Of impending disorders there are many signs, in explaining which I shall not hesitate to make use of the authority of ancient men, and especially of Hippocrates; for although more recent practitioners have made some changes in methods of treatment, they allow none the less that the ancients prognosticated best. Before I note, however, those preceding symptoms which suggest fear of disease, it does not seem unfitting to set out: the seasons of the year (1, 1‑2), the sorts of weather (1, 3‑4), periods of life and temperaments which may be in particular safe or open to risks (1, 5), and what kind of disorders is most to be apprehended in each (1, 6‑23). Not that men may not sicken and die at any season, in any sort of weather, at any age, whatever their temperament, from any kind of disease, but since certain kinds occur less . . . but some kinds occur more often, so it is of use that everyone should recognize against what, and when, he should be most on his guard.
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1 So then spring is the most salubrious, next after it comes winter; summer is rather more dangerous than salubrious, autumn is by far the most dangerous. But as regards weather the best is that which is settled, whether cold or hot, the worst that which is the most changeable, and that is why autumn brings down the greatest number. For generally about midday there is heat, but at night and in the early morning, cold, as also in the evening. Thus the body, relaxed by the preceding summer, and now by the midday heat, is caught by the sudden cold. But while this chiefly occurs at this season, so whenever the like happens harm is done.
In settled weather fine days are the most salubrious, rainy better than foggy or cloudy days; and in winter the best days are those in which there is an entire absence of wind, in summer those in which westerly winds blow. As for the other winds, the northerly are more salubrious than those from the sunrising or south; nevertheless, these vary somewhat according to the character of the district. For almost everywhere wind when coming from inland is salubrious, and injurious when from the sea. And not only is health more assured in settled weather, but pre-existing diseases also, if there have been any, are milder and more quickly terminated. But the worst weather for the sick man is that which has
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caused his sickness, so much so that a change to weather of a naturally worse sort may be, in his condition, salutary.
The middle period of life is the safest, for it is not disturbed by the heat of youth, nor by the chill of age. Old age is more exposed to chronic diseases, youth to acute ones. The square-built frame, neither thin nor fat, is the fittest; for tallness, as it is graceful in youth, shrinks in the fulness of age; a thin frame is weak, a fat one sluggish.
In spring those diseases are usually to be apprehended which are stirred up anew by movement of humor. Consequently there tend to arise runnings from the eyes, pustules, haemorrhages, congestions in the body, which the Greeks call apostemata, black bile which they call μελανχολίαν, madness, fits, angina, choked nostrils, runnings from the nose. Also those diseases which affect joints and sinews, being at one time troublesome, at another quiescent, then especially both begin and recur.
But summer, while not wholly exempt from most of the foregoing maladies, adds to them fevers whether continued or ardent or tertian, vomitings, diarrhoeas, earaches, oral ulcerations, cankers which occur on other parts but especially upon the pudenda, and whatever exhausts the patient by sweating.
In autumn there is scarcely one of the foregoing which does not happen; but at this season in addition there arise irregular fevers, splenic pain, subcutaneous dropsy, consumption, called by the Greeks phthisis, urinary difficulty, which they call strangury, the
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small intestine malady which they term ileos, the intestinal lubricity which they call leienteria, hip-pains, fits. Autumn too is a season fatal to those exhausted by chronic diseases and overwhelmed by the heat just past, others it weakens by fresh maladies; and it involves some in very chronic ones, especially quartan fevers, which may last even through the winter. Nor is any other period of the year more exposed to pestilence of whatever sort; although it is harmful in a variety of ways.
Winter provokes headache, coughs, and all the affections which attack the throat, and the sides of the chest and lungs.
Of the various sorts of weather, the north wind excites cough, irritates the throat, constipates the bowels, suppresses the urine, excites shiverings, as also pain of the lungs and chest. Nevertheless it is bracing to a healthy body, rendering it more mobile and brisk. The south wind dulls hearing, blunts the senses, produces headache, loosens the bowels; the body as a whole is rendered sluggish, humid, languid. The other winds, as they approximate to the north or south wind, produce affections corresponding to the one or other. Moreover, any hot weather inflates the liver and spleen, and dulls the mind; the result is that there are faintings, that there is an outburst of blood. Cold on the other hand brings about: at times tenseness of sinews which the Greeks call spasmos, at times the rigor which they call tetanos, the blackening of ulcerations, shiverings in fevers. In times of drought there arise acute fevers, runnings from the eyes, dysenteries, urinary difficulty, articular pains. In wet weather there occur chronic fevers, diarrhoeas, angina, canker,
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fits, and the loosening of sinews which the Greeks call paralysis. Not only does the weather of the day but also of the preceding days matter. If a dry winter has been accompanied by north winds, or again a spring by south winds and rain, generally there ensue runnings from the eye, dysenteries, fevers, and most of all in more delicate bodies, hence especially in women. If on the other hand south winds and rain have prevailed during winter, and the spring is cold and dry, pregnant women near their confinement are in danger of miscarrying; those indeed who reach term, give birth only to weaklings hardly alive. Other people are attacked by dry ophthalmia, and if elderly by choked nostrils and runnings from the nose. But when the south wind prevails from the beginning of winter to the end of spring, side pains, also the insanity of those in fever which is called phrenesis, are very rapidly fatal. And when hot weather begins in the spring, and lasts through the summer, severe sweating must ensue in cases of fever. If a summer has been kept dry by northerly winds, but in the autumn there are showers and south winds, there may then arise cough, runnings from the nose, hoarseness, and indeed in some, consumption. But if the autumn is dry owing to a north wind continuing to blow, all those with more delicate bodies, among whom, as I have mentioned, are women, enjoy good health. The harder constitutions, however, may possibly be attacked by dry ophthalmias, and by fevers, some acute, some chronic, also by those maladies which arise from black bile.
As regards the various times of life, children and
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adolescents enjoy the best health in spring, and are safest in early summer; old people are at their best during summer and the beginning of autumn; young and middle-aged adults in winter. At these periods should any indisposition arise, it is very probable that infants and children still of tender age should suffer from the creeping ulcerations of the mouth which the Greeks call aphthas, vomiting, insomnia, discharges from the ear, and inflammations about the navel. Especially in those teething there arise ulcerations of the gums, slight fevers, sometimes spasms, diarrhoea; and they suffer as the canine teeth in particular are growing up; the most well-nourished children, and those constipated, are especially in danger. In those somewhat older there occur affections of the tonsils, various spinal curvatures, swelling in the neck, the painful kind of warts which the Greeks call acrochordones, and a number of other swellings. At the commencement of puberty, in addition to many of the above troubles, there occur chronic fevers and also nose-bleedings. Throughout childhood there are special dangers, first about the fortieth day, then in the seventh month, next in the seventh year, and after that about puberty. The sorts of affections which occur in infancy, when not ended by the time of puberty, or of the first coitions, or of the first menstruations in the females, generally become chronic; more often, however, puerile affections, after persisting for a rather long while, come to an end. Adolescence is liable to acute diseases, such as fits, especially to consumption; those who spit blood are generally youths. After that age come on
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pain in the side and lung, lethargy, cholera, madness, and outpourings of blood from certain mouths of veins which the Greeks call haemorrhoids. In old age there occur breathing and urinary difficulties, choked nostrils, joint and renal pains, paralysis, the bad habit of body which the Greeks call cachexia, insomnias, the more chronic maladies of the ears, eyes, also of the nostrils, and especially looseness of the bowels with its sequences, dysentery, intestinal lubricity, and the other ills due to bowel looseness. In addition thin people are fatigued by consumption, diarrhoea, running from the nose, pain in the lung and side. The obese, many of them, are throttled by acute diseases and difficult breathing; they die often suddenly, which rarely happens in a thinner person.
2 Now antecedent to illness, as I have stated above, certain signs arise, all of which have this in common, that the body becomes altered from its accustomed state, and that not only for the worse, but it may be even for the better. Hence when a man has become fatter and better looking and with a higher colour, he should regard with suspicion these gains of his for, because they can neither remain in the same state nor advance further, as a rule they fall back in a sort of collapse. Still it is a worse sign when anyone, contrary to his habit, becomes thinner, and loses his colour and good looks; for when there is a superfluity of flesh there is something for the disease to draw upon; when there is a deficiency, there is nothing to hold out against the disease itself. Further, there should be apprehension at once: if the limbs become heavier, if frequent ulcerations arise, if the body feels hotter
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than customary; if heavier sleep oppresses, if there are tumultuous dreams, if anyone wakes up oftener than usual, then falls asleep again; if the body of the sleeper has partial sweats in unaccustomed places, and especially about the chest or neck or legs or knees or hips. Again, if the spirit flags, if he is reluctant to talk or move about, if the body be torpid; if there is pain over the heart or over all the chest, or of the head as happens in most; if the mouth becomes filled with saliva, if there is pain in turning the eyes, if the troops are constricted, when the limbs shiver, if the breathing becomes more laboured; if the blood-vessels of the forehead are distended and throb, if there are frequent yawns; if the knees feel as if fatigued, or the whole body feels weary. Of these signs, many are often, some always, antecedents of fever. The first thing, however, to be considered is, whether any of these signs happen somewhat frequently, yet no bodily trouble has followed it. For there are some peculiarities of persons, without knowledge of which it is not easy for anybody to prognosticate what is going to happen. Consequently anyone may readily be at ease in the case of happenings which he has frequently escaped without harm: the man who ought to be anxious is the one to whom these signs are new, or who has never found them free from danger unless he has taken precautions.
3 But when fever has actually seized upon a man, it may be known that he is not in danger: if he lies upon his side, whether on his right or left, just as suits him, with his legs a little drawn up, as is generally the way with a healthy person when lying
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down; if the patient turns readily in bed, if he sleeps through the night, and keeps awake by day; if he breathes easily; if he does not toss about; if the skin around the navel and pubes is plump; if the parts below the ribs on the two sides are uniformly soft, without any sensation of pain; for even although they are somewhat tumid, so long as they yield to pressure by the fingers, and are not tender, this illness, though it will continue for some time, yet will be safe. There is promise of freedom from anxiety when the body in general is uniformly soft and warm, and it sweats uniformly all over, and if with this sweating the touch of fever comes to an end. Among good signs are: sneezing, also a desire for food, whether maintained from the first, or even beginning after a distaste for food. Nor should a fever which ends on the same day cause alarm, nor indeed one which, although longer in disappearing, yet entirely quiets down before the next paroxysm, so that the body is rendered sound, or, as the Greeks call it, eilikrines. But should any vomiting occur, it should be of bile and of phlegm mixed; any sediment in the urine would be white, slimy, and uniform, and so that even if small clouds, as it were, are swimming in it, they sink to the bottom. Again the belly of one who is safe from danger yields soft, formed motions, at much the same time as was customary in health, as well as proportionate to the food taken. A loose motion
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is worse; but not even this should cause alarm at once, if on the following morning the stool is rather more solid, or if each succeeding motion becomes firmer, reddish, and smelling no worse than that of a man in health. There is no harm in passing off some round worms towards the crisis of the malady. When flatulence causes pain and swelling in the upper part of the abdomen, it is a good sign when intestinal rumbling passes thence downwards towards the lower belly, and the more so, when without difficulty the wind escapes along with the faeces.
4 On the contrary there is danger of a severe disease: when the patient lies on his back with his arms and legs outstretched; when at the onset of an acute disease, especially in lung troubles, he wants to sit up; when he is worn down by insomnia even if he gets some sleep in the day-time, in which case to sleep between ten o'clock in the morning and night is worse than from early morning till ten o'clock. The worst, however, is if he gets sleep neither by day nor by night; for this generally cannot happen unless there is continuous pain. It is not a good sign, however, to be oppressed beyond measure by sleep, and it is the worse the more that somnolence continues day and night. It is also evidence of a serious malady: when the breathing is forcible and quick, when the patient begins to have shiverings from the sixth day, to spit up pus, to expectorate it with difficulty, to have continuous pain, to bear up against the disease with difficulty, to toss the arms and legs, to shed tears involuntarily, to have sticky humor adhering to the teeth, the skin about the navel and the pubes wasted; the parts below the ribs inflamed, painful, hard, tumid, tense and this more on the right than on the left side; the greatest danger, however, is if in that region the
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blood-vessels throb forcibly. It also indicates a serious malady: to become thinner too quickly; to have the head, feet and hands hot, and the belly and sides cold, or to have the extremities cold at the height of an acute disease, or to shiver after sweating; or after vomiting to hiccough or to get red eyes; or to have loss of appetite after eagerness for food or after prolonged fevers; or to sweat profusely, especially a cold sweat, or to have sweats unequally distributed over the body which do not put an end to the fever; and when those fevers which recur every day at the same hour, or which have always equal paroxysms, are not relieved on the third day, but continue; serious also are those fevers which, whilst they increase by paroxysms and are relieved by declining, yet never leave the body free. The worst is when the fever is not even relieved but continues uniformly at its height. It is likewise dangerous for a fever to supervene upon jaundice, especially if the parts below the ribs on the right side remain hard. In these sufferers every acute fever must make us seriously anxious; and never in acute fever or following on sleep is a spasm otherwise than terrifying. To lie in a fright on awaking from sleep is a sign of serious malady; and also when, immediately upon the onset of a fever, there is mental disturbance, or any one of the limbs is paralysed; in which case, although there is a return of vitality, yet generally that limb is weakened. A vomit also is a danger-sign if purely of phlegm or of bile, unmixed, and it is the worse if green or black. It is a bad sign when the urinary sediment is reddish and slimy; worse if it is like flower-petals, thin and white; worst of all if there is an appearance as if of fine clouds composed
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of bran. Also thin and white urine is faulty, but above all in phrenetics. Again it is bad for the motions to be totally suppressed; it is dangerous also during fevers when fluid stools allow the patient no rest in bed, and especially if the evacuation is quite liquid, whether it be whitish or greenish or frothy. In addition danger is indicated when the motion is scanty, viscid, slimy, white, the same when greenish yellow; or if it is either livid or bilious, or bloody, or if a worse odour when ordinary. It is bad after a prolonged fever when the stool is unmixed.
5 After such signs the only thing to pray for is that the disease may be a long one, for so it must be unless it kills. Nor is there any other hope of life in grave illnesses except that the patient may avoid the attack of the disease by protracting it, and that it may be prolonged for sufficient time to afford opportunity for treatment. At the onset, however, there are certain signs from which it is possible to conclude that the disease, even if it be not fatal, nevertheless is going to last rather a long time: when in fevers which are not acute a cold sweat breaks out over the head and neck only, or when there is general sweating without the fever subsiding, or when the patient is at one time cold, at another time hot, or his colour changes from moment to moment, or when in the course of fever there is a congestion in some part, which does not lead the way to recovery, or when the patient wastes a little for a considerable time, again if the urine is at one time clear and limpid, at another time has some sediment which is slimy, white or red, or if there
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is in the sediment an appearance of bread crumbs, or it sends up bubbles.
6 But among the foregoing signs, though there are indeed grounds for fear, still there is hope left: however, that the last stage has now been reached is indicated by the nose becoming pointed, the temples sunken, the eyes hollowed, the ears cold and flaccid with the tips drooping slightly, the skin of the forehead hard and tight: the aspect is dusky or very pallid, and much more so when there has been no preceding insomnia, nor diarrhoea, nor loss of appetite. From which causes these appearances at times arise, but only last one day: and so when they last longer death is indicated. In the case of long-standing disease, when such signs have lasted for the third day, death is at hand, and the more so if besides this the eyes also shun the light and shed tears, and are reddened where they should be white, and the veins in them are pale, and phlegm floating in them comes to stick to the angles and one eye becomes smaller than the other, and either both are deep-sunken, or more tumid, and the eyelids are not closed in sleep, but some of the white of the eyes appears between them — always provided that this has not been occasioned by fluid motions; the same is the case when the eyelids become pale and a similar pallor renders colourless the lips and nostrils; so also when the lips and nostrils and eyes and eyebrows or any one of them become distorted; and the patient owing to weakness either hears not or sees not. Death is likewise denoted: when the patient lies on his back with his knees bent; when he keeps on slipping down towards the foot of the bed; when he uncovers his arms and legs and tosses them
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about anyhow, whilst they lack warmth; when he gapes, when he continually falls asleep; when he whose mind is amiss grinds his teeth, which he did not do in health; when an ulceration, whether pre-existing or arising in the course of the illness, has become dry and either pallid or livid. The following are also indications of death: the nails and fingers pallid; the breath cold; or if the patient, in a fever or acute disease, or mad or with pain either in the lung or head, picks with his hands at the flock or pulls at the fringes of the bedclothes, or claws at anything small projecting from the adjacent wall. Pains about the hips and lower parts, which, after starting and spreading to the viscera, then suddenly subside, afford evidence of oncoming death, and the more so if there are other signs in addition. It is impossible for a patient to be saved, who, having fever without any swelling, is suddenly choked, or who cannot swallow his saliva; or who, in the same condition of fever and body, has the neck twisted so that he can swallow nothing whatever; or who has continuous fever and is in the last stage of bodily weakness; or when, without the fever subsiding, the surface of the body becomes cold whilst the interior is so hot as even to produce thirst; or when, likewise without the fever subsiding, he is distressed at once by delirium and difficulty in breathing; or when, after a draught of hellebore, he is seized with spasm; or becoming drunk he loses his speech: for generally he is carried off in a spasm, unless either fever supervenes, or he begins to speak by the time that the intoxication should have passed off. A woman also when pregnant is easily carried of by an acute disease, as also a man
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in whom sleep aggravates pain, and one in whom, at the very beginning of a fresh disorder, black bile presents itself, whether below or above; or after his body has become attenuated by a long illness and weakened, when such bile gains exit either way. Expectoration of bile or pus, whether they come up separately or mixed, discloses a danger of death. And when either commences about the seventh day, the patient will most likely die about the fourteenth day, unless other signs, better or worse, supervene; and according as these subsequent signs are the slighter or the graver, so they denote a later or earlier death. In an acute fever a cold sweat is noxious, and so is a vomit in any malady when varied in composition and multicoloured, particularly so when malodorous. And to have vomited blood in a fever is also noxious. Now red and thin urine is usual in severe indigestion, and often, before there is time for it to mature, it carries the man off; and so when such urine persists for a rather long while, danger of death is indicated. The worst and especially death-bringing urine, however, is that which is black, thick, malodorous; such urine is most to be dreaded both in men and in women; but in children urine which is thin and diluted. A motion also is noxious: when varied in composition, when it presents shreds, blood, bile, greenish matter, whether at different times, or simultaneously mixed together yet distinguishable. But although it is possible for the patient to bear up awhile against such symptoms, a speedy termination is denoted, when the motion is livid and also when it is either
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black, or pallid, or fatty, especially if there is added an intensely fetid odour.
I know that on this point someone may question me:— if there are such sure signs of approaching death, how is it that patients who have been deserted by their medical attendants sometimes recover? And rumour has spread it about that some have revived whilst being carried out to burial. Democritus, indeed, a man justly renowned, even held that the signs of life having ended, upon which practitioners had relied, were not sufficiently sure; much more did he not admit that there could be any sure signs of approaching death. In answer to these I shall not even assert that some signs, stated as approximately certain, often deceive inexperienced practitioners, but not good ones; for instance Asclepiades, when he met the funeral procession, recognized that a man who was being carried out to burial was alive; and it is not primarily a fault of the art if there is a fault on the part of its professor. But I shall more modestly suggest that the art of medicine is conjectural, and such is the characteristic of a conjecture, that though it answers more frequently, yet it sometimes deceives. A sign therefore is not to be rejected if it is deceptive in scarcely one out of a thousand cases, since it holds good in countless patients. I state this, not merely in connexion with noxious signs, but as to salutary signs as well; seeing that hope is disappointed now and again, and that the patient dies whom the practitioner at first deemed safe; and further that measures proper for curing now and again make a change into something worse. Nor, in the face of such a variety of temperaments, can
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human frailty avoid this. Nevertheless the medical art is to be relied upon, which more often, and in by far the greater number of patients, benefits the sick. It should not be ignored, however, that it is rather in acute diseases that signs, whether of recovery or of death, may be fallacious.
7 Now that I have set out the signs which are of general occurrence in any case of illness, I pass on to indicate signs which may be presented in particular sorts of diseases. There are, moreover, certain signs, some preceding, some in the course of fevers, which show what is, or what is about to become, the state of the internal parts. Before fever, if the head is heavy, or the eyes dimmed after sleep, or there are frequent sneezings, some attack of phlegm about the head is to be apprehended. If a man is full blooded or very hot, it is likely that there will be haemorrhage from some part. If a man without cause becomes thin, there is fear that his body may lapse into a dangerous state. If there is pain below the ribs or severe flatulence, or if for a whole day undigested urine is passed, there is clearly indigestion present. Persons whose colour is bad when they are not jaundiced are either sufferers from pains in the head or are earth eaters. Those who for a long time have a pale or puffy face are sufferers from head, bowel or stomach trouble. If in the case of a child with constant fever no motion is passed, the colour is altered, and sleeplessness persists and constant crying, there is danger of spasms. Again running from the nose recurring often in a slender and tall man is a sign that consumption is to be apprehended. When for several days no motion passes, it shows that a sudden
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motion or a touch of fever is impending. Dropsy is impending, when with prolonged diarrhoea the feet swell; when there is pain in the lower belly and hips; but this class of disease is wont to arise from the flanks. There is danger, the same as just stated, to those in whom, when there is a desire for stool, the bowels yield nothing unless a forced hard motion; also in whom there is swelling in the feet, and a swelling in turn in the right and then the left half of the abdomen which rises and subsides: but this disease appears to begin from the liver. It is a sign of the same disease, when intestines in the umbilical region undergo twisting (the Greeks call it strophos), when pains in the hips persist, which are not dispersed either by time or by medicaments. But when heat of joints, whether in the feet, hands, or any other part, is such that at that spot the sinews are contracted, or if that same limb, fatigued by a slight cause, is disturbed by heat and by cold alike, it denotes that there is about to set in pain in feet or hands, or disease of that joint in which heat is felt. Children in whom there has been nose-bleeding, which then has ceased, are sure to be troubled by pains in the head, or they get some severe joint-ulcerations, or they also become debilitated by disease of some kind. Women in whom the menstrua are not forthcoming are sure to have the most acute pains in the head, or some part or other becomes subject to disease. There are similarly dangers for those in whom joint-disorders, pains and swellings, arise and subside
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without pain in the feet and such like diseases, especially if they have often pain in the temples and night sweats. Running from the eyes is to be apprehended when the forehead itches. If after childbirth a woman has severe pains, yet without other bad signs, about the twentieth day either blood will burst out from the nose, or there will be some congestion in the lower parts. Indeed anyone getting great pain in the temples or forehead may be rid of it in one of these two ways, by haemorrhage especially if young, if older by suppuration. Fever, moreover, which suddenly, unaccountably and without good signs comes to an end, generally recurs. He will be found to have ulceration either in the nose or in the throat, whose throat, whether in the day-time, or by night, fills with blood, when this has been preceded neither by pains in the head, nor by pain over the heart, nor by coughing, nor by vomiting, nor by slight fever. In a woman, if without apparent cause an inguinal swelling has arisen with slight fever, there is ulceration in the womb. Again thick urine, the sediment from which is white, indicates that pain and disease are to be apprehended in the region of joints or viscera. Similar urine, when greenish, is a sign that there will be either visceral pain and swelling with some danger, or certainly that the patient is not free from fever. But if there is blood or pus in the urine, either the bladder or the kidneys have become ulcerated. The kidneys at any rate are the seat of disorder: if the urine is thick and contains bits of flesh like hairs; if it froths and is malodorous; if at one time it presents something like sand, at another time like blood; when the hips are painful,
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as also the parts intermediate and above the pubes, and there are frequent eructations, now and again bilious vomiting, and the extremities become cold; when there is frequent desire to urinate but great urinary difficulty, and when what is passed is like water, reddish or pallid, yet is followed by little relief, and much wind too is passed with a motion. But the bladder is the actual seat of the disorder: when urine is passed drop by drop, or when blood is emitted with it, and in the blood are some clots which are passed with difficulty, and when the lower parts in the region of the pubes are painful. Cases of stone in the bladder are recognized by the following signs: urine is passed with difficulty and slowly, now and again even involuntarily, drop by drop, the urine being sandy; at times blood, or something blood-stained or purulent, is excreted with the urine; this some pass more readily standing, some whilst lying on the back and especially those with large calculi, some even pass urine bending forwards whilst they relieve the pain by drawing out the penis. There is in that part also a feeling of weight, increased by running, or by any kind of movement. Some also when in great pain interlock their feet, crossing alternately the one over the other. Women again are forced to put their hands to their vulvar orifice and scratch; at times they feel the stone when they put a finger to the place where it is pressing upon the neck of the bladder. But there is a lung disease in those who spit up frothy blood. In a pregnant woman immoderate looseness of the bowels can drive out the foetus; in the same condition, what she is carrying is a weakling, if milk escapes from her breasts; firm breasts testify that it is
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healthy. It signifies that the liver is inflamed when there is hiccough both frequent and continuing longer than usual. When swellings which have supervened upon ulcerations subside suddenly, if situated in the back, either spasm or rigor may be apprehended; but if this happens in front, either acute pleural pain or madness is to be expected: at times also in such a case, diarrhoea follows, which is the safest thing. If a customary bleeding from haemorrhoids is suddenly suppressed, dropsy or phthisis follows. Phthisis likewise supervenes if, after beginning with pain in the side, suppuration cannot be cleared off within forty days. And the black bile disease supervenes upon prolonged despondency with prolonged fear and sleeplessness. Those who often have bleeding from the nose, have swelling of the spleen, or pains in the head, and as a consequence some observe phantoms before their eyes. But those in whom the spleens are enlarged, in these the gums are diseased, the mouth foul, or blood bursts out from some part. When none of these things happen, of necessity bad ulcers will be produced on the legs, and from these black scars. In those who, with a cause for pain, do not feel it, the mind is disordered. If blood flows into the abdomen it is there turned into pus. There is danger of suppuration in the chest when pain spreads there from the hips and lower parts, even although no other bad sign is added. When, without any fever, there is pain or itching in some part, with redness and heat, some suppuration is taking place there. Also urine which is not limpid enough for a man in health denotes that some parotid suppuration is about to set in.
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Now these signs, though even in the absence of fever, they afford indications of latent or oncoming affections, do so with much more certainty when there is fever in addition; and then signs of other diseases besides may develop. Thus madness is to be apprehended immediately: when a patient speaks more hurriedly than he did when well, and of a sudden becomes loquacious, and that with more audacity than was his wont; or when he breathes slowly and forcibly, and has dilated blood-vessels, while the parts below the ribs are hard and swollen. Further signs of madness are: frequent movement of the eyes, and, in cases of headache, shadows passing before the eyes; or loss of sleep in the absence of pain, the wakefulness persisting night and day; or lying on the belly contrary to habit without being obliged to do so by abdominal pain; or, while the body is still vigorous, an unaccustomed grinding of the teeth. If also there has been congestion which has subsided without the formation of pus, whilst fever persists, there is brought about danger first of delirium, then of death. Acute pain in ear with continuous severe fever also often disturbs the mind; from which affection younger patients die at times within seven days; older ones later, for they experience neither such high fever, nor are equally delirious, hence they hold out until this condition is converted into pus. The breasts of a woman, when they become suffused with blood, also indicate that delirium is about to supervene. But in those in whom fevers are prolonged, there will be an abscess somewhere or pains in the joints. When during fever the breathing in the throat becomes impeded, spasms are impending. If angina subsides suddenly, the malady has passed
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into the lung; and it is then often fatal within seven days. If that does not happen, it follows that somewhere there is suppuration. Again after a prolonged looseness of the bowels there arise dysenteries, and after these intestinal lubricity; phthisis after excessive runnings from the nose; lung diseases after pain in the side; and from these madness; after ardent fevers rigor or spasm of sinews; after a head wound, delirium; when wakefulness tortures, spasms of sinews; when in wounds blood-vessels throb violently, haemorrhage. But suppuration is induced by many diseases; for if fever continues for a long while without pain and without evident cause, suppuration is developing in some part — in younger patients, however; for generally in the elderly from a self-same malady a quartan fever is developed. Suppuration is likewise being produced if the parts below the
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ribs are hard and painful, and have not carried off the patient by the twentieth day, or nose-bleeding has not occurred, and this chiefly in the case of adolescents, especially if from the commencement there has been dimness of vision, or headache; but in these cases something is abscessing in the lower parts of the abdomen. Or if the parts below the ribs present a soft swelling which persists and does not subside within sixty days, and fever holds all that time; but in these cases an abscess is being produced in the upper parts of the abdomen. And if it is not produced in the actual viscera, it breaks out around the ears. Whilst every swelling of long standing is generally an expectant abscess, it tends more to this in the region in front of the heart, than in the abdomen, and in the abdomen rather above than below the navel. Something is abscessing, either in the jaws or in the joints, if there is with the fever also a feeling of lassitude. At times too the urine remains thin and unconcocted for so long that other signs are salutary, and from this condition an abscess often occurs below the transverse membrane which the Greeks call diaphragma. Pain in the lung again, when not terminated by expectoration or by blood-letting, or by regulation of the diet, may excite some abscesses in it about the twentieth, thirtieth, fortieth, occasionally sixtieth day. But we will count from the day when there is first fever or shivering or sense of weight in that part. These abscesses originate sometimes from the lung, sometimes from the opposite side. Whichever side is affected the suppuration gives rise to pain in inflammation; it is hotter there, and if the patient lies on the sound side he seems to oppress it by some weight. Further, any suppuration, not yet evident to the eye, can be detected as follows: if the fever does not remit, but whilst diminishing by day, increases at night, there is profuse sweating, a desire to cough, yet hardly anything is expectorated in coughing; the eyes are sunken, the cheeks flushed, the veins under the tongue pale; the finger nails become curved, the fingers hot, especially at their tips; there are swellings in the feet; there is greater difficulty in breathing, and distaste for food; pustules spring up all over the body. But if there was pain from the commencement with cough and difficult breathing, the abscess will burst before or
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about the twentieth day; if these signs happen later they necessarily have to develop, but the less quickly they come to a head, the later the relief. In a grave disease the feet, toes and nails also tend to blacken; and when death does not follow, and the rest of the body recovers, nevertheless the feet fall off.