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.
8 It follows now that I have to explain the special signs which in any particular affection indicate either hope or danger.
When there is pain in the bladder, if purulent urine is discharged which has in it a sediment slimy and white, it allays apprehension.
In pulmonary disease a patient may possibly regain health, if expectoration, although purulent, relieves pain, so long as he breathes and expectorates freely, and bears the disease without difficulty. Nor is there cause for alarm at an early stage, if the expectoration is mixed with something reddish and with blood, so long as it is expectorated at once.
Pain in the side ends if the suppuration which has arisen is cleared off within forty days.
If there is an abscess in the liver, and the pus let out is uniform and white, in that case recovery is easy, because the mischief is enclosed in a capsule.
Among suppurations too those are tolerable which point and discharge outwards. And of those which move inwards, those are the most favourable which do not affect the overlying skin, but leave it free from pain, and of the same colour as the surroundings. Pus indeed causes no fear, wherever it breaks out, when slimy and uniformly white, and if the fever subsides at once upon its discharge, and distaste for food and thirst cease to be troublesome. Also whenever suppuration descends into the legs,
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and the patient's expectoration from being reddish becomes purulent, there is less danger.
But in phthisis, he that is to recover should have his expectoration white, uniform in consistency and colour, unmixed with phlegm; and that which drips into the nose from the head should have similar characters. It is the best by far for there to be no fever; second best when the fever is so slight as not to impair the appetite or cause frequent thirst. In this affection the patient's state is favourable: when the bowels are moved once a day, the motions being formed and in amount corresponding to the food consumed; the body least attenuated, the chest most broad and hairy; its cartilages small, and covered with flesh. If supervening on phthisis, a woman's menses also become suppressed and pain is continuous over her chest and shoulders, a sudden eruption of blood customarily relieves the disease; for the cough becomes less, and the thirst and slight fever subside. But generally in these cases, unless the haemorrhage recurs, an abscess bursts, and the more blood comes from it the better.
Dropsy is the least alarming when it has commenced without being preceded by any disease; next when it has supervened upon a long illness, certainly if the viscera are sound, if the breathing is easy, if there is no pain, if the body is not hot, and the extremities are wasted uniformly, if the abdomen is soft, if there is no cough, no thirst, if the tongue is not much parched even after sleep; if there is desire for food, if the bowels are moved by medicaments, if the motions when spontaneous are soft and formed, if the size of the abdomen are reduced; if the urine is altered both by a change of
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the wine and of certain medicinal draughts; if there is no lassitude and the disorder is easily borne: a patient who presents all these signs is thoroughly safe, and that case is hopeful which exhibits the greater number of them.
Joint-disorders, too, such as foot and hand aches, if they attack young people and have not induced callosities, can be resolved; for the most part they are removed by dysenteries and fluid motions, whatever the sort.
Epileptic fits again are not difficult to bring to an end, when they have commenced before puberty, and whenever the sensation of the coming fit begins in some one part of the body. It is best for it to begin from the hands or feet, next from the flanks, worst of all from the head.
In such patients, also, the most favourable signs are when the disease can be discharged in the stools. Diarrhoea is itself harmless, when there is no fever, if it is quickly over, if on touching the abdomen no movements are to be felt, if wind follows the last of the motion.
Even dysenteries are not a danger although blood or shreds are passed, as long as fever and other accessories of this malady are absent, so that even a pregnant woman can not only be preserved herself, but the foetus preserved also. It is helpful in this malady if the patient's age is already mature.
Intestinal lubricity on the other hand is more easy got rid of in childhood, certainly if urine begins to be passed and the body to be nourished by the food.
The same age has the advantage in cases both of hip and shoulder pains, and of all forms of para-
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lysis; in such the hip may be cured easily and early, if it is not numbed, if slightly cool, even though the pains are severe, and a paralysed limb can be restored if its nutrition is not at all impaired. Paralysis of the face may be even ended by a quick motion; and any purging benefits runnings of the eyes. But madness is relieved rather by the formation of varicose veins or by a sudden effusion of blood from haemorrhoids or by dysentery.
Shoulder pains spreading to the shoulder-blades or hands are relieved by a vomit of black bile; and pain of any kind which moves downwards is the more curable.
Sneezing puts an end to hiccough.
Prolonged diarrhoeas are suppressed by vomiting.
In a woman a vomiting of blood is relieved by menstruation; when not cleared up by menstruation, nose-bleeding removes all danger. A woman in trouble with her womb or labour difficulty is relieved by sneezing.
Quartan fever in summer is mostly short. In a case of ardent fever with a tremor, delirium is salutary. For enlargement of the spleen dysenteries are good.
Then again fever itself is in the end often a protection, which may appear very strange. For it brings to an end pains over the heart if there is no inflammation; and it also relieves a painful liver; and if it begins after spasm and rigor, it gives entire relief; and it removes the disease of the small intestine arising from urinary difficulty, if by its heat it promotes urination.
Now pains in the head, accompanied by dimness of vision and redness of the eyes, along with some
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itching of the forehead, may be relieved by a haemorrhage, whether fortuitous or procured. Pains in the head and forehead due to wind or to cold or to heat are terminated by running from the nose and sneezings.
The ardent fever, however, which the Greeks call causodes, is got rid of by a sudden shivering. During a fever, if the ears have become dulled, that trouble is entirely removed by a flux of blood from the nose, or by loose motions from the bowel. Against deafness nothing can be more efficacious than a bilious stool. Those who have begun to suffer from the smaller kinds of abscesses in the urethra which they call phumata, get well when pus has come away from that part.
. . . and since they mostly arise of themselves, we may know that even where the resources of art are applied, nature can do the most.
On the other hand, pain in the bladder with persistent fever, when nothing is passed by the bowel, is a fatal evil; the danger is greatest in boys from the seventh to the fourteenth year.
In pulmonary disease, if there was no expectoration during the first days, if it then begins from the seventh day and persists beyond a further seven days, it is dangerous. And the more the sputum has an undistinguishable admixture of colours, the worse it is. But nevertheless nothing is worse than for the expectoration emitted to be homogeneous, whether reddish, or clotted, or white, or glutinous, or pallid,
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or frothy; worst of all, however, is the black. In this same disease the following are signs of danger: cough, catarrh, and even sneezing, which in other maladies is held salutary; and a sudden diarrhoea following upon the above is a most dangerous sign.
Generally too the same signs hold good for pain in the side as for that in the lung, both the more favourable as well as the graver signs.
If the pus discharged from the liver is bloody, it is a deadly sign.
Now of suppurations the worst are those which tend inwards, whilst also discolouring the overlying skin: of those again which burst externally, the worst are those which are largest and most widespread. But even after the abscess has ruptured, or the pus has been let outwards, there is danger for certain if the fever does not subside, or although it subsides, nevertheless recurs; or further if there is thirst, if distaste for food, if liquid motions, if the pus is livid and pallid, if the patient expectorates nothing but frothy phlegm. And of such suppurations, old people die mostly of those excited by lung diseases; younger people of other kinds.
But that in phthisis danger threatens a thin man is signified as follows: the expectoration is purulent with admixtures, a persistent fever robs him of his appetite at meal-times and afflicts him with thirst. Death is at hand if, after the patient has dragged on for a long while, the hair falls out, the urine exhibits sediment like cobwebs and has a foul odour, and most of all when upon the above diarrhoea supervenes; especially if it is the autumn season, when patients who have lasted through the rest of the year are generally undone. Moreover, in this
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disease, after pus has been expectorated, it is fatal for there to be an entire cessation of spitting. In the course of phthisis, even in adolescents, abscesses followed by fistulae arise in the lung; and unless numerous signs of convalescence follow, they do not readily heal. But as regards others, the least easily cured are girls, or those women in whom suppression of menses has supervened upon the phthisis. When again in a man who has been healthy there arises suddenly pain in the head, next he is so overcome by sleep that he snores and cannot be awaked, he will die by the seventh day; the more so, if a loose motion has not preceded, if the eyelids of the sleeper are unclosed and the whites of the eyes show. And in these cases death follows except if the malady has been dispersed by fever.
Again dropsy, if caused by an acute disease, is seldom conducted to a cure, at any rate when signs supervene the reverse of those noted above. Likewise too in this disease a cough takes away hope as is also the case if there is an outburst of blood whether upwards or downwards and water fills the middle of the body. In some also in this disease swellings arise, then subside, and again recur: such patients are in a somewhat safer state than those mentioned above, if they give attention; but generally they are undone by over-confidence in their health. Here we may wonder with good reason why there should be occurrences which cause our bodies harm, and yet at the same time in a measure are beneficial: for whether it is dropsical fluid which has filled a patient up, or whether it is a quantity of pus which has collected in a large abscess, evacuation all at once is as fatal to him, as if a healthy man loses blood by a wound.
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Those too who suffer in their joints, so that growths of hard stuff are formed upon them, are never relieved entirely: all these damages, whether they have begun in old age, or have lasted from youth up to old age, although there is a possibility of some alleviation, are never entirely cured.
Also fits which have arisen after the twenty-fifth year are hard to relieve, much harder when they begin after the fortieth; hence at this age, whilst there may be some hope from nature, there is scarcely any from the Art of Medicine. In this affection, if the whole body is affected all together, and there has not been beforehand in any part some feeling of an oncoming ill, but the patient falls down unexpectedly, he scarcely ever gets well, be his age what it may: further, if either the mind is diseased, or paralysis has been set up, there is no opportunity for the Art of Medicine.
Again in cases of diarrhoea, danger of death is at hand: if there is fever in addition, if there is inflammation of the liver or of the parts over the heart or of the stomach, if excessive thirst, if the affection is prolonged; if the stools are varied and passed with pain, and especially if with these signs true dysenteries set in; and this disease carries off mostly children up to the age of ten; other ages bear it more easily. Also a pregnant woman can be swept away by such an event, and even if she herself recovers, yet she loses the child. Dysenteries are fatal, moreover, when originated by black bile, or if a black motion suddenly issues from a body already wasted by dysentery.
Now intestinal lubricity is the more dangerous, if there is a frequent motion, if there is a flux from
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the bowel at all hours, with or without noise, if the same condition continues by night and in the day-time, if what is passed is either undigested or black, and besides that also slimy and foul; if there is urgent thirst, if urine is not passed after a drink (which happens because then all fluid passes down, not into the bladder, but into the intestine); if the mouth becomes ulcerated, the face reddened and marked as if by kinds of spots of all colours; if the belly is as though in a state of fermentation, fatty and wrinkled, also if there is no desire for food . . . ; while death is imminent in these circumstances, it is much more imminent if also this disease has already lasted a long while, especially if it be in an old patient.
If again there is disease in the smaller intestine, vomiting, hiccough, spasm, delirium are bad signs.
In jaundice again it is most pernicious for the liver to become hard.
If dysentery has seized upon those with disease of the spleen which has then turned into dropsy or into leientery, scarcely any medical treatment can save them from danger.
The disease of the smaller intestine, unless resolved, kills within seven days.
A woman after childbirth is in danger of death, if
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also oppressed by violent and persistent pain in the head along with fever.
To breathe rapidly is a bad sign if there is pain and inflammation in those parts which contain viscera.
A prolonged pain in the head, if without cause it shifts to the neck and shoulders, and again returns to the head, or if it spreads from the head to reach the neck and shoulders, is most pernicious, unless it induces some abscess so that pus is coughed up, or unless there is an outburst of blood from some part, or unless there is upon the head an eruption of much scurf or of pimples all over the body. Equally severe is this malady when a numbness or an itching wanders, now all over the head, now over part of it, or there is felt there a sensation as of something cold, and when these symptoms extend to the tip of the tongue. And since the abscesses described above are beneficial, recovery is more difficult, in proportion as they supervene less often upon such maladies.
When there are pains in the hips, if there is great numbness, and both the leg and hip become cold, if there is no movement of the bowel except forced, and the stool passed is mucous, and if the patient is already over forty, there will be a very prolonged illness, lasting at least a year, nor will it possibly come to an end except either in spring or in autumn.
Treatment is likewise difficult at that age when pain in the shoulders either spreads to the hands or extending to the shoulder-blades gives rise to numbness and pain there, which is not relieved by a vomit
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of bile.
Whatever too the part of the body, any limb which becomes paralysed if it is not moved and wastes, will not be restored to its former state, and the less so the longer the paralysis has been, and the older the patient. And for the cure of all cases of paralysis, winter and autumn are not favourable seasons; there is possibly hope in spring and summer; even when mild this disease is scarcely curable, a severe attack cannot be cured.
All pain also becomes less amenable to treatment as it spreads upwards.
In a pregnant woman, if the breasts suddenly shrivel up, there is danger of abortion. A woman has a defective menstruation who has milk in her breasts, not having just borne a child, or being pregnant.
Quartan fever, whilst brief in summer, is generally prolonged in autumn, and especially so when beginning at the approach of winter. There is danger of death if haemorrhage is followed by dementia and by spasm; the same is the case when, after purgation by medicaments, and, with the bowel still empty, there is an attack of spasm, as also if with great pain in the bowel the extremities become cold.
He does not return to life who has been taken down from hanging with foam around the mouth.
A black stool resembling black blood, passed suddenly, whether accompanied by fever, or even without fever, is dangerous.
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9 Having recognized the indications which either console us with hope, or terrify us with fear, we must pass to the methods of treating Diseases. Of these some are general aids, some special. General Aids are those which are beneficial in most diseases, Special Aids in particular ones. I shall speak first of the general, some of which, however, sustain not alone the sick but also those in health; some are applied against illness only.
Now every corporeal aid either diminishes substance or adds to it, either draws it out or represses it, either cools or warms, either hardens or softens; some act, not merely in one way, but even in two ways, not contrary the one to the other. Substance is withdrawn by blood-letting, cupping, purging, vomiting, rubbing, rocking, and by bodily exercises of all kinds, by abstinence, by sweating; of these I shall now speak.
10 To let blood by incising a vein is no novelty; what is novel is that there should be scarcely any malady in which blood may not be let. Again, to let blood in young women who are not pregnant is an old practice; but it is not an old practice for the same to be tried in children and in the elderly and also in pregnant women: for indeed the ancients were of opinion that the first and last years could not sustain this kind of treatment, and they were persuaded that a pregnant woman, so treated, would abort. Practice subsequently showed indeed that in these matters there is no unvarying rule, and that other observations are rather to be made, to which the consideration of the practitioner ought to be directed. For
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it matters not what is the age, nor whether there is pregnancy, but what may be the patient's strength. So, then, if a youth is weakly, or a woman, although not pregnant, has little strength, it is bad to let blood; for any remaining strength dies out if it is thus stripped away. But a strong child, or a robust old man, or a pregnant woman in good health, may be so treated with safety. It is mostly, however, in such cases that an inexperienced practitioner can be deceived, because at the above ages there is usually a less degree of strength; and a pregnant woman has need also, after the blood-letting, of forces to sustain, not merely herself, but also her unborn child. Not that we should be in a hurry to do anything that demands anxious attention and care; for in that very point lies the art of medicine, which does not count years, or regard only the pregnancy, but calculates the strength of the patient, and infers from that whether possibly or no there is a superfluity, enough to sustain either a child or an old man or simultaneously two beings within one woman. There is a difference between a strong and an obese body, between a thin and an infirm one: thinner bodies have more blood, those of fuller habit more flesh. The more easily, therefore, do the former sustain this sort of depletion; and the more quickly is he who is over-fat distressed by it; hence it is that the body's strength may be estimated better by its blood-vessels than by its actual appearance. And the foregoing are not the sole considerations, but there is also the kind of disease, whether a superabundance or a deficiency of bodily material has done the harm, whether the body is corrupted or sound. For if the material
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of the body is either deficient, or is sound, blood-letting in unsuitable; but if the harm is its copiousness, or the material has become corrupted, there is no better remedy. Therefore severe fever, when the bodily surface is reddened, and the blood-vessels full and swollen, requires withdrawal of blood; so too diseases of the viscera, also paralysis and rigor and spasm of sinews, in fact whatever strangulates the throat by causing difficulty of breathing, whatever suppresses the voice suddenly, whenever there is intolerable pain, and whenever there is from any cause rupture and contusion of internal organs; so also a bad habit of body and all acute diseases, provided, as I have stated above, they are doing harm, not by weakness, but by overloading. But it may happen that some disease demands blood-letting, although the body seems scarcely able to bear it; if, however, there appears to be no other remedy, and if the patient is likely to die unless he be helped even at some risk — that being the position, it is the part of a good practitioner to show that without the withdrawal of blood there is no hope, and to confess how much fear there may be in that step, and then at length, if the attempt is demanded, to let blood. In such a case there should be no hesitation about it; for it is better to try a double-edged remedy than none at all; and in particular it should be done: when there are paralyses; when a man becomes speechless suddenly; when angina causes choking; when the preceding paroxysm of a fever has been almost fatal, and it is very probable that a like paroxysm is about to set in which it seems impossible for the patient's strength to sustain. Further although it is least proper to let blood whilst food is
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undigested, yet that is not an invariable precept; for the case will not always wait for digestion. Thus if a man falls from a height, if there is contusion, or something else happening suddenly has caused vomiting of blood, although food may have been taken but a short while before, yet at once the bodily material should be depleted, lest, if it forms a congestion, it should harm the body; and the same rule will hold good also in other sudden accidents which cause suffocation. But if the character of the affection permits, it should be done then only when there remains no suspicion of undigested food; and therefore the second or third day of the illness may seem the most fitting for the procedure. But whilst there is sometimes a necessity for blood-letting even on the first day, it is never of service after the fourth day, for within that interval the material itself has both been sucked up and corrupted the body, so that then depletion can make it weak but cannot make it sound. But if there is the oppression of a vehement fever, to let blood during the actual paroxysm is to cut the man's throat; the remission is therefore to be awaited: if the fever does not decrease, but merely stops increasing, and there is no hope of remission, then also the opportunity, bad as it is, as it is the only one, should not be missed. When the measure is necessary it should generally be divided between two days; on the first it is better to relieve, and later to deplete the patient, rather than perchance to precipitate his end by dissipating his strength all at once. But if this answers in the case of pus, or of the water in dropsy, all the more necessarily should it answer in the letting out of blood. If the cause affects the body as a whole, blood should be let from the arm;
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if some part, then actually from that part, or at any rate from a spot as near as may be, for it is not possible to let blood from everywhere, but only from the temples, arms and near the ankles. Nor am I ignorant that some say blood should be let from a place the furthest away from the damaged part, for that thus the course of the material of the disease is diverted, but that otherwise it is drawn into the very part which is damaged. Yet this is erroneous, for blood-letting draws blood out of the nearest place first, and thereupon blood from more distant parts follows so long as the letting out of blood is continued; when put a stop to, no more blood comes to the part diseased, because it is no longer drawn to the opened vein. Practice itself, however, seems to have taught that for a broken head blood should be let preferably from the arm; when the pain is situated in one upper limb, then from the arm opposite; I believe because, if anything goes wrong, those parts are more liable to take harm which are already in a bad state. Blood is also at times diverted when, having burst out at one place, it is let out at another. For bleeding from a place where it is not desired ceases after something is applied to stop it there, when the blood is given another exit. Now blood-letting, whilst it may be very speedily done by one practised in it, yet for one without experience is very difficult, for to the vein is joined an artery, and to both sinews. Hence should the scalpel strike a sinew, spasm follows, and this makes a cruel end to the patient. Again, when an artery is cut into, it neither coalesces nor heals; it even sometimes happens that a violent outburst of blood results. As to the actual vein, when completely divided by a forceful cut, its two ends
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are pressed together, and do not let out the blood. Yet if the scalpel is entered timidly, it lacerates the skin but does not enter the vein; at times, indeed, the vein is concealed and not readily found. Thus many things make difficult to one who is unskilled what to one experienced is very easy. The vein ought to be cut half through. As the blood streams out its colour and character should be noted. For when the blood is thick and black, it is vitiated, and therefore shed with advantage, if red and translucent it is sound, and that blood-letting, so far from being beneficial, is even harmful; and the blood should be stopped at once. But this cannot happen under that practitioner who knows from what sort of body blood should be let. It more often happens that the flow of blood continues as black as on the first day; although this be so, nevertheless, if enough has flowed out, blood-letting should be stopped, and always an end should be put to it before the patient faints, and the arm should be bandaged after superimposing a pad squeezed out of cold water, and the next day the vein is to be flicked open by the tip of the middle finger so that, its recent coalescence being undone, it may again let out blood. Whether it be on the first or on the second day that the blood, which has at first flowed out thick and black, begins to become red and translucent, a sufficient quantity has been withdrawn, and the rest of the blood is pure; and so at once the arm should be bandaged and kept so until the little scar is strong, and this, in a vein, becomes firm very quickly.