on regimen in acute diseases-第1章

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　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　400　BC
　　　　　　　　　　　　　　　　　　　　　　　　　　ON　REGIMEN　IN　ACUTE　DISEASES

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　by　Hippocrates

　　　　　　　　　　　　　　　　　　　　　　　　　　Translated　by　Francis　Adams

　　　　　　　　　　　　　　　

　　THOSE　who　composed　what　are　called　〃The　Cnidian　Sentences〃　have
described　accurately　what　symptoms　the　sick　experience　in　every
disease；　and　how　certain　of　them　terminate；　and　in　so　far　a　man；
even　who　is　not　a　physician；　might　describe　them　correctly；　provided
he　put　the　proper　inquiries　to　the　sick　themselves　what　their
complaints　are。　But　those　symptoms　which　the　physician　ought　to　know
beforehand　without　being　informed　of　them　by　the　patient；　are；　for　the
most　part；　omitted；　some　in　one　case　and　some　in　others；　and　certain
symptoms　of　vital　importance　for　a　conjectural　judgment。　But　when；
in　addition　to　the　diagnosis；　they　describe　how　each　complaint
should　be　treated；　in　these　cases　I　entertain　a　still　greater
difference　of　opinion　with　them　respecting　the　rules　they　have　laid
down；　and　not　only　do　I　not　agree　with　them　on　this　account；　but
also　because　the　remedies　they　use　are　few　in　number；　for；　with　the
exception　of　acute　diseases；　the　only　medicines　which　they　give　are
drastic　purgatives；　with　whey；　and　milk　at　certain　times。　If；
indeed；　these　remedies　had　been　good　and　suitable　to　the　complaints　in
which　they　are　recommended；　they　would　have　been　still　more
deserving　of　recommendation；　if；　while　few　in　number；　they　were
sufficient；　but　this　is　by　no　means　the　case。　Those；　indeed；　who
have　remodeled　these　〃Sentences〃　have　treated　of　the　remedies
applicable　in　each　complaint　more　in　a　medical　fashion。　But　neither
have　the　ancients　written　anything　worth　regimen；　although　this　be　a
great　omission。　Some　of　them；　indeed；　were　not　ignorant　of　the　many
varieties　of　each　complaint；　and　their　manifold　divisions；　but　when
they　wish　to　tell　clearly　the　numbers　（species？）　of　each　disease
they　do　not　write　for　their　species　would　be　almost　innumerable　if
every　symptom　experienced　by　the　patients　were　held　to　constitute　a
disease；　and　receive　a　different　name。
　　2。　For　my　part；　I　approve　of　paying　attention　to　everything　relating
to　the　art；　and　that　those　things　which　can　be　done　well　or　properly
should　all　be　done　properly；　such　as　can　be　quickly　done　should　be
done　quickly；　such　as　can　be　neatly　done　should　be　done　neatly；　such
operations　as　can　be　performed　without　pain　should　be　done　with　the
least　possible　pain；　and　that　all　other　things　of　the　like　kind　should
be　done　better　than　they　could　be　managed　by　the　attendants。　But　I
would　more　especially　commend　the　physician　who；　in　acute　diseases；　by
which　the　bulk　of　mankind　are　cut　off；　conducts　the　treatment　better
than　others。　Acute　diseases　are　those　which　the　ancients　named
pleurisy；　pneumonia；　phrenitis；　lethargy；　causus；　and　the　other
diseases　allied　to　these；　including　the　continual　fevers。　For；
unless　when　some　general　form　of　pestilential　disease　is　epidemic；　and
diseases　are　sporadic　and　＇not＇　of　a　similar　character；　there　are　more
deaths　from　these　diseases　than　from　all　the　others　taken　together。
The　vulgar；　indeed；　do　not　recognize　the　difference　between　such
physicians　and　their　common　attendants；　and　are　rather　disposed　to
commend　and　censure　extraordinary　remedies。　This；　then；　is　a　great
proof　that　the　common　people　are　most　incompetent；　of　themselves；　to
form　a　judgment　how　such　diseases　should　be　treated：　since　persons　who
are　not　physicians　pass　for　physicians　owing　most　especially　to
these　diseases；　for　it　is　an　easy　matter　to　learn　the　names　of　those
things　which　are　applicable　to　persons　laboring　under　such　complaints。
For；　if　one　names　the　juice　of　ptisan；　and　such　and　such　a　wine；　and
hydromel；　the　vulgar　fancy　that　he　prescribes　exactly　the　same
things　as　the　physicians　do；　both　the　good　and　the　bad；　but　in　these
matters　there　is　a　great　difference　between　them。
　　3。　But　it　appears　to　me　that　those　things　are　more　especially
deserving　of　being　consigned　to　writing　which　are　undetermined　by
physicians；　notwithstanding　that　they　are　of　vital　importance；　and
either　do　much　good　or　much　harm。　By　undetermined　I　mean　such　as
these；　wherefore　certain　physicians；　during　their　whole　lives；　are
constantly　administering　unstrained　ptisans；　and　fancy　they　thus
accomplish　the　cure　properly；　whereas　others　take　great　pains　that　the
patient　should　not　swallow　a　particle　of　the　barley　（thinking　it　would
do　much　harm）；　but　strain　the　juice　through　a　cloth　before　giving
it；　others；　again；　will　neither　give　thick　ptisan　nor　the　juice；
some　until　the　seventh　day　of　the　disease；　and　some　until　after　the
crisis。　Physicians　are　not　in　the　practice　of　mooting　such
questions；　nor；　perhaps；　if　mooted；　would　a　solution　of　them　be　found；
although　the　whole　art　is　thereby　exposed　to　much　censure　from　the
vulgar；　who　fancy　that　there　really　is　no　such　science　as　medicine；
since；　in　acute　diseases；　practitioners　differ　so　much　among
themselves；　that　those　things　which　one　administers　as　thinking　it　the
best　that　can　be　given；　another　holds　to　be　bad；　and；　in　this　respect；
they　might　say　that　the　art　of　medicine　resembles　augury；　since　augurs
hold　that　the　same　bird　（omen）　if　seen　on　the　left　hand　is　good；　but
if　on　the　right　bad：　and　in　divination　by　the　inspection　of　entrails
you　will　find　similar　differences；　but　certain　diviners　hold　the
very　opposite　of　these　opinions。　I　say；　then；　that　this　question　is
a　most　excellent　one；　and　allied　to　very　many　others；　some　of　the　most
vital　importance　in　the　Art；　for　that　it　can　contribute　much　to　the
recovery　of　the　sick；　and　to　the　preservation　of　health　in　the　case　of
those　who　are　well；　and　that　it　promotes　the　strength　of　those　who　use
gymnastic　exercises；　and　is　useful　to　whatever　one　may　wish　to　apply
it。
　　4。　Ptisan；　then；　appears　to　me　to　be　justly　preferred　before　all　the
other　preparations　from　grain　in　these　diseases；　and　I　commend　those
who　made　this　choice；　for　the　mucilage　of　it　is　smooth；　consistent；
pleasant；　lubricant；　moderately　diluent；　quenches　thirst　if　this　be
required；　and　has　no　astringency；　gives　no　trouble　nor　swells　up　in
the　bowels；　for　in　the　boiling　it　swells　up　as　much　as　it　naturally
can。　Those；　then；　who　make　use　of　ptisan　in　such　diseases；　should
never　for　a　day　allow　their　vessels　to　be　empty　of　it；　if　I　may　say
so；　but　should　use　it　and　not　intermit；　unless　it　be　necessary　to　stop
for　a　time；　in　order　to　administer　medicine　or　a　clyster。　And　to　those
who　are　accustomed　to　take　two　meals　in　the　day　it　is　to　be　given
twice；　and　to　those　accustomed　to　live　upon　a　single　meal　it　is　to
be　given　once　at　first；　and　then；　if　the　case　permit；　it　is　to　be
increased　and　given　twice　to　them；　if　they　appear　to　stand　in　need
of　it。　At　first　it　will　be　proper　not　to　give　a　large　quantity　nor
very　thick；　but　in　proportion　to　the　quantity　of　food　which　one　has
been　accustomed　to　take；　and　so　as　that　the　veins　may　not　be　much
emptied。　And；　with　regard　to　the　augmentation　of　the　dose；　if　the
disease　be　of　a　drier　nature　than　one　had　supposed；　one　must　not
give　more　of　it；　but　should　give　before　the　draught　of　ptisan；
either　hydromel　or　wine；　in　as　great　quantity　as　may　be　proper；　and
what　is　proper　in　each　case　will　be　afterward　stated　by　us。　But　if　the
mouth　and　the　passages　from　the　lungs　be　in　a　proper　state　as　to
moisture；　the　quantity　of　the　draught　is　to　be　increased；　as　a　general
rule；　for　an　early　and　abundant　state　of　moisture　indicates　an　early
crisis；　but　a　late　and　deficient　moisture　indicates　a　slower　crisis。
And　these　things　are　as　I　have　stated　for　the　most　part；　but　many
other　things　are　omitted　which　are　important　to　the　prognosis；　as　will
be　explained　afterwards。　And　the　more　that　the　patient　is　troubled
with　purging；　in　so　much　greater　quantity　is　it　to　be　given　until
the　crisis；　and　moreover　until　two　days　beyond　the　crisis；　in　such
cases　as　it　appears　to　take　place　on　the　fifth；　seventh；　or　ninth　day；
so　as　to　have　respect　both　for　the　odd　and　even　day：　after　this　the
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　o