But Themison, recently, took into account

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not when the fever began, but when it ceased, or at any rate was alleviated; and awaiting the third day from that time, if there was no return of the fever, gave food at once; if fever recurred, he gave food when it ceased, or if it obstinately persisted, he certainly gave it if the fever abated. But on none of these matters is there actually an invariable precept. For it may be that the first food should be given on the first day, it may be on the second, it may be on the third, it may be not until the fourth or fifth day; it may be after one paroxysm, it may be after two, it may be after several. For it all depends upon the kind of disease, the patient's body, the climate, his age, and the time of year; where circumstances differ so greatly, there cannot be an invariable rule of time by any means. In the case of a disease which takes away more of the patient's strength, food is to be given earlier, and the same in a climate in which he uses up more. Hence in Africa it seems right that a patient should never fast over a day. Food should also be given sooner to a child than to an adolescent, sooner in summer than in winter. There is one thing that should be observed, always, and everywhere, that the patient's strength should be continually under the eye of the attending practitioner; and so long as there is a superfluity, he should counter it by abstinence; if he begins to fear weakness, he should assist with food. For it is his business to see that the patient is neither burdened by superfluous material nor rendered weak by hunger. And this I find also in the writings of Erasistratus; who although he did not direct when the bowels should be emptied, or when the body in general, nevertheless, by saying that such things should be seen to, and food given
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when it was needed by the body, showed sufficiently that food should not be given while the strength was in excess, but that care should be taken not to let it become deficient. Hence it can be understood that it is not possible for many patients to be cared for by one practitioner, and provided that he is skilled in the art, he is a suitable one who does not much absent himself from the patient. But they who are slaves to gain, since more is to be got out of a crowd, are glad to adopt those precepts which do not exact a sedulous attendance, as in this very instance. For even those who see the patient but seldom find it easy to count days or paroxysms; a physician must always be at hand, if he is to see the one thing that matters, the point when the patient is about to become too weak unless he gets food. The fourth day, however, is generally the most suitable date for beginning to give food.

But there is another uncertainty which concerns even the days themselves, since the ancients chiefly preferred the odd days and termed them critical, as though then the fate of the sick man was decided. These were the third, fifth, seventh, ninth, eleventh, fourteenth and twenty-first days, the most importance being attached to the seventh, next to the fourteenth and then to the twenty-first. Therefore they administered food to their patients as follows: they awaited paroxysms on odd days, and after that they gave food, as though slighter paroxysms were impending, insomuch that Hippocrates, when the fever desisted on any other than an odd day, was accustomed to fear a recurrence. Asclepiades has justly repudiated this as false, and he said that no day was more or less dangerous

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to patients for being even or odd. For sometimes even days are the worse, and it is more suitable to give food after paroxysms on these days. Sometimes even in the course of the same fever the daily order changes, and that day becomes graver which had wont to have more of a remission; and besides, the fourteenth day itself, which the ancients confessed to be of great importance, is an even day. Since they held that the eighth day had the character of the first day, because from it began the second numbering of seven, they contradicted themselves in not giving more importance to the eighth, tenth and twelfth days, for they gave more to the ninth and eleventh. After doing this without any rational probability, they went on from the eleventh,
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not to the thirteenth, but to the fourteenth day. There is even in Hippocrates this statement, that the fourth day is the gravest in the case of those whom the seventh day is to liberate. So according to that very authority, there may be on an even day both a graver fever and a certain sign of what will happen. In another passage the same authority regarded each fourth day, namely, the fourth, seventh, eleventh, fourteenth, and seventeenth, as the most effective in both respects. Thus he passed from an odd system of reckoning to an even one, yet did not, even then, keep to his proposition; for the eleventh is not the fourth day after the seventh, but the fifth. It is clear enough that by whatever reasoning we view this numbering, there is to be found nothing rational in that authority at least. But in these matters indeed the Pythagorean numbers, then quite famous, deceived the ancients, since here also the practitioner ought not to count days, but observe the actual paroxysms, and from these infer when food should be given.

But it is much more pertinent to this subject to know whether food should be given when the pulse has well quieted down, or while remnants of the fever still persist. For the ancients proffered food when the bodies were as far as possible from fever: Asclepiades did so when the fever was beginning to abate although present. In this he followed false reasoning; not that food may not be given earlier sometimes, if another paroxysm is feared soon, but it certainly ought to be given when the patient is at his soundest: for food is less corrupted when introduced into a body free from fever. Nor however, is that true, which Themison held, that if the patient was likely to be free from fever for a couple of hours, it was better to give food then, in order that the food might be distributed when the body was as far as possible fever-free. For if it were possible for it to be distributed so quickly, that would be the best plan; but since that short time does not allow of it, it is better that the first food should be received by a declining fever, rather than

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that remnants of food should be received by a recommencing fever. In this case, if the favourable time is longer, it should be given when the body is as free as possible; if short, even before it becomes quite free. But what also holds good for a full freedom does so also for a remission, which can occur, especially in the course of a continuous fever.

And there is the further question, whether it is necessary to wait for the same number of hours as the fever lasted, or if it is sufficient to suffer the first part of them to elapse so that the food may settle down more comfortably for the patient, if sometimes there is no intermission. It is safest, however, first to let pass the period of the whole preceding paroxysm, although in the case of a prolonged fever the patient may be indulged earlier, provided that half at least of that time has first passed. And this is to be observed not only in the fever just mentioned but in all.