Regimen of Health
The Second Chapter
On the Regimen of the Sick in General when a
Physician cannot be Found or when the
Physician Available is Deficient and his Knowledge is not to be Trusted
The Second Chapter
On the Regimen of the Sick in General when a
Physician cannot be Found or when the
Physician Available is Deficient and his Knowledge is not to be Trusted
The sages have already observed that the practice of medicine is most necessary for man, especially for the people of the cities which abound in food, and that the physician cannot be dispensed with at any time, or in any way. This is because the art of medicine comprises three regimens, of which the first and most noble is the regimen of the healthy, that is, the regimen of the state of health so that it is not lost. The second is the regimen of the sick, that is, the employment of the craft to restore lost health; this is known as the art of cure. The third is the regimen Galen calls vivification, that is, the regimen of those who are neither in perfectly sound health, nor sick, such as the regimen of the convalescent and the old.
It is therefore manifest that man requires the guidance of a physician in all circumstances, and at all times. Nevertheless, the need for the physician in time of illness is more intense, and the lack of the physician at that time is most perilous. Because of this the populace supposes that a physician is not needed except during illness, not otherwise. Yet frequently a man falls sick while on a journey, or in a town wherein there is no physician, or when, if available, the physician's knowledge is not to be trusted. Therefore this Servant has seen fit to give advice as to what ought to be done in such a case.
I say regarding this, that Galen has already explained to us that all the ancient Greeks, when the disease was obscure to them, would not treat it with anything, rather they would relinquish the sick to Nature, for she is sufficient in the cure of diseases. Hippocrates has already dilated in numerous places in his books in commendation of Nature, stating that she is dexterous and sagacious in doing what is proper, that she requires nothing in the cure of ailments, and that the physician is needed only to sustain her, not otherwise, and to follow in her path.
Al-Razi [Rhazes 850-932] has said in one of his notable treatises, that if the disease is stronger than the vigor of the sick, there is no hope of saving them and a physician will not be of any benefit at all. If the vigor of the sick is stronger than the strength of the disease, there is no need for the physician at all; Nature will cure them. But if the disease and the vigor are equal, then the physician is needed to aid the vigor. This is so when the physician is accomplished, and knows how to aid Nature, assist her and remove what impedes her. Most physicians err greatly in this, supposing that they are aiding the vigor, yet they destroy her, or hinder her, or confuse her ways. For this reason, Aristotle says in his book on Perception and the Perceptible that most of those who die, die from the treatment, because of the ignorance of most physicians about Nature. Physicians mean by Nature, in this connection, that power which governs the bodies of living creatures; its existence and the soundness of its action have been demonstrated in the learned books of the wisdom of the ancients. For these reasons kings gather numerous physicians and select from among them those endowed with wisdom and those of long experience, for perhaps by the coming together of such minds they will be saved from error.
It has become manifest from all that we have presented above, that it is proper to relinquish the sick to Nature when an accomplished physician cannot be found. The meaning of leaving it to Nature is that one should not take remedies other than those customary for the healthy to take, or forsake nourishment altogether; when thirsty one should drink and when hungry one should eat, at whatever time it is his habit to eat. At that time he should eat the lightest meal that he is accustomed to eat. One should know that even if attended by a well-known physician, or several physicians, he should not submit, and take the strong remedies except on the advice of a physician who is very accomplished, whose knowledge has been verified, and whose experience has been attested. Otherwise, one should, when ill, employ the weak remedies, not the strong.
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It is therefore manifest that man requires the guidance of a physician in all circumstances, and at all times. Nevertheless, the need for the physician in time of illness is more intense, and the lack of the physician at that time is most perilous. Because of this the populace supposes that a physician is not needed except during illness, not otherwise. Yet frequently a man falls sick while on a journey, or in a town wherein there is no physician, or when, if available, the physician's knowledge is not to be trusted. Therefore this Servant has seen fit to give advice as to what ought to be done in such a case.
I say regarding this, that Galen has already explained to us that all the ancient Greeks, when the disease was obscure to them, would not treat it with anything, rather they would relinquish the sick to Nature, for she is sufficient in the cure of diseases. Hippocrates has already dilated in numerous places in his books in commendation of Nature, stating that she is dexterous and sagacious in doing what is proper, that she requires nothing in the cure of ailments, and that the physician is needed only to sustain her, not otherwise, and to follow in her path.
Al-Razi [Rhazes 850-932] has said in one of his notable treatises, that if the disease is stronger than the vigor of the sick, there is no hope of saving them and a physician will not be of any benefit at all. If the vigor of the sick is stronger than the strength of the disease, there is no need for the physician at all; Nature will cure them. But if the disease and the vigor are equal, then the physician is needed to aid the vigor. This is so when the physician is accomplished, and knows how to aid Nature, assist her and remove what impedes her. Most physicians err greatly in this, supposing that they are aiding the vigor, yet they destroy her, or hinder her, or confuse her ways. For this reason, Aristotle says in his book on Perception and the Perceptible that most of those who die, die from the treatment, because of the ignorance of most physicians about Nature. Physicians mean by Nature, in this connection, that power which governs the bodies of living creatures; its existence and the soundness of its action have been demonstrated in the learned books of the wisdom of the ancients. For these reasons kings gather numerous physicians and select from among them those endowed with wisdom and those of long experience, for perhaps by the coming together of such minds they will be saved from error.
It has become manifest from all that we have presented above, that it is proper to relinquish the sick to Nature when an accomplished physician cannot be found. The meaning of leaving it to Nature is that one should not take remedies other than those customary for the healthy to take, or forsake nourishment altogether; when thirsty one should drink and when hungry one should eat, at whatever time it is his habit to eat. At that time he should eat the lightest meal that he is accustomed to eat. One should know that even if attended by a well-known physician, or several physicians, he should not submit, and take the strong remedies except on the advice of a physician who is very accomplished, whose knowledge has been verified, and whose experience has been attested. Otherwise, one should, when ill, employ the weak remedies, not the strong.
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I shall declare what the strong remedies are. They are: phlebotomy with the extraction of much blood; evacuation by violently attractive purgatives such as the pulp of the colocynth and the Mahmuudah [an Arabic electuary with scammony]; evacuation by vomiting with the strong medications such as the two hellebores and nux vomica; sharp clysters containing colocynth pulp, sagapenum; castoreum, and their like; the deprivation of nourishment in its entirety, and ordering the sick not to consume anything at all; the prohibition of drinking water and the endurance of thirst; taking the great electuaries of multiple adjuvants such as Theriacs, the Mithridatic and the Theodoretic, and their like.
All these are very strong remedies, and one ought not to have a thing to do with them except on the advice of a physician of surpassing knowledge, because all these things, when they hit their mark, cure the sick instantaneously or within a short time, or deliver them from death, but if they miss their mark, they usually kill at once, or they engender an illness that ultimately leads its host to death; therefore one should beware of them.
As for the weak medications, they are: the extraction of blood by scarification of the legs or the upper parts of the body; softening the belly with the two these reasons kings gather numerous physicians and mannas, prunes, cherries, violets, refined syrup of roses; and their like; emesis with barley water, or oxymel, or radish, or orach seeds, or melon roots, and their like; mild clysters, like the injection of barley gruel, or a decoction of bran, or aquamel [Honey water], or oil alone, and the like of these; lightening the food by taking th customary drinks prepared from sugar, or honey, or barley water, or kashk [porridge] or barley, or soaked bread crumbs, or a little bread in a broth for the sick; medication with the healthy medicaments, that is to say, things that are often taken by the healthy like the renowned syrups, such as the syrup of oxymel, roses, lemon, violets, and their like, and the preserves that are similar, that is, preserved roses, preserved violets, preserved myrobalans, and their like; taking decoctions compounded of light and safe medicaments, like licorice, maidenhair, oxtongue, endive seeds, citron rind, sea holly, parsley, seed of the gourd, purslane seeds, cucumber seed, melon seeds, the stem of the marshmallow and its seeds, and their like; infusions compounded from the fruits, seeds and flowers that are customary for the healthy to take, and infusion of tamarind. All these are light remedies; if they hit their mark they benefit and cure the mild illnesses, and they can in time cure severe illnesses. If they miss their mark, they do not kill, or cause great damage; you find therefore that most physicians resort to these and their like among the remedies in seeking security.
As for the evacuation with the hiera, the agaric, the turpeth, and their like, and likewise with the cassia fistula, the situation is an intermediate one. They are not of the order of the strong purgatives nor are they weak medications. The cassia fistula, even though it might produce distress and often tenesmus, is nevertheless very reliable. Similarly, agaric, although it is reliable as a purgative, can nevertheless cause very serious harm because of its acuity and the vehemence of its drying whenever we need to moisten either the entire body or a member thereof. Similarly, the harm of the hiera and the Itrifal in the feverish is grave at most times.
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All these are very strong remedies, and one ought not to have a thing to do with them except on the advice of a physician of surpassing knowledge, because all these things, when they hit their mark, cure the sick instantaneously or within a short time, or deliver them from death, but if they miss their mark, they usually kill at once, or they engender an illness that ultimately leads its host to death; therefore one should beware of them.
As for the weak medications, they are: the extraction of blood by scarification of the legs or the upper parts of the body; softening the belly with the two these reasons kings gather numerous physicians and mannas, prunes, cherries, violets, refined syrup of roses; and their like; emesis with barley water, or oxymel, or radish, or orach seeds, or melon roots, and their like; mild clysters, like the injection of barley gruel, or a decoction of bran, or aquamel [Honey water], or oil alone, and the like of these; lightening the food by taking th customary drinks prepared from sugar, or honey, or barley water, or kashk [porridge] or barley, or soaked bread crumbs, or a little bread in a broth for the sick; medication with the healthy medicaments, that is to say, things that are often taken by the healthy like the renowned syrups, such as the syrup of oxymel, roses, lemon, violets, and their like, and the preserves that are similar, that is, preserved roses, preserved violets, preserved myrobalans, and their like; taking decoctions compounded of light and safe medicaments, like licorice, maidenhair, oxtongue, endive seeds, citron rind, sea holly, parsley, seed of the gourd, purslane seeds, cucumber seed, melon seeds, the stem of the marshmallow and its seeds, and their like; infusions compounded from the fruits, seeds and flowers that are customary for the healthy to take, and infusion of tamarind. All these are light remedies; if they hit their mark they benefit and cure the mild illnesses, and they can in time cure severe illnesses. If they miss their mark, they do not kill, or cause great damage; you find therefore that most physicians resort to these and their like among the remedies in seeking security.
As for the evacuation with the hiera, the agaric, the turpeth, and their like, and likewise with the cassia fistula, the situation is an intermediate one. They are not of the order of the strong purgatives nor are they weak medications. The cassia fistula, even though it might produce distress and often tenesmus, is nevertheless very reliable. Similarly, agaric, although it is reliable as a purgative, can nevertheless cause very serious harm because of its acuity and the vehemence of its drying whenever we need to moisten either the entire body or a member thereof. Similarly, the harm of the hiera and the Itrifal in the feverish is grave at most times.
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Our warning against taking Theriac and Mithridatium, except on the advice of an accomplished physician, is only for the sick. As for the healthy, it has already been mentioned that it is in accord with the regimen of health to take Theriac every ten days. So have the physicians stated; yet there is not a tenet in the doctrines of medicine that is an absolute one, but for anything allowable there are necessary reservations, as in the instance mentioned regarding the taking of Theriac every ten days in accordance with the regimen of health. Thus, it should not be taken by one of hot temperament, nor at a time of intense heat, nor by one who has in his stomach an evil humor of any kind. As to the statement that vomiting once or twice a month is very good in the regimen of health, it also has reservations, and these are that the person should not have a feeble chest, or be one whose head becomes congested easily, or have frequent headaches. Emesis at the time of intense cold is not beneficial. Thus, any given tenet has reservations, as we have illustrated.
Our instruction to use the weak medicaments, some points of which we have mentioned, when a skilled physician cannot be found, should be followed, whoever the physician in attendance, only when necessary, because even small quantities of medicaments can also be harmful, should the physician err in them, and apply them out of place. Galen has already explained to us that at times a patient is ordered to drink water until satiated, and his body becomes wet with sweat, his stools soften, his fever departs, and he recovers completely, while at other times a patient is allowed a draught of water at an improper time, and this causes the loss of the patient or his acquisition of a chronic disease from which he never recovers. All the conditions in which the drinking of water is to be permitted or prohibited have already been determined. If this is the case with drinking water, how much more so with other things!
When the indications are equivocal and it is obscure to us whether drinking water ought to be permitted or prohibited, the sick should be permitted to drink water, but not to excess. Likewise, when uncertain whether to feed the sick or prohibit food altogether, we should feed them with light nourishment. It follows from this that it is proper that the regimen, when a skillful physician cannot be found, should always be in accord with what is customary in health. One should take a little of what is customary, and always maintain his strength by taking nourishment, either light nourishment like chicken soup, meat broth, yolk of soft-boiled eggs, and a drink for him who may take it, or those nourishments that are heavier than these, like meat of chicken, and bread.
One should never neglect strengthening the Natural Faculty with nourishment, strengthening the Psychic Faculty with good odors, either the hot, like musk, ambergris and basil in cold diseases, or the cold, like rose, water lily, myrtle and violet in hot ailments, and strengthening the Vital Faculty with musical instruments, by bringing the patient joyful news that cheers him and dilates his heart, by telling tales that divert him and make him laugh, and by the presence of someone whose company cheers him. All these must be done in all illnesses whenever there is no physician to arrange things as is proper.
The physicians have already admonished all practitioners not to employ medicaments if they can manage the sick by regulating nourishment [diet] alone. If they cannot manage without medication, they should manage with things that are customary, like the nourishing medicaments or the nutrients that are medicinal. If they cannot do without what is solely medication, they should begin with the weaker medicaments. If this suffices, it is good; should it not suffice, they should repair to the stronger in potency. Whenever it is possible to manage with a simple medicament they should not manage with the compounded, and if it is not possible without the compounded, they should manage with one of lesser complexity. They should not resort to very complex medicaments except when absolutely necessary. And if this is an injunction in the laws of the accomplished physicians, how should it be when there is no physician? Indeed, it behooves one to be most diligent and never rush to the stronger medicament or be inclined to those that are multiple, but to be content with what is customary among the lighter regimens.
This is the measure of what I had envisaged as counsel on this subject.
ADVERTISEMENT:
Our instruction to use the weak medicaments, some points of which we have mentioned, when a skilled physician cannot be found, should be followed, whoever the physician in attendance, only when necessary, because even small quantities of medicaments can also be harmful, should the physician err in them, and apply them out of place. Galen has already explained to us that at times a patient is ordered to drink water until satiated, and his body becomes wet with sweat, his stools soften, his fever departs, and he recovers completely, while at other times a patient is allowed a draught of water at an improper time, and this causes the loss of the patient or his acquisition of a chronic disease from which he never recovers. All the conditions in which the drinking of water is to be permitted or prohibited have already been determined. If this is the case with drinking water, how much more so with other things!
When the indications are equivocal and it is obscure to us whether drinking water ought to be permitted or prohibited, the sick should be permitted to drink water, but not to excess. Likewise, when uncertain whether to feed the sick or prohibit food altogether, we should feed them with light nourishment. It follows from this that it is proper that the regimen, when a skillful physician cannot be found, should always be in accord with what is customary in health. One should take a little of what is customary, and always maintain his strength by taking nourishment, either light nourishment like chicken soup, meat broth, yolk of soft-boiled eggs, and a drink for him who may take it, or those nourishments that are heavier than these, like meat of chicken, and bread.
One should never neglect strengthening the Natural Faculty with nourishment, strengthening the Psychic Faculty with good odors, either the hot, like musk, ambergris and basil in cold diseases, or the cold, like rose, water lily, myrtle and violet in hot ailments, and strengthening the Vital Faculty with musical instruments, by bringing the patient joyful news that cheers him and dilates his heart, by telling tales that divert him and make him laugh, and by the presence of someone whose company cheers him. All these must be done in all illnesses whenever there is no physician to arrange things as is proper.
The physicians have already admonished all practitioners not to employ medicaments if they can manage the sick by regulating nourishment [diet] alone. If they cannot manage without medication, they should manage with things that are customary, like the nourishing medicaments or the nutrients that are medicinal. If they cannot do without what is solely medication, they should begin with the weaker medicaments. If this suffices, it is good; should it not suffice, they should repair to the stronger in potency. Whenever it is possible to manage with a simple medicament they should not manage with the compounded, and if it is not possible without the compounded, they should manage with one of lesser complexity. They should not resort to very complex medicaments except when absolutely necessary. And if this is an injunction in the laws of the accomplished physicians, how should it be when there is no physician? Indeed, it behooves one to be most diligent and never rush to the stronger medicament or be inclined to those that are multiple, but to be content with what is customary among the lighter regimens.
This is the measure of what I had envisaged as counsel on this subject.
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