Celsus, De Medicina
W. G. Spencer, Ed.

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22 Longer and more dangerous is the illness which follows when wasting disease attacks a patient. This also has several species. There is one in which the body is not nourished enough, and as there is some natural loss going on all the time without replacement, extreme emaciation ensues, which unless countered, kills. The Greeks call it atrophia. It proceeds commonly from two causes: for either from excessive dread the patient consumes less, or from excessive greed more, than he ought: thus either the deficiency weakens, or the superfluity undergoes decomposition. There is another species which the Greeks call cachexia, in which owing to bad habit of body all the aliments undergo decomposition. This occurs generally in those whose bodies have become vitiated by prolonged disease, and even if they have rid themselves of this, yet they do not regain health; or when the system has become affected by bad medicaments; or for a long while necessaries of life have been deficient; or unusual or unserviceable food has been consumed; or something similar has happened. In this case besides the wasting, it not unfrequently occurs that the skin surface undergoes irritation by persistent pustulation or ulceration, or else some parts of the body become swollen. The third species, which the Greeks call phthisis, is the most dangerous by far. The malady usually arises in the head, thence it drips into the lung; there ulceration supervenes, from this a slight feverishness is produced, which even after it has become quiescent nevertheless returns; there is frequent[p. 327] cough, pus is expectorated, sometimes blood-stained. When the sputum is thrown upon a fire, there is a bad odour, hence those who are in doubt as to the disease employ this as a test.

As these are the species of wasting, the first consideration should be, which the patient is suffering from: next, if it is only that the body is not being sufficiently nourished, we must look to the cause of this, and if the patient has been consuming less food than he ought, addition is to be made, but only a little at a time, lest if the system becomes overloaded suddenly by an unaccustomed quantity, it may hinder digestion. On the other hand, if the patient has been consuming more than he ought, he should first fast for a day, then begin with a scanty amount of food, increasing daily until he reaches the proper amount. Further, he should walk in places as little cold as possible, whilst avoiding the sun; he should also use the hand exercises; if he is weaker, he should be rocked, anointed and then rubbed, doing as much as possible of this himself, several times each day, before and after meals, until he sweats — sometimes adding heating agents to the oil. It is advantageous on an empty stomach to pinch up and pull on the skin in a number of places, in order to relax it, or to do the same by applying a pitch plaster and at once pulling it off. The bath also is sometimes beneficial, but only after a scanty meal. And whilst actually in the solium, some food may properly be taken, also immediately after a rubbing, when applied without the bath. The food too should be of the kinds easily digested, which are most nutritious. Hence also the use of wine is necessary, but it should be dry; urination is to be stimulated.

[p. 329] But if there is a bad habit of body, the patient should abstain at first, next have the bowels moved by a clyster, then take food a little at a time, with exercise, anointing and rubbing. A frequent bath is useful for these cases, but on an empty stomach, prolonged till there is sweating. Abundant and varied and succulent food is necessary, such as will less readily decompose, and dry wine. If there is no relief from anything else, blood should be let, but only a little each day for several days; with this proviso, that the other remedies also should be employed as described.

But if there is more serious illness and a true phthisis, it is necessary to counter it forthwith at the very commencement; for when of long standing it is not readily overcome. If the strength allows of it a long sea voyage is requisite with a change of air, of such a kind that a denser climate should be sought than that which the patient quits; hence the most suitable is the voyage to Alexandria from Italy. And the body ought generally to be able to bear this in the early stages, since this disease arises especially during the most stable part of life, namely between eighteen and thirty-five years of age. If the patient's weak state does not allow of the above, the best thing for him is to be rocked in a ship without going far away. If anything prevents a sea voyage, the body is to be rocked in a litter, or in some other way. Further, the patient should keep away from business, and everything disturbing to his spirit; he should indulge in sleep; he is to be warned against catarrh, lest that should make worse what the treatment is relieving; indigestion should be avoided, also the sun and cold; the mouth should be covered, the neck wrapped up,[p. 331] any cough put a stop to by its appropriate remedies; and whenever there is an intercurrent fever, it is countered, sometimes by abstinence, sometimes by timely meals, at which water is to be drunk. Milk also, which in headaches, in acute fevers and for the excessive thirst they occasion, also when the chest swells, or there is bilious urine, or a flux of blood, is as bad as a poison, can nevertheless be given appropriately in phthisis, as also in all prolonged feverishness. But if there has either been no intercurrent fever yet, or if it has already remitted, recourse should be had to moderate exercise, walking in particular, also to gentle rubbing. The bath is unsuitable. The food should at first be acrid, such as garlic and leeks, also this latter or endive, basil or lettuce after soaking in vinegar; later the food should be bland, such as a gruel made with pearl barley, or spelt flour, or starch to which milk is added. Rice also, and if there is nothing else, parched groats of spelt answer. Subsequently use is to be made of the above foods in turn, with some additions from food of the middle class, especially grilled brains, small fish and such like. Flour mixed with mutton- or goat-fat and then boiled serves for a medicament. The wine taken ought to be light and dry. So far there is no great difficulty in countering the disease. But if it is more severe, and the body is evidently wasting, stronger remedies are required. Ulceration is to be set up by cautery, at one spot under the chin, at another on the neck, two upon each breast, and the same below the shoulder-blades which the Greeks call omoplatae. The ulcerations are not to be allowed to heal until the cough has stopped, and[p. 333] for this there must clearly be a special treatment also. Then three or four times a day the extremities should be rubbed vigorously, the chest being merely stroked with the hands; an hour after food both legs and arms are to be rubbed. At intervals of ten days the patient should be immersed in the solium contain in oil with the hot water. On other days he should drink first water, then wine; if there is no cough, the drink should be cold, if there is cough lukewarm. It is also of advantage to give food every day during the remission; rubbing and rocking should be employed likewise. On the fourth or fifth day he should take the above mentioned acrid food, now and then polygonum or plantain juice in vinegar. A further remedy is either plantain juice by itself, or horehound juice cooked with honey; of the former a cupful may be sipped, of the latter a spoonful, a little at a time, put upon the tongue, or one half part of turpentine resin, and another part of butter and honey may be mixed together and cooked. But of all these measures the principal ones are the diet, rocking in a litter or on a ship, and the gruel. Loose motions must be especially obviated. Frequent vomiting in this affection is a sign of danger, especially when blood is vomited. A patient who is beginning to improve a little should resume exercises, rubbing, and increase of food, next rub himself while holding his breath, but for a long while abstain from wine, the bath and venery.