Of Medicine, in Eight Books

by Aulus Cornelius Celsus

CHAP. VIII. WHAT SYMPTOMS ARE DANGEROUS, OR HOPEFUL IN PARTICULAR DISEASES.

Our next business is to explain the particular marks in every kind of distemper, which either afford hope, or indicate danger. If the bladder be pained, and there be a discharge of purulent urine, and also a smooth and white sediment in it, there is no danger. In a peripneumony, if the pain is mitigated by the spitting, although that be purulent, yet if the patient breathes easily, expectorates freely, and is not much distressed with the distemper, he may possibly recover his health. Nor need we immediately give way to fears, if the spittle is mixed with some reddish blood, provided that presently ceases. Pleurisies, that suppurate, when the matter is carried off within forty days, are thereby terminated. If there is a vomica in the liver, and the matter discharged from it be unmixed and white, the patient easily recovers, for that disorder is seated in the membrane. Now these kinds of suppurated tumours are tolerable, which are directed towards the external parts, and rise to a point. But of those, which point inward, the more mild are such, as while close, don’t affect the skin, and suffer it to remain without pain, and of the same colour with the other parts. Also pus from whatever part it is discharged, if it be smooth, white, and uniform, is not at all dangerous; and if after the evacuation of it the fever has presently abated, and the nausea and thirst have ceased to be troublesome. If at any time also a suppuration falls into the legs, and the patient’s discharge by spitting becomes purulent instead of reddish, the danger is less. But in a consumption, he that is to recover, will have his spitting white, uniform, and of the same colour, with out phlegm: and whatever falls down from the head by the nostrils, should be of a like nature. ’Tis far best to be altogether free from a fever: next to this, that it be so gentle, as neither to prevent the taking of food, nor occasion a frequent thirst. In this distemper that state of the belly is safe, in which every day consistent excrements are evacuated, in quantity proportioned to the food; and so is that body, which is least slender, and has the broadest and most hairy chest, and whose cartilage is small and fleshy. In a consumption too, if a woman has had her menses suppressed, and while the pain still remains about her breast, and shoulders, and the blood has of a sudden made its way, the distemper is commonly mitigated: for both the cough is lessened, and the thirst and febricula cease. But in the same patients, if their menses do not return, for the most part the vomica breaks: and the more bloody the discharge from it is, so much the better. A dropsical disorder is the least to be feared, which has begun without any preceding distemper. Of the next favourable sort is that, which succeeds a long distemper, if at the same time the bowels be firm; if the breathing be easy; if there is no pain; if the body is not hot; and is equally lean in its extremities; if the belly is soft; if there be no cough, no thirst; if the tongue even in sleep does grow dry; if there is an appetite for meat; if the belly yields to purging medicines; if spontaneously it discharges excrements soft and figured; if it grows less[(12)]; if the urine is altered by the change of wine, and by drinking certain medicinal potions; if the body is free from lassitude, and easily bears motion: for where one has all these symptoms, he is altogether safe; where most of them appear, the patient is in a hopeful way. Diseases of the joints, as the gout in the feet or hands, if they have attacked the patients young, and have not brought on a callus, may be removed; and they are most of all allayed by a dysentery, and when by any means the belly becomes loose. Also an epilepsy, that begins before puberty, is easily removed; and where a person sensibly feels the approaching fit first affecting some part of the body. It is best, that it begin at the hands or feet; next to them, at the sides; but worst of all, when it begins at the head. And in these patients also, excretions by the belly are of the greatest service. Now a purging is not in the least hurtful, which is without a fever, if it quickly, ceases; if upon feeling the belly, there is no motion perceived; if wind is discharged at the end of a stool. Nay even a dysentery is not dangerous, if blood and strigments are discharged, provided the patient is without a fever, and the other concomitants of this distemper: insomuch, that a pregnant woman may not only be cured, but her fœtus also preserved. And it is an advantage in this disorder, if the patient has come to some age. On the contrary, a lientery is more easily cured in tender age: especially if the urine begins to be excreted, and the body to be nourished with food. The same age is most favourable in pains of the hip, and arms, and in every paralytic disorder. Amongst these, the hip, if it be without numbness, if its coldness be slight, although it be greatly pained, yet it is easily and quickly cured; and a paralytic limb, if it continue to be nourished, may be recovered. A palsy of the mouth also is cured by a loose belly. And all purging does good to one labouring under a lippitude. Madness is removed by the appearance of a varicous swelling, or sudden eruption of blood from the hæmorrhoidal veins, or a dysentery. Pains of the arms, which are propagated either to the shoulders, or hands, are cured by vomiting of atrabilis. And whatever pain moves downward, is more easily cured. A hiccough is cured by sneezing. A vomiting stops long purgings. A woman, that vomits blood, is relieved by the flux of her menses. She, whose menses are deficient, if there has been an hæmorrhage from the nose, is free from all danger. And one, that is hysteric[(13)] or has a difficult labour, is relieved by sneezing. To one, that has a heat and tremour, a delirium is salutary. Dysenteries are of service to splenetic people. Lastly, a fever itself, which may seem very wonderful, is often a remedy for other distempers. For it both cures pains of the præcordia, that are not attended with inflammation, and relieves in a pain of the liver; and entirely removes convulsions, and a tetanus, if it comes after them; and where the distemper of the smaller intestine has been occasioned by a difficulty in making urine, if by the heat it promotes urine, it gives ease. Pains of the head attended with dimness of the eyes and redness with an itching in the forehead, are removed by a discharge of blood, either spontaneous or procured. If pains of the head and forehead arise from being exposed to the wind, or cold, or heat, they are cured by a gravedo, and sneezing. A sudden shuddering puts an end to an ardent fever, which the Greeks call causodes[ AV ]. When in a fever, there is a deafness, if blood is discharged from the nose, or the belly turns loose, that disorder is entirely removed. Nothing is more prevalent against deafness, than bilious stools. Those, that have small abscesses, which the Greeks call phymata[ AW ], formed in the urethra, are cured, when pus is discharged from thence. Now as most of these favourable turns happen of themselves, we may conclude, that nature has very great power in these very helps, which are applied by art.

On the contrary, when there is a pain in the head in a continued fever, and it does not at all remit, it is a bad and mortal symptom: and boys from the seventh to the fourteenth year are most liable to this danger. In a peripneumony, if the spitting did not come on in the beginning, but after the seventh day, and has continued above other seven days, it is dangerous: and the more mixed and less distinct the colours are, so much the worse. And yet nothing is worse, than for it to be excreted entirely homogeneous, whether it be reddish, or bloody, or white, or glutinous, or pale, or frothy: but the worst of all colours is black. A cough and catarrh are dangerous in the same disease; also a sneezing, which in other cases is reckoned salutary; and there is the greatest danger of all, if these things have been followed by a sudden purging. Now generally the symptoms, which are either good or bad in peripneumonies, are so in pleurisies too. A discharge of bloody pus from the liver is mortal. These are the worst kinds of suppurations, which tend inward, and discolour the external skin at the same time. Of that kind, that breaks outward[(14)], the worst are those, that are largest and flattest. But if the fever has not gone off, when the vomica is broke, or the pus evacuated, or after its ceasing returns again; also if there be a thirst, or a nausea, or a loose belly, or livid and pale pus, if the patient expectorates nothing but frothy phlegm; then there is certain danger. And of these kinds of suppurations, which have been produced by diseases of the lungs, old men commonly die: but those; those that are younger, by the other kinds. But in a consumption, a mixed and purulent spitting, a continued fever, which also destroys the appetite, and torments with thirst, in a slender body are sure prognosticks of immediate danger. If one has lasted under this distemper even for a considerable time, when the hairs first fall off, when the urine has something floating upon it like cobwebs, and the spittle has a fetid smell, and particularly when after these a purging has appeared, he will die soon: and more especially if it be autumn: in which season commonly those, that have got over the other part of the year, come to the close of their life. It is also mortal in this distemper to have expectorated pus, and afterwards for that to have entirely disappeared. It is likewise common for this disease in young people to arise from a vomica or fistula; and they do not readily recover, unless many salutary symptoms have ensued. With regard to others, virgins are the hardest to cure, or those women, that fall into a consumption from a suppression of the menses. A healthy person who has been taken with a sudden pain of his head, and then fallen into a deep sleep, so as to snore, and does not awake, will die before seven days are expired: and more especially if, when a looseness has not preceded, his eyelids are not closed in sleep, but the white of his eyes appears. Death however is not the certain consequence, if a fever comes on, which may remove the distemper. A dropsical disorder occasioned by an acute distemper, is seldom cured: especially if followed by the opposite symptoms to those above-mentioned. A cough likewise is equally destructive of hope in this distemper: also an hæmorrhage either upward or downward, and a collection of water in the middle of the body[(15)]. Some people too in this disease have swellings, which afterwards subside, and then appear again. Such indeed are more safe than those mentioned before, if they take the proper care: but they commonly perish from a persuasion of their being well. Some people with good reason will wonder, how any thing can at once both be hurtful to our bodies, and in part conduce to their preservation. For whether a dropsy has filled one with water, or a great quantity of pus has been collected in a large abscess, for the whole to be discharged at once is equally mortal, as for a sound person to lose all his blood by a wound. If the joints of any person are pained, so that some tubercles from a callus grow upon them, they are never cured: and the disorders of those parts, which have either begun in old age, or have continued from youth to that time of life, though they may be sometimes mitigated, yet are never entirely removed. An epilepsy also, that begins after the twenty-fifth year, is difficult to cure: and much more so that, which has begun after the fortieth; so that, although there may be some hope from nature, scarce any thing is to be expected from medicine at that age. In the same disease if the whole body is affected at once, and the patient is not sensible of the fit beginning in any part, but falls down suddenly, whatever his age be, he rarely gets free of the distemper: but if his intellects be injured, or a palsy has come on, there is no room for medicine. In purgings too, if attended with a fever; if with an inflammation of the liver, or præcordia, or belly; if with an intolerable thirst; if the disease has continued long; if the discharge of the belly is variegated; if it is expelled with pain, there is danger even of death: and more especially if with these symptoms a dysentery has grown inveterate. And this distemper sweeps off children chiefly to their tenth year: at other times of life, it is more easily endured. A pregnant woman also may be carried off by such a case: and although she herself recovers, yet she loses her child. Moreover a dysentery occasioned by atrabilis is mortal: or a sudden and black discharge from the belly, when the body is already wasted by that distemper. But a lientery is more dangerous, if the purging be frequent; if the belly is discharged at all hours, both with a rumbling, and without it; if it continues with equal violence both night and day; if what is excreted, is either crude, or black, and besides smooth and fetid; if thirst is troublesome; if urine is not made after drinking (the cause of which is, that all the liquor at that time descends, not into the bladder, but into the intestines) if the mouth is ulcerated; if the face is red, and marked with certain spots of all colours; if the belly is puffed up as it were by fermentation[(16)], fat and full of wrinkles; and if there is no appetite for food. And as in these circumstances death is the plain consequence; it is much more evidently so, if the disease is already of long standing; especially if withal the patient be old. In the distemper of the smaller intestine, a vomiting, hiccough, convulsion, and delirium, are bad symptoms. In the jaundice it is the most pernicious symptom for the liver to be indurated. Those, that have disorders in the spleen, if they be seized with a dysentery, which afterwards turns to a dropsy or a lientery, it is scarce in the power of medicine to save. The distemper of the smaller intestine arising from a difficulty of urine, unless it be removed by a fever, kills within seven days. If a woman after delivery is seized with a fever, and violent and constant pains of the head, she is in danger of dying. If there is a pain and inflammation in those parts, which contain the bowels, it is a bad sign to fetch the breath often. If a pain of the head continues long without a perceptible cause, and removes into the neck and shoulders, and again returns into the head; or comes from the head to the neck and shoulders, it is dangerous: unless it produce some vomica, so that the pus may be expectorated; or unless there is an hæmorrhage from some part; or scurf break out plentifully in the head, or pustules over the whole body. It is an equally formidable distemper when a numbness and itching wander about; sometimes over the whole head, sometimes in a part of it; or when there is something like a sensation of cold in the part, and these reach even to the end of the tongue. And though in these cases abscesses are beneficial, yet there is less hope of a recovery by their means, as they are seldom formed after such disorders begin. In pains of the hip, if there is a great numbness, and the leg and hip are cold, and the belly has no passage, but when assisted, and the excrements are slimy, and the age of the person exceed forty, the distemper will be very tedious, and at least of a year’s continuance; neither will it be possible to remove it, unless it be either in the spring or autumn. At the same time of life, the cure is equally difficult, when a pain of the arms removes into the hands, or reaches to the shoulders, and produces a torpor and pain, and is not relieved by a bilious vomiting. A paralytic limb in any part of the body, if it has no motion, and pines away, will not recover its former state; and the more inveterate the distemper, and the more advanced in years the patient is, so much the less probable is the cure. And in every paralytic disorder, the winter and autumn are improper seasons for medicine: some benefit may possibly be hoped for in the spring and summer. And this distemper, when moderate, is cured with difficulty; when violent, it cannot be cured at all. Every pain also, which moves upward, yields less to medicine. If the breasts of a pregnant woman have shrunk suddenly, there is danger of a miscarriage. In a woman that has milk, and has neither had a child, nor is pregnant, the menses are suppressed. A quartan ague in the summer is short, but in the autumn commonly long; especially that, which has come on, when the winter was approaching. If there has been an hæmorrhage followed with madness and convulsions, there is danger of death. Also if a convulsion has seized a person purged by medicines and still empty; or if the extremities are cold in the time of great pain. Nor does a person return to life, who has been hanged, and taken down with a frothing mouth. A black and sudden discharge of the belly, like black blood, whether it be attended with a fever or not, is pernicious.

CHAP. IX. OF THE CURE OF DISEASES.

Having considered those signs, which may give us hope or fear, we must proceed to the methods of curing diseases. Now these are divided into the general and particular: the general, which relieve several distempers, the particular, which are confined to single disorders. I shall first treat of the general. But there are some of those, that not only support the sick, but conduce to the preservation of the healthy, others are made use of in sickness only.

Now every thing that assists the body, either evacuates somewhat, or adds, or draws, or restrains, or cools, or heats, and at the same time either hardens, or mollifies. Some things also are useful not in one way only, but even in two, that are not contrary to each other. An evacuation is made by bleeding, cupping, purging, vomiting, friction, gestation, and all exercise of the body, abstinence and sweat. Of these I shall now treat.

CHAP. X. OF BLEEDING.

To let blood by the incision of a vein is not new: but to practise this in almost every distemper is new. Again, to bleed younger people, and women, that are not pregnant, is of ancient use. But to attempt the same in children and old people, and in pregnant women, is not an old practice. For indeed the ancients judged, that the first and last stages of life were not able to bear this kind of remedy; and they were persuaded, that a pregnant woman, who had been thus treated, would miscarry. But afterwards experience proved, that none of these rules were universal, and that some other circumstances were rather to be regarded, by which the intention of the physician was to be directed. For the material point is not, what the age may be, or what is contained within the body, but what degree of strength there is. Upon this account if a young man is valetudinary, or a woman not with child be weak, bleeding is bad: for the remaining strength, is by this evacuation destroyed. Whereas to a stout boy, and a robust old man, and a strong pregnant woman, it may be used with safety. ’Tis true an unskilful physician may be greatly deceived in such patients: because there is commonly less strength at these times of life. And a pregnant woman stands in need of strength after her cure, to support not only herself, but her fœtus also. But whatever requires either attention of mind, or prudence, is not to be immediately rejected: since the excellency of the art here consists, not in numbering the years, nor in regarding conception alone, but in considering the strength, and collecting from thence, whether there will be left sufficient to support either a boy, or an old man, or two bodies at once in one woman. There is a difference also between bodies strong, and corpulent: and those, that are slender, and infirm. In the slender, blood more abounds, but in those of a fuller habit, flesh. Wherefore the first bear this evacuation more easily: and he, that is over fat, is soonest distressed by it. For this reason the strength of the body is to be estimated rather by the state of the vessels, than from its appearance.

Nor are these the only particulars to be considered, but also what kind of distemper it is: whether a redundancy, or deficiency of matter has been hurtful; whether the body be corrupted or sound. For if there be a deficiency, or the humours be sound, this method is prejudicial. But if either the quantity of matter is hurtful, or it is corrupted, no other remedy is more successful; for this reason a violent fever, when the skin is red, and the veins are full and turgid, requires bleeding: likewise diseases of the bowels, and palsies, and the tetanus, and convulsions; in fine, whatever strangulates the fauces, so as to cause a difficulty in breathing; whatever suddenly stops the speech; any pain, that is intolerable; and any internal rupture, or bruise, from whatever cause; also a bad habit of body; and all acute distempers; provided, as I observed above, they hurt not by weakness, but by redundancy.

But it may possibly happen, that a distemper may indeed require this method, and at the same time the body may seem hardly able to bear it: but yet if there appears no other remedy, and the patient must perish, unless he shall be relieved even by a rash attempt; in this case, it is the part of a good physician to shew, that there is no hope without bleeding; and to confess what bad consequences may be apprehended even from that remedy; and after that, to bleed if desired. It is by no means proper to hesitate about it in such a situation as this: for it is better to try a doubtful remedy, than none at all. And this ought especially to be practised, when there is a palsy; when one has lost his speech suddenly; when an angina suffocates; when the preceding paroxysm of a fever has almost killed a person, and another equally severe is likely to follow, and the strength of the patient seems unable to bear it.