The Hippocratic Writings

The Oath

I swear by Apollo the Physician, by Asclepius, by Hygieia and Panacea, and by all the gods and goddesses, making them my witnesses, that I will carry out, as far as my ability and judgment allow, this oath and this written covenant.¹

I will regard the man who taught me this art, the craft of medicine, as equal to my own parents. I will share my livelihood with him, and if he needs money, I will give him a share of mine. I will look on his sons as my own brothers, and if they want to learn this art, I will teach it to them without fee and without a written contract.

I will pass on the rules of the art, the lectures, and all the rest of the teaching to my own sons, to the sons of the man who taught me, and to pupils who have signed the covenant and sworn the oath according to the physicians' law, but to no one else.

I will use diet and regimen to help the sick, as far as my ability and judgment allow, and I will keep them from harm and from wrong.

I will not give a deadly drug to anyone, even if asked, nor will I suggest such a course. Nor will I give a woman a pessary to cause an abortion.

I will keep my life and my art pure and holy.

I will not use the knife, not even on patients suffering from stones, but will leave that work to the men whose trade it is.

Whatever houses I enter, I will go in to help the sick, keeping myself free of all deliberate wrongdoing and corruption, and above all of sexual relations with anyone's body, whether woman or man, free or slave.

Whatever I see or hear while treating patients, or even outside my practice, in the everyday life of the people I meet, if it is something that ought never to be spread abroad, I will keep silent about it, holding such things to be secrets not to be spoken.

If I keep this oath and do not break it, may I enjoy my life and my art, honoured among all people for all time to come. If I break it and swear falsely, may the opposite be my lot.

The Law

1. Medicine is the most distinguished of all the arts (the skilled crafts that can be learned and taught). But because of the ignorance of those who practise it, and of those who judge such practitioners carelessly, it has by now fallen far behind all the others. To my mind the chief cause of this failure is that in our cities medicine is the only art that carries no penalty at all except disgrace, and disgrace does not wound men who are made of it. Such men are very like the extras who are brought on stage in a tragedy. Those extras have the figure, the costume and the mask of an actor, but they are not actors. It is the same with physicians: many in name, but very few in fact.

2. Anyone who means to gain a true understanding of medicine must have the following: natural ability, teaching, a place suited to study, instruction from childhood, a love of hard work, and time. First of all, natural ability is needed, for if nature is against you, everything else is wasted. But when nature points the way to the best, then teaching in the art can begin. The student must take hold of it with intelligence, having been taught from childhood in a place well suited to learning. He must also bring a love of hard work to it over a long time, so that his learning may take root in his nature and bear fruit, rich and well grown.

3. Learning medicine is like raising the crops that grow in the earth. Our natural ability is the soil. The doctrines of our teachers are the seed. Learning from childhood is the seed falling on the ploughed field in its proper season. The place where the learning happens is like the nourishment that growing things draw from the air around them. Hard work is the tilling of the field. And time strengthens all these things, until they come to their full growth.

4. These, then, are what we must bring to the art of medicine. Once we have gained a true knowledge of it, we may travel from city to city and be regarded as physicians not in word only but in deed. Inexperience, on the other hand, is a poor treasure and a poor heirloom for those who own it, asleep or awake. It knows nothing of confidence or cheerfulness, and it is the nurse of both cowardice and recklessness. Cowardice is a sign of weakness, and recklessness a sign of a lack of skill. There are two different things, knowledge and opinion: the one makes a man know, the other leaves him ignorant.

5. Holy things are revealed only to holy men. It is not lawful to show them to outsiders until they have been initiated, as worshippers are into the mysteries, into the secret rites of knowledge.

On Ancient Medicine

1. All those who have tried to speak or write about medicine have begun by laying down a postulate for their argument, an assumption taken for granted at the outset. Their postulate is hot, or cold, or wet, or dry, or anything else they like. With it they shrink the cause of disease and death in human beings down to a single starting point, the same one for everybody, postulating one thing or two. All these people are plainly wrong in much of what they actually say. But they most deserve blame because what they are wrong about is an art, a real craft with knowledge and skill behind it that can be taught, and one that everyone relies on when the most important things are at stake, and whose good craftsmen and practitioners everyone honours most highly. Some practitioners are poor, and others are far better. That could not happen if there were no art of medicine at all, and if nothing in it had ever been investigated or discovered. Then everyone would be equally inexperienced and ignorant of it, and the treatment of the sick would be left wholly to chance. But that is not how things are. Just as in every other art the practitioners differ greatly from one another in skill of hand and in judgment, so they do in medicine.

That is why I have never thought medicine needed an empty postulate, as subjects do that are hidden from us and baffling. On those subjects, such as things up in the sky or things under the earth, anyone who tries to say anything at all has to use a postulate. If someone were to state, and even to know, how these things really are, it would be clear neither to the speaker himself nor to his listeners whether what he said was true or not. There is nothing to check it against that would give certain knowledge.

2. But medicine has long had everything it needs: it has found both a starting point and a method. By that method many excellent discoveries have been made over a long period of time, and the rest will be discovered too, if someone capable, who knows what has already been found, sets out from there and keeps on searching. But whoever throws all this away and rejects it, and tries to search by some other road and in some other fashion, and then claims to have found something, has been deceived and is deceiving himself. It cannot be done. Why it cannot be done I will try to show, by explaining and setting out what the art is. From that it will become clear that discoveries cannot be made in any other way than this one.

Above all, it seems to me, anyone who talks about this art must say things that ordinary people can understand, since there is nothing else to investigate or to talk about except what these very people suffer when they are ill and in pain. For ordinary people to work out their own sufferings by themselves, how they begin and how they end, and what makes them grow worse or better, is not easy. But once someone else has discovered these things and explains them, it is easy, since each listener has only to remember what has happened to him. If a speaker fails to reach the understanding of ordinary people, and does not put his hearers in that frame of mind, he will fail to reach the truth. For this reason too, then, medicine has no need of a postulate.

3. To begin with, the art of medicine would never have been discovered, or even looked for, since there would have been no need for it, if the sick had done well on the same way of life and the same food as the healthy eat and drink and live by, and if nothing else had been better for them than that. But in fact it was sheer necessity that made people look for medicine and find it, because the sick did not do well on the same diet as the healthy, any more than they do now.

To go back further still: I believe that even the way of life and the food that healthy people now use would never have been discovered, if a human being had been satisfied with eating and drinking the same things as an ox, a horse, and every creature except man: the things that grow out of the earth, such as fruits, twigs and grass. On these the animals feed and grow and live without trouble, needing no other way of life at all. And indeed I think that in the beginning human beings too lived on food of this kind. Our present diets seem to me to have been discovered and worked out over a long period of time, because people suffered many terrible things from that harsh, beastlike way of living, eating raw, unmixed foods that had great powers in them, that is, strong effects on the body. They suffered the same things they would suffer from such foods now: they fell into violent pains and illnesses, and died quickly. In those days, no doubt, they suffered less, because they were used to it, but even then they suffered badly. Most of them, the ones with weaker constitutions, probably died, while those who were stronger held out longer, just as now some people get over strong foods easily, and others only with much pain and trouble.

For this reason, then, I think these early people too searched for food that suited human nature, and found the food we use now. They soaked wheat, husked it, ground and sifted it, kneaded and baked it, and made bread; from barley they made barley cake. They worked away at many other foods besides, boiling and baking and mixing them, blending the strong, unmixed foods with weaker ones, and shaping everything to fit the nature and the power of a human being. Their thinking was this: foods too strong for the body's nature to master, if they are eaten, will bring pain, disease and death, while foods it can master will bring nourishment, growth and health. What fairer or more fitting name could anyone give to this discovery and this search than medicine? It was discovered for the health, the safety and the nourishment of human beings, to replace that way of life which brought pains, diseases and deaths.

4. If this is not thought of as an art, that is not surprising. Where nobody is a layman, and everyone has the knowledge because everyone must use it and cannot do without it, it is not fitting to call anyone a practitioner of the art. Yet the discovery was a great one, and it took much inquiry and skill. Even now, at any rate, the men in charge of gymnasiums and athletic training keep on making new discoveries, searching along this same road for what a man should eat and drink so that he masters it best and grows stronger than he was.

5. Now let us look at what everyone agrees is medicine, the art discovered for the treatment of the sick, which has both a name and practitioners of its own, and ask whether it too aims at the same things, and where on earth it began. As I said at the start, I think nobody would ever have looked for medicine if the same diets had suited the sick and the healthy. Even now, at any rate, people who make no use of medicine, non-Greeks and some Greeks too, live just as the healthy do when they are ill, eating for pleasure; they will not give up anything they want, or even cut it down.

But those who looked for medicine and found it had the same idea in mind as the men I spoke of in my earlier argument. First, I suppose, they cut down the amount of those same foods, and gave very little instead of a lot. Sometimes this was enough for some of the sick, and it clearly helped them, but not for all. There were some in such a state that they could not master even a little food, and people like that seemed to need something weaker. The doctors therefore invented broths, mixing a little of the strong foods with a lot of water, and taking away their strength by mixing and boiling. For those who could not master even the broths, they took these away too, and came down to drinks alone. And they took care that the drinks too were moderate in their mixture and their quantity, giving neither more than was needed, nor too strong a drink, nor too weak a one.

6. One thing must be clearly understood: for some people who are ill, broths do no good at all. On the contrary, the moment they take them, their fevers and their pains grow worse. Plainly, what they took became food and growth for the disease, and wasting and weakness for the body. And any people in that condition who take dry food, barley cake or bread, even a very little of it, will be harmed ten times more, and more obviously, than if they took broths, for no other reason than that the food is too strong for their condition. And a person for whom broths are good, but solid food is not, will be harmed far more if he eats a lot of it than if he eats a little, though even a little will give him pain. All the causes of suffering, then, come back to one and the same thing: the strongest foods do the most harm, and the most obvious harm, to a person, whether he is healthy or sick.

7. What difference in thinking, then, do we see between the man we call a doctor, an acknowledged craftsman, who discovered the diet and the food for the sick, and the man who, at the very beginning, discovered and prepared for all mankind the food we use now, in place of that wild and beastlike way of life? To me the reasoning seems the same, and the discovery one and alike. The first man tried to take away whatever human nature, even in health, could not master when it was taken in, because it was beastlike and unmixed. The doctor tried to take away whatever the condition a person happens to be in at a given moment cannot master. How does the doctor's discovery differ from the first one, except that it covers more ground, is more varied, and takes more work? The first one is simply the starting point, and came earlier.

8. If we compare the diet of the sick with that of the healthy, we will find that the food of wild beasts and other animals is no more harmful to the healthy than the healthy diet is to the sick. Take a man ill with a disease that is neither severe and desperate nor, on the other hand, quite mild, but one in which any mistake on his part is bound to show. Suppose he decides to eat bread and meat, or anything else that does the healthy good: not much of it, but far less than he could have eaten if he were well. And take a healthy man, whose constitution is neither very weak nor very strong, and suppose he eats something that would do an ox or a horse good and make it strong, such as bitter vetch, or barley, or something of that sort: again not much of it, but far less than he could manage. The healthy man who does this will suffer just as much pain and danger as the sick man who took bread or barley cake at the wrong time. All this is proof that the whole art of medicine could be discovered by searching along this same road.

9. If it were as simple as I have described it so far, with whatever was stronger doing harm, and whatever was weaker doing good and nourishing both the sick and the healthy, the business would be easy. One would only have to play safe and steer everything toward the weaker side, and that would protect a great deal. But in fact it is no smaller mistake, and does a person no less harm, to give him less food, or weaker food, than he needs. Hunger has great power over human nature: it can cripple, weaken and kill. Emptiness brings many other evils too, different from the evils of overfilling but no less terrible. That is why the whole thing is far more complicated and calls for far greater precision. We must aim at some measure, and you will find no measure, no number or weight, to check against for exact knowledge, except the feeling of the body itself. That is why it is hard work to learn this so precisely that you make only small mistakes one way or the other. I would praise very highly the doctor who makes only small mistakes; perfect accuracy is seldom to be seen.

Most doctors, to my mind, are in the same position as bad ship's pilots. When those men make mistakes steering in a calm, nobody notices. But when a great storm catches them, with a gale that drives them off course, then it is plain to everyone that they have lost the ship through their ignorance and their blundering. It is the same with bad doctors, who are the great majority. When they treat people with nothing serious the matter, people whom even the greatest blunder would not seriously harm (and illnesses like that are common, far more common than serious ones), their mistakes go unnoticed by laymen. But when they meet a great, violent and dangerous illness, then their mistakes and their lack of skill are plain to all. Neither pilot nor doctor waits long for his punishment: it comes quickly.

10. That untimely emptying does a person no less damage than untimely filling can be learned well by looking at the healthy. Some of them do best on one meal a day, and have made that their rule because it suits them. Others, for the same reason, take lunch as well as dinner, because that suits them. And there are some who took up one habit or the other for pleasure, or by some other chance. For most people it makes no difference which habit they follow, whether one meal a day or lunch as well. But there are some who could not easily get away with doing what does not suit them. For either kind, if they change their habit for a single day, and not even a whole day, terrible discomfort follows. Those whom lunch does not suit, if they take it, at once become heavy and sluggish in body and mind, full of yawning, drowsiness and thirst; and if they go on to eat dinner too, they get wind and colic, and their bowels break out in diarrhoea. For many this has been the beginning of a serious illness, even though they ate twice a day the same food they were used to eating once, and no more.

On the other hand, if a man who is used to lunch, because it suits him, goes without it, then as soon as the hour has passed he is at once seized by terrible weakness, trembling and faintness. After that his eyes grow hollow, his urine yellower and hotter, his mouth bitter; his insides seem to him to hang loose; he has dizziness, low spirits, and no energy for work. On top of all this, when he tries to eat dinner, the food tastes less pleasant, and he cannot get through what he used to eat for dinner when he had had his lunch. And this very food goes down with colic and rumbling and scorches the belly; such people sleep badly and have troubled, turbulent dreams. For many of these too, this has been the beginning of an illness.

11. We must look into the reason why these things happened to them. The man who was used to one meal a day suffered, I think, because he did not wait long enough for his belly to take the full good of the food eaten the day before, to master it, and to empty and settle down. Instead he put new food on top of food that was still seething and fermenting. Bellies like that digest much more slowly, and need more rest and quiet. The man who was used to lunch suffered because, as soon as his body needed food, and the earlier meal had been used up, and he had nothing left to draw on, no new food came to him at once; and so he wastes and melts away from hunger. Everything that I say such a person suffers I put down to hunger. And I say that all other people too, if they go without food for two or three days while they are healthy, will suffer the same things I have described in those who went without their lunch.

12. Constitutions like these, which feel the effects of mistakes quickly and severely, are, I maintain, weaker than the others. The weakly man comes very close to the sick man, and the sick man is weaker still, and is all the more likely to suffer whenever he misses the right moment. With so much precision required in the art, it is hard always to hit on the exact truth. Yet many parts of medicine have reached that degree of precision, and I will speak of them later. I say, though, that the ancient art should not be thrown out as if it did not exist, or as if its search had been badly conducted, just because it is not precise in every detail. Far rather, since it has been able to come close to perfect accuracy by reasoning, starting out from deep ignorance, I think we should marvel at its discoveries, as the work of good and right inquiry, and not of chance.

13. But I want to bring the argument back to those who search for the art in the new way, starting from a postulate. If what harms a person is something hot or cold or dry or wet, then the doctor who treats correctly must fight hot with cold, cold with hot, dry with wet, and wet with dry. Give me a man whose constitution is not one of the strong ones but one of the weaker. Let him eat wheat just as he takes it from the threshing floor, raw and unprepared, with raw meat, and let him drink water. On this diet, I know very well, he will suffer many terrible things: he will have pains, his body will grow weak, his belly will be ruined, and he will not be able to live long. What remedy, then, should be prepared for a man in this state? Hot or cold or dry or wet? Obviously one of these, for if what is harming him is one of them, then, as their theory goes, its opposite ought to put an end to it.

The surest and most obvious remedy is to take away the diet he was using, and give him bread instead of wheat, boiled meat instead of raw, and wine to drink with it. With this change he cannot fail to get well again, unless he has been completely ruined by time and by the diet. What shall we say, then? That he was suffering from cold, and that these hot things helped him? Or the opposite? Whoever is asked, I think, will be completely at a loss. When the baker made bread out of the wheat, did he take away its hot, or its cold, or its dry, or its wet? Bread has been given to the fire and to water, and worked together with many other things, each of which has its own power and nature. It has lost some of the qualities it had, and has been blended and mixed with others.

14. Of course I also know this: it makes a difference to a person's body whether bread is made of fine sifted flour or of whole meal, of hulled wheat or of unhulled, whether it is kneaded with a lot of water or a little, kneaded hard or hardly kneaded at all, baked through or underbaked. And there are countless other differences besides. The same is true of barley cake. The powers of each kind are great, and no two are alike. Whoever has not looked into these things, or has looked and learned nothing, how could he know anything about what human beings suffer? Every single one of these things acts on a person and changes him, in one way or another, and the whole of life depends on them, for the healthy, for those recovering from illness, and for the sick. Surely, then, nothing could be more useful or more necessary to know than these things. It was with fine and fitting reasoning, suited to human nature, that the first discoverers searched for them and found them. They thought the art worthy to be credited to a god, as indeed people still believe.

For they did not think that the dry or the wet, or the hot or the cold, or anything else of that sort, either harms a person or is something he needs. What they thought did the harm was the strength of each thing: whatever is too strong for human nature, so that the body cannot master it. That is what they tried to take away. The strongest part of the sweet is the sweetest, of the bitter the bitterest, of the sour the sourest, and of every one of the things in us, its extreme. They saw that these things are present in a human being, and that they do him harm. In a human being there is salt and bitter, sweet and sour, astringent (the puckering taste of unripe fruit) and insipid, and countless other things. They have powers of every kind, in quantity and in strength. When these are mixed and blended with one another, nobody notices them, and they do the person no harm. But when one of them separates off and stands by itself, then it can be noticed, and it does harm.

Again, take the foods that do not suit us and harm a person when they get into him. Every one of them is either bitter, or salt, or sour, or something else unmixed and strong. That is why they upset us, just as the things that separate off inside the body upset us. But the foods a person eats and drinks every day plainly have very little share in such an unmixed, distinct humour (humour being the doctors' word for a juice, whether in a food or in the body). I mean bread, barley cake and the like, which people are used to taking in great quantity and all the time. I leave aside the dishes seasoned and dressed up for pleasure and for stuffing oneself. Great quantities of these plain foods go into a person, yet they cause very little upset, and very little separating off of the powers in the body. Instead, strength, growth and nourishment come from them more than from anything. And the reason is simply this: they are well blended, with nothing unmixed or strong in them. They have become one simple whole.

15. For my part, I am at a loss to know how the men who argue the other way, and lead the art off this road and onto a postulate, actually treat people according to their postulate. They have not, I think, discovered anything that is hot or cold or dry or wet in itself, with no share in any other form. I think they have at hand the same foods and drinks that all of us use. They just attach a label to each: to one "hot," to another "cold," to another "dry," to another "wet." It would be hopeless to order a patient to take "something hot." He will ask at once: "What?" They must then either talk nonsense or take refuge in one of these familiar foods.

Suppose one hot thing happens to be astringent, and another hot thing insipid, and a third hot thing causes wind; there are many other hot things too, with other powers that are opposed to one another. Surely it will make a difference whether the doctor gives the hot astringent thing, or the hot insipid one, or the one that is cold and astringent at the same time (there is such a thing too), or the cold insipid one. As far as I know, each of these pairs has exactly the opposite effect of the other. That is true not only in a human being but in leather and wood and many other things that feel less than a human being does. It is not the hot that has the great power. It is the astringent and the insipid and the other qualities I have mentioned, both inside a human being and outside him, whether eaten or drunk, rubbed on the skin, or put on as a plaster.

16. I believe that of all the powers, cold and heat have the least sway in the body. Here are my reasons. As long as the hot and the cold are in the body mixed together, they do no harm, since the hot is tempered and moderated by the cold, and the cold by the hot. But when either is separated off on its own, then it does harm. And at that very moment, when cold comes on and does a person some harm, heat comes at once for that very reason, from right inside the person, needing no help or preparation. This happens both in the healthy and in the sick.

Take a healthy man who chooses to chill his body in winter, with a cold bath or in some other way. The more he does it, as long as his body is not frozen solid, the more his body grows hot, and the longer it stays hot, once he puts his clothes on and comes indoors. Again, suppose he chooses to heat himself thoroughly, in a hot bath or at a big fire, and then stays in the same clothes and in the same place as when he was chilled. He seems far colder, and more shivery besides. Or suppose someone fans himself because of stifling heat, making a cool breeze for himself. When he stops, the heat and stuffiness will be ten times worse for him than for someone who does nothing of the kind.

Here is something much stronger still. Think of people who walk through snow or other cold and get badly chilled in the feet, the hands or the head. What they suffer at night, once they are wrapped up and in a warm place, is burning and itching. Some of them even come up in blisters, like people burned by fire. And they suffer none of this until they have been warmed. That is how readily each of the two passes over into the other. I could give countless other examples. And what about the sick? Is it not those who have had a shivering fit in whom the fever blazes up most sharply? Yet it is not a strong fever. It stops after a short while, it is mostly harmless besides, and it is hot through and through for as long as it lasts. It passes through the whole body and ends up mostly in the feet, where the shivering and the chill were most violent and lingered longest. And when the patient sweats and the fever leaves him, he is far colder than if he had never caught it at all. When the very opposite arrives this quickly, and of its own accord takes away the power of the cold, what great or terrible thing could come of it? And what need is there of much help against it?

17. Someone might say: "But people in the fever of burning fevers (fevers with intense heat and thirst), of pneumonia and of other violent diseases are not quickly rid of the heat. And here the hot and the cold are no longer taking turns." For my part, I think this is my strongest proof that people do not have fevers simply because of heat, and that heat is not the only cause of the harm. Rather, the same thing is both bitter and hot, or sour and hot, or salt and hot, and there are countless other pairings. And cold, again, goes along with other powers. These pairings, then, are what do the harm. The heat is there too, alongside them. It has as much force as the leading thing, growing worse and increasing along with it, but it has no power beyond what belongs to it.

18. That this is so is plain from the following signs. First, take the more obvious ones, which all of us have often had and will have again. Some of us catch a cold in the head, with a flux running from the nose (a flux being a flow of fluid from one part of the body to another). This flux is usually sharper and more biting than what was forming before and coming out of the nose every day. It makes the nose swell, and it inflames it until it is extremely hot and fiery, if you put your hand to it. And if it lasts longer, the place even breaks into sores, though it has no flesh on it and is hard. But the burning in the nose stops somehow. It does not stop while the flux is running and the inflammation lasts. It stops when the flow becomes thicker and less sharp, ripened and more mixed than before (ripened meaning that the body has worked it into a state in which it can be got rid of). Then, at last, the burning is over. But in cases that plainly come from cold alone, with nothing else joining it, the cure is the same for everyone: to be warmed after the chill, and cooled after the heat. These changes come quickly and need no ripening. But all the rest, which come from humours that are sharp and unmixed, arise in the same way, I say, and settle back to normal when they are ripened and blended.

19. Again, think of the fluxes that turn toward the eyes. They carry strong, sharp juices of every kind. They make sores on the eyelids, and in some people they eat away the cheeks and the parts below the eyes, wherever they flow. They even break through and eat away the membrane around the eye. Pain, burning and extreme inflammation hold on for a time, until the fluxes ripen and grow thicker, and the gummy matter forms from them. Ripening comes from being mixed, blended with one another and stewed together.

Next, the fluxes that go to the throat, which cause hoarseness, quinsy (a choking swelling of the throat), erysipelas (a spreading red inflammation) and pneumonia. All these at first give off salty, watery, sharp matter, and in that state the diseases are strong. But when the matter becomes thicker and riper, and loses all its sharpness, then at last the fevers stop too, along with everything else that troubles the patient. Surely we must count as the cause of each complaint the things whose presence necessarily produces a complaint of that kind, and whose change into another blend makes it stop. Whatever comes, then, from pure heat or pure cold, with no share in any other power, would stop when it changes from hot to cold or from cold to hot. And it changes in the way I described before.

What is more, everything else a person suffers comes from powers. Take the case when a bitterness is poured out, the one we call yellow bile. What nausea, burning and weakness then grip the patient! But when people get rid of it, sometimes by being purged, either of their own accord or by a drug, then, if this happens at the right moment, they are plainly rid of both the pains and the heat. But as long as these things are floating loose, unripened and unmixed, there is no way at all to stop the pains or the fevers. And think of the people in whom sharp, corrosive acids rise up. What frenzy, what gnawing in the bowels and the chest, what restlessness! None of it stops until the acid is purged away, or calmed down and mixed with the rest.

Now consider ripening, changing, thinning and thickening into the form of humours, through forms of every other kind. That is why crises and the counting of days carry such weight in illnesses like these (a crisis being the decisive turn of the illness, toward recovery or death). The hot and the cold are less subject than anything to any of these processes: neither of them could ferment or thicken. What, then, shall we say undergoes them? Blends of humours, each with a different power in relation to the others. The hot, mixed with anything else, will not lose its heat, except when it is mixed with the cold. Nor will the cold lose its coldness, except with the hot. But everything else in a person becomes gentler and better the more things it is mixed with. And a person is in the best condition of all when everything in him is ripened and at rest, with no single power showing itself. On this, I believe, I have said enough.

20. Some doctors and philosophers say that nobody can know medicine who does not know what a human being is. This, they say, is what anyone who means to treat people correctly must learn thoroughly. But their argument turns toward philosophy, like the work of Empedocles (the philosopher who taught that everything is made of four elements) or of others who have written about nature: what a human being is from the very beginning, how he first came into being, and what he was put together from. For my part, I think that whatever any philosopher or doctor has said or written about nature has less to do with the art of medicine than with the art of painting.

I also think that clear knowledge about nature can come from no other source than medicine. One can gain it once one has grasped medicine itself, correctly and as a whole. Until then, it seems to me, one is very far from it. I mean this kind of inquiry: knowing precisely what a human being is, what causes make him what he is, and the rest. This much, at least, a doctor must know about nature, I think, and must take great pains to know it, if he is to do any of his duty. He must know what a human being is in relation to what he eats and drinks, and in relation to his other habits, and what will happen to each person from each of them. And he must not know it in a simple way, like this: "Cheese is a bad food, because it gives pain to anyone who fills himself with it." He must know what pain it gives, and why, and which of the things in a human being it does not suit. There are many other bad foods and drinks too, and they affect a person in different ways.

Let me put it like this. Unmixed wine (wine not cut with water, the way Greeks normally drank it) affects a person in a certain way when he drinks a lot of it. Everyone who knows this would recognise that this is a power of wine, and that the wine itself is the cause. And we know which parts of a person it acts on most. That is the kind of truth I want to see made plain in the other cases too. Take cheese, since I used it as my example. It does not harm all people alike. There are some who can eat their fill of it without the slightest harm. Indeed, it gives wonderful strength to those it suits. And there are others who come off badly. The natures of these people, then, differ. They differ in this: there is something in the body that is hostile to cheese, and it is roused and stirred up by it. Those in whom such a humour happens to be present in greater quantity, and with more mastery in the body, are naturally the ones who suffer more. But if cheese were bad for human nature as a whole, it would have harmed everyone. Whoever knew these things would not fall into the mistakes that follow.

21. During recovery from illness, and also in long illnesses, many upsets happen. Some come of their own accord, and some from whatever the patient happened to be given. I know that most doctors behave just like laymen here. Suppose the patient happened to do something new around that day: took a bath, or a walk, or ate something different. Even if all of these did more good than harm, the doctors still put the blame on one of them. They do not know the real cause, and they take away what may have been most useful. They should not do this. They should know what a bath taken at the wrong time will do, or what fatigue will do. The harm from the one is never the same as the harm from the other, nor the same as the harm from overeating, or from this food or that. Whoever, then, does not know how each of these things acts on a human being will not be able to recognise what comes from them, or to use them correctly.

22. I think a doctor must also know which of a person's sufferings come from powers and which from structures. What I mean is roughly this. By a power I mean the intensity and strength of the humours. By structures I mean the shapes of the parts inside a human being. Some are hollow, narrowing from wide to narrow. Some are spread open. Some are hard and round, some broad and hanging, some stretched, some long. Some are dense, some loose and plump, some spongy and porous.

Now which shape would be best at drawing fluid to itself and sucking it out of the rest of the body? The hollow and spread-open, the hard and round, or the hollow that narrows from wide to narrow? I think it is the ones that narrow from a wide hollow. But these things must be learned from outside, from what can be seen. For instance, if you open your mouth wide, you will suck up no liquid. But if you push out your lips and purse them, press them together, and then put a tube to them, you can easily suck up whatever you like. Again, cupping vessels (the cups doctors put on the skin to draw blood) narrow from wide to narrower, and they are made that way for this very purpose: to draw and suck from the flesh. There are many other things of the same kind. Of the parts inside a human being, the bladder and the head have this shape, and so, in women, does the womb. And plainly these draw most strongly, and are always full of fluid brought in from elsewhere.

The hollow, spread-open parts would be best of all at receiving fluid that flows into them, but they would not draw it in so well. The hard, round parts would neither draw fluid in nor receive it when it flows in, since it would slip round them and find no seat to rest on. The spongy, porous parts, such as the spleen, the lungs and the breasts, would soak up most readily whatever lies against them. These parts most of all would grow hard and swell when fluid comes to them. It is not as in the belly, where the fluid is inside and the belly holds it from the outside, and it is emptied out every day. When one of these spongy parts drinks the fluid and takes it into itself, its empty, porous spaces fill up, even the small ones, everywhere. Instead of soft and loose, it becomes hard and dense, and it neither digests the fluid nor lets it go. It suffers this because of the nature of its shape.

Things that cause wind and swelling in the body naturally make noise and rumbling in the hollow, roomy parts, such as the belly and the chest. When the wind does not fill a part so completely that it stands still, but keeps changing and moving, it must make noise and movements you can see. In fleshy, soft parts, such things cause numbness and congestion, like what happens in a stroke. But suppose the wind meets something broad and resisting and rushes against it. And suppose this thing is by nature neither strong enough to bear the force and take no harm, nor soft and porous enough to take it in and give way. Suppose instead it is tender, plump with blood and dense, like the liver. Then, because it is dense and broad, it stands firm and does not give way. The wind, held back, grows and becomes stronger, and rushes most of all against whatever blocks it. And because the part is tender and full of blood, it cannot be free of pain. For these reasons the sharpest and most frequent pains occur in this region, and abscesses and growths are very common there. This also happens under the diaphragm, and violently, but much less so. The diaphragm is spread broad and resisting, but its nature is more sinewy and stronger, and that is why it is less painful. But pains and growths occur around it too.

23. There are many other kinds of shapes, inside the body and outside it, which differ greatly from one another in what they make a person suffer, sick or healthy. Heads are small or large; necks are thin or thick, long or short; bellies are long or round; chests and ribs are broad or narrow. There are countless others. A doctor must know how all of these differ, so that, knowing the causes of each thing, he may take the right precautions.

24. As for the powers of the humours themselves, we must examine what each of them can do to a person, as I said before, and how they are related to one another. I mean something like this. Suppose a sweet humour changed into another form, not by being mixed with something, but by leaving its own nature of itself. What would it become first: bitter, salt, astringent or sour? Sour, I think. The sour humour, then, would be the most unsuitable of the rest to give, if the sweet is the most unsuitable of all. In this way, if one could succeed in searching from outside, in things that can be seen, one could always pick out the best of all. And the best is always what lies farthest from the unsuitable.

On the Sacred Disease

1. As for the so-called sacred disease (what we call epilepsy), this is how it stands: it is not, in my opinion, any more divine or more sacred than any other disease, but has a nature of its own, as the other diseases do, and a cause from which it arises. People came to think that its nature and its cause were something divine because they had no experience of it and were amazed by it, since it is not like other diseases at all. Their helplessness, their failure to understand it, keeps its divinity alive, but the easy way they cure it destroys that divinity, for they treat it with purifications and incantations.

Besides, if it is to be thought divine because it is wonderful, there will be many sacred diseases, not just one. I will point out others that are no less wonderful and no less monstrous, and nobody thinks they are sacred. First, there are the fevers that come back every day, the tertian fevers that come back every other day, and the quartan fevers that come back every third day (the Greeks counted both ends, so they called them the third-day and fourth-day fevers). These seem to me no less sacred, and no less sent by a god, than this disease, and yet nobody marvels at them. Next, I see people who rave and are out of their minds from no visible cause, and do many things that make no sense. I know many who groan and shout in their sleep, some who choke, and some who leap up and run out of doors and are out of their minds until they wake; after that they are healthy and sane again, just as before, though pale and weak. And this happens to them not once but many times. There are many other things of every kind like these, and to speak of each one would take a long time.

To my mind, the first people who made this disease sacred were men of the same kind as the magicians, purifiers, begging priests and quacks of our own day, the people who pretend to be extremely pious and to know more than other men. Such men, then, used the divine as a cloak and a shield for their own helplessness, since they had nothing they could give that would help. So that no one would see that they knew nothing, they declared this illness sacred; then they picked out a plausible story to go with it and set up a treatment that kept themselves safe, prescribing purifications and incantations, and ordering the patient to stay away from baths and from many foods that are unsuitable for sick people to eat.

Of sea fish, he must not eat the red mullet, the blacktail, the grey mullet or the eel, for these, they say, are the most dangerous fish. Of meats, he must not eat goat, venison, pork or dog, for these are the meats that most upset the belly. Of birds, he must not eat the cock, the turtle-dove or the bustard, nor anything else that is thought to be very strong. Of vegetables, he must not eat mint, garlic or onion, for nothing sharp does a weak man any good. He must not wear a black cloak, for black means death. He must not lie on a goatskin or wear one. He must not put one foot on top of the other, or one hand on top of the other. All these things, they say, are hindrances to the cure.

They impose all these rules for the sake of the divine, as if they knew something more than others, and they give other reasons besides. Their purpose is this: if the patient gets well, the fame and the credit for cleverness are theirs; but if he dies, their excuses are safely in place, and they can claim that they are not to blame, but the gods are. After all, they gave him no drug to eat or drink, and they did not stew him in baths, so nobody can think them the cause.

For my part, I think that if this were true, none of the Libyans who live in the interior would ever be healthy, since they lie on goatskins and eat goat meat; indeed they have no bedding, no cloak and no shoe that is not made of goat, because they have no livestock except goats and cattle. If these things, when eaten or worn, give birth to the disease and make it worse, and if keeping away from them cures it, then the god is not the cause of anything, and the purifications do no good. It is the foods that cure and the foods that harm, and the power of the divine disappears.

It seems to me, then, that those who try to cure these diseases in this way do not really believe them to be either sacred or divine. If such purifications and such treatment can remove them, what is to stop other tricks of the same kind from bringing them on people and attacking them? In that case the cause is no longer divine, but something human. Whoever can drive such an illness away by purifying and by magic could also bring other illnesses on by some trick of his own, and by this argument the divine disappears.

By saying and contriving such things they pretend to know something more than others, and they deceive people by laying ritual cleansings and purities on them. Most of their talk turns on the divine and on spirits. And yet, as I see it, they are not talking about piety, as they suppose, but rather about impiety, and as though the gods did not exist. What they call pious and divine is impious and unholy, as I will now show.

Suppose they claim to know how to pull down the moon, and blot out the sun, and make storms and fair weather, rains and droughts, the sea barren and the earth too, and everything else of that sort. Whether the men who practise these things say they can do them through initiation into mysteries, or through some other knowledge or study, they seem to me to be guilty of impiety. They seem to believe that the gods do not exist, or that if they do exist they have no power at all, and that they themselves need hold back from no deed, however extreme. If that is how they act, are they not dreadful in the gods' sight? If a man, by magic and by sacrifices, can bring down the moon and blot out the sun and make storms and fair weather, I would not believe that any of these things was divine, but would think it human, since the power of the divine would then be mastered and enslaved by a man's cleverness.

But perhaps none of this is so. Perhaps men who need a living invent and embroider all sorts of things, in every other matter and in this disease too, and lay the blame for each form the disease takes on some god. Nor do they blame one god only, but several. If the patient makes noises like a goat, or roars, or his right side is convulsed, they say the Mother of the Gods is to blame. If his cry is shriller and more piercing, they compare it to a horse's, and say Poseidon is to blame. If he passes some stool, which often happens to people under the violence of the disease, they give it the name of Enodia, the goddess of the roads. If the stool is thinner and more frequent, like a bird's, it is Apollo Nomios, Apollo of the flocks. If he foams at the mouth and kicks with his feet, Ares takes the blame. When there are terrors in the night, and fears, and fits of madness, and leaping out of bed, and frightful visions, and running out of the house, they say these are the assaults of Hecate and the attacks of the heroes, the spirits of the dead.

They use purifications and incantations, and in doing so, it seems to me, they make the divine into something utterly unholy and godless. They purify people who have this disease with blood and other such things, as though the sufferers were polluted, or haunted by avenging spirits, or bewitched by other men, or had done some unholy deed. They ought to do exactly the opposite: sacrifice and pray, and bring the sick to the temples, and beg the gods for help. Instead they do none of this, but purify. Some of the leftovers of the purifications they hide in the earth, some they throw into the sea, and some they carry off to the mountains, where no one will touch them or step on them. They ought to take these things to the temples and give them back to the god, if a god really is the cause.

For my part, I do not think a man's body is defiled by a god, the most corruptible of things by the most holy. Even if a body happened to be defiled by something else, or to suffer some harm, the god would be more likely to purify it and make it holy than to defile it. It is the divine, after all, that cleanses us of the greatest and most unholy of our wrongs, and purifies us, and washes us clean. We ourselves mark out boundaries for the gods around their temples and sacred precincts, so that no one may cross them unless he is pure. And when we go in, we sprinkle ourselves with holy water, not because we are being defiled, but to wash away any stain we may already have. That is what I think about purifications.

2. This disease, then, seems to me no more divine than the rest. It has a nature, as the other diseases do, and a cause from which each of them arises. In its nature and its cause it is divine in the same way as all the others, and from the same source. It can be cured, no less than the others, unless a long time has already worn it in so deeply that it has grown stronger than the drugs that are given for it.

It begins, like the other diseases, in the family. A phlegmatic parent has a phlegmatic child (phlegm is the cold, wet humour, and in such people it is strong). A bilious parent has a bilious child, a consumptive parent a consumptive child, and a parent with a diseased spleen a child with a diseased spleen. What, then, is to stop some of the children of a father and mother who had this disease from having it too? The seed comes from every part of the body: healthy seed from the healthy parts, and diseased seed from the diseased parts.

Here is another strong proof that it is no more divine than the other diseases. It attacks people who are phlegmatic by nature, but it does not strike the bilious. Yet if it were more divine than the others, this disease ought to come to everyone alike, and make no distinction between the bilious and the phlegmatic.

3. No: the cause of this illness is the brain, as it is of the other most serious diseases. How it happens, and from what cause, I will explain clearly. The human brain is double, as it is in every other animal, and a thin membrane divides it down the middle. That is why a headache is not always in the same part of the head, but sometimes on one side, sometimes on the other, and sometimes over the whole of it.

Vessels run to the brain from every part of the body (the Greek word covers what we call arteries as well as veins). Many of these vessels are thin, but two are thick, one coming from the liver and the other from the spleen. The one from the liver runs like this: part of it stretches down on the right side, past the kidney itself and the loin muscle, to the inside of the thigh, and goes on down to the foot. It is called the hollow vein. The other part runs upward, through the right side of the diaphragm and through the lung, and branches off into the heart and into the right arm. The rest of it travels up through the collarbone to the right side of the neck, running just under the skin, so that you can see it. Near the ear it goes out of sight, and there it divides. Its thickest, largest and most hollow branch ends in the brain. A small thin vessel goes to the right ear, another to the right eye, and another to the nostril. That is how the vessels from the liver run. A vessel also stretches from the spleen to the left side, both downward and upward, just like the one from the liver, but thinner and weaker.

4. It is through these vessels that we take in most of our breath. They are our body's breathing passages: they draw the air into themselves, channel it to the rest of the body along the smaller vessels, cool the body, and let the air out again. The breath cannot stand still, but moves up and down, for if it stops anywhere and is trapped, the part where it stops loses its power. Here is the proof: when a man is sitting or lying down and some small vessels are pressed, so that the breath cannot pass through the vessel, numbness comes over that part at once. That is how things stand with the vessels and the rest.

5. This disease attacks the phlegmatic, but not the bilious. It begins to grow in the unborn child while it is still in the womb, for the brain, like the other parts of the body, is cleansed and blossoms before birth. In this cleansing, if the brain is purged well and in due measure, and neither more nor less flows off it than ought to, the child will have the healthiest of heads. But if more flows off the whole brain, and a great deal of it melts away, then as he grows up he will have a sickly head, full of ringing, and he will not be able to bear either the sun or the cold. If the flow comes from one particular place, the eye or the ear, or if some vessel has shrunk, that part is damaged, in proportion to the melting. And if no cleansing takes place, but the matter gathers together in the brain, then the child is bound to be phlegmatic.

Children who break out in sores on the head, on the ears and on the rest of the skin, and who drool and have running noses, have the easiest time as they grow older. In this way the phlegm that should have been cleansed away in the womb is let out and purged, and children cleansed like this are, as a rule, not seized by this disease. But children who are clean, who have no sores, no mucus and no drool coming from them, and who did not go through the cleansing in the womb, are in danger of being caught by this disease.

6. If the catarrh (the flow of phlegm down from the head) makes its way to the heart, palpitations and gasping set in, the chest is ruined, and some people even become hunchbacked, for when cold phlegm comes down on the lung or on the heart, the blood is chilled; the vessels next to the lung and the heart are violently chilled and leap, and the heart throbs, so that under this compulsion the gasping comes on, and the patient can breathe only sitting upright. He cannot take in as much breath as he wants until the phlegm that has flowed down is mastered, warmed through, and spread out into the vessels. Then the palpitation and the gasping stop. How soon they stop depends on how much phlegm there is: if more has flowed down, they stop more slowly; if less, more quickly. And if the catarrhs come more often, the attacks come more often; if not, less often. These are the sufferings when the flow goes to the lung and the heart. If it goes to the belly, diarrhoea takes hold.

7. But if the phlegm is shut out of these paths, and makes its flow into the vessels I described earlier, the patient loses his voice and chokes. Foam runs from his mouth, his teeth clench, his hands are drawn tight, his eyes roll, and he has no understanding at all. In some, the stool is passed as well. And these things happen sometimes on the left side, sometimes on the right, and sometimes on both.

I will explain how each of these things happens to him. He loses his voice when the phlegm comes down suddenly into the vessels and shuts out the air, and does not let it through, either to the brain or to the hollow vessels or to the body's cavities, but cuts off his breathing. When a man takes in breath through his mouth and nostrils, it goes first to the brain. Then most of it goes to the belly, some goes to the lung, and some to the vessels. From these it is scattered along the vessels to the other parts. The part that goes into the belly cools the belly and does nothing else; but the air that goes into the lung and the vessels does its work by entering the cavities and the brain, and in this way it gives the mind its understanding and the limbs their movement. When the vessels, then, are shut off from the air by the phlegm, and do not let it through, they leave the man voiceless and senseless.

His hands lose their power and are convulsed, because the blood is held still and does not spread through them as it used to. His eyes roll because the small vessels are shut off from the air and throb. Foam comes from his mouth, out of the lung, for when the breath does not get into the lung, it froths and bubbles up, as in a dying man. The stool is forced out by the violence of the choking. He chokes because the liver and the belly are pushed up against the diaphragm, and the mouth of the stomach is shut off; and they are pushed up when less breath than usual comes into the mouth. He kicks with his feet when the air is shut up in the limbs and cannot slip out, because of the phlegm, and as it rushes up and down through the blood, it causes convulsions and pain, and so he kicks.

He suffers all these things when cold phlegm flows into the blood, which is warm, because the phlegm chills the blood and brings it to a stop. If the flux (the flow of phlegm from one part of the body to another) is large and thick, it kills him at once, for its cold overpowers the blood and congeals it. If there is less of it, it masters the blood for the moment and blocks his breathing; then in time it is scattered along the vessels and mixed with the blood, which is plentiful and warm, and once the phlegm is mastered in this way, the vessels take in the air again, and the patient comes back to his senses.

8. Most small children who are seized by this disease die of it, if the flux is large and comes in a south wind, for their small vessels are thin and cannot let the phlegm through, because it is so thick and so plentiful; instead the blood is chilled and congeals, and so the child dies. But if there is only a little phlegm, and it makes its flow into the vessels on both sides, or into those on one side, the child survives, but is marked by it: the mouth is pulled crooked, or an eye, or the neck, or a hand, wherever the small vessel was filled with phlegm, overpowered and wasted. This part of the body, the part that was damaged, is then bound to be weaker and to have less than it needs, because of that small vessel.

Yet in the long run this usually does the child good. Once he has been marked, he is no longer seized by the disease, and here is why: under this compulsion the remaining vessels are damaged and shrink to some degree, so that they still take in the air, but the flow of phlegm no longer runs down into them as it did. It is only to be expected, though, that the limbs will be weaker, since the vessels have been damaged. When the flow comes in a north wind, and is very small, and goes to the right side, the children survive without any mark. But there is a danger that the disease will grow up with the child and grow stronger as he does, unless he is treated with the right remedies. That, or something very close to it, is how it goes with children.

9. In those who are older, the disease does not kill when it attacks, nor does it twist them, for their vessels are hollow and full of hot blood, so the phlegm cannot get the better of them, or chill the blood so far as to congeal it; instead the phlegm itself is mastered and quickly mixed in with the blood. In this way the vessels take in the air, the mind keeps working, and the signs described above take hold of them less, because of their strength.

But in the very old, when this disease attacks, it kills them or paralyses them on one side, because their vessels have emptied, and their blood is scanty, thin and watery. If a great deal of phlegm flows down, and it is winter, it kills them, for it chokes off their breathing passages and congeals their blood, if the flow goes to both sides. If it goes to one side only, it paralyses that side, since the blood cannot master the phlegm, being thin and cold and scanty, but is itself mastered and congeals, so that the parts in which the blood has been spoiled lose their power.

10. The flow goes to the right side more than to the left, because the vessels on the right are more hollow and more numerous than those on the left, since on the right they come from the liver, and on the left from the spleen. The phlegm flows down and melts off most of all in children whose heads have been heated, either by the sun or by a fire, when the brain then suddenly shivers, for that is when the phlegm separates out: it melts off because the brain is warmed and spreads; it separates out because the brain is chilled and draws together; and in this way it flows down.

In some, this is the cause; in others, it happens when a south wind suddenly takes over from north winds: the brain, which was firm and strong, is suddenly loosened and slackened, so that the phlegm floods, and in this way it makes its flow. It also flows down from some cause that cannot be seen, when there is a fright: if the child is frightened when someone shouts, or if while crying he cannot get his breath back quickly, as often happens to children. Whichever of these things happens to him, his body shivers at once. He loses his voice and does not draw his breath; the breath is held still, the brain draws together, the blood stops, and so the phlegm separates out and flows down. These are the causes of the attack in children at the beginning.

For old people, winter is the worst enemy: when a man's head and brain have been heated through beside a big fire, and he then goes out into the cold and shivers, or comes in from the cold into the warmth and sits beside a fire, the very same thing happens to him, and so he is seized in the way I have described. There is great danger of the same thing in spring too, if his head is caught by the sun, but least of all in summer, because there are no sudden changes then.

Once a person has passed the age of twenty, this disease no longer seizes him, unless it has grown up with him from childhood; or rather, it seizes few people of that age, or none, for their vessels are full of blood and the brain is firm and close-knit, so that the phlegm does not flow down into the vessels, and if it does flow down, it does not master the blood, which is plentiful and hot.

11. But in someone in whom the disease has grown up and been nourished from childhood, it has become a habit to suffer this whenever the winds change, and he is usually seized then, especially in south winds. Getting rid of it becomes difficult too, for his brain has become wetter than its nature and is flooded by phlegm, so that the flows come more often, and the phlegm can no longer be separated out, nor the brain dried, but it stays soaked through and wet.

You can see this best in the flock animals that are seized by this disease, especially goats, for they are attacked most often. If you cut open the head, you will find the brain wet, full of fluid as in dropsy (a swelling with fluid), and smelling foul. And in this you will plainly see that it is not the god that harms the body, but the disease. It is the same with a human being: once the disease has had time, it can no longer be cured, for the brain is eaten away by the phlegm and melts, and what melts off turns into water. This water surrounds the brain on the outside and washes all round it, and that is why such people are seized more often and more easily. The disease lasts a long time for this reason: what flows down is thin, because there is so much of it, and the blood masters it at once and warms it through.

12. Those who are already used to the disease know beforehand when they are going to be seized, and they run away from people. If their own house is near, they run home; if not, to the loneliest place they can find, where the fewest people will see them fall, and at once they cover their heads. They do this from shame at their illness, and not, as most people think, from fear of the divine. Little children at first fall down wherever they happen to be, because they are not used to it. But after they have been seized several times, they run, as soon as they feel it coming, to their mothers or to someone else they know very well, out of dread and fear of what is happening to them, for being children they do not yet know what shame is.

13. I will now say why people are seized when the winds change, especially in south winds, then in north winds, and then in the rest. These are the strongest of the winds, and the most opposed to each other in their direction and their power. The north wind draws the air together, separates out what is murky and cloudy, and makes the air clear and transparent. In the same way it acts on everything else, beginning with the sea and the other waters, for it draws the moisture and the gloom out of all of them, and out of people themselves too, which is why it is the healthiest of the winds.

The south wind does the opposite: first it begins to melt the air that has been drawn together and to spread it out. That is why it does not blow strongly at once, but is calm at first: it cannot master the air straight away, since the air was dense and drawn together before, but it loosens it in time. It does the very same thing to the earth and the sea, to the rivers, the springs and the wells, and to everything that grows and everything that has moisture in it. And there is moisture in everything, more in some things and less in others. All these things feel this wind, and turn from bright to gloomy, from cold to hot, and from dry to damp. All the clay jars in houses or in the ground that are full of wine or any other liquid feel the south wind, and change their form into something else. The south wind makes the sun and the moon and the stars much dimmer than they naturally are.

Since, then, it masters even these things, great and strong as they are, so powerfully, and makes the body feel these winds and change with them as they shift, it follows that in south winds the brain is loosened and grows sodden, and the vessels are slacker. In north winds, the healthiest part of the brain draws together, while the most diseased and the wettest part separates out and washes round it on the outside. In this way the flows of phlegm come on when these winds change. This disease, then, is born and thrives from the things that come to the body and go from it. It is no harder to understand or to cure than the others, and it is no more divine than the rest.

14. People ought to know that our pleasures, our joys, our laughter and our games come from the brain and from nothing else, and so do our sorrows, our pains, our misery and our tears. It is with the brain above all that we think and understand, see and hear, and know what is ugly and what is beautiful, what is bad and what is good, what is pleasant and what is unpleasant, judging some things by custom and perceiving others by their usefulness. With it, too, we tell pleasures and displeasures apart according to the moment, and the same things do not always please us.

With this same organ we go mad and lose our wits, and fears and terrors come over us, some by night and some by day. So do dreams, and wanderings at the wrong time, and worries that do not fit the case, and failure to recognise what is in front of us, and forgetting what we know and are used to. All these things we suffer from the brain, when it is not healthy, but becomes hotter than its nature, or colder, or wetter, or drier, or suffers some other condition against its nature that it was not used to.

We go mad because of wetness: when the brain is wetter than its nature, it is bound to move, and when it moves, neither the sight nor the hearing can stay still: the man sees and hears now one thing and now another, and his tongue speaks of whatever he sees and hears at each moment. But for as long as the brain is still, the man is sane.

15. The brain is damaged by phlegm and by bile. You can tell the two apart like this: those who are mad from phlegm are quiet, and do not shout or make a commotion, while those who are mad from bile are noisy and mischievous and never still, but always doing something they should not. If their madness is continuous, these are its causes.

But if terrors and fears come over a man, it is because the brain is changed; it is changed when it is heated, and it is heated by bile when the bile rushes to the brain along the blood vessels from the body. The fear stays until the bile goes back into the vessels and the body, and then it stops. He is distressed and sick at heart when the brain is chilled out of season and draws together more than usual. This happens to it because of phlegm, and the same condition also makes him forget things.

He shouts and screams in the night when the brain is suddenly heated through, which happens to the bilious, but not to the phlegmatic. The brain is also heated through when a great deal of blood comes to it and boils up. A great deal of blood comes along the vessels I have described when a man happens to be having a frightening dream and is in terror. Just as, when he is awake and frightened, his face burns and his eyes grow red, and his mind is planning to do some harm, so it happens to him in his sleep. But when he wakes and comes to his senses, and the blood is scattered back into the vessels I described, it stops.

16. For these reasons I hold that the brain has the greatest power in a human being, for as long as it is healthy it is our interpreter of what comes to us from the air, and it is the air that gives it its intelligence. The eyes, the ears, the tongue, the hands and the feet do whatever the brain understands, since intelligence comes to the whole body to the extent that the body shares in the air. And it is the brain that carries the message to the understanding: when a man draws breath into himself, it reaches the brain first, and only then does the air spread to the rest of the body, leaving in the brain its finest part, whatever it has that is intelligent and has judgment. If it reached the body first and the brain afterwards, it would leave its power of discernment behind in the flesh and the vessels, and come to the brain hot and no longer pure, but mixed with the moisture from the flesh and the blood, so that it would no longer be exact.

17. That is why I say that the brain is the interpreter of understanding. The diaphragm is called the phrenes, a name that makes it sound like the organ we think with, since "to think" in Greek is phronein. But it got that name by chance and by custom, not from what it really is, nor from its nature. I do not know what power the diaphragm has for thinking and understanding. All it does is this: if a man is suddenly overjoyed or grieved, it jumps and leaps, because it is thin and stretched out more than any other part of the body, and it has no hollow in which to take in anything good or bad that comes upon it, but is thrown into confusion by both, because of the weakness of its nature. Indeed it feels nothing before the other parts of the body do, and has this name and this reputation for nothing, just like the parts beside the heart that are called its "ears", which contribute nothing to hearing.

Some say that we think with the heart, and that it is the heart that feels grief and worry. But that is not so: the heart is convulsed, like the diaphragm, and even more so, for these reasons. Vessels run to it from all over the body, and it holds them closed in, so that it feels any pain or strain that comes upon a man. When a man is grieved, his body is bound to shiver and tense, and the same thing happens when he is overjoyed. That is why the heart and the diaphragm are the parts that feel most. But neither of them has any share in thought; the brain is the cause of all these things.

Just as the brain, of all the parts of the body, is the first to perceive the intelligence that comes from the air, so too, if some stronger change takes place in the air because of the seasons, and the air becomes unlike itself, the brain is the first to feel it. That is why I say that the diseases that fall on the brain are the sharpest, the greatest, the most deadly, and the hardest for the inexperienced to judge.

18. This disease that is called sacred arises from the same causes as the rest: from the things that come to the body and go from it, from cold, and sun, and winds that change and are never still. These things are divine, so there is no need to set this disease apart and think it more divine than the others: all of them are divine, and all of them are human. Each has a nature and a power of its own, and none is beyond our understanding or beyond our help. Most of them can be cured by the very same things from which they arise, since one thing is food to one creature and harm to another.

This, then, is what the doctor must know: how to recognise the right moment in each case, so that he can give nourishment to one thing and make it grow, and take it away from another and weaken it. In this disease, as in all the others, he must not feed the disease, but hurry to wear it down by bringing against each disease whatever is most hostile to it, and not what is friendly and familiar to it. What is familiar makes it thrive and grow; what is hostile makes it waste away and fade. Whoever knows how to bring about such a change in people, and can make a person wet or dry, hot or cold, by regimen, could cure this disease too, if he could recognise the right moments for what helps, and he could do it without purifications and magic and all the rest of that vulgar trickery.

Airs, Waters, Places

1. Whoever wants to study medicine properly must do the following. First, he must think about the seasons of the year, and what each of them can bring about. They are not at all alike, but differ greatly from one another, both in themselves and in the way they change from one to the next. Next he must think about the winds, the hot ones and the cold. Above all he must study the winds that are common to all mankind, and then those that belong to each particular region. He must also think about the properties of the waters. Waters differ in taste and in weight, and in the same way the property of each one (what it does to the body) differs greatly from the rest.

When a doctor arrives in a city he does not know, therefore, he must work out carefully how it lies, both toward the winds and toward the risings of the sun. A city that faces north does not have the same effect as one that faces south, nor does one facing the rising sun have the same effect as one facing the setting sun. He must consider these things as carefully as he can. He must also find out how the people are off for water. Do they use marshy, soft water? Or hard water that comes from high, rocky ground? Or water that is brackish and harsh? He must look at the land, too. Is it bare and dry, or wooded and well watered? Does it lie in a hollow, where the air is stifling, or high up, where it is cold? And he must look at the way the people live and what they enjoy. Are they heavy drinkers, who eat a big midday meal and avoid exertion? Or are they lovers of exercise and hard work, who eat a great deal and drink little?

2. From these things he must work out each particular question. Suppose he knows all of them well, or if not all, then most of them. Then when he comes to a city he does not know, neither the diseases of the place nor the nature of the common diseases will escape him. He will not be at a loss in treating the sick, nor will he make mistakes, as is likely to happen if he has not learned these things and thought about each of them in advance. And as time goes on and the year runs its course, he will be able to say what diseases are going to seize the whole city, in summer or in winter. He will also be able to say what diseases each person is in danger of from a change in his way of life. If he knows the changes of the seasons, and the risings and settings of the stars, and how each of these comes about, he will know in advance what sort of year is coming.

A man who thinks things through like this, and knows the right moments in advance, will understand each case best. He will most often succeed in bringing about health, and he will win no small success in the art of medicine. And if anyone thinks all this is talk about the heavens that belongs to the astronomers, let him think again. He will learn that astronomy contributes not the smallest part to medicine, but a very large part indeed. As the seasons change, people's diseases change with them, and so does the state of their bowels.

3. I will now explain clearly how each of the things I have mentioned should be examined and tested. Take first a city that lies exposed to the hot winds. These are the winds that blow from between the winter sunrise and the winter sunset (from the south-east round to the south-west). Suppose these winds are its usual ones, and it is sheltered from the winds from the north. In such a city the waters are plentiful and brackish, and they must lie near the surface, so they are hot in summer and cold in winter. The people's heads are moist and full of phlegm (phlegm being the cold, wet humour). Their bowels are often upset by phlegm running down into them from the head. Most of them are rather flabby in build, and they are poor eaters and poor drinkers. Men with weak heads cannot be good drinkers, since the hangover hits them harder.

The diseases native to the place are these. First, the women are sickly and subject to fluxes (heavy discharges from the womb). Then many of them are barren, from disease and not by nature, and they often miscarry. The children are attacked by convulsions and fits of breathlessness, and by what people take to be "the children's disease" and believe to be sacred: the so-called sacred disease, what we call epilepsy. The men suffer from dysentery, diarrhoea and shivering fevers, and from long fevers in winter. They suffer from many rashes that break out at night, and from piles in the anus. Pleurisy, pneumonia, burning fever (a fever with intense heat and thirst) and the other diseases regarded as acute are not common there. These diseases cannot get a strong hold where the bowels are loose. Inflammations of the eyes occur, with a running discharge, but they are not serious and do not last long, unless some epidemic disease takes hold after a great change in the weather. And when the people are over fifty, catarrhs (flows of phlegm down from the head) come down from the brain and leave them paralysed, whenever their heads are suddenly struck by the sun or chilled. These are the diseases native to them. Besides these, if some epidemic disease takes hold because of a change in the seasons, they share in that too.

4. Now take the cities that lie the opposite way, facing the cold winds. These are the winds that blow from between the summer sunset and the summer sunrise (from the north-west round to the north-east). Suppose these winds are native to such cities, and they are sheltered from the south wind and the hot winds. With these cities it is like this. First, the waters are mostly hard and cold. The people must be sinewy and lean. Most of them have lower bowels that are hard and slow to empty, though the upper bowels empty more freely. They are full of bile rather than of phlegm. Their heads are healthy and hard, but most of them are prone to tearing something inside.

The diseases that visit them are these. Pleurisy is common, and so are the diseases regarded as acute. This must be so, since their bowels are hard. Many of them also develop abscesses full of pus inside, from any cause at all. The reason is the tension of their bodies and the hardness of their bowels. Their dryness, and the coldness of the water, make them prone to inner tears. People of this nature must be big eaters and not great drinkers, for a man cannot be a great eater and a great drinker at once. Inflammations of the eyes come only at long intervals, but when they come they are hard and violent, and soon make the eyes burst. Young men under thirty have violent nosebleeds in summer. Cases of the so-called sacred disease are few, but severe. These people are likely to live longer than the others. Their sores do not become full of phlegm, nor do they turn angry and spread. And their characters are fierce rather than gentle. These are the diseases native to the men. Besides them, they share in any epidemic disease that takes hold because of a change in the seasons.

As for the women, first, many of them are barren because the waters are hard, harsh and cold. Their monthly periods do not come as they should, but are scanty and bad. Then they give birth with difficulty, though they do not often miscarry. When they have given birth they are unable to nurse their babies, for their milk dries up because of the hardness and harshness of the waters. Consumption (a wasting disease) often follows childbirth, because the strain of labour gives them ruptures and sprains. The little boys get dropsy (a swelling with fluid) in the testicles while they are small, but it disappears as they grow older. And in this city they reach puberty late.

5. That, then, is how things stand with the hot winds and the cold, and with the cities that face them, as I have described. Now for the cities that lie toward the winds blowing from between the summer and the winter sunrise, that is, from the east, and the cities that face the opposite way. With these it is like this. Cities that lie toward the sunrise are likely to be healthier than those turned to the north or to the hot winds, even if they are only a stade apart (about 200 yards). First, the heat and the cold there are more moderate. Next, the waters that face the sunrise must be clear, sweet-smelling, soft and pleasant in such a city. The rising sun shines down on them and purifies them, clearing away the mist that usually hangs over them in the morning.

The people there are of a better colour and more blooming than elsewhere, unless some disease prevents it. They have clear voices, and in temper and intelligence they are better than those who live facing the north, just as everything else that grows there is better too. A city that lies like this is most like spring, because its heat and cold are so moderate. Its diseases are fewer and milder, and they resemble the diseases of the cities turned toward the hot winds. And the women there conceive very easily and give birth easily.

6. That is how things stand with these cities. Now take the cities that lie toward the sunset. They are sheltered from the winds that blow from the east, while the hot winds and the cold winds from the north blow past them. Such cities must have the unhealthiest position of all. First, their waters are not clear. The reason is that a mist usually hangs over them in the morning, and it mixes into the water and spoils its clearness, since the sun does not shine on them until it is high in the sky. In summer, cold breezes blow in the morning and dews fall. For the rest of the day the sun, sinking toward the west, scorches the people terribly. They are therefore likely to be pale and weak, and to share in some part of every disease I have described, for none is set apart for them alone. They are likely to have deep, hoarse voices because of the air, which is usually impure and unhealthy there. It is not much cleared by the north winds, since those winds do not reach them. And the winds that do reach them, and blow on them constantly, are very rainy, as the west winds are. A city in such a position is most like autumn in the way its day changes, since there is a great difference between the morning and the afternoon.

7. That is how things stand with the winds, the healthy ones and the unhealthy. Now I want to describe the rest of the waters: which are unhealthy and which are healthiest, and what harm and what good are likely to come from water. Water contributes a very great deal to health.

Waters that are marshy, standing and stagnant must be hot, thick and foul-smelling in summer, since they have no outflow. Fresh rain keeps pouring into them and the sun burns them, so they must be discoloured, unwholesome and bilious. In winter they must be icy, cold and muddied by snow and frost, so that they breed more phlegm and hoarseness than any other water. Those who drink them always have large, hard spleens, and bellies that are hard, thin and hot. Their shoulders, collarbones and faces waste away, for their flesh melts away to feed the spleen, and that is why they are thin. Such people are big eaters and always thirsty. Their bowels, upper and lower, are very dry and very hot, so they need stronger purges. This disease stays with them summer and winter alike.

On top of this, they get dropsy more often than anyone, and it is more often fatal. In summer there are many outbreaks of dysentery and diarrhoea, and long quartan fevers (fevers that come back every third day; the Greeks counted both ends, so they called it the fourth-day fever). When these diseases drag on, they bring people of this nature to dropsy, and kill them. That is what happens to them in summer. In winter the young men get pneumonia and illnesses with raving, and the older men get burning fever because their bowels are hard. Among the women, swellings occur, and "white phlegm," a pale puffiness of the flesh. They conceive with difficulty and give birth with difficulty. Their babies are large and swollen, and then, while they are being nursed, they waste away and do badly. And the women's cleansing after childbirth does not come as it should. The children are very prone to ruptures, and the men to swollen veins and to sores on the shins. People of this nature, then, cannot be long-lived, but grow old before their time. Besides, the women seem to be pregnant, but when the time for the birth comes, the fullness of the belly vanishes. This happens when the womb has become dropsical.

Waters like these I consider bad for every purpose. Next worst are waters whose springs come out of rock, since they must be hard, and waters from ground where there are hot springs, or where iron is found, or copper, or silver, or gold, or sulphur, or alum, or bitumen, or soda. All these are produced by the force of heat. Good waters cannot come from ground like that. They will be hard and heating, hard to pass as urine, and binding to the bowels.

The best waters are those that flow from high places and from hills of earth. They are sweet and clear in themselves, and need only a little wine mixed in. In winter they are warm and in summer cold, as they would be if they came from very deep springs. I especially praise those whose streams break out toward the sunrise, and above all toward the summer sunrise. They are bound to be clearer, sweet-smelling and light.

All waters that are brackish, harsh and hard are bad to drink. But there are some natures and some diseases for which such waters are good to drink, and I will speak of them shortly. With springs, it is like this. Those whose sources face the sunrise are the best of all. Second come those between the summer sunrise and the summer sunset, especially those toward the sunrise. Third come those between the summer and the winter sunsets. Worst are those facing the south, and those between the winter sunrise and the winter sunset. These are very bad when the wind is in the south, and better when it is in the north.

This is how waters should be used. A man who is healthy and strong need not choose, but may always drink whatever is at hand. But a man who wants to drink the most suitable water because he is ill will best regain his health in the following way. Those whose bowels are hard and easily heated do best with the sweetest, lightest and clearest waters. Those whose bellies are soft, moist and full of phlegm do best with the hardest and harshest waters, and the slightly brackish ones, for these dry them out most. Waters that are best for cooking, and soften things most easily, are also likely to loosen the bowels most and to melt them away. But waters that are harsh and hard, and worst for cooking, bind the bowels most and dry them out. People are wrong about salt waters, through lack of experience, because they are thought to be laxative. In fact they are quite the opposite of laxative. They are harsh and do not cook well, so that the bowels are bound by them rather than loosened.

8. That is how things stand with spring waters. Now I will explain how it is with rain water and with water from snow. Rain waters are the lightest, sweetest, finest and clearest of all. To begin with, the sun draws up and carries off the finest and lightest part of water. Salt shows this plainly. The salty part is left behind because it is thick and heavy, and becomes salt, while the sun carries off the finest part because it is light. And the sun draws up such water not only from pools, but also from the sea, and from everything that has any moisture in it; and there is moisture in everything. Even from human beings it draws up the finest and lightest part of their moisture.

Here is the strongest proof. When a man walks or sits in the sun wearing a cloak, the parts of his skin the sun shines on will not sweat, for the sun carries off each bead of sweat as it appears. But the parts covered by his cloak, or by anything else, do sweat. The sweat is drawn out and forced out by the sun, but the covering keeps it from being carried away by the sun. And when he comes into the shade, his whole body sweats alike, for the sun no longer shines on it. This is also why rain water goes bad faster than any other water and has a foul smell: it has been gathered and mixed together from a great many sources, and so it goes bad very quickly.

Besides this, once it has been carried off and lifted up, and mixed into the air as it circles around, its muddy and murky part separates out and turns into mist and fog. But its clearest and lightest part remains, and grows sweet as it is heated and cooked by the sun, just as everything else grows sweeter when it is cooked. As long as it is scattered and not yet gathered together, it is carried about high in the air. But when it is collected somewhere and packed together in one place, by winds that suddenly blow against each other, it bursts down wherever it happens to be most tightly packed. This is most likely to happen when the clouds are driven along by a wind that never rests, and then suddenly meet a contrary wind and other clouds. Then the front of the mass is packed together, while the rear comes crowding on behind. It grows thicker and darker and is packed into one place, until its weight makes it burst, and the rains fall. These waters are likely to be the best. But they need to be boiled and purified. Otherwise they have a foul smell, and give those who drink them hoarseness, coughs and a heavy voice.

Waters from snow and ice are all bad. Once water has frozen, it never returns to its old nature. Its clear, light and sweet part separates out and vanishes, and the muddiest and heaviest part is left. You can see this for yourself. If you like, in winter, pour water by measure into a vessel and set it out in the open air, where it will freeze hardest. Then next day bring it into a warm place, where the ice will melt best. When it has melted, measure the water again: you will find much less of it. This is proof that freezing makes the lightest and finest part vanish and dry up, not the heaviest and thickest part, which it could not do. That is why I think waters from snow and ice, and the waters that come close to them, are the worst for every purpose.

9. That is how things stand with rain water and with water from snow and ice. People get stones most of all where they drink waters of very many different kinds. There they are also attacked by kidney disease, by painful passing of urine drop by drop, and by sciatica, and they get ruptures. This happens with water from great rivers that other rivers flow into, and from a lake fed by many streams of every kind, and wherever people use water brought from far away rather than from close by. No one water can be like another. Some are sweet, others brackish and full of alum, and others flow from hot springs. When these are mixed together they quarrel, and the strongest always wins. But it is not always the same one that is strongest. Now one wins and now another, depending on the winds: one gets its strength from the north wind, another from the south wind, and the same holds for the rest. Such waters, then, must leave a deposit of mud and sand in their vessels. Drinking them causes the diseases I have named. But not everyone gets them, and I will next explain why.

When the bowels move freely and are healthy, and the bladder is not feverish, and the neck of the bladder is not too much narrowed, people pass water easily, and nothing gathers in the bladder. But when the belly is feverish, the bladder must suffer the same thing. When the bladder is heated beyond its nature, its neck becomes inflamed. When this happens, it does not let the urine go, but boils it up and bakes it inside itself. The finest part of the urine separates out, and the purest part passes through and is passed as urine. But the thickest and muddiest part gathers together and sets solid. At first it is small, but then it grows larger. As it is rolled about by the urine, it joins to itself whatever thick matter forms, and so it grows and hardens into stone. And when the person passes water, the stone is forced by the urine against the neck of the bladder. It stops him from passing water and causes violent pain. That is why children who have stones rub and pull at their private parts, because they think that is where the cause of their trouble with passing water lies.

Here is the proof that this is how it works. People with stones pass very clear urine, because its thickest and muddiest part stays behind and gathers together. That is how most stones form. But in children they also come from milk, if the milk is not wholesome but too hot and bilious. It overheats the belly and the bladder, so that the urine is baked and suffers what I have described. And I say it is better to give children their wine as watered as possible, since it burns and parches the vessels less. Girls do not get stones in the same way. The urinary passage from the bladder is short and wide in a female, so that the urine is easily forced out. Nor does she rub her private parts with her hand as a boy does, nor touch the passage, since in females it opens straight into the private parts. In males, though, the passage does not run straight, and it is narrow. And girls drink more than boys do.

10. That is how these things stand, or something very close to it. As for the seasons, a doctor who thinks about the following things can judge what kind of year is coming, whether sickly or healthy. Suppose the signs come as they should when the stars set and rise. Suppose there is rain in autumn, and the winter is moderate, neither too mild nor unseasonably cold. And suppose the rains in spring and in summer are seasonable. Then the year is likely to be very healthy.

But suppose the winter is dry, with north winds, and the spring rainy, with south winds. Then the summer must be feverish and bring inflammations of the eyes and dysentery. When the stifling heat comes on suddenly while the earth is still wet from the spring rains and the south wind, the heat must be doubled. It comes both from the soaked, hot earth and from the burning sun. And people's bowels have not firmed up, nor has the brain dried out, since when the spring is like that, the body and the flesh cannot help being soft and soggy. Fevers of the most acute kind therefore attack everyone, and especially people full of phlegm. Dysentery is likely too, among the women and among people of the moistest build. If rain and a storm come at the rising of the Dog Star (late July), and the Etesian winds blow (the steady north winds of high summer), there is hope that the diseases will stop and that the autumn will be healthy. If not, there is a danger of deaths among the children and the women, though least among the old men. And there is a danger that those who survive will end up with quartan fevers, and pass from quartan fevers into dropsy.

But suppose the winter is rainy and mild, with south winds, and the spring is dry and wintry, with north winds. Then, first, women who happen to be pregnant and are due to give birth in spring will miscarry. And those who do give birth will have children who are feeble and sickly, so that they either die at once, or live on thin, weak and sickly. That is what happens to the women. The rest of the people get dysentery and dry inflammations of the eyes, and some get catarrhs running down from the head to the lungs. People full of phlegm are likely to get dysentery, and so are the women, from phlegm running down from the brain because of the moistness of their nature. People full of bile get dry inflammations of the eyes, because of the heat and dryness of their flesh. Old men get catarrhs because their vessels are slack and wasted, so that some of them die suddenly and others are paralysed on the right side or the left.

This is why. When the winter is southerly and the body is warm, neither the brain nor the vessels firm up. Then a spring follows that is northerly, dry and cold. Just when the brain ought to be loosening along with the spring and cleansing itself by head colds and hoarseness, it freezes and sets hard instead. When, then, the summer and its heat come on suddenly, and the change comes with them, these diseases strike. Cities that lie well toward the sun and the winds, and use good waters, feel such changes less. But cities that use marshy and stagnant waters, and lie badly toward the winds and the sun, feel them more. If the summer turns out dry, the diseases stop sooner. If it is rainy, they last a long time. And there is a danger that any sore will turn into a spreading ulcer that eats away the flesh, from any cause at all. And at the end of these illnesses, dropsy follows, and a diarrhoea in which the food passes through undigested, for the bowels do not easily dry out.

If the summer is rainy, with south winds, and the autumn too, the winter must be sickly. People full of phlegm, and those over forty, are likely to get burning fevers, and people full of bile to get pleurisy and pneumonia. If the summer is dry, with north winds, and the autumn rainy, with south winds, then in winter headaches are likely, and gangrene of the brain, and besides that hoarseness, head colds and coughs, and in some cases consumption too.

But if the weather is northerly and dry, with no rain either at the Dog Star or at the rising of Arcturus (mid-September), it does the most good to people who are full of phlegm by nature, to those of a moist nature, and to the women. But it is the worst enemy of people full of bile. They dry out too much, and get dry inflammations of the eyes and acute, long-lasting fevers, and some of them get melancholy (a disorder of black bile). The moistest and most watery part of the bile is dried up and used up, and the thickest and sharpest part is left; and the same happens to the blood. These diseases come to them from that. But for people full of phlegm, all these things are a help. They are dried out, and reach the winter not soggy, but dried.

11. A doctor who thinks about these things and studies them in this way will foresee most of what is going to happen from the changes of the weather. He must be most on his guard against the greatest changes of the seasons. At those times he must not, if he can help it, give a purging drug, or burn the belly with cautery, or cut, until ten days or more have passed. The greatest and most dangerous changes are these four: the two solstices, especially the summer one, and the two equinoxes, as they are called, especially the autumn one. He must also be on his guard at the risings of the stars, above all of the Dog Star, then of Arcturus, and also at the setting of the Pleiades (early November). It is on these days above all that diseases come to their crisis (the decisive turn of the illness, toward recovery or death). Some waste away and end in death, some come to an end, and all the rest change into another form and another state.

12. That is how things stand with these. Now I want to show how greatly Asia and Europe differ from each other in every respect (Asia meaning Asia Minor and the lands that lie beyond it to the east). I want to show, too, how the peoples of the two differ in their build, so that they are not at all like one another. To speak of every one of them would take a long time, so I will speak of the most important and the greatest differences, and say how things seem to me to be.

I say that Asia differs very greatly from Europe in the nature of everything in it, both of what grows from the earth and of the people. Everything grows far finer and larger in Asia. The one land is gentler than the other, and the people's characters are milder and more even-tempered. The cause of this is the balanced blend of the seasons. Asia lies toward the dawn, midway between the sunrises of winter and of summer, and farther from the cold. Growth and gentleness are fostered most of all when nothing dominates by force, and every element has its equal share in power.

But Asia is not the same everywhere. The part of it that lies midway between the heat and the cold is the most fruitful, the best wooded and the mildest in its weather, and it has the finest waters, both from the sky and from the ground. It is not burned up too much by heat, nor dried out by drought and lack of water. Nor is it oppressed by cold, nor damp and soaked by heavy rains and snow. The crops there are likely to be plentiful, both those grown from seed and the plants the earth produces of itself. People eat the fruits of these plants, taming them from wild ones and planting them out in suitable soil. The livestock raised there are likely to thrive, and above all to bear young very often and to rear them very well. The people are likely to be well fed, very fine in build and very tall, and to differ very little from one another in build and in height. This land is likely to come closest to spring, both in its nature and in the mildness of its seasons. But courage, endurance, hard work and high spirit could not arise in such conditions, whether among the natives or among settlers from elsewhere. Pleasure must rule instead.²

13. That, I think, is how things stand with the Egyptians and the Libyans. Now for the peoples who live to the right of the summer sunrise, as far as Lake Maeotis (the Sea of Azov), the boundary between Europe and Asia. With them it is like this. These peoples differ more among themselves than the ones I have described, because of the changes of the seasons and the nature of the land.

It is the same with the land as with people in general. Where the seasons make the greatest and most frequent changes, the land too is the wildest and most uneven, and you will find many wooded mountains there, and plains and meadows. But where the seasons do not change much, the land is the most even. It is the same with the people, if anyone cares to look into it. Some natures are like wooded, well-watered mountains, others like thin, dry soil, others like marshy meadows, and others like a plain of bare, dry ground, because the seasons that shape a body's form differ from one another. And if they differ greatly among themselves, there will be more differences in people's shapes too.

14. The peoples who differ only a little I will pass over. But I will describe those that differ greatly, whether by nature or by custom, and say how things stand with them. First, the Macrocephali, the "Longheads." No other people has heads like theirs. At the start, custom was chiefly responsible for the length of their heads, but now nature helps custom along. They think the people with the longest heads are the noblest.

The custom is this. As soon as a child is born, while its head is still soft and its body tender, they reshape the head with their hands and force it to grow long, by putting bandages and suitable devices on it. These spoil the roundness of the head and make it grow longer. In this way custom at first brought it about that the head took this shape by force. But as time went on, it became part of their nature, so that custom no longer had to force it. The seed comes from every part of the body: healthy seed from the healthy parts, and diseased seed from the diseased parts. Bald parents, then, generally have bald children, grey-eyed parents grey-eyed children, and squinting parents squinting children, and the same holds for the rest of a person's form. If that is so, what is to stop a longheaded parent from having a longheaded child? But nowadays they are no longer born like that as often as before, since the custom has lost its force because they mix with other peoples.

15. That, I think, is how things stand with the Longheads. Now for the people who live on the river Phasis. That country is marshy, hot, wet and wooded, and heavy, violent rains fall there in every season. The people spend their lives in the marshes, and their houses are built of wood and reeds, set up in the water. They do little walking in the city and the market-port. Instead they sail up and down in dugout canoes, each made from a single log, for there are many canals. They drink water that is hot and stagnant, rotted by the sun and swollen by the rains. The Phasis itself is the most stagnant of all rivers, and flows most sluggishly. The crops that grow there are all stunted, soft and imperfect, because of the great quantity of water, and so they do not ripen. And a thick mist rising from the waters covers the land.

For these reasons the people of the Phasis are unlike the rest of mankind in build. They are tall, and enormously stout, and no joint or vein can be seen on them. Their skin is a yellowish colour, as if they had jaundice. Their voices are the deepest in the world, because the air they breathe is not clear, but damp and murky. And by nature they are rather sluggish when it comes to bodily exertion. The seasons there do not change much, either toward stifling heat or toward cold. The winds are mostly from the south, except for one local breeze. This one sometimes blows violent, harsh and hot, and they call it the kenchron. The north wind seldom reaches them, and when it blows it is weak and feeble.

16. That is how things stand with the difference in nature and in build between the peoples of Asia and of Europe. Now for the lack of spirit and of courage among the peoples of Asia. The Asians are less warlike than the Europeans, and gentler in character, and the chief cause of this is the seasons. They make no great changes, either toward heat or toward cold, but stay much the same. There are no shocks to the mind, and no violent changes in the body. These are the things that are likely to make a man's temper fierce, and give him a larger share of recklessness and high spirit, than if he always stays in the same state. It is change, in all things, that rouses people's minds and does not let them rest.

For these reasons, I think, the Asian race is feeble, and also because of their laws and customs. Most of Asia is ruled by kings. Where people are not their own masters, and do not govern themselves, but are ruled by despots, they do not care about training themselves for war. They care instead about not seeming warlike, since the risks are not the same. Such subjects are likely to be forced to serve in the army, to endure hardship and to die for their masters, far from their children, their wives and the rest of their friends. And whatever useful and brave deeds they do, it is their masters who are made great and rise by them, while the subjects themselves reap only danger and death. Besides this, the land of such people is bound to be laid waste, both by enemies and by idleness. Even if a man is brave and stout-hearted by nature, then, his mind is turned away from it by their laws.

There is strong proof of this. All those in Asia, Greeks or non-Greeks, who are not ruled by despots but govern themselves, and endure hardship for their own sake, are the most warlike people of all. They run their risks for themselves, and they themselves carry off the prizes of courage, and pay the penalty of cowardice in the same way. You will also find that the Asians differ among themselves, some being better and some worse. The cause of this is the changes of the seasons, as I said earlier.

17. That is how things stand with the peoples of Asia. In Europe there is a Scythian people that lives around Lake Maeotis and differs from the other peoples. They are called the Sauromatae. Their women ride horses, shoot with the bow and throw javelins from horseback, and fight against their enemies, as long as they are unmarried girls. They do not give up their virginity until they have killed three of their enemies, and they do not live with a husband until they have performed the customary sacrifices. A woman who has taken a husband stops riding, unless she is forced to by a general call to arms. They have no right breast. While they are still babies, their mothers heat red-hot a bronze instrument made for this very purpose and press it against the right breast, which is burned. Its growth is destroyed, and all its strength and bulk pass into the right shoulder and arm instead.

18. As for the build of the rest of the Scythians, how they are like one another and not at all like anyone else, the same account holds as for the Egyptians, except that the Egyptians are oppressed by heat and the Scythians by cold. What is called the Scythian Desert is a plain, grassy and bare of trees, and fairly well watered, since great rivers drain the water off the plains. Here too the Scythians live who are called Nomads, because they have no houses, but live in wagons. The smallest of the wagons have four wheels, and others have six. They are closed in all round with felt, and built like houses, some with two rooms and some with three. These are proof against rain, snow and wind. The wagons are drawn by two or three yoke of hornless oxen. The oxen have no horns because of the cold. The women live in these wagons, while the men ride on horseback. Their sheep and cattle and horses follow them. They stay in one place as long as there is enough fodder for their animals, and when it runs out they move to another region. They eat boiled meat and drink mares' milk. And they eat hippake, which is a cheese made from mares' milk.

19. That is how things stand with their way of life and their customs. Now for their seasons and their build. The Scythian race is very unlike the rest of mankind, and like the Egyptians it resembles only itself. It is the least fertile of races, and the country breeds very few wild animals, and very small ones. It lies right up under the northern stars, and under the Rhipaean Mountains, from which the north wind blows. The sun comes nearest to them only at the end of its course, when it reaches the summer solstice, and even then it warms them only for a short time, and not much. The winds that blow from the hot regions do not reach them, except rarely and feebly. Instead, cold winds blow constantly from the north, from snow and ice and many waters. The snow and ice never leave the mountains, and that is what makes the country hard to live in. A thick mist covers the plains by day, and it is on these plains that they live. It is always winter there, and the summer lasts only a few days, and those not very warm. The plains are high and bare, and are not ringed with mountains, except that they slope upward toward the north. The wild animals there are not large either, but only such as can shelter underground. The winter stunts them, and so does the bareness of the land, since there is no warmth or shelter there.

The changes of the seasons are neither great nor violent. The seasons are alike and change very little. That is why the people are alike in build. They always eat the same kind of food and wear the same clothes, summer and winter. They breathe air that is damp and thick. They drink water from snow and ice, and they do no hard exertion. Neither the body nor the soul can be hardened by toil where there are no strong changes. Because of these necessities their bodies are thick, fleshy, with no joints showing, moist and slack, and their lower bowels are the moistest of all bowels. The belly cannot dry out in a country like this, with a nature like this and a climate like this. And because of their fat and their smooth, hairless flesh, their bodies are like one another, men's like men's and women's like women's. When the seasons are much the same, no damage or defect occurs in the setting of the seed, when it forms a child in the womb, unless some violent accident or some disease intervenes.

20. I will give strong proof of their moistness. You will find that most of the Scythians, all who are Nomads, have been burned with cautery on the shoulders, the arms, the wrists, the chest, the hips and the loins. This is for no other reason than the moistness and softness of their nature. Because of their moistness and slackness they cannot draw a bow, or throw a javelin with force from the shoulder. But when they have been cauterised, most of the moisture dries out of their joints, and their bodies become more braced, better nourished and better jointed.

Their bodies grow slack and broad. The first reason is that they are not swaddled as children are in Egypt; they do not hold with it, because of their riding, since they want them to sit a horse well. The second reason is that they sit so much. The boys, until they are able to ride, spend most of their time sitting in the wagons, and walk very little, because the people are always moving camp and driving their herds about. As for the girls, it is amazing how slack and sluggish they are in build. The Scythian race is ruddy because of the cold, since the sun does not beat down fiercely on them. The cold burns their white skin and turns it ruddy.

21. A nature like this cannot be fertile. The man does not feel much desire for intercourse, because his nature is so moist and his belly so soft and cold. Those are the conditions that make a man least inclined to intercourse. Besides, the constant jolting on horseback makes them weak at intercourse. These are the causes in the men. In the women, the causes are the fatness and the moistness of their flesh. The womb can no longer take hold of the seed. Their monthly periods do not come as they should, but are scanty and come only at long intervals. The mouth of the womb is closed by fat and does not take in the seed. And the women themselves are idle and fat, and their bellies are cold and soft. For these reasons the Scythian race is not fertile. Their slave women give strong proof of it. They hardly have to go to a man before they are pregnant, because they work hard and their flesh is lean.

22. Besides this, the great majority of the Scythians become impotent, like eunuchs. They do women's work, live as women do and talk as women do. Such men are called Anaries. The local people put the cause down to a god, and they revere and worship these men, each of them afraid that the same will happen to him. I myself also think these afflictions are divine, and so are all the others. None is more divine or more human than another; all are alike, and all divine. But each of them has its own nature, and none happens without a natural cause. And I will explain how I think this affliction comes about.

Their riding gives them swellings at the joints, because they are always on horseback with their feet hanging down. Then those who are badly affected become lame, and get sores on the hips. They treat themselves in the following way. When the disease begins, they cut the vein behind each ear. When the blood has flowed away, they are overcome by sleep from weakness, and they sleep. Then they wake up, some of them cured and some not. In my opinion the seed is destroyed by this treatment. There are veins beside the ears, and if anyone cuts them, the men who have been cut become infertile. These, I think, are the veins they cut. After this, when they go to women and cannot have intercourse with them, at first they do not take it to heart, but stay quiet. But when they have tried two or three times or more, and nothing turns out any differently, they think they have sinned against the god they blame for it. They judge themselves to have lost their manhood, and put on women's clothes. They live as women, and do the same work as the women do alongside them.

This affliction strikes the rich Scythians, not the lowest of them but the best born, those who have the most strength, and it strikes them because of their riding. The poor suffer it less, since they do not ride. And yet, if this disease were more divine than the rest, it ought not to fall only on the noblest and richest of the Scythians. It ought to fall on everyone alike, and on those who own little more than on anyone, if the gods really do enjoy being honoured and admired by men, and pay them back with favours for it. The rich, having a great deal of money, are likely to make many sacrifices to the gods and set up many offerings, and to honour them. The poor do so less, because they have less, and besides, they blame the gods for not giving them money. The poor, then, rather than the rich, would be likely to pay the penalty for such offences.

But in truth, as I said before, these afflictions are divine in the same way as all the others, and each of them happens according to nature. A disease like this comes to the Scythians from the cause I have described. And it is the same with other people too. Wherever men ride most and most often, there the most men are attacked by swellings at the joints, by sciatica and by gout, and they are the least capable of intercourse. These troubles afflict the Scythians, and they are the most eunuch-like of all men, for the reasons I have given. Another reason is that they always wear trousers and spend most of their time on horseback, so that they never touch their genitals with their hands, and because of the cold and their weariness they forget about desire and intercourse, and feel no stirring at all before they have lost their manhood.

23. That is how things stand with the Scythian race. The rest of the people of Europe differ among themselves, both in size and in shape, because of the changes of the seasons. These are great and frequent: there are strong spells of heat, hard winters, heavy rains and then long droughts, and winds. All these bring many changes of every kind. Because of them, it is likely that a child's making, in the setting of the seed, will be affected too, and will differ from time to time. It will not be the same for the same seed in summer as in winter, nor in a rainy season as in a drought. That is why I think the build of Europeans varies more than that of Asians, and why their sizes differ very greatly even from city to city. More damage happens to the seed as it sets when the changes of the seasons are frequent than when the seasons are much the same and alike.

The same reasoning holds for character. Wildness, unsociability and high spirit arise in a nature like this. Frequent shocks to the mind put wildness into it, and dim its tameness and gentleness. That is why I think the people who live in Europe are more courageous than those who live in Asia. Where everything stays much the same, there is ease and slackness. But where things change, body and soul must work hard. Cowardice grows out of rest and slackness, and courage out of hardship and toil.

That is why the people who live in Europe are more warlike, and also because of their laws and customs, since they are not ruled by kings, as the Asians are. Where men are ruled by kings, there they must be the greatest cowards, as I have said before. Their souls are enslaved, and they are not willing to run risks freely and rashly for the sake of someone else's power. But those who govern themselves choose to run risks for their own sake and not for others. They go into danger eagerly and willingly, since they themselves carry off the prizes of victory. In this way laws and customs do not a little to produce courage.

24. That, in general and as a whole, is how things stand with Europe and Asia. In Europe, too, there are tribes that differ from one another in size, in shape and in courage. What makes them differ is the same as I described before, but I will explain it still more clearly. People who live in a mountainous country, rugged, high and well watered, where the changes of the seasons are very sharp, are likely to be large in build, and well made by nature for endurance and courage. Such natures also have not a little wildness and fierceness in them. But people who live in hollow places, full of meadows and stifling, who get more of the hot winds than of the cold, and drink warm waters, will not be tall or straight. They will be built broad, fleshy and dark-haired, and they themselves will be dark rather than fair, and less full of phlegm than of bile. Courage and endurance will not be in their souls by nature in the same way, but law and custom, once added, could produce them. And if there are rivers in the country that drain off the stagnant water and the rain water, the people will be healthy and of a clear complexion. But if there are no rivers, and they drink water from lakes, standing and marshy, such people must have big bellies and enlarged spleens. People who live in a high country, level, windy and well watered, will be tall in build and much like one another, but rather unmanly and tame in mind. As for people who live on thin, dry, bare soil, where the changes of the seasons are not well balanced, in such a country they are likely to be hard and sinewy in build, fair rather than dark, and stubborn and independent in character and in temper. Where the changes of the seasons are most frequent and most different from one another, there you will find the greatest differences in build, in character and in nature.

These, then, are the greatest causes of difference in nature. After them come the land a man is raised in, and the waters. You will find that in general both the build and the ways of people follow the nature of the land. Where the land is rich, soft and well watered, and the waters lie very near the surface, so that they are warm in summer and cold in winter, and where the land lies well toward the seasons, there the people are fleshy, with no joints showing, moist, unfit for hard work, and generally poor in spirit. You can see laziness and sleepiness in them. And at the crafts they are dull-witted, not subtle or sharp. But where the land is bare, waterless and rough, oppressed by winter and scorched by the sun, there you will see people who are hard, lean, well jointed, sinewy and hairy. In such natures you will find energy and wakefulness. You will find them stubborn and independent in character and in temper, with more of the wild in them than of the tame. And you will find them sharper and more intelligent at the crafts, and better at war. And everything else that grows in the earth follows the earth too. These are the most opposite natures and forms. Judge the rest from these, and you will not go wrong.

Prognosis

1. I think it is an excellent thing for a doctor to practise forethought. Suppose he can recognise in advance, and tell his patients at the bedside, what is happening to them now, what has happened before, and what is going to happen, and can fill in the things the patients themselves leave out when they describe their illness. Then people will believe he understands their case better than anyone else, and they will have the confidence to put themselves in his hands. He will also treat them best, because he will know in advance, from the present symptoms, what is coming. To make every sick person well is impossible. That would indeed be better than foreseeing what will happen. But people do die. Some die from the violence of the disease before they call in the doctor. Others call him in and die at once, some after living only one day, others a little longer, before the doctor can bring his art to bear against each disease. He must therefore learn the nature of illnesses like these, and how far they are beyond the strength of the body. At the same time he must learn whether there is anything divine in the diseases, and learn to foresee that too. In this way he will rightly be admired and will be a good doctor. He will be all the better able to keep safe those who can recover, since he will have planned for each thing well in advance. And because he recognises and announces beforehand who is going to die and who is going to be saved, no one will be able to blame him.

2. In acute diseases (the sharp, fast-moving illnesses with fever) this is how the doctor should make his examination. First he should look at the patient's face, to see whether it is like the faces of healthy people, and above all whether it is like itself, as it looks in health. That is the best sign of all. The more unlike its usual self it is, the more dangerous. The worst face is one like this: the nose sharp, the eyes hollow, the temples sunken. The ears are cold and drawn in, and their lobes turned outward. The skin of the forehead is hard, stretched tight and dry. The colour of the whole face is greenish-yellow, or even black, or livid, or the colour of lead.

Suppose the face looks like this at the beginning of the disease, and it is not yet possible to judge by the other signs as well. Then the doctor must ask whether the patient has been lying awake, or has had very loose bowels, or is suffering from hunger. If the patient admits to any of these, the doctor should think the danger smaller. Whether the face looks like this for one of those reasons is settled within a day and a night. But if the patient says none of these things has happened, and if the face does not return to normal within that time, the doctor must know that the patient is close to death.

If the disease is older, on the third day or the fourth, and the face looks like this, he must ask the same questions I told him to ask before. He must also look at the other signs, those in the face as a whole, those in the body, and those in the eyes. Suppose the eyes shy away from the light, or shed tears without the patient meaning to, or squint, or one becomes smaller than the other. Suppose the whites turn red, or livid, or have small black veins in them, or gummy matter appears around the pupils. Suppose the eyes wander restlessly, or bulge out, or become deeply sunken, or the pupils look dull and lose their shine, or the colour of the whole face has changed. All these things the doctor must consider bad and deadly.

He must also look at how much of the eye shows under the lids during sleep. If some of the white shows because the eyelids do not close, and this is not caused by diarrhoea or by a purging drug, and the patient does not usually sleep that way, it is a bad sign and a very deadly one. If an eyelid becomes bent out of shape, or livid, or pale, or the lip does, or the nose, together with any one of the other signs, the doctor must know that the patient is close to death. It is a deadly sign, too, when the lips hang loose and droop, and are cold and very white.

3. When the doctor arrives, he should find the patient lying on his right side or his left, with his arms, neck and legs slightly bent, and his whole body lying loose and relaxed. That is how most healthy people lie too, and the best ways of lying in bed are those most like the ways of the healthy. To lie on the back with the arms, neck and legs stretched out straight is less good. If the patient slumps forward and slides down the bed toward his feet, it is more dangerous still. If he is found with his feet uncovered and not very warm, and his arms, neck and legs flung about at odd angles and uncovered, that is bad, because it shows restless anguish. It is a deadly sign, too, when the patient always sleeps with his mouth open, and when he lies on his back with his legs bent up tightly and twisted around each other. To lie on the belly, for someone who did not sleep that way in health, shows some delirium, or pain somewhere in the region of the belly.

For the patient to want to sit up when the disease is at its height is bad in all acute diseases, and worst of all in pneumonia. To grind the teeth in fevers, for anyone who has not done it since childhood, is a sign of madness and of death. The doctor should warn beforehand of both dangers. And if the patient does this while delirious, it is a very deadly sign indeed.

If the patient happens to have a sore, whether he had it before or it came during the illness, the doctor must watch it closely. If the patient is going to die, the sore will become livid and dry before he dies, or pale yellow and dry.

4. About the movements of the hands, this is what I know. In acute fevers, in pneumonia, in phrenitis (a fever with delirium) or in severe headaches, the hands may move about in front of the face, hunting through empty air, or picking at bits of straw, or plucking tufts of wool from the blankets, or pulling chaff from the wall. All such movements are bad and deadly.

5. Rapid breathing is a sign of pain or of inflammation in the parts above the diaphragm. Breathing that is deep and comes at long intervals shows delirium. Breath that comes out cold from the nose and mouth is a very deadly sign indeed. Easy breathing, on the other hand, must be considered a very great power toward recovery in all the acute diseases that come with fevers and reach their crisis (the decisive turn of the illness, toward recovery or death) within forty days.

6. Sweats are best, in all acute diseases, when they come on the critical days (the days on which a crisis is to be expected) and get rid of the fever completely. Sweats are good, too, when they come over the whole body and show that the patient is bearing the disease more easily. Sweats that do nothing of this kind are of no use. The worst are cold sweats that come only on the head, the face and the neck. With an acute fever these foretell death, and with a milder one a long illness. Cold sweats over the whole body mean the same as those on the head. Sweats that come out like millet seeds, and only around the neck, are bad. Sweats that come in drops and give off steam are good. The doctor must understand sweats as a whole: some come because the body has broken down and gone slack, and others because the inflammation is so intense.

7. The abdomen below the ribs is in the best condition when it is free of pain, soft and even on both the right side and the left. If it is inflamed, or painful, or stretched tight, or the right side is out of proportion with the left, the doctor must be on his guard against all of these. If there is also a throbbing in the upper abdomen, it is a sign of agitation or of delirium, and the doctor should look closely at the eyes of such patients. If the pupils keep moving rapidly, they can be expected to go mad.

A swelling in the upper abdomen that is hard and painful is worst if it spreads over the whole of it. If it is on only one side, it is less dangerous on the left. Swellings like this at the beginning of the illness are a sign that death will come quickly. But if the fever lasts more than twenty days and the swelling does not go down, it turns to pus. In these patients a nosebleed also comes during the first period of the disease, and it helps a great deal. But the doctor should ask whether they have a headache or dim sight, for if they have anything of the kind, that is where the disease will tend to go. The nosebleed is to be expected especially in patients younger than thirty-five.

Swellings that are soft and painless and give way under the finger bring crises that come later, and they are less dangerous than the others. But if the fever lasts more than sixty days and the swelling does not go down, it is a sign that there will be a collection of pus inside. The same holds for a swelling in the rest of the belly. In short, swellings that are painful, hard and large are a sign of the danger of a quick death. Those that are soft and painless and give way when pressed with the finger are slower than those.

Swellings in the belly produce deposits (the disease matter settling in one place, as a swelling, an abscess or a pain in a joint) less often than those in the upper abdomen. Swellings below the navel are the least likely of all to turn to pus. From the upper parts a burst of blood is the thing most to be expected. But with all swellings in these regions that last a long time, the doctor must be on the lookout for pus.

Collections of pus in these places should be judged as follows. Of those that point outward, the best are small, bulge out as far as possible, and rise to a sharp peak. Those that are large and broad, and hardly rise to a peak at all, are the worst. Of those that burst inward, the best are the ones that have no connection with the outside, but stay drawn in and painless, while the whole area outside stays its normal colour. The best pus is white, even, smooth and as little foul-smelling as possible. Pus of the opposite kind is the worst.

8. Dropsies (swellings with fluid) that come after acute diseases are all bad. They do not get rid of the fever, and they are very painful and deadly. Most of them begin from the flanks and the loins, but some begin from the liver. In those whose dropsy begins from the flanks and loins, the feet swell, and long-lasting diarrhoea sets in. It neither relieves the pains in the flanks and loins nor softens the belly. In those whose dropsy comes from the liver, there is an urge to cough, but they bring up nothing worth mentioning. Their feet swell, and the bowels pass nothing except what is hard and forced out. Swellings form around the belly, some on the right side and some on the left, rising up and then dying down again.

9. It is bad for the head, hands and feet to be cold while the belly and the sides are hot. It is best for the whole body to be warm, and evenly soft. The patient should be able to turn over easily, and be light when he is lifted up. If he seems heavy, in the rest of his body as well as in his hands and feet, it is more dangerous. If, besides the heaviness, his nails and fingers turn livid, death can be expected at once. If the fingers and feet turn completely black, it is less deadly than when they are livid. But the doctor must look at the other signs as well. If the patient seems to bear his trouble easily, and shows some other sign of recovery besides these, there is hope that the disease will turn into a deposit. Then the patient will survive, and the blackened parts of the body will fall off. Testicles and genitals drawn up into the body are a sign of severe pain and of the danger of death.

10. As for sleep, the patient should stay awake during the day and sleep at night, as is natural and usual for us. If this is reversed, it is worse. He will come to least harm if he sleeps in the morning, up to the end of the first third of the day. Sleep after that time is worse. Worst of all is not to sleep at all, either by night or by day. This sign means either that pain and suffering are keeping him awake, or that delirium will follow.

11. The best stool is soft and holds together. It is passed at the same hour as it was when the patient was healthy, and in amounts in proportion to what he takes in. When the bowels act like this, the lower belly is healthy. If the stool is liquid, it is better that it makes no gurgling noise, and does not come often, and is passed a little at a time. Otherwise the patient, worn out by getting up again and again, will lose his sleep. And if he often passes a great deal all at once, there is a danger that he will faint. He should pass stools two or three times a day, in proportion to what he takes in, and once at night, and more toward morning, as is usual for a person in health. The stool should thicken as the disease moves toward its crisis. It should be yellowish-red and not too foul-smelling. It is a helpful sign, too, for roundworms to pass with the stool as the disease moves toward its crisis. Throughout the whole illness the belly should be soft and of a moderate size.

Stools that are very watery, or white, or greenish-yellow, or very red, or frothy are all bad. A stool is bad, too, when it is small, sticky, white, greenish and smooth. More deadly than these are stools that are black, or fatty, or livid, or the colour of verdigris, or foul-smelling. Stools of mixed colours mean a longer illness than these, but they are no less deadly. Such stools look like scrapings of flesh, or are full of bile, or leek-green, or black. These are sometimes passed together and sometimes one after another.

It is best for wind to pass without noise and without farting. Still, it is better for it to pass even with noise than to stay rolled up inside. And when it passes in that way, it is a sign either that the patient is in some pain or that he is delirious, unless he lets the wind out like that on purpose. Pains and swellings in the upper abdomen, if they are recent and come without inflammation, are relieved by a rumbling that starts there. This is best of all if the rumbling passes out with stool, urine and wind. If it does not, it still helps simply by passing along through, and it helps too by moving down into the lower parts.

12. Urine is best when its sediment is white, smooth and even through the whole course of the illness, until the disease reaches its crisis. That is a sign of safety, and of an illness that will not last long. If the sediment stops and starts, and the urine is sometimes passed clear and sometimes forms the white, smooth sediment, the disease becomes longer and less safe. If the urine is reddish and its sediment is even and smooth, the illness lasts longer than the first kind, but it is very likely to end in recovery.

Sediments in the urine that look like coarse meal are bad. Worse than these are sediments like flakes. White, thin ones are very bad. Worse still than those are sediments like bran. Clouds floating in the urine are good when they are white and bad when they are black.

As long as the urine is yellowish-red and thin, it is a sign that the disease is unripe (that the body has not yet ripened it, working the disease matter into a state in which it can be got rid of). And if the urine stays like this for a long time, there is a danger that the patient will not be able to hold out until the disease has ripened. The more deadly kinds of urine are those that are foul-smelling, watery, black and thick. In grown men and women black urine is the worst, but in children watery urine is. When patients pass thin, raw urine for a long time, if their other signs are those of people who will survive, a deposit is to be expected in the parts below the diaphragm. The doctor should also mistrust oily films like cobwebs forming on the surface, for they are signs of the body melting away.

The doctor should look at urines that contain clouds, to see whether the clouds are high or low, and what colours they have. He should consider the clouds that settle downward, with the colours I have described, to be good, and welcome them. He should consider those that rise upward, with the colours I have described, to be bad, and mistrust them. But do not let yourself be deceived if the bladder itself has a disease and produces urine like this. It is then not a sign of the whole body, but only of the bladder by itself.

13. The most helpful vomit is phlegm and bile mixed together as thoroughly as possible. It should not be very thick, and not much should be brought up, for vomit that is less mixed is worse. If what is vomited is leek-green, or livid, or black, whichever of these colours it is, the doctor must consider it bad. If the same patient vomits all these colours, that is a very deadly sign. The livid kind of vomit is a sign of the quickest death, if it smells foul. All smells that are somewhat rotten and foul are bad in everything that is vomited.

14. In all pains of the lungs and the sides, the sputum should be coughed up quickly and easily, and the yellow should appear thoroughly mixed into it. If it is coughed up long after the pain began, and is yellow, or reddish, or brings on much coughing, or is not thoroughly mixed, it is worse. Unmixed yellow sputum is dangerous, and white, sticky, round sputum does no good. It is bad, too, when it is very greenish-yellow and frothy. If it is so unmixed that it looks black, that is more dangerous than the others. It is bad, too, when nothing is cleared out and the lungs send nothing up, but are full and seethe in the windpipe.

Running from the nose and sneezing are bad in all diseases of the lungs, whether they came before or follow after. But in the other diseases, even the deadliest, sneezing is helpful. Yellow sputum mixed with a little blood in pneumonia, if it is coughed up at the beginning of the disease, is a sign of recovery and helps a great deal. If it comes on the seventh day or later, it is less safe. All sputum is bad that does not stop the pain. The worst is black, as I have described. Sputum that stops the pain is the best of all to cough up.

15. Some pains in these regions do not stop, whether the sputum is cleared out, or the bowels are moved, or the patient is bled, or given drugs, or put on a diet. The doctor must know that these pains will turn to pus. Of these collections of pus, the ones that form while the sputum is still full of bile are very deadly, whether the bile is coughed up separately from the pus or together with it. They are most deadly if the pus begins to come up after sputum like this on the seventh day of the disease. A patient who coughs up such things can be expected to die on the fourteenth day, unless something good happens to him.

The good signs are these: he bears the disease easily; he breathes easily; he is free of pain; he coughs up the sputum without trouble; his body seems evenly warm and soft; he has no thirst; and his urine, stools, sleep and sweats turn out to be good, each in the way I have described. If all these things come about, the patient will not die, but if some of them come and others do not, he will not live longer than fourteen days, and will die.

The bad signs are the opposite of these: he bears the disease with difficulty; his breathing is deep and rapid; the pain does not stop; he coughs up the sputum only with an effort; he is very thirsty; the fever holds his body unevenly, so that his belly and sides are very hot, but his forehead, hands and feet are cold; and his urine, stools, sleep and sweats turn out to be bad, each in the way I have described. If things like these come along with this sputum, the patient will die before he reaches the fourteenth day, on the ninth or the eleventh. The doctor must conclude, then, that this sputum is very deadly, and that the patient will not live to the fourteenth day. He must weigh up the bad and the good things that come with it, and make his predictions from them, for that is how he will most often be right.

Most of the other collections of pus burst: some on the twentieth day, some on the thirtieth, some on the fortieth, and some run on as long as sixty days.

16. The doctor must work out when the collection of pus began, counting from the day the patient first had fever, or from any time he had a shivering fit, or from when he says that a heaviness has come in place of the pain in the spot where it hurt, since these things happen at the beginning of collections of pus. Counting from these times, then, the doctor should expect the pus to burst at the times I have already given. If the pus is on one side only, the doctor should turn the patient over and find out whether he has any pain in the other side. If one side is warmer than the other, he should lay the patient on his healthy side and ask whether he feels some weight hanging down from above. If he does, the pus is on the other side, the side where the weight is felt.

17. All patients with pus collecting inside them can be recognised by the following signs. First, the fever does not leave them, but is slight during the day and stronger at night; heavy sweats break out; they feel an urge to cough, but bring up nothing worth mentioning; their eyes grow hollow, and their cheeks turn red; the nails of their hands curve over, and their fingers grow hot, especially at the tips; their feet swell; they have no appetite for food; and small blisters break out over the body.

Collections of pus that last a long time have these signs, and the doctor can trust them fully. Those that last only a short time are signalled by any signs that appear like the ones at the beginning, and also if the patient has somewhat more difficulty in breathing.

Whether they will burst sooner or later can be recognised as follows. If the pain comes at the beginning, and the difficulty in breathing, the cough and the spitting go on hard, the doctor should expect the pus to burst within twenty days, or even sooner. If the pain is milder, and everything else in proportion, he should expect it to burst later. But there must be pain, difficult breathing and spitting before the pus bursts.

Of these patients, the ones most likely to recover are those whose fever leaves them on the same day the pus bursts. They soon want food again, and are free of thirst, and the bowels pass small, firm stools. The pus is white, smooth, all one colour and free of phlegm, and it is cleared out without pain or hard coughing. These patients get over it best and fastest. If not, then those whose case comes nearest to this. The patients who die are those whose fever does not leave them, or seems to leave them and then plainly heats up again. They are thirsty but have no appetite for food. Their bowels are loose. And they cough up pus that is greenish-yellow or livid, or full of phlegm and frothy. If all these things happen, they die. When some of these things happen and others do not, some of the patients die, and others recover after a long time. The doctor must judge from all the evidence there is in these cases, and in all the others too.

18. After diseases of the lungs, some patients form deposits beside the ears, which turn to pus, or in the lower parts of the body, which become fistulas (channels that open out through the skin). These patients recover. The doctor should watch for these deposits like this. Suppose the fever persists, and the pain does not stop, and the sputum does not come up as it should. Suppose the stools from the bowels are not full of bile, and are not loose and unmixed, and the urine is not very plentiful with a heavy sediment. Suppose, though, that the patient is helped toward recovery by all the remaining signs of recovery. In these patients the doctor should expect deposits like these to come.

They form in the lower parts in patients who have some phlegm in the upper abdomen. They form in the upper parts when the upper abdomen stays soft and painless, and the patient has had trouble breathing for a while and then it stops with no other obvious cause.

In violent and dangerous attacks of pneumonia, deposits in the legs are all helpful. The best are the ones that come while the sputum is changing. If the swelling and the pain come when the sputum is turning from yellow to pus and coming up freely, then the patient will recover most safely, and the deposit will soon stop hurting and go away. But if the sputum does not come up properly, and the urine does not show a good sediment, there is a danger that the joint will be left lame, or that it will cause a great deal of trouble. If the deposits vanish and go back inside, while the sputum does not come up and the fever holds on, it is dangerous: the patient may become delirious and die.

Among patients with pus inside them after pneumonia, the older ones are more likely to die. With the other kinds of internal pus, the younger ones die more often. Patients with internal pus who are treated by burning or by cutting are saved if the pus is clean, white and not foul-smelling. If it is bloody and muddy, they die.

19. Pains with fever around the loins and the lower parts are very deadly if they leave the lower parts and reach the diaphragm. The doctor must therefore pay attention to the other signs. If any of the other signs that appears is bad, there is no hope for the patient. But if the disease shoots up toward the diaphragm and the other signs that come with it are not bad, there is every reason to expect that pus will collect inside him.

A bladder that is hard and painful is altogether dangerous and deadly. It is more deadly still when it comes with continuous fever, since the pains from the bladder alone are enough to kill. And at this time the bowels pass nothing except what is hard and forced out. The trouble is relieved if the patient passes urine like pus, with a white, smooth sediment. But if the urine shows no improvement, and the bladder does not soften, and the fever is continuous, the patient can be expected to die within the first periods of the disease. This form of the disease attacks children most of all, from the age of seven until they reach fifteen.

20. Fevers come to a crisis on the same number of days, whether the patients recover from them or die. The mildest fevers, which set in with the safest signs, stop on the fourth day or before it. The most malignant fevers, which come with the most dangerous signs, kill on the fourth day or before it. That is how the first round of them ends. The second runs on to the seventh day, the third to the eleventh, the fourth to the fourteenth, the fifth to the seventeenth, and the sixth to the twentieth. In the most acute diseases, then, these rounds end by adding four days at a time, up to twenty. None of these periods can be counted exactly in whole days, any more than the year and the months can be counted in whole days. After these, in the same way and by the same additions, the first period is thirty-four days, the second forty days and the third sixty days.

At their beginning it is very hard to tell which of these fevers will take the longest time to reach their crisis, because their beginnings are very much alike. But the doctor must pay attention from the first day, and look again as each further set of four days is added. Then he will not fail to see which way the disease will turn. The quartan fever, the fever that comes back every third day (the Greeks counted both ends, so they called it the fourth-day fever), also takes its form from this same pattern.

The fevers that are going to reach their crisis in the shortest time are easier to recognise, because they differ most from one another from the beginning. Patients who are going to survive breathe easily and are free of pain. They sleep at night and have the other signs that are safest. Patients who are going to die have difficulty in breathing. They are delirious and cannot sleep, and they have the other signs that are worst. Since things happen in this way, the doctor must draw his conclusions by the time and by each addition of days, as the diseases move toward their crisis. By the same reckoning, women's crises after childbirth also happen in this way.

21. Take severe, continuous headache with fever. If any of the deadly signs is added to it, it is very deadly. But suppose the pain goes on for more than twenty days without such signs, and the fever holds on. Then the doctor must look out for a nosebleed, or some other deposit in the lower parts. While the pain is still recent, he should expect, in the same way, a nosebleed, or the forming of pus, especially if the pain is around the temples and the forehead. He should expect the nosebleed more in patients younger than thirty-five, and the forming of pus in older ones.

22. Sharp pain in the ear with continuous, high fever is dangerous, because the patient may become delirious and die. Since this is a treacherous place, then, the doctor must quickly pay attention to all the signs from the first day. Younger people die of this disease on the seventh day, or even sooner. Old people die much more slowly, because fever and delirium are less likely to come on in them, and so their ears have time to turn to pus first. But at these ages relapses of the disease come on and kill most of them. Younger people die before the ear turns to pus. Still, if white pus flows from the ear, there is hope that a younger patient will survive, as long as some other helpful sign appears in him too.

23. An ulcerated throat with fever is dangerous. But if any other sign appears of those already judged to be bad, the doctor must warn that the patient is in danger. Cases of quinsy (a choking swelling of the throat) are most dangerous and kill most quickly when they show nothing that can be seen, either in the throat or in the neck, but cause very great pain and make the patient able to breathe only when sitting upright. These choke the patient on the first day itself, or the second, or the third, or the fourth. Others cause pain in much the same way, but swell up and bring redness into the throat. These are very deadly, but they last longer than the first kind, if the redness becomes great. When the throat and the neck both turn red together, these cases last longer still, and some patients escape from them, most of all if the neck and the chest show the redness, and the erysipelas (a spreading red inflammation) does not go back inward. But suppose the erysipelas does not vanish on the critical days, and no swelling gathers on the outside, and the patient does not cough up pus, and yet he seems to be at ease and free of pain. Then it is a sign of death, or of the redness coming back. It is safer for the swelling and the redness to turn outward as far as possible. If they turn toward the lungs, they bring on delirium, and some of these patients usually develop pus inside them.

It is dangerous to cut off the uvula, or to lance it, while it is red and large, because inflammation and bleeding follow. At such a time the doctor should try to shrink it by other means. But when it has all separated off into what people call the "grape," and the tip of the uvula has become larger and rounded while the part above it is thinner, then it is safe to operate. It is better, too, to empty the bowels a little first and then to operate, if time allows and the patient is not choking.

24. When fevers stop without any signs that the disease is resolving, and not on the critical days, the doctor should expect a relapse. When a fever lasts a long time while the patient is in a state that promises recovery, and there is no longer pain from any inflammation or from any other obvious cause, the doctor should expect a deposit, with swelling and pain, in one of the joints, and not least in the lower ones. Deposits like these come more often and more quickly in patients under thirty. The doctor should look out at once for signs of a deposit if the fever goes on for more than twenty days. In older patients they come less often, and only when the fever has lasted longer. He should expect such a deposit if the fever is continuous. But if the fever stops and starts again, and seizes the patient in an irregular way, and goes on like this until autumn comes near, he should expect it to settle into a quartan. Just as deposits come in patients under thirty, so quartans come more often to those of thirty and older. The doctor should know that deposits come more often in winter, and take longer to stop, but are less likely to come back.

Suppose a patient, in a fever that is not deadly, says that his head aches, or that something dark seems to appear before his eyes, or he gets heartburn. Then he will vomit bile. If a shivering fit also seizes him, and the lower part of his upper abdomen is cold, the vomiting will come sooner still. And if he drinks or eats anything at about this time, it will be vomited up very quickly. Of these patients, those whose pain begins on the first day are most oppressed on the fourth day and the fifth, and are free of it by the seventh. Most of them, however, begin to feel pain on the third day, are most storm-tossed on the fifth, and are free of it on the ninth or the eleventh. In those who begin to feel pain on the fifth day, if everything else goes as it should, the disease comes to a crisis by the fourteenth day. These things happen to men and women mostly in tertian fevers, fevers that come back every other day (the Greeks counted both ends, so they called it the third-day fever). In younger people they happen in these fevers too, but more in the more continuous fevers and in true tertians.

In a fever of this kind, some patients with headache have dim sight, or see flashes of light, instead of something dark appearing before their eyes. And instead of heartburn they feel something tighten in the upper abdomen, on the right side or the left, without pain or inflammation. In these patients the doctor should expect a nosebleed instead of vomiting. Here too he should expect the nosebleed more in the young. In those of thirty-five and older he should expect it less, and should expect vomiting in them instead.

Children have convulsions if the fever is acute and the bowels pass nothing, and if they cannot sleep, and are frightened, and whimper and cry, and change colour, turning greenish-yellow, or livid, or red. These things happen most readily to the youngest children, up to the age of seven. Older children and grown men are no longer seized by convulsions in fevers, unless some of the strongest and worst signs come first, like those that come in phrenitis. Which patients will die and which will survive, among children and among everyone else, the doctor must judge by all the signs taken together, as each has been described for each case. I say these things about the acute diseases, and about all the illnesses that come from them.

25. Anyone who means to foretell correctly who will survive and who will die, and in which patients the disease will last more days and in which fewer, must learn all the signs and be able to judge them, weighing their powers against one another, as I have described for the other signs, and for urine and sputum, when the patient coughs up pus and bile together. He must also be quick to take note of the onset of the diseases that are going around at any time, and of the character of the season.

He must know the evidence and the other signs well. And he must not fail to see that in every year and in every season bad signs mean something bad and good signs something good. The signs I have written down prove true in Libya, on Delos and in Scythia. From this the doctor must know that in the same places, too, there is nothing surprising in his being right far more often than not, if he has learned the signs and knows how to judge them and reckon them up correctly. And he must not feel the lack of the name of any disease that is not written down here. All the diseases that come to a crisis within the times I have given, you will recognise by these same signs.

Epidemics, Book One

The First Constitution

1. On Thasos, in the autumn, around the equinox (late September) and on into the setting of the Pleiades (early November), there were heavy rains, gentle and unbroken, with the wind in the south. The winter was southerly, with light north winds and dry spells: taken as a whole, for a winter it was like a spring. The spring was southerly and chilly, with light showers. The summer was mostly cloudy. No rain. The etesian winds (the steady north winds of summer) blew seldom, lightly and by fits and starts.

The whole season, then, ran to southerly winds and drought. The constitution before it (the character of the year before, its weather and the diseases that went with it) had been the opposite, a northerly one. Because of this, early in the spring a few people had burning fevers (fevers with intense heat and thirst), and these were very mild. A few had nosebleeds, and none of them died of these fevers. Many had swellings beside the ears, on one side, or on both. Most of these had no fever and stayed on their feet, though some ran a slight temperature too. In every case the swellings went down without doing harm, and in no one did they turn to pus, as swellings from other causes do. In character they were soft, large and spread out, with no inflammation and no pain, and in every case they vanished without leaving any sign. They came to boys, to young men and to men in their prime, and most of all to those who spent their time at the wrestling schools and the gymnasiums. Few women had them. Many people had dry coughs: they coughed and brought nothing up, and their voices were hoarse. Not long after, though in some only after a while, painful inflammations came on in one testicle, or in some in both. Some had fever with this, others did not. For most it was very painful. In every other way people stayed healthy, with nothing that sent them to the doctor's surgery.

2. From early in the summer, all through the summer and into the winter, many who had been ailing for a long time took to their beds with consumption (a wasting disease). And in many who had been doubtful cases, it now became certain. In some it began for the first time then: in those whose nature leaned toward consumption. Many died, most of these in fact, and of those who took to their beds I do not know whether a single one survived even for a moderate time. They died more quickly than this kind of illness usually runs its course. Yet the other diseases, though longer and with fever, they bore well and did not die of; these I shall describe. Consumption was the only one of the diseases that occurred, and the greatest, that killed people in large numbers.

In most of them the illness went like this. Fevers with shivering, continuous and acute, never letting up altogether. Their pattern was semi-tertian: lighter one day, worse the next, and on the whole growing more and more acute. Sweats all the time, but not over the whole body. The hands and feet very cold, and hard to warm again. The bowels upset, with bilious stools, scanty, unmixed, thin and stinging, so that they got up often to pass them. The urine was either thin, colourless, unripe and scanty, or thick with a slight sediment that did not settle well but was raw and out of season. Ripening is the body working the disease matter into a state in which it can be got rid of; unripe urine shows that work not yet done. They coughed often, bringing up small amounts of ripened sputum, little by little and with difficulty. But those in whom the illness fell most violently did not reach even a little ripening, and went on spitting raw sputum to the end. In most of these the throat was sore from beginning to end, red and inflamed. There were fluxes (flows of fluid from one part of the body to another), small, thin and sharp. They wasted away quickly and grew worse, with no appetite for any food to the end, and no thirst; and many rambled as death came near. That is how things stood with the consumptions.

3. In the summer, and on into the autumn, there were many continuous fevers, but not violent ones. They lasted a long time in those who had them, but the patients did not have a hard time of it in other ways. In most of them the bowels gave very little trouble and did no harm worth mentioning. In most the urine was of good colour and clear, but thin, and after a time, around the crisis (the decisive turn of the illness, toward recovery or death), it ripened. They did not cough much, and what they coughed up came without difficulty. Nor did they lose their appetite: it was quite possible even to give them food. On the whole they were ill in a mild way. They did not have the shivering fevers of the consumptives, but slight sweats, and the fever grew worse at different times and in different ways, without any pattern. Among these, the earliest crisis came about the twentieth day; in most, about the fortieth; and in many, about the eightieth. In some the illness did not end even like that: the fever left them irregularly, without a crisis. In most of these the fevers came back after no long interval, and after the relapse they came to a crisis in the same periods as before. In many of them the illness dragged on so long that they were still sick in the winter.

Of all the illnesses described in this constitution, only the consumptions proved deadly. All the other patients bore their illness well, and the other fevers were not deadly.

The Second Constitution

4. On Thasos, early in the autumn, there were storms out of season, sudden, with much north wind and south wind, wet, and bursting out ahead of their time. Weather like this went on until the setting of the Pleiades and through that season. The winter was northerly, with heavy rains, violent and abundant, and snow, but mostly with fair spells between. All this happened, but the cold was not very far out of season. Then, right after the winter solstice, at the time when the west wind begins to blow, came severe late storms of winter: much north wind, snow and heavy rains without a break, and the sky squally and overcast. This kept on and did not let up until the equinox. The spring was cold, northerly, wet and overcast. The summer was not very hot; the etesian winds blew steadily. But soon, around the rising of Arcturus (mid-September), there was much rain again, with north winds.

5. The whole year, then, had been wet, cold and northerly. In the winter most people were healthy, but early in the spring a great many, most in fact, were in poor health. First came inflammations of the eyes, running, painful, with a watery discharge that did not ripen. Small sticky crusts formed, which in many broke out only with difficulty. In most the trouble came back, and it did not stop until late, toward the autumn. In the summer and autumn there were illnesses like dysentery, tenesmus (painful straining at stool) and lientery, in which food passes through undigested. And there was bilious diarrhoea: in many it was thin, raw and stinging, and in some watery too. Many also had painful discharges of urine, bilious, watery, full of shreds, full of pus, and painful like strangury (urine passed painfully, drop by drop). This was not disease of the kidneys: in these patients one symptom followed another. There was vomiting of phlegm and bile, and bringing up of undigested food. Sweats: in everyone, much moisture all over the body. In many these things happened without fever, and they stayed on their feet; but many others had fevers, which I shall describe. Those who showed all the symptoms described here went on to consumption, with pain. Then in autumn and toward winter came continuous fevers (a few of them of the burning kind) and day fevers, night fevers, semi-tertians, true tertians, quartans and wandering fevers. A tertian is a fever that comes back every other day, and a quartan one that comes back every third day (the Greeks counted both ends, so they called them the third-day and fourth-day fevers). Each of the fevers I have listed came to many people.

6. Now the burning fevers came to the fewest people, and these patients suffered least of all the sick. They had no nosebleeds, except very slight ones in a few, and no rambling. Everything else they bore well. These fevers came to a crisis very regularly, in most cases in seventeen days, counting the days without fever. I do not know of anyone who died of a burning fever then, nor of any case of phrenitis (a fever with delirium) at that time. The tertians were more common than the burning fevers, and more painful. But in all of them they ran a regular course of four bouts from the first attack, came to a complete crisis in seven, and came back in none of them. The quartans in many began from the start with the pattern of a quartan. But in not a few they turned into quartans by a deposit (the disease matter settling in one place, as a swelling, an abscess or a pain in a joint) out of other fevers and illnesses. They ran long, as quartans usually do, and even longer. The day fevers, the night fevers and the wandering fevers came to many people, and stayed with them a long time, whether they were up and about or in bed. In most of them the fevers lasted through the season of the Pleiades and on until winter. Many people, and children especially, had convulsions, with a slight fever, from the beginning; and convulsions also came on top of fevers. In most of them these illnesses lasted long, but did no harm, except to those who were in a deadly state from every other cause as well.

7. But the fevers that were continuous throughout and never let up at all, but grew worse in every patient in the tertian manner, easing one day and growing worse the next, were the most violent of all that occurred then, the longest, and the most painful. They began gently, but on the whole they kept increasing and growing worse, and climbing toward the worst. They eased a little, and then quickly, after the pause, grew worse again more violently, and they generally took a bad turn on the critical days (the days on which a crisis is to be expected). All the patients had shivering fits, irregular and without pattern; but in these fevers the shivering was rarest and least, while in the other fevers it was greater. Sweats were plentiful, but least in these; they brought no relief, but on the contrary did harm. These patients had severe chilling of the hands and feet, which were hard to warm again. In general they could not sleep, these patients most of all, and then again they fell into a stupor. In everyone the bowels were upset and in a bad state, but in these they were by far the worst. In most of them the urine was of three kinds. It was thin, raw and colourless, ripening a little after a time, at a critical point. Or it was thick, but muddy, never clearing and never forming a sediment. Or it had a small, bad, raw sediment, and this was the worst of all. Coughs went along with the fevers, but I cannot record that any harm or any good came from the coughing at that time.

8. Most of these illnesses went on being long and troublesome, utterly disordered and irregular, and without a crisis, both in those who were in mortal danger and in those who were not. If the fever let up a little in some of them, it quickly came back. In a few it came to a crisis, the earliest about the eightieth day, and in some of these it came back, so that most of them were still ill in the winter. In most the fever left without any crisis. These things happened alike to those who survived and to those who did not. There was a great lack of crisis in these illnesses, and great variety. The greatest sign, and the worst, which stayed with most of them to the end, was a loathing for all food, most of all in those whose condition was deadly in other ways too. In these fevers they were not much troubled by thirst out of season. After long stretches of time, much pain and a bad wasting, deposits came on, either too great for the patient to bear, or too small to do any good: the disease quickly ran back and pressed on toward the worse.

9. What these patients suffered was illnesses like dysentery, and tenesmus, lientery and fluxes. Some had dropsies (swellings with fluid) along with these, or without them. Whichever of these came on violently quickly carried the patient off; otherwise it did no good. There were small rashes, not as large as the scale of the illnesses called for, which quickly vanished again; or swellings beside the ears, which shrank and signified nothing; or in some, swellings in the joints, especially the hip. In a few these went away at a critical point, and then quickly the illness took hold again and brought back the state it began with.

10. People died of all these illnesses, but most of all of these fevers, and among these most of all children: those already weaned, older ones of eight and ten, and those not yet at puberty. These had the later symptoms never without the first ones I described, but many had the first without the later ones. The only good sign, and the greatest that occurred, which saved most of those in the greatest danger, came when the illness turned to strangury and the deposits went there. And strangury happened to come most of all at these ages. It also came to many of the others, whether they were on their feet or in their sickbeds. And in these patients a quick and great change came over everything. The bowels, even if they had happened to be loose in a bad way, quickly firmed up; they enjoyed all their food again; and after that the fevers were mild. But in these patients too the strangury lasted long and was painful. Their urine came copious, thick, varied, red, mixed with pus, and with pain. But they all survived, and I know of none of them who died.

11. In all dangerous cases, watch for the ripening of everything the body discharges, from every part, coming at the right moment, or for good deposits, at a critical point. Ripening means a quick crisis and a sure return to health. Raw and unripened matter, and matter that turns to bad deposits, means no crisis, or pain, or long illness, or death, or a relapse of the same symptoms. Which of these will happen most is to be judged from other signs. Tell the past, understand the present, foretell the future. Practise these things. In dealing with diseases, make a habit of two things: to help, or at least to do no harm. The art has three parts: the disease, the patient, and the doctor. The doctor is the servant of the art. The patient must join with the doctor in fighting the disease.

12. Pains in the head and neck, and heaviness with pain, come both without fever and with it. Those with phrenitis have convulsions and vomit matter as green as verdigris, the green rust of copper, and some of them die very quickly. In burning fevers and the other fevers, those who have pain in the neck, heaviness in the temples, dimness of sight, and a tension of the abdomen below the ribs without pain, will bleed from the nose. Those who have heaviness of the whole head, heartburn and nausea will vomit bile and phlegm. In cases like these, children for the most part have convulsions above all. Women have these too, and also pains from the womb. Older people, and those whose natural heat is already failing, have paralysis, or madness, or loss of sight.

The Third Constitution

13. On Thasos, a little before the rising of Arcturus and during it, there were many heavy rains with north winds. Around the equinox and until the Pleiades, light southerly showers. The winter was northerly: dry spells, cold snaps, strong winds, snow. Around the spring equinox, very severe storms. The spring was northerly, dry, with light showers and cold snaps. Around the summer solstice, light rains, and great cold until close to the Dog Star, which rises in late July. After the Dog Star, until Arcturus, a hot summer: great heat, not building up gradually but continuous and fierce. No rain fell. The etesian winds blew. Around Arcturus, southerly rains until the equinox.

14. In this constitution, cases of paralysis began in the winter and came to many people, and some of them died quickly; indeed the disease was going round among the people generally. In other ways people stayed free of illness. Early in the spring, burning fevers began, and went on until the equinox and toward the summer. Those who fell ill right at the start of spring and summer mostly came through, though a few died. But once autumn had come, and the rains, the cases were deadly, and more were lost.

As for the course of the burning fevers: those who had a good, plentiful bleeding from the nose were most often saved by it, and in this constitution I know of no one who died if he bled well. Philiscus, Epaminon and Silenus had only a few drops from the nose on the fourth and fifth days, and they died. Most of the sick had a shivering fit around the crisis, especially those who did not bleed from the nose. But these also had a shivering fit, and sweated.

15. Some had jaundice on the sixth day. But these were helped either by a purging through the bladder, or by an upset of the bowels, or by a heavy bleeding: Heraclides, for example, who lay sick at the house of Aristocydes. He, in fact, bled from the nose, had his bowels upset and was purged through the bladder, and he came to a crisis on the twentieth day. It was not so with the slave of Phanagoras, who had none of these, and died. Most people had bleeding from the nose, especially boys and men in their prime, and of these, most who did not bleed died. Older people turned to jaundice or upset bowels: Bion, for example, who lay sick at Silenus's house. Dysentery also went round in the summer. And in some who had come through their illness, and who had also had bleeding, it ended in dysentery: in the slave of Eraton, for example, and in Myllus, after a heavy bleeding, it turned to dysentery. They survived.

Blood, then, was the humour that ran highest of all. Even in those who had no bleeding around the crisis, but had swellings come up beside the ears and then vanish, things went this way. When the swellings vanished, there was a heaviness along the left flank down to the point of the hip. After the crisis came pain, and thin urine passed; and they began to bleed a little around the twenty-fourth day, so that the deposits turned into bleeding. In Antiphon, the son of Critobulus, the illness stopped and came to a complete crisis around the fortieth day.

16. Many women fell ill, but fewer than men, and fewer of them died. Most of them, though, had difficult labours, and fell ill after giving birth, and these were the ones who died most, as the daughter of Telebulus died on the sixth day after giving birth. In most women menstruation came on during the fevers, and many girls had their first period then. Some bled from the nose. Sometimes both the nosebleed and the period came in the same women, as with the daughter of Daitharses, a girl, whose first period came then, and who also had a violent nosebleed. I know of no woman who died if any of these came on well. But all the women I know of who happened to fall ill while pregnant miscarried.

17. In most the urine was of good colour, but thin, with little sediment. In most the bowels were upset, with thin, bilious stools. In many, after everything else had come to a crisis, the illness ended in dysentery: Xenophanes and Critias, for example. I shall record those who passed urine that was watery, copious, clear and thin, even after the crisis, when a good sediment had formed and everything else had come to a good crisis: Bion, who lay sick at Silenus's house; Cratis, who lodged at the house of Xenophanes; the slave of Areton; and the wife of Mnesistratus. Afterwards all of these had dysentery.

Around the rising of Arcturus, many came to a crisis on the eleventh day, and in these not even the relapses that are to be expected came back. There were also cases of stupor at this time, more often in children, and of all the patients these died least.

18. Around the equinox, and until the Pleiades, and on into winter, the burning fevers went on; but the cases of phrenitis were most numerous at this time, and most of them died. There had been a few in the summer too. In the burning fevers, in those whose illness was to be fatal, the signs showed at the very beginning. Right from the start they had acute fever; slight shivering fits; sleeplessness; thirst; nausea; slight sweats around the forehead and collarbones, but in no one over the whole body; much talking at random; fears; despondency; the extremities very cold, the toes, and the hands even more. The worse turns came on the even days. In most the pains were greatest on the fourth day, with sweat that was mostly cold, and the hands and feet would no longer warm up but stayed livid and cold; and with this they were no longer thirsty. Their urine was scanty, black and thin, and the bowels were bound. No one in whom these signs appeared had a nosebleed, beyond a few drops. Not one of them lasted until a relapse: they died on the sixth day, sweating. Those with phrenitis had all the signs described too, but in them the crisis came mostly on the eleventh day. In some it came on the twentieth. These were the ones in whom the phrenitis did not begin right at the start, or about the third or fourth day: they were fairly well at first, and then, around the seventh day, the illness turned acute.

19. There were, then, a great many illnesses. Of the sick, the ones who died most were boys, young men and men in their prime; the smooth-skinned, the pale-skinned, the straight-haired, the black-haired, the black-eyed; those who had lived carelessly and taken life easy; the thin-voiced, the rough-voiced, those who lisped, and the hot-tempered. And very many women of this type died. In this constitution people were saved chiefly by four signs: a good bleeding from the nose; or copious urine passed through the bladder, with much good sediment; or upset bowels with bilious stools at the right moment; or dysentery. In many the crisis did not come with only one of these signs. Most went through all of them and seemed to be in a worse way, but all in whom these things happened were saved. Women and girls had all the signs described too. Those in whom any of these came on well, or whose periods came plentifully, were saved by them and came to a crisis; and I know of no woman who died in whom any of these came on well. Philo's daughter did die after a violent nosebleed, but she had eaten dinner at the wrong time on the seventh day.

In acute fevers, and especially burning ones, when tears run down without the patient meaning to weep, expect a bleeding from the nose, provided the other signs are not deadly. In those who are in a bad way, such tears signal not a nosebleed but death.

20. The painful swellings that came up beside the ears in fevers sometimes neither went down nor turned to pus when the fever left at a crisis. In these patients they were cleared up by diarrhoea of bile, or by dysentery, or by a sediment forming in thick urine: Hermippus of Clazomenae, for example. The features of the crises, from which we also came to understand them, were either alike or unlike. Take the two brothers, for example, who fell ill together, at the same hour; they lay sick near the summer house of Epigenes. In the elder the crisis came on the sixth day, in the younger on the seventh. The fever came back in both together, at the same hour, after they had been free of it for five days. After the relapse both came to a crisis together, on the seventeenth day counted from the start. Most came to a crisis on the sixth day, were free of fever for six days, and after the relapse came to a crisis on the fifth. Those who came to a crisis on the seventh day were free for seven, and after the relapse came to a crisis on the third. Others who came to a crisis on the seventh day were free for three and then came to a crisis on the seventh. Those who came to a crisis on the sixth day, after six days free, had the fever for three days, were free for one, had it for one, and came to a crisis: Euagon, the son of Daitharses, for example. Others who came to a crisis on the sixth were free for seven, and after the relapse came to a crisis on the fourth: the daughter of Aglaidas, for example. Most of those who fell ill in this constitution went through their illness in this way. I know of no one who survived in whom the relapses to be expected did not come back. And all whom I know of, whose relapses followed this pattern, survived. Nor do I know of anyone who went through the illness in this way and then had a relapse again.

21. Most who died of these diseases died on the sixth day: Epaminondas, Silenus, and Philiscus the son of Antagoras, for example. In those who had swellings beside the ears, the crisis came on the twentieth day. In all of them the swellings went down without turning to pus, and the illness turned instead to the bladder. In Cratistonax, who lived by the temple of Heracles, and in the slave woman of Scymnus the fuller, who finished cloth, they did turn to pus, and both died. Those who came to a crisis on the seventh day were free for nine, relapsed, and came to a crisis on the fourth day after the relapse: Pantacles, for example, who lived by the temple of Dionysus. Those who came to a crisis on the seventh were free for six; then came a relapse, and after the relapse they came to a crisis on the seventh: Phanocritus, for example, who lay sick at the house of Gnathon the fuller.

22. In the winter, around the winter solstice and until the equinox, the burning fevers and the cases of phrenitis went on, and many died. But the crises shifted. In most the crisis came on the fifth day from the start; they were free for four days; the fever came back; and after the relapse they came to a crisis on the fifth day, which was the fourteenth day in all. Most children came to a crisis in this way, but older people did too. In some the crisis came on the eleventh day, a relapse on the fourteenth, and a complete crisis on the twentieth. If any had a shivering fit around the twentieth day, the crisis came for them on the fortieth. Most had shivering fits around the first crisis. And those who had shivered around the first crisis shivered again in the relapses, at the same time as the crisis. Fewest had shivering fits in the spring, more in the summer, more still in the autumn, and by far the most toward winter. But the bleedings died away.

23. The features of the diseases, from which we came to our judgments, we learned in these ways. From the nature common to all people, and the nature peculiar to each. From the disease; from the patient; from what is given him and from the one who gives it, since these make the case easier or harder. From the constitution as a whole and in its parts, both of the weather and of each region. From the patient's habits, his way of life, his occupations, his age. From his talk, his manner, his silence, his thoughts, his sleep or his lack of it, and his dreams, what kind they are and when they come. From his plucking at things, his scratching, his tears. From the worse turns; from stools, urine, sputum and vomit. From the way one disease follows another, and from what into what they pass, and from deposits that lead to death or to a crisis. From sweat, shivering, chill, cough, sneezes, hiccups, breathing, belches, and wind, silent or noisy; from bleedings, and from haemorrhoids. These things must be studied, and whatever comes about through them.

24. Some fevers are continuous. Some hold by day and leave off by night; others hold by night and leave off by day. There are semi-tertians, tertians and quartans, and quintans, septans and nonans, returning on the fifth, the seventh and the ninth day by Greek counting. The most acute diseases, the most severe, the hardest and the most deadly come with continuous fever. The safest of all and the easiest, but the longest of all, is the quartan. Not only is it like this in itself, but it also frees people from other great diseases. In the fever called semi-tertian, acute diseases tend to occur as well, and of the rest it is the most deadly. Consumptives, too, and those who suffer from other, longer diseases, are especially apt to fall ill with it. The night fever is not very deadly, but it is long. The day fever is longer still, and in some it also leans toward consumption. The septan is long, but not deadly. The nonan is longer still, and not deadly. The true tertian comes to a quick crisis and is not deadly. But the quintan is the worst of all: if it comes before consumption, or in those already wasting, it kills.

25. Each of these fevers has its own patterns, its own constitutions and its own worse turns. A continuous fever, for example, in some patients flowers at the very beginning, is at its height, and climbs to its most severe, but around the crisis and at the crisis it thins away. In others it begins mildly and smoulders underneath, but rises and grows worse each day, and around the crisis it blazes up in full. In others it begins gently, increases and grows worse, and when it has reached its height for a time, it eases off again until the crisis and around the crisis. These patterns can occur in any fever and in any disease. One must also look at the patient's way of life, and prescribe with that in view. Many other important signs are closely related to these. Some of them I have described somewhere already, and some I shall describe later. With all of these in mind one must reckon, test and decide. In which patient is the disease acute and deadly, or one he can survive? In which is it long and deadly, or one he can survive? For whom should something be prescribed, and for whom not? And when, how much, and what shall be given?

26. Fevers that grow worse on even days come to a crisis on even days; those whose worse turns fall on odd days come to a crisis on odd days. For those that come to a crisis on the even days, the first period is the fourth day, then the sixth, the eighth, the tenth, the fourteenth, the twentieth, the twenty-fourth, the thirtieth, the fortieth, the sixtieth, the eightieth and the hundred and twentieth. For those that come to a crisis on the odd days, the first period is the third, then the fifth, the seventh, the ninth, the eleventh, the seventeenth, the twenty-first, the twenty-seventh and the thirty-first. You must know, further, that if the crisis falls on other days than these, there will be relapses, and the outcome may also be fatal. You must therefore pay attention, and know that on these days the crises will come, toward recovery or toward death, or the illness will tip toward better or worse. And you must study in what periods the wandering fevers, the quartans, the quintans, the septans and the nonans come to a crisis.

Fourteen Patients

Case 1. Philiscus lived by the wall. He took to his bed. First day: acute fever; sweated; a painful night.

Second day: everything grew worse; late in the day a small enema brought a good movement of the bowels. A quiet night.

Third day: in the morning and until midday he seemed to be free of fever, but toward evening came acute fever with sweating; thirst; the tongue was growing dry; passed black urine. A restless night; no sleep; wholly delirious.

Fourth day: everything grew worse; urine black. An easier night; urine of a better colour.

Fifth day: about midday a few drops of pure blood from the nose. Urine varied, with round particles like semen floating in it, scattered; they did not settle. When a suppository was put in, a little stool and wind passed. A painful night: snatches of sleep; talking; rambling; hands and feet cold all over and no longer warming up; passed black urine; slept a little toward daybreak; speechless; a cold sweat; hands and feet livid. He died about midday on the sixth day. In this patient the breathing was, throughout, like that of someone who keeps remembering to breathe: slow and deep. The spleen rose in a round bulge. Cold sweats throughout. The worse turns came on even days.

Case 2. Silenus lived on the Flats, near the house of Eualcidas. After overexertion, drinking, and exercise at the wrong time, he was seized with fever. He began with pain in the loins, heaviness in the head and stiffness of the neck. First day: from the bowels passed many stools, bilious, unmixed, frothy and deep-coloured. Urine black, with a black sediment; thirst; tongue dry; no sleep at night.

Second day: acute fever; stools more copious, thinner, frothy; urine black; a restless night; slightly delirious.

Third day: everything grew worse. A tension of the abdomen below the ribs on both sides, stretching long toward the navel, soft underneath. Stools thin and blackish; urine muddy and blackish; no sleep at night; much talk, laughing, singing; he could not hold himself back.

Fourth day: the same.

Fifth day: stools unmixed, bilious, smooth and greasy; urine thin and transparent; a little rational.

Sixth day: a slight sweat about the head; hands and feet cold and livid; much tossing about; nothing passed from the bowels; urine stopped; acute fever.

Seventh day: speechless; hands and feet no longer warmed up; passed no urine.

Eighth day: a cold sweat all over; with the sweat came red spots, round and small, like pimples, which stayed and did not go down. From the bowels, after slight stimulation, came many thin stools, as if undigested, with pain. Urine painful and stinging. Hands and feet a little warmer; light sleep; stupor; speechless; urine thin and transparent.

Ninth day: the same.

Tenth day: took no drink; stupor; light sleep. From the bowels, the same. Passed a large amount of thickish urine all at once; when it stood, it left a white sediment like coarse barley meal. Hands and feet cold again.

Eleventh day: died.

In this patient, from the beginning to the end, the breathing was slow and deep. Constant throbbing of the abdomen below the ribs. His age was about twenty.

Case 3. Herophon: acute fever; at first scanty stools, with straining; afterward thin, bilious stools, fairly frequent. No sleep; urine black and thin.

Fifth day: early in the morning, deafness; everything grew worse; the spleen swelled; tension of the abdomen below the ribs; scanty black stools passed; delirium.

Sixth day: rambling; toward night, sweat and chill; the rambling persisted.

Seventh day: chilled all over; thirst; delirious. At night rational; slept.

Eighth day: fever; the spleen grew smaller; fully rational. Pain first in the groin, on the side of the spleen, then pains running into both shins. An easy night; urine of a better colour, with a slight sediment.

Ninth day: sweated; crisis; the fever left him.

On the fifth day after, relapse. At once the spleen swelled; acute fever; deafness again. On the third day after the relapse the spleen grew smaller; less deafness; pain in the legs. At night he sweated. Crisis about the seventeenth day. He was not delirious during the relapse.

Case 4. In Thasos the wife of Philinus gave birth to a daughter. The discharge after childbirth came normally, and in other ways she was getting on well; but on the fourteenth day after the birth she was seized with fever and a shivering fit. At the start she had pain at the pit of the stomach and in the abdomen below the ribs on the right; pains in the womb; the discharge stopped. A pessary eased these, but pains in the head, neck and loins persisted. No sleep; hands and feet cold; thirst; bowels burning hot; scanty stools; urine thin, and colourless at first.

Sixth day: toward night, very delirious, then rational again.

Seventh day: thirst; scanty stools, bilious and deep-coloured.

Eighth day: a shivering fit; acute fever; many convulsions, with pain; she talked a great deal at random. After a suppository she kept getting up to the stool, and much passed, with a bilious flux. No sleep.

Ninth day: convulsions.

Tenth day: a little rational.

Eleventh day: slept; remembered everything, but soon delirious again. With convulsions, she passed a great deal of urine all at once, for those around her seldom reminded her to pass it. It was thick and white, like urine that has stood and settled and then been shaken up. It stood a long time without settling. In colour and thickness it was like the urine of a pack animal. That is the kind of urine she passed, as I saw for myself.

About the fourteenth day: twitching over the whole body; much talk; a little rational, but soon delirious again.

About the seventeenth day: speechless.

Twentieth day: died.

Case 5. The wife of Epicrates, who lay sick near the shrine of the city's Founder, was seized with a violent shivering fit when she was near her time, and did not grow warm, so they said; and on the next day the same. On the third day she gave birth to a daughter, and everything else went normally. On the second day after the birth she was seized with acute fever, with pain at the pit of the stomach and in the womb. A pessary eased these, but there was pain in the head, neck and loins. No sleep. From the bowels passed scanty stools, bilious, thin and unmixed. Urine thin and blackish. On the night of the sixth day from the onset of the fever, she was delirious.

Seventh day: everything grew worse; sleepless; delirious; thirst; stools bilious and deep-coloured.

Eighth day: a shivering fit; slept more.

Ninth day: the same.

Tenth day: painful aching in the legs; pain at the pit of the stomach again; heaviness in the head; not delirious; slept more; the bowels stopped.

Eleventh day: passed urine of a better colour, with plenty of sediment; she was easier.

Fourteenth day: a shivering fit; acute fever.

Fifteenth day: vomited bilious, yellow matter fairly often; sweated, free of fever; toward night, though, acute fever; urine thick, with a white sediment.

Sixteenth day: worse; a restless night; no sleep; delirious.

Eighteenth day: thirst; tongue parched; no sleep; very delirious; the legs painful.

About the twentieth day: early in the morning a slight shivering fit; stupor; slept quietly; vomited a little bilious, black matter; toward night, deafness.

About the twenty-first day: a heaviness all through the left side, with pain; a slight cough. Urine thick, muddy and reddish; on standing it did not settle. In other ways easier, but not free of fever. From the beginning she had had a sore throat: redness; the uvula drawn up; a sharp, stinging, salty flux, which persisted to the end.

About the twenty-seventh day: free of fever; sediment in the urine; slight pain in the side.

About the thirty-first day: fever seized her; the bowels upset, with bilious stools.

Fortieth day: vomited a little bilious matter.

Eightieth day: a complete crisis; free of fever.

Case 6. Cleanactides, who lay sick above the temple of Heracles, was seized with an irregular fever. From the start he had pain in the head and the left side, and in the other parts pains like those of exhaustion. The fevers grew worse now in one way, now in another, without order; sometimes there were sweats, sometimes not. For the most part the worse turns showed most on the critical days.

About the twenty-fourth day: pain in the hands; vomited bilious, yellow matter, fairly often, and after a little while matter green as verdigris; relief in everything.

About the thirtieth day: began to bleed from the nose, from both nostrils, and this went on irregularly, a little at a time, until the crisis. All through the illness he did not lose his appetite, was not thirsty and did not lie sleepless. Urine thin, but not colourless.

About the fortieth day: passed reddish urine with plenty of red sediment; he was easier. After that the urine varied: sometimes it had a sediment, sometimes not.

Sixtieth day: plenty of sediment in the urine, white and smooth; improvement in everything; the fevers left off; urine thin again, but of good colour.

Seventieth day: fever; it left off for ten days.

Eightieth day: a shivering fit; acute fever seized him; sweated heavily; a red, smooth sediment in the urine. A complete crisis.

Case 7. Meton was seized with fever, with a painful heaviness in the loins.

Second day: after drinking water, a fairly copious, good movement of the bowels.

Third day: heaviness in the head; stools thin, bilious and reddish.

Fourth day: everything grew worse; twice a little blood ran from the right nostril. A restless night; stools like those of the third day; urine blackish, with a blackish cloud floating in it, scattered, which did not settle.

Fifth day: a violent flow of pure blood from the left nostril; sweated; crisis. After the crisis, sleepless; talked at random; urine thin and blackish. His head was bathed; slept; rational. He had no relapse, but bled from the nose often after the crisis.

Case 8. Erasinus lived by the ravine of Boötes. He was seized with fever after dinner; a troubled night.

First day: quiet; a painful night.

Second day: everything grew worse; toward night, delirious.

Third day: in pain; very delirious.

Fourth day: in the greatest distress; at night no sleep at all; dreams and wandering thoughts; then worse signs, striking and ominous; fear; distress.

Fifth day: in the morning he was composed, fully rational; but well before midday he went raving mad and could not hold himself back; hands and feet cold and somewhat livid; urine stopped. He died about sunset.

In this patient the fever was accompanied by sweat throughout. The abdomen below the ribs was raised, tense and painful. Urine black, with round particles floating in it, which did not settle. From the bowels, solid stools passed. Thirst throughout, but not great. Many convulsions, with sweat, about the time of death.

Case 9. Crito, in Thasos, while walking about, began to have a violent pain in the foot, starting from the big toe. He took to his bed the same day, shivering and nauseous, slightly feverish; toward night, delirium.

Second day: swelling over the whole foot, reddish about the ankle, and tense; small black blisters; acute fever; he went raving mad. From the bowels, unmixed, bilious stools, fairly frequent. He died on the second day from the onset.

Case 10. The man from Clazomenae, who lay sick by the well of Phrynichides, was seized with fever. From the start he had pain in the head, neck and loins, and at once came deafness. No sleep; acute fever seized him; the abdomen below the ribs was raised, with a swelling, though not a great one; tension; tongue dry.

Fourth day: toward night, delirium.

Fifth day: in pain.

Sixth day: everything grew worse.

About the eleventh day: a slight easing. From the bowels, from the beginning until the fourteenth day, thin, copious stools passed, watery and bilious; he bore them well. Then the bowels stopped. The urine throughout was thin, but of good colour, with much cloudy matter floating in it, somewhat scattered, which did not settle.

About the sixteenth day: passed urine a little thicker, with a slight sediment; he was eased a little; more rational.

Seventeenth day: urine thin again; swellings came up beside both ears, with pain; no sleep; rambling; the legs painful.

Twentieth day: crisis; free of fever; did not sweat; fully rational.

About the twenty-seventh day: violent pain in the right hip, which soon stopped. The swellings beside the ears neither went down nor turned to pus, but they were painful.

About the thirty-first day: diarrhoea, with copious watery stools and signs of dysentery; passed thick urine; the swellings beside the ears went down.

Fortieth day: pain in the right eye, and he saw more dimly. It cleared up.

Case 11. The wife of Dromeades gave birth to a daughter, and everything else went normally; but on the second day after, she was seized with a shivering fit; acute fever. On the first day she began to have pain about the abdomen below the ribs; nausea; shivering; restlessness; and on the following nights she did not sleep. Breathing slow and deep, and each breath at once broken off as it was drawn in.

Second day from the shivering fit: a good movement of the bowels. Urine thick, white and muddy, like urine that has stood a long time and settled, and then been stirred up; it did not settle. No sleep at night.

Third day: about midday a shivering fit; acute fever; urine the same; pain in the abdomen below the ribs; nausea; a restless night; no sleep; a cold sweat all over, but she soon grew warm again.

Fourth day: slight relief about the abdomen below the ribs, but heaviness in the head, with pain; somewhat torpid; a few drops of blood from the nose; tongue dry; thirst; urine scanty, thin and oily; slept a little.

Fifth day: thirst; nausea; urine the same; nothing from the bowels. About midday very delirious, then soon a little rational again; when she got up she grew torpid; a slight chill; slept at night; delirious.

Sixth day: in the morning a shivering fit; soon grew hot all through; sweated all over; hands and feet cold; delirious; breathing deep and slow. After a little while convulsions began from the head, and she quickly died.

Case 12. A man dined while he was overheated, and drank too much. In the night he vomited everything; acute fever; pain in the abdomen below the ribs on the right; an inflammation, soft underneath, on the inner side; a restless night. Urine thick and red at first; on standing it did not settle. Tongue dry; not very thirsty.

Fourth day: acute fever; pains everywhere.

Fifth day: passed a great deal of smooth, oily urine; acute fever.

Sixth day: in the afternoon very delirious. No sleep at night either.

Seventh day: everything grew worse; urine the same; much talk; he could not hold himself back. From the bowels, after stimulation, watery, disturbed stools passed, with worms. A painful night; in the morning a shivering fit; acute fever; a hot sweat, and he seemed to be free of fever; did not sleep long; after sleep, a chill; much spitting. In the afternoon very delirious, and a little later vomited a little black, bilious matter.

Ninth day: a chill; much rambling; no sleep.

Tenth day: the legs painful; everything grew worse; rambling.

Eleventh day: died.

Case 13. A woman who lay sick on the shore, three months pregnant, was seized with fever, and at once began to have pain in the loins.

Third day: pain in the neck and head, and about the right collarbone. Soon she lost the power of her tongue; the right arm was paralysed, with a convulsion, in the manner of a stroke; she rambled about everything. A restless night; no sleep; the bowels upset, with bilious stools, unmixed and scanty.

Fourth day: her speech was indistinct, then came free; convulsions; the pains in the same places persisted; a swelling in the abdomen below the ribs, with pain; no sleep; wholly delirious; bowels upset; urine thin and not of good colour.

Fifth day: acute fever; pain in the abdomen below the ribs; wholly delirious; bilious stools. Toward night she sweated; free of fever.

Sixth day: rational; relief in everything, but pain persisted about the left collarbone; thirst; urine thin; no sleep.

Seventh day: trembling; somewhat torpid; slightly delirious; the pains about the collarbone and the left upper arm persisted; everything else eased; fully rational. For three days she stayed free of fever.

Eleventh day: relapse; a shivering fit; fever seized her.

About the fourteenth day: vomited bilious, yellow matter fairly often; sweated; crisis; free of fever.

Case 14. Melidia, who lay sick by the temple of Hera, began to have violent pain in the head, neck and chest. At once acute fever seized her; a little menstrual blood appeared; continuous pains in all these parts.

Sixth day: stupor; nausea; shivering; redness on the cheeks; slightly delirious.

Seventh day: sweated; the fever left off; the pains persisted; relapse; snatches of sleep. Urine throughout of good colour, but thin. Stools thin, bilious, stinging, scanty, black and foul-smelling; a white, smooth sediment in the urine; sweated.

Eleventh day: a complete crisis.

Epidemics, Book Three

Case 1. Pythion, who lived by the temple of Earth, began with a trembling that started in his hands.

First day: acute fever; rambling.

Second day: everything grew worse.

Third day: the same.

Fourth day: from the bowels, small stools, unmixed and full of bile.

Fifth day: everything grew worse; sleep only light; the bowels stopped.

Sixth day: sputum of mixed colours, reddish.

Seventh day: his mouth was drawn to one side.

Eighth day: everything grew worse; the trembling went on. His urine, from the beginning up to the eighth day, was thin and colourless, with a cloudy matter floating in it.

Tenth day: he sweated; the sputum was partly ripened (ripening is the body working the disease matter into a state in which it can be got rid of), and the illness came to a crisis (the decisive turn of the illness, toward recovery or death). Around the crisis, his urine was fairly thin. After the crisis, forty days later, an abscess formed near the anus, and there was a deposit (the disease matter settling in one place, as a swelling, an abscess or a pain in a joint) that brought on strangury (urine passed painfully, drop by drop).

Case 2. Hermocrates, who lay sick by the new wall, was taken with fever. He began with pain in the head and the lower back. The abdomen below the ribs was tense, but without swelling. His tongue was parched at the start. He went deaf at once. No sleep. Not very thirsty. Urine thick and red, which did not settle when it stood. From the bowels, burnt-looking stools, and not a few.

Fifth day: he passed thin urine with matter floating in it, which did not settle; toward night he was delirious.

Sixth day: jaundiced; everything grew worse; not rational.

Seventh day: restless; urine thin, as before.

The following days: much the same.

About the eleventh day: everything seemed to ease. A stupor began (a heavy, drowsy sleep from which he could be roused). He passed thicker, reddish urine, thin at the bottom, which did not settle. Little by little he became rational.

Fourteenth day: no fever; no sweat; he slept; fully rational; urine much as before.

About the seventeenth day: he relapsed and grew hot.

The following days: acute fever; urine thin; delirious.

Twentieth day: once again a crisis; no fever; no sweat. The whole time he had no appetite. He was fully rational but could not talk. Tongue dryish; no thirst. He slept in snatches, in a stupor.

About the twenty-fourth day: he grew hot; the bowels loose, with many thin stools.

The following days: acute fever; tongue parched.

Twenty-seventh day: died.

In this case the deafness lasted to the end. The urine was thick and red and did not settle, or else thin and colourless with matter floating in it. He could not take food.

Case 3. The man who lay sick in the garden of Delearces had had a heaviness in the head and a pain in the right temple for a long time. Then, from some obvious cause, he was taken with fever and went to bed.

Second day: a little unmixed blood ran from the left nostril. The bowels moved well. Urine thin and of mixed colours, with small clumps floating in it like coarse barley meal, or like semen.

Third day: acute fever; stools black, thin and frothy, with a livid sediment in them. He was slightly dazed, and getting up distressed him. In the urine, a livid, rather sticky sediment.

Fourth day: he vomited a little yellow bile, and after a short while a little greenish matter. A little unmixed blood ran from the left nostril. Stools the same; urine the same. He sweated a little about the head and collarbones. The spleen was enlarged. Pain along the line of the thigh. The right side of the abdomen below the ribs was tense, though fairly soft. No sleep at night; slightly delirious.

Fifth day: more stools, black and frothy, with a black sediment in them. No sleep at night; delirious.

Sixth day: stools black, oily, sticky and foul-smelling; he slept; more rational.

Seventh day: tongue dryish; thirsty; no sleep; delirious; urine thin, not of a good colour.

Eighth day: a few black stools, firm; he slept; rational; not very thirsty.

Ninth day: a shivering fit; acute fever; he sweated; coldness; delirious; his right eye squinted; tongue dryish; thirsty; sleepless.

Tenth day: much the same.

Eleventh day: fully rational; no fever; he slept; urine thin around the crisis.

He went two days without fever, then relapsed on the fourteenth day, and at once had no sleep that night and was wholly delirious.

Fifteenth day: urine turbid, like urine that has settled and then been stirred up again; acute fever; wholly delirious; no sleep; pain in the knees and shins. When a suppository was put in, black stools came from the bowels.

Sixteenth day: urine thin, with a cloudy matter floating in it; delirious.

Seventeenth day: early in the morning his hands and feet were cold, and he kept wrapping himself up. Acute fever; he sweated all over and felt relieved; more rational, though not free of fever; thirsty. He vomited a little yellow bile. From the bowels, solid stools, and soon after a few black, thin ones. Urine thin, not of a good colour.

Eighteenth day: not rational; in a stupor.

Nineteenth day: the same.

Twentieth day: he slept; fully rational; he sweated; no fever; no thirst; but the urine was thin.

Twenty-first day: slightly delirious; rather thirsty; pain in the abdomen below the ribs, and a throbbing about the navel that lasted to the end.

Twenty-fourth day: a sediment in the urine; fully rational.

Twenty-seventh day: pain in the right hip, but otherwise he was very comfortable; a sediment in the urine.

About the twenty-ninth day: pain in the right eye; urine thin.

Fortieth day: he passed stools full of phlegm, white and fairly frequent; he sweated heavily all over; a complete crisis.

Case 4. In Thasos, Philistes had had a pain in the head for a long time, and at last he went to bed half dazed. After heavy drinking he had constant fevers, and the pain grew worse. At night he first grew hot.

First day: he vomited bile, a little and yellow at first, and after that more of it, greenish. From the bowels, solid stools. A restless night.

Second day: deafness; acute fever; the right side of the abdomen below the ribs was drawn tight and pulled inward. Urine thin and clear, with a little matter floating in it like semen. About midday he went raving mad.

Third day: restless.

Fourth day: convulsions; everything grew worse.

Fifth day: early in the morning, died.

Case 5. Chaerion, who lay sick at the house of Demaenetus, was taken with fever after drinking. At once there was a painful heaviness of the head. He could not sleep. The bowels were upset, with thin stools, somewhat bilious.

Third day: acute fever; a trembling of the head, and most of all of the lower lip. After a while a shivering fit, convulsions, and he was wholly delirious. A restless night.

Fourth day: quiet; he slept a little; he talked at random.

Fifth day: in pain; everything grew worse; rambling; a restless night; no sleep.

Sixth day: the same.

Seventh day: a shivering fit; acute fever; he sweated all over; crisis.

All through, this patient's stools were bilious, few and unmixed. His urine was thin, not of a good colour, with a cloudy matter floating in it. About the eighth day he passed urine of better colour, with a little white sediment; he was rational and without fever. A lull.

Ninth day: he relapsed.

About the fourteenth day: acute fever.

Sixteenth day: he vomited yellow bile, fairly often.

Seventeenth day: a shivering fit; acute fever; he sweated; the fever left him in a crisis.

After the relapse and the crisis the urine was of a good colour, with a sediment. Nor was he delirious during the relapse.

Eighteenth day: a little hot; rather thirsty; urine thin, with a cloudy matter floating in it; slightly delirious.

Nineteenth day: no fever; pain in the neck; a sediment in the urine.

Twentieth day: a complete crisis.

Case 6. The daughter of Euryanax, a young unmarried girl, was taken with fever. She was not thirsty at any point, and would not take food. From the bowels, a few small stools. Urine thin, scanty, not of a good colour. When the fever began she had pain near the anus. On the sixth day she was without fever but did not sweat; crisis. The sore near the anus came to a little pus and burst at the time of the crisis. After the crisis, on the seventh day, she had a shivering fit, grew a little hot, and sweated. After that her hands and feet were always cold. About the tenth day, after the sweat that came, she was delirious, and then was soon rational again. They said she had eaten grapes. After a lull, on the twelfth day, she again rambled a great deal. The bowels were upset, with bilious stools, unmixed, few, thin and stinging, and she was often getting up to pass them. She died on the seventh day after she became delirious the second time.

When the illness began, this patient had a sore throat. It stayed red all through, and the uvula was drawn up. There were many fluxes (flows of fluid from one part of the body to another), small and sharp. Her cough was ripened, but she brought nothing up. The whole time she had no appetite for anything, and wanted nothing at all. She was not thirsty, and drank nothing worth mentioning. She was silent and spoke not a word. She was downcast, and had given up hope for herself. There was also some inherited tendency to consumption (a wasting disease).

Case 7. The woman with quinsy (a choking swelling of the throat) who lay at the house of Aristion, began with indistinct speech. Her tongue was red and became parched.

First day: she shivered and grew hot.

Third day: a shivering fit; acute fever; a reddish, hard swelling of the neck, spreading to the chest on both sides. Hands and feet cold and livid. The breathing high in the chest. Drink came back through the nose; she could not swallow. Stools and urine stopped.

Fourth day: everything grew worse.

Fifth day: died.

Case 8. The young man who lay sick by the Liars' Market was taken with fever after tiredness, hard work and running beyond what he was used to.

First day: the bowels upset, with many thin, bilious stools; urine thin and blackish; no sleep; thirsty.

Second day: everything grew worse; more stools, and worse ones. No sleep; his mind was disturbed; a slight sweat.

Third day: restless; thirsty; nauseated; much tossing about; great distress; delirious; hands and feet livid and cold; the abdomen below the ribs tense on both sides, though fairly soft.

Fourth day: no sleep; worse.

Seventh day: died, at about twenty years of age.

Case 9. The woman who lodged with Tisamenus was in bed with a painful attack of ileus (a blockage of the bowels). She vomited a great deal and could not keep her drink down. Pains in the region of the abdomen below the ribs, and pains lower down in the belly as well. Constant griping. She was not thirsty. She grew hot, but her hands and feet stayed cold to the end. Nauseated; sleepless. Urine scanty and thin. Stools raw, thin and few. Nothing could help her any longer. Died.

Case 10. A woman of the household of Pantimides was taken with fever on the first day after a miscarriage. Tongue dryish; thirsty; nauseated; sleepless. The bowels upset, with many thin, raw stools.

Second day: a shivering fit; acute fever; much from the bowels; no sleep.

Third day: the pains greater.

Fourth day: delirious.

Seventh day: died.

All through, the bowels were loose, with many thin, raw stools. Urine scanty and thin.

Case 11. Another woman, the wife of Hicetas, was taken with fever after a miscarriage at about five months. At the start she was in a stupor, then sleepless again; pain in the lower back; heaviness of the head.

Second day: the bowels upset, with a few thin stools, unmixed at first.

Third day: more stools, and worse; no sleep at all that night.

Fourth day: delirious; fears; low spirits. Her right eye squinted. A little cold sweat about the head; hands and feet cold.

Fifth day: everything grew worse. She talked a great deal at random, then was soon rational again. Not thirsty; sleepless. The bowels gave many stools, at the wrong times, to the end. Urine scanty, thin and blackish. Hands and feet cold and rather livid.

Sixth day: the same.

Seventh day: died.

Case 12. A woman who lay sick by the Liars' Market had just given birth for the first time, after a painful labour, to a boy, and was taken with fever. From the very start she was thirsty and nauseated, with a slight pain at the pit of the stomach. Tongue dryish. The bowels upset, with a few thin stools. No sleep.

Second day: a slight shivering fit; acute fever; a little cold sweat about the head.

Third day: in pain; from the bowels, many raw, thin stools.

Fourth day: a shivering fit; everything grew worse; sleepless.

Fifth day: in pain.

Sixth day: the same; from the bowels, much fluid.

Seventh day: a shivering fit; acute fever; thirst; much tossing about. Toward evening she sweated all over with a cold sweat; coldness; hands and feet cold, and she could no longer get warm. Toward night she had another shivering fit; her hands and feet would not warm up; no sleep; slightly delirious, then soon rational again.

Eighth day: about midday she grew warm again. Thirsty; in a stupor; nauseated; she vomited a little yellowish bile. A restless night; no sleep. She passed a great deal of urine all at once without knowing it.

Ninth day: everything eased; in a stupor. Toward evening a slight shivering fit; she vomited a little bile.

Tenth day: a shivering fit; the fever grew worse; no sleep at all. Early in the morning she passed a great deal of urine with no sediment; her hands and feet grew warm again.

Eleventh day: she vomited greenish bile. Before long a shivering fit, and her hands and feet were cold again. Toward evening, sweating, a shivering fit, much vomiting; a painful night.

Twelfth day: she vomited a great deal of black, foul-smelling matter; much hiccupping; a painful thirst.

Thirteenth day: she vomited a great deal of black, foul-smelling matter; a shivering fit. About midday she lost her voice.

Fourteenth day: blood from the nose; died.

All through, this patient's bowels were loose, and she was shivery. Age about seventeen.

The Constitution of the Year

2. The constitution of the year (its weather, and the diseases that went with it) was this. The year was southerly and rainy, with no wind the whole time. There had been droughts in the period before. Then, about the rising of Arcturus, in mid-September, there were heavy rains with south winds. The autumn was overcast and cloudy, with a great deal of rain. The winter was southerly, damp and mild after the winter solstice. Much later, close to the spring equinox, there were spells of winter weather again, and right at the equinox north winds with snow, though not for long. The spring was southerly again and windless, with heavy rains all through until the Dog Star rose, in late July. The summer was clear and hot, with great stifling heat. The Etesian winds (the steady north winds of summer) blew only a little, and in fits and starts. Then again, about the rising of Arcturus, there were heavy rains with north winds.

Since the year turned out southerly, wet and mild, people stayed healthy through the winter, apart from the consumptives, who will be described later.

3. Early in the spring, along with the cold snaps that came, there were many cases of erysipelas (a spreading red inflammation). In some it came from an obvious cause, in others not, and it was malignant and killed many. Many had sore throats; voices were damaged; there were burning fevers (fevers with intense heat and thirst) and cases of phrenitis (a fever with delirium); there were ulcers in the mouth, growths on the genitals, inflammation of the eyes, and carbuncles. Bowels were upset, and people had no appetite; some were thirsty, others not. The urine was disturbed, plentiful and bad. Patients lay long in a stupor, then were sleepless again. In many there was no crisis, or a crisis hard to make out. There was dropsy (a swelling with fluid) and many cases of consumption. These were the diseases that went round. There were sufferers from each of the kinds listed above, and many died. In each of them, things went as follows.

4. In many people the erysipelas came from an obvious cause, some chance injury, even a very small wound, and spread over the whole body. This happened most of all in people about sixty years old, and when the wound was on the head, if it was neglected even a little. Many, even while they were under treatment, developed great inflammations, and the erysipelas spread very fast in every direction. In most of them, deposits formed and turned to abscesses full of pus. Flesh, sinews and bones fell away in large pieces. The fluid that gathered was not like pus but some other kind of rotting, and the flow was large and of many kinds.

When any of this happened about the head, all the hair of the head fell out, and of the chin too. The bones were laid bare and fell away, and there were heavy fluxes. This happened with fever and without it. But these things were more frightening than dangerous, for when the disease came to pus, or to some other ripening of that kind, most of the patients recovered. But when the inflammation and the erysipelas went away without making any such deposit, many died.

It went the same way wherever else in the body the disease wandered: many lost the whole arm and forearm, the flesh coming away all round. When it went to the sides, the damage was either in front or behind. In some the whole thigh was laid bare, or the shin and the whole foot. But the most dangerous of all such cases were those in the region of the pubic bone and the genitals.

That was the course of the cases that came from sores and an obvious cause. But in many it came on in fevers, before a fever, or after a fever. In these too, whenever a deposit formed through suppuration, or the bowels were upset at the right time, or good urine was passed, the illness was resolved by these. But when none of these things happened, and the signs vanished without a trace, the result was fatal. By far the most cases of erysipelas came in the spring, though it went on through the summer and into the autumn.

5. Some patients had a great deal of trouble from growths in the throat, inflammations of the tongue, and abscesses by the teeth. In many, a damaged and muffled voice gave warning, first of all in those who were beginning consumption, but also in those with burning fever and with phrenitis.

6. The burning fevers and the phrenitis began early in the spring, after the cold snaps that came. Very many fell ill at that time, and their cases were acute and fatal. This was the constitution of the burning fevers that came: at the start, the patients were in a stupor, nauseated and shivery, with acute fever. They were not very thirsty, and not rambling. A little blood dripped from the nose. In most, the fever grew worse on the even days, and at those times came loss of memory, collapse and loss of voice. The hands and feet of these patients were always rather cold, and much colder at the times when the fever grew worse. They grew warm again slowly and not properly, and then became rational again and talked. Either a constant stupor held them, not like real sleep, or they lay awake in pain.

In most of these the bowels were upset, with raw, thin, plentiful stools. The urine was plentiful and thin, with nothing in it that pointed to a crisis or to anything good. Nor did any other sign of a crisis appear in patients in this state, for there was no helpful bleeding, nor any other of the usual deposits that bring a crisis. Each one died as it happened, mostly irregularly, around the crises. Some had lost their voices long before, and many were sweating.

These things happened in those who were going to die, and it was much the same with the cases of phrenitis. These patients were not thirsty at all, nor did any of them go raving mad, as happened in others; they died instead in a different way, sunk in a sluggish lethargy, with heavy heads.

7. There were other fevers too, which will be described later. Many had mouths full of ulcers and sores. There were many fluxes about the genitals, with sores, and growths outside and inside; and the swellings in the groin. There were watery inflammations of the eyes, lasting a long time and painful. There were growths on the eyelids, outside and inside, which ruined the sight of many; people call them "figs." Such growths sprouted on other sores as well, and often on the genitals. In the summer there were many carbuncles, and other sores called "rot." There were large pustules, and many people had large creeping sores.

8. Many people had many harmful troubles of the bowels. First, many had tenesmus (painful straining at stool). Most of these were young children (in fact all who had not yet reached puberty), and most of them died. There were many cases of lientery, where the food passes through undigested. There were cases of dysentery, though these too were not very painful. The stools were bilious, greasy, thin and watery. In many people the disease itself came down to this, both without fevers and with them. There was painful griping and malignant colic. Stools were passed, while much remained inside and held on. What was passed did not relieve the pains, and it hardly yielded to the remedies given; indeed purging made most of them worse. Of those in this state many died quickly, though some lasted longer. To put it in a word: everyone, whether the illness was long or acute, died chiefly of the bowel troubles. It was the bowels that carried them all off.

9. Loss of appetite came with all the illnesses described above, to a degree I have never met before. It was worst of all in these last patients, and also among the others, in those who were going to die. Some were thirsty, others not. Among the fever patients and the others, no one was unreasonably thirsty, so you could manage their drink as you liked.

10. A great deal of urine was passed, not in keeping with the drink given but far more than that. And the urine that was passed was very bad indeed: it had neither thickness, nor ripening, nor a good clearing. In most patients it signified wasting, upset bowels, pains and no crisis.

11. The patients with phrenitis and those with burning fever were the ones most in a stupor. But it came also with all the other most serious diseases that went with fever. All through, most patients either lay in a heavy stupor or slept only short, light sleeps.

12. Many other kinds of fever went round as well. There were tertian fevers, which come back every other day, and quartan fevers, which come back every third day (the Greeks counted both ends, so they called them the third-day and fourth-day fevers). There were night fevers, continuous fevers, long ones, irregular ones, fevers with nausea, and fevers that kept no pattern. All of these came with a great deal of upset, since most of these patients had upset bowels and were shivery. Sweats did not bring a crisis, and the urine was as I have described above. Most of these cases were long, since the deposits that came in them did not bring a crisis, as they did in others. In all the patients everything was hard to bring to a crisis, or came to no crisis, or dragged on, but most of all in these. A few of them reached a crisis about the eightieth day. In most the fever simply left off at random. A few of them died of dropsy without ever taking to bed. In many with the other diseases, too, swellings were a trouble, and most of all in the consumptives.

13. The greatest disease, the hardest and the one that killed the most, was consumption. Many began with it in the winter. Of these, many took to their beds, while some kept on their feet with it. Early in the spring most of those who had taken to bed died. Of the others, none lost the cough, but it eased in the summer. Toward autumn they all took to their beds, and many died. Most of them were ill a long time.

In most of these, the illness began suddenly to grow worse, in this way. They were often shivery. Many times there were continuous, high fevers. There were many sweats at the wrong times, cold to the end. There was great coldness, and they were hardly able to get warm again. The bowels stopped in various ways and then quickly grew loose again; and toward the end, in all of them, they grew violently loose. Everything about the lungs passed downward. There was a great deal of bad urine. There was a harmful wasting away.

The coughs went on to the end. They were frequent and brought up a great deal, ripened and moist, but without much pain. Even if there was pain, the clearing of the lungs went on very gently in all of them. The throat was not much irritated, and no salty humours troubled them at all. But sticky, white, moist, frothy matter came down from the head in quantity. By far the worst thing, in these and in the others, was the loss of appetite, as I described above. They took no pleasure in drink with their food either, but went on quite without thirst. There was a heaviness of the body. They were in a stupor. In most of them there was swelling, which turned into dropsy. They were shivery, and rambling near death.

14. The kind of person who got consumption had smooth skin, whitish, freckled with lentil-coloured spots, or reddish. Their eyes were bright. They were pale and puffy with phlegm (phlegm being the cold, wet humour). Their shoulder blades stood out like wings. The women were the same. People of a melancholic or rather full-blooded type (those in whom black bile or blood was strong) were attacked by the burning fevers, the phrenitis and the dysentery. Tenesmus attacked young people full of phlegm. The long diarrhoeas and the sharp, greasy stools attacked people full of bitter bile.

15. For all the patients described above, the spring was the hardest season, and killed the most. The summer was the easiest, and the fewest died. In the autumn, and at the time of the Pleiades, in early November, they began to die again, most of them on the fourth day. It seems to me only reasonable that the summer, when it came, was a help, since a winter that comes after summer resolves the summer diseases, and a summer that comes after winter drives out the winter diseases. And yet the summer that came was not steady in itself, for it turned suddenly hot, southerly and windless; but even so, because it brought a change from the rest of the constitution, it did good.

16. I think that a great part of the art of medicine lies in being able to study correctly what has been written down, for whoever understands these things and uses them will not, I believe, make great mistakes in the art. You must learn exactly the constitution of each season, and the disease as well: what is good that the constitution and the disease have in common, and what is bad that they have in common; which disease is long and fatal, and which is long but likely to end in recovery; which acute disease is fatal, and which acute disease is likely to end in recovery. From these you can study the order of the critical days (the days on which a crisis is to be expected), and from these you can easily foretell. Whoever knows these things can know whom he ought to treat, and when, and how.

Sixteen Patients

Case 1. In Thasos, the man from Paros who lay sick beyond the temple of Artemis was taken with an acute fever, continuous at first, of the burning kind. Thirst. At the start he was in a stupor, then sleepless again. The bowels were upset at the start; urine thin.

Sixth day: he passed oily urine; delirious.

Seventh day: everything grew worse; no sleep at all. The urine was the same, and his mind was disturbed. From the bowels, bilious, greasy stools.

Eighth day: a little blood dripped from the nose; he vomited a little greenish matter; he slept a little.

Ninth day: the same.

Tenth day: everything eased.

Eleventh day: he sweated all over; he went cold all over, but quickly grew warm again.

Fourteenth day: acute fever; stools bilious, thin, many; matter floating in the urine; delirious.

Seventeenth day: in pain, for there was no sleep, and the fever grew stronger.

Twentieth day: he sweated all over; no fever; stools bilious; no appetite; in a stupor.

Twenty-fourth day: he relapsed.

Thirty-fourth day: no fever; the bowels did not firm up; and he grew hot again.

Fortieth day: no fever; the bowels firmed up for a short time; no appetite. He had a little fever again, and irregularly all through: sometimes no fever, sometimes fever: whenever it let up and eased, it quickly came back again. He took little bits of food, and poor ones. His sleep was bad, and he was delirious at the relapses. At these times he passed urine that had thickness, but it was disturbed and bad. The bowels firmed up and then came loose again. Slight fevers, continuous. Stools thin and many.

Hundred and twentieth day: died.

In this patient the bowels, from the first day, were continually loose, with bilious, watery stools, many of them; or else they firmed up, with seething, unripe stools. The urine was bad to the end. He was in a stupor most of the time, or else lay sleepless in pain, and he had no appetite all along.

Case 2. In Thasos, the woman who lay sick by the Cold Water had given birth to a daughter, and the discharge that should cleanse the womb after a birth did not come. On the third day she was taken with an acute fever, with shivering. For a long time before the birth she had been feverish, confined to bed, and without appetite. After the shivering fit that came, the fevers were continuous, high and shivery.

Eighth day and the days after: she was very delirious, and then soon rational again. The bowels upset, with many thin, watery, bilious stools. Not thirsty.

Eleventh day: rational, but in a stupor. Urine plentiful, thin and black. Sleepless.

Twentieth day: she went a little cold all over, and quickly grew warm again. She talked a little at random. Sleepless. The bowels the same. Urine watery and plentiful.

Twenty-seventh day: no fever; the bowels firmed up. Not long after, a severe pain in the right hip, lasting a long time. Fevers came with it again. Urine watery.

Fortieth day: the hip eased, but there were continual coughs, moist and bringing up a great deal. The bowels firmed up. No appetite. Urine the same. The fevers never left her altogether, but grew worse irregularly, sometimes yes and sometimes no.

Sixtieth day: the coughs stopped, but with no sign, for there was no ripening of the sputum, nor any of the usual deposits. Her jaw on the right side was drawn down. In a stupor. She talked at random, and then was soon rational again. She turned from food in despair. The jaw relaxed again, and the bowels passed a little bile. The fever grew more acute, with shivering. On the days that followed she lost her voice, and then talked again.

Eightieth day: died.

All through, this patient's urine was black, thin and watery. Stupor came with it, and lack of appetite, low spirits, sleeplessness, fits of anger, restlessness. The state of her mind was melancholic.

Case 3. In Thasos, Pythion, who lay sick above the shrine of Heracles, was taken with a violent shivering fit and an acute fever, after hard work, tiredness and careless living. Tongue dryish; thirsty; bilious; no sleep. Urine blackish, with matter hanging high in it, which did not settle.

Second day: about midday, coldness of the hands and feet, more in the hands and head. He could not speak or make a sound. His breathing was short for a long time. Then he grew warm again. Thirst. A quiet night. A little sweat about the head.

Third day: a quiet day. But late, about sunset, he grew a little cold; nausea; upset bowels. A painful night; no sleep at all. From the bowels, a few small, firm stools.

Fourth day: early in the morning, quiet. But about midday everything grew worse: coldness; he could not speak or make a sound; worse. After a time he grew warm again. He passed black urine with matter floating in it. A quiet night; he slept.

Fifth day: he seemed relieved, but there was a heaviness in the bowels, with pain. Thirsty. A painful night.

Sixth day: early in the morning, quiet. Toward evening the pains were greater, and he grew worse. Late in the day a small enema moved the bowels well. He slept at night.

Seventh day: nauseated; rather restless. He passed oily urine. At night a great deal of upset; he talked at random; no sleep at all.

Eighth day: early in the morning he slept a little, but soon came coldness and loss of voice, with thin, weak breathing. Late in the day he grew warm again, and was delirious. Then, toward daybreak, he was a little relieved. Stools unmixed, few and bilious.

Ninth day: in a stupor; nauseated whenever he was woken. Not very thirsty. About sunset he was restless and talked at random. A bad night.

Tenth day: early in the morning he could not speak; great coldness; acute fever; heavy sweating; died.

In this patient the pains came on the even days.

Case 4. The man with phrenitis, on the first day he took to bed, vomited a great deal of thin, greenish matter. A high fever, with much shivering. A continuous sweat all over. A painful heaviness of the head and neck. Urine thin, with small scattered clumps floating in it, which did not settle. From the bowels he passed a great deal all at once. He was delirious, and slept not at all.

Second day: early in the morning he could not speak; acute fever; he sweated; no let-up; throbbing all over the body; at night, convulsions.

Third day: everything grew worse.

Fourth day: died.

Case 5. In Larisa, a bald man was suddenly taken with pain in the right thigh. Nothing that was given him did any good.

First day: acute fever, of the burning kind. He lay still, but the pains went on.

Second day: the pains in the thigh let up, but the fever grew stronger. He was rather restless, and could not sleep. Hands and feet cold. He passed a great quantity of urine, not good.

Third day: the pain in the thigh stopped. But his mind was deranged, with upset bowels and much tossing about.

Fourth day: about midday, died.

Case 6. In Abdera, Pericles was taken with an acute fever, continuous and painful. Great thirst; nausea; he could not keep his drink down. He had a rather enlarged spleen, and heaviness of the head.

First day: bleeding from the left nostril. Still, the fever grew much stronger. He passed a great deal of urine, turbid and white, which did not settle when it stood.

Second day: everything grew worse. Yet the urine, though thick, settled more, and the nausea eased. He slept.

Third day: the fever softened. Plenty of urine, ripened, with a great deal of sediment. A quiet night.

Fourth day: about midday he sweated heavily all over, a hot sweat; no fever; crisis; no relapse.

Case 7. In Abdera, the young unmarried girl who lay sick on the Sacred Way was taken with a fever of the burning kind. She was thirsty and sleepless. Her monthly period came then for the first time.

Sixth day: much nausea; flushing; shivery; restless and tossing.

Seventh day: the same. Urine thin, but of good colour. No trouble from the bowels.

Eighth day: deafness; acute fever; sleepless; nauseated; shivery; rational; urine the same.

Ninth day: the same, and so on the following days. The deafness went on.

Fourteenth day: her mind was disturbed; the fever eased.

Seventeenth day: a great deal of blood ran from the nose; the deafness eased a little.

The following days: nausea and deafness; she was rambling as well.

Twentieth day: pain in the feet. The deafness and the rambling left her. A little bleeding from the nose; she sweated; no fever.

Twenty-fourth day: the fever relapsed; deafness again; the pain in the feet stayed; her mind wandered.

Twenty-seventh day: she sweated heavily; no fever. The deafness left her. The pain in the feet remained, but in everything else the crisis was complete.

Case 8. In Abdera, Anaxion, who lay sick by the Thracian Gate, was taken with an acute fever. A continuous pain in the right side. He had a dry cough, and on the first days brought nothing up. Thirsty; sleepless. Urine of good colour, plentiful and thin.

Sixth day: rambling. Hot applications did not relieve him at all.

Seventh day: in pain. The fever grew stronger, the pains did not ease, the coughs troubled him, and his breathing was laboured.

Eighth day: I opened the vein at his elbow. Plenty of blood flowed, as it should. The pains eased, but the dry coughs went on.

Eleventh day: the fevers eased. A little sweat about the head. The coughs, and what came up from the lungs, were moister.

Seventeenth day: he began to spit up a little ripened sputum; he was relieved.

Twentieth day: he sweated; no fever. But after the crisis he was thirsty, and the clearing of the lungs was not good.

Twenty-seventh day: the fever relapsed. He coughed and brought up a great deal of ripened sputum. A heavy white sediment in the urine. He lost his thirst, and breathed easily.

Thirty-fourth day: he sweated all over; no fever; the crisis was complete in every way.

Case 9. In Abdera, Heropythus had a pain in the head while still on his feet, and not long after he took to his bed. He lived near the Upper Road. He was taken with an acute fever, of the burning kind. At the start he vomited a great deal of bile. Thirsty; very restless. Urine thin and black, sometimes with matter hanging high in it, sometimes not. A painful night. The fever grew worse at varying times, mostly with no order.

About the fourteenth day: deafness; the fevers grew stronger; urine the same.

Twentieth day: very delirious, and on the following days.

Fortieth day: a great deal of blood ran from the nose, and he was more rational. The deafness was still there, but less. The fevers eased. On the following days he bled from the nose often, a little at a time.

About the sixtieth day: the bleeding stopped. But there was a severe pain in the right hip, and the fevers grew stronger. Not long after, pains in all the lower parts. It happened either that the fevers were greater and the deafness heavy, or that these let up and eased, while the pains in the lower parts, about the hips, were greater.

By about the eightieth day: everything eased, though nothing left him entirely: the urine came down of good colour, with more sediment, and the rambling was less.

About the hundredth day: the bowels were upset, with a great deal of bile. A great deal of this kind passed for a good long time, and then again stools like dysentery, with pain. But everything else was easier. In short, the fevers left him and the deafness stopped.

Hundred and twentieth day: a complete crisis.

Case 10. In Abdera, Nicodemus was taken with fever after sex and drinking. At the start he was nauseated, with pain at the pit of the stomach. Thirsty; tongue parched; urine thin and black.

Second day: the fever grew worse; shivery; nauseated; no sleep at all. He vomited yellow bile. Urine the same. A quiet night; he slept.

Third day: everything let up; a respite. But about sunset he was rather restless again. A painful night.

Fourth day: a shivering fit; much fever; pains everywhere; urine thin, with matter floating in it. A quiet night again.

Fifth day: everything was still there, but there was a respite.

Sixth day: the same pains everywhere; matter floating in the urine; he was very delirious.

Seventh day: a respite.

Eighth day: everything else eased.

Tenth day and the days after: the pains were still there, but all of them less. In this patient the fever's worse turns and the pains came more on the even days, all through.

Twentieth day: he passed white urine. It had thickness, but did not settle when it stood. He sweated heavily and seemed to be free of fever. But toward evening he grew hot again, with pains in the same places, shivering and thirst. Slightly delirious.

Twenty-fourth day: he passed a great deal of white urine, with a heavy sediment. He sweated heavily all over, a hot sweat; the fever left him in a crisis.

Case 11. In Thasos, a woman of a gloomy temper, after a grief with an obvious cause, became sleepless while still on her feet. She had no appetite, and was thirsty and nauseated. She lived near the house of Pylades, on the flat ground.

First day: as night came on, fears, much talking, low spirits, a slight fever. Early in the morning, many convulsions. Whenever the many convulsions let up, she talked at random and used obscene language. Many pains, great and continuous.

Second day: the same; she slept not at all; the fever more acute.

Third day: the convulsions stopped. But there was stupor and heavy drowsiness, and then waking again. She kept jumping up and could not be held down. She talked a great deal at random. Acute fever. That same night she sweated heavily all over, a hot sweat. No fever; she slept; fully rational; crisis. About the third day her urine was black and thin, with matter floating in it, mostly round, which did not settle. Around the time of the crisis she had a heavy monthly period.

Case 12. In Larisa, a young unmarried girl was taken with an acute fever of the burning kind. Sleepless; thirsty; tongue sooty and dry. Urine of good colour, but thin.

Second day: in pain; no sleep.

Third day: a great many watery, yellow-green stools from the bowels; and on the following days she passed more of the same, without distress.

Fourth day: she passed a little thin urine, with matter hanging high in it, which did not settle. Delirious toward night.

Sixth day: a great deal of blood rushed from the nose. After shivering she sweated heavily all over, a hot sweat. No fever; crisis. During the fever, and when the crisis had already come, she had her monthly period then for the first time, for she was a young girl.

All through she was nauseated and shivery, with a flushed face and pain in the eyes. Her head was heavy. In this case there was no relapse, but a crisis. The pains came on the even days.

Case 13. In Abdera, Apollonius had been ailing for a long time while still on his feet. His inner organs were enlarged, and he had long had his usual pain about the liver. Then, at this time, he became jaundiced as well, and bloated with wind, with a whitish complexion. After he ate beef and drank, at the wrong time, he grew slightly hot at first and took to his bed. He drank a great deal of milk, boiled and raw, goat's milk and sheep's milk, and his whole regimen was bad. Great harm came of it: the fevers grew worse. The bowels passed nothing worth mentioning of what he took. His urine was thin and scanty. There was no sleep. He was badly bloated, very thirsty, and in a stupor. The right side of the abdomen below the ribs was swollen and painful. His hands and feet were rather cold all over. He talked a little at random, and forgot everything he said. He was not himself.

About the fourteenth day after he took to his bed, he had a shivering fit and grew hot. He raved: shouting, turmoil, much talking, and then calm again. It was then that the stupor came on. After this the bowels were upset, with many bilious stools, unmixed and raw. His urine was black, scanty and thin. He was very restless. The stools varied. They were either black, small and greenish, or greasy, raw and stinging. At times, too, he seemed to pass something like milk.

About the twenty-fourth day: he was comfortable. Everything else was the same, but he became a little rational. He remembered nothing since he had taken to his bed. But soon his mind wandered again, and everything rushed toward the worse.

About the thirtieth day: acute fever; many thin stools; rambling; hands and feet cold; he could not speak.

Thirty-fourth day: died.

All through, in this patient, from the time I knew of the case, the bowels were upset, the urine thin and black. He was in a stupor and sleepless, his hands and feet cold, and he was rambling to the end.

Case 14. In Cyzicus, a woman gave birth to twin daughters after a hard labour, and the cleansing after the birth was far from complete.

First day: an acute fever, with shivering; a painful heaviness of the head and neck. She was sleepless from the start, but silent, sullen, and would not do as she was told. Urine thin and colourless. Thirsty; nauseated most of the time. The bowels upset irregularly, and then firm again.

Sixth day: toward night she talked a great deal at random; no sleep at all.

About the eleventh day: she went raving mad, and then was rational again. Urine black and thin, and then, after a pause, oily. From the bowels, many thin, upset stools.

Fourteenth day: many convulsions; hands and feet cold; she was never rational again; the urine stopped.

Sixteenth day: she could not speak.

Seventeenth day: died.

Case 15. In Thasos, the wife of Delearces, who lay sick on the flat ground, was taken with an acute fever, with shivering, after a grief. From the start she kept wrapping herself up. All through, always silent, she fumbled about, plucked at things, scratched herself and picked at hairs. She wept, and then laughed again. She did not sleep. Even when the bowels were stimulated, nothing passed. She drank a little when they reminded her. Urine thin and scanty. The fever felt slight to the hand. Her hands and feet were cold.

Ninth day: she talked a great deal at random, and then came to herself again. Silent.

Fourteenth day: her breathing was slow and deep, at long intervals, and then short again.

Seventeenth day: when the bowels were stimulated, upset stools came, and then her very drink passed straight through; nothing held together. She noticed nothing at all. Her skin was stretched tight and dry.

Twentieth day: much talking, and then she came to herself again. She could not speak; her breathing was short.

Twenty-first day: died.

All through, this patient's breathing was slow and deep. She noticed nothing at all. She kept wrapping herself up. Either she talked a great deal or she was silent, to the end.

Case 16. In Meliboea, a young man took to his bed after being heated for a long time by drinking and much sex. He was shivery, nauseated, sleepless, and not thirsty.

First day: a great many solid stools passed from the bowels, with a great deal of fluid round them, and on the following days he passed a great deal of watery, yellow-green matter. Urine thin, scanty and colourless. His breathing was slow and deep, at long intervals. The abdomen below the ribs was tense, though fairly soft, and stretched out lengthwise on both sides. A throbbing at the pit of the stomach, continuous to the end. He passed oily urine.

Tenth day: he was delirious, but quietly, for he was orderly and silent. His skin was dry and stretched tight. Stools either many and thin, or bilious and greasy.

Fourteenth day: everything grew worse; delirious; he talked a great deal at random.

Twentieth day: he went raving mad; much tossing about; he passed no urine; he kept down small amounts of drink.

Twenty-fourth day: died.

Regimen in Acute Diseases

1. The men who wrote what are called the Cnidian Sentences, the handbook of the medical school at Cnidus, described correctly what the sick suffer in each disease, and how some of these diseases turned out. That much even a man who was not a doctor could write correctly, if he took care to ask each patient what he was suffering. But much of what the doctor ought to find out for himself beforehand, without the patient telling him, they left out, different things in different places, and some of it is vital for judging a case. And when it comes to judging how each case should be treated, I see many things differently from the way they set them out. Nor is that my only reason for not praising them. They also used very few remedies. Apart from the acute diseases, nearly all they prescribed was to give purging drugs, and to have the patient drink whey and milk at the right season. If these remedies were good and suited to the diseases they recommended them for, they would deserve all the more praise for being few and yet enough. But they are not. It is true that the men who later revised the book went into what should be given in each case in a somewhat more medical way. But the old writers wrote nothing worth mentioning about regimen, the management of the patient's food and drink and way of life, and that was a great thing to leave out. Some of them, it is true, knew how many forms each disease takes, and how many branches each one divides into. But when they tried to state exactly how many kinds of each disease there are, they went wrong. The kinds would be past counting if a patient's disease were to be marked off by every small way in which one case differs from another, and given a new name whenever it did not seem to be exactly the same disease.

2. For my part, I like to give my attention to the whole of the art of medicine. All the work that can be done well or correctly should be done well and correctly; what can be done quickly, quickly; what can be done cleanly, cleanly; what can be done without pain should be done with as little pain as possible. And everything else of this kind should be done better than one's neighbours in the trade do it. But the doctor I would praise most is the one who stands out above the rest in the acute diseases, which kill the greatest number of people. The acute diseases are the ones the ancients named pleurisy, pneumonia, phrenitis (a fever with delirium), lethargy (a fever with heavy drowsiness), burning fever (a fever with intense heat and thirst), and the other diseases related to these, whose fevers are, on the whole, continuous. When no plague is going about, and the diseases are scattered here and there and much alike, more people die of these than of all the others put together. Ordinary people hardly know the doctors who stand out in these diseases from the rest. They are readier to praise or blame remedies for being unusual. And here is strong proof that on no subject are laymen more at sea than on how these diseases should be treated: it is chiefly because of them that men who are not doctors pass for doctors. It is easy to learn the names of the things usually given to people who are ill in this way. If someone names strained barley water, and such-and-such a wine, and honey-water, ordinary people think that all doctors, good and bad alike, are saying the same thing. But that is not how it is. On these very matters some doctors differ enormously from others.

3. The things that seem to me most worth writing about are these: what doctors have not yet understood, though it is vital to know it; and what brings great benefit or great harm. Here is one thing they have not understood. Why is it that in the acute diseases some doctors spend their whole lives giving barley gruel unstrained, and think they are treating their patients correctly, while others make it their first concern that the patient should not swallow a single grain of barley (for they think it does great harm), and strain the liquid through a linen cloth before they give it? Others again will give neither thick gruel nor the strained liquid: some until the patient reaches the seventh day, others right through until the disease has come to a crisis, the decisive turn of the illness, toward recovery or death. Doctors are certainly not in the habit of even raising questions like these. And perhaps, even if they were raised, the answers would not be found. Yet the whole art has a bad name with ordinary people because of it, so bad that they do not think there is any such thing as medicine at all. In the acute diseases, at any rate, the practitioners differ so much from one another that what one gives in the belief that it is the best thing there is, the next already thinks bad. On that showing people might almost say that the art is like soothsaying. Soothsayers think the same bird a good omen if it is on the left and a bad one if it is on the right. In reading the omens of a sacrifice, too, you find the same sort of thing, one reading in one case and another in another, while some soothsayers hold the exact opposite. I say, then, that this is a very fine question to study, and closely bound up with most of the questions in the art, and with the most vital of them. It can do a great deal toward health for all who are sick, toward safety for those who are well, toward fitness for those in athletic training, and toward whatever end anyone wants.

4. Barley gruel, then, seems to me to have been rightly preferred, in these diseases, to every other food made from grain, and I praise those who preferred it. Its gluey substance is smooth, uniform and soothing. It is slippery, moderately moistening, and quenches thirst. It is easily washed out of the body, if that too is needed. It is not astringent, it causes no bad disturbance, and it does not swell up in the belly, because in the boiling it has already swollen as much as it naturally can. Those who use barley gruel in these diseases should therefore, one might say, never "leave the vessels empty," as doctors put it, by making the patient fast on a single day. They should use it and not break off, unless it is necessary to break off for a purging drug or an enema. Patients who are used to eating twice a day should be given it twice. Those used to eating once a day should be given it once at first. Then, by degrees, if the case allows, they too should be given it twice, if it seems they need more. At the start it is enough to give not much of it and not too thick: just enough for something to go in, for the sake of habit, and to keep the vessels from being left very empty. As for increasing the amount of gruel, if the disease is drier than one would expect, do not give more of it. Instead, before the gruel, have the patient drink either honey-water or wine, whichever is suitable; what is suitable in each kind of case will be stated. But if the mouth is moist, and what comes up from the lungs is as it should be, then, to put it in a word, increase the amount of gruel. Moistness that comes sooner and more plentifully signals a quick crisis, and moistness that comes later and less signals a slower one. That is what these signs generally mean taken by themselves. Many other important signs that tell the course in advance are left out here, and they will be described later. And the more the cleansing (the clearing of the chest by sputum), the more you should increase the gruel, until the crisis. Above all, keep it up until two days past the crisis, in patients whose crisis seems to come on the fifth, the seventh or the ninth day, so that you take care for the even day as well as for the odd. After that, gruel should be given in the morning, with a change to solid food in the evening. Measures like these generally suit those who use whole barley gruel from the very start. The pains in pleurisy stop at once of their own accord, as soon as the patients begin to cough up anything worth mentioning and to clear their chests. The cleansing is much more complete, fewer patients collect pus in the chest than under any other diet, and the crises are simpler, decide the illness better, and are less often followed by a relapse.

5. Barley gruel should be made from the best barley there is, and boiled as well as possible, especially if you do not intend to use the strained liquid alone. Besides its other virtues, its slipperiness keeps the barley that is swallowed from doing harm, since it does not stick anywhere or stay in the passage through the chest. The best-boiled gruel is the most slippery, the best for quenching thirst, the easiest to digest and the weakest, and all these qualities are needed. If, then, one does not supply everything this way of feeding with gruel needs if it is to be enough, it will do harm in many ways. Take patients who have food shut up inside them from a recent meal. Unless one empties the bowels before giving the gruel, it will make a pain that is already there worse, and if there is none, it will bring one on at once, and the breathing will become faster. That is bad, because it dries out the lungs and strains the abdomen below the ribs, the lower belly and the diaphragm. Suppose, moreover, the pain in the side is still continuous and does not give way to warm applications, and the sputum is not coming up but is turning sticky and unripened. (Ripening is the body working the disease matter into a state in which it can be got rid of.) If one does not relieve the pain, either by loosening the bowels or by opening a vein, whichever of these is suitable, but gives barley gruel to patients in this condition, they die quickly. For these reasons, and for others like them still more, those who are given whole barley gruel die on the seventh day or even sooner. Some lose their minds; others are choked by breathlessness, unable to breathe unless they sit upright, and by the rattle in the chest. The ancients used to think that people like this had been "struck," as if by some unseen blow, not least because when they died the side was found livid, rather like the mark of a blow. The cause of it is this: they die before the pain is relieved, because they quickly become short of breath. And because of the heavy, rapid breathing, as I have already said, the sputum turns sticky and unripe, and so cannot come up. Instead it is held fast in the airways of the lung and makes the rattle. And once things have come to this, it is generally fatal already. The sputum held fast keeps the breath from going in and forces it out quickly. In this way the two help each other toward the bad end: the sputum that is held fast makes the breathing rapid, and the rapid breathing makes the sputum stickier still and keeps it from slipping away. These things happen not only when barley gruel is given at the wrong time, but much more when the patient eats or drinks something else less suitable than barley gruel.

6. For the most part the measures to be taken are much the same for those who are given whole barley gruel and for those given only the strained liquid. But for those given neither, only drink, there are points on which they must be treated differently. In general this is what should be done. If the fever starts when the patient has just eaten and the bowels have not yet moved, whether with pain or without it, hold back the gruel until you think the food has gone down into the lower part of the gut. For drink, if there is some pain, use vinegar-and-honey (honey and water sharpened with vinegar), warm in winter and cold in summer. If there is great thirst, use honey-water, and water. Then, if there is pain, or any dangerous sign shows itself, give gruel neither in quantity nor thick, and only after the seventh day, if the patient is strong. If the older food has not passed down in a patient who has just eaten, give an enema if he is strong and in the prime of life. If he is weaker, use a suppository, unless the bowels pass it well of their own accord. Here is the right moment for giving gruel, to be watched for above all at the beginning and right through the illness. When the feet are cold, hold back the gruel, and above all keep the patient from drink as well. When the heat comes down into the feet, then give it. Count this right moment as a thing of great power in all diseases, not least in the acute ones, and most of all in those with the most fever and the most danger. Use first, by preference, the strained liquid, and then barley gruel, watching closely the signs set out above.

7. When there is pain in the side, whether at the beginning or later on, it is not out of place to try first to break up the pain with warm applications. The best warm application is hot water in a wineskin, or in a bladder, or in a bronze vessel, or in an earthenware one. But you should first put something soft against the side, for comfort. A large soft sponge, squeezed out of hot water and laid on, is good too. The warm application should be covered over on top, so that it will last longer and keep its heat, and also to keep the steam from reaching the patient's breath, unless that too is thought useful for something, as at times it is. Barley or bitter vetch can be used as well. Steep them in vinegar mixed with water, a little stronger than one would drink it, boil them up, sew them into small bags, and lay them on. Bran can be used in the same way. For a dry warm application, salt, or toasted millet in woollen bags, is the most suitable, since millet is light and soothing. A soft application like this relieves even the pains that shoot through to the collarbone. Bleeding, on the other hand, does not relieve pain so well, unless the pain shoots through to the collarbone. If the pain does not give way to the warm applications, do not go on warming for long, because that dries out the lung and makes pus form. But if the pain points toward the collarbone, or there is heaviness in the arm, or around the breast, or above the diaphragm, you should open the inner vein at the elbow. Do not hesitate to draw off a good deal of blood, until it runs much redder, or livid instead of clean and red; both happen. If the pain is below the diaphragm and does not point toward the collarbone, you should loosen the bowels, either with black hellebore or with peplion, a kind of spurge. With black hellebore, mix in wild carrot, or seseli, or cumin, or anise, or some other fragrant herb; with peplion, the juice of silphium, a pungent herb. Mixed together, these drugs work in a similar way. Black hellebore brings away better stools than peplion, and stools that do more to decide the disease, but peplion breaks up wind better than black hellebore. Both stop pain, and many other laxatives stop it too, but these are the best I know. The laxatives given in gruel help as well, so long as they are not too unpleasant through bitterness, or some other unpleasantness, or their quantity, or their colour, or some suspicion about them. When the patient has drunk the drug, give him barley gruel to sip straight after, not noticeably less than he was used to, since it stands to reason to give none while the purging is going on. When the purging has stopped, let him then take less gruel than he was used to. After that, let him go on always increasing it, if the pain has stopped and nothing else stands in the way. My rule is the same if strained barley water has to be used. I hold that in general it is better to begin the gruel at once than to fast first and begin it on the third day, or the fourth, or the fifth, or the sixth, or the seventh, at least if the disease has not already come to a crisis in that time. And the same preparations should be made beforehand in these cases too, as I have described.

8. This, then, is my view about the giving of gruel. And as for drink, whichever of those I am going to describe a patient is to drink, my rule is in general the same. I know that doctors do the very opposite of what they should. At the start of the illness they all want to dry their patients out like salted fish, for two or three days or even more, and only then to bring in gruel and drinks. And perhaps it seems reasonable to them that when a great change has taken place in the body, a very great change should be made in reply. A change is a good thing, and no small one. But it must be made correctly and steadily, and the bringing in of food after the change must be managed more carefully still. A change made wrongly harms most those who are given whole barley gruel. It harms those given only the strained liquid too, and those given only drink as well, but these least of all.

9. We should also learn lessons from the regimen of people who are still healthy, about what is good for them. If one way of eating or another plainly makes a great difference to the healthy, in other respects and above all when the way is changed, then surely it makes a great difference in disease as well, and the greatest of all in the most acute diseases. It is easy to learn, at any rate, that a poor diet of food and drink that always stays the same is on the whole safer for health than a sudden great change to something else. In those who eat twice a day and in those who eat once alike, sudden changes cause harm and weakness. Take people who have not learned to eat a midday meal. If they eat one, it at once makes them weak and heavy all over, feeble and sluggish. And if they eat their evening meal on top of it, they get sour belching. Some may even get diarrhoea, because the belly, which was used to drying out in between and not to being swollen with food twice and digesting it twice, has carried a load it was not used to. It helps such people to make up for the change. They should go to sleep after the meal, as if they were spending the night, and keep from being cold in winter and from being hot in summer. If a person cannot sleep, he should take a long, slow walk, wandering about and not standing still. He should eat no evening meal, or a little of something that will do no harm. And he should drink less, and that not watered down. Such a person would suffer even more if he ate three times a day until he was full, and still more if he ate more often than that. And yet there are many people who easily bear eating three large meals a day, if they have got used to it. Then again, people who have learned to eat twice a day, if they miss their midday meal, are weak and feeble, shrinking from any work, and sick at the pit of the stomach. Their insides seem to hang loose, their urine is hot and greenish, and their stool is scorched dry. In some the mouth tastes bitter, the eyes grow hollow, the temples throb and the hands and feet go cold. Most of those who have missed their midday meal cannot eat their evening one. And when they have eaten it, their belly feels heavy and they sleep much worse than if they had eaten at midday first. Since these things happen to healthy people because of a change, against habit, in half a day's diet, it seems profitable neither to add to the diet nor to take away from it. Take, then, the man who ate only once, against habit, and went a whole day with his vessels empty. If eating his usual evening meal made him feel heavy, then eating more than usual, because he was suffering and weak from missing his midday meal, would likely make him feel much heavier still. And if he had fasted for longer and then suddenly ate a meal, he would feel heavier yet. The man who has fasted against his habit should therefore make up for that day as follows. He should keep from cold, from heat and from hard work, since he would bear all these badly. He should make his evening meal much smaller than he is used to, and not of dry food, but of the moister kind. He should drink wine that is not watery, and not less than his food calls for. And the next day he should eat a small midday meal, so that he comes back by degrees to his habit. People whose upper parts are full of bitter bile bear such changes worst of all. Those whose upper parts are full of phlegm, the cold, wet humour, bear going without food, against habit, more easily on the whole, so that they would also bear eating only once a day, against habit, more easily. This too is sign enough that the greatest changes in what concerns our nature and our habits are what most cause disease. It will not do, then, to make the fasting severe or untimely, or to give food when the disease is at its height and inflamed, or to change the whole regimen suddenly, in one direction or the other.

10. One could say many other things related to these about the belly. People easily bear the foods they are used to, even if these are not naturally good, and the same goes for drink. And they bear badly the foods they are not used to, even if these are not bad, and the same goes for drink. Take the effects of eating a lot of meat against habit, or garlic, or silphium, either its juice or its stalk, or other things of this kind that have great powers of their own. One would be less surprised if things like these cause the belly more trouble than other foods. But consider how much distress and bulk, wind and griping, barley cake gives the belly when eaten against habit by someone not used to barley cake. Or what heaviness and swelling of the belly bread gives to someone used to barley cake. Or what thirst bread gives when eaten hot, and what sudden fullness, because it is drying and passes slowly. And how differently loaves of very fine flour and of coarse whole meal act, when eaten against habit. And barley cake that is dry against habit, or moist, or sticky. And what fresh barley meal does to those not used to it, and other barley meal to those used to the fresh. And drinking wine and drinking water, when one is suddenly changed for the other against habit. And watered wine, and unmixed wine (wine not cut with water, the way Greeks normally drank it), drunk suddenly against habit. The one makes the upper belly waterlogged and causes wind in the lower; the other causes throbbing of the vessels, heaviness of the head and thirst. And white wine and dark wine, if one changes from one to the other against habit, make many changes in the body, even if both are strong wines. It is all the less surprising, then, that sweet wine and strong wine do not have the same effect when one is suddenly changed for the other.

11. Something must be said here, though, on behalf of the opposite argument. In these healthy people the change of diet came about while the body itself was not changing, neither toward strength, so that food needed to be added, nor toward weakness, so that it needed to be taken away. In the sick, then, we must also take into account the strength and the character of each disease, the nature of the person, and the patient's habits of diet, of drink as well as of food. We should be much slower to add food than to take it away, since in many cases it pays to take food away altogether, where the patient is going to hold out until the disease has reached its height and ripened. In which cases this should be done will be written later. One could write many other things related to what has been said, but here is stronger evidence, for it is not merely related to the matter I have spent most of my argument on: it is the matter itself, and the most telling lesson of all. At the beginning of acute diseases some patients have eaten food on the very day the illness began, and some on the next day. Some have sipped whatever came to hand, and some have even sipped kykeon, the thick mixed drink of barley meal, wine and cheese. All of this is worse than being treated some other way, but mistakes made at this time do much less harm than if someone were to fast completely for the first two or three days, and then, on the fourth day, or the fifth, were to take a diet like this. It would be worse still if someone fasted beforehand through all these days, and then took this diet in the days that followed, before the disease had ripened, for that way plainly brings death to most patients, unless the disease is altogether mild. The mistakes made at the beginning are not past curing as these are, but much easier to put right. This, then, I think the greatest lesson of all: patients who are going to be given gruel of this kind or that a little later should not be robbed of gruel of this kind or that in the first days. Those who use barley gruel with the barley in it have no idea at all that they are harmed by it when they begin to sip it, if they have fasted first for two or three days or more; nor, again, do those who use the strained liquid realise that they are harmed by sipping it when they begin the gruel at the wrong time. This much, at least, they do guard against and know: that it does great harm if, before the disease has ripened, a patient used to the strained liquid sips barley gruel with the barley in it. All these things, then, are strong evidence that doctors do not lead their patients into a regimen correctly: in diseases where patients who are to be fed on gruel should not fast, they make them fast; in diseases where they should not change from fasting to gruel, there they make the change; and they usually make the change from fasting to gruel at exactly the moments when it often helps to go from gruel to something close to fasting, if the disease happens to be taking a turn for the worse just then. Sometimes, too, these patients draw raw, bilious matter down from the head and the region of the chest. Sleeplessness comes upon them, and because of it the disease does not ripen; they become deeply gloomy and bitter-tempered, and delirious; their eyes see flashing sparks, and their ears are full of ringing; their hands and feet are chilled; their urine is unripe; their sputum is thin and salty, a little of it, tinged with a strong, pure colour. There are sweats around the neck, and restless distress. The breath stumbles as it rises, rapid or very deep. The eyebrows take on a frightening look. There are bad fainting fits. They throw the bedclothes off their chests, their hands tremble, and sometimes the lower lip shakes. These signs, when they appear at the beginning, show that a violent delirium is coming, and the patients usually die. Those who escape do so with a deposit (the disease matter settling in one place, as a swelling, an abscess or a pain in a joint), or with a flow of blood from the nose, or by coughing up thick pus, and not otherwise. Nor do I see that doctors are experienced in things like these: they do not know how to tell apart the different kinds of weakness in disease: the weakness that comes from fasting, the weakness that comes from some other irritation, and the weakness that comes from pain and from the sharpness of the disease. Nor do they know all the conditions and forms of every kind that our nature and constitution give birth to in each of us. And yet knowing or not knowing things like these brings safety or death. It is the greater evil if a patient is weak because of pain and the sharpness of the disease, and someone gives him drink, or more gruel, or food, thinking he is weak from fasting. But it is also disgraceful not to recognise a patient who is weak from fasting, and to squeeze him hard with his diet. This mistake too carries some danger, but much less than the other. Yet it makes the doctor far more of a laughingstock than the other does. If another doctor, or even a layman, comes in, sees what has happened and gives the patient food and drink, the very things the first doctor forbade, he plainly seems to have done him good. It is mistakes like these, above all, that make people jeer at practitioners: the doctor or layman who came in seems to them to have raised a dead man to life. I will therefore also write down signs by which each of these conditions should be recognised.

12. Then there are the following facts, which are much like those about the belly. If the whole body rests for a long time, more than it is used to, it is not at once the stronger for it. And if, after idling for a longer time, it suddenly goes back to hard work, it will plainly come to some harm. The same holds for every single part of the body. The feet suffer something of this kind, and so do the other joints, if they are not used to working and suddenly, after a long time, go back to work. The teeth and the eyes suffer the same, and so does every part whatever. A bed that is softer than one is used to causes aches, and so does one that is harder than one is used to, and sleeping out of doors, when one is not used to it, stiffens the body. But one example will do for all these things. Suppose someone has a wound in the leg, neither very serious nor very slight, and he is neither a man whose wounds heal very easily nor one whose wounds heal very badly. If he lies down and is treated from the very first day, and never lifts his leg at all, it will be less likely to become inflamed, and he will be well much sooner than if he were treated while walking about. But if, on the fifth or sixth day, or later still, he got up and wanted to walk, he would suffer more then than if he had been walking about under treatment from the very beginning. And if he also suddenly exerted himself a great deal, he would suffer much more than if, treated the other way, he had exerted himself just as much on the same days. All these things, then, bear witness to one another from start to finish: every sudden change much greater than moderate, in one direction or the other, does harm. The harm to the belly, then, is many times greater if, after much fasting, it is suddenly given more than a moderate amount (and the rest of the body too, if it suddenly goes from much rest to more work, will be harmed far more) than if it changes from much eating to fasting. Even so, in these cases too the body must rest. And if someone suddenly falls from much hard work into leisure and idleness, he too must rest the belly from a large amount of food. Otherwise it will cause aching in the body and heaviness all over.

13. Most of my argument, then, has been about change, in one direction or the other. It is useful to know these things for every purpose. But it is useful above all for the subject I was discussing: that in acute diseases they change from fasting to gruel. The change must be made as I direct. And then gruel must not be used until the disease has ripened, or some other sign has appeared, such as will be described: in the gut, a sign of emptiness or of irritation, or one in the abdomen below the ribs. Severe sleeplessness makes drink and food harder to digest. And the change the other way, too much sleep, relaxes the body, and makes it sodden and the head heavy.

14. Sweet wine and strong wine, white and dark, honey-water, water and vinegar-and-honey: in the acute diseases, decide between them by the following signs. Sweet wine is less apt than strong wine to make the head heavy, and less apt to affect the mind. It is somewhat more laxative to the gut than the other, but it enlarges the spleen and the liver. It is not suitable for people prone to bitter bile either, for in people like that it causes thirst. It also causes wind in the upper gut, though it is not as hard on the lower gut as the wind would lead one to expect. And yet the wind from sweet wine does not pass through very easily, but lingers around the abdomen below the ribs. That is why this wine is on the whole less apt to make urine flow than white strong wine. But sweet wine is better than the other at bringing up sputum. In patients it makes thirsty, it brings up less than the other wine does; in those it does not make thirsty, more. As for white strong wine, most of its merits and faults, and the greatest of them, have already been given in the account of sweet wine. Since it passes more readily to the bladder than the other, and makes urine flow and breaks things up, it is always a great extra help in these diseases. Even if by nature it suits less well than the other in other respects, the clearing of the bladder that it brings about rescues the patient, if it is steered the right way. These are good lessons about the benefits and harms of wine, and my elders had not understood them. Pale yellow wine and dark, harsh wine can be used in these diseases in the following cases. If there is no heaviness of the head and the mind is not affected, if the sputum is not hindered from coming up and the urine is not held back, but the stools are rather watery and full of scrapings, like shreds, then that is the time to change from white wine to these, and to wines like them. Bear in mind too that wine will do less harm to all the upper parts, and to the bladder, if it is more watered, and will do more good to the gut if it is less watered.

15. Honey-water, drunk throughout the illness in the acute diseases, is on the whole less suitable for people prone to bitter bile and those with enlarged organs than for others. It causes no less thirst than sweet wine, at any rate. It softens the lung, brings up sputum moderately and soothes a cough. It has something soapy in it, which makes the sputum stickier than is right. Honey-water also makes urine flow well enough, unless something in the organs hinders it. It also tends to carry bilious matter down through the bowels, sometimes in good stools, sometimes in stools more deeply coloured than is right, and frothier. This happens more in bilious people and those with enlarged organs. Watered honey-water does more to bring up sputum and soften the lung. But frothy stools, and stools more deeply bilious than is right, and hotter, come more from unmixed honey-water than from watered. A stool like this does other great harm as well. It does not put out the burning heat in the abdomen below the ribs, but stirs it up. It causes restless distress and tossing of the limbs, and it rubs sores into the gut and the anus. Remedies for these things will be written down. If you use honey-water, without gruel, in place of any other drink in these diseases, you will succeed often, and you will not often fail. Who should be given it, and who should not, and why not, has been told in its main points. Honey-water has been condemned by people on the ground that it weakens those who drink it, and for this reason it is believed to bring death quickly. The belief arose from people who starve themselves to death, since some of them take honey-water as their only drink, as if it really had this effect. But that is not so at all. Drunk alone, it is much stronger than water, unless it upsets the bowels. And compared with thin, weak, odourless wine, it is stronger in one way and weaker in another. Unmixed wine and unmixed honey do differ greatly in strength. Yet, as to the strength of the two, if someone drank twice as much unmixed wine as he licked up honey, he would surely be much stronger from the honey, so long as it did not upset his bowels, although he would also pass many times more stool. But if he took barley gruel and drank honey-water after it, it would be much too filling and windy, and bad for the organs in the abdomen below the ribs. Drunk before the gruel, however, honey-water does not harm as it does when drunk after, and even does some good. Boiled honey-water is much finer to look at than raw. It becomes bright, thin, white and clear. But I have no virtue to add for it that sets it apart from the raw. It is not even more pleasant than raw, if the honey happens to be good. But it is weaker than raw, and makes less stool, and honey-water needs neither of those effects. It is best used boiled if the honey happens to be poor, impure, dark and not sweet-smelling, since boiling takes away most of its faults and its ugliness.

16. The drink called vinegar-and-honey you will find useful in many ways in these diseases. It brings up sputum and makes breathing easier. But it has its right moments, which are these. Very sour, it does nothing by halves with sputum that will not come up easily. If it brings up the matter that rattles in the throat, makes it slippery and, as it were, sweeps out the windpipe as with a feather, it soothes the lung, since it softens it. And if all this comes together, it will do great good. But there are times when very sour vinegar-and-honey does not manage to bring up the sputum, but makes it stickier and does harm. This happens most to those who are doomed in any case, and who cannot cough and bring up what is stuck fast. On this point, then, weigh the patient's strength, and give it if there is hope. And if you do give it, give it only just warm, a little at a time, and not in gulps. Vinegar-and-honey that is only slightly sour, on the other hand, moistens the mouth and throat. It brings up sputum and quenches thirst. It is kind to the abdomen below the ribs and to the organs there. And it prevents the harm that comes from honey, for the bilious quality in honey is held in check. It also breaks up wind and encourages urine. In the lower part of the gut, however, it makes things more watery and causes scrapings. Sometimes this turns out badly in the acute diseases, above all because it keeps wind from passing through and makes it run back. Besides that, it also weakens the patient and chills the hands and feet. This is the only harm I know of that comes from vinegar-and-honey which is worth writing down. A little of this drink is suitable to take at night, and on an empty stomach before the gruel. And when it is a long while after the gruel, nothing prevents its being drunk. But for those fed on drink alone, without gruel, it is not suitable to use it always and all the way through. That is chiefly because it scrapes and roughens the gut (more so when the gut is empty of stool, and the patient fasting), and secondly because it would also rob the honey-water of its strength. If, however, it does seem to help, through the whole disease, to use a great deal of this drink, pour in only a little vinegar, just enough to be tasted. In this way it does least harm to what it tends to harm, and helps what needs its help. To put it in a word, the sourness of vinegar suits people prone to bitter bile better than those prone to black bile. The bitter matters are lifted up by it, broken up and turned into phlegm, but the black ones ferment, rise and multiply, since vinegar brings up black bile. To women, vinegar is on the whole more hostile than to men, because it causes pain in the womb.

17. As for water as a drink in the acute diseases, I have no particular virtue to credit it with. It does not soothe the cough in cases of pneumonia, nor does it bring up sputum, but does less than the other drinks, if one uses water as the drink throughout. Between vinegar-and-honey and honey-water, though, a little water sipped helps to bring up sputum, because of the change in the quality of the drinks, for it makes a kind of flood tide. Otherwise it does not quench thirst, but makes it more bitter, because it is bilious to a bilious nature, and bad for the abdomen below the ribs. It is at its worst, its most bilious and its most weakening when it goes into an empty belly. It also enlarges the spleen and the liver, when they are fevered. It sloshes about and floats on top, because it passes slowly, being coldish and hard to digest. It neither loosens the bowels nor makes urine flow. It does some harm too because by its nature it makes no stool. And if it is ever drunk while the feet are cold, all these harms are many times worse, wherever it goes. When, in these diseases, you suspect severe heaviness of the head or an effect on the mind, the patient must keep from wine entirely. In such a case water should be used, or wine should be given very watered, pale yellow and with no smell at all, and after it is drunk, a little water should be drunk too. In this way the force of the wine is less likely to reach the head and the mind. In which of these cases water is chiefly to be used as a drink, and when in large amounts, where in moderate ones, where cold and where hot, has partly been said already; the rest will be told when the moments themselves come. In the same way, the other drinks, such as the barley drink, the drinks made from green herbs, and those made from raisins, from grape skins, from wheat, from safflower, from myrtle, from pomegranate and the rest: whenever there is a right moment to use one of them, it will be written about along with the disease itself, just like the other compound drugs.

18. A bath helps patients in many diseases, in some if given continually, in others not. Sometimes it must be used less, because people are not equipped for it: few households have the equipment ready, and attendants who know how to manage it. And if the patient is not bathed very well, he will be harmed in no small way. He needs a shelter free of smoke, and plenty of water, and the water poured over him often, and not too violently, unless that is needed. It is better that he should not be rubbed with a cleansing paste. But if he is, it should be warm, and many times more of it should be used than is usual, and plenty of water should be poured over him as well, and quickly poured over him again. The way to the tub must be short, and the tub easy to get into and out of. The bather must be quiet and silent and do nothing himself. Others must pour the water over him and rub him. Plenty of water, mixed to the right warmth, must be ready, and the pourings made quickly. Sponges should be used instead of the strigil, the curved scraper bathers use, and the body should be anointed while it is not too dry. The head, however, must be dried as thoroughly as possible, wiped with a sponge. The extremities must not be chilled, nor the head, nor the rest of the body. The patient should not be bathed just after taking gruel or a drink, nor should he take gruel or drink soon after the bath. Great weight should be given to the patient's own habits, if when healthy he is very fond of baths and used to bathing. Such people long for a bath more, and are helped by bathing and harmed by not bathing. On the whole a bath suits cases of pneumonia better than cases of burning fever. It soothes the pain in the side, the chest and the back. It ripens the sputum and brings it up. It eases the breathing and takes away weariness, for it softens the joints and the surface of the skin. It also makes urine flow, relieves heaviness of the head and moistens the nose. These are the good things a bath brings, and all of them are needed. But if there is any lack in the equipment, of one thing or more, there is a danger that the bath will not profit but rather harm, since each one of these things does great harm if the attendants do not prepare it as they should. The time is least right for bathing those patients whose bowels, in their illness, are looser than is right. Nor is it right for those whose bowels are more bound than is right and have not first moved. Nor should one bathe patients who are enfeebled, or who feel sick or are vomiting, or who are belching up bile, or who are bleeding from the nose, unless the bleeding is less than is right (you know what is right). If it is less than is right, bathe the patient, either the whole body, if that helps in other ways, or the head only. If, then, the equipment is suitable, and the patient will take the bath well, he should be bathed every day. And those who are fond of bathing you would not harm even if you bathed them twice a day. Baths are much more allowable for patients given whole barley gruel than for those given only the strained liquid, though they are sometimes allowable for these too. They are least allowable for those given only drink, though for some of these too they are allowable. Judge by what has been written above which patients a bath will help, in each kind of regimen, and which it will not. Those who badly need any of the good things a bath does, and who have the conditions a bath would help, should be bathed. Those who need none of these things, and who have any of the signs that make bathing harmful, should not be bathed.

On Injuries of the Head

1. People's heads are not at all alike, and the sutures of the head (the seams where the bones of the skull meet) are not formed the same way in everyone. Take a man who has a prominence at the front of his head. (A prominence is the rounded part of the bone that stands out beyond the rest.) In him the sutures run the way the letter T is written. He has the shorter line running crosswise in front of the prominence, and the other line running lengthwise through the middle of the head, all the way back to the neck.

A man who has the prominence at the back of his head has sutures formed the opposite way to the first. The shorter line runs crosswise in front of that prominence, and the longer runs lengthwise through the middle of the head, all the way forward to the forehead.

A man who has a prominence at both ends of the head, front and back, has sutures formed like the letter H. The long lines of the letter run crosswise, one in front of each prominence, and the short line runs lengthwise through the middle of the head, ending at each of the long lines.

A man who has no prominence at either end has the sutures of his head formed like the letter X. One line runs crosswise and reaches down to the temple. The other runs lengthwise through the middle of the head.

The bone along the middle of the head is double. Its hardest and densest parts are the topmost layer, where the smooth surface of the bone lies under the flesh, and the lowest layer, next to the membrane that covers the brain, where the bone's smooth inner surface is. Moving inward from the topmost and from the lowest layer, away from the hardest and densest parts, the bone grows steadily softer, less dense and more hollow, until you reach the diploe, the spongy layer in the middle. The diploe is the most hollow and the softest part, and the most full of holes. In fact the whole bone of the head, apart from a very little of its topmost and lowest layers, is like a sponge. Inside, the bone holds many soft, moist bits like little pieces of flesh, and if you rubbed them between your fingers, blood would come out of them. There are also small vessels in the bone, quite fine and hollow, full of blood. That is how things stand with hardness, softness and hollowness.

2. Now for thickness and thinness. Of the whole head, the bone is thinnest and weakest at the bregma, the top of the head toward the front. In that part of the head, too, the bone has the least flesh over it, and the thinnest, and the largest part of the brain lies underneath it. Because this is so, the bone there is more likely to be bruised, to crack and to be driven in than anywhere else in the head. That holds when the wounds and the weapons are of the same size, and even when they are smaller, and when the man is hurt to the same degree, or even less. Wounds there are deadlier, harder to treat, and harder to survive than anywhere else in the head. And when the wounds are equal, or even smaller, and the man is hurt to the same degree or less, a man who would die of his wound in any event dies sooner with his wound in that part of the head than anywhere else. It is at the bregma that the brain feels soonest and most strongly any damage done to the flesh and to the bone. There the brain lies under the thinnest bone and the least flesh, and the largest part of the brain lies under the bregma.

Of the other parts, the weakest is the region of the temples. That is where the lower jaw joins the skull, and in the temple there is movement up and down, as at a joint. The hearing is close by, too, and a vessel, wide and important, runs through the temple.

The whole bone of the head behind the crown and the ears is stronger than all the bone in front, and this bone has more flesh over it, and deeper. Because this is so, the bone in that part of the head is less likely to crack and to be driven in. That holds when the wounds and the weapons are of the same size and kind, and even when they are larger, and when the man is hurt to the same degree, or even more. And if a man is going to die of his wound in any event, he will take longer to die when his wound is at the back of the head. Pus takes longer to form in the bone there and to work its way down through it to the brain, because the bone is thick. There is also less brain under that part of the head. As a rule, then, more of those wounded at the back of the head escape death than of those wounded at the front. And a man who is going to die of his wound in any event lives longer in winter than in summer, whatever part of the head his wound is in.

3. Now the hedra. A hedra (the word means "seat") is the mark a weapon leaves where it lodged in the bone. Hedras made by sharp, lighter weapons may occur in the bone on their own, with no crack, no bruise and no driving in, and they occur just as often at the front of the head as at the back. By rights these do not kill, and if death does follow, it is not from them.

A suture that shows in a wound, once the bone is laid bare, is the weakest place to stand up to an injury and a weapon, wherever on the head the wound is, if the weapon happens to lodge in the suture itself. This is most of all the case when the wound is at the bregma, the weakest part of the head, and the sutures happen to lie around the wound, and the weapon has struck the sutures themselves.

4. The bone of the head is injured in the following ways, and each way has several forms of fracture in the wound.

The bone cracks when it is wounded. And when it cracks, bruising must follow in the bone around the crack, since whatever weapon cracks the bone also bruises the bone, more or less, both where it makes the crack and in the bone around the crack. That is the first way.

Cracks take every form. Some are fine, so very fine that some of them cannot be seen, either right after the injury or during the days when it would be of most use to the patient to see them. Other cracks are thicker and wider, and some are very wide. Some run a longer distance, some a shorter. Some are straighter, and some quite straight; others are more curved, and some very curved. And some run deeper, down through the whole bone, while others are less deep and do not go through the whole bone.

5. The bone might be bruised while staying in its natural place, with no crack at all added to the bruise in the bone. That is the second way.

The bruise takes several forms. The bone can be bruised more or less. It can be bruised deeper, through the whole bone, or less deep, not through the whole bone. And the bruise can cover more or less length and breadth. But none of these forms can be recognised by looking: you cannot see what form the bruise has, or how large it is. Even whether the bone has been bruised or not cannot be seen plainly with the eyes right after the injury, though it has been bruised and the damage done, just as some cracks that lie at a distance from the wound cannot be seen either.

6. When the bone is cracked, it may be driven in, out of its natural place, with cracks. It could not be driven in otherwise, because the piece that is driven in is broken off and fractured, and driven in away from the rest of the bone, which stays in its natural place. And so a crack would go along with the driving in. That is the third way: a depression, a piece of bone driven inward below the level of the rest.

The bone is driven in in many forms. It can cover more of the bone or less. And it can go more and deeper down, or less and closer to the surface.

7. When a weapon makes a hedra in the bone, a crack might be added to the hedra. And if a crack is added, bruising must be added too, more or less, both where the hedra and the crack are and in the bone around the hedra and the crack. That is the fourth way.

There might also be a hedra with bruising of the bone around it, but with no crack added to the hedra and the bruise the weapon made. A weapon also makes a hedra in the bone on its own. It is called a hedra when the bone stays in its natural place, but the weapon, lodging in the bone, makes plain where it lodged.

In each way there are several forms. As for the bruise and the crack, whether both are added to the hedra or only a bruise, I have already said that the bruise and the crack both take many forms. The hedra itself, on its own, may be longer or shorter, more curved or straighter, or round. There are many other forms of this way too, according to the shape of the weapon. Hedras may also go deeper down, more or less, and be narrower, or wider, or very wide.

Where the bone has been cut, the cut is a hedra, whatever its length and breadth in the bone, so long as the rest of the bone around the cut stays in its natural place and is not driven in along with the cut, out of its natural place. If it were, it would be a depression and no longer a hedra.

8. The bone is injured in another part of the head from the place where the man has his wound and where the bone has been laid bare of flesh. That is the fifth way. And when this misfortune happens, there is nothing you can do to help. If the man has suffered this damage, there is no way of testing him to know whether he has suffered it, or in what part of the head.

9. Of these ways of fracture, the following call for trephining (sawing a disc out of the skull): the bruise that cannot be seen, and also the one that happens to become visible; and the crack that cannot be seen, and also the one that is visible. And when a weapon has made a hedra in the bone, and a crack and a bruise are added to the hedra, or even a bruise alone with no crack, this case too calls for trephining.

A bone driven in out of its natural place needs trephining in few cases out of many. And the bones most driven in and most broken are the ones that least need trephining. Nor does a hedra on its own, with no crack and no bruise, need trephining. Nor does a cut, if it is large and wide, need it either, since a cut and a hedra are the same thing.

10. First you must examine the wounded man to see where on the head the wound is, whether in the stronger parts or the weaker. Look carefully at the hair around the wound, to see whether the weapon has cut through it and the hair has gone into the wound. If so, say that the bone is probably laid bare of flesh and has some damage from the weapon. You should say these things after looking from a distance, without touching the man.

Then, touching him, try to learn for certain whether the bone is laid bare of flesh or not. If the bare bone can be seen plainly with the eyes, that settles it. If not, examine it with the probe. And if you find the bone laid bare of flesh and not sound after the wound, you must first make a diagnosis of what is in the bone, seeing how great the damage is and what treatment it needs.

You must also ask the wounded man how he came by the injury, and in what way. And if it cannot be seen plainly whether the bone has any damage or not, you must ask all the more, provided the bone is laid bare, how the wound happened, and in what way. There are bruises and cracks that do not show in the bone and yet are there. Try first to recognise from the wounded man's answers whether the bone has suffered any of these or not, and then test it by reasoning and by action, but not by probing. Probing does not reveal whether the bone has suffered any of these injuries and has something in it, or has not. What probing does reveal is a hedra from a weapon, a bone driven in out of its natural place, and a bone badly cracked, and these you can also recognise by looking with your eyes.

11. The bone suffers cracks, both those that cannot be seen and those that can, and bruises that cannot be seen, and is driven in out of its natural place, chiefly in these cases. One is when one man is wounded by another on purpose. Another is when the throw or the blow comes from higher ground rather than from the same level, whichever of the two it is, and whether the man meant to wound or not. Another is when the striker grips his weapon firmly in his hand, whether he throws or strikes. And another is when a stronger man wounds a weaker.

Among those hurt by a fall, whether near the bone or in the bone itself, the man who falls from a great height onto something very hard and blunt is in danger of having the bone cracked and bruised and driven in out of its natural place. The man who falls from more level ground onto something softer suffers these things less in the bone, or may not suffer them at all.

Among the objects that fall on the head and wound it, near the bone or in the bone itself, the one that falls from the greatest height, and least from the same level, and is at once the hardest, bluntest and heaviest, and least light, least sharp and least soft: that is the one that would crack the bone and bruise it. And the danger that the bone will suffer these things is greatest when, along with all this, the wound is struck straight on, and the bone is square to the weapon. That holds whether he is struck by a hand or by a throw, or something falls on him, or he is hurt by falling down himself, in whatever way he is wounded, with the bone square to the weapon. Weapons that glance off the bone at a slant are less likely to crack, bruise or drive in the bone, even if the bone is laid bare of flesh. In fact, in some wounds made this way, the bone is not even laid bare of flesh.

Of weapons, the ones most likely to crack the bone, both with visible cracks and with ones that cannot be seen, and to bruise it and drive it in out of its natural place, are the round ones, rounded all over and smooth-edged, blunt, heavy and hard. These bruise the flesh, mash it to a pulp and pound it. The wounds such weapons make, whether at a slant or all around, are undercut, and they are more inclined to fill with pus, stay moist and take longer to clean, because the flesh that has been bruised and pounded must turn to pus and melt away.

Long weapons, which are mostly thin, sharp and light, slice through the flesh rather than bruise it, and the bone in the same way. Such a weapon makes a hedra and cuts the bone (a cut and a hedra are the same thing), but weapons like this do not much bruise the bone, or crack it, or drive it in out of its natural place.

Besides using your own eyes on whatever you can see in the bone, then, you must also ask about all these things, since they are signs of whether the wound is more or less serious. Ask too whether the wounded man was stunned, whether darkness spread over his eyes, whether he was dizzy, and whether he fell down.

12. When the weapon happens to have laid the bone bare of flesh, and the wound happens to lie right on the sutures, it becomes hard to make out even the weapon's hedra, which shows plainly enough in the rest of the bone, whether it is there in the bone or not, if the hedra happens to lie in the sutures themselves. The suture, being rougher than the rest of the bone, hides it, and you cannot clearly tell which part is suture and which is the weapon's hedra, unless the hedra is very large.

A break usually goes along with a hedra that lies in the sutures, and the break itself is harder to make out when the bone has cracked, for this reason: when the bone does break, the break usually runs along the suture itself. The bone there is ready to break and to gape apart, because the bone is weak by nature at that place and loose in texture, and because the suture is ready to break and gape. But the rest of the bone around the suture stays unbroken, since it is stronger than the suture. And the break that runs along the suture is also a gaping of the suture, and it is not easy to make out, whether it breaks and gapes because a weapon made a hedra in the suture, or because the bone was bruised at the sutures and so broke and gaped. Harder still to make out is the crack that comes from a bruise. These sutures deceive the doctor's judgment and his eyes: they look like cracks, and they are rougher than the rest of the bone, unless the bone has been cut deep and gapes. (A cut and a hedra are the same thing.)

If the wound is at the sutures, then, and the weapon struck at the bone and lodged in the bone, you must pay close attention and find out what the bone has suffered. With weapons of the same size and kind, and even much smaller, and when he is hurt to the same degree, and even much less, the man who took the weapon in the sutures has come by far greater damage to the bone than the man who did not. Most of these cases need trephining. But you must not trephine the sutures themselves. Move away into the bone nearby and make your trephining there, if you trephine.

13. On the treatment of wounds in the head, and how to test the bone for injuries that cannot be seen, this is my view.

A wound in the head must not be moistened with anything, not even wine, or as little as possible. It must not be poulticed, or treated by packing it with lint, or bandaged, unless the wound is on the forehead, where there is no hair, or near the eyebrow and the eye. Wounds there need poulticing and bandaging more than anywhere else on the head, because the rest of the head surrounds the whole forehead, and from the surrounding parts the wounds, and whatever part the wounds are in, become inflamed and swell up, because blood flows into them. But even wounds on the forehead must not be poulticed and bandaged the whole time. Once the inflammation stops and the swelling settles, stop poulticing and bandaging.

On the rest of the head, a wound must not be packed with lint, poulticed or bandaged, unless it also needs cutting. You must cut into wounds of the head, and of the forehead too, where the bone is laid bare of flesh and seems to have some damage from the weapon, but the wounds are not large enough, in length and breadth, for you to look at the bone. You need to see whether the weapon has done the bone some harm, and what harm it has done; how far the flesh is bruised and the bone damaged; or again, whether the bone is undamaged by the weapon and has suffered no harm; and you need room for the treatment, whatever the wound, the flesh and the injury to the bone require. Wounds like these need cutting.

If the bone is laid bare of flesh, and the wound is undercut a long way to one side, cut open the hollow where the drug, whatever you may use, cannot easily reach. Wounds that are round and much undercut, and the like, should be cut open by slitting the circle in two, lengthwise along the line of the body, so as to make the wound long.

When you cut into the head, the other parts of the head are safe to cut. But the temple, and the area above the temple along the vessel that runs through the temple: that place you must not cut, because a convulsion seizes the man who is cut there. If he is cut on the left of the temple, the convulsion seizes his right side. If he is cut on the right of the temple, the convulsion seizes his left side.

14. When you cut into a wound in the head, then, because the bones are laid bare of flesh, wanting to know whether the bone has some damage from the weapon or not, you must make the cut as large as seems sufficient. In cutting, you must lift the flesh back from the bone, where it grows onto the membrane over the bone and onto the bone. Then pack the whole wound with lint, which will leave the wound as wide open as possible the next day, with the least pain. With the lint, use a poultice for as long as you use the lint: knead fine barley meal into a paste with vinegar, or boil it and make it as sticky as you can.

On the next day, when you take out the lint, look at the bone to see what it has suffered. The injury in the bone, and what kind it is, may not be plain to you, and you may not be able to tell whether the bone has some damage in it or not, while the weapon seems to have reached the bone and harmed it. Then you must scrape with the scraper, downward into the bone and along the length of the body, as the man is built, and then across the bone, so as to see the cracks that cannot be seen and the bruising that cannot be seen, the kind that is not driven in out of the natural place of the rest of the bone of the head. Scraping shows up the damage very well, if these injuries in the bone are not plain to see in some other way.

And if you see a weapon's hedra in the bone, you must scrape both the hedra itself and the bone around it, in case a crack and a bruise, or a bruise alone, has been added to the hedra and goes unnoticed because it cannot be seen.

When you have scraped the bone with the scraper, if the injury to the bone seems to call for trephining, you must trephine. You must not let three days go by without trephining. Trephine within those three days, especially in the hot season, if you have had the treatment from the start.

You may suspect that the bone is cracked or bruised, or both. You judge that the wound is a serious one from what the wounded man tells you: that the man who wounded him was the stronger, if one man was wounded by another; that the weapon he was wounded with was one of the dangerous kind; and then that the man was dizzy, darkness came over his eyes, he was stunned and he fell down. When this is how things are, and you cannot tell whether the bone is cracked or bruised, or both, and cannot see anything at all, then do this. Pour onto the bone the darkest of the black ointments, the kind that melts, and fill the wound with the melted black ointment. Lay a strip of linen over it, soaked in oil, then poultice it with the barley paste and bandage it. On the next day, take off the bandage, clean out the wound, and scrape.

If the bone is not sound, but cracked and bruised, the rest of the bone will come up white as it is scraped. But the crack and the bruise will have soaked up the ointment, black as it is, once it melted, and they will stand out black against the rest of the bone, which is white. Then you must scrape this crack that shows black again, downward. If by scraping you remove the crack and make it vanish, then there has been a bruise in the bone, greater or less, which broke the bone around it and made the crack that the scraper took away. That is less to be feared, and less trouble would come of it, now the crack has vanished. But if the crack goes deep and will not come out with scraping, an accident like this calls for trephining. Once you have trephined, treat the rest of the wound.

15. You must take care that the bone suffers no harm from the flesh, if the flesh is badly treated. A bone that has been trephined, or laid bare in some other way, whether it is sound or has some damage from the weapon but seems sound, is in greater danger of festering. It may do so even if it would not have otherwise, if the flesh around the bone is badly treated, becomes inflamed and is squeezed tight. The flesh then grows feverish and full of great inflammation. And the bone takes into itself, from the flesh around it, heat and inflammation, irritation and throbbing, and all the troubles the flesh has in it. That is how the bone comes to fester.

It is also bad for the flesh in the wound to be moist and sodden, and to take a long time to clean. Rather, you must bring the wound to suppurate (to fill with pus) as soon as possible. That way the parts around the wound will be least inflamed, and the wound will be clean soonest, since the flesh that the weapon cut and bruised must turn to pus and melt away. Once the wound has been cleaned, it must be kept drier. That way it would heal soonest, with dry flesh growing in it and not moist, and the wound would not overgrow with excess flesh.

The same reasoning holds for the membrane that covers the brain. If you trephine the bone at once and take it off, laying the membrane bare, you must make it clean and dry as soon as possible, so that it does not stay moist for a long time and become sodden and swell up. If that happens, there is a danger that it will rot.

16. When a wound has been made in the head, a piece of bone that is going to separate from the rest of the bone, because there is a weapon's hedra in the bone or because the bone has been laid bare over a large area some other way, generally separates by becoming bloodless. The blood dries up out of the bone, both with time and with most drugs. The piece would separate fastest if you cleaned the wound as soon as possible and then kept drying both the wound and the bone, whether the piece is larger or smaller. The piece that dries out fastest and turns hard like a potsherd is the one most readily let go by the rest of the bone, which still has blood in it and is alive. Having become bloodless and dry, it very readily stands away from the part that has blood and is alive.

17. Bones that are driven in out of their natural place, being broken through or cut very wide, are less dangerous, provided the membrane is sound. And those driven in with more cracks, and wider ones, are less dangerous still, and easier to remove. You must not trephine any of these, or take the risk of trying to remove the bones, until they rise of their own accord, once the swelling has first gone down. They rise as flesh grows in underneath them. It grows in from the diploe of the bone and from the sound bone, if only the upper layer dies. The flesh would grow in underneath and sprout fastest, and the bones rise fastest, if you brought the wound to suppurate as soon as possible and made it clean. And even if both layers are driven in through the whole bone onto the membrane, the upper layer of the bone and the lower, the wound will heal fastest if you treat it the same way, and the bones driven in will rise fastest.

18. In young children the bones are thinner and softer, because they have more blood in them, and are hollow and full of holes, and neither dense nor solid. With weapons of the same size and even weaker, and when he is hurt to the same degree or less, the bone of the younger child festers more, and faster, than that of the older child, and in less time. And in cases where the child would die of the wound in any event, the younger dies sooner than the older.

But if the bone is laid bare of flesh, you must pay close attention and try to make out what cannot be seen with the eyes. Find out whether the bone is cracked and bruised, or only bruised. And if there is a weapon's hedra, find out whether a bruise goes with it, or a crack, or both. If the bone has suffered any of these, let out some of the blood by boring into the bone with a small drill, taking care to go only a little way, because the bone is thinner and closer to the surface in the young than in older people.

19. When a man is going to die of wounds in the head, and cannot be made well or saved, you must recognise from the following signs that he is going to die, and foretell what is to come. These are the things he suffers.

Suppose a doctor fails to notice that the bone is fractured, or cracked, or bruised, or fractured in some other way, and so makes a mistake. He neither scrapes nor trephines it, though it needs it, but leaves it alone as if the bone were sound. Then fever will usually seize the patient before the fourteenth day in winter. In summer the fever seizes him after the seventh day.

And when this happens, the wound loses its colour, and a little thin watery fluid runs from it. The inflammation in it dies away, and it turns sticky and looks like salted fish, reddish-yellow and a little livid. The bone then begins to die. It was white, and it turns dusky, and at last it becomes pale yellow or dead white. And when it is already festering, blisters form on the tongue, and he dies out of his mind. In most cases, too, a convulsion seizes the opposite side of the body. If the man has the wound on the left of his head, the convulsion seizes the right side of his body. If he has the wound on the right of his head, the convulsion seizes the left side of his body. Some also have a stroke. And so they die before seven days in summer, or fourteen in winter. These signs mean the same whether the wound is older or more recent.

But if you notice the fever seizing him, and any of the other signs added to it, you must not delay. Trephine the bone down to the membrane, or scrape it away with the scraper (it is then easy to trephine and easy to scrape), and then treat the rest as seems best, watching what happens.

20. When a man has a wound in the head, whether it has been trephined or not, and the bone is laid bare, a swelling may come on, red and like erysipelas (a spreading red inflammation), in the face and in both eyes, or in one. If someone touches the swelling, it is painful, and fever and shivering seize him. Yet the wound itself looks well, as far as the flesh goes and as far as the bone goes, and the parts around the wound are in good condition, apart from the swelling in the face. And the swelling cannot be blamed on any other mistake in the rest of his regimen. Then you must purge this man's lower bowels with a drug that draws off bile. When he has been purged this way, the fever leaves him, the swelling settles, and he gets well. You must give the drug with an eye to the man's power, according to how strong he is.

21. As for trephining, when it is necessary to trephine a man, know the following. If you have had the treatment from the start and you trephine, you must not saw the bone right through to the membrane at once. It does no good for the membrane to be bare of bone for a long time, suffering harm; in the end it may well become sodden. There is another danger, too: if you saw the bone right through to the membrane at once and take it off, you may wound the membrane with the trephine (the circular saw) as you work. Instead, when there is only a very little left to saw through and the bone already moves, you must stop sawing and let the bone come away of its own accord. No harm could come to a bone not sawn all the way through, where part of the sawing is left. What is left is thin by now. Then treat the rest as seems to suit the wound.

While you saw, you must take the trephine out often, because of the heat in the bone, and dip it in cold water. The trephine grows hot as it goes round, and it heats and dries the bone, burns it, and makes the bone around the sawing come away over a larger area than it would have. And if you mean to saw right through to the membrane at once and then take off the bone, you must likewise take the trephine out often and dip it in cold water.

If you have not had the treatment from the start, but take it over from another doctor and come late to it, you must saw the bone right through to the membrane at once with a toothed trephine. Take the trephine out often to look, and examine the track of the trephine all round with the probe as well. The bone is sawn through much faster if you saw it when there is already pus under it and through it. Often, too, the bone turns out to be shallow, especially if the wound is in that part of the head where the bone is thinner rather than thicker. You must take care that you do not set the trephine down without noticing where. Always fix the trephine where the bone seems thickest, look often, and try to lift the bone out by working it loose. When you have taken it off, treat the rest as seems to suit the wound.

And if you have had the treatment from the start and mean to saw through the bone at once and take it off the membrane, you must likewise examine the track of the trephine often with the probe, always fix the trephine in the thickest part of the bone, and aim to take the bone off by working it loose.

If you use a drill, and you have had the treatment from the start, you must not go through to the membrane as you bore. Leave a thin layer of bone, just as I have written for trephining.

Aphorisms

Section One

1.1 Life is short, the art long, the moment soon gone, trial perilous, decision hard. And it is not enough for the doctor to do what is needed himself: the patient, the people at the bedside and everything around them must play their part too.

1.2 When the bowels are upset, or there is vomiting, and it comes on of its own accord, then if the body is purged of what ought to be purged, it helps, and the patient bears it well. If not, the opposite. It is the same with emptying the vessels by a lowering diet: if it happens as it should, it helps, and the patient bears it well. If not, the opposite. The doctor must therefore take into account the country, the season, the patient's age, and the diseases in which emptying is called for, and those in which it is not.

1.3 In athletes, a peak of fitness pushed to its very limit is dangerous. It cannot stay where it is, or stand still. And since it cannot stand still, and can get no better, the only way left is down. For these reasons it is best to bring that peak down, and without delay, so that the body can make a fresh start at building itself up. But do not carry the reduction of the body to the extreme either, for that is dangerous too. Carry it only as far as the nature of the person who must bear it allows. In the same way, emptyings carried to the extreme are dangerous; and so, again, are feedings-up carried to the extreme.

1.4 Thin, strict diets are dangerous in long illnesses, always, and in acute illnesses where the case will not bear them. Again, diets brought to the extreme of thinness are hard on the patient; and so, for that matter, are fillings-up brought to the extreme.

1.5 On a thin diet patients break the rules, and so they are harmed more. Any slip they make becomes a bigger one than it would be on a diet a little fuller. For the same reason, very thin, fixed and strict diets are dangerous even for healthy people, because they bear any slip worse. That is why thin, strict diets are, in most cases, more dangerous than ones a little fuller.

1.6 For extreme diseases, extreme treatments, carried out with precision, are best.

1.7 Where the disease is very acute, its worst sufferings come at once, and the very thinnest diet must be used. Where it is not, and a fuller diet can be allowed, come down from the extreme only as far as the disease is milder than the extreme.

1.8 When the disease is at its height, then the thinnest diet must be used.

1.9 The doctor must also weigh up the patient: whether he will hold out on the diet until the disease reaches its height. Which will give out first: the patient, unable to hold out on the diet, or the disease, worn out and losing its force?

1.10 Where the height comes at once, then, put the patient on a thin diet at once. Where it comes later, cut the diet back at that point, and a little before it. Until then, feed him more generously, so that he has the strength to hold out.

1.11 During paroxysms (the attacks in which a fever grows worse) the diet must be held back, since adding food then does harm. And in every illness whose attacks come in regular cycles, the diet must be held back during the attacks.

1.12 The paroxysms and the settled pattern of an illness are shown by the disease itself, by the season of the year, and by the way the cycles answer one another, whether the attacks come every day, every other day, or at longer intervals. They are also shown by the signs that appear as the illness goes on. In pleurisy, for instance, if sputum appears at once, at the very beginning, the illness will be short; if it appears later, the illness will be long. Urine, stools and sweats, too, as they appear, show whether the disease will come to its crisis (the decisive turn of the illness, toward recovery or death) easily or with difficulty, and whether it will be short or long.

1.13 Old men bear fasting most easily; next, men in the prime of life; young men least well; and worst of all, children, especially the liveliest among them.

1.14 Growing bodies have the most inborn heat, and so they need the most food. Without it the body wastes away. Old men have little heat, and so they need only a little fuel; a great deal puts the heat out. That is also why fevers in the old are not as acute as in the young: their bodies are cold.

1.15 The belly is naturally hottest in winter and spring, and sleep is then longest. In these seasons, then, more food should be given, since the inborn heat is then greatest and needs more food. The proof is in the young and in athletes.

1.16 Liquid diets suit everyone with a fever, especially children, and others who are used to living on such food.

1.17 Consider also who should eat once a day and who twice, who more and who less, and who in small portions. Something must be granted to habit, to the season, to the country and to the patient's age.

1.18 In summer and autumn people bear food worst; in winter, most easily; in spring, next best.

1.19 When the attacks come in regular cycles, give the patient nothing and force nothing on him during them. Cut back what you add before the crisis.

1.20 When a disease is coming to a crisis, or has just come to one, do not disturb it or try anything new, either with purging drugs or with any other stimulus. Leave it alone.

1.21 Whatever has to be drawn off, draw it off where nature most inclines it to go, through the proper passages.

1.22 Purge and stir up the disease matter when it has ripened (ripening is the body working the disease matter into a state in which it can be got rid of), and not while it is raw, nor at the beginning, unless it is swelling up and ready to move. Most of the time it is not.

1.23 Judge what is passed not by its amount, but by whether it is the kind of thing that ought to pass, and whether the patient bears it well. And where the purging must be carried as far as fainting, do that too, if the patient can hold out.

1.24 In acute illnesses use purging drugs rarely, and at the beginning, and only after thinking the matter through carefully.

1.25 If the body is purged of what ought to be purged, it helps, and the patient bears it well. If the opposite, he bears it badly.

Section Two

2.1 In any disease where sleep brings distress, it is fatal. Where sleep helps, it is not fatal.

2.2 When sleep puts an end to delirium, it is good.

2.3 Sleep and sleeplessness, either one beyond due measure: bad.

2.4 Neither overeating, nor hunger, nor anything else is good when it goes beyond what is natural.

2.5 Weariness without a cause foretells disease.

2.6 Those who are ill in some part of the body and yet feel little of the pain are sick in the mind.

2.7 Bodies that have wasted away over a long time must be built up again slowly; those that wasted in a short time, quickly.

2.8 If someone recovering from an illness is eating but does not gain strength, it shows that his body is taking more food than it can use. If this happens when he is not eating, you must understand that he needs emptying.

2.9 When you want to purge a body, you must first make it flow easily.

2.10 The more you feed a body that is not clean inside, the more you will harm it.

2.11 It is easier to fill up on drink than on food.

2.12 Whatever is left behind in a disease after the crisis usually brings on relapses.

2.13 When a crisis is coming, the night before the paroxysm is hard to bear, and the night after is, as a rule, easier.

2.14 In diarrhoea, changes in the stools help, unless they change for the worse.

2.15 When the throat is diseased, or swellings break out on the body, look at what the body discharges. If it is full of bile, the whole body is sick along with the part. If it is like a healthy person's, it is safe to feed the body.

2.16 When there is hunger, a person should not work hard.

2.17 When more food is taken than nature can deal with, it causes disease. The cure shows it.

2.18 Foods that nourish all at once and quickly are also passed quickly.

2.19 In acute diseases, predictions are never quite certain, either of death or of recovery.

2.20 Those whose bowels are loose when they are young have them dry up as they grow old. Those whose bowels are dry when they are young have them loosen as they grow older.

2.21 Drinking unmixed wine (wine not cut with water, the way Greeks normally drank it) relieves hunger.

2.22 Diseases that come from overfilling are cured by emptying; those that come from emptying, by filling; and so with the rest: each is cured by its opposite.

2.23 Acute diseases come to a crisis within fourteen days.

2.24 Of each seven days, the fourth gives the sign. The eighth is the start of the second week. The eleventh must be watched, since it is the fourth day of the second week. The seventeenth must be watched again, since it is the fourth from the fourteenth and the seventh from the eleventh.

2.25 Quartan fevers (fevers that come back every third day; the Greeks counted both ends, so they called it the fourth-day fever) are mostly short when they come in summer. In autumn they are long, especially those that run on into winter.

2.26 It is better for a fever to follow a convulsion than for a convulsion to follow a fever.

2.27 Do not trust an improvement that makes no sense, and do not be too frightened of bad turns that make no sense. Most such changes are unstable. They do not usually last, or go on for long.

2.28 When a fever is not altogether light, it is a bad sign if the body stays as it is and loses nothing, or if it wastes away more than it should. The first means a long illness; the second, weakness.

2.29 At the beginning of a disease, if something seems to need stirring up, stir it up. When the disease is at its height, it is better to keep quiet.

2.30 Around the beginning and the end, everything is weakest; around the height, strongest.

2.31 When a patient recovering from an illness eats well but his body does not improve, it is a bad sign.

2.32 As a rule, all patients in a poor way who eat well at the start and do not improve end up losing their appetite again. Those who at first have no appetite at all, but later eat well, come through better.

2.33 In every disease, it is good for the mind to stay sound and for the patient to take his food well. The opposite is bad.

2.34 In diseases, patients are in less danger when the disease is in keeping with their nature, their build, their age and the season than when it is out of keeping with any one of these.

2.35 In all diseases it is better for the parts around the navel and the lower belly to keep their thickness. When they are very thin and wasted, it is a bad sign. Such a state is also risky when the patient must be purged downward.

2.36 People whose bodies are in a healthy state soon grow faint when they are purged with drugs. Those who live on poor food do too.

2.37 People whose bodies are in good condition are hard to purge with drugs.

2.38 Food or drink that is a little worse but more pleasant should be chosen over food or drink that is better but less pleasant.

2.39 Old people are, on the whole, ill less often than the young. But whatever chronic diseases they do get mostly stay with them until they die.

2.40 In the very old, hoarseness and head colds do not ripen.

2.41 Those who faint often and badly, for no clear reason, die suddenly.

2.42 A severe stroke cannot be cured; a mild one, not easily.

2.43 Of those who have been hanged and cut down, but are not yet dead, those with foam around the mouth do not come round.

2.44 Those who are very fat by nature are more likely to die suddenly than the lean.

2.45 In young people with epilepsy, release from it comes above all through changes: of age, of place and of way of life.

2.46 When two pains come at once, but not in the same place, the stronger one dims the other.

2.47 Pains and fevers come more while pus is forming than once it has formed.

2.48 In any exertion of the body, as soon as it begins to hurt, stop and rest at once, and weariness is kept away.

2.49 People used to their accustomed work bear it more easily, even if they are weak or old, than strong young people who are not used to it.

2.50 Whatever we have long been used to, even if it is worse than what we are not used to, usually troubles us less. But a person must also be able to change to things he is not used to.

2.51 To empty the body, or fill it, or heat it, or cool it, or stir it up in any other way, by a great deal and suddenly, is dangerous. Anything in excess is the enemy of nature. What is done little by little is safe, especially when you are changing over from one thing to another.

2.52 When you are doing everything according to reason, and things do not turn out according to reason, do not change to something else, as long as your first judgment still holds.

2.53 Those with loose bowels come through better while they are young than those with dry bowels. But in old age they come through worse, since their bowels usually dry up as they grow old.

2.54 A large body is handsome in youth, and not at all unpleasing. In old age it is awkward, and worse than a smaller one.

Section Three

3.1 Changes of season are what chiefly breed diseases, and within the seasons, great changes of cold or heat; and other changes in proportion.

3.2 Some natures are well or badly suited to summer, others to winter.

3.3 Diseases, too, are well or badly suited, some to one season and some to another; and certain ages are well or badly suited to certain seasons, places and diets.

3.4 In any season, when on the same day it is hot one moment and cold the next, expect the diseases of autumn.

3.5 South winds dull the hearing, dim the sight, make the head heavy, and make people sluggish and slack. When the south wind prevails, the sick suffer these things in their illnesses. If the wind is from the north, there are coughs, sore throats, hard bowels, difficulty passing urine with shivering, and pains in the sides and chest. When this wind prevails, expect such things in illnesses.

3.6 When summer is like spring, expect a great deal of sweating in fevers.

3.7 In droughts, acute fevers occur. And if most of the year is like that, and the weather has set that pattern, the diseases too must as a rule be expected to match it.

3.8 When the seasons are settled, and each brings at its proper time what belongs to it, diseases are steady and come easily to a crisis. When the seasons are unsettled, diseases are unsettled and come to a crisis with difficulty.

3.9 In autumn, diseases are most acute and, on the whole, most deadly. Spring is the healthiest season and the least deadly.

3.10 Autumn, the waning of the year, is bad for those who are wasting away.

3.11 As for the seasons: if winter is dry, with north winds, and spring is rainy, with south winds, then in summer there will be acute fevers, inflamed eyes and dysentery (a bloody flux of the bowels), especially in women and in men of a moist nature.

3.12 If winter is southerly, rainy and calm, and spring is dry, with north winds, then women whose babies are due in spring miscarry at the slightest cause. Those who do give birth bear weak, sickly children, who either die at once or live on, thin and sickly. Everyone else gets dysentery and dry inflammations of the eyes. And the older people get catarrhs (flows of phlegm down from the head) that kill them quickly.

3.13 If summer is dry, with north winds, and autumn is rainy, with south winds, then in winter there are headaches, coughs, hoarseness and head colds, and in some people consumption (a wasting disease) as well.

3.14 But if autumn is northerly and without rain, it is good for those of a moist nature and for women. Everyone else will have dry inflammations of the eyes, acute fevers and head colds, and some will have melancholy (a disorder of black bile).

3.15 Of the year's patterns of weather, on the whole, droughts are healthier and less deadly than rainy spells.

3.16 The diseases that usually come in rainy spells are long fevers, diarrhoea, rotting sores, epilepsy, strokes and quinsy (a choking swelling of the throat). In droughts there are consumption, inflamed eyes, arthritis, strangury (urine passed painfully, drop by drop) and dysentery.

3.17 As for the weather from day to day: north winds brace the body, and make it firm and quick in its movements, give it a good colour and sharpen the hearing. They dry up the bowels and sting the eyes, and any pain already present in the chest grows worse. South winds relax the body and make it moist. They bring dullness of hearing, heaviness in the head and dizziness. They make the eyes and the whole body slow to move, and they loosen the bowels.

3.18 As for the seasons: in spring and at the start of summer, children and those next to them in age do best and are healthiest. In summer, and in part of autumn, the old do best. For the rest of autumn and in winter, those of middle age.

3.19 All diseases occur in all seasons, but some are more apt to arise and to grow worse in certain seasons.

3.20 In spring: madness, melancholy, epilepsy, bleedings, quinsy, head colds, hoarseness, coughs, scaly skin diseases, itching rashes, white patches on the skin, a great many ulcerating eruptions, swellings, and pains in the joints.

3.21 In summer: some of these, and also continuous fevers, burning fevers (fevers with intense heat and thirst), a great many tertian fevers (fevers that come back every other day; the Greeks counted both ends, so they called it the third-day fever), vomiting, diarrhoea, inflamed eyes, earache, ulcers of the mouth, rotting sores on the genitals, and heat rash.

3.22 In autumn: most of the summer diseases, and also quartan fevers, irregular fevers, enlarged spleens, dropsy (a swelling with fluid), consumption, strangury, lientery (food passing through undigested), dysentery, sciatica, quinsy, asthma, ileus (a blockage of the bowels), epilepsy, madness and melancholy.

3.23 In winter: pleurisy, pneumonia, head colds, hoarseness, coughs, pains in the chest, pains in the sides and loins, headaches, dizziness, strokes.

3.24 At the different ages, these are the things that happen. In little children and newborn babies: thrush in the mouth, vomiting, coughs, sleeplessness, night terrors, inflammation of the navel, running ears.

3.25 As they come to teething: itching of the gums, fevers, convulsions, diarrhoea, especially when they are cutting the canine teeth, and in the fattest children and those with hard bowels.

3.26 In children a little older: swollen tonsils, the vertebra at the nape of the neck pushed inward, asthma, stones, round worms, threadworms, warts, swellings beside the ears, swollen glands in the neck, and other growths, but above all those already mentioned.

3.27 In those older still and coming up to puberty: most of these, and also fevers that are more often long-lasting, and nosebleeds.

3.28 Most children's illnesses come to a crisis, some in forty days, some in seven months, some in seven years, some as they approach puberty. Whatever stays with children, and does not go away at puberty (or, in girls, when their periods begin) usually becomes chronic.

3.29 In young men: spitting of blood, consumption, acute fevers, epilepsy and the other diseases, but above all those already mentioned.

3.30 In those past this age: asthma, pleurisy, pneumonia, lethargy (a fever with heavy drowsiness), phrenitis (a fever with delirium), burning fevers, chronic diarrhoea, cholera (violent vomiting and diarrhoea together), dysentery, lientery, piles.

3.31 In old men: difficulty breathing, catarrhs with coughing, strangury, painful urination, pains in the joints, kidney disease, dizziness, strokes, a poor and wasted condition, itching all over the body, sleeplessness, watery discharges from the bowels, the eyes and the nose, dim sight, a grey clouding of the eyes, dullness of hearing.

Section Four

4.1 Purge pregnant women, if the matter is swelling up and ready to move, from the fourth month up to the seventh, but those in the seventh month less freely. When the unborn child is younger or older than that, be cautious.

4.2 In purging, draw off from the body the kinds of thing that do good when they pass of their own accord; and stop those that pass in the opposite way.

4.3 If the body is purged of what ought to be purged, it helps, and the patient bears it well. If the opposite, he bears it badly.

4.4 In summer, purge upward, by vomiting, by preference; in winter, downward.

4.5 Around the rising of the Dog Star, in late July, and just before it, purging drugs are hard going.

4.6 Thin people who vomit easily should be purged upward, but hold back in winter.

4.7 Those who vomit with difficulty, and are moderately fleshy, should be purged downward, but hold back in summer.

4.8 With people inclined to consumption, hold back on purging upward.

4.9 With melancholy patients, purge downward, and more freely, by the same reasoning, applying the opposite rule.

4.10 In very acute diseases, if the matter is swelling up and ready to move, purge the same day. In such cases delay is bad.

4.11 When there is griping, with pains around the navel, and a pain in the loins that is not relieved either by purging or in any other way, the trouble settles into a dry dropsy.

4.12 When the bowels are prone to lientery, purging upward in winter is bad.

4.13 Before giving hellebore (the strong root given to purge by vomiting) to people who are not easily purged upward, moisten their bodies beforehand with more food and with rest.

4.14 After someone has taken hellebore, set him moving rather than letting him sleep or lie still, and it will work more strongly. Seasickness shows that movement upsets the body.

4.15 When you want the hellebore to work more strongly, move the body. When you want it to stop, put the patient to sleep and do not move him.

4.16 Hellebore is dangerous for people whose flesh is healthy, for it brings on convulsion.

4.17 When there is no fever, loss of appetite, heartburn, dizziness with darkness before the eyes, and a bitter taste in the mouth show that the patient needs purging upward.

4.18 Pains above the diaphragm show that purging upward is needed; pains below it, purging downward.

4.19 Those who are not thirsty while a purging drug is working go on being purged until they become thirsty.

4.20 When there is no fever, griping, heaviness in the knees and pain in the loins show that purging downward is needed.

4.21 Black stools like blood, passing of their own accord, with fever or without it, are very bad. The more colours they have, and the worse the colours, the worse it is. When a drug brings them on, it is better, and then many colours are not a bad sign.

4.22 At the start of any disease, if black bile passes either upward or downward, it is fatal.

4.23 Those who have been thinned by acute or long illnesses, or by wounds, or in any other way, and then pass black bile, or something like black blood, die the next day.

4.24 Dysentery that begins from black bile is fatal.

4.25 Blood passed upward, of whatever kind, is bad. Passed downward, it is good, and so is black matter passed downward.

4.26 If someone suffering from dysentery passes what look like pieces of flesh, it is fatal.

4.27 Those who lose a great deal of blood in fevers, from wherever it comes, have loose bowels while they are recovering.

4.28 In those whose stools are bilious, the bile stops when deafness sets in; and in those who are deaf, the deafness stops when bilious stools appear.

4.29 When shivering fits come in fevers on the sixth day, the crisis comes with difficulty.

4.30 When there are paroxysms, if the fever comes back the next day at the same hour at which it left off, the crisis comes with difficulty.

4.31 In fevers with weariness, deposits (the disease matter settling in one place, as a swelling, an abscess or a pain in a joint) form mostly in the joints and beside the jaws.

4.32 When people getting up from an illness have pain somewhere, deposits form there.

4.33 And if some part was already in pain before the illness, that is where the disease settles.

4.34 If someone with a fever is suddenly seized with choking, and there is no swelling in the throat, it is fatal.

4.35 If someone with a fever suddenly has his neck twisted round, and can hardly swallow, and there is no swelling, it is fatal.

4.36 Sweats in a fever are good if they begin on the third day, the fifth, the seventh, the ninth, the eleventh, the fourteenth, the seventeenth, the twenty-first, the twenty-seventh, the thirty-first or the thirty-fourth. These sweats bring diseases to a crisis. Sweats that do not come in this way mean pain, a long illness and relapses.

4.37 Cold sweats with a high fever mean death; with a milder fever, a long illness.

4.38 And wherever on the body there is sweat, that is where the disease shows itself.

4.39 And wherever on the body there is heat or cold, that is where the disease is.

4.40 And where there are changes over the whole body, if it grows cold and then hot again, or one colour gives way to another, it means a long illness.

4.41 Heavy sweating after sleep, with no obvious cause, shows that the body is taking more food than it can use. If this happens when the person is not eating, it shows that he needs emptying.

4.42 Heavy sweating that keeps on flowing, cold or hot, means disease: cold sweat a more serious one, hot sweat a lesser one.

4.43 Fevers that do not let up, but grow stronger every other day, are dangerous. If they let up in any way at all, it shows they are not dangerous.

4.44 Those who have long fevers get swellings, or pains in the joints.

4.45 Those who get swellings, or pains in the joints, after fevers are eating too much.

4.46 If a shivering fit comes on during a fever that does not let up, when the patient is already weak, it is fatal.

4.47 In fevers that do not let up, what is coughed up livid, bloody, foul-smelling or bilious is all bad. If it comes away well, it is good. The same goes for the stools and the urine. And if nothing useful is discharged through these channels, it is bad.

4.48 In fevers that do not let up, if the outside of the body is cold while the inside burns, and the patient is thirsty, it is fatal.

4.49 In a fever that does not let up, if a lip, an eyebrow, an eye or the nose is twisted out of place, if the patient cannot see, if he cannot hear, and he is already weak: whichever of these happens, death is near.

4.50 When, in a fever that does not let up, there is difficulty in breathing and delirium, it is fatal.

4.51 In fevers, abscesses that have not cleared up by the first crises mean a long illness.

4.52 When patients weep by choice in fevers or other illnesses, there is nothing strange in it. When they weep without meaning to, it is stranger.

4.53 When, in fevers, a very sticky film forms on the teeth, the fevers grow stronger.

4.54 Those who have dry coughs that go on a long time, with only a slight tickle, in fevers like the burning fever, are not very thirsty.

4.55 Fevers that come with swollen glands in the groin are all bad, except fevers that last a single day.

4.56 When a fever patient sweats but the fever does not go, it is bad. The disease is being drawn out, and the sweat shows too much moisture.

4.57 When someone has a convulsion or tetanus (the body locked rigid in spasm), a fever that comes on ends the disease.

4.58 When someone has a burning fever, a shivering fit that comes on brings the end of it.

4.59 A true tertian comes to a crisis in seven cycles at most.

4.60 When the ears go deaf in fevers, blood flowing from the nose, or an upset of the bowels, ends the disease.

4.61 If the fever leaves a patient on a day that is not an odd day, it usually comes back.

4.62 When jaundice comes on in fevers before the seventh day, it is bad, unless watery stools pass from the bowels.

4.63 When shivering fits come every day in fevers, the fevers break every day.

4.64 When jaundice comes on in fevers on the seventh, ninth, eleventh or fourteenth day, it is good, unless the right side of the abdomen below the ribs is hard. If it is, it is not good.

4.65 In fevers, strong burning around the belly, and heartburn, are bad.

4.66 In acute fevers, convulsions and strong pains in the inner organs are bad.

4.67 In fevers, terrors on waking from sleep, or convulsions, are bad.

4.68 In fevers, breath that catches is bad, for it means convulsion.

4.69 When the urine is thick, clotted and scanty, in patients who are not free of fever, a large flow of thin urine coming after it helps. It comes mostly to those whose urine has had a sediment from the beginning, or soon after.

4.70 When the urine in fevers is churned up, like a pack animal's, there is a headache now, or there will be.

4.71 When the crisis comes on the seventh day, the urine has a red cloud in it on the fourth day, and the other signs match.

4.72 Urine that is clear and white is bad. It appears mostly in phrenitis.

4.73 When the abdomen below the ribs is swollen up and rumbling, and a pain in the loins comes on, the bowels become loose, unless wind breaks out or a large amount of urine is passed. This happens in fevers.

4.74 When a deposit is to be expected in the joints, a large amount of urine, very thick and white, saves the patient from it. Urine of this kind begins to pass in some patients in quartan fevers with weariness. And if blood flows from the nose as well, the deposit clears up very quickly.

4.75 Passing blood or pus in the urine means an ulcer of the kidneys or of the bladder.

4.76 When small pieces of flesh like hairs come out in thick urine, they come from the kidneys.

4.77 When flakes like bran are passed in thick urine, the bladder has a scaly sore.

4.78 Passing blood in the urine of its own accord means that a small vessel in the kidneys has burst.

4.79 When sand settles in the urine, there is a stone in the bladder.

4.80 If someone passes blood and clots in his urine, and has strangury, and pain comes on in the lower belly and the perineum, between the genitals and the anus, the parts around the bladder are diseased.

4.81 If blood, pus and scales are passed in the urine, and the smell is foul, it means an ulcer of the bladder.

4.82 When swellings grow in the urinary passage, relief comes when they fill with pus and burst.

4.83 Passing a great deal of urine at night means that the stools are small.

Section Five

5.1 A convulsion brought on by hellebore is fatal.

5.2 A convulsion that comes on after a wound is fatal.

5.3 When a great deal of blood has been lost, convulsion or hiccups coming on after it are bad.

5.4 When purging has gone too far, convulsion or hiccups coming on after it are bad.

5.5 If a drunk man suddenly loses his voice, he dies in convulsions, unless a fever takes hold of him, or he speaks again when the hour comes at which a hangover passes off.

5.6 Those who are seized by tetanus die within four days. If they get past these, they recover.

5.7 Epilepsy that begins before puberty can change and go away. In those who get it at twenty-five, it mostly stays with them until they die.

5.8 Patients with pleurisy who are not cleaned out by coughing within fourteen days end up with pus collecting in the chest.

5.9 Consumption comes chiefly between the ages of eighteen and thirty-five.

5.10 Those who come through quinsy, when the disease turns to the lungs, die within seven days. If they get past these, pus forms in the chest.

5.11 In those troubled with consumption, if what they cough up smells foul when it is poured on hot coals, and the hair falls from the head, it is deadly.

5.12 Consumptives whose hair is falling out die when diarrhoea comes on.

5.13 When people cough up frothy blood, it comes up from the lungs.

5.14 In someone with consumption, diarrhoea coming on is deadly.

5.15 Those in whom pleurisy leads to pus in the chest recover if they are cleaned out within forty days from the day it bursts. If not, the disease passes into consumption.

5.16 Heat does these harms to those who use it too often: it makes the flesh soft and womanish, the sinews powerless and the mind numb; it brings bleedings and faintings; and in some, death.

5.17 Cold brings on convulsions, tetanus, blackening of the skin, and feverish shivering.

5.18 Cold is the enemy of the bones, the teeth, the sinews, the brain and the spinal marrow. Heat is good for them.

5.19 Warm up whatever has been chilled, except where there is bleeding, or bleeding is about to start.

5.20 On sores, cold stings, hardens the skin around them, causes pain that does not turn to pus, blackens, and brings on feverish shivering, convulsions and tetanus.

5.21 Sometimes, in a well-fleshed young man who has tetanus without a wound, in the middle of summer, pouring a great deal of cold water over him calls the heat back, and the heat called back is what saves him.

5.22 Heat brings on pus, though not in every sore; when it does, that is the surest sign of safety. It softens the skin and thins it, eases pain, and soothes shivering, convulsions and tetanus. In the head it also relieves heaviness. It does most good in broken bones, especially those laid bare, and most of all in those with wounds in the head. And in whatever has been killed or ulcerated by cold, in spreading sores that eat away the flesh, and in the anus, the genitals, the womb and the bladder: in all these, heat is a friend and brings on the crisis, and cold is an enemy and kills.

5.23 In the following cases cold must be used. Where there is bleeding, or bleeding is about to start, apply it not to the spot itself but around the place the blood is flowing from. In inflammations, and fiery swellings that tend toward red and a blood-filled colour because of fresh blood, apply it to them, since on old ones it causes blackening. And use it on erysipelas (a spreading red inflammation) that has not ulcerated, since once it has ulcerated, cold harms it.

5.24 Cold things, such as snow and ice, are the enemy of the chest: they provoke coughs, bleeding and catarrhs.

5.25 Swellings and pains in the joints without a wound, gout, and sprains: most of these are eased and reduced by pouring a great deal of cold water over them, and the pain goes. A moderate numbness relieves pain.

5.26 Water that heats quickly and cools quickly is the lightest.

5.27 When people who are very thirsty want a drink at night, it is good if they fall asleep again.

5.28 A vapour bath with aromatic herbs brings on a woman's periods. It would be useful in many other ways too, if it did not make the head heavy.

5.29 Purge pregnant women, if the matter is swelling up and ready to move, from the fourth month up to the seventh, but those in the seventh month less freely. When the unborn child is younger or older than that, be cautious.

5.30 For a pregnant woman to be seized by any of the acute diseases is deadly.

5.31 A pregnant woman who is bled from a vein miscarries, and all the more so the larger the unborn child.

5.32 When a woman is vomiting blood, the start of her period ends it.

5.33 When a woman's periods have stopped, it is good for blood to flow from her nose.

5.34 When a pregnant woman has heavy diarrhoea, there is a danger that she will miscarry.

5.35 When a woman suffers from disorders of the womb, or is having a hard labour, sneezing that comes on is good.

5.36 When a woman's periods are a poor colour, and do not always come at the same time, it shows that she needs purging.

5.37 When the breasts of a pregnant woman suddenly grow thin, she miscarries.

5.38 If a woman pregnant with twins has one breast grow thin, she miscarries one of the twins. If it is the right breast that grows thin, she loses the boy; if the left, the girl.

5.39 If a woman who is not pregnant, and has not given birth, has milk, her periods have stopped.

5.40 When blood gathers in a woman's breasts, it means madness.

5.41 If you want to know whether a woman is pregnant, give her honey-water to drink when she is going to bed, without her supper. If she then has griping pains in the belly, she is pregnant; if not, she is not.

5.42 A pregnant woman has a good colour if she is carrying a boy, a poor one if a girl.

5.43 If erysipelas arises in the womb of a pregnant woman, it is deadly.

5.44 Women who are unnaturally thin and become pregnant miscarry before they grow fatter.

5.45 When women of moderate build miscarry in the second or third month for no obvious reason, it is because the cotyledons (the points where the unborn child is fastened to the womb) are full of mucus. They cannot hold the weight of the child, and they tear away.

5.46 When women who are unnaturally fat do not conceive, it is because the omentum (the fatty apron in the belly) presses on the mouth of the womb. They do not conceive until they grow thinner.

5.47 If the womb, lying against the hip, fills with pus, it must be dressed with plugs of lint.

5.48 Male babies in the womb lie more on the right side, female ones more on the left.

5.49 To bring away the afterbirth, put something into the nose to make the woman sneeze, and hold her nostrils and mouth shut.

5.50 If you want to check a woman's period, put the largest cupping vessel you can (a heated cup that draws on the skin as it cools) to her breasts.

5.51 In pregnant women, the mouth of the womb is closed.

5.52 If a great deal of milk flows from the breasts of a pregnant woman, it means the unborn child is weak. If the breasts are firm, it means the child is healthier.

5.53 In women who are about to miscarry, the breasts grow thin. If they grow hard again, there will be pain in the breasts, or the hips, or the eyes, or the knees, and they will not miscarry.

5.54 When the mouth of the womb is hard, it must also be closed.

5.55 Pregnant women who are seized with fever and grow very thin, for no obvious reason, give birth with difficulty and danger, or else miscarry and are in danger themselves.

5.56 When a woman has a flow from the womb, convulsions and fainting that come on are bad.

5.57 When the periods are too heavy, diseases follow; and when they fail to come, diseases arise from the womb.

5.58 After inflammation of the rectum, or of the womb, comes strangury; after pus in the kidneys comes strangury; and after inflammation of the liver come hiccups.

5.59 If a woman does not conceive and you want to know whether she can, wrap her round in cloaks and burn incense beneath her. If the smell seems to pass through her body to her nostrils and mouth, you may be sure that the barrenness is not her own fault.

5.60 If a pregnant woman goes on having her periods, the unborn child cannot be healthy.

5.61 If a woman's periods do not come, and neither shivering nor fever follows, but she has fits of nausea, reckon that she is pregnant.

5.62 Women whose wombs are cold and dense do not conceive. Women whose wombs are very moist do not conceive either, for the seed is quenched. Nor do women whose wombs are too dry and burning hot, for the seed perishes for lack of nourishment. But women whose wombs have a balanced blend of the two qualities are fertile.

5.63 It is much the same with men. Either the body is loose in texture, and the breath escapes outward, so that it does not carry the seed along with it; or the body is dense, and the fluid does not pass outward; or it is cold, and the seed is not heated enough to gather in its proper place; or it is hot, and the same thing happens.

5.64 It is bad to give milk to people with headaches. It is bad, too, for those with fever, for those whose abdomen below the ribs is swollen up and rumbling, and for those who are thirsty. It is also bad for those whose stools are bilious in acute fevers, and for those who have passed a great deal of blood. It suits consumptives who do not have very much fever. Give it also in long, low fevers, when none of the signs just named are present and the patient has wasted away beyond all reason.

5.65 When swellings appear on wounds, the patients are not much subject to convulsions or madness. But if the swellings vanish suddenly, then, when the wounds are at the back, convulsions and tetanus follow; when they are at the front, madness, sharp pains in the side, pus in the chest, or dysentery, if the swellings were rather red.

5.66 If, when wounds are severe and bad, no swelling appears, it is a very bad thing.

5.67 Soft, spongy swellings are good; raw ones are bad.

5.68 When there is pain at the back of the head, cutting the upright vein in the forehead helps.

5.69 Shivering fits begin, in women, mostly from the loins, and run up the back to the head. In men, too, they begin more at the back of the body than at the front: from the forearms and the thighs, for example. The skin there is open-textured as well, as the hair shows.

5.70 Those who are seized with quartan fevers are hardly ever seized with convulsions. If they have convulsions first, and a quartan follows, the convulsions stop.

5.71 Those whose skin is stretched tight, dry and hard die without sweating. Those whose skin is loose and open-textured die in a sweat.

5.72 People with jaundice are not much troubled by wind.

Section Six

6.1 In long-lasting lientery, sour belching that comes on when there was none before is a good sign.

6.2 People whose noses are naturally rather runny, and whose seed is rather watery, have a sicklier kind of health. Those with the opposite nature have a sounder one.

6.3 In long bouts of dysentery, loss of appetite is bad; with fever, it is worse.

6.4 Sores with the hair falling out all round them are malignant.

6.5 With pains in the sides, the chest and the other parts, you must find out whether they differ much from one another.

6.6 Diseases of the kidneys, and those of the bladder, are hard to cure in old people.

6.7 Of pains that arise in the belly, those near the surface are lighter, and those that are not near the surface are more severe.

6.8 In people with dropsy, sores that form on the body do not heal easily.

6.9 Broad rashes are not very itchy.

6.10 When someone has pain in the head, and severe pain all round it, pus or water or blood running from the nose, the mouth or the ears ends the disease.

6.11 For the melancholic, and for those with kidney disease, haemorrhoids that come on are good.

6.12 When someone has been cured of long-standing haemorrhoids, unless one is left alone, there is a danger that dropsy or consumption will follow.

6.13 When someone has hiccups, sneezing that comes on ends the hiccups.

6.14 When someone has dropsy, if the water runs down through the vessels into the bowels, that ends it.

6.15 When someone has had diarrhoea for a long time, vomiting that comes on of its own accord ends the diarrhoea.

6.16 When someone has pleurisy or pneumonia, diarrhoea coming on is bad.

6.17 For a patient with inflamed eyes, to be seized by diarrhoea is good.

6.18 A wound cutting through the bladder, the brain, the heart, the diaphragm, any part of the small intestines, the stomach or the liver is deadly.

6.19 When a bone, a cartilage or a sinew is cut through, or the thin part of the cheek, or the foreskin, it neither grows back nor knits together.

6.20 If blood is poured out into the belly, against nature, it must turn to pus.

6.21 In madness, if varicose veins or haemorrhoids come on, the madness ends.

6.22 Tears in the muscles that run down from the back to the elbows are cured by bleeding (opening a vein).

6.23 If fear or low spirits last a long time, the condition is a melancholic one.

6.24 If any part of the small intestines is cut through, it does not knit together.

6.25 If erysipelas spreading on the outside turns inward, that is not good; if it turns from the inside outward, that is good.

6.26 In any burning fever where trembling sets in, a fit of delirium ends it.

6.27 When people with a collection of pus inside them, or with dropsy, are cut open or cauterised, if the pus or the water all flows out at once, they die without fail.

6.28 Eunuchs do not get gout, nor do they go bald.

6.29 A woman does not get gout unless her monthly periods have stopped.

6.30 A boy does not get gout before he begins to have sex.

6.31 Pain in the eyes is cured by drinking unmixed wine, or a bath, or a steam bath, or bleeding, or a purging drug.

6.32 People who lisp are especially prone to long-lasting diarrhoea.

6.33 People given to sour belching do not often get pleurisy.

6.34 Bald people do not get large varicose veins. And when bald people do get varicose veins, their hair grows thick again.

6.35 In people with dropsy, a cough coming on is bad.

6.36 Bleeding cures difficulty in passing urine; open the veins on the inner side.

6.37 When someone has quinsy, it is good for swellings to form on the outside of the throat.

6.38 When people have hidden cancers, it is better not to treat them. If they are treated, they die quickly; if they are not, they go on living a long time.

6.39 Convulsions come either from filling or from emptying; and so does hiccup.

6.40 When people have pains in the abdomen below the ribs without inflammation, a fever that comes on ends the pain.

6.41 When there is pus somewhere in the body and it gives no sign of itself, it gives no sign because the part where it lies is so thick.

6.42 In jaundice, it is bad for the liver to become hard.

6.43 When people with enlarged spleens are seized by dysentery, and the dysentery goes on a long time, dropsy follows, or lientery, and they die.

6.44 When people with strangury are seized by an obstruction of the bowels, they die within seven days, unless a fever comes on and urine flows in plenty.

6.45 When sores last a year or hang on longer still, a piece of bone must come away, and the scars must be hollow.

6.46 Those who become hunchbacked from asthma or a cough before puberty die.

6.47 People who benefit from bleeding or from a purging drug should be bled or purged in spring.

6.48 For people with enlarged spleens, dysentery coming on is good.

6.49 Attacks of gout, once the inflammation has gone down, settle again within forty days.

6.50 When the brain is cut by a wound, fever and the vomiting of bile must follow.

6.51 When people in good health are suddenly seized by pain in the head, and at once fall down speechless and snore, they die within seven days, unless a fever takes hold of them.

6.52 You must also look at what shows of the eyes during sleep. If some of the white shows when the eyelids are closed, and this does not come from diarrhoea or from taking a purging drug, it is a bad sign and a very deadly one.

6.53 Delirium that comes with laughter is safer; delirium that comes with seriousness is more dangerous.

6.54 In acute diseases with fever, breathing like sobbing is bad.

6.55 Gout is mostly stirred up in spring and in autumn.

6.56 In melancholic diseases, a shift of the humour to another part is dangerous in these ways: it portends a stroke that paralyses the body, or a convulsion, or madness, or blindness.

6.57 People are most likely to have strokes between the ages of forty and sixty.

6.58 If the omentum falls out through a wound, it must rot.

6.59 When people suffering from sciatica have the hip come out of its socket and go back in again, mucus collects there.

6.60 When people suffering from long-standing sciatica have the hip come out of its socket, the leg wastes away and they go lame, unless they are cauterised.

Section Seven

7.1 In acute diseases, coldness of the hands and feet is bad.

7.2 Over a diseased bone, livid flesh is bad.

7.3 After vomiting, hiccup and red eyes are bad.

7.4 After sweating, shivering is not good.

7.5 After madness, dysentery or dropsy or a wild distraction of the mind is good.

7.6 In a very long illness, refusing food and passing unmixed stools is bad.

7.7 After heavy drinking, a shivering fit and delirium is bad.

7.8 When a growth bursts inward, collapse, vomiting and fainting follow.

7.9 After a flow of blood, delirium or convulsion is bad.

7.10 In an obstruction of the bowels, vomiting or hiccup or convulsion or delirium is bad.

7.11 After pleurisy, pneumonia is bad.

7.12 After pneumonia, phrenitis is bad.

7.13 After severe burns, convulsion or tetanus is bad.

7.14 After a blow to the head, stupor or delirium is bad.

7.15 After coughing up blood comes coughing up pus.

7.16 After coughing up pus come consumption and a flux. And when the sputum stops, they die.

7.17 In inflammation of the liver, hiccup is bad.

7.18 After sleeplessness, convulsion or delirium is bad.

7.18b In lethargy, trembling is bad.

7.19 After a bone is laid bare comes erysipelas.

7.20 After erysipelas comes rotting or the forming of pus.

7.21 After strong throbbing in wounds comes bleeding.

7.22 After long-lasting pain in the parts about the belly comes the forming of pus.

7.23 After unmixed stools comes dysentery.

7.24 After a bone of the skull is cut through comes delirium, if the cut reaches the hollow space inside.

7.25 After drinking a purging drug, convulsion is deadly.

7.26 With severe pain in the parts about the belly, coldness of the hands and feet is bad.

7.27 In a pregnant woman, tenesmus (painful straining at stool) makes her miscarry.

7.28 When a bone, a cartilage or a sinew is cut off in the body, it neither grows back nor knits together.

7.29 When someone has white phlegm (a pale, puffy swelling of the body), strong diarrhoea coming on ends the disease.

7.30 When the stools are frothy in bouts of diarrhoea, that matter is flowing down from the head.

7.31 When people with fever have a sediment in their urine like coarse barley meal, it means a long illness.

7.32 When the sediment is bilious and the urine above it thin, it means an acute illness.

7.33 When the urine separates into parts, there is a violent disturbance in the body.

7.34 When bubbles stand on the surface of the urine, they mean kidney disease, and that the illness will be long.

7.35 When the film on top is greasy and all in one mass, it means kidney disease, and acute.

7.36 When people with kidney disease show the signs just described, and sharp pains also come in the muscles along the spine, then if the pains are in the outer parts, expect an abscess on the outside. But if the pains lie more toward the inner parts, expect the abscess, too, to lie more on the inside.

7.37 When people vomit blood without fever, they will live; with fever, it is bad. Treat it with cooling and astringent remedies.

7.38 Catarrhs that run down into the upper cavity, the chest, turn to pus within twenty days.

7.39 If a patient passes blood and clots in his urine, and has strangury, and pain strikes into the perineum and the pubes, it means that the parts about the bladder are diseased.

7.40 If the tongue suddenly loses its power, or some part of the body is struck by paralysis, the condition is a melancholic one.

7.41 If old people are purged too much and hiccup comes on, that is not good.

7.42 If a fever is not caused by bile, pouring plenty of hot water over the head ends it.

7.43 A woman is never ambidextrous.

7.44 When people with a collection of pus inside them are cauterised or cut open, they survive if the pus flows out clean and white. But if it is bloody, muddy and foul-smelling, they die.

7.45 When people with pus in the liver are cauterised or cut open, they survive if the pus flows out clean and white, because in such cases the pus is held in a membrane. But if what flows out looks like the dregs of olive oil, they die.

7.46 For pain in the eyes, give unmixed wine to drink, bathe the patient in plenty of hot water, and then bleed him.

7.47 If a patient with dropsy has a cough, there is no hope for him.

7.48 Strangury and difficulty in passing urine are cured by drinking wine freely and by bleeding; open the veins on the inner side.

7.49 When someone has quinsy, swelling and redness coming on the chest is good, because the disease is turning outward.

7.50 When gangrene strikes the brain, the patients die within three days. If they get through those, they recover.

7.51 Sneezing comes from the head, when the brain is heated through, or when the hollow space in the head is filled with moisture. The air inside then overflows, and it makes a noise because its way out is narrow.

7.52 When people have severe pain in the liver, a fever that comes on ends the pain.

7.53 People who benefit from having blood drawn from their veins should be bled in spring.

7.54 When phlegm is shut in between the diaphragm and the stomach and causes pain, because it has no way out into either of the two cavities, the disease ends if the phlegm turns through the vessels into the bladder.

7.55 When the liver fills with water and bursts into the omentum, the belly fills with water and the patient dies.

7.56 Restlessness, yawning and shivering are cured by wine mixed half and half with water.

7.57 When growths form in the urethra, the pain ends once they come to a head and burst.

7.58 When the brain is shaken by any cause, the patient must at once lose his voice.

7.60 Bodies with moist flesh must be made to go hungry, because hunger dries the body.

7.59 If someone with a fever suddenly starts to choke, with no swelling in the throat, and cannot swallow, or only with great difficulty, it is fatal.

7.59b If someone with a fever has his neck twisted round, and cannot swallow, with no swelling in the neck, it is fatal.

7.61 Where there are changes over the whole body, if it grows cold and then hot again, or one colour gives way to another, it means a long illness.

7.62 Heavy sweating, hot or cold, that flows all the time, means there is too much fluid in the body. It must therefore be drawn off: upward, by vomiting, in a strong patient, and downward, by the bowels, in a weak one.

7.63 Fevers that never let up are dangerous if they grow stronger every other day. But if they let up in any way at all, it means they are not dangerous.

7.64 When people have long fevers, either growths form in them or pains settle in the joints.

7.65 When growths or pains in the joints come on after fevers, the patients are eating too much.

7.66 If you give a feverish patient the food you would give a healthy person, what is strength to the healthy is disease to the sick.

7.67 You must look at what is passed through the bladder, to see whether it is like what healthy people pass. What is least like theirs is the most diseased; what is like that of healthy people is the least diseased.

7.68 And when the stools, if you let them stand and do not stir them, settle a sediment like shavings, it helps to purge the bowels gently. If you give broths without first clearing the bowels, the more you give, the more harm you will do.

7.69 When raw stools are passed below, they come from black bile: the more of them, the more bile; the fewer, the less.

7.70 In fevers that never let up, sputum that is livid, bloody and foul-smelling is all bad. But when it comes away well it is good, and the same holds for what passes by the bowels and by the bladder. And wherever any discharge stops before the body has been cleared, that is bad.

7.71 When you want to purge a body, you must first make it flow easily. If you want it to flow easily upward, bind the bowels; if you want it to flow easily downward, moisten the bowels.

7.72 Sleep and sleeplessness, either of them beyond what is moderate, is disease.

7.73 In fevers that never let up, if the outside of the body is cold while the inside burns, and the fever holds, it is fatal.

7.74 In a fever that never lets up, if a lip, or the nose, or an eye is twisted out of shape, or if the patient cannot see, or cannot hear, when he is already weak: whichever of these signs it is, it is fatal.

7.75 After white phlegm comes dropsy.

7.76 After diarrhoea comes dysentery.

7.77 After dysentery comes lientery.

7.78 After gangrene, a piece of bone comes away.

7.79–80 After vomiting blood comes wasting, and pus brought up from above. After wasting comes a flux from the head; after the flux, diarrhoea; after diarrhoea, the purging from above stops; after it stops, death.

7.81 Whatever passes from the body, by the bladder, by the bowels, or through the flesh, and wherever else the body departs from its nature: if the change is small, the disease is small; if it is great, the disease is great; if it is very great, the case is fatal.

7.82 People over forty who get phrenitis seldom recover. The danger is smaller when the disease is one that suits the patient's nature and age.

7.83 When the eyes weep in an illness and the patient means them to, it is good; when they weep without his meaning it, it is bad.

7.84 When blood flows from the nose in quartan fevers, it is bad.

7.85 Sweats are dangerous when they do not come on the critical days (the days on which a crisis is to be expected); when they are violent and are forced quickly out of the forehead, in drops or in streams; and when they are very cold and heavy, since a sweat like that must come with violence, with pain beyond measure, and with long, crushing distress.

7.86 In a long-standing disease, a heavy downward flow from the bowels is bad.

7.87 What drugs do not cure, the knife cures; what the knife does not cure, fire cures; and what fire does not cure, you must reckon beyond cure.