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15 In a quartan fever the same should be done. But seeing that unless it has been shaken off within the first days, it is a long while in terminating, we must be more careful from the very first to lay down what should be done in it. Therefore if a paroxysm has set in with shivering and has remitted, the patient ought to observe a regimen on the same day and on the following and on the third day; on the first day after the paroxysm he should take only hot water; on the next two days abstain if possible even from that;; on the fourth day, if the fever recurs with shivering, he should vomit, as was prescribed before; then after the paroxysm he should take a limited quantity of food and of wine four ounces. On the next two days he should fast, taking only hot water if thirsty. On the seventh day the cold stage should be anticipated by the bath; if a paroxysm recurs, the bowels should be moved by a clyster; having settled down after the clyster, the patient should be anointed and rubbed vigorously; then take food and wine as above; on the next two days abstain, and undergo rubbing. On the tenth day trial is again made of the bath; and if after that a paroxysm follows, he should in the same way be rubbed, and drink wine more freely. And it is likely that so many days of fasting, along with the other measures prescribed, will get rid of the fever. But if the quartan fever persists notwithstanding, a totally different line of treatment is to be pursued, the aim being that the body may easily bear what has to be borne for a long while. Therefore we cannot approve the practice of Heraclides of Tarentum, who said that in the first days the bowel was to be clystered and then there was to be abstinence until the seventh day.[p. 285] Even supposing a man could endure this, yet if he does become freed from fever, he will have scarcely strength enough to recover; they themselves if there be more frequent recurrences of the fever he will sink. If, therefore, the disease shall remain on the thirteenth day, the bath should not be tried, either before or after the paroxysm, except occasionally when the shivering has been thrown off. The actual shivering is to be driven off by the measures above prescribed; then after the paroxysm it will be proper that the patient be anointed, and rubbed vigorously, and take food both nourishing and abundant, with as much wine as he likes; on the day following, when sufficiently rested, he is to walk, to take exercise, to be anointed and vigorously rubbed, then to take food without wine, and on the third day to abstain. On the day that a recurrence of the paroxysm is expected, he should get up beforehand, and so arrange the performance of the exercises that the time for the onset of the fever concurs with that of the exercise; for often in this way the paroxysm is thrown off. But if attacked during the exercise, he should thereupon return home to bed. In this kind of sickness the remedies are: anointing, rubbing, exercise, food, wine. If constipated, the bowels are to be clystered. But whilst the stronger patients can easily carry out the above, if weakness has supervened, rocking should replace exercise; if even that cannot be borne, nevertheless rubbing should be applied. If this also, when vigorous, is trying to the patient, treatment should be restricted to rest and anointing and food; care being taken that indigestion does not convert the quartan into a[p. 287] quotidian fever. For a quartan kills no one, but when a quotidian is made out of it, the patient is in a bad way; this, however, does not happen unless through the fault either of the patient or of the practitioner.
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