on regimen in acute diseases-第2章

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draught　is　to　be　given　early　in　the　day；　and　the　other　food　in　place
is　to　be　given　in　the　evening。　These　things　are　proper；　for　the　most
part；　to　be　given　to　those　who；　from　the　first；　have　used　ptisan
containing　its　whole　substance；　for　the　pains　in　pleuritic
affections　immediately　cease　of　their　own　accord　whenever　the　patients
begin　to　expectorate　anything　worth　mentioning；　and　the　purgings
become　much　better；　and　empyema　much　more　seldom　takes　place；　than
if　the　patients　used　a　different　regimen；　and　the　crises　are　more
simple；　occur　earlier；　and　the　cases　are　less　subject　to　relapses。
　　5。　Ptisans　are　to　be　made　of　the　very　best　barley；　and　are　to　be
well　boiled；　more　especially　if　you　do　not　intend　to　use　them
strained。　For；　besides　the　other　virtues　of　ptisan；　its　lubricant
quality　prevents　the　barley　that　is　swallowed　from　proving
injurious；　for　it　does　not　stick　nor　remain　in　the　region　of　the
breast；　for　that　which　is　well　boiled　is　very　lubricant；　excellent　for
quenching　thirst；　of　very　easy　digestion；　and　very　weak；　all　which
qualities　are　wanted。　If；　then；　one　do　not　pay　proper　attention　to　the
mode　of　administering　the　ptisan；　much　harm　may　be　done；　for　when
the　food　is　shut　up　in　the　bowels；　unless　one　procure　some
evacuation　speedily；　before　administering　the　draught；　the　pain；　if
present；　will　be　exasperated；　and；　if　not　present；　it　will　be
immediately　created；　and　the　respiration　will　become　more　frequent；
which　does　mischief；　for　it　dries　the　lungs；　fatigues　the
hypochondria；　the　hypogastrium；　and　diaphragm。　And　moreover　if；
while　the　pain　of　the　side　persists；　and　does　not　yield　to　warm
fomentations；　and　the　sputa　are　not　brought　up；　but　are　viscid　and
unconcocted；　unless　one　get　the　pain　resolved；　either　by　loosening　the
bowels；　or　opening　a　vein；　whichever　of　these　may　be　proper；…　if　to
persons　so　circumstanced　ptisan　be　administered；　their　speedy　death
will　be　the　result。　For　these　reasons；　and　for　others　of　a　similar
kind　still　more；　those　who　use　unstrained　ptisan　die　on　the　seventh
day；　or　still　earlier；　some　being　seized　with　delirium；　and　others
dying　suffocated　with　orthopnoee　and　riles。　Such　persons　the
ancients　thought　struck；　for　this　reason　more　especially；　that　when
dead　the　affected　side　was　livid；　like　that　of　a　person　who　had　been
struck。　The　cause　of　this　is　that　they　die　before　the　pain　is
resolved；　being　seized　with　difficulty　of　respiration；　and　by　large
and　rapid　breathing；　as　has　been　already　explained；　the　spittle
becoming　thick；　acid；　and　unconcocted；　cannot　be　brought　up；　but；
being　retained　in　the　bronchi　of　the　lungs；　produces　riles；　and；
when　it　has　come　to　this；　death；　for　the　most　part；　is　inevitable；　for
the　sputa　being　retained　prevent　the　breath　from　being　drawn　in；　and
force　it　speedily　out；　and　thus　the　two　conspire　together　to　aggravate
the　sputa　being　retained　renders　the　respiration　frequent；　while　the
respiration　being　frequent　thickens　the　sputa；　and　prevents　them
from　being　evacuated。　These　symptoms　supervene；　not　only　if　ptisan
be　administered　unseasonably；　but　still　more　if　any　other　food　or
drink　worse　than　ptisan　be　given。
　　6。　For　the　most　part；　then；　the　results　are　the　same；　whether　the
patient　have　used　the　unstrained　ptisan　or　have　used　the　juice
alone；　or　even　only　drink；　and　sometimes　it　is　necessary　to　proceed
quite　differently。　In　general；　one　should　do　thus：　if　fever
commences　shortly　after　taking　food；　and　before　the　bowels　have　been
evacuated；　whether　with　or　without　pain；　the　physician　ought　to
withhold　the　draught　until　he　thinks　that　the　food　has　descended　to
the　lower　part　of　the　belly；　and　if　any　pain　be　present；　the　patient
should　use　oxymel；　hot　if　it　is　winter；　and　cold　if　it　is　summer；　and；
if　there　be　much　thirst；　he　should　take　hydromel　and　water。　Then；　if
any　pain　be　present；　or　any　dangerous　symptoms　make　their
appearance；　it　will　be　proper　to　give　the　draught　neither　in　large
quantity　nor　thick；　but　after　the　seventh　day；　if　the　patient　be
strong。　But　if　the　earlier…taken　food　has　not　descended；　in　the　case
of　a　person　who　has　recently　swallowed　food；　and　if　he　be　strong　and
in　the　vigor　of　life；　a　clyster　should　be　given；　or　if　he　be　weaker；　a
suppository　is　to　be　administered；　unless　the　bowels　open　properly
of　themselves。　The　time　for　administering　the　draught　is　to　be
particularly　observed　at　the　commencement　and　during　the　whole
illness；　when；　then；　the　feet　are　cold；　one　should　refrain　from　giving
the　ptisan；　and　more　especially　abstain　from　drink；　but　when　the
heat　has　descended　to　the　feet；　one　may　then　give　it；　and　one　should
look　upon　this　season　as　of　great　consequence　in　all　diseases；　and　not
least　in　acute　diseases；　especially　those　of　a　febrile　character；
and　those　of　a　very　dangerous　nature。　One　may　first　use　the　juice；　and
then　the　ptisan；　attending　accurately　to　the　rules　formerly　laid　down。
　　7。　When　pain　seizes　the　side；　either　at　the　commencement　or　at　a
later　stage；　it　will　not　be　improper　to　try　to　dissolve　the　pain　by
hot　applications。　Of　hot　applications　the　most　powerful　is　hot　water
in　a　bottle；　or　bladder；　or　in　a　brazen　vessel；　or　in　an　earthen
one；　but　one　must　first　apply　something　soft　to　the　side；　to　prevent
pain。　A　soft　large　sponge；　squeezed　out　of　hot　water　and　applied；
forms　a　good　application；　but　it　should　be　covered　up　above；　for
thus　the　heat　will　remain　the　longer；　and　at　the　same　time　the　vapor
will　be　prevented　from　being　carried　up　to　the　patient's　breath；
unless　when　this　is　thought　of　use；　for　sometimes　it　is　the　case。
And　further；　barley　or　tares　may　be　infused　and　boiled　in　diluted
vinegar；　stronger　than　that　it　could　be　drunk；　and　may　then　be　sewed
into　bladders　and　applied；　and　one　may　bran　in　like　manner。　Salts　or
toasted　millet　in　woolen　bags　are　excellent　for　forming　a　dry
fomentation；　for　the　millet　is　light　and　soothing。　A　soft
fomentation　like　this　soothes　pains；　even　such　as　shoot　to　the
clavicle。　Venesection；　however；　does　not　alleviate　the　pain　unless
when　it　extends　to　the　clavicle。　But　if　the　pain　be　not　dissolved　by
the　fomentations；　one　ought　not　to　foment　for　a　length　of　time；　for
this　dries　the　lungs　and　promotes　suppuration；　but　if　the　pain　point
to　the　clavicle；　or　if　there　be　a　heaviness　in　the　arm；　or　about　the
breast；　or　above　the　diaphragm；　one　should　open　the　inner　vein　at
the　elbow；　and　not　hesitate　to　abstract　a　large　quantity；　until　it
become　much　redder；　or　instead　of　being　pure　red；　it　turns　livid；
for　both　these　states　occur。　But　if　the　pain　be　below　the　diaphragm；
and　do　not　point　to　the　clavicle；　we　must　open　the　belly　either　with
black　hellebore　or　peplium；　mixing　the　black　hellebore　with　carrot
or　seseli；　or　cumin；　or　anise；　or　any　other　of　the　fragrant　herbs；　and
with　the　peplium　the　juice　of　sulphium　（asafoetida）；　for　these
substances；　when　mixed　up　together；　are　of　a　similar　nature。　The　black
hellebore　acts　more　pleasantly　and　effectually　than　the　peplium；
while；　on　the　other　hand；　the　peplium　expels　wind　much　more
effectually　than　the　black　hellebore；　and　both　these　stop　the　pain；
and　many　other　of　the　laxatives　also　stop　it；　but　these　two　are　the
most　efficacious　that　I　am　acquainted　with。　And　the　laxatives　given　in
draughts　are　beneficial；　when　not　very　unpalatable　owing　to
bitterness；　or　any　other　disagreeable　taste；　or　from　quantity；
color；　or　any　apprehension。　When　the　patient　has　drunk　the　medicine；
one　ought　to　give　him　to　swallow　but　little　less　of　the　ptisan　than
what　he　had　been　accustomed　to；　but　it　is　according　to　rule　not　to
according　to　rule　not　to　give　any　draughts　while　the　medicine　is　under
operation；　but　when　the　purging　is　stopped　then　he　should　take　a
smaller　draught　than　what　he　had　been　accustomed　to；　and　afterwards　go
on　increasing　it　progressively；　until　the　pain　cease；　provided　nothing
else　contra…indicate。　This　is　my　rule；　also；　if　one　would　use　the
juice　of　ptisan　（for　I　hold　that　it　is　better；　on　the　whole；　to
begin　with　taking　the　decoction　at　once；　rather　than　by　first　emptying
the　veins　before　doing　so；　or　on　the　third；　fourth；　fifth；　sixth；　or
seventh　day；　provided　the　disease　has　not　previously　come　to　a
c