Book V

The Epidemics.

The Epidemics.

— Book I.

The Argument.

The ancient physicians commonly used the term Epidemic in the same sense as it is understood now, that is to say, as applying to any disease which attacks a multitude of persons in a locality at any particular period. This, as will be seen in our annotations below, is nearly the definition which Galen gives of it; and it is generally used by Hippocrates, in the first and third books of the “Epidemics,” in pretty much the same sense as it is used by our great modern authority on epidemics, Sydenham. But, although this be the strict sense in which the ancient authorities use the term, it must be borne in mind that, as applied to the whole seven books of the “Epidemics,” it must be taken in a much wider signification; for there are many things treated of in them to which the term epidemic can by no means be thus applied, such as surgical cases, fragments of anatomical descriptions, philosophical speculations, empirical remedies, general reflections on various topics, and so forth. In fact, the work entitled “The Books of Epidemics” can be viewed in no other light than as an Adversaria, or Memorandum Book, in which is collected a variety of isolated facts and detached observations, to serve as the materials for more elaborate and finished works on professional subjects. Indeed, Galen does not hesitate to give it as his opinion, that some of the most celebrated of our author’s productions, such as the “Aphorisms” and “Prognostics,” are in a great measure made up from the materials originally laid up in this capacious repertory of observations; and, with regard to the former of these works, there is no person familiarly acquainted with it but must admit the truth of Galen’s remark. But, respecting the other, although it must be obvious, upon a comparison of them, that there is a close connection between it and the “Epidemics,” there can be no doubt that, in composing the “Prognostics,” Hippocrates availed himself of other materials ready prepared for his use, in the “Prorrhetics” and “Coan Prænotions” of his predecessors, the Asclepiadæ; so that, of all his admired productions, it, perhaps, is the one which has the least pretension to any originality of matter. If it be thought strange that the term epidemics should have been applied to a work composed of such heterogeneous materials, I would remark, in explanation, that, although the subject-matters of which it consists are not all of this nature, the most valuable portion of them refers to epidemics, and it is not to be wondered at that the whole collection should have got its appellation from the most prominent subject to which it relates.

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I shall now proceed to give a succinct analysis of the various subjects which are contained in the First and Third Books of the “Epidemics.”

The first book opens with a description of the leading phenomena of a certain season, which is called the First Constitution; it was southerly, coldish, rainy, clouded and misty, with some intervals of drought. The most noted diseases of spring in this constitution were causus and an epidemical parotitis. But the most important subject which is handled under this head, is an epidemic phthisis, of which a very interesting description is given.

The Second Constitution is described as being northerly and humid; humid ophthalmies, dysenteries, and diarrhœas are described among the prevailing diseases of the season; but the most marked affection which is said to have occurred in this constitution, is a continual fever of a serious character, which did not come to a crisis until after it had run a long course. It is described as passing off by deposits, and principally by dropsies, and an affection of the urinary organs. One cannot help being struck with the remark which Hippocrates makes, that he never knew a case prove fatal in which the strangury supervened. The directions as to the treatment he condenses into one general rule, which well deserves to be engraved in letters of gold, that “the aim of the physician should be to do good to his patient, or, at least, to do no harm.” The description of this constitution concludes with some general reflections on the prognostics in causus and phrenitis.

The Third Constitution is described as being of a very variable character; winter stormy, spring rainy, summer hot, autumn cold and dry. The ardent fevers (or causi) began early in the season, but did not assume a fatal character until autumn. This disease came to a crisis in four modes--by an epistaxis, by a copious flow of urine, by a deposit, or by an alvine discharge. In women, there was also sometimes a crisis by menstruation.

The Fourth Constitution is one which, by Galen and the other authorities, has been entitled the pestilential, and has attracted great attention, as being supposed to have derived its peculiar characters from the great Plague which prevailed during the Peloponnesian war, and which is described in so interesting a manner by Thucydides. Galen, not only in his Commentary, but in various other parts of his works, advocates this opinion, and it will be seen from what is stated in our annotations, that there is in reality a striking resemblance between the features of the plague, as delineated by Thucydides, and the epidemical diseases which are noticed by Hippocrates as having prevailed during this constitution. Of all the diseases here described the most remarkable is the erysipelas, which, although not of a very fatal character, was still of a formidable nature, as it frequently terminated in gangrene. Causus, phrenitis, and anthrax are also described as being common under this constitution. The last of these being a well-known symptom of the Oriental plague, it has naturally excited a good deal of speculation to determine whether or not our author here refers to the glandular plague. See our remarks on Epidem. III.

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In these books it is remarkable that phthisis is treated of as a febrile disease, and in particular as supervening upon attacks of the semitertian. There seems reason to suppose that our author means to describe a hectic fever succeeding to intermittents, which had caused organic derangement of the internal viscera, more especially of the liver and spleen. See PAULUS ÆGINETA, Book II., 32.

In the first book, fourteen cases of disease are related, and in the beginning of the third twelve, and sixteen in the end; thus making forty-two in all. It is worthy of remark, that in twenty-five of these the result was fatal. There is every reason, then, to suppose that they were selected for a purpose, but what that purpose was cannot now be easily determined. The most natural would, no doubt, have been to illustrate, by examples, the forms of the different diseases which are described as occurring during the Constitutions previously described. But there seems to be little or no reason to suppose that this is the object for which they are related. In proof of this, I may mention that there is not in the collection a single case of the epidemical erysipelas which is described as having been the prevailing disease during the fourth Constitution. Indeed it must strike everybody, who reads them carefully, as a singular feature in these cases, that the lineaments of a particular disease are seldom to be recognized, and this perhaps may be regarded as a proof of the faithfulness with which they have been copied from nature. In short, we here recognize the features of disease in the concrete, and not in the abstract. And is not this what we should expect in all true copies from Nature? How often does the candid physician find himself forced honestly to admit that he is at a loss what name to give to the combination of morbid actions which he is called upon to treat! The common herd of mankind would seem to fancy, as in Nature there are certain types of all animal and vegetable substances, and the botanist has no difficulty in classing such a plant, for example, as the conium maculatum; and the natural historian can readily pronounce that such a bird is the alcedo Ispida; that the physician, in like manner, upon examining the characteristic features of any case, should have no difficulty in pronouncing that it is pleuritis, for example, or pneumonia, or the like. But how often does it happen, that the complaint in question is an aggregate of symptoms, produced by peculiarities of constitution, and incidental circumstances, which, taken together, constitute an ensemble which does not well admit of being referred to any one of the general forms of disease described in our nosological systems? Now, I say the most wonderful feature in the cases related by Hippocrates, is that they are descriptive of the symptoms observed in certain diseased individuals, instead of being, what most modern cases are, symptoms drawn to correspond with certain ideal forms of disease.

What, in my opinion, likewise adds very much to the value of these cases is, that (as Galen somewhere remarks in his Commentary) the author never aimed to make his Books of Epidemics a work on Therapeutics, and hence, in noting morbid phenomena, his mind in not warped by any particular hypothesis, nor by any selfish interest, in order to place some favorite mode of practice, advocated by himself, in a favorable light. May I be permitted here to remark, that the reader will be much struck with our author’s admirable talent for describing the phenomena of disease as they are actually presented to us, if he will compare the case related by him in these two books with those of almost any modern authority whatever;--for example, with those related by the late Dr. James Hamilton, in his celebrated work on Purgative Medicines. In the latter, you look in vain for the strongly-marked features which present themselves in all the cases related by our author,--for a description of the condition of the hypochondriac region,--of the state of the animal heat in the extremities,--of the minute characters of the alvine and urinary discharges,--of the respiration,--of the patients’ position in bed,--and many other symptoms, which are invariably noticed by Hippocrates. And what reasonable person will venture to deny, that the symptoms I have just now mentioned are most important features in every febrile disease, and that no one can be said to have a sufficient view of such a case, who does not take these into account? To confine our attention at present to only one of these symptoms,--can it ever be a matter of indifference what are the physical characters of so important an excretion as the urine? that is to say, whether the grosser particles of it, which usually fall to the bottom, be present in the urine or not? Yet in all the seventeen cases related in the modern work just now referred to, the characters of the urine are not given in a single instance. And although the object of the writer is to enforce his own peculiar views, as to the utility of purgative medicines in this disease, he scarcely ever gives the minute characters of the alvine discharges, as is uniformly the case with Hippocrates; or if they are noticed at all, it is in so confused a manner that the reader is at a loss to determine whether they are produced by the disease, or by the medicines which have been administered. For the issue of the case no obvious cause is stated, but the reader is expected to draw the conclusion that, as purgatives were freely given, and a considerable proportion of the cases did well,--(agreeably to the hackneyed rule, post quod, ergo propter quod,)--the purgatives brought about the fortunate result.

Had the cases been fully and circumstantially detailed, it might have been found that, as in those related by Hippocrates, recovery was preceded by a critical discharge of urine, accompanied with a copious sediment; and then the more probable inference would have been, that the amendment was referable to it, and not to the purgative medicines which were administered. It is, I regret to say, a notable example of the want of logical training in the education of professional men, in the present age, that inferences regarding a peculiar method of practice were allowed to be founded upon narratives of observations so defective and one-sided as those I refer to.

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I cannot quit the present subject of discussion, without saying a few words in reference to what must strike the reader as a singular feature in the cases related in the books of the Epidemics; I mean the general omission of any mention of treatment. The reader will find in our annotations various remarks of Galen on this head, from which he will learn that the Great Commentator inclines to the opinion, that in all these cases the usual routine of practice was followed, but that no mention is made of medicines, unless when there was some deviation from the established rules. For example, in a certain febrile case, it is stated that the patient was bled on the eighth day, and Galen contends that venesection is noticed in this instance, merely because it was contrary to the established rule of not bleeding after the fourth day; for that if the practice had been in accordance with the general rule, it would not have been noticed at all. Now it must be admitted, that this supposition is by no means improbable, and that examples of this usage are not wanting, even in the modern literature of medicine. To give an example, which just occurs to me; in not a few of the cases of cerebral disease related by Dr. Abercrombie, in his work “On the Brain,” there is no allusion whatever to remedies, although no one, who recollects the vigorous system of treatment then pursued by the profession in “Modern Athens,” will doubt for a moment that they must have been applied. As this eminent authority, then, when he believed that the treatment had no perceptible effect on the course which the disease ran, thought himself warranted in omitting all mention of it, it might be supposed, in like manner, that Hippocrates may have passed over the remedies applied, from some such motive or consideration. But another reason for the absence of remedies in these Reports may be readily supposed. May not Hippocrates have been at first quite undecided what was the proper plan of treatment to be adopted in those cases, and thought it the wisest course to attempt nothing rashly, but to be for a season the quiet spectator of the course which the diseases in question were naturally disposed to run, before attempting to interfere in the struggle between morbific agents with which he was imperfectly acquainted, and their great physician, as he held Nature to be? And however much the advocates for a bold system of treating diseases may be disposed to deride this expectant method, which Asclepiades contemptuously denominated “the contemplation of death,” it does not want the sanction of a name which is second only to Hippocrates in the literature of epidemical fevers.

Sydenham admits, that with all the diligence which he had applied to the study of these diseases, he was always greatly puzzled what plan of treatment to adopt at the first breaking out of a new epidemic, and that it was only “ingenti adhibita cautela intentisque animi nervis,” that he could make up his mind what course of treatment to adopt in such an emergency. Need it be wondered at, then, that two thousand years earlier the modest mind of our great author should have hesitated for a time, before deciding how to act under similar circumstances? I must own, therefore, that I have long inclined to the opinion, that, distracted with the conflicting plans of treatment adopted by his contemporaries, Hippocrates at first did little or nothing in the treatment of epidemical fevers, and that it was only after a patient study of their symptoms, and many cautious trials, that he ventured to lay down those excellent rules of treatment which he has described so admirably in his work “On Regimen in Acute Diseases.” This, however, is merely my individual opinion, and the reader must receive it as such.

M. Littré, in the Argument prefixed to his translation of the Epidemics, enters very fully into the discussion of the question regarding the nature of the diseases which are treated of in the course of this work. This is a task, however, which I deem it superfluous to undertake at any length, as I have stated my opinions on this subject in the Commentaries on the Second Book of PAULUS ÆGINETA, and after maturely weighing what has been elicited by subsequent inquirers, I find no cause to retract any of the opinions which are there advanced. That the causus of Hippocrates, and the other ancient authorities, was not the typhus of the more temperate parts of Europe, but a bilious fever, of the remittent type, must be quite apparent to every person at all acquainted with the medical literature of febrile diseases. M. Littré’s researches lead him to exactly the same conclusion, and much deference is due to his judgment in this case, as it must be admitted that a French physician is now very favorably situated for contrasting the diseases of temperate and hot climates, owing to the familiar intercourse which at present subsists between Paris and Algiers. Of all the materials which he has collected from the observations of French physicians in Algeria, the most interesting are those which he draws from a work on Fevers, by M. Maillot. The description which is there given of “la fièvre algide,” is so striking, and is so much calculated to illustrate the nature of the fevers which are treated of in this work of Hippocrates, that I shall not scruple to quote it entire.

“La fièvre algide (dit M. Maillot) n’est pas généralement, comme on le dit, la prolongation indéfinie du stade de froid; je l’ai vue rarement débuter de la sorte. Il y a même entre ces deux états une contraste frappante. Dans le premier stade des fièvres intermittentes, la sensation du froid est hors de toute proportion avec l’abaissement réel de la température de la peau, tandis que, dans la fièvre algide, le froid n’est pas perçu par le malade, alors que la peau est glacée. C’est ordinairement pendant la réaction que commencent les symptômes qui la caractérisent; souvent ils surviennent tout à coup au milieu d’une réaction qui paraissait franche. Au trouble de la circulation succède en peu d’instants et presque sans transition le ralentissement du pouls, qui devient bientôt très rare, fuit sous le doigt et disparaît; l’abaissement de la température du corps va vite et suit la progression promptement décroissante de la circulation; les extrémitiés, la face, le torse, se refroidissent successivement; l’abdomen seul conserve encore quelque temps un peu de chaleur; le contact de la peau donne la sensation de froid que procure le marbre. Les lèvres sont décolorées, l’haleine froide, la voix cassée, les battemens du cœur rares, incomplets, appréciables seulement par l’auscultation; les facultés intellectuelles sont intactes, et le malade se complaît dans cet état de repos, surtout lorsqu’il succède à une fièvre violente, la physionomie est sans mobilité, l’impassibilité la plus grande est peinte sur son visage; ses traits sont morts. La marche de cette fièvre est très insidieuse; il n’est peut-être personne, dont elle n’ait surpris la vigilance, avant d’être familiarisé avec l’observation des accidens de cette nature, on prend souvent pour une très grande amélioration due aux déplétions sanguines, le calme qui succède aux accidents inflammatoires; et plus d’une fois, dans de semblables circonstances, on n’a été détrompé que par la mort soudaine du malade. Toutes les fois qu’à une réaction plus on moins forte, on verra succéder tout à coup un ralentissement du pouls, avec pâleur de la langue et décoloration des lèvres, on ne devra hésiter à diagnostiquer une fièvre algide. La temporisation ici donne la mort, en quelques heures. Dans quelques cas très rares, j’ai cependant vu cet état algide se prolonger trois ou quatre jours. Le malade expire en conservant toutes ses facultés intellectuelles, il s’éteint comme par un arrêt de l’innervation. Lorsque la mort n’est pas le terme de cet état morbide si grave, le pouls se relève; la peau reprend sa chaleur naturelle; quelquefois alors la réaction détermine une irritation de l’encéphale ou des voies digestives; mais rarement elle est assez intense pour qu’on soit obligé de la combattre par des déplétions sanguines.” I shall add a remark, which M. Littré gives on the same authority: “J’ai tenu à mentionner ici l’impression qu’éprouva M.

Maillot au début de sa pratique en Algérie, et qui est si instructive; car, aller subitement de France exercer la médecine dans un pays chaud, ou lire les observations d’Hippocrate, c’est tout un: l’impression est la même, le changement de scène est aussi grand.”

I cannot help remarking in this place, however, that it appears to me singular, that M. Littré should represent the febris algida as being confined to southern climates, and should speak of it as being unknown in Paris; for, at all events, there seems to be no doubt that it prevails in a more northerly region, namely, in Holland. It is thus described by the celebrated Franciscus de le Boe (or Sylvius), who was professor of practical medicine at Leyden about the middle of the 17th century: “Febres algidæ observantur nonnunquam, non tantum frigore præsertim, sed frigore tantum molestæ: adeo ut aliquando et frequentius levis, aliquando et rarius nullus sequatur calor. Tales, etiam semper algidas in Nosocomio academico habuimus ita manifestas, ut non tantum incipiente, atque augescente, sed etiam vigente et déclinante, imò cessante paroxysmo, id est, semper tum suo, tum adstantium, tum medicorum sensu moleste ubique frigerent, nunquam teperent, minus calerent ullibi ægri. Suntque hæ algidæ graviores semper forsan quotidianæ.” The febris algida is also named “rigor without heat,” by the Greek authorities, and “frigus quod non calefit” by the Arabians, who, like Sylvius, as quoted above, regard it as a variety of the quotidian intermittent. See PAULUS ÆGINETA, — Book II., 26.

M. Littré quotes the remark of an excellent English authority on fever, J. Johnson, 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.” 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.” 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, 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, 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. 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, about the autumnal equinox, and under the Pleiades, the rains were abundant, constant, and soft, with southerly winds; the winter southerly, the northerly winds faint, droughts; on the whole, the winter having the character of spring. The spring was southerly, cool, rains small in quantity. Summer, for the most part, cloudy, no rain, the Etesian winds, rare and small, blew in an irregular manner. The whole constitution of the season being thus inclined to the southerly, and with droughts early in the spring, from the preceding opposite and northerly state, ardent fevers occurred in a few instances, and these very mild, being rarely attended with hemorrhage, and never proving fatal. Swellings appeared about the ears, in many on either side, and in the greatest number on both sides, being unaccompanied by fever so as not to confine the patient to bed; in all cases they disappeared without giving trouble, neither did any of them come to suppuration, as is common in swellings from other causes. They were of a lax, large, diffused character, without inflammation or pain, and they went away without any critical sign. They seized children, adults, and mostly those who were engaged in the exercises of the palestra and gymnasium, but seldom attacked women. Many had dry coughs without expectoration, and accompanied with hoarseness of voice. In some instances earlier, and in others later, inflammations with pain seized sometimes one of the testicles, and sometimes both; some of these cases were accompanied with fever and some not; the greater part of these were attended with much suffering. In other respects they were free of disease, so as not to require medical assistance.

2. Early in the beginning of spring, and through the summer, and towards winter, many of those who had been long gradually declining, took to bed with symptoms of phthisis; in many cases formerly of a doubtful character the disease then became confirmed; in these the constitution inclined to the phthisical. Many, and, in fact, the most of them, died; and of those confined to bed, I do not know if a single individual survived for any considerable time; they died more suddenly than is common in such cases. But other diseases, of a protracted character, and attended with fever, were well supported, and did not prove fatal: of these we will give a description afterwards. Consumption was the most considerable of the diseases which then prevailed, and the only one which proved fatal to many persons. Most of them were affected by these diseases in the following manner: fevers accompanied with rigors, of the continual type, acute, having no complete intermissions, but of the form of the 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.

3. In the course of the summer and autumn many fevers of the continual type, but not violent; they attacked persons who had been long indisposed, but who were otherwise not in an uncomfortable state. In most cases the bowels were disordered in a very moderate degree, and they did not suffer thereby in any manner worth mentioning; the urine was generally well 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). 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.

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. The winter was northerly, the rains frequent, in torrents, and large, with snow, but with a frequent mixture of fair weather. These things were all so, but the setting in of the cold was not much out of season. After the winter solstice, and at the time when the zephyr usually begins to blow, severe winterly storms out of season, with much northerly wind, snow, continued and copious rains; the sky tempestuous and clouded; these things were protracted, and did not remit until the equinox. The spring was cold, northerly, rainy, and clouded; the summer was not very sultry, the Etesian winds blew constant, but quickly afterwards, about the rising of Arcturus, there were again many rains with north winds. The whole season being wet, cold, and northerly, people were, for the most part, healthy during winter; but early in the spring very many, indeed, the greater part, were valetudinary. At first ophthalmies set in, with rheums, pains, unconcocted discharges, small concretions, generally breaking with difficulty, in most instances they relapsed, and they did not cease until late in autumn. During summer and autumn there were dysenteric affections, attacks of tenesmus and lientery, bilious 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. The tertians were more numerous than the ardent fevers, and attended with more pain; but these all had four periods in regular succession from the first attack, and they had a complete crisis in seven, without a relapse in any instance.

The quartans attacked many at first, in the form of regular quartans, but in no few cases a transition from other fevers and diseases into quartans took place; they were protracted, as is wont with them, indeed, more so than usual. Quotidian, nocturnal, and wandering fevers attacked many persons, some of whom continued to keep up, and others were confined to bed. In most instances these fevers were prolonged under the Pleiades and till winter. Many persons, and more especially children, had convulsions from the commencement; and they had fever, and the convulsions supervened upon the fevers; in most cases they were protracted, but free from danger, unless in those who were in a deadly state from other complaints. Those fevers which were continual in the main, and with no intermissions, but having exacerbations in the tertian form, there being remissions the one day and exacerbations the next, were the most violent of all those which occurred at that time, and the most protracted, and occurring with the greatest pains, beginning mildly, always on the whole increasing, and being exacerbated, and always turning worse, having small remissions, and after an abatement having more violent paroxysms, and growing worse, for the most part, on the critical days. Rigors, in all cases, took place in an irregular and uncertain manner, very rare and weak in them, but greater in all other fevers; frequent sweats, but most seldom in them, bringing no alleviation, but, on the contrary, doing mischief. Much cold of the extremities in them, and these were warmed with difficulty. Insomnolency, for the most part, especially in these fevers, and again a disposition to coma. The bowels, in all diseases, were disordered, and in a bad state, but worst of all in these. The urine, in most of them, was either thin and crude, yellow, and after a time with slight symptoms of concoction in a critical form, or having the proper thickness, but muddy, and neither settling nor subsiding; or having small and bad, and crude sediments; these being the worst of all. Coughs attended these fevers, but I cannot state that any harm or good ever resulted from the cough. 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. 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. The strangury attacked, most especially, persons of the ages I have mentioned, but it also occurred in many others, both of those who were not confined to bed and those who were. There was a speedy and great change in all these cases. For the bowels, if they happened previously to have watery discharges of a bad character, became regular, they got an appetite for food, and the fevers were mild afterwards. But, with regard to the strangury itself, the symptoms were protracted and painful. Their urine was copious, thick, of various characters, red, mixed with pus, and was passed with pain. These all recovered, and I did not see a single instance of death among them.

5. With regard to the dangers of these cases, one must always attend to the seasonable concoction of all the evacuations, and to the favorable and critical abscesses. The concoctions indicate a speedy crisis and recovery of health; crude and undigested evacuations, and those which are converted into bad abscesses, indicate either want of crisis, or pains, or prolongation of the disease, or death, or relapses; which of these it is to be must be determined from other circumstances. The physician must be able to tell the antecedents, know the present, and foretell the future--must 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.

6. Pains about the head and neck, and heaviness of the same along with pain, occur either without fevers or in fevers. Convulsions occurring in persons attacked with frenzy, and having vomitings of verdigris-green bile, in some cases quickly prove fatal. In ardent fevers, and in those other fevers in which there is pain of the neck, heaviness of the temples, mistiness about the eyes, and distention about the hypochondriac region, not unattended with pain, hemorrhage from the nose takes place, but those who have heaviness of the whole head, cardialgia and nausea, vomit bilious and pituitous matters; children, in such affections, are generally attacked with convulsions, and women have these and also pains of the uterus; whereas, in elder persons, and those in whom the heat is already more subdued, these cases end in paralysis, mania, and loss of sight.

Third Constitution.

7. In Thasus, a little before and during the season of Arcturus, there were frequent and great rains, with northerly winds. About the equinox, and till the setting of the Pleiades, there were a few southerly rains: the winter northerly and parched, cold, with great winds and snow. Great storms about the equinox, the spring northerly, dryness, rains few and cold. About the summer solstice, scanty rains, and great cold until near the season of the Dog-star. After the Dog-days, until the season of Arcturus, the summer hot, great droughts, not in intervals, but continued and severe: no rain; the Etesian winds blew; about the season of Arcturus southerly rains until the equinox.

8. In this state of things, during winter, paraplegia set in, and attacked many, and some died speedily; and otherwise the disease prevailed much in an epidemical form, but persons remained free from all other diseases. Early in the spring, ardent fevers commenced and continued through the summer until the equinox. Those then that were attacked immediately after the commencement of the spring and summer, for the most part recovered, and but few of them died. But when the autumn and the rains had set in, they were of a fatal character, and the greater part then died. When in these attacks of ardent fevers there was a proper and copious hemorrhage from the nose, they were generally saved by it, and I do not know a single person who had a proper hemorrhage who died in this constitution. Philiscus, Epaminon, and Silenus, indeed, who had a trifling epistaxis on the fourth and fifth day, died. 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, but these were benefited either by an urinary purgation, or a disorder of the bowels, or a copious hemorrhage, as in the case of Heraclides, who was lodged with Aristocydes: this person, though he had the hemorrhage from the nose, the purgation by the bladder, and disorder of the bowels, experienced a favorable crisis on the twentieth day, not like the servant of Phanagoras, who had none of these symptoms, and died. The hemorrhages attacked most persons, but especially young persons and those in the prime of life, and the greater part of those who had not the hemorrhage died: elderly persons had jaundice or disorder of the bowels, such as Bion, who was lodged with Silenus. Dysenteries were epidemical during the summer, and some of those cases in which the hemorrhage occurred, terminated in dysentery, as happened to the slave of Eraton, and to Mullus, who had a copious hemorrhage, which settled down into dysentery, and they recovered. This humor was redundant in many cases, since in those who had not the hemorrhage about the crisis, but the risings about the ears disappeared, after their disappearance there was a sense of weight in the left flank extending to the extremity of the hip, and pain setting in after the crisis, with a discharge of thin urine; they began to have small hemorrhages about the twenty-fourth day, and the swelling was converted into the hemorrhage. In the case of Antiphon, the son of Critobulus, 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. 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: in most the bowels were disordered with thin and bilious dejections; and many, after passing through the other crises, terminated in dysenteries, as happened to Xenophanes and Critias. The urine was watery, copious, clear, and thin; and even after the crises, when the sediment was natural, and all the other critical symptoms were favorable, as I recollect having happened to Bion, who was lodged in the house of Silenus, and Critias, who lived with Xenophanes, the slave of Areton, and the wife of Mnesistratus. But afterwards all these were attacked with dysentery. It would be worth while to inquire whether the watery urine was the cause of this. About the season of Arcturus many had the crisis on the eleventh day, and in them the regular relapses did not take place, but they became comatose about this time, especially children; but there were fewest deaths of all among them.

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; a few cases also occurred during the summer. These then made their attack at the commencement of ardent fevers, which were attended with fatal symptoms; for immediately upon their setting in, there were acute fever and small rigors, insomnolency, aberration, thirst, nausea, insignificant sweats about the forehead and clavicles, but no general perspiration; they had much delirious talking, fears, despondency, great coldness of the extremities, in the feet, but more especially in their hands: the paroxysms were on the even days; and in most cases, on the fourth day, the most violent pains set in, with sweats, generally coldish, and the extremities could not be warmed, but were livid and rather cold, and they had then no thirst; in them the urine was black, scanty, thin, and the bowels were constipated; there was an hemorrhage from the nose in no case in which these symptoms occurred, but merely a trifling epistaxis; and none of them had a relapse, but they died on the sixth day with sweats. In the phrenitic cases, all the symptoms which have been described did not occur, but in them the disease mostly came to a crisis on the eleventh day, and in some on the twentieth. In those cases in which the phrenitis did not begin immediately, but about the third or fourth day, the disease was moderate at the commencement, but assumed a violent character about the seventh day. There was a great number of diseases, and of those affected, they who died were principally infants, young persons, adults having smooth bodies, white skins, straight and black hair, dark eyes, those living recklessly and luxuriously; persons with shrill, or rough voices, who stammered and were passionate, and women more especially died from this form. In this constitution, four symptoms in particular proved salutary; either a hemorrhage from the nose, or a copious discharge by the bladder of urine, having an abundant and proper sediment, or a bilious disorder of the bowels at the proper time, or an attack of dysentery. And in many cases it happened, that the crisis did not take place by any one of the symptoms which have been mentioned, but the patient passed through most of them, and appeared to be in an uncomfortable way, and yet all who were attacked with these symptoms recovered. All the symptoms which I have described occurred also to women and girls; and whoever of them had any of these symptoms in a favorable manner, or the menses appeared abundantly, were saved thereby, and had a crisis, so that I do not know a single female who had any of these favorably that died. But the daughter of Philo, who had a copious hemorrhage from the nose, and took supper unseasonably on the seventh day, died.

In those cases of acute, and more especially of ardent fevers, in which there is an involuntary discharge of tears, you may expect a 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. 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;--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.

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; 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. 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. The nocturnal fever is not very fatal, but protracted; the diurnal is still more protracted, and in some cases passes into phthisis. The septan is protracted, but not fatal; the nonan more protracted, and not fatal. The true tertian comes quickly to a crisis, and is not fatal; but the quintan is the worst of all, for it proves fatal when it precedes an attack of phthisis, and when it supervenes on persons who are already consumptive. There are peculiar modes, and constitutions, and paroxysms, in every one of these fevers; for example,--the continual, in some cases at the very commencement, grows, as it were, and attains its full strength, and rises to its most dangerous pitch, but is diminished about and at the crisis; in others it begins gentle and suppressed, but gains ground and is exacerbated every day, and bursts forth with all its heat about and at the crisis; while in others, again, it commences mildly, increases, and is exacerbated until it reaches its acmé, and then remits until at and about the crisis. These varieties occur in every fever, and in every disease. From these observations one must regulate the regimen accordingly. There are many other important symptoms allied to these, part of which have been already noticed, and part will be described afterwards, from a consideration of which one may judge, and 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.

CASE I.--Philiscus, who lived by the Wall, took to bed on the first day of acute fever; he sweated; towards night was uneasy. On the second day all the symptoms were exacerbated; late in the evening had a proper stool from a small clyster; the night quiet. On the third day, early in the morning and until noon, he appeared to be free from fever; towards evening, acute fever, with sweating, thirst, tongue parched; passed black urine; night uncomfortable, no sleep; he was delirious on all subjects. On the fourth, all the symptoms exacerbated, urine black; night more comfortable, urine of a better color. On the fifth, about mid-day, had a slight trickling of pure blood from the nose; urine varied in character, having floating in it round bodies, resembling semen, and scattered, but which did not fall to the bottom; a suppository having been applied, some scanty flatulent matters were passed; night uncomfortable, little sleep, talking incoherently; extremities altogether cold, and could not be warmed; urine black; slept a little towards day; loss of speech, cold sweats; extremities livid; about the middle of the sixth day he died. The respiration throughout, like that of a person recollecting himself, was rare, and large, and spleen was swelled upon in a round tumor, the sweats cold throughout, the paroxysms on the even days.

CASE II.--Silenus lived on the Broad-way, near the house of Evalcidas. From fatigue, drinking, and unseasonable exercises, he was seized with fever. He began with having pain in the loins; he had heaviness of the head, and there was stiffness of the neck. On the first day the alvine discharges were bilious, unmixed, frothy, high colored, and copious; urine black, having a black sediment; he was thirsty, tongue dry; no sleep at night. On the second, acute fever, stools more copious, thinner, frothy; urine black, an uncomfortable night, slight delirium. On the third, all the symptoms exacerbated; an oblong distention, of a softish nature, from both sides of the hypochondrium to the navel; stools thin, and darkish; urine muddy, and darkish; no sleep at night; much talking, laughter, singing, he could not restrain himself. On the fourth, in the same state. On the fifth, stools bilious, unmixed, smooth, greasy; urine thin, and transparent; slight absence of delirium. On the sixth, slight perspiration about the head; extremities cold and livid; much tossing about; no passage from the bowels, urine suppressed, acute fever. On the seventh, loss of speech; extremities could no longer be kept warm; no discharge of urine. On the eighth, a cold sweat all over; red rashes with sweat, of a round figure, small, like vari, persistent, not subsiding; by means of a slight stimulus, a copious discharge from the bowels, of a thin and undigested character, with pain; urine acrid, and passed with pain; extremities slightly heated; sleep slight, and comatose; speechless; urine thin, and transparent. On the ninth, in the same state. On the tenth, no drink taken; comatose, sleep slight; alvine discharges the same; urine abundant, and thickish; when allowed to stand, the sediment farinaceous and white; extremities again cold. On the eleventh, he died. At the commencement, and throughout, the respiration was slow and large; there was a constant throbbing in the hypochondrium; his age was about twenty.

CASE III.--Herophon was seized with an acute fever; alvine discharges at first were scanty, and attended with tenesmus; but afterwards they were passed of a thin, bilious character, and frequent; there was no sleep; urine black, and thin. On the fifth, in the morning, deafness; all the symptoms exacerbated; spleen swollen; distention of the hypochondrium; alvine discharges scanty, and black; he became delirious. On the sixth, delirious; at night, sweating, coldness; the delirium continued. On the seventh, he became cold, thirsty, was disordered in mind; at night recovered his senses; slept. On the eighth, was feverish; the spleen diminished in size; quite collected; had pain at first about the groin, on the same side as the spleen; had pains in both legs; night comfortable; urine better colored, had a scanty sediment. On the ninth, sweated; the crisis took place; fever remitted. On the fifth day afterwards, fever relapsed, spleen immediately became swollen; acute fever; deafness again. On the third day after the relapse, the spleen diminished; deafness less; legs painful; sweated during the night; crisis took place on the seventeenth day; had no disorder of the senses during the relapse.

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

CASE V.--The wife of Epicrates, who was lodged at the house of Archigetes, being near the term of delivery, was seized with a violent rigor, and, as was said, she did not become heated; next day the same. On the third, she was delivered of a daughter, and everything went on properly. On the day following her delivery, she was seized with acute fever, pain in the cardiac region of the stomach, and in the genital parts. Having had a suppository, was in so far relieved; pain in the head, neck, and loins; no sleep; alvine discharges scanty, bilious, thin, and unmixed; urine thin, and blackish. Towards the night of the sixth day from the time she was seized with the fever, became delirious. On the seventh, all the symptoms exacerbated; insomnolency, delirium, thirst; stools bilious, and high colored. On the eighth, had a rigor; slept more. On the ninth, the same. On the tenth, her limbs painfully affected; pain again of the cardiac region of the stomach; heaviness of the head; no delirium; slept more; bowels constipated. On the eleventh, passed urine of a better color, and having an abundant sediment; felt lighter. On the fourteenth had a rigor; acute fever. On the fifteenth, had a copious vomiting of bilious and yellow matters; sweated; fever gone; at night acute fever; urine thick, sediment white. On the seventeenth, an exacerbation; night uncomfortable; no sleep; delirium. On the eighteenth, thirsty; tongue parched; no sleep; much delirium; legs painfully affected. About the twentieth, in the morning, had 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.

CASE VI.--Cleonactides, who was lodged above the Temple of Hercules, was seized with a fever in an irregular form; was pained in the head and left side from the commencement, and had other pains resembling those produced by fatigue: paroxysms of the fevers inconstant and irregular; occasional sweats; the paroxysms generally attacked on the critical days. About the twenty-fourth was cold in the extremities of the hands, vomitings bilious, yellow, and frequent, soon turning to a verdigris-green color; general relief. About the thirtieth, began to have hemorrhage from both nostrils, and this continued in an irregular manner until near the crisis; did not loathe food, and had no thirst throughout, nor was troubled with insomnolency; urine thin, and not devoid of color. When about the thirtieth day, passed reddish urine, having a copious red sediment; was relieved, but afterwards the characters of the urine varied, sometimes having sediment, and sometimes not. On the sixtieth, the sediment in the urine copious, white, and smooth; all the symptoms ameliorated; intermission of the fever; urine thin, and well colored. On the seventieth, fever gone for ten days. On the eightieth had a rigor, was seized with acute fever, sweated much; a red, smooth sediment in the urine; and a perfect crisis.

CASE VII.--Meton was seized with fever; there was a painful weight in the loins. Next day, after drinking water pretty copiously, had proper evacuations from the bowels. On the third, heaviness of the head, stools thin, bilious, and reddish. On the fourth, all the symptoms exacerbated; had twice a scanty trickling of blood from the right nostril; passed an uncomfortable night; alvine discharges like those on the third day; urine darkish, had a darkish cloud floating in it, of a scattered form, which did not subside. On the fifth, a copious hemorrhage of pure blood from the left 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.

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.

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.

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.

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.

CASE XII.--A man, in a heated state, took supper, and drank more than enough; he vomited the whole during the night; acute fever, pain of the right hypochondrium, a softish inflammation from the inner part; passed an uncomfortable night; urine at the commencement thick, red, but when allowed to stand, had no sediment, tongue dry, and not very thirsty. On the fourth, acute fever, pains all over. On the fifth, urine smooth, oily, and copious; acute fever. On the sixth, in the evening, very incoherent, no sleep during the night. On the seventh, all the symptoms exacerbated; urine of the same characters; much talking, and he could not contain himself; the bowels being stimulated, passed a watery discharge with lumbrici: night equally painful. In the morning had a rigor; acute fever, hot sweat, appeared to be free of fever; did not sleep long; after the sleep a chill, ptyalism; in the evening, great incoherence; after a little, vomited a small quantity of dark bilious matters. On the ninth, coldness, much delirium, did not sleep. On the tenth, pains in the limbs, all the symptoms exacerbated; he was delirious. On the eleventh, he died.

CASE XIII.--A woman, who lodged on the Quay, being three months gone with child, was seized with fever, and immediately began to have pains in the loins. On the third day, pain of the head and neck, extending to the clavicle, and right hand; she immediately lost the power of speech; was paralyzed in the right hand, with spasms, after the manner of paraplegia; was quite incoherent; passed an uncomfortable night; did not sleep; disorder of the bowels, attended with bilious, 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.

CASE XIV.--Melidia, who lodged near the Temple of Juno, began to feel a violent pain of the head, neck, and chest. She was straightway seized with acute fever; a slight appearance of the menses; continued pains of all these parts. On the sixth, was affected with coma, nausea, and rigor; redness about the cheeks; slight delirium. On the seventh, had a sweat; the fever intermitted, the pains remained. A relapse; little sleep; urine throughout of a good color, but thin; the alvine evacuations were thin, bilious, acrid, very scanty, black, and fetid; a white, smooth sediment in the urine; had a sweat, and experienced a perfect crisis on the eleventh day.

— Book 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.

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.

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. 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.” From these two passages alone, without taking into account several others of less importance, which might be gathered from other medical authorities, 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, 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.

CASE II.--Hermocrates, who lived by the New Wall, was seized with fever. He began to have pain in the head and loins; an empty distention of the hypochondrium; the tongue at first was parched; deafness at the commencement; there was no sleep; not very thirsty; urine thick and red, when allowed to stand it did not subside; alvine discharge very dry, and not scanty. On the fifth, urine thin, had substances floating in it which did not fall to the bottom; at night he was delirious. On the sixth, had jaundice; all the symptoms were exacerbated; had no recollection. On the seventh, in an uncomfortable state; urine thin, as formerly; on the following days the same. About the eleventh day, all the symptoms appeared to be lightened. Coma set in; urine thicker, reddish, thin substances below, had no sediment; by degrees he became collected. On the fourteenth, fever gone; had no sweat; slept, quite collected; urine of the same characters. About the seventeenth, had a relapse, became hot. On the following days, acute fever, urine thin, was delirious. Again, on the twentieth, had a crisis; free of fever; had no sweat; no appetite through the whole time; was perfectly collected; could not speak, tongue dry, without thirst; deep sleep. About the twenty-fourth day he became heated; bowels loose, with a thin, watery discharge; on the following days acute fever, tongue parched. On the twenty-seventh he died. In this patient deafness continued throughout; the urine either thick and red, without sediment, or thin, devoid of color, and having substances floating in it; he could taste nothing.

Explanation of the characters. It is 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: had heaviness of the head and pain in the right temple for a considerable time, from some accidental cause, was seized with fever, and took to bed. On the second, there was a trickling of pure blood from the left nostril, but the alvine discharges were proper, urine thin, mixed, having small substances floating in it, like coarse barley meal, or semen. On the third, acute fever; stools black, thin, frothy, a livid sediment in the dejections; slight coma; uneasiness at the times he had to get up; sediment in the urine livid, and somewhat viscid. On the fourth, slight vomiting of bilious, yellow matters, and, after a short interval, of the color of verdigris; a few drops of pure blood ran from the left nostril; stools the same; urine the same; sweated about the head and clavicles; spleen enlarged, pain of the thigh on the same side; loose swelling of the right hypochondrium; at night had no sleep, slight delirium. On the sixth, stools black, fatty, viscid, fetid; slept, more collected. On the seventh, tongue dry, thirsty, did not sleep; was somewhat delirious; urine thin, not of a good color. On the eighth, stools black, scanty, and compact; slept, became collected; not very thirsty. On the ninth had a rigor, acute fever, sweated, a chill, was delirious, strabismus of the right eye, tongue dry, thirsty, without sleep. On the tenth, much the same. On the eleventh, became quite collected; free from fever, slept, urine thin about the crisis. The two following days without fever; it returned on the fourteenth, then immediately insomnolency and complete delirium. On the fifteenth, urine muddy, like that which has been shaken after the sediment has fallen to the bottom; acute fever, quite delirious, did not sleep; knees and legs painful; after a suppository, had alvine 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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

— Section Iii.--Constitution 2.

The year was southerly, rainy; no winds throughout. Droughts having prevailed during the previous seasons of the year, the south winds towards the rising of Arcturus were attended with much rain. Autumn gloomy and cloudy, with copious rains. Winter southerly, damp, and soft. But long after the solstice, and near the equinox, much 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. They were of a malignant nature, and proved fatal to many; many had sore-throat and loss of speech. There were many cases of ardent fever, phrensy, aphthous affections of the mouth, tumors on the genital organs; of ophthalmia, anthrax, disorder of the bowels, anorexia, with thirst and without it; of disordered urine, large in quantity, and bad in quality; of persons affected with coma for a long time, and then falling into a state of insomnolency. There were many cases of failure of crisis, and many of unfavorable crisis; many of dropsy and of phthisis. Such were the diseases then epidemic. There were patients affected with every one of the species which have been mentioned, and many died. The symptoms in each of these cases were as follows:

4. In many cases erysipelas, from some obvious cause, such as an accident, and sometimes from even a very small wound, broke out all over the body, especially, in persons about sixty years of age, about the head, if such an accident was neglected in the slightest degree; and this happened in some who were under treatment; great inflammation took place, and the erysipelas quickly spread all over. In the most of them 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. In like manner, the same things happened to whatever part of the body the disease wandered, for in many cases both forearm and arm dropped off; and in those cases in which it fell upon the sides, the parts there, either before or behind, got into a bad state; and in some cases the whole femur and bones of the leg and whole foot were laid bare. But of all such cases, the most formidable were those which took place about the pubes and genital organs. Such was the nature of these cases when attended with sores, and proceeding from an external cause; but the same things occurred in fevers, before fevers, and after fevers. 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; 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, the paroxysms for the most part on even days; and, about the time of the paroxysms, forgetfulness, loss of strength and of speech, the extremities, that is to say, the hands and feet, at all times, but more especially about the time of the paroxysms, were colder than natural; they slowly and imperfectly became warmed, and again recovered their recollection and speech. They were constantly affected either with coma, in which they got no sleep, or with insomnolency, attend with pains; most had disorders of the bowels, attended with undigested, thin, and copious evacuations; urine copious, thin, having nothing critical nor favorable about it; neither was there any other critical appearance in persons affected thus; for neither was there any proper hemorrhage, nor any other of the accustomed evacuations, to prove a crisis. They died, as it happened, in an irregular manner, mostly about the crisis, but in some instances after having lost their speech for a long time, and having had copious sweats. These were the symptoms which marked the fatal cases of ardent fever; similar symptoms occurred in the phrenitic cases; but these were particularly free from thirst, and none of these had wild delirium as in other cases, but they died oppressed by a bad tendency to sleep, and stupor.

7. But there were also other fevers, as will be described. Many had their mouths affected with aphthous ulcerations. There were also many defluxions about the genital parts, and ulcerations, boils (phymata), externally and internally, about the groins. Watery ophthalmies of a chronic character, with pains; fungous excrescences of the eyelids, externally and internally, called fici, which destroyed the sight of many persons. There were fungous growths, in many other instances, on ulcers, especially on those seated on the genital organs. There were many attacks of carbuncle (anthrax) through the summer, and other affections, which are called “the putrefaction” (seps); also large ecthymata, and large tetters (herpetes) in many instances.

8. And many and serious complaints attacked many persons in the region of the belly. In the first place, tenesmus, accompanied with pain, attacked many, but more especially children, and all who had not attained to puberty; and the most of these died. There were many cases of lientery and of dysentery; but these were not attended with much pain. The evacuations were bilious, and fatty, and thin, and watery; in many instances the disease terminated in this way, with and without fever; there were painful tormina and volvuli of a malignant kind; copious evacuations of the contents of the guts, and yet much remained behind; and the passages did not carry off the pains, but yielded with difficulty to the means administered; for in most cases purgings were hurtful to those affected in this manner; many died speedily, but in many others they held out longer. In a word, all died, both those who had acute attacks and those who had chronic, most especially from affections of the belly, for it was the belly which carried them all off.

9. All persons had an aversion to food in all the afore-mentioned complaints to a degree such as I never met with before, and persons in these complaints most especially, and those recovering from them, and in all other diseases of a mortal nature. Some were troubled with thirst, and some not; and both in febrile complaints and in others no one drank unseasonably or disobeyed injunctions.

10. The urine in many cases was not in proportion to the drink administered, but greatly in excess; and the badness of the urine voided was great, for it had not the proper thickness, nor concoction, nor purged properly; for in many cases purgings by the bladder indicate favorably, but in the greatest number they indicated a melting of the body, disorder of the bowels, pains, and a want of crisis.

11. Persons laboring under phrenitis and causus were particularly disposed to coma; but also in all other great diseases which occurred along with fever. In the main, most cases were attended either by heavy coma, or by short and light sleep.

12. And many other forms of fevers were then epidemic, of tertian, of quartan, of nocturnal, of continual, of chronic, of erratic, of fevers attended with nausea, and of irregular fevers. All these were attended with much disorder, for the bowels in most cases were disordered, accompanied with rigors, sweats not of a critical character, and with the state of the urine as described. In most instances the disease was protracted, for neither did the deposits which took place prove critical as in other cases; for in all complaints and in all cases there was difficulty of crisis, want of crisis, and protraction of the disease, but most especially in these. A few had the crisis about the eightieth day, but in most instances it (the disease?) left them irregularly. A few of them died of dropsy without being confined to bed. And in many other diseases people were troubled with swelling, but more especially in phthisical cases.

13. The greatest and most dangerous disease, and the one that proved fatal to the greatest number, was the consumption. With many persons it commenced during the winter, and of these some were confined to bed, and others bore up on foot; the most of those died early in spring who were confined to bed; of the others, the cough left not a single person, but it became milder through the summer; during the autumn, all these were confined to bed, and many of them died, but in the greater number of cases the disease was long protracted. Most of these were suddenly attacked with these diseases, having frequent rigors, often continual and acute fevers; unseasonable, copious, and cold sweats throughout; great coldness, from which they had great difficulty in being restored to heat; the bowels variously constipated, and again immediately in a loose state, but towards the termination in all cases with violent looseness of the bowels; a determination downwards of all matters collected about the lungs; urine excessive, and not good; troublesome melting. The coughs throughout were frequent, and 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, and that with the scapulæ having the appearance of wings: and women in like manner, with regard to the melancholic and subsanguineous, phrenitic and dysenteric affections principally attacked them. Tenesmus troubled young persons of a phlegmatic temperament. Chronic 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.

Sec. 17. Sixteen Cases.

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.

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.

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.

CASE IV.--The patient affected with phrenitis, having taken to bed on the first day, vomited largely of verdigris-green and thin matters; fever, accompanied with rigors, copious and continued sweats all over; heaviness of the head and neck, with pain; urine thin, substances floating in the urine small, scattered, did not subside; had copious dejections from the bowels; very delirious; no sleep. On the second, in the morning, loss of speech; acute fever; he sweated, fever did not leave him; palpitations over the whole body, at night, convulsions. On the third, all the symptoms exacerbated; he died.

Explanation of the characters. It is probable that the sweats and convulsions caused death.

CASE V.--In Larissa, a man, who was bald, suddenly was seized with pain in the right thigh; none of the things which were administered did him any good. On the first day, fever acute, of the ardent type, not agitated, but the pains persisted. On the second, the pains in the thigh abated, but the fever increased; somewhat tossed about; did not sleep; extremities cold; passed a large quantity of urine, not of a good character. On the third, the pain of the thigh ceased; derangement of the intellect, confusion, and much tossing about. On the fourth, about noon, he died. An acute disease.

CASE VI.--In Abdera, Pericles was seized with a fever of the acute, continual type, with pain; much thirst, nausea, could not retain his drink; somewhat swelled about the spleen, with heaviness of the head. On the first day, had hemorrhage from the left nostril, but still the fever became more violent; passed much muddy, white urine, which when allowed to stand did not subside. On the second day, all the symptoms were exacerbated, yet the urine was thick, and more inclined to have a sediment; the nausea less; he slept. On the third, fever was milder; abundance of urine, which was concocted, and had a copious sediment; passed a quiet night. On the fourth, had a copious and warm sweat all over about noon; was free of fever, had a crisis, no relapse. An acute affection.

CASE VII.--In Abdera, the young woman who was lodged in the Sacred Walk was seized with an ardent fever. She was thirsty, and could not sleep; had menstruation for the first time. On the sixth, much nausea, flushing, was chilly, and tossed about. On the seventh, in the same state; urine thin, but of a good color; no disturbance about the bowels. On the eighth, deafness, acute fever, insomnolency, nausea, rigors, became collected; urine the same. On the ninth, in the same state, and also on the following days; thus the deafness persisted. On the fourteenth, disorder of the intellect; the fever abated. On the seventeenth, a copious hemorrhage from the nose; the deafness slightly better; and on the following days, nausea, deafness, and incoherence. On the twentieth, pain of the feet; deafness and delirium left her; a small hemorrhage from the nose; sweat, apyrexia. On the twenty-fourth, the fever returned, deafness again; pain of the feet remained; incoherence. On the twenty-seventh, had a copious sweat, apyrexia; the deafness left her; the pain of her feet partly remained; in other respects had a complete crisis.

Explanation of the characters. It is probable that the restoration of health on the twentieth day was the result of the evacuation of urine.

CASE VIII.--In Abdera, Anaxion, who was lodged near the 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.

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.

CASE X.--In Abdera, Nicodemus was seized with fever from venery and drinking. At the commencement he was troubled with nausea and cardialgia; thirsty, tongue was parched; urine thin and dark. On the second day, the fever exacerbated; he was troubled with rigors and nausea; had no sleep; vomited yellow bile; urine the same; passed a quiet night, and slept. On the third, a general remission; amelioration; but about sunset felt again somewhat uncomfortable; passed an uneasy night. On the fourth, rigor, much fever, general pains; urine thin, with substances floating in it; again a quiet night. On the fifth, all the symptoms remained, but there was an amelioration. On the sixth, some general pains; substances floating in the urine; very incoherent. On the seventh, better. On the eighth, all the other symptoms abated. On the tenth, and following days, there were pains, but all less; in this case throughout, the paroxysms and pains were greater on the even days. On the twentieth, the urine white and thick, but when allowed to stand had no sediment; much sweat; seemed to be free from fever; but again in the evening he became hot, with the same pains, rigor, thirst, slightly incoherent. On the twenty-fourth, urine copious, white, with an abundant sediment; a copious and warm sweat all over; apyrexia; the fever came to its crisis.

Explanation of the characters. It is probable that the cure was owing to the bilious evacuations and the sweats.

CASE XI.--In Thasus, a woman, of a melancholic turn of mind, from some accidental cause of sorrow, while still going about, became affected with loss of sleep, aversion to food, and had thirst and nausea. She lived near the 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.

CASE XII.--In Larissa, a young unmarried woman was seized with a fever of the acute and ardent type; insomnolency, thirst; tongue sooty and dry; urine of a good color, but thin. On the second, in an uneasy state, did not sleep. On the third, alvine discharges copious, watery, and greenish, and on the following days passed such with relief. On the fourth, passed a small quantity of thin urine, having substances floating towards its surface, which did not subside; was delirious towards night. On the sixth, a great hemorrhage from the nose; a chill, with a copious and hot sweat all over; apyrexia, had a crisis. In the fever, and when it had passed the crisis, the menses took place for the first time, for she was a young woman. Throughout she was oppressed with nausea, and rigors; redness of the face; pain of the eyes; heaviness of the head; she had no relapse, but the fever came to a crisis. The pains were on the even days.

CASE XIII.--Apollonius, in Abdera, bore up (under the fever?) for some time, without betaking himself to bed. His viscera were enlarged, and for a considerable time there was a constant pain about the liver, and then he became affected with jaundice; he was flatulent, and of a whitish complexion. Having eaten beef, and drunk unseasonably, he became a little heated at first, and betook himself to bed, and having used large quantities of milk, that of goats and sheep, and both boiled and raw, with a bad diet otherwise, great mischief was occasioned by all these things; for the fever was exacerbated, and of the food taken scarcely any portion worth mentioning was passed from the bowels; the urine was thin and scanty; no sleep; troublesome meteorism; much thirst; disposition to coma; painful swelling of the right hypochondrium; extremities altogether coldish; slight incoherence, forgetfulness of everything he said; he was beside himself. About the fourteenth day after he betook himself to bed, had a rigor, became heated, and was seized with furious delirium; loud cries, much talking, again composed, and then coma came on; afterwards the bowels disordered, with copious, bilious, unmixed, and undigested stools; urine black, scanty, and thin; much restlessness; alvine evacuations of varied characters, either black, scanty, and 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.

CASE XIV.--In Cyzicus, a woman who had brought forth twin daughters, after a difficult labor, and in whom the lochial discharge was insufficient, at first was seized with an acute fever, attended with chills; heaviness of the head and neck, with pain; insomnolency from the commencement; she was silent, sullen, and disobedient; urine thin, and devoid of color; thirst, nausea for the most part; bowels irregularly disordered, and again constipated. On the sixth, towards night, talked much incoherently; had no sleep. About the eleventh day was seized with wild delirium, and again became collected; urine black, thin, and again deficient, and of an oily appearance; copious, thin, and disordered evacuations from the bowels. On the fourteenth, frequent convulsions; extremities cold; not in anywise collected; suppression of urine. On the sixteenth loss of speech. On the seventeenth, she died. Phrenitis.

Explanation of the characters. It is probable that death was caused, on the seventeenth day, by the affection of the brain consequent upon her accouchement.

CASE XV.--In Thasus, the wife of Dealces, who was lodged upon the Plain, from sorrow was seized with an acute fever, attended with chills. From first to last she wrapped herself up in her bedclothes; still silent, she fumbled, picked, bored, and gathered hairs (from them); tears, and again laughter; no sleep; bowels irritable, but passed nothing; when directed, drank a little; urine thin and scanty; to the touch of the hand the fever was slight; coldness of the extremities. On the ninth, talked much incoherently, and again became composed and silent. On the fourteenth, breathing rare, large, at intervals; and again hurried respiration. On the sixteenth, looseness of the bowels from a stimulant clyster; afterwards she passed her drink, nor could retain anything, for she was completely insensible; skin parched and tense. On the twentieth, much talk, and again became composed; loss of speech; respiration hurried. On the twenty-first she died. Her respiration throughout was rare and large; she was totally insensible; always wrapped up in her bedclothes; either much talk, or complete silence throughout. Phrenitis.

CASE XVI.--In Melibœa, 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.