Sect. III

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

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

3. Those diseases which have their paroxysms on even days have their crises on even days; and those which have their paroxysms on uneven days have their crises on uneven days. The first period of those which have the crisis on even days, is the 4th, 6th, 8th, 10th, 14th, 20th, 30th, 40th, 60th, 80th, 100th; and the first period of those which have their crises on uneven days, is the 1st, 3d, 5th, 7th, 9th, 11th, 17th, 21th, 27th, 31st. It should be known, that if the crisis take place on any other day than on those described, it indicates that there will be a relapse, which may prove fatal. But one ought to pay attention, and know in these seasons what crises will lead to recovery and what to death, or to changes for the better or the worse. Irregular fevers, quartans, quintans, septans, and nonans should be studied, in order to find out in what periods their crises take place.

Fourteen Cases of Disease

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

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

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

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

CASE V. The wife of Epicrates, who was lodged at the house of Archigetes, being near the term of delivery, was seized with a violent rigor, and, as was said, she did not become heated; next day the same. On the third, she was delivered of a daughter, and everything went on properly. On the day following her delivery, she was seized with acute fever, pain in the cardiac region of the stomach, and in the genital parts. Having had a suppository, was in so far relieved; pain in the head, neck, and loins; no sleep; alvine discharges scanty, bilious, thin, and unmixed; urine thin, and blackish. Towards the night of the sixth day from the time she was seized with the fever, became delirious. On the seventh, all the symptoms exacerbated; insomnolency, delirium, thirst; stools bilious, and high colored. On the eighth, had a rigor; slept more. On the ninth, the same. On the tenth, her limbs painfully affected; pain again of the cardiac region of the stomach; heaviness of the head; no delirium; slept more; bowels constipated. On the eleventh, passed urine of a better color, and having an abundant sediment; felt lighter. On the fourteenth had a rigor; acute fever. On the fifteenth, had a copious vomiting of bilious and yellow matters; sweated; fever gone; at night acute fever; urine thick, sediment white. On the seventeenth, an exacerbation; night uncomfortable; no sleep; delirium. On the eighteenth, thirsty; tongue parched; no sleep; much delirium; legs painfully affected. About the twentieth, in the morning, had as light rigor; was comatose; slept tranquilly; had slight vomiting of bilious and black matters; towards night deafness. About the twenty-first, weight generally in the left side, with pain; slight urine thick, muddy, and reddish; when allowed to stand, had no sediment; in other respects felt lighter; fever not gone; fauces painful from the commencement, and red; uvula retracted; defluxion remained acrid, pungent, and saltish throughout. About the twenty-seventh, free of fever; sediment in the urine; pain in the side. About the thirty-first, was attacked with fever, bilious diarrhea; slight bilious vomiting on the fortieth. Had a complete crisis, and was freed from the fever on the eightieth day.

CASE VI. Cleonactides, who was lodged above the Temple of Hercules, was seized with a fever in an irregular form; was pained in the head and left side from the commencement, and had other pains resembling those produced by fatigue; paroxysms of the fevers inconstant and irregular; occasional sweats; the paroxysms generally attacked on the critical days. About the twenty-fourth was cold in the extremities of the hands, vomitings bilious, yellow, and frequent, soon turning to a verdigris-green color; general relief. About the thirtieth, began to have hemorrhage from both nostrils, and this continued in an irregular manner until near the crisis; did not loathe food, and had no thirst throughout, nor was troubled with insomnolency; urine thin, and not devoid of color. When about the thirtieth day, passed reddish urine, having a copious red sediment; was relieved, but afterwards the characters of the urine varied, sometimes having sediment, and sometimes not. On the sixtieth, the sediment in the urine copious, white, and smooth; all the symptoms ameliorated; intermission of the fever; urine thin, and well colored. On the seventieth, fever gone for ten days. On the eightieth had a rigor, was seized with acute fever, sweated much; a red, smooth sediment in the urine; and a perfect crisis.

CASE VII. Meton was seized with fever; there was a painful weight in the loins. Next day, after drinking water pretty copiously, had proper evacuations from the bowels. On the third, heaviness of the head, stools thin, bilious, and reddish. On the fourth, all the symptoms exacerbated; had twice a scanty trickling of blood from the right nostril; passed an uncomfortable night; alvine discharges like those on the third day; urine darkish, had a darkish cloud floating in it, of a scattered form, which did not subside. On the fifth, a copious hemorrhage of pure blood from the left he sweated, and had a crisis. After the fever restless, and had some delirium; urine thin, and darkish; had an affusion of warm water on the head; slept and recovered his senses. In this case there was no relapse, but there were frequent hemorrhages after the crisis.

CASE VIII. Erasinus, who lived near the Canal of Bootes, was seized with fever after supper; passed the night in an agitated state. During the first day quiet, but in pain at night. On the second, symptoms all exacerbated; at night delirious. On the third, was in a painful condition; great incoherence. On the fourth, in a most uncomfortable state; had no sound sleep at night, but dreaming and talking; then all the appearances worse, of a formidable and alarming character; fear, impatience. On the morning of the fifth, was composed, and quite coherent, but long before noon was furiously mad, so that he could not constrain himself; extremities cold, and somewhat livid; urine without sediment; died about sunset. The fever in this case was accompanied by sweats throughout; the sweats throughout; the hypochondria were in a state of meteorism, with distention and pain; the urine was black, has round substances floating in it, which did not subside; the alvine evacuations were not stopped; thirst throughout not great; much spasms with sweats about the time of death.

CASE IX. Criton, in Thasus, while still on foot, and going about, was seized with a violent pain in the great toe; he took to bed the same day, had rigors and nausea, recovered his heat slightly, at night was delirious. On the second, swelling of the whole foot, and about the ankle erythema, with distention, and small bullae (phlyctaenae); acute fever; he became furiously deranged; alvine discharges bilious, unmixed, and rather frequent. He died on the second day from the commencement.

CASE X. The Clazomenian who was lodged by the Well of Phrynichides was seized with fever. He had pain in the head, neck, and loins from the beginning, and immediately afterwards deafness; no sleep, acute fever, hypochondria elevated with a swelling, but not much distention; tongue dry. On the fourth, towards night, he became delirious. On the fifth, in an uneasy state. On the sixth, all the symptoms exacerbated. About the eleventh a slight remission; from the commencement to the fourteenth day the alvine discharges thin, copious, and of the color of water, but were well supported; the bowels then became constipated. Urine throughout thin, and well colored, and had many substances scattered through it, but no sediment. About the sixteenth, urine somewhat thicker, which had a slight sediment; somewhat better, and more collected. On the seventeenth, urine again thin; swellings about both his ears, with pain; no sleep, some incoherence; legs painfully affected. On the twentieth, free of fever, had a crisis, no sweat, perfectly collected. About the twenty-seventh, violent pain of the right hip; it speedily went off. The swellings about the ears subsided, and did not suppurate, but were painful. About the thirty-first, a diarrhea attended with a copious discharge of watery matter, and symptoms of dysentery; passed thick urine; swellings about the ears gone. About the fortieth day, had pain in the right eye, sight dull. It went away.

CASE XI. The wife of Dromeades having been delivered of a female child, and all other matters going on properly, on the second day after was seized with rigor and acute fever. Began to have pain about the hypochondrium on the first day; had nausea and incoherence, and for some hours afterwards had no sleep; respiration rare, large, and suddenly interrupted. On the day following that on which she had the rigor, alvine discharges proper; urine thick, white, muddy, like urine which has been shaken after standing for some time, until the sediment had fallen to the bottom; it had no sediment; she did not sleep during the night. On the third day, about noon, had a rigor, acute fever; urine the same; pain of the hypochondria, nausea, an uncomfortable night, no sleep; a coldish sweat all over, but heat quickly restored. On the fourth, slight alleviation of the symptoms about the hypochondria; heaviness of the head, with pain; somewhat comatose; slight epistaxis, tongue dry, thirst, urine thin and oily; slept a little, upon awaking was somewhat comatose; slight coldness, slept during the night, was delirious. On the morning of the sixth had a rigor, but soon recovered her heat, sweated all over; extremities cold, was delirious, respiration rare and large. Shortly afterwards spasms from the head began, and she immediately expired.

CASE XII. A man, in a heated state, took supper, and drank more than enough; he vomited the whole during the night; acute fever, pain of the right hypochondrium, a softish inflammation from the inner part; passed an uncomfortable night; urine at the commencement thick, red, but when allowed to stand, had no sediment, tongue dry, and not very thirsty. On the fourth, acute fever, pains all over. On the fifth, urine smooth, oily, and copious; acute fever. On the sixth, in the evening, very incoherent, no sleep during the night. On the seventh, all the symptoms exacerbated; urine of the same characters; much talking, and he could not contain himself; the bowels being stimulated, passed a watery discharge with lumbrici: night equally painful. In the morning had a rigor; acute fever, hot sweat, appeared to be free of fever; did not sleep long; after the sleep a chill, ptyalism; in the evening, great incoherence; after a little, vomited a small quantity of dark bilious matters. On the ninth, coldness, much delirium, did not sleep. On the tenth, pains in the limbs, all the symptoms exacerbated; he was delirious. On the eleventh, he died.

CASE XIII. A woman, who lodged on the Quay, being three months gone with child, was seized with fever, and immediately began to have pains in the loins. On the third day, pain of the head and neck, extending to the clavicle, and right hand; she immediately lost the power of speech; was paralyzed in the right hand, with spasms, after the manner of paraplegia; was quite incoherent; passed an uncomfortable night; did not sleep; disorder of the bowels, attended with bilious, On the fourth, recovered the use of her tongue; spasms of the same parts, and general pains remained; swelling in the hypochondrium, accompanied with pain; did not sleep, was quite incoherent; bowels disordered, urine thin, and not of a good color. On the fifth, acute fever; pain of the hypochondrium, quite incoherent; alvine evacuations bilious; towards night had a sweat, and was freed from the fever. On the sixth, recovered her reason; was every way relieved; the pain remained about the left clavicle; was thirsty, urine thin, had no sleep. On the seventh trembling, slight coma, some incoherence, pains about the clavicle and left arm remained; in all other respects was alleviated; quite coherent. For three days remained free from fever. On the eleventh, had a relapse, with rigor and fever. About the fourteenth day, vomited pretty abundantly bilious and yellow matters, had a sweat, the fever went off, by coming to a crisis.

CASE XIV. Melidia, who lodged near the Temple of Juno, began to feel a violent pain of the head, neck, and chest. She was straightway seized with acute fever; a slight appearance of the menses; continued pains of all these parts. On the sixth, was affected with coma, nausea, and rigor; redness about the cheeks; slight delirium. On the seventh, had a sweat; the fever intermitted, the pains remained. A relapse; little sleep; urine throughout of a good color, but thin; the alvine evacuations were thin, bilious, acrid, very scanty, black, and fetid; a white, smooth sediment in the urine; had a sweat, and experienced a perfect crisis on the eleventh day.