EPIDEMICS I
FIRST CONSTITUTION
PART 1
I. IN Thasos during autumn, about the time of
the equinox to near the setting of the Pleiades,
1
there were many rains, gently continuous, with
southerly winds. Winter southerly,
2 north winds
light, droughts ; on the whole, the winter was
like a spring. Spring southerly and chilly ; slight
showers. Summer in general cloudy. No rain.
Etesian winds few, light and irregular.
The whole weather proved southerly, with droughts,
but early in the spring, as the previous constitution
had proved the opposite and northerly, a few patients
suffered from ardent fevers, and these very mild,
causing hemorrhage in few cases and no deaths.
Many had swellings beside one ear, or both ears, in
most cases unattended with fever,
3 so that confinement
to bed was unnecessary. In some cases there was
slight heat, but in all the swellings subsided without
causing harm ; in no case was there suppuration
such as attends swellings of other origin. This was
the character of them :--flabby, big, spreading, with
neither inflammation nor pain ; in every case they
[p. 149]
disappeared without a sign.
4 The sufferers were
youths, young men, and men in their prime, usually
those who frequented the wrestling school and
gymnasia. Few women were attacked. Many had
dry coughs which brought up nothing when they
coughed, but their voices were hoarse. Soon after,
though in some cases after some time, painful
inflammations occurred either in one testicle or in
both, sometimes accompanied with fever, in other
cases not. Usually they caused much suffering. In
other respects the people had no ailments requiring
medical assistance.
5
PART 2
II. Beginning early in the summer, throughout
the summer and in winter many of those who had
been ailing a long time took to their beds in a state
of consumption, while many also who had hitherto
been doubtful sufferers at this time showed undoubted
symptoms. Some showed the symptoms now for
the first time ; these were those whose constitution
inclined to be consumptive. Many, in fact most of
these, died ; of those who took to their beds I do not
know one who survived even for a short time. Death
came more promptly than is usual in consumption,
and yet the other complaints, which will be described
presently, though longer and attended with fever,
were easily supported and did not prove fatal. For
consumption was the worst of the diseases that
occurred, and alone was responsible for the great
mortality.
In the majority of cases the symptoms were these.
Fever with shivering, continuous, acute, not completely
intermitting, but of the semitertian type ;
remitting during one day they were exacerbated on
the next, becoming on the whole more acute. Sweats
[p. 151]
were continual, but not all over the body. Severe
chill in the extremities, which with difficulty
recovered their warmth. Bowels disordered, with
bilious, scanty, unmixed, thin, smarting stools,
causing the patient to get up often. Urine either
thin, colourless,
6 unconcocted
and scanty, or thick
and with a slight deposit, not settling favourably,
but with a crude and unfavourable deposit. The
patients frequently coughed up small, concocted
sputa, brought up little by little with difficulty.
Those exhibiting the symptoms in their most
violent form showed no concoction at all, but
continued spitting crude sputa. In the majority
of these cases the throat was throughout painful
from the beginning, being red and inflamed. Fluxes
slight, thin, pungent. Patients quickly wasted away
and grew worse, being throughout averse to all food
and experiencing no thirst. Delirium in many cases
as death approached. Such were the symptoms of
the consumption.
PART 3
III. But when summer came, and during autumn
occurred many continuous but not violent fevers, which
attacked persons who were long ailing without
suffering distress in any other particular manner ; for
the bowels were in most cases quite easy, and hurt
to no appreciable extent. Urine in most cases of
good colour and clear, but thin, and after a time near
the crisis it grew concocted. Coughing was slight,
and caused no distress. No lack of appetite ; in fact
it was quite possible even to give food. In general
the patients did not sicken, as did the consumptives,
[p. 153]
with shivering fevers, but with slight sweats, the
paroxysms being variable and irregular.
7 The earliest
crisis was about the twentieth day ; in most cases
the crisis was about the fortieth day, though in
many it was about the eightieth. In some cases
the illness did not end in this way, but in an
irregular manner without a crisis. In the majority
of these cases the fevers relapsed after a brief
interval, and after the relapse a crisis occurred at
the end of the same periods as before. The disease
in many of these instances was so protracted that
it even lasted during the winter.
Out of all those described in this constitution
only the consumptives showed a high mortality-rate ;
for all the other patients bore up well, and the
other fevers did not prove fatal.
SECOND CONSTITUTION
PART 4
IV. In Thasos early in autumn occurred unseasonable
wintry storms, suddenly with many north
and south winds bursting out into rains. These conditions
continued until the setting of the Pleiades and
during their season. Winter was northerly ; many
violent and abundant rains ; snows ; generally there
were fine intervals. With all this, however, the cold
weather was not exceptionally unseasonable. But
immediately after the winter solstice, when the west
wind usually begins to blow, there was a return of
severe wintry weather, much north wind, snow and
[p. 155]
copious rains continuously, sky stormy and clouded.
These conditions lasted on, and did not remit before
the equinox. Spring cold, northerly, wet, cloudy.
Summer did not turn out excessively hot, the Etesian
winds blowing continuously. But soon after, near
the rising of Arcturus, there was much rain again,
with northerly winds.
PART 5
V. The whole year having been wet, cold and
northerly, in the winter the public health in most
respects was good, but in early spring many, in fact
most, suffered illnesses. Now there began at first
inflammations of the eyes, marked by rheum,
pain, and unconcocted discharges. Small gummy
sores, in many cases causing distress when they
broke out ; the great majority relapsed, and ceased
late on the approach of autumn. In summer and
autumn dysenteric diseases, tenesmus and lientery ;
bilious diarrhœa, with copious, thin, crude, smarting
stools ; in some cases it was also watery.
In many cases there were also painful, bilious defluxions,
watery, full of thin particles, purulent
and causing strangury. No kidney trouble, but
their various symptoms succeeded in various orders.
Vomitings of phlegm, bile, and undigested food.
Sweats ; in all cases much moisture over all the
body. These complaints in many cases were unattended
with fever, and the sufferers were not confined
to bed ; but in many others there was fever,
as I am going to describe. Those who showed all
the symptoms mentioned above were consumptives
who suffered pain. When autumn came, and during
winter, continuous fevers--in some few cases ardent--day
fevers, night fevers, semitertians, exact
tertians, quartans, irregular fevers. Each of the
fevers mentioned found many victims.
[p. 157]
PART 6
VI. Now the ardent fevers attacked the fewest
persons, and these were less distressed than any
of the other sick. There was no bleeding from the
nose, except very slight discharges in a few cases,
and no delirium. All the other symptoms were
slight. The crises of these diseases were quite
regular, generally in seventeen days, counting the
days of intermission, and I know of no ardent fever
proving fatal at this time, nor of any phrenitis.
The tertians were more numerous than the ardent
fevers and more painful. But all these had four
regular periods from the first onset, had complete
crises in seven, and in no case relapsed. But the
quartans, while in many instances they began at first
with quartan periodicity, yet in not a few they became
quartan by an abscession from other fevers or illnesses.
8
They were protracted, as quartans usually
are, or even more protracted than usual. Many
fell victims to quotidians, night fevers, or irregular
fevers, and were ill for a long time, either in bed
or walking about. In most of these cases the fevers
continued during the season of the Pleiades or even
until winter. In many patients, especially children,
there were convulsions and slight feverishness from
the beginning ; sometimes, too, convulsions supervened
upon fevers. Mostly these illnesses were
protracted, but not dangerous, except for those who
from all other causes were predisposed to die.
PART 7
VII. But those fevers which were altogether continuous
and never intermitted at all, but in all cases
[p. 159]
grew worse after the manner of semitertians, with
remission during one day followed by exacerbation
during the next, were the most severe of all the
fevers which occurred at this time, the longest
and the most painful. Beginning mildly, and on
the whole increasing always, with exacerbation,
and growing worse, they had slight remissions
followed quickly after an abatement by more violent
exacerbations, generally becoming worse on the
critical days. All patients had irregular rigors that
followed no fixed law, most rarely and least in
the semitertians,
9 but more
violent in the other
fevers. Copious sweats, least copious in the semitertians ;
they brought no relief, but on the contrary
caused harm. These patients suffered great
chill in the extremities, which grew warm again
with difficulty. Generally there was sleeplessness,
especially with the semitertians, followed afterwards
by coma. In all the bowels were disordered
and in a bad state, but in the semitertians they were
far the worst. In most of them urine either (
a）
thin, crude, colourless, after a time becoming slightly
concocted with signs of crisis, or (
b) thick enough
but turbid, in no way settling or forming sediment,
or (
c) with small, bad, crude sediments, these being
the worst of all. Coughs attended the fevers, but
I cannot say that either harm or good resulted from
the coughing on this occasion.
PART 8
VIII. Now the greatest number of these symptoms
continued to be protracted, troublesome, very disordered,
very irregular, and without any critical signs,
both in the case of those who came very near death
[p. 161]
and in the case of those who did not. For even if
some patients enjoyed slight intermissions, there
followed a quick relapse. A few of them experienced
a crisis, the earliest being about the eightieth day,
some of the latter having a relapse, so that most of
them were still ill in the winter. The greatest
number had no crisis before the disease terminated.
These symptoms occurred in those who recovered
just as much as in those who did not. The illnesses
showed a marked absence of crisis and a great variety ;
the most striking and the worst symptom, which
throughout attended the great majority, was a complete
loss of appetite, especially in those whose
general condition exhibited fatal signs, but in these
fevers they did not suffer much from unseasonable
thirst. After long intervals, with many pains and
with pernicious wasting, there supervened abscessions
either too severe to be endured, or too slight to be
beneficial, so that there was a speedy return of the
original symptoms, and an aggravation of the
mischief.
10
PART 9
IX. The symptoms from which these patients
suffered were dysenteries and tenesmus, lienteries
also and fluxes. Some had dropsies also, either with
or without these. Whenever any of these attacked
violently they were quickly fatal, or, if mild, they did
no good. Slight eruptions, which did not match the
extent of the diseases and quickly disappeared again,
or swellings by the ears that grew smaller
11 and
[p. 163]
signified nothing, in some cases appearing at the
joints, especially the hip-joint, in few instances
leaving with signs of crisis, when they quickly
re-established themselves in their original state.
PART 10
X. From all the diseases some died, but the greatest
number from these fevers,
12 especially children--those
just weaned, older children of eight or ten years,
and those approaching puberty. These victims
never suffered from the latter symptoms without
the first I have described above, but often the first
without the latter. The only good sign, the most
striking that occurred, which saved very many of
those who were in the greatest danger, was when
there was a change to strangury, into which abscessions
took place. The strangury, too, came mostly
to patients of the ages mentioned, though it did
happen to many of the others, either without their
taking to bed or when they were ill. Rapid and
great was the complete change that occurred in
their case. For the bowels, even if they were
perniciously loose, quickly recovered ; their appetite
for everything returned, and hereafter the fever
abated. But the strangury, even in these cases, was
long and painful. Their urine was copious, thick,
varied, red, mixed with pus, and passed with pain.
But they all survived, and I know of none of these
that died.
PART 11
XI. In all dangerous cases you should be on the
watch for all favourable coctions of the evacuations
from all parts, or for fair and critical abscessions.
Coctions signify nearness of crisis and sure recovery
[p. 165]
of health, but crude and unconcocted evacuations,
which change into bad abscessions, denote absence
of crisis, pain, prolonged illness, death, or a return
of the same symptoms. But it is by a consideration
of other signs that one must decide which of these
results will be most likely. Declare the past,
diagnose the present, foretell the future ; practise
these acts. As to diseases, make a habit of two
things--to help, or at least to do no harm. The
art has three factors, the disease, the patient, the
physician. The physician is the servant of the art.
The patient must co-operate with the physician in
combating the disease.
PART 12
XII. Pains about the head and neck, and heaviness
combined with pain, occur both without and with
fever. Sufferers from phrenitis have convulsions, and
eject verdigris-coloured vomit ; some die very quickly.
But in ardent and the other fevers, those with pain in
the neck, heaviness of the temples, dimness of sight,
and painless tension of the hypochondrium, bleed
from the nose ; those with a general heaviness of the
head, cardialgia, and nausea, vomit afterwards bile and
phlegm. Children for the most part in such cases
suffer chiefly from the convulsions. Women have
both these symptoms and pains in the womb. Older
people, and those whose natural heat is failing, have
paralysis or raving or blindness.
THIRD CONSTITUTION
PART 13
XIII. In Thasos a little before and at the season
of Arcturus many violent rains with northerly winds.
About the equinox until the setting of the Pleiades
[p. 167]
slight, southerly rains. Winter northerly, droughts,
cold periods, violent winds, snow. About the
equinox very severe storms. Spring northerly,
droughts, slight rains, periods of cold. About the
summer solstice slight showers, periods of great cold
until near the Dog Star. After the Dog Star, until
Arcturus, hot summer. Great heat, not intermittent
but continuous and severe. No rain fell. The
Etesian winds blew. About Arcturus southerly
rains until the equinox.
PART 14
XIV. In this constitution during winter began
paralyses which attacked many, a few of whom
quickly died. In fact, the disease was generally
epidemic. In other respects the public health
continued good. Early in spring began ardent
fevers which continued until the equinox and on to
summer. Now those who began to be ill at once, in
spring or the beginning of summer, in most cases
got well, though a few died ; but when autumn and
the rains came the cases were dangerous, and
more died.
As to the peculiarities of the ardent fevers, the
most likely patients to survive were those who had a
proper and copious bleeding from the nose, in fact I
do not know of a single case in this constitution that
proved fatal when a proper bleeding occurred, For
Philiscus and Epaminon and Silenus, who died, had
only a slight epistaxis on the fourth and fifth days.
Now the majority of the patients had rigors near the
[p. 169]
crisis, especially such as had no epistaxis, but these
had sweats also as well as rigors.
PART 15
XV. Some had jaundice on the sixth day, but
these were benefited by either a purging through
the bladder or a disturbance of the bowels or a
copious hemorrhage, as was the case with Heraclides,
who lay sick at the house of Aristocydes.
This patient, however, who had a crisis on the
twentieth day, not only bled from the nose, but also
experienced disturbance of the bowels and a purging
through the bladder. Far otherwise was it with the
servant of Phanagoras, who had none of these
symptoms, and died. But the great majority had
hemorrhage, especially youths and those in the
prime of life, and of these the great majority who
had no hemorrhage died. Older people had jaundice
or disordered bowels, for example Bion, who lay
sick at the house of Silenus. Dysenteries also were
general in summer, and some too of those who had
fallen ill, and also suffered from hemorrhage, finally
had dysentery ; for example, the slave of Erato and
Myllus, after copious hemorrhage, lapsed into dysentery.
They recovered.
This humour,
13 then, especially was in great
abundance,
since even those who had no hemorrhage
near the crisis, but swellings by the ears which
disappeared--and after their disappearance there
was a heaviness along the left flank up to the extremity
of the hip--after the crisis had pain and
passed thin urine, and then began to suffer slight
hemorrhage about the twenty-fourth day, and
[p. 171]
abscessions into hemorrhage occurred. In the case
of Antipho, son of Critobulus, the illness ceased and
came to a complete crisis about the fortieth day.
PART 16
XVI. Though many women fell ill, they were
fewer than the men and less frequently died. But
the great majority had difficult childbirth, and after
giving birth they would fall ill, and these especially
died, as did the daughter of Telebulus on the sixth
day after delivery. Now menstruation appeared
during the fevers in most cases, and with many
maidens it occurred then for the first time. Some
bled from the nose. Sometimes both epistaxis and
menstruation appeared together ; for example, the
maiden daughter of Daitharses had her first menstruation
during fever and also a violent discharge
from the nose. I know of no woman who died if
any of these symptoms showed themselves properly,
but all to my knowledge had abortions if they
chanced to fall ill when with child.
PART 17
XVII. Urine in most cases was of good colour, but
thin and with slight sediments, and the bowels of most
were disordered with thin, bilious excretions. Many
after a crisis of the other symptoms ended with dysentery,
as did Xenophanes and Critias. I will mention
cases in which was passed copious, watery, clear and
thin urine, even after a crisis in other respects favourable,
and a favourable sediment : Bion, who lay sick
at the house of Silenus, Cratis, who lodged with
Xenophanes, the slave of Areto, and the wife of Mnesistratus.
Afterwards all these suffered from dysentery.
About the season of Arcturus many had crisis on
[p. 173]
the eleventh day, and these did not suffer even the
normal relapses. There were also comatose fevers
about this time, usually in children, and of all
patients these showed the lowest mortality.
PART 18
XVIII. About the equinox up to the setting of
the Pleiades, and during winter, although the ardent
fevers continued, yet cases of phrenitis were most
frequent at this time, and most of them were fatal.
In summer, too, a few cases had occurred. Now the
sufferers from ardent fever, when fatal symptoms
attended, showed signs at the beginning. For right
from the beginning there was acute fever with slight
rigors, sleeplessness, thirst, nausea, slight sweats
about the forehead and collar-bones, but in no case
general, much delirium, fears, depression, very cold
extremities, toes and hands, especially the latter.
The exacerbations on the even days ; but in most
cases the pains were greatest on the fourth day, with
sweat for the most part chilly, while the extremities
could not now be warmed again, remaining livid and
cold ; and in these cases the thirst ceased. Their
urine was scanty, black, thin, with constipation of the
bowels. Nor was there hemorrhage from the nose in
any case when these symptoms occurred, but only
slight epistaxis. None of these cases suffered relapse,
but they died on the sixth day, with sweating.
The cases of phrenitis had all the above symptoms,
but the crises generally occurred on the eleventh
day. Some had their crises on the twentieth day,
namely those in whom the phrenitis did not begin
at first, or began about the third or fourth day, but
[p. 175]
though these fared tolerably at the beginning, yet
the disease assumed an acute form about the seventh
day.
PART 19
XIX. Now the number of illnesses was great. And
of the patients there died chiefly striplings, young
people, people in their prime, the smooth, the fair-skinned,
the straight-haired, the black-haired, the
black-eyed, those who had lived recklessly and care-lessly,
the thin-voiced, the rough-voiced, the lispers,
the passionate. Women too died in very great
numbers who were of this kind. In this constitution
there were four symptoms especially which denoted
recovery :--a proper hemorrhage through the nostrils ;
copious discharges by the bladder of urine with
much sediment of a proper character ; disordered
bowels with bilious evacuations at the right time ;
the appearance of dysenteric characteristics. The
crisis in many cases did not come with one only
of the symptoms described above, but in most cases
all symptoms were experienced, and the patients
appeared to be more distressed ; but all with these
symptoms got well. Women and maidens experienced
all the above symptoms, but besides, whenever
any took place properly, and whenever copious menstruation
supervened, there was a crisis therefrom
which resulted in recovery ; in fact I know of no
woman who died when any of these symptoms took
place properly. For the daughter of Philo, who
died, though she had violent epistaxis, dined rather
unseasonably on the seventh day.
In acute fevers, more especially in ardent fevers,
when involuntary weeping occurs, epistaxis is to be
[p. 177]
expected it the patient have no fatal symptoms
besides ; for when he is in a bad way such weeping
portends not hemorrhage but death.
PART 20
XX. The painful swellings by the ears in fevers
in some cases neither subsided nor suppurated when
the fever ceased with a crisis. They were cured by
bilious diarrhœa, or dysentery, or a sediment of
thick urine such as closed the illness of Hermippus
of Clazomenæ. The circumstances of the crises,
from which too I formed my judgments, were either
similar or dissimilar ; for example, the two brothers,
who fell sick together at the same time, and lay ill
near the bungalow of Epigenes. The elder of these
had a crisis on the sixth day, the younger on the
seventh. Both suffered a relapse together at the
same time with an intermission of five days. After
the relapse both had a complete crisis together on
the seventeenth day. But the great majority had
a crisis on the sixth day, with an intermission of
six days followed by a crisis on the fifth day after the
relapse. Those who had a crisis on the seventh day
had an intermission of seven days, with a crisis on
the third day after the relapse. Others with a crisis
on the seventh had an intermission of three days,
with a crisis on the seventh day after the relapse.
Some who had a crisis on the sixth day had an
intermission of six and a relapse of three, an intermission
of one and a relapse of one, followed by a
crisis ; for example, Euagon the son of Daitharses.
Others with a crisis on the sixth had an intermission
of seven days, and after the relapse a crisis on the
fourth ; for example, the daughter of Aglai+das. Now
most of those who fell ill in this constitution went
through their illness in this manner, and none of
[p. 179]
those who recovered, so far as I know, failed to
suffer the relapses which were normal in these cases,
but all, so far as I know, recovered if their relapses
took place after this fashion. Further, I know of
none who suffered a fresh relapse after going through
the illness in the manner described above.
PART 21
XXI. In these diseases most died on the sixth
day, as did Epaminondas, Silenus and Philiscus the
son of Antagoras. Those who had the swellings by
the ears had a crisis on the twentieth day, but these
subsided in all cases without suppuration, being
diverted to the bladder. There were two cases of
suppuration, both fatal, Cratistonax, who lived near
the temple of Heracles, and the serving-maid of
Scymnus the fuller. When there was a crisis on
the seventh day, with an intermission of nine days
followed by a relapse, there was a second crisis on
the fourth day after the relapse--in the case of
Pantacles, for example, who lived by the temple of
Dionysus. When there was a crisis on the seventh
day, with an intermission of six days followed by a
relapse, there was a second crisis on the seventh day
after the relapse--in the case of Phanocritus, for
example, who lay sick at the house of Gnathon the
fuller.
PART 22
XXII. During winter, near the time of the
winter solstice, and continuing until the equinox,
the ardent fevers and the phrenitis still caused
many deaths, but their crises changed. Most cases
had a crisis on the fifth day from the outset, then
intermitted four days, relapsed, had a crisis on the
fifth day after the relapse, that is, after thirteen
days altogether. Mostly children experienced crises
thus, but older people did so too. Some had a crisis
[p. 181]
on the eleventh day, a relapse on the fourteenth,
and a complete crisis on the twentieth. But if rigor
came on about the twentieth day the crisis came on
the fortieth. Most had rigors near the first crisis,
and those who had rigors at first near the crisis,
had rigors again in the relapses at the time of the
crisis. Fewest experienced rigors in the spring,
more in summer, more still in autumn, but by far
the most during winter. But the hemorrhages
tended to cease.
PART 23
XXIII. The following were the circumstances
attending the diseases, from which I framed my
judgments, learning from the common nature of all
and the particular nature of the individual, from the
disease, the patient, the regimen prescribed and the
prescriber--for these make a diagnosis more favourable
or less ; from the constitution, both as a whole
and with respect to the parts, of the weather and of
each region ; from the custom, mode of life, practices
and ages of each patient ; from talk, manner, silence,
thoughts, sleep or absence of sleep, the nature and
time of dreams, pluckings, scratchings, tears ; from
the exacerbations, stools, urine, sputa, vomit, the
antecedents and consequents of each member in the
successions of diseases, and the abscessions to a fatal
issue or a crisis, sweat, rigor, chill, cough, sneezes,
hiccoughs, breathing, belchings, flatulence, silent or
noisy, hemorrhages, and hemorrhoids. From these
things must we consider what their consequents also
will be.
PART 24
XXIV. Some fevers are continuous, some have an
access during the day and an intermission during
the night, or an access during the night and an
intermission during the day ; there are semitertians,
[p. 183]
tertians, quartans, quintans, septans, nonans. The
most acute diseases, the most severe, difficult and
fatal, belong to the continuous fevers. The least
fatal and least difficult of all, but the longest of all,
is the quartan. Not only is it such in itself, but it
also ends other, and serious, diseases. In the fever
called semitertian, which is more fatal than any
other, there occur also acute diseases, while it
especially precedes the illness of consumptives, and
of those who suffer from other and longer diseases.
The nocturnal is not very fatal, but it is long. The
diurnal is longer still, and to some it also brings
a tendency to consumption. The septan is long but
not fatal. The nonan is longer still but not fatal.
The exact tertian has a speedy crisis and is not
fatal. But the quintan is the worst of all. For if it
comes on before consumption or during consumption
the patient dies.
PART 25
XXV. Each of these fevers has its modes, its
constitutions and its exacerbations. For example,
a continuous fever in some cases from the beginning
is high and at its worst, leading up to the most
severe stage, but about and at the crisis it moderates.
In other cases it begins gently and in a suppressed
manner, but rises and is exacerbated each
day, bursting out violently near the crisis. In some
cases it begins mildly, but increases and is exacerbated,
reaching its height after a time ; then it
declines again until the crisis or near the crisis.
These characteristics may show themselves in any
fever and in any disease. It is necessary also to
consider the patient's mode of life and to take it
[p. 185]
into account when prescribing. Many other important
symptoms there are which are akin to
these, some of which I have described, while others
I shall describe later. These must be duly weighed
when considering and deciding who is suffering from
one of these diseases in an acute, fatal form, or
whether the patient may recover ; who has a chronic,
fatal illness, or one from which he may recover ;
who is to be prescribed for or not, what the prescription
is to be, the quantity to be given and the
time to give it.
PART 26
XXVI. When the exacerbations are on even days,
the crises are on even days. But the diseases exacerbated
on odd days have their crises on odd days.
The first period of diseases with crises on the even
days is the fourth day, then the sixth, eighth, tenth,
fourteenth, twentieth, twenty-fourth, thirtieth,
fortieth, sixtieth, eightieth, hundred and twentieth.
Of those with a crisis on the odd days the first period
is the third, then the fifth, seventh, ninth, eleventh,
seventeenth, twenty-first, twenty-seventh, thirty-first.
Further, one must know that, if the crises
be on other days than the above, there will be
relapses, and there may also be a fatal issue. So
one must be attentive and know that at these times
there will be the crises resulting in recovery, or
death, or a tendency for better or worse. One must
also consider in what periods the crises occur of
irregular fevers, of quartans, of quintans, of septans
and of nonans.
[p. 187]
FOURTEEN CASES
CASE I
Philiscus lived by the wall. He took to his bed
with acute fever on the first day and sweating ;
night uncomfortable.
Second day. General exacerbation, later a small
clyster moved the bowels well. A restful night.
Third day. Early and until mid-day he appeared
to have lost the fever ; but towards evening acute
fever with sweating ; thirst ; dry tongue ; black urine.
An uncomfortable night, without sleep ; completely
out of his mind.
Fourth day. All symptoms exacerbated ; black
urine ; a more comfortable night, and urine of a
better colour.
Fifth day. About mid-day slight epistaxis of unmixed
blood. Urine varied, with scattered, round
particles suspended in it, resembling semen ; they
did not settle. On the application of a suppository
the patient passed, with flatulence, scanty excreta.
A distressing night, snatches of sleep, irrational talk ;
extremities everywhere cold, and would not get
warm again ; black urine ; snatches of sleep towards
dawn ; speechless ; cold sweat ; extremities livid.
About mid-day on the sixth day the patient died.
The breathing throughout, as though he were recollecting
to do it,
14 was rare and large.
Spleen
raised in a round swelling ; cold sweats all the
time. The exacerbations on even days.
CASE II
Silenus lived on Broadway near the place of
Eualcidas. After over-exertion, drinking, and exercises
[p. 189]
at the wrong time he was attacked by fever.
He began by having pains in the loins, with heaviness
in the head and tightness of the neck. From
the bowels on the first day there passed copious
discharges of bilious matter, unmixed, frothy, and
highly coloured. Urine black, with a black sediment ;
thirst ; tongue dry ; no sleep at night.
Second day. Acute fever, stools more copious,
thinner, frothy ; urine black ; uncomfortable night ;
slightly out of his mind.
Third day. General exacerbation ; oblong tightness
15
of the hypochondrium, soft underneath, extending
on both sides to the navel ; stools thin,
blackish ; urine turbid, blackish ; no sleep at night ;
much rambling, laughter, singing ; no power of
restraining himself.
Fourth day. Same symptoms.
Fifth day. Stools unmixed, bilious, smooth, greasy ;
urine thin, transparent ; lucid intervals.
Sixth day. Slight sweats about the head ; extremities
cold and livid ; much tossing ; nothing passed
from the bowels ; urine suppressed ; acute fever.
Seventh day. Speechless ; extremities would no
longer get warm ; no urine.
Eighth day. Cold sweat all over ; red spots with
sweat, round, small like acne, which persisted without
subsiding. From the bowels with slight stimulus
[p. 191]
there came a copious discharge of solid stools, thin,
16
as it were unconcocted, painful. Urine painful and
irritating. Extremities grow a little warmer ;
fitful sleep ; coma ; speechlessness ; thin, transparent
urine.
Ninth day. Same symptoms.
Tenth day. Took no drink ; coma ; fitful sleep.
Discharges from the bowels similar ; had a copious
discharge of thickish urine, which on standing left
a farinaceous, white deposit ; extremities again cold.
Eleventh day. Death.
From the beginning the breath in this case was
throughout rare and large. Continuous throbbing
of the hypochondrium ; age about twenty years.
CASE III
Herophon had acute fever ; scanty stools with
tenesmus at the beginning, afterwards becoming
thin, bilious and fairly frequent. No sleep ; urine
black and thin.
Fifth day. Deafness early in the day ; general
exacerbation ; spleen swollen ; tension of the hypochondrium ;
scanty black stools ; delirium.
Sixth day. Wandering talk ; at night sweat and
chill ; the wandering persisted.
Seventh Day. Chill all over ; thirst ; out of his
mind. During the night he was rational, and slept.
Eighth day. Fever ; spleen lessened ; quite
rational ; pain at first in the groin, on the side of
the spleen ; then the pains extended to both legs.
Night comfortable ; urine of a better colour, with a
slight deposit.
Ninth day. Sweat, crisis, intermission.
[p. 193]
On the fifth day after the crisis the patient
relapsed. Immediately the spleen swelled ; acute
fever ; return of deafness. On the third day after
the relapse the spleen grew less and the deafness
diminished, but there was pain in the legs. During
the night he sweated. The crisis was about the
seventeenth day. There was no delirium during
the relapse.
CASE IV
In Thasos the wife of Philinus gave birth to a
daughter. The lochial discharge was normal, and
the mother was doing well when on the fourteenth
day after delivery she was seized with fever attended
with rigor. At first she suffered in the stomach
and the right hypochondrium. Pains in the genital
organs. The discharge ceased. By a pessary these
troubles were eased, but pains persisted in the head,
neck and loins. No sleep ; extremities cold ; thirst ;
bowels burnt ; scanty stools ; urine thin, and at first
colourless.
Sixth day. Much delirium at night, followed by
recovery of reason.
Seventh day. Thirst ; stools scanty, bilious, highly
coloured.
Eighth day. Rigor ; acute fever ; many painful
convulsions ; much delirium. The application of a
suppository made her keep going to stool, and
there were copious motions with a bilious flux. No
sleep.
Ninth day. Convulsions.
Tenth day. Lucid intervals.
Eleventh day. Slept ; complete recovery of her
memory, followed quickly by renewed delirium.
[p. 195]
A copious passing of urine with convulsions--her
attendants seldom reminding her--which was white
and thick, like urine with a sediment and then
shaken ; it stood for a long time without forming a
sediment ; colour and consistency like that of the
urine of cattle. Such was the nature of the urine
that I myself saw.
About the fourteenth day there were twitchings
over all the body ; much wandering, with lucid
intervals followed quickly by renewed delirium.
About the seventeenth day she became speechless.
Twentieth day. Death.
CASE V
The wife of Epicrates, who lay sick near the
founder,
17 when near her delivery was seized with
severe rigor without, it was said, becoming warm,
and the same symptoms occurred on the following day.
On the third day she gave birth to a daughter, and
the delivery was in every respect normal. On the
second day after the delivery she was seized with
acute fever, pain at the stomach and in the genitals.
A pessary relieved these symptoms, but there was
pain in the head, neck and loins. No sleep. From
the bowels passed scanty stools, bilious, thin and
unmixed. Urine thin and blackish. Delirium on
the night of the sixth day from the day the fever
began.
Seventh day. All symptoms exacerbated ; sleeplessness ;
delirium ; thirst ; bilious, highly-coloured
stools.
Eighth day. Rigor ; more sleep.
Ninth day. The same symptoms.
[p. 197]
Tenth day. Severe pains in the legs ; pain again
at the stomach ; heaviness in the head ; no delirium ;
more sleep ; constipation.
Eleventh day. Urine of better colour, with a
thick deposit ; was easier.
Fourteenth day. Rigor ; acute fever.
Fifteenth day. Vomited fairly frequently bilious,
yellow vomit ; sweated without fever ; at night, however,
acute fever ; urine thick, with a white sediment.
Sixteenth day. Exacerbation ; an uncomfortable
night ; no sleep ; delirium.
Eighteenth day. Thirst ; tongue parched ; no
sleep ; much delirium ; pain in the legs.
About the twentieth day. Slight rigors in the
early morning ; coma ; quiet sleep ; scanty, bilious,
black vomits ; deafness at night.
About the twenty-first day. Heaviness all over
the left side, with pain ; slight coughing ; urine
thick, turbid, reddish, no sediment on standing.
In other respects easier ; no fever. From the
beginning she had pain in the throat ; redness ; uvula
drawn back ; throughout there persisted an acrid
flux, smarting, and salt.
About the twenty-seventh day. No fever ; sediment
in urine ; some pain in the side.
About the thirty-first day. Attacked by fever ;
bowels disordered and bilious.
Fortieth day. Scanty, bilious vomits.
Eightieth day. Complete crisis with cessation of
fever.
CASE VI
Cleanactides, who lay sick above the temple of
Heracles, was seized by an irregular fever. He had
[p. 199]
at the beginning pains in the head and the left side,
and in the other parts pains like those caused by
fatigue. The exacerbations of the fever were varied
and irregular ; sometimes there were sweats, sometimes
there were not. Generally the exacerbations
manifested themselves most on the critical days.
About the twenty-fourth day. Pain in the hands ;
bilious, yellow vomits, fairly frequent, becoming after
a while like verdigris ; general relief.
About the thirtieth day. Epistaxis from both
nostrils began, and continued, irregular and slight,
until the crisis. All the time he suffered no thirst,
nor lack of appetite or sleep. Urine thin, and not
colourless.
About the fortieth day. Urine reddish, and with
an abundant, red deposit. Was eased. Afterwards
the urine varied, sometimes having, sometimes not
having, a sediment.
Sixtieth day. Urine had an abundant sediment,
white and smooth ; general improvement ; fever
intermitted ; urine again thin but of good colour.
Seventieth day. Fever, which intermitted for
ten days.
Eightieth day. Rigor ; attacked by acute fever ;
much sweat ; in the urine a red, smooth sediment.
A complete crisis.
CASE VII
Meton was seized with fever, and painful heaviness
in the loins.
Second day. After a fairly copious draught of
water had his bowels well moved.
Third day. Heaviness in the head ; stools thin,
bilious, rather red.
[p. 201]
Fourth day. General exacerbation ; slight epistaxis
twice from the right nostril. An uncomfortable
night ; stools as on the third day ; urine rather
black ; had a rather black cloud floating in it, spread
out, which did not settle.
Fifth day. Violent epistaxis of unmixed blood
from the left nostril ; sweat ; crisis. After the crisis
sleeplessness ; wandering ; urine thin and rather
black. His head was bathed ; sleep ; reason restored.
The patient suffered no relapse, but after
the crisis bled several times from the nose.
CASE VIII
Erasinus lived by the gully of Boétes. Was seized
with fever after supper ; a troubled night.
First day. Quiet, but the night was painful.
Second day. General exacerbation ; delirium at
night.
Third day. Pain and much delirium.
Fourth day. Very uncomfortable ; no sleep at
night ; dreams and wandering. Then worse
symptoms, of a striking and significant character ;
fear and discomfort.
Fifth day. Early in the morning was composed,
and in complete possession of his senses. But long
before mid-day was madly delirious ; could not
restrain himself ; extremities cold and rather livid ;
urine suppressed ; died about sunset.
In this patient the fever was throughout accompanied
by sweat ; the hypochondria were swollen,
distended and painful. Urine black, with round,
suspended particles which did not settle. There
were solid discharges from the bowels. Thirst
[p. 203]
throughout not very great. Many convulsions with
sweating about the time of death.
CASE IX
Crito, in Thasos, while walking about, was seized
with a violent pain in the great toe. He took to bed
the same day with shivering and nausea ; regained
a little warmth ; at night was delirious.
Second day. Swelling of the whole foot, which
was rather red about the ankle, and distended ;
black blisters ; acute fever ; mad delirium. Alvine
discharges unmixed, bilious and rather frequent.
He died on the second day from the commencement.
CASE X
The man of Clazomenae, who lay sick by the well
of Phrynichides, was seized with fever. Pain at the
beginning in head, neck and loins, followed immediately
by deafness. No sleep ; seized with acute
fever ; hypochondrium swollen, but not very much ;
distension ; tongue dry.
Fourth day. Delirium at night.
Fifth day. Painful.
Sixth day. All symptoms exacerbated.
About the eleventh day slight improvement.
From the beginning to the fourteenth day there
were from the bowels thin discharges, copious, of
a watery biliousness ; they were well supported by
the patient. Then the bowels were constipated.
Urine throughout thin, but of good colour. It had
much cloud spread through it, which did not
settle in a sediment. About the sixteenth day the
urine was a little thicker, and had a slight sediment.
[p. 205]
The patient became a little easier, and was more
rational.
Seventeenth day. Urine thin again ; painful swellings
by both ears. No sleep ; wandering ; pain in
the legs.
Twentieth day. A crisis left the patient free
from fever ; no sweating ; quite rational. About
the twenty-seventh day violent pain in the right
hip, which quickly ceased. The swellings by the
ears neither subsided nor suppurated, but continued
painful. About the thirty-first day diarrhéa with
copious, watery discharges and signs of dysentery.
Urine thick ; the swellings by the ears subsided.
Fortieth day. Pain in the right eye ; sight rather
impaired ; recovery.
CASE XI
The wife of Dromeades, after giving birth to a
daughter, when everything had gone normally, on
the second day was seized with rigor ; acute fever.
On the first day she began to feel pain in the region
of the hypochondrium ; nausea ; shivering ; restless ;
and on the following days did not sleep. Respiration
rare, large, interrupted at once as by an inspiration.
18
Second day from rigor. Healthy action of the
bowels. Urine thick, white, turbid, like urine
which has settled, stood a long time, and then
been stirred up. It did not settle. No sleep at
night.
Third day. At about mid-day rigor ; acute fever ;
urine similar ; pain in the hypochondrium ; nausea ;
an uncomfortable night without sleep ; a cold sweat
all over the body, but the patient quickly recovered
heat.
[p. 207]
Fourth day. Slight relief of the pains about the
hypochondrium ; painful heaviness of the head ;
somewhat comatose ; slight epistaxis ; tongue dry ;
thirst ; scanty urine, thin and oily ; snatches of sleep.
Fifth day. Thirst ; nausea ; urine similar ; no
movement of the bowels ; about mid-day much
delirium, followed quickly by lucid intervals ; rose,
but grew somewhat comatose ; slight chilliness ;
slept at night ; was delirious.
Sixth day. In the morning had a rigor ; quickly
recovered heat ; sweated all over ; extremities cold ;
was delirious ; respiration large and rare. After a
while convulsions began from the head, quickly
followed by death.
CASE XII
A man dined when hot and drank too much.
During the night he vomited everything ; acute
fever ; pain in the right hypochondrium ; inflammation,
soft underneath, from the inner part
19; an
uncomfortable night ; urine at the first thick and
red ; on standing it did not settle ; tongue dry ; no
great thirst.
Fourth day. Acute fever ; pains all over.
Fifth day. Passed much smooth, oily urine ;
acute fever.
Sixth day. In the afternoon much delirium. No
sleep at night.
Seventh day. General exacerbation ; urine similar ;
much rambling ; could not restrain himself ; on
stimulation the bowels passed watery, disturbed
discharges, with worms. An uncomfortable night,
with rigor in the morning. Acute fever. Hot
sweat, and the patient seemed to lose his fever ;
[p. 209]
little sleep, followed by chilliness ; expectoration.
In the evening much delirium, and shortly afterwards
he vomited black, scanty, bilious vomits.
Ninth day. Chill ; much wandering ; no sleep.
Tenth day. Legs painful ; general exacerbation ;
wandering.
Eleventh day. Death.
CASE XIII
A woman lying sick by the shore, who was three
months gone with child, was seized with fever, and
immediately began to feel pains in the loins.
Third day. Pain in the neck and in the head,
and in the region of the right collar-bone. Quickly
she lost her power of speech, the right arm was
paralyzed, with a convulsion, after the manner of
a stroke ; completely delirious. An uncomfortable
night, without sleep ; bowels disordered with bilious,
unmixed, scanty stools.
Fourth day. Her speech was recovered, but was
indistinct ; convulsions ; pains of the same parts
remained ; painful swelling in the hypochondrium ;
no sleep ; utter delirium ; bowels disordered ; urine
thin, and not of good colour.
Fifth day. Acute fever ; pain in the hypochondrium ;
utter delirium ; bilious stools. At night
sweated ; was without fever.
Sixth day. Rational ; general relief, but pain
remained about the left collar-bone ; thirst ; urine
thin ; no sleep.
Seventh day. Trembling ; some coma ; slight
delirium ; pains in the region of the collar-bone
and left upper arm remained ; other symptoms
[p. 211]
relieved ; quite rational. For three days there
was an intermission of fever.
Eleventh day. Relapse ; rigor ; attack of fever.
But about the fourteenth day the patient vomited
bilious, yellow matter fairly frequently ; sweated ;
a crisis took off the fever.
CASE XIV
Melidia, who lay sick by the temple of Hera,
began to suffer violent pain in the head, neck and
chest. Immediately she was attacked by acute
fever, and there followed a slight menstrual flow.
There were continuous pains in all these parts.
Sixth day. Coma ; nausea ; shivering ; flushed
cheeks ; slight delirium.
Seventh day. Sweat ; intermittence of fever ; the
pains persisted ; relapse ; snatches of sleep ; urine
throughout of good colour but thin ; stools thin,
bilious, irritating, scanty, black and of bad odour ;
sediment in the urine white and smooth ; sweating.
Eleventh day. Perfect crisis.
