400 BC

OF THE EPIDEMICS

by Hippocrates

translated by Francis Adams

OF THE EPIDEMICS

BOOK I. Sect. I. First Constitution

1. IN THASUS, about the autumn equinox, and under the Pleiades,

the rains were abundant, constant, and soft, with southerly winds; the

winter southerly, the northerly winds faint, droughts; on the whole,

the winter having the character of spring. The spring was southerly,

cool, rains small in quantity. Summer, for the most part, cloudy, no

rain, the Etesian winds, rare and small, blew in an irregular

manner. The whole constitution of the season being thus inclined to

the southerly, and with droughts early in the spring, from the

preceding opposite and northerly state, ardent fevers occurred in a

few instances, and these very mild, being rarely attended with

hemorrhage, and never proving fatal. Swellings appeared about the

ears, in many on either side, and in the greatest number on both

sides, being unaccompanied by fever so as not to confine the patient

to bed; in all cases they disappeared without giving trouble,

neither did any of them come to suppuration, as is common in swellings

from other causes. They were of a lax, large, diffused character,

without inflammation or pain, and they went away without any

critical sign. They seized children, adults, and mostly those who were

engaged in the exercises of the palestra and gymnasium, but seldom

attacked women. Many had dry coughs without expectoration, and

accompanied with hoarseness of voice. In some instances earlier, and

in others later, inflammations with pain seized sometimes one of the

testicles, and sometimes both; some of these cases were accompanied

with fever and some not; the greater part of these were attended

with much suffering. In other respects they were free of disease, so

as not to require medical assistance.

2. Early in the beginning of spring, and through the summer, and

towards winter, many of those who had been long gradually declining,

took to bed with symptoms of phthisis; in many cases formerly of a

doubtful character the disease then became confirmed; in these the

constitution inclined to the phthisical. Many, and, in fact, the

most of them, died; and of those confined to bed, I do not know if a

single individual survived for any considerable time; they died more

suddenly than is common in such cases. But other diseases, of a

protracted character, and attended with fever, were well supported,

and did not prove fatal: of these we will give a description

afterwards. Consumption was the most considerable of the diseases

which then prevailed, and the only one which proved fatal to many

persons. Most of them were affected by these diseases in the following

manner: fevers accompanied with rigors, of the continual type,

acute, having no complete intermissions, but of the form of the

semi-tertians, being milder the one day, and the next having an

exacerbation, and increasing in violence; constant sweats, but not

diffused over the whole body; extremities very cold, and warmed with

difficulty; bowels disordered, with bilious, scanty, unmixed, thin,

pungent, and frequent dejections. The urine was thin, colorless,

unconcocted, or thick, with a deficient sediment, not settling

favorably, but casting down a crude and unseasonable sediment. Sputa

small, dense, concocted, but brought up rarely and with difficulty;

and in those who encountered the most violent symptoms there was no

concoction at all, but they continued throughout spitting crude

matters. Their fauces, in most of them, were painful from first to

last, having redness with inflammation; defluxions thin, small and

acrid; they were soon wasted and became worse, having no appetite

for any kind of food throughout; no thirst; most persons delirious

when near death. So much concerning the phthisical affections.

3. In the course of the summer and autumn many fevers of the

continual type, but not violent; they attacked persons who had been

long indisposed, but who were otherwise not in an uncomfortable state.

In most cases the bowels were disordered in a very moderate degree,

and they did not suffer thereby in any manner worth mentioning; the

urine was generally well colored, clear, thin, and after a time

becoming concocted near the crisis. They had not much cough, nor it

troublesome; they were not in appetite, for it was necessary to give

them food (on the whole, persons laboring under phthisis were not

affected in the usual manner). They were affected with fevers, rigors,

and deficient sweats, with varied and irregular paroxysms, in

general not intermitting, but having exacerbations in the tertian

form. The earliest crisis which occurred was about the twentieth

day, in most about the fortieth, and in many about the eightieth.

But there were cases in which it did not leave them thus at all, but

in an irregular manner, and without any crisis; in most of these the

fevers, after a brief interval, relapsed again; and from these

relapses they came to a crisis in the same periods; but in many they

were prolonged so that the disease was not gone at the approach of

winter. Of all those which are described under this constitution,

the phthisical diseases alone were of a fatal character; for in all

the others the patients bore up well, and did not die of the other

fevers.

Sect. II. Second Constitution

1. In Thasus, early in autumn, the winter suddenly set in rainy

before the usual time, with much northerly and southerly winds.

These things all continued so during the season of the Pleiades, and

until their setting. The winter was northerly, the rains frequent,

in torrents, and large, with snow, but with a frequent mixture of fair

weather. These things were all so, but the setting in of the cold

was not much out of season. After the winter solstice, and at the time

when the zephyr usually begins to blow, severe winterly storms out

of season, with much northerly wind, snow, continued and copious

rains; the sky tempestuous and clouded; these things were

protracted, and did not remit until the equinox. The spring was

cold, northerly, rainy, and clouded; 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

reduncance 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.

2. All these fevers described attacked great numbers. All these

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 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.

3. The most of these were protracted and troublesome, went on in a

very disorderly and irregular form, and, for the most part, did in a

crisis, either in the fatal cases or in the others; for if it left

some of them for a season it soon returned again. In a few instances

the lever terminated with a crisis; 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.

4. People 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 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.

5. With regard to the dangers of these cases, one must always attend

to the seasonable concoction of all the evacuations, and to the

favorable and critical abscesses. The concoctions indicate a speedy

crisis and recovery of health; crude and undigested evacuations, and

those which are converted into bad abscesses, indicate either want

of crisis, or pains, or prolongation of the disease, or death, or

relapses; which of these it is to be must be determined from other

circumstances. The physician must be able to tell the antecedents,

know the present, and foretell the future- must mediate these

things, and have two special objects in view with regard to disease,

namely, to do good or to do no harm. The art consists in three things-

the disease, the patient, and the physician. The physician is the

servant of the art, and the patient must combat the disease along with

the physician.

6. Pains about the head and neck, and heaviness of the same along

with pain, occur either without fevers or in fevers. Convulsions

occurring in persons attacked with frenzy, and having vomitings of

verdigris-green bile, in some cases quickly prove fatal. In ardent

fevers, and in those other fevers in which there is pain of the

neck, heaviness of the temples, mistiness about the eyes, and

distention about the hypochondriac region, not unattended with pain,

hemorrhage from the nose takes place, but 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.

Third Constitution

7. In Thasus, a little before and during the season of Arcturus,

there were frequent and great rains, with northerly winds. About the

equinox, and till the setting of the Pleiades, there were a few

southerly rains: the winter northerly and parched, cold, with great

winds and snow. Great storms about the equinox, the spring

northerly, dryness, rains few and cold. About the summer solstice,

scanty rains, and great cold until near the season of the Dog-star.

After the Dog-days, until the season of Arcturus, the summer hot,

great droughts, not in intervals, but continued and severe: no rain;

the Etesian winds blew; about the season of Arcturus southerly rains

until the equinox.

8. In this state of things, during winter, paraplegia set in, and

attacked many, and some died speedily; and otherwise the disease

prevailed much in an epidemical form, but persons remained free from

all other diseases. Early in the spring, ardent fevers commenced and

continued through the summer until the equinox. Those then that were

attacked immediately after the commencement of the spring and

summer, for the most part recovered, and but few of them died. But

when the autumn and the rains had set in, they were of a fatal

character, and the greater part then died. When in these attacks of

ardent fevers there was a proper and copious hemorrhage from the nose,

they were generally saved by it, and I do not know a single person who

had a proper hemorrhage who died in this constitution. Philiscus,

Epaminon, and Silenus, indeed, who had a trifling epistaxis on the

fourth and fifth day, died. Most of those taken with had a rigor about

the time of the crisis, and notably those who had no hemorrhage; these

had also rigor associated.

9. Some were attacked with jaundice on the sixth day, but these were

benefited either by an urinary purgation, or a disorder of the bowels,

or a copious hemorrhage, as in the case of Heraclides, who was

lodged with Aristocydes: this person, though he had the hemorrhage

from the nose, the purgation by the bladder, and disorder of the

bowels, experienced a favorable crisis on the twentieth day, not

like the servant of Phanagoras, who had none of these symptoms, and

died. The hemorrhages attacked most persons, but especially young

persons and those in the prime of life, and the greater part of

those who had not the hemorrhage died: elderly persons had jaundice or

disorder of the bowels, such as Bion, who was lodged with Silenus.

Dysenteries were epidemical during the summer, and some of those cases

in which the hemorrhage occurred, terminated in dysentery, as happened

to the slave of Eraton, and to Mullus, who had a copious hemorrhage,

which settled down into dysentery, and they recovered. This humor

was redundant in many cases, since in those who had not the hemorrhage

about the crisis, but the risings about the ears disappeared, after

their disappearance there was a sense of weight in the left flank

extending to the extremity of the hip, and pain setting in after the

crisis, with a discharge of thin urine; they began to have small

hemorrhages about the twenty-fourth day, and the swelling was

converted into the hemorrhage. In the case of Antiphon, the son of

Critobulus' son, the fever ceased and came to a crisis about the

fortieth day.

10. Many women were seized, but fewer than of the men, and there

were fewer deaths among them. But most of them had difficult

parturition, and after labor they were taken ill, and these most

especially died, as, for example, the daughter of Telebolus died on

the sixth day after delivery. Most females had the menstrual discharge

during the fever, and many girls had it then for the first time: in

certain individuals both the hemorrhage from the nose and the menses

appeared; thus, in the case of the virgin daughter of Daetharses,

the menses then took place for the first time, and she had also a

copinous hemorrhage from the nose, and I knew no instance of any one

dying when one or other of these took place properly. But all those in

the pregnant state that were attacked had abortions, as far as I

observed. The urine in most cases was of the proper color, but thin,

and having scanty sediments: in most the bowels were disordered with

thin and bilious dejections; and many, after passing through the other

crises, terminated in dysenteries, as happened to Xenophanes and

Critias. The urine was watery, copious, clear, and thin; and even

after the crises, when the sediment was natural, and all the other

critical symptoms were favorable, as I recollect having happened to

Bion, who was lodged in the house of Silenus, and Critias, who lived

with Xenophanes, the slave of Areton, and the wife of Mnesistratus.

But afterwards all these were attacked with dysentery. It would be

worth while to inquire whether the watery urine was the cause of this.

About the season of Arcturus many had the crisis on the eleventh

day, and in them the regular relapses did not take place, but they

became comatose about this time, especially children; but there were

fewest deaths of all among them.

11. About the equinox, and until the season of the Pleiades, and

at the approach of winter, many ardent fevers set in; but great

numbers at that season were seized with phrenitis, and many died; a

few cases also occurred during the summer. These then made their

attack at the commencement of ardent fevers, which were attended

with fatal symptoms; for immediately upon their setting in, there were

acute fever and small rigors, insomnolency, aberration, thirst,

nausea, insignificant sweats about the forehead and clavicles, but

no general perspiration; they had much delirious talking, fears,

despondency, great coldness of the extremities, in the feet, but

more especially in their hands: the paroxysms were on the even days;

and in most cases, on the fourth day, the most violent pains set in,

with sweats, generally coldish, and the extremities could not be

warmed, but were livid and rather cold, and they had then no thirst;

in them the urine was black, scanty, thin, and the bowels were

constipated; there was an hemorrhage from the nose in no case in which

these symptoms occurred, but merely a trifling epistaxis; and none

of them had a relapse, but they died on the sixth day with sweats.

In the phrenitic cases, all the symptoms which have been described did

not occur, but in them the disease mostly came to a crisis on the

eleventh day, and in some on the twentieth. In those cases in which

the phrenitis did not begin immediately, but about the third or fourth

day, the disease was moderate at the commencement, but assumed a

violent character about the seventh day. There was a great number of

diseases, and of those affected, they who died were principally

infants, young persons, adults having smooth bodies, white skins,

straight and black hair, dark eyes, those living recklessly and

luxuriously; persons with shrill, or rough voices, who stammered and

were passionate, and women more especially died from this form. In

this constitution, four symptoms in particular proved salutary; either

a hemorrhage from the nose, or a copious discharge by the bladder of

urine, having an abundant and proper sediment, or a bilious disorder

of the bowels at the proper time, or an attack of dysentery. And in

many cases it happened, that the crisis did not take place by any

one of the symptoms which have been mentioned, but the patient

passed through most of them, and appeared to be in an uncomfortable

way, and yet all who were attacked with these symptoms recovered.

All the symptoms which I have described occurred also to women and

girls; and whoever of them had any of these symptoms in a favorable

manner, or the menses appeared abundantly, were saved thereby, and had

a crisis, so that I do not know a single female who had any of these

favorably that died. But the daughter of Philo, who had a copious

hemorrhage from the nose, and took supper unseasonably on the

seventh day, died. In those cases of acute, and more especially of

ardent fevers, in which there is an involuntary discharge of tears,

you may expect a nasal hemorrhage unless the other symptoms be of a

fatal type, for in those of a bad description, they do not indicate

a hemorrhage, but death.

12. Swellings about the ears, with pain in fevers, sometimes when

the fever went off critically, neither subsided nor were converted

into pus; in these cases a bilious diarrhoea, or dysentery, or thick

urine having a sediment, carried off the disease, as happened to

Hermippus of Clazomenae. The circumstances relating to crises, as

far as we can recognize them, were so far similar and so far

dissimilar. Thus two brothers became ill at the same hour (they were

brothers of Epigenes, and lodged near the theatre), of these the elder

had a crisis on the sixth day, and the younger on the seventh, and

both had a relapse at the same hour; it then left them for five

days, and from the return of the fever both had a crisis together on

the seventeenth day. Most had a crisis on the sixth day; it then

left them for six days, and from the relapse there was a crisis on the

fifth day. But those who had a crisis on the seventh day, had an

intermission for seven days; and the crisis took place on the third

day after the relapse. Those who had a crisis on the sixth day,

after an interval of six days were seized again on the third, and

having left them for one day, the fever attacked them again on the

next and came to a crisis, as happened to Evagon the son of

Daetharses. Those in whom the crisis happened on the sixth day, had an

intermission of seven days, and from the relapse there was a crisis on

the fourth, as happened to the daughter of Aglaidas. The greater

part of those who were taken ill under this constitution of things,

were affected in this manner, and I did not know a single case of

recovery, in which there was not a relapse agreeably to the stated

order of relapses; and all those recovered in which the relapses

took place according to this form: nor did I know a single instance of

those who then passed through the disease in this manner who had

another relapse.

13. In these diseases death generally happened on the sixth day,

as with Epaminondas, Silenus, and Philiscus the son of Antagoras.

Those who had parotid swellings experienced a crisis on the

twentieth day, but in all these cases the disease went off without

coming to a suppuration, and was turned upon the bladder. But in

Cratistonax, who lived by the temple of Hercules, and in the maid

servant of Scymnus the fuller, it turned to a suppuration, and they

died. Those who had a crisis on the seventh day, had an intermission

of nine days, and a relapse which came to a crisis on the fourth day

from the return of the fever, as was the case with Pantacles, who

resided close by the temple of Bacchus. Those who had a crisis on

the seventh day, after an interval of six days had a relapse, from

which they had a crisis on the seventh day, as happened to

Phanocritus, who was lodged with Gnathon the fuller. During the

winter, about the winter solstices, and until the equinox, the

ardent fevers and frenzies prevailed, and many died. The crisis,

however, changed, and happened to the greater number on the fifth

day from the commencement, left them for four days and relapsed; and

after the return, there was a crisis on the fifth day, making in all

fourteen days. The crisis took place thus in the case of most

children, also in elder persons. Some had a crisis on the eleventh

day, a relapse on the fourteenth, a complete crisis on the

twentieth; but certain persons, who had a rigor about the twentieth,

had a crisis on the fortieth. The greater part had a rigor along

with the original crisis, and these had also a rigor about the

crisis in the relapse. There were fewest cases of rigor in the spring,

more in summer, still more in autumn, but by far the most in winter;

then hemorrhages ceased.

Sect. III

1. With regard to diseases, the circumstances from which we form a

judgment of them are,- by attending to the general nature of all,

and the peculiar nature of each individual,- to the disease, the

patient, and the applications,- to the person who applies them, as

that makes a difference for better or for worse,- to the whole

constitution of the season, and particularly to the state of the

heavens, and the nature of each country;- to the patient's habits,

regimen, and pursuits;- to his conversation, manners, taciturnity,

thoughts, sleep, or absence of sleep, and sometimes his dreams, what

and when they occur;- to his picking and scratching;- to his tears;-

to the alvine discharges, urine, sputa, and vomitings; and to the

changes of diseases from the one into the other;- to the deposits,

whether of a deadly or critical character;- to the sweat, coldness,

rigor, cough, sneezing, hiccup, respiration, eructation, flatulence,

whether passed silently or with a noise;- to hemorrhages and

hemorrhoids;- from these, and their consequences, we must form our

judgment.

2. Fevers are,- the continual, some of which hold during the day and

have a remission at night, and others hold a remission during the day;

semi-tertians, tertians, quartans, quintans, septans, nonans. The most

acute, strongest, most dangerous, and fatal diseases, occur in the

continual fever. The least dangerous of all, and the mildest and

most protracted, is the quartan, for it is not only such from

itself, but it also carries off other great diseases. In what is

called the semi-tertian, other acute diseases are apt to occur, and it

is the most fatal of all others, and moreover phthisical persons,

and those laboring under other protracted diseases, are apt to be

attacked by it. The nocturnal fever is not very fatal, but protracted;

the diurnal is still more protracted, and in some cases passes into

phthisis. The septan is protracted, but not fatal; the nonan more

protracted, and not fatal. The true tertian comes quickly to a crisis,

and is not fatal; but the quintan is the worst of all, for it proves

fatal when it precedes an attack of phthisis, and when it supervenes

on persons who are already consumptive. There are peculiar modes,

and constitutions, and paroxysms, in every one of these fevers; for

example,- the continual, in some cases at the very commencement,

grows, as it were, and attains its full strength, and rises to its

most dangerous pitch, but is diminished about and at the crisis; in

others it begins gentle and suppressed, but gains ground and is

exacerbated every day, and bursts forth with all its heat about and at

the crisis; while in others, again, it commences mildly, increases,

and is exacerbated until it reaches its acme, and then remits until at

and about the crisis. These varieties occur in every fever, and in

every disease. From these observations one must regulate the regimen

accordingly. There are many other important symptoms allied to

these, part of which have been already noticed, and part will be

described afterwards, from a consideration of which one may judge, and

decided in each case, whether the disease be acute, acute, and whether

it will end in death or recovery; or whether it will be protracted,

and will end in death or recovery; and in what cases food is to be

given, and in what not; and when and to what amount, and what

particular kind of food is to be administered.

3. Those diseases which have their paroxysms on even days have their

crises on even days; and those which have their paroxysms on uneven

days have their crises on uneven days. The first period of those which

have the crisis on even days, is the 4th, 6th, 8th, 10th, 14th,

20th, 30th, 40th, 60th, 80th, 100th; and the first period of those

which have their crises on uneven days, is the 1st, 3d, 5th, 7th, 9th,

11th, 17th, 21th, 27th, 31st. It should be known, that if the crisis

take place on any other day than on those described, it indicates that

there will be a relapse, which may prove fatal. But one ought to pay

attention, and know in these seasons what crises will lead to recovery

and what to death, or to changes for the better or the worse.

Irregular fevers, quartans, quintans, septans, and nonans should be

studied, in order to find out in what periods their crises take place.

Fourteen Cases of Disease

CASE I. Philiscus, who lived by the Wall, took to bed on the first

day of acute fever; he sweated; towards night was uneasy. On the

second day all the symptoms were exacerbated; late in the evening

had a proper stool from a small clyster; the night quiet. On the third

day, early in the morning and until noon, he appeared to be free

from fever; towards evening, acute fever, with sweating, thirst,

tongue parched; passed black urine; night uncomfortable, no sleep;

he was delirious on all subjects. On the fourth, all the symptoms

exacerbated, urine black; night more comfortable, urine of a better

color. On the fifth, about mid-day, had a slight trickling of pure

blood from the nose; urine varied in character, having floating in

it round bodies, resembling semen, and scattered, but which did not

fall to the bottom; a suppository having been applied, some scanty

flatulent matters were passed; night uncomfortable, little sleep,

talking incoherently; extremities altogether cold, and could not be

warmed; urine, black; slept a little towards day; loss of speech, cold

sweats; extremities livid; about the middle of the sixth day he

died. The respiration throughout, like that of a person recollecting

himself, was rare, and large, and spleen was swelled upon in a round

tumor, the sweats cold throughout, the paroxysms on the even days.

CASE II. Silenus lived on the Broad-way, near the house of

Evalcidas. From fatigue, drinking, and unseasonable exercises, he

was seized with fever. He began with having pain in the loins; he

had heaviness of the head, and there was stiffness of the neck. On the

first day the alvine discharges were bilious, unmixed, frothy, high

colored, and copious; urine black, having a black sediment; he was

thirsty, tongue dry; no sleep at night. On the second, acute fever,

stools more copious, thinner, frothy; urine black, an uncomfortable

night, slight delirium. On the third, all the symptoms exacerbated; an

oblong distention, of a softish nature, from both sides of the

hypochondrium to the navel; stools thin, and darkish; urine muddy, and

darkish; no sleep at night; much talking, laughter, singing, he

could not restrain himself. On the fourth, in the same state. On the

fifth, stools bilious, unmixed, smooth, greasy; urine thin, and

transparent; slight absence of delirium. On the sixth, slight

perspiration about the head; extremities cold and livid; much

tossing about; no passage from the bowels, urine suppressed, acute

fever. On the seventh, loss of speech; extremities could no longer

be kept warm; no discharge of urine. On the eighth, a cold sweat all

over; red rashes with sweat, of a round figure, small, like vari,

persistent, not subsiding; by means of a slight stimulus, a copious

discharge from the bowels, of a thin and undigested character, with

pain; urine acrid, and passed with pain; extremities slightly

heated; sleep slight, and comatose; speechless; urine thin, and

transparent. On the ninth, in the same state. On the tenth, no drink

taken; comatose, sleep slight; alvine discharges the same; urine

abundant, and thickish; when allowed to stand, the sediment

farinaceous and white; extremities again cold. On the eleventh, he

died. At the commencement, and throughout, the respiration was slow

and large; there was a constant throbbing in the hypochondrium; his

age was about twenty.

CASE III. Herophon was seized with an acute fever; alvine discharges

at first were scanty, and attended with tenesmus; but afterwards

they were passed of a thin, bilious character, and frequent; there was

no sleep; urine black, and thin. On the fifth, in the morning,

deafness; all the symptoms exacerbated; spleen swollen; distention

of the hypochondrium; alvine discharges scanty, and black; he became

delirious. On the sixth, delirious; at night, sweating, coldness;

the delirium continued. On the seventh, he became cold, thirsty, was

disordered in mind; at night recovered his senses; slept. On the

eighth, was feverish; the spleen diminished in size; quite

collected; had pain at first about the groin, on the same side as

the spleen; had pains in both legs; night comfortable; urine better

colored, had a scanty sediment. On the ninth, sweated; the crisis took

place; fever remitted. On the fifth day afterwards, fever relapsed,

spleen immediately became swollen; acute fever; deafness again. On the

third day after the relapse, the spleen diminished; deafness less;

legs painful; sweated during the night; crisis took place on the

seventeenth day; had no disorder of the senses during the relapse.

CASE IV. In Thasus, the wife of Philinus, having been delivered of a

daughter, the discharge being natural, and other matters going on

mildly, on the fourteenth day after delivery was seized with fever,

attended with rigor; was pained at first in the cardiac region of

the stomach and right hypochondrium; pain in the genital organs;

lochial discharge ceased. Upon the application of a pessary all

these symptoms were alleviated; pains of the head, neck, and loins

remained; no sleep; extremities cold; thirst; bowels in a hot state;

stools scanty; urine thin, and colorless at first. On the sixth,

towards night, senses much disordered, but again were restored. On the

seventh, thirsty; the evacuations bilious, and high colored. On the

eighth, had a rigor; acute fever; much spasm, with pain; talked

much, incoherently; upon the application of a suppository, rose to

stool, and passed copious dejections, with a bilious flux; no sleep.

On the ninth, spasms. On the tenth, slightly recollected. On the

eleventh, slept; had perfect recollection, but again immediately

wandered; passed a large quantity of urine with spasms, (the

attendants seldom putting her in mind), it was thick, white, like

urine which has been shaken after it has stood for a considerable time

until it has subsided, but it had no sediment; in color and

consistence, the urine resembled that of cattle, as far as I observed.

About the fourteenth day, startings over the whole body; talked

much; slightly collected, but presently became again delirious.

About the seventeenth day became speechless, on the twentieth died.

CASE V. The wife of Epicrates, who was lodged at the house of

Archigetes, being near the term of delivery, was seized with a violent

rigor, and, as was said, she did not become heated; next day the same.

On the third, she was delivered of a daughter, and everything went

on properly. On the day following her delivery, she was seized with

acute fever, pain in the cardiac region of the stomach, and in the

genital parts. Having had a suppository, was in so far relieved;

pain in the head, neck, and loins; no sleep; alvine discharges scanty,

bilious, thin, and unmixed; urine thin, and blackish. Towards the

night of the sixth day from the time she was seized with the fever,

became delirious. On the seventh, all the symptoms exacerbated;

insomnolency, delirium, thirst; stools bilious, and high colored. On

the eighth, had a rigor; slept more. On the ninth, the same. On the

tenth, her limbs painfully affected; pain again of the cardiac

region of the stomach; heaviness of the head; no delirium; slept more;

bowels constipated. On the eleventh, passed urine of a better color,

and having an abundant sediment; felt lighter. On the fourteenth had a

rigor; acute fever. On the fifteenth, had a copious vomiting of

bilious and yellow matters; sweated; fever gone; at night acute fever;

urine thick, sediment white. On the seventeenth, an exacerbation;

night uncomfortable; no sleep; delirium. On the eighteenth, thirsty;

tongue parched; no sleep; much delirium; legs painfully affected.

About the twentieth, in the morning, had as light rigor; was comatose;

slept tranquilly; had slight vomiting of bilious and black matters;

towards night deafness. About the twenty-first, weight generally in

the left side, with pain; slight urine thick, muddy, and reddish; when

allowed to stand, had no sediment; in other respects felt lighter;

fever not gone; fauces painful from the commencement, and red; uvula

retracted; defluxion remained acrid, pungent, and saltish

throughout. About the twenty-seventh, free of fever; sediment in the

urine; pain in the side. About the thirty-first, was attacked with

fever, bilious diarrhea; slight bilious vomiting on the fortieth.

Had a complete crisis, and was freed from the fever on the eightieth

day.

CASE VI. Cleonactides, who was lodged above the Temple of

Hercules, was seized with a fever in an irregular form; was pained

in the head and left side from the commencement, and had other pains

resembling those produced by fatigue; paroxysms of the fevers

inconstant and irregular; occasional sweats; the paroxysms generally

attacked on the critical days. About the twenty-fourth was cold in the

extremities of the hands, vomitings bilious, yellow, and frequent,

soon turning to a verdigris-green color; general relief. About the

thirtieth, began to have hemorrhage from both nostrils, and this

continued in an irregular manner until near the crisis; did not loathe

food, and had no thirst throughout, nor was troubled with

insomnolency; urine thin, and not devoid of color. When about the

thirtieth day, passed reddish urine, having a copious red sediment;

was relieved, but afterwards the characters of the urine varied,

sometimes having sediment, and sometimes not. On the sixtieth, the

sediment in the urine copious, white, and smooth; all the symptoms

ameliorated; intermission of the fever; urine thin, and well

colored. On the seventieth, fever gone for ten days. On the

eightieth had a rigor, was seized with acute fever, sweated much; a

red, smooth sediment in the urine; and a perfect crisis.

CASE VII. Meton was seized with fever; there was a painful weight in

the loins. Next day, after drinking water pretty copiously, had proper

evacuations from the bowels. On the third, heaviness of the head,

stools thin, bilious, and reddish. On the fourth, all the symptoms

exacerbated; had twice a scanty trickling of blood from the right

nostril; passed an uncomfortable night; alvine discharges like those

on the third day; urine darkish, had a darkish cloud floating in it,

of a scattered form, which did not subside. On the fifth, a copious

hemorrhage of pure blood from the left he sweated, and had a crisis.

After the fever restless, and had some delirium; urine thin, and

darkish; had an affusion of warm water on the head; slept and

recovered his senses. In this case there was no relapse, but there

were frequent hemorrhages after the crisis.

CASE VIII. Erasinus, who lived near the Canal of Bootes, was

seized with fever after supper; passed the night in an agitated state.

During the first day quiet, but in pain at night. On the second,

symptoms all exacerbated; at night delirious. On the third, was in a

painful condition; great incoherence. On the fourth, in a most

uncomfortable state; had no sound sleep at night, but dreaming and

talking; then all the appearances worse, of a formidable and

alarming character; fear, impatience. On the morning of the fifth, was

composed, and quite coherent, but long before noon was furiously

mad, so that he could not constrain himself; extremities cold, and

somewhat livid; urine without sediment; died about sunset. The fever

in this case was accompanied by sweats throughout; the sweats

throughout; the hypochondria were in a state of meteorism, with

distention and pain; the urine was black, has round substances

floating in it, which did not subside; the alvine evacuations were not

stopped; thirst throughout not great; much spasms with sweats about

the time of death.

CASE IX. Criton, in Thasus, while still on foot, and going about,

was seized with a violent pain in the great toe; he took to bed the

same day, had rigors and nausea, recovered his heat slightly, at night

was delirious. On the second, swelling of the whole foot, and about

the ankle erythema, with distention, and small bullae (phlyctaenae);

acute fever; he became furiously deranged; alvine discharges

bilious, unmixed, and rather frequent. He died on the second day

from the commencement.

CASE X. The Clazomenian who was lodged by the Well of Phrynichides

was seized with fever. He had pain in the head, neck, and loins from

the beginning, and immediately afterwards deafness; no sleep, acute

fever, hypochondria elevated with a swelling, but not much distention;

tongue dry. On the fourth, towards night, he became delirious. On

the fifth, in an uneasy state. On the sixth, all the symptoms

exacerbated. About the eleventh a slight remission; from the

commencement to the fourteenth day the alvine discharges thin,

copious, and of the color of water, but were well supported; the

bowels then became constipated. Urine throughout thin, and well

colored, and had many substances scattered through it, but no

sediment. About the sixteenth, urine somewhat thicker, which had a

slight sediment; somewhat better, and more collected. On the

seventeenth, urine again thin; swellings about both his ears, with

pain; no sleep, some incoherence; legs painfully affected. On the

twentieth, free of fever, had a crisis, no sweat, perfectly collected.

About the twenty-seventh, violent pain of the right hip; it speedily

went off. The swellings about the ears subsided, and did not

suppurate, but were painful. About the thirty-first, a diarrhea

attended with a copious discharge of watery matter, and symptoms of

dysentery; passed thick urine; swellings about the ears gone. About

the fortieth day, had pain in the right eye, sight dull. It went away.

CASE XI. The wife of Dromeades having been delivered of a female

child, and all other matters going on properly, on the second day

after was seized with rigor and acute fever. Began to have pain

about the hypochondrium on the first day; had nausea and

incoherence, and for some hours afterwards had no sleep; respiration

rare, large, and suddenly interrupted. On the day following that on

which she had the rigor, alvine discharges proper; urine thick, white,

muddy, like urine which has been shaken after standing for some

time, until the sediment had fallen to the bottom; it had no sediment;

she did not sleep during the night. On the third day, about noon,

had a rigor, acute fever; urine the same; pain of the hypochondria,

nausea, an uncomfortable night, no sleep; a coldish sweat all over,

but heat quickly restored. On the fourth, slight alleviation of the

symptoms about the hypochondria; heaviness of the head, with pain;

somewhat comatose; slight epistaxis, tongue dry, thirst, urine thin

and oily; slept a little, upon awaking was somewhat comatose; slight

coldness, slept during the night, was delirious. On the morning of the

sixth had a rigor, but soon recovered her heat, sweated all over;

extremities cold, was delirious, respiration rare and large. Shortly

afterwards spasms from the head began, and she immediately expired.

CASE XII. A man, in a heated state, took supper, and drank more than

enough; he vomited the whole during the night; acute fever, pain of

the right hypochondrium, a softish inflammation from the inner part;

passed an uncomfortable night; urine at the commencement thick, red,

but when allowed to stand, had no sediment, tongue dry, and not very

thirsty. On the fourth, acute fever, pains all over. On the fifth,

urine smooth, oily, and copious; acute fever. On the sixth, in the

evening, very incoherent, no sleep during the night. On the seventh,

all the symptoms exacerbated; urine of the same characters; much

talking, and he could not contain himself; the bowels being

stimulated, passed a watery discharge with lumbrici: night equally

painful. In the morning had a rigor; acute fever, hot sweat,

appeared to be free of fever; did not sleep long; after the sleep a

chill, ptyalism; in the evening, great incoherence; after a little,

vomited a small quantity of dark bilious matters. On the ninth,

coldness, much delirium, did not sleep. On the tenth, pains in the

limbs, all the symptoms exacerbated; he was delirious. On the

eleventh, he died.

CASE XIII. A woman, who lodged on the Quay, being three months

gone with child, was seized with fever, and immediately began to

have pains in the loins. On the third day, pain of the head and

neck, extending to the clavicle, and right hand; she immediately

lost the power of speech; was paralyzed in the right hand, with

spasms, after the manner of paraplegia; was quite incoherent; passed

an uncomfortable night; did not sleep; disorder of the bowels,

attended with bilious, On the fourth, recovered the use of her tongue;

spasms of the same parts, and general pains remained; swelling in

the hypochondrium, accompanied with pain; did not sleep, was quite

incoherent; bowels disordered, urine thin, and not of a good color. On

the fifth, acute fever; pain of the hypochondrium, quite incoherent;

alvine evacuations bilious; towards night had a sweat, and was freed

from the fever. On the sixth, recovered her reason; was every way

relieved; the pain remained about the left clavicle; was thirsty,

urine thin, had no sleep. On the seventh trembling, slight coma,

some incoherence, pains about the clavicle and left arm remained; in

all other respects was alleviated; quite coherent. For three days

remained free from fever. On the eleventh, had a relapse, with rigor

and fever. About the fourteenth day, vomited pretty abundantly bilious

and yellow matters, had a sweat, the fever went off, by coming to a

crisis.

CASE XIV. Melidia, who lodged near the Temple of Juno, began to feel

a violent pain of the head, neck, and chest. She was straightway

seized with acute fever; a slight appearance of the menses;

continued pains of all these parts. On the sixth, was affected with

coma, nausea, and rigor; redness about the cheeks; slight delirium. On

the seventh, had a sweat; the fever intermitted, the pains remained. A

relapse; little sleep; urine throughout of a good color, but thin; the

alvine evacuations were thin, bilious, acrid, very scanty, black,

and fetid; a white, smooth sediment in the urine; had a sweat, and

experienced a perfect crisis on the eleventh day.

BOOK II. Sect. I

CASE I. Pythion, who lived by the Temple of the Earth, on the

first day, trembling commencing from his hands; acute fever, delirium.

On the second, all the symptoms were exacerbated. On the third, the

same. On the fourth alvine discharges scanty, unmixed, and bilious. On

the fifth, all the symptoms were exacerbated, the tremors remained;

little sleep, the bowels constipated. On the sixth sputa mixed,

reddish. On the seventh, mouth drawn aside. On the eighth, all the

symptoms were exacerbated; the tremblings were again constant;

urine, from the beginning to the eighth day, thin, and devoid of

color; substances floating in it, cloudy. On the tenth he sweated;

sputa somewhat digested, had a crisis; urine thinnish about the

crisis; but after the crisis, on the fortieth day, an abscess about

the anus, which passed off by a strangury.

Explanation of the characters. It is probably that the great

discharge of urine brought about the resolution of the disease, and

the cure of the patient on the fortieth day.

CASE II. Hermocrates, who lived by the New Wall, was seized with

fever. He began to have pain in the head and loins; an empty

distention of the hypochondrium; the tongue at first was parched;

deafness at the commencement; there was no sleep; not very thirsty;

urine thick and red, when allowed to stand it did not subside;

alvine discharge very dry, and not scanty. On the fifth, urine thin,

had substances floating in it which did not fall to the bottom; at

night he was delirious. On the sixth, had jaundice; all the symptoms

were exacerbated; had no recollection. On the seventh, in an

uncomfortable state; urine thin, as formerly; on the following days

the same. About the eleventh day, all the symptoms appeared to be

lightened. Coma set in; urine thicker, reddish, thin substances below,

had no sediment; by degrees he became collected. On the fourteenth,

fever gone; had no sweat; slept, quite collected; urine of the same

characters. About the seventeenth, had a relapse, became hot. On the

following days, acute fever, urine thin, was delirious. Again, on

the twentieth, had a crisis; free of fever; had no sweat; no

appetite through the whole time; was perfectly collected; could not

speak, tongue dry, without thirst; deep sleep. About the twenty-fourth

day he became heated; bowels loose, with a thin, watery discharge;

on the following days acute fever, tongue parched. On the

twenty-seventh he died. In this patient deafness continued throughout;

the urine either thick and red, without sediment, or thin, devoid of

color, and, having substances floating in it: he could taste nothing.

Explanation of the characters. It is probably that it was the

suppression of the discharges from the bowels which occasioned death

on the twenty-seventh day.

CASE III. The man who was lodged in the Garden of Dealces: had

heaviness of the head and pain in the right temple for a

considerable time, from some accidental cause, was seized with

fever, and took to bed. On the second, there was a trickling of pure

blood from the left nostril, but the alvine discharges were proper,

urine thin, mixed, having small substances floating in it, like coarse

barley meal, or semen. On the third, acute fever; stools black,

thin, frothy, a livid sediment in the dejections; slight coma;

uneasiness at the times he had to get up; sediment in the urine livid,

and somewhat viscid. On the fourth, slight vomiting of bilious, yellow

matters, and, after a short interval, of the color of verdigris; a few

drops of pure blood ran from the left nostril; stools the same;

urine the same; sweated about the head and clavicles; spleen enlarged,

pain of the thigh on the same side; loose swelling of the right

hypochondrium; at night had no sleep, slight delirium. On the sixth,

stools black, fatty, viscid, fetid; slept, more collected. On the

seventh, tongue dry, thirsty, did not sleep; was somewhat delirious;

urine thin, not of a good color. On the eighth, stools black,

scanty, and compact; slept, became collected; not very thirsty. On the

ninth had a rigor, acute fever, sweated, a chill, was delirious,

strabismus of the right eye, tongue dry, thirsty, without sleep. On

the tenth, much the same. On the eleventh, became quite collected;

free from fever, slept, urine thin about the crisis. The two following

days without fever; it returned on the fourteenth, then immediately

insomnolency and complete delirium. On the fifteenth, urine muddy,

like that which has been shaken after the sediment has fallen to the

bottom; acute fever, quite delirious, did not sleep; knees and legs

painful; after a suppository, had alvine dejections of a black

color. On the sixteenth, urine thin, had a cloudy eneorema, was

delirious. On the seventeenth, in the morning, extremities cold, was

covered up with the bedclothes, acute fever, general sweat, felt

relieved, more collected; not free of fever, thirsty, vomited yellow

bile, in small quantities; formed faeces passed from the bowels, but

soon afterwards black, scanty, and thin; urine thin, not well colored.

On the eighteenth, not collected, comatose. On the nineteenth, in

the same state. On the twentieth, slept; quite collected, sweated,

free from fever, not thirsty, but the urine thin. On the twenty-first,

slight delirium; somewhat thirsty, pain of the hypochondrium, and

throbbing about the navel throughout. On sediment in the urine,

quite collected. Twenty-seventh, pain of the right hip joint; urine

thin and bad, a sediment; all the other symptoms milder. About the

twenty-ninth, pain of the right eye; urine thin. Fortieth,

dejections pituitous, white, rather frequent; sweated abundantly all

over; had a complete crisis.

Explanation of the characters. It is probable that, by means of

the stools, the urine, and the sweat, this patient was cured in

forty days.

Sect. II

CASE I. In Thasus, Philistes had headache of long continuance, and

sometimes was confined to bed, with a tendency to deep sleep; having

been seized with continual fevers from drinking, the pain was

exacerbated; during the night he, at first, became hot. On the first

day, he vomited some bilious matters, at first yellow, but

afterwards of a verdigris-green color, and in greater quantity; formed

faeces passed from the bowels; passed the night uncomfortably. On

the second, deafness, acute fever; retraction of the right

hypochondrium; urine thin, transparent, had some small substances like

semen floating in it; delirium ferox about mid-day. On the third, in

an uncomfortable state. On the fourth, convulsions; all the symptoms

exacerbated. On the fifth, early in the morning, died.

Explanation of the characters. It is probable that the death of

the patient on the fifth day is to be attributed to a phrenitis,

with unfavorable evacuations.

CASE II. Charion, who was lodged at the house of Demaenetus,

contracted a fever from drinking. Immediately he had a painful

heaviness of the head; did not sleep; bowels disordered, with thin and

somewhat bilious discharges. On the third day, acute fever;

trembling of the head, but especially of the lower lip; after a little

time a rigor, convulsions; he was quite delirious; passed the night

uncomfortably. On the fourth, quiet, slept little, talked

incoherently. On the fifth, in pain; all the symptoms exacerbated;

delirium; passed the night uncomfortably; did not sleep. On the sixth,

in the same state. On the seventh had a rigor, acute fever, sweated

all over his body; had a crisis. Throughout the alvine discharges were

bilious, scanty, and unmixed; urine thin, well colored, having

cloudy substances floating in it. About the eighth day, passed urine

of a better color, having a white scanty sediment; was collected, free

from fever for a season. On the ninth it relapsed. About the

fourteenth, acute fever. On the sixteenth, vomited pretty frequently

yellow, bilious matters. On the seventeenth had a rigor, acute

fever, sweated, free of fever; had a crisis; urine, after the

relapse and the crisis, well colored, having a sediment; neither was

he delirious in the relapse. On the eighteenth, became a little

heated; some thirst, urine thin, with cloudy substances floating in

it; slight wandering in his mind. About the nineteenth, free of fever,

had a pain in his neck; a sediment in the urine. Had a complete crisis

on the twentieth.

Explanation of the characters. It is probable that the patient was

cured in twenty days, by the abundance of bilious stools and urine.

CASE III. The daughter of Euryanax, a maid, was taken ill of

fever. She was free of thirst throughout, but had no relish for

food. Alvine discharges small, urine thin, scanty, not well colored.

In the beginning of the fever, had a pain about the nates. On the

sixth day, was free of fever, did not sweat, had a crisis; the

complaint about the nates came to a small suppuration, and burst at

the crisis. After the crisis, on the seventh day, had a rigor,

became slightly heated, sweated. On the eighth day after the rigor,

had an inconsiderable rigor; the extremities cold ever after. About

the tenth day, after a sweat which came on, she became delirious,

and again immediately afterwards was collected; these symptoms were

said to have been brought on by eating grapes. After an intermission

of the twelfth day, she again talked much incoherently; her bowels

disordered with bilious, scanty, unmixed, thin, acrid discharges;

she required to get frequently up. She died on the seventh day after

the return of the delirium. At the commencement of the disease she had

pain in the throat, and it red throughout, uvula retracted, defluxions

abundant, thin, acrid; coughed, but had no concocted sputa; during the

whole time loathed all kinds of food, nor had the least desire of

anything; had no thirst, nor drank anything worth mentioning; was

silent, and never spoke a word; despondency; had no hopes of

herself. She had a congenital tendency to phthisis.

CASE IV. The woman affected with quinsy, who lodged in the house

of Aristion: her complaint began in the tongue; speech inarticulate;

tongue red and parched. On the first day, felt chilly, and

afterwards became heated. On the third day, a rigor, acute fever; a

reddish and hard swelling on both sides of the neck and chest,

extremities cold and livid; and livid; respiration elevated; the drink

returned by the nose; she could not swallow; alvine and urinary

discharges suppressed. On the fourth, all of the symptoms were

exacerbated. On the fifth she died of the quinsy.

Explanation of the characters. It is probable that the cause of

death on the sixth day was the suppression of the discharges.

CASE V. The young man who was lodged by the Liars' Market was seized

with fever from fatigue, labor, and running out of season. On the

first day, the bowels disordered, with bilious, thin, and copious

dejections; urine thin and blackish; had no sleep; was thirsty. On the

second all the symptoms were exacerbated; dejections more copious

and unseasonable; he had no sleep; disorder of the intellect; slight

sweat. On the third day, restless, thirst, nausea, much tossing about,

bewilderment, delirium; extremities livid and cold; softish distention

of the hypochondrium on both sides. On the fourth, did not sleep;

still worse. On the seventh he died. He was about twenty years of age.

Explanation of the characters. It is probable that the cause of

his death on the seventh day was the unseasonable practices

mentioned above. An acute affection.

CASE VI. The woman who lodged at the house of Tisamenas had a

troublesome attack of iliac passion, much vomiting; could not keep her

drink; pains about the hypochondria, and pains also in the lower

part of the belly; constant tormina; not thirsty; became hot;

extremities cold throughout, with nausea and insomnolency; urine

scanty and thin; dejections undigested, thin, scanty. Nothing could do

her any good. She died.

CASE VII. A woman of Pantimides, from a miscarriage, was taken ill

of fever. On the first day, tongue dry, thirst, nausea,

insomnolency, belly disordered, with thin, copious, undigested

dejections. On the second day, had a rigor, acute fever; alvine

discharges copious; had no sleep. On the third, pains greater. On

the fourth, delirious. On the seventh she died. Belly throughout

loose, with copious, thin, undigested evacuations; urine scanty, thin.

An ardent fever.

CASE VIII. Another woman, after a miscarriage about the fifth month,

the wife of Ocetes, was seized with fever. At first had sometimes coma

and sometimes insomnolency; pain of the loins; heaviness of the

head. On the second, the bowels were disordered, with scanty, thin,

and at first unmixed dejections. On the third, more copious, and

worse; at night did not sleep. On the fourth was delirious; frights,

despondency; strabismus of the right eye; a faint cold sweat about the

head; extremities cold. On the fifth day, all the symptoms were

exacerbated; talked much incoherently, and again immediately became

collected; had no thirst; labored under insomnolency; alvine

dejections copious, and unseasonable throughout; urine scanty, thin,

darkish; extremities cold, somewhat livid. On the sixth day, in the

same state. On the seventh she died. Phrenitis.

CASE IX. A woman who lodged near the Liars' Market, having then

brought forth a son in a first and difficult labor, was seized with

fever. Immediately on the commencement had thirst, nausea, and

cardialgia; tongue dry; bowels disordered, with thin and scanty

dejections; had no sleep. On the second, had slight rigor, acute

fever; a faint cold sweat about the head. On the third, painfully

affected; evacuations from the bowels undigested, thin, and copious.

On the fourth, had a rigor; all the symptoms exacerbated;

insomnolency. On the fifth, in a painful state. On the sixth, in the

same state; discharges from the bowels liquid and copious. On the

seventh, had a rigor, fever acute; much thirst; much tossing about;

towards evening a cold sweat over all; extremities cold, could no

longer be kept warm; and again at night had a rigor; extremities could

not be warmed; she did not sleep; was slightly delirious, and again

speedily collected. On the eighth, about mid-day, she became warm, was

thirsty, comatose, had nausea; vomited small quantities of yellowish

bile; restless at night, did not sleep; passed frequently large

quantities of urine without consciousness. On the ninth, all the

symptoms gave way; comatose, towards evening slight rigors; small

vomitings of bile. On the tenth, rigor; exacerbation of the fever, did

not sleep at all; in the morning passed much urine having a

sediment; extremities recovered their heat. On the eleventh, vomited

bile of a verdigris-green color; not long after had a rigor, and again

the extremities cold; towards evening a rigor, a cold sweat, much

vomiting; passed a painful night. On the twelfth, had copious black

and fetid vomitings; much hiccup, painful thirst. On the thirteenth,

vomitings black, fetid, and copious; rigor about mid-day, loss of

speech. On the fourteenth, some blood ran from her nose, she died.

In this case the bowels were loose throughout; with rigors: her age

about seventeen. An ardent fever.

Sect. III

1. The year was southerly, rainy; no winds throughout. Droughts

having prevailed during the previous seasons of the year, the south

winds towards the rising of Arcturus were attended with much rain.

Autumn gloomy and cloudy, with copious rains. Winter southerly,

damp, and soft. But long after the solstice, and near the equinox,

much wintery weather out of season; and when now close to the equinox,

northerly, and winterly weather for no long time. The spring again

southerly, calm, much rain until the dog-days. Summer fine and hot;

great suffocating heats. The Etesian winds blew small and irregular;

again, about the season of Arcturus, much rains with north winds.

2. The year being southerly, damp, and soft towards winter, all were

healthy, except those affected with phthisis, of whom we shall write

afterwards.

3. Early in spring, along with the prevailing cold, there were

many cases of erysipelas, some from a manifest cause, and some not.

They were of a malignant nature, and proved fatal to many; many had

sore-throat and loss of speech. There were many cases of ardent fever,

phrensy, aphthous affections of the mouth, tumors on the genital

organs; of ophthalmia, anthrax, disorder of the bowels, anorexia, with

thirst and without it; of disordered urine, large in quantity, and bad

in quality; of persons affected with coma for a long time, and then

falling into a state of insomnolency. There were many cases of failure

of crisis, and many of unfavorable crisis; many of dropsy and of

phthisis. Such were the diseases then epidemic. There were patients

affected with every one of the species which have been mentioned,

and many died. The symptoms in each of these cases were as follows:

4. In many cases erysipelas, from some obvious cause, such as an

accident, and sometimes from even a very small wound, broke out all

over the body, especially, in persons about sixty years of age,

about the head, if such an accident was neglected in the slightest

degree; and this happened in some who were under treatment; great

inflammation took place, and the erysipelas quickly spread all over.

in the most of them abscessed ended in suppurations, and there were

great fallings off (sloughing) of the flesh, tendons, and bones; and

the defluxion which seated in the part was not like pus, but a sort of

putrefaction, and the running was large and of various characters.

Those cases in which any of these things happened about the head

were accompanied with falling off of the hairs of the head and chin,

the bones were laid bare and separated, and there were excessive

runnings; and these symptoms happened in fevers and without fevers.

But these things were more formidable in appearance than dangerous;

for when the concoction in these cases turned to a these cases

turned to a suppuration, most of them recovered; but when the

inflammation and erysipelas disappeared, and when no abscess was

formed, a great number of these died. In like manner, the same

things happened to whatever part of the body the disease wandered, for

in many cases both forearm and arm dropped off; and in those cases

in which it fell upon the sides, the parts there, either before or

behind, got into a bad state; and in some cases the whole femur and

bones of the leg and whole foot were laid bare. But of all such cases,

the most formidable were those which took place about the pubes and

genital organs. Such was the nature of these cases when attended

with sores, and proceeding from an external cause; but the same things

occurred in fevers, before fevers, and after fevers. fevers. But those

cases in which an abscess was formed, and turned to a suppuration,

or a seasonable diarrhea or discharge of good urine took place, were

relieved thereby: but those cases in which none of these symptoms

occurred, but they disappeared without a crisis, proved fatal. The

greater number of these erysipelatous cases took place in the

spring, but were prolonged through the summer and during autumn.

5. In certain cases there was much disorder, and tumors about the

fauces, and inflammations of the tongue, and abscesses about the

teeth. And many were attacked with impairment or loss of speech; at

first, those in the commencement of phthisis, but also persons in

ardent fever and in phrenitis.

6. The cases of ardent fever and phrenitis occurred early in

spring after the cold set in, and great numbers were taken ill at that

time, and these cases were attended with acute and fatal symptoms. The

constitution of the ardent fevers which then occurred was as

follows: at the commencement they were affected with coma, nausea, and

rigors; fever acute, not much thirst, nor delirium, slight

epistaxis, the paroxysms for the most part on even days; and, about

the time of the paroxysms, forgetfulness, loss of strength and of

speech, the extremities, that is to say, the hands and feet, at all

times, but more especially about the time of the paroxysms, were

colder than natural; they slowly and imperfectly became warmed, and

again recovered their recollection and speech. They were constantly

affected either with coma, in which they got which they got no

sleep, or with insomnolency, attended with pains; most had disorders

of the bowels, attended with undigested, thin, and copious

evacuations; urine copious, thin, having nothing critical nor

favorable about it; neither was there any other critical appearance in

persons affected thus; for neither was there any proper hemorrhage,

nor any other of the accustomed evacuations, to prove a crisis. They

died, as it happened, in an irregular manner, mostly about the crisis,

but in some instances after having lost their speech for a long

time, and having had copious sweats. These were the symptoms which

marked the fatal cases of ardent fever; similar symptoms occurred in

the phrenitic cases; but these were particularly free from thirst, and

none of these had wild delirium as in other cases, but they died

oppressed by a bad tendency to sleep, and stupor.

7. But there were also other fevers, as will be described. Many

had their mouths affected with aphthous ulcerations. There were also

many defluxions about the genital parts, and ulcerations, boils

(phymata), externally and internally, about the groins. Watery

ophthalmies of a chronic character, with pains; fungous excrescences

of the eyelids, externally and internally, called fig, which destroyed

the sight of many persons. There were fungous growths, in many other

instances, on ulcers, especially on those seated on the genital

organs. There were many attacks of carbuncle (anthrax) through the

summer, and other affections, which are called "the putrefaction"

(seps); also large ecthymata, and large tetters (herpetes) in many

instances.

8. And many and serious complaints attacked many persons in the

region of the belly. In the first place, tenesmus, accompanied with

pain, attacked many, but more especially children, and all who had not

attained to puberty; and the most of these died. There were many cases

of lientery and of dysentery; but these were not attended with much

pain. The evacuations were bilious, and fatty, and thin, and watery;

in many instances the disease terminated in this way, with and without

fever; there were painful tormina and volvuli of a malignant kind;

copious evacuations of the contents of the guts, and yet much remained

behind; and the passages did not carry off the pains, but yielded with

difficulty to the means administered; for in most cases purgings

were hurtful to those affected in this manner; many died speedily, but

in many others they held out longer. In a word, all died, both those

who had acute attacks and those who had chronic, most especially

from affections of the belly, for it was the belly which carried

them all off.

9. All persons had an aversion to food in all the afore-mentioned

complaints to a degree such as I never met with before, and persons in

these complaints most especially, and those recovering from them,

and in all other diseases of a mortal nature. Some were troubled

with thirst, and some not; and both in febrile complaints and in

others no one drank unseasonably or disobeyed injunctions.

10. The urine in many cases was not in proportion to the drink

administered, but greatly in excess; and the badness of the urine

voided was great, for it had not the proper thickness, nor concoction,

nor purged properly; for in many cases purgings by the bladder

indicate favorably, but in the greatest number they indicated a

melting of the body, disorder of the bowels, pains, and a want of

crisis.

11. Persons laboring under phrenitis and causus were particularly

disposed to coma; but also in all other great diseases which

occurred along with fever. In the main, most cases were attended

either by heavy coma, or by short and light sleep.

12. And many other forms of fevers were then epidemic, of tertian,

of quartan, of nocturnal, of continual, of chronic, of erratic, of

fevers attended with nausea, and of irregular fevers. All these were

attended with much disorder, for the bowels in most cases were

disordered, accompanied with rigors, sweats not of a critical

character, and with the state of the urine as described. In most

instances the disease was protracted, for neither did the deposits

which took place prove critical as in other cases; for in all

complaints and in all cases there was difficulty of crisis, want of

crisis, and protraction of the disease, but most especially in

these. A few had the crisis about the eightieth day, but in most

instances it (the disease?) left them irregularly. A few of them

died of dropsy without being confined to bed. And in many other

diseases people were troubled with swelling, but more especially in

phthisical cases.

13. The greatest and most dangerous disease, and the one that proved

fatal to the greatest number, was consumption. With many persons it

commenced during the winter, and of these some were confined to bed,

and others bore up on foot; the most of those died early in spring who

were confined to bed; of the others, the cough left not a single

person, but it became milder through the summer; during the autumn,

all these were confined to bed, and many of them died, but in the

greater number of cases the disease was long protracted. Most of these

were suddenly attacked with these diseases, having frequent rigors,

often continual and acute fevers; unseasonable, copious, and cold

sweats throughout; great coldness, from which they had great

difficulty in being restored to heat; the bowels variously

constipated, and again immediately in a loose state, but towards the

termination in all cases with violent looseness of the bowels; a

determination downwards of all matters collected about the lungs;

urine excessive, and not good; troublesome melting. The coughs

throughout were frequent, and copious, digested, and liquid, but not

brought up with much pain; and even when they had some slight pain, in

all cases the purging of the matters about the lungs went on mildly.

The fauces were not very irritable, nor were they troubled with any

saltish humors; but there were viscid, white, liquid, frothy, and

copious defluxions from the head. But by far the greatest mischief

attending these and the other complaints, was the aversion to food, as

has been described. For neither been described. For neither had they

any relish for drink along with their food, but continued without

thirst. There was heaviness of the body, disposition to coma, in

most cases swelling, which ended in dropsy; they had rigors, and

were delirious towards death.

14. The form of body peculiarly subject to phthisical complaints was

the smooth, the whitish, that resembling the lentil; the reddish,

the blue-eyed, the leucophlegmatic, and that with the scapulae

having the appearance of wings: and women in like manner, with

regard to the melancholic and subsanguineous, phrenitic and dysenteric

affections principally attacked them. Tenesmus troubled young

persons of a phlegmatic temperament. Chronic diarrhoea, acrid and

viscid discharges from the bowels, attacked those who were troubled

with bitter bile.

15. To all those which have been described, the season of spring was

most inimical, and proved fatal to the greatest numbers: the summer

was the most favorable to them, and the fewest died then; in autumn,

and under the Pleiades, again there died great numbers. It appears

to me, according to the reason of things, that the coming on of summer

should have done good in these cases; for winter coming on cures the

diseases of summer, and summer coming on removes the diseases of

winter. And yet the summer in question was not of itself well

constituted, for it became suddenly hot, southerly, and calm; but, not

withstanding, it proved beneficial by producing a change on the

other constitution.

16. I look upon it as being a great part of the art to be able to

judge properly of that which has been written. For he that knows and

makes a proper use of these things, would appear to me not likely to

commit any great mistake in the art. He ought to learn accurately

the constitution of every one of the seasons, and of the diseases;

whatever that is common in each constitution and disease is good,

and whatever is bad; whatever disease will be protracted and end in

death, and whatever will be protracted and end in recovery; which

disease of an acute nature will end in death, and which in recovery.

From these it is easy to know the order of the critical days, and

prognosticate from them accordingly. And to a person who is skilled in

these things, it is easy to know to whom, when, and how aliment

ought to be administered.

Sixteen Cases of Disease

CASE I. In Thasus, the Parian who lodged above the Temple of Diana

was seized with an acute fever, at first of a continual and ardent

type; thirsty, inclined to be comatose at first, and afterwards

troubled with insomnolency; bowels disordered at the beginning,

urine thin. On the sixth day, passed oily urine, was delirious. On the

seventh, all the symptoms were exacerbated; had no sleep, but the

urine of the same characters, and the understanding disordered; alvine

dejections bilious and fatty. On the eighth, a slight epistaxis; small

vomiting of verdigris-green matters; slept a little. On the ninth,

in the same state. On the tenth, all the symptoms gave way. On the

eleventh, he sweated, but not over the whole body; he became cold, but

immediately recovered his heat again. On the fourteenth, acute

fever; discharges bilious, thin, and copious; substances floating in

the urine; he became incoherent. On the seventeenth, in a painful

state, for he had no sleep, and the fever was more intense. On the

twentieth, sweated all over; apyrexia, dejections bilious; aversion to

food, comatose. On the twenty-fourth, had a relapse. On the

thirty-fourth, apyrexia; bowels not confined; and he again recovered

his heat. Fortieth, apyrexia, bowels confined for no long time,

aversion to food; had again slight symptoms of fever, and throughout

in an irregular form; apyrexia at times, and at others not; for if the

fever intermitted, and was alleviated for a little, it immediately

relapsed again; he used much and improper food; sleep bad; about the

time of the relapse he was delirious; passed thick urine at that time,

but troubled, and of bad characters; bowels at first confined, and

again loose; slight fevers of a continual type; discharges copious and

thin. On the hundred and twentieth day he died. In this patient the

bowels were constantly from the first either loose, with bilious,

liquid, and copious dejections, or constipated with hot and undigested

faeces; the urine throughout bad; for the most part coma, or

insomnolency with pain; continued aversion to food. Ardent fever.

Explanation of the characters. It is probable that the weakness

produced by the fever, the phrenitis, and affection of the

hypochondrium caused death on the hundred and twentieth day.

CASE II. In Thasus, the woman who lodged near the Cold Water, on the

third day after delivery of a daughter, the lochial discharge not

taking place, was seized with acute fever, accompanied with rigors.

But a considerable time before delivery she was feverish, confined

to bed, and loathed her food. After the rigor which took place,

continual and acute fevers, with rigors. On the eighth and following

days, was very incoherent, and immediately afterwards became

collected; bowels disordered, with copious, thin, watery, and

bilious stools; no thirst. On the eleventh was collected, but disposed

to coma; urine copious, thin, and black; no sleep. On the twentieth,

slight chills, and immediately afterwards was warm; slight

incoherence; no sleep; with regard to the bowels, in the same

condition; urine watery, and copious. On the twenty-seventh, free from

fever; bowels constipated; not long afterwards violent pain of the

right hip-joint for a considerable time; fevers afterwards supervened;

urine watery. On the fortieth, complaints about the hip-joint

better; continued coughs, with copious, watery sputa; bowels

constipated; aversion to food; urine the same; fever not leaving her

entirely, but having paroxysms in an irregular form, sometimes

present, sometimes not. On the sixtieth, the coughs left her without a

crisis, for no concoction of the sputa took place, nor any of the

usual abscesses; jaw on the right side convulsively retracted;

comatose, was again incoherent, and immediately became collected;

utter aversion to food; the jaw became relaxed; alvine discharges

small, and bilious; fever more acute, affected with rigors; on the

following days lost her speech, and again became collected, and

talked. On the eightieth she died. In this case the urine throughout

was black, thin, and watery; coma supervened; there was aversion to

food, aversion to food, despondency, and insomnolency; irritability,

restlessness; she was of a melancholic turn of mind.

Explanation of the characters. It is probable that the suppression

of the lochial discharge caused death on the day.

CASE III. In Thasus, Pythion, who was lodged above the Temple of

Hercules, from labor, fatigue, and neglected diet, was seized with

strong rigor and acute fever; tongue dry, thirsty, and bilious; had no

sleep; urine darkish, eneorema floating on the top of the urine, did

not subside. On the second day, about noon, coldness of the

extremities, especially about the hands and head; loss of speech and

of articulation; breathing short for a considerable time; recovered

his heat; thirst; passed the night quietly; slight sweats about the

head. On the third, passed the day in a composed state; in the

evening, about sunset, slight chills; nausea, agitation; passed the

night in a painful state; had no sleep; small stools of compact faeces

passed from the bowels. On the fourth, in the morning, composed; about

noon all the symptoms became exacerbated; coldness, loss of speech,

and of articulation; became worse; recovered his heat after a time;

passed black urine, having substances floating in it; the night quiet;

slept. On the fifth, seemed to be lightened, but a painful weight

about the belly; thirsty, passed the night in a painful state. On

the sixth, in the morning, in a quiet state; in the evening the

pains greater; had a paroxysm; in the evening the bowels properly

opened by a small clyster; slept at night. On the seventh, during

the day, in a state of nausea, somewhat disturbed; passed urine of the

appearance of oil; at night, much agitation, was incoherent, did not

sleep. On the eighth, in the morning, slept a little; but

immediately coldness, loss of speech, respiration small and weak;

but in the evening recovered his heat again; was delirious, but

towards day was somewhat lightened; stools small, bilious, and

unmixed. On the ninth, affected with coma, and with nausea when

roused; not very thirsty; about sunset he became restless and

incoherent; passed a bad night. On the tenth, in the morning, had

become speechless; great coldness; acute fever; much perspiration;

he died. His sufferings were on the even days.

Explanation of the characters. It is probable that the excessive

sweats caused death on the tenth day.

CASE IV. The patient affected with phrenitis, having taken to bed on

the first day, vomited largely of verdigris-green and thin matters;

fever, accompanied with rigors, copious and continued sweats all over;

heaviness of the head and neck, with pain; urine thin, substances

floating in the urine small, scattered, did not subside; had copious

dejections from the bowels; very delirious; no sleep. On the second,

in the morning, loss of speech; acute fever; he sweated, fever did not

leave him; palpitations over the whole body, at night, convulsions. On

the third, all the symptoms exacerbated; he died.

Explanation of the characters. It is probable that the sweats and

convulsions caused death.

CASE V. In Larissa, a man, who was bald, suddenly was seized with

pain in the right thigh; none of the things which were administered

did him any good. On the first day, fever acute, of the ardent type,

not agitated, but the pains persisted. On the second, the pains in the

thigh abated, but the fever increased; somewhat tossed about; did

not sleep; extremities cold; passed a large quantity of urine, not

of a good character. On the third, the pain of the thigh ceased;

derangement of the intellect, confusion, and much tossing about. On

the fourth, about noon, he died. An acute disease.

CASE VI. In Abdera, Pericles was seized with a fever of the acute,

continual type, with pain; much thirst, nausea, could not retain his

drink; somewhat swelled about the spleen, with heaviness of the

head. On the first day, had hemorrhage from the left nostril, but

still the fever became more violent; passed much muddy, white urine,

which when allowed to stand did not subside. On the second day, all

the symptoms were exacerbated, yet the urine was thick, and more

inclined to have a sediment; the nausea less; he slept. On the

third, fever was milder; abundance of urine, which was concocted,

and had a copious sediment; passed a quiet night. On the fourth, had a

copious and warm sweat all over about noon; was free of fever, had a

crisis, no relapse. An acute affection.

CASE VII. In Abdera, the young woman who was lodged in the Sacred

Walk was seized with an ardent fever. She was thirsty, and could not

sleep; had menstruation for the first time. On the sixth, much nausea,

flushing, was chilly, and tossed about. On the seventh, in the same

state; urine thin,but of a good color; no disturbance about the

bowels. On the eighth, deafness, acute fever, insomnolency, nausea,

rigors, became collected; urine the same. On the ninth, in the same

state, and also on the following days; thus the deafness persisted. On

the fourteenth, disorder of the intellect; the fever abated. On the

seventeenth, a copious hemorrhage from the nose; the deafness slightly

better; and on the following days, nausea, deafness, and

incoherence. On the twentieth, pain of the feet; deafness and delirium

left her; a small hemorrhage from the nose; sweat, apyrexia. On the

twenty-fourth, the fever returned, deafness again; pain of the feet

remained; incoherence. On the twenty-seventh, had a copious sweat,

apyrexia; the deafness left her; the pain of her feet partly remained;

in other respects had a complete crisis.

Explanation of the characters. It is probable that the restoration

of health on the twentieth day was the result of the evacuation of

urine.

CASE VIII. In Abdera, Anaxion, who was lodged near the with Thracian

Gates, was seized with an acute fever; pain of the right dry cough,

without expectoration during the first days, thirst, insomnolency;

urine well colored, copious, and thin. On the sixth, delirious; no

relief from the warm applications. On the seventh, in a painful state,

for the fever while the pains did not abate, and the cough was

troublesome, and attended with dyspnoea. On the eighth, I opened a

vein at the elbow, and much blood, of a proper character, flowed;

the pains were abated, but the dry coughs continued. On the

eleventh, the fever diminished; slight sweats about the head;

coughs, with more liquid sputa; he was relieved. On the twentieth,

sweat, apyrexia; but after the crisis he was thirsty, and the

expectorations were not good. On the twenty-seventh the fever

relapsed; he coughed, and brought up much concocted sputa: sediment in

the urine copious and white; he became free of thirst, and the

respiration was good. On the thirty-fourth, sweated all over, apyrexia

general crisis.

Explanation of the characters. It is probable that the evacuation of

the sputa brought about the recovery on the thirty-fourth day.

CASE IX. In Abdera, Heropythus, while still on foot, had pain in the

head, and not long afterwards he took to bed; he lived near the High

Street. Was seized with acute fever of the ardent type; vomitings at

first of much bilious matter; thirst; great restlessness; urine

thin, black, substances sometimes floating high in it, and sometimes

not; passed the night in a painful state; paroxysms of the fever

diversified, and for the most part irregular. About the fourteenth

day, deafness; the fever increased; urine the same. On the twentieth

and following days, much delirium. On the thirtieth, copious

hemorrhage from the nose, and became more collected; deafness

continued, but less; the fever diminished; on the following days,

frequent hemorrhages, at short intervals. About the sixtieth, the

hemorrhages ceased, but violent pain of the hip-joint, and increase of

fever. Not long afterwards, pains of all the inferior rule, that

either the fever and deafness increased, or, pains of the inferior

parts were increased. About the eightieth day, all the complaints gave

way, without leaving any behind; for the urine was of a good color,

and had a copious sediment, while the delirium became less. About

the hundredth day, disorder of the bowels, with copious and bilious

evacuations, and these continued for a considerable time, and again

assumed the dysenteric form with pain; but relief of all the other

complaints. On the whole, the fevers went off, and the deafness

ceased. On the hundred and twentieth day, had a complete crisis.

Ardent fever.

Explanation of the characters. It is probable that the bilious

discharge brought about the recovery on the hundred and twentieth day.

CASE X. In Abdera, Nicodemus was seized with fever from venery and

drinking. At the commencement he was troubled with nausea and

cardialgia; thirsty, tongue was parched; urine thin and dark. On the

second day, the fever exacerbated; he was troubled with rigors and

nausea; had no sleep; vomited yellow bile; urine the same; passed a

quiet night, and slept. On the third, a general remission;

amelioration; but about sunset felt again somewhat uncomfortable;

passed an uneasy night. On the fourth, rigor, much fever, general

pains; urine thin, with substances floating in it; again a quiet

night. On the fifth, all the symptoms remained, but there was an

amelioration. On the sixth, some general pains; substances floating in

the urine; very incoherent. On the seventh, better. On the eighth, all

the other symptoms abated. On the tenth, and following days, there

were pains, but all less; in this case throughout, the paroxysms and

pains were greater on the even days. On the twentieth, the urine white

and thick, but when allowed to stand had no sediment; much sweat;

seemed to be free from fever; but again in the evening he became

hot, with the same pains, rigor, thirst, slightly incoherent. On the

twenty-fourth, urine copious, white, with an abundant sediment; a

copious and warm sweat all over; apyrexia; the fever came to its

crisis.

Explanation of the characters. It is probable that the cure was

owing to the bilious evacuations and the sweats.

CASE XI. In Thasus, a woman, of a melancholic turn of mind, from

some accidental cause of sorrow, while still going about, became

affected with loss of sleep, aversion to food, and had thirst and

nausea. She lived near the Pylates, upon the Plain. On the first, at

the commencement of night, frights, much talking, despondency,

slight fever; in the morning, frequent spasms, and when they ceased,

she was incoherent and talked obscurely; pains frequent, great and

continued. On the second, in the same state; had no sleep; fever

more acute. On the third, the spasms left her; but coma, and

disposition to sleep, and again awaked, started up, and could not

contain herself; much incoherence; acute fever; on that night a

copious sweat all over; apyrexia, slept, quite collected; had a

crisis. About the third day, the urine black, thin, substances

floating in it generally round, did not fall to the bottom; about

the crisis a copious menstruation.

CASE XII. In Larissa, a young unmarried woman was seized with a

fever of the acute and ardent type; insomnolency, thirst; tongue sooty

and dry; urine of a good color, but thin. On the second, in an

uneasy state, did not sleep. On the third, alvine discharges

copious, watery, and greenish, and on the following days passed such

with relief. On the fourth, passed a small quantity of thin urine,

having substances floating towards its surface, which did not subside;

was delirious towards night. On the sixth, a great hemorrhage from the

nose; a chill, with a copious and hot sweat all over; apyrexia, had

a crisis. In the fever, and when it had passed the crisis, the

menses took place for the first time, for she was a young woman.

Throughout she was oppressed with nausea, and rigors; redness of the

face; pain of the eyes; heaviness of the head; she had no relapse, but

the fever came to a crisis. The pains were on the even days.

CASE XIII. Apollonius, in Abdera, bore up (under the fever?) for

some time, without betaking himself to bed. His viscera were enlarged,

and for a considerable time there was a constant pain about the liver,

and then he became affected with jaundice; he was flatulent, and of

a whitish complexion. Having eaten beef, and drunk unseasonably, he

became a little heated at first, and betook himself to bed, and having

used large quantities of milk, that of goats and sheep, and both

boiled and raw, with a bad diet otherwise, great mischief was

occasioned by all these things; for the fever was exacerbated, and

of the food taken scarcely any portion worth mentioning was passed

from the bowels; the urine was thin and scanty; no sleep;

troublesome meteorism; much thirst; disposition to coma; painful

swelling of the right hypochondrium; extremities altogether coldish;

slight incoherence, forgetfulness of everything he said; he was beside

himself. About the fourteenth day after he betook himself to bed,

had a rigor, became heated, and was seized with furious delirium; loud

cries, much talking, again composed, and then coma came on; afterwards

the bowels disordered, with copious, bilious, unmixed, and

undigested stools; urine black, scanty, and thin; much restlessness;

alvine evacuations of varied characters, either black, scanty, and

verdigrisgreen, or fatty, undigested, and acrid; and at times the

dejections resembled milk. About the twenty-fourth, enjoyed a calm;

other matters in the same state; became somewhat collected; remembered

nothing that had happened since he was confined to bed; immediately

afterwards became delirious; every symptom rapidly getting worn. About

the thirtieth, acute fever; stools copious and thin; was delirious;

extremities cold; loss of speech. On the thirty-fourth he died. In

this case, as far as I saw, the bowels were disordered; urine thin and

black; disposition to coma; insomnolency; extremities cold;

delirious throughout. Phrenitis.

CASE XIV. In Cyzicus, a woman who had brought forth twin

daughters, after a difficult labor, and in whom the lochial

discharge was insufficient, at first was seized with an acute fever,

attended with chills; heaviness of the head and neck, with pain;

insomnolency from the commencement; she was silent, sullen, and

disobedient; urine thin, and devoid of color; thirst, nausea for the

most part; bowels irregularly disordered, and again constipated. On

the sixth, towards night, talked much incoherently; had no sleep.

About the eleventh day was seized with wild delirium, and again became

collected; urine black, thin, and again deficient, and of an oily

appearance; copious, thin, and disordered evacuations from the bowels.

On the fourteenth, frequent convulsions;extremities cold; not in

anywise collected; suppression of urine. On the sixteenth loss of

speech. On the seventeenth, she died. Phrenitis.

Explanation of the characters. It is probable that death was caused,

on the seventeenth day, by the affection of the brain consequent

upon her accouchement.

CASE XV. In Thasus, the wife of Dealces, who was lodged upon the

Plain, from sorrow was seized with an acute fever, attended with

chills. From first to last she wrapped herself up in her bedclothes;

still silent, she fumbled, picked, bored, and gathered hairs (from

them); tears, and again laughter; no sleep; bowels irritable, but

passed nothing; when directed, drank a little; urine thin and

scanty; to the touch of the hand the fever was slight; coldness of the

extremities. On the ninth, talked much incoherently, and again

became composed and silent. On the fourteenth, breathing rare,

large, at intervals; and again hurried respiration. On the

sixteenth, looseness of the bowels from a stimulant clyster;

afterwards she passed her drink, nor could retain anything, for she

was completely insensible; skin parched and tense. On the twentieth,

much talk, and again became composed; loss of speech; respiration

hurried. On the twenty-first she died. Her respiration throughout

was rare and large; she was totally insensible; always wrapped up in

her bedclothes; either much talk, or completely silent throughout.

Phrenitis.

CASE XVI. In Meliboea, a young man having become heated by

drinking and much venery, was confined to bed; he was affected with

rigors and nausea; insomnolency and absence of thirst. On the first

day much faeces passed from the bowels along with a copious flux;

and on the following days he passed many watery stools of a green

color; urine thin, scanty, and deficient in color; respiration rare,

large, at long intervals; softish distention of the hypochondrium,

of an oblong form, on both sides; continued palpitation in the

epigastric region throughout; passed urine of an oily appearance. On

the tenth, he had calm delirium, for he was naturally of an orderly

and quiet disposition; skin parched and tense; dejections either

copious and thin, or bilious and fatty. On the fourteenth, all the

symptoms were exacerbated; he became delirious, and talked much

incoherently. On the twentieth, wild delirium, On the twentieth,

wild delirium, jactitation, passed no urine; small drinks were

retained. On the twenty-fourth he died. Phrenitis.

-THE END-