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.
8 But when the fever is that kind of tertian which the physicians call hemitritaion, great care is required to avoid a mistake, for it has a number of frequently recurring paroxysms and remissions, so that it can appear to be some other class of disease and the fever may last from twenty-four to thirty-six hours, so that what is really the same paroxysm may not seem to be the same. And it is then exceedingly important not to give food except in that remission which is a real one, and when that does come, to give it at once. Many die suddenly from error one way or the other on the part of the practitioner. And unless something strongly prohibits, blood should be let at the onset, then food is to be given, which, without exciting the fever, should yet sustain a long course of it.
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.
11 Generally also preceding fevers there is a chill, and that is a most troublesome class of malady.
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When it is expected, the patient is to be prohibited from drinking anything: for this, given a little while beforehand, adds much to the illness. Likewise he is to be covered up quite soon with a quantity of bed-clothes; to the parts about which we feel concern there are to be applied such dry and hot foments as will not immediately set up a very vehement heat, but gradually increase it. The said parts are also to be rubbed by hands anointed with cold olive oil, to which has been added one of the heating agents. And some practitioners are satisfied with one rubbing of any kind of oil. During remissions of these fevers, some give three or four cupfuls of barley water even although some fever still persists; then, the fever having definitely ended, they reinvigorate the stomach with cold and light food. This, I think, should be tried only when there has been little benefit from food given once and at the end of the paroxysm. It must be carefully looked to, however, that the time of the remission is not deceptive; for often in this class of illness the fever seems to diminish, and then again becomes intense. Some degree of trust must be placed in that remission which is prolonged, and diminishes restlessness and the foulness of the mouth which the Greeks term ozaena. This is pretty generally agreed, that if the daily paroxysms are equal, a little food should be given every day: if the paroxysms are unequal, food should be given after the more severe, after the slighter ones hydromel.
12 Now shivering usually precedes those fevers which have a fixed cycle and a complete remission; hence they are the most safe, and specially admit of treatment. For when periodicity is uncertain,
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neither clyster nor bath, nor wine nor other medicament, is administered at the right moment: for it is uncertain when the fever will supervene, so that if it comes on suddenly, it may happen that there is the greatest harm in what is intended to serve as an aid. And there is nothing else that can be one, except for the patient to abstain strictly for the first days, then, upon the decline of that paroxysm which is the severest, to take food. When, however, there is an assured cycle, all those remedies are more easily tried, because we are more able to inform ourselves of the alternations between paroxysms and remissions. In those fevers, however, which have become inveterate, starving is not of service; it is only in the first days that the fever is to be thus countered; later the treatment is to be divided, first to disperse the shivering, then the fever. Therefore, as soon as the patient shivers, and after the shivering grows hot, he should be given to drink tepid water with a little salt in it, and so made to vomit: for generally such shivering arises from a bilious sediment in the stomach. Likewise if shivering recurs at the next cycle, the same should be done; for often the fever is thus shaken off, and now we may learn to what class it belongs. And so in view of the possibility of the next paroxysm, the third which may be threatening, the patient should be conducted to the bath, and it should be do arranged that he is already in the solium at the moment for the shivering. If there also he feels chilled, yet none the less he should do the same again in view of a fourth paroxysm, for often in that way the shivering is shaken off. If there is no benefit even from the bath, before the paroxysm let him eat garlic, or drink hot water containing pepper;
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to see if these when taken excite heat which prevents the shivering. Further in the same way as prescribed for a chill before shivering can come on, the patient should be covered up, and the whole body surrounded with foments — but the stronger ones are to be used at once — and thoroughly encompassed by wraps which enclose hot tiles and cinders. If, notwithstanding, shivering breaks out, let the patient be anointed freely under the wraps with hot oil, to which add one of the heating elements: let rubbing be applied, so far as he can bear it, especially of the arms and legs, while he holds his breath. Nor should it be stopped even if he shivers; for often the pertinacity of the rubber overcomes the body's malady. If he vomits somewhat, tepid water is to be given him, and he is to be forced to vomit again; the same measures must be used until shivering comes to an end. But if the shivering is too slow in subsiding, in addition to the above, a clyster should be given; for that also is of good effect by unloading the body. The last remedies after these are rocking and rubbing. Now in such illness the food to be given is such chiefly as will secure a soft motion, meat glutinous, wine, when any is given, dry.
13 The foregoing remarks apply to all periodic fevers: but they are to be distinguished, according to the dissimilar characters of each. If it is a daily fever, it is particularly important to abstain for the first three days, then to make use of food upon alternate days: if this fever has become inveterate, the bath and wine are to be tried at the end of the paroxysm, and especially so when the fever persists after the shivering has been removed.