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 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 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 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 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 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 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 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 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 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 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, 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 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.

5 The foregoing rules are rather of general application to fevers of all sorts: now I pass to their particular kinds. If, therefore, there has been only one paroxysm, then an intermission, and the fever arises either from the groin, or from fatigue, or from hot weather, or some other similar thing, and so that it gives no apprehension of a more internal cause, then on the day following, when the time for the recurrence of a paroxysm has elapsed without any disturbance, food can be given. But when there supervenes a deeply seated heat and a sense of weight, whether in the head or in the parts below the ribs, and it is not evident what is disturbing the system, even although freedom follows upon a single paroxysm, nevertheless the third day is to be awaited because a tertian is to be apprehended; and when the time for such a paroxysm has passed, food is to be given, but in small amount, because a quartan may yet be apprehended; and not until the fourth day, if the body is still free, may it be used with confidence. But if on the second, or third, or fourth day fever has recurred, the disease can be recognized. But tertian and quartan fever in which there is both a definite cycle ending in freedom from fever, and ample periods of quiet, are most quickly dealt with, and of these I will speak in their proper place (III.14, 15). Now, however, I will explain the treatment of those fevers which cause trouble every day. Food, therefore, is more suitably given to the patient upon alternate days, in order one day to diminish the fever, the other to recruit his strength. But if it be that sort of quotidian fever in which there is a complete intermission, food should be given immediately upon the body becoming fever-free: if, although there are no paroxysms, the fever is nevertheless continuous and daily increasing, but with remissions that are not complete, food should be given when the system is in that state that no major remission is expected; if the paroxysm on one day is more severe, on the next day milder, food is to be given after the more severe paroxysm. But if the fever continues without ever becoming milder, and it is necessary to give food, there is a great controversy as to the time when it should be given. Some, because patients generally have more of a remission early in the morning, think that food should be given then. But if this answers, the reason for giving food is not the fact that it is morning, but the fact that the patient has more of a remission. But if the patient has no relief even in the morning, it becomes all the worse time for food, just because, although by itself that time should be better, owing to the fault of the disease it is not so; and at the same time, it is followed by midday, after which generally patients become worse, and so it may be feared that the patient may become more distressed than usual. To such a patient, therefore, others give food in the evening: but since at that time those who are ill are generally at their worst, there is fear that any action we may then take may exasperate the fever somewhat. For these reasons I delay until midnight, that is, when one critical time is over, and the next furthest off, whilst the hours which follow before dawn are those during which all patients generally sleep the most; after that comes early morning, naturally a period of greatest relief. If, however, fevers are erratic, since there is apprehension that paroxysms may immediately follow food, whenever a patient begins to have relief after a paroxysm, then food ought to be taken. But if several paroxysms occur on the same day, it should be noted whether they are equal in all respects, which can scarcely ever be the case, or unequal. If they are equal in all respects, food should be given rather after any paroxysm which does not desist between midday and evening. If they are unequal, it is to be considered in what way they differ; for if one is more severe and another slighter, food should be given after the more severe; if one lasts longer, another a shorter time, after the longer; if one is more severe, another more prolonged, it is to be observed which of thetwo causes more distress, the former by its severity, or the latter by its length, and food must be given after the one which causes the most distress. But what matters almost more than anything is, how long and of what kind are the remissions between them: for if after one paroxysm shivering persists, after another the body is free from this, the more suitable time for food is when the body is free. If a slight feverishness persists all the time, but a longer period of remission occurs at one time than at another, that is the time to be selected; so that, when paroxysms are continuous, straightway, when the first one has begun to pass off, food may be given. For it is the general rule to which every pan of treatment should be directed, to give food always as long as possible before the next ensuing paroxysm, and while keeping this rule, to give the food when the body is most free from fever. This should be observed not merely with two paroxysms but also with several. But although it is most proper to give food on alternate days, yet if the system is weak, it should be given every day; and far more so if the fevers continue without remissions, inasmuch as they distress the patient more; or when two or more paroxysms occur on the same day. This occurrence renders it necessary that immediately from the first day, food must be administered daily if the pulse has immediately become weak, and several times on the same day, if in the course of several paroxysms there is progressive diminution of the bodily strength. However, in these cases we must keep to this rule, that less food is to be given after paroxysms of such a kind that no food at all would be given after them if the bodily condition allowed it. When, however, a fever threatens, begins, increases, continues stationary, declines, then persists at a low level, or terminates, it should be recognized that the best time for food is after the fever has terminated; next, when it is continuing at a diminished level; and thirdly, if need be, whenever there is a decline; all other times are dangerous. If, however, there is urgent necessity on account of weakness, it is better to give some food when the increase in the fever has become stationary, rather than whilst it is increasing, better whilst the paroxysm is as yet imminent, rather than after it has commenced, nevertheless with this proviso, that there is no time at which a patient who is failing should not be supported. Most emphatically, it is not enough for the practitioner to pay attention merely to the actual fevers, but also he must look to the habit of the body as a whole, and direct treatment to that, whether patients have superabundance or deficiency of strength, or whether there are other intervening affections. While, however, it is always of advantage for patients to be free from care, so that they may suffer in body alone, and not also in spirit, it is so especially after food has been taken. Therefore if there are any things which might exasperate their emotions, it is best to withhold these from notice whilst they are ill: if this cannot be done, nevertheless to keep all back after food, until the time of sleep, and to tell them when they wake up.

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 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, 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 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, 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 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 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 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 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 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 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 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. 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, 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; 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.

14 But if it be a tertian, when there are complete intermissions, or a quartan, on the intermediate days the patient should make use of walking and of other exercises and of anointings. In this kind of malady, well before the paroxysm, a certain Cleophantus, one of the ancient physicians, poured over the patient's head quantities of hot water; and then gave wine. Asclepiades, although he followed many of this man's precepts, rejected this one, and rightly, for it is of doubtful effect. In the case of a tertian fever, Asclepiades said that on the third day following the paroxysm, the bowels should be moved by a clyster; on the fifth day after the shivering a vomit should be elicited; then, after the paroxysm, according to the custom of Cleophantus, patients whilst still heated were to be given food and wine, on the sixth day to be kept in bed; for so he hoped to prevent a paroxysm on the seventh day. It is likely that this may often happen. It is safer, however, so that we may use the exact order laid down, to try the three remedies, vomiting, clystering, and wine-drinking, on three several days, that is, on the third, fifth and seventh days, with this proviso that on the seventh day wine is not to be drunk until after the time for the paroxysm. But if a tertian fever is not dispersed within the first days, but is becoming chronic on the day that the paroxysm is expected, the patient should keep his bed; after the paroxysm he should be rubbed, then, having taken food, drink water; on the day following, which is free from fever, the patient should keep quiet, avoid exercise and anointing, and be content with water only. And that indeed is the best procedure; but if there is urgent weakness, he may both take wine after the paroxysm and a little food on the intermediate day.

15 In a quartan fever the same should be done. But seeing that unless it has been shaken off within the first days, it is a long while in terminating, we must be more careful from the very first to lay down what should be done in it. Therefore if a paroxysm has set in with shivering and has remitted, the patient ought to observe a regimen on the same day and on the following and on the third day; on the first day after the paroxysm he should take only hot water; on the next two days abstain if possible even from that;; on the fourth day, if the fever recurs with shivering, he should vomit, as was prescribed before; then after the paroxysm he should take a limited quantity of food and of wine four ounces. On the next two days he should fast, taking only hot water if thirsty. On the seventh day the cold stage should be anticipated by the bath; if a paroxysm recurs, the bowels should be moved by a clyster; having settled down after the clyster, the patient should be anointed and rubbed vigorously; then take food and wine as above; on the next two days abstain, and undergo rubbing. On the tenth day trial is again made of the bath; and if after that a paroxysm follows, he should in the same way be rubbed, and drink wine more freely. And it is likely that so many days of fasting, along with the other measures prescribed, will get rid of the fever. But if the quartan fever persists notwithstanding, a totally different line of treatment is to be pursued, the aim being that the body may easily bear what has to be borne for a long while. Therefore we cannot approve the practice of Heraclides of Tarentum, who said that in the first days the bowel was to be clystered and then there was to be abstinence until the seventh day. Even supposing a man could endure this, yet if he does become freed from fever, he will have scarcely strength enough to recover; they themselves if there be more frequent recurrences of the fever he will sink. If, therefore, the disease shall remain on the thirteenth day, the bath should not be tried, either before or after the paroxysm, except occasionally when the shivering has been thrown off. The actual shivering is to be driven off by the measures above prescribed; then after the paroxysm it will be proper that the patient be anointed, and rubbed vigorously, and take food both nourishing and abundant, with as much wine as he likes; on the day following, when sufficiently rested, he is to walk, to take exercise, to be anointed and vigorously rubbed, then to take food without wine, and on the third day to abstain. On the day that a recurrence of the paroxysm is expected, he should get up beforehand, and so arrange the performance of the exercises that the time for the onset of the fever concurs with that of the exercise; for often in this way the paroxysm is thrown off. But if attacked during the exercise, he should thereupon return home to bed. In this kind of sickness the remedies are: anointing, rubbing, exercise, food, wine. If constipated, the bowels are to be clystered. But whilst the stronger patients can easily carry out the above, if weakness has supervened, rocking should replace exercise; if even that cannot be borne, nevertheless rubbing should be applied. If this also, when vigorous, is trying to the patient, treatment should be restricted to rest and anointing and food; care being taken that indigestion does not convert the quartan into a quotidian fever. For a quartan kills no one, but when a quotidian is made out of it, the patient is in a bad way; this, however, does not happen unless through the fault either of the patient or of the practitioner.

16 But if there is a double quartan fever, and those exercises which I have mentioned cannot be adopted, either the patient should rest entirely, or if that is difficult walk quietly, then sit with his feet and head carefully wrapped up; as often as a paroxysm has recurred and has remitted, he should take food in moderation and wine; for the remainder of the remission, unless there is urgent weakness, he should fast. But if two paroxysms are almost continuous, he should take food after both are over; then in the intermission he should move about a little, and after being anointed take food. Now since an inveterate quartan is seldom got rid of except in the spring, it is at that season especially that attention is to be given, lest something occur to hinder recovery. And it is of advantage in an old quartan to later now and then the class of diet, and change from wine to water, from bland food to acrid, from acrid to bland; to eat radish, then to vomit; to move the bowels by shell-fish or chicken broth; to add heating agents to the oil for rubbing; before the paroxysm to sip two cups of vinegar, or one cup of mustard in three of Greek salted wine, or pepper, castoreum, laser and myrrh in equal proportions in water. For by these and such-like remedies the system is to be stirred up in order that it may be moved from the state in which it is being held. When the fever has quieted down, for a long while it is well to keep in mind the day on which it occurred, and on that day to avoid cold, heat, indigestion, fatigue: for fever readily recurs unless even a convalescent patient fears that day for some time to come.

17 But if a quotidian has been made out of a quartan fever, since this may have happened from mismanagement, the patient ought to fast for two days, make use of rubbing, and be given only a drink of water in the evening: it often happens that on the third day there is no paroxysm. But whether or not, food should be given after the time for the paroxysm. But if this fever persists, a two days' fast should be enjoined so far as the system can bear it, and rubbing used every day.

18 The regimen of fevers has now been expounded; there are, however, other affections of the body which follow upon this, among which I subjoin in the first place those which cannot be assigned to any definite part.

I shall begin with insanity, and first that form of it which is both acute and found in fever. The Greeks call it phrenesis. Before all things it should be recognized, that at times, during the paroxysm of a fever, patients are delirious and talk nonsense. This is indeed no light matter, and it cannot occur unless in the case of a severe fever; it is not, however, always equally dangerous; for commonly it is of short duration, and when the onslaught of the paroxysm is relieved, at once the mind comes back. This form of the malady does not require other remedy than that prescribed for the curing of the fever. But insanity is really there when a continuous dementia begins, when the patient, although up till then in his sanity in his senses, yet entertains certain vain imaginings; the insanity becomes established when the mind becomes at the mercy of such imaginings. But there are several sorts of insanity; for some among insane persons are sad, others hilarious; some are more readily controlled and rave in words only, others are rebellious and act with violence; and of these latter, some only do harm by impulse, others are artful too, and show the most complete appearance of sanity while seizing occasion for mischief, but they are detected by the result of their acts. Now that those who merely ave in their talk, or who make but trifling misuse of their hands, should be coerced with the severer forms of constraint is superfluous; but those who conduct themselves more violently it is expedient to fetter, lest they should do harm either to themselves or to others. Anyone so fettered, although he talks rationally and pitifully when he wants his fetters removed, is not to be trusted, for that is a madman's trick. The ancients generally kept such patients in darkness, for they held that it was against their good to be frightened, and that the very darkness confers something towards the quieting of the spirit. But Asclepiades said that they should be kept in the light, since the very darkness was terrifying. Yet neither rule is invariable: for light disturbs one more, darkness another; and some are met with in whom no difference can be observed, either one way or the other. It is best, therefore, to make trial of both, and to keep that patient in the light who is frightened by darkness, and him in darkness who is frightened by light. And when there is no such difference, the patient if strong should be kept in a light room, if not strong he should be kept in a dim one. Now it is useless to adopt remedies when the delirium is at its height; for simultaneously fever is also increasing. So then there is nothing else to do than to restrain the patient, but when circumstances permit, relief must be given with haste. Asclepiades said that in such cases to let blood is to commit murder; following the line of reasoning, that there was no insanity unless with high fever, and that properly blood was let only during the stage of remission. But he himself in these cases sought to bring on sleep by prolonged rubbing, though it is the intensity of the fever which hinders sleep, and it is only during the remission that rubbing is of service. Hence he ought to have passed over this remedy also. What then is there to do? Many things may be rightly done in imminent danger, which otherwise ought to be omitted. And fever also, when continuous, has times during which, although it does not remit, yet it does not increase, and this time, although not the best, yet is the second best time for remedies; and at this time blood ought to be let, if the patient's strength allow it. There can be less question as to whether a motion should be induced. Next, after a day's interval, the head should be shaved bare and then fomented with water in which vervains or other repressive herbs have been boiled; alternatively it is proper first to foment, then to shave, and again to foment; and lastly to pour rose oil over the head and into the nostrils; also to hold to the nose rue pounded up in vinegar, and to excite sneezing by drugs efficacious for the purpose. Such things, however, should be done only in the case of those who are not lacking in strength; but if there is weakness, the head is merely moistened by rose oil to which thyme or something similar has been added. Whatever the patient's strength, the two herbs, bitter-sweet and pellitory, are beneficial, if the head is wetted with the juice expressed from both simultaneously. When the fever has remitted, recourse should be had to rubbing, more sparingly, however, in those who are over-cheerful, than in those who are too gloomy. But in dealing with the spirits of all patients suffering from this type of insanity, it is necessary to proceed according to the nature of each case. Some need to have empty fears relieved, as was done for a wealthy man in dread of starvation, to whom pretend legacies were from time to time announced. Others need to have their violence restrained as is done in the case of those who are controlled even by flogging. In some also untimely laughter has to be put a stop to by reproof and threats; in others, melancholy thoughts are to be dissipated, for which purpose music, cymbals, and noises are of use. More often, however, the patient is to be agreed with rather than opposed, and his mind slowly and imperceptibly is to be turned from the irrational talk to something better. At times also his interest should be awakened; as may be done in the case of men fond of literature, to whom a book may be read, correctly when they are pleased by it, or incorrectly if that very thing annoys them; for by making corrections they begin to divert their mind. Moreover, they should be pressed to recite anything they can remember. Some who did not want to eat were induced to do so, by be placed on couches between other diners. But certainly for all so affected sleep is both difficult and especially necessary; for under it many get well. Beneficial for this, as also for composing the mind itself, is saffron ointment with orris applied to the head. If in spite of this the patients are wakeful, some endeavour to induce sleep by draughts of decoction of poppy or hyoscyamus; others put mandrake apples under the pillow; others smear the forehead with cardamomum balsam or sycamine tears. This name I find used by practitioners, but there are no tears on the mulberry, although the Greeks call the mulberry sycaminon. What in fact is meant are the tears of a tree growing in Egypt, which they call in that country sycamoros. Many foment the face and head at intervals with a sponge dipped in a decoction of poppy heads. Asclepiades said that these things were of no benefit, because they often produced a change into lethargy (III.20); but he prescribed for the patient that during the first day he should keep from food, drink and sleep, in the evening water should be given him to drink, after which he should be rubbed with gentleness, but the rubber must not press hard even with the hand (II.14); during the day following the same was to be done, then in the evening gruel and water should be given and rubbing again applied: for by this he said we should succeed in bringing on sleep. This does happen sometimes, and to such a degree that Asclepiades allowed that excess of rubbing may even cause danger of lethargy. But if sleep does not thus occur, then at length it is to be procured by the above medicaments, having regard, of course, to the same moderation, which is necessary here also, for fear we may afterwards not be able to wake up the patient whom we wish to put to sleep. Sleep is also assisted by the sound of falling water near by, also rocking after food and at night, and especially the motion of a slung hammock (II.15). If blood has not been let before, and the patient's mind is unstable and sleep does not occur, it is not unfitting to apply a cup over an incision into the occiput, which can produce sleep because it relieves the disease. Now moderation in food is also to be observed: for the patient ought not to be surfeited lest it madden him, and he should certainly not be tormented by fasting lest he collapse through debility. The food should be light, in particular gruel, and hydromel for drink, of which three cups are enough, given twice a day in winter, and four times in summer.

There is another sort of insanity, of longer duration because it generally begins without a fever, but later excites a slight feverishness. It consists in depression which seems caused by black bile. Blood-letting is here of service; but if anything prohibit this, then comes firstly abstinence, secondly a clearance by white hellebore and a vomit. After either, rubbing twice a day is to be adopted; if the patient is strong, frequent exercise as well: vomiting on an empty stomach. Food of the middle class should be given without wine; but as often as I indicate this class of food, it should be understood that some of the weakest class of food also may be given, provided that this is not used alone; and that it is only the strongest class of food which is excluded. In addition to the above: the motions are to be kept very soft, causes of fright excluded, good hope rather put forward; entertainment sought by story-telling, and by games, especially by those with which the patient was wont to be attracted when sane; work of his, if there is any, should be praised, and set out before his eyes; his depression should be gently reproved as being without cause; he should have it pointed out to him now and again how in the very things which trouble him there may be a cause of rejoicing rather than of solicitude. When there is fever besides, it is to be treated like other fevers.

The third kind of insanity is of all the most prolonged whilst it does not shorten life, for usually the patient is robust. Now of this sort there are two species: some are duped not by their mind, but by phantoms, such as the poets say Ajax saw when mad or Orestes; some become foolish in spirit.

If phantoms mislead, we must note in the first place whether the patients are depressed or hilarious. For depression black hellebore should be given as a purge, for hilarity white hellebore as an emetic; and if the patient will not take the hellebore in a draught, it should be put into his bread to deceive him the more easily; for if he has well purged himself, he will in great measure relieve himself of his malady. Therefore even if one does of the hellebore has little effect, after an interval another should be given. It should be known that a madman's illness is less serious when accompanied by laughter than by gravity. This also is an invariable precept in all disease, that when a patient is to be purged downwards, his belly is to be loosened beforehand, but confined when he is to be purged upwards.

If, however, it is the mind that deceives the madman, he is best treated by certain tortures. When he says or does anything wrong, he is to be coerced by starvation, fetters and flogging. He is to be forced both to fix his attention and to learn something and to memorize it; for thus it will be brought about that little by little he will be forced by fear to consider what he is doing. To be terrified suddenly and to be thoroughly frightened is beneficial in this illness and so, in general, is anything which strongly agitates the spirit. For it is possible that some change may be effected when the mind has been withdrawn from its previous state. It also makes a difference, whether from time to time without cause the patient laughs, or is sad and dejected: for the hilarity of madness is better treated by those terrors I have mentioned above. If there is excessive depression light and prolonged rubbing twice a day is beneficial, as well as cold water poured over the head, and immersion of the body in water and oil. The following are general rules: the insane should be put to fatiguing exercise, and submitted to prolonged rubbing, and given neither fat meat nor wine: after the clearance the lightest food of the middle class is to be used; they should not be left alone or among those they do not know, or among those whom either they despise or disregard; they ought to have a change of scene, and if the mind returns, they should undergo the tossing incident to travel (II.15), once a year.

Rarely, yet now and then, however, delirium is the produce of fright; this class of insanity, has similar sub-divisions, and is to be treated by the same species of dietetic regimen, except that, in this form of insaneness alone, wine is properly given.

19 That kind of affection which the Greeks call cardiac is a complete contrast to the foregoing diseases, although insane persons often pass over into it; in those the mind gives way, in this it holds firm. Indeed the illness is nothing other than excessive weakness of the body, which, while the stomach is languid, wastes away through immoderate sweating. And it may be recognized at once by the exiguous and weak pulsation of the blood vessels, while sweat, at once unaccustomed and excessive and untimely, breaks out all over the chest and neck, and even over the head, the feet and legs remaining more dry and cold; and it is a form of acute disease.

The primary treatment is the application over the chest of repressant plasters; the secondary, to stop sweating. The latter is accomplished by bitter olive oil, or rose or quince or myrtle oil, with any of which the body is to be lightly anointed, then a salve made up of any of them is to be applied. If the sweating wins, the patient is to be smeared over with gypsum or litharge or cimolian chalk, or even powdered over with the same at intervals. A powder consisting of the pounded leaves of dried myrtle or of blackberry, or of the dried lees of dry and good wine, attains the same end; there are many simple materials, and if these are not at hand, it is useful enough to scatter on any dust from the road. In addition to this, moreover, in order that he may sweat less, the patient should be lightly covered and lie in a cool room, with the windows open, so that some breeze reaches him.

A third aid is to help his weakness whilst in bed by food and wine. The food, whilst not much in quantity, should be given often, as well by night as by day, so as to nourish without becoming onerous. It should consist of the weakest class of materials and should be suitable to the stomach. Unless there is necessity, it is not well to hurry on to wine. But when fainting is apprehended, then there is given both bread crumbled into the wine and wine by itself dry indeed yet thin, undiluted, lukewarm, at intervals liberally, and if the patient is taking but little food, polenta may be scattered into the wine; and that wine should not be lacking in strength, yet not over-strong the patient may properly drink three quarters of a litre, and even more if of large build, in the course of a day and night: if he does not take his food, the patient should be anointed, should have cold water poured over him, and after that be given food. But if the stomach has become relaxed and retains but little, let the patient vomit as he will, whether before or after food, and after vomiting take food again. If even after that food is not retained, he should sip a cupful of wine, and another after the interval of an hour. If the stomach returns this wine also, he should be rubbed all over with pounded onions, which as they dry cause the stomach to retain the wine, and as a result, cause heat to return throughout the body, and a forceful pulsation to the blood vessels. The last resource is the introduction into the bowel from below of barley or spelt gruel, since that too supports the patient's strength. Should he feel hot, it is not inappropriate to hold to his nostrils a restorative such as rose oil in wine; if he has cold extremities, they should be rubbed by hands anointed and warmed. If we can by these measures obtain a diminution in the severity of the sweating, and a prolongation of life, time itself now begins to come to our aid. When the patient appears to have reached safety, rapid release into the same state of weakness is still to be feared; hence along with a gradual withdrawal of wine, the patient ought each day to take stronger food, until a sufficiency of bodily strength is gained.

20 There is also another disease, a contrast in a different way to the phrenetic. In the latter sleep is got with great difficulty, and the mind is disposed to any foolhardiness; in this disease there is a pining away, and an almost insurmountable need of sleep. The Greeks name it lethargy. And it also is an acute sort, and unless remedied, quickly kills. Some strive to excite these patients by applying at intervals medicaments to promote sneezing, and those which stimulate by their offensive odour, such as burning pitch, unscoured wool, pepper, hellebore, castoreum, vinegar, garlic, onion. Moreover, they burn near them galbanum, hair or hartshorn, or when that is not at hand, some other kind of horn, for these when burnt give out an offensive odour. One Tharrias said, indeed, that this affection is a sort of feverish paroxysm, and that the patient is relieved when that remits, hence those without keep on irritating such patients do harm uselessly. But the important point is whether the patient wakes up with the remission; or whether the fever is either not relieved, or else it is relieved and yet sleep still oppresses him. For if the patient wakes up, it is needless to treat him as if in a stupor; for he is not made better by keep in him awake, but if he is better he keeps awake of himself. If the sleepiness in us interrupted the patient must certainly be aroused, but only at those times when the fever is of the slightest, in order that he may both make a natural evacuation and take food. Now a most powerful excitant is cold water poured suddenly over him; therefore when the fever has remitted, and he has been anointed freely, he should have three or four jarfuls poured over his head. But this measure should be employed only when the patient's breathing is regular, and the parts below the ribs soft: otherwise those are to be preferred which have been mentioned above. Such is the most suitable procedure, so far as concerns sleeplessness.

But in order to cure, the head is to be shaved, and then fomented with vinegar and water in which laurel or rue leaves have been boiled. On the following day castoreum may be applied, or rue pounded up in vinegar, or laurel berries or ivy with rose oil and vinegar; mustard put to the nostrils is particularly efficacious both for arousing the patient, and when put on the head or forehead for driving out the disease itself. Rocking is also advantageous in this malady; and most of all food given opportunely, that is in the greatest degree of remission that can be found. Now gruel is most fitting until the disease begins to decrease; so if there is a severe paroxysm every day, it is given daily; if every other day, after a more severe paroxysm, gruel, and after a slighter paroxysm, hydromel. Wine is also of no mean service, when given at the proper time all with suitable food. But if this kind of torpor attacks the body after prolonged fevers, all the other measures are to be carried out, in the same way, and in addition three or four hours before the paroxysm castoreum is administered, mixed with scammony if the bowels are costive, if not, then by itself in water. If the parts below the ribs are soft, food should be given more freely; if hard, the patient must subsist on the gruel mentioned above, whilst something is to be applied to the parts below the ribs to repress and mollify at the same time.

21 Now the foregoing is indeed an acute disease. But a chronic malady may develop in those patients who suffer from a collection of water under the skin, unless this is dispersed within the first days. The Greeks call this hydrops. And of this there are three species: sometimes the belly being very tense, there is within a frequent noise from the movement of wind; sometimes the body is rendered uneven by swellings rising up here and there all over; sometimes the water is drawn all together within, and is moved with the movement of the body, so that its movement can be observed. The Greeks call the first tympanites, the second leukophlegmasia or hyposarka, the third ascites. The characteristic common to all three species is an excessive abundance of humour, owing to which in these patients ulcerations even do not readily heal. This is a malady which often begins of itself, often it supervenes upon a disease of long standing, upon quartan fever especially (III.15, 16). It is relieved more easily in slaves than in freemen, for since it demands hunger, thirst, and a thousand other troublesome treatments and prolonged endurance, it is easier to help those who are easily constrained than those who have an unserviceable freedom. But even those who are in subjection, if they cannot exercise complete self-control, are not brought back to health. Hence a not undistinguished physician, a pupil of Chrysippus, at the court of King Antigonus, held that a certain friend of the king, noted for intemperance, could not be cured, although but moderately affected by that malady; and when another physician, Philip of Epirus, promised that he would cure him, the pupil of Chrysippus replied that Philip was regarding the disease, he the patient's spirit. Nor was he mistaken. For although the patient was watched with the greatest diligence, not only by his physician but by the king as well, by devouring his poultices and by drinking his own urine, he hurried himself headlong to his end. At the beginning, however, cure is not difficult, if there is imposed upon the body thirst, rest, and abstinence; but if the malady has become of long standing, it is not dispersed except with great trouble. They say, however, that Metrodorus, a pupil of Epicurus, when afflicted with this disease, and unable to bear with equanimity necessary thirst, after abstaining for a long while, was accustomed to drink and then to vomit. Now if what has been drunk is then returned, distress is much reduced; but if retained in the stomach, it increases the disorder; and so it must not be tried in every case. But if there is also fever, this is first of all to be overcome by the methods which have been prescribed concerning possible relief in such cases (III.4‑17). If the patient has become free from fever, then at length we must go on to those measures by which the disorder itself is usually treated. And here, whatever the species, so long as the disease has not taken too firm a hold, the same remedies are required. The patient should walk much, run a little, and his upper parts in particular are to be rubbed while he holds his breath. Sweating is also to be procured, not only by exercise, but also by heated sand, or in the Laconicum, or with a clibanus and such-like; especially serviceable are the natural and dry sweating places, such as we have in the myrtle groves above Baiae. The bath and moisture of every kind is wrong. Pills composed of wormwood two parts, myrrh one part, are given on an empty stomach. Food should be of the middle class indeed, but, of the harder kind; no more of drink is to be given than to sustain life, and the best is that which stimulates urine. But that, however, is better brought about by diet than by medicament. If, nevertheless, the matter is urgent, one of those drugs which are efficacious is to be made into a decoction, and that given as a draught. Now this faculty seems to belong to iris root, spikenard, saffron, cinnamon, cassia, myrrh, balsam, galbanum, ladanum, oenanthe, opopanax, cardamomum, ebony, cypress seeds, the Taminian berry which the Greeks call staphis agria, southernwood, rose leaves, sweet flag root, bitter almonds, goat's marjoram, styrax, costmary, seeds of rush, square and round (the Greeks call the former cyperon, the latter schoinon): whenever I use these terms I refer, not to native plants, but to such as are imported among spices. The mildest of these, however, are to be tried first, such as rose leaves or spikenard. A dry wine is beneficial, but it must be very thin. It is good besides to measure every day with string the circumference of the abdomen, and to put a mark where it surrounds the belly, then the day following to see whether the body is fuller or thinner, for the thinning shows a yielding to the treatment. Nor is it unserviceable to take the measure of his drink, and of his urine; for if more humour is evacuated than taken in, then at least there is hope of recovery. Asclepiades has put it on record that for a patient who had lapsed from a quartan into dropsy, he employed for two days abstinence and rubbing, on the third day, the patient having all become freed from both the fever and the water, he gave food and wine.

So far the prescription can be common to all the species; if the disease is more severe, the method of treatment must be different. For instance, if there is flatulence and owing to that pain is frequent, a vomit is beneficial, either daily or on alternate days, after food; hot and dry foments are to be applied. If the pain is not ended by these, dry cuppings are needed, but if the torment is not relieved even by these, skin incisions are made and then the cups applied. If cupping does no good, the last resource is to infuse hot water copiously into the rectum and draw it out again. Nay even vigorous rubbing with oil and any one of the heating agents should be carried out three or four times a day, but in this rubbing the abdomen is to be left out; but to this mustard should be applied repeatedly until the skin is excoriated; and ulcerations are to be set up in many places upon the abdominal wall by means of the red hot cautery, and the ulcers to be kept open for some time. It is useful also to suck a boiled squill bulb; but for a long while after such attacks of flatulence the patient should abstain from everything that causes it.

But if the affection is that named leukophlegmasia, the swollen parts should be exposed to the sun, but not too much lest feverishness ensue. If the sun is over-strong, the head is to be covered, and rubbing is to be used with hands just moistened with water to which salt and soda and a little oil is added, taking care that the hands of children or of women are employed, for theirs is a softer touch; and this ought to be done, should the patient's strength allow of it, for a whole hour before noon, or for half an hour after noon. Repressing poultices are of benefit, especially for the more delicate. Also an incision should be made our fingers' breadth above the ankle on the inner side through which humour may discharge freely for some days, and the actual swellings ought to be incised by deep cuts; the body also is to be shaken up by much rocking (II.15); then after the incisions have formed a scab, both exercises and food must be increased, until the patient is restored to his former state of health. The food should be nutritious and glutinous, mostly meat. The wine, when the stomach permits of it, should be rather sweet, but should be drunk alternately with water every two or three days. The seeds of the wolf's-milk plant, which grows to a large size on the seacoast, may be advantageously administered in a draught with water. If the patient is strong enough, he should suck a boiled squill bulb as noted above. There are many authorities who would have the swelling beaten with inflated ox-bladders.

But if the form of the affection is that in which much water is drawn into the belly, the patient should take walks, but with much more moderation, and have applied a dispersive poultice, covered with three folds of linen, bandaged on not too tightly; a practice begun by Tharrias, which I see many have followed. If the liver or spleen is plainly affected, a fatty fig bruised with honey should be put on over it: if the belly is not dried up by such remedies, and in spite of them the humour is in large amount, aid must be given in a quicker way, by giving issue to it through the belly itself (VII.15). I am quite aware that such a way of treatment was disapproved of by Erasistratus, for he deemed the disease to be one of the liver, that therefore it was the liver which had to be rendered sound, and that it was of no use to let out water which, if that organ is diseased, will continually be reproduced. But firstly, the disease is not primarily one of that organ alone; for it occurs when the spleen is affected, and there is a general diseased condition of the body; further, granted that it begins from the liver, the water unnaturally collected there, unless evacuated, injures both the liver and all the rest of the internal organs. And it is agreed, nevertheless, that the body generally has to be treated; for the mere evacuation of the humour does not restore health, but it affords an opportunity for medicaments which the accumulation within impedes. And indeed it is not in dispute that not everybody with this affection can be so treated, but only the young and robust, in whom fever is wholly absent, or who have sufficiently long intermissions. For those are unfitted for this treatment whose stomach is corrupted, or who have lapsed into the malady owing to black bile, or who have a diseased condition of body. But food on the day the humour is first let out is not needed unless strength fails. On the days following, both food and wine, undiluted indeed, but not overmuch in quantity, should be given; little by little the patient should be submitted to exercise, rubbing, sun-heat, sweating, a sea voyage, along with a suitable diet, until he has completely recovered. Such a case requires a bath seldom, more often an emetic on an empty stomach; in summer a swim in the sea is beneficial. For a long while after his recovery, however, the practice of venery is unsuitable.

22 Longer and more dangerous is the illness which follows when wasting disease attacks a patient. This also has several species. There is one in which the body is not nourished enough, and as there is some natural loss going on all the time without replacement, extreme emaciation ensues, which unless countered, kills. The Greeks call it atrophia. It proceeds commonly from two causes: for either from excessive dread the patient consumes less, or from excessive greed more, than he ought: thus either the deficiency weakens, or the superfluity undergoes decomposition. There is another species which the Greeks call cachexia, in which owing to bad habit of body all the aliments undergo decomposition. This occurs generally in those whose bodies have become vitiated by prolonged disease, and even if they have rid themselves of this, yet they do not regain health; or when the system has become affected by bad medicaments; or for a long while necessaries of life have been deficient; or unusual or unserviceable food has been consumed; or something similar has happened. In this case besides the wasting, it not unfrequently occurs that the skin surface undergoes irritation by persistent pustulation or ulceration, or else some parts of the body become swollen. The third species, which the Greeks call phthisis, is the most dangerous by far. The malady usually arises in the head, thence it drips into the lung; there ulceration supervenes, from this a slight feverishness is produced, which even after it has become quiescent nevertheless returns; there is frequent cough, pus is expectorated, sometimes blood-stained. When the sputum is thrown upon a fire, there is a bad odour, hence those who are in doubt as to the disease employ this as a test.

As these are the species of wasting, the first consideration should be, which the patient is suffering from: next, if it is only that the body is not being sufficiently nourished, we must look to the cause of this, and if the patient has been consuming less food than he ought, addition is to be made, but only a little at a time, lest if the system becomes overloaded suddenly by an unaccustomed quantity, it may hinder digestion. On the other hand, if the patient has been consuming more than he ought, he should first fast for a day, then begin with a scanty amount of food, increasing daily until he reaches the proper amount. Further, he should walk in places as little cold as possible, whilst avoiding the sun; he should also use the hand exercises; if he is weaker, he should be rocked, anointed and then rubbed, doing as much as possible of this himself, several times each day, before and after meals, until he sweats — sometimes adding heating agents to the oil. It is advantageous on an empty stomach to pinch up and pull on the skin in a number of places, in order to relax it, or to do the same by applying a pitch plaster and at once pulling it off. The bath also is sometimes beneficial, but only after a scanty meal. And whilst actually in the solium, some food may properly be taken, also immediately after a rubbing, when applied without the bath. The food too should be of the kinds easily digested, which are most nutritious. Hence also the use of wine is necessary, but it should be dry; urination is to be stimulated.

But if there is a bad habit of body, the patient should abstain at first, next have the bowels moved by a clyster, then take food a little at a time, with exercise, anointing and rubbing. A frequent bath is useful for these cases, but on an empty stomach, prolonged till there is sweating. Abundant and varied and succulent food is necessary, such as will less readily decompose, and dry wine. If there is no relief from anything else, blood should be let, but only a little each day for several days; with this proviso, that the other remedies also should be employed as described.

But if there is more serious illness and a true phthisis, it is necessary to counter it forthwith at the very commencement; for when of long standing it is not readily overcome. If the strength allows of it a long sea voyage is requisite with a change of air, of such a kind that a denser climate should be sought than that which the patient quits; hence the most suitable is the voyage to Alexandria from Italy. And the body ought generally to be able to bear this in the early stages, since this disease arises especially during the most stable part of life, namely between eighteen and thirty-five years of age. If the patient's weak state does not allow of the above, the best thing for him is to be rocked in a ship without going far away. If anything prevents a sea voyage, the body is to be rocked in a litter, or in some other way. Further, the patient should keep away from business, and everything disturbing to his spirit; he should indulge in sleep; he is to be warned against catarrh, lest that should make worse what the treatment is relieving; indigestion should be avoided, also the sun and cold; the mouth should be covered, the neck wrapped up, any cough put a stop to by its appropriate remedies; and whenever there is an intercurrent fever, it is countered, sometimes by abstinence, sometimes by timely meals, at which water is to be drunk. Milk also, which in headaches, in acute fevers and for the excessive thirst they occasion, also when the chest swells, or there is bilious urine, or a flux of blood, is as bad as a poison, can nevertheless be given appropriately in phthisis, as also in all prolonged feverishness. But if there has either been no intercurrent fever yet, or if it has already remitted, recourse should be had to moderate exercise, walking in particular, also to gentle rubbing. The bath is unsuitable. The food should at first be acrid, such as garlic and leeks, also this latter or endive, basil or lettuce after soaking in vinegar; later the food should be bland, such as a gruel made with pearl barley, or spelt flour, or starch to which milk is added. Rice also, and if there is nothing else, parched groats of spelt answer. Subsequently use is to be made of the above foods in turn, with some additions from food of the middle class, especially grilled brains, small fish and such like. Flour mixed with mutton- or goat-fat and then boiled serves for a medicament. The wine taken ought to be light and dry. So far there is no great difficulty in countering the disease. But if it is more severe, and the body is evidently wasting, stronger remedies are required. Ulceration is to be set up by cautery, at one spot under the chin, at another on the neck, two upon each breast, and the same below the shoulder-blades which the Greeks call omoplatae. The ulcerations are not to be allowed to heal until the cough has stopped, and for this there must clearly be a special treatment also. Then three or four times a day the extremities should be rubbed vigorously, the chest being merely stroked with the hands; an hour after food both legs and arms are to be rubbed. At intervals of ten days the patient should be immersed in the solium contain in oil with the hot water. On other days he should drink first water, then wine; if there is no cough, the drink should be cold, if there is cough lukewarm. It is also of advantage to give food every day during the remission; rubbing and rocking should be employed likewise. On the fourth or fifth day he should take the above mentioned acrid food, now and then polygonum or plantain juice in vinegar. A further remedy is either plantain juice by itself, or horehound juice cooked with honey; of the former a cupful may be sipped, of the latter a spoonful, a little at a time, put upon the tongue, or one half part of turpentine resin, and another part of butter and honey may be mixed together and cooked. But of all these measures the principal ones are the diet, rocking in a litter or on a ship, and the gruel. Loose motions must be especially obviated. Frequent vomiting in this affection is a sign of danger, especially when blood is vomited. A patient who is beginning to improve a little should resume exercises, rubbing, and increase of food, next rub himself while holding his breath, but for a long while abstain from wine, the bath and venery.

23 That malady which is called comitialis, or the greater, is one of the best known. The man suddenly falls down and foam issues out of his mouth; after an interval he returns to himself, and actually gets up by himself. This kind affects men oftener than women. And usually it persists even until the day of death without danger to life; nevertheless occasionally, whilst still recent, it is fatal to the man. And often if remedies have been ineffectual, in boys the commencement of puberty, in girls of menstruation, has removed it. Now sometimes there is a spasm of the sinews when the man falls down, sometimes there is none. Some try to rouse the patients as is done in the case of those affected by lethargy; which is quite useless, both because not even the lethargic patient is cured by this method, and because, though it may be impossible to waken him and he may thus die of starvation, the epileptic, on the other hand, returns to himself. If a man falls in a fit without the addition of spasms, certainly he should not be bled; if there are spasms, at any rate he should not be bled unless there are other indications for the bleeding. But it is necessary to move the bowels by a clyster, or by a purge of black hellebore, or by both if the strength allows of it. Next the head should be shaved and oil and vinegar poured over it, the patient should be given food on the third day, as soon as the hour has passed at which he had a fit. But neither gruels, nor other soft and easily digested food, nor meat, least of all pork, are suitable for such patients, but food materials of the middle class: for there is need to give strength and indigestion is to be avoided; in addition he should avoid sunshine, the bath, a fire, all heating agents; also cold, wine, venery, overlooking a precipice, and everything terrifying, vomiting, fatigue, anxiety, and all business.

When food has been given upon the third day, it should be omitted on the fourth, and then on alternate days, observing the same hour for the meal, until fourteen days have elapsed. When the malady lasts beyond this period, it loses its acute character, and if it persists, it is now to be treated as chronic. But if the practitioner has not been in attendance from the day of the first fit, but a patient who is liable to fits has been handed over to of him, the class of diet given above should straightway be adhered to, and the day awaited upon which the patient may have a fit; than there is to be used either blood-letting, or clystering, or purgation by black hellebore, as prescribed above. Next on the following days the patient is to be supported by those foods I have mentioned, avoiding everything which I have said must be avoided. If the malady has not been brought to an end by these measures recourse should be had to white hellebore, administering it three or four times, without many days between, never, however, repeating it unless he has had a fit. Moreover, on intermediate days his strength must be supported by additions to what has been prescribed above. On awakening in the morning, his body should be lightly rubbed with old oil, including the head, but excluding the stomach; he should then walk as straight and as far as he can; after the walk he should be rubbed vigorously for a long while in a warm place, and with not less than two hundred hand-strokings, unless he is weak (II.14); next plenty of cold water should be poured over his head; he should take a little food; rest; again before night take a walk; and once more be vigorously rubbed, yet without touching either his stomach or his head; after this he may have dinner, and at intervals of three or four days he should eat for a day or two acrid foods. If not freed by these measures, his head should be shaved; anointed with old oil, to which vinegar and nitre have been added; have salt water poured over it; next upon an empty stomach he should take castoreum in water; no water should be used for drinking unless it has been boiled. Some have freed themselves from such a disease by drinking the hot blood from the cut throat of a gladiator: a miserable aid made tolerable by a malady still most miserable. But as to what is really the concern of the practitioner, the last resources are: to let a left blood from both legs near the ankle, to incise the back of the scalp and apply cups, to burn in two places with a cautery, at the back of the scalp and just below where the highest vertebra joins the head, in order that pernicious humour may exude through the burns. If the disease has not been brought to an end by the foregoing measures, it is probable that it will be lifelong. To mitigate it to some extent all you can do is to use exercise, plenty of rubbing, and the food which has been mentioned above, particularly avoiding what we have declared to be harmful.

24 Equally well-known is the disease which they name sometimes the rainbow-hued, sometimes the royal. Of this Hippocrates said that if it comes on after the patient has been suffering from fever for seven days, the patient is safe, provided that the parts under the ribs remain soft. Diocles stated positively that if it arise after a fever, it is even favourable, but deadly if fever follows it. The colour reveals this malady, particularly of the eyes; they become yellow in the parts which should be white. And it is usually accompanied by thirst and headache and frequent hiccough and induration under the ribs on the right side, and when a sharp movement of the body is made there is difficulty in breathing and laxness of the limbs; and when the disease persists for a long while, the whole body whitens with a sort of pallor.

On the first day the patient should fast, on the second day have the bowels moved by a clyster, then if there is fever, it is dispersed by appropriate diet; if not, scammony is given in a draught, or white beet pounded up in water, or bitter almonds, wormwood, and a very little aniseed in hydromel. Asclepiades used also to make the patient drink salted water, even for a couple of days, in order to purge, and rejected diuretics. Some, omitting the remedies given above, say they gain the same end through diuretics and those foods which cause thinness. For myself, if there is sufficient strength, I prefer the stronger remedies, the milder if there is but little. After purgation, for the first three days a moderate amount of food of the middle-class should be taken with salted Greek wine to drink, in order to keep the bowels loose; then on the ensuing three days, food of the stronger class with some meat, keeping to water for drink; next there is a return to the middle class of food, but in such a way that he may be more satisfied therewith, and for drink an undiluted dry wine in place of the Greek; and this diet is varied so that sometimes acrid foods are put in, sometimes the salted wine is again given. But throughout the whole time use is to be made of exercise, of rubbing, in winter of the bath, in summer of swimming in cold water, the patient should enjoy a specially good bed and room, also dicing, jesting, play-acting and jollification, whereby the mind may be exhilarated; on account of this treatment the disease seems to have been termed royal. In addition a dispersive poultice, applied under the ribs, is beneficial, or if the liver or spleen has become affected a dried fig is put on.

25 The disease which the Greeks call elephantiasis, whilst almost unknown in Italy, is of very frequent occurrence in certain regions; it is counted among chronic affections; in this the whole body becomes so affected that even the bones are said to become diseased. The surface of the body presents a multiplicity of spots and of swellings, which, at first red, are gradually changed to be black in colour. The skin is thickened and thinned in an irregular way, hardened and softened, roughened in some places with a kind of scales; the trunk wastes, the face, calves and feet swell. When the disease is of long standing, the fingers and toes are sunk under the swelling: feverishness supervenes, which may easily destroy a patient overwhelmed by such troubles. At once, therefore, at the commencement, he should be bled for two days, or the bowels loosened by black hellebore, then a scanty diet is to be adopted as far as can be borne; after that the strength should be a little reinforced and the bowels clystered; subsequently, when the system has been relieved, exercise and especially running is to be used. Sweating should be induced primarily by the patient's own exertion, afterwards also by dry sweatings, rubbing is to be employed with moderation so that strength is preserved. The bath should be seldom used; neither fatty nor glutinous nor flatulent food; wine is properly given except on the first days. Plantain crushed and smeared on seems to protect the body best.

26 We also see occasionally some who have been stunned, in whom the body and the mind are stupefied. This is produced sometimes by lightning stroke, sometimes by disease; the Greeks call this latter apoplexia. In these cases, blood is to be let, and either white hellebore (II.13.2) or a clyster administered; then rubbings are applied, and food of the middle class given, and that the least fatty; also some which is acrid; there is to be abstinence from wine.

27 Relaxing of the sinews, on the other hand, is a frequent disease everywhere. It attacks at times the whole body, at times part of it. Ancient writers named the former apoplexy, the latter paralysis: I see that now both are called paralysis. Those who are gravely paralyzed in all their limbs are as a rule quickly carried off, but if not so carried off, some may live a long while, yet rarely however regain health. Mostly they drag out a miserable existence, their memory lost also. The disease, when partial only, is never acute, often prolonged, generally remediable. If all the limbs are gravely paralyzed withdrawal of blood either kills or cures. Any other kind of treatment scarcely ever restores health, it often merely postpones death, and meanwhile makes life a burden. If after blood-letting, neither movement nor the mind is recovered, there is no hope left; if they do return, health also is in prospect. But when a particular part is paralyzed, in accordance with the force of the disease, and the strength of the body, either blood is to be let, or the bowel clystered. The rest that has to be done is the same in both conditions: in particular cold should be avoided; and the patient should return to exercise a little at a time, in such a way that he should begin to walk at once, if he can. If the weakness of the legs prevent this, he should be carried about in a litter or rocked in his bed, then, if possible, his defective limb should be moved by himself, failing that by someone else, and by a form of compulsion, it should be restored to is customary state. It is also beneficial to stimulate the skin of the torpid limb, either by whipping with nettles, or by applying mustard plasters, these latter being removed as soon as the skin becomes red. Appropriate applications also are crushed squills, and onions pounded up with frankincense. Nor is it amiss to pluck on the skin for some time by the aid of a pitch plaster every third day (III.22.6) and sometimes to apply dry cups in several places. Again for anointing, old olive oil is most suitable, or soda mixed with oil and vinegar. Further, it is also highly necessary to foment with warm sea water, or failing that with salt and water. And if there are at hand swimming baths, whether natural or artificial, they should be used as much as possible; especially the defective limb should be moved in them; if there are none such the ordinary bath is of service. The food should be of the middle class, particularly game, the drink hot water without wine. If, however, the disease is of long standing, every fourth or fifth day Greek salted wine may be given, in order to purge. An emetic after supper is of use.

At times also there occurs pain in the sinews. In that case it is not expedient to excite vomiting nor urination as some prescribe, nor indeed sweating other than through exercise; water should be drunk; twice a day in bed the body should be rubbed gently and for some time, and then whilst holding the breath, the limbs, preferably the upper, are to be moved in the course of exercise. The bath should be seldom used; from time to time there should be a change of air by travel. If there is pain, the part should be wetted with water containing soda, but not oil, then wrapped up, and under it should be placed a brazier containing some glowing charcoal with sulphur, so that it may be fumigated for a while; this should be repeated from time to time, but only on an empty stomach and after digestion is completed. Cups also may be applied at frequent intervals to the painful part, and this place lightly beaten with inflated ox bladders. It is also of service to mix fat with pounded henbane and nettle seeds, equal parts of each, and put this on, also to foment with a decoction of sulphur. Further, it is a good plan to apply leather bottles filled with hot water, or bitumen mixed with barley meal. And for the actual pain the best remedy is forceful rocking; which in other kinds of pain is the worst.

Tremor of sinews again is like with made worse by an emetic, and by medicaments causing urination. Inimical also are baths and dry sweatings. Water is to be drunk; the patient should there are a smart walk and be anointed and rubbed as well, especially by himself; the upper limbs are to be exercised by ball games and the like; he may think what food he likes provided that he studies his digestion. He should avoid worry after meals; make the rarest use of venery. If at any time he has given way to it, then he ought to be rubbed, with oil, gently and for some time, whilst in bed, by the hands of boys rather than men.

Now suppurations which arise in some interior part, when they become noticeable, first should be acted upon by those poultices which repress, less there is produced a harmful collection of the material of disease; next if these remedies are unsuccessful, the suppurations may be dissipated by dispersive poultices. If we are not successful in that, it follows that the suppuration should be drawn outwards, next that it should mature. The ending of every abscess is to rupture; the indication is pus discharged either from the bowels or mouth. But nothing ought to be done to diminish the discharge of the pus. Broth and hot water are chiefly to be given. When pus ceases to be discharged, then there should be a transition to digestible yet nutritious food consumed cold, also cold water for drink, commencing, however, with lukewarm. To begin with, things such as pine kernels, or almonds, or hazel nuts, may be eaten along with honey; afterwards these make way for whatever can make the scar form earlier. At this stage as a medicament for the ulceration there is to be taken either leek or horehound juice, and whatever the food, leeks should be added. Rubbing is required also for parts unaffected, so also gentle walks; to be avoided are wrestling and running and other things tending to irritate healing ulcerations, for in this malady the vomiting of blood is most pernicious and to be guarded against in every way.