EPIDEMICS III
CASE I
Pythion
1, who lived by the temple of Earth, was
seized with trembling which began in the hands.
First day. Acute fever ; wandering.
Second day. General exacerbation.
Third day. Same symptoms.
Fourth day. Stools scanty, uncompounded and
bilious.
Fifth day. General exacerbation ; fitful sleep ;
constipation.
Sixth day. Varied, reddish sputa.
Seventh day. Mouth drawn awry.
Eighth day. General exacerbation ; tremblings persisted
; urine from the beginning to the eighth day
thin, colourless, with a cloudy substance floating
in it.
Tenth day. Sweat ; sputa somewhat concocted ;
crisis ; urine somewhat thin about the time of the
crisis. After the crisis, forty days subsequent to
it, abscess in the seat, and an abscession through
strangury.
CASE II
Hermocrates, who lay sick by the new wall, was
seized with fever. He began to feel pain in the
head and loins ; tension of the hypochondrium without
[p. 221]
swelling
2; tongue at the beginning parched ;
deafness at once ; no sleep ; no great thirst ; urine
thick, red, with no sediment on standing ; stools not
scanty, and burnt.
Fifth day. Urine thin, with particles floating in
it, without sediment ; at night delirium.
Sixth day. Jaundice ; general exacerbation ; not
rational.
Seventh day. Discomfort ; urine thin, and as
before. The following days similar. About the
eleventh day there seemed to be general relief ;
coma began ; urine thicker, reddish, thin
3 at the
bottom, without sediment ; by degrees grew more
rational.
Fourteenth day. No fever ; no sweat ; sleep ;
reason quite recovered ; urine as before.
About the seventeenth day there was a relapse,
and the patient grew hot. On the following days
there was acute fever ; urine thin ; delirium.
Twentieth day. A fresh crisis ; no fever ; no sweat.
All the time the patient had no appetite ; was perfectly
collected but could not talk ; tongue dry ; no
thirst ; snatches of sleep ; coma. About the twenty-fourth
day he grew hot ; bowels loose with copious,
thin discharges. On the following days acute fever ;
tongue parched.
Twenty-seventh day. Death.
In this case deafness persisted throughout ; urine
thick, red, without settling, or thin, colourless, with
substances floating in it. The patient had no power
to take food.
[p. 223]
CASE III
The man lying sick in the garden of Delearces
had for a long time heaviness in the head and pain
in the right temple. From some exciting cause he
was seized with fever, and took to his bed.
Second day. Slight flow of unmixed blood from
the left nostril. The bowels were well moved ;
urine thin and varied, with particles in small groups,
like barley-meal or semen, floating in it.
Third day. Acute fever ; stools black, thin,
frothy, with a livid sediment in them ; slight stupor ;
getting up caused distress ; in the urine a livid,
rather viscous sediment.
Fourth day. Vomited scanty, bilious, yellow vomits,
and after a short interval, verdigris-coloured ones ;
slight flow of unmixed blood from the left nostril ;
stools unaltered and urine unaltered ; sweat about
the head and collar-bones ; spleen enlarged ; pain
in the direction of the thigh ; tension, soft under-neath,
of the right hypochondrium ;
4 no sleep at
night ; slight delirium.
Fifth day. Stools more copious, black, frothy ; a
black sediment in the stools ; no sleep at night ;
delirium.
Sixth day. Stools black, oily, viscid, foul-smelling ;
slept ; was more rational.
Seventh day. Tongue dry ; thirsty ; no sleep ;
delirium ; urine thin, not of a good colour.
Eighth day. Stools black, scanty, compact ; sleep ;
was collected ; not very thirsty.
Ninth day. Rigor, acute fever ; sweat ; chill ;
delirium ; squinting of the right eye ; tongue dry ;
thirsty ; sleepless.
[p. 225]
Tenth day. Symptoms about the same.
Eleventh day. Quite rational ; no fever ; slept,
urine thin about the time of the crisis.
The patient remained free from fever for two days,
relapsed on the fourteenth day, and immediately
had no sleep at night and was completely delirious.
Fifteenth day. Urine muddy, like that which has
been stirred up after settling ; acute fever ; completely
delirious ; no sleep ; pain in knees and
legs. On the application of a suppository, black,
solid motions were passed.
Sixteenth day. Urine thin, with a cloudy substance
floating in it ; delirium.
Seventeenth day. Extremities cold in the early
morning ; would wrap himself up ; acute fever ;
sweated all over ; was relieved ; more rational ;
some fever ; thirst ; vomited bilious matters, yellow
and scanty ; solid motions from the bowels ; after
a while they became black, scanty and thin ; urine
thin, and not of a good colour.
Eighteenth day. Was not rational ; comatose.
Nineteenth day. The same symptoms.
Twentieth day. Slept ; completely rational ;
sweated ; no fever ; no thirst ; urine thin.
Twenty-first day. Slightly delirious ; rather thirsty ;
pain in the hypochondrium and throbbing about the
navel continuously.
Twenty-fourth day. Sediment in urine ; completely
rational.
Twenty-seventh day. Pain in the right hip, but in
other respects very comfortable ; sediment in the
urine.
About the twenty-ninth day pain in the right eye ;
urine thin.
[p. 227]
Fortieth day. Passed motions full of phlegm, white
and rather frequent ; copious sweat all over ; a
perfect crisis.
CASE IV
Philistes in Thasos had for a long time pain in the
head, and at last fell into a state of stupor and took
to his bed. Heavy drinking having caused continuous
fevers the pain grew worse. At night he grew
hot at the first.
First day. Vomited bilious matters, scanty, at
first yellow, afterwards increasing and of the colour
of verdigris ; solid motions from the bowels ; an
uncomfortable night.
Second day. Deafness ; acute fever ; tension of
the right hypochondrium, which fell inwards. Urine
thin, transparent, with a small quantity of substance,
like semen, floating in it. About mid-day became
raving.
Third day. Uncomfortable.
Fourth day. Convulsions ; exacerbation.
Fifth day. Died early in the morning.
CASE V
Chaerion, who lay sick in the house of Demaenetus,
5
was seized with fever after drinking. At once there
was painful heaviness of the head ; no sleep ; bowels
disturbed with thin, rather bilious stools.
Third day. Acute fever, trembling of the head,
particularly of the lower lip ; after a while rigor,
convulsions, complete delirium ; an uncomfortable
night.
Fourth day. Quiet ; snatches of sleep ; wandering.
[p. 229]
Fifth day. Pain ; general exacerbation ; irrational
talk ; uncomfortable night ; no sleep.
Sixth day. The same symptoms.
Seventh day. Rigor ; acute fever ; sweating all
over ; crisis.
This patient's stools were throughout bilious,
scanty and uncompounded. Urine thin, not of a
good colour, with a cloudy substance floating in it.
About the eighth day the urine had a better colour,
with a slight, white sediment ; quite rational and
no fever ; an intermission.
Ninth day. Relapse.
About the fourteenth day acute fever.
Sixteenth day. Vomited bilious, yellow matters
rather frequently.
Seventeenth day. Rigor ; acute fever ; sweating ;
crisis ended the fever.
Urine after relapse and crisis of a good colour,
with a sediment ; no delirium during the relapse.
Eighteenth day. Slight heat ; rather thirsty ; urine
thin, with cloudy substance floating in it ; slight
delirium.
Nineteenth day. No fever ; pain in the neck ;
sediment in urine.
Twentieth day. Complete crisis.
CASE VI
The maiden daughter of Euryanax was seized
with fever. Throughout the illness she suffered no
thirst and had no inclination for food. Slight alvine
discharges ; urine thin, scanty, and not of a good
colour. At the beginning of the fever suffered pain
in the seat. On the sixth day did not sweat, being
[p. 231]
without fever ; a crisis. The sore near the seat
suppurated slightly, and burst at the crisis. After
the crisis, on the seventh day, she had a rigor ; grew
slightly hot ; sweated. Afterwards the extremities
always cold. About the tenth day, after the sweating
that occurred, she grew delirious, but was soon
rational again. They said that the trouble was due
to eating grapes. After an intermission, on the
twelfth day she again wandered a great deal ; the
bowels were disturbed, with bilious, uncompounded,
scanty, thin, irritating stools, which frequently made
her get up. She died the seventh day from the
second attack of delirium. This patient at the
beginning of the illness had pain in the throat,
which was red throughout. The uvula was drawn
back. Many fluxes,
6 scanty and acrid. She had a
cough with signs of coction, but brought up nothing.
7
No appetite for any food the whole time, nor did
she desire anything. No thirst, and she drank
nothing worth mentioning. She was silent, and did
not converse at all. Depression, the patient despairing
of herself. There was also some inherited
tendency to consumption.
CASE VII
The woman suffering from angina who lay sick
in the house of Aristion began her complaint with
indistinctness of speech. Tongue red, and grew
parched.
First day. Shivered, and grew hot.
[p. 233]
Third day. Rigor ; acute fever ; a reddish, hard
swelling in the neck, extending to the breast on
either side ; extremities cold and livid, breathing
elevated ;
8 drink returned through the nostrils--she
could not swallow--stools and urine ceased.
Fourth day. General exacerbation.
Fifth day. Death.
CASE VIII
The youth who lay sick by the Liars' Market was
seized with fever after unaccustomed fatigue, toil
and running.
First day. Bowels disturbed with bilious, thin,
copious stools ; urine thin and blackish ; no sleep ;
thirst.
Second day. General exacerbation ; stools more
copious and more unfavourable. No sleep ; mind
disordered ; slight sweating.
Third day. Uncomfortable ; thirst ; nausea ; much
tossing ; distress ; delirium ; extremities livid and
cold ; tension, soft underneath, of the hypochondrium
9
on both sides.
Fourth day. No sleep ; grew worse.
Seventh day. Died, being about twenty years old.
CASE IX
The woman who lodged with Tisamenus was in
bed with a troublesome attack of inflammation of
the upper bowel. Copious vomits ; could not retain
her drink. Pains in the region of the hypochondria.
The pains were also lower, in the region of the
bowels. Constant tormina. No thirst. She grew
hot, though the extremities were cold all the time.
[p. 235]
Nausea ; sleeplessness. Urine scanty and thin.
Excreta crude, thin and scanty. It was no longer
possible to do her any good, and she died.
CASE X
A woman who was one of the house of Pantimides after a miscarriage was seized
with fever on the first day. Tongue dry ; thirst ; nausea ; sleeplessness. Bowels
disordered, with thin, copious and crude stools.
Second day. Rigor ; acute fever ; copious stools ; no sleep.
Third day. The pains greater.
Fourth day. Delirium.
Seventh day. Death.
The bowels were throughout loose, with copious, thin, crude stools. Urine scanty and thin.
CASE XI
Another woman, after a miscarriage about the
fifth month, the wife of Hicetas, was seized with
fever. At the beginning she had alternations of
coma and sleeplessness ; pain in the loins ; heaviness
in the head.
Second day. Bowels disordered with scanty, thin
stools, which at first were uncompounded.
Third day. Stools more copious and worse ; no
sleep at night.
Fourth day. Delirium ; fears ; depression. Squinting
of the right eye ; slight cold sweat about the
head ; extremities cold.
Fifth day. General exacerbation ; much wandering,
with rapid recovery of reason ; no thirst ; no
[p. 237]
sleep ; stools copious and unfavourable throughout ;
urine scanty, thin and blackish ; extremities cold
and rather livid.
Sixth day. Same symptoms.
Seventh day. Death.
CASE XII
A woman who lay sick by the Liars' Market, after
giving birth in a first and painful delivery to a male
child, was seized with fever. From the very first
there was thirst, nausea, slight pain at the stomach,
dry tongue, bowels disordered with thin and scanty
discharges, no sleep.
Second day. Slight rigor ; acute fever ; slight,
cold sweating around the head.
Third day. In pain ; crude, thin, copious discharges
from the bowels.
Fourth day. Rigor ; general exacerbation ; sleepless.
Fifth day. In pain.
Sixth day. The same symptoms ; copious, fluid
discharges from the bowels.
Seventh day. Rigor ; acute fever ; thirst ; much
tossing ; towards evening cold sweat all over ; chill ;
extremities cold, and would not be warmed. At
night she again had a rigor ; the extremities would
not be warmed ; no sleep ; slight delirium, but
quickly was rational again.
Eighth day. About mid-day recovered her heat ;
thirst ; coma ; nausea ; vomited bilious, scanty,
yellowish matters. An uncomfortable night ; no
sleep ; unconsciously passed a copious discharge
of urine.
[p. 239]
Ninth day. General abatement of the symptoms ;
coma. Towards evening slight rigor ; vomited
scanty, bilious matters.
Tenth day. Rigor ; exacerbation of the fever ; no
sleep whatsoever. In the early morning a copious
discharge of urine without sediment ; extremities
were warmed.
Eleventh day. Vomited bilious matters, of the
colour of verdigris. A rigor shortly afterwards, and
the extremities became cold again ; in the evening
sweat, rigor and copious vomiting ; a painful night.
Twelfth day. Vomited copious, black, fetid matters ;
much hiccoughing ; painful thirst.
Thirteenth day. Vomited black, fetid, copious
matters ; rigor. About mid-day lost her speech.
Fourteenth day. Epistaxis ; death.
The bowels of this patient were throughout loose,
and there were shivering fits. Age about seventeen.
PART 2
CONSTITUTION
II. The year was southerly and rainy, with no
winds throughout. About the rising of Arcturus,
while during the immediately preceding period
droughts had prevailed, there were now heavy rains,
with southerly winds. Autumn dark and cloudy,
with abundance of rain. The winter southerly,
humid, and mild after the solstice. Long after the
solstice, near the equinox, wintry weather returned,
and at the actual equinoctial period there were
northerly winds with snow, but not for long. The
spring southerly again, with no winds ; many rains
throughout until the Dog Star. The summer was
clear and warm, with waves of stifling heat. The
[p. 241]
Etesian winds were faint and intermittent. But, on
the other hand, near the rising of Arcturus there
were heavy rains with northerly winds.
The year having proved southerly, wet and mild,
in the winter the general health was good except for
the consumptives, who will be described in due course.
PART 3
III. Early in the spring, at the same time as the
cold snaps which occurred, were many malignant
cases
10 of erysipelas, some from a known exciting cause
and some not. Many died, and many suffered pain
in the throat. Voices impaired ; ardent fevers ;
phrenitis ; aphthae in the mouth ; tumours in the
private parts ; inflammations of the eyes ; carbuncles ;
disordered bowels ; loss of appetite ; thirst in some
cases, though not in all ; urine disordered, copious,
bad ; long coma alternating with sleeplessness ;
absence of crisis in many cases, and obscure crises ;
dropsies ; many consumptives. Such were the
diseases epidemic. There were patients suffering
from each of the above types, and fatal cases were
many. The symptoms in each type were as follow.
PART 4
IV. Many were attacked by the erysipelas all
over the body when the exciting cause was a trivial
accident or a very small wound ; especially when the
patients were about sixty years old and the wound
was in the head, however little the neglect might
have been. Many even while undergoing treatment
suffered from severe inflammations,
11 and the
erysipelas would quickly spread widely in all directions.
Most of the patients experienced abscessions
ending in suppurations. Flesh, sinews and bones
[p. 243]
fell away in large quantities. The flux which formed
was not like pus, but was a different sort of putre-faction
with a copious and varied flux. If any of these
symptoms occurred in the head, there was loss of
hair from all the head and from the chin ; the bones
were bared and fell away, and there were copious
fluxes. Fever was sometimes present and sometimes
absent. These symptoms were terrifying rather
than dangerous. For whenever they resulted in
suppuration or some similar coction the cases usually
recovered. But whenever the inflammation and the
erysipelas disappeared without producing any such
abscession, there were many deaths. The course of
the disease was the same to whatever part of the
body it spread. Many lost the arm and the entire
forearm. If the malady settled in the sides there
was rotting either before or behind. In some cases
the entire thigh was bared, or the shin and the
entire foot. But the most dangerous of all such
cases were when the pubes and genital organs were
attacked. Such were the sores which sprang from
an exciting cause. In many cases, however, sores
occurred in fevers, before a fever, or supervening on
fevers. In some of these also, when an abscession
took place through suppuration, or when a seasonable
disturbance of the bowels occurred or a passing of
favourable urine, this gave rise to a solution ; but
when none of these events happened, and the symptoms
disappeared without a sign, death resulted. It
was in the spring that by far the greater number of
cases of erysipelas occurred, but they continued
throughout the summer and during autumn.
[p. 245]
PART 5
V. Much trouble was caused to some patients by
the tumours in the throat, inflammations of the
tongue and the abscesses about the teeth. Many had
the symptom of impaired and muffled
12 voice, at first
at the beginning of the cases of consumption, but
also in the ardent fevers and in phrenitis.
PART 6
VI. Now the ardent fevers and phrenitis began
early in the spring after the cold snaps which
occurred, and very many fell sick at that time.
These suffered acute and fatal symptoms. The constitution
of the ardent fevers that occurred was as
follows. At the beginning coma, nausea, shivering,
acute fever, no great thirst, no delirium, slight
epistaxis. The exacerbations in most cases on even
days, and about the time of the exacerbations there
was loss of memory with prostration and speechlessness.
The feet and hands of these patients were
always colder than usual, most especially about the
times of exacerbation. Slowly and in no healthy
manner they recovered their heat, becoming rational
again and conversing. Either the coma held them
continuously without sleep, or they were wakeful
and in pain. Bowels disordered in the majority of
these cases, with crude, thin, copious stools. Urine
copious, thin, with no critical or favourable sign, nor
did any other critical sign appear in these patients.
For there occurred neither favourable hemorrhage
[p. 247]
nor any other of the usual critical abscessions. The
manner of their dying varied with the individual ; it
was usually irregular, at the crises, but in some cases
after long loss of speech and in many with sweating.
These were the symptoms attending the fatal cases
of ardent fever, and the cases of phrenitis were
similar. These suffered from no thirst at all, and
no case showed the mad delirium that attacked
others, but they passed away overpowered by a dull
oppression of stupor.
PART 7
VII. There were other fevers also, which I shall
describe in due course. Many had aphthae and
sores in the mouth. Fluxes about the genitals were
copious
13; sores, tumours external and internal ;
the
swellings which appear in the groin.
14 Watery inflammations
of the eyes, chronic and painful. Growths
on the eyelids, external and internal, in many cases
destroying the sight, which are called "figs." There
were also often growths on other sores, particularly
in the genitals. Many carbuncles in the summer,
and other affections called "rot." Large pustules.
Many had large tetters.
PART 8
VIII. The bowel troubles in many cases turned
out many and harmful. In the first place many
were attacked by painful tenesmus, mostly children--all
in fact who were approaching puberty--and
most of these died. Many lienteries. Cases of
dysentery, but they too
15 were not very painful.
Stools bilious, greasy, thin and watery. In many
[p. 249]
cases this condition of the bowels constituted the
disease itself, fever being sometimes absent and
sometimes present.
16 Painful tormina and malignant
colic. There were evacuations, though the bulk of
the contents remained behind.
17 The evacuations
did not take away the pains, and yielded with difficulty
to the remedies administered. Purgings, in
fact, did harm in most cases. Of those in this condition
many died rapidly, though a few held out
longer. In brief, all patients, whether the disease
was prolonged or acute, died chiefly from the bowel
complaints. For the bowels carried all off together.
18
PART 9
IX. Loss of appetite, to a degree that I never
met before, attended all the cases described above,
but most especially the last, and of them, and of the
others also, especially such as were fatally stricken.
19
[p. 251]
Thirst afflicted some, but not others ; of the fever
patients, as well as of the other cases, none were unseasonably
affected, but as far as drink was concerned
you could diet them as you pleased.
PART 10
X. The urine that was passed was copious, not in
proportion to, but far exceeding, the drink administered.
Yet the urine too that was passed showed
a great malignancy. For it had neither the proper
consistency, nor coction, nor cleansing powers ; it
signified for most patients wasting, trouble,
20 pains,
and absence of crisis.
PART 11
XI. Coma attended mostly the phrenitis and ardent
fevers, without excluding, however, all the other diseases
of the most severe sort that were accompanied
by fever. Most patients throughout either were
sunk in heavy coma or slept only in fitful snatches.
PART 12
XII. Many other forms also of fever were epidemic
: -- tertians, quartans, night fevers, fevers
continuous, protracted, irregular, fevers attended with
nausea, fevers of no definite character. All these
cases suffered severely from trouble.
21
For the
bowels in most cases were disordered, with shivering
fits. Sweats portended no crisis, and the
character of the urine was as I have described.
Most of these cases were protracted, for the abscessions
too which took place did not prove critical
as in other cases ; nay rather, in all cases all
symptoms marked obscurity of crisis,
22 or absence
of crisis, or protraction of the disease, but most
especially in the patients last described. A few
[p. 253]
of these had a crisis about the eightieth day ;
with most recovery followed no rule. A few of
them died of dropsy, without taking to their bed ;
many sufferers from the other diseases too were
troubled with swellings, most particularly the
consumptives.
PART 13
XIII. The severest and most troublesome disease,
as well as the most fatal, was the consumption.
Many cases began in the winter, and of these
several took to their bed, though some went about
ailing without doing so. Early in the spring most
of those who had gone to bed died, while none of the
others lost their cough, though it became easier in
the summer. During autumn all took to bed and
many died. Most of these were ill for a long time.
Now most of these began suddenly to grow worse,
showing the following symptoms :--frequent shivering ;
often continuous and acute fever ; unseasonable,
copious,
23 cold sweats throughout ; great
chill with
difficult recovery of heat ; bowels variously constipated,
then quickly relaxing, and violently relaxing
in all cases near the end ; the humours about the
lungs spread downwards ; abundance of unfavourable
urine ; malignant wasting. The coughs throughout
were frequent, bringing up copious,
24 concocted and
liquid sputa, but without much pain ; but even if
there was pain, in all cases the purging from the
lungs took place very mildly. The throat did not
smart very much, nor did salt humours cause any
distress at all. The fluxes, however, viscid, white,
[p. 255]
moist, frothy, which came from the head, were
abundant. But by far the worst symptom that
attended both these cases and the others was the
distaste for food, as has been mentioned. They had
no relish either for drink with nourishment, but they
remained entirely without thirst. Heaviness in the
body. Coma. In most of them there was swelling,
which developed into dropsy. Shivering fits and
delirium near death.
PART 14
XIV. The physical characteristics of the consumptives
were :--skin smooth, whitish, lentil-coloured,
reddish ; bright eyes ;
25 a leucophlegmatic
26 condition ;
shoulder-blades projecting like wings. Women
too so.
27 As to those with a
melancholic
28 or a rather
sanguine
29 complexion, they were attacked by ardent
fevers, phrenitis and dysenteric troubles. Tenesmus
affected young, phlegmatic
30 people ; the chronic
diarrhoea and acrid, greasy stools affected persons
of a bilious
31 temperament.
PART 15
XV. In all the cases described spring was the
worst enemy, and caused the most deaths ; summer
was the most favourable season, in which fewest
died. In autumn and during the season of the
Pleiades, on the other hand, there were again
deaths, usually on the fourth day. And it seems
to me natural that the coming on of summer should
have been helpful. For the coming on of winter
resolves the diseases of summer, and the coming on
of summer removes those of winter. And yet in
[p. 257]
itself the summer in question was not healthful ;
32
in fact it was suddenly hot, southerly, and calm.
But nevertheless the change from the other constitution
proved beneficial.
PART 16
XVI. The power, too, to study correctly what has
been written I consider to be an important part of
the art of medicine. The man who has learnt these
things and uses them will not, I think, make
great mistakes in the art. And it is necessary to
learn accurately each constitution of the seasons
as well as the disease ; what common element
in the constitution or in the disease is good, and
what common element in the constitution or in the
disease is bad ; what malady is protracted and fatal,
what is protracted and likely to end in recovery ;
what acute illness is fatal, what acute illness is likely
to end in recovery. With this knowledge it is easy
to examine the order of the critical days, and to
prognosticate therefrom. One who has knowledge
of these matters can know whom he ought to treat,
as well as the time and method of treatment.
33
SIXTEEN CASES
CASE I
XVII. In Thasos the Parian who lay sick beyond
the temple of Artemis was seized with acute fever,
which at the beginning was continuous and ardent.
Thirst. At the beginning coma followed by sleeplessness.
Bowels disordered at the beginning ; urine
thin.
Sixth day. Oily urine ; delirium.
Seventh day. General exacerbation ; no sleep ;
[p. 259]
urine similar and mind disordered ; stools bilious and
fatty.
Eighth day. Slight epistaxis ; vomited scanty
matters of the colour of verdigris ; snatches of sleep.
Ninth day. Same symptoms.
Tenth day. General improvement.
Eleventh day. Sweated all over ; grew chilly, but
quickly recovered heat.
Fourteenth day. Acute fever ; stools bilious, thin,
copious ; substance floating in urine ; delirium.
Seventeenth day. In pain ; no sleep, while the fever
grew worse.
Twentieth day. Sweated all over ; no fever ; stools
bilious ; aversion to food ; coma.
Twenty-fourth day. Relapse.
Thirty-fourth day. No fever ; no constipation ; recovered
heat.
Fortieth day. No fever ; bowels constipated for a
short time ; aversion to food ; became slightly
feverish again, throughout irregularly, the fever being
sometimes absent, sometimes present ; for if the
fever intermitted and was alleviated there was a
relapse soon afterwards. He took little bits of
food, and that of an unsuitable sort. Sleep bad ;
delirium at the relapses. Urine at these times had
consistency, but was troubled and bad. Bowels constipated,
but afterwards relaxed. Continuous slight
fevers. Stools thin and copious.
Hundred and twentieth day. Death.
In this case the bowels continuously from the
first day loose with bilious, loose, copious stools, or
[p. 261]
constipated with hot,
34 undigested stools. Urine
throughout bad ; mostly comatose ; painful sleeplessness
;
35 continued aversion to food.
CASE II
In Thasos the woman who lay sick by the Cold
Water, on the third day after giving birth to a
daughter without lochial discharge, was seized with
acute fever accompanied by shivering. For a long
time before her delivery she had suffered from fever,
being confined to bed and averse to food. After the
rigor that took place, the fevers were continuous,
acute, and attended with shivering.
Eighth and following days. Much delirium, quickly
followed by recovery of reason ; bowels disturbed
with copious, thin, watery and bilious stools ; no
thirst.
Eleventh day. Was rational, but comatose. Urine
copious, thin and black ; no sleep.
Twentieth day. Slight chills,
36 but heat quickly
recovered ; slight wandering ; no sleep ; bowels the
same ; urine watery and copious.
Twenty-seventh day. No fever ; bowels constipated ;
not long afterwards severe pain in the right hip for
a long time. Fevers again attended ; urine watery.
Fortieth day. Pain in the hip relieved ; continuous
coughing, with watery, copious sputa ; bowels constipated ;
aversion to food ; urine the same. The
fevers, without entirely intermitting, were exacerbated
[p. 263]
irregularly, sometimes increasing and sometimes
not doing so.
Sixtieth day. The coughing ceased without any
critical sign ; there was no coction of the sputa, nor
any of the usual abscessions ; jaw on the right side
convulsed ; comatose ; wandering, but reason quickly
recovered ; desperately averse to food ; jaw relaxed ;
passed small, bilious stools ; fever grew more acute,
with shivering. On the succeeding days she lost
power of speech, but would afterwards converse.
Eightieth day. Death.
The urine of this patient was throughout black,
thin and watery. Coma was present, aversion to
food, despondency, sleeplessness, irritability, restlessness,
the mind being affected by melancholy.
37
CASE III
In Thasos Pythion, who lay sick above the shrine
of Heracles, after labour, fatigue and careless living,
was seized by violent rigor and acute fever. Tongue
dry ; thirst ; bilious ; no sleep ; urine rather black,
with a substance suspended in it, which formed no
sediment.
Second day. About mid-day chill in the extremities,
especially in the hands and head ; could not speak
or utter a sound ; respiration short for a long time ;
recovered warmth ; thirst ; a quiet night ; slight
sweats about the head.
Third day. A quiet day, but later, about sunset,
grew rather chilly ; nausea ; distress ;
38 painful night
without sleep ; small, solid stools were passed.
Fourth day. Early morning peaceful, but about
mid-day all symptoms were exacerbated ; chill ;
[p. 265]
speechless and voiceless ; grew worse ; recovered
warmth after a time ; black urine with a substance
floating in it ; night peaceful ; slept.
Fifth day. Seemed to be relieved, but there was
heaviness in the bowels with pain ; thirst ; painful
night.
Sixth day. Early morning peaceful ; towards evening
the pains were greater ; exacerbation ; but later
a little clyster caused a good movement of the
bowels. Slept at night.
Seventh day. Nausea ; rather uneasy ; urine oily ;
much distress
39 at night ;
wandering ; no sleep at all.
Eighth day. Early in the morning snatches of
sleep ; but quickly there was chill ; loss of speech ;
respiration thin and weak ; in the evening he
recovered warmth again ; was delirious ; towards
morning slightly better ; stools uncompounded,
small, bilious.
Ninth day. Comatose ; nausea whenever he woke
up. Not over-thirsty. About sunset was uncomfortable ;
wandered ; a bad night.
Tenth day. In the early morning was speechless ;
great chill ; acute fever ; much sweat ; death.
In this case the pains on even days.
CASE IV
The patient suffering from phrenitis on the first
day that he took to bed vomited copiously thin
vomits of the colour of verdigris ; much fever with
shivering ; continuous sweating all over ; painful
heaviness of head and neck ; urine thin, with small,
scattered substances floating in it, which did not
settle. Copious excreta at a single evacuation ;
delirium ; no sleep.
[p. 267]
Second day. In the early morning speechless ; acute
fever ; sweating ; no intermission ; throbbing all over
the body ; convulsions at night.
Third day. General exacerbation.
Fourth day. Death.
CASE V
In Larisa a bald man suddenly experienced pain
in the right thigh. No remedy did any good.
First day. Acute fever of the ardent type ; the
patient was quiet, but the pains persisted.
Second day. The pains in the thigh subsided, but
the fever grew worse ; the patient was rather uncomfortable
and did not sleep ; extremities cold ;
copious and unfavourable urine was passed.
Third day. The pain in the thigh ceased, but there
was derangement of the intellect, with distress
40 and
much tossing.
Fourth day. Death about mid-day.
CASE VI
In Abdera Pericles was seized with acute fever,
continuous and painful ; much thirst ; nausea ; could
not retain what he drank. There was slight enlargement
of the spleen and heaviness in the head.
First day. Epistaxis from the left nostril ; the
fever, however, increased greatly. Copious urine,
turbid and white. On standing it did not settle.
Second day. General exacerbation ; the urine, however,
had consistency, but there was some sediment ;
the nausea was relieved and the patient slept.
Third day. The fever went down ; abundance of
urine, with concocted and copious sediment ; a quiet
night.
[p. 269]
Fourth day. About mid-day a hot, violent sweating
all over ; no fever ; crisis ; no relapse.
CASE VII
In Abdera the maiden who lay sick by the Sacred
Way was seized with a fever of the ardent type. She
was thirsty and sleepless. Menstruation occurred
for the first time.
Sixth day. Much nausea ; redness ; shivering ;
restlessness.
Seventh day. Same symptoms. Urine thin but of
good colour ; no trouble in the bowels.
Eighth day. Deafness ; acute fever ; sleeplessness ;
nausea ; shivering ; was rational ; urine similar.
Ninth day Same symptoms, and also on the
following days. The deafness persisted.
Fourteenth day. Reason disturbed ; the fever
subsided.
Seventeenth day. Copious epistaxis ; the deafness
improved a little. On the following days nausea
and deafness, while there was also delirium.
Twentieth day. Pain in the feet ; deafness ; the
delirium ceased ; slight epistaxis ; sweating ; no
fever.
Twenty-fourth day. The fever returned, with the
deafness ; pain in the feet persisted ; delirium.
Twenty-seventh day. Copious sweating ; no fever ;
the deafness ceased ; the pain in the feet remained,
but in other respects there was a perfect crisis.
CASE VIII
In Abdera Anaxion, who lay sick by the Thracian
gate, was seized with acute fever. Continuous pain
[p. 271]
in the right side ; a dry cough, with no sputa on the
first days. Thirst ; sleeplessness ; urine of good
colour, copious and thin.
Sixth day. Delirium ; warm applications gave no
relief.
Seventh day. In pain, for the fever grew worse
and the pains were not relieved, while the coughing
was troublesome and there was difficulty in breathing.
Eighth day. I bled him in the arm. There was
an abundant, proper flow of blood ; the pains were
relieved, although the dry coughing persisted.
Eleventh day. The fever went down ; slight
sweating about the head ; the coughing and the
sputa more moist.
Seventeenth day. Began to expectorate small,
concocted sputa ; was relieved.
Twentieth day. Sweated and was free from fever ;
after a crisis was thirsty, and the cleansings from
the lungs were not favourable.
Twenty-seventh day. The fever returned ; coughing,
with copious, concocted sputa ; copious, white
sediment in urine ; thirst and difficulty in breathing
disappeared.
Thirty-fourth day. Sweated all over ; no fever ;
general crisis.
41
CASE IX
In Abdera Heropythus had pain in the head
without taking to bed, but shortly afterwards was
[p. 273]
compelled to do so. He lived close to the Upper
Road.
42 An acute,
ardent fever seized him. Vomited
at the beginning copious, bilious matters ; thirst ;
great discomfort ; urine thin and black, sometimes
with, sometimes without, substances suspended in
it. Painful night, with fever rising now in this
way, now in that, but for the most part irregularly.
About the fourteenth day, deafness ; the fever grew
worse ; urine the same.
Twentieth day. Much delirium, also on the
following days.
Fortieth day. Copious epistaxis ; more rational ;
some deafness, but less than before ; the fever went
down. Frequent, but slight, epistaxis on the
following days. About the sixtieth day the bleedings
from the nose ceased, but there was violent pain
in the right hip and the fever increased. Not long
afterwards, pains in all the lower parts. It happened
that either the fever was higher and the deafness
great, or else, though these symptoms were relieved
and less severe, yet the pains in the lower parts
about the hips grew worse. But from about the
eightieth day all the symptoms were relieved without
any disappearing. The urine that was passed
was of good colour and had greater deposits, while
the delirious mutterings were less. About the hundredth
day the bowels were disordered with copious,
bilious stools, and copious evacuations of this nature
were passed for a long time. Then followed painful
symptoms of dysentery, with relief of the other
symptoms. In brief, the fever disappeared and the
deafness ceased.
Hundred and twentieth day. Complete crisis.
[p. 275]
CASE X
In Abdera Nicodemus after venery and drunkenness
was seized with fever. At the beginning he
had nausea and cardialgia ; thirst ; tongue parched ;
urine thin and black.
Second day. The fever increased ; shivering ;
nausea ; no sleep ; bilious, yellow vomits ; urine the
same ; a quiet night ; sleep.
Third day. All symptoms less severe ; relief.
But about sunset he was again somewhat uncomfortable ;
painful night.
Fourth day. Rigor ; much fever ; pains every-where ;
urine thin, with floating substance in it ;
the night, on the other hand, was quiet.
Fifth day. All symptoms present, but relieved.
Sixth day. Same pains everywhere ; substance
floating in urine ; much delirium.
Seventh day. Relief.
Eighth day. All the other
43 symptoms less severe.
Tenth day and following days. The pains were
present, but all less severe. The exacerbations and
the pains in the case of this patient tended through-out
to occur on the even days.
Twentieth day. Urine white, having consistency ;
no sediment on standing. Copious sweating ;
seemed to lose his fever, but towards evening grew
hot again, with pains in the same parts ; shivering ;
thirst ; slight delirium.
Twenty-fourth day. Much white urine, with much
sediment. Hot sweating all over ; the fever passed
away in a crisis.
[p. 277]
CASE XI
In Thasos a woman of gloomy temperament, after
a grief with a reason for it, without taking to bed
lost sleep and appetite, and suffered thirst and
nausea. She lived near the place of Pylades on the
plain.
First day. As night began there were fears, much
rambling, depression and slight feverishness. Early
in the morning frequent convulsions ; whenever these
frequent convulsions intermitted, she wandered
and uttered obscenities ; many pains, severe and
continuous.
Second day. Same symptoms ; no sleep ; fever
more acute.
Third day. The convulsions ceased, but were
succeeded by coma and oppression, followed in turn
by wakefulness. She would jump up ; could not
restrain herself ; wandered a great deal ; fever
acute ; on this night a copious, hot sweating all
over ; no fever ; slept, was perfectly rational, and
had a crisis. About the third day urine black and
thin, with particles mostly round floating in it,
which did not settle. Near the crisis copious
menstruation.
CASE XII
In Larisa a maiden was seized with an acute fever
of the ardent type. Sleeplessness ; thirst ; tongue
sooty and parched ; urine of good colour, but thin.
Second day. In pain ; no sleep.
Third day. Copious stools, watery and of a
yellowish green ; similar stools on the following
days, passed without distress.
Fourth day. Scanty, thin urine, with a substance
[p. 279]
suspended in it which did not settle ; delirium at
night.
Sixth day. Violent and abundant epistaxis ; after
a shivering fit followed a hot, copious sweating all
over ; no fever ; a crisis. In the fever and after the
crisis menstruation for the first time, for she was a
young maiden. Throughout she suffered nausea and
shivering ; redness of the face ; pain in the eyes ;
heaviness in the head. In this case there was no
relapse, but a definite crisis. The pains on the even
days.
CASE XIII
Apollonius in Abdera was ailing for a long time
without being confined to bed. He had a swollen
abdomen, and a continual pain in the region of the
liver had been present for a long time ; moreover,
he became during this period jaundiced and flatulent ;
his complexion was whitish. After dining and
drinking unseasonably cow's milk
44 he at first grew
rather hot ; he took to his bed. Having drunk
copiously of milk, boiled and raw, both goat's and
sheep's, and adopting a thoroughly bad regimen,
45
he suffered much therefrom. For there were
exacerbations of the fever ; the bowels passed
practically nothing of the food taken ; the urine was
thin and scanty. No sleep. Grievous distension ;
much thirst ; coma ; painful swelling of the right
hypochondrium ; extremities all round rather cold ;
slight delirious mutterings ; forgetfulness of every-thing
he said ; he was not himself. About the
[p. 281]
fourteenth day from his taking to bed, after a rigor,
he grew hot ; wildly delirious ; shouting, distress,
46
much rambling, followed by calm ; the coma came
on at this time. Afterwards the bowels were disordered
with copious stools, bilious, uncompounded
and crude ; urine black, scanty and thin. Great
discomfort. The evacuations showed varying symptoms
; they were either black, scanty and verdigris-coloured,
or else greasy, crude and smarting ; at
times they seemed actually to be like milk. About
the twenty-fourth day comfortable ; in other respects
the same, but he had lucid intervals. He remembered
nothing since he took to bed. But he quickly was
again delirious, and all symptoms took a sharp turn
for the worse. About the thirtieth day acute fever ;
copious, thin stools ; wandering ; cold extremities ;
speechlessness.
Thirty-fourth day. Death.
This patient throughout, from the time I had
knowledge of the case, suffered from disordered
bowels ; urine thin and black ; coma ; sleeplessness ;
extremities cold ; delirious throughout.
CASE XIV
In Cyzicus a woman gave birth with difficult
labour to twin daughters, and the lochial discharge
was far from good.
First day. Acute fever with shivering ; painful
heaviness of head and neck. Sleepless from the
first, but silent, sulky and refractory. Urine thin
and of no colour ; thirsty ; nausea generally ; bowels
irregularly disturbed with constipation following.
Sixth day. Much wandering at night ; no sleep.
[p. 283]
About the eleventh day she went out of her mind
and then was rational again ; urine black, thin, and
then, after an interval, oily ; copious, thin, disordered
stools.
Fourteenth day. Many convulsions ; extremities
cold ; no further recovery of reason ; urine
suppressed.
Sixteenth day. Speechless.
Seventeenth day. Death.
CASE XV
In Thasos the wife of Delearces, who lay sick on
the plain, was seized after a grief with an acute fever
with shivering. From the beginning she would
wrap herself up, and throughout, without speaking
a word, she would fumble, pluck, scratch, pick hairs,
weep and then laugh, but she did not sleep ; though
stimulated, the bowels passed nothing. She drank
a little when the attendants suggested it. Urine
thin and scanty ; fever slight to the touch ; coldness
of the extremities.
Ninth day. Much wandering followed by return
of reason ; silent.
Fourteenth day. Respiration rare and large with
long intervals,
47 becoming afterwards short.
Seventeenth day. Bowels under a stimulus passed
disordered matters, then her very drink passed
unchanged ; nothing coagulated. The patient
noticed nothing ; the skin tense and dry.
Twentieth day. Much rambling followed by recovery
of reason ; speechless ; respiration short.
Twenty-first day. Death.
The respiration of this patient throughout was
[p. 285]
rare and large ; took no notice of anything ; she
constantly wrapped herself up ; either much rambling
or silence throughout.
48
CASE XVI
In Meliboea a youth took to his bed after being
for a long time heated by drunkenness and sexual
indulgence. He had shivering fits, nausea, sleeplessness,
but no thirst.
First day. Copious, solid stools passed in abundance
of fluid, and on the following days the excreta were
copious, watery and of a greenish yellow. Urine
thin, scanty and of no colour ; respiration rare and
large with long intervals ; tension, soft underneath,
of the hypochondrium,
49 extending out to either
side ; continual throbbing throughout of the epigastrium ;
50 urine oily.
Tenth day. Delirious but quiet, for he was orderly
and silent ;
51 skin dry and tense ; stools either
copious and thin or bilious and greasy.
[p. 287]
Fourteenth day. General exacerbation ; delirious
with much wandering talk.
Twentieth day. Wildly out of his mind ; much
tossing ; urine suppressed ; slight quantities of drink
were retained.
Twenty-fourth day. Death.
