All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of the publisher, nor be otherwise circulated in any form other than that in which it is published.

Delphi Classics

is an imprint of

Delphi Publishing Ltd

Hastings, East Sussex

United Kingdom

Contact: sales@delphiclassics.com

www.delphiclassics.com

Works of Hippocrates

Harbour of Cos (ancient Kos) — Hippocrates’ birthplace

ON ANCIENT MEDICINE

OR, TRADITION IN MEDICINE

Translated by Charles Darwin Adams

This treatise is regarded as one of the most significant works of the Hippocratic Corpus, the collection of approximately sixty writings covering all areas of medical thought and practice, which are traditionally associated with Hippocrates (c. 460 BC – c. 370 BC), the father of Western medicine. In more recent times, thirteen of the works have been identified as being possibly by the hand of Hippocrates, with On Ancient Medicine being a key text of this number. The origins of the Hippocratic Corpus can be traced to the sixth and fifth centuries BC in Italy.

There were two seminal schools of Western medical thought; Agrigentum on the southern coast of Sicily and Croton on the west coast of the Gulf of Taranto. Agrigentum was the home of Empedocles, while Croton belonged to the Pythagorean sect of medical philosophy. The school of Agrigentum and Empedocles placed great emphasis on cure by contraries, while the school of Croton rejected this notion, championing the medical philosophy that perceived the human organism consists of an infinite number of humours. The first medical philosopher of the school of Croton was Alcmaeon, who argued that the maintenance of good health required a balance of the powers of moist and dry, cold and hot, bitter and sweet. He argued that sickness arises when there is an imbalance within the human organism, caused by the predominance of one power over another. In the Agrigentum school of thought Empedocles hypothesised that the universe consisted of four elements: earth, water, air and fire. On the basis of these four elements he sought to account for the origin of matter. Matter or the universe was generated out of these four elements and their mutual attraction and repulsion.

The conflict between these two schools of thought became manifest in their medical philosophies. Whereas, Alcmaeon argued that there were indefinite number of diverse qualities that made up the human organism, Empedocles believed that there were four concrete or substantial elements. Although it is Empedocles’ medical philosophy that ultimately inspires the humoral doctrine of human nature, it is Alcmaeon’s theory that provides the backdrop to the medical therapeutic doctrine proposed in On Ancient Medicine . Alcmaeon’s argument that there are an infinite number of causes for disease that cannot be simply organised into categories is the basic operating assumption of empirical medicine. Therefore medical knowledge continuously expanded thorough a firsthand experience and observation of the human organism within nature. It is in this light that On Ancient Medicine should be seen as an attempt by Alcmaeon’s followers and the empirical school of thought to respond to and critique the Empedoclean or humoral theory of medicine.

On Ancient Medicine is formed of three parts. In chapters 1–19 the author responds to the supporters of the hypothesis theory of medicine, arguing that the exploration of medicine itself reveals the human organism as a blend of diverse substances or humours. Having set forth this humoral theory, he then critiques the hypothesis theory proposed by his opponents as being an oversimplified conception of the cause of disease. He then discusses his own theory and method employed in its discovery (chapters 20-24), before responding to the charge that ancient medicine is not a genuine medical art because it has limited accuracy. These arguments must be seen in the light of the author’s theory of human physiology (chapters 9-12).

It is generally believed that On Ancient Medicine was written between 440 and 350 BC, with several hints suggesting a date in the late fifth century. In particular, the author refers to Empedocles (490–430 B.C.) as the motivation of the method he attacks, which would suggest a date not long after Empedocles’ peak of activity.

Since the work of Émile Littré in the nineteenth century, the treatise has been scrutinised in thorough detail, in an attempt to determine which of the works in the Hippocratic Corpus were composed by Hippocrates. Littré was the scholar most associated with advocating that On Ancient Medicine was written by Hippocrates, as he believed that it was the work to which Plato was referring to in The Phaedrus . However, it is difficult to establish any certainty as to whether the historical Hippocrates actually wrote the treatise On Ancient Medicine , due to the scanty surviving evidence from references in Plato and Aristotle.

Vaticanus graecus 277, 10v-11r — a fourteenth century Hippocratic Corpus manuscript.

ON ANCIENT MEDICINE

1. Whoever having undertaken to speak or write on Medicine, have first laid down for themselves some hypothesis to their argument, such as hot, or cold, or moist, or dry, or whatever else they choose (thus reducing their subject within a narrow compass, and supposing only one or two original causes of diseases or of death among mankind), are all clearly mistaken in much that they say; and this is the more reprehensible as relating to an art which all men avail themselves of on the most important occasions, and the good operators and practitioners in which they hold in especial honor. For there are practitioners, some bad and some far otherwise, which, if there had been no such thing as Medicine, and if nothing had been investigated or found out in it, would not have been the case, but all would have been equally unskilled and ignorant of it, and everything concerning the sick would have been directed by chance. But now it is not so; for, as in all the other arts, those who practise them differ much from one another in dexterity and knowledge, so is it in like manner with Medicine. Wherefore I have not thought that it stood in need of an empty hypothesis, like those subjects which are occult and dubious, in attempting to handle which it is necessary to use some hypothesis; as, for example, with regard to things above us and things below the earth; if any one should treat of these and undertake to declare how they are constituted, the reader or hearer could not find out, whether what is delivered be true or false; for there is nothing which can be referred to in order to discover the truth.

2. But all these requisites belong of old to Medicine, and an origin and way have been found out, by which many and elegant discoveries have been made, during a length of time, and others will yet be found out, if a person possessed of the proper ability, and knowing those discoveries which have been made, should proceed from them to prosecute his investigations. But whoever, rejecting and despising all these, attempts to pursue another course and form of inquiry, and says he has discovered anything, is deceived himself and deceives others, for the thing is impossible. And for what reason it is impossible, I will now endeavor to explain, by stating and showing what the art really is. From this it will be manifest that discoveries cannot possibly be made in any other way. And most especially, it appears to me, that whoever treats of this art should treat of things which are familiar to the common people. For of nothing else will such a one have to inquire or treat, but of the diseases under which the common people have labored, which diseases and the causes of their origin and departure, their increase and decline, illiterate persons cannot easily find out themselves, but still it is easy for them to understand these things when discovered and expounded by others. For it is nothing more than that every one is put in mind of what had occurred to himself. But whoever does not reach the capacity of the illiterate vulgar and fails to make them listen to him, misses his mark. Wherefore, then, there is no necessity for any hypothesis.

3. For the art of Medicine would not have been invented at first, nor would it have been made a subject of investigation (for there would have been no need of it), if when men are indisposed, the same food and other articles of regimen which they eat and drink when in good health were proper for them, and if no others were preferable to these. But now necessity itself made medicine to be sought out and discovered by men, since the same things when administered to the sick, which agreed with them when in good health, neither did nor do agree with them. But to go still further back, I hold that the diet and food which people in health now use would not have been discovered, provided it had suited with man to eat and drink in like manner as the ox, the horse, and all other animals, except man, do of the productions of the earth, such as fruits, weeds, and grass; for from such things these animals grow, live free of disease, and require no other kind of food. And, at first, I am of opinion that man used the same sort of food, and that the present articles of diet had been discovered and invented only after a long lapse of time, for when they suffered much and severely from strong and brutish diet, swallowing things which were raw, unmixed, and possessing great strength, they became exposed to strong pains and diseases, and to early deaths. It is likely, indeed, that from habit they would suffer less from these things then than we would now, but still they would suffer severely even then; and it is likely that the greater number, and those who had weaker constitutions, would all perish; whereas the stronger would hold out for a longer time, as even nowadays some, in consequence of using strong articles of food, get off with little trouble, but others with much pain and suffering. From this necessity it appears to me that they would search out the food befitting their nature, and thus discover that which we now use: and that from wheat, by macerating it, stripping it of its hull, grinding it all down, sifting, toasting, and baking it, they formed bread; and from barley they formed cake (maza), performing many operations in regard to it; they boiled, they roasted, they mixed, they diluted those things which are strong and of intense qualities with weaker things, fashioning them to the nature and powers of man, and considering that the stronger things Nature would not be able to manage if administered, and that from such things pains, diseases, and death would arise, but such as Nature could manage, that from them food, growth, and health, would arise. To such a discovery and investigation what more suitable name could one give than that of Medicine? since it was discovered for the health of man, for his nourishment and safety, as a substitute for that kind of diet by which pains, diseases, and deaths were occasioned.

4. And if this is not held to be an art, I do not object. For it is not suitable to call any one an artist of that which no one is ignorant of, but which all know from usage and necessity. But still the discovery is a great one, and requiring much art and investigation. Wherefore those who devote themselves to gymnastics and training, are always making some new discovery, by pursuing the same line of inquiry, where, by eating and drinking certain things, they are improved and grow stronger than they were.

5. Let us inquire then regarding what is admitted to be Medicine; namely, that which was invented for the sake of the sick, which possesses a name and practitioners, whether it also seeks to accomplish the same objects, and whence it derived its origin. To me, then, it appears, as I said at the commencement, that nobody would have sought for medicine at all, provided the same kinds of diet had suited with men in sickness as in good health. Wherefore, even yet, such races of men as make no use of medicine, namely, barbarians, and even certain of the Greeks, live in the same way when sick as when in health; that is to say, they take what suits their appetite, and neither abstain from, nor restrict themselves in anything for which they have a desire. But those who have cultivated and invented medicine, having the same object in view as those of whom I formerly spoke, in the first place, I suppose, diminished the quantity of the articles of food which they used, and this alone would be sufficient for certain of the sick, and be manifestly beneficial to them, although not to all, for there would be some so affected as not to be able to manage even small quantities of their usual food, and as such persons would seem to require something weaker, they invented soups, by mixing a few strong things with much water, and thus abstracting that which was strong in them by dilution and boiling. But such as could not manage even soups, laid them aside, and had recourse to drinks, and so regulated them as to mixture and quantity, that they were administered neither stronger nor weaker than what was required.

6. But this ought to be well known, that soups do not agree with certain persons in their diseases, but, on the contrary, when administered both the fevers and the pains are exacerbated, and it becomes obvious that what was given has proved food and increase to the disease, but a wasting and weakness to the body. But whatever persons so affected partook of solid food, or cake, or bread, even in small quantity, would be ten times and more decidedly injured than those who had taken soups, for no other reason than from the strength of the food in reference to the affection; and to whomsoever it is proper to take soups and not eat solid food, such a one will be much more injured if he eat much than if he eat little, but even little food will be injurious to him. But all the causes of the sufferance refer themselves to this rule, that the strongest things most especially and decidedly hurt man, whether in health or in disease.

7. What other object, then, had he in view who is called a physician, and is admitted to be a practitioner of the art, who found out the regimen and diet befitting the sick, than he who originally found out and prepared for all mankind that kind of food which we all now use, in place of the former savage and brutish mode of living? To me it appears that the mode is the same, and the discovery of a similar nature. The one sought to abstract those things which the constitution of man cannot digest, because of their wildness and intemperature, and the other those things which are beyond the powers of the affection in which any one may happen to be laid up. Now, how does the one differ from the other, except that the latter admits of greater variety, and requires more application, whereas the former was the commencement of the process?

8. And if one would compare the diet of sick persons with that of persons in health, he will find it not more injurious than that of healthy persons in comparison with that of wild beasts and of other animals. For, suppose a man laboring under one of those diseases which are neither serious and unsupportable, nor yet altogether mild, but such as that, upon making any mistake in diet, it will become apparent, as if he should eat bread and flesh, or any other of those articles which prove beneficial to healthy persons, and that, too, not in great quantity, but much less than he could have taken when in good health; and that another man in good health, having a constitution neither very feeble, nor yet strong, eats of those things which are wholesome and strengthening to an ox or a horse, such as vetches, barley, and the like, and that, too, not in great quantity, but much less than he could take; the healthy person who did so would be subjected to no less disturbance and danger than the sick person who took bread or cake unseasonably. All these things are proofs that Medicine is to be prosecuted and discovered by the same method as the other.

9. And if it were simply, as is laid down, that such things as are stronger prove injurious, but such as are weaker prove beneficial and nourishing, both to sick and healthy persons, it were an easy matter, for then the safest rule would be to circumscribe the diet to the lowest point. But then it is no less mistake, nor one that injuries a man less, provided a deficient diet, or one consisting of weaker things than what are proper, be administered. For, in the constitution of man, abstinence may enervate, weaken, and kill. And there are many other ills, different from those of repletion, but no less dreadful, arising from deficiency of food; wherefore the practice in those cases is more varied, and requires greater accuracy. For one must aim at attaining a certain measure, and yet this measure admits neither weight nor calculation of any kind, by which it may be accurately determined, unless it be the sensation of the body; wherefore it is a task to learn this accurately, so as not to commit small blunders either on the one side or the other, and in fact I would give great praise to the physician whose mistakes are small, for perfect accuracy is seldom to be seen, since many physicians seem to me to be in the same plight as bad pilots, who, if they commit mistakes while conducting the ship in a calm do not expose themselves, but when a storm and violent hurricane overtake them, they then, from their ignorance and mistakes, are discovered to be what they are, by all men, namely, in losing their ship. And thus bad and commonplace physicians, when they treat men who have no serious illness, in which case one may commit great mistakes without producing any formidable mischief (and such complaints occur much more frequently to men than dangerous ones): under these circumstances, when they commit mistakes, they do not expose themselves to ordinary men; but when they fall in with a great, a strong, and a dangerous disease, then their mistakes and want of skill are made apparent to all. Their punishment is not far off, but is swift in overtaking both the one and the other.

10. And that no less mischief happens to a man from unseasonable depletion than from repletion, may be clearly seen upon reverting to the consideration of persons in health. For, to some, with whom it agrees to take only one meal in the day, and they have arranged it so accordingly; whilst others, for the same reason, also take dinner, and this they do because they find it good for them, and not like those persons who, for pleasure or from any casual circumstance, adopt the one or the other custom and to the bulk of mankind it is of little consequence which of these rules they observe, that is to say, whether they make it a practice to take one or two meals. But there are certain persons who cannot readily change their diet with impunity; and if they make any alteration in it for one day, or even for a part of a day, are greatly injured thereby. Such persons, provided they take dinner when it is not their wont, immediately become heavy and inactive, both in body and mind, and are weighed down with yawning, slumbering, and thirst; and if they take supper in addition, they are seized with flatulence, tormina, and diarrhea, and to many this has been the commencement of a serious disease, when they have merely taken twice in a day the same food which they have been in the custom of taking once. And thus, also, if one who has been accustomed to dine, and this rule agrees with him, should not dine at the accustomed hour, he will straightway feel great loss of strength, trembling, and want of spirits, the eyes of such a person will become more pallid, his urine thick and hot, his mouth bitter; his bowels will seem, as it were, to hang loose; he will suffer from vertigo, lowness of spirit, and inactivity,- such are the effects; and if he should attempt to take at supper the same food which he was wont to partake of at dinner, it will appear insipid, and he will not be able to take it off; and these things, passing downwards with tormina and rumbling, burn up his bowels; he experiences insomnolency or troubled and disturbed dreams; and to many of them these symptoms are the commencement of some disease.

11. But let us inquire what are the causes of these things which happened to them. To him, then, who was accustomed to take only one meal in the day, they happened because he did not wait the proper time, until his bowels had completely derived benefit from and had digested the articles taken at the preceding meal, and until his belly had become soft, and got into a state of rest, but he gave it a new supply while in a state of heat and fermentation, for such bellies digest much more slowly, and require more rest and ease. And as to him who had been accustomed to dinner, since, as soon as the body required food, and when the former meal was consumed, and he wanted refreshment, no new supply was furnished to it, he wastes and is consumed from want of food. For all the symptoms which I describe as befalling to this man I refer to want of food. And I also say that all men who, when in a state of health, remain for two or three days without food, experience the same unpleasant symptoms as those which I described in the case of him who had omitted to take dinner.

12. Wherefore, I say, that such constitutions as suffer quickly and strongly from errors in diet, are weaker than others that do not; and that a weak person is in a state very nearly approaching to one in disease; but a person in disease is the weaker, and it is, therefore, more likely that he should suffer if he encounters anything that is unseasonable. It is difficult, seeing that there is no such accuracy in the Art, to hit always upon what is most expedient, and yet many cases occur in medicine which would require this accuracy, as we shall explain. But on that account, I say, we ought not to reject the ancient Art, as if it were not, and had not been properly founded, because it did not attain accuracy in all things, but rather, since it is capable of reaching to the greatest exactitude by reasoning, to receive it and admire its discoveries, made from a state of great ignorance, and as having been well and properly made, and not from chance.

13. But I wish the discourse to revert to the new method of those who prosecute their inquiries in the Art by hypothesis. For if hot, or cold, or moist, or dry, be that which proves injurious to man, and if the person who would treat him properly must apply cold to the hot, hot to the cold, moist to the dry, and dry to the moist- let me be presented with a man, not indeed one of a strong constitution, but one of the weaker, and let him eat wheat, such as it is supplied from the thrashing-floor, raw and unprepared, with raw meat, and let him drink water. By using such a diet I know that he will suffer much and severely, for he will experience pains, his body will become weak, and his bowels deranged, and he will not subsist long. What remedy, then, is to be provided for one so situated? Hot? or cold? or moist? or dry? For it is clear that it must be one or other of these. For, according to this principle, if it is one of the which is injuring the patient, it is to be removed by its contrary. But the surest and most obvious remedy is to change the diet which the person used, and instead of wheat to give bread, and instead of raw flesh, boiled, and to drink wine in addition to these; for by making these changes it is impossible but that he must get better, unless completely disorganized by time and diet. What, then, shall we say? whether that, as he suffered from cold, these hot things being applied were of use to him, or the contrary? I should think this question must prove a puzzler to whomsoever it is put. For whether did he who prepared bread out of wheat remove the hot, the cold, the moist, or the dry principle in it?- for the bread is consigned both to fire and to water, and is wrought with many things, each of which has its peculiar property and nature, some of which it loses, and with others it is diluted and mixed.

14. And this I know, moreover, that to the human body it makes a great difference whether the bread be fine or coarse; of wheat with or without the hull, whether mixed with much or little water, strongly wrought or scarcely at all, baked or raw- and a multitude of similar differences; and so, in like manner, with the cake (maza); the powers of each, too, are great, and the one nowise like the other. Whoever pays no attention to these things, or, paying attention, does not comprehend them, how can he understand the diseases which befall a man? For, by every one of these things, a man is affected and changed this way or that, and the whole of his life is subjected to them, whether in health, convalescence, or disease. Nothing else, then, can be more important or more necessary to know than these things. So that the first inventors, pursuing their investigations properly, and by a suitable train of reasoning, according to the nature of man, made their discoveries, and thought the Art worthy of being ascribed to a god, as is the established belief. For they did not suppose that the dry or the moist, the hot or the cold, or any of these are either injurious to man, or that man stands in need of them, but whatever in each was strong, and more than a match for a man’s constitution, whatever he could not manage, that they held to be hurtful, and sought to remove. Now, of the sweet, the strongest is that which is intensely sweet; of the bitter, that which is intensely bitter; of the acid, that which is intensely acid; and of all things that which is extreme, for these things they saw both existing in man, and proving injurious to him. For there is in man the bitter and the salt, the sweet and the acid, the sour and the insipid, and a multitude of other things having all sorts of powers both as regards quantity and strength. These, when all mixed and mingled up with one another, are not apparent, neither do they hurt a man; but when any of them is separate, and stands by itself, then it becomes perceptible, and hurts a man. And thus, of articles of food, those which are unsuitable and hurtful to man when administered, every one is either bitter, or intensely so, or saltish or acid, or something else intense and strong, and therefore we are disordered by them in like manner as we are by the secretions in the body. But all those things which a man eats and drinks are devoid of any such intense and well-marked quality, such as bread, cake, and many other things of a similar nature which man is accustomed to use for food, with the exception of condiments and confectioneries, which are made to gratify the palate and for luxury. And from those things, when received into the body abundantly, there is no disorder nor dissolution of the powers belonging to the body; but strength, growth, and nourishment result from them, and this for no other reason than because they are well mixed, have nothing in them of an immoderate character, nor anything strong, but the whole forms one simple and not strong substance.

15. I cannot think in what manner they who advance this doctrine, and transfer Art from the cause I have described to hypothesis, will cure men according to the principle which they have laid down. For, as far as I know, neither the hot nor the cold, nor the dry, nor the moist, has ever been found unmixed with any other quality; but I suppose they use the same articles of meat and drink as all we other men do. But to this substance they give the attribute of being hot, to that cold, to that dry, and to that moist. Since it would be absurd to advise the patient to take something hot, for he would straightway ask what it is? so that he must either play the fool, or have recourse to some one of the well known substances; and if this hot thing happen to be sour, and that hot thing insipid, and this hot thing has the power of raising a disturbance in the body (and there are many other kinds of heat, possessing many opposite powers), he will be obliged to administer some one of them, either the hot and the sour, or the hot and the insipid, or that which, at the same time, is cold and sour (for there is such a substance), or the cold and the insipid. For, as I think, the very opposite effects will result from either of these, not only in man, but also in a bladder, a vessel of wood, and in many other things possessed of far less sensibility than man; for it is not the heat which is possessed of great efficacy, but the sour and the insipid, and other qualities as described by me, both in man and out of man, and that whether eaten or drunk, rubbed in externally, and otherwise applied.

16. But I think that of all the qualities heat and cold exercise the least operation in the body, for these reasons: as long time as hot and cold are mixed up with one another they do not give trouble, for the cold is attempered and rendered more moderate by the hot, and the hot by the cold; but when the one is wholly separate from the other, then it gives pain; and at that season when cold is applied it creates some pain to a man, but quickly, for that very reason, heat spontaneously arises in him without requiring any aid or preparation. And these things operate thus both upon men in health and in disease. For example, if a person in health wishes to cool his body during winter, and bathes either in cold water or in any other way, the more he does this, unless his body be fairly congealed, when he resumes his clothes and comes into a place of shelter, his body becomes more heated than before. And thus, too, if a person wish to be warmed thoroughly either by means of a hot bath or strong fire, and straight-way having the same clothing on, takes up his abode again in the place he was in when he became congealed, he will appear much colder, and more disposed to chills than before. And if a person fan himself on account of a suffocating heat, and having procured refrigeration for himself in this manner, cease doing so, the heat and suffocation will be ten times greater in his case than in that of a person who does nothing of the kind. And, to give a more striking example, persons travelling in the snow, or otherwise in rigorous weather, and contracting great cold in their feet, their hands, or their head, what do they not suffer from inflammation and tingling when they put on warm clothing and get into a hot place? In some instances, blisters arise as if from burning with fire, and they do not suffer from any of those unpleasant symptoms until they become heated. So readily does either of these pass into the other; and I could mention many other examples. And with regard to the sick, is it not in those who experience a rigor that the most acute fever is apt to break out? And yet not so strongly neither, but that it ceases in a short time, and, for the most part, without having occasioned much mischief; and while it remains, it is hot, and passing over the whole body, ends for the most part in the feet, where the chills and cold were most intense and lasted longest; and, when sweat supervenes, and the fever passes off, the patient is much colder than if he had not taken the fever at all. Why then should that which so quickly passes into the opposite extreme, and loses its own powers spontaneously, be reckoned a mighty and serious affair? And what necessity is there for any great remedy for it?

17. One might here say- but persons in ardent fevers, pneumonia, and other formidable diseases, do not quickly get rid of the heat, nor experience these rapid alterations of heat and cold. And I reckon this very circumstance the strongest proof that it is not from heat simply that men get into the febrile state, neither is it the sole cause of the mischief, but that this species of heat is bitter, and that acid, and the other saltish, and many other varieties; and again there is cold combined with other qualities. These are what proves injurious; heat, it is true, is present also, possessed of strength as being that which conducts, is exacerbated and increased along with the other, but has no power greater than what is peculiar to itself.

18. With regard to these symptoms, in the first place those are most obvious of which we have all often had experience. Thus, then, in such of us as have a coryza and defluxion from the nostrils, this discharge is much more acrid than that which formerly was formed in and ran from them daily; and it occasions swelling of the nose, and it inflames, being of a hot and extremely ardent nature, as you may know, if you apply your hand to the place; and, if the disease remains long, the part becomes ulcerated although destitute of flesh and hard; and the heat in the nose ceases, not when the defluxion takes place and the inflammation is present, but when the running becomes thicker and less acrid, and more mixed with the former secretion, then it is that the heat ceases. But in all those cases in which this decidedly proceeds from cold alone, without the concourse of any other quality, there is a change from cold to hot, and from hot to cold, and these quickly supervene, and require no coction. But all the others being connected, as I have said, with acrimony and intemperance of humors, pass off in this way by being mixed and concocted.

19. But such defluxions as are determined to the eyes being possessed of strong and varied acrimonies, ulcerate the eyelids, and in some cases corrode the and parts below the eyes upon which they flow, and even occasion rupture and erosion of the tunic which surrounds the eyeball. But pain, heat, and extreme burning prevail until the defluxions are concocted and become thicker, and concretions form about the eyes, and the coction takes place from the fluids being mixed up, diluted, and digested together. And in defluxions upon the throat, from which are formed hoarseness, cynanche, crysipelas, and pneumonia, all these have at first saltish, watery, and acrid discharges, and with these the diseases gain strength. But when the discharges become thicker, more concocted, and are freed from all acrimony, then, indeed, the fevers pass away, and the other symptoms which annoyed the patient; for we must account those things the cause of each complaint, which, being present in a certain fashion, the complaint exists, but it ceases when they change to another combination. But those which originate from pure heat or cold, and do not participate in any other quality, will then cease when they undergo a change from cold to hot, and from hot to cold; and they change in the manner I have described before. Wherefore, all the other complaints to which man is subject arise from powers (qualities?). Thus, when there is an overflow of the bitter principle, which we call yellow bile, what anxiety, burning heat, and loss of strength prevail! but if relieved from it, either by being purged spontaneously, or by means of a medicine seasonably administered, the patient is decidedly relieved of the pains and heat; but while these things float on the stomach, unconcocted and undigested, no contrivance could make the pains and fever cease; and when there are acidities of an acrid and aeruginous character, what varieties of frenzy, gnawing pains in the bowels and chest, and inquietude, prevail! and these do not cease until the acidities be purged away, or are calmed down and mixed with other fluids. The coction, change, attenuation, and thickening into the form of humors, take place through many and various forms; therefore the crises and calculations of time are of great importance in such matters; but to all such changes hot and cold are but little exposed, for these are neither liable to putrefaction nor thickening. What then shall we say of the change? that it is a combination (crasis) of these humors having different powers toward one another. But the hot does not loose its heat when mixed with any other thing except the cold; nor again, the cold, except when mixed with the hot. But all other things connected with man become the more mild and better in proportion as they are mixed with the more things besides. But a man is in the best possible state when they are concocted and at rest, exhibiting no one peculiar quality; but I think I have said enough in explanation of them.

20. Certain sophists and physicians say that it is not possible for any one to know medicine who does not know what man is [and how he was made and how constructed], and that whoever would cure men properly, must learn this in the first place. But this saying rather appertains to philosophy, as Empedocles and certain others have described what man in his origin is, and how he first was made and constructed. But I think whatever such has been said or written by sophist or physician concerning nature has less connection with the art of medicine than with the art of painting. And I think that one cannot know anything certain respecting nature from any other quarter than from medicine; and that this knowledge is to be attained when one comprehends the whole subject of medicine properly, but not until then; and I say that this history shows what man is, by what causes he was made, and other things accurately. Wherefore it appears to me necessary to every physician to be skilled in nature, and strive to know, if he would wish to perform his duties, what man is in relation to the articles of food and drink, and to his other occupations, and what are the effects of each of them to every one. And it is not enough to know simply that cheese is a bad article of food, as disagreeing with whoever eats of it to satiety, but what sort of disturbance it creates, and wherefore, and with what principle in man it disagrees; for there are many other articles of food and drink naturally bad which affect man in a different manner. Thus, to illustrate my meaning by an example, undiluted wine drunk in large quantity renders a man feeble; and everybody seeing this knows that such is the power of wine, and the cause thereof; and we know, moreover, on what parts of a man’s body it principally exerts its action; and I wish the same certainty to appear in other cases. For cheese (since we used it as an example) does not prove equally injurious to all men, for there are some who can take it to satiety without being hurt by it in the least, but, on the contrary, it is wonderful what strength it imparts to those it agrees with; but there are some who do not bear it well, their constitutions are different, and they differ in this respect, that what in their body is incompatible with cheese, is roused and put in commotion by such a thing; and those in whose bodies such a humor happens to prevail in greater quantity and intensity, are likely to suffer the more from it. But if the thing had been pernicious to of man, it would have hurt all. Whoever knows these things will not suffer from it.

21. During convalescence from diseases, and also in protracted diseases, many disorders occur, some spontaneously, and some from certain things accidentally administered. I know that the common herd of physicians, like the vulgar, if there happen to have been any innovation made about that day, such as the bath being used, a walk taken, or any unusual food eaten, all which were better done than otherwise, attribute notwithstanding the cause of these disorders, to some of these things, being ignorant of the true cause but proscribing what may have been very proper. Now this ought not to be so; but one should know the effects of a bath or a walk unseasonably applied; for thus there will never be any mischief from these things, nor from any other thing, nor from repletion, nor from such and such an article of food. Whoever does not know what effect these things produce upon a man, cannot know the consequences which result from them, nor how to apply them.

22. And it appears to me that one ought also to know what diseases arise in man from the powers, and what from the structures. What do I mean by this? By powers, I mean intense and strong juices; and by structures, whatever conformations there are in man. For some are hollow, and from broad contracted into narrow; some expanded, some hard and round, some broad and suspended, some stretched, some long, some dense, some rare and succulent, some spongy and of loose texture. Now, then, which of these figures is the best calculated to suck to itself and attract humidity from another body? Whether what is hollow and expanded, or what is solid and round, or what is hollow, and from broad, gradually turning narrow? I think such as from hollow and broad are contracted into narrow: this may be ascertained otherwise from obvious facts: thus, if you gape wide with the mouth you cannot draw in any liquid; but by protruding, contracting, and compressing the lips, and still more by using a tube, you can readily draw in whatever you wish. And thus, too, the instruments which are used for cupping are broad below and gradually become narrow, and are so con-structed in order to suck and draw in from the fleshy parts. The nature and construction of the parts within a man are of a like nature; the bladder, the head, the uterus in woman; these parts clearly attract, and are always filled with a juice which is foreign to them. Those parts which are hollow and expanded are most likely to receive any humidity flowing into them, but cannot attract it in like manner. Those parts which are solid and round could not attract a humidity, nor receive it when it flows to them, for it would glide past, and find no place of rest on them. But spongy and rare parts, such as the spleen, the lungs, and the breasts, drink up especially the juices around them, and become hardened and enlarged by the accession of juices. Such things happen to these organs especially. For it is not with the spleen as with the stomach, in which there is a liquid, which it contains and evacuates every day; but when it (the spleen) drinks up and receives a fluid into itself, the hollow and lax parts of it are filled, even the small interstices; and, instead of being rare and soft, it becomes hard and dense, and it can neither digest nor discharge its contents: these things it suffers, owing to the nature of its structure. Those things which engender flatulence or tormina in the body, naturally do so in the hollow and broad parts of the body, such as the stomach and chest, where they produce rumbling noises; for when they do not fill the parts so as to be stationary, but have changes of place and movements, there must necessarily be noise and apparent movements from them. But such parts as are fleshy and soft, in these there occur torpor and obstructions, such as happen in apoplexy. But when it (the flatus?) encounters a broad and resisting structure, and rushes against such a part, and this happens when it is by nature not strong so as to be able to withstand it without suffering injury; nor soft and rare, so as to receive or yield to it, but tender, juicy, full of blood, and dense, like the liver, owing to its density and broadness, it resists and does not yield. But flatus, when it obtains admission, increases and becomes stronger, and rushes toward any resisting object; but owing to its tenderness, and the quantity of blood which it (the liver) contains, it cannot be without uneasiness; and for these reasons the most acute and frequent pains occur in the region of it, along with suppurations and chronic tumors (phymata). These symptoms also occur in the site of the diaphragm, but much less frequently; for the diaphragm is a broad, expanded, and resisting substance, of a nervous (tendinous?) and strong nature, and therefore less susceptible of pain; and yet pains and chronic abscesses do occur about it.

23. There are both within and without the body many other kinds of structure, which differ much from one another as to sufferings both in health and disease; such as whether the head be small or large; the neck slender or thick, long or short; the belly long or round; the chest and ribs broad or narrow; and many others besides, all which you ought to be acquainted with, and their differences; so that knowing the causes of each, you may make the more accurate observations.

24. And, as has been formerly stated, one ought to be acquainted with the powers of juices, and what action each of them has upon man, and their alliances towards one another. What I say is this: if a sweet juice change to another kind, not from any admixture, but because it has undergone a mutation within itself; what does it first become?- bitter? salt? austere? or acid? I think acid. And hence, an acid juice is the most improper of all things that can be administered in cases in which a sweet juice is the most proper. Thus, if one should succeed in his investigations of external things, he would be the better able always to select the best; for that is best which is farthest removed from that which is unwholesome.

PROGNOSTICS

Translated by Charles Darwin Adams

1. It appears to me a most excellent thing for the physician to cultivate Prognosis; for by foreseeing and foretelling, in the presence of the sick, the present, the past, and the future, and explaining the omissions which patients have been guilty of, he will be the more readily believed to be acquainted with the circumstances of the sick; so that men will have confidence to intrust themselves to such a physician. And he will manage the cure best who has foreseen what is to happen from the present state of matters. For it is impossible to make all the sick well; this, indeed, would have been better than to be able to foretell what is going to happen; but since men die, some even before calling the physician, from the violence of the disease, and some die immediately after calling him, having lived, perhaps, only one day or a little longer, and before the physician could bring his art to counteract the disease; it therefore becomes necessary to know the nature of such affections, how far they are above the powers of the constitution; and, moreover, if there be anything divine in the diseases, and to learn a foreknowledge of this also. Thus a man will be the more esteemed to be a good physician, for he will be the better able to treat those aright who can be saved, having long anticipated everything; and by seeing and announcing beforehand those who will live and those who will die, he will thus escape censure.

2. He should observe thus in acute diseases: first, the countenance of the patient, if it be like those of persons in health, and more so, if like itself, for this is the best of all; whereas the most opposite to it is the worst, such as the following; a sharp nose, hollow eyes, collapsed temples; the ears cold, contracted, and their lobes turned out: the skin about the forehead being rough, distended, and parched; the color of the whole face being green, black, livid, or lead-colored. If the countenance be such at the commencement of the disease, and if this cannot be accounted for from the other symptoms, inquiry must be made whether the patient has long wanted sleep; whether his bowels have been very loose; and whether he has suffered from want of food; and if any of these causes be confessed to, the danger is to be reckoned so far less; and it becomes obvious, in the course of a day and a night, whether or not the appearance of the countenance proceeded from these causes. But if none of these be said to exist, if the symptoms do not subside in the aforesaid time, it is to be known for certain that death is at hand. And, also, if the disease be in a more advanced stage either on the third or fourth day, and the countenance be such, the same inquiries as formerly directed are to be made, and the other symptoms are to be noted, those in the whole countenance, those on the body, and those in the eyes; for if they shun the light, or weep involuntarily, or squint, or if the one be less than the other, or if the white of them be red, livid, or has black veins in it; if there be a gum upon the eyes, if they are restless, protruding, or are become very hollow; and if the countenance be squalid and dark, or the color of the whole face be changed- all these are to be reckoned bad and fatal symptoms. The physician should also observe the appearance of the eyes from below the eyelids in sleep; for when a portion of the white appears, owing to the eyelids not being closed together, and when this is not connected with diarrhea or purgation from medicine, or when the patient does not sleep thus from habit, it is to be reckoned an unfavorable and very deadly symptom; but if the eyelid be contracted, livid, or pale, or also the lip, or nose, along with some of the other symptoms, one may know for certain that death is close at hand. It is a mortal symptom, also, when the lips are relaxed, pendent, cold, and blanched.

3. It is well when the patient is found by his physician reclining upon either his right or his left side, having his hands, neck, and legs slightly bent, and the whole body lying in a relaxed state, for thus the most of persons in health recline, and these are the best of postures which most resemble those of healthy persons. But to lie upon one’s back, with the hands, neck, and the legs extended, is far less favorable. And if the patient incline forward, and sink down to the foot of the bed, it is a still more dangerous symptom; but if he be found with his feet naked and not sufficiently warm, and the hands, neck, and legs tossed about in a disorderly manner and naked, it is bad, for it indicates aberration of intellect. It is a deadly symptom, also, when the patient sleeps constantly with his mouth open, having his legs strongly bent and plaited together, while he lies upon his back; and to lie upon one’s belly, when not habitual to the patient to sleep thus while in good health, indicates delirium, or pain in the abdominal regions. And for the patient to wish to sit erect at the acme of a disease is a bad symptom in all acute diseases, but particularly so in pneumonia. To grind the teeth in fevers, when such has not been the custom of the patient from childhood, indicates madness and death, both which dangers are to be announced beforehand as likely to happen; and if a person in delirium do this it is a very deadly symptom. And if the patient had an ulcer previously, or if one has occurred in the course of the disease, it is to be observed; for if the man be about to die the sore will become livid and dry, or yellow and dry before death.

4. Respecting the movement of the hands I have these observations to make: When in acute fevers, pneumonia, phrenitis, or headache, the hands are waved before the face, hunting through empty space, as if gathering bits of straw, picking the nap from the coverlet, or tearing chaff from the wall- all such symptoms are bad and deadly.

5. Respiration, when frequent, indicates pain or inflanunation in the parts above the diaphragm: a large respiration performed at a great interval announces delirium; but a cold respiration at nose or mouth is a very fatal symptom. Free respiration is to be looked upon as contributing much to the safety of the patient in all acute diseases, such as fevers, and those complaints which come to a crisis in forty days.

6. Those sweats are the best in all acute diseases which occur on the critical days, and completely carry off the fever. Those are favorable, too, which taking place over the whole body, show that the man is bearing the disease better. But those that do not produce this effect are not beneficial. The worst are cold sweats, confined to the head, face, and neck; these in an acute fever prognosticate death, or in a milder one, a prolongation of the disease; and sweats which occur over the whole body, with the characters of those confined to the neck, are in like manner bad. Sweats attended with a miliary eruption, and taking place about the neck, are bad; sweats in the form of drops and of vapour are good. One ought to know the entire character of sweats, for some are connected with prostration of strength in the body, and some with intensity of the inflammation.

7. That state of the hypochondrium is best when it is free from pain, soft, and of equal size on the right side and the left. But if inflamed, or painful, or distended; or when the right and left sides are of disproportionate sizes;- all these appearances are to be dreaded. And if there be also pulsation in the hypochondrium, it indicates perturbation or delirium; and the physician should examine the eyes of such persons; for if their pupils be in rapid motion, such persons may be expected to go mad. A swelling in the hypochondrium, that is hard and painful, is very bad, provided it occupy the whole hypochondrium; but if it be on either side, it is less dangerous when on the left. Such swellings at the commencement of the disease prognosticate speedy death; but if the fever has passed twenty days, and the swelling has not subsided, it turns to a suppuration. A discharge of blood from the nose occurs to such in the first period, and proves very useful; but inquiry should be made if they have headache or indistinct vision; for if there be such, the disease will be determined thither. The discharge of blood is rather to be expected in those who are younger than thirty-five years. Such swellings as are soft, free from pain, and yield to the finger, occasion more protracted crises, and are less dangerous than the others. But if the fever continue beyond sixty days, without any subsidence of the swelling, it indicates that empyema is about to take place; and a swelling in any other part of the cavity will terminate in like manner. Such, then, as are painful, hard, and large, indicate danger of speedy death; but such as are soft, free of pain, and yield when pressed with the finger, are more chronic than these. Swellings in the belly less frequently form abscesses than those in the hypochondrium; and seldomest of all, those below the navel are converted into suppuration; but you may rather expect a hemorrhage from the upper parts. But the suppuration of all protracted swellings about these parts is to be anticipated. The collections of matter there are to be thus judged of: such as are determined outwards are the best when they are small, when they protrude very much, and swell to a point; such as are large and broad, and which do not swell out to a sharp point, are the worst. Of such as break internally, the best are those which have no external communication, but are covered and indolent; and when the whole place is free from discoloration. That pus is best which is white, homogeneous, smooth, and not at all fetid; the contrary to this is the worst.

8. All dropsies arising from acute diseases are bad; for they do not remove the fever, and are very painful and fatal. The most of them commence from the flanks and loins, but some from the liver; in those which derive their origin from the flanks and loins the feet swell, protracted diarrhoeas supervene, which neither remove the pains in the flanks and loins, nor soften the belly, but in dropsies which are connected with the liver there is a tickling cough, with scarcely any perceptible expectoration, and the feet swell; there are no evacuations from the bowels, unless such as are hard and forced; and there are swellings about the belly, sometimes on the one side and sometimes on the other, and these increase and diminish by turns.

9. It is a bad symptom when the head, hands, and feet are cold, while the belly and sides are hot; but it is a very good symptom when the whole body is equally hot. The patient ought to be able to turn round easily, and to be agile when raised up; but if he appear heavy in the rest of his body as well as in his hands and feet, it is more dangerous; and if, in addition to the weight, his nails and fingers become livid, immediate death may be anticipated; and if the hands and feet be black it is less dangerous than if they be livid, but the other symptoms must be attended, to; for if he appear to bear the illness well, and if certain of the salutary symptoms appear along with these there may be hope that the disease will turn to a deposition, so that the man may recover; but the blackened parts of the body will drop off. When the testicles and members are retracted upwards, they indicate strong pains and danger of death.

10. With regard to sleep- as is usual with us in health, the patient should wake during the day and sleep during the night. If this rule be anywise altered it is so far worse: but there will be little harm provided he sleep in the morning for the third part of the day; such sleep as takes place after this time is more unfavorable; but the worst of all is to get no sleep either night or day; for it follows from this symptom that the insomnolency is connected with sorrow and pains, or that he is about to become delirious.

11. The excrement is best which is soft and consistent, is passed at the hour which was customary to the patient when in health, in quantity proportionate to the ingests; for when the passages are such, the lower belly is in a healthy state. But if the discharges be fluid, it is favorable that they are not accompanied with a noise, nor are frequent, nor in great quantity; for the man being oppressed by frequently getting up, must be deprived of sleep; and if the evacuations be both frequent and large, there is danger of his falling into deliquium animi. But in proportion to the ingesta he should have evacuations twice or thrice in the day, once at night and more copiously in the morning, as is customary with a person in health. The faeces should become thicker when the disease is tending to a crisis; they ought to be yellowish and not very fetid. It is favorable that round worms be passed with the discharges when the disease is tending to a crisis. The belly, too, through the whole disease, should be soft and moderately distended; but excrements that are very watery, or white, or green, or very red, or frothy, are all bad. It is also bad when the discharge is small, and viscid, and white, and greenish, and smooth; but still more deadly appearances are the black, or fatty, or livid, or verdigris-green, or fetid. Such as are of varied characters indicate greater duration of the complaint, but are no less dangerous; such as those which resemble scrapings, those which are bilious, those resembling leeks, and the black; these being sometimes passed together, and sometimes singly. It is best when wind passes without noise, but it is better that flatulence should pass even thus than that it should be retained; and when it does pass thus, it indicates either that the man is in pain or in delirium, unless he gives vent to the wind spontaneously. Pains in the hypochondria, and swellings, if recent, and not accompanied with inflammation, are relieved by borborygmi supervening in the hypochondrium, more especially if it pass off with faeces, urine, and wind; but even although not, it will do good by passing along, and it also does good by descending to the lower part of the belly.

12. The urine is best when the sediment is white, smooth, and consistent during the whole time, until the disease come to a crisis, for it indicates freedom from danger, and an illness of short duration; but if deficient, and if it be sometimes passed clear, and sometimes with a white and smooth sediment, the disease will be more protracted, and not so void of danger. But if the urine be reddish, and the sediment consistent and smooth, the affection, in this case, will be more protracted than the former, but still not fatal. But farinaceous sediments in the urine are bad, and still worse are the leafy; the white and thin are very bad, but the furfuraceous are still worse than these. Clouds carried about in the urine are good when white, but bad if black. When the urine is yellow and thin, it indicates that the disease is unconcocted; and if it (the disease) should be protracted, there maybe danger lest the patient should not hold out until the urine be concocted. But the most deadly of all kinds of urine are the fetid, watery, black, and thick; in adult men and women the black is of all kinds of urine the worst, but in children, the watery. In those who pass thin and crude urine for a length of time, if they have otherwise symptoms of convalescence, an abscess may be expected to form in the parts below the diaphragm. And fatty substances floating on the surface are to be dreaded, for they are indications of melting. And one should consider respecting the kinds of urine, which have clouds, whether they tend upwards or downwards, and upwards or downwards, and the colors which they have and such as fall downwards, with the colors as described, are to be reckoned good and commended; but such as are carried upwards, with the colors as described, are to be held as bad, and are to be distrusted. But you must not allow yourself to be deceived if such urine be passed while the bladder is diseased; for then it is a symptom of the state, not of the general system, but of a particular viscus.

13. That vomiting is of most service which consists of phlegm and bile mixed together, and neither very thick nor in great quantity; but those vomitings which are more unmixed are worse. But if that which is vomited be of the color of leeks or livid, or black, whatever of these colors it be, it is to be reckoned bad; but if the same man vomit all these colors, it is to be reckoned a very fatal symptom. But of all the vomitings, the livid indicates the danger of death, provided it be of a fetid smell. But all the smells which are somewhat putrid and fetid, are bad in all vomitings.

14. The expectoration in all pains about the lungs and sides, should be quickly and easily brought up, and a certain degree of yellowness should appear strongly mixed up with the sputum. But if brought up long after the commencement of the pain, and of a yellow or ruddy color, or if it occasions much cough, or be not strongly mixed, it is worse; for that which is intensely yellow is dangerous, but the white, and viscid, and round, do no good. But that which is very green and frothy is bad; but if so intense as to appear black, it is still more dangerous than these; it is bad, if nothing is expectorated, and the lungs discharge nothing, but are gorged with matters which boil (as it were) in the air-passages. It is bad when coryza and sneezing either precede or follow affections of the lungs, but in all other affections, even the most deadly, sneezing is a salutary symptom. A yellow spittle mixed up with not much blood in cases of pneumonia, is salutary and very beneficial if spit up at the commencement of the disease, but if on the seventh day, or still later, it is less favorable. And all sputa are bad which do not remove the pain. But the worst is the black, as has been described. Of all others the sputa which remove the pain are the best.

15. When the pains in these regions do not cease, either with the discharge of the sputa, nor with alvine evacuations, nor from venesection, purging with medicine, nor a suitable regimen, it is to be held that they will terminate in suppurations. Of empyemata such as are spit up while the sputum is still bilious, are very fatal, whether the bilious portion be expectorated separate, or along with the other; but more especially if the empyema begin to advance after this sputum on the seventh day of the disease. It is to be expected that a person with such an expectoration shall die on the fourteenth day, unless something favorable supervene. The following are favorable symptoms: to support the disease easily, to have free respiration, to be free from pain, to have the sputa readily brought up, the whole body to appear equally warm and soft, to have no thirst, the urine, and faeces, sleep, and sweats to be all favorable, as described before; when all these symptoms concur, the patient certainly will not die; but if some of these be present and some not, he will not survive longer than the fourteenth day. The bad symptoms are the opposite of these, namely, to bear the disease with difficulty, respiration large and dense, the pain not ceasing, the sputum scarcely coughed up, strong thirst, to have the body unequally affected by the febrile heat, the belly and sides intensely hot, the forehead, hands, and feet cold; the urine, and excrements, the sleep, and sweats, all bad, agreeably to the characters described above; if such a combination of symptoms accompany the expectoration, the man will certainly die before the fourteenth day, and either on the ninth or eleventh. Thus then one may conclude regarding this expectoration, that it is very deadly, and that the patient will not survive until the fourteenth day. It is by balancing the concomitant symptoms whether good or bad, that one is to form a prognosis; for thus it will most probably prove to be a true one. Most other suppurations burst, some on the twentieth, some on the thirtieth, some on the fortieth, and some as late as the sixtieth day.

16. One should estimate when the commencement of the suppuration will take place, by calculating from the day on which the patient was first seized with fever, or if he had a rigor, and if he says, that there is a weight in the place where he had pain formerly, for these symptoms occur in the commencement of suppurations. One then may expect the rupture of the abscesses to take place from these times according to the periods formerly stated. But if the empyema be only on either side, one should turn him and inquire if he has pain on the other side; and if the one side be hotter than the other, and when laid upon the sound side, one should inquire if he has the feeling of a weight hanging from above, for if so, the empyema will be upon the opposite side to that on which the weight was felt.

17. Empyema may be recognized in all cases by the following symptoms: In the first place, the fever does not go off, but is slight during the day, and increases at night, and copious sweats supervene, there is a desire to cough, and the patients expectorate nothing worth mentioning, the eyes become hollow, the cheeks have red spots on them, the nails of the hands are bent, the fingers are hot especially their extremities, there are swellings in the feet, they have no desire of food, and small blisters (phlyctaenae) occur over the body. These symptoms attend chronic empyemata, and may be much trusted to; and such as are of short standing are indicated by the same, provided they be accompanied by those signs which occur at the commencement, and if at the same time the patient has some difficulty of breathing. Whether they will break earlier or later may be determined by these symptoms; if there be pain at the commencement, and if the dyspnoea, cough, and ptyalism be severe, the rupture may be expected in the course of twenty days or still earlier; but if the pain be more mild, and all the other symptoms in proportion, you may expect from these the rupture to be later; but pain, dyspnoea, and ptyalism, must take place before the rupture of the abscess. Those patients recover most readily whom the fever leaves the same day that the abscess bursts,- when they recover their appetite speedily, and are freed from the thirst,- when the alvine discharges are small and consistent, the matter white, smooth, uniform in color, and free of phlegm, and if brought up without pain or strong coughing. Those die whom the fever does not leave, or when appearing to leave them it returns with an exacerbation; when they have thirst, but no desire of food, and there are watery discharges from the bowels; when the expectoration is green or livid, or pituitous and frothy; if all these occur they die, but if certain of these symptoms supervene, and others not, some patients die and some recover, after a long interval. But from all the symptoms taken together one should form a judgment, and so in all other cases.

18. When abscesses form about the ears, after peripneumonic affections, or depositions of matter take place in the inferior extremities and end in fistula, such persons recover. The following observations are to be made upon them: if the fever persist, and the pain do not cease, if the expectoration be not normal, and if the alvine discharges be neither bilious, nor free and unmixed; and if the urine be neither copious nor have its proper sediment, but if, on the other hand, all the other salutary symptoms be present, in such cases abscesses may be expected to take place. They form in the inferior parts when there is a collection of phlegm about the hypochondria; and in the upper when the hypochondria continue soft and free of pain, and when dyspnoea having been present for a certain time, ceases without any obvious cause. All deposits which take place in the legs after severe and dangerous attacks of pneumonia, are salutary, but the best are those which occur at the time when the sputa undergo a change; for if the swelling and pain take place while the sputa are changing from yellow and becoming of a purulent character, and are expectorated freely, under these circumstances the man will recover most favorably and the abscess becoming free of pain, will soon cease; but if the expectoration is not free, and the urine does not appear to have the proper sediment, there is danger lest the limb should be maimed, or that the case otherwise should give trouble. But if the abscesses disappear and go back, while expectoration does not take place, and fever prevails, it is a bad symptom; for there is danger that the man may get into a state of delirium and die. Of persons having empyema after peripneumonic affections, those that are advanced in life run the greatest risk of dying; but in the other kinds of empyema younger persons rather die. In cases of empyema treated by the cautery or incision, when the matter is pure, white, and not fetid, the patient recovers; but if of a bloody and dirty character, he dies.

19. Pains accompanied with fever which occur about the loins and lower parts, if they attack the diaphragm, and leave the parts below, are very fatal. Wherefore one ought to pay attention to the other symptoms, since if any unfavorable one supervene, the case is hopeless; but if while the disease is determined to the diaphragm, the other symptoms are not bad, there is great reason to expect that it will end in empyema. When the bladder is hard and painful, it is an extremely bad and mortal symptom, more especially in cases attended with continued fever; for the pains proceeding from the bladder alone are to kill the patient; and at such a time the bowels are not moved, or the discharges are hard and forced. But urine of a purulent character, and having a white and smooth sediment, relieves the patient. But if no amendment takes place in the characters of the urine, nor the bladder become soft, and the fever is of the continual type, it may be expected that the patient will die in the first stages of the complaint. This form attacks children more especially, from their seventh to their fifteenth year.

20. Fevers come to a crisis on the same days as to number on which men recover and die. For the mildest class of fevers, and those originating with the most favorable symptoms, cease on the fourth day or earlier; and the most malignant, and those setting in with the most dangerous symptoms, prove fatal on the fourth day or earlier. The first class of them as to violence ends thus: the second is protracted to the seventh day, the third to the eleventh, the fourth to the fourteenth, the fifth to the seventeenth, and the sixth to the twentieth. Thus these periods from the most acute disease ascend by fours up to twenty. But none of these can be truly calculated by whole days, for neither the year nor the months can be numbered by entire days. After these in the same manner, according to the same progression, the first period is of thirty-four days, the second of forty days, and the third of sixty days. In the commencement of these it is very difficult to determine those which will come to a crisis after a long interval; for these beginnings are very similar, but one should pay attention from the first day, and observe further at every additional tetrad, and then one cannot miss seeing how the disease will terminate. The constitution of quartans is agreeable to the same order. Those which will come to a crisis in the shortest space of time, are the easiest to be judged of; for the differences of them are greatest from the commencement, thus those who are going to recover breathe freely, and do not suffer pain, they sleep during the night, and have the other salutary symptoms, whereas those that are to die have difficult respiration, are delirious, troubled with insomnolency, and have other bad symptoms. Matters being thus, one may conjecture, according to the time, and each additional period of the diseases, as they proceed to a crisis. And in women, after parturition, the crises proceed agreeably to the same ratio.

21. Strong and continued headaches with fever, if any of the deadly symptoms be joined to them, are very fatal. But if without such symptoms the pain be prolonged beyond twenty days, a discharge of blood from the nose or some abscess in the inferior parts may be anticipated; but while the pain is recent, we may expect in like manner a discharge of blood from the nose, or a suppuration, especially if the pain be seated above the temples and forehead; but the hemorrhage is rather to be looked for in persons younger than thirty years, and the suppuration in more elderly persons.

22. Acute pain of the ear, with continual and strong fever, is to be dreaded; for there is danger that the man may become delirious and die. Since, then, this is a hazardous spot, one ought to pay particular attention to all these symptoms from the commencement. Younger persons die of this disease on the seventh day, or still earlier, but old persons much later; for the fevers and delirium less frequently supervene upon them, and on that account the ears previously come to a suppuration, but at these periods of life, relapses of the disease coming on generally prove fatal. Younger persons die before the ear suppurates; only if white matter run from the ear, there may be hope that a younger person will recover, provided any other favorable symptom be combined.

23. Ulceration of the throat with fever, is a serious affection, and if any other of the symptoms formerly described as being bad, be present, the physician ought to announce that his patient is in danger. Those quinsies are most dangerous, and most quickly prove fatal, which make no appearance in the fauces, nor in the neck, but occasion very great pain and difficulty of breathing; these induce suffocation on the first day, or on the second, the third, or the fourth. Such as, in like manner, are attended with pain, are swelled up, and have redness (erythema) in the throat, are indeed very fatal, but more protracted than the former, provided the redness be great. Those cases in which both the throat and the neck are red, are more protracted, and certain persons recover from them, especially if the neck and breast be affected with erythema, and the erysipelas be not determined inwardly. If neither the erysipelas disappear on the critical day, nor any abscess form outwardly, nor any pus be spit up, and if the patient fancy himself well, and be free from pain, death, or a relapse of the erythema is to be apprehended. It is much less hazardous when the swelling and redness are determined outwardly; but if determined to the lungs, they superinduce delirium, and frequently some of these cases terminate in empyema. It is very dangerous to cut off or scarify enlarged uvulae while they and red and large, for inflammations and hemorrhages supervene; but one should try to reduce such swellings by some other means at this season. When the whole of it is converted into an abscess, which is called Uva, or when the extremity of the variety called Columella is larger and round, but the upper part thinner, at this time it will be safe to operate. But it will be better to open the bowels gently before proceeding to the operation, if time will permit, and the patient be not in danger of being suffocated.

24. When the fevers cease without any symptoms of resolution occurring, and not on the critical days, in such cases a relapse may be anticipated. When any of the fevers is protracted, although the man exhibits symptoms of recovery, and there is no longer pain from any inflammation, nor from any other visible cause, in such a case a deposit, with swelling and pain, may be expected in some one of the joints, and not improbably in those below. Such deposits occur more readily and in less time to persons under thirty years of age; and one should immediately suspect the formation of such a deposit, if the fever be protracted beyond twenty days; but to aged persons these less seldom happen, and not until the fever be much longer protracted. Such a deposit may be expected, when the fever is of a continual type, and that it will pass into a quartan, if it become intermittent, and its paroxysms come on in an irregular manner, and if in this form it approach autumn. As deposits form most readily in persons below thirty years of age, so quartans most commonly occur to persons beyond that age. It is proper to know that deposits occur most readily in winter, that then they are most protracted, but are less given to return. Whoever, in a fever that is not of a fatal character, says that he has pain in his head, and that something dark appears to be before his eyes, and that he has pain at the stomach, will be seized with vomiting of bile; but if rigor also attack him, and the inferior parts of the hypochondrium are cold, vomiting is still nearer at hand; and if he eat or drink anything at such a season, it will be quickly vomited. In these cases, when the pain commences on the first day, they are particularly oppressed on the fourth and the fifth; and they are relieved on the seventh, but the greater part of them begin to have pain on the third day, and are most especially tossed on the fifth, but are relieved on the ninth or eleventh; but in those who begin to have pains on the fifth day, and other matters proceed properly with them, the disease comes to a crisis on the fourteenth day. But when in such a fever persons affected with headache, instead of having a dark appearance before their eyes, have dimness of vision, or flashes of light appear before their eyes, and instead of pain at the pit of the stomach, they have in their hypochondrium a fullness stretching either to the right or left side, without either pain or inflammation, a hemorrhage from the nose is to be expected in such a case, rather than a vomiting. But it is in young persons particularly that the hemorrhage is to be expected, for in persons beyond the age of thirty-five, vomitings are rather to be anticipated. Convulsions occur to children if acute fever be present, and the belly be they cannot sleep, are agitated, and moan, and change color, and become green, livid, or ruddy. These complaints occur most readily to children which are very young up to their seventh year; older children and adults are not equally liable to be seized with convulsions in fevers, unless some of the strongest and worst symptoms precede, such as those which occur in frenzy. One must judge of children as of others, which will die and which recover, from the whole of the symptoms, as they have been specially described. These things I say respecting acute diseases, and the affections which spring from them.

25. He who would correctly beforehand those that will recover, and those that will die, and in what cases the disease will be protracted for many days, and in what cases for a shorter time, must be able to form a judgment from having made himself acquainted with all the symptoms, and estimating their powers in comparison with one another, as has been described, with regard to the others, and the urine and sputa, as when the patient coughs up pus and bile together. One ought also to consider promptly the influx of epidemical diseases and the constitution of the season. One should likewise be well acquainted with the particular signs and the other symptoms, and not be ignorant how that, in every year, and at every season, bad symptoms prognosticate ill, and favorable symptoms good, since the aforesaid symptoms appear to have held true in Libya, in Delos, and in Scythia, from which it may be known that, in the same regions, there is no difficulty in attaining a knowledge of many more things than these; if having learned them, one knows also how to judge and reason correctly of them. But you should not complain because the name of any disease may happen not to be described here, for you may know all such as come to a crisis in the aforementioned times, by the same symptoms.

APHORISMS

Translated by Charles Darwin Adams

SECTION I.

1. Life is short, and Art long; the crisis fleeting; experience perilous, and decision difficult. The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants, and externals cooperate.

2. In disorders of the bowels and vomitings, occurring spontaneously, if the matters purged be such as ought to be purged, they do good, and are well borne; but if not, the contrary. And so artificial evacuations, if they consist of such matters as should be evacuated, do good, and are well borne; but if not, the contrary. One, then, ought to look to the country, the season, the age, and the diseases in which they are proper or not.

3. In the athletae, embonpoint, if carried to its utmost limit, is dangerous, for they cannot remain in the same state nor be stationary; and since, then, they can neither remain stationary nor improve, it only remains for them to get worse; for these reasons the embonpoint should be reduced without delay, that the body may again have a commencement of reparation. Neither should the evacuations, in their case, be carried to an extreme, for this also is dangerous, but only to such a point as the person’s constitution can endure. In like manner, medicinal evacuations, if carried to an extreme, are dangerous; and again, a restorative course, if in the extreme, is dangerous.

4. A slender restricted diet is always dangerous in chronic diseases, and also in acute diseases, where it is not requisite. And again, a diet brought to the extreme point of attenuation is dangerous; and repletion, when in the extreme, is also dangerous.

5. In a restricted diet, patients who transgress are thereby more hurt (than in any other?); for every such transgression, whatever it may be, is followed by greater consequences than in a diet somewhat more generous. On this account, a very slender, regulated, and restricted diet is dangerous to persons in health, because they bear transgressions of it more difficultly. For this reason, a slender and restricted diet is generally more dangerous than one a little more liberal.

6. For extreme diseases, extreme methods of cure, as to restriction, are most suitable.

7. When the disease is very acute, it is attended with extremely severe symptoms in its first stage; and therefore an extremely attenuating diet must be used. When this is not the case, but it is allowable to give a more generous diet, we may depart as far from the severity of regimen as the disease, by its mildness, is removed from the extreme.

8. When the disease is at its height, it will then be necessary to use the most slender diet.

9. We must form a particular judgment of the patient, whether he will support the diet until the acme of the disease, and whether he will sink previously and not support the diet, or the disease will give way previously, and become less acute.

10. In those cases, then, which attain their acme speedily, a restricted diet should be enjoined at first; but in those cases which reach their acme later, we must retrench at that period or a little before it; but previously we must allow a more generous diet to support the patient.

11. We must retrench during paroxysms, for to exhibit food would be injurious. And in all diseases having periodical paroxysms, we must restrict during the paroxysms.

12. The exacerbations and remissions will be indicated by the diseases, the seasons of the year, the reciprocation of the periods, whether they occur every day, every alternate day, or after a longer period, and by the supervening symptoms; as, for example, in pleuritic cases, expectoration, if it occur at the commencement, shortens the attack, but if it appear later, it prolongs the same; and in the same manner the urine, and alvine discharges, and sweats, according as they appear along with favorable or unfavorable symptoms, indicate diseases of a short or long duration.

13. Old persons endure fasting most easily; next, adults; young persons not nearly so well; and most especially infants, and of them such as are of a particularly lively spirit.

14. Growing bodies have the most innate heat; they therefore require the most food, for otherwise their bodies are wasted. In old persons the heat is feeble, and therefore they require little fuel, as it were, to the flame, for it would be extinguished by much. On this account, also, fevers in old persons are not equally acute, because their bodies are cold.

15. In winter and spring the bowels are naturally the hottest, and the sleep most prolonged; at these seasons, then, the most sustenance is to be administered; for as the belly has then most innate heat, it stands in need of most food. The well-known facts with regard to young persons and the athletae prove this.

16. A humid regimen is befitting in all febrile diseases, and particularly in children, and others accustomed to live on such a diet.

17. We must consider, also, in which cases food is to be given once or twice a day, and in greater or smaller quantities, and at intervals. Something must be conceded to habit, to season, to country, and to age.

18. Invalids bear food worst during summer and autumn, most easily in winter, and next in spring.

19. Neither give nor enjoin anything to persons during periodical paroxysms, but abstract from the accustomed allowance before the crisis.

20. When things are at the crisis, or when they have just passed it, neither move the bowels, nor make any innovation in the treatment, either as regards purgatives or any other such stimulants, but let things alone.

21. Those things which require to be evacuated should be evacuated, wherever they most tend, by the proper outlets.

22. We must purge and move such humors as are concocted, not such as are unconcocted, unless they are struggling to get out, which is mostly not the case.

23. The evacuations are to be judged of not by their quantity, but whether they be such as they should be, and how they are borne. And when proper to carry the evacuation to deliquium animi , this also should be done, provided the patient can support it.

24. Use purgative medicines sparingly in acute diseases, and at the commencement, and not without proper circumspection.

25. If the matters which are purged be such as should be purged, the evacuation is beneficial, and easily borne; but, not withstanding, if otherwise, with difficulty.

SECTION II

1. In whatever disease sleep is laborious, it is a deadly symptom; but if sleep does good, it is not deadly.

2. When sleep puts an end to delirium, it is a good symptom.

3. Both sleep and insomnolency, when immoderate, are bad.

4. Neither repletion, nor fasting, nor anything else, is good when more than natural.

5. Spontaneous lassitude indicates disease.

6. Persons who have a painful affection in any part of the body, and are in a great measure sensible of the pain, are disordered in intellect.

7. Those bodies which have been slowly emaciated should be slowly recruited; and those which have been quickly emaciated should be quickly recruited.

8. When a person after a disease takes food, but does not improve in strength, it indicates that the body uses more food than is proper; but if this happen when he does not take food, it is to be understood evacuation is required.

9. When one wishes to purge, he should put the body into a fluent state.

10. Bodies not properly cleansed, the more you nourish the more you injure.

11. It is easier to fill up with drink than with food.

12. What remains in diseases after the crisis is apt to produce relapses.

13. Persons in whom a crisis takes place pass the night preced-ing the paroxysm uncomfortably, but the succeeding night generally more comfortably.

14. In fluxes of the bowels, a change of the dejections does good, unless the change be of a bad character.

15. When the throat is diseased, or tubercles ( phymata ) form on the body, attention must paid to the secretions; for if they be bilious, the disease affects the general system; but if they resemble those of a healthy person, it is safe to give nourishing food.

16. When in a state of hunger, one ought not to undertake labor.

17. When more food than is proper has been taken, it occasions disease; this is shown by the treatment.

18. From food which proves nourishing to the body either immediately or shortly, the dejections also are immediate.

19. In acute diseases it is not quite safe to prognosticate either death or recovery.

20. Those who have watery discharges from their bowels when young have dry when they are old; and those who have dry discharges when they are young will have watery when they are old.

21. Drinking strong wine cures hunger.

22. Diseases which arise from repletion are cured by depletion; and those that arise from depletion are cured by repletion; and in general, diseases are cured by their contraries.

23. Acute disease come to a crisis in fourteen days.

24. The fourth day is indicative of the seventh; the eighth is the commencement of the second week; and hence, the eleventh being the fourth of the second week, is also indicative; and again, the seventeenth is indicative, as being the fourth from the fourteenth, and the seventh from the eleventh.

25. The summer quartans are, for the most part, of short duration; but the autumnal are protracted, especially those occurring near the approach of winter.

26. It is better that a fever succeed to a convulsion, than a convulsion to a fever.

27. We should not trust ameliorations in diseases when they are not regular, nor be much afraid of bad symptoms which occur in an irregular form; for such are commonly inconstant, and do not usually continue, nor have any duration.

28. In fevers which are not altogether slight, it is a bad symptom for the body to remain without any diminution of bulk, or to be wasted beyond measure; for the one state indicates a protracted disease, and the other weakness of body.

29. If it appear that evacuations are required, they should be made at the commencement of diseases; at the acme it is better to be quiet.

30. Toward the commencement and end of diseases all the symptoms are weaker, and toward the acme they are stronger.

31. When a person who is recovering from a disease has a good appetite, but his body does not improve in condition, it is a bad symptom.

32. For the most part, all persons in ill health, who have a good appetite at the commencement, but do not improve, have a bad appetite again toward the end; whereas, those who have a very bad appetite at the commencement, and afterward acquire a good appetite, get better off.

33. In every disease it is a good sign when the patient’s intellect is sound, and he is disposed to take whatever food is offered to him; but the contrary is bad.

34. In diseases, there is less danger when the disease is one to which the patient’s constitution, habit, age, and the season are allied, than when it is one to which they are not allied.

35. In all diseases it is better that the umbilical and hypogastric regions preserve their fullness; and it is a bad sign when they are very slender and emaciated; in the latter case it is dangerous to administer purgatives.

36. Persons in good health quickly lose their strength by taking purgative medicines, or using bad food.

37. Purgative medicines agree ill with persons in good health.

38. An article of food or drink which is slightly worse, but more palatable, is to be preferred to such as are better but less palatable.

39. Old have fewer complaints than young; but those chronic diseases which do befall them generally never leave them.

40. Catarrhs and coryza in very old people are not concocted.

41. Persons who have had frequent and severe attacks of swooning, without any manifest cause, die suddenly.

42. It is impossible to remove a strong attack of apoplexy, and not easy to remove a weak attack.

43. Of persons who have been suspended by the neck, and are in a state of insensibility, but not quite dead, those do not recover who have foam at the mouth.

44. Persons who are naturally very fat are apt to die earlier than those who are slender.

45. Epilepsy in young persons is most frequently removed by changes of air, of country, and of modes of life.

46. Of two pains occurring together, not in the same part of the body, the stronger weakens the other.

47. Pains and fevers occur rather at the formation of pus than when it is already formed.

48. In every movement of the body, whenever one begins to endure pain, it will be relieved by rest.

49. Those who are accustomed to endure habitual labors, although they be weak or old, bear them better than strong and young persons who have not been so accustomed.

50. Those things which one has been accustomed to for a long time, although worse than things which one is not accustomed to, usually give less disturbance; but a change must sometimes be made to things one is not accustomed to.

51. To evacuate, fill up, heat, cool, or otherwise, move the body in any way much and suddenly, is dangerous; and whatever is excessive is inimical to nature; but whatever is done by little and little is safe, more especially when a transition is made from one thing to another.

52. When doing everything according to indications, although things may not turn out agreeably to indication, we should not change to another while the original appearances remain.

53. Those persons who have watery discharges from the bowels when they are young, come off better than those who have dry; but in old age they come off worse, for the bowels in aged persons are usually dried up.

54. Largeness of person in youth is noble and not unbecoming; but in old age it is inconvenient, and worse than a smaller structure.

SECTION III

1. The changes of the season mostly engender diseases, and in the seasons great changes either of heat or of cold, and the rest agreeably to the same rule.

2. Of natures ( temperaments? ), some are well- or ill-adapted for summer, and some for winter.

3. Of diseases and ages, certain of them are well- or ill-adapted to different seasons, places, and kinds of diet.

4. In the seasons, when during the same day there is at one time heat and at another time cold, the diseases of autumn may be expected.

5. South winds induce dullness of hearing, dimness of visions, heaviness of the head, torpor, and languor; when these prevail, such symptoms occur in diseases. But if the north wind prevail, coughs, affections of the throat, hardness of the bowels, dysuria attended with rigors, and pains of the sides and breast occur. When this wind prevails, all such symptoms may be expected in diseases.

6. When summer is like spring, much sweating may be expected in fevers.

7. Acute diseases occur in droughts; and if the summer be particularly such, according to the constitution which it has given to the year, for the most part such diseases maybe expected.

8. In seasons which are regular, and furnish the productions of the season at the seasonable time, the diseases are regular, and come readily to a crisis; but in inconstant seasons, the diseases are irregular, and come to a crisis with difficulty.

9. In autumn, diseases are most acute, and most mortal, on the whole. The spring is most healthy, and least mortal.

10. Autumn is a bad season for persons in consumption.

11. With regard to the seasons, if the winter be of a dry and northerly character, and the spring rainy and southerly, in summer there will necessarily be acute fevers, ophthalmies, and dysenteries, especially in women, and in men of a humid temperament.

12. If the but the spring dry and northerly, women whose term of delivery should be in spring, have abortions from any slight cause; and those who reach their full time, bring forth children who are feeble, and diseased, so that they either die presently, or, if they live, are puny and unhealthy. Other people are subject to dysenteries and ophthalmies, and old men to catarrhs, which quickly cut them off.

13. If the summer be dry and northerly and the autumn rainy and southerly, headaches occur in winter, with coughs, hoarsenesses, coryzae, and in some cases consumptions.

14. But if the autumn be northerly and dry, it agrees well with persons of a humid temperament, and with women; but others will be subject to dry ophthalmies, acute fevers, coryzae, and in some cases melancholy.

15. Of the constitutions of the year, the dry, upon the whole, are more healthy than the rainy, and attended with less mortality.

16. The diseases which occur most frequently in rainy seasons are, protracted fevers, fluxes of the bowels, mortifications, epilepsies, apoplexies, and quinsies; and in dry, consumptive diseases, ophthalmies, arthritic diseases, stranguries, and dysenteries.

17. With regard to the states of the weather which continue but for a day, that which is northerly, braces the body, giving it tone, agility, and color, improves the sense of hearing, dries up the bowels, pinches the eyes, and aggravates any previous pain which may have been seated in the chest. But the southerly relaxes the body, and renders it humid, brings on dullness of hearing, heaviness of the head, and vertigo, impairs the movements of the eyes and the whole body, and renders the alvine discharges watery.

18. With regard to the seasons, in spring and in the commencement of summer, children and those next to them in age are most comfortable, and enjoy best health; in summer and during a certain portion of autumn, old people; during the remainder of the autumn and in winter, those of the intermediate ages.

19. All diseases occur at all seasons of the year, but certain of them are more apt to occur and be exacerbated at certain seasons.

20. The diseases of spring are, maniacal, melancholic, and epileptic disorders, bloody flux, quinsy, coryza, hoarseness, cough, leprosy, lichen alphos, exanthemata mostly ending in ulcerations, tubercles, and arthritic diseases.

21. Of summer, certain of these, and continued, ardent, and tertian fevers, most especially vomiting, diarrhoea, ophthalmy, pains of the ears, ulcerations of the mouth, mortifications of the privy parts, and the sudamina.

22. Of autumn, most of the summer, quartan, and irregular fevers, enlarged spleen, dropsy, phthisis, strangury, lientery, dysentery, sciatica, quinsy, asthma, ileus, epilepsy, maniacal and melancholic disorders.

23. Of winter, pleurisy, pneumonia, coryza, hoarseness, cough, pains of the chest, pains of the ribs and loins, headache, vertigo, and apoplexy.

24. In the different ages the following complaints occur: to little and new-born children, aphthae, vomiting, coughs, sleeplessness, frights inflammation of the navel, watery discharges from the ears.

25. At the approach of dentition, pruritus of the gums, fevers, convulsions, diarrhoea, especially when cutting the canine teeth, and in those who are particularly fat, and have constipated bowels.

26. To persons somewhat older, affections of the tonsils, incurvation of the spine at the vertebra next the occiput, asthma, calculus, round worms, ascarides, acrochordon, satyriasmus, struma, and other tubercles (phymata), but especially the aforesaid.

27. To persons of a more advanced age, and now on the verge of manhood, the most of these diseases, and, moreover, more chronic fevers, and epistaxis.

28. Young people for the most part have a crisis in their complaints, some in forty days, some in seven months, some in seven years, some at the approach to puberty; and such complaints of children as remain, and do not pass away about puberty, or in females about the commencement of menstruation, usually become chronic.

29. To persons past boyhood, haemoptysis, phthisis, acute fevers, epilepsy, and other diseases, but especially the aforementioned.

30. To persons beyond that age, asthma, pleurisy, pneumonia, lethargy, phrenitis, ardent fevers, chronic diarrhoea, cholera, dysentery, lientery, hemorrhoids.

31. To old people dyspnoea, catarrhs accompanied with coughs, dysuria, pains of the joints, nephritis, vertigo, apoplexy, cachexia, pruritus of the whole body, insomnolency, defluxions of the bowels, of the eyes, and of the nose, dimness of sight, cataract (glaucoma), and dullness of hearing.

SECTION IV

1. We must purge pregnant women, if matters be turgid (in a state of orgasm?), from the fourth to the seventh month, but less freely in the latter; in the first and last stages of pregnancy it should be avoided.

2. In purging we should bring away such matters from the body as it would be advantageous had they come away spontaneously; but those of an opposite character should be stopped.

3. If the matters which are purged be such as should be purged, it is beneficial and well borne; but if the contrary, with difficulty.

4. We should rather purge upward in summer, and downward in winter.

5. About the time of the dog-days, and before it, the administration of purgatives is unsuitable.

6. Lean persons who are easily made to vomit should be purged upward, avoiding the winter season.

7. Persons who are difficult to vomit, and are moderately fat, should be purged downward, avoiding the summer season.

8. We must be guarded in purging phthisical persons upward.

9. And from the same mode of reasoning, applying the opposite rule to melancholic persons, we must purge them freely downward.

10. In very acute diseases, if matters be in a state of orgasm, we may purge on the first day, for it is a bad thing to procrastinate in such cases.

11. Those cases in which there are tormina, pains about the umbilicus, and pains about the loins, not removed either by purgative medicines or otherwise, usually terminate in dry dropsy.

12. It is a bad thing to purge upward in winter persons whose bowels are in a state of lientery.

13. Persons who are not easily purged upward by the hellebores, should have their bodies moistened by plenty of food and rest before taking the draught.

14. When one takes a draught of hellebore, one should be made to move more about, and indulge less in sleep and repose. Sailing on the sea shows that motion disorders the body.

15. When you wish the hellebore to act more, move the body, and when to stop, let the patient get sleep and rest.

16. Hellebore is dangerous to persons whose flesh is sound, for it induces convulsion.

17. Anorexia, heartburn, vertigo, and a bitter taste of the mouth, in a person free from fever, indicate the want of purging upward.

18. Pains seated above the diaphragm indicate purging upward, and those below it, downward.

19. Persons who have no thirst while under the action of a purgative medicine, do not cease from being purged until they become thirsty.

20. If persons free from fever be seized with tormina, heaviness of the knees, and pains of the loins, this indicates that purging downward is required.

21. Alvine dejections which are black, like blood, taking place spontaneously, either with or without fever, are very bad; and the more numerous and unfavorable the colors, so much the worse; when with medicine it is better, and a variety of colors in this case is not bad.

22. When black bile is evacuated in the beginning of any disease whatever, either upward or downward, it is a mortal symptom.

23. In persons attenuated from any disease, whether acute or chronic, or from wounds, or any other cause, if there be a discharge either of black bile, or resembling black blood, they die on the following day.

24. Dysentery, if it commence with black bile, is mortal.

25. Blood discharged upward, whatever be its character, is a bad symptom, but downward it is (more?) favorable, and so also black dejections.

26. If in a person ill of dysentery, substances resembling flesh be discharged from the bowels, it is a mortal symptom.

27. In whatever cases of fever there is a copious hemorrhage from whatever channel, the bowels are in a loose state during convalescence.

28. In all cases whatever, bilious discharges cease if deafness supervenes, and in all cases deafness ceases when bilious discharges supervene.

29. Rigors which occur on the sixth day have a difficult crisis.

30. Diseases attended with paroxysms, if at the same hour that the fever leaves it return again next day, are of difficult crisis.

31. In febrile diseases attended with a sense of lassitude, deposits form about the joints, and especially those of the jaws.

32. In convalescents from diseases, if any part be pained, there deposits are formed.

33. But if any part be in a painful state previous to the illness, there the disease fixes.

34. If a person laboring under a fever, without any swelling in the fauces, be seized with a sense of suffocation suddenly, it is a mortal symptom.

35. If in a person with fever, the become suddenly distorted, and he cannot swallow unless with difficulty, although no swelling be present, it is a mortal symptom.

36. Sweats, in febrile diseases, are favorable, if they set in on the third, fifth, seventh, ninth, eleventh, fourteenth, seventeenth, twenty-first, twenty-seventh, and thirty-fourth day, for these sweats prove a crisis to the disease; but sweats not occurring thus, indicate pain, a protracted disease, and relapses.

37. Cold sweats occurring with an acute fever, indicate death; and along with a milder one, a protracted disease.

38. And in whatever part of the body there is a sweat, it shows that the disease is seated there.

39. And in whatever part of the body heat or cold is seated, there is disease.

40. And wherever there are changes in the whole body, and if the body be alternately cold and hot, or if one color succeed another, this indicates a protracted disease.

41. A copious sweat after sleep occuring without any manifest cause, indicates that the body is using too much food. But if it occur when one is not taking food, it indicates that evacuation is required.

42. A copious sweat, whether hot or cold, flowing continuously, indicates, the cold a greater, and the hot a lesser disease.

43. Fevers, not of the intermittent type, which are exacerbated on the third day, are dangerous; but if they intermit in any form, this indicates that they are not dangerous.

44. In cases attended with protracted fevers, tubercles ( phymata ） or pains occur about the joints.

45. When tubercles ( phymata ) or pains attack the joints after fevers, such persons are using too much food.

46. If in a fever not of the intermittent type a rigor seize a person already much debilitated, it is mortal.

47. In fevers not of the intermittent type, expectorations which are livid bloody, fetid and bilious, are all bad; but if evacuated properly, they are favorable. So it is with the alvine evacuations and the urine. But if none of the proper excretions take place by these channels, it is bad.

48. In fevers not of the intermittent type, if the external parts be cold, but the internal be burnt up, and if there be thirst, it is a mortal symptom.

49. In a fever not of the intermittent type, if a lip, an eye-brow, an eye, or the nose, be distorted; or if there be loss of sight or of hearing, and the patient be in a weak state-whatever of these symptoms occur, death is at hand.

50. Apostemes in fevers which are not resolved at the first crisis, indicate a protracted disease.

51. When in a fever not of the intermittent type dyspnoea and delirium come on, the case is mortal.

52. When persons in fevers, or in other illnesses, shed tears voluntarily, it is nothing out of place; but when they shed tears involuntarily, it is more so.

53. In whatever cases of fever very viscid concretions form about the teeth, the fevers turn out to be particularly strong.

54. In whatever case of ardent fever dry coughs of a tickling nature with slight expectoration are long protracted, there is usually not much thirst.

55. All fevers complicated with buboes are bad, except ephemerals.

56. Sweat supervening in a case of the fever ceasing, is bad, for the disease is protracted, and it indicates more copious humors.

57. Fever supervening in a case of confirmed spasm, or of tetanus, removes the disease.

58. A rigor supervening in a case of ardent fever, produces resolution of it.

59. A true tertian comes to a crisis in seven periods at furthest.

60. When in fevers there is deafness, if blood run from the nostrils, or the bowels become disordered, it carries off the disease.

61. In a febrile complaint, if the fever do not leave on the odd days, it relapses.

62. When jaundice supervenes in fevers before the seventh day, it a bad symptom, unless there be watery discharges from the bowels.

63. In whatever cases of fever rigors occur during the day, the fevers come to a resolution during the day.

64. When in cases of fever jaundice occurs on the seventh, the ninth, the eleventh, or the fourteenth day, it is a good symp-tom, provided the hypochondriac region be not hard. Otherwise it is not a good symptom.

65. A strong heat about the stomach and cardialgia are bad symptoms in fevers.

66. In acute fevers, spasms, and strong pains about the bowels are bad symptoms.

67. In fevers, frights after sleep, or convulsions, are a bad symptom.

68. In fevers, a stoppage of the respiration is a bad symptom, for it indicates convulsions.

69. When the urine is thick, grumoss, and scanty in cases not free from fever a copious discharge of thinner urine proves beneficial. Such a discharge more commonly takes place when the urine has had a sediment from the first, or soon after the commencement.

70. When in fevers the urine is turbid, like that of a beast of burden, in such a case there either is or will be headache.

71. In cases which come to a crisis on the seventh day, the urine has a red nubecula on the fourth day, and the other symptoms accordingly.

72. When the urine is transparent and white, it is bad; it appears principally in cases of phrenitis.

73. When the hypochondriac region is affected with meteorism and borborygmi, should pain of the loins supervene, the bowels get into a loose and watery state, unless there be an eruption of flatus or a copious evacuation of urine. These things occur in fevers.

74. When there is reason to expect that an abscess will form in joints, the abscess is carried off by a copious discharge of urine, which is thick, and becomes white, like what begins to form in certain cases of quartan fever, attended with a sense of lassitude. It is also speedily carried off by a hemorrhage from the nose.

75. Blood or pus in the urine indicates ulceration either of the kidneys or of the bladder.

76. When small fleshy substances like hairs are discharged along with thick urine, these substances come from the kidneys.

77. In those cases where there are furfuraceous particles discharged along with thick urine, there is scabies of the bladder.

78. In those cases where there is a spontaneous discharge of bloody urine, it indicates rupture of a small vein in the kidneys.

79. In those cases where there is a sandy sediment in the urine, there is calculus in the bladder (or kidneys).

80. If a patient pass blood and clots in his urine, and have strangury, and if a pain seize the hypogastric region and perineum, the parts about the bladder are affected.

81. If a patient pass blood, pus, and scales, in the urine, and if it have a heavy smell, ulceration of the bladder is indicated.

82. When tubercles form in the urethra, if these suppurate and burst, there is relief.

83. When much urine is passed during the night, it indicates that the alvine evacuations are scanty.

SECTION V

1. A spasm from taking hellebore is of a fatal nature.

2. Spasm supervening on a wound is fatal.

3. A convulsion, or hiccup, supervening on a copious discharge of blood is bad.

4. A convulsion, or hiccup, supervening upon hypercatharsis is bad.

5. If a drunken person suddenly lose his speech, he will die convulsed, unless fever come on, or he recover his speech at the time when the consequences of a debauch pass off.

6. Such persons as are seized with tetanus die within four days, or if they pass these they recover.

7. Those cases of epilepsy which come on before puberty may undergo a change; but those which come on after twenty-five years of age, for the most part terminate in death.

8. In pleuritic affections, when the disease is not purged off in fourteen days, it usually terminates in empyema.

9. Phthisis most commonly occurs between the ages of eighteen and thirty-five years.

10. Persons who escape an attack of quinsy, and when the disease is turned upon the lungs, die in seven days; or if they pass these they become affected with empyema.

11. In persons affected with phthisis, if the sputa which they cough up have a heavy smell when poured upon coals, and if the hairs of the head fall off, the case will prove fatal.

12. Phthisical persons, the hairs of whose head fall off, die if diarrhoea set in.

13. In persons who cough up frothy blood, the discharge of it comes from the lungs.

14. Diarrhoea attacking a person affected with phthisis is a mortal symptom.

15. Persons who become affected with empyema after pleurisy, if they get clear of it in forty days from the breaking of it, escape the disease; but if not, it passes into phthisis.

16. Heat produces the following bad effects on those who use it frequently: enervation of the fleshy parts, impotence of the nerves, torpor of the understanding, hemorrhages, deliquia, and, along with these, death.

17. Cold induces convulsions, tetanus, mortification, and febrile rigors.

18. Cold is inimical to the bones, the teeth, the nerves, the brain, and the spinal marrow, but heat is beneficial.

19. Such parts as have been congealed should be heated, except where there either is a hemorrhage, or one is expected.

20. Cold pinches ulcers, hardens the skin, occasions pain which does not end in suppuration, blackens, produces febrile rigors, convulsions, and tetanus.

21. In the case of a muscular youth having tetanus without a wound, during the midst of summer, it sometimes happens that the allusion of a large quantity of cold water recalls the heat. Heat relieves these diseases.

22. Heat is suppurative, but not in all kinds of sores, but when it is, it furnishes the greatest test of their being free from danger. It softens the skin, makes it thin, removes pain, soothes rigor, convulsions, and tetanus. It removes affections of the head, and heaviness of it. It is particularly efficacious in fractures of the bones, especially of those which have been exposed, and most especially in wounds of the head, and in mortifications and ulcers from cold; in herpes exedens, of the anus, the privy parts, the womb, the bladder, in all these cases heat is agreeable, and brings matters to a crisis; but cold is prejudicial, and does mischief.

23. Cold water is to be applied in the following cases; when there is a hemorrhage, or when it is expected, but not applied to the spot, but around the spot whence the blood flows; and in inflammations and inflammatory affections, inclining to a red and subsaguineous color, and consisting of fresh blood, in these cases it is to be applied but it occasions mortification in old cases; and in erysipelas not attended with ulceration, as it proves injurious to erysipelas when ulcerated.

24. Cold things, such as snow and ice, are inimical to the chest, being provocative of coughs, of discharges of blood, and of catarrhs.

25. Swellings and pains in the joints, ulceration, those of a gouty nature, and sprains, are generally improved by a copious affusion of cold water, which reduces the swelling, and removes the pain; for a moderate degree of numbness removes pain.

26. The lightest water is that which is quickly heated and quickly cooled.

27. When persons have intense thirst, it is a good thing if they can sleep off the desire of drinking.

28. Fumigation with aromatics promotes menstruation, and would be useful in many other cases, if it did not occasion heaviness of the head.

29. Women in a state of pregnancy may be purged, if there be any urgent necessity ( or , if the humors be in a state of orgasm?), from the fourth to the seventh month, but less so in the latter case. In the first and last periods it must be avoided.

30. It proves fatal to a woman in a state of pregnancy, if she be seized with any of the acute diseases.

31. If a woman with child be bled, she will have an abortion, and this will be the more likely to happen, the larger the foetus.

32. Haemoptysis in a woman is removed by an eruption of the menses.

33. In a woman when there is a stoppage the menses, a discharge of blood from the nose is good.

34. When a pregnant woman has a violent diarrhoea, there is danger of her miscarrying.

35. Sneezing occurring to a woman affected with hysterics, and in difficult labor, is a good symptom.

36. When the menstrual discharge is of a bad color and irregular, it indicates that the woman stands in need of purging.

37. In a pregnant woman, if the breasts suddenly lose their fullness, she has a miscarriage.

38. If, in a woman pregnant with twins, either of her breasts lose its fullness, she will part with one of her children; and if it be the right breast which becomes slender, it will be the male child, or if the left, the female.

39. If a woman who is not with child, nor has brought forth, have milk, her menses are obstructed.

40. In women, blood collected in the breasts indicates madness.

41. If you wish to ascertain if a woman be with child, give her hydromel to drink when she is going to sleep, and has not taken supper, and if she be seized with tormina in the belly, she is with child, but otherwise she is not pregnant.

42. A woman with child, if it be a male, has a good color, but if a female, she has a bad color.

43. If erysipelas of the womb seize a woman with child, it will probably prove fatal.

44. Women who are very lean, have miscarriages when they prove with child, until they get into better condition.

45. When women, in a moderate condition of body, miscarry in the second or third month, without any obvious cause, their cotyledones are filled with mucosity, and cannot support the weight of the foetus, but are broken asunder.

46. Such women as are immoderately fat, and do not prove with child, in them it is because the epiploon ( fat? ) blocks up the mouth of the womb, and until it be reduced, they do not conceive.

47. If the portion of the uterus seated near the hip-joint suppurate, it gets into a state requiring to be treated with tents.

48. The male foetus is usually seated in the right, and the female in the left side.

49. To procure the expulsion of the secundines, apply a sternutatory, and shut the nostrils and mouth.

50. If you wish to stop the menses in a woman, apply as large a cupping instrument as possible to the breasts.

51. When women are with child, the mouth of their womb is closed.

52. If in a woman with child, much milk flow from the breasts, it indicates that the foetus is weak; but if the breasts be firm, it indicates that the foetus is in a more healthy state.

53. In women that are about to miscarry, the breasts become slender; but if again they become hard, there will be pain, either in the breasts, or in the hip-joints, or in the eyes, or in the knees, and they will not miscarry.

54. When the mouth of the uterus is hard, it is also necessarily shut.

55. Women with child who are seized with fevers, and who are greatly emaciated, without any (other?) obvious cause, have difficult and dangerous labors, and if they miscarry, they are in danger.

56. In the female flux ( immoderate menstruation? ), if convulsion and deliquium come on, it is bad.

57. When the menses are excessive, diseases take place, and when the menses are stopped, diseases from the uterus take place.

58. Strangury supervenes upon inflammation of the rectum, and of the womb, and strangury supervenes upon suppuration of the kidney, and hiccup upon inflammation of the liver.

59. If a woman do not conceive, and wish to ascertain whether she can conceive, having wrapped her up in blankets, fumigate below, and if it appear that the scent passes through the body to the nostrils and mouth, know that of herself she is not unfruitful.

60. If woman with a child have her courses, it is impossible that the child can be healthy.

61. If a woman’s courses be suppressed, and neither rigor nor fever has followed, but she has been affected with nausea, you may reckon her to be with child.

62. Women who have the uterus cold and dense ( compact? ) do not conceive; and those also who have the uterus humid, do not conceive, for the semen is extinguished, and in women whose uterus is very dry, and very hot, the semen is lost from the want of food; but women whose uterus is in an intermediate state between these temperaments prove fertile.

63. And in like manner with respect to males; for either, owing to the laxity of the body, the pneuma is dissipated outwardly, so as not to propel the semen, or, owing to its density, the fluid ( semen? ） does not pass outwardly; or, owing to coldness, it is not heated so as to collect in its proper place ( seminal vessels? ), or, owing to its heat, the very same thing happens.

64. It is a bad thing to give milk to persons having headache, and it is also bad to give it in fevers, and to persons whose hypochondria are swelled up, and troubled with borborygmi, and to thirsty persons; it is bad also, when given to those who have bilious discharges in acute fevers, and to those who have copious discharges of blood; but it is suitable in phthisical cases, when not attended with very much fever; it is also to be given in fevers of a chronic and weak nature, when none of the aforementioned symptoms are present, and the patients are excessively emaciated.

65. When swellings appear on wounds, such cases are not likely to be attacked either with convulsions, or delirium, but when these disappear suddenly, if situated behind, spasms and tetanus supervene, and if before, mania, acute pains of the sides, or suppurations, or dysentery, if the swellings be rather red.

66. When no swelling appears on severe and bad wounds, it is a great evil.

67. In such cases, the soft are favorable; and crude, unfavorable.

68. When a person is pained in the back part of the head, he is benefited by having the straight vein in the forehead opened.

69. Rigors commence in women, especially at the loins, and spread by the back to the head; and in men also, rather in the posterior than the anterior side of the body, as from the arms and thighs; the skin there is rare, as is obvious from the growth of hair on them.

70. Persons attacked with quartans are not readily attacked with convulsions, or if previously attacked with convulsions, they cease if a quartan supervene.

71. In those persons in whom the skin is stretched, and parched and hard, the disease terminates without sweats; but in those in whom the skin is loose and rare, it terminates with sweats.

72. Persons disposed to jaundice are not very subject to flatulence.

SECTION VI

1. In cases of chronic lientery, acid eructations supervening when there were none previously, is a good symptom.

2. Persons whose noses are naturally watery, and their seed watery, have rather a deranged state of health; but those in the opposite state, a more favorable.

3. In protracted cases of dysentery, loathing of food is a bad symptom, and still worse, if along with fever.

4. Ulcers, attended with a falling off of the hair, are mali moris.

5. It deserves to be considered whether the pains in the sides, and in the breasts, and in the other parts, differ much from one another.

6. Diseases about the kidneys and bladder are cured with difficulty in old men.

7. Pains occurring about the stomach, the more superficial they are, the more slight are they; and the less superficial, the more severe.

8. In dropsical persons, ulcers forming on the body are not easily healed.

9. Broad exanthemata are not very itchy.

10. In a person having a painful spot in the head, with intense cephalalgia, pus or water running from the nose, or by the mouth, or at the ears, removes the disease.

11. Hemorrhoids appearing in melancholic and nephritic affections are favorable.

12. When a person has been cured of chronic hemorrhoids, unless one be left, there is danger of dropsy or phthisis supervening.

13. Sneezing coming on, in the case of a person afflicted with hiccup, removes the hiccup.

14. In a case of dropsy, when the water runs by the veins into the belly, it removes the disease.

15. In confirmed diarrhoea, vomiting, when it comes on spontaneously, removes the diarrhoea.

16. A diarrhoea supervening in a confirmed case of pleurisy or pneumonia is bad.

17. It is a good thing in ophthalmy for the patient to be seized with diarrhoea.

18. A severe wound of the bladder, of the brain, of the heart, of the diaphragm, of the small intestines, of the stomach, and of the liver, is deadly.

19. When a bone, cartilage, nerve, the slender part of the jaw, or prepuce, are cut out, the part is neither restored, nor does it unite.

20. If blood be poured out preternaturally into a cavity, it must necessarily become corrupted.

21. In maniacal affections, if varices or hemorrhoids come on, they remove the mania.

22. Those ruptures in the back which spread down to the elbows are removed by venesection.

23. If a fright or despondency lasts for a long time, it is a melancholic affection.

24. If any of the intestines be transfixed, it does not unite.

25. It is not a good sign for an erysipelas spreading outwardly to be determined inward; but for it to be determined outward from within is good.

26. In whatever cases of ardent fever tremors occur, they are carried off by a delirium.

27. Those cases of empyema or dropsy which are treated by incision or the cautery, if the water or pus flow rapidly all at once, certainly prove fatal.

28. Eunuchs do not take the gout, nor become bald.

29. A woman does not take the gout, unless her menses be stopped.

30. A young man does not take the gout until he indulges in coition.

31. Pains of the eyes are removed by drinking pure wine, or the bath, or a fomentation, or venesection, or purging.

32. Persons whose speech has become impaired are likely to be seized with chronic diarrhoea.

33. Persons having acid eructations are not very apt to be seized with pleurisy.

34. Persons who have become bald are not subject to large varices; but should varices supervene upon persons who are bald, their hair again grows thick.

35. Hiccup supervening in dropsical cases is bad.

36. Venesection cures dysuria; open the internal veins of the arm.

37. It is a good symptom when swelling on the outside of the neck seizes a person very ill of quinsy, for the disease is turned outwardly.

38. It is better not to apply any treatment in cases of occult cancer; for, if treated, the patients die quickly; but if not treated, they hold out for a long time.

39. Convulsions take place either from repletion or depletion; and so it is with hiccup.

40. When pains, without inflammation, occur about the hypochondria, in such cases, fever supervening removes the pain.

41. When pus formed anywhere in the body does not point, this is owing to the thickness of the part.

42. In cases of jaundice, it is a bad symptom when the liver becomes indurated.

43. When persons having large spleens are seized with dysentery, and if the dysentery pass into a chronic state, either dropsy or lientery supervenes, and they die.

44. When ileus comes on in a case of strangury, they prove fatal in seven days, unless, fever supervening, there be a copious discharge of urine.

45. When ulcers continue open for a year or upward, there must necessarily be exfoliation of bone, and the cicatrices are hollow.

46. Such persons as become hump-backed from asthma or cough before puberty, die.

47. Persons who are benefited by venesection or purging, should be bled or purged in spring.

48. In enlargement of the spleen, it is a good symptom when dysentery comes on.

49. In gouty affections, the inflammation subsides in the course of forty days.

50. When the brain is severely wounded, fever and vomiting of bile necessarily supervene.

51. When persons in good health are suddenly seized with pains in the head, and straightway are laid down speechless, and breathe with stertor, they die in seven days, unless fever come on.

52. We must attend to the appearances of the eyes in sleep, as presented from below; for if a portion of the white be seen between the closed eyelids, and if this be not connected with diarrhaea or severe purging, it is a very bad and mortal symptom.

53. Delirium attended with laughter is less dangerous than delirium attended with a serious mood.

54. In acute diseases, complicated with fever, a moaning respiration is bad.

55. For the most part, gouty affections rankle in spring and in autumn.

56. In melancholic affections, determinations of the humor which occasions them produce the following diseases; either apoplexy of the whole body, or convulsion, or madness, or blindness.

57. Persons are most subject to apoplexy between the ages of forty and sixty.

58. If the omentum protrude, it necessarily mortifies and drops off.

59. In chronic diseases of the hip-joint, if the bone protrude and return again into its socket, there is mucosity in the place.

60. In persons affected with chronic disease of the hip-joint, if the bone protrude from its socket, the limb becomes wasted and maimed, unless the part be cauterized.

SECTION VII

1. In acute diseases, coldness of the extremities is bad.

2. Livid flesh on a diseased bone is bad.

3. Hiccup and redness of the eyes, when they supervene on vomiting, are bad.

4. A chill supervening on a sweat is not good.

5. Dysentery, or dropsy, or ecstacy coming on madness is good.

6. In a very protracted disease, loss of appetite and unmixed discharges from the bowels are bad symptoms.

7. A rigor and delirium from excessive drinking are bad.

8. From the rupture of an internal abscess, prostration of strength, vomiting, and deliquium animi result.

9. Delirium or convulsion from a flow of blood is bad.

10. Vomiting, or hiccup, or convulsion, or delirium, in ileus, is bad.

11. Pneumonia coming on pleurisy is bad.

12. Phrenitis along with pneumonia is bad.

13. Convulsion or tetanus, coming upon severe burning, is bad.

14. Stupor or delirium from a blow on the head is bad.

15. From a spitting of blood there is a spitting of pus.

16. From spitting of pus arise phthisis and a flux; and when the sputa are stopped, they die.

17. Hiccup in inflammation of the liver bad.

18. Convulsion or delirium supervening upon insomnolency is bad.

18. a

Trembling upon lethargus is bad.

19. Erysipelas upon exposure of a bone (is bad?).

20. Mortification or suppuration upon erysipelas is bad.

21. Hemorrhage upon a strong pulsation in wounds is bad.

22. Suppuration upon a protracted pain of the parts about the bowels is bad.

23. Dysentery upon unmixed alvine discharges is bad.

24. Delirium upon division of the cranium, if it penetrate into the cavity of the head, is bad.

25. Convulsion upon severe purging is mortal.

26. Upon severe pain of the parts about the bowels, coldness of the extremities coming on is bad.

27. Tenesmus coming on in a case of pregnancy causes abortion.

28. Whatever piece of bone, cartilage, or nerve ( tendon? ) is cut off, it neither grows nor unites.

29. When strong diarrhoea supervenes in a case of leucophlegmatia, it removes the disease.

30. In those cases in which frothy discharges occur in diarrhoea there are defluxions from the head.

31. When there is a farinaceous sediment in the urine during fever, it indicates a protracted illness.

32. In those cases in which the urine is thin at first, and the sediments become bilious, an acute disease is indicated.

33. In those cases in which the urine becomes divided there is great disorder in the body.

34. When bubbles settle on the surface of the urine, they indicate disease of the kidneys, and that the complaint will be protracted.

35. When the scum on the surface is fatty and copious, it indicates acute diseases of the kidneys.

36. Whenever the aforementioned symptoms occur in nephritic diseases, and along with them acute pains about the muscles of the back, provided these be seated about the external parts, you may expect that there will be an abscess; but if the pains be rather about the internal parts, you may also rather expect that the abscess will be seated internally.

37. Haematemesis, without fever, does not prove fatal, but with fever it is bad; it is to be treated with refrigerant and styptic things.

38. Defluxions into the cavity of the chest suppurate in twenty days.

39. When a patient passes blood and clots, and is seized with strangury and pain in the perineum and pubes, disease about the bladder is indicated.

40. If the tongue suddenly lose its powers, or a part of the body become apoplectic, the affection is of a melancholic nature.

41. In hypercatharsis, of old persons, hiccup supervening is not a good symptom.

42. In a fever, is not of a bilious nature, a copious allusion of hot water upon the head removes the fever.

43. A woman does not become ambidexterous.

44. When empyema is treated either by the cautery or incision, if pure and white pus flow from the wound, the patients recover; but if mixed with blood, slimy and fetid, they die.

45. When abscess of the liver is treated by the cautery or incision, if the pus which is discharged be pure and white, the patients recover, (for in this case it is situated in the coats of the liver;) but if it resemble the lees of oil as it flows, they die.

46. Pains of the eyes are removed by drinking undiluted wine, plenteous bathing with hot water, and venesection.

47. If a dropsical patient be seized with hiccup the case is hopeless.

48. Strangury and dysuria are cured by drinking pure wine, and venesection; open the vein on the inside.

49. It is a good sign when swelling and redness on the breast seize a person very ill of quinsy, for in this case the disease is diverted outwardly.

50. When the brain is attacked with sphacelus, the patients die in three days; or if they escape these, they recover.

51. Sneezing arises from the head, owing to the brain being heated, or the cavity ( ventricle ) in the head being filled with humors; the air confined in it then is discharged, and makes a noise, because it comes through a narrow passage.

52. Fever supervening on painful affections of the liver removes the pain.

53. Those persons to whom it is beneficial to have blood taken from their veins, should have it done in spring.

54. In those cases where phlegm is collected between the diaphragm and the stomach, and occasions pain, as not finding a passage into either of the cavities, the disease will be carried off if the phlegm be diverted to the bladder by the veins.

55. When the liver is filled with water and bursts into the epiploon, in this case the belly is filled with water and the patient dies.

56. Anxiety, yawning, rigor,-wine drunk with an equal proportion of water, removes these complaints.

57. When tubercles ( phymata ) form in the urethra, if they suppurate and burst, the pain is carried off.

58. In cases of concussion of the brain produced by any cause, the patients necessarily lose their speech.

59. In a person affected with fever, when there is no swelling in the fauces, should suffocation suddenly come on, and the patient not be able to swallow, except with difficulty, it is a mortal symptom.

59. a

In the case of a person oppressed by fever, if the neck be turned aside, and the patient cannot swallow, while there is no swelling in the neck, it is a mortal sign.

60. Fasting should be prescribed the those persons who have humid flesh; for fasting dries bodies.

61. When there are changes in the whole body, and the body becomes sometimes cold and sometimes hot, and the color changes, a protracted disease is indicated.

62. A copious sweat, hot or cold, constantly flowing, indicates a superabundance of humidity; we must evacuate then, in a strong person upward, and in a weak, downward.

63. Fevers, not of the intermittent type, if they become exacerbated every third day are dangerous; but if they intermit in any form whatever, this shows that they are not dangerous.

64. In cases of protracted fever, either chronic abscesses or pains in the joints come on.

65. When chronic abscesses ( phymata ) or pains in the joints take place after fevers, the patients are using too much food.

66. If one give to a person in fever the same food which is given to a person in good health, what is strength to the one is disease to the other.

67. We must look to the urinary evacuations, whether they resemble those of persons in health; if not at all so, they are particularly morbid, but if they are like those of healthy persons, they are not at all morbid.

68. When the dejections are allowed to stand and not shaken, and a sediment is formed like scrapings (of the bowels), in such a case it is proper to purge the bowels; and if you give ptisans before purging, the more you give the more harm you will do.

69. Crude dejections are the product of black bile; if abundant, of more copious, and if deficient, of less copious collections of it.

70. The sputa in fevers, not of an intermittent type, which are livid, streaked with blood, and fetid, are all bad, it is favorable when this evacuation, like the urinary and alvine, passes freely; and whenever any discharge is suppressed and not purged off it is bad.

71. When you wish to purge the body, you must bring it into a state favorable to evacuations; and if you wish to dispose it to evacuations upward, you must bind the belly; and if you wish to dispose it to evacuations downward, you must moisten the belly.

72. Sleep and watchfulness, both of them, when immoderate, constitute disease.

73. In fevers which do not intermit, if the external parts be cold, and the internal burning hot, and fever prevail, it is a mortal sign.

74. In a fever which does not intermit, if a lip, the nose, or an eye be distorted, if the patient lose his sense of sight or of hearing, while now in a weak state,-whatever of these symptoms occurs it is mortal.

75. Upon leucophlegmatia dropsy supervenes.

76. Upon diarrhoea dysentery.

77. Upon dysentery lientery.

78. Upon sphacelus exfoliation of the bone.

79. and 80

Upon vomiting of blood consumption, and a purging of pus upward; upon consumption a defluxion from the head; upon a defluxion diarrhoea; upon diarrhoea a stoppage of the purging upward; upon the stoppage of it death.

81. In the discharges by the bladder, the belly, and the flesh ( the skin? ) if the body has departed slightly from its natural condition, the disease is slight; if much, it is great; if very much, it is mortal.

82. Persons above forty years of age who are affected with frenzy, do not readily recover; the danger is less when the disease is cognate to the constitution and age.

83. In whatever diseases the eyes weep voluntarily, it is a good symptom, but when involuntarily, it is a bad.

84. When in quartan fevers blood flows from the nostrils it is a bad symptom.

85. Sweats are dangerous when they do not occur on critical days, when they are strong, and quickly forced out of the forehead, either in the form of drops or in streams, and if excessively cold and copious; for such a sweat must proceed from violence, excess of pain, and prolonged squeezing ( affliction? ).

86. In a chronic disease an excessive flux from the bowels is bad.

87. Those diseases which medicines do not cure, iron ( the knife? ） cures; those which iron cannot cure, fire cures; and those which fire cannot cure, are to be reckoned wholly incurable.

EPIDEMICS I AND III

Translated by W. H. S. Jones

Bust of Hippocrates in the British Museum

EPIDEMICS I

FIRST CONSTITUTION

I. IN Thasos during autumn, about the time of the equinox to near the setting of the Pleiades, there were many rains, gently continuous, with southerly winds. Winter southerly, north winds light, droughts ; on the whole, the winter was like a spring. Spring southerly and chilly ; slight showers. Summer in general cloudy. No rain. Etesian winds few, light and irregular.

The whole weather proved southerly, with droughts, but early in the spring, as the previous constitution had proved the opposite and northerly, a few patients suffered from ardent fevers, and these very mild, causing hemorrhage in few cases and no deaths. Many had swellings beside one ear, or both ears, in most cases unattended with fever, so that confinement to bed was unnecessary. In some cases there was slight heat, but in all the swellings subsided without causing harm ; in no case was there suppuration such as attends swellings of other origin. This was the character of them : — flabby, big, spreading, with neither inflammation nor pain ; in every case they disappeared without a sign. The sufferers were youths, young men, and men in their prime, usually those who frequented the wrestling school and gymnasia. Few women were attacked. Many had dry coughs which brought up nothing when they coughed, but their voices were hoarse. Soon after, though in some cases after some time, painful inflammations occurred either in one testicle or in both, sometimes accompanied with fever, in other cases not. Usually they caused much suffering. In other respects the people had no ailments requiring medical assistance.

II. Beginning early in the summer, throughout the summer and in winter many of those who had been ailing a long time took to their beds in a state of consumption, while many also who had hitherto been doubtful sufferers at this time showed undoubted symptoms. Some showed the symptoms now for the first time ; these were those whose constitution inclined to be consumptive. Many, in fact most of these, died ; of those who took to their beds I do not know one who survived even for a short time. Death came more promptly than is usual in consumption, and yet the other complaints, which will be described presently, though longer and attended with fever, were easily supported and did not prove fatal. For consumption was the worst of the diseases that occurred, and alone was responsible for the great mortality.

In the majority of cases the symptoms were these. Fever with shivering, continuous, acute, not completely intermitting, but of the semitertian type ; remitting during one day they were exacerbated on the next, becoming on the whole more acute. Sweats were continual, but not all over the body. Severe chill in the extremities, which with difficulty recovered their warmth. Bowels disordered, with bilious, scanty, unmixed, thin, smarting stools, causing the patient to get up often. Urine either thin, colourless, unconcocted and scanty, or thick and with a slight deposit, not settling favourably, but with a crude and unfavourable deposit. The patients frequently coughed up small, concocted sputa, brought up little by little with difficulty. Those exhibiting the symptoms in their most violent form showed no concoction at all, but continued spitting crude sputa. In the majority of these cases the throat was throughout painful from the beginning, being red and inflamed. Fluxes slight, thin, pungent. Patients quickly wasted away and grew worse, being throughout averse to all food and experiencing no thirst. Delirium in many cases as death approached. Such were the symptoms of the consumption.

III. But when summer came, and during autumn occurred many continuous but not violent fevers, which attacked persons who were long ailing without suffering distress in any other particular manner ; for the bowels were in most cases quite easy, and hurt to no appreciable extent. Urine in most cases of good colour and clear, but thin, and after a time near the crisis it grew concocted. Coughing was slight, and caused no distress. No lack of appetite ; in fact it was quite possible even to give food. In general the patients did not sicken, as did the consumptives, with shivering fevers, but with slight sweats, the paroxysms being variable and irregular. The earliest crisis was about the twentieth day ; in most cases the crisis was about the fortieth day, though in many it was about the eightieth. In some cases the illness did not end in this way, but in an irregular manner without a crisis. In the majority of these cases the fevers relapsed after a brief interval, and after the relapse a crisis occurred at the end of the same periods as before. The disease in many of these instances was so protracted that it even lasted during the winter.

Out of all those described in this constitution only the consumptives showed a high mortality-rate ; for all the other patients bore up well, and the other fevers did not prove fatal.

SECOND CONSTITUTION

IV. In Thasos early in autumn occurred unseasonable wintry storms, suddenly with many north and south winds bursting out into rains. These conditions continued until the setting of the Pleiades and during their season. Winter was northerly ; many violent and abundant rains ; snows ; generally there were fine intervals. With all this, however, the cold weather was not exceptionally unseasonable. But immediately after the winter solstice, when the west wind usually begins to blow, there was a return of severe wintry weather, much north wind, snow and copious rains continuously, sky stormy and clouded. These conditions lasted on, and did not remit before the equinox. Spring cold, northerly, wet, cloudy. Summer did not turn out excessively hot, the Etesian winds blowing continuously. But soon after, near the rising of Arcturus, there was much rain again, with northerly winds.

V. The whole year having been wet, cold and northerly, in the winter the public health in most respects was good, but in early spring many, in fact most, suffered illnesses. Now there began at first inflammations of the eyes, marked by rheum, pain, and unconcocted discharges. Small gummy sores, in many cases causing distress when they broke out ; the great majority relapsed, and ceased late on the approach of autumn. In summer and autumn dysenteric diseases, tenesmus and lientery ; bilious diarrhœa, with copious, thin, crude, smarting stools ; in some cases it was also watery. In many cases there were also painful, bilious defluxions, watery, full of thin particles, purulent and causing strangury. No kidney trouble, but their various symptoms succeeded in various orders. Vomitings of phlegm, bile, and undigested food. Sweats ; in all cases much moisture over all the body. These complaints in many cases were unattended with fever, and the sufferers were not confined to bed ; but in many others there was fever, as I am going to describe. Those who showed all the symptoms mentioned above were consumptives who suffered pain. When autumn came, and during winter, continuous fevers — in some few cases ardent — day fevers, night fevers, semitertians, exact tertians, quartans, irregular fevers. Each of the fevers mentioned found many victims.

VI. Now the ardent fevers attacked the fewest persons, and these were less distressed than any of the other sick. There was no bleeding from the nose, except very slight discharges in a few cases, and no delirium. All the other symptoms were slight. The crises of these diseases were quite regular, generally in seventeen days, counting the days of intermission, and I know of no ardent fever proving fatal at this time, nor of any phrenitis. The tertians were more numerous than the ardent fevers and more painful. But all these had four regular periods from the first onset, had complete crises in seven, and in no case relapsed. But the quartans, while in many instances they began at first with quartan periodicity, yet in not a few they became quartan by an abscession from other fevers or illnesses. They were protracted, as quartans usually are, or even more protracted than usual. Many fell victims to quotidians, night fevers, or irregular fevers, and were ill for a long time, either in bed or walking about. In most of these cases the fevers continued during the season of the Pleiades or even until winter. In many patients, especially children, there were convulsions and slight feverishness from the beginning ; sometimes, too, convulsions supervened upon fevers. Mostly these illnesses were protracted, but not dangerous, except for those who from all other causes were predisposed to die.

VII. But those fevers which were altogether continuous and never intermitted at all, but in all cases grew worse after the manner of semitertians, with remission during one day followed by exacerbation during the next, were the most severe of all the fevers which occurred at this time, the longest and the most painful. Beginning mildly, and on the whole increasing always, with exacerbation, and growing worse, they had slight remissions followed quickly after an abatement by more violent exacerbations, generally becoming worse on the critical days. All patients had irregular rigors that followed no fixed law, most rarely and least in the semitertians, but more violent in the other fevers. Copious sweats, least copious in the semitertians ; they brought no relief, but on the contrary caused harm. These patients suffered great chill in the extremities, which grew warm again with difficulty. Generally there was sleeplessness, especially with the semitertians, followed afterwards by coma. In all the bowels were disordered and in a bad state, but in the semitertians they were far the worst. In most of them urine either ( a ） thin, crude, colourless, after a time becoming slightly concocted with signs of crisis, or ( b ) thick enough but turbid, in no way settling or forming sediment, or ( c ) with small, bad, crude sediments, these being the worst of all. Coughs attended the fevers, but I cannot say that either harm or good resulted from the coughing on this occasion.

VIII. Now the greatest number of these symptoms continued to be protracted, troublesome, very disordered, very irregular, and without any critical signs, both in the case of those who came very near death and in the case of those who did not. For even if some patients enjoyed slight intermissions, there followed a quick relapse. A few of them experienced a crisis, the earliest being about the eightieth day, some of the latter having a relapse, so that most of them were still ill in the winter. The greatest number had no crisis before the disease terminated. These symptoms occurred in those who recovered just as much as in those who did not. The illnesses showed a marked absence of crisis and a great variety ; the most striking and the worst symptom, which throughout attended the great majority, was a complete loss of appetite, especially in those whose general condition exhibited fatal signs, but in these fevers they did not suffer much from unseasonable thirst. After long intervals, with many pains and with pernicious wasting, there supervened abscessions either too severe to be endured, or too slight to be beneficial, so that there was a speedy return of the original symptoms, and an aggravation of the mischief.

IX. The symptoms from which these patients suffered were dysenteries and tenesmus, lienteries also and fluxes. Some had dropsies also, either with or without these. Whenever any of these attacked violently they were quickly fatal, or, if mild, they did no good. Slight eruptions, which did not match the extent of the diseases and quickly disappeared again, or swellings by the ears that grew smaller and signified nothing, in some cases appearing at the joints, especially the hip-joint, in few instances leaving with signs of crisis, when they quickly re-established themselves in their original state.

X. From all the diseases some died, but the greatest number from these fevers, especially children — those just weaned, older children of eight or ten years, and those approaching puberty. These victims never suffered from the latter symptoms without the first I have described above, but often the first without the latter. The only good sign, the most striking that occurred, which saved very many of those who were in the greatest danger, was when there was a change to strangury, into which abscessions took place. The strangury, too, came mostly to patients of the ages mentioned, though it did happen to many of the others, either without their taking to bed or when they were ill. Rapid and great was the complete change that occurred in their case. For the bowels, even if they were perniciously loose, quickly recovered ; their appetite for everything returned, and hereafter the fever abated. But the strangury, even in these cases, was long and painful. Their urine was copious, thick, varied, red, mixed with pus, and passed with pain. But they all survived, and I know of none of these that died.

XI. In all dangerous cases you should be on the watch for all favourable coctions of the evacuations from all parts, or for fair and critical abscessions. Coctions signify nearness of crisis and sure recovery of health, but crude and unconcocted evacuations, which change into bad abscessions, denote absence of crisis, pain, prolonged illness, death, or a return of the same symptoms. But it is by a consideration of other signs that one must decide which of these results will be most likely. Declare the past, diagnose the present, foretell the future ; practise these acts. As to diseases, make a habit of two things — to help, or at least to do no harm. The art has three factors, the disease, the patient, the physician. The physician is the servant of the art. The patient must co-operate with the physician in combating the disease.

XII. Pains about the head and neck, and heaviness combined with pain, occur both without and with fever. Sufferers from phrenitis have convulsions, and eject verdigris-coloured vomit ; some die very quickly. But in ardent and the other fevers, those with pain in the neck, heaviness of the temples, dimness of sight, and painless tension of the hypochondrium, bleed from the nose ; those with a general heaviness of the head, cardialgia, and nausea, vomit afterwards bile and phlegm. Children for the most part in such cases suffer chiefly from the convulsions. Women have both these symptoms and pains in the womb. Older people, and those whose natural heat is failing, have paralysis or raving or blindness.

THIRD CONSTITUTION

XIII. In Thasos a little before and at the season of Arcturus many violent rains with northerly winds. About the equinox until the setting of the Pleiades slight, southerly rains. Winter northerly, droughts, cold periods, violent winds, snow. About the equinox very severe storms. Spring northerly, droughts, slight rains, periods of cold. About the summer solstice slight showers, periods of great cold until near the Dog Star. After the Dog Star, until Arcturus, hot summer. Great heat, not intermittent but continuous and severe. No rain fell. The Etesian winds blew. About Arcturus southerly rains until the equinox.

XIV. In this constitution during winter began paralyses which attacked many, a few of whom quickly died. In fact, the disease was generally epidemic. In other respects the public health continued good. Early in spring began ardent fevers which continued until the equinox and on to summer. Now those who began to be ill at once, in spring or the beginning of summer, in most cases got well, though a few died ; but when autumn and the rains came the cases were dangerous, and more died.

As to the peculiarities of the ardent fevers, the most likely patients to survive were those who had a proper and copious bleeding from the nose, in fact I do not know of a single case in this constitution that proved fatal when a proper bleeding occurred, For Philiscus and Epaminon and Silenus, who died, had only a slight epistaxis on the fourth and fifth days. Now the majority of the patients had rigors near the crisis, especially such as had no epistaxis, but these had sweats also as well as rigors.

XV. Some had jaundice on the sixth day, but these were benefited by either a purging through the bladder or a disturbance of the bowels or a copious hemorrhage, as was the case with Heraclides, who lay sick at the house of Aristocydes. This patient, however, who had a crisis on the twentieth day, not only bled from the nose, but also experienced disturbance of the bowels and a purging through the bladder. Far otherwise was it with the servant of Phanagoras, who had none of these symptoms, and died. But the great majority had hemorrhage, especially youths and those in the prime of life, and of these the great majority who had no hemorrhage died. Older people had jaundice or disordered bowels, for example Bion, who lay sick at the house of Silenus. Dysenteries also were general in summer, and some too of those who had fallen ill, and also suffered from hemorrhage, finally had dysentery ; for example, the slave of Erato and Myllus, after copious hemorrhage, lapsed into dysentery. They recovered.

This humour, then, especially was in great abundance, since even those who had no hemorrhage near the crisis, but swellings by the ears which disappeared — and after their disappearance there was a heaviness along the left flank up to the extremity of the hip — after the crisis had pain and passed thin urine, and then began to suffer slight hemorrhage about the twenty-fourth day, and abscessions into hemorrhage occurred. In the case of Antipho, son of Critobulus, the illness ceased and came to a complete crisis about the fortieth day.

XVI. Though many women fell ill, they were fewer than the men and less frequently died. But the great majority had difficult childbirth, and after giving birth they would fall ill, and these especially died, as did the daughter of Telebulus on the sixth day after delivery. Now menstruation appeared during the fevers in most cases, and with many maidens it occurred then for the first time. Some bled from the nose. Sometimes both epistaxis and menstruation appeared together ; for example, the maiden daughter of Daitharses had her first menstruation during fever and also a violent discharge from the nose. I know of no woman who died if any of these symptoms showed themselves properly, but all to my knowledge had abortions if they chanced to fall ill when with child.

XVII. Urine in most cases was of good colour, but thin and with slight sediments, and the bowels of most were disordered with thin, bilious excretions. Many after a crisis of the other symptoms ended with dysentery, as did Xenophanes and Critias. I will mention cases in which was passed copious, watery, clear and thin urine, even after a crisis in other respects favourable, and a favourable sediment : Bion, who lay sick at the house of Silenus, Cratis, who lodged with Xenophanes, the slave of Areto, and the wife of Mnesistratus. Afterwards all these suffered from dysentery.

About the season of Arcturus many had crisis on the eleventh day, and these did not suffer even the normal relapses. There were also comatose fevers about this time, usually in children, and of all patients these showed the lowest mortality.

XVIII. About the equinox up to the setting of the Pleiades, and during winter, although the ardent fevers continued, yet cases of phrenitis were most frequent at this time, and most of them were fatal. In summer, too, a few cases had occurred. Now the sufferers from ardent fever, when fatal symptoms attended, showed signs at the beginning. For right from the beginning there was acute fever with slight rigors, sleeplessness, thirst, nausea, slight sweats about the forehead and collar-bones, but in no case general, much delirium, fears, depression, very cold extremities, toes and hands, especially the latter. The exacerbations on the even days ; but in most cases the pains were greatest on the fourth day, with sweat for the most part chilly, while the extremities could not now be warmed again, remaining livid and cold ; and in these cases the thirst ceased. Their urine was scanty, black, thin, with constipation of the bowels. Nor was there hemorrhage from the nose in any case when these symptoms occurred, but only slight epistaxis. None of these cases suffered relapse, but they died on the sixth day, with sweating. The cases of phrenitis had all the above symptoms, but the crises generally occurred on the eleventh day. Some had their crises on the twentieth day, namely those in whom the phrenitis did not begin at first, or began about the third or fourth day, but though these fared tolerably at the beginning, yet the disease assumed an acute form about the seventh day.

XIX. Now the number of illnesses was great. And of the patients there died chiefly striplings, young people, people in their prime, the smooth, the fair-skinned, the straight-haired, the black-haired, the black-eyed, those who had lived recklessly and care-lessly, the thin-voiced, the rough-voiced, the lispers, the passionate. Women too died in very great numbers who were of this kind. In this constitution there were four symptoms especially which denoted recovery : — a proper hemorrhage through the nostrils ; copious discharges by the bladder of urine with much sediment of a proper character ; disordered bowels with bilious evacuations at the right time ; the appearance of dysenteric characteristics. The crisis in many cases did not come with one only of the symptoms described above, but in most cases all symptoms were experienced, and the patients appeared to be more distressed ; but all with these symptoms got well. Women and maidens experienced all the above symptoms, but besides, whenever any took place properly, and whenever copious menstruation supervened, there was a crisis therefrom which resulted in recovery ; in fact I know of no woman who died when any of these symptoms took place properly. For the daughter of Philo, who died, though she had violent epistaxis, dined rather unseasonably on the seventh day.

In acute fevers, more especially in ardent fevers, when involuntary weeping occurs, epistaxis is to be expected it the patient have no fatal symptoms besides ; for when he is in a bad way such weeping portends not hemorrhage but death.

XX. The painful swellings by the ears in fevers in some cases neither subsided nor suppurated when the fever ceased with a crisis. They were cured by bilious diarrhœa, or dysentery, or a sediment of thick urine such as closed the illness of Hermippus of Clazomenæ. The circumstances of the crises, from which too I formed my judgments, were either similar or dissimilar ; for example, the two brothers, who fell sick together at the same time, and lay ill near the bungalow of Epigenes. The elder of these had a crisis on the sixth day, the younger on the seventh. Both suffered a relapse together at the same time with an intermission of five days. After the relapse both had a complete crisis together on the seventeenth day. But the great majority had a crisis on the sixth day, with an intermission of six days followed by a crisis on the fifth day after the relapse. Those who had a crisis on the seventh day had an intermission of seven days, with a crisis on the third day after the relapse. Others with a crisis on the seventh had an intermission of three days, with a crisis on the seventh day after the relapse. Some who had a crisis on the sixth day had an intermission of six and a relapse of three, an intermission of one and a relapse of one, followed by a crisis ; for example, Euagon the son of Daitharses. Others with a crisis on the sixth had an intermission of seven days, and after the relapse a crisis on the fourth ; for example, the daughter of Aglai+das. Now most of those who fell ill in this constitution went through their illness in this manner, and none of those who recovered, so far as I know, failed to suffer the relapses which were normal in these cases, but all, so far as I know, recovered if their relapses took place after this fashion. Further, I know of none who suffered a fresh relapse after going through the illness in the manner described above.

XXI. In these diseases most died on the sixth day, as did Epaminondas, Silenus and Philiscus the son of Antagoras. Those who had the swellings by the ears had a crisis on the twentieth day, but these subsided in all cases without suppuration, being diverted to the bladder. There were two cases of suppuration, both fatal, Cratistonax, who lived near the temple of Heracles, and the serving-maid of Scymnus the fuller. When there was a crisis on the seventh day, with an intermission of nine days followed by a relapse, there was a second crisis on the fourth day after the relapse — in the case of Pantacles, for example, who lived by the temple of Dionysus. When there was a crisis on the seventh day, with an intermission of six days followed by a relapse, there was a second crisis on the seventh day after the relapse — in the case of Phanocritus, for example, who lay sick at the house of Gnathon the fuller.

XXII. During winter, near the time of the winter solstice, and continuing until the equinox, the ardent fevers and the phrenitis still caused many deaths, but their crises changed. Most cases had a crisis on the fifth day from the outset, then intermitted four days, relapsed, had a crisis on the fifth day after the relapse, that is, after thirteen days altogether. Mostly children experienced crises thus, but older people did so too. Some had a crisis on the eleventh day, a relapse on the fourteenth, and a complete crisis on the twentieth. But if rigor came on about the twentieth day the crisis came on the fortieth. Most had rigors near the first crisis, and those who had rigors at first near the crisis, had rigors again in the relapses at the time of the crisis. Fewest experienced rigors in the spring, more in summer, more still in autumn, but by far the most during winter. But the hemorrhages tended to cease.

XXIII. The following were the circumstances attending the diseases, from which I framed my judgments, learning from the common nature of all and the particular nature of the individual, from the disease, the patient, the regimen prescribed and the prescriber — for these make a diagnosis more favourable or less ; from the constitution, both as a whole and with respect to the parts, of the weather and of each region ; from the custom, mode of life, practices and ages of each patient ; from talk, manner, silence, thoughts, sleep or absence of sleep, the nature and time of dreams, pluckings, scratchings, tears ; from the exacerbations, stools, urine, sputa, vomit, the antecedents and consequents of each member in the successions of diseases, and the abscessions to a fatal issue or a crisis, sweat, rigor, chill, cough, sneezes, hiccoughs, breathing, belchings, flatulence, silent or noisy, hemorrhages, and hemorrhoids. From these things must we consider what their consequents also will be.

XXIV. Some fevers are continuous, some have an access during the day and an intermission during the night, or an access during the night and an intermission during the day ; there are semitertians, tertians, quartans, quintans, septans, nonans. The most acute diseases, the most severe, difficult and fatal, belong to the continuous fevers. The least fatal and least difficult of all, but the longest of all, is the quartan. Not only is it such in itself, but it also ends other, and serious, diseases. In the fever called semitertian, which is more fatal than any other, there occur also acute diseases, while it especially precedes the illness of consumptives, and of those who suffer from other and longer diseases. The nocturnal is not very fatal, but it is long. The diurnal is longer still, and to some it also brings a tendency to consumption. The septan is long but not fatal. The nonan is longer still but not fatal. The exact tertian has a speedy crisis and is not fatal. But the quintan is the worst of all. For if it comes on before consumption or during consumption the patient dies.

XXV. Each of these fevers has its modes, its constitutions and its exacerbations. For example, a continuous fever in some cases from the beginning is high and at its worst, leading up to the most severe stage, but about and at the crisis it moderates. In other cases it begins gently and in a suppressed manner, but rises and is exacerbated each day, bursting out violently near the crisis. In some cases it begins mildly, but increases and is exacerbated, reaching its height after a time ; then it declines again until the crisis or near the crisis. These characteristics may show themselves in any fever and in any disease. It is necessary also to consider the patient’s mode of life and to take it into account when prescribing. Many other important symptoms there are which are akin to these, some of which I have described, while others I shall describe later. These must be duly weighed when considering and deciding who is suffering from one of these diseases in an acute, fatal form, or whether the patient may recover ; who has a chronic, fatal illness, or one from which he may recover ; who is to be prescribed for or not, what the prescription is to be, the quantity to be given and the time to give it.

XXVI. When the exacerbations are on even days, the crises are on even days. But the diseases exacerbated on odd days have their crises on odd days. The first period of diseases with crises on the even days is the fourth day, then the sixth, eighth, tenth, fourteenth, twentieth, twenty-fourth, thirtieth, fortieth, sixtieth, eightieth, hundred and twentieth. Of those with a crisis on the odd days the first period is the third, then the fifth, seventh, ninth, eleventh, seventeenth, twenty-first, twenty-seventh, thirty-first. Further, one must know that, if the crises be on other days than the above, there will be relapses, and there may also be a fatal issue. So one must be attentive and know that at these times there will be the crises resulting in recovery, or death, or a tendency for better or worse. One must also consider in what periods the crises occur of irregular fevers, of quartans, of quintans, of septans and of nonans.

COPYRIGHT

Works of Hippocrates

ON ANCIENT MEDICINE

PROGNOSTICS

APHORISMS

CONTENTS

EPIDEMICS I AND III

CONTENTS

EPIDEMICS I

FIRST CONSTITUTION

SECOND CONSTITUTION

THIRD CONSTITUTION