2. Early in the beginning of spring, and through the summer, and towards winter, many of those who had been long gradually declining, took to bed with symptoms of phthisis; in many cases formerly of a doubtful character the disease then became confirmed; in these the constitution inclined to the phthisical.[622] Many, and, in fact, the most of them, died; and of those confined to bed, I do not know if a single individual survived for any considerable time; they died more suddenly than is common in such cases. But other diseases, of a protracted character, and attended with fever, were well supported, and did not prove fatal: of these we will give a description afterwards. Consumption was the most considerable of the diseases which then prevailed, and the only one which proved fatal to many persons. Most of them were affected by these diseases in the following manner: fevers accompanied with rigors, of the continual type, acute, having no complete intermissions, but of the form of the semitertians, being milder the one day, and the next having an exacerbation, and increasing in violence; constant sweats, but not diffused over the whole body; extremities very cold, and warmed with difficulty; bowels disordered, with bilious, scanty, unmixed, thin, pungent, and frequent dejections. The urine was thin, colourless, unconcocted, or thick, with a deficient sediment, not settling favorably, but casting down a crude and unseasonable sediment. Sputa small, dense, concocted, but brought up rarely and with difficulty; and in those who encountered the most violent symptoms there was no concoction at all, but they continued throughout spitting crude matters. Their fauces, in most of them, were painful from first to last, having redness with inflammation; defluxions thin, small and acrid; they were soon wasted and became worse, having no appetite for any kind of food throughout; no thirst; most persons delirious when near death. So much concerning the phthisical affections.[623]
3. In the course of the summer and autumn many fevers of the continual type, but not violent;[624] they attacked persons who had been long indisposed, but who were otherwise not in an uncomfortable state. In most cases the bowels were disordered in a very moderate degree, and they did not suffer thereby in any manner worth mentioning; the urine was generally well coloured, clear, thin, and after a time becoming concocted near the crisis. They had not much cough, nor was it troublesome; they were not deficient in appetite, for it was necessary to give them food, (on the whole, persons labouring under phthisis were not affected in the usual manner).[625] They were affected with fevers, rigors, and deficient sweats, with varied and irregular paroxysms, in general not intermitting, but having exacerbations in the tertian form. The earliest crisis which occurred was about the twentieth day, in most about the fortieth, and in many about the eightieth. But there were cases in which it did not leave them thus at all, but in an irregular manner, and without any crisis; in most of these the fevers, after a brief interval, relapsed again; and from these relapses they came to a crisis in the same periods; but in many they were prolonged so that the disease was not gone at the approach of winter. Of all those which are described under this constitution, the phthisical diseases alone were of a fatal character; for in all the others the patients bore up well, and did not die of the other fevers.[626]
Sec. II.—Constitution Second.
1. In Thasus, early in autumn, the winter suddenly set in rainy before the usual time, with much northerly and southerly winds. These things all continued so during the season of the Pleiades, and until their setting.[627] The winter was northerly, the rains frequent, in torrents, and large, with snow, but with a frequent mixture of fair weather. These things were all so, but the setting in of the cold was not much out of season. After the winter solstice, and at the time when the zephyr usually begins to blow, severe winterly storms out of season, with much northerly wind, snow, continued and copious rains; the sky tempestuous and clouded; these things were protracted, and did not remit until the equinox. The spring was cold, northerly, rainy, and clouded; the summer was not very sultry, the Etesian winds blew constant, but quickly afterwards, about the rising of Arcturus, there were again many rains with north winds. The whole season being wet, cold, and northerly, people were, for the most part, healthy during winter; but early in the spring very many, indeed, the greater part, were valetudinary. At first ophthalmies set in, with rheums, pains, unconcocted discharges, small concretions, generally breaking with difficulty, in most instances they relapsed, and they did not cease until late in autumn.[628] During summer and autumn there were dysenteric affections, attacks of tenesmus and lientery, bilious diarrhœa, with thin, copious, undigested, and acrid dejections, and sometimes with watery stools; many had copious defluxions, with pain, of a bilious, watery, slimy, purulent nature, attended with strangury, not connected with disease of the kidneys, but one complaint succeeding the other; vomitings of bile, phlegm, and undigested food, sweats, in all cases a redundance of humors. In many instances these complaints were unattended with fever, and did not prevent the patients from walking about, but some cases were febrile, as will be described. In some all those described below occurred with pain. During autumn, and at the commencement of winter, there were phthisical complaints, continual fevers; and, in a few cases, ardent; some diurnal, others nocturnal, semitertians, true tertians, quartans, irregular fevers. All the fevers which are described attacked great numbers. The ardent fevers attacked the smallest numbers, and the patients suffered the least from them, for there were no hemorrhages, except a few and to a small amount, nor was there delirium; all the other complaints were slight; in these the crises were regular, in most instances, with the intermittents, in seventeen days; and I know no instance of a person dying of causus, nor becoming phrenitic.[629] The tertians were more numerous than the ardent fevers, and attended with more pain;[630] but these all had four periods in regular succession from the first attack, and they had a complete crisis in seven, without a relapse in any instance. The quartans attacked many at first, in the form of regular quartans, but in no few cases a transition from other fevers and diseases into quartans took place; they were protracted, as is wont with them, indeed, more so than usual. Quotidian, nocturnal, and wandering fevers attacked many persons, some of whom continued to keep up, and others were confined to bed. In most instances these fevers were prolonged under the Pleiades and till winter. Many persons, and more especially children, had convulsions from the commencement;[631] and they had fever, and the convulsions supervened upon the fevers; in most cases they were protracted, but free from danger, unless in those who were in a deadly state from other complaints. Those fevers which were continual in the main, and with no intermissions, but having exacerbations in the tertian form,[632] there being remissions the one day and exacerbations the next, were the most violent of all those which occurred at that time, and the most protracted, and occurring with the greatest pains, beginning mildly, always on the whole increasing, and being exacerbated, and always turning worse, having small remissions, and after an abatement having more violent paroxysms, and growing worse, for the most part, on the critical days. Rigors, in all cases, took place in an irregular and uncertain manner, very rare and weak in them, but greater in all other fevers; frequent sweats, but most seldom in them, bringing no alleviation, but, on the contrary, doing mischief. Much cold of the extremities in them, and these were warmed with difficulty. Insomnolency, for the most part, especially in these fevers, and again a disposition to coma. The bowels, in all diseases, were disordered, and in a bad state, but worst of all in these. The urine, in most of them, was either thin and crude, yellow, and after a time with slight symptoms of concoction in a critical form, or having the proper thickness, but muddy, and neither settling nor subsiding; or having small and bad, and crude sediments; these being the worst of all. Coughs attended these fevers, but I cannot state that any harm or good ever resulted from the cough. The most of these were protracted and troublesome, went on in a very disorderly and irregular form, and, for the most part, did not end in a crisis, either in the fatal cases or in the others; for if it left some of them for a season it soon returned again. In a few instances the fever terminated with a crisis; in the earliest of these about the eightieth day, and some of these relapsed, so that most of them were not free from the fever during the winter; but the fever left most of them without a crisis, and these things happened alike to those who recovered and to those who did not. There being much want of crisis and much variety as to these diseases, the greatest and worst symptom attended the most of them, namely, a loathing of all articles of food, more especially with those who had otherwise fatal symptoms; but they were not unseasonably thirsty in such fevers. After a length of time, with much suffering and great wasting, abscesses were formed in these cases, either unusually large, so that the patients could not support them, or unusually small, so that they did no good, but soon relapsed and speedily got worse. The diseases which attacked them were in the form of dysenteries, tenesmus, lientery, and fluxes; but, in some cases, there were dropsies, with or without these complaints. Whatever attacked them violently speedily cut them off, or again, did them no good. Small rashes, and not corresponding to the violence of the disease, and quickly disappearing, or swellings occurred about the ears, which were not resolved, and brought on no crisis.[633] In some they were determined to the joints, and especially to the hip-joint, terminating critically with a few, and quickly again increasing to its original habit. Persons died of all these diseases, but mostly of these fevers, and especially infants just weaned, and older children, until eight or ten years of age, and those before puberty. These things occurred to those affected with the complaints described above, and to many persons at first without them. The only favorable symptom, and the greatest of those which occurred, and what saved most of those who were in the greatest dangers, was the conversion of it to a strangury, and when, in addition to this, abscesses were formed.[634] The strangury attacked, most especially, persons of the ages I have mentioned, but it also occurred in many others, both of those who were not confined to bed and those who were. There was a speedy and great change in all these cases. For the bowels, if they happened previously to have watery discharges of a bad character, became regular, they got an appetite for food, and the fevers were mild afterwards. But, with regard to the strangury itself, the symptoms were protracted and painful. Their urine was copious, thick, of various characters, red, mixed with pus, and was passed with pain. These all recovered, and I did not see a single instance of death among them.
5.[635] With regard to the dangers of these cases, one must always attend to the seasonable concoction of all the evacuations, and to the favorable and critical abscesses. The concoctions indicate a speedy crisis and recovery of health; crude and undigested evacuations, and those which are converted into bad abscesses, indicate either want of crisis, or pains, or prolongation of the disease, or death, or relapses; which of these it is to be must be determined from other circumstances. The physician must be able to tell the antecedents, know the present, and foretell the future—must meditate these things, and have two special objects in view with regard to diseases, namely, to do good or to do no harm. The art consists in three things—the disease, the patient, and the physician. The physician is the servant of the art, and the patient must combat the disease along with the physician.[636]
6. Pains about the head and neck, and heaviness of the same along with pain, occur either without fevers or in fevers. Convulsions occurring in persons attacked with frenzy, and having vomitings of verdigris-green bile, in some cases quickly prove fatal. In ardent fevers, and in those other fevers in which there is pain of the neck, heaviness of the temples, mistiness about the eyes, and distention about the hypochondriac region, not unattended with pain, hemorrhage from the nose takes place,[637] but those who have heaviness of the whole head, cardialgia and nausea, vomit bilious and pituitous matters; children, in such affections, are generally attacked with convulsions, and women have these and also pains of the uterus; whereas, in elder persons, and those in whom the heat is already more subdued, these cases end in paralysis, mania, and loss of sight.
Third Constitution.
7. In Thasus, a little before and during the season of Arcturus,[638] there were frequent and great rains, with northerly winds. About the equinox, and till the setting of the Pleiades, there were a few southerly rains: the winter northerly and parched, cold, with great winds and snow. Great storms about the equinox, the spring northerly, dryness, rains few and cold. About the summer solstice, scanty rains, and great cold until near the season of the Dog-star.[639] After the Dog-days, until the season of Arcturus, the summer hot, great droughts, not in intervals, but continued and severe: no rain; the Etesian winds blew; about the season of Arcturus southerly rains until the equinox.
8. In this state of things, during winter, paraplegia set in, and attacked many, and some died speedily; and otherwise the disease prevailed much in an epidemical form, but persons remained free from all other diseases.[640] Early in the spring, ardent fevers commenced and continued through the summer until the equinox. Those then that were attacked immediately after the commencement of the spring and summer, for the most part recovered, and but few of them died. But when the autumn and the rains had set in, they were of a fatal character, and the greater part then died.[641] When in these attacks of ardent fevers there was a proper and copious hemorrhage from the nose, they were generally saved by it, and I do not know a single person who had a proper hemorrhage who died in this constitution. Philiscus, Epaminon, and Silenus, indeed, who had a trifling epistaxis on the fourth and fifth day, died.[642] The most of those seized with the disease had a rigor about the time of the crisis, and especially those who had no hemorrhage; these had also the rigor associated. Some were attacked with jaundice on the sixth day,[643] but these were benefited either by an urinary purgation, or a disorder of the bowels, or a copious hemorrhage, as in the case of Heraclides, who was lodged with Aristocydes: this person, though he had the hemorrhage from the nose, the purgation by the bladder, and disorder of the bowels, experienced a favorable crisis on the twentieth day, not like the servant of Phanagoras, who had none of these symptoms, and died. The hemorrhages attacked most persons, but especially young persons and those in the prime of life, and the greater part of those who had not the hemorrhage died:[644] elderly persons had jaundice or disorder of the bowels, such as Bion, who was lodged with Silenus. Dysenteries were epidemical during the summer, and some of those cases in which the hemorrhage occurred, terminated in dysentery, as happened to the slave of Eraton, and to Mullus, who had a copious hemorrhage, which settled down into dysentery, and they recovered. This humor was redundant in many cases, since in those who had not the hemorrhage about the crisis, but the risings about the ears disappeared, after their disappearance there was a sense of weight in the left flank extending to the extremity of the hip, and pain setting in after the crisis, with a discharge of thin urine; they began to have small hemorrhages about the twenty-fourth day, and the swelling was converted into the hemorrhage. In the case of Antiphon, the son of Critobulus, the fever ceased and came to a crisis about the fortieth day. Many women were attacked, but fewer than of the men, and there were fewer deaths among them. But most of them had difficult parturition, and after labor they were taken ill, and these most especially died, as, for example, the daughter of Telebolus died on the sixth day after delivery.[645] Most females had the menstrual discharge during the fever, and many girls had it then for the first time: in certain individuals both the hemorrhage from the nose and the menses appeared; thus, in the case of the virgin daughter of Dætharses, the menses then took place for the first time, and she had also a copious hemorrhage from the nose, and I knew no instance of any one dying when one or other of these took place properly. But all those in the pregnant state that were attacked had abortions, as far as I observed. The urine in most cases was of the proper color, but thin, and having scanty sediments:[646] in most the bowels were disordered with thin and bilious dejections; and many, after passing through the other crises, terminated in dysenteries, as happened to Xenophanes and Critias. The urine was watery, copious, clear, and thin; and even after the crises, when the sediment was natural, and all the other critical symptoms were favorable, as I recollect having happened to Bion, who was lodged in the house of Silenus, and Critias, who lived with Xenophanes, the slave of Areton, and the wife of Mnesistratus. But afterwards all these were attacked with dysentery. It would be worth while to inquire whether the watery urine was the cause of this.[647] About the season of Arcturus many had the crisis on the eleventh day, and in them the regular relapses did not take place, but they became comatose about this time, especially children; but there were fewest deaths of all among them.
9. About the equinox, and until the season of the Pleiades, and at the approach of winter, many ardent fevers set in; but great numbers at that season were seized with phrenitis, and many died;[648] a few cases also occurred during the summer. These then made their attack at the commencement of ardent fevers, which were attended with fatal symptoms; for immediately upon their setting in, there were acute fever and small rigors, insomnolency, aberration, thirst, nausea, insignificant sweats about the forehead and clavicles, but no general perspiration; they had much delirious talking, fears, despondency, great coldness of the extremities, in the feet, but more especially in their hands: the paroxysms were on the even days; and in most cases, on the fourth day, the most violent pains set in, with sweats, generally coldish, and the extremities could not be warmed, but were livid and rather cold, and they had then no thirst; in them the urine was black, scanty, thin, and the bowels were constipated; there was an hemorrhage from the nose in no case in which these symptoms occurred, but merely a trifling epistaxis; and none of them had a relapse, but they died on the sixth day with sweats.[649] In the phrenitic cases, all the symptoms which have been described did not occur, but in them the disease mostly came to a crisis on the eleventh day, and in some on the twentieth. In those cases in which the phrenitis did not begin immediately, but about the third or fourth day, the disease was moderate at the commencement, but assumed a violent character about the seventh day. There was a great number of diseases, and of those affected, they who died were principally infants, young persons, adults having smooth bodies, white skins, straight and black hair, dark eyes, those living recklessly and luxuriously; persons with shrill, or rough voices, who stammered and were passionate, and women more especially died from this form. In this constitution, four symptoms in particular proved salutary; either a hemorrhage from the nose, or a copious discharge by the bladder of urine, having an abundant and proper sediment, or a bilious disorder of the bowels at the proper time, or an attack of dysentery.[650] And in many cases it happened, that the crisis did not take place by any one of the symptoms which have been mentioned, but the patient passed through most of them, and appeared to be in an uncomfortable way, and yet all who were attacked with these symptoms recovered. All the symptoms which I have described occurred also to women and girls; and whoever of them had any of these symptoms in a favorable manner, or the menses appeared abundantly, were saved thereby, and had a crisis, so that I do not know a single female who had any of these favorably that died. But the daughter of Philo, who had a copious hemorrhage from the nose, and took supper unseasonably on the seventh day, died. In those cases of acute, and more especially of ardent fevers, in which there is an involuntary discharge of tears, you may expect a hemorrhage from the nose, unless the other symptoms be of a fatal character, for in those of a bad description, they do not indicate a hemorrhage, but death. Swellings about the ears, with pain in fevers, sometimes when the fever went off critically, neither subsided nor were converted into pus; in these cases a bilious diarrhœa, or dysentery, or thick urine having a sediment, carried off the disease, as happened to Hermippus of Clazomenæ. The circumstances relating to crises, as far as we can recognize them, were so far similar and so far dissimilar. Thus two brothers became ill at the same hour (they were brothers of Epigenes, and lodged near the theatre), of these the elder had a crisis on the sixth day, and the younger on the seventh, and both had a relapse at the same hour; it then left them for five days, and from the return of the fever both had a crisis together on the seventeenth day. Most had a crisis on the sixth day; it then left them for six days, and from the relapse there was a crisis on the fifth day.[651] But those who had a crisis on the seventh day, had an intermission for seven days; and the crisis took place on the third day after the relapse. Those who had a crisis on the sixth day, after an interval of six days were seized again on the third, and having left them for one day, the fever attacked them again on the next and came to a crisis, as happened to Evagon the son of Dætharses. Those in whom the crisis happened on the sixth day, had an intermission of seven days, and from the relapse there was a crisis on the fourth, as happened to the daughter of Aglaïdas. The greater part of those who were taken ill under this constitution of things, were affected in this manner, and I did not know a single case of recovery, in which there was not a relapse agreeably to the stated order of relapses; and all those recovered in which the relapses took place according to this form: nor did I know a single instance of those who then passed through the disease in this manner who had another relapse. In these diseases death generally happened on the sixth day, as happened to Epaminondas, Silenus, and Philiscus the son of Antagoras. Those who had parotid swellings experienced a crisis on the twentieth day, but in all these cases the disease went off without coming to a suppuration, and was turned upon the bladder. But in Cratistonax, who lived by the temple of Hercules, and in the maid servant of Scymnus the fuller, it turned to a suppuration, and they died. Those who had a crisis on the seventh day, had an intermission of nine days, and a relapse which came to a crisis on the fourth day from the return of the fever, as was the case with Pantacles, who resided close by the temple of Bacchus. Those who had a crisis on the seventh day, after an interval of six days had a relapse, from which they had a crisis on the seventh day, as happened to Phanocritus, who was lodged with Gnathon the painter. During the winter, about the winter solstices, and until the equinox, the ardent fevers and frenzies prevailed, and many died. The crisis, however, changed, and happened to the greater number on the fifth day from the commencement, left them for four days and relapsed; and after the return, there was a crisis on the fifth day, making in all fourteen days. The crisis took place thus in the case of most children, also in elder persons. Some had a crisis on the eleventh day, a relapse on the fourteenth, a complete crisis on the twentieth; but certain persons, who had a rigor about the twentieth, had a crisis on the fortieth. The greater part had a rigor along with the original crisis, and these had also a rigor about the crisis in the relapse. There were fewest cases of rigor in the spring, more in summer, still more in autumn, but by far the most in winter; then hemorrhages ceased.