Of Medicine, in Eight Books

by Aulus Cornelius Celsus

But patients are more easily managed with regard to food; because in spite of some inclination of their own, the stomach then refuses it. But in the article of drink the struggle is hard; and the more violent, the higher the fever is: for this inflames the thirst, and demands water most importunately, when it is most dangerous. But the patient is to be informed, that when the fever has abated, the thirst also will immediately decline; and that the paroxysm will be longer, if any nourishment be given to him: and that he that drinks none, is sooner freed from the thirst. However as even people in health can bear hunger a good deal easier than thirst, it is necessary to indulge the sick more with regard to drink than food. But on the first day no moisture ought to be given, unless the pulse has suddenly sunk so low, that there is a necessity for giving food also; but on the second and following days likewise, where food is not to be allowed, yet if the thirst be violent, drink may be given.

What was said by Heraclides of Tarentum is not altogether without reason; that when either bile or crudity make a patient uneasy; it is expedient by a moderate quantity of a drink to mix new matter with the corrupted. This rule ought carefully to be observed, that the same times be chosen for drink as for food: when it is to be given without the other, let it be at a time, when we would desire the patient to sleep, which commonly thirst prevents. It is generally allowed, that as too much moisture is hurtful to every person in a fever, it is especially so to such women, as have fallen into fevers after child-bearing.

But as the fever and the manner of its remission direct to the proper seasons for food and drink, so it is not very easy to know, when the patient has a fever upon him, when he is better, or when his strength fails; without which these cannot be properly administered. For we principally trust the pulse, a most fallacious mark; because this is often slower or more quick from the age, and sex, and difference of constitutions. And generally when the body is in good enough health, if the stomach be weak, sometimes also in the beginning of a fever, it rises and sinks; so that the person may seem to be weak, when he can very well stand a severe fit that is just approaching. On the other hand, the pulse is often raised, and the vessels relaxed by the influence of the sun, and the bath, and exercise, and fear, and anger, and any other passion of the mind. So that, when a physician first comes in, the anxiety of the patient, doubtful how he may think him, accelerates the pulse. For this reason it is the business of a skilful physician not to take hold of the patient’s arm with his hand, as soon as he comes in; but first to sit down with a cheerful countenance, and ask him how he does; and if he has any apprehension, to encourage him with plausible discourse: then to apply his hand to his wrist[(5)]. Now if the sight of the physician quickens the pulse, how easily may a thousand other accidents disorder it! Another mark, to which we trust, is heat, equally deceitful; for this is excited by warmth, labour, sleep, fear, and anxiety.

Wherefore it is fit to consider those things; but not to trust entirely to them. And we may at once assure ourselves that a person has no fever, whose pulse moves regularly, and who has such a heat as is common to people in health; and that a fever is not necessarily breeding, when there is heat and motion; but only with these circumstances, if the surface of the skin, be unequally dry; if there be a heat in the forehead, and at the same time arising from the internal part of the præcordia; if the breath rushes out of the nostrils very hot; if the colour be changed either for a redness or an unusual paleness; if the eyes are heavy, and either very dry or somewhat moist; if when a sweat comes on, it is partial; if the pulse does not beat at equal intervals. Upon this account the physician ought to sit down neither in the dark, nor at the patient’s head, but in a light place opposite to him, that he may take all the marks from the countenance of the patient as he lies.

Now where there has been a fever, and it has decreased, it is, proper to take notice, whether the temples or other parts of the body grow a little moist, so as to portend an approaching sweat. And if there is any prognostic of it, upon that to give warm water to drink, the effect of which is salutary, if it diffuse a sweat over the whole body. For this purpose the patient ought to keep his hands under a good quantity of clothes; and to cover his legs and feet in the same manner. By laying on such a load many people mismanage patients in the very height of the fever, and especially where it is of the ardent kind. If the body begins to sweat, it is necessary to warm a linen cloth, and slowly to wipe every part. But when the sweat is entirely off, or if it have not come on, when the patient is warmest, and seems fit for food, he is to be gently anointed under the clothes, then wiped, and after that food is to be given him.

Liquid food is most proper for persons in fevers, at least as near as possible to liquids, and that of the lightest kind, particularly gruel; and even this, if the fever be violent, ought to be very thin. Clarified honey also is properly added to it, that the body may be more nourished: but if that offends the stomach, it should be omitted; and so should the gruel itself in like case. Instead of it may be given either intrita,[(6)] mixed with hot water, or washed alica; if the stomach is firm, and the belly bound, with hydromel; or if the first is weak, and the other loose, with vinegar and water. And this kind of food is sufficient for the first day: but on the second day something may be added, yet of the same nature, either greens, or conchylia, or apples. And while fevers are increasing, this is the only proper food. But when they either go off, or abate, we must always begin with something of the lightest nature, and make an addition of the middle kind, having in the mean time a regard both to the strength of the patient, and of the disease.

To set a variety of food before a patient (as Asclepiades directs) is never proper, but when he is oppressed with a nausea, and his strength fails; that by tasting a little of each he may escape being famished. But if the patient wants neither strength nor appetite, he must be tempted by no variety; lest he take more than he is able to concoct. Neither is that true, which he alleges, that food of various kinds is more easily concocted; it is indeed taken in more easily; but to concoction the genus and quantity of the food are material. Neither is it safe during great pains, nor in an encreasing distemper, for a patient to fill himself with food; but when there is already a turn towards recovery.

There are also other observations necessary to be made in fevers: and that indeed must be considered, which some regard solely, whether the body be bound or loose: the one of which suffocates, and the other dissipates. For if it is bound, the belly must be opened by clysters, urine promoted, and a sweat sollicited by every method. In this kind of disorder it is serviceable even to let blood, to agitate the body by strong gestations, to keep the person in the light, to enjoin fasting, thirst, and watchfulness. It does good also to take the person into the bath, first to plunge him into the warm bath, then anoint him. Then he should return to the warm bath, and foment his groin plentifully with water; sometimes mix oil in the bath with warm water; take food more seldom, and at greater distances than ordinary, and such as is slight, simple, soft, warm, and small in quantity; especially greens, such as dock, nettles, mallows, or the broth of shell-fish, or muscles, or locustae; and eat no flesh, but what is boiled. But the quantity of drink ought to be more liberal, both before meat, and after it, and while eating too, beyond what thirst will require. And after the bath may be given even fat broth, or wine of the sweeter kind: during which course once or twice salt Greek wine may be used.

But on the contrary, if the body incline to discharge excessively, then sweat must be restrained, and rest enjoined; and the patient may have his room darkened, and go to sleep, whenever he shall chuse it; the body is not to be agitated, unless by a gentle gestation, and to be relieved according to the nature of its disorder. For if the belly is loose, or the stomach does not retain, when the fever has abated, it is proper to give warm water to drink plentifully, and make him vomit; unless there is a pain either in the fauces, or praecordia, or side, or the distemper be inveterate.

If again a sweat prevails, the skin must be hardened, either by nitre or salt, mixed with oil. But if that disorder is more slight, the body must be anointed with pure oil: if more violent, with oil of roses, or of quinces, or of myrtles, with an addition of austere wine.