on regimen in acute diseases-第6章

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proper　to　administer　purgative　medicine；　it　ought　not　be　done　during
the　first　three　days；　nor　earlier　than　the　fourth。　When　you　give　the
medicine；　use　the　ptisan；　observing　the　paroxysms　of　the　fevers；　so　as
not　to　give　it　when　the　fever　is　setting　in；　but　when　it　is　ceasing；
or　on　the　decline；　and　as　far　as　possible　from　the　commencement。
When　the　feet　are　cold；　give　neither　drink　nor　ptisan；　nor　anything
else　of　the　kind；　but　reckon　it　an　important　rule　to　refrain　until
they　become　warm；　and　then　you　may　administer　them　with　advantage。　For
the　most　part；　coldness　of　the　feet　is　a　symptom　of　a　paroxysm　of
the　fever　coming　on；　and　if　at　such　a　season　you　apply　those　things；
you　will　commit　the　greatest　possible　mistake；　for　you　will　augment
the　disease　in　no　small　degree。　But　when　the　fever　ceases；　the　feet；
on　the　contrary；　become　hotter　than　the　rest　of　the　body；　for　when　the
heat　leaves　the　feet；　it　is　kindled　up　in　the　breast；　and　sends　its
flame　up　to　the　head。　And　when　all　the　heat　rushes　upwards；　and　is
exhaled　at　the　head；　it　is　not　to　be　wondered　at　that　the　feet
become　cold；　being　devoid　of　flesh；　and　tendinous；　and　besides；　they
contract　cold；　owing　to　their　distance　from　the　hotter　parts　of　the
body；　an　accumulation　of　heat　having　taken　place　in　the　chest：　and
again；　in　like　manner；　when　the　fever　is　resolved　and　dissipated；
the　heat　descends　to　the　feet；　and；　at　the　same　time；　the　head　and
chest　become　cold。　Wherefore　one　should　attend　to　this；　that　when
the　feet　are　cold；　the　bowels　are　necessarily　hot；　and　filled　with
nauseous　matters；　the　hypochondrium　distended：　there　is　jactitation　of
the　body；　owing　to　the　internal　disturbance；　and　aberration　of　the
intellect；　and　pains；　the　patient　is　agitated；　and　wishes　to　vomit；
and　if　he　vomits　bad　matters　he　is　pained；　but　when　the　heat
descends　to　the　feet；　and　the　urine　passes　freely；　he　is　every　way
lightened；　even　although　he　does　not　sweat；　at　this　season；　then；
the　ptisan　ought　to　be　given；　it　would　be　death　to　give　it　before。
　　8。　When　the　bowels　are　loose　during　the　whole　course　of　fevers；　in
this　case　we　are　most　especially　to　warm　the　feet；　and　see　that　they
are　properly　treated　with　cerates；　and　wrapped　in　shawls；　so　that　they
may　not　become　colder　than　the　rest　of　the　body；　but　when　they　are
hot；　no　fomentation　must　be　made　to　them；　but　care　is　to　be　taken　that
they　do　not　become　cold；　and　very　little　drink　is　to　be　used；　either
cold　water　or　hydromel。　In　those　cases　of　fever　where　the　bowels　are
loose；　and　the　mind　is　disordered；　the　greater　number　of　patients　pick
the　wool　from　their　blankets；　scratch　their　noses；　answer　briefly　when
questions　are　put　to　them；　but；　when　left　to　themselves；　utter　nothing
that　is　rational。　Such　attacks　appear　to　me　to　be　connected　with　black
bile。　When　in　these　cases　there　is　a　colliquative　diarrhoea；　I　am　of
opinion　that　we　ought　to　give　the　colder　and　thicker　ptisans；　and　that
the　drinks　ought　to　be　binding；　of　a　vinous　nature；　and　rather
astringent。　In　cases　of　fever　attended　from　the　first　with　vertigo；
throbbing　of　the　head；　and　thin　urine；　you　may　expect　the　fever　to
be　exacerbated　at　the　crisis；　neither　need　it　excite　wonder；
although　there　be　delirium。　When；　at　the　commencement；　the　urine　is
cloudy　or　thick；　it　is　proper　to　purge　gently；　provided　this　be
otherwise　proper；　but　when　the　urine　at　first　is　thin；　do　not　purge
such　patients；　but；　if　thought　necessary；　give　a　clyster；　such
patients　should　be　thus　treated；　they　should　be　kept　in　a　quiet　state；
have　unguents　applied　to　them；　and　be　covered　up　properly　with
clothes；　and　they　should　use　for　drink　a　watery　hydromel；　and　the
juice　of　ptisan　as　a　draught　in　the　evening；　clear　out　the　bowels　at
first　with　a　clyster；　but　give　no　purgative　medicines　to　them；　for；　if
you　move　the　bowels　strongly；　the　urine　is　not　concocted；　but　the
fever　remains　long；　without　sweats　and　without　a　crisis。　Do　not　give
draughts　when　the　time　of　the　crisis　is　at　hand；　if　there　be
agitation；　but　only　when　the　fever　abates　and　is　alleviated。　It　is
proper　to　be　guarded　at　the　crises　of　other　fevers；　and　to　withhold
the　draughts　at　that　season。　Fevers　of　this　description　are　apt　to
be　protracted；　and　to　have　determinations；　if　the　inferior　extremities
be　cold；　about　the　ears　and　neck；　or；　if　these　parts　are　not　cold；
to　have　other　changes；　they　have　epistaxis；　and　disorder　of　the
bowels。　But　in　cases　of　fever　attended　with　nausea；　or　distention　of
the　hypochondria；　when　the　patients　cannot　lie　reclined　in　the　same
position；　and　the　extremities　are　cold；　the　greatest　care　and
precaution　are　necessary；　nothing　should　be　given　to　them；　except
oxymel　diluted　with　water；　no　draught　should　be　administered；　until
the　fever　abate　and　the　urine　be　concocted；　the　patient　should　be　laid
in　a　dark　apartment；　and　recline　upon　the　softest　couch；　and　he　should
be　kept　as　long　as　possible　in　the　same　position；　so　as　not　to　toss
about；　for　this　is　particularly　beneficial　to　him。　Apply　to　the
hypochondrium　linseed　by　inunctions；　taking　care　that　he　do　not
catch　cold　when　the　application　is　made；　let　it　be　in　a　tepid　state；
and　boiled　in　water　and　oil。　One　may　judge　from　the　urine　what　is　to
take　place；　for　if　the　urine　be　thicker；　and　more　yellowish；　so　much
the　better；　but　if　it　be　thinner；　and　blacker；　so　much　the　worse；
but　if　it　undergo　changes；　it　indicates　a　prolongation　of　the　disease；
and　the　patient；　in　like　manner；　must　experience　a　change　to　the　worse
and　the　better。　Irregular　fevers　should　be　let　alone　until　they　become
settled；　and；　when　they　do　settle；　they　are　to　be　treated　by　a
suitable　diet　and　medicine；　attending　to　the　constitution　of　the
patient。
　　9。　The　aspects　of　the　sick　are　various；　wherefore　the　physician
should　pay　attention；　that　he　may　not　miss　observing　the　exciting
causes；　as　far　as　they　can　be　ascertained　by　reasoning；　nor　such
symptoms　as　should　appear　on　an　even　or　odd　day；　but　he　ought　to；　be
particularly　guarded　in　observing　the　odd　days；　as　it　is　in　them；　more
especially；　that　changes　take　place　in　patients。　He　should　mark；
particularly；　the　first　day　on　which　the　patient　became　ill；
considering　when　and　whence　the　disease　commenced；　for　this　is　of
primary　importance　to　know。　When　you　examine　the　patient；　inquire　into
all　particulars；　first　how　the　head　is；　and　if　there　be　no　headache；
nor　heaviness　in　it；　then　examine　if　the　and　sides　be　free　of　pain；
for　if　the　hypochondrium　be　painful；　swelled；　and　unequal；　with　a
sense　of　satiety；　or　if　there　be　pain　in　the　side；　and；　along　with　the
pain；　either　cough；　tormina；　or　belly…ache；　if　any　of　these　symptoms
be　present　in　the　hypochondrium；　the　bowels　should　be　opened　with
clysters；　and　the　patient　should　drink　boiled　hydromel　in　a　hot　state。
The　physician　should　ascertain　whether　the　patient　be　apt　to　faint
when　he　is　raised　up；　and　whether　his　breathing　be　free；　and　examine
the　discharges　from　the　bowels；　whether　they　be　very　black；　or　of　a
proper　color；　like　those　of　persons　in　good　health；　and　ascertain
whether　the　fever　has　a　paroxysm　every　third　day；　and　look　well　to
such　persons　on　those　days。　And　should　the　fourth　day　prove　like　the
third；　the　patient　is　in　a　dangerous　state。　With　regard　to　the
symptoms；　black　stools　prognosticate　death；　but　if　they　resemble　the
discharges　of　a　healthy　person；　and　if　such　is　their　appearance
every　day；　it　is　a　favorable　symptom；　but　when　the　bowels　do　not　yield
to　a　suppository；　and　when；　though　the　respiration　be　natural；　the
patient　when　raised　to　the　night　table；　or　even　in　bed；　be　seized　with
deliquium；　you　may　expect　that　the　patient；　man　or　woman；　who
experiences　these　symptoms；　is　about　to　fall　to　fall　into　a　state　of
delirium。　Attention　also　should　be　paid　to　the　hands；　for　if　they
tremble；　you　may　expect　epistaxis；　and　observe　the　nostrils；　whether
the　breath　be　drawn　in　equally　by　both；　and　if　expiration　by　the
nostrils　be　large；　a　convulsion　is　apt　to　take　place；　and　should　a
convulsion　occur　to　such　a　person；　death　may　be　anticipated；　and　it　is
well　to　announce　it　beforehand。
　　10。　If；　in　a　winter　fever；　the　tongue　be　rough；　and　if　there　be
swoonings；　it　is　likely　to　be　the　remission　of　the　fever。　Nevertheless
such　a　person　is　to　be　kept　upon　a　restricted　diet；　with　water　for
drink；　and　hydromel；　and　the　strained　juices；　not　trusting　to　the
remission　of　the　fevers；　as　persons　having　these　symptoms　are　in
danger　of　dying；　when；　therefore；　you　perceive　these　symptoms；
announce　this　prognostic；　if　you　shall　judge　proper；　after　making
the　suitable　observations。　When；　in　fevers；　any　dangerous　symptom
appears　on　the　fifth　day；　when　watery　discharges　suddenly　take　place
from　the　bowels；　when　deliquium　animi　occurs；　or　the　patient　is
attacked　with　loss　of　speech；　convulsions；　or　hiccup；　under　such
circumstances　he　is　likely　to　be　affected　with　nausea；　and　sweats
break　out　under　the　nose　and　forehead；　or　on　the　back　part　of　the　neck
and　head；　and　patients　with　such　symptoms　shortly　die；　from　stoppage
of　the　respiration。　When；　in　fevers；　abscesses　form　about　the　legs；
and；　getting　into　a　chronic　state；　are　not　concocted　while　the　fever
persists；　and　if　one　is　seized　with　a　sense　of　suffocation　in　the
throat；　while　the　fauces　are　not　swelled；　and　if　it　do　not　come　to
maturation；　but　is　repressed；　in　such　a　case　there　is　apt　to　be　a　flow
of　blood　from　the　nose；　if　this；　then；　be　copious；　it　indicates　a
resolution　of　the　disease；　but　if　not；　a　prolongation　of　the
complaint；　and　the　less　the　discharge；　so　much　worse　the　symptoms；　and
the　more　protracted　the　disease；　but　if　the　other　symptoms　are　very
favorable；　expect　in　such　a　case　that　pains　will　fall　upon　the　feet；
if　then　they　attack　the　feet；　and　if　these　continue　long　in　a　very
painful；　and　inflamed　state；　and　if　there　be　no　resolution；　the
pains　will　extend　by　degrees　to　the　neck；　to　the　clavicle；　shoulder；
breast；　or　to　some　articulation；　in　which　an　inflammatory　tumor　will
necessarily　form。　When　these　are　reduced；　if　the　hands　are　contracted；
and　become　trembling；　convulsion　and　delirium　seize　such　a　person；　but
blisters　break　out　on　the　eyebrow；　erythema　takes　place；　the　one
eyelid　being　tumefied　overtops　the　other；　a　hard　inflammation　sets　in；
the　eye　become　strongly　swelled；　and　the　delirium　increases　much；
but　makes　its　attacks　rather　at　night　than　by　day。　These　symptoms　more
frequently　occur　on　odd　than　on　even　days；　but；　whether　on　the　one
or　the　other；　they　are　of　a　fatal　character。　Should　you　determine　to
give　purgative　medicines　in　such　cases；　at　the　commencement；　you
should　do　so　before　the　fifth　day；　if　there　be　borborygmi　in　the
bowels；　or；　if　not；　you　should　omit　the　medicines　altogether。　If　there
be　borborygmi；　with　bilious　stools；　purge　moderately　with　scammony；
but　with　regard　to　the　treatment　otherwise；　administer　as　few　drinks
and　draughts　as　until　there　be　some　amendment；　and　the　disease　is　past
the　fourteenth　day。　When　loss　of　speech　seizes　a　person；　on　the
fourteenth　day　of　a　fever；　there　is　not　usually　a　speedy　resolution；
nor　any　removal　of　the　disease；　for　this　symptom　indicates　a
protracted　disease；　and　when　it　appears　on　that　day；　it　will　be
still　more　prolo