The genuine works of Hippocrates, Vol. 1 (of 2)

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;[602] 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;[603] 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.

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.

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.

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?[604] 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,”[605] 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,[606] 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.”[607] 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.”[608]

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.”[609] 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[610] quotes the remark of an excellent English authority on fever, J. Johnson,[611] that it is singular the effects of marsh effluvia should have escaped the observation of Hippocrates, more especially as the remittent and intermittent fevers, of which he treats so fully, are mostly derived from this source. Now I must say, that I am not aware of there being any passages in the works of Hippocrates where the effects of marsh effluvia in engendering such fevers are distinctly noticed; but if Hippocrates was ignorant of this fact, in the etiology of fevers, it was well known to Galen, as may be seen on reference to his very interesting work “On the Difference of Fevers.”[612] The Arabians also were familiar with the fact. See Avicenna, iv., 1, 2, 1.

In the treatise “On Airs,” which, although not admitted by us into the list of genuine works, has considerable pretension to be so regarded, the causes of fever are treated of with great precision, and there the pestilential fevers are said to derive their origin from miasma, but whether or not under this term be included marsh effluvia, cannot be determined. But perhaps a better reason might be assigned for there being little or no allusion to malaria in the works of Hippocrates, namely, that after all, this was not the cause of the epidemical diseases which he describes. The following extract from a work of very high authority on fever is well deserving of consideration in this place: “A question has arisen as to whether or not the inflammatory states of fever, in warm countries, are caused by malaria, or by the other causes now instanced (excess of heat, etc.). There can be no doubt that malaria very frequently produces in the plethoric, young, and robust, who have recently arrived in a hot climate, fever of an inflammatory and continued kind; but it must also be conceded that this fever chiefly occurs, even in persons thus constituted, during the dry season, and at times and in places where the existence of malaria is doubtful, or, at least, by no means proved. It is notoriously admitted that the inflammatory states of continued fever, in both the East and West Indies, appear among those soldiers, sailors, and civilians, who have not been long in a warm country, and who have not suffered from disease since their arrival; and that they take place chiefly during the dry and warm seasons, and in situations where the usual affects of malaria are never observed. This is the result of the experience of Jackson, Annesley, Boyle, Twining, Conwell, and the other experienced practitioners in warm countries. It agrees with my own observations, and is even admitted by Dr. Fergusson, who has gone much further than any one else in assigning malaria as the cause of intertropical fevers.”[613] I may mention, moreover, that Hippocrates and his contemporaries were evidently not ignorant of the fact, that the atmosphere in the vicinity of marshes and large rivers is unwholesome to the inhabitants of warm climates. See De Diæta, ii, 2.

The following are part of the conclusions which M. Littré draws from his investigations into the nature of the fevers described by Hippocrates. I quote them as being strongly confirmatory of the opinions delivered by me in the Commentary on the Second Book of Paulus Ægineta.

“Les fièvres décrites dans les Epidémies d’Hippocrate différent de nos fièvres continués.

“Les fièvres décrites dans les Epidémies ont, dans leur apparence générale, une similitude très grande avec celles des pays chauds.

“La similitude n’est pas moins grande dans les détails que dans l’ensemble.

“Dans les unes comme dans les autres les hypochondres sont pour un tiers des cas, le siége d’une manifestation toute spéciale.

“Dans les unes comme dans les autres, il y a une forte tendence ou réfroidissement du corps, à la sueur froide et à la lividité des extrémités.”

On almost all the other diseases treated of in these books, M. Littré’s opinions, in like manner, exactly coincide with those delivered by me in the above-mentioned work. Thus he arrives at the conclusion, that the Phrenitis and Lethargus of Hippocrates were varieties of the Causus. Compare Paulus Ægineta, Book III., 6, 9. He refers them to les fièvres pernicieuses comateuses pseudo-continués et les fièvres pernicieuses dolorantes pseudo-continués of M. Maillot. It would appear from the extracts which he quotes from a work of M. Roux, on the Diseases of Morea, that a similar tendency to pass into phrenitis and lethargy is still observable in the land of Greece. The fevers of the East Indies also, as described by Dr. Twining,[614] appear to partake very much of the same character. In a word, the conclusions to which a patient study of modern authorities on the subject have brought me amount to this; that the fevers described by Hippocrates in his “Epidemics,” are exactly the same as those which are now described as still prevailing in the land of Greece: that they correspond very well with those described by Cleghorn as occurring in Majorca; differ but little from those described by Pringle, Monro, and Sylvius, as happening in the Low Countries, and differ from those described by Twining, as happening in Bengal, only in a few particulars.

From the analysis of their contents given above it will readily be understood that the subject-matters of these two books are not arranged methodically. Indeed it is quite obvious from the nature of the work that the matters which are treated of in it had never been methodized by the author. Certainly then, as proposed by Desmair,[615] it would be a much more natural arrangement to give the four Constitutions of the season first, and then to give the forty-two cases together. But the present arrangement being of old standing, no editor has thought himself warranted to depart from it.

There are two important professional subjects of which it may appear surprising that there is no mention in the “Books of the Epidemics,” I mean sphygmology and contagion. Galen repeatedly declares it as his opinion, that Hippocrates paid no attention to the characters of the arterial pulse, and that the subject was not at all studied until after his time; and as far as I can see there is no ground for calling in question this opinion of Galen. Herophilus, in fact, would appear to have been the first person that made any progress in this study. It is more remarkable that Hippocrates should omit all allusion to the other subject, more especially as the contagiousness of certain diseases would appear to have been the popular belief of his age. Thus his contemporary, Thucydides, in describing the plague, expresses himself in such terms as puts it beyond a doubt that he regarded the disease as being of a contagious nature. And another contemporary, Isocrates, makes such observations on a certain case of empyema, by which he evidently means phthisis pulmonalis, as to show that it also was regarded as being communicable.[616] How the omission is to be accounted for I do not know, but certain it is that not the least reference to contagion, in any shape, is to be found in any of the Hippocratic treatises.

BOOK I.—OF THE EPIDEMICS.

Sec. I.—Constitution First.

1. In Thasus,[617] about the autumnal equinox, and under the Pleiades,[618] the rains were abundant, constant, and soft, with southerly winds; the winter southerly, the northerly winds faint, droughts; on the whole, the winter having the character of spring. The spring was southerly, cool, rains small in quantity. Summer, for the most part, cloudy, no rain, the Etesian winds, rare and small, blew in an irregular manner. The whole constitution of the season being thus inclined to the southerly, and with droughts early in the spring, from the preceding opposite and northerly state, ardent fevers occurred in a few instances, and these very mild, being rarely attended with hemorrhage, and never proving fatal.[619] Swellings appeared about the ears, in many on either side, and in the greatest number on both sides, being unaccompanied by fever so as not to confine the patient to bed; in all cases they disappeared without giving trouble, neither did any of them come to suppuration, as is common in swellings from other causes. They were of a lax, large, diffused character, without inflammation or pain, and they went away without any critical sign. They seized children, adults, and mostly those who were engaged in the exercises of the palestra and gymnasium, but seldom attacked women. Many had dry coughs without expectoration, and accompanied with hoarseness of voice. In some instances earlier, and in others later, inflammations with pain seized sometimes one of the testicles, and sometimes both;[620] some of these cases were accompanied with fever and some not; the greater part of these were attended with much suffering. In other respects they were free of disease, so as not to require medical assistance.[621]

2. Early in the beginning of spring, and through the summer, and towards winter, many of those who had been long gradually declining, took to bed with symptoms of phthisis; in many cases formerly of a doubtful character the disease then became confirmed; in these the constitution inclined to the phthisical.[622] Many, and, in fact, the most of them, died; and of those confined to bed, I do not know if a single individual survived for any considerable time; they died more suddenly than is common in such cases. But other diseases, of a protracted character, and attended with fever, were well supported, and did not prove fatal: of these we will give a description afterwards. Consumption was the most considerable of the diseases which then prevailed, and the only one which proved fatal to many persons. Most of them were affected by these diseases in the following manner: fevers accompanied with rigors, of the continual type, acute, having no complete intermissions, but of the form of the semitertians, being milder the one day, and the next having an exacerbation, and increasing in violence; constant sweats, but not diffused over the whole body; extremities very cold, and warmed with difficulty; bowels disordered, with bilious, scanty, unmixed, thin, pungent, and frequent dejections. The urine was thin, colourless, unconcocted, or thick, with a deficient sediment, not settling favorably, but casting down a crude and unseasonable sediment. Sputa small, dense, concocted, but brought up rarely and with difficulty; and in those who encountered the most violent symptoms there was no concoction at all, but they continued throughout spitting crude matters. Their fauces, in most of them, were painful from first to last, having redness with inflammation; defluxions thin, small and acrid; they were soon wasted and became worse, having no appetite for any kind of food throughout; no thirst; most persons delirious when near death. So much concerning the phthisical affections.[623]

3. In the course of the summer and autumn many fevers of the continual type, but not violent;[624] they attacked persons who had been long indisposed, but who were otherwise not in an uncomfortable state. In most cases the bowels were disordered in a very moderate degree, and they did not suffer thereby in any manner worth mentioning; the urine was generally well coloured, clear, thin, and after a time becoming concocted near the crisis. They had not much cough, nor was it troublesome; they were not deficient in appetite, for it was necessary to give them food, (on the whole, persons labouring under phthisis were not affected in the usual manner).[625] They were affected with fevers, rigors, and deficient sweats, with varied and irregular paroxysms, in general not intermitting, but having exacerbations in the tertian form. The earliest crisis which occurred was about the twentieth day, in most about the fortieth, and in many about the eightieth. But there were cases in which it did not leave them thus at all, but in an irregular manner, and without any crisis; in most of these the fevers, after a brief interval, relapsed again; and from these relapses they came to a crisis in the same periods; but in many they were prolonged so that the disease was not gone at the approach of winter. Of all those which are described under this constitution, the phthisical diseases alone were of a fatal character; for in all the others the patients bore up well, and did not die of the other fevers.[626]

Sec. II.—Constitution Second.

1. In Thasus, early in autumn, the winter suddenly set in rainy before the usual time, with much northerly and southerly winds. These things all continued so during the season of the Pleiades, and until their setting.[627] The winter was northerly, the rains frequent, in torrents, and large, with snow, but with a frequent mixture of fair weather. These things were all so, but the setting in of the cold was not much out of season. After the winter solstice, and at the time when the zephyr usually begins to blow, severe winterly storms out of season, with much northerly wind, snow, continued and copious rains; the sky tempestuous and clouded; these things were protracted, and did not remit until the equinox. The spring was cold, northerly, rainy, and clouded; the summer was not very sultry, the Etesian winds blew constant, but quickly afterwards, about the rising of Arcturus, there were again many rains with north winds. The whole season being wet, cold, and northerly, people were, for the most part, healthy during winter; but early in the spring very many, indeed, the greater part, were valetudinary. At first ophthalmies set in, with rheums, pains, unconcocted discharges, small concretions, generally breaking with difficulty, in most instances they relapsed, and they did not cease until late in autumn.[628] During summer and autumn there were dysenteric affections, attacks of tenesmus and lientery, bilious diarrhœa, with thin, copious, undigested, and acrid dejections, and sometimes with watery stools; many had copious defluxions, with pain, of a bilious, watery, slimy, purulent nature, attended with strangury, not connected with disease of the kidneys, but one complaint succeeding the other; vomitings of bile, phlegm, and undigested food, sweats, in all cases a redundance of humors. In many instances these complaints were unattended with fever, and did not prevent the patients from walking about, but some cases were febrile, as will be described. In some all those described below occurred with pain. During autumn, and at the commencement of winter, there were phthisical complaints, continual fevers; and, in a few cases, ardent; some diurnal, others nocturnal, semitertians, true tertians, quartans, irregular fevers. All the fevers which are described attacked great numbers. The ardent fevers attacked the smallest numbers, and the patients suffered the least from them, for there were no hemorrhages, except a few and to a small amount, nor was there delirium; all the other complaints were slight; in these the crises were regular, in most instances, with the intermittents, in seventeen days; and I know no instance of a person dying of causus, nor becoming phrenitic.[629] The tertians were more numerous than the ardent fevers, and attended with more pain;[630] but these all had four periods in regular succession from the first attack, and they had a complete crisis in seven, without a relapse in any instance. The quartans attacked many at first, in the form of regular quartans, but in no few cases a transition from other fevers and diseases into quartans took place; they were protracted, as is wont with them, indeed, more so than usual. Quotidian, nocturnal, and wandering fevers attacked many persons, some of whom continued to keep up, and others were confined to bed. In most instances these fevers were prolonged under the Pleiades and till winter. Many persons, and more especially children, had convulsions from the commencement;[631] and they had fever, and the convulsions supervened upon the fevers; in most cases they were protracted, but free from danger, unless in those who were in a deadly state from other complaints. Those fevers which were continual in the main, and with no intermissions, but having exacerbations in the tertian form,[632] there being remissions the one day and exacerbations the next, were the most violent of all those which occurred at that time, and the most protracted, and occurring with the greatest pains, beginning mildly, always on the whole increasing, and being exacerbated, and always turning worse, having small remissions, and after an abatement having more violent paroxysms, and growing worse, for the most part, on the critical days. Rigors, in all cases, took place in an irregular and uncertain manner, very rare and weak in them, but greater in all other fevers; frequent sweats, but most seldom in them, bringing no alleviation, but, on the contrary, doing mischief. Much cold of the extremities in them, and these were warmed with difficulty. Insomnolency, for the most part, especially in these fevers, and again a disposition to coma. The bowels, in all diseases, were disordered, and in a bad state, but worst of all in these. The urine, in most of them, was either thin and crude, yellow, and after a time with slight symptoms of concoction in a critical form, or having the proper thickness, but muddy, and neither settling nor subsiding; or having small and bad, and crude sediments; these being the worst of all. Coughs attended these fevers, but I cannot state that any harm or good ever resulted from the cough. The most of these were protracted and troublesome, went on in a very disorderly and irregular form, and, for the most part, did not end in a crisis, either in the fatal cases or in the others; for if it left some of them for a season it soon returned again. In a few instances the fever terminated with a crisis; in the earliest of these about the eightieth day, and some of these relapsed, so that most of them were not free from the fever during the winter; but the fever left most of them without a crisis, and these things happened alike to those who recovered and to those who did not. There being much want of crisis and much variety as to these diseases, the greatest and worst symptom attended the most of them, namely, a loathing of all articles of food, more especially with those who had otherwise fatal symptoms; but they were not unseasonably thirsty in such fevers. After a length of time, with much suffering and great wasting, abscesses were formed in these cases, either unusually large, so that the patients could not support them, or unusually small, so that they did no good, but soon relapsed and speedily got worse. The diseases which attacked them were in the form of dysenteries, tenesmus, lientery, and fluxes; but, in some cases, there were dropsies, with or without these complaints. Whatever attacked them violently speedily cut them off, or again, did them no good. Small rashes, and not corresponding to the violence of the disease, and quickly disappearing, or swellings occurred about the ears, which were not resolved, and brought on no crisis.[633] In some they were determined to the joints, and especially to the hip-joint, terminating critically with a few, and quickly again increasing to its original habit. Persons died of all these diseases, but mostly of these fevers, and especially infants just weaned, and older children, until eight or ten years of age, and those before puberty. These things occurred to those affected with the complaints described above, and to many persons at first without them. The only favorable symptom, and the greatest of those which occurred, and what saved most of those who were in the greatest dangers, was the conversion of it to a strangury, and when, in addition to this, abscesses were formed.[634] The strangury attacked, most especially, persons of the ages I have mentioned, but it also occurred in many others, both of those who were not confined to bed and those who were. There was a speedy and great change in all these cases. For the bowels, if they happened previously to have watery discharges of a bad character, became regular, they got an appetite for food, and the fevers were mild afterwards. But, with regard to the strangury itself, the symptoms were protracted and painful. Their urine was copious, thick, of various characters, red, mixed with pus, and was passed with pain. These all recovered, and I did not see a single instance of death among them.

5.[635] With regard to the dangers of these cases, one must always attend to the seasonable concoction of all the evacuations, and to the favorable and critical abscesses. The concoctions indicate a speedy crisis and recovery of health; crude and undigested evacuations, and those which are converted into bad abscesses, indicate either want of crisis, or pains, or prolongation of the disease, or death, or relapses; which of these it is to be must be determined from other circumstances. The physician must be able to tell the antecedents, know the present, and foretell the future—must meditate these things, and have two special objects in view with regard to diseases, namely, to do good or to do no harm. The art consists in three things—the disease, the patient, and the physician. The physician is the servant of the art, and the patient must combat the disease along with the physician.[636]

6. Pains about the head and neck, and heaviness of the same along with pain, occur either without fevers or in fevers. Convulsions occurring in persons attacked with frenzy, and having vomitings of verdigris-green bile, in some cases quickly prove fatal. In ardent fevers, and in those other fevers in which there is pain of the neck, heaviness of the temples, mistiness about the eyes, and distention about the hypochondriac region, not unattended with pain, hemorrhage from the nose takes place,[637] but those who have heaviness of the whole head, cardialgia and nausea, vomit bilious and pituitous matters; children, in such affections, are generally attacked with convulsions, and women have these and also pains of the uterus; whereas, in elder persons, and those in whom the heat is already more subdued, these cases end in paralysis, mania, and loss of sight.

Third Constitution.

7. In Thasus, a little before and during the season of Arcturus,[638] there were frequent and great rains, with northerly winds. About the equinox, and till the setting of the Pleiades, there were a few southerly rains: the winter northerly and parched, cold, with great winds and snow. Great storms about the equinox, the spring northerly, dryness, rains few and cold. About the summer solstice, scanty rains, and great cold until near the season of the Dog-star.[639] After the Dog-days, until the season of Arcturus, the summer hot, great droughts, not in intervals, but continued and severe: no rain; the Etesian winds blew; about the season of Arcturus southerly rains until the equinox.

8. In this state of things, during winter, paraplegia set in, and attacked many, and some died speedily; and otherwise the disease prevailed much in an epidemical form, but persons remained free from all other diseases.[640] Early in the spring, ardent fevers commenced and continued through the summer until the equinox. Those then that were attacked immediately after the commencement of the spring and summer, for the most part recovered, and but few of them died. But when the autumn and the rains had set in, they were of a fatal character, and the greater part then died.[641] When in these attacks of ardent fevers there was a proper and copious hemorrhage from the nose, they were generally saved by it, and I do not know a single person who had a proper hemorrhage who died in this constitution. Philiscus, Epaminon, and Silenus, indeed, who had a trifling epistaxis on the fourth and fifth day, died.[642] The most of those seized with the disease had a rigor about the time of the crisis, and especially those who had no hemorrhage; these had also the rigor associated. Some were attacked with jaundice on the sixth day,[643] but these were benefited either by an urinary purgation, or a disorder of the bowels, or a copious hemorrhage, as in the case of Heraclides, who was lodged with Aristocydes: this person, though he had the hemorrhage from the nose, the purgation by the bladder, and disorder of the bowels, experienced a favorable crisis on the twentieth day, not like the servant of Phanagoras, who had none of these symptoms, and died. The hemorrhages attacked most persons, but especially young persons and those in the prime of life, and the greater part of those who had not the hemorrhage died:[644] elderly persons had jaundice or disorder of the bowels, such as Bion, who was lodged with Silenus. Dysenteries were epidemical during the summer, and some of those cases in which the hemorrhage occurred, terminated in dysentery, as happened to the slave of Eraton, and to Mullus, who had a copious hemorrhage, which settled down into dysentery, and they recovered. This humor was redundant in many cases, since in those who had not the hemorrhage about the crisis, but the risings about the ears disappeared, after their disappearance there was a sense of weight in the left flank extending to the extremity of the hip, and pain setting in after the crisis, with a discharge of thin urine; they began to have small hemorrhages about the twenty-fourth day, and the swelling was converted into the hemorrhage. In the case of Antiphon, the son of Critobulus, the fever ceased and came to a crisis about the fortieth day. Many women were attacked, but fewer than of the men, and there were fewer deaths among them. But most of them had difficult parturition, and after labor they were taken ill, and these most especially died, as, for example, the daughter of Telebolus died on the sixth day after delivery.[645] Most females had the menstrual discharge during the fever, and many girls had it then for the first time: in certain individuals both the hemorrhage from the nose and the menses appeared; thus, in the case of the virgin daughter of Dætharses, the menses then took place for the first time, and she had also a copious hemorrhage from the nose, and I knew no instance of any one dying when one or other of these took place properly. But all those in the pregnant state that were attacked had abortions, as far as I observed. The urine in most cases was of the proper color, but thin, and having scanty sediments:[646] in most the bowels were disordered with thin and bilious dejections; and many, after passing through the other crises, terminated in dysenteries, as happened to Xenophanes and Critias. The urine was watery, copious, clear, and thin; and even after the crises, when the sediment was natural, and all the other critical symptoms were favorable, as I recollect having happened to Bion, who was lodged in the house of Silenus, and Critias, who lived with Xenophanes, the slave of Areton, and the wife of Mnesistratus. But afterwards all these were attacked with dysentery. It would be worth while to inquire whether the watery urine was the cause of this.[647] About the season of Arcturus many had the crisis on the eleventh day, and in them the regular relapses did not take place, but they became comatose about this time, especially children; but there were fewest deaths of all among them.

9. About the equinox, and until the season of the Pleiades, and at the approach of winter, many ardent fevers set in; but great numbers at that season were seized with phrenitis, and many died;[648] a few cases also occurred during the summer. These then made their attack at the commencement of ardent fevers, which were attended with fatal symptoms; for immediately upon their setting in, there were acute fever and small rigors, insomnolency, aberration, thirst, nausea, insignificant sweats about the forehead and clavicles, but no general perspiration; they had much delirious talking, fears, despondency, great coldness of the extremities, in the feet, but more especially in their hands: the paroxysms were on the even days; and in most cases, on the fourth day, the most violent pains set in, with sweats, generally coldish, and the extremities could not be warmed, but were livid and rather cold, and they had then no thirst; in them the urine was black, scanty, thin, and the bowels were constipated; there was an hemorrhage from the nose in no case in which these symptoms occurred, but merely a trifling epistaxis; and none of them had a relapse, but they died on the sixth day with sweats.[649] In the phrenitic cases, all the symptoms which have been described did not occur, but in them the disease mostly came to a crisis on the eleventh day, and in some on the twentieth. In those cases in which the phrenitis did not begin immediately, but about the third or fourth day, the disease was moderate at the commencement, but assumed a violent character about the seventh day. There was a great number of diseases, and of those affected, they who died were principally infants, young persons, adults having smooth bodies, white skins, straight and black hair, dark eyes, those living recklessly and luxuriously; persons with shrill, or rough voices, who stammered and were passionate, and women more especially died from this form. In this constitution, four symptoms in particular proved salutary; either a hemorrhage from the nose, or a copious discharge by the bladder of urine, having an abundant and proper sediment, or a bilious disorder of the bowels at the proper time, or an attack of dysentery.[650] And in many cases it happened, that the crisis did not take place by any one of the symptoms which have been mentioned, but the patient passed through most of them, and appeared to be in an uncomfortable way, and yet all who were attacked with these symptoms recovered. All the symptoms which I have described occurred also to women and girls; and whoever of them had any of these symptoms in a favorable manner, or the menses appeared abundantly, were saved thereby, and had a crisis, so that I do not know a single female who had any of these favorably that died. But the daughter of Philo, who had a copious hemorrhage from the nose, and took supper unseasonably on the seventh day, died. In those cases of acute, and more especially of ardent fevers, in which there is an involuntary discharge of tears, you may expect a hemorrhage from the nose, unless the other symptoms be of a fatal character, for in those of a bad description, they do not indicate a hemorrhage, but death. Swellings about the ears, with pain in fevers, sometimes when the fever went off critically, neither subsided nor were converted into pus; in these cases a bilious diarrhœa, or dysentery, or thick urine having a sediment, carried off the disease, as happened to Hermippus of Clazomenæ. The circumstances relating to crises, as far as we can recognize them, were so far similar and so far dissimilar. Thus two brothers became ill at the same hour (they were brothers of Epigenes, and lodged near the theatre), of these the elder had a crisis on the sixth day, and the younger on the seventh, and both had a relapse at the same hour; it then left them for five days, and from the return of the fever both had a crisis together on the seventeenth day. Most had a crisis on the sixth day; it then left them for six days, and from the relapse there was a crisis on the fifth day.[651] But those who had a crisis on the seventh day, had an intermission for seven days; and the crisis took place on the third day after the relapse. Those who had a crisis on the sixth day, after an interval of six days were seized again on the third, and having left them for one day, the fever attacked them again on the next and came to a crisis, as happened to Evagon the son of Dætharses. Those in whom the crisis happened on the sixth day, had an intermission of seven days, and from the relapse there was a crisis on the fourth, as happened to the daughter of Aglaïdas. The greater part of those who were taken ill under this constitution of things, were affected in this manner, and I did not know a single case of recovery, in which there was not a relapse agreeably to the stated order of relapses; and all those recovered in which the relapses took place according to this form: nor did I know a single instance of those who then passed through the disease in this manner who had another relapse. In these diseases death generally happened on the sixth day, as happened to Epaminondas, Silenus, and Philiscus the son of Antagoras. Those who had parotid swellings experienced a crisis on the twentieth day, but in all these cases the disease went off without coming to a suppuration, and was turned upon the bladder. But in Cratistonax, who lived by the temple of Hercules, and in the maid servant of Scymnus the fuller, it turned to a suppuration, and they died. Those who had a crisis on the seventh day, had an intermission of nine days, and a relapse which came to a crisis on the fourth day from the return of the fever, as was the case with Pantacles, who resided close by the temple of Bacchus. Those who had a crisis on the seventh day, after an interval of six days had a relapse, from which they had a crisis on the seventh day, as happened to Phanocritus, who was lodged with Gnathon the painter. During the winter, about the winter solstices, and until the equinox, the ardent fevers and frenzies prevailed, and many died. The crisis, however, changed, and happened to the greater number on the fifth day from the commencement, left them for four days and relapsed; and after the return, there was a crisis on the fifth day, making in all fourteen days. The crisis took place thus in the case of most children, also in elder persons. Some had a crisis on the eleventh day, a relapse on the fourteenth, a complete crisis on the twentieth; but certain persons, who had a rigor about the twentieth, had a crisis on the fortieth. The greater part had a rigor along with the original crisis, and these had also a rigor about the crisis in the relapse. There were fewest cases of rigor in the spring, more in summer, still more in autumn, but by far the most in winter; then hemorrhages ceased.

Sec. III.

10. With regard to diseases, the circumstances from which we form a judgment of them are,—by attending to the general nature of all, and the peculiar nature of each individual,—to the disease, the patient, and the applications,—to the person who applies them, as that makes a difference for better or for worse,—to the whole constitution of the season, and particularly to the state of the heavens, and the nature of each country;—to the patient’s habits, regimen, and pursuits;—to his conversation, manners, taciturnity, thoughts, sleep, or absence of sleep, and sometimes his dreams, what and when they occur;—to his picking and scratching;[652]—to his tears;—to the alvine discharges, urine, sputa, and vomitings; and to the changes of diseases from the one into the other;—to the deposits, whether of a deadly or critical character;—to the sweat, coldness, rigor, cough, sneezing, hiccup, respiration, eructation, flatulence, whether passed silently or with a noise;—to hemorrhages and hemorrhoids;—from these, and their consequences, we must form our judgment.[653]

11. Fevers are,—the continual, some of which hold during the day and have a remission at night, and others hold during the night and have a remission during the day;[654] semitertians, tertians, quartans, quintans, septans, nonans. The most acute, strongest, most dangerous, and fatal diseases, occur in the continual fever. The least dangerous of all, and the mildest and most protracted, is the quartan, for it is not only such from itself, but it also carries off other great diseases.[655] In what is called the semitertian, other acute diseases are apt to occur, and it is the most fatal of all others, and moreover phthisical persons, and those laboring under other protracted diseases, are apt to be attacked by it.[656] The nocturnal fever is not very fatal, but protracted; the diurnal is still more protracted, and in some cases passes into phthisis. The septan is protracted, but not fatal; the nonan more protracted, and not fatal. The true tertian comes quickly to a crisis, and is not fatal; but the quintan is the worst of all, for it proves fatal when it precedes an attack of phthisis, and when it supervenes on persons who are already consumptive.[657] There are peculiar modes, and constitutions, and paroxysms, in every one of these fevers; for example,—the continual, in some cases at the very commencement, grows, as it were, and attains its full strength, and rises to its most dangerous pitch, but is diminished about and at the crisis; in others it begins gentle and suppressed, but gains ground and is exacerbated every day, and bursts forth with all its heat about and at the crisis; while in others, again, it commences mildly, increases, and is exacerbated until it reaches its acmé, and then remits until at and about the crisis.[658] These varieties occur in every fever, and in every disease. From these observations one must regulate the regimen accordingly. There are many other important symptoms allied to these, part of which have been already noticed, and part will be described afterwards, from a consideration of which one may judge, and decide in each case, whether the disease be acute, and whether it will end in death or recovery; or whether it will be protracted, and will end in death or recovery; and in what cases food is to be given, and in what not; and when and to what amount, and what particular kind of food is to be administered.

12. Those diseases which have their paroxysms on even days have their crises on even days; and those which have their paroxysms on uneven days have their crises on uneven days. The first period of those which have the crisis on even days, is the 4th, 6th, 8th, 10th, 14th, 20th, 30th, 40th, 60th, 80th, 100th; and the first period of those which have their crises on uneven days, is the let, 3d, 5th, 7th, 9th, 11th, 17th, 21st, 27th, 31st. It should be known, that if the crisis take place on any other day than on those described, it indicates that there will be a relapse, which may prove fatal. But one ought to pay attention, and know in these seasons what crises will lead to recovery and what to death, or to changes for the better or the worse. Irregular fevers, quartans, quintans, septans, and nonans should be studied, in order to find out in what periods their crises take place.

13. Fourteen Cases of Disease.[659]

Case I.—Philiscus, who lived by the Wall, took to bed on the first day of acute fever; he sweated; towards night was uneasy. On the second day all the symptoms were exacerbated; late in the evening had a proper stool from a small clyster; the night quiet. On the third day, early in the morning and until noon, he appeared to be free from fever; towards evening, acute fever, with sweating, thirst, tongue parched; passed black urine; night uncomfortable, no sleep; he was delirious on all subjects. On the fourth, all the symptoms exacerbated, urine black; night more comfortable, urine of a better color. On the fifth, about mid-day, had a slight trickling of pure blood from the nose; urine varied in character, having floating in it round bodies, resembling semen, and scattered, but which did not fall to the bottom; a suppository having been applied, some scanty flatulent matters were passed; night uncomfortable, little sleep, talking incoherently; extremities altogether cold, and could not be warmed; urine black; slept a little towards day; loss of speech, cold sweats; extremities livid; about the middle of the sixth day he died. The respiration throughout, like that of a person recollecting himself, was rare, and large, and spleen was swelled upon in a round tumor, the sweats cold throughout, the paroxysms on the even days.[660]

Case II.—Silenus lived on the Broad-way, near the house of Evalcidas. From fatigue, drinking, and unseasonable exercises, he was seized with fever. He began with having pain in the loins; he had heaviness of the head, and there was stiffness of the neck. On the first day the alvine discharges were bilious, unmixed, frothy, high colored, and copious; urine black, having a black sediment; he was thirsty, tongue dry; no sleep at night. On the second, acute fever, stools more copious, thinner, frothy; urine black, an uncomfortable night, slight delirium. On the third, all the symptoms exacerbated; an oblong distention, of a softish nature, from both sides of the hypochondrium to the navel; stools thin, and darkish; urine muddy, and darkish; no sleep at night; much talking, laughter, singing, he could not restrain himself. On the fourth, in the same state. On the fifth, stools bilious, unmixed, smooth, greasy; urine thin, and transparent; slight absence of delirium. On the sixth, slight perspiration about the head; extremities cold and livid; much tossing about; no passage from the bowels, urine suppressed, acute fever. On the seventh, loss of speech; extremities could no longer be kept warm; no discharge of urine. On the eighth, a cold sweat all over; red rashes with sweat, of a round figure, small, like vari, persistent, not subsiding; by means of a slight stimulus, a copious discharge from the bowels, of a thin and undigested character, with pain; urine acrid, and passed with pain; extremities slightly heated; sleep slight, and comatose; speechless; urine thin, and transparent. On the ninth, in the same state. On the tenth, no drink taken; comatose, sleep slight; alvine discharges the same; urine abundant, and thickish; when allowed to stand, the sediment farinaceous and white; extremities again cold. On the eleventh, he died. At the commencement, and throughout, the respiration was slow and large; there was a constant throbbing in the hypochondrium; his age was about twenty.[661]

Case III.—Herophon was seized with an acute fever; alvine discharges at first were scanty, and attended with tenesmus; but afterwards they were passed of a thin, bilious character, and frequent; there was no sleep; urine black, and thin. On the fifth, in the morning, deafness; all the symptoms exacerbated; spleen swollen; distention of the hypochondrium; alvine discharges scanty, and black; he became delirious. On the sixth, delirious; at night, sweating, coldness; the delirium continued. On the seventh, he became cold, thirsty, was disordered in mind; at night recovered his senses; slept. On the eighth, was feverish; the spleen diminished in size; quite collected; had pain at first about the groin, on the same side as the spleen; had pains in both legs; night comfortable; urine better colored, had a scanty sediment. On the ninth, sweated; the crisis took place; fever remitted. On the fifth day afterwards, fever relapsed, spleen immediately became swollen; acute fever; deafness again. On the third day after the relapse, the spleen diminished; deafness less; legs painful; sweated during the night; crisis took place on the seventeenth day; had no disorder of the senses during the relapse.[662]

Case IV.—In Thasus, the wife of Philinus, having been delivered of a daughter, the lochial discharge being natural, and other matters going on mildly, on the fourteenth day after delivery was seized with fever, attended with rigor; was pained at first in the cardiac region of the stomach and right hypochondrium; pain in the genital organs; lochial discharge ceased. Upon the application of a pessary all these symptoms were alleviated; pains of the head, neck, and loins remained; no sleep; extremities cold; thirst; bowels in a hot state; stools scanty; urine thin, and colorless at first. On the sixth, towards night, senses much disordered, but again were restored. On the seventh, thirsty; the evacuations bilious, and high colored. On the eighth, had a rigor; acute fever; much spasm, with pain; talked much, incoherently; upon the application of a suppository, rose to stool, and passed copious dejections, with a bilious flux; no sleep. On the ninth, spasms. On the tenth, slightly recollected. On the eleventh, slept; had perfect recollection, but again immediately wandered; passed a large quantity of urine with spasms, (the attendants seldom putting her in mind,) it was thick, white, like urine which has been shaken after it has stood for a considerable time until it has subsided, but it had no sediment; in color and consistence, the urine resembled that of cattle, as far as I observed. About the fourteenth day, startings over the whole body; talked much; slightly collected, but presently became again delirious. About the seventeenth day became speechless, on the twentieth died.[663]