Of the Epidemics
By Hippocrates
Commentary: A few comments have been posted about
Of the Epidemics.
Download: A
text-only version is available for download.
Of the Epidemics
By Hippocrates
Written 400 B.C.E
Translated by Francis Adams
Section 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.
Section 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.
Section 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 i. 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 ii. 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 v. 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 i. 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 ii. 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 iii. 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 x. 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 i. 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 ii. 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 iii. 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 iv. 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.
© 1994-2009
