THIRD CONSTITUTION
PART 13
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
[p. 167]
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.
PART 14
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
[p. 169]
crisis, especially such as had no epistaxis, but these
had sweats also as well as rigors.
PART 15
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,
1 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
[p. 171]
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.
PART 16
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.
PART 17
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
[p. 173]
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.
PART 18
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
[p. 175]
though these fared tolerably at the beginning, yet
the disease assumed an acute form about the seventh
day.
PART 19
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
[p. 177]
expected it the patient have no fatal symptoms
besides ; for when he is in a bad way such weeping
portends not hemorrhage but death.
PART 20
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
[p. 179]
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.
PART 21
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.
PART 22
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
[p. 181]
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.
PART 23
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.
PART 24
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,
[p. 183]
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.
PART 25
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
[p. 185]
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.
PART 26
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.