EPIDEMICS I
FIRST CONSTITUTION
PART 1
I. IN Thasos during autumn, about the time of the equinox to near the setting of the Pleiades,1 there were many rains, gently continuous, with southerly winds. Winter southerly,2 north winds light, droughts ; on the whole, the winter was like a spring. Spring southerly and chilly ; slight showers. Summer in general cloudy. No rain. Etesian winds few, light and irregular.The whole weather proved southerly, with droughts, but early in the spring, as the previous constitution had proved the opposite and northerly, a few patients suffered from ardent fevers, and these very mild, causing hemorrhage in few cases and no deaths. Many had swellings beside one ear, or both ears, in most cases unattended with fever,3 so that confinement to bed was unnecessary. In some cases there was slight heat, but in all the swellings subsided without causing harm ; in no case was there suppuration such as attends swellings of other origin. This was the character of them :--flabby, big, spreading, with neither inflammation nor pain ; in every case they
[p. 149] disappeared without a sign.4 The sufferers were youths, young men, and men in their prime, usually those who frequented the wrestling school and gymnasia. Few women were attacked. Many had dry coughs which brought up nothing when they coughed, but their voices were hoarse. Soon after, though in some cases after some time, painful inflammations occurred either in one testicle or in both, sometimes accompanied with fever, in other cases not. Usually they caused much suffering. In other respects the people had no ailments requiring medical assistance.5
PART 2
II. Beginning early in the summer, throughout the summer and in winter many of those who had been ailing a long time took to their beds in a state of consumption, while many also who had hitherto been doubtful sufferers at this time showed undoubted symptoms. Some showed the symptoms now for the first time ; these were those whose constitution inclined to be consumptive. Many, in fact most of these, died ; of those who took to their beds I do not know one who survived even for a short time. Death came more promptly than is usual in consumption, and yet the other complaints, which will be described presently, though longer and attended with fever, were easily supported and did not prove fatal. For consumption was the worst of the diseases that occurred, and alone was responsible for the great mortality.In the majority of cases the symptoms were these. Fever with shivering, continuous, acute, not completely intermitting, but of the semitertian type ; remitting during one day they were exacerbated on the next, becoming on the whole more acute. Sweats
[p. 151] were continual, but not all over the body. Severe chill in the extremities, which with difficulty recovered their warmth. Bowels disordered, with bilious, scanty, unmixed, thin, smarting stools, causing the patient to get up often. Urine either thin, colourless,6 unconcocted and scanty, or thick and with a slight deposit, not settling favourably, but with a crude and unfavourable deposit. The patients frequently coughed up small, concocted sputa, brought up little by little with difficulty. Those exhibiting the symptoms in their most violent form showed no concoction at all, but continued spitting crude sputa. In the majority of these cases the throat was throughout painful from the beginning, being red and inflamed. Fluxes slight, thin, pungent. Patients quickly wasted away and grew worse, being throughout averse to all food and experiencing no thirst. Delirium in many cases as death approached. Such were the symptoms of the consumption.
PART 3
III. But when summer came, and during autumn occurred many continuous but not violent fevers, which attacked persons who were long ailing without suffering distress in any other particular manner ; for the bowels were in most cases quite easy, and hurt to no appreciable extent. Urine in most cases of good colour and clear, but thin, and after a time near the crisis it grew concocted. Coughing was slight, and caused no distress. No lack of appetite ; in fact it was quite possible even to give food. In general the patients did not sicken, as did the consumptives,[p. 153] with shivering fevers, but with slight sweats, the paroxysms being variable and irregular.7 The earliest crisis was about the twentieth day ; in most cases the crisis was about the fortieth day, though in many it was about the eightieth. In some cases the illness did not end in this way, but in an irregular manner without a crisis. In the majority of these cases the fevers relapsed after a brief interval, and after the relapse a crisis occurred at the end of the same periods as before. The disease in many of these instances was so protracted that it even lasted during the winter.
Out of all those described in this constitution only the consumptives showed a high mortality-rate ; for all the other patients bore up well, and the other fevers did not prove fatal.
SECOND CONSTITUTION
PART 4
IV. In Thasos early in autumn occurred unseasonable wintry storms, suddenly with many north and south winds bursting out into rains. These conditions continued until the setting of the Pleiades and during their season. Winter was northerly ; many violent and abundant rains ; snows ; generally there were fine intervals. With all this, however, the cold weather was not exceptionally unseasonable. But immediately after the winter solstice, when the west wind usually begins to blow, there was a return of severe wintry weather, much north wind, snow and[p. 155] copious rains continuously, sky stormy and clouded. These conditions lasted on, and did not remit before the equinox. Spring cold, northerly, wet, cloudy. Summer did not turn out excessively hot, the Etesian winds blowing continuously. But soon after, near the rising of Arcturus, there was much rain again, with northerly winds.
PART 5
V. The whole year having been wet, cold and northerly, in the winter the public health in most respects was good, but in early spring many, in fact most, suffered illnesses. Now there began at first inflammations of the eyes, marked by rheum, pain, and unconcocted discharges. Small gummy sores, in many cases causing distress when they broke out ; the great majority relapsed, and ceased late on the approach of autumn. In summer and autumn dysenteric diseases, tenesmus and lientery ; bilious diarrhœa, with copious, thin, crude, smarting stools ; in some cases it was also watery. In many cases there were also painful, bilious defluxions, watery, full of thin particles, purulent and causing strangury. No kidney trouble, but their various symptoms succeeded in various orders. Vomitings of phlegm, bile, and undigested food. Sweats ; in all cases much moisture over all the body. These complaints in many cases were unattended with fever, and the sufferers were not confined to bed ; but in many others there was fever, as I am going to describe. Those who showed all the symptoms mentioned above were consumptives who suffered pain. When autumn came, and during winter, continuous fevers--in some few cases ardent--day fevers, night fevers, semitertians, exact tertians, quartans, irregular fevers. Each of the fevers mentioned found many victims.[p. 157]
PART 6
VI. Now the ardent fevers attacked the fewest persons, and these were less distressed than any of the other sick. There was no bleeding from the nose, except very slight discharges in a few cases, and no delirium. All the other symptoms were slight. The crises of these diseases were quite regular, generally in seventeen days, counting the days of intermission, and I know of no ardent fever proving fatal at this time, nor of any phrenitis. The tertians were more numerous than the ardent fevers and more painful. But all these had four regular periods from the first onset, had complete crises in seven, and in no case relapsed. But the quartans, while in many instances they began at first with quartan periodicity, yet in not a few they became quartan by an abscession from other fevers or illnesses.8 They were protracted, as quartans usually are, or even more protracted than usual. Many fell victims to quotidians, night fevers, or irregular fevers, and were ill for a long time, either in bed or walking about. In most of these cases the fevers continued during the season of the Pleiades or even until winter. In many patients, especially children, there were convulsions and slight feverishness from the beginning ; sometimes, too, convulsions supervened upon fevers. Mostly these illnesses were protracted, but not dangerous, except for those who from all other causes were predisposed to die.
PART 7
VII. But those fevers which were altogether continuous and never intermitted at all, but in all cases[p. 159] grew worse after the manner of semitertians, with remission during one day followed by exacerbation during the next, were the most severe of all the fevers which occurred at this time, the longest and the most painful. Beginning mildly, and on the whole increasing always, with exacerbation, and growing worse, they had slight remissions followed quickly after an abatement by more violent exacerbations, generally becoming worse on the critical days. All patients had irregular rigors that followed no fixed law, most rarely and least in the semitertians,9 but more violent in the other fevers. Copious sweats, least copious in the semitertians ; they brought no relief, but on the contrary caused harm. These patients suffered great chill in the extremities, which grew warm again with difficulty. Generally there was sleeplessness, especially with the semitertians, followed afterwards by coma. In all the bowels were disordered and in a bad state, but in the semitertians they were far the worst. In most of them urine either (a） thin, crude, colourless, after a time becoming slightly concocted with signs of crisis, or (b) thick enough but turbid, in no way settling or forming sediment, or (c) with small, bad, crude sediments, these being the worst of all. Coughs attended the fevers, but I cannot say that either harm or good resulted from the coughing on this occasion.
PART 8
VIII. Now the greatest number of these symptoms continued to be protracted, troublesome, very disordered, very irregular, and without any critical signs, both in the case of those who came very near death[p. 161] and in the case of those who did not. For even if some patients enjoyed slight intermissions, there followed a quick relapse. A few of them experienced a crisis, the earliest being about the eightieth day, some of the latter having a relapse, so that most of them were still ill in the winter. The greatest number had no crisis before the disease terminated. These symptoms occurred in those who recovered just as much as in those who did not. The illnesses showed a marked absence of crisis and a great variety ; the most striking and the worst symptom, which throughout attended the great majority, was a complete loss of appetite, especially in those whose general condition exhibited fatal signs, but in these fevers they did not suffer much from unseasonable thirst. After long intervals, with many pains and with pernicious wasting, there supervened abscessions either too severe to be endured, or too slight to be beneficial, so that there was a speedy return of the original symptoms, and an aggravation of the mischief.10
PART 9
IX. The symptoms from which these patients suffered were dysenteries and tenesmus, lienteries also and fluxes. Some had dropsies also, either with or without these. Whenever any of these attacked violently they were quickly fatal, or, if mild, they did no good. Slight eruptions, which did not match the extent of the diseases and quickly disappeared again, or swellings by the ears that grew smaller11 and[p. 163] signified nothing, in some cases appearing at the joints, especially the hip-joint, in few instances leaving with signs of crisis, when they quickly re-established themselves in their original state.
PART 10
X. From all the diseases some died, but the greatest number from these fevers,12 especially children--those just weaned, older children of eight or ten years, and those approaching puberty. These victims never suffered from the latter symptoms without the first I have described above, but often the first without the latter. The only good sign, the most striking that occurred, which saved very many of those who were in the greatest danger, was when there was a change to strangury, into which abscessions took place. The strangury, too, came mostly to patients of the ages mentioned, though it did happen to many of the others, either without their taking to bed or when they were ill. Rapid and great was the complete change that occurred in their case. For the bowels, even if they were perniciously loose, quickly recovered ; their appetite for everything returned, and hereafter the fever abated. But the strangury, even in these cases, was long and painful. Their urine was copious, thick, varied, red, mixed with pus, and passed with pain. But they all survived, and I know of none of these that died.
PART 11
XI. In all dangerous cases you should be on the watch for all favourable coctions of the evacuations from all parts, or for fair and critical abscessions. Coctions signify nearness of crisis and sure recovery[p. 165] of health, but crude and unconcocted evacuations, which change into bad abscessions, denote absence of crisis, pain, prolonged illness, death, or a return of the same symptoms. But it is by a consideration of other signs that one must decide which of these results will be most likely. Declare the past, diagnose the present, foretell the future ; practise these acts. As to diseases, make a habit of two things--to help, or at least to do no harm. The art has three factors, the disease, the patient, the physician. The physician is the servant of the art. The patient must co-operate with the physician in combating the disease.
PART 12
XII. Pains about the head and neck, and heaviness combined with pain, occur both without and with fever. Sufferers from phrenitis have convulsions, and eject verdigris-coloured vomit ; some die very quickly. But in ardent and the other fevers, those with pain in the neck, heaviness of the temples, dimness of sight, and painless tension of the hypochondrium, bleed from the nose ; those with a general heaviness of the head, cardialgia, and nausea, vomit afterwards bile and phlegm. Children for the most part in such cases suffer chiefly from the convulsions. Women have both these symptoms and pains in the womb. Older people, and those whose natural heat is failing, have paralysis or raving or blindness.
THIRD CONSTITUTION
PART 13
XIII. In Thasos a little before and at the season of Arcturus many violent rains with northerly winds. About the equinox until the setting of the Pleiades[p. 167] slight, southerly rains. Winter northerly, droughts, cold periods, violent winds, snow. About the equinox very severe storms. Spring northerly, droughts, slight rains, periods of cold. About the summer solstice slight showers, periods of great cold until near the Dog Star. After the Dog Star, until Arcturus, hot summer. Great heat, not intermittent but continuous and severe. No rain fell. The Etesian winds blew. About Arcturus southerly rains until the equinox.
PART 14
XIV. In this constitution during winter began paralyses which attacked many, a few of whom quickly died. In fact, the disease was generally epidemic. In other respects the public health continued good. Early in spring began ardent fevers which continued until the equinox and on to summer. Now those who began to be ill at once, in spring or the beginning of summer, in most cases got well, though a few died ; but when autumn and the rains came the cases were dangerous, and more died.As to the peculiarities of the ardent fevers, the most likely patients to survive were those who had a proper and copious bleeding from the nose, in fact I do not know of a single case in this constitution that proved fatal when a proper bleeding occurred, For Philiscus and Epaminon and Silenus, who died, had only a slight epistaxis on the fourth and fifth days. Now the majority of the patients had rigors near the
[p. 169] crisis, especially such as had no epistaxis, but these had sweats also as well as rigors.
PART 15
XV. Some had jaundice on the sixth day, but these were benefited by either a purging through the bladder or a disturbance of the bowels or a copious hemorrhage, as was the case with Heraclides, who lay sick at the house of Aristocydes. This patient, however, who had a crisis on the twentieth day, not only bled from the nose, but also experienced disturbance of the bowels and a purging through the bladder. Far otherwise was it with the servant of Phanagoras, who had none of these symptoms, and died. But the great majority had hemorrhage, especially youths and those in the prime of life, and of these the great majority who had no hemorrhage died. Older people had jaundice or disordered bowels, for example Bion, who lay sick at the house of Silenus. Dysenteries also were general in summer, and some too of those who had fallen ill, and also suffered from hemorrhage, finally had dysentery ; for example, the slave of Erato and Myllus, after copious hemorrhage, lapsed into dysentery. They recovered.This humour,13 then, especially was in great abundance, since even those who had no hemorrhage near the crisis, but swellings by the ears which disappeared--and after their disappearance there was a heaviness along the left flank up to the extremity of the hip--after the crisis had pain and passed thin urine, and then began to suffer slight hemorrhage about the twenty-fourth day, and
[p. 171] abscessions into hemorrhage occurred. In the case of Antipho, son of Critobulus, the illness ceased and came to a complete crisis about the fortieth day.
PART 16
XVI. Though many women fell ill, they were fewer than the men and less frequently died. But the great majority had difficult childbirth, and after giving birth they would fall ill, and these especially died, as did the daughter of Telebulus on the sixth day after delivery. Now menstruation appeared during the fevers in most cases, and with many maidens it occurred then for the first time. Some bled from the nose. Sometimes both epistaxis and menstruation appeared together ; for example, the maiden daughter of Daitharses had her first menstruation during fever and also a violent discharge from the nose. I know of no woman who died if any of these symptoms showed themselves properly, but all to my knowledge had abortions if they chanced to fall ill when with child.
PART 17
XVII. Urine in most cases was of good colour, but thin and with slight sediments, and the bowels of most were disordered with thin, bilious excretions. Many after a crisis of the other symptoms ended with dysentery, as did Xenophanes and Critias. I will mention cases in which was passed copious, watery, clear and thin urine, even after a crisis in other respects favourable, and a favourable sediment : Bion, who lay sick at the house of Silenus, Cratis, who lodged with Xenophanes, the slave of Areto, and the wife of Mnesistratus. Afterwards all these suffered from dysentery.About the season of Arcturus many had crisis on
[p. 173] the eleventh day, and these did not suffer even the normal relapses. There were also comatose fevers about this time, usually in children, and of all patients these showed the lowest mortality.
PART 18
XVIII. About the equinox up to the setting of the Pleiades, and during winter, although the ardent fevers continued, yet cases of phrenitis were most frequent at this time, and most of them were fatal. In summer, too, a few cases had occurred. Now the sufferers from ardent fever, when fatal symptoms attended, showed signs at the beginning. For right from the beginning there was acute fever with slight rigors, sleeplessness, thirst, nausea, slight sweats about the forehead and collar-bones, but in no case general, much delirium, fears, depression, very cold extremities, toes and hands, especially the latter. The exacerbations on the even days ; but in most cases the pains were greatest on the fourth day, with sweat for the most part chilly, while the extremities could not now be warmed again, remaining livid and cold ; and in these cases the thirst ceased. Their urine was scanty, black, thin, with constipation of the bowels. Nor was there hemorrhage from the nose in any case when these symptoms occurred, but only slight epistaxis. None of these cases suffered relapse, but they died on the sixth day, with sweating. The cases of phrenitis had all the above symptoms, but the crises generally occurred on the eleventh day. Some had their crises on the twentieth day, namely those in whom the phrenitis did not begin at first, or began about the third or fourth day, but[p. 175] though these fared tolerably at the beginning, yet the disease assumed an acute form about the seventh day.
PART 19
XIX. Now the number of illnesses was great. And of the patients there died chiefly striplings, young people, people in their prime, the smooth, the fair-skinned, the straight-haired, the black-haired, the black-eyed, those who had lived recklessly and care-lessly, the thin-voiced, the rough-voiced, the lispers, the passionate. Women too died in very great numbers who were of this kind. In this constitution there were four symptoms especially which denoted recovery :--a proper hemorrhage through the nostrils ; copious discharges by the bladder of urine with much sediment of a proper character ; disordered bowels with bilious evacuations at the right time ; the appearance of dysenteric characteristics. The crisis in many cases did not come with one only of the symptoms described above, but in most cases all symptoms were experienced, and the patients appeared to be more distressed ; but all with these symptoms got well. Women and maidens experienced all the above symptoms, but besides, whenever any took place properly, and whenever copious menstruation supervened, there was a crisis therefrom which resulted in recovery ; in fact I know of no woman who died when any of these symptoms took place properly. For the daughter of Philo, who died, though she had violent epistaxis, dined rather unseasonably on the seventh day.In acute fevers, more especially in ardent fevers, when involuntary weeping occurs, epistaxis is to be
[p. 177] expected it the patient have no fatal symptoms besides ; for when he is in a bad way such weeping portends not hemorrhage but death.
PART 20
XX. The painful swellings by the ears in fevers in some cases neither subsided nor suppurated when the fever ceased with a crisis. They were cured by bilious diarrhœa, or dysentery, or a sediment of thick urine such as closed the illness of Hermippus of Clazomenæ. The circumstances of the crises, from which too I formed my judgments, were either similar or dissimilar ; for example, the two brothers, who fell sick together at the same time, and lay ill near the bungalow of Epigenes. The elder of these had a crisis on the sixth day, the younger on the seventh. Both suffered a relapse together at the same time with an intermission of five days. After the relapse both had a complete crisis together on the seventeenth day. But the great majority had a crisis on the sixth day, with an intermission of six days followed by a crisis on the fifth day after the relapse. Those who had a crisis on the seventh day had an intermission of seven days, with a crisis on the third day after the relapse. Others with a crisis on the seventh had an intermission of three days, with a crisis on the seventh day after the relapse. Some who had a crisis on the sixth day had an intermission of six and a relapse of three, an intermission of one and a relapse of one, followed by a crisis ; for example, Euagon the son of Daitharses. Others with a crisis on the sixth had an intermission of seven days, and after the relapse a crisis on the fourth ; for example, the daughter of Aglai+das. Now most of those who fell ill in this constitution went through their illness in this manner, and none of[p. 179] those who recovered, so far as I know, failed to suffer the relapses which were normal in these cases, but all, so far as I know, recovered if their relapses took place after this fashion. Further, I know of none who suffered a fresh relapse after going through the illness in the manner described above.
PART 21
XXI. In these diseases most died on the sixth day, as did Epaminondas, Silenus and Philiscus the son of Antagoras. Those who had the swellings by the ears had a crisis on the twentieth day, but these subsided in all cases without suppuration, being diverted to the bladder. There were two cases of suppuration, both fatal, Cratistonax, who lived near the temple of Heracles, and the serving-maid of Scymnus the fuller. When there was a crisis on the seventh day, with an intermission of nine days followed by a relapse, there was a second crisis on the fourth day after the relapse--in the case of Pantacles, for example, who lived by the temple of Dionysus. When there was a crisis on the seventh day, with an intermission of six days followed by a relapse, there was a second crisis on the seventh day after the relapse--in the case of Phanocritus, for example, who lay sick at the house of Gnathon the fuller.
PART 22
XXII. During winter, near the time of the winter solstice, and continuing until the equinox, the ardent fevers and the phrenitis still caused many deaths, but their crises changed. Most cases had a crisis on the fifth day from the outset, then intermitted four days, relapsed, had a crisis on the fifth day after the relapse, that is, after thirteen days altogether. Mostly children experienced crises thus, but older people did so too. Some had a crisis[p. 181] on the eleventh day, a relapse on the fourteenth, and a complete crisis on the twentieth. But if rigor came on about the twentieth day the crisis came on the fortieth. Most had rigors near the first crisis, and those who had rigors at first near the crisis, had rigors again in the relapses at the time of the crisis. Fewest experienced rigors in the spring, more in summer, more still in autumn, but by far the most during winter. But the hemorrhages tended to cease.
PART 23
XXIII. The following were the circumstances attending the diseases, from which I framed my judgments, learning from the common nature of all and the particular nature of the individual, from the disease, the patient, the regimen prescribed and the prescriber--for these make a diagnosis more favourable or less ; from the constitution, both as a whole and with respect to the parts, of the weather and of each region ; from the custom, mode of life, practices and ages of each patient ; from talk, manner, silence, thoughts, sleep or absence of sleep, the nature and time of dreams, pluckings, scratchings, tears ; from the exacerbations, stools, urine, sputa, vomit, the antecedents and consequents of each member in the successions of diseases, and the abscessions to a fatal issue or a crisis, sweat, rigor, chill, cough, sneezes, hiccoughs, breathing, belchings, flatulence, silent or noisy, hemorrhages, and hemorrhoids. From these things must we consider what their consequents also will be.
PART 24
XXIV. Some fevers are continuous, some have an access during the day and an intermission during the night, or an access during the night and an intermission during the day ; there are semitertians,[p. 183] tertians, quartans, quintans, septans, nonans. The most acute diseases, the most severe, difficult and fatal, belong to the continuous fevers. The least fatal and least difficult of all, but the longest of all, is the quartan. Not only is it such in itself, but it also ends other, and serious, diseases. In the fever called semitertian, which is more fatal than any other, there occur also acute diseases, while it especially precedes the illness of consumptives, and of those who suffer from other and longer diseases. The nocturnal is not very fatal, but it is long. The diurnal is longer still, and to some it also brings a tendency to consumption. The septan is long but not fatal. The nonan is longer still but not fatal. The exact tertian has a speedy crisis and is not fatal. But the quintan is the worst of all. For if it comes on before consumption or during consumption the patient dies.
PART 25
XXV. Each of these fevers has its modes, its constitutions and its exacerbations. For example, a continuous fever in some cases from the beginning is high and at its worst, leading up to the most severe stage, but about and at the crisis it moderates. In other cases it begins gently and in a suppressed manner, but rises and is exacerbated each day, bursting out violently near the crisis. In some cases it begins mildly, but increases and is exacerbated, reaching its height after a time ; then it declines again until the crisis or near the crisis. These characteristics may show themselves in any fever and in any disease. It is necessary also to consider the patient's mode of life and to take it[p. 185] into account when prescribing. Many other important symptoms there are which are akin to these, some of which I have described, while others I shall describe later. These must be duly weighed when considering and deciding who is suffering from one of these diseases in an acute, fatal form, or whether the patient may recover ; who has a chronic, fatal illness, or one from which he may recover ; who is to be prescribed for or not, what the prescription is to be, the quantity to be given and the time to give it.
PART 26
XXVI. When the exacerbations are on even days, the crises are on even days. But the diseases exacerbated on odd days have their crises on odd days. The first period of diseases with crises on the even days is the fourth day, then the sixth, eighth, tenth, fourteenth, twentieth, twenty-fourth, thirtieth, fortieth, sixtieth, eightieth, hundred and twentieth. Of those with a crisis on the odd days the first period is the third, then the fifth, seventh, ninth, eleventh, seventeenth, twenty-first, twenty-seventh, thirty-first. Further, one must know that, if the crises be on other days than the above, there will be relapses, and there may also be a fatal issue. So one must be attentive and know that at these times there will be the crises resulting in recovery, or death, or a tendency for better or worse. One must also consider in what periods the crises occur of irregular fevers, of quartans, of quintans, of septans and of nonans.[p. 187]
FOURTEEN CASES
CASE I
Philiscus lived by the wall. He took to his bed with acute fever on the first day and sweating ; night uncomfortable.Second day. General exacerbation, later a small clyster moved the bowels well. A restful night.
Third day. Early and until mid-day he appeared to have lost the fever ; but towards evening acute fever with sweating ; thirst ; dry tongue ; black urine. An uncomfortable night, without sleep ; completely out of his mind.
Fourth day. All symptoms exacerbated ; black urine ; a more comfortable night, and urine of a better colour.
Fifth day. About mid-day slight epistaxis of unmixed blood. Urine varied, with scattered, round particles suspended in it, resembling semen ; they did not settle. On the application of a suppository the patient passed, with flatulence, scanty excreta. A distressing night, snatches of sleep, irrational talk ; extremities everywhere cold, and would not get warm again ; black urine ; snatches of sleep towards dawn ; speechless ; cold sweat ; extremities livid. About mid-day on the sixth day the patient died. The breathing throughout, as though he were recollecting to do it,14 was rare and large. Spleen raised in a round swelling ; cold sweats all the time. The exacerbations on even days.
CASE II
Silenus lived on Broadway near the place of Eualcidas. After over-exertion, drinking, and exercises[p. 189] at the wrong time he was attacked by fever. He began by having pains in the loins, with heaviness in the head and tightness of the neck. From the bowels on the first day there passed copious discharges of bilious matter, unmixed, frothy, and highly coloured. Urine black, with a black sediment ; thirst ; tongue dry ; no sleep at night.
Second day. Acute fever, stools more copious, thinner, frothy ; urine black ; uncomfortable night ; slightly out of his mind.
Third day. General exacerbation ; oblong tightness15 of the hypochondrium, soft underneath, extending on both sides to the navel ; stools thin, blackish ; urine turbid, blackish ; no sleep at night ; much rambling, laughter, singing ; no power of restraining himself.
Fourth day. Same symptoms.
Fifth day. Stools unmixed, bilious, smooth, greasy ; urine thin, transparent ; lucid intervals.
Sixth day. Slight sweats about the head ; extremities cold and livid ; much tossing ; nothing passed from the bowels ; urine suppressed ; acute fever.
Seventh day. Speechless ; extremities would no longer get warm ; no urine.
Eighth day. Cold sweat all over ; red spots with sweat, round, small like acne, which persisted without subsiding. From the bowels with slight stimulus
[p. 191] there came a copious discharge of solid stools, thin,16 as it were unconcocted, painful. Urine painful and irritating. Extremities grow a little warmer ; fitful sleep ; coma ; speechlessness ; thin, transparent urine.
Ninth day. Same symptoms.
Tenth day. Took no drink ; coma ; fitful sleep. Discharges from the bowels similar ; had a copious discharge of thickish urine, which on standing left a farinaceous, white deposit ; extremities again cold.
Eleventh day. Death.
From the beginning the breath in this case was throughout rare and large. Continuous throbbing of the hypochondrium ; age about twenty years.
CASE III
Herophon had acute fever ; scanty stools with tenesmus at the beginning, afterwards becoming thin, bilious and fairly frequent. No sleep ; urine black and thin.Fifth day. Deafness early in the day ; general exacerbation ; spleen swollen ; tension of the hypochondrium ; scanty black stools ; delirium.
Sixth day. Wandering talk ; at night sweat and chill ; the wandering persisted.
Seventh Day. Chill all over ; thirst ; out of his mind. During the night he was rational, and slept.
Eighth day. Fever ; spleen lessened ; quite rational ; pain at first in the groin, on the side of the spleen ; then the pains extended to both legs. Night comfortable ; urine of a better colour, with a slight deposit.
Ninth day. Sweat, crisis, intermission.
[p. 193] On the fifth day after the crisis the patient relapsed. Immediately the spleen swelled ; acute fever ; return of deafness. On the third day after the relapse the spleen grew less and the deafness diminished, but there was pain in the legs. During the night he sweated. The crisis was about the seventeenth day. There was no delirium during the relapse.
CASE IV
In Thasos the wife of Philinus gave birth to a daughter. The lochial discharge was normal, and the mother was doing well when on the fourteenth day after delivery she was seized with fever attended with rigor. At first she suffered in the stomach and the right hypochondrium. Pains in the genital organs. The discharge ceased. By a pessary these troubles were eased, but pains persisted in the head, neck and loins. No sleep ; extremities cold ; thirst ; bowels burnt ; scanty stools ; urine thin, and at first colourless.Sixth day. Much delirium at night, followed by recovery of reason.
Seventh day. Thirst ; stools scanty, bilious, highly coloured.
Eighth day. Rigor ; acute fever ; many painful convulsions ; much delirium. The application of a suppository made her keep going to stool, and there were copious motions with a bilious flux. No sleep.
Ninth day. Convulsions.
Tenth day. Lucid intervals.
Eleventh day. Slept ; complete recovery of her memory, followed quickly by renewed delirium.
[p. 195] A copious passing of urine with convulsions--her attendants seldom reminding her--which was white and thick, like urine with a sediment and then shaken ; it stood for a long time without forming a sediment ; colour and consistency like that of the urine of cattle. Such was the nature of the urine that I myself saw.
About the fourteenth day there were twitchings over all the body ; much wandering, with lucid intervals followed quickly by renewed delirium. About the seventeenth day she became speechless.
Twentieth day. Death.
CASE V
The wife of Epicrates, who lay sick near the founder,17 when near her delivery was seized with severe rigor without, it was said, becoming warm, and the same symptoms occurred on the following day. On the third day she gave birth to a daughter, and the delivery was in every respect normal. On the second day after the delivery she was seized with acute fever, pain at the stomach and in the genitals. A pessary relieved these symptoms, but there was pain in the head, neck and loins. No sleep. From the bowels passed scanty stools, bilious, thin and unmixed. Urine thin and blackish. Delirium on the night of the sixth day from the day the fever began.Seventh day. All symptoms exacerbated ; sleeplessness ; delirium ; thirst ; bilious, highly-coloured stools.
Eighth day. Rigor ; more sleep.
Ninth day. The same symptoms.
[p. 197] Tenth day. Severe pains in the legs ; pain again at the stomach ; heaviness in the head ; no delirium ; more sleep ; constipation.
Eleventh day. Urine of better colour, with a thick deposit ; was easier.
Fourteenth day. Rigor ; acute fever.
Fifteenth day. Vomited fairly frequently bilious, yellow vomit ; sweated without fever ; at night, however, acute fever ; urine thick, with a white sediment.
Sixteenth day. Exacerbation ; an uncomfortable night ; no sleep ; delirium.
Eighteenth day. Thirst ; tongue parched ; no sleep ; much delirium ; pain in the legs.
About the twentieth day. Slight rigors in the early morning ; coma ; quiet sleep ; scanty, bilious, black vomits ; deafness at night.
About the twenty-first day. Heaviness all over the left side, with pain ; slight coughing ; urine thick, turbid, reddish, no sediment on standing. In other respects easier ; no fever. From the beginning she had pain in the throat ; redness ; uvula drawn back ; throughout there persisted an acrid flux, smarting, and salt.
About the twenty-seventh day. No fever ; sediment in urine ; some pain in the side.
About the thirty-first day. Attacked by fever ; bowels disordered and bilious.
Fortieth day. Scanty, bilious vomits.
Eightieth day. Complete crisis with cessation of fever.
CASE VI
Cleanactides, who lay sick above the temple of Heracles, was seized by an irregular fever. He had[p. 199] at the beginning pains in the head and the left side, and in the other parts pains like those caused by fatigue. The exacerbations of the fever were varied and irregular ; sometimes there were sweats, sometimes there were not. Generally the exacerbations manifested themselves most on the critical days.
About the twenty-fourth day. Pain in the hands ; bilious, yellow vomits, fairly frequent, becoming after a while like verdigris ; general relief.
About the thirtieth day. Epistaxis from both nostrils began, and continued, irregular and slight, until the crisis. All the time he suffered no thirst, nor lack of appetite or sleep. Urine thin, and not colourless.
About the fortieth day. Urine reddish, and with an abundant, red deposit. Was eased. Afterwards the urine varied, sometimes having, sometimes not having, a sediment.
Sixtieth day. Urine had an abundant sediment, white and smooth ; general improvement ; fever intermitted ; urine again thin but of good colour.
Seventieth day. Fever, which intermitted for ten days.
Eightieth day. Rigor ; attacked by acute fever ; much sweat ; in the urine a red, smooth sediment. A complete crisis.
CASE VII
Meton was seized with fever, and painful heaviness in the loins.Second day. After a fairly copious draught of water had his bowels well moved.
Third day. Heaviness in the head ; stools thin, bilious, rather red.
[p. 201] Fourth day. General exacerbation ; slight epistaxis twice from the right nostril. An uncomfortable night ; stools as on the third day ; urine rather black ; had a rather black cloud floating in it, spread out, which did not settle.
Fifth day. Violent epistaxis of unmixed blood from the left nostril ; sweat ; crisis. After the crisis sleeplessness ; wandering ; urine thin and rather black. His head was bathed ; sleep ; reason restored. The patient suffered no relapse, but after the crisis bled several times from the nose.
CASE VIII
Erasinus lived by the gully of Boétes. Was seized with fever after supper ; a troubled night.First day. Quiet, but the night was painful.
Second day. General exacerbation ; delirium at night.
Third day. Pain and much delirium.
Fourth day. Very uncomfortable ; no sleep at night ; dreams and wandering. Then worse symptoms, of a striking and significant character ; fear and discomfort.
Fifth day. Early in the morning was composed, and in complete possession of his senses. But long before mid-day was madly delirious ; could not restrain himself ; extremities cold and rather livid ; urine suppressed ; died about sunset.
In this patient the fever was throughout accompanied by sweat ; the hypochondria were swollen, distended and painful. Urine black, with round, suspended particles which did not settle. There were solid discharges from the bowels. Thirst
[p. 203] throughout not very great. Many convulsions with sweating about the time of death.
CASE IX
Crito, in Thasos, while walking about, was seized with a violent pain in the great toe. He took to bed the same day with shivering and nausea ; regained a little warmth ; at night was delirious.Second day. Swelling of the whole foot, which was rather red about the ankle, and distended ; black blisters ; acute fever ; mad delirium. Alvine discharges unmixed, bilious and rather frequent. He died on the second day from the commencement.
CASE X
The man of Clazomenae, who lay sick by the well of Phrynichides, was seized with fever. Pain at the beginning in head, neck and loins, followed immediately by deafness. No sleep ; seized with acute fever ; hypochondrium swollen, but not very much ; distension ; tongue dry.Fourth day. Delirium at night.
Fifth day. Painful.
Sixth day. All symptoms exacerbated.
About the eleventh day slight improvement. From the beginning to the fourteenth day there were from the bowels thin discharges, copious, of a watery biliousness ; they were well supported by the patient. Then the bowels were constipated. Urine throughout thin, but of good colour. It had much cloud spread through it, which did not settle in a sediment. About the sixteenth day the urine was a little thicker, and had a slight sediment.
[p. 205] The patient became a little easier, and was more rational.
Seventeenth day. Urine thin again ; painful swellings by both ears. No sleep ; wandering ; pain in the legs.
Twentieth day. A crisis left the patient free from fever ; no sweating ; quite rational. About the twenty-seventh day violent pain in the right hip, which quickly ceased. The swellings by the ears neither subsided nor suppurated, but continued painful. About the thirty-first day diarrhéa with copious, watery discharges and signs of dysentery. Urine thick ; the swellings by the ears subsided.
Fortieth day. Pain in the right eye ; sight rather impaired ; recovery.
CASE XI
The wife of Dromeades, after giving birth to a daughter, when everything had gone normally, on the second day was seized with rigor ; acute fever. On the first day she began to feel pain in the region of the hypochondrium ; nausea ; shivering ; restless ; and on the following days did not sleep. Respiration rare, large, interrupted at once as by an inspiration.18Second day from rigor. Healthy action of the bowels. Urine thick, white, turbid, like urine which has settled, stood a long time, and then been stirred up. It did not settle. No sleep at night.
Third day. At about mid-day rigor ; acute fever ; urine similar ; pain in the hypochondrium ; nausea ; an uncomfortable night without sleep ; a cold sweat all over the body, but the patient quickly recovered heat.
[p. 207] Fourth day. Slight relief of the pains about the hypochondrium ; painful heaviness of the head ; somewhat comatose ; slight epistaxis ; tongue dry ; thirst ; scanty urine, thin and oily ; snatches of sleep.
Fifth day. Thirst ; nausea ; urine similar ; no movement of the bowels ; about mid-day much delirium, followed quickly by lucid intervals ; rose, but grew somewhat comatose ; slight chilliness ; slept at night ; was delirious.
Sixth day. In the morning had a rigor ; quickly recovered heat ; sweated all over ; extremities cold ; was delirious ; respiration large and rare. After a while convulsions began from the head, quickly followed by death.
CASE XII
A man dined when hot and drank too much. During the night he vomited everything ; acute fever ; pain in the right hypochondrium ; inflammation, soft underneath, from the inner part19; an uncomfortable night ; urine at the first thick and red ; on standing it did not settle ; tongue dry ; no great thirst.Fourth day. Acute fever ; pains all over.
Fifth day. Passed much smooth, oily urine ; acute fever.
Sixth day. In the afternoon much delirium. No sleep at night.
Seventh day. General exacerbation ; urine similar ; much rambling ; could not restrain himself ; on stimulation the bowels passed watery, disturbed discharges, with worms. An uncomfortable night, with rigor in the morning. Acute fever. Hot sweat, and the patient seemed to lose his fever ;
[p. 209] little sleep, followed by chilliness ; expectoration. In the evening much delirium, and shortly afterwards he vomited black, scanty, bilious vomits.
Ninth day. Chill ; much wandering ; no sleep.
Tenth day. Legs painful ; general exacerbation ; wandering.
Eleventh day. Death.
CASE XIII
A woman lying sick by the shore, who was three months gone with child, was seized with fever, and immediately began to feel pains in the loins.Third day. Pain in the neck and in the head, and in the region of the right collar-bone. Quickly she lost her power of speech, the right arm was paralyzed, with a convulsion, after the manner of a stroke ; completely delirious. An uncomfortable night, without sleep ; bowels disordered with bilious, unmixed, scanty stools.
Fourth day. Her speech was recovered, but was indistinct ; convulsions ; pains of the same parts remained ; painful swelling in the hypochondrium ; no sleep ; utter delirium ; bowels disordered ; urine thin, and not of good colour.
Fifth day. Acute fever ; pain in the hypochondrium ; utter delirium ; bilious stools. At night sweated ; was without fever.
Sixth day. Rational ; general relief, but pain remained about the left collar-bone ; thirst ; urine thin ; no sleep.
Seventh day. Trembling ; some coma ; slight delirium ; pains in the region of the collar-bone and left upper arm remained ; other symptoms
[p. 211] relieved ; quite rational. For three days there was an intermission of fever.
Eleventh day. Relapse ; rigor ; attack of fever. But about the fourteenth day the patient vomited bilious, yellow matter fairly frequently ; sweated ; a crisis took off the fever.
CASE XIV
Melidia, who lay sick by the temple of Hera, began to suffer violent pain in the head, neck and chest. Immediately she was attacked by acute fever, and there followed a slight menstrual flow. There were continuous pains in all these parts.Sixth day. Coma ; nausea ; shivering ; flushed cheeks ; slight delirium.
Seventh day. Sweat ; intermittence of fever ; the pains persisted ; relapse ; snatches of sleep ; urine throughout of good colour but thin ; stools thin, bilious, irritating, scanty, black and of bad odour ; sediment in the urine white and smooth ; sweating.
Eleventh day. Perfect crisis.
