Of Medicine, in Eight Books

by Aulus Cornelius Celsus

This then is the general nature of fevers. But the methods of cure differ, according to their different authors. Asclepiades says, that it is the duty of a physician to effect the cure safely, speedily, and with ease to the patient. This is to be desired: but generally too great haste and too great indulgence both prove dangerous. What moderation must be used in order to obtain all these ends as far as possible, the principal regard being always had to the safety of the patient, will come into consideration, when we treat of the particulars of the cure.

And the first inquiry is, how the patient is to be treated in the beginning of the distemper. The ancients by the use of some medicines endeavoured to promote concoction; for this reason, that they were extremely afraid of crudity: next they discharged by frequent clysters that matter, which seemed to hurt. Asclepiades laying aside the use of medicines, ordered clysters not so frequently as they, but in almost every distemper. And he professed his principal cure for a fever was the disease itself. He thought also, that the strength of the patient was to be worn out by light, watching, and great thirst: insomuch that he would not even allow the mouth to be washed in the first days. So much are those mistaken, who imagine the whole of his regimen to be agreeable. For indeed in the advance of the distemper he even administered to the luxury of the patient; but at the beginning he acted the part of a tormentor.

Now I grant that medicinal potions and clysters, ought to be used but sparingly. And yet I do not think these are to be administered with a view to destroy the patient’s strength: because the greatest danger arises from weakness. Wherefore it is proper only to diminish the redundant matter; which is naturally dissipated, when there is no new accession to it. For this reason the patient must abstain from food in the beginning, and in the day-time be kept in the light, unless he be weak, because even that contributes to the discharge. And he ought to lye in a very large room.

As to thirst and sleep, the best mean is, that he be awake in the day-time, and rest in the night, if possible; and neither drink plentifully, nor be too much tormented with thirst. His mouth also may be washed, when it is both dry, and has a fetid taste; although such time is not seasonable for drinking. And Erasistratus very justly observed, that often the mouth and fauces require moisture, when there is no want of it in the internal parts; and that it is of no consequence, that the patient is uneasy. Such then ought to be the treatment at first.

Now the best medicine is food seasonably administered: when that must be given first, is a question. Most of the ancients were slow in giving it; often on the fifth or sixth day: and that perhaps the nature of the climate in Asia or in Egypt admits of. Asclepiades, after he had for three days fatigued the patient in every way, appointed the fourth for food. But Themison of late considered, not when the fever had begun, but when it had gone off, or at least was abated; and waiting for the third day from that time, if the fever had not returned, he gave food immediately; if it did come on, when it had ceased; or if it continued constantly, when at least it was mitigated.

Now none of these rules is always to be followed. For it may be proper to give food on the first day, it may on the second, it may on the third, it may not before the fourth or fifth; it may after one fit, it may after two, it may after several. For the qualities of the distemper, constitution, air, age, and season of the year make some difference. And no time can be universally fixed in things so widely different from each other. In a distemper that weakens more, food must be sooner allowed; also in an air that is more dissipating. Upon this account in Africa for no day it seems proper to prescribe fasting. It should be given also sooner to a boy, than a young man; more quickly in summer, than winter. This one thing must be practised always and every where, that a physician sitting by should now and then observe the strength of the patient, and as long as that continues, encounter the disease by abstinence; if he begins to apprehend weakness, support him by food. For it is his business to be careful neither to load the patient by superfluous matter, nor when he is weaker, to kill him by fasting. And this I find in Erasistratus, who though he did not direct, when the belly, when the body itself was to be evacuated, yet by saying that these were to be regarded, and that food was to be given, when the body stood in need of it, has plainly enough shewn, that it ought not to be given, while there w as a sufficient quantity of strength, and that care should be taken, that it was not too much exhausted.

From these things it may be inferred, that many people cannot be attended by one physician; and that the man to be trusted is he, that knows his profession, and is not much absent from the patient. But they, that practise only from views of gain, because their profits arise in proportion to the number of patients, readily fall in with such rules, as do not require close attendance; as in this very case. For it is easy even for such, as seldom see the patient, to count the days and the fits: but it is necessary for him to sit by his patient, who would form a true judgment what is alone fit to be done; when he will be too weak unless he get food. In most people however the fourth day is usually the most proper for beginning to give food.

But there is still another doubt about the days themselves, because the ancients chiefly regarded the odd days, and called them critical[ BC ], as if on these a judgment was to be formed concerning the patients. These days were the third, fifth, seventh, ninth, eleventh, fourteenth, and twenty-first; so that the greatest influence was attributed to the seventh, next to the fourteenth, and then to the twenty-first. And therefore with regard to the nourishment of the sick, they waited for the fits of the odd days: then afterwards they gave food, expecting the approaching fits to be easier; insomuch that Hippocrates, if the fever had ceased on any other day, used to be apprehensive of a relapse.

This Asclepiades justly rejected as idle, and said that no day was more or less dangerous to the patients, by its being either even or odd. For sometimes the even days are worse; and food is given more properly after the paroxysm of the fevers: sometimes also in the same distemper the quality of the days is changed: and that becomes more severe, which had used to be more mild: and the fourteenth day itself is even, upon which the ancients laid a great stress. And when they maintained, that the eighth was of the same nature with the first, because the second number of seven began from it, they were inconsistent with themselves in not taking the eighth, or tenth, or twelfth day, as the more important: for they attributed more to the ninth and eleventh. When they had done this without any plausible reason, they passed on from the eleventh, not to the thirteenth, but to the fourteenth. It is a remark of Hippocrates too, that the fourth day is worst to him, that is to be relieved on the seventh. So that even by his own account, upon an even day both the fever may be more violent, and a sure indication given of what is to follow. And the same author elsewhere takes every fourth day to have the strongest influence with regard to both events; that is the fourth, seventh, eleventh, fourteenth, seventeenth: in which he passes from the odd to the even reckoning. Neither in this indeed has he kept to his point: since the eleventh is not the fourth, but the fifth day after the seventh. Whence it appears, in whatever light we consider the number, no true reasoning can be found in his doctrine. But with regard to these the ancients were misled by the Pythagoric numbers at that time in great vogue: whereas here as well as in other cases a physician ought not to count the days, but to consider the paroxysms themselves; and upon them to found his conjecture when food is to be given.