Of Medicine, in Eight Books

by Aulus Cornelius Celsus

After the foregoing symptoms have appeared, ’tis known, that a distemper will become tedious: for it must necessarily be so, unless it be mortal. And there is no other hope in violent diseases, than that the patient may escape by eluding the first shock of the distemper, that there may be room for the application of proper methods of cure. But some signs appear in the beginning of a distemper, from which we may gather, that although it does not prove mortal, yet it will last for a considerable time. In fevers not violent, when a cold sweat comes on only about the head or neck; or when the body sweats without the fever intermitting; or when the body is sometimes cold, and sometimes hot, and the colour changes; or when in fevers an abscess, which has been formed in some part, does not prove salutary; or when the patient, considering the time of his illness, is but little emaciated. Also, if the urine at some times is thin and limpid, and at other times has some sediment; and if what subsides be smooth, and white, or red; or if it have the appearance of motes; or if it send up air bubbles.

CHAP. VI. THE SYMPTOMS OF DEATH.

But though in such circumstances there is reason to fear, yet there remains some hope. But we are sure a person is come to the last stage, when the nose is sharp, the temples shrivelled, the eyes hollow, the ears cold, and languid, and slightly inverted at their extremities, the skin about the forehead hard and tense, the colour either black or very pale; and much more so, if these things happen without any preceding wakefulness, or purging, or fasting: from which causes this appearance sometimes arises, but then it vanishes in one day. So that if it continues longer, it is a forerunner of death. And if it remains the same for three days in a tedious distemper, death is very near: and more especially if besides the eyes can’t bear the light and shed tears; and the white part of them grows red; and their small vessels are pale; and humour floating in them at last sticks to the angles; and one eye is less than the other; and they are either very much sunk, or much swelled; and when the eye-lids in sleep are not closed, but betwixt them there appears some part of the white of the eye; provided it be not occasioned by a flux; when the eye-lids also are pale, and the same paleness discolours the lips and nose; and also when the lips, and nose, and eyes, and eye-lids, and eye-brows, or some of these, are distorted, and the patient from pure weakness loses his hearing, or sight.

Death is also to be expected, when the patient lies supine, and his knees are contracted; when he slides downward now and then towards his feet; when he lays bare his arms and legs, and tosses them about irregularly, and there is no heat in them; when he gapes with his mouth; when he sleeps constantly; when being insensible, he grinds his teeth, and had not that custom in health; when an ulcer, which broke out either before, or in the time of his sickness, has grown dry, and turned either pale or livid, The following symptoms are also deadly; pale-coloured nails, and fingers; a cold breath; or if one in a fever, and acute disease, or madness, or peripneumony, or pain of the head, gathers the wool off the cloaths with his hands, or draws out and smooths their edges, or catches at any small prominences in an adjoining wall. Pains also, that have begun in the hips and lower parts, if they have been translated to the bowels, and suddenly ceased, are sure prognostics of approaching death; and more so, if any of the other symptoms have also concurred. And it is impossible to save that person, who labouring under a fever without any tumour, is suddenly, as it were, strangled, or cannot swallow his spittle; or one, whose neck, while the fever and habit of body remain the same, is turned aside, so that it is equally impossible for him to swallow any thing; or him, who at the same time has a continued fever, and extreme weakness of body; or when, without an abatement of the fever, the external surface of his body is cold, and the internal parts so hot as to produce thirst; or one, who, the fever continuing as in the former case, is distressed at once with a delirium and difficulty of breathing; or one, who, after drinking hellebore, has been seized with convulsions; or one, that has lost his speech after being intoxicated with liquor, for he is commonly carried off by convulsions, unless either a fever has supervened, or he has begun to speak at the time, when the effects of the liquor shall be over. A pregnant woman is also easily destroyed by an acute distemper. And likewise any person, whose disorder is increased by sleep; and one, who in the beginning of a recent disorder, vomits, or voids by stool, atrabilis; and the event is the same, where this has been discharged in either of these ways, when the body has been already extenuated, and wasted by a long illness. A bilious spitting, and purulent, whether they come up separately, or mixed, shew that there is danger of death. And if this appearance has commenced about the seventh day of a disease, the consequence is, that the patient will die about the fourteenth, unless some other symptoms more benign, or malignant, come on: and these after symptoms, the more gentle or violent they are, signify that death will happen so much the later, or sooner. A cold sweat likewise in an acute fever is mortal; and in every disease, a vomiting variegated with different colours; and especially if it be fetid. And it is also extremely bad to vomit blood in a fever. The urine is commonly of a bright yellow colour and thin in great crudity; and often before it has time to concoct, kills the patient. Upon this account, if it continue so for any time, it prognosticates danger of death. But the worst of all and most deadly is the black, thick, and fetid. And such as this is the worst in men and women; but in children that, which is thin and watery. A variegated discharge also by the belly is very bad; and such as contains strigments[(9)], blood, bile, and something green, and these either at different times, or all together in a kind of mixture, but so as each of them appear distinctly. Yet ’tis possible for one to endure this somewhat longer. But a speedy death is denoted, when the discharge is liquid, and withal either black, or pale, or fat; especially if besides it have an intolerable stench.

I am sensible I may be asked, how it happens, if the signs of future death are infallible, that some, who are entirely given over by physicians, should recover, and that some are reported to have come to life again, even when they were carried out to be buried? Nay, the justly famed Democritus maintained, that even the marks that life was gone, which physicians had trusted, were not certain: so far was he from allowing, that there could be any certain prognostics of death. In answer to which I shall not insist, that some marks, which bear a great resemblance to each other, often deceive not the able, but the unskilful physicians, (which Asclepiades knowing, when he met a funeral, cried out, that the person, whom they were about to bury, was alive) and that the art is not to be charged with the faults of any of its professors. But I will answer with more moderation; that medicine is a conjectural art, and that the nature of conjecture is such, that although it answers for the most part, yet sometimes it fails. And if a prognostic may deceive a person, perhaps in one of a thousand instances, it must not therefore be denied credit, since it answers in innumerable others. And this I say not only with regard to the mortal, but also to the salutary symptoms. For hope too is sometimes disappointed, and one dies, whom at first the physician thought in no danger. And those things, which have been contrived for curing, sometimes occasion a change for the worse. Nor is it possible for human weakness to avoid this, in so great a variety of constitutions. But medicine however deserves credit, which most frequently, and in the greatest number of sick people by far, is of service. Nevertheless we ought not to be ignorant, that the prognostics both of recovery and death are more fallacious in acute distempers.

CHAP. VII. OF THE SIGNS IN PARTICULAR DISEASES.

Having then mentioned those signs, which belong to diseases in general, I shall now proceed to point out those marks, which may attend the particular kinds of them. Now there are some of these, which happen before, and others in the time of fevers, which discover either the state of the internal parts, or what is likely to follow. Before fevers, if the head be heavy, or there be a dimness in the eyes after sleep, or there be frequent sneezings, some disorder from phlegm about the head may be feared. If a person abound with blood, or be very hot, the consequence is, that there may be an hæmorrhage from some part. If any person is emaciated without an evident cause, he is in danger of falling into a bad habit of body. If the præcordia are pained, or there is a troublesome flatulency, or if the urine is discharged the whole day unconcocted, ’tis plain there is a crudity. Such as have a bad colour for a long time without a jaundice, are either distressed with pains of the head, or labour under a malacia. Those, whose faces long continue pale and swelled, have disorders either of the head, or bowels, or belly. If a boy in a continued fever has no passage in his belly, and his colour is changed and he is deprived of sleep, and is constantly bemoaning, himself, convulsions are to be apprehended. A frequent catarrh in a slender body and tall, gives ground to fear a consumption. When for several days there is no stool, it portends either a sudden purging, or a slight fever. When the feet swell, and there is a long continued purging, or pain in the bottom of the belly and hips, a dropsical disorder is impending: but this kind of distemper commonly arises from the ilia. Those also are exposed to the same danger, whose belly, discharges nothing, when they have a stimulus, unless with difficulty, and the excrements hard. When there is a swelling in the feet, and when the like tumour, sometimes in the right, sometimes in the left side of the belly alternately rises and falls, that disorder seems to arise from the liver. It is a mark of the same distemper, when the intestines about the navel are pained, which the Greeks call strophos[ AU ], and pains of the hip continue without being relieved either by time or remedies. If a pain of the joints, for instance in the feet or hands, or in any other part, be attended with a contraction of the nerves there; or if any limb fatigued by slight exercise, is equally distressed by heat and cold, we may expect the gout either in the feet or hands, or that there will be a disease in that joint, where the pain is felt. Such as have had hæmorrhages from the nose, while they were children, which afterwards ceased, must either be afflicted with pains of the head, or have some troublesome exulcerations in their joints, or fall into some languishing distemper. Women, whose menses are suppressed, will be subject to excruciating pains of the head, or a disorder in some other part. And those are liable to the same dangers, who have complaints in their joints, such as pains and swellings coming and going, without the gout, and such-like distempers. Particularly if their temples are often pained, and their body sweats in the night-time, and their forehead itches, there is fear of a lippitude. If a woman after delivery has violent pains, with no other bad symptoms, about the twentieth day there will either be an eruption of blood from the nose, or some abscess in the lower parts. And in general in any person, a violent pain about the temples and forehead, will be removed in one of these two ways: more probably by an hæmorrhage, if the person be young; if somewhat more advanced, by a suppuration. A fever, which goes off suddenly without any apparent reason, without good signs, commonly returns. A person, whose fauces are filled with blood, both in the day-time, and in the night, will be found to have an ulcer there, if neither pains of the head, nor of the præcordia, nor a cough, nor vomiting, nor slight fever have preceded. If a woman is attacked with a slight fever from a disorder in the groin, and the cause does not appear, there is an ulcer in the womb. Thick urine, in which there is a white sediment, implies that there is a pain about the joints, or the bowels, and fear of some impending distemper. When it is green, it shows, that the bowels will be pained, or that there will be a swelling attended with some danger; or at least, that the body is not sound. But if there is blood or pus in the urine, either the bladder or kidneys are ulcerated. If it be thick, and contain in it some small caruncles, or something like hairs; or if it be frothy, or fetid; or sometimes bring off something like sand, and sometimes like blood; and the hips be pained, and those parts, which lie between them, and above the pubes; and besides these if there be frequent eructations, sometimes a bilious vomiting, and the extremities be cold, and there is a frequent inclination to make water, but great difficulty in it, and what comes away be limpid, or reddish, or pale, and gives some small relief, and the belly be discharged with much wind; in such circumstances the distemper lies in the kidneys. But if the urine drops away slowly, or if blood is discharged with it, and in that some bloody concretions, and it is made with difficulty, and the internal parts about the pubes are pained, the fault is in the bladder. Those, that have calculous concretions, are known by these symptoms. The urine is made with difficulty, and comes away slowly, and by drops, and sometimes involuntarily, is sandy; sometimes blood, or bloody concretions, or something purulent is discharged with it. Some make it more readily standing upright, others lying upon their back: especially those, that have large stones; some even in an inclined posture, and these by drawing out the penis, alleviate their pain. There is also a sensation of weight in that part, which is increased by running, and every kind of motion. Some also in the paroxysm of the pain, cross their feet over one another, often changing them. But women are often obliged to rub the external orifice of their pudenda with their hands: sometimes applying their finger to that part, when it presses upon the neck of the bladder, they feel the stone. But where any expectorate frothy blood, their disorder is in the lungs. A pregnant woman, whose belly is very loose, may possibly miscarry. If the milk flows from her breast, the fœtus is weak. Hard breasts shew the child to be sound. A frequent hiccough, and of longer continuance than ordinary, is a sign of an inflammation of the liver. If tumours upon ulcers have suddenly disappeared, and this has happened in the back, we may be apprehensive either of convulsions, or a tetanus: but if in the fore part of the body, either a pleurisy or madness is to be expected. Sometimes also a purging, which is the safest of them all, follows such an accident. If the hæmorrhoidal veins, in one used to a discharge of blood from them, suddenly stop, either a dropsical disorder or a consumption ensues. A consumption also comes on, if suppurated matter derived from a pleurisy cannot be carried off within forty days. But where there is a long continued grief attended with long fear and watching, the atrabiliary distemper is the consequence. Those, who have frequent hæmorrhages from the nose, labour under a swelling of the spleen, or pains of the head: and they commonly see imaginary objects floating before their eyes. But those, whose spleens are large, have their gums diseased and a stinking mouth, or an hæmorrhage in some part. If none of these happen, bad ulcers will be formed in their legs, and black cicatrices from them. Where there is a cause of pain and no sense of it, the mind is disordered. If blood has been collected in the abdomen, it is there converted into pus. If a pain removes from the hips and the lower parts into the breast, and no bad symptom has supervened, there is danger of a suppuration in that place. Those, that without a fever have a pain, or itching, with redness and heat, in any part, will have a suppuration there. Limpid urine also in a valetudinary person portends some suppuration about the ears.

Now as these appearances, even without a fever, contain indications of what is latent or future, they are much more certain when accompanied with a fever; and then symptoms of other disorders also shew themselves. Wherefore when a person speaks more quickly than he used to do in health, and of a sudden talks much, and that with greater confidence than ordinary; or when one breathes slow, and with great force, and the pulse beats high, with hard and swelled præcordia, then there is a fear of approaching madness. Frequent motion of the eyes also, and a darkness arising before them, together with head-ach; or loss of sleep without any pain, and a continual watching day and night; or lying upon the belly contrary to custom, if that is not occasioned by a pain of the belly itself; also an unusual grinding of the teeth, while the body continues strong, are signs of madness. If an abscess has been formed, and subsides before a discharge by spitting comes on, the usual fever still continuing, there will be danger first of madness, and then of death. An acute pain also of the ear, with a continued and strong fever, often disorders the mind: and of this malady younger people sometimes die in seven days; those that are older hold out something longer: because their fevers are not equally violent, nor their distraction so great; so that they last till the distemper is resolved into pus. A suffusion of blood in the breasts of a woman betokens approaching madness. Those, that have long fevers, will either have an abscess formed somewhere, or pains of the joints. Those, whose breath is greatly straitened in passing through the fauces in fevers, will soon fall into convulsions. If an angina suddenly disappears, the distemper is removing into the lungs; and that is often fatal before the seventh day: and if that does not happen, the consequence is a suppuration in some part. Lastly, after long purgings come dysenteries; after these a lientery; after violent catarrhs a consumption; after pleurisies diseases of the lungs; after which madness; after great heats of the body a tetanus or convulsion; after a wound of the head a delirium; after great torment for want of sleep, convulsions; when the blood vessels above ulcers are in strong motion, there will be an hæmorrhage.

A suppuration is produced many ways[(10)]; for if fevers unattended with pain continue long without any manifest cause, the disorder is transferred upon some particular part: but this happens only in younger people; for in the elderly, a quartan ague is the common consequence of such a disease. A suppuration also happens, if the præcordia being hard and pained have neither carried off the patient before the twentieth day, nor an hæmorrhage from the nose has ensued; and this holds chiefly in youths, especially if in the beginning of the distemper they had dimness of the eyes, or pains of the head: but then the abscess forms in the lower parts of the body. But if there be a soft tumour in the præcordia, and it has not ceased within sixty days, and the fever continues all that time, then the abscess forms in the superior parts: and if there is not a discharge of blood from the nose[(11)] in the beginning, it breaks out about the ears. And as every tumour of long standing generally tends to suppuration, so one, that is seated in the præcordia is more likely to have that issue, than one that is in the belly: and one, that is above the navel, than one, that is below it. Also if there is a sense of lassitude in a fever, an abscess is formed either in the jaws, or the joints. Sometimes too the urine continues long and thin, and crude, and the other symptoms are good: in this case for the most part an abscess is formed below the transverse septum (which the Greeks call diaphragma). If a peripneumony is removed neither by expectoration, nor by cupping, nor bleeding, nor a proper regimen, it sometimes gives rise to some vomicæ, either about the twentieth day, or thirtieth, or fortieth, and even sometimes about the sixtieth. Now we must date our reckoning from that day, in which the person was first taken with the fever, or seized with a horror, or felt a weight in the part. But these vomicæ are generated sometimes in the lungs, sometimes about the ribs. Where the suppuration is seated, it raises a pain and inflammation, and there is a greater heat there: and if one has lain down upon the sound side, he imagines it loaded with some weight. And every suppuration, that is not yet visible, may be known by the following signs: the fever does not wholly intermit, but is more mild in the day-time, and increases at night, there is plentiful sweating, an inclination to cough, and hardly any thing brought up by it, the eyes are hollow, cheeks red, the veins under the tongue white, the nails of the hands crooked, the fingers, especially their extremities, hot; there are swellings in the feet, difficulty in breathing, loathing of food, pimples breaking out over the whole body. But if the pain, cough, and difficulty of breathing have come on immediately at the beginning, the vomica will break before, or about the twentieth day. If these have begun later, they must of course increase; but the less quickly they have appeared, the more slowly will they be removed. It is common also in a severe distemper for the feet, hands, and nails to turn black: and if death has not followed, and the other parts of the body are restored, yet the feet fall off.