On Diet in Acute Diseases — First Draft Translation

ON DIET IN ACUTE DISEASES The authors of what are called the Cnidian Maxims wrote correctly about what the sick suffer in each of the diseases, and about how some of these cases turned out; and up to that point even a non-physician could write correctly, if he inquired carefully of the sick themselves about what they suffer. 1 But the many things a physician needs to learn in advance, without the patient saying them — most of these are omitted, differing from case to case, including some that are critical for forming a judgment. And when they proceed to state judgments about how each case is to be treated, in these matters I find myself thinking very differently from how those men went through them. And it is not only for this reason that I do not praise them, but also because they used remedies few in number. For most of what they have stated, apart from the acute diseases, amounts to this: give purging drugs, and administer whey and milk in season as a drink. If these were good and fitting for the diseases in respect of which they recommended giving them, that would make them all the more worthy of praise — that, being few, they suffice. But as things stand, it is not so. Those who later revised and elaborated the work did take a somewhat more physician-like approach to what should be applied in each case; yet even the ancients wrote nothing on diaita — regimen, the ordering of life — worth mentioning, though they left aside something of great importance in doing so. To be sure, some of them were not ignorant of the varied forms within each of the diseases and their many branches. But those who wished to state clearly the number of distinct diseases wrote incorrectly; for the count would become unmanageable if one is going to identify each patient's disease by the fact that one case differs in some way from another, and, whenever the disease does not appear to be the same, to give it a different name. For my part, I am pleased to give attention in every part of the art; for whatever tasks are to be done finely or correctly, each must be done finely and correctly; and whatever tasks require speed, done with speed; and whatever require cleanliness, cleanly; and whatever are to be handled painlessly, done as painlessly as possible; and all other things of this kind must be done better than one's neighbors. 2 The physician I would praise most highly is the one who, in acute diseases — those that kill the greatest number of people — would in these very cases excel over others. These are the acute diseases that the ancients named: pleuritis, peripneumonia, phrenitis, lethargy, causus, and all the other diseases that are akin to these, in which fevers are for the most part continuous. For when no common form of plague-like disease is spreading through a population, but the diseases are scattered and of similar kind, it is from these diseases that people die more than from all the others combined. Laypeople do not readily recognize those who excel over their neighbors in these cases, and they are more disposed to praise and blame unusual treatments. And there is this great indication: that ordinary people are themselves most lacking in understanding about these diseases, in respect of what deserves study; for those who are not physicians seem most like physicians precisely because of these diseases — for it is easy to learn the names of what is customarily given to those who are sick with such conditions. For if someone names ptisane-juice and wine of this or that kind and melikraton, all physicians seem to laypeople to be saying the same things, both the better and the worse ones. But it is not so; on the contrary, in these very matters some differ very greatly from others. It seems to me that most worthy of being written down are those things which physicians have not learned thoroughly, though they are critical to know, and whatever things bring great benefits or great harms. 3 Things not thoroughly learned are the following. Why is it that in acute diseases some physicians throughout their entire practice go on giving unfiltered ptisane — with the barley grains intact — and consider themselves to be treating correctly; while others make it their greatest concern that the patient swallow not a single grain of barley (for they consider this a great harm), and give the juice strained through linen cloth; while yet others among them would give neither thick ptisane nor juice — some until the patient reaches the seventh day, others throughout the whole course until the disease is decided? Well, physicians are not at all accustomed to pose such questions for investigation; and perhaps even when posed they are not easily resolved. And yet the art as a whole has incurred great reproach from ordinary people, to the point that it does not even seem to them that medicine exists at all — given that in acute diseases the practitioners will differ from one another to such a degree that what one applies, judging it to be best, the other already considers harmful; and one might almost say that in this respect the art resembles divination, in that seers consider the same bird a good sign if it appears on the left and a bad sign if it appears on the right, and in inspection of entrails one would find things of this kind one after another; though some seers hold the opposite of these positions. I say that this inquiry is altogether fine and closely akin to most of the things that are most critical in the art; for in the case of all who are sick it has great power toward health, in the case of those who are healthy toward safety, in the case of those in training toward good condition, and toward whatever end each person wishes. Now ptisane seems to me to have been correctly preferred above the cereal foods in these diseases, and I praise those who preferred it. 4 For the glutinous substance of it is smooth, continuous, mild, slippery, moderately moist, not thirst-producing, and easy to wash through if any of this should also be needed; and it has neither astringency, nor harmful flatulence, nor does it swell up in the belly — for it has already swollen during cooking to the greatest degree that it naturally tends to expand. Now those who use ptisane in these diseases need not, generally speaking, leave the vessels empty on any day, but must use it and not leave off, unless one must leave off for some purgation or enema. For those accustomed to eating twice a day, it should be given twice; for those accustomed to eating once a day, it should be given once on the first day, but gradually, if circumstances allow, it should be given twice to these patients too, if it seems that more is needed. As for quantity, it suffices at the outset to give not much, and not too thick — only enough to introduce something on account of habit, and to prevent much emptiness of the vessels. Concerning increase in the amount of the gruel: if the disease is drier than one might suppose, one should not give more of it, but rather give melikraton or wine as a drink before the gruel, whichever is fitting; and what is fitting in each type of case will be stated. But if the mouth is moist and what comes from the lung is as it ought to be, then one should increase the amount of the gruel — to speak summarily. For things that become moist more quickly and more fully indicate a quicker crisis, while those that do so more slowly and less fully indicate a slower crisis. These signs in themselves are generally as I have described; but many other critical signs are also left out, by which one must be forewarned, and these will be stated later. And by however much the cleansing becomes greater, by that much more should one give, up to the crisis; especially exceeding the crisis by two days, for those who seem likely to reach a crisis on the fifth, seventh, or ninth day, so that you may take account of both the even and the odd; and after this, use the gruel in the morning, and toward evening shift to solid food. The following things are generally beneficial for those who use the whole ptisane at once. The pains in pleuritic patients cease spontaneously as soon as they begin to expectorate something worth noting and to cleanse themselves; the cleansings are far more complete; suppuration occurs less than if one were to manage the case differently; and the crises are simpler, easier to resolve, and less liable to relapse. The ptisane must be made from the best barley and boiled most finely, especially if you are not going to use only the juice. 5 For along with the other virtue of the ptisane, its slipperiness ensures that barley swallowed whole does not cause harm; for it does not stick anywhere, nor does it lodge at the level of the chest. The most finely boiled ptisane is most slippery, least thirst-producing, easiest to concoct, and lightest — all of which are needed. If then one does not attend to whatever is needed for this manner of taking ptisane-gruel to be sufficient, harm will result in many ways. For in those in whom food is already shut up inside, if one gives the gruel without first partially emptying them, it would sharpen the pain already present, and if no pain is present would immediately produce one; and the pneuma — breath — would become more rapid. This is harmful, for it dries the lung and causes fatigue in the hypochondria, the belly, and the diaphragm. And if this happens while the pain in the side is still continuous and does not relax with warming applications, and the sputum is not coming up but is becoming viscous without properly ripening — if one does not relieve the pain — either by softening the belly or by opening a vein, whichever of these is fitting — and gives ptisane to those in such a condition, death comes quickly for such patients. It is on account of these causes and others of similar kind, and even more so, that those using whole ptisane die on the seventh day and even sooner; some with their thinking impaired, others suffocated by orthopnoia and rattling. The ancients mostly considered such patients to have been struck down, chiefly for this reason; and not least because, when they died, the side was found to be livid, something resembling the mark of a blow. The cause of this is that they die before the pain has been resolved; for they quickly develop a pneumatic condition; and under the force of the much and rapid pneuma, as has already been stated, the sputum becoming viscous without properly ripening prevents its passage upward, but instead causes the rattling by becoming lodged in the bronchia of the lung. And when it comes to this point, death generally follows; for the sputum itself lodged there both prevents the pneuma from being carried inward and forces it to be carried outward quickly; and thus they work against each other for the worse — the lodged sputum makes the pneuma rapid, and the rapid pneuma makes the sputum more viscous and prevents it from slipping away. These things befall patients not only if they use ptisane untimely, but far more if they eat or drink anything less suitable than ptisane. On the whole, then, the harms are in most respects similar for those who use the whole ptisane and those who use the juice alone; but for those who use neither of these, but only drink, the harms must in some respects be attended to differently. 6 One should, in any case, do the following as a general rule: if the fever begins when the patient has recently eaten and the bowels have not yet moved — whether the fever comes with pain or without — withhold the giving of the gruel until one judges that the food has passed down into the lower part of the intestine. Use as drink, if there is some pain, oxymeli — hot in winter, cold in summer; if there is great thirst, melikraton and water. Then, if there is some pain present, or something dangerous is appearing, give the gruel neither in large quantity nor thick — and after the seventh day, if the patient is strong enough. If the older food has not passed through in a recently-fed patient: if the patient is strong and in the prime of life, use an enema; if weaker, use a suppository, unless things are passing through well on their own. Guard especially this opportune moment for giving the gruel, at the outset and throughout the entire disease: whenever the feet are cold, one must withhold the giving of the gruel, and most importantly abstain from drink as well; but whenever warmth descends into the feet, then give it, and regard this moment as having great power in all diseases — and not least in acute ones, and most of all in those that are more febrile and most dangerous. Use first and foremost the juice, then the ptisane, observing carefully the signs already written above. If pain in the side arises either at the outset or later, it is not inappropriate to try first to dissolve the pain using warming applications. 7 Of warming applications, the most powerful is hot water in a wineskin, or a bladder, or a bronze vessel, or an earthenware one; one should first place something soft against the side, for the sake of comfort. A soft, large sponge wrung out from hot water is also good to apply; one must keep the warmth covered above, for it will last a longer time and remain, and at the same time so that the vapor does not go toward the patient's breath — unless indeed this too seems useful for something; for there are times when it is needed. Barley or bitter vetch, mixed in vinegar somewhat more sharp than one would drink, soaked and boiled, sewn into pouches and applied — these too are good; and bran in the same way. For dry fomentation: salt and millet roasted in woolen pouches are most suitable; for millet is light and gentle; and such softening relieves even the pains extending toward the collarbone. Incision, however, does not relieve pain equally, unless the pain extends to the collarbone. If the distress is not relieved by the warming applications, one should not heat for a long time; for this dries the lung and promotes suppuration. But if the pain indicates heaviness toward the collarbone or toward the arm or around the breast or above the diaphragm, one must cut the inner vein in the elbow, and not hesitate to draw off a good quantity of blood until it flows considerably redder — livid instead of pure and red; for both conditions occur. But if the pain is below the diaphragm and does not indicate toward the collarbone, one must soften the belly, either with black hellebore or with peplis: with black hellebore, mixing in daucus or seseli or cumin or anise or some other aromatic; with peplis, the juice of silphium; and indeed these mixed together with each other are of similar character. Black hellebore brings better and more decisive results than peplis; peplis, however, is more effective than black hellebore at breaking up flatulence; both relieve pain; and many other purging drugs also relieve pain; but these are the most powerful that I know of. For even purging drugs given in gruels help, as long as they are not excessively unpleasant, whether through bitterness, or some other unpleasantness, or through quantity, color, or some misgiving. When the patient has drunk the drug, ptisane should immediately be given to sip afterward in a quantity no less than what is worthwhile — no less than the customary amount; though it is also reasonable not to give the gruel to sip in the middle of the cleansing; but when the cleansing has ceased, then the patient should sip less than the customary amount; and after that, always increase toward the larger amount, if the pain has ceased and nothing else is contrary. My reasoning is the same even if one needs to use ptisane juice (for I say it is generally better to begin sipping right away than to begin the gruel after first emptying the vessels, whether on the third, fourth, fifth, sixth, or seventh day — unless the disease has already been decided in that time); and the preliminary preparations must be made for these cases in a similar way to what has been stated. 8 My judgment on administering the gruel is as stated; and regarding drink as well — whatever kind one is going to give from what will be written — my reasoning is in general the same. I know that physicians are doing the very opposite of what they should: they want to dry out patients at the outset of diseases for two or three or even more days, and then give the gruels and drinks. And perhaps it seems to them somewhat reasonable that when a great change has come over the body, one must make an equally great opposite change in response. That a change should be made, and not a small one, is well; but the change must be made correctly and steadily, and the introduction of foods following from the change must be made still more so. Those who would be harmed most, if the change were not made correctly, are those using the whole ptisane; those using only the juice would also be harmed; those using only drink would also be harmed, but least of all. One must also attend to the lessons drawn from the diaita — the regimen, the ordering of life — of people while they are still healthy, regarding what is beneficial; for if in the case of healthy people such or such regimens clearly make great differences in other matters and also in changes, how would they not also make great differences in diseases, and in the most acute of these the greatest? And furthermore, it is easy to understand that a merely adequate diaita of food and drink, always consistent with itself, is on the whole safer for health than if someone were suddenly to make a great change to something else. 9 For in the case of those who eat twice a day and those who eat once a day, sudden changes produce harms and debility. Those not accustomed to taking a midday meal, if they do take one, are immediately made unwell, and heavy throughout the whole body, and weak and sluggish; and if they also eat an evening meal, prone to acid eructations; and in some, loose stools might even result, because the belly, accustomed to drying out and not to being distended twice and not to concocting food twice, has been burdened contrary to custom. For these patients it helps to make the change tolerable: one must lie down to sleep after dinner, just as though passing through a night — in winter without chilling, in summer without overheating; but if one cannot sleep, to take a slow, extended walk, wandering without standing still, and eat nothing at dinner, or little and harmless things; and to drink even less, and not diluted. Such a person would suffer still more if he ate three times a day to satiety; and still more if more often than that; and yet there are many who bear eating three times a day in large quantities with ease, if they have become accustomed to it. But also those accustomed to eating twice a day, if they do not take a midday meal, are weak and debilitated, cowardly in every task, and afflicted with heartburn; for their viscera seem to them to hang, and they pass warm and greenish urine, and the stool is burning; in some the mouth also becomes bitter, the eyes sunken, the temples pulsing, and the extremities cool. Most of those who have skipped their midday meal cannot eat their dinner; and when they do eat it, they weigh down the belly and sleep far worse than if they had eaten at midday. Since then such things happen to healthy people on account of a change of half a day's diaita contrary to habit, neither adding to it nor taking away from it appears to be useful. If then this man who has eaten once contrary to habit, having had the vessels empty for a whole day, eats his dinner in the customary amount — and having eaten it is then heavy — it is reasonable that if, because he was toiling and debilitated through not having eaten a midday meal, he eats more than the customary amount, he would be weighed down far more; and if he had kept the vessels empty for a longer time and then suddenly ate a late supper, he would be weighed down still more. It is therefore beneficial for the man who has had the vessels empty contrary to habit to make this day tolerable in the following way: without chilling, without overheating, without toil — for all these things he would bear heavily; and to make the evening meal considerably less than the customary amount, and not dry but of the moister kind; and to drink not diluted, and not less than in proportion to the food; and on the next day to eat a light midday meal, so that he arrives gradually back at his habit. 9 (50) Those who are bitter-bilious in the upper parts, however, bear such conditions more distressfully for themselves; whereas those who are phlegmatic in the upper parts bear a fast contrary to habit more easily in general, and so would also bear single-meal eating contrary to habit more easily. This then is sufficient evidence that the greatest changes in things that befall our natures and our habitual states produce disease most of all; and so it is not possible at an inopportune time to produce violent emptings of the vessels, nor to apply food when diseases are at their peak and in a state of inflammation, nor is it possible to change suddenly in the whole matter either in one direction or the other. One could say many things closely related to these concerning the belly and other matters: that people bear foods they are accustomed to tolerably, even if those foods are not good by nature, and likewise drinks; while they bear foods they are not accustomed to with difficulty, even if those foods are not bad, and likewise drinks. 10 [5] And as for what large amounts of meat-eating beyond habit produce when eaten, or garlic, or silphion, or its juice, or its stalk, or other such things having great distinctive powers — one might be less surprised if such things cause distress in the bowels more than other things do. But if you were to observe closely how much trouble, and bloating, and wind, and griping the bowel barley-cake causes when eaten contrary to habit by one not accustomed to eating barley-cake, or what heaviness and tension of the bowel bread causes in one accustomed to eating barley-cake; or how hot bread when eaten produces a certain thirst, and sudden repletion, owing to its drying quality and its slow passage through; and how the very fine and thoroughly bolted kinds, when eaten contrary to habit, produce effects differing from one another; and how dry barley-cake contrary to habit, or moist, or sticky; and what fresh-ground barley-meal does to those unaccustomed to it, and old-ground to those accustomed to fresh; and how drinking wine and drinking water, when one is suddenly changed for the other contrary to habit, and dilute wine and undiluted wine when suddenly drunk contrary to habit — the former will produce waterlogging in the upper bowel and wind in the lower; the latter palpitation of the vessels, heaviness of the head, and thirst; and how white and dark wine, when one shifts contrary to habit, even if both are vinous, would nonetheless produce many different effects in the body — so that one might say it is less surprising that sweet wine and vinous wine cannot do the same thing when suddenly exchanged. And yet a counterweight of reasoning must be brought to bear here: in these cases the change was in the diaita — that is, the regimen and way of living — with the body itself not changing either toward strength, such that food should be added, or toward weakness, such that it should be taken away. Therefore both the strength and the character of each disease must be additionally assessed, and the nature of the person, and the habit of the diaita of the sick person — not in food alone, but also in drink. 11 [60] Much less ought one to proceed toward increasing intake; since reduction — removing it entirely — is often beneficial in many cases, wherever the patient is going to hold out, until the peak of the disease is ripened through. In what sorts of cases this is to be done will be written. And one might write many other things closely related to what has been said; yet the stronger testimony is this: for it is not merely related to the matter about which most of my argument has been stated, but is itself the most opportune teaching. For those at the onset of acute diseases: there are times when some have eaten solid food on the very day they fell ill, and others on the day after, and others have sipped at whatever came to hand, and others have sipped cyceon — a mixed drink. All of these are worse than if one were managed otherwise in one's diaita; yet the harm done by going wrong at this time is much less than if one were to keep the vessels entirely empty for the first two or three days and then, being on the fourth or fifth day, were managed in such a way. And it is still worse if, after keeping the vessels empty through all those days, one were managed in this way in the subsequent days, before the disease has ripened; for managed in this way, it plainly brings death to most, unless the disease is altogether mild. Errors at the outset are not similarly incurable to these, but far more easily remedied. I therefore consider it the greatest teaching-point, that the first days should not be deprived of one kind of sipped drink or another for those who are about to use sipped drinks of one kind or another a little while later. And yet those using barley ptisane with the grain do not fundamentally know that they are harmed by it when they begin to sip it, if they have kept their vessels empty for two or three days or more; and those using the juice likewise do not recognize that they are harmed when they sip it, whenever they have not rightly begun the sipping. This much, however, they do guard against and recognize: that it brings great harm if, before the disease has ripened, the patient sips barley ptisane with grain, being accustomed to using the juice. All these things are great testimonies that physicians do not rightly lead patients in their diaita — but in those diseases where one should not empty the vessels before the patients are going to be maintained on sipped drinks, they do empty them; and in those where one should not shift from emptying the vessels to sipped drinks, they make the shift; and as a rule they shift to sipped drinks from vessel-emptying at precisely those moments when it is often beneficial to approach vessel-emptying from the sipped drinks, if the disease happens to be coming to an exacerbation at that point. And sometimes unconcocted, bilious matters are drawn down from the head and the region about the chest; wakefulness falls upon them together, through which the disease is not concocted; they become deeply distressed and bitter; their eyes flash with glimmering lights; their hearing is full of ringing; the extremities are chilled; the urine is unconcocted; the sputum is thin and salt and stained with unmixed color in small amounts; sweating about the neck; states of perplexity; pneuma stumbling in its upward movement, frequent or very large; the brows marked with a look of alarm; faintings of a bad kind; throwings off of the bedclothes from the chest; hands trembling; and sometimes the lower lip also shakes. 11 (50) [5] These things appearing at the outset indicate severe delirium, and as a rule such patients die; those who escape, escape either with an abscess, or a flow of blood from the nose, or by coughing up thick pus — otherwise not. For I do not see that physicians are experienced in such matters, as one must be to distinguish the weaknesses in diseases: which are weakened through emptying of the vessels, which through some other irritation, and which through distress and through the acuteness of the disease; and what suffering and forms of every kind our nature and habitual condition give rise to in each person — and yet recognizing or not recognizing such things makes the difference between survival and death. For it is a greater harm if, when a person is weakened by distress and the acuteness of the disease, someone administers too much drink, or a sipped drink, or food, thinking the weakness is from emptying of the vessels. And it is shameful not to recognize weakness from emptying of the vessels, and to press hard upon the patient with the diaita; for this error too carries some danger, though far less than the other. Yet this error is far more laughable than the other; for if another physician — or even a layperson — were to come in, recognize what had happened, and give food and drink such as the first had withheld, it would plainly seem that he had benefited the patient. It is in cases like these that those who work with their hands are most dishonored by people; for those who come in — physician or layperson — seem to them to have raised someone from the dead. Signs by which each of these must be distinguished will therefore be written. These cases are similar, however, to those concerning the bowel: for if the whole body rests a great deal more than its habit, it is not immediately in better strength; and if, after resting for a longer time, it suddenly goes to exertion, it would plainly fare badly. 12 [5] And so likewise with each individual part of the body: the feet would fare in such a way, and the other joints not accustomed to labor, if they come suddenly after a long interval to laboring. And the teeth and the eyes would suffer this too, and every single thing. Since even a soft bed contrary to habit causes distress, and a hard one contrary to habit likewise, and sleeping in the open air contrary to habit hardens the body. But indeed it is enough to write examples of all such things. For if someone having a wound on the lower leg — not very serious nor yet very trifling, neither naturally very quick-healing nor very slow-healing — were at once from the first day to lie down and be treated, and were not to raise the leg at all, it would be less inflamed in this way, and would become healthy far more quickly, than if treated while moving about; yet if, being on the fifth or sixth day or even later, he were to get up and wish to walk about, he would suffer more then than if, from the start, he had been treated while moving about; and if he were to undergo much hardship suddenly, he would suffer far more than if while being treated in the other way he had undergone those same hardships on those same days. All these things therefore bear witness throughout to one another: that all things suddenly changed too far in either direction beyond the moderate cause harm. The harm to the bowel is many times greater if, out of prolonged vessel-emptying, more than a moderate amount is suddenly taken in (and also in the rest of the body, if out of prolonged rest one should suddenly come to greater exertion, the harm would be far more); than if one were to shift from much eating to vessel-emptying — though the body in these cases also needs rest. And if one falls suddenly out of much hardship into leisure and ease, the bowel in such cases also needs rest from abundance of food; and if not, it will produce distress in the body and heaviness of the whole body. My discussion has been mostly about change in one direction and the other: it is useful to know these things in every application; and also concerning that which the argument was about — that in acute diseases they shift to sipped drinks from vessel-emptying. The shift should be made as I prescribe; and then sipped drinks should not be used before the disease is ripened, or some other sign appears — either purgative or irritative in the intestine, or in the hypochondria, of the kinds that will be written. 13 [10] Severe wakefulness makes both drink and food less well concocted, and the shift again in the other direction dissolves the body, and produces heaviness and heaviness of the head. Sweet wine, vinous wine, white and dark, and mead, and water, and oxymel — one must distinguish these by the following signs in acute diseases. 14 [5] Sweet wine causes less heaviness of the head than the vinous, and touches the mind less, and is somewhat more productive of passage through the intestine than the other; but it enlarges the spleen and liver. It is not suitable for the bitterly bilious either; for in such people it is thirst-producing; and it is also wind-producing in the upper intestine. It is not, however, hostile to the lower intestine in proportion to the wind it produces; and yet the wind from sweet wine is not very easy-passing, but lingers about the hypochondria. Moreover, it is in general less productive of urine than the vinous white wine; but the sweet wine promotes the bringing up of sputum more than the other. In those for whom it is thirst-producing when drunk, it would bring up sputum less than the other wine; but in those for whom it is not thirst-producing, it would bring up more than the other. White vinous wine has been both praised and blamed in most and greatest respects already in the account of sweet wine; but being more readily passable to the bladder than the other, and diuretic and dissolving, it would continually benefit much in these diseases; for if in other respects it is less suitable than the other by nature, nevertheless the purification through the bladder which it brings about is protective, if the right kind is promoted. These are fine proofs concerning the benefit and harm of wine — things unlearned by those older than me. Tawny wine and dark astringent wine in these diseases you would use for the following purposes: if there is no heaviness of the head, no touching of the mind, no blocking of the upward movement of sputum, no retention of urine, but the stools are more watery and scraping — in such cases it would be most fitting to shift from the white, and similarly disposed wines. One must further understand that all the upper parts and the bladder will be harmed less if the wine be more dilute, and the intestinal parts will be more benefited if it be more undiluted. Mead drunk throughout the whole course of the disease in acute diseases is in general less suitable for the bitterly bilious and for those with enlarged organs than for those not so constituted; yet it is less thirst-producing than sweet wine; for it softens the lung, moderately promotes bringing up of sputum, and soothes coughing; for it contains something detergent, which makes the sputum more viscous than the moderate. 15 [45] Mead is also sufficiently diuretic, unless something from the internal organs hinders it. And it is more productive of downward passage of bilious stools — sometimes good ones, sometimes overly saturated beyond the right moment, and frothier; and this happens more in those who are bilious and have enlarged organs. The more dilute mead promotes the bringing up of sputum and the softening of the lung more; but the frothy stools, and those more intensely bilious beyond the right moment, and warmer, the undiluted drives more than the dilute; and such a stool has other great harms as well: for it does not quench the burning in the hypochondria, but spurs it on, produces difficulty and tossing of the limbs, and is ulcerating to both the intestine and the seat. Remedies for these will be written. When using mead without sipped drinks, as a substitute for other drink in these diseases, you would succeed in many things and fail in few; the cases where it is to be given and where not have been stated in greatest part, along with the reasons why it should not be given. Mead has been condemned by people on the grounds that it enfeebles those who drink it, and on this account it has come to be regarded as hastening death; and this reputation arose because of those who persist unto death using only mead, for some use mead as their sole drink, since it is supposed to be of this kind. But the matter does not stand quite thus: for drunk alone it is much stronger than water, unless it disturbs the bowel; and compared to a thin, low-sustaining, and odorless wine, it is in some respects stronger, in other respects weaker. Yet the strength of undiluted wine and of honey differs greatly; but for the strength of both together, if one were to drink a double measure of undiluted wine compared to however much honey one might lick up, one would plainly be much stronger from the honey — provided only it does not disturb the bowel — for the excrement would also pass through him in many times greater quantity. If, however, one were using sipped ptisane and were to drink mead after it, it would be excessively filling and wind-producing, and unsuitable for the organs in the hypochondria; but mead drunk before a sipped drink does not harm as it does when drunk after, but actually benefits somewhat. Boiled mead is far finer in appearance than raw: for it becomes bright and thin and white and clear; but what quality surpassing the raw I am to attribute to it I cannot say; for it is not even pleasanter than the raw, if the honey happens to be good; and it is weaker than the raw and less productive of excrement — neither of which properties does mead stand in need of as a remedy. One would best use it in this form when the honey happens to be bad and impure and dark and not well-scented; for boiling would remove the greater part of the flaws from it. 16 [5] The drink called oxymel you will find useful in many situations in these diseases; for it promotes the bringing up of sputum and makes for easy breathing. Yet it has the following moments of opportunity: for the very sharp kind would accomplish nothing intermediate toward sputums that do not come up easily; if it were to bring up the material rattling in the throat, and produce slipperiness, and as it were wing open the windpipe, it would soothe the lung — for it softens the lung; and if these things were to occur together, it would produce great benefit. But there are times when the very sharp kind did not master the bringing up of sputum, but made it more viscous and caused harm; and this especially befalls those who are otherwise in a dire state, and unable to cough and expectorate what is lodged there. For this then one must additionally assess the strength of the patient, and if there is hope, give it; and if one does give it, give it lukewarm, in small amounts, and not gushing. The mildly sour kind moistens the mouth and the throat, promotes the bringing up of sputum, and allays thirst; it is favorable to the hypochondrium and the organs in that region; and it prevents the harms from honey: for the bilious quality in honey is restrained. It is also dispersing of winds, and promoting of urination; yet it renders the lower part of the intestine more watery, and produces scraping; and there are times when this too becomes harmful in acute diseases — chiefly because it prevents wind from passing through, but causes it to run back; and beyond this it also enfeebles and chills the extremities. This is the only harm I know that comes from oxymel that is worth recording. A small amount of this drink is suitable to drink at night and on an empty stomach before a sipped drink; and when a long time has passed after a sipped drink, there is nothing to prevent drinking it. For those managed on drink alone without sipped drinks, it is not suitable to use this always and throughout — chiefly because of the scraping or roughening of the intestine (for it would produce this more in one whose bowel is empty of excrement, and especially with vessel-emptying present); and then the mead would also subtract from the strength. If, however, it appears to be helping against the disease as a whole, and one must use much of this drink, one should pour in the vinegar in small amount — enough only to be perceptible; for in this way it would harm least in what it tends to harm, and benefit in what it should benefit. To state it in summary: the sharpnesses from vinegar are more beneficial to the bitterly bilious than to the melancholically bilious; for the bitter things are dissolved and rid of phlegm, being raised up by it; but the dark things are fermented and raised up and multiplied — for vinegar promotes the bringing up of dark things. In general, vinegar is more hostile to women than to men, for it causes pain in the womb. As for plain water as drink in acute diseases, I have no other function to ascribe to it: it is not soothing to coughing in those with pneumonia, nor does it promote bringing up of sputum, but rather less so than the others, if one were to use plain water as drink throughout. 17 [30] Water sipped in small amount between oxymel and mead does promote the bringing up of sputum, through the change in the quality of the drinks; for it produces a kind of surge. Otherwise it neither relieves thirst, but makes it more bitter — for it is bilious by nature to a bilious constitution, and bad for the hypochondrium; and it is worst of itself, most bilious, and most tending to produce weakness, when it enters into emptiness; it is also enlarging of the spleen and liver when these are inflamed; and it washes back and forth and stays at the surface — for it is slow in passage because of being somewhat cold and unconcocted; and it is neither productive of passage through the intestine nor diuretic. And it causes additional harm for this reason as well, that it produces no excrement by nature; and if it is drunk when the feet happen at some point to be cold, all these harms are multiplied many times, in whichever of them it tends toward. If one suspects in these diseases either severe heaviness of the head or a touching of the mind, wine must be withheld entirely; and in such a case water must be used, or a very dilute, tawny, and altogether odorless wine must be given, and after drinking it a little water must be drunk to follow; for in this way the force from the wine would least touch the head and the judgment. In which cases water as drink is to be used most, and when in great abundance, and when in moderate amount, and when cold, and when warm — some of these have been stated before, and some will be stated in the actual moments. And along these same lines concerning the other drinks — such as the barley-based, and those made from green herbs, and those from raisins and grape-pressings and wheat and safflower and myrtles and pomegranate and others — whenever the occasion arises to use any of them, it will be written alongside the disease itself, just as with the other compound remedies. Bathing would benefit many of the diseases in those who use it — in some cases continuously, in others not. 18 [45] There are occasions when one must use bathing less, because of lack of preparation: for in only a few houses are the necessary equipment and attendants properly prepared. If bathing is not done in a fully adequate manner, harm may result, and it is not small. For there is need of a smoke-free shelter, of water in abundance, of frequent bathing that is not too violent — unless that is precisely what is required. Better, on the whole, not to use a scrubbing substance; but if scrubbing is done, one should use it warm and in much greater quantity than is customary, and pour additional water over generously, and follow quickly with a fresh rinse. The path to the bathing tub must also be short, and the entry and exit from it easy. The person bathing must be composed and silent, and must do no additional work himself; others must do both the pouring and the scrubbing. A large quantity of fresh mixed water must be prepared in advance, and the pourings-over must be done quickly. Sponges should be used instead of a strigil, and the body should not be anointed when it is too dry. The head, however, must be dried as thoroughly as possible by wiping with a sponge, and the extremities must not be allowed to cool — neither the head nor the rest of the body. And one must not bathe newly having taken gruel or newly having drunk, nor sip gruel or drink soon after the bath. One must make great allowance for the patient, if when healthy he was excessively fond of bathing and accustomed to it: for such people crave it more, are benefited by bathing, and harmed by not bathing. On the whole, bathing suits cases of peripneumonia more than cases of burning fever; for the bath is soothing to pain in the side, chest, and upper back, and it ripens sputum and draws it up, promotes easy breathing, and relieves fatigue — since it softens both the joints and the surface skin; and it promotes urination, loosens heaviness of the head, and moistens the nostrils. These, then, are the benefits bathing offers, and all of them are needed. If, however, there is any deficiency in the preparations, in one respect or in several, there is a risk that the bath will not be beneficial but will rather do harm: for each one of them, if not properly prepared by the attendants, brings considerable harm. The least suitable time to bathe is when the bowel is more fluid than is appropriate in the course of the disease; but likewise when it is more constipated than is appropriate and has not already been cleared through; nor should one bathe those whose limbs have been weakened, nor those who are nauseated or prone to vomiting, nor those who are belching up bilious matter, nor those bleeding from the nostrils — unless the flow is less than is appropriate to the occasion; you know the proper occasions. But if the flow is less than appropriate, one should bathe — whether the bath is to benefit the whole body in relation to other conditions, or the head alone. If, then, the preparations are suitable and the patient is likely to receive the bath well, one should bathe every day; and for those who are lovers of bathing, bathing twice a day would do no harm. Bathing is far more feasible for those taking whole-grain barley-preparation than for those taking only the strained juice; yet it is sometimes possible even for the latter; least of all for those on liquid alone, though even there it may sometimes be done. One must judge from the foregoing indications which patients are likely to be benefited by bathing in each mode of their diaita, and which are not. 18 (50) [55] Those who have strong need of the benefits bathing provides, and in whom those benefits are present — these should be bathed. Those who have no need of any of these things, and in whom are present the signs indicating that bathing is not advantageous — these should not be bathed.