BOOK I
Section I. -- First Constitution
PART 1
IN THASUS, about the autumn equinox, and under the Pleiades, the
rains were abundant, constant, and soft, with southerly winds; the
winter southerly, the northerly winds faint, droughts; on the whole,
the winter having the character of spring. The spring was southerly,
cool, rains small in quantity. Summer, for the most part, cloudy,
no rain, the Etesian winds, rare and small, blew in an irregular manner.
The whole constitution of the season being thus inclined to the southerly,
and with droughts early in the spring, from the preceding opposite
and northerly state, ardent fevers occurred in a few instances, and
these very mild, being rarely attended with hemorrhage, and never
proving fatal. Swellings appeared about the ears, in many on either
side, and in the greatest number on both sides, being unaccompanied
by fever so as not to confine the patient to bed; in all cases they
disappeared without giving trouble, neither did any of them come to
suppuration, as is common in swellings from other causes. They were
of a lax, large, diffused character, without inflammation or pain,
and they went away without any critical sign. They seized children,
adults, and mostly those who were engaged in the exercises of the
palestra and gymnasium, but seldom attacked women. Many had dry coughs
without expectoration, and accompanied with hoarseness of voice. In
some instances earlier, and in others later, inflammations with pain
seized sometimes one of
[p. 101]the testicles, and sometimes both; some of
these cases were accompanied with fever and some not; the greater
part of these were attended with much suffering. In other respects
they were free of disease, so as not to require medical assistance.
PART 2
Early in the beginning of spring, and through the summer, and towards
winter, many of those who had been long gradually declining, took
to bed with symptoms of phthisis; in many cases formerly of a doubtful
character the disease then became confirmed; in these the constitution
inclined to the phthisical. Many, and, in fact, the most of them,
died; and of those confined to bed, I do not know if a single individual
survived for any considerable time; they died more suddenly than is
common in such cases. But other diseases, of a protracted character,
and attended with fever, were well supported, and did not prove fatal:
of these we will give a description afterwards. Consumption was the
most considerable of the diseases which then prevailed, and the only
one which proved fatal to many persons. Most of them were affected
by these diseases in the following manner: fevers accompanied with
rigors, of the continual type, acute, having no complete intermissions,
but of the form of the semi-tertians, being milder the one day, and
the next having an exacerbation, and increasing in violence; constant
sweats, but not diffused over the whole body; extremities very cold,
and warmed with difficulty; bowels disordered, with bilious, scanty,
unmixed, thin, pungent, and frequent dejections. The urine was thin,
colorless, unconcocted, or thick, with a deficient sediment, not settling
favorably, but casting down a crude and unseasonable sediment. Sputa
small, dense, concocted, but brought up rarely and with difficulty;
and in those who encountered the most violent symptoms there was no
concoction at all, but they continued throughout spitting crude matters.
Their fauces, in most of them, were painful from first to last, having
redness with inflammation; defluxions thin, small and acrid; they
were soon wasted and became worse, having no appetite for any kind
of food throughout; no thirst; most persons delirious when near death.
So much concerning the phthisical affections.
PART 3
In the course of the summer and autumn many fevers of the
[p. 102]continual
type, but not violent; they attacked persons who had been long indisposed,
but who were otherwise not in an uncomfortable state. In most cases
the bowels were disordered in a very moderate degree, and they did
not suffer thereby in any manner worth mentioning; the urine was generally
well colored, clear, thin, and after a time becoming concocted near
the crisis. They had not much cough, nor it troublesome; they were
not in appetite, for it was necessary to give them food (on the whole,
persons laboring under phthisis were not affected in the usual manner).
They were affected with fevers, rigors, and deficient sweats, with
varied and irregular paroxysms, in general not intermitting, but having
exacerbations in the tertian form. The earliest crisis which occurred
was about the twentieth day, in most about the fortieth, and in many
about the eightieth. But there were cases in which it did not leave
them thus at all, but in an irregular manner, and without any crisis;
in most of these the fevers, after a brief interval, relapsed again;
and from these relapses they came to a crisis in the same periods;
but in many they were prolonged so that the disease was not gone at
the approach of winter. Of all those which are described under this
constitution, the phthisical diseases alone were of a fatal character;
for in all the others the patients bore up well, and did not die of
the other fevers.
Section II. -- Second Constitution
PART 1
In Thasus, early in autumn, the winter suddenly set in rainy before
the usual time, with much northerly and southerly winds. These things
all continued so during the season of the Pleiades, and until their
setting. The winter was northerly, the rains frequent, in torrents,
and large, with snow, but with a frequent mixture of fair weather.
These things were all so, but the setting in of the cold was not much
out of season. After the winter solstice, and at the time when the
zephyr usually begins to blow, severe winterly storms out of season,
with much northerly wind, snow, continued and copious rains; the sky
tempestuous and clouded; these things were protracted, and did not
remit until the equinox. The spring was cold, northerly, rainy, and
clouded;
[p. 103] the summer was not very sultry, the Etesian winds blew constant,
but quickly afterwards, about the rising of Arcturus, there were again
many rains with north winds. The whole season being wet, cold, and
northerly, people were, for the most part, healthy during winter;
but early in the spring very many, indeed, the greater part, were
valetudinary. At first ophthalmies set in, with rheums, pains, unconcocted
discharges, small concretions, generally breaking with difficulty,
in most instances they relapsed, and they did not cease until late
in autumn. During summer and autumn there were dysenteric affections,
attacks of tenesmus and lientery, bilious diarrhoea, with thin, copious,
undigested, and acrid dejections, and sometimes with watery stools;
many had copious defluxions, with pain, of a bilious, watery, slimy,
purulent nature, attended with strangury, not connected with disease
of the kidneys, but one complaint succeeding the other; vomitings
of bile, phlegm, and undigested food, sweats, in all cases a redundance
of humors. In many instances these complaints were unattended with
fever, and did not prevent the patients from walking about, but some
cases were febrile, as will be described. In some all those described
below occurred with pain. During autumn, and at the commencement of
winter, there were phthisical complaints, continual fevers; and, in
a few cases, ardent; some diurnal, others nocturnal, semi-tertians,
true tertians, quartans, irregular fevers.
PART 2
All the fevers which are described attacked great numbers. The ardent fevers
attacked the smallest numbers, and the patients suffered the least
from them, for there were no hemorrhages, except a few and to a small
amount, nor was there delirium; all the other complaints were slight;
in these the crises were regular, in most instances, with the intermittents,
in seventeen days; and I know no instance of a person dying of causus,
nor becoming phrenitic. The tertians were more numerous than the ardent
fevers, and attended with more pain; but these all had four periods
in regular succession from the first attack, and they had a complete
crisis in seven, without a relapse in any instance. The quartans attacked
many at first, in the form of regular quartans, but in no few cases
a transition from other fevers and diseases into quartans took place;
they were
[p. 104] protracted, as is wont with them, indeed, more so than usual. Quotidian, nocturnal, and wandering fevers attacked many persons,
some of whom continued to keep up, and others were confined to bed.
In most instances these fevers were prolonged under the Pleiades and
till winter. Many persons, and more especially children, had convulsions
from the commencement; and they had fever, and the convulsions supervened
upon the fevers; in most cases they were protracted, but free from
danger, unless in those who were in a deadly state from other complaints.
Those fevers which were continual in the main, and with no intermissions,
but having exacerbations in the tertian form, there being remissions
the one day and exacerbations the next, were the most violent of all
those which occurred at that time, and the most protracted, and occurring
with the greatest pains, beginning mildly, always on the whole increasing,
and being exacerbated, and always turning worse, having small remissions,
and after an abatement having more violent paroxysms, and growing
worse, for the most part, on the critical days. Rigors, in all cases,
took place in an irregular and uncertain manner, very rare and weak
in them, but greater in all other fevers; frequent sweats, but most
seldom in them, bringing no alleviation, but, on the contrary, doing
mischief. Much cold of the extremities in them, and these were warmed
with difficulty. Insomnolency, for the most part, especially in these
fevers, and again a disposition to coma. The bowels, in all diseases,
were disordered, and in a bad state, but worst of all in these. The
urine, in most of them, was either thin and crude, yellow, and after
a time with slight symptoms of concoction in a critical form, or having
the proper thickness, but muddy, and neither settling nor subsiding;
or having small and bad, and crude sediments; these being the worst
of all. Coughs attended these fevers, but I cannot state that any
harm or good ever resulted from the cough.
PART 3
The most of these were protracted and troublesome, went on in a
very disorderly and irregular form, and, for the most part, did in
a crisis, either in the fatal cases or in the others; for if it left
some of them for a season it soon returned again. In a few instances
the lever terminated with a crisis;
[p. 105] in the earliest of these about
the eightieth day, and some of these relapsed, so that most of them
were not free from the fever during the winter; but the fever left
most of them without a crisis, and these things happened alike to
those who recovered and to those who did not. There being much want
of crisis and much variety as to these diseases, the greatest and
worst symptom attended the most of them, namely, a loathing of all
articles of food, more especially with those who had otherwise fatal
symptoms; but they were not unseasonably thirsty in such fevers. After
a length of time, with much suffering and great wasting, abscesses
were formed in these cases, either unusually large, so that the patients
could not support them, or unusually small, so that they did no good,
but soon relapsed and speedily got worse. The diseases which attacked
them were in the form of dysenteries, tenesmus, lientery, and fluxes;
but, in some cases, there were dropsies, with or without these complaints.
Whatever attacked them violently speedily cut them off, or again,
did them no good. Small rashes, and not corresponding to the violence
of the disease, and quickly disappearing, or swellings occurred about
the ears, which were not resolved, and brought on no crisis. In some
they were determined to the joints, and especially to the hip-joint,
terminating critically with a few, and quickly again increasing to
its original habit.
PART 4
Perons died of all these diseases, but mostly of these fevers,
and notably infants just weaned, and older children, until eight or
ten years of age, and those before puberty. These things occurred
to those affected with the complaints described above, and to many
persons at first without them. The only favorable symptom, and the
greatest of those which occurred, and what saved most of those who
were in the greatest dangers, was the conversion of it to a strangury,
and when, in addition to this, abscesses were formed. The strangury
attacked, most especially, persons of the ages I have mentioned, but
it also occurred in many others, both of those who were not confined
to bed and those who were. There was a speedy and great change in
all these cases. For the bowels, if they happened previously to have
watery discharges of a bad character, became regular, they got an
appetite for food, and the
[p. 106]fevers were mild afterwards. But, with
regard to the strangury itself, the symptoms were protracted and painful.
Their urine was copious, thick, of various characters, red, mixed
with pus, and was passed with pain. These all recovered, and I did
not see a single instance of death among them.
PART 5
With regard to the dangers of these cases, one must always attend
to the seasonable concoction of all the evacuations, and to the favorable
and critical abscesses. The concoctions indicate a speedy crisis and
recovery of health; crude and undigested evacuations, and those which
are converted into bad abscesses, indicate either want of crisis,
or pains, or prolongation of the disease, or death, or relapses; which
of these it is to be must be determined from other circumstances.
The physician must be able to tell the antecedents, know the present,
and foretell the future- must mediate these things, and have two special
objects in view with regard to disease, namely, to do good or to do
no harm. The art consists in three things- the disease, the patient,
and the physician. The physician is the servant of the art, and the
patient must combat the disease along with the physician.1
PART 6
Pains about the head and neck, and heaviness of the same along
with pain, occur either without fevers or in fevers. Convulsions occurring
in persons attacked with frenzy, and having vomitings of verdigris-green
bile, in some cases quickly prove fatal. In ardent fevers, and in
those other fevers in which there is pain of the neck, heaviness of
the temples, mistiness about the eyes, and distention about the hypochondriac
region, not unattended with pain, hemorrhage from the nose takes place,
but
[p. 107]those who have heaviness of the whole head, cardialgia and nausea,
vomit bilious and pituitous matters; children, in such affections,
are generally attacked with convulsions, and women have these and
also pains of the uterus; whereas, in elder persons, and those in
whom the heat is already more subdued, these cases end in paralysis,
mania, and loss of sight.
Section III. -- Third Constitution
PART 1
In Thasus, a little before and during the season of Arcturus, there
were frequent and great rains, with northerly winds. About the equinox,
and till the setting of the Pleiades, there were a few southerly rains:
the winter northerly and parched, cold, with great winds and snow.
Great storms about the equinox, the spring northerly, dryness, rains
few and cold. About the summer solstice, scanty rains, and great cold
until near the season of the Dog-star. After the Dog-days, until the
season of Arcturus, the summer hot, great droughts, not in intervals,
but continued and severe: no rain; the Etesian winds blew; about the
season of Arcturus southerly rains until the equinox.
PART 2
In this state of things, during winter, paraplegia set in, and
attacked many, and some died speedily; and otherwise the disease prevailed
much in an epidemical form, but persons remained free from all other
diseases. Early in the spring, ardent fevers commenced and continued
through the summer until the equinox. Those then that were attacked
immediately after the commencement of the spring and summer, for the
most part recovered, and but few of them died. But when the autumn
and the rains had set in, they were of a fatal character, and the
greater part then died. When in these attacks of ardent fevers there
was a proper and copious hemorrhage from the nose, they were generally
saved by it, and I do not know a single person who had a proper hemorrhage
who died in this constitution. Philiscus, Epaminon, and Silenus, indeed,
who had a trifling epistaxis on the fourth and fifth day, died. Most
of those taken with had a rigor about the time of the crisis, and
notably those who had no hemorrhage; these had also rigor associated.
PART 3
Some were attacked with jaundice on the sixth day, but these were
benefited
[p. 108]either by an urinary purgation, or a disorder of the bowels,
or a copious hemorrhage, as in the case of Heraclides, who was lodged
with Aristocydes: this person, though he had the hemorrhage from the
nose, the purgation by the bladder, and disorder of the bowels, experienced
a favorable crisis on the twentieth day, not like the servant of Phanagoras,
who had none of these symptoms, and died. The hemorrhages attacked
most persons, but especially young persons and those in the prime
of life, and the greater part of those who had not the hemorrhage
died: elderly persons had jaundice or disorder of the bowels, such
as Bion, who was lodged with Silenus. Dysenteries were epidemical
during the summer, and some of those cases in which the hemorrhage
occurred, terminated in dysentery, as happened to the slave of Eraton,
and to Mullus, who had a copious hemorrhage, which settled down into
dysentery, and they recovered. This humor was redundant in many cases,
since in those who had not the hemorrhage about the crisis, but the
risings about the ears disappeared, after their disappearance there
was a sense of weight in the left flank extending to the extremity
of the hip, and pain setting in after the crisis, with a discharge
of thin urine; they began to have small hemorrhages about the twenty-fourth
day, and the swelling was converted into the hemorrhage. In the case
of Antiphon, the son of Critobulus' son, the fever ceased and came
to a crisis about the fortieth day.
PART 4
Many women were attacked, but fewer than of the men, and there were
fewer deaths among them. But most of them had difficult parturition,
and after labor they were taken ill, and these most especially died,
as, for example, the daughter of Telebolus died on the sixth day after
delivery. Most females had the menstrual discharge during the fever,
and many girls had it then for the first time: in certain individuals
both the hemorrhage from the nose and the menses appeared; thus, in
the case of the virgin daughter of Daetharses, the menses then took
place for the first time, and she had also a copinous hemorrhage from
the nose, and I knew no instance of any one dying when one or other
of these took place properly. But all those in the pregnant state
that were attacked had abortions, as far as I observed. The urine
in most cases was of the proper color, but thin, and having scanty
sediments: in
[p. 109]most the bowels were disordered with thin and bilious
dejections; and many, after passing through the other crises, terminated
in dysenteries, as happened to Xenophanes and Critias. The urine was
watery, copious, clear, and thin; and even after the crises, when
the sediment was natural, and all the other critical symptoms were
favorable, as I recollect having happened to Bion, who was lodged
in the house of Silenus, and Critias, who lived with Xenophanes, the
slave of Areton, and the wife of Mnesistratus. But afterwards all
these were attacked with dysentery. It would be worth while to inquire
whether the watery urine was the cause of this. About the season of
Arcturus many had the crisis on the eleventh day, and in them the
regular relapses did not take place, but they became comatose about
this time, especially children; but there were fewest deaths of all
among them.
PART 5
About the equinox, and until the season of the Pleiades, and at
the approach of winter, many ardent fevers set in; but great numbers
at that season were seized with phrenitis, and many died; a few cases
also occurred during the summer. These then made their attack at the
commencement of ardent fevers, which were attended with fatal symptoms;
for immediately upon their setting in, there were acute fever and
small rigors, insomnolency, aberration, thirst, nausea, insignificant
sweats about the forehead and clavicles, but no general perspiration;
they had much delirious talking, fears, despondency, great coldness
of the extremities, in the feet, but more especially in their hands:
the paroxysms were on the even days; and in most cases, on the fourth
day, the most violent pains set in, with sweats, generally coldish,
and the extremities could not be warmed, but were livid and rather
cold, and they had then no thirst; in them the urine was black, scanty,
thin, and the bowels were constipated; there was an hemorrhage from
the nose in no case in which these symptoms occurred, but merely a
trifling epistaxis; and none of them had a relapse, but they died
on the sixth day with sweats. In the phrenitic cases, all the symptoms
which have been described did not occur, but in them the disease mostly
came to a crisis on the eleventh day, and in some on the twentieth.
In those cases in which the phrenitis did not begin immediately, but
about the
[p. 110]third or fourth day, the disease was moderate at the commencement,
but assumed a violent character about the seventh day. There was a
great number of diseases, and of those affected, they who died were
principally infants, young persons, adults having smooth bodies, white
skins, straight and black hair, dark eyes, those living recklessly
and luxuriously; persons with shrill, or rough voices, who stammered
and were passionate, and women more especially died from this form.
In this constitution, four symptoms in particular proved salutary;
either a hemorrhage from the nose, or a copious discharge by the bladder
of urine, having an abundant and proper sediment, or a bilious disorder
of the bowels at the proper time, or an attack of dysentery. And in
many cases it happened, that the crisis did not take place by any
one of the symptoms which have been mentioned, but the patient passed
through most of them, and appeared to be in an uncomfortable way,
and yet all who were attacked with these symptoms recovered. All the
symptoms which I have described occurred also to women and girls;
and whoever of them had any of these symptoms in a favorable manner,
or the menses appeared abundantly, were saved thereby, and had a crisis,
so that I do not know a single female who had any of these favorably
that died. But the daughter of Philo, who had a copious hemorrhage
from the nose, and took supper unseasonably on the seventh day, died.
In those cases of acute, and more especially of ardent fevers, in
which there is an involuntary discharge of tears, you may expect a
nasal hemorrhage unless the other symptoms be of a fatal type, for
in those of a bad description, they do not indicate a hemorrhage,
but death.
PART 6
Swellings about the ears, with pain in fevers, sometimes when
the fever went off critically, neither subsided nor were converted
into pus; in these cases a bilious diarrhoea, or dysentery, or thick
urine having a sediment, carried off the disease, as happened to Hermippus
of Clazomenae. The circumstances relating to crises, as far as we
can recognize them, were so far similar and so far dissimilar. Thus
two brothers became ill at the same hour (they were brothers of Epigenes,
and lodged near the theatre), of these the elder had a crisis on the
sixth day, and the younger on the seventh,
[p. 111]and both had a relapse
at the same hour; it then left them for five days, and from the return
of the fever both had a crisis together on the seventeenth day. Most
had a crisis on the sixth day; it then left them for six days, and
from the relapse there was a crisis on the fifth day. But those who
had a crisis on the seventh day, had an intermission for seven days;
and the crisis took place on the third day after the relapse. Those
who had a crisis on the sixth day, after an interval of six days were
seized again on the third, and having left them for one day, the fever
attacked them again on the next and came to a crisis, as happened
to Evagon the son of Daetharses. Those in whom the crisis happened
on the sixth day, had an intermission of seven days, and from the
relapse there was a crisis on the fourth, as happened to the daughter
of Aglaidas. The greater part of those who were taken ill under this
constitution of things, were affected in this manner, and I did not
know a single case of recovery, in which there was not a relapse agreeably
to the stated order of relapses; and all those recovered in which
the relapses took place according to this form: nor did I know a single
instance of those who then passed through the disease in this manner
who had another relapse.
PART 7
In these diseases death generally happened on the sixth day, as
with Epaminondas, Silenus, and Philiscus the son of Antagoras. Those
who had parotid swellings experienced a crisis on the twentieth day,
but in all these cases the disease went off without coming to a suppuration,
and was turned upon the bladder. But in Cratistonax, who lived by
the temple of Hercules, and in the maid servant of Scymnus the fuller,
it turned to a suppuration, and they died. Those who had a crisis
on the seventh day, had an intermission of nine days, and a relapse
which came to a crisis on the fourth day from the return of the fever,
as was the case with Pantacles, who resided close by the temple of
Bacchus. Those who had a crisis on the seventh day, after an interval
of six days had a relapse, from which they had a crisis on the seventh
day, as happened to Phanocritus, who was lodged with Gnathon the fuller.
During the winter, about the winter solstices, and until the equinox,
the ardent fevers and frenzies prevailed, and many died. The crisis,
however, changed, and
[p. 112]happened to the greater number on the fifth
day from the commencement, left them for four days and relapsed; and
after the return, there was a crisis on the fifth day, making in all
fourteen days. The crisis took place thus in the case of most children,
also in elder persons. Some had a crisis on the eleventh day, a relapse
on the fourteenth, a complete crisis on the twentieth; but certain
persons, who had a rigor about the twentieth, had a crisis on the
fortieth. The greater part had a rigor along with the original crisis,
and these had also a rigor about the crisis in the relapse. There
were fewest cases of rigor in the spring, more in summer, still more
in autumn, but by far the most in winter; then hemorrhages ceased.
PART 8
With regard to diseases, the circumstances from which we form a
judgment of them are,- by attending to the general nature of all,
and the peculiar nature of each individual,- to the disease, the patient,
and the applications,- to the person who applies them, as that makes
a difference for better or for worse,- to the whole constitution of
the season, and particularly to the state of the heavens, and the
nature of each country;- to the patient's habits, regimen, and pursuits;-
to his conversation, manners, taciturnity, thoughts, sleep, or absence
of sleep, and sometimes his dreams, what and when they occur;- to
his picking and scratching;- to his tears;- to the alvine discharges,
urine, sputa, and vomitings; and to the changes of diseases from the
one into the other;- to the deposits, whether of a deadly or critical
character;- to the sweat, coldness, rigor, cough, sneezing, hiccup,
respiration, eructation, flatulence, whether passed silently or with
a noise;- to hemorrhages and hemorrhoids;- from these, and their consequences,
we must form our judgment.
PART 9
Fevers are,- the continual, some of which hold during the day and
have a remission at night, and others hold a remission during the
day; semi-tertians, tertians, quartans, quintans, septans, nonans.
The most acute, strongest, most dangerous, and fatal diseases, occur
in the continual fever. The least dangerous of all, and the mildest
and most protracted,
[p. 113] is the quartan, for it is not only such from
itself, but it also carries off other great diseases. In what is called
the semi-tertian, other acute diseases are apt to occur, and it is
the most fatal of all others, and moreover phthisical persons, and
those laboring under other protracted diseases, are apt to be attacked
by it. The nocturnal fever is not very fatal, but protracted; the
diurnal is still more protracted, and in some cases passes into phthisis.
The septan is protracted, but not fatal; the nonan more protracted,
and not fatal. The true tertian comes quickly to a crisis, and is
not fatal; but the quintan is the worst of all, for it proves fatal
when it precedes an attack of phthisis, and when it supervenes on
persons who are already consumptive. There are peculiar modes, and
constitutions, and paroxysms, in every one of these fevers; for example,-
the continual, in some cases at the very commencement, grows, as it
were, and attains its full strength, and rises to its most dangerous
pitch, but is diminished about and at the crisis; in others it begins
gentle and suppressed, but gains ground and is exacerbated every day,
and bursts forth with all its heat about and at the crisis; while
in others, again, it commences mildly, increases, and is exacerbated
until it reaches its acme, and then remits until at and about the
crisis. These varieties occur in every fever, and in every disease.
From these observations one must regulate the regimen accordingly.
There are many other important symptoms allied to these, part of which
have been already noticed, and part will be described afterwards,
from a consideration of which one may judge, and decided in each case,
whether the disease be acute, and whether it will end in death
or recovery; or whether it will be protracted, and will end in death
or recovery; and in what cases food is to be given, and in what not;
and when and to what amount, and what particular kind of food is to
be administered.
PART 10
Those diseases which have their paroxysms on even days have their
crises on even days; and those which have their paroxysms on uneven
days have their crises on uneven days. The first period of those which
have the crisis on even days, is the 4th, 6th, 8th, 10th, 14th, 20th,
30th, 40th, 60th, 80th, 100th; and the first period of those which
have their crises on uneven
[p. 114] days, is the 1st, 3d, 5th, 7th, 9th, 11th,
17th, 21th, 27th, 31st. It should be known, that if the crisis take
place on any other day than on those described, it indicates that
there will be a relapse, which may prove fatal. But one ought to pay
attention, and know in these seasons what crises will lead to recovery
and what to death, or to changes for the better or the worse. Irregular
fevers, quartans, quintans, septans, and nonans should be studied,
in order to find out in what periods their crises take place.
Fourteen Cases of Disease
Case I
Philiscus, who lived by the Wall, took to bed on the first
day of acute fever; he sweated; towards night was uneasy. On the second
day all the symptoms were exacerbated; late in the evening had a proper
stool from a small clyster; the night quiet. On the third day, early
in the morning and until noon, he appeared to be free from fever;
towards evening, acute fever, with sweating, thirst, tongue parched;
passed black urine; night uncomfortable, no sleep; he was delirious
on all subjects. On the fourth, all the symptoms exacerbated, urine
black; night more comfortable, urine of a better color. On the fifth,
about mid-day, had a slight trickling of pure blood from the nose;
urine varied in character, having floating in it round bodies, resembling
semen, and scattered, but which did not fall to the bottom; a suppository
having been applied, some scanty flatulent matters were passed; night
uncomfortable, little sleep, talking incoherently; extremities altogether
cold, and could not be warmed; urine, black; slept a little towards
day; loss of speech, cold sweats; extremities livid; about the middle
of the sixth day he died. The respiration throughout, like that of
a person recollecting himself, was rare, and large, and spleen was
swelled upon in a round tumor, the sweats cold throughout, the paroxysms
on the even days.
Case 2
Silenus lived on the Broad-way, near the house of Evalcidas.
From fatigue, drinking, and unseasonable exercises, he was seized
with fever. He began with having pain in the loins; he had heaviness
of the head, and there was stiffness of the neck. On the first day
the alvine discharges were bilious, unmixed,
[p. 115]frothy, high colored,
and copious; urine black, having a black sediment; he was thirsty,
tongue dry; no sleep at night. On the second, acute fever, stools
more copious, thinner, frothy; urine black, an uncomfortable night,
slight delirium. On the third, all the symptoms exacerbated; an oblong
distention, of a softish nature, from both sides of the hypochondrium
to the navel; stools thin, and darkish; urine muddy, and darkish;
no sleep at night; much talking, laughter, singing, he could not restrain
himself. On the fourth, in the same state. On the fifth, stools bilious,
unmixed, smooth, greasy; urine thin, and transparent; slight absence
of delirium. On the sixth, slight perspiration about the head; extremities
cold and livid; much tossing about; no passage from the bowels, urine
suppressed, acute fever. On the seventh, loss of speech; extremities
could no longer be kept warm; no discharge of urine. On the eighth,
a cold sweat all over; red rashes with sweat, of a round figure, small,
like vari, persistent, not subsiding; by means of a slight stimulus,
a copious discharge from the bowels, of a thin and undigested character,
with pain; urine acrid, and passed with pain; extremities slightly
heated; sleep slight, and comatose; speechless; urine thin, and transparent.
On the ninth, in the same state. On the tenth, no drink taken; comatose,
sleep slight; alvine discharges the same; urine abundant, and thickish;
when allowed to stand, the sediment farinaceous and white; extremities
again cold. On the eleventh, he died. At the commencement, and throughout,
the respiration was slow and large; there was a constant throbbing
in the hypochondrium; his age was about twenty.
Case 3
Herophon was seized with an acute fever; alvine discharges
at first were scanty, and attended with tenesmus; but afterwards they
were passed of a thin, bilious character, and frequent; there was
no sleep; urine black, and thin. On the fifth, in the morning, deafness;
all the symptoms exacerbated; spleen swollen; distention of the hypochondrium;
alvine discharges scanty, and black; he became delirious. On the sixth,
delirious; at night, sweating, coldness; the delirium continued. On
the seventh, he became cold, thirsty, was disordered in mind; at night
recovered his senses; slept. On the eighth, was feverish;
[p. 116] the spleen
diminished in size; quite collected; had pain at first about the groin,
on the same side as the spleen; had pains in both legs; night comfortable;
urine better colored, had a scanty sediment. On the ninth, sweated;
the crisis took place; fever remitted. On the fifth day afterwards,
fever relapsed, spleen immediately became swollen; acute fever; deafness
again. On the third day after the relapse, the spleen diminished;
deafness less; legs painful; sweated during the night; crisis took
place on the seventeenth day; had no disorder of the senses during
the relapse.
Case 4
In Thasus, the wife of Philinus, having been delivered of
a daughter, the discharge being natural, and other matters going on
mildly, on the fourteenth day after delivery was seized with fever,
attended with rigor; was pained at first in the cardiac region of
the stomach and right hypochondrium; pain in the genital organs; lochial
discharge ceased. Upon the application of a pessary all these symptoms
were alleviated; pains of the head, neck, and loins remained; no sleep;
extremities cold; thirst; bowels in a hot state; stools scanty; urine
thin, and colorless at first. On the sixth, towards night, senses
much disordered, but again were restored. On the seventh, thirsty;
the evacuations bilious, and high colored. On the eighth, had a rigor;
acute fever; much spasm, with pain; talked much, incoherently; upon
the application of a suppository, rose to stool, and passed copious
dejections, with a bilious flux; no sleep. On the ninth, spasms. On
the tenth, slightly recollected. On the eleventh, slept; had perfect
recollection, but again immediately wandered; passed a large quantity
of urine with spasms, (the attendants seldom putting her in mind),
it was thick, white, like urine which has been shaken after it has
stood for a considerable time until it has subsided, but it had no
sediment; in color and consistence, the urine resembled that of cattle,
as far as I observed. About the fourteenth day, startings over the
whole body; talked much; slightly collected, but presently became
again delirious. About the seventeenth day became speechless, on the
twentieth died.
Case 5
The wife of Epicrates, who was lodged at the house
[p. 117] of Archigetes,
being near the term of delivery, was seized with a violent rigor,
and, as was said, she did not become heated; next day the same. On
the third, she was delivered of a daughter, and everything went on
properly. On the day following her delivery, she was seized with acute
fever, pain in the cardiac region of the stomach, and in the genital
parts. Having had a suppository, was in so far relieved; pain in the
head, neck, and loins; no sleep; alvine discharges scanty, bilious,
thin, and unmixed; urine thin, and blackish. Towards the night of
the sixth day from the time she was seized with the fever, became
delirious. On the seventh, all the symptoms exacerbated; insomnolency,
delirium, thirst; stools bilious, and high colored. On the eighth,
had a rigor; slept more. On the ninth, the same. On the tenth, her
limbs painfully affected; pain again of the cardiac region of the
stomach; heaviness of the head; no delirium; slept more; bowels constipated.
On the eleventh, passed urine of a better color, and having an abundant
sediment; felt lighter. On the fourteenth had a rigor; acute fever.
On the fifteenth, had a copious vomiting of bilious and yellow matters;
sweated; fever gone; at night acute fever; urine thick, sediment white.
On the seventeenth, an exacerbation; night uncomfortable; no sleep;
delirium. On the eighteenth, thirsty; tongue parched; no sleep; much
delirium; legs painfully affected. About the twentieth, in the morning,
had as light rigor; was comatose; slept tranquilly; had slight vomiting
of bilious and black matters; towards night deafness. About the twenty-first,
weight generally in the left side, with pain; slight urine thick,
muddy, and reddish; when allowed to stand, had no sediment; in other
respects felt lighter; fever not gone; fauces painful from the commencement,
and red; uvula retracted; defluxion remained acrid, pungent, and saltish
throughout. About the twenty-seventh, free of fever; sediment in the
urine; pain in the side. About the thirty-first, was attacked with
fever, bilious diarrhea; slight bilious vomiting on the fortieth.
Had a complete crisis, and was freed from the fever on the eightieth
day.
Case 6
Cleonactides, who was lodged above the Temple of Hercules,
was seized with a fever in an irregular form; was pained
[p. 118]in the head
and left side from the commencement, and had other pains resembling
those produced by fatigue; paroxysms of the fevers inconstant and
irregular; occasional sweats; the paroxysms generally attacked on
the critical days. About the twenty-fourth was cold in the extremities
of the hands, vomitings bilious, yellow, and frequent, soon turning
to a verdigris-green color; general relief. About the thirtieth, began
to have hemorrhage from both nostrils, and this continued in an irregular
manner until near the crisis; did not loathe food, and had no thirst
throughout, nor was troubled with insomnolency; urine thin, and not
devoid of color. When about the thirtieth day, passed reddish urine,
having a copious red sediment; was relieved, but afterwards the characters
of the urine varied, sometimes having sediment, and sometimes not.
On the sixtieth, the sediment in the urine copious, white, and smooth;
all the symptoms ameliorated; intermission of the fever; urine thin,
and well colored. On the seventieth, fever gone for ten days. On the
eightieth had a rigor, was seized with acute fever, sweated much;
a red, smooth sediment in the urine; and a perfect crisis.
Case 7
Meton was seized with fever; there was a painful weight in
the loins. Next day, after drinking water pretty copiously, had proper
evacuations from the bowels. On the third, heaviness of the head,
stools thin, bilious, and reddish. On the fourth, all the symptoms
exacerbated; had twice a scanty trickling of blood from the right
nostril; passed an uncomfortable night; alvine discharges like those
on the third day; urine darkish, had a darkish cloud floating in it,
of a scattered form, which did not subside. On the fifth, a copious
hemorrhage of pure blood from the left he sweated, and had a crisis.
After the fever restless, and had some delirium; urine thin, and darkish;
had an affusion of warm water on the head; slept and recovered his
senses. In this case there was no relapse, but there were frequent
hemorrhages after the crisis.
Case 8
Erasinus, who lived near the Canal of Bootes, was seized
with fever after supper; passed the night in an agitated state. During
the first day quiet, but in pain at night. On the second, symptoms
all exacerbated; at night delirious. On the
[p. 119]third, was in a painful
condition; great incoherence. On the fourth, in a most uncomfortable
state; had no sound sleep at night, but dreaming and talking; then
all the appearances worse, of a formidable and alarming character;
fear, impatience. On the morning of the fifth, was composed, and quite
coherent, but long before noon was furiously mad, so that he could
not constrain himself; extremities cold, and somewhat livid; urine
without sediment; died about sunset. The fever in this case was accompanied
by sweats throughout; the sweats throughout; the hypochondria were
in a state of meteorism, with distention and pain; the urine was black,
has round substances floating in it, which did not subside; the alvine
evacuations were not stopped; thirst throughout not great; much spasms
with sweats about the time of death.
Case 9
Criton, in Thasus, while still on foot, and going about, was
seized with a violent pain in the great toe; he took to bed the same
day, had rigors and nausea, recovered his heat slightly, at night
was delirious. On the second, swelling of the whole foot, and about
the ankle erythema, with distention, and small bullae (phlyctaenae);
acute fever; he became furiously deranged; alvine discharges bilious,
unmixed, and rather frequent. He died on the second day from the commencement.
Case 10
The Clazomenian who was lodged by the Well of Phrynichides
was seized with fever. He had pain in the head, neck, and loins from
the beginning, and immediately afterwards deafness; no sleep, acute
fever, hypochondria elevated with a swelling, but not much distention;
tongue dry. On the fourth, towards night, he became delirious. On
the fifth, in an uneasy state. On the sixth, all the symptoms exacerbated.
About the eleventh a slight remission; from the commencement to the
fourteenth day the alvine discharges thin, copious, and of the color
of water, but were well supported; the bowels then became constipated.
Urine throughout thin, and well colored, and had many substances scattered
through it, but no sediment. About the sixteenth, urine somewhat thicker,
which had a slight sediment; somewhat better, and more collected.
On the seventeenth, urine again thin; swellings about both his ears,
with pain; no sleep, some incoherence; legs painfully affected. On
the twenti-
[p. 120]eth, free of fever, had a crisis, no sweat, perfectly collected.
About the twenty-seventh, violent pain of the right hip; it speedily
went off. The swellings about the ears subsided, and did not suppurate,
but were painful. About the thirty-first, a diarrhea attended with
a copious discharge of watery matter, and symptoms of dysentery; passed
thick urine; swellings about the ears gone. About the fortieth day,
had pain in the right eye, sight dull. It went away.
Case 11
The wife of Dromeades having been delivered of a female child,
and all other matters going on properly, on the second day after was
seized with rigor and acute fever. Began to have pain about the hypochondrium
on the first day; had nausea and incoherence, and for some hours afterwards
had no sleep; respiration rare, large, and suddenly interrupted. On
the day following that on which she had the rigor, alvine discharges
proper; urine thick, white, muddy, like urine which has been shaken
after standing for some time, until the sediment had fallen to the
bottom; it had no sediment; she did not sleep during the night. On
the third day, about noon, had a rigor, acute fever; urine the same;
pain of the hypochondria, nausea, an uncomfortable night, no sleep;
a coldish sweat all over, but heat quickly restored. On the fourth,
slight alleviation of the symptoms about the hypochondria; heaviness
of the head, with pain; somewhat comatose; slight epistaxis, tongue
dry, thirst, urine thin and oily; slept a little, upon awaking was
somewhat comatose; slight coldness, slept during the night, was delirious.
On the morning of the sixth had a rigor, but soon recovered her heat,
sweated all over; extremities cold, was delirious, respiration rare
and large. Shortly afterwards spasms from the head began, and she
immediately expired.
Case 12
A man, in a heated state, took supper, and drank more than
enough; he vomited the whole during the night; acute fever, pain of
the right hypochondrium, a softish inflammation from the inner part;
passed an uncomfortable night; urine at the commencement thick, red,
but when allowed to stand, had no sediment, tongue dry, and not very
thirsty. On the fourth, acute fever, pains all over. On the fifth,
urine smooth, oily, and
[p. 121] copious; acute fever. On the sixth, in the
evening, very incoherent, no sleep during the night. On the seventh,
all the symptoms exacerbated; urine of the same characters; much talking,
and he could not contain himself; the bowels being stimulated, passed
a watery discharge with lumbrici: night equally painful. In the morning
had a rigor; acute fever, hot sweat, appeared to be free of fever;
did not sleep long; after the sleep a chill, ptyalism; in the evening,
great incoherence; after a little, vomited a small quantity of dark
bilious matters. On the ninth, coldness, much delirium, did not sleep.
On the tenth, pains in the limbs, all the symptoms exacerbated; he
was delirious. On the eleventh, he died.
Case 13
A woman, who lodged on the Quay, being three months gone
with child, was seized with fever, and immediately began to have pains
in the loins. On the third day, pain of the head and neck, extending
to the clavicle, and right hand; she immediately lost the power of
speech; was paralyzed in the right hand, with spasms, after the manner
of paraplegia; was quite incoherent; passed an uncomfortable night;
did not sleep; disorder of the bowels, attended with bilious, On the
fourth, recovered the use of her tongue; spasms of the same parts,
and general pains remained; swelling in the hypochondrium, accompanied
with pain; did not sleep, was quite incoherent; bowels disordered,
urine thin, and not of a good color. On the fifth, acute fever; pain
of the hypochondrium, quite incoherent; alvine evacuations bilious;
towards night had a sweat, and was freed from the fever. On the sixth,
recovered her reason; was every way relieved; the pain remained about
the left clavicle; was thirsty, urine thin, had no sleep. On the seventh
trembling, slight coma, some incoherence, pains about the clavicle
and left arm remained; in all other respects was alleviated; quite
coherent. For three days remained free from fever. On the eleventh,
had a relapse, with rigor and fever. About the fourteenth day, vomited
pretty abundantly bilious and yellow matters, had a sweat, the fever
went off, by coming to a crisis.
Case 14
Melidia, who lodged near the Temple of Juno, began to feel
a violent pain of the head, neck, and chest. She
[p. 122]was straightway seized
with acute fever; a slight appearance of the menses; continued pains
of all these parts. On the sixth, was affected with coma, nausea,
and rigor; redness about the cheeks; slight delirium. On the seventh,
had a sweat; the fever intermitted, the pains remained. A relapse;
little sleep; urine throughout of a good color, but thin; the alvine
evacuations were thin, bilious, acrid, very scanty, black, and fetid;
a white, smooth sediment in the urine; had a sweat, and experienced
a perfect crisis on the eleventh day.