6 But the rationing of patients' food is the easier because often the stomach spues it back, although the appetite is eager for it; over drink, however, there is a mighty battle, the more so the greater the fever. For fever inflames thirst, and then most demands water when it is most dangerous. But
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the patient is to be taught that when the fever quiets down, thirst also will become quiet at once, and that the paroxysm will be prolonged if any sustenance is given to it: thus he who does not drink will the sooner cease to be thirsty. It is necessary, however, seeing that even in health hunger is more easily borne than thirst, to indulge patients more as to drink than food. But on the first day, at any rate, no fluid at all should be given, unless the pulse sinks so suddenly that food as well ought to be given: on the second day too and even on later days upon which food is not given, yet if great thirst oppresses, drink should be given. And indeed that dictum of Heraclides of tarentum was not wanting in reason: whenever either bile or indigestion disorders the patient, it is also expedient by draughts in moderation to mingle fresh material with the decomposing. We must see that, just as times are appointed for food, so they are appointed also for drink when given apart from food, . . . or when we want the patient to get the sleep which thirst usually prevents. But there is sufficient agreement that for all who are feverish an excess of fluid is unsuitable, and especially for women who have lapsed into fever after childbirth.
But although the character of the fever, and of its remission, fixes the time for giving food and drink, yet it is not very easy to know when the patient has fever, when he is better, when he is becoming worse: without which food and drink cannot be administered. For the pulse upon which we mostly rely (III.4, 16) is a very deceptive thing, because often it is rendered slower or faster by age and by sex and by constitution. And very frequently when the body is fairly healthy, if the stomach is weak,
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also at times when a fever is beginning, the pulse is low and quiescent, so that possibly a patient may seem weak who will yet easily support the impending severe paroxysm. On the contrary, the bath and exercise and fear and anger and any other feeling of the mind is often apt to excite the pulse; so that when the practitioner makes his first visit, the solicitude of the patient who is in doubt as to what the practitioner may think of his state, may disturb the pulse. On this account a practitioner of experience does not seize the patient's forearm with his hand, as soon as he comes, but first sits down and with a cheerful countenance asks how the patient finds himself; and if the patient has any fear, he calms him with entertaining talk, and only after that moves his hand to touch the patient. If now the sight of the practitioner makes the pulse beat, how easily may a thousand things disturb it! Another thing which we put faith in, a sensation of heat, is equally fallacious: for it may be excited by hot weather, by work, by sleep, by fear, by anxiety. Such things also should be noted indeed, but not altogether relied on. And we know at once that he is not feverish, whose pulse is of natural regularity, and his warmth such as is customary in health: we must not, however, at once assume fever if there is heat and high pulse, but under the following conditions: if also the surface of the skin is dry in patches; if both the forehead feels hot, and it feels hot deep under the heart; if the breath streams out of the nostrils with burning heat; if there is a change of colour whether to unusual redness or to pallor; if the eyes are heavy and either very dry or somewhat moist; if sweat, when there is any, comes in patches; if the
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pulse is irregular. On this account the practitioner should not take his seat in a dark part of the room, nor at the patient's head, but he should face the patient in a good light, so that he may note all the signs from his face as he lies in bed. Now when there has been fever and it has decreased, one should observe whether the temples or other parts of the body are becoming a little moist, which is evidence that sweating is about to set in; and if there is any sign of it, then and not before hot water should be given to drink, of which the effect is salutary if it causes a general sweating all over the body. Now to promote this the patient should keep his hands well covered under the bed-clothes, and do the same with his legs and feet. But it is a mistake to torment patients with bed-clothes, as many do, at the very paroxysm of the fever, worst of all when it is an ardent fever. If the body begins to sweat, a linen towel should be warmed, and each part gradually wiped over. But when the sweating has quite ended, or if none has come, when the patient seems in the most fit state for food, he should be anointed lightly under the bedclothes, next wiped over, and then given food. For patients in fever, liquid food is best, or whatever approximates to fluid, and that of the lightest possible kind, barley gruel in particular; and if there have been high fevers, that should be of the thinnest. Honey also which has been freed from the comb may be correctly added to give the body more nutriment; not if it upsets the stomach this is unnecessary, as also is the gruel itself. But in its place can be given either crumbled bread or washed spelt groats in hot water; in hydromel if the stomach is firm and the bowels tight,
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or in vinegar and water if the former is weak and the latter loose. And indeed this will suffice for food on the first day; then on the next day some addition can be made, yet from the same class of food, either pot-herbs or shell-fish or orchard fruit. And whilst fevers are on the actual increase, this is the only suitable food; but when the fevers have subsided or abated, a beginning indeed is to be made always with something of the lightest kind, then something to be added of the middle class, regard being had throughout both to the patient's strength and to his disease. A variety of food may be placed before the patient as Asclepiades prescribed, only when he is troubled by loss of appetite, and insufficiency of strength, in order that by tasting a little of each he may avoid starvation. But if there is no lack of strength nor loss of appetite, the patient should not be tempted by a variety of food, lest he take more than he can digest. And there is no truth in what Asclepiades said, that a variety of food is more easily digested; for it is eaten more readily, but digestion depends upon what the food is, and how much. Nor is it safe for the patient to be filled up with food whilst there are great pains, nor during an increase of the malady, but only after his illness has turned towards improvement.
In fevers there are also other things that have to be observed. And this also must be noted, which some give as their sole precept, whether the body is constricted or relaxes; the first condition chokes it, the second wastes it away.
For if there is constriction, the bowels are to be moved by a clyster, urination promoted, and sweating elicited in every way. In this class of maladies it is
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beneficial to let blood, to shake up the body by vigorous rocking, to keep the patient in the light, to impose hunger and thirst and wakefulness. It is also useful to take the patient to the bath, putting him first into the solium, next to anoint him, then to return him to the solium again and foment his groins with plenty of water; at times also oil may be mixed with the water in the solium; food is to be used later and not too often: it is to be thin, plain, soft, hot, scanty, consisting mainly of pot-herbs, such as sorrel, nettle-tops, mallow, and also of soup made from shell-fish, mussels or spiny lobsters. No meat should be given unless boiled. But as to drink, there should be more freedom, both before and after and along with food, beyond what thirst demands. Again, after the bath wine of fuller body and sweeter can also be given; once or twice Greek salted wine can be used.
On the contrary, however, if the system is relaxed, sweating is to be suppressed, rest in a dark room resorted to, and sleep allowed at will; the body is to be rocked only in the lightest fashion, and helped as may suit the illness. For if the patient has loose motions, or if the stomach does not retain its contents, when the fever has subsided he should be given a large drink of tepid water, and be induced to vomit, unless the throat or the chest or the side is painful, or the disease is of long standing. But if sweating is troublesome, the skin should be hardened by nitre or salt, mixed with oil; and if the sweating is rather slight, the body is to be anointed with olive oil: if more profuse, with rose, quince, or myrtle oil, to which a dry wine should be added. But any patient with loose motions, when he reaches the bath, should
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be first anointed, then put into the solium. When there is anything wrong with the skin, it is better to use cold rather than hot water. Coming to the food, this should be nutritious, cold, dry, plain, with the least possible tendency to decomposition, bread toasted, meat roasted, wine dry or at any rate somewhat dry; if the bowels are loose, the wine should be hot, but cold when there is trouble from sweating or vomiting.
7 Among fevers the case of pestilence demands special consideration. In this it is practically useless to prescribe fasting or medicine or clysters. If strength permits of it, blood-letting is best, and especially if there is fever with pain: but if that is hardly safe, after the fever has either declined or remitted, the chest is cleared by an emetic. But in such cases the patient requires to be taken to the bath earlier than in other affections, to be given hot and undiluted wine, and all food glutinous, including that sort of meat. For the more quickly such violent disorders seize hold, the earlier are remedies to be taken in hand, even with some temerity. But if a child is the sufferer, and not robust enough for lo-letting to be possible, thirst is to be used in his case, the bowels are to be moved by a clyster whether of water or of pearl-barley gruel; then and not before he is to be sustained by light food. Indeed in general children ought not to be treated like adults. Therefore, as in any other sort of disease, we must set to work with more caution in these cases; not let blood readily, not readily clyster, not torment by wakefulness and by hunger or excess of thirst, nor is a wine treatment very suitable. After the remission of the fever a vomit is to be elicited, then
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food of the lightest nature is given, after which let the child sleep; next day, if the fever persists, let the child be kept without food, and on the third day return to food as above. Our aim should be, as far as possible to sustain the child, by food when suitable, with abstinence in between when suitable, omitting all else.
But if an ardent fever is parching up the patient, no medicinal draught is to be given, but during the paroxysms he is to be cooled by oil and water, mixed by the hand until they turn white. He should be kept in a room where he can inhale plenty of pure air; he is not to be stifled by a quantity of bed-clothes, but merely covered by light ones. Vine leaves also which have been dipped in cold water can be laid over the stomach. He is not even to be distressed by too much thirst; he should get food fairly soon, namely from the third day, and after being anointed beforehand. If phlegm collects in the stomach, when the paroxysm has already declined he is to be made to vomit; then to be given cold salads, or orchard fruit agreeable to the stomach. If the stomach remains dry, there should be given to begin with either pearl barley or spelt or rice gruel with which fresh lard has been boiled. Whilst the fever is at its height, certainly not before the fourth day, and if there is already great thirst, cold water is to be administered copiously so that the patient may drink even beyond satiety. As soon as the stomach and chest have become replete beyond measure and sufficiently cooled, he should vomit. Some do not even insist on the vomit, but use the cold water by itself, given up to satiety, as the medicament. When either of the above has been done, the patient is to
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be well wrapped up and put to bed so that he may sleep; and generally, after prolonged thirst and wakefulness, after full sating with water, after making a break in the heat, there comes abundant sleep: which brings on a profuse sweat, and this is an immediate relief, but only to those who have no pains accompanying the ardent fever, no swelling of the parts below the ribs, nothing prohibitory either in the chest or in the lung or in the throat, no ulcerations, no diarrhoea, no flux from the bowel. But if in fever of this sort the patient coughs readily, he is not to be distressed by severe thirst, nor ought he to drink water cold, but he is to be treated in the way prescribed for other fevers.
9 Sometimes also slow fevers hold the body without any remission, and give no place for either food or any medicament. In that case it should be the aim of the practitioner to change the disease, for
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perhaps that will make it more amenable to treatment.. For this object cold water, to which oil has been added, should be sprinkled at frequent intervals over the patient's body, for it thus comes about now and again that a shivering follows, and some beginning of a fresh pulse motion, and after this when, after the body has become hotter, there may even follow a remission. Rubbing with oil and salt appears also to benefit such cases. But if for a long while there is a chill, and a numbness and a tossing of the body, it is not unfitting to administer three or four cups of honeyed wine even while the fever is present, or food along with wine well diluted. For often in this way the fever is augmented, and the increased heat which arises simultaneously both relieves the pre-existing disorders and offers hope of a remission, and through that of treatment. Assuredly that treatment is no novelty by which some nowadays at times cure by contrary remedies patients who have been handed over to them, after dragging on under more cautious practitioners. Even among the ancients, before Herophilus and Erasistratus, but especially after Hippocrates. There was a certain Petron, who on taking over a patient with fever, covered him with a quantity of clothes in order simultaneously to excite great heat and thirst. Then when the fever began to remit somewhat, he gave cold water to drink; and if this raised a sweat, he declared that the patient was recovering; if it did not, he administered even more cold water and then forced him to vomit. If by either of the above ways he had rendered the patient free from fever, he at once gave him roast pork and wine; if he had not so freed him, he boiled water
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with salt, and obliged the patient to drink it, in order that by moving the bowels he might cleanse the stomach. And the above formed the whole of this man's practice; and it pleased those whom successors of Hippocrates had failed to cure, no less than in our time it pleases those, who, after they have dragged on for a long while under disciples of Herophilus and Erasistratus, have not been benefited. Yet it is harsh treatment none the less, for if it is adopted forthwith at the commencement, it kills many patients. Since, however, it is impossible for the same remedies to suit everybody, rashness helps those whom the usual regimen has not made well; hence it is that practitioners of this class manage other people's patients better than their own. Yet it is the part also of a circumspect man at times to renew and increase a disease and to inflame fevers, for when the existing condition does not answer to a treatment, that which is to come may do so.
10 We must also take into consideration whether fevers exist alone, or whether there are additional troubles, namely whether the head aches, whether the tongue is roughened, whether the chest is tight.
If there is headache, rose oil should be mixed with vinegar and poured over the head; next two strips of linen are taken, each corresponding in length and breadth to the forehead, of which in turn one is placed in the rose oil and vinegar, the other on the forehead; or unscoured wool is soaked in the same and applied. If the vinegar hurts, the rose oil alone is to be used; if rose oil itself irritates, then bitter olive oil. If there is little relief from the above, we may pound up either dried orris root, or bitter almonds, or some other from among refrigerant
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herbs; any one of these applied with vinegar lessens pain, one more in one case, another in another. There is benefit from the application of bread soaked in poppy head decoction, or in rose oil containing cerussa or litharge. Also it is not unsuitable to snuff up thyme or dill.
But first there is inflammation and pain in the chest, the first thing is to apply to it repressing plasters, lest more diseased matter should gather there, if hotter ones were applied; next, when the primary inflammation has subsided, and not before, we must go on to hot and moist plasters, in order to disperse what remains of the matter. Now the signs of an inflammation are four: redness and swelling with heat and pain. Over this Erasistratus greatly erred, when he said that no fever occurred apart from inflammation. Therefore if there is pain without inflammation, nothing is to be put on: for the actual fever at once will dissolve the pain. But if there is neither inflammation nor fever, but just pain in the chest, it is allowable to use hot and dry foments from the first.
Again if the tongue is dry and scabrous, it is to be wiped over first with a pledget of wool dipped in hot water, then to be smeared with a mixture of rose oil and honey. Honey cleans, rose oil represses and at the same time does not allow the tongue to dry. But if the tongue is not scabrous, only dry, after being wiped over with the pledget of wool, it should be smeared with rose oil to which a little wax has been added.