But this is of more importance, to know whether the proper time for giving food be, when the tumultuous motion of the vessels has pretty much subsided, or while some relicks of the fever still remain. For the ancients prescribed nourishment, when the body was in the soundest state: Asclepiades, upon the decline of the fit, but before it was over; his reason for which was weak; not but that food is to be given sometimes more quickly, if another paroxysm is apprehended soon; but because certainly it ought not to be given, but when the body is in its best condition: for what is received by a body free from disorder is less liable to corruption. Neither is it true, which Themison imagined, if a patient was to be well for two hours, that it would be better to give it then, that it might be digested[(2)], while the body was in health. Indeed if it could be so speedily digested, that would be best. But as so short a time is not sufficient, it is better that the beginning of food should be upon the end of one paroxysm, than that any of it should lie in the stomach, when another begins. Thus if a pretty long interval is to follow, it is to be given, when the person is freest of all indisposition; if but a short one, before the patient be quite well. What has been said of the sound state during an intermission, holds likewise with respect to the greatest remission we find in a continued fever. But it is also a question, whether it is necessary to wait so many hours, as use to be taken up by the fit; or whether it is sufficient to pass over the first part of them, that those patients may be more easy, who sometimes have not a perfect intermission. But it is most safe to suffer the whole time of the fit to be over first: although when the paroxysm has been long, the patient may be indulged sooner; nevertheless so that at least the one half be suffered to elapse first. And this is not only to be observed in the kind last mentioned, but in all fevers.
CHAP. V. PARTICULAR DIRECTIONS FOR THE GIVING OF FOOD IN THE DIFFERENT SPECIES OF FEVERS.
These observations are of a more general nature belonging to all kinds of fevers: I shall now descend to the particular species of them. Wherefore if there has been only one fit, which has gone off, and that arose either from the inguen[(3)], or from fatigue, or from heat, or from some such accident, so that there is no reason to apprehend danger from any internal cause, the following day, when the time of the fit has passed without any disorder, food may be given. But if the heat come from within; and a heaviness of the head or præcordia has followed; and there is no apparent cause for the disturbance of the body; although health has followed one fit, yet because a tertian may be apprehended, the third day is to be expected; and when the time for the fit is over, food is to be given, but very little of it; because a quartan may also be feared. But upon the fourth day, if the body is well, it may be freely used. If indeed the paroxysm has followed upon the second, third, or fourth day, then we may conclude it to be a disease. But the method of cure in tertians and quartans (whose periods are certain, whose fits leave no indisposition, and the intervals are in a good measure calm) is easier: of which I shall speak in their proper place.
At present I shall treat of those, which distress every day. Wherefore it is most convenient to give food to the patient every third day; that the abstinence of one day may lessen the fever, on the other nourishment may recruit the strength. But when the fever is quotidian, and goes entirely off, it ought to be given as soon as the body becomes well. But if though there are not distinct fits immediately succeeding each other, yet there are feverish heats without intermission, and these daily increase without going entirely off, then it is to be allowed at that point of time, when a greater remission is not to be expected: if on one day the fit is more severe, and on another milder, after the most severe. Now commonly a more severe fit is followed by an easier night: whence it happens also, that a more troublesome night precedes a severer fit.
But if the fever is continued, and is never mitigated, and there is a necessity for giving food, the proper time for doing this is much disputed. Some, because patients are commonly easier in the morning, think that the opportunity. Which if it be so, is a proper time, not because it is the morning, but because the patients then have a remission. If even at that time the patient has no ease, since upon this very account that time is worse, that whereas from its own nature it ought to be better, from the force of the distemper it is not so; and likewise because the middle of the day follows, after which as almost every patient grows worse, there is room to fear, lest he be then more distressed, than he used to be: therefore, some give food to such a patient in the evening. But since at that time sick people are commonly worst, there is cause to be afraid, lest if we raise any commotion then, the disorder may be increased. For these reasons others defer it[(4)] till midnight, when the severest is just over, and while the same is at the greatest distance. It is more safely given before day-light, when most sick people get the quietest sleep; next to that in the morning, the time which is naturally the easiest of all.
But if the fits are irregular, because in such a case there is room to fear, that they may follow immediately after food; whenever a patient is relieved from the paroxysms he ought to eat. But if several paroxysms come on the same day, it is necessary to consider, whether these be in all respects equal (which can scarcely happen) or unequal. If they be in every point equal, food ought rather to be given after that fit, the end of which does not fall betwixt mid-day and the evening. If they are unequal, it must be considered what the difference is. For if one is more severe, and the other more mild, it ought to be given after the more severe fit: if the one is longer, and the other shorter, after the longer: if one is more severe, and the other of longer continuance, it must be examined, which of the two distresses most, the one by its violence, or the other by its continuance; and it must be given after the most weakening. But it is plainly the most important point of all, how great the remissions are, and of what nature, which happen between the fits. For if an uneasiness remains after one paroxysm, and the body feels no indisposition after the other; when the body is well, it is the fitter time for food.
If a feverishness always continues, but yet one remission is longer than the other, that is rather to be chosen: so that when the fits are continued, food may be administered immediately upon the decline of the first. For this is an universal rule, and may serve for directing all our measures in this article, to give food at the greatest distance always from a future fit; and with this caution to give it in the best state of the body. Which must be observed not only between two fits, but also amongst several. But whereas it is most generally proper to give food every third day, yet if the body is weak it must be given every day: and much more so, if the fevers are continued without any remission: and it is the more needful, the more they weaken the body; or if two or more fits attack on the same day. Which occurrence also requires the giving of food every day immediately from the first, if the pulse has presently sunk; and oftener on the same day, if in the midst of several fits the strength of the body now and then fails. Yet in these this observation must be regarded; that after such fits less food be given, where if the strength of the body would admit, none would be given at all. Now as a paroxysm must either be instantly expected, or beginning, or increasing, or at its height, or abating; and again in its abatement either at a stand, or entirely gone off; it is certain the best season for food is, when the fever is ended; next to that, when in its abatement it stops; thirdly, if there be a necessity, whenever it begins to abate: all other times are dangerous. But if upon account of weakness there is an absolute necessity for it, it is better to give somewhat, when its increase is at a stand, than while it still increases; better when it is instantly expected, than when it is beginning. Nevertheless no time is improper for supporting one, who faints for want.
Nor indeed is it sufficient for a physician to regard only the fevers, but also the state of the whole body, and direct his cure by that; whether the patient has a sufficient measure of strength or not, whether some troublesome passions affect the mind. And as the sick should always be in a state of tranquillity, that they be distressed in body only, and not in mind at the same time; so it is more especially necessary immediately after food; so that if there be any thing, which would render them uneasy, it is the best way, while they are sick, to conceal it from them; if that cannot be done, at least to forbear after food; and after their time of sleep, and when they have awaked, then to communicate it.