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.
