on fever, J. Johnson,[611] that it is singular the effects of marsh
effluvia should have escaped the observation of Hippocrates, more
especially as the remittent and intermittent fevers, of which he
treats so fully, are mostly derived from this source. Now I must
say, that I am not aware of there being any passages in the works of
Hippocrates where the effects of marsh effluvia in engendering such
fevers are distinctly noticed; but if Hippocrates was ignorant of this
fact, in the etiology of fevers, it was well known to Galen, as may
be seen on reference to his very interesting work “On the Difference
of Fevers.”[612] The Arabians also were familiar with the fact. See
Avicenna, iv., 1, 2, 1.
In the treatise “On Airs,” which, although not admitted by us into the
list of genuine works, has considerable pretension to be so regarded,
the causes of fever are treated of with great precision, and there the
pestilential fevers are said to derive their origin from miasma, but
whether or not under this term be included marsh effluvia, cannot be
determined. But perhaps a better reason might be assigned for there
being little or no allusion to malaria in the works of Hippocrates,
namely, that after all, this was _not_ the cause of the epidemical
diseases which he describes. The following extract from a work of very
high authority on fever is well deserving of consideration in this
place: “A question has arisen as to whether or not the inflammatory
states of fever, in warm countries, are caused by malaria, or by the
other causes now instanced (excess of heat, etc.). There can be no
doubt that malaria very frequently produces in the plethoric, young,
and robust, who have recently arrived in a hot climate, fever of an
inflammatory and continued kind; but it must also be conceded that this
fever chiefly occurs, even in persons thus constituted, during the dry
season, and at times and in places where the existence of malaria is
doubtful, or, at least, by no means proved. It is notoriously admitted
that the inflammatory states of continued fever, in both the East and
West Indies, appear among those soldiers, sailors, and civilians, who
have not been long in a warm country, and who have not suffered from
disease since their arrival; and that they take place chiefly during
the dry and warm seasons, and in situations where the usual affects of
malaria are never observed. This is the result of the experience of
Jackson, Annesley, Boyle, Twining, Conwell, and the other experienced
practitioners in warm countries. It agrees with my own observations,
and is even admitted by Dr. Fergusson, who has gone much further
than any one else in assigning malaria as the cause of intertropical
fevers.”[613] I may mention, moreover, that Hippocrates and his
contemporaries were evidently not ignorant of the fact, that the
atmosphere in the vicinity of marshes and large rivers is unwholesome
to the inhabitants of warm climates. See De Diæta, ii, 2.
The following are part of the conclusions which M. Littré draws
from his investigations into the nature of the fevers described by
Hippocrates. I quote them as being strongly confirmatory of the
opinions delivered by me in the Commentary on the Second Book of
PAULUS ÆGINETA.
“Les fièvres décrites dans les _Epidémies_ d’Hippocrate différent
de nos fièvres continués.
“Les fièvres décrites dans les _Epidémies_ ont, dans leur
apparence générale, une similitude très grande avec celles des pays
chauds.
“La similitude n’est pas moins grande dans les détails que dans
l’ensemble.
“Dans les unes comme dans les autres les hypochondres sont pour un
tiers des cas, le siége d’une manifestation toute spéciale.
“Dans les unes comme dans les autres, il y a une forte tendence ou
réfroidissement du corps, à la sueur froide et à la lividité des
extrémités.”
On almost all the other diseases treated of in these books, M. Littré’s
opinions, in like manner, exactly coincide with those delivered by
me in the above-mentioned work. Thus he arrives at the conclusion,
that the Phrenitis and Lethargus of Hippocrates were varieties of the
Causus. Compare PAULUS ÆGINETA, Book III., 6, 9. He refers
them to _les fièvres pernicieuses comateuses pseudo-continués et les
fièvres pernicieuses dolorantes pseudo-continués_ of M. Maillot.
It would appear from the extracts which he quotes from a work of M.
Roux, on the Diseases of Morea, that a similar tendency to pass into
phrenitis and lethargy is still observable in the land of Greece. The
fevers of the East Indies also, as described by Dr. Twining,[614]
appear to partake very much of the same character. In a word, the
conclusions to which a patient study of modern authorities on the
subject have brought me amount to this; that the fevers described by
Hippocrates in his “Epidemics,” are exactly the same as those which
are now described as still prevailing in the land of Greece: that they
correspond very well with those described by Cleghorn as occurring in
Majorca; differ but little from those described by Pringle, Monro,
and Sylvius, as happening in the Low Countries, and differ from those
described by Twining, as happening in Bengal, only in a few particulars.
From the analysis of their contents given above it will readily be
understood that the subject-matters of these two books are not arranged
methodically. Indeed it is quite obvious from the nature of the work
that the matters which are treated of in it had never been methodized
by the author. Certainly then, as proposed by Desmair,[615] it would
be a much more natural arrangement to give the four Constitutions of
the season first, and then to give the forty-two cases together. But
the present arrangement being of old standing, no editor has thought
himself warranted to depart from it.
There are two important professional subjects of which it may appear
surprising that there is no mention in the “Books of the Epidemics,”
I mean sphygmology and contagion. Galen repeatedly declares it as his
opinion, that Hippocrates paid no attention to the characters of the
arterial pulse, and that the subject was not at all studied until
after his time; and as far as I can see there is no ground for calling
in question this opinion of Galen. Herophilus, in fact, would appear
to have been the first person that made any progress in this study.
It is more remarkable that Hippocrates should omit all allusion to
the other subject, more especially as the contagiousness of certain
diseases would appear to have been the popular belief of his age. Thus
his contemporary, Thucydides, in describing the plague, expresses
himself in such terms as puts it beyond a doubt that he regarded the
disease as being of a contagious nature. And another contemporary,
Isocrates, makes such observations on a certain case of empyema, by
which he evidently means phthisis pulmonalis, as to show that it also
was regarded as being communicable.[616] How the omission is to be
accounted for I do not know, but certain it is that not the least
reference to contagion, in any shape, is to be found in any of the
Hippocratic treatises.
BOOK I.--OF THE EPIDEMICS.
SEC. I.--CONSTITUTION FIRST.
1. In Thasus,[617] about the autumnal equinox, and under the
Pleiades,[618] the rains were abundant, constant, and soft, with
southerly winds; the winter southerly, the northerly winds faint,
droughts; on the whole, the winter having the character of spring. The
spring was southerly, cool, rains small in quantity. Summer, for the
most part, cloudy, no rain, the Etesian winds, rare and small, blew in
an irregular manner. The whole constitution of the season being thus
inclined to the southerly, and with droughts early in the spring, from
the preceding opposite and northerly state, ardent fevers occurred
in a few instances, and these very mild, being rarely attended with
hemorrhage, and never proving fatal.[619] Swellings appeared about
the ears, in many on either side, and in the greatest number on both
sides, being unaccompanied by fever so as not to confine the patient
to bed; in all cases they disappeared without giving trouble, neither
did any of them come to suppuration, as is common in swellings from
other causes. They were of a lax, large, diffused character, without
inflammation or pain, and they went away without any critical sign.
They seized children, adults, and mostly those who were engaged in
the exercises of the palestra and gymnasium, but seldom attacked
women. Many had dry coughs without expectoration, and accompanied
with hoarseness of voice. In some instances earlier, and in others
later, inflammations with pain seized sometimes one of the testicles,
and sometimes both;[620] some of these cases were accompanied with
fever and some not; the greater part of these were attended with much
suffering. In other respects they were free of disease, so as not to
require medical assistance.[621]
2. Early in the beginning of spring, and through the summer, and
towards winter, many of those who had been long gradually declining,
took to bed with symptoms of phthisis; in many cases formerly of a
doubtful character the disease then became confirmed; in these the
constitution inclined to the phthisical.[622] Many, and, in fact,
the most of them, died; and of those confined to bed, I do not know
if a single individual survived for any considerable time; they died
more suddenly than is common in such cases. But other diseases, of a
protracted character, and attended with fever, were well supported, and
did not prove fatal: of these we will give a description afterwards.
Consumption was the most considerable of the diseases which then
prevailed, and the only one which proved fatal to many persons. Most
of them were affected by these diseases in the following manner:
fevers accompanied with rigors, of the continual type, acute, having
no complete intermissions, but of the form of the semitertians,
being milder the one day, and the next having an exacerbation, and
increasing in violence; constant sweats, but not diffused over the
whole body; extremities very cold, and warmed with difficulty; bowels
disordered, with bilious, scanty, unmixed, thin, pungent, and frequent
dejections. The urine was thin, colourless, unconcocted, or thick, with
a deficient sediment, not settling favorably, but casting down a crude
and unseasonable sediment. Sputa small, dense, concocted, but brought
up rarely and with difficulty; and in those who encountered the most
violent symptoms there was no concoction at all, but they continued
throughout spitting crude matters. Their fauces, in most of them,
were painful from first to last, having redness with inflammation;
defluxions thin, small and acrid; they were soon wasted and became
worse, having no appetite for any kind of food throughout; no thirst;
most persons delirious when near death. So much concerning the
phthisical affections.[623]
3. In the course of the summer and autumn many fevers of the continual
type, but not violent;[624] they attacked persons who had been long
indisposed, but who were otherwise not in an uncomfortable state.
In most cases the bowels were disordered in a very moderate degree,
and they did not suffer thereby in any manner worth mentioning; the
urine was generally well coloured, clear, thin, and after a time
becoming concocted near the crisis. They had not much cough, nor was it
troublesome; they were not deficient in appetite, for it was necessary
to give them food, (on the whole, persons labouring under phthisis were
not affected in the usual manner).[625] They were affected with fevers,
rigors, and deficient sweats, with varied and irregular paroxysms, in
general not intermitting, but having exacerbations in the tertian form.
The earliest crisis which occurred was about the twentieth day, in most
about the fortieth, and in many about the eightieth. But there were
cases in which it did not leave them thus at all, but in an irregular
manner, and without any crisis; in most of these the fevers, after a
brief interval, relapsed again; and from these relapses they came to a
crisis in the same periods; but in many they were prolonged so that the
disease was not gone at the approach of winter. Of all those which are
described under this constitution, the phthisical diseases alone were
of a fatal character; for in all the others the patients bore up well,
and did not die of the other fevers.[626]
SEC. II.--CONSTITUTION SECOND.
1. In Thasus, early in autumn, the winter suddenly set in rainy
before the usual time, with much northerly and southerly winds. These
things all continued so during the season of the Pleiades, and until
their setting.[627] The winter was northerly, the rains frequent, in
torrents, and large, with snow, but with a frequent mixture of fair
weather. These things were all so, but the setting in of the cold
was not much out of season. After the winter solstice, and at the
time when the zephyr usually begins to blow, severe winterly storms
out of season, with much northerly wind, snow, continued and copious
rains; the sky tempestuous and clouded; these things were protracted,
and did not remit until the equinox. The spring was cold, northerly,
rainy, and clouded; the summer was not very sultry, the Etesian winds
blew constant, but quickly afterwards, about the rising of Arcturus,
there were again many rains with north winds. The whole season being
wet, cold, and northerly, people were, for the most part, healthy
during winter; but early in the spring very many, indeed, the greater
part, were valetudinary. At first ophthalmies set in, with rheums,
pains, unconcocted discharges, small concretions, generally breaking
with difficulty, in most instances they relapsed, and they did not
cease until late in autumn.[628] During summer and autumn there were
dysenteric affections, attacks of tenesmus and lientery, bilious
diarrhœa, with thin, copious, undigested, and acrid dejections, and
sometimes with watery stools; many had copious defluxions, with pain,
of a bilious, watery, slimy, purulent nature, attended with strangury,
not connected with disease of the kidneys, but one complaint succeeding
the other; vomitings of bile, phlegm, and undigested food, sweats, in
all cases a redundance of humors. In many instances these complaints
were unattended with fever, and did not prevent the patients from
walking about, but some cases were febrile, as will be described. In
some all those described below occurred with pain. During autumn,
and at the commencement of winter, there were phthisical complaints,
continual fevers; and, in a few cases, ardent; some diurnal, others
nocturnal, semitertians, true tertians, quartans, irregular fevers.
All the fevers which are described attacked great numbers. The ardent
fevers attacked the smallest numbers, and the patients suffered the
least from them, for there were no hemorrhages, except a few and to a
small amount, nor was there delirium; all the other complaints were
slight; in these the crises were regular, in most instances, with the
intermittents, in seventeen days; and I know no instance of a person
dying of causus, nor becoming phrenitic.[629] The tertians were more
numerous than the ardent fevers, and attended with more pain;[630]
but these all had four periods in regular succession from the first
attack, and they had a complete crisis in seven, without a relapse
in any instance. The quartans attacked many at first, in the form of
regular quartans, but in no few cases a transition from other fevers
and diseases into quartans took place; they were protracted, as is
wont with them, indeed, more so than usual. Quotidian, nocturnal, and
wandering fevers attacked many persons, some of whom continued to keep
up, and others were confined to bed. In most instances these fevers
were prolonged under the Pleiades and till winter. Many persons, and
more especially children, had convulsions from the commencement;[631]
and they had fever, and the convulsions supervened upon the fevers;
in most cases they were protracted, but free from danger, unless in
those who were in a deadly state from other complaints. Those fevers
which were continual in the main, and with no intermissions, but having
exacerbations in the tertian form,[632] there being remissions the one
day and exacerbations the next, were the most violent of all those
which occurred at that time, and the most protracted, and occurring
with the greatest pains, beginning mildly, always on the whole
increasing, and being exacerbated, and always turning worse, having
small remissions, and after an abatement having more violent paroxysms,
and growing worse, for the most part, on the critical days. Rigors, in
all cases, took place in an irregular and uncertain manner, very rare
and weak in them, but greater in all other fevers; frequent sweats, but
most seldom in them, bringing no alleviation, but, on the contrary,
doing mischief. Much cold of the extremities in them, and these were
warmed with difficulty. Insomnolency, for the most part, especially
in these fevers, and again a disposition to coma. The bowels, in all
diseases, were disordered, and in a bad state, but worst of all in
these. The urine, in most of them, was either thin and crude, yellow,
and after a time with slight symptoms of concoction in a critical form,
or having the proper thickness, but muddy, and neither settling nor
subsiding; or having small and bad, and crude sediments; these being
the worst of all. Coughs attended these fevers, but I cannot state that
any harm or good ever resulted from the cough. The most of these were
protracted and troublesome, went on in a very disorderly and irregular
form, and, for the most part, did not end in a crisis, either in the
fatal cases or in the others; for if it left some of them for a season
it soon returned again. In a few instances the fever terminated with
a crisis; in the earliest of these about the eightieth day, and some
of these relapsed, so that most of them were not free from the fever
during the winter; but the fever left most of them without a crisis,
and these things happened alike to those who recovered and to those
who did not. There being much want of crisis and much variety as to
these diseases, the greatest and worst symptom attended the most of
them, namely, a loathing of all articles of food, more especially with
those who had otherwise fatal symptoms; but they were not unseasonably
thirsty in such fevers. After a length of time, with much suffering and
great wasting, abscesses were formed in these cases, either unusually
large, so that the patients could not support them, or unusually small,
so that they did no good, but soon relapsed and speedily got worse. The
diseases which attacked them were in the form of dysenteries, tenesmus,
lientery, and fluxes; but, in some cases, there were dropsies, with or
without these complaints. Whatever attacked them violently speedily
cut them off, or again, did them no good. Small rashes, and not
corresponding to the violence of the disease, and quickly disappearing,
or swellings occurred about the ears, which were not resolved, and
brought on no crisis.[633] In some they were determined to the joints,
and especially to the hip-joint, terminating critically with a few,
and quickly again increasing to its original habit. Persons died of
all these diseases, but mostly of these fevers, and especially infants
just weaned, and older children, until eight or ten years of age, and
those before puberty. These things occurred to those affected with the
complaints described above, and to many persons at first without them.
The only favorable symptom, and the greatest of those which occurred,
and what saved most of those who were in the greatest dangers, was
the conversion of it to a strangury, and when, in addition to this,
abscesses were formed.[634] The strangury attacked, most especially,
persons of the ages I have mentioned, but it also occurred in many
others, both of those who were not confined to bed and those who
were. There was a speedy and great change in all these cases. For the
bowels, if they happened previously to have watery discharges of a
bad character, became regular, they got an appetite for food, and the
fevers were mild afterwards. But, with regard to the strangury itself,
the symptoms were protracted and painful. Their urine was copious,
thick, of various characters, red, mixed with pus, and was passed with
pain. These all recovered, and I did not see a single instance of death
among them.
5.[635] With regard to the dangers of these cases, one must always
attend to the seasonable concoction of all the evacuations, and to the
favorable and critical abscesses. The concoctions indicate a speedy
crisis and recovery of health; crude and undigested evacuations, and
those which are converted into bad abscesses, indicate either want
of crisis, or pains, or prolongation of the disease, or death, or
relapses; which of these it is to be must be determined from other
circumstances. _The physician must be able to tell the antecedents,
know the present, and foretell the future--must meditate these things,
and have two special objects in view with regard to diseases, namely,
to do good or to do no harm. The art consists in three things--the
disease, the patient, and the physician. The physician is the servant
of the art, and the patient must combat the disease along with the
physician._[636]
6. Pains about the head and neck, and heaviness of the same along
with pain, occur either without fevers or in fevers. Convulsions
occurring in persons attacked with frenzy, and having vomitings of
verdigris-green bile, in some cases quickly prove fatal. In ardent
fevers, and in those other fevers in which there is pain of the neck,
heaviness of the temples, mistiness about the eyes, and distention
about the hypochondriac region, not unattended with pain, hemorrhage
from the nose takes place,[637] but those who have heaviness of the
whole head, cardialgia and nausea, vomit bilious and pituitous matters;
children, in such affections, are generally attacked with convulsions,
and women have these and also pains of the uterus; whereas, in elder
persons, and those in whom the heat is already more subdued, these
cases end in paralysis, mania, and loss of sight.
THIRD CONSTITUTION.
7. In Thasus, a little before and during the season of Arcturus,[638]
there were frequent and great rains, with northerly winds. About
the equinox, and till the setting of the Pleiades, there were a few
southerly rains: the winter northerly and parched, cold, with great
winds and snow. Great storms about the equinox, the spring northerly,
dryness, rains few and cold. About the summer solstice, scanty rains,
and great cold until near the season of the Dog-star.[639] After the
Dog-days, until the season of Arcturus, the summer hot, great droughts,
not in intervals, but continued and severe: no rain; the Etesian winds
blew; about the season of Arcturus southerly rains until the equinox.
8. In this state of things, during winter, paraplegia set in, and
attacked many, and some died speedily; and otherwise the disease
prevailed much in an epidemical form, but persons remained free from
all other diseases.[640] Early in the spring, ardent fevers commenced
and continued through the summer until the equinox. Those then that
were attacked immediately after the commencement of the spring and
summer, for the most part recovered, and but few of them died. But when
the autumn and the rains had set in, they were of a fatal character,
and the greater part then died.[641] When in these attacks of ardent
fevers there was a proper and copious hemorrhage from the nose, they
were generally saved by it, and I do not know a single person who
had a proper hemorrhage who died in this constitution. Philiscus,
Epaminon, and Silenus, indeed, who had a trifling epistaxis on the
fourth and fifth day, died.[642] The most of those seized with the
disease had a rigor about the time of the crisis, and especially those
who had no hemorrhage; these had also the rigor associated. Some were
attacked with jaundice on the sixth day,[643] but these were benefited
either by an urinary purgation, or a disorder of the bowels, or a
copious hemorrhage, as in the case of Heraclides, who was lodged with
Aristocydes: this person, though he had the hemorrhage from the nose,
the purgation by the bladder, and disorder of the bowels, experienced
a favorable crisis on the twentieth day, not like the servant of
Phanagoras, who had none of these symptoms, and died. The hemorrhages
attacked most persons, but especially young persons and those in the
prime of life, and the greater part of those who had not the hemorrhage
died:[644] elderly persons had jaundice or disorder of the bowels,
such as Bion, who was lodged with Silenus. Dysenteries were epidemical
during the summer, and some of those cases in which the hemorrhage
occurred, terminated in dysentery, as happened to the slave of Eraton,
and to Mullus, who had a copious hemorrhage, which settled down into
dysentery, and they recovered. This humor was redundant in many cases,
since in those who had not the hemorrhage about the crisis, but the
risings about the ears disappeared, after their disappearance there was
a sense of weight in the left flank extending to the extremity of the
hip, and pain setting in after the crisis, with a discharge of thin
urine; they began to have small hemorrhages about the twenty-fourth
day, and the swelling was converted into the hemorrhage. In the case of
Antiphon, the son of Critobulus, the fever ceased and came to a crisis
about the fortieth day. Many women were attacked, but fewer than of
the men, and there were fewer deaths among them. But most of them had
difficult parturition, and after labor they were taken ill, and these
most especially died, as, for example, the daughter of Telebolus died
on the sixth day after delivery.[645] Most females had the menstrual
discharge during the fever, and many girls had it then for the first
time: in certain individuals both the hemorrhage from the nose and the
menses appeared; thus, in the case of the virgin daughter of Dætharses,
the menses then took place for the first time, and she had also a
copious hemorrhage from the nose, and I knew no instance of any one
dying when one or other of these took place properly. But all those
in the pregnant state that were attacked had abortions, as far as I
observed. The urine in most cases was of the proper color, but thin,
and having scanty sediments:[646] in most the bowels were disordered
with thin and bilious dejections; and many, after passing through the
other crises, terminated in dysenteries, as happened to Xenophanes
and Critias. The urine was watery, copious, clear, and thin; and even
after the crises, when the sediment was natural, and all the other
critical symptoms were favorable, as I recollect having happened to
Bion, who was lodged in the house of Silenus, and Critias, who lived
with Xenophanes, the slave of Areton, and the wife of Mnesistratus. But
afterwards all these were attacked with dysentery. It would be worth
while to inquire whether the watery urine was the cause of this.[647]
About the season of Arcturus many had the crisis on the eleventh day,
and in them the regular relapses did not take place, but they became
comatose about this time, especially children; but there were fewest
deaths of all among them.
9. About the equinox, and until the season of the Pleiades, and at
the approach of winter, many ardent fevers set in; but great numbers at
that season were seized with phrenitis, and many died;[648] a few cases
also occurred during the summer. These then made their attack at the
commencement of ardent fevers, which were attended with fatal symptoms;
for immediately upon their setting in, there were acute fever and
small rigors, insomnolency, aberration, thirst, nausea, insignificant
sweats about the forehead and clavicles, but no general perspiration;
they had much delirious talking, fears, despondency, great coldness of
the extremities, in the feet, but more especially in their hands: the
paroxysms were on the even days; and in most cases, on the fourth day,
the most violent pains set in, with sweats, generally coldish, and the
extremities could not be warmed, but were livid and rather cold, and
they had then no thirst; in them the urine was black, scanty, thin,
and the bowels were constipated; there was an hemorrhage from the nose
in no case in which these symptoms occurred, but merely a trifling
epistaxis; and none of them had a relapse, but they died on the sixth
day with sweats.[649] In the phrenitic cases, all the symptoms which
have been described did not occur, but in them the disease mostly came
to a crisis on the eleventh day, and in some on the twentieth. In those
cases in which the phrenitis did not begin immediately, but about the
third or fourth day, the disease was moderate at the commencement,
but assumed a violent character about the seventh day. There was a
great number of diseases, and of those affected, they who died were
principally infants, young persons, adults having smooth bodies, white
skins, straight and black hair, dark eyes, those living recklessly and
luxuriously; persons with shrill, or rough voices, who stammered and
were passionate, and women more especially died from this form. In
this constitution, four symptoms in particular proved salutary; either
a hemorrhage from the nose, or a copious discharge by the bladder of
urine, having an abundant and proper sediment, or a bilious disorder
of the bowels at the proper time, or an attack of dysentery.[650] And
in many cases it happened, that the crisis did not take place by any
one of the symptoms which have been mentioned, but the patient passed
through most of them, and appeared to be in an uncomfortable way,
and yet all who were attacked with these symptoms recovered. All the
symptoms which I have described occurred also to women and girls; and
whoever of them had any of these symptoms in a favorable manner, or
the menses appeared abundantly, were saved thereby, and had a crisis,
so that I do not know a single female who had any of these favorably
that died. But the daughter of Philo, who had a copious hemorrhage from
the nose, and took supper unseasonably on the seventh day, died. In
those cases of acute, and more especially of ardent fevers, in which
there is an involuntary discharge of tears, you may expect a hemorrhage
from the nose, unless the other symptoms be of a fatal character, for
in those of a bad description, they do not indicate a hemorrhage, but
death. Swellings about the ears, with pain in fevers, sometimes when
the fever went off critically, neither subsided nor were converted into
pus; in these cases a bilious diarrhœa, or dysentery, or thick urine
having a sediment, carried off the disease, as happened to Hermippus
of Clazomenæ. The circumstances relating to crises, as far as we can
recognize them, were so far similar and so far dissimilar. Thus two
brothers became ill at the same hour (they were brothers of Epigenes,
and lodged near the theatre), of these the elder had a crisis on the
sixth day, and the younger on the seventh, and both had a relapse at
the same hour; it then left them for five days, and from the return
of the fever both had a crisis together on the seventeenth day. Most
had a crisis on the sixth day; it then left them for six days, and
from the relapse there was a crisis on the fifth day.[651] But those
who had a crisis on the seventh day, had an intermission for seven
days; and the crisis took place on the third day after the relapse.
Those who had a crisis on the sixth day, after an interval of six
days were seized again on the third, and having left them for one
day, the fever attacked them again on the next and came to a crisis,
as happened to Evagon the son of Dætharses. Those in whom the crisis
happened on the sixth day, had an intermission of seven days, and
from the relapse there was a crisis on the fourth, as happened to
the daughter of Aglaïdas. The greater part of those who were taken
ill under this constitution of things, were affected in this manner,
and I did not know a single case of recovery, in which there was not
a relapse agreeably to the stated order of relapses; and all those
recovered in which the relapses took place according to this form:
nor did I know a single instance of those who then passed through the
disease in this manner who had another relapse. In these diseases
death generally happened on the sixth day, as happened to Epaminondas,
Silenus, and Philiscus the son of Antagoras. Those who had parotid
swellings experienced a crisis on the twentieth day, but in all these
cases the disease went off without coming to a suppuration, and was
turned upon the bladder. But in Cratistonax, who lived by the temple
of Hercules, and in the maid servant of Scymnus the fuller, it turned
to a suppuration, and they died. Those who had a crisis on the seventh
day, had an intermission of nine days, and a relapse which came to a
crisis on the fourth day from the return of the fever, as was the case
with Pantacles, who resided close by the temple of Bacchus. Those who
had a crisis on the seventh day, after an interval of six days had a
relapse, from which they had a crisis on the seventh day, as happened
to Phanocritus, who was lodged with Gnathon the painter. During the
winter, about the winter solstices, and until the equinox, the ardent
fevers and frenzies prevailed, and many died. The crisis, however,
changed, and happened to the greater number on the fifth day from the
commencement, left them for four days and relapsed; and after the
return, there was a crisis on the fifth day, making in all fourteen
days. The crisis took place thus in the case of most children, also in
elder persons. Some had a crisis on the eleventh day, a relapse on the
fourteenth, a complete crisis on the twentieth; but certain persons,
who had a rigor about the twentieth, had a crisis on the fortieth. The
greater part had a rigor along with the original crisis, and these had
also a rigor about the crisis in the relapse. There were fewest cases
of rigor in the spring, more in summer, still more in autumn, but by
far the most in winter; then hemorrhages ceased.
SEC. III.
10. With regard to diseases, the circumstances from which we form a
judgment of them are,--by attending to the general nature of all, and
the peculiar nature of each individual,--to the disease, the patient,
and the applications,--to the person who applies them, as that makes a
difference for better or for worse,--to the whole constitution of the
season, and particularly to the state of the heavens, and the nature
of each country;--to the patient’s habits, regimen, and pursuits;--to
his conversation, manners, taciturnity, thoughts, sleep, or absence
of sleep, and sometimes his dreams, what and when they occur;--to his
picking and scratching;[652]--to his tears;--to the alvine discharges,
urine, sputa, and vomitings; and to the changes of diseases from the
one into the other;--to the deposits, whether of a deadly or critical
character;--to the sweat, coldness, rigor, cough, sneezing, hiccup,
respiration, eructation, flatulence, whether passed silently or with
a noise;--to hemorrhages and hemorrhoids;--from these, and their
consequences, we must form our judgment.[653]
11. Fevers are,--the continual, some of which hold during the day and
have a remission at night, and others hold during the night and have
a remission during the day;[654] semitertians, tertians, quartans,
quintans, septans, nonans. The most acute, strongest, most dangerous,
and fatal diseases, occur in the continual fever. The least dangerous
of all, and the mildest and most protracted, is the quartan, for it
is not only such from itself, but it also carries off other great
diseases.[655] In what is called the semitertian, other acute diseases
are apt to occur, and it is the most fatal of all others, and moreover
phthisical persons, and those laboring under other protracted diseases,
are apt to be attacked by it.[656] The nocturnal fever is not very
fatal, but protracted; the diurnal is still more protracted, and in
some cases passes into phthisis. The septan is protracted, but not
fatal; the nonan more protracted, and not fatal. The true tertian comes
quickly to a crisis, and is not fatal; but the quintan is the worst of
all, for it proves fatal when it precedes an attack of phthisis, and
when it supervenes on persons who are already consumptive.[657] There
are peculiar modes, and constitutions, and paroxysms, in every one of
these fevers; for example,--the continual, in some cases at the very
commencement, grows, as it were, and attains its full strength, and
rises to its most dangerous pitch, but is diminished about and at the
crisis; in others it begins gentle and suppressed, but gains ground and
is exacerbated every day, and bursts forth with all its heat about and
at the crisis; while in others, again, it commences mildly, increases,
and is exacerbated until it reaches its acmé, and then remits until at
and about the crisis.[658] These varieties occur in every fever, and in
every disease. From these observations one must regulate the regimen
accordingly. There are many other important symptoms allied to these,
part of which have been already noticed, and part will be described
afterwards, from a consideration of which one may judge, and decide in
each case, whether the disease be acute, and whether it will end in
death or recovery; or whether it will be protracted, and will end in
death or recovery; and in what cases food is to be given, and in what
not; and when and to what amount, and what particular kind of food is
to be administered.
12. Those diseases which have their paroxysms on even days have their
crises on even days; and those which have their paroxysms on uneven
days have their crises on uneven days. The first period of those which
have the crisis on even days, is the 4th, 6th, 8th, 10th, 14th, 20th,
30th, 40th, 60th, 80th, 100th; and the first period of those which have
their crises on uneven days, is the let, 3d, 5th, 7th, 9th, 11th, 17th,
21st, 27th, 31st. It should be known, that if the crisis take place on
any other day than on those described, it indicates that there will
be a relapse, which may prove fatal. But one ought to pay attention,
and know in these seasons what crises will lead to recovery and what
to death, or to changes for the better or the worse. Irregular fevers,
quartans, quintans, septans, and nonans should be studied, in order to
find out in what periods their crises take place.
13. FOURTEEN CASES OF DISEASE.[659]
CASE I.--Philiscus, who lived by the Wall, took to bed on
the first day of acute fever; he sweated; towards night was uneasy. On
the second day all the symptoms were exacerbated; late in the evening
had a proper stool from a small clyster; the night quiet. On the third
day, early in the morning and until noon, he appeared to be free from
fever; towards evening, acute fever, with sweating, thirst, tongue
parched; passed black urine; night uncomfortable, no sleep; he was
delirious on all subjects. On the fourth, all the symptoms exacerbated,
urine black; night more comfortable, urine of a better color. On the
fifth, about mid-day, had a slight trickling of pure blood from the
nose; urine varied in character, having floating in it round bodies,
resembling semen, and scattered, but which did not fall to the bottom;
a suppository having been applied, some scanty flatulent matters were
passed; night uncomfortable, little sleep, talking incoherently;
extremities altogether cold, and could not be warmed; urine black;
slept a little towards day; loss of speech, cold sweats; extremities
livid; about the middle of the sixth day he died. The respiration
throughout, like that of a person recollecting himself, was rare, and
large, and spleen was swelled upon in a round tumor, the sweats cold
throughout, the paroxysms on the even days.[660]
CASE II.--Silenus lived on the Broad-way, near the house
of Evalcidas. From fatigue, drinking, and unseasonable exercises, he
was seized with fever. He began with having pain in the loins; he had
heaviness of the head, and there was stiffness of the neck. On the
first day the alvine discharges were bilious, unmixed, frothy, high
colored, and copious; urine black, having a black sediment; he was
thirsty, tongue dry; no sleep at night. On the second, acute fever,
stools more copious, thinner, frothy; urine black, an uncomfortable
night, slight delirium. On the third, all the symptoms exacerbated;
an oblong distention, of a softish nature, from both sides of the
hypochondrium to the navel; stools thin, and darkish; urine muddy, and
darkish; no sleep at night; much talking, laughter, singing, he could
not restrain himself. On the fourth, in the same state. On the fifth,
stools bilious, unmixed, smooth, greasy; urine thin, and transparent;
slight absence of delirium. On the sixth, slight perspiration about
the head; extremities cold and livid; much tossing about; no passage
from the bowels, urine suppressed, acute fever. On the seventh, loss
of speech; extremities could no longer be kept warm; no discharge of
urine. On the eighth, a cold sweat all over; red rashes with sweat, of
a round figure, small, like _vari_, persistent, not subsiding; by
means of a slight stimulus, a copious discharge from the bowels, of
a thin and undigested character, with pain; urine acrid, and passed
with pain; extremities slightly heated; sleep slight, and comatose;
speechless; urine thin, and transparent. On the ninth, in the same
state. On the tenth, no drink taken; comatose, sleep slight; alvine
discharges the same; urine abundant, and thickish; when allowed to
stand, the sediment farinaceous and white; extremities again cold.
On the eleventh, he died. At the commencement, and throughout, the
respiration was slow and large; there was a constant throbbing in the
hypochondrium; his age was about twenty.[661]
CASE III.--Herophon was seized with an acute fever; alvine discharges
at first were scanty, and attended with tenesmus; but afterwards
they were passed of a thin, bilious character, and frequent; there
was no sleep; urine black, and thin. On the fifth, in the morning,
deafness; all the symptoms exacerbated; spleen swollen; distention
of the hypochondrium; alvine discharges scanty, and black; he became
delirious. On the sixth, delirious; at night, sweating, coldness;
the delirium continued. On the seventh, he became cold, thirsty, was
disordered in mind; at night recovered his senses; slept. On the
eighth, was feverish; the spleen diminished in size; quite collected;
had pain at first about the groin, on the same side as the spleen;
had pains in both legs; night comfortable; urine better colored, had
a scanty sediment. On the ninth, sweated; the crisis took place;
fever remitted. On the fifth day afterwards, fever relapsed, spleen
immediately became swollen; acute fever; deafness again. On the third
day after the relapse, the spleen diminished; deafness less; legs
painful; sweated during the night; crisis took place on the seventeenth
day; had no disorder of the senses during the relapse.[662]
CASE IV.--In Thasus, the wife of Philinus, having been delivered of a
daughter, the lochial discharge being natural, and other matters going
on mildly, on the fourteenth day after delivery was seized with fever,
attended with rigor; was pained at first in the cardiac region of the
stomach and right hypochondrium; pain in the genital organs; lochial
discharge ceased. Upon the application of a pessary all these symptoms
were alleviated; pains of the head, neck, and loins remained; no sleep;
extremities cold; thirst; bowels in a hot state; stools scanty; urine
thin, and colorless at first. On the sixth, towards night, senses much
disordered, but again were restored. On the seventh, thirsty; the
evacuations bilious, and high colored. On the eighth, had a rigor;
acute fever; much spasm, with pain; talked much, incoherently; upon
the application of a suppository, rose to stool, and passed copious
dejections, with a bilious flux; no sleep. On the ninth, spasms. On
the tenth, slightly recollected. On the eleventh, slept; had perfect
recollection, but again immediately wandered; passed a large quantity
of urine with spasms, (the attendants seldom putting her in mind,) it
was thick, white, like urine which has been shaken after it has stood
for a considerable time until it has subsided, but it had no sediment;
in color and consistence, the urine resembled that of cattle, as far as
I observed. About the fourteenth day, startings over the whole body;
talked much; slightly collected, but presently became again delirious.
About the seventeenth day became speechless, on the twentieth died.[663]
CASE V.--The wife of Epicrates, who was lodged at the house
of Archigetes, being near the term of delivery, was seized with a
violent rigor, and, as was said, she did not become heated;[664] next
day the same. On the third, she was delivered of a daughter, and
everything went on properly. On the day following her delivery, she was
seized with acute fever, pain in the cardiac region of the stomach, and
in the genital parts. Having had a suppository, was in so far relieved;
pain in the head, neck, and loins; no sleep; alvine discharges scanty,
bilious, thin, and unmixed; urine thin, and blackish. Towards the night
of the sixth day from the time she was seized with the fever, became
delirious. On the seventh, all the symptoms exacerbated; insomnolency,
delirium, thirst; stools bilious, and high colored. On the eighth, had
a rigor; slept more. On the ninth, the same. On the tenth, her limbs
painfully affected; pain again of the cardiac region of the stomach;
heaviness of the head; no delirium; slept more; bowels constipated. On
the eleventh, passed urine of a better color, and having an abundant
sediment; felt lighter. On the fourteenth had a rigor; acute fever. On
the fifteenth, had a copious vomiting of bilious and yellow matters;
sweated; fever gone; at night acute fever; urine thick, sediment
white.[665] On the seventeenth, an exacerbation; night uncomfortable;
no sleep; delirium. On the eighteenth, thirsty; tongue parched; no
sleep; much delirium; legs painfully affected. About the twentieth,
in the morning, had a slight rigor; was comatose; slept tranquilly;
had slight vomiting of bilious and black matters; towards night
deafness. About the twenty-first, weight generally in the left side,
with pain; slight cough; urine thick, muddy, and reddish; when allowed
to stand, had no sediment; in other respects felt lighter; fever not
gone; fauces painful from the commencement, and red; uvula retracted;
defluxion remained acrid, pungent, and saltish throughout. About the
twenty-seventh, free of fever; sediment in the urine; pain in the side.
About the thirty-first, was attacked with fever, bilious diarrhœa;
slight bilious vomiting on the fortieth. Had a complete crisis, and was
freed from the fever on the eightieth day.[666]
CASE VI.--Cleonactides, who was lodged above the Temple of
Hercules, was seized with a fever in an irregular form; was pained
in the head and left side from the commencement, and had other
pains resembling those produced by fatigue: paroxysms of the fevers
inconstant and irregular; occasional sweats; the paroxysms generally
attacked on the critical days. About the twenty-fourth was cold in the
extremities of the hands, vomitings bilious, yellow, and frequent,
soon turning to a verdigris-green color; general relief. About the
thirtieth, began to have hemorrhage from both nostrils, and this
continued in an irregular manner until near the crisis; did not loathe
food, and had no thirst throughout, nor was troubled with insomnolency;
urine thin, and not devoid of color. When about the thirtieth day,
passed reddish urine, having a copious red sediment; was relieved,
but afterwards the characters of the urine varied, sometimes having
sediment, and sometimes not. On the sixtieth, the sediment in the urine
copious, white, and smooth; all the symptoms ameliorated; intermission
of the fever; urine thin, and well colored. On the seventieth, fever
gone for ten days. On the eightieth had a rigor, was seized with acute
fever, sweated much; a red, smooth sediment in the urine; and a perfect
crisis.[667]
CASE VII.--Meton was seized with fever; there was a painful
weight in the loins. Next day, after drinking water pretty copiously,
had proper evacuations from the bowels. On the third, heaviness of
the head, stools thin, bilious, and reddish. On the fourth, all the
symptoms exacerbated; had twice a scanty trickling of blood from the
right nostril; passed an uncomfortable night; alvine discharges like
those on the third day; urine darkish, had a darkish cloud floating in
it, of a scattered form, which did not subside. On the fifth, a copious
hemorrhage of pure blood from the left nostril; he sweated, and had a
crisis. After the fever restless, and had some delirium; urine thin,
and darkish; had an affusion of warm water on the head; slept and
recovered his senses. In this case there was no relapse, but there were
frequent hemorrhages after the crisis.[668]
CASE VIII.--Erasinus, who lived near the Canal of Bootes,
was seized with fever after supper; passed the night in an agitated
state. During the first day quiet, but in pain at night. On the
second, symptoms all exacerbated; at night delirious. On the third,
was in a painful condition; great incoherence. On the fourth, in a
most uncomfortable state; had no sound sleep at night, but dreaming
and talking; then all the appearances worse, of a formidable and
alarming character; fear, impatience. On the morning of the fifth, was
composed, and quite coherent, but long before noon was furiously mad,
so that he could not constrain himself; extremities cold, and somewhat
livid; urine without sediment; died about sunset. The fever in this
case was accompanied by sweats throughout; the hypochondria were in
a state of meteorism, with distention and pain; the urine was black,
had round substances floating in it, which did not subside; the alvine
evacuations were not stopped; thirst throughout not great; much spasms
with sweats about the time of death.[669]
CASE IX.--Criton, in Thasus, while still on foot, and going
about, was seized with a violent pain in the great toe; he took to bed
the same day, had rigors and nausea, recovered his heat slightly, at
night was delirious. On the second, swelling of the whole foot, and
about the ankle erythema, with distention, and small bullæ (phlyctænæ);
acute fever; he became furiously deranged; alvine discharges bilious,
unmixed, and rather frequent. He died on the second day from the
commencement.[670]
CASE X.--The Clazomenian who was lodged by the Well of Phrynichides
was seized with fever. He had pain in the head, neck, and loins from
the beginning, and immediately afterwards deafness; no sleep, acute
fever, hypochondria elevated with a swelling, but not much distention;
tongue dry. On the fourth, towards night, he became delirious. On the
fifth, in an uneasy state. On the sixth, all the symptoms exacerbated.
About the eleventh a slight remission; from the commencement to the
fourteenth day the alvine discharges thin, copious, and of the color
of water, but were well supported; the bowels then became constipated.
Urine throughout thin, and well colored, and had many substances
scattered through it, but no sediment. About the sixteenth, urine
somewhat thicker, which had a slight sediment; somewhat better, and
more collected. On the seventeenth, urine again thin; swellings about
both his ears, with pain; no sleep, some incoherence; legs painfully
affected. On the twentieth, free of fever, had a crisis, no sweat,
perfectly collected. About the twenty-seventh, violent pain of the
right hip; it speedily went off. The swellings about the ears subsided,
and did not suppurate, but were painful. About the thirty-first, a
diarrhœa, attended with a copious discharge of watery matter, and
symptoms of dysentery; passed thick urine; swellings about the ears
gone. About the fortieth day, had pain in the right eye, sight dull. It
went away.[671]
CASE XI.--The wife of Dromeades having been delivered of a
female child, and all other matters going on properly, on the second
day after was seized with rigor and acute fever. Began to have pain
about the hypochondrium on the first day; had nausea and incoherence,
and for some hours afterwards had no sleep; respiration rare, large,
and suddenly interrupted. On the day following that on which she had
the rigor, alvine discharges proper; urine thick, white, muddy, like
urine which has been shaken after standing for some time, until the
sediment had fallen to the bottom; it had no sediment; she did not
sleep during the night. On the third day, about noon, had a rigor,
acute fever; urine the same; pain of the hypochondria, nausea, an
uncomfortable night, no sleep; a coldish sweat all over, but heat
quickly restored. On the fourth, slight allevation of the symptoms
about the hypochondria; heaviness of the head, with pain; somewhat
comatose; slight epistaxis, tongue dry, thirst, urine thin and oily;
slept a little, upon awaking was somewhat comatose; slight coldness,
slept during the night, was delirious. On the morning of the sixth had
a rigor, but soon recovered her heat, sweated all over; extremities
cold, was delirious, respiration rare and large. Shortly afterwards
spasms from the head began, and she immediately expired.[672]
CASE XII.--A man, in a heated state, took supper, and drank
more than enough; he vomited the whole during the night; acute fever,
pain of the right hypochondrium, a softish inflammation from the inner
part; passed an uncomfortable night; urine at the commencement thick,
red, but when allowed to stand, had no sediment, tongue dry, and not
very thirsty. On the fourth, acute fever, pains all over. On the fifth,
urine smooth, oily, and copious; acute fever. On the sixth, in the
evening, very incoherent, no sleep during the night. On the seventh,
all the symptoms exacerbated; urine of the same characters; much
talking, and he could not contain himself; the bowels being stimulated,
passed a watery discharge with lumbrici: night equally painful. In the
morning had a rigor; acute fever, hot sweat, appeared to be free of
fever; did not sleep long; after the sleep a chill, ptyalism; in the
evening, great incoherence; after a little, vomited a small quantity of
dark bilious matters. On the ninth, coldness, much delirium, did not
sleep. On the tenth, pains in the limbs, all the symptoms exacerbated;
he was delirious. On the eleventh, he died.[673]
CASE XIII.--A woman, who lodged on the Quay, being three
months gone with child, was seized with fever, and immediately began to
have pains in the loins. On the third day, pain of the head and neck,
extending to the clavicle, and right hand; she immediately lost the
power of speech; was paralyzed in the right hand, with spasms, after
the manner of paraplegia; was quite incoherent; passed an uncomfortable
night; did not sleep; disorder of the bowels, attended with bilious,
unmixed, and scanty stools. On the fourth, recovered the use of her
tongue; spasms of the same parts, and general pains remained; swelling
in the hypochondrium, accompanied with pain; did not sleep, was quite
incoherent; bowels disordered, urine thin, and not of a good color. On
the fifth, acute fever; pain of the hypochondrium, quite incoherent;
alvine evacuations bilious; towards night had a sweat, and was freed
from the fever. On the sixth, recovered her reason; was every way
relieved; the pain remained about the left clavicle; was thirsty,
urine thin, had no sleep. On the seventh trembling, slight coma, some
incoherence, pains about the clavicle and left arm remained; in all
other respects was alleviated; quite coherent. For three days remained
free from fever. On the eleventh, had a relapse, with rigor and fever.
About the fourteenth day, vomited pretty abundantly bilious and yellow
matters, had a sweat, the fever went off, by coming to a crisis.[674]
CASE XIV.--Melidia, who lodged near the Temple of Juno, began to
feel a violent pain of the head, neck, and chest. She was straightway
seized with acute fever; a slight appearance of the menses; continued
pains of all these parts. On the sixth, was affected with coma, nausea,
and rigor; redness about the cheeks; slight delirium. On the seventh,
had a sweat; the fever intermitted, the pains remained. A relapse;
little sleep; urine throughout of a good color, but thin; the alvine
evacuations were thin, bilious, acrid, very scanty, black, and fetid;
a white, smooth sediment in the urine; had a sweat, and experienced a
perfect crisis on the eleventh day.[675]
BOOK III.--OF THE EPIDEMICS.
THE ARGUMENT.
Though in the Argument prefixed to the First Book of the Epidemics I
have given a pretty full summary of the contents both of that book and
the third, I have still a few observations to make on some important
points, which were not sufficiently considered on that occasion; and
this I do the more readily, as it will afford me an opportunity of
noticing a subject on which M. Littré has bestowed very extensive
research. I allude to the origin of the Glandular Plague. As I make it
a rule, in giving these my annotations, not to enter into any lengthy
details, I shall now state, in a very succinct manner, the result of
my inquiries. The reader is referred, for a fuller discussion of the
subject, to the more ample disquisitions of M. Littré.[676]
The opinion has been pretty generally maintained by modern
authorities, that the first description which we have of the glandular
plague of the East is that given by the historian Procopius, in the
sixth century; and the inference drawn therefrom is that the disease
was unknown until his time. This opinion is still held, to a certain
extent, by Hecker, Rosenbaum, Pariset, Nauman, and others of the most
distinguished scholars of the day, but it appears to be untenable after
the discovery of the “Fragment” of Ruffus, published by Mai, Rome,
1831. As the passage is very important, I shall give a translation of
it in this place. It is as follows: “The buboes called pestilential are
most fatal and acute, especially those which are seen occurring about
Libya, Egypt, and Syria, and which are mentioned by Dionysius Curtus.
Dioscorides and Posidonius make much mention of them in the plague
which occurred in their time in Libya; they say it was accompanied by
acute fever, pain, and prostration of the whole body, delirium, and the
appearance of large and hard buboes, which did not suppurate, not only
in the accustomed parts, but also in the groins and armpits.” The only
thing which detracts from the value of this paragraph is the difficulty
of determining exactly who the authorities are which are referred to
in it. Of Dionysius Curtus nothing is known; indeed it is more than
probable, that there is some mistake in this name. There are several
medical authors of the name of Dioscorides and Posidonius, and it is
difficult to determine to which of them reference is here made. Still,
however, there seems to be no reason for questioning the authenticity
of the passage. Ruffus, I may add, is generally admitted to have
flourished in the reign of Trajan.[677]
To this important document let me join an interesting extract
from Galen’s work “On Fevers.” Galen, _treating professedly of
Pestilential Fevers_, which he maintains are all connected with a
tendency to putridity, expresses himself as follows: “Moreover, as
Hippocrates says, all fevers from buboes are bad, with the exception
of ephemerals; although the bubo is also of the class of phlegmons.
And I agree in so far with what is said of putrefaction, for this
is the cause of the fever in inflammations, and not as Erasistratus
supposed.[678] But yet there are certain fevers from buboes of the
class of ephemerals, as certain others proclaim them to be; diseases
difficult to cure, which derive their origin from an inflammation,
an ulcer, an abscess, or some other such affection in a viscus. But
the ephemeral fevers from buboes differ from those connected with
putrefactions, either in a certain viscus, or in the hollow and very
large vessels, that in those from buboes, which always impart their
heat to the surrounding parts, the heat is communicated to the heart,
and the putrefactive fume does not reach it, but remains circumscribed
in the seat of the bubo, and the heat reaching the heart solely by a
change in the connecting parts, in like manner as in those exposed
to excessive heat and fatigue, the diffusion of the heat takes
place from the parts first warmed to the source of vitality; but in
a putrefaction about the viscera and large vessels, a fume, as it
were, from the putrefying humors reaches the cavities of the heart,
etc.”[679] From these two passages alone, without taking into account
several others of less importance, which might be gathered from other
medical authorities,[680] it must be quite obvious that the glandular
plague was known, at all events, in the second century of the Christian
era. Moreover it is equally clear, that Galen did not look upon it
as a new disease, but considered that it was noticed in the works
of Hippocrates. To my mind, then, there can be no doubt that the
pestilence which prevailed during the Peloponnesian war partook of the
nature of the glandular plague. What has tended to create doubts on
this subject, in the minds of many learned men, is the omission of any
distinct mention of buboes in the graphic description of it given by
Thucydides. But it should always be taken into account that Thucydides
was not a professional man, and therefore there is a strong presumption
that his acquaintance with the disease, even although, as he states, he
himself had experienced an attack of it, must have been altogether of
a general nature. Indeed Galen, both in the treatise from which I have
quoted above and in many other parts of his works, does not hesitate
to declare, that the historian describes the disease as a common,
that is to say, a non-professional man, whereas Hippocrates gives
its characters as a physician. It is also to be borne in mind, that
the description of it given by Thucydides applies to it only at its
outbreak in the city of Athens, and it is a well-known characteristic
of pestilential epidemics that they change very much during their
progress. This character of them was well illustrated in the Plague
of Aleppo, so admirably described by Dr. Russel; for although the
glandular form of the disease prevailed in a large number of cases, a
considerable proportion of them were unaffected with buboes. Indeed
it appears to me to be too much the practice for the profession, as
well as the public, to imagine to themselves a certain type or ideal
of every disease, and when they do not recognize the exact characters
which they fancy it should present, they immediately set down such
cases as constituting an entirely different disease. This is an error
that is constantly committed, and one which I believe to be at the
bottom of the discordant opinions which prevail among professional
men, on the subject of the glandular plague. It would be well for the
physician to bear in mind how many varieties of symptoms the fever
designated as Typhus puts on,--some with the rash reckoned peculiar
to this fever, and some without it,--some with petechiæ, and miliary
eruptions, and others without them; and many other complications of
symptoms, which are sometimes present and sometimes not.
With regard to the hypothesis lately advanced by Mr. Theod.
Krause,[681] and in so far countenanced by M. Littré, that the plague
of Athens was an epidemical variola, I must say that I can see no
probability in this supposition; for that a disease so strongly
marked as smallpox should have prevailed in ancient times, and yet
not be distinctly noticed by the Greek and Roman writers on medicine,
I cannot conceive, more especially when we call to recollection the
very accurate descriptions which they have left us of other cutaneous
diseases, by no means attended with symptoms of so obvious a nature.
Indeed it appears to me most wonderful, that such an opinion should
have been entertained by any person at all acquainted with the Arabic
writers on medicine, who described most distinctly both the plague and
the smallpox. Not to lose ourselves amidst a host of authorities, I
would refer the reader, in particular, to Avicenna, iv., 1, 4, where
the two diseases are treated of most distinctly, so that I cannot
entertain a doubt that the Arabian physicians considered them to be
essentially different.
In a considerable number of the cases reported in this book, there are
affixed to them in the original certain characters, the interpretation
of which the reader will find given in the translation. It will be
necessary, then, to give the reader some account of the origin of
these characters, regarding which our sole authority is Galen, who,
in his Commentaries on this book, enters on the question in his
usual elegant and attractive style. He admits that he derived his
information principally from Zeuxis, one of his predecessors in the
office of commenting upon the works of Hippocrates. (See § 2, of the
Preliminary Discourse.) It appears that Ptolemy Philadelphus was so
zealous in his search for books to adorn his library, in Alexandria,
that he gave instructions to the masters of ships going on distant
voyages to collect all the books they could procure, and bring them
back with them; that he ordered copies to be taken of books brought
to him in this way, and kept the originals, but returned the copies,
along with large sums of money, in certain cases, to those who had
lent them to him; and that the works so obtained were preserved in a
separate department of the library, with the inscription, “The Books
of the Ships.” Among these was found a copy of the Third Book of the
Epidemics, with the inscription, “One of the Books of the Ships,
according to the _redacteur_ Memnon of Sida.” Others say, that the
term “_redacteur_” was wanting, and that the book bore simply the
inscription of “Memnon;” and that the servants of the king inscribed
the names of all the seamen who had brought these books, when they were
installed on the shelves of the library. This, it would seem, was not
done immediately after their arrival in Alexandria, but that at first
they were collected together in certain houses. Memnon, the librarian,
then, is generally supposed to have surreptitiously introduced the
characters into one of the copies, in order that he might raise himself
into importance by interpreting them. But whether or not this ruse was
actually perpetrated by Memnon, the general belief of the commentators
was, that Hippocrates himself had nothing to do with them. In fact,
Zeno would appear to have been the only commentator who held them to
be genuine, and ascribed the introduction of them to our author. The
opinion thus advanced by Zeno led him into a violent controversy with
the two Apollonii, namely, the Empiric and Biblas, who strenuously
maintained that the characters were an interpolation executed by
Memnon. This came to be the settled opinion of the commentators,
and among others of Galen, who, although he gives a key to the
interpretation of the characters, maintains, on all occasions, that
they are of no authority, and had in fact been forged by Memnon.
The following is the key which Galen gives to the interpretation
of the characters: α, signifies ἀποφθορὰν, _abortion_, or ἀπώλειαν,
_loss_; γ, signifies γονοειδὲς ὁυρον, _urine resembling semen_; δ,
punctuated below, thus, δ, signifies ἱδρῶτα, _sweat_, and διάρροιαν,
_diarrhœa_, and διαφόρησιν, _perspiration_, or in fact any other
_evacuation_ which it is wished to express; ἐ, signifies ἐποχὴν,
_retention_, or ἒδραν, _seat_; ζ, signifies ζήτημα, _the object
of research_; θ, signifies θάνατον, _death_; ι, signifies ἱδρῶτα,
_sweat_; κ, signifies κρίσιν, _crisis_, or κοιλιακὴν διάθεσιν; μ,
signifies μανίαν, _madness_, or μήτραν, _the womb_; ν, signifies
νεότητα, _youth_, or νέκρωσιν, _mortification_; x, signifies ξανθὴν
χολὴν, _yellow bile_, or ξένον τι καὶ σπάνιον, _something strange and
rare_, or ξυσμὸν, _irritation_, or ξηρότητα, _dryness_; ο, signifies
ὀδύνας, _pains_, or οὖρον, _urine_ (but some think that it is only
when it has a ὐ above it that it signifies urine); π signifies πλῆθος,
_abundance_, or πτύελον, _sputum_, or πυρὸν (πυρρὸν?), _yellow_, or
πυρετὸν, _fever_, or πνεύμονος τάθος, _affection of the lungs_; π, with
a character ι in its middle [symbol] or [symbol]), signifies πυθανὸν,
_probable_; ρ, signifies ῥύσιν, _flux_, or ρίγος, _chill_; φ, signifies
φρενῖτιν, _phrensy_; ς, signifies σπασμὸν, _convulsion_, or στομαχοῦ
ἢ στόματός κάκωσιν, _illness of the stomach or mouth_; τ, signifies
τόκον, _accouchement_; υ, signifies ὑγείαν, _health_, or ὑποχόνδριον,
_hypochondrium_; χ, signifies χολὴν, _bile_, or χολῶδες, _bilious_; ψ,
signifies ψύξιν, _congealing_; ω, signifies ὠμότητα, _crudity_. See
Galeni Opera, t. v., p. 412, ed. Basil.; and Littré’s Hippocrates, t.
iii., p. 33.
According to this key, the characters at the end of the first case are
thus explained by Galen: they are [symbol]ΠΟΥΜΥ. Here, then, [symbol]
signifies πιθανὸν, _it is probable_, Π, πλῆθος, _that an abundance_,
ου, οὔρων, _of urine_; Μ, _on the 40th day_; Υ, ὑγείαν, _brought
health_. It is more fully expressed thus by Galen: πιθανὸν ειναιδιὰ τὸ
πλῆθος τῶν ἐκριθέντων όυρων ἀυτὸ λυρθῆναι τό νοσημα καὶ ὑγιῆ γενέσθαι
τὸν ἄνθρωπον ἑν τῂ τεσσαρακοστῇ τῶν ἡμερῶν, that is to say, “_it is
probable that, owing to the copious discharge of urine, the disease was
resolved, and the patient became well on the fortieth day_.”
BOOK III.--OF THE EPIDEMICS.
SEC. I.
CASE I.--Pythion, who lived by the Temple of the Earth, on
the first day, trembling commencing from his hands; acute fever,
delirium. On the second, all the symptoms were exacerbated. On the
third, the same. On the fourth alvine discharges scanty, unmixed, and
bilious. On the fifth, all the symptoms were exacerbated, the tremors
remained; little sleep, the bowels constipated. On the sixth sputa
mixed, reddish. On the seventh, mouth drawn aside. On the eighth, all
the symptoms were exacerbated; the tremblings were again constant;
urine, from the beginning to the eighth day, thin, and devoid of color;
substances floating in it, cloudy. On the tenth he sweated; sputa
somewhat digested, had a crisis; urine thinnish about the crisis; but
after the crisis, on the fortieth day, an abscess about the anus, which
passed off by a strangury.
_Explanation of the characters._ It is probable that the great
discharge of urine brought about the resolution of the disease, and the
cure of the patient on the fortieth day.[682]
CASE II.--Hermocrates, who lived by the New Wall,[683] was seized with
fever. He began to have pain in the head and loins; an empty distention
of the hypochondrium; the tongue at first was parched; deafness at the
commencement; there was no sleep; not very thirsty; urine thick and
red, when allowed to stand it did not subside; alvine discharge very
dry, and not scanty. On the fifth, urine thin, had substances floating
in it which did not fall to the bottom;[684] at night he was delirious.
On the sixth, had jaundice;[685] all the symptoms were exacerbated;
had no recollection. On the seventh, in an uncomfortable state; urine
thin, as formerly; on the following days the same. About the eleventh
day, all the symptoms appeared to be lightened. Coma set in; urine
thicker, reddish, thin substances below, had no sediment; by degrees he
became collected. On the fourteenth, fever gone; had no sweat; slept,
quite collected; urine of the same characters. About the seventeenth,
had a relapse, became hot. On the following days, acute fever, urine
thin, was delirious. Again, on the twentieth, had a crisis; free of
fever; had no sweat; no appetite through the whole time; was perfectly
collected; could not speak, tongue dry, without thirst; deep sleep.
About the twenty-fourth day he became heated; bowels loose, with a
thin, watery discharge; on the following days acute fever, tongue
parched. On the twenty-seventh he died. In this patient deafness
continued throughout;[686] the urine either thick and red, without
sediment, or thin, devoid of color, and having substances floating in
it; he could taste nothing.
_Explanation of the characters._ It is probable that it was the
suppression of the discharges from the bowels which occasioned death on
the twenty-seventh day.
CASE III.--The man who was lodged in the Garden of Dealces:[687] had
heaviness of the head and pain in the right temple for a considerable
time, from some accidental cause, was seized with fever, and took to
bed. On the second, there was a trickling of pure blood from the left
nostril, but the alvine discharges were proper, urine thin, mixed,
having small substances floating in it, like coarse barley meal, or
semen. On the third, acute fever; stools black, thin, frothy, a livid
sediment in the dejections; slight coma; uneasiness at the times he
had to get up; sediment in the urine livid, and somewhat viscid. On
the fourth, slight vomiting of bilious, yellow matters, and, after a
short interval, of the color of verdigris; a few drops of pure blood
ran from the left nostril; stools the same; urine the same; sweated
about the head and clavicles; spleen enlarged, pain of the thigh on
the same side; loose swelling of the right hypochondrium; at night had
no sleep, slight delirium. On the sixth, stools black, fatty, viscid,
fetid; slept, more collected. On the seventh, tongue dry, thirsty,
did not sleep; was somewhat delirious; urine thin, not of a good
color. On the eighth, stools black, scanty, and compact; slept, became
collected; not very thirsty. On the ninth had a rigor, acute fever,
sweated, a chill, was delirious, strabismus of the right eye, tongue
dry, thirsty, without sleep.[688] On the tenth, much the same. On the
eleventh, became quite collected; free from fever, slept, urine thin
about the crisis. The two following days without fever; it returned on
the fourteenth, then immediately insomnolency and complete delirium.
On the fifteenth, urine muddy, like that which has been shaken after
the sediment has fallen to the bottom; acute fever, quite delirious,
did not sleep; knees and legs painful; after a suppository, had
alvine dejection of a black color. On the sixteenth, urine thin, had
a cloudy eneorema, was delirious. On the seventeenth, in the morning,
extremities cold, was covered up with the bedclothes, acute fever,
general sweat, felt relieved, more collected; not free of fever,
thirsty, vomited yellow bile, in small quantities; formed fæces passed
from the bowels, but soon afterwards black, scanty, and thin; urine
thin, not well colored. On the eighteenth, not collected, comatose.
On the nineteenth, in the same state. On the twentieth, slept; quite
collected, sweated, free from fever, not thirsty, but the urine thin.
On the twenty-first, slight delirium; somewhat thirsty, pain of the
hypochondrium, and throbbing about the navel throughout. On the
twenty-fourth, sediment in the urine, quite collected. Twenty-seventh,
pain of the right hip joint; urine thin and bad, a sediment; all the
other symptoms milder. About the twenty-ninth, pain of the right eye;
urine thin. Fortieth, dejections pituitous, white, rather frequent;
sweated abundantly all over; had a complete crisis.[689]
_Explanation of the characters._ It is probable that, by means of
the stools, the urine, and the sweat, this patient was cured in forty
days.
SEC. II.
CASE IV.--In Thasus, Philistes had headache of long continuance,
and sometimes was confined to bed, with a tendency to deep sleep;
having been seized with continual fevers from drinking, the pain was
exacerbated; during the night he, at first, became hot. On the first
day, he vomited some bilious matters, at first yellow, but afterwards
of a verdigris-green color, and in greater quantity; formed fæces
passed from the bowels; passed the night uncomfortably. On the second,
deafness, acute fever; retraction of the right hypochondrium; urine
thin, transparent, had some small substances like semen floating in it;
delirium ferox about mid-day. On the third, in an uncomfortable state.
On the fourth, convulsions; all the symptoms exacerbated. On the fifth,
early in the morning, died.
_Explanation of the characters._ It is probable that the death of
the patient on the fifth day is to be attributed to a phrenitis, with
unfavorable evacuations.[690]
CASE V.--Charion, who was lodged at the house of Demænetus,
contracted a fever from drinking. Immediately he had a painful
heaviness of the head; did not sleep; bowels disordered, with thin
and somewhat bilious discharges. On the third day, acute fever;
trembling of the head, but especially of the lower lip; after a little
time a rigor, convulsions; he was quite delirious; passed the night
uncomfortably. On the fourth, quiet, slept little, talked incoherently.
On the fifth, in pain; all the symptoms exacerbated; delirium; passed
the night uncomfortably; did not sleep. On the sixth, in the same
state. On the seventh had a rigor, acute fever, sweated all over his
body; had a crisis. Throughout the alvine discharges were bilious,
scanty, and unmixed; urine thin, well colored, having cloudy substances
floating in it. About the eighth day, passed urine of a better color,
having a white scanty sediment; was collected, free from fever for a
season. On the ninth it relapsed. About the fourteenth, acute fever. On
the sixteenth, vomited pretty frequently yellow, bilious matters. On
the seventeenth had a rigor, acute fever, sweated, free of fever; had a
crisis; urine, after the relapse and the crisis, well colored, having a
sediment; neither was he delirious in the relapse. On the eighteenth,
became a little heated; some thirst, urine thin, with cloudy substances
floating in it; slight wandering in his mind. About the nineteenth,
free of fever, had a pain in his neck; a sediment in the urine. Had a
complete crisis on the twentieth.
_Explanation of the characters._ It is probable that the patient
was cured in twenty days, by the abundance of bilious stools and
urine.[691]
CASE VI.--The daughter of Euryanax, a maid, was taken ill of
fever. She was free of thirst throughout, but had no relish for food.
Alvine discharges small, urine thin, scanty, not well colored. In the
beginning of the fever, had a pain about the nates. On the sixth day,
was free of fever, did not sweat, had a crisis; the complaint about
the nates came to a small suppuration, and burst at the crisis. After
the crisis, on the seventh day, had a rigor, became slightly heated,
sweated. On the eighth day after the rigor, had an inconsiderable
rigor; the extremities cold ever after. About the tenth day, after
a sweat which came on, she became delirious, and again immediately
afterwards was collected; these symptoms were said to have been brought
on by eating grapes. After an intermission of the twelfth day, she
again talked much incoherently; her bowels disordered with bilious,
scanty, unmixed, thin, acrid discharges; she required to get frequently
up. She died on the seventh day after the return of the delirium. At
the commencement of the disease she had pain in the throat, and it was
red throughout; uvula retracted, defluxions abundant, thin, acrid;
coughed, but had no concocted sputa; during the whole time loathed all
kinds of food, nor had the least desire of anything; had no thirst, nor
drank anything worth mentioning; was silent, and never spoke a word;
despondency; had no hopes of herself. She had a congenital tendency to
phthisis.[692]
CASE VII.--The woman affected with quinsy, who lodged in
the house of Aristion: her complaint began in the tongue; speech
inarticulate; tongue red and parched. On the first day, felt chilly,
and afterwards became heated. On the third day, a rigor, acute fever;
a reddish and hard swelling on both sides of the neck and chest,
extremities cold and livid; respiration elevated; the drink returned
by the nose; she could not swallow; alvine and urinary discharges
suppressed. On the fourth, all the symptoms were exacerbated. On the
sixth she died of the quinsy.
_Explanation of the characters._ It is probable that the cause of
death on the sixth day was the suppression of the discharges.[693]
CASE VIII.--The young man who was lodged by the Liars’ Market
was seized with fever from fatigue, labor, and running out of season.
On the first day, the bowels disordered, with bilious, thin, and
copious dejections; urine thin and blackish; had no sleep; was thirsty.
On the second all the symptoms were exacerbated; dejections more
copious and unseasonable; he had no sleep; disorder of the intellect;
slight sweat. On the third day, restless, thirst, nausea, much tossing
about, bewilderment, delirium; extremities livid and cold; softish
distention of the hypochrondrium on both sides. On the fourth, did not
sleep; still worse. On the seventh he died. He was about twenty years
of age.
_Explanation of the characters._ It is probable that the cause of
his death on the seventh day was the unseasonable practices mentioned
above. An acute affection.[694]
CASE IX.--The woman who lodged at the house of Tisamenas had a
troublesome attack of iliac passion; much vomiting; could not keep her
drink; pains about the hypochondria, and pains also in the lower part
of the belly; constant tormina; not thirsty; became hot; extremities
cold throughout, with nausea and insomnolency; urine scanty and thin;
dejections undigested, thin, scanty. Nothing could do her any good. She
died.[695]
CASE X.--A woman of those who lodged with Pantimides, from
a miscarriage, was taken ill of fever. On the first day, tongue dry,
thirst, nausea, insomnolency, belly disordered, with thin, copious,
undigested dejections. On the second day, had a rigor, acute fever;
alvine discharges copious; had no sleep. On the third, pains greater.
On the fourth, delirious. On the seventh she died. Belly throughout
loose, with copious, thin, undigested evacuations; urine scanty, thin.
An ardent fever.[696]
CASE XI.--Another woman, after a miscarriage about the fifth month,
the wife of Ocetes, was seized with fever. At first had sometimes coma
and sometimes insomnolency; pain of the loins; heaviness of the head.
On the second, the bowels were disordered, with scanty, thin, and at
first unmixed dejections. On the third, more copious, and worse; at
night did not sleep. On the fourth was delirious; frights, despondency;
strabismus of the right eye; a faint cold sweat about the head;
extremities cold. On the fifth day, all the symptoms were exacerbated;
talked much incoherently, and again immediately became collected; had
no thirst; labored under insomnolency; alvine dejections copious, and
unseasonable throughout; urine scanty, thin, darkish; extremities cold,
somewhat livid. On the sixth day, in the same state. On the seventh she
died. Phrenitis.[697]
CASE XII.--A woman who lodged near the Liars’ Market, having
then brought forth a son in a first and difficult labor, was seized
with fever. Immediately on the commencement had thirst, nausea, and
cardialgia; tongue dry; bowels disordered, with thin and scanty
dejections; had no sleep. On the second, had slight rigor, acute fever;
a faint cold sweat about the head. On the third, painfully affected;
evacuations from the bowels undigested, thin, and copious. On the
fourth, had a rigor; all the symptoms exacerbated; insomnolency. On the
fifth, in a painful state. On the sixth, in the same state; discharges
from the bowels liquid and copious. On the seventh, had a rigor, fever
acute; much thirst; much tossing about; towards evening a cold sweat
over all; extremities cold; could no longer be kept warm; and again
at night had a rigor; extremities could not be warmed; she did not
sleep; was slightly delirious, and again speedily collected. On the
eighth, about mid-day, she became warm, was thirsty, comatose, had
nausea; vomited small quantities of yellowish bile; restless at night,
did not sleep; passed frequently large quantities of urine without
consciousness. On the ninth, all the symptoms gave way; comatose,
towards evening slight rigors; small vomitings of bile. On the tenth,
rigor; exacerbation of the fever, did not sleep at all; in the morning
passed much urine having a sediment; extremities recovered their heat.
On the eleventh, vomited bile of a verdigris-green color; not long
after had a rigor, and again the extremities cold; towards evening a
rigor, a cold sweat, much vomiting; passed a painful night. On the
twelfth, had copious black and fetid vomitings; much hiccup, painful
thirst. On the thirteenth, vomitings black, fetid, and copious; rigor
about mid-day, loss of speech. On the fourteenth, some blood ran from
her nose, she died. In this case the bowels were loose throughout; with
rigors; her age about seventeen. An ardent fever.[698]
SECTION III.--CONSTITUTION 2.[699]
The year was southerly, rainy; no winds throughout.[700] Droughts
having prevailed during the previous seasons of the year, the south
winds towards the rising of Arcturus were attended with much rain.
Autumn gloomy and cloudy, with copious rains. Winter southerly, damp,
and soft. But long after the solstice, and near the equinox, much
winterly weather out of season; and when now close to the equinox,
northerly, and winterly weather for no long time. The spring again
southerly, calm, much rain throughout until the dog-days. Summer fine
and hot; great suffocating heats. The Etesian winds blew small and
irregular; again, about the season of Arcturus, much rains with north
winds. The year being southerly, damp, and soft towards winter, all
were healthy, except those affected with phthisis, of whom we shall
write afterwards.
3. Early in spring, along with the prevailing cold, there were many
cases of erysipelas, some from a manifest cause, and some not.[701]
They were of a malignant nature, and proved fatal to many; many had
sore-throat and loss of speech. There were many cases of ardent fever,
phrensy, aphthous affections of the mouth,[702] tumors on the genital
organs; of ophthalmia, anthrax,[703] disorder of the bowels, anorexia,
with thirst and without it; of disordered urine, large in quantity,
and bad in quality; of persons affected with coma for a long time,
and then falling into a state of insomnolency. There were many cases
of failure of crisis, and many of unfavorable crisis; many of dropsy
and of phthisis. Such were the diseases then epidemic.[704] There
were patients affected with every one of the species which have been
mentioned, and many died. The symptoms in each of these cases were as
follows:
4. In many cases erysipelas, from some obvious cause, such as an
accident, and sometimes from even a very small wound, broke out all
over the body, especially, in persons about sixty years of age, about
the head, if such an accident was neglected in the slightest degree;
and this happened in some who were under treatment; great inflammation
took place, and the erysipelas quickly spread all over.[705] In the
most of them the abscesses ended in suppurations, and there were great
fallings off (sloughing) of the flesh, tendons, and bones; and the
defluxion which seated in the part was not like pus, but a sort of
putrefaction, and the running was large and of various characters.
Those cases in which any of these things happened about the head were
accompanied with falling off of the hairs of the head and chin, the
bones were laid bare and separated, and there were excessive runnings;
and these symptoms happened in fevers and without fevers. But these
things were more formidable in appearance than dangerous; for when
the concoction in these cases turned to a suppuration, most of them
recovered; but when the inflammation and erysipelas disappeared, and
when no abscess was formed, a great number of these died.[706] In like
manner, the same things happened to whatever part of the body the
disease wandered, for in many cases both forearm and arm dropped off;
and in those cases in which it fell upon the sides, the parts there,
either before or behind, got into a bad state; and in some cases the
whole femur and bones of the leg and whole foot were laid bare. But of
all such cases, the most formidable were those which took place about
the pubes and genital organs.[707] Such was the nature of these cases
when attended with sores, and proceeding from an external cause; but
the same things occurred in fevers, before fevers, and after fevers.
But those cases in which an abscess was formed, and turned to a
suppuration, or a seasonable diarrhœa or discharge of good urine took
place, were relieved thereby: but those cases in which none of these
symptoms occurred, but they disappeared without a crisis, proved fatal.
The greater number of these erysipelatous cases took place in the
spring, but were prolonged through the summer and during autumn.
5. In certain cases there was much disorder, and tumors about the
fauces, and inflammations of the tongue, and abscesses about the
teeth. And many were attacked with impairment or loss of speech;[708]
at first, those in the commencement of phthisis, but also persons in
ardent fever and in phrenitis.
6. The cases of ardent fever and phrenitis occurred early in spring
after the cold set in, and great numbers were taken ill at that time,
and these cases were attended with acute and fatal symptoms. The
constitution of the ardent fevers which then occurred was as follows:
at the commencement they were affected with coma, nausea, and rigors;
fever not acute, not much thirst, nor delirium, slight epistaxis,[709]
the paroxysms for the most part on even days; and, about the time of
the paroxysms, forgetfulness, loss of strength and of speech, the
extremities, that is to say, the hands and feet, at all times, but more
especially about the time of the paroxysms, were colder than natural;
they slowly and imperfectly became warmed, and again recovered their
recollection and speech.[710] They were constantly affected either with
coma, in which they got no sleep, or with insomnolency, attend with
pains;[711] most had disorders of the bowels, attended with undigested,
thin, and copious evacuations; urine copious, thin, having nothing
critical nor favorable about it; neither was there any other critical
appearance in persons affected thus; for neither was there any proper
hemorrhage, nor any other of the accustomed evacuations, to prove a
crisis. They died, as it happened, in an irregular manner, mostly about
the crisis, but in some instances after having lost their speech for a
long time, and having had copious sweats. These were the symptoms which
marked the fatal cases of ardent fever; similar symptoms occurred in
the phrenitic cases; but these were particularly free from thirst, and
none of these had wild delirium[712] as in other cases, but they died
oppressed by a bad tendency to sleep, and stupor.
7. But there were also other fevers, as will be described. Many had
their mouths affected with aphthous ulcerations. There were also many
defluxions about the genital parts, and ulcerations, boils (phymata),
externally and internally, about the groins.[713] Watery ophthalmies of
a chronic character, with pains; fungous excrescences of the eyelids,
externally and internally, called fici, which destroyed the sight of
many persons.[714] There were fungous growths, in many other instances,
on ulcers, especially on those seated on the genital organs. There
were many attacks of carbuncle (anthrax) through the summer, and other
affections, which are called “the putrefaction” (_seps_); also
large ecthymata,[715] and large tetters (_herpetes_) in many
instances.
8. And many and serious complaints attacked many persons in the
region of the belly. In the first place, tenesmus, accompanied with
pain, attacked many, but more especially children, and all who had
not attained to puberty; and the most of these died. There were many
cases of lientery and of dysentery; but these were not attended with
much pain.[716] The evacuations were bilious, and fatty, and thin, and
watery; in many instances the disease terminated in this way, with and
without fever; there were painful tormina and volvuli of a malignant
kind; copious evacuations of the contents of the guts, and yet much
remained behind; and the passages did not carry off the pains, but
yielded with difficulty to the means administered; for in most cases
purgings were hurtful to those affected in this manner; many died
speedily, but in many others they held out longer. In a word, all
died, both those who had acute attacks and those who had chronic, most
especially from affections of the belly, for it was the belly which
carried them all off.
9. All persons had an aversion to food in all the afore-mentioned
complaints to a degree such as I never met with before,[717] and
persons in these complaints most especially, and those recovering from
them, and in all other diseases of a mortal nature. Some were troubled
with thirst, and some not; and both in febrile complaints and in others
no one drank unseasonably or disobeyed injunctions.
10. The urine in many cases was not in proportion to the drink
administered, but greatly in excess; and the badness of the urine
voided was great, for it had not the proper thickness, nor concoction,
nor purged properly; for in many cases purgings by the bladder indicate
favorably, but in the greatest number they indicated a melting of the
body, disorder of the bowels, pains, and a want of crisis.[718]
11. Persons laboring under phrenitis and causus were particularly
disposed to coma; but also in all other great diseases which occurred
along with fever. In the main, most cases were attended either by heavy
coma, or by short and light sleep.
12. And many other forms of fevers were then epidemic, of tertian,
of quartan, of nocturnal,[719] of continual, of chronic, of erratic,
of fevers attended with nausea, and of irregular fevers. All these
were attended with much disorder, for the bowels in most cases
were disordered, accompanied with rigors, sweats not of a critical
character, and with the state of the urine as described. In most
instances the disease was protracted, for neither did the deposits
which took place prove critical as in other cases; for in all
complaints and in all cases there was difficulty of crisis, want of
crisis, and protraction of the disease, but most especially in these.
A few had the crisis about the eightieth day, but in most instances
it (the disease?) left them irregularly. A few of them died of dropsy
without being confined to bed. And in many other diseases people were
troubled with swelling, but more especially in phthisical cases.
13. The greatest and most dangerous disease, and the one that proved
fatal to the greatest number, was the consumption.[720] With many
persons it commenced during the winter, and of these some were confined
to bed, and others bore up on foot; the most of those died early in
spring who were confined to bed; of the others, the cough left not a
single person, but it became milder through the summer; during the
autumn, all these were confined to bed, and many of them died, but
in the greater number of cases the disease was long protracted. Most
of these were suddenly attacked with these diseases, having frequent
rigors, often continual and acute fevers; unseasonable, copious, and
cold sweats throughout; great coldness, from which they had great
difficulty in being restored to heat; the bowels variously constipated,
and again immediately in a loose state, but towards the termination
in all cases with violent looseness of the bowels; a determination
downwards of all matters collected about the lungs; urine excessive,
and not good; troublesome melting. The coughs throughout were frequent,
and sputa copious, digested, and liquid, but not brought up with much
pain; and even when they had some slight pain, in all cases the purging
of the matters about the lungs went on mildly. The fauces were not
very irritable, nor were they troubled with any saltish humors; but
there were viscid, white, liquid, frothy, and copious defluxions from
the head. But by far the greatest mischief attending these and the
other complaints, was the aversion to food, as has been described.
For neither had they any relish for drink along with their food, but
continued without thirst. There was heaviness of the body, disposition
to coma, in most cases swelling, which ended in dropsy; they had
rigors, and were delirious towards death.
14. The form of body peculiarly subject to phthisical complaints was
the smooth, the whitish, that resembling the lentil; the reddish, the
blue-eyed, the leucophlegmatic,[721] and that with the scapulæ having
the appearance of wings: and women in like manner,[722] with regard to
the melancholic and subsanguineous, phrenitic and dysenteric affections
principally attacked them. Tenesmus troubled young persons of a
phlegmatic temperament. Chronic diarrhœa, acrid and viscid discharges
from the bowels, attacked those who were troubled with bitter bile.
15. To all those which have been described, the season of spring was
most inimical, and proved fatal to the greatest numbers: the summer was
the most favorable to them, and the fewest died then; in autumn, and
under the Pleiades, again there died great numbers. It appears to me,
according to the reason of things, that the coming on of summer should
have done good in these cases; for winter coming on cures the diseases
of summer, and summer coming on removes the diseases of winter. And
yet the summer in question was not of itself well constituted, for it
became suddenly hot, southerly, and calm; but, notwithstanding, it
proved beneficial by producing a change on the other constitution.
16. I look upon it as being a great part of the art to be able to judge
properly of that which has been written. For he that knows and makes a
proper use of these things, would appear to me not likely to commit any
great mistake in the art. He ought to learn accurately the constitution
of every one of the seasons, and of the diseases; whatever that is
common in each constitution and disease is good, and whatever is bad;
whatever disease will be protracted and end in death, and whatever
will be protracted and end in recovery; which disease of an acute
nature will end in death, and which in recovery. From these it is easy
to know the order of the critical days, and prognosticate from them
accordingly. And to a person who is skilled in these things, it is easy
to know to whom, when, and how aliment ought to be administered.[723]
SEC. 17. SIXTEEN CASES.[724]
CASE I.--In Thasus, the Parian who lodged above the Temple
of Diana was seized with an acute fever, at first of a continual and
ardent type; thirsty, inclined to be comatose at first, and afterwards
troubled with insomnolency; bowels disordered at the beginning, urine
thin. On the sixth day, passed oily urine, was delirious. On the
seventh, all the symptoms were exacerbated; had no sleep, but the
urine of the same characters, and the understanding disordered; alvine
dejections bilious and fatty. On the eighth, a slight epistaxis; small
vomiting of verdigris-green matters; slept a little. On the ninth,
in the same state. On the tenth, all the symptoms gave way. On the
eleventh, he sweated, but not over the whole body; he became cold, but
immediately recovered his heat again. On the fourteenth, acute fever;
discharges bilious, thin, and copious; substances floating in the
urine; he became incoherent. On the seventeenth, in a painful state,
for he had no sleep, and the fever was more intense. On the twentieth,
sweated all over; apyrexia, dejections bilious; aversion to food,
comatose. On the twenty-fourth, had a relapse. On the thirty-fourth,
apyrexia; bowels not confined; and he again recovered his heat.
Fortieth, apyrexia, bowels confined for no long time, aversion to
food; had again slight symptoms of fever, and throughout in an
irregular form; apyrexia at times, and at others not; for if the fever
intermitted, and was alleviated for a little, it immediately relapsed
again; he used much and improper food; sleep bad; about the time of
the relapse he was delirious; passed thick urine at that time, but
troubled, and of bad characters; bowels at first confined, and again
loose; slight fevers of a continual type; discharges copious and thin.
On the hundred and twentieth day he died. In this patient the bowels
were constantly from the first either loose, with bilious, liquid, and
copious dejection, or constipated with hot and undigested fæces; the
urine throughout bad; for the most part coma, or insomnolency with
pain; continued aversion to food. Ardent fever.
_Explanation of the characters._ It is probable that the
weakness produced by the fever, the phrenitis, and affection of the
hypochondrium caused death on the hundred and twentieth day.[725]
CASE II.--In Thasus, the woman who lodged near the Cold Water, on
the third day after delivery of a daughter, the lochial discharge not
taking place, was seized with acute fever, accompanied with rigors.
But a considerable time before delivery she was feverish, confined to
bed, and loathed her food. After the rigor which took place, continual
and acute fevers, with rigors. On the eighth and following days, was
very incoherent, and immediately afterwards became collected; bowels
disordered, with copious, thin, watery, and bilious stools; no thirst.
On the eleventh was collected, but disposed to coma; urine copious,
thin, and black; no sleep. On the twentieth, slight chills, and
immediately afterwards was warm; slight incoherence; no sleep; with
regard to the bowels, in the same condition; urine watery, and copious.
On the twenty-seventh, free from fever; bowels constipated; not long
afterwards violent pain of the right hip-joint for a considerable time;
fevers afterwards supervened; urine watery. On the fortieth, complaints
about the hip-joint better; continued coughs, with copious, watery
sputa; bowels constipated; aversion to food; urine the same; fever
not leaving her entirely, but having paroxysms in an irregular form,
sometimes present, sometimes not. On the sixtieth, the coughs left her
without a crisis, for no concoction of the sputa took place, nor any
of the usual abscesses; jaw on the right side convulsively retracted;
comatose, was again incoherent, and immediately became collected; utter
aversion to food; the jaw became relaxed; alvine discharges small,
and bilious; fever more acute, affected with rigors; on the following
days lost her speech, and again became collected, and talked. On the
eightieth she died. In this case the urine throughout was black, thin,
and watery; coma supervened; there was aversion to food, despondency,
and insomnolency; irritability, restlessness; she was of a melancholic
turn of mind.
_Explanation of the characters_. It is probable that the suppression of
the lochial discharge caused death on the eightieth day.[726]
CASE III.--In Thasus, Pythion, who was lodged above the Temple of
Hercules, from labor, fatigue, and neglected diet, was seized with
strong rigor and acute fever; tongue dry, thirsty, and bilious; had
no sleep; urine darkish, eneorema floating on the top of the urine,
did not subside. On the second day, about noon, coldness of the
extremities, especially about the hands and head; loss of speech and
of articulation; breathing short for a considerable time; recovered
his heat; thirst; passed the night quietly; slight sweats about the
head. On the third, passed the day in a composed state; in the evening,
about sunset, slight chills; nausea, agitation; passed the night in
a painful state; had no sleep; small stools of compact fæces passed
from the bowels. On the fourth, in the morning, composed; about noon
all the symptoms became exacerbated; coldness, loss of speech, and of
articulation; became worse; recovered his heat after a time; passed
black urine, having substances floating in it; the night quiet; slept.
On the fifth, seemed to be lightened, but a painful weight about the
belly; thirsty, passed the night in a painful state. On the sixth, in
the morning, in a quiet state; in the evening the pains greater; had a
paroxysm; in the evening the bowels properly opened by a small clyster;
slept at night. On the seventh, during the day, in a state of nausea,
somewhat disturbed; passed urine of the appearance of oil; at night,
much agitation, was incoherent, did not sleep. On the eighth, in the
morning, slept a little; but immediately coldness, loss of speech,
respiration small and weak; but in the evening recovered his heat
again; was delirious, but towards day was somewhat lightened; stools
small, bilious, and unmixed. On the ninth, affected with coma, and with
nausea when roused; not very thirsty; about sunset he became restless
and incoherent; passed a bad night. On the tenth, in the morning, had
become speechless; great coldness; acute fever; much perspiration; he
died. His sufferings were on the even days.
_Explanation of the characters._ It is probable that the excessive
sweats caused death on the tenth day.[727]
CASE IV.--The patient affected with phrenitis, having taken
to bed on the first day, vomited largely of verdigris-green and thin
matters; fever, accompanied with rigors, copious and continued sweats
all over; heaviness of the head and neck, with pain; urine thin,
substances floating in the urine small, scattered, did not subside;
had copious dejections from the bowels; very delirious; no sleep. On
the second, in the morning, loss of speech; acute fever; he sweated,
fever did not leave him; palpitations over the whole body, at night,
convulsions. On the third, all the symptoms exacerbated; he died.
_Explanation of the characters._ It is probable that the sweats
and convulsions caused death.[728]
CASE V.--In Larissa, a man, who was bald, suddenly was seized with
pain in the right thigh; none of the things which were administered
did him any good. On the first day, fever acute, of the ardent type,
not agitated, but the pains persisted. On the second, the pains in the
thigh abated, but the fever increased; somewhat tossed about; did not
sleep; extremities cold; passed a large quantity of urine, not of a
good character. On the third, the pain of the thigh ceased; derangement
of the intellect, confusion, and much tossing about. On the fourth,
about noon, he died. An acute disease.[729]
CASE VI.--In Abdera, Pericles was seized with a fever of the acute,
continual type, with pain; much thirst, nausea, could not retain his
drink; somewhat swelled about the spleen, with heaviness of the head.
On the first day, had hemorrhage from the left nostril, but still the
fever became more violent; passed much muddy, white urine, which when
allowed to stand did not subside. On the second day, all the symptoms
were exacerbated, yet the urine was thick, and more inclined to have a
sediment; the nausea less; he slept. On the third, fever was milder;
abundance of urine, which was concocted, and had a copious sediment;
passed a quiet night. On the fourth, had a copious and warm sweat all
over about noon; was free of fever, had a crisis, no relapse. An acute
affection.[730]
CASE VII.--In Abdera, the young woman who was lodged in the
Sacred Walk was seized with an ardent fever. She was thirsty, and could
not sleep; had menstruation for the first time. On the sixth, much
nausea, flushing, was chilly, and tossed about. On the seventh, in the
same state; urine thin, but of a good color; no disturbance about the
bowels. On the eighth, deafness, acute fever, insomnolency, nausea,
rigors, became collected; urine the same. On the ninth, in the same
state, and also on the following days; thus the deafness persisted. On
the fourteenth, disorder of the intellect; the fever abated. On the
seventeenth, a copious hemorrhage from the nose; the deafness slightly
better; and on the following days, nausea, deafness, and incoherence.
On the twentieth, pain of the feet; deafness and delirium left her; a
small hemorrhage from the nose; sweat, apyrexia. On the twenty-fourth,
the fever returned, deafness again; pain of the feet remained;
incoherence. On the twenty-seventh, had a copious sweat, apyrexia;
the deafness left her; the pain of her feet partly remained; in other
respects had a complete crisis.
_Explanation of the characters._ It is probable that the
restoration of health on the twentieth day was the result of the
evacuation of urine.[731]
CASE VIII.--In Abdera, Anaxion, who was lodged near the Thracian
Gates, was seized with an acute fever; continued pain of the right
side; dry cough, without expectoration during the first days, thirst,
insomnolency; urine well colored, copious, and thin. On the sixth,
delirious; no relief from the warm applications. On the seventh, in
a painful state, for the fever increased, while the pains did not
abate, and the cough was troublesome, and attended with dyspnœa. On
the eighth, I opened a vein at the elbow, and much blood, of a proper
character, flowed; the pains were abated, but the dry coughs continued.
On the eleventh, the fever diminished; slight sweats about the head;
coughs, with more liquid sputa; he was relieved. On the twentieth,
sweat, apyrexia; but after the crisis he was thirsty, and the
expectorations were not good. On the twenty-seventh the fever relapsed;
he coughed, and brought up much concocted sputa: sediment in the urine
copious and white; he became free of thirst, and the respiration was
good. On the thirty-fourth, sweated all over, apyrexia, general crisis.
_Explanation of the characters._ It is probable that the evacuation of
the sputa brought about the recovery on the thirty-fourth day.[732]
CASE IX.--In Abdera, Heropythus, while still on foot, had
pain in the head, and not long afterwards he took to bed; he lived
near the High Street. Was seized with acute fever of the ardent type;
vomitings at first of much bilious matter; thirst; great restlessness;
urine thin, black, substances sometimes floating high in it, and
sometimes not; passed the night in a painful state; paroxysms of
the fever diversified, and for the most part irregular. About the
fourteenth day, deafness; the fever increased; urine the same. On
the twentieth and following days, much delirium. On the thirtieth,
copious hemorrhage from the nose, and became more collected; deafness
continued, but less; the fever diminished; on the following days,
frequent hemorrhages, at short intervals. About the sixtieth, the
hemorrhages ceased, but violent pain of the hip-joint, and increase
of fever. Not long afterwards, pains of all the inferior parts; it
then became a rule, that either the fever and deafness increased, or,
if these abated and were lightened, the pains of the inferior parts
were increased. About the eightieth day, all the complaints gave way,
without leaving any behind; for the urine was of a good color, and had
a copious sediment, while the delirium became less. About the hundredth
day, disorder of the bowels, with copious and bilious evacuations,
and these continued for a considerable time, and again assumed the
dysenteric form with pain; but relief of all the other complaints. On
the whole, the fevers went off, and the deafness ceased. On the hundred
and twentieth day, had a complete crisis. Ardent fever.
_Explanation of the characters._ It is probable that the bilious
discharge brought about the recovery on the hundred and twentieth
day.[733]
CASE X.--In Abdera, Nicodemus was seized with fever from
venery and drinking. At the commencement he was troubled with nausea
and cardialgia; thirsty, tongue was parched; urine thin and dark. On
the second day, the fever exacerbated; he was troubled with rigors
and nausea; had no sleep; vomited yellow bile; urine the same;
passed a quiet night, and slept. On the third, a general remission;
amelioration; but about sunset felt again somewhat uncomfortable;
passed an uneasy night. On the fourth, rigor, much fever, general
pains; urine thin, with substances floating in it; again a quiet night.
On the fifth, all the symptoms remained, but there was an amelioration.
On the sixth, some general pains; substances floating in the urine;
very incoherent. On the seventh, better. On the eighth, all the other
symptoms abated. On the tenth, and following days, there were pains,
but all less; in this case throughout, the paroxysms and pains were
greater on the even days. On the twentieth, the urine white and thick,
but when allowed to stand had no sediment; much sweat; seemed to be
free from fever; but again in the evening he became hot, with the same
pains, rigor, thirst, slightly incoherent. On the twenty-fourth, urine
copious, white, with an abundant sediment; a copious and warm sweat all
over; apyrexia; the fever came to its crisis.
_Explanation of the characters._ It is probable that the cure was
owing to the bilious evacuations and the sweats.[734]
CASE XI.--In Thasus, a woman, of a melancholic turn of mind, from
some accidental cause of sorrow, while still going about, became
affected with loss of sleep, aversion to food, and had thirst and
nausea. She lived near the Pylades, upon the Plain. On the first,
at the commencement of night, frights, much talking; despondency,
slight fever; in the morning, frequent spasms, and when they ceased,
she was incoherent and talked obscurely; pains frequent, great, and
continued. On the second, in the same state; had no sleep; fever more
acute. On the third, the spasms left her; but coma, and disposition
to sleep, and again awake, started up, and could not contain herself;
much incoherence; acute fever; on that night a copious sweat all over;
apyrexia, slept, quite collected; had a crisis. About the third day,
the urine black, thin, substances floating in it generally round, did
not fall to the bottom; about the crisis a copious menstruation.[735]
CASE XII.--In Larissa,[736] a young unmarried woman was seized
with a fever of the acute and ardent type; insomnolency, thirst; tongue
sooty and dry; urine of a good color, but thin. On the second, in an
uneasy state, did not sleep. On the third, alvine discharges copious,
watery, and greenish, and on the following days passed such with
relief. On the fourth, passed a small quantity of thin urine, having
substances floating towards its surface, which did not subside; was
delirious towards night. On the sixth, a great hemorrhage from the
nose; a chill, with a copious and hot sweat all over; apyrexia, had a
crisis. In the fever, and when it had passed the crisis, the menses
took place for the first time, for she was a young woman. Throughout
she was oppressed with nausea, and rigors; redness of the face; pain of
the eyes; heaviness of the head; she had no relapse, but the fever came
to a crisis. The pains were on the even days.[737]
CASE XIII.--Apollonius, in Abdera, bore up (under the fever?) for
some time, without betaking himself to bed. His viscera were enlarged,
and for a considerable time there was a constant pain about the liver,
and then he became affected with jaundice; he was flatulent, and of
a whitish complexion. Having eaten beef, and drunk unseasonably, he
became a little heated at first, and betook himself to bed, and having
used large quantities of milk, that of goats and sheep, and both boiled
and raw, with a bad diet otherwise, great mischief was occasioned by
all these things; for the fever was exacerbated, and of the food taken
scarcely any portion worth mentioning was passed from the bowels;
the urine was thin and scanty; no sleep; troublesome meteorism;
much thirst; disposition to coma; painful swelling of the right
hypochondrium; extremities altogether coldish; slight incoherence,
forgetfulness of everything he said; he was beside himself. About
the fourteenth day after he betook himself to bed, had a rigor,
became heated, and was seized with furious delirium; loud cries, much
talking, again composed, and then coma came on; afterwards the bowels
disordered, with copious, bilious, unmixed, and undigested stools;
urine black, scanty, and thin; much restlessness; alvine evacuations of
varied characters, either black, scanty, and verdigris-green, or fatty,
undigested, and acrid; and at times the dejections resembled milk.
About the twenty-fourth, enjoyed a calm; other matters in the same
state; became somewhat collected; remembered nothing that had happened
since he was confined to bed; immediately afterwards became delirious;
every symptom rapidly getting worse. About the thirtieth, acute fever;
stools copious and thin; was delirious; extremities cold; loss of
speech. On the thirty-fourth he died. In this case, as far as I saw,
the bowels were disordered; urine thin and black; disposition to coma;
insomnolency; extremities cold; delirious throughout. Phrenitis.[738]
CASE XIV.--In Cyzicus,[739] a woman who had brought forth twin
daughters, after a difficult labor, and in whom the lochial discharge
was insufficient, at first was seized with an acute fever, attended
with chills; heaviness of the head and neck, with pain; insomnolency
from the commencement; she was silent, sullen, and disobedient; urine
thin, and devoid of color; thirst, nausea for the most part; bowels
irregularly disordered, and again constipated. On the sixth, towards
night, talked much incoherently; had no sleep. About the eleventh day
was seized with wild delirium, and again became collected; urine black,
thin, and again deficient, and of an oily appearance; copious, thin,
and disordered evacuations from the bowels. On the fourteenth, frequent
convulsions; extremities cold; not in anywise collected; suppression of
urine. On the sixteenth loss of speech. On the seventeenth, she died.
Phrenitis.
_Explanation of the characters._ It is probable that death
was caused, on the seventeenth day, by the affection of the brain
consequent upon her accouchement.[740]
CASE XV.--In Thasus, the wife of Dealces, who was lodged upon
the Plain, from sorrow was seized with an acute fever, attended with
chills. From first to last she wrapped herself up in her bedclothes;
still silent, she fumbled, picked, bored, and gathered hairs (from
them); tears, and again laughter; no sleep; bowels irritable, but
passed nothing; when directed, drank a little; urine thin and scanty;
to the touch of the hand the fever was slight; coldness of the
extremities. On the ninth, talked much incoherently, and again became
composed and silent. On the fourteenth, breathing rare, large, at
intervals; and again hurried respiration. On the sixteenth, looseness
of the bowels from a stimulant clyster; afterwards she passed her
drink, nor could retain anything, for she was completely insensible;
skin parched and tense. On the twentieth, much talk, and again became
composed; loss of speech; respiration hurried. On the twenty-first she
died. Her respiration throughout was rare and large; she was totally
insensible; always wrapped up in her bedclothes; either much talk, or
complete silence throughout. Phrenitis.[741]
CASE XVI.--In Melibœa,[742] a young man having become heated by
drinking and much venery, was confined to bed; he was affected with
rigors and nausea; insomnolency and absence of thirst. On the first
day much fæces passed from the bowels along with a copious flux; and
on the following days he passed many watery. stools of a green color;
urine thin, scanty, and deficient in color; respiration rare, large,
at long intervals; softish distention of the hypochondrium, of an
oblong form, on both sides; continued palpitation in the epigastric
region throughout; passed urine of an oily appearance. On the tenth,
he had calm delirium, for he was naturally of an orderly and quiet
disposition; skin parched and tense; dejections either copious and
thin, or bilious and fatty. On the fourteenth, all the symptoms were
exacerbated; he became delirious, and talked much incoherently. On the
twentieth, wild delirium, jactitation, passed no urine; small drinks
were retained. On the twenty-fourth he died. Phrenitis.[743]
ON INJURIES OF THE HEAD.
THE ARGUMENT.
This treatise opens with a description of the bones of the head,
which, although in most respects pretty accurate, is remarkable for
containing an account of particular configurations of the cranium,
and of certain varieties in the arrangement of the sutures, which it
has puzzled modern authorities in anatomy to explain, otherwise than
upon the supposition that the writer must have been but imperfectly
acquainted with the subject. But as the work otherwise bears evidence
that our author must have examined the bones of the head very
carefully, and moreover, as in all his works he displays a wonderfully
minute acquaintance with osteology, (to say nothing of the historical
tradition, mentioned by Pausanias, that he was possessed of a skeleton,
which at his death he bequeathed to the Temple of Apollo, at Delphi,)
it seems incredible that he should have committed most glaring blunders
in describing the prominent features of a part to which it is clear
that he had paid very great attention. Moreover, the reputation of
Hippocrates for accuracy stood so high, that an eminent authority
does not hesitate to declare of him, that he was a man who knew not
how to deceive or be deceived.[744] An easy way of getting rid of
the difficulty would no doubt be, to adopt the conjecture advanced
by Scaliger,[745] and in part approved of by Riolanus,[746] that the
treatise had suffered much in early times, from the interpolations of
ignorant transcribers; or to hold, with M. Malgaigne, that the whole
work is to be condemned as spurious. But it would be a dangerous
practice in ancient criticism, to reject as spurious a work which has
such unexceptionable evidence in its favor, although it may contain
matter which appears to us derogatory to the reputation of its author,
and it will be admitted, by any competent judge who examines the
arguments by Scaliger, that the proofs which he brings forward of great
interpolations in this treatise, are generally of a very fanciful
nature.
On a point so obscure, and which has puzzled so many eminent
scholars, it is to be feared that I shall not be able to throw much
additional light, but as, consistently with my general plan, I cannot
well avoid stating some opinion on the question I shall endeavor to
elucidate it in so far by giving in the first place a brief sketch
of the information supplied by all the other ancient authorities who
have touched upon this subject. I shall begin, then, with Aristotle,
the contemporary of our author, who, in his work “On the History of
Animals,” gives the following very inaccurate description of the
sutures of the human skull: “The female cranium has one circular
suture, but men generally three, which unite in one point. But a male
skull has been seen not having a suture.”[747] Celsus describes the
sutures in the following terms: “Ex ceteris, quo suturæ pauciores
sunt, eo capitis valetudo commodior est. Neque enim certus eorum
numerus est, sicut ne locus quidem. Ferè tamen duæ, super aures,
tempora a superiori parte discernunt; tertia ad aures, occipitium a
summo capite deducit; quarta, ab eodem vertice per medium caput ad
frontem procedit; eaque modo sub imo capillo desinit, modo frontem
ipsam secans inter supercilia finitur.” (viii., 1.) “Nam neque utique
certa sedes, supra posui, suturarum est.” (viii., 4.) Pliny gives
the following description of the head, which it is impossible not to
recognize as having been borrowed from our author: “Vertices bini
hominum tantum aliquibus. Capitis ossa plana, tenuia, sine medullis,
serratis pectinatim structa compagibus.”[748] Of Ruffus Ephesius I may
just mention, that his descriptions of the human body are in general
remarkable for their correctness, which is not to be wondered at, as he
would appear to have followed, in general, Erasistratus and the other
authorities belonging to the great Alexandrian period in anatomy; and
that he has described very accurately all the sutures of the human
cranium, but says not a word of the different configurations of the
head, as here given by our author.[749] We now come to Galen, who gives
a very lengthy description of the various forms of the head, in nearly
the same terms as our author, and after alluding to the uses of the
sutures, the principal of which he holds to be to permit transpiration
from the brain, he proceeds thus to describe the distribution of the
sutures: “That there is one which runs straight along the middle of the
head, (the sagittal?) and two transverse, (the coronal and lambdoid?)
has been stated previously, and need not require many words in this
place. For, the head being like an oblong sphere, one was justly
made to extend straight through its middle from behind forwards, and
two transverse sutures meet it, and the form of the three sutures is
like the letter H. For the whole head being more elongated in this
case than usual, and, as it were, compressed towards the ears, it
was equitable that the number of the sutures should be unequal as to
length and breadth, otherwise Nature would undeservedly have been
named just, by Hippocrates, in thus giving equal gifts to the unequal.
But it is not the case; for being most just, she formed the strongest
suture which extends along the length of the head single, being thus
proportionate to the width of the parts on both sides of it; namely,
on the right and on the left; but she formed the transverse double in
number, the one behind, as formerly said, called the lambdoid, and
the other before, called the coronal, so that the bone of the head
between these two sutures might be equal to those in the middle, on
each side (the parietal bones?). The sutures of the head, in that
configuration which is acuminated,[750] furnish a very great example of
the justness of Nature. For there are three principal figures of the
head: the one entirely opposed to the natural configuration already
described, when the head loses both its protuberances, that behind and
the other before, and is equal on all hands, and like a true sphere;
and two others, the one form having no protuberance in front, and the
other none in the occiput. The sutures of the spherical head are like
the letter χ, two only in number, and intersecting one another; the
one extending transverse from the one ear to the other, and the other
extending straight through the middle of the vertex to the middle
of the forehead. For, as when one part of the head is excessive,
being longer than the other, it was just that the longer form should
have more sutures, so, when both are alike, Nature bestowed an equal
number on both. But in the head which wants the protuberance at the
occiput, the straight and the coronal sutures remain, but the lambdoid
is wanting (it being near to the protuberance that is wanting), so
that the figure of the two resembles the letter T; as also when the
protuberance of the head in front is wanting, the coronal at the same
time is wanting, but there remains the one running lengthways and
joining the lambdoid, and this form of construction is made to resemble
the letter T. A fourth species of acuminated (sugar-loaf) head might
be imagined, but which does not occur, with the head more prominent at
the two ears than in front and behind.” He goes on to state the reasons
why there is no such construction of the head as this, and concludes as
follows: “Wherefore Hippocrates described four configurations, and the
sutures of each, in the manner we have now said that they exist, being
justly distributed to each configuration by Nature as to position and
number.”[751] The description of the bones and sutures of the head,
given in the Latin work “De Ossibus,” generally attributed to Galen, is
to the same effect. The same number of distinct configurations of the
head, and the same characters as regards the sutures, is also given by
Avicenna, who professedly copies from Galen. (I., i., 5, 3.)
When examined together, these descriptions certainly must be admitted
to have the appearance of being all derived from one original,
namely, from our author, in this place; and taken literally, there
can be no doubt that their meaning amounts to this: that the number
of the sutures varies with the form of the head; that when there are
protuberances both before and behind, the head in its upper part has
two transverse sutures, namely, the coronal and the lambdoid, and one
longitudinal, namely, the sagittal; that if the anterior protuberance
be wanting, the coronal is wanting, and, if the posterior, the
lambdoid. Now I need scarcely remark, that modern anatomists do not
recognize such varieties in the configuration of the head nor in the
numbers of the sutures, and that it is very rare indeed for either the
coronal or the lambdoid suture to be found wanting. To all appearance,
then, Galen was mistaken, and it only appears remarkable that, with all
his knowledge of anatomy, theoretical and practical, and considering
the opportunities which he must have possessed of examining human
skeletons in Alexandria, he should have failed to observe and describe
the bones of the cranium for himself.