Life is short, and Art long; the crisis fleeting; experience perilous,
and decision difficult. The physician must not only be prepared to
do what is right himself, but also to make the patient, the attendants,
and externals cooperate.
In disorders of the bowels and vomitings, occurring spontaneously,
if the matters purged be such as ought to be purged, they do good,
and are well borne; but if not, the contrary. And so artificial evacuations,
if they consist of such matters as should be evacuated, do good, and
are well borne; but if not, the contrary. One, then, ought to look
to the country, the season, the age, and the diseases in which they
are proper or not.
In the athletae, embonpoint, if carried to its utmost limit, is
dangerous, for they cannot remain in the same state nor be stationary;
and since, then, they can neither remain stationary nor improve, it
only remains for them to get worse; for these reasons the embonpoint
should be reduced without delay, that the body may again have a commencement
of reparation. Neither should the evacuations, in their case, be carried
to an extreme, for this also is dangerous, but only to such a point
as the person's constitution can endure. In like manner, medicinal
evacuations, if carried to an extreme, are dangerous; and again, a
restorative course, if in the extreme, is dangerous.
A slender restricted diet is always dangerous in chronic diseases,
and also in acute diseases, where it is not requisite. And again,
a diet brought to the extreme point of attenuation is[p. 300]
repletion, when in the extreme, is also dangerous.
In a restricted diet, patients who transgress are thereby more
hurt (than in any other?); for every such transgression, whatever
it may be, is followed by greater consequences than in a diet somewhat
more generous. On this account, a very slender, regulated, and restricted
diet is dangerous to persons in health, because they bear transgressions
of it more difficultly. For this reason, a slender and restricted
diet is generally more dangerous than one a little more liberal.
For extreme diseases, extreme methods of cure, as to restriction,
are most suitable.
When the disease is very acute, it is attended with extremely severe
symptoms in its first stage; and therefore an extremely attenuating
diet must be used. When this is not the case, but it is allowable
to give a more generous diet, we may depart as far from the severity
of regimen as the disease, by its mildness, is removed from the extreme.
When the disease is at its height, it will then be necessary to
use the most slender diet.
We must form a particular judgment of the patient, whether he will
support the diet until the acme of the disease, and whether he will
sink previously and not support the diet, or the disease will give
way previously, and become less acute.
In those cases, then, which attain their acme speedily, a restricted
diet should be enjoined at first; but in those cases which reach their
acme later, we must retrench at that period or a little before it;
but previously we must allow a more generous diet to support the patient.
We must retrench during paroxysms, for to exhibit food would be
injurious. And in all diseases having periodical paroxysms, we must
restrict during the paroxysms.
The exacerbations and remissions will be indicated by the diseases,
the seasons of the year, the reciprocation of the periods, whether
they occur every day, every alternate day, or after a longer period,
and by the supervening symptoms; as, for example, in pleuritic cases,
expectoration, if it occur at the commencement, shortens the attack,
but if it appear later, it prolongs the same; [p. 301]
and in the same manner
the urine, and alvine discharges, and sweats, according as they appear
along with favorable or unfavorable symptoms, indicate diseases of
a short or long duration.
Old persons endure fasting most easily; next, adults; young persons
not nearly so well; and most especially infants, and of them such
as are of a particularly lively spirit.
Growing bodies have the most innate heat; they therefore require
the most food, for otherwise their bodies are wasted. In old persons
the heat is feeble, and therefore they require little fuel, as it
were, to the flame, for it would be extinguished by much. On this
account, also, fevers in old persons are not equally acute, because
their bodies are cold.
In winter and spring the bowels are naturally the hottest, and
the sleep most prolonged; at these seasons, then, the most sustenance
is to be administered; for as the belly has then most innate heat,
it stands in need of most food. The well-known facts with regard to
young persons and the athletae prove this.
A humid regimen is befitting in all febrile diseases, and particularly
in children, and others accustomed to live on such a diet.
We must consider, also, in which cases food is to be given once
or twice a day, and in greater or smaller quantities, and at intervals.
Something must be conceded to habit, to season, to country, and to
Invalids bear food worst during summer and autumn, most easily
in winter, and next in spring.
Neither give nor enjoin anything to persons during periodical
paroxysms, but abstract from the accustomed allowance before the crisis.
When things are at the crisis, or when they have just passed it,
neither move the bowels, nor make any innovation in the treatment,
either as regards purgatives or any other such stimulants, but let
Those things which require to be evacuated should be evacuated,
wherever they most tend, by the proper outlets.
We must purge and move such humors as are concocted, not such
as are unconcocted, unless they are struggling to get out, which is
mostly not the case.
The evacuations are to be judged of not by their quantity, [p. 302]
whether they be such as they should be, and how they are borne. And
when proper to carry the evacuation to deliquium animi
, this also
should be done, provided the patient can support it.
Use purgative medicines sparingly in acute diseases, and at the
commencement, and not without proper circumspection.
If the matters which are purged be such as should be purged, the
evacuation is beneficial, and easily borne; but, not withstanding,
if otherwise, with difficulty.