diff --git a/data/tlg0627/tlg006/tlg0627.tlg006.perseus-eng4.xml b/data/tlg0627/tlg006/tlg0627.tlg006.perseus-eng4.xml new file mode 100644 index 000000000..3d77daead --- /dev/null +++ b/data/tlg0627/tlg006/tlg0627.tlg006.perseus-eng4.xml @@ -0,0 +1,644 @@ + + + + + + +Epidemics I and III +Hippocrates +William Henry Samuel Jones + +Gregory Crane + +Prepared under the supervision of +Bridget Almas +Lisa Cerrato +Rashmi Singhal + +National Library of Medicine History of Medicine Division + + + +Cultural Heritage Language Technologies +Kansas City Missouri +February 1, 2005 + +Trustees of Tufts University +Medford, MA +Perseus Digital Library Project +Perseus 4.0 +tlg0627.tlg006.perseus-eng4.xml + +Available under a Creative Commons Attribution-ShareAlike 4.0 International License + + + + + + +Hippocrates +Hippocrates +William Henry Samuel Jones + +London +William Heinemann Ltd. +Cambridge, MA +Harvard University Press +1923 + +1 + +Loeb Classical Library +Internet Archive + + + + + + + +

Data Entry

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This pointer pattern extracts book, section, and subsection.

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This pointer pattern extracts book and section.

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This pointer pattern extracts book.

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+EPIDEMICS I +
+FIRST CONSTITUTION +
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IN Thasos during autumn, about the time of the equinox to near the setting of the Pleiades,ὑπδ in expressions denoting time seems in Hippocrates to mean about or during. The period is roughly from September 21 to November 8. there were many rains, gently continuous, with southerly winds. Winter southerly,That is, the winds were generally from the south, and such north winds as blew were light. 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.

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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,Or, punctuating after ͂̔ωτα and πλείστοισιν, There were swellings beside the ears, in many cases on one side, but in most on both. The epidemio was obviously mumps. 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 disappeared without a sign.That is, with no symptoms indicative of a crisis. 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.That is, nobody was ill enough to make a visit to the physician’s surgery (ἱητρεῖον) necessary.

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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.

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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 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,Throughout Epidemics ἂχρως may mean, not merely without colour, but of bad colour. It certainly has this meaning in Airs Waters Places, VII, l. ii. See p. 85. 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.

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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, with shivering fevers, but with slight sweats, the paroxysms being variable and irregular.The words omitted by Kéhlewein mean not intermitting altogether, but with exacerbations after the manner of tertians. 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.

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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.

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+SECOND CONSTITUTION +
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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 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.

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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 feversin some few cases ardentday fevers, night fevers, semitertians, exact tertians, quartans, irregular fevers. Each of the fevers mentioned found many victims.

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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.There are often mixed infections in malaria. If the quartan be one of these, being the longest it outlasts the others. So the disease appears to have turned into a quartan. 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.

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But those fevers which were altogether continuous and never intermitted at all, but in all cases 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,I take the pronoun αὖτος throughout this chapter to refer to the remittent semitertian, or to sufferers from it. 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.

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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 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.That is, the abscessions did not carry off the morbid humours, which spread again throughout the system.

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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 smallerμωλυόμενα would mean remained crude. and 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.

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From all the diseases some died, but the greatest number from these fevers,It is not clear to what πάντων and τούτων refer. Probably πάντων refers to all the semitertians, and τούτων to the special type of them described in Chapter IX. especially childrenthose 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.

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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 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 thingsto 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.

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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.

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+THIRD CONSTITUTION +
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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 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.

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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.

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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 crisis, especially such as had no epistaxis, but these had sweats also as well as rigors.

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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.

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This humour,That is, blood. then, especially was in great abundance, since even those who had no hemorrhage near the crisis, but swellings by the ears which disappearedand after their disappearance there was a heaviness along the left flank up to the extremity of the hipafter the crisis had pain and passed thin urine, and then began to suffer slight hemorrhage about the twenty-fourth day, and 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.

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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.

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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.

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About the season of Arcturus many had crisis on 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.

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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 though these fared tolerably at the beginning, yet the disease assumed an acute form about the seventh day.

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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.

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In acute fevers, more especially in ardent fevers, when involuntary weeping occurs, epistaxis is to be expected it the patient have no fatal symptoms besides; for when he is in a bad way such weeping portends not hemorrhage but death.

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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 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.

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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 relapsein 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 relapsein the case of Phanocritus, for example, who lay sick at the house of Gnathon the fuller.

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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 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.

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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 prescriberfor 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.

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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, 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.

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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 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.

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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.

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+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.

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Second day. General exacerbation, later a small clyster moved the bowels well. A restful night.

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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.

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Fourth day. All symptoms exacerbated; black urine; a more comfortable night, and urine of a better colour.

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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,The patient seemed to forget the necessity of breathing, and then to remember it and to breathe consciously. 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 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 tightnessThe word ὑπολάπαρος is often applied to σύντασις or ἔντασις of the hypochondria. Galen (see Littré on Epidemics III, Case II, Vol. III, p. 34) says that it means without bulk, or without swelling. This is possible if the word is etymologically connected with λαπάζω. The translators are not very precise. Littré has sans beaucoup de rénitence, sans tumeur, sans gonflement, sans grand gonflement; Adams has empty, loose, softish. In Epidemics I, Case XII, occurs the phrase φλεγμονὴ ὑπολάπαρος ἐκ τοῦ ἔσω μέρεος, from which it seems that the prefix ὑπο- means underneath, not rather. Empty underneath seems the primary meaning, and suggests a tightness, or inflammation, with nothing hard and bulky immediately beneath the surface to cause the tightness or inflammation. Perhaps the word also suggests the tenderness often found in the hypochoudria of malaria patients. 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 there came a copious discharge of solid stools, thin,I take λεπτός here to mean thinner than usual, than might have been expected, a meaning it has once or twice in the Hippocratic Corpus. It might also mean consisting of small pieoes. See on Epidemics III, Case II (first series). 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.

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.

A copious passing of urine with convulsionsher attendants seldom reminding herwhich 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,I. e. near the statue of the founder of the city, or near the temple of the god who presided over the founding of the city. 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.

+ +

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 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.

+ +

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 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.

+ +

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.As we might say, with a catch in it.

+

Second 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.

+ +

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 partSee note, p. 188.; 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; 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 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.

+ + + +
+EPIDEMICS III +
+
+CASE I +

PythionThe third book of the Epidemics has always been regarded as a continuation of the first book. Even a casual glance will convince any reader that the two books are really one work. The Paris manuscript called A, which breaks off after the opening words of Epidemics III, nevertheless joins these words without interruption to the end of the first book., who lived by the temple of Earth, was seized with trembling which began in the hands.

+

First day. Acute fever; wandering.

+

Second day. General exacerbation.

+

Third day. Same symptoms.

+

Fourth day. Stools scanty, uncompounded and bilious.

+

Fifth day. General exacerbation; fitful sleep; constipation.

+

Sixth day. Varied, reddish sputa.

+

Seventh day. Mouth drawn awry.

+

Eighth day. General exacerbation; tremblings persisted; urine from the beginning to the eighth day thin, colourless, with a cloudy substance floating in it.

+

Tenth day. Sweat; sputa somewhat concocted; crisis ; urine somewhat thin about the time of the crisis. After the crisis, forty days subsequent to it, abscess in the seat, and an abscession through strangury.

+
+CASE II +

Hermocrates, who lay sick by the new wall, was seized with fever. He began to feel pain in the head and loins; tension of the hypochondrium without swellingBut see note on p. 188.; tongue at the beginning parched; deafness at once; no sleep; no great thirst; urine thick, red, with no sediment on standing; stools not scanty, and burnt.

+

Fifth day. Urine thin, with particles floating in it, without sediment; at night delirium.

+

Sixth day. Jaundice; general exacerbation; not rational.

+

Seventh day. Discomfort; urine thin, and as before. The following days similar. About the eleventh day there seemed to be general relief; coma began; urine thicker, reddish, thinGalen says that the meaning of λεπτὰ is here small, i. e. he thinks that there wore small particles at the bottom. Such is not the meaning of the word in Hippocrates when applied to urine. at the bottom, without sediment; by degrees grew more rational.

+

Fourteenth day. No fever; no sweat; sleep; reason quite recovered; urine as before.

+

About the seventeenth day there was a relapse, and the patient grew hot. On the following days there was acute fever; urine thin; delirium.

+

Twentieth day. A fresh crisis; no fever; no sweat. All the time the patient had no appetite; was perfectly collected but could not talk; tongue dry; no thirst; snatches of sleep; coma. About the twenty-fourth day he grew hot; bowels loose with copious, thin discharges. On the following days acute fever; tongue parched.

+

Twenty-seventh day. Death.

+

In this case deafness persisted throughout; urine thick, red, without settling, or thin, colourless, with substances floating in it. The patient had no power to take food.

+
+CASE III +

The man lying sick in the garden of Delearces had for a long time heaviness in the head and pain in the right temple. From some exciting cause he was seized with fever, and took to his bed.

+

Second day. Slight flow of unmixed blood from the left nostril. The bowels were well moved; urine thin and varied, with particles in small groups, like barley-meal or semen, floating in it.

+

Third day. Acute fever; stools black, thin, frothy, with a livid sediment in them; slight stupor; getting up caused distress; in the urine a livid, rather viscous sediment.

+

Fourth day. Vomited scanty, bilious, yellow vomits, and after a short interval, verdigris-coloured ones; slight flow of unmixed blood from the left nostril; stools unaltered and urine unaltered; sweat about the head and collar-bones; spleen enlarged; pain in the direction of the thigh; tension, soft under-neath, of the right hypochondrium;See note, p. 188. no sleep at night; slight delirium.

+

Fifth day. Stools more copious, black, frothy; a black sediment in the stools; no sleep at night; delirium.

+

Sixth day. Stools black, oily, viscid, foul-smelling ; slept; was more rational.

+

Seventh day. Tongue dry; thirsty; no sleep; delirium; urine thin, not of a good colour.

+

Eighth day. Stools black, scanty, compact; sleep; was collected; not very thirsty.

+

Ninth day. Rigor, acute fever; sweat; chill; delirium; squinting of the right eye; tongue dry; thirsty; sleepless.

+ +

Tenth day. Symptoms about the same.

+

Eleventh day. Quite rational; no fever; slept, urine thin about the time of the crisis.

+

The patient remained free from fever for two days, relapsed on the fourteenth day, and immediately had no sleep at night and was completely delirious.

+

Fifteenth day. Urine muddy, like that which has been stirred up after settling; acute fever; completely delirious; no sleep; pain in knees and legs. On the application of a suppository, black, solid motions were passed.

+

Sixteenth day. Urine thin, with a cloudy substance floating in it; delirium.

+

Seventeenth day. Extremities cold in the early morning; would wrap himself up; acute fever; sweated all over; was relieved; more rational; some fever; thirst; vomited bilious matters, yellow and scanty; solid motions from the bowels; after a while they became black, scanty and thin; urine thin, and not of a good colour.

+

Eighteenth day. Was not rational; comatose.

+

Nineteenth day. The same symptoms.

+

Twentieth day. Slept; completely rational; sweated ; no fever; no thirst; urine thin.

+

Twenty-first day. Slightly delirious; rather thirsty; pain in the hypochondrium and throbbing about the navel continuously.

+

Twenty-fourth day. Sediment in urine; completely rational.

+

Twenty-seventh day. Pain in the right hip, but in other respects very comfortable; sediment in the urine.

+

About the twenty-ninth day pain in the right eye; urine thin.

+

Fortieth day. Passed motions full of phlegm, white and rather frequent; copious sweat all over; a perfect crisis.

+
+CASE IV +

Philistes in Thasos had for a long time pain in the head, and at last fell into a state of stupor and took to his bed. Heavy drinking having caused continuous fevers the pain grew worse. At night he grew hot at the first.

+

First day. Vomited bilious matters, scanty, at first yellow, afterwards increasing and of the colour of verdigris; solid motions from the bowels; an uncomfortable night.

+

Second day. Deafness; acute fever; tension of the right hypochondrium, which fell inwards. Urine thin, transparent, with a small quantity of substance, like semen, floating in it. About mid-day became raving.

+

Third day. Uncomfortable.

+

Fourth day. Convulsions; exacerbation.

+

Fifth day. Died early in the morning.

+
+CASE V +

Chaerion, who lay sick in the house of Demaenetus,The variants indicate corruption. Can Δηλίαν be Delian goddess or Delias? The form is not Ionic. was seized with fever after drinking. At once there was painful heaviness of the head; no sleep; bowels disturbed with thin, rather bilious stools.

+

Third day. Acute fever, trembling of the head, particularly of the lower lip; after a while rigor, convulsions, complete delirium; an uncomfortable night.

+

Fourth day. Quiet; snatches of sleep; wandering.

+

Fifth day. Pain; general exacerbation; irrational talk; uncomfortable night; no sleep.

+

Sixth day. The same symptoms.

+

Seventh day. Rigor; acute fever; sweating all over ; crisis.

+

This patient’s stools were throughout bilious, scanty and uncompounded. Urine thin, not of a good colour, with a cloudy substance floating in it. About the eighth day the urine had a better colour, with a slight, white sediment; quite rational and no fever; an intermission.

+

Ninth day. Relapse.

+

About the fourteenth day acute fever.

+

Sixteenth day. Vomited bilious, yellow matters rather frequently.

+

Seventeenth day. Rigor; acute fever; sweating; crisis ended the fever.

+

Urine after relapse and crisis of a good colour, with a sediment; no delirium during the relapse.

+

Eighteenth day. Slight heat; rather thirsty; urine thin, with cloudy substance floating in it; slight delirium.

+

Nineteenth day. No fever; pain in the neck; sediment in urine.

+

Twentieth day. Complete crisis.

+
+CASE VI +

The maiden daughter of Euryanax was seized with fever. Throughout the illness she suffered no thirst and had no inclination for food. Slight alvine discharges; urine thin, scanty, and not of a good colour. At the beginning of the fever suffered pain in the seat. On the sixth day did not sweat, being without fever; a crisis. The sore near the seat suppurated slightly, and burst at the crisis. After the crisis, on the seventh day, she had a rigor; grew slightly hot; sweated. Afterwards the extremities always cold. About the tenth day, after the sweating that occurred, she grew delirious, but was soon rational again. They said that the trouble was due to eating grapes. After an intermission, on the twelfth day she again wandered a great deal; the bowels were disturbed, with bilious, uncompounded, scanty, thin, irritating stools, which frequently made her get up. She died the seventh day from the second attack of delirium. This patient at the beginning of the illness had pain in the throat, which was red throughout. The uvula was drawn back. Many fluxes,Here ῥεύματα πολλὰ must mean many fluxes, but in Epidemics III. iv. it means copions fluxes. scanty and acrid. She had a cough with signs of coction, but brought up nothing.Or, with Galen’s reading, she had a cough, but brought up no concocted suptum. No appetite for any food the whole time, nor did she desire anything. No thirst, and she drank nothing worth mentioning. She was silent, and did not converse at all. Depression, the patient despairing of herself. There was also some inherited tendency to consumption.

+
+CASE VII +

The woman suffering from angina who lay sick in the house of Aristion began her complaint with indistinctness of speech. Tongue red, and grew parched.

+

First day. Shivered, and grew hot.

+

Third day. Rigor; acute fever; a reddish, hard swelling in the neck, extending to the breast on either side; extremities cold and livid, breathing elevated;The ancient commentators did not know the meaning of this word when applied to respiration, and a modern can only guess. drink returned through the nostrilsshe could not swallowstools and urine ceased.

+

Fourth day. General exacerbation.

+

Fifth day. Death.

+
+CASE VIII +

The youth who lay sick by the Liars’ Market was seized with fever after unaccustomed fatigue, toil and running.

+

First day. Bowels disturbed with bilious, thin, copious stools; urine thin and blackish; no sleep; thirst.

+

Second day. General exacerbation; stools more copious and more unfavourable. No sleep; mind disordered; slight sweating.

+

Third day. Uncomfortable; thirst; nausea; much tossing; distress; delirium; extremities livid and cold; tension, soft underneath, of the hypochondriumSee note, p. 188. on both sides.

+

Fourth day. No sleep; grew worse.

+

Seventh day. Died, being about twenty years old.

+
+CASE IX +

The woman who lodged with Tisamenus was in bed with a troublesome attack of inflammation of the upper bowel. Copious vomits; could not retain her drink. Pains in the region of the hypochondria. The pains were also lower, in the region of the bowels. Constant tormina. No thirst. She grew hot, though the extremities were cold all the time.

+

Nausea; sleeplessness. Urine scanty and thin. Excreta crude, thin and scanty. It was no longer possible to do her any good, and she died.

+
+CASE X +

A woman who was one of the house of Pantimides after a miscarriage was seized with fever on the first day. Tongue dry; thirst; nausea; sleeplessness. Bowels disordered, with thin, copious and crude stools.

+

Second day. Rigor; acute fever; copious stools; no sleep.

+

Third day. The pains greater.

+

Fourth day. Delirium.

+

Seventh day. Death.

+

The bowels were throughout loose, with copious, thin, crude stools. Urine scanty and thin.

+
+CASE XI +

Another woman, after a miscarriage about the fifth month, the wife of Hicetas, was seized with fever. At the beginning she had alternations of coma and sleeplessness; pain in the loins; heaviness in the head.

+

Second day. Bowels disordered with scanty, thin stools, which at first were uncompounded.

+

Third day. Stools more copious and worse; no sleep at night.

+

Fourth day. Delirium; fears; depression. Squinting of the right eye; slight cold sweat about the head; extremities cold.

+

Fifth day. General exacerbation; much wandering, with rapid recovery of reason; no thirst; no sleep; stools copious and unfavourable throughout; urine scanty, thin and blackish; extremities cold and rather livid.

+

Sixth day. Same symptoms.

+

Seventh day. Death.

+
+CASE XII +

A woman who lay sick by the Liars’ Market, after giving birth in a first and painful delivery to a male child, was seized with fever. From the very first there was thirst, nausea, slight pain at the stomach, dry tongue, bowels disordered with thin and scanty discharges, no sleep.

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Second day. Slight rigor; acute fever; slight, cold sweating around the head.

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Third day. In pain; crude, thin, copious discharges from the bowels.

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Fourth day. Rigor; general exacerbation; sleepless.

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Fifth day. In pain.

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Sixth day. The same symptoms; copious, fluid discharges from the bowels.

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Seventh day. Rigor; acute fever; thirst; much tossing; towards evening cold sweat all over; chill; extremities cold, and would not be warmed. At night she again had a rigor; the extremities would not be warmed; no sleep; slight delirium, but quickly was rational again.

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Eighth day. About mid-day recovered her heat; thirst; coma; nausea; vomited bilious, scanty, yellowish matters. An uncomfortable night; no sleep; unconsciously passed a copious discharge of urine.

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Ninth day. General abatement of the symptoms; coma. Towards evening slight rigor; vomited scanty, bilious matters.

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Tenth day. Rigor; exacerbation of the fever; no sleep whatsoever. In the early morning a copious discharge of urine without sediment; extremities were warmed.

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Eleventh day. Vomited bilious matters, of the colour of verdigris. A rigor shortly afterwards, and the extremities became cold again; in the evening sweat, rigor and copious vomiting; a painful night.

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Twelfth day. Vomited copious, black, fetid matters; much hiccoughing; painful thirst.

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Thirteenth day. Vomited black, fetid, copious matters; rigor. About mid-day lost her speech.

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Fourteenth day. Epistaxis; death.

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The bowels of this patient were throughout loose, and there were shivering fits. Age about seventeen.

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+
+

CONSTITUTION

+

The year was southerly and rainy, with no winds throughout. About the rising of Arcturus, while during the immediately preceding period droughts had prevailed, there were now heavy rains, with southerly winds. Autumn dark and cloudy, with abundance of rain. The winter southerly, humid, and mild after the solstice. Long after the solstice, near the equinox, wintry weather returned, and at the actual equinoctial period there were northerly winds with snow, but not for long. The spring southerly again, with no winds; many rains throughout until the Dog Star. The summer was clear and warm, with waves of stifling heat. The Etesian winds were faint and intermittent. But, on the other hand, near the rising of Arcturus there were heavy rains with northerly winds.

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The year having proved southerly, wet and mild, in the winter the general health was good except for the consumptives, who will be described in due course.

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+

Early in the spring, at the same time as the cold snaps which occurred, were many malignant casesOr, forms. of erysipelas, some from a known exciting cause and some not. Many died, and many suffered pain in the throat. Voices impaired; ardent fevers; phrenitis; aphthae in the mouth; tumours in the private parts; inflammations of the eyes; carbuncles; disordered bowels; loss of appetite; thirst in some cases, though not in all; urine disordered, copious, bad; long coma alternating with sleeplessness; absence of crisis in many cases, and obscure crises; dropsies; many consumptives. Such were the diseases epidemic. There were patients suffering from each of the above types, and fatal cases were many. The symptoms in each type were as follow.

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+

Many were attacked by the erysipelas all over the body when the exciting cause was a trivial accident or a very small wound; especially when the patients were about sixty years old and the wound was in the head, however little the neglect might have been. Many even while undergoing treatment suffered from severe inflammations,With Littré’s punctuation the meaning is, however slight the neglect, and even when a patient was actually undergoing treatment. There were severe inflammations, etc. and the erysipelas would quickly spread widely in all directions. Most of the patients experienced abscessions ending in suppurations. Flesh, sinews and bones fell away in large quantities. The flux which formed was not like pus, but was a different sort of putre-faction with a copious and varied flux. If any of these symptoms occurred in the head, there was loss of hair from all the head and from the chin; the bones were bared and fell away, and there were copious fluxes. Fever was sometimes present and sometimes absent. These symptoms were terrifying rather than dangerous. For whenever they resulted in suppuration or some similar coction the cases usually recovered. But whenever the inflammation and the erysipelas disappeared without producing any such abscession, there were many deaths. The course of the disease was the same to whatever part of the body it spread. Many lost the arm and the entire forearm. If the malady settled in the sides there was rotting either before or behind. In some cases the entire thigh was bared, or the shin and the entire foot. But the most dangerous of all such cases were when the pubes and genital organs were attacked. Such were the sores which sprang from an exciting cause. In many cases, however, sores occurred in fevers, before a fever, or supervening on fevers. In some of these also, when an abscession took place through suppuration, or when a seasonable disturbance of the bowels occurred or a passing of favourable urine, this gave rise to a solution; but when none of these events happened, and the symptoms disappeared without a sign, death resulted. It was in the spring that by far the greater number of cases of erysipelas occurred, but they continued throughout the summer and during autumn.

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Much trouble was caused to some patients by the tumours in the throat, inflammations of the tongue and the abscesses about the teeth. Many had the symptom of impaired and muffledThe word so rendered has puzzled the commentators from very early times. See the full disoussion of Littré ad loc. The ancients interpreted either cooped up or altered, faussée (Littré). See Erotian sub voce φωναὶ κατείλλουσαι. I think that H. used a strange word metaphorically on purpose to describe a strange alteration in the voice, which was as it were imprisoned or (to borrow a motoring expression) silenced. voice, at first at the beginning of the cases of consumption, but also in the ardent fevers and in phrenitis.

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+

Now the ardent fevers and phrenitis began early in the spring after the cold snaps which occurred, and very many fell sick at that time. These suffered acute and fatal symptoms. The constitution of the ardent fevers that occurred was as follows. At the beginning coma, nausea, shivering, acute fever, no great thirst, no delirium, slight epistaxis. The exacerbations in most cases on even days, and about the time of the exacerbations there was loss of memory with prostration and speechlessness. The feet and hands of these patients were always colder than usual, most especially about the times of exacerbation. Slowly and in no healthy manner they recovered their heat, becoming rational again and conversing. Either the coma held them continuously without sleep, or they were wakeful and in pain. Bowels disordered in the majority of these cases, with crude, thin, copious stools. Urine copious, thin, with no critical or favourable sign, nor did any other critical sign appear in these patients. For there occurred neither favourable hemorrhage nor any other of the usual critical abscessions. The manner of their dying varied with the individual; it was usually irregular, at the crises, but in some cases after long loss of speech and in many with sweating. These were the symptoms attending the fatal cases of ardent fever, and the cases of phrenitis were similar. These suffered from no thirst at all, and no case showed the mad delirium that attacked others, but they passed away overpowered by a dull oppression of stupor.

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There were other fevers also, which I shall describe in due course. Many had aphthae and sores in the mouth. Fluxes about the genitals were copiousPossibly frequent, common. So Littré. This is one of the most doubtful cases of those difficult words in a medical context, πολύς and ὀλίγος in the plural. See General Introduction, p. lxi.; sores, tumours external and internal; the swellings which appear in the groin.A curious phrase. I suspect that τὰ hides a corruption of the text. Watery inflammations of the eyes, chronic and painful. Growths on the eyelids, external and internal, in many cases destroying the sight, which are called figs. There were also often growths on other sores, particularly in the genitals. Many carbuncles in the summer, and other affections called rot. Large pustules. Many had large tetters.

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The bowel troubles in many cases turned out many and harmful. In the first place many were attacked by painful tenesmus, mostly childrenall in fact who were approaching pubertyand most of these died. Many lienteries. Cases of dysentery, but they tooI. c. as Galen suggests in his commentary, they were like the lienteries in not causing much pain. Lientery is not particularly painful. were not very painful. Stools bilious, greasy, thin and watery. In many cases this condition of the bowels constituted the disease itself, fever being sometimes absent and sometimes present.Littré in a long and obscure note argues that only ἄνευ πυρετῶν and not ἐν πυρετοῖσι can belong to the preceding phrase, apparently because it is illogical to say that fever was present when the disease consisted merely of unhealthy stools. But the writer does not wish to exclude fever; he merely wishes to exclude from this class of patient tenesmus, lientery and dysentery. The commentary of Galen, πολλοῖς ῦέ φησιν αὐτὸ τοῦτο γενέσθαι τὸ νόσημα, τουτέστι τὸ διαχωρεῖν τὰ τοιαῦτα· καὶ γὰρ καὶ χωρὶς πυρετῶν ἐνίοις τοῦτο γενέσθαι Φησι, does not, as Littré supposes, support his contention. The phrase καὶ χωρὶς πυρετῶν ἐνίοις τοῦτο γενέσθαι φησὶ implies καὶ ἐν πυρετοῖς τοῦτο ἐγένετο. Painful tormina and malignant colic. There were evacuations, though the bulk of the contents remained behind.It is hard to separate διέξοδοι from τῶν πολλῶν, yet the sense seems to require it. The next sentence states that these evacuations caused no relief, evidently because they did not clear the trouble from the bowel. Now if διέξοδοι be taken with τῶν πολλῶν, the only possible translation is evacuations of the many contents which were retained there, implying complete evacuation. Galen’s comment (Kéhn XVII, Part I, p. 708) bears out the former interpretation : τὰς δὲ διεξόδους, τουτέστὶ τὰς κενώσεις, αὐτοῖς συμβῆναι, πολλῶν ἐνόντων καὶ ἐπισχόντων . . . . . καὶ διὰ τοῦτο μηδὲ τοὺς πόνους λύειν τὰ διεξιόντα. πῶς γαρ ὀ͂όν τε λύειν αὐτά, πολλῶν ἔτι τῶν ἐπεχομένων όντων; It should be noticed that ἐπισχόντων is probably from ἐπίσχω (Galen’s ἐπεχομένων) and not from ἐπέχω, although I cannot find a parallel for intransitive ἐπίσχω in this sense. The evacuations did not take away the pains, and yielded with difficulty to the remedies administered. Purgings, in fact, did harm in most cases. Of those in this condition many died rapidly, though a few held out longer. In brief, all patients, whether the disease was prolonged or acute, died chiefly from the bowel complaints. For the bowels carried all off together.The writer has not expressed himself clearly in this chapter, which seems to be the roughest of rough notes. The last two sentences apparently mean :—- +

(a) It was always the bowel complaints which caused most deaths. This was natural, since (b) all attacked by bowel complaints died.

+
+

Loss of appetite, to a degree that I never met before, attended all the cases described above, but most especially the last, and of them, and of the others also, especially such as were fatally stricken.The emendation of Blass permits the translator of this passage to harmonize both sense and grammar. Before it was impossible to do so.

+

Thirst afflicted some, but not others; of the fever patients, as well as of the other cases, none were unseasonably affected, but as far as drink was concerned you could diet them as you pleased.

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+

The urine that was passed was copious, not in proportion to, but far exceeding, the drink administered. Yet the urine too that was passed showed a great malignancy. For it had neither the proper consistency, nor coction, nor cleansing powers; it signified for most patients wasting, trouble,Probably disordered bowels, a common meaning of ταραχὴ in the Corpus. pains, and absence of crisis.

+
+

Coma attended mostly the phrenitis and ardent fevers, without excluding, however, all the other diseases of the most severe sort that were accompanied by fever. Most patients throughout either were sunk in heavy coma or slept only in fitful snatches.

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+

Many other forms also of fever were epidemic: tertians, quartans, night fevers, fevers continuous, protracted, irregular, fevers attended with nausea, fevers of no definite character. All these cases suffered severely from trouble.See the preceding note. For the bowels in most cases were disordered, with shivering fits. Sweats portended no crisis, and the character of the urine was as I have described. Most of these cases were protracted, for the abscessions too which took place did not prove critical as in other cases; nay rather, in all cases all symptoms marked obscurity of crisis,For δύσκριτον see Foes’ Oeconomia, sub voce. It means that it was hard to see when a crisis took place, or that the crisis was not a marked one. or absence of crisis, or protraction of the disease, but most especially in the patients last described. A few of these had a crisis about the eightieth day; with most recovery followed no rule. A few of them died of dropsy, without taking to their bed; many sufferers from the other diseases too were troubled with swellings, most particularly the consumptives.

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+

The severest and most troublesome disease, as well as the most fatal, was the consumption. Many cases began in the winter, and of these several took to their bed, though some went about ailing without doing so. Early in the spring most of those who had gone to bed died, while none of the others lost their cough, though it became easier in the summer. During autumn all took to bed and many died. Most of these were ill for a long time. Now most of these began suddenly to grow worse, showing the following symptoms :—-frequent shivering; often continuous and acute fever; unseasonable, copious,I am often doubtful as to the meaning of πολλοὶ in instances like these; does it refer to quantity or frequency? In these two examples either meaning would give excellent sense. See General Introduction, p. lxi. cold sweats throughout; great chill with difficult recovery of heat; bowels variously constipated, then quickly relaxing, and violently relaxing in all cases near the end ; the humours about the lungs spread downwards; abundance of unfavourable urine; malignant wasting. The coughs throughout were frequent, bringing up copious,I am often doubtful as to the meaning of πολλοὶ in instances like these; does it refer to quantity or frequency? In these two examples either meaning would give excellent sense. See General Introduction, p. lxi. concocted and liquid sputa, but without much pain; but even if there was pain, in all cases the purging from the lungs took place very mildly. The throat did not smart very much, nor did salt humours cause any distress at all. The fluxes, however, viscid, white, moist, frothy, which came from the head, were abundant. But by far the worst symptom that attended both these cases and the others was the distaste for food, as has been mentioned. They had no relish either for drink with nourishment, but they remained entirely without thirst. Heaviness in the body. Coma. In most of them there was swelling, which developed into dropsy. Shivering fits and delirium near death.

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+

The physical characteristics of the consumptives were :—-skin smooth, whitish, lentil-coloured, reddish; bright eyes;It seems impossible to decide whether the adjective χαροπός refers here to the brightness of the eyes or to their colour (blue or grey). a leucophlegmaticSee General Introduction, p. xlvi-li, on the humours. Bitter bile was the same as that sometimes called yellow. condition; shoulder-blades projecting like wings. Women too so.This brief phrase seems to mean that the same characteristics marked consumptive women as consumptive men. As to those with a melancholicSee General Introduction, p. xlvi-li, on the humours. Bitter bile was the same as that sometimes called yellow. or a rather sanguineSee General Introduction, p. xlvi-li, on the humours. Bitter bile was the same as that sometimes called yellow. complexion, they were attacked by ardent fevers, phrenitis and dysenteric troubles. Tenesmus affected young, phlegmaticSee General Introduction, p. xlvi-li, on the humours. Bitter bile was the same as that sometimes called yellow. people; the chronic diarrhoea and acrid, greasy stools affected persons of a biliousSee General Introduction, p. xlvi-li, on the humours. Bitter bile was the same as that sometimes called yellow. temperament.

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+

In all the cases described spring was the worst enemy, and caused the most deaths; summer was the most favourable season, in which fewest died. In autumn and during the season of the Pleiades, on the other hand, there were again deaths, usually on the fourth day. And it seems to me natural that the coming on of summer should have been helpful. For the coming on of winter resolves the diseases of summer, and the coming on of summer removes those of winter. And yet in itself the summer in question was not healthful;Of a good constitution. in fact it was suddenly hot, southerly, and calm. But nevertheless the change from the other constitution proved beneficial.

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The power, too, to study correctly what has been written I consider to be an important part of the art of medicine. The man who has learnt these things and uses them will not, I think, make great mistakes in the art. And it is necessary to learn accurately each constitution of the seasons as well as the disease; what common element in the constitution or in the disease is good, and what common element in the constitution or in the disease is bad; what malady is protracted and fatal, what is protracted and likely to end in recovery; what acute illness is fatal, what acute illness is likely to end in recovery. With this knowledge it is easy to examine the order of the critical days, and to prognosticate therefrom. One who has knowledge of these matters can know whom he ought to treat, as well as the time and method of treatment.This chapter does not fit in with the context, and occurs again at the beginning of the book περὶ κρισίμων. Ermerins brackets it.

+
+SIXTEEN CASES +
+CASE I

In Thasos the Parian who lay sick beyond the temple of Artemis was seized with acute fever, which at the beginning was continuous and ardent. Thirst. At the beginning coma followed by sleeplessness. Bowels disordered at the beginning; urine thin.

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Sixth day. Oily urine; delirium.

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Seventh day. General exacerbation; no sleep; urine similar and mind disordered; stools bilious and fatty.

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Eighth day. Slight epistaxis; vomited scanty matters of the colour of verdigris; snatches of sleep.

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Ninth day. Same symptoms.

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Tenth day. General improvement.

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Eleventh day. Sweated all over; grew chilly, but quickly recovered heat.

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Fourteenth day. Acute fever; stools bilious, thin, copious; substance floating in urine; delirium.

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Seventeenth day. In pain; no sleep, while the fever grew worse.

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Twentieth day. Sweated all over; no fever; stools bilious; aversion to food; coma.

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Twenty-fourth day. Relapse.

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Thirty-fourth day. No fever; no constipation; recovered heat.

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Fortieth day. No fever; bowels constipated for a short time; aversion to food; became slightly feverish again, throughout irregularly, the fever being sometimes absent, sometimes present; for if the fever intermitted and was alleviated there was a relapse soon afterwards. He took little bits of food, and that of an unsuitable sort. Sleep bad; delirium at the relapses. Urine at these times had consistency, but was troubled and bad. Bowels constipated, but afterwards relaxed. Continuous slight fevers. Stools thin and copious.

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Hundred and twentieth day. Death.

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In this case the bowels continuously from the first day loose with bilious, loose, copious stools, or constipated with hot,Lit. seething or boiling. The reference is possibly not so much to heat as to the steaming, frothy nature of the stools. undigested stools. Urine throughout bad; mostly comatose; painful sleeplessness;The meaning apparently is that the patient was generally in a state of coma; if not comatose, he was in pain and could not sleep. continued aversion to food.

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+CASE II +

In Thasos the woman who lay sick by the Cold Water, on the third day after giving birth to a daughter without lochial discharge, was seized with acute fever accompanied by shivering. For a long time before her delivery she had suffered from fever, being confined to bed and averse to food. After the rigor that took place, the fevers were continuous, acute, and attended with shivering.

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Eighth and following days. Much delirium, quickly followed by recovery of reason; bowels disturbed with copious, thin, watery and bilious stools; no thirst.

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Eleventh day. Was rational, but comatose. Urine copious, thin and black; no sleep.

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Twentieth day. Slight chills,This sentence shows that περί in περιψύχω means not very, but all over. The phrase may mean slight chilliness. but heat quickly recovered; slight wandering; no sleep; bowels the same; urine watery and copious.

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Twenty-seventh day. No fever; bowels constipated; not long afterwards severe pain in the right hip for a long time. Fevers again attended; urine watery.

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Fortieth day. Pain in the hip relieved; continuous coughing, with watery, copious sputa; bowels constipated; aversion to food; urine the same. The fevers, without entirely intermitting, were exacerbated irregularly, sometimes increasing and sometimes not doing so.

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Sixtieth day. The coughing ceased without any critical sign; there was no coction of the sputa, nor any of the usual abscessions; jaw on the right side convulsed; comatose; wandering, but reason quickly recovered; desperately averse to food; jaw relaxed ; passed small, bilious stools; fever grew more acute, with shivering. On the succeeding days she lost power of speech, but would afterwards converse.

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Eightieth day. Death.

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The urine of this patient was throughout black, thin and watery. Coma was present, aversion to food, despondency, sleeplessness, irritability, restlessness, the mind being affected by melancholy.For melancholy see General Introduction, p. lviii.

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+CASE III +

In Thasos Pythion, who lay sick above the shrine of Heracles, after labour, fatigue and careless living, was seized by violent rigor and acute fever. Tongue dry; thirst; bilious; no sleep; urine rather black, with a substance suspended in it, which formed no sediment.

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Second day. About mid-day chill in the extremities, especially in the hands and head; could not speak or utter a sound; respiration short for a long time; recovered warmth; thirst; a quiet night; slight sweats about the head.

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Third day. A quiet day, but later, about sunset, grew rather chilly; nausea; distress;Probably bowel trouble. See p. 250 painful night without sleep; small, solid stools were passed.

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Fourth day. Early morning peaceful, but about mid-day all symptoms were exacerbated; chill; speechless and voiceless; grew worse; recovered warmth after a time; black urine with a substance floating in it; night peaceful; slept.

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Fifth day. Seemed to be relieved, but there was heaviness in the bowels with pain; thirst; painful night.

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Sixth day. Early morning peaceful; towards evening the pains were greater; exacerbation; but later a little clyster caused a good movement of the bowels. Slept at night.

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Seventh day. Nausea; rather uneasy; urine oily; much distressProbably bowel trouble. See p. 250. at night; wandering; no sleep at all.

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Eighth day. Early in the morning snatches of sleep; but quickly there was chill; loss of speech; respiration thin and weak ; in the evening he recovered warmth again; was delirious; towards morning slightly better; stools uncompounded, small, bilious.

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Ninth day. Comatose; nausea whenever he woke up. Not over-thirsty. About sunset was uncomfortable; wandered; a bad night.

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Tenth day. In the early morning was speechless; great chill; acute fever; much sweat; death.

+

In this case the pains on even days.

+
+CASE IV +

The patient suffering from phrenitis on the first day that he took to bed vomited copiously thin vomits of the colour of verdigris; much fever with shivering; continuous sweating all over; painful heaviness of head and neck; urine thin, with small, scattered substances floating in it, which did not settle. Copious excreta at a single evacuation; delirium; no sleep. Second day. In the early morning speechless; acute fever; sweating; no intermission; throbbing all over the body; convulsions at night.

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Third day. General exacerbation.

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Fourth day. Death.

+
+CASE V +

In Larisa a bald man suddenly experienced pain in the right thigh. No remedy did any good.

+

First day. Acute fever of the ardent type; the patient was quiet, but the pains persisted.

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Second day. The pains in the thigh subsided, but the fever grew worse; the patient was rather uncomfortable and did not sleep; extremities cold; copious and unfavourable urine was passed.

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Third day. The pain in the thigh ceased, but there was derangement of the intellect, with distressProbably trouble in the bowels. and much tossing.

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Fourth day. Death about mid-day.

+
+CASE VI +

In Abdera Pericles was seized with acute fever, continuous and painful; much thirst; nausea; could not retain what he drank. There was slight enlargement of the spleen and heaviness in the head.

+

First day. Epistaxis from the left nostril; the fever, however, increased greatly. Copious urine, turbid and white. On standing it did not settle.

+

Second day. General exacerbation; the urine, however, had consistency, but there was some sediment; the nausea was relieved and the patient slept.

+

Third day. The fever went down; abundance of urine, with concocted and copious sediment; a quiet night.

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Fourth day. About mid-day a hot, violent sweating all over; no fever; crisis; no relapse.

+
+CASE VII +

In Abdera the maiden who lay sick by the Sacred Way was seized with a fever of the ardent type. She was thirsty and sleepless. Menstruation occurred for the first time.

+

Sixth day. Much nausea; redness; shivering; restlessness.

+

Seventh day. Same symptoms. Urine thin but of good colour; no trouble in the bowels.

+

Eighth day. Deafness; acute fever; sleeplessness; nausea; shivering; was rational; urine similar.

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Ninth day Same symptoms, and also on the following days. The deafness persisted.

+

Fourteenth day. Reason disturbed; the fever subsided.

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Seventeenth day. Copious epistaxis; the deafness improved a little. On the following days nausea and deafness, while there was also delirium.

+

Twentieth day. Pain in the feet; deafness; the delirium ceased; slight epistaxis; sweating; no fever.

+

Twenty-fourth day. The fever returned, with the deafness; pain in the feet persisted; delirium.

+

Twenty-seventh day. Copious sweating; no fever; the deafness ceased; the pain in the feet remained, but in other respects there was a perfect crisis.

+
+CASE VIII +

In Abdera Anaxion, who lay sick by the Thracian gate, was seized with acute fever. Continuous pain in the right side; a dry cough, with no sputa on the first days. Thirst ; sleeplessness; urine of good colour, copious and thin.

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Sixth day. Delirium; warm applications gave no relief.

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Seventh day. In pain, for the fever grew worse and the pains were not relieved, while the coughing was troublesome and there was difficulty in breathing.

+

Eighth day. I bled him in the arm. There was an abundant, proper flow of blood; the pains were relieved, although the dry coughing persisted.

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Eleventh day. The fever went down; slight sweating about the head; the coughing and the sputa more moist.

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Seventeenth day. Began to expectorate small, concocted sputa; was relieved.

+

Twentieth day. Sweated and was free from fever; after a crisis was thirsty, and the cleansings from the lungs were not favourable.

+

Twenty-seventh day. The fever returned; coughing, with copious, concocted sputa; copious, white sediment in urine; thirst and difficulty in breathing disappeared.

+

Thirty-fourth day. Sweated all over; no fever; general crisis.I am conscious of a slight change in diction and method in this part of the Epidcmics. I mention four points :—- +

(1) The frequent use of πυρετὸς in the plural, which is unusual when it simply means feverishness (Cases VIII, IX, XII, XIII).

+

(2) καταβαίνω is used of evacuations (Cases VII, IX οὔρα . . . κατέβαινεν, XII).

+

(3) Treatment is mentioned (Case VIII, θερμάσματα, and ἀγκῶνα ἔταμον, where note the personal touch).

+

(4) ἱδρύνομαι used of recovery of reason, = κατανοῶ (Case XV). The change is marked enough to lead one to suppose that these histories were composed at a different period in the writer’s life.

+
+CASE IX +

In Abdera Heropythus had pain in the head without taking to bed, but shortly afterwards was compelled to do so. He lived close to the Upper Road.With Blass’ reading, Upper Market-place. An acute, ardent fever seized him. Vomited at the beginning copious, bilious matters; thirst; great discomfort; urine thin and black, sometimes with, sometimes without, substances suspended in it. Painful night, with fever rising now in this way, now in that, but for the most part irregularly. About the fourteenth day, deafness; the fever grew worse; urine the same.

+

Twentieth day. Much delirium, also on the following days.

+

Fortieth day. Copious epistaxis; more rational; some deafness, but less than before; the fever went down. Frequent, but slight, epistaxis on the following days. About the sixtieth day the bleedings from the nose ceased, but there was violent pain in the right hip and the fever increased. Not long afterwards, pains in all the lower parts. It happened that either the fever was higher and the deafness great, or else, though these symptoms were relieved and less severe, yet the pains in the lower parts about the hips grew worse. But from about the eightieth day all the symptoms were relieved without any disappearing. The urine that was passed was of good colour and had greater deposits, while the delirious mutterings were less. About the hundredth day the bowels were disordered with copious, bilious stools, and copious evacuations of this nature were passed for a long time. Then followed painful symptoms of dysentery, with relief of the other symptoms. In brief, the fever disappeared and the deafness ceased.

+

Hundred and twentieth day. Complete crisis.

+
+CASE X +

In Abdera Nicodemus after venery and drunkenness was seized with fever. At the beginning he had nausea and cardialgia; thirst; tongue parched ; urine thin and black.

+

Second day. The fever increased; shivering; nausea ; no sleep; bilious, yellow vomits; urine the same; a quiet night; sleep.

+

Third day. All symptoms less severe; relief. But about sunset he was again somewhat uncomfortable; painful night.

+

Fourth day. Rigor; much fever; pains every-where; urine thin, with floating substance in it; the night, on the other hand, was quiet.

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Fifth day. All symptoms present, but relieved.

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Sixth day. Same pains everywhere; substance floating in urine; much delirium.

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Seventh day. Relief.

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Eighth day. All the otherWhat other symptoms? It is clear that some symptoms are excepted, but there is no hint what these are. As V has τὰ δʼ ἄλλα, but all the other symptoms were relieved, I believe that after ?̓γδόῃ has fallen out a phrase containing the symptoms which were not relieved. symptoms less severe.

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Tenth day and following days. The pains were present, but all less severe. The exacerbations and the pains in the case of this patient tended through-out to occur on the even days.

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Twentieth day. Urine white, having consistency; no sediment on standing. Copious sweating; seemed to lose his fever, but towards evening grew hot again, with pains in the same parts; shivering ; thirst; slight delirium.

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Twenty-fourth day. Much white urine, with much sediment. Hot sweating all over; the fever passed away in a crisis.

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+CASE XI +

In Thasos a woman of gloomy temperament, after a grief with a reason for it, without taking to bed lost sleep and appetite, and suffered thirst and nausea. She lived near the place of Pylades on the plain.

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First day. As night began there were fears, much rambling, depression and slight feverishness. Early in the morning frequent convulsions; whenever these frequent convulsions intermitted, she wandered and uttered obscenities; many pains, severe and continuous.

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Second day. Same symptoms; no sleep; fever more acute.

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Third day. The convulsions ceased, but were succeeded by coma and oppression, followed in turn by wakefulness. She would jump up; could not restrain herself; wandered a great deal; fever acute; on this night a copious, hot sweating all over; no fever ; slept, was perfectly rational, and had a crisis. About the third day urine black and thin, with particles mostly round floating in it, which did not settle. Near the crisis copious menstruation.

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+CASE XII +

In Larisa a maiden was seized with an acute fever of the ardent type. Sleeplessness; thirst; tongue sooty and parched; urine of good colour, but thin.

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Second day. In pain; no sleep.

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Third day. Copious stools, watery and of a yellowish green; similar stools on the following days, passed without distress.

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Fourth day. Scanty, thin urine, with a substance suspended in it which did not settle; delirium at night.

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Sixth day. Violent and abundant epistaxis; after a shivering fit followed a hot, copious sweating all over; no fever; a crisis. In the fever and after the crisis menstruation for the first time, for she was a young maiden. Throughout she suffered nausea and shivering; redness of the face; pain in the eyes; heaviness in the head. In this case there was no relapse, but a definite crisis. The pains on the even days.

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+CASE XIII +

Apollonius in Abdera was ailing for a long time without being confined to bed. He had a swollen abdomen, and a continual pain in the region of the liver had been present for a long time; moreover, he became during this period jaundiced and flatulent; his complexion was whitish. After dining and drinking unseasonably cow’s milkφαγὼμ according to this translation has no expressed object. Furthermore, βόειον is more naturally beef. As the words stand the above version is the natural one, but I suspect that either βόειον should be transposed to between δὲ and καί, or else it is used ἀπὸ κοινοῦ and zengmatically with both φαγὼν and πιών, after eating beef and drinking cow’s milk. So Littré and, apparently, from his translation, Calvus. he at first grew rather hot; he took to his bed. Having drunk copiously of milk, boiled and raw, both goat’s and sheep’s, and adopting a thoroughly bad regimen,Or, changing the comma at πάντων to κακῆ, adopting a bad regimen, he suffered great harm in every way. he suffered much therefrom. For there were exacerbations of the fever; the bowels passed practically nothing of the food taken; the urine was thin and scanty. No sleep. Grievous distension; much thirst; coma; painful swelling of the right hypochondrium; extremities all round rather cold; slight delirious mutterings; forgetfulness of every-thing he said; he was not himself. About the fourteenth day from his taking to bed, after a rigor, he grew hot; wildly delirious; shouting, distress,Here perhaps not bowel trouble. much rambling, followed by calm; the coma came on at this time. Afterwards the bowels were disordered with copious stools, bilious, uncompounded and crude; urine black, scanty and thin. Great discomfort. The evacuations showed varying symptoms; they were either black, scanty and verdigris-coloured, or else greasy, crude and smarting ; at times they seemed actually to be like milk. About the twenty-fourth day comfortable; in other respects the same, but he had lucid intervals. He remembered nothing since he took to bed. But he quickly was again delirious, and all symptoms took a sharp turn for the worse. About the thirtieth day acute fever; copious, thin stools; wandering; cold extremities; speechlessness.

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Thirty-fourth day. Death.

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This patient throughout, from the time I had knowledge of the case, suffered from disordered bowels; urine thin and black; coma; sleeplessness; extremities cold; delirious throughout.

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+CASE XIV +

In Cyzicus a woman gave birth with difficult labour to twin daughters, and the lochial discharge was far from good.

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First day. Acute fever with shivering; painful heaviness of head and neck. Sleepless from the first, but silent, sulky and refractory. Urine thin and of no colour; thirsty; nausea generally ; bowels irregularly disturbed with constipation following.

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Sixth day. Much wandering at night; no sleep.

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About the eleventh day she went out of her mind and then was rational again; urine black, thin, and then, after an interval, oily; copious, thin, disordered stools.

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Fourteenth day. Many convulsions; extremities cold ; no further recovery of reason; urine suppressed.

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Sixteenth day. Speechless.

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Seventeenth day. Death.

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+CASE XV +

In Thasos the wife of Delearces, who lay sick on the plain, was seized after a grief with an acute fever with shivering. From the beginning she would wrap herself up, and throughout, without speaking a word, she would fumble, pluck, scratch, pick hairs, weep and then laugh, but she did not sleep; though stimulated, the bowels passed nothing. She drank a little when the attendants suggested it. Urine thin and scanty; fever slight to the touch; coldness of the extremities.

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Ninth day. Much wandering followed by return of reason; silent.

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Fourteenth day. Respiration rare and large with long intervals,I take this, in apite of Galen, to mean with extra long intervals between each breath. The phrase is rather care-less but scarcely tautological. At intervals or after a long interval are possible meanings, but inconsistent with διὰ τέλεος later on. becoming afterwards short.

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Seventeenth day. Bowels under a stimulus passed disordered matters, then her very drink passed unchanged; nothing coagulated. The patient noticed nothing; the skin tense and dry.

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Twentieth day. Much rambling followed by recovery of reason; speechless; respiration short.

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Twenty-first day. Death.

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The respiration of this patient throughout was rare and large; took no notice of anything; she constantly wrapped herself up; either much rambling or silence throughout.In many ways this case, though one of the most picturesque, is also one of the most carelessly written. Galen points out that διὰ Χπόνον is ambiguous, and that its possible meanings are inconsistent with the rest of the description. How can the respiration be ἀραιόν throughout, when on both the fourteenth and the twentieth days the patient was βραχύπνοος? It is strange that the writer specifies the fourteenth day as the day when the respiration was rare and large, seeing that it had these characteristics throughout. A similar remark applies to ἀναισθήτως εἰχε πάντων of the seventeenth day. Further, ἀεὶ σιγῶσα of the second sentence becomes strangely ἣ λόγοι χολλοὶ ἣ σιγῶσα διὰ τέλεος in the last. I conclude that this medical history was hastily written and never revised. A slight revision could easily have cleared away the inconsistencies, which are, as Galen seems to have seen, more apparent than real.

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+CASE XVI +

In Meliboea a youth took to his bed after being for a long time heated by drunkenness and sexual indulgence. He had shivering fits, nausea, sleeplessness, but no thirst.

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First day. Copious, solid stools passed in abundance of fluid, and on the following days the excreta were copious, watery and of a greenish yellow. Urine thin, scanty and of no colour; respiration rare and large with long intervals; tension, soft underneath, of the hypochondrium,See note, p. 188. extending out to either side; continual throbbing throughout of the epigastrium;So Littré, following Galen. Perhaps, however, it means heart, i. e. there was violent palpitation. urine oily.

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Tenth day. Delirious but quiet, for he was orderly and silent;Said by Galen, followed by Littré (who reads ἥσυχος for σιγῶν), to refer to the character of the young man when well, which interpretation to modern minds is rather inconsistent with the first sentence. They would paraphrase, the delirium was really serious, but appeared slight because the patient was naturally self-controlled and calm. I take the meaning to be that though delirious he remained quiet and comparatively silent. skin dry and tense; stools either copious and thin or bilious and greasy.

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Fourteenth day. General exacerbation; delirious with much wandering talk.

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Twentieth day. Wildly out of his mind; much tossing ; urine suppressed; slight quantities of drink were retained.

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Twenty-fourth day. Death.

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