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Section II. -- Second Constitution


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.


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.


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.


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.


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


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.

1 I need scarcely remark that this passage is of classical celebrity. Galen, in his Commentary, remarks that the first time he read it he thought it unworthy of Hippocrates to lay it down as a rule of practice, that "the physician should do good to his patient, or at least no harm;" but that, after having seen a good deal of the practice of other physicians, and observed how often they were justly exposed to censure for having bled, or applied the bath, or given medicines, or wine unseaonably, he came to recognize the propriety and importance of the rule laid down by Hippocrates. The practice of certain physicians, Galen remarks, is like playing at the dice, when what turns up may occasion the greatest mischief to their patients. The last clause of this passage is very forcibly put. Galen, however, informs us that in some of th MSS. instead of "art" he found "nature"; that is to say, that the physician is "the minister (or servant) of nature." Either of the readings, he remarks, will agree very well with the meaning of the passage.

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