De Medicina (Celsus)

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	De Medicina Author: Celsus	Translator: Walter George Spencer
17	Post haec indicia uotum est longum morbum fieri : si c enim necesse est , nisi occidit . Neque uitae alia spes in magnis malis est , quam ut impetum morbi trahendo aliquis effugiat porrigaturque in id tempus , quod curationi locum praestet . Protinus tamen signa quaedam sunt , ex quibus colligere possimus morbum , etsi non interemit , longius tamen tempus habiturum : ubi frigidus sudor inter febres non acutas circa caput tantum aut ceruices oritur , aut ubi febre non quiescente corpus insudat , aut ubi corpus modo frigidum modo calidum est et color alius ex alio fit , aut ubi , quod inter febres aliqua parte abscessit , ad sanitatem non peruenit , aut ubi aeger pro spatio parum emacrescit ; item si urina modo pura et liquida est , modo habet quaedam subsidentia , aut si leuia atque alba rubraue sunt , quae in ea subsidunt , aut si quasdam quasi m iculas repraesentat , aut si bull ulas excitat .	5 After such signs the only thing to pray for is that the disease may be a long one, for so it must be unless it kills. Nor is there any other hope of life in grave illnesses except that the patient may avoid the attack of the disease by protracting it, and that it may be prolonged for sufficient time to afford opportunity for treatment. At the onset, however, there are certain signs from which it is possible to conclude that the disease, even if it be not fatal, nevertheless is going to last rather a long time: when in fevers which are not acute a cold sweat breaks out over the head and neck only, or when there is general sweating without the fever subsiding, or when the patient is at one time cold, at another time hot, or his colour changes from moment to moment, or when in the course of fever there is a congestion in some part, which does not lead the way to recovery, or when the patient wastes a little for a considerable time, again if the urine is at one time clear and limpid, at another time has some sediment which is slimy, white or red, or if there is in the sediment an appearance of bread crumbs, or it sends up bubbles.
18	Sed inter haec quidem proposito metu spes tamen superest : ad ultima uero iam uentum esse testantur nares acutae , conlapsa tempora , oculi concaui , frigidae languidaeque aures et imis partibus leuiter auersae , cutis circa frontem dura et intenta : color aut niger aut perpallidus , multoque magis , si ita haec sunt , ut neque uigilia praecesserit neque uentris resolutio neque inedia . Ex quibus causis interdum haec spe cies oritur , sed uno die finitur : itaque diutius durans mortis index est . Si uero in morbo uetere iam triduo talis est , in propinquo mors est , magisque , si praeter haec oculi quoque lumen refugiunt et inlacrimant , quaeque in iis alba esse debent , rubescunt , atque in isdem uenulae pallent , pituitaque in iis innatans nouissime angulis inhaerescit , alterque ex his minor est , iique aut uehementer subsederunt , aut facti tumidiores sunt , perque somnum palpebrae non committuntur , sed inter has ex albo oculorum aliquid apparet , neque id fluens aluus expressit ; eaedemque palpebrae pallent , et idem pallor labra et nares decolorat ; eademque labra et nares oculique et palpebrae et supercilia aliquaue ex his peruertuntur ; isque propter inbecillitatem iam non audit , aut non uidet . Eadem mors denuntiatur , ubi aegri supini cubantis genua contracta sunt ; ubi is deorsum ad pedes subinde delabitur ; ubi brachia et crura nudat et inaequaliter dispergit , neque iis calor subest ; ubi hiat , ubi adsidue dormit ; ubi is , qui mentis suae non est , neque id facere sanus solet , dentibus stridet ; ubi ulcus , quod aut ante aut in ipso morbo natum est , aridum et aut pallidum aut liuidum factum est . Illa quoque mortis indicia sunt : ungues digitique pallidi , frigidus spiritus ; aut si manibus quis in febre et acuto morbo uel insania pulmonisue dolore uel capitis in ueste floccos legit fimbriasue deducit , uel in adiuncto pariete , si qua minuta eminent , ca rpit. Dolores etiam circa coxas et inferiores partes orti , si ad uiscera transierunt , subitoque desierunt , mortem subesse testantur , magisque si alia quoque signa accesserunt . Neque is seruari potest , qui sine ullo tumore febricitans subito strangulatur , aut deuorare saliuam suam non potest ; cuiue in eodem febris corporisque habitu ceruix conuertitur sic , ut deuorare aeque nihil possit ; aut cui simul et continua febris et ultima corporis infirmitas est ; aut cui febre non quiescente exterior pars friget , interior sic calet , ut etiam sitim faciat ; aut qui febre aeque non quiescente simul et delirio et spirandi difficultate uexatur ; aut qui epoto ueratro exceptus distentione neruorum est ; aut qui ebrius ommutuit : is enim neruorum distentione consumitur , nisi aut febris accessit , aut eo tempore , quo ebrietas solui debet , loqui coepit . Mulier quoque grauida acuto morbo facile consumitur ; et is , cui somnus dolorem auget ; et cui protinus in recenti morbo bilis atra uel infra uel supra se ostendit ; cuiue alterutr o modo se prompsit , cum iam longo morbo corpus eius esset extenuatum et adfectum . Sputum etiam biliosum et purulentum , siue separatim ista siue mixta proueniunt , interitus periculum ostendunt . Ac si circa septimum diem tale esse coepit , in proximum est , ut is circa quartum decimum diem decedat , nisi alia signa mitiora peioraue accesserint ; quae quo leuiora grauioraue subsecuta sunt , eo uel seriorem mortem uel maturiorem denuntiant . Frigidus quoque sudor in acuta febre pestifer est , atque in omni morbo uomitus , qui uarius et multorum colorum est , praecipueque si malus in hoc odor est . Ac sanguinem quoque in febre uomuisse pestiferum est . Vrina uero rubra et tenuis in magna cruditate esse consueuit , et saepe , antequam spatio maturescat , hominem rapit : itaque si talis diutius permanet , periculum mortis ostendit . Pessima tamen est praecipueque mortifera nigra , crassa , mali odoris ; atque in uiris quidem et mulieribus talis deterrima est : in pueris uero quae tenuis et diluta est . Aluus quoque uaria pestifera est , quae strigmentum , sanguinem , bilem , uiride aliquid , modo diuersis temporibus , modo simul , et in mixtura quadam , discreta tamen repraesentat . Sed haec quidem potest paulo diutius trahere : in praecipiti uero iam esse denuntiat , quae liuida eademque uel nigra uel pallida uel pinguis est , utique si magna foeditas odoris accessit . Illud interrogari me posse ab aliquo scio : si certa futurae mortis indicia sunt , quomodo interdum deserti a medicis conualescunt ? * * quosdamque fama prodiderit in ipsis funeribus reuixisse . Quin etiam uir iure magni nominis Democritus ne finitae quidem uitae satis certas notas esse proposuit , quibus medici credidissent : adeo illud non reliquit , ut certa aliqua signa futurae mortis essent . Aduersus quos ne dicam illud quidem , quod in uicino saepe quaedam notae positae non bonos sed inperitos medicos decipiunt , quod Asclepiades funeri obuius intellexit uiuere qui efferebatur ; nec protinus crimen artis esse , si quod professoris sit . Illa tamen moderatius subiciam , coniecturalem artem esse medicinam , rationemque coniecturae talem esse , ut , cum saepius aliquando responderit , interdum tamen fallat . Non si quid itaque uix in millensimo corpore aliquando decipit , id notam non habet , cum per innumerabiles homines respondeat . Idque non in is tantum , quae pestifera sunt , dico , sed in is quoque , quae salutaria ; siquidem etiam spes interdum frustratur , et moritur aliquis , de quo medicus securus primo fuit : quaeque medendi causa reperta sunt , nonnumquam in peius aliquid conuertunt . Neque id euitare humana inbecillitas in tanta uarietate corporum potest . Sed tamen medicinae fides est , quae multo saepius perque multo plures aegros prodest . Neque tamen ignorare oportet in acutis morbis fallaces magis notas esse et salutis et mortis .	6 But among the foregoing signs, though there are indeed grounds for fear, still there is hope left: however, that the last stage has now been reached is indicated by the nose becoming pointed, the temples sunken, the eyes hollowed, the ears cold and flaccid with the tips drooping slightly, the skin of the forehead hard and tight: the aspect is dusky or very pallid, and much more so when there has been no preceding insomnia, nor diarrhoea, nor loss of appetite. From which causes these appearances at times arise, but only last one day: and so when they last longer death is indicated. In the case of long-standing disease, when such signs have lasted for the third day, death is at hand, and the more so if besides this the eyes also shun the light and shed tears, and are reddened where they should be white, and the veins in them are pale, and phlegm floating in them comes to stick to the angles and one eye becomes smaller than the other, and either both are deep-sunken, or more tumid, and the eyelids are not closed in sleep, but some of the white of the eyes appears between them — always provided that this has not been occasioned by fluid motions; the same is the case when the eyelids become pale and a similar pallor renders colourless the lips and nostrils; so also when the lips and nostrils and eyes and eyebrows or any one of them become distorted; and the patient owing to weakness either hears not or sees not. Death is likewise denoted: when the patient lies on his back with his knees bent; when he keeps on slipping down towards the foot of the bed; when he uncovers his arms and legs and tosses them about anyhow, whilst they lack warmth; when he gapes, when he continually falls asleep; when he whose mind is amiss grinds his teeth, which he did not do in health; when an ulceration, whether pre-existing or arising in the course of the illness, has become dry and either pallid or livid. The following are also indications of death: the nails and fingers pallid; the breath cold; or if the patient, in a fever or acute disease, or mad or with pain either in the lung or head, picks with his hands at the flock or pulls at the fringes of the bedclothes, or claws at anything small projecting from the adjacent wall. Pains about the hips and lower parts, which, after starting and spreading to the viscera, then suddenly subside, afford evidence of oncoming death, and the more so if there are other signs in addition. It is impossible for a patient to be saved, who, having fever without any swelling, is suddenly choked, or who cannot swallow his saliva; or who, in the same condition of fever and body, has the neck twisted so that he can swallow nothing whatever; or who has continuous fever and is in the last stage of bodily weakness; or when, without the fever subsiding, the surface of the body becomes cold whilst the interior is so hot as even to produce thirst; or when, likewise without the fever subsiding, he is distressed at once by delirium and difficulty in breathing; or when, after a draught of hellebore, he is seized with spasm; or becoming drunk he loses his speech: for generally he is carried off in a spasm, unless either fever supervenes, or he begins to speak by the time that the intoxication should have passed off. A woman also when pregnant is easily carried of by an acute disease, as also a man in whom sleep aggravates pain, and one in whom, at the very beginning of a fresh disorder, black bile presents itself, whether below or above; or after his body has become attenuated by a long illness and weakened, when such bile gains exit either way. Expectoration of bile or pus, whether they come up separately or mixed, discloses a danger of death. And when either commences about the seventh day, the patient will most likely die about the fourteenth day, unless other signs, better or worse, supervene; and according as these subsequent signs are the slighter or the graver, so they denote a later or earlier death. In an acute fever a cold sweat is noxious, and so is a vomit in any malady when varied in composition and multicoloured, particularly so when malodorous. And to have vomited blood in a fever is also noxious. Now red and thin urine is usual in severe indigestion, and often, before there is time for it to mature, it carries the man off; and so when such urine persists for a rather long while, danger of death is indicated. The worst and especially death-bringing urine, however, is that which is black, thick, malodorous; such urine is most to be dreaded both in men and in women; but in children urine which is thin and diluted. A motion also is noxious: when varied in composition, when it presents shreds, blood, bile, greenish matter, whether at different times, or simultaneously mixed together yet distinguishable. But although it is possible for the patient to bear up awhile against such symptoms, a speedy termination is denoted, when the motion is livid and also when it is either black, or pallid, or fatty, especially if there is added an intensely fetid odour. I know that on this point someone may question me:— if there are such sure signs of approaching death, how is it that patients who have been deserted by their medical attendants sometimes recover? And rumour has spread it about that some have revived whilst being carried out to burial. Democritus, indeed, a man justly renowned, even held that the signs of life having ended, upon which practitioners had relied, were not sufficiently sure; much more did he not admit that there could be any sure signs of approaching death. In answer to these I shall not even assert that some signs, stated as approximately certain, often deceive inexperienced practitioners, but not good ones; for instance Asclepiades, when he met the funeral procession, recognized that a man who was being carried out to burial was alive; and it is not primarily a fault of the art if there is a fault on the part of its professor. But I shall more modestly suggest that the art of medicine is conjectural, and such is the characteristic of a conjecture, that though it answers more frequently, yet it sometimes deceives. A sign therefore is not to be rejected if it is deceptive in scarcely one out of a thousand cases, since it holds good in countless patients. I state this, not merely in connexion with noxious signs, but as to salutary signs as well; seeing that hope is disappointed now and again, and that the patient dies whom the practitioner at first deemed safe; and further that measures proper for curing now and again make a change into something worse. Nor, in the face of such a variety of temperaments, can human frailty avoid this. Nevertheless the medical art is to be relied upon, which more often, and in by far the greater number of patients, benefits the sick. It should not be ignored, however, that it is rather in acute diseases that signs, whether of recovery or of death, may be fallacious.
19	Sed cum proposuerim signa , quae in omni aduersa ualetudine communia esse consuerunt , eo quoque transibo , ut , quas aliquis in singulis morborum generibus habere possit notas , indicem . Quaedam autem sunt quae ante febres , quaedam quae inter eas , quid aut intus sit aut uenturum sit , ostendunt . Ante febres , si caput graue est , aut ex somno oculi caligant , aut frequentia sternumenta sunt , circa caput aliquis pituitae impetus timeri potest . Si sanguis aut calor abundat , proxumum est , ut aliqua parte profluuium sanguinis fiat . Si sine causa quis emacrescit , ne in malum habitum corpus eius recidat , metus est . Si praecordia dolent , aut inflatio grauis est , aut toto die non concocta fertur urina , cruditatem esse manifestum est . Quibus diu color sine morbo regio malus est , ii uel capitis doloribus conflictantur , uel terram edunt . Qui diu habent faciem pallidam et tumidam , aut capite aut uisceribus aut aluo laborant . Si in continua febre puero uenter nihil reddidit , mutaturque ei color , neque somnus accedit , ploratque is adsidue , metuenda neruorum distentio est . Frequens autem destillatio in corpore tenui longoque tabem timendam esse testatur . Vbi pluribus diebus non descendit aluus , docet aut subitam deiectionem aut febriculam instare . Vbi pedes turgent , longae deiectio nes sunt ; ubi dolor in imo uentre et coxis est , aqua inter cutem instat : sed hoc morbi genus ab ilibus oriri solet . Idem propositum periculum est iis , quibus uoluntas desidendi est , uenter nihil reddit nisi et aegre et durum , tumor in pedibus est , idemque modo dextra modo sinistra parte uentris inuicem oritur atque finitur : sed a iocinere id malum proficisci uidetur . Eiusdem morbi nota est , ubi circa umbilicum intestina torquentur ( ΣΤΡΟΦΟΥΣ Graeci nominant ) , coxaeque dolores manent , eaque neque tempore neque remediis soluuntur . Calor autem articulorum prout in pedibus manibusue aut alia qualibet parte sic est ut eo loco nerui contrahantur , aut si id membrum ex leui causa fatigatum aeque frigido calidoque offenditur , podagram cheragramue , uel eius articuli , in quo id sentitur , morbum futurum esse denuntiat . Quibus in pueritia sanguis ex naribus fluxit , deinde fluere desiit , uel capitis doloribus conflictentur necesse est , uel in articulis aliquas exulcerationes grauis habeant , uel aliquo morbo etiam debilitentur . Quibus feminis menstrua non proueniunt , necesse est capitis acerbissimi dolores sint , uel quaelibet alia pars morbo infestetur . Eademque iis pericula sunt , quibus articulorum uitia , dolores tumoresque , sine podagra similibusque morbis , oriuntur et desinunt , utique , si saepe tempora isdem dolent noctuque corpora insudant . Si fros prurit , lippitudinis metus est . Si mulier a partu uehementes dolores habet , neque alia praeterea signa mala sunt , circa uicensimum diem aut sanguis per nares erumpet , aut in inferioribus partibus aliquid abscedet . Quicumque etiam dolorem ingentem circa tempora et frontem habebit , is alterutra ratione eum finiet , magisque si iuuenis erit , per sanguinis profusionem , si senior , per suppurationem . Febris autem , quae subito sine ratione , sine bonis signis finita est , fere reuertitur . Cui sanguine fauces et interdiu et noctu replentur , sic ut neque capitis dolores neque praecordiorum neque tussis neque uomitus neque febricula praecesserit , huius aut in naribus aut in faucibus ulcus reperietur . Si mulieri inguen et febricula orta est , neque causa apparet , ulcus in uulua est . Urina autem crassa , ex qua quod desidet album est , significat circa articulos aut circa viscera dolorem metumque morbi esse . Eadem uiridis aut uiscerum dolorem tumoremque cum aliquo periculo subesse , aut certe corpus integrum non esse testatur . At si sanguis aut pus in urina est , uel uesica uel renes exulcerati sunt . Si haec crassa carunculas quasdam exiguas quasi capillos habet , aut si bullat et male olet , et interdum quasi harenam , interdum quasi sanguinem trahit , dolent autem coxae et quae inter has superque pubem sunt , et accedunt frequentes ructus , interdum uomitus biliosus , extremaeque partes frigescunt , urinae crebra cupiditas sed magna difficultas est , et quod inde excretum est , aquae simile uel rufum uel pallidum est , paulum tamen in eo leuamenti est , aluus uero cum multo spiritu redditur , utique in renibus uitium est . At si paulatim destillat , uel si sanguis per hanc editur , et in eo quaedam cruenta concreta sunt , idque ipsum cum difficultate redditur , et circa pubem inferiores partes delent , in eadem uesica uitium est . Calculosi uero his indiciis cognoscuntur : difficulter urina redditur paulatimque ; interdum etiam sine uoluntate destillat ; eadem harenosa est ; nonnumquam sanguis aut cruentum aut purulentum aliquid cum ea excernitur ; eamque quidam promptius recti , quidam resupinati , maximeque ii , qui grandes calculos habent , quidam etiam inclinati reddunt , colemque extendendo dolorem leuant . Grauitatis quoque cuiusdam in ea parte sensus est ; atque ea cursu omnique motu augentur . Quidam etiam , cum torquentur , pedes inter se , subinde mutatis uicibus , inplicant . Feminae uero oras naturalium suorum manibus admotis scabere coguntur : nonnumquam , si digitum admouerunt , ubi uesicae ceruicem is urguet , calculum sentiunt . At qui spumantem sanguinem excreant , iis in pulmone uitium est . Mulieri grauidae sine modo fusa aluus excutere partum potest . Eidem si lac ex mammis profluit , inbecillum est quod intus gerit : durae mammae sanum illud esse testantur . Frequens singultus et praeter consuetudinem continuus iecur inflammatum esse significat . Si tumores super ulcera subito esse desierunt , idque a tergo incidit , uel distentio neruorum uel rigor timeri potest : at si a priore parte id euenit , uel lateris acutus dolor uel insania expectanda est : interdum etiam eiusmodi casum , quae tutissima inter haec est , profusio alui sequitur . Si ora uenarum , sanguinem solita fundere , subito suppressa sunt , aut aqua inter cutem aut tabes sequitur . Eadem tabes subit , si in lateris dolore orta suppuratio intra quadraginta dies purgari non potuit . At si longa tristitia cum longo timore et uigilia est , atrae bilis morbus subest . Quibus saepe ex naribus fluit sanguis , iis aut lienis tumet , aut capitis dolores sunt , quos sequitur , ut quaedam ante oculos tamquam imagines obuersentur . At quibus magni lienes sunt , iis gingiuae malae sunt , et os olet , aut sanguis aliqua parte prorumpit ; quorum si nihil euenit , necesse est in cruribus mala ulcera , et ex his nigrae cicatrices fiant . Quibus causa doloris neque sensus eius est , his mens labat . Si in uentrem sanguis confluxit , ibi in pus uertitur . Si a coxis et inferioribus partibus dolor in pectus transit , neque ullum signum malum accessit , suppurationis eo loco periculum est . Quibus sine febre aliqua parte dolor aut prurigo cum rubore et calore est , ibi aliquid suppurat . Vrina quoque , quae in homine sano parum liquida est , circa aures futuram aliquam suppurationem esse denuntiat . Haec uero , cum sine febre quoque uel latentium uel futurarum rerum notas habeant , multo certiora sunt , ubi febris accessit , atque etiam aliorum morborum tum signa nascuntur . Ergo protinus insania timenda est , ubi expeditior alicuius , quam sani fuit , sermo subitaque loquacitas orta est , et haec ipsa solito audacior ; aut ubi raro quis et uehementer spirat , uenasque concitatas habet praecordiis duris et tumentibus . Oculorum quoque frequens motus , et in capitis dolore offusae oculis tenebrae , uel nullo dolore substante somnus ereptus , continuataque nocte et die uigilia , uel prostratum contra consuetudinem corpus in uentrem , sic ut ipsius alui dolor id non coegerit , item robusto adhuc corpore insolitus dentium stridor insaniae signa sunt . Si quid etiam abscessit , et antequam suppuraret manente adhuc febre subsedit , periculum adfert primum furoris , deinde interitus . Auris quoque dolor acutus cum febre continua uehementique saepe mentem turbat ; ex eo casu iuueniores interdum intra septimum diem moriuntur , seniores tardius , quoniam neque aeque magnas febres experiuntur , neque aeque insaniunt : ita sustinent , dum is adfectus in pus uer tatur. Suffusae quoque sanguine mulieris mammae furorem uenturum esse testantur . Quibus autem longae febres sunt , iis aut abscessus aliqui aut articulorum dolores erunt . Quorum faucibus in febre inliditur spiritus , instat his neruorum distentio . Si angina subito finita est , in pulmone m id malum transit ; idque saepe intra septimum diem occidit . Quod nisi incidat , sequitur , ut aliqua parte suppuret . Deinde post alui longam resolutionem tormina , post haec intestinorum leuitas oritur ; post nimias destillationes tabes , post lateris dolorem uitia pulmonum , post haec insania ; post magnos feruores corporis neruorum rigor aut distentio ; ubi caput uulneratum est , delirium ; ubi uigilia torsit , neruorum distentio ; ubi uehementer uenae super ulcera mouentur , sanguinis profluuium . Suppuratio uero pluribus morbis excitatur : nam si longae febres sine dolore , sine manifesta causa remanent , in aliquam partem id malum incumbit , in iuuenioribus tamen : nam senioribus ex eiusmodi morbo quartana fere nascitur . Eadem suppuratio fit , si praecordia dura , dolentia ante uicensimum diem hominem non sustulerunt , neque sanguis ex naribus fluxit , maximeque in adulescentibus , utique si inter principia aut oculorum caligo aut capitis dolores fuerunt : sed tum in inferioribus partibus aliquid abscedit . Aut si praecordia tumorem mollem habent , neque habere intra sexaginta dies desinunt , haeretque per omne id tempus febris ; sed tum in superioribus partibus fit abscessus ; ac si inter ipsa uiscera non f it , circa aures erumpit . Quo mque omnis longus tumor ad suppurationem fere spectet , magis eo tendit is , qui in praecordiis quam is , qui in uentre est ; is , qui supra umbilicum quam is , qui infra est . Si lassitudinis etiam sensus in febre est , uel in maxillis uel in articulis aliquid abscedit . Interdum quoque urina tenuis et cruda sic diu fertur , ut alia salutaria signa sint , exque eo casu plerumque infra transuersum septum , quod ΔΙΑΦΡΑΓΜΑ Graeci uocant , fit abcessus . Dolor etiam pulmonis , si neque etiam per sputa neque per sanguinis detractionem neque per uictus rationem finitus est , uomicas aliquas intus excitat aut circa uicesimum diem aut circa tricesimum aut circa quadragesimum , nonnumquam etiam circa sexagensimum . Numerabimus autem ab eo die , quo primum febricitauit aliquis aut inhorruit aut grauitatem eius partis sensit . Sed hae uomicae modo a pulmone modo a contraria parte nascuntur . Quod suppurat , ab ea parte , quam adficit , dolorem inflammationemque concitat : ipsum calidius est et , si in partem sanam aliquis decubuit , onerare eam ex pondere aliquo uidetur . Omnis etiam suppuratio , quae nondum oculis patet , sic deprehendi potest : si febris non dimittit , eaque interdiu leuior est , noctu increscit , multus sudor oritur , cupiditas tussiendi est , et paene nihil in tussi excreatur , oculi caui sunt , malae rubent , uenae sub lingua inalbescunt , in manibus fiunt adunci ungues , digiti maximeque summi calent , in pedibus tumores sunt , spiritus difficilius trahitur , cibi fastidium est , pustulae toto corpore oriuntur . Quod si protinus initio dolor et tussis fuit et spiritus difficultas , uomica uel ante uel circa uicesimum diem erumpet : si serius ista coeperint , necesse est quidem increscant , sed quo minus cito adfecerint , eo tardius soluentur . Solent etiam in graui morbo pedes cum digitis unguibusque nigrescere : quod si non est mors consecuta et reliquum corpus inualuit , pedes tamen decidunt .	7 Now that I have set out the signs which are of general occurrence in any case of illness, I pass on to indicate signs which may be presented in particular sorts of diseases. There are, moreover, certain signs, some preceding, some in the course of fevers, which show what is, or what is about to become, the state of the internal parts. Before fever, if the head is heavy, or the eyes dimmed after sleep, or there are frequent sneezings, some attack of phlegm about the head is to be apprehended. If a man is full blooded or very hot, it is likely that there will be haemorrhage from some part. If a man without cause becomes thin, there is fear that his body may lapse into a dangerous state. If there is pain below the ribs or severe flatulence, or if for a whole day undigested urine is passed, there is clearly indigestion present. Persons whose colour is bad when they are not jaundiced are either sufferers from pains in the head or are earth eaters. Those who for a long time have a pale or puffy face are sufferers from head, bowel or stomach trouble. If in the case of a child with constant fever no motion is passed, the colour is altered, and sleeplessness persists and constant crying, there is danger of spasms. Again running from the nose recurring often in a slender and tall man is a sign that consumption is to be apprehended. When for several days no motion passes, it shows that a sudden motion or a touch of fever is impending. Dropsy is impending, when with prolonged diarrhoea the feet swell; when there is pain in the lower belly and hips; but this class of disease is wont to arise from the flanks. There is danger, the same as just stated, to those in whom, when there is a desire for stool, the bowels yield nothing unless a forced hard motion; also in whom there is swelling in the feet, and a swelling in turn in the right and then the left half of the abdomen which rises and subsides: but this disease appears to begin from the liver. It is a sign of the same disease, when intestines in the umbilical region undergo twisting (the Greeks call it strophos), when pains in the hips persist, which are not dispersed either by time or by medicaments. But when heat of joints, whether in the feet, hands, or any other part, is such that at that spot the sinews are contracted, or if that same limb, fatigued by a slight cause, is disturbed by heat and by cold alike, it denotes that there is about to set in pain in feet or hands, or disease of that joint in which heat is felt. Children in whom there has been nose-bleeding, which then has ceased, are sure to be troubled by pains in the head, or they get some severe joint-ulcerations, or they also become debilitated by disease of some kind. Women in whom the menstrua are not forthcoming are sure to have the most acute pains in the head, or some part or other becomes subject to disease. There are similarly dangers for those in whom joint-disorders, pains and swellings, arise and subside without pain in the feet and such like diseases, especially if they have often pain in the temples and night sweats. Running from the eyes is to be apprehended when the forehead itches. If after childbirth a woman has severe pains, yet without other bad signs, about the twentieth day either blood will burst out from the nose, or there will be some congestion in the lower parts. Indeed anyone getting great pain in the temples or forehead may be rid of it in one of these two ways, by haemorrhage especially if young, if older by suppuration. Fever, moreover, which suddenly, unaccountably and without good signs comes to an end, generally recurs. He will be found to have ulceration either in the nose or in the throat, whose throat, whether in the day-time, or by night, fills with blood, when this has been preceded neither by pains in the head, nor by pain over the heart, nor by coughing, nor by vomiting, nor by slight fever. In a woman, if without apparent cause an inguinal swelling has arisen with slight fever, there is ulceration in the womb. Again thick urine, the sediment from which is white, indicates that pain and disease are to be apprehended in the region of joints or viscera. Similar urine, when greenish, is a sign that there will be either visceral pain and swelling with some danger, or certainly that the patient is not free from fever. But if there is blood or pus in the urine, either the bladder or the kidneys have become ulcerated. The kidneys at any rate are the seat of disorder: if the urine is thick and contains bits of flesh like hairs; if it froths and is malodorous; if at one time it presents something like sand, at another time like blood; when the hips are painful, as also the parts intermediate and above the pubes, and there are frequent eructations, now and again bilious vomiting, and the extremities become cold; when there is frequent desire to urinate but great urinary difficulty, and when what is passed is like water, reddish or pallid, yet is followed by little relief, and much wind too is passed with a motion. But the bladder is the actual seat of the disorder: when urine is passed drop by drop, or when blood is emitted with it, and in the blood are some clots which are passed with difficulty, and when the lower parts in the region of the pubes are painful. Cases of stone in the bladder are recognized by the following signs: urine is passed with difficulty and slowly, now and again even involuntarily, drop by drop, the urine being sandy; at times blood, or something blood-stained or purulent, is excreted with the urine; this some pass more readily standing, some whilst lying on the back and especially those with large calculi, some even pass urine bending forwards whilst they relieve the pain by drawing out the penis. There is in that part also a feeling of weight, increased by running, or by any kind of movement. Some also when in great pain interlock their feet, crossing alternately the one over the other. Women again are forced to put their hands to their vulvar orifice and scratch; at times they feel the stone when they put a finger to the place where it is pressing upon the neck of the bladder. But there is a lung disease in those who spit up frothy blood. In a pregnant woman immoderate looseness of the bowels can drive out the foetus; in the same condition, what she is carrying is a weakling, if milk escapes from her breasts; firm breasts testify that it is healthy. It signifies that the liver is inflamed when there is hiccough both frequent and continuing longer than usual. When swellings which have supervened upon ulcerations subside suddenly, if situated in the back, either spasm or rigor may be apprehended; but if this happens in front, either acute pleural pain or madness is to be expected: at times also in such a case, diarrhoea follows, which is the safest thing. If a customary bleeding from haemorrhoids is suddenly suppressed, dropsy or phthisis follows. Phthisis likewise supervenes if, after beginning with pain in the side, suppuration cannot be cleared off within forty days. And the black bile disease supervenes upon prolonged despondency with prolonged fear and sleeplessness. Those who often have bleeding from the nose, have swelling of the spleen, or pains in the head, and as a consequence some observe phantoms before their eyes. But those in whom the spleens are enlarged, in these the gums are diseased, the mouth foul, or blood bursts out from some part. When none of these things happen, of necessity bad ulcers will be produced on the legs, and from these black scars. In those who, with a cause for pain, do not feel it, the mind is disordered. If blood flows into the abdomen it is there turned into pus. There is danger of suppuration in the chest when pain spreads there from the hips and lower parts, even although no other bad sign is added. When, without any fever, there is pain or itching in some part, with redness and heat, some suppuration is taking place there. Also urine which is not limpid enough for a man in health denotes that some parotid suppuration is about to set in. Now these signs, though even in the absence of fever, they afford indications of latent or oncoming affections, do so with much more certainty when there is fever in addition; and then signs of other diseases besides may develop. Thus madness is to be apprehended immediately: when a patient speaks more hurriedly than he did when well, and of a sudden becomes loquacious, and that with more audacity than was his wont; or when he breathes slowly and forcibly, and has dilated blood-vessels, while the parts below the ribs are hard and swollen. Further signs of madness are: frequent movement of the eyes, and, in cases of headache, shadows passing before the eyes; or loss of sleep in the absence of pain, the wakefulness persisting night and day; or lying on the belly contrary to habit without being obliged to do so by abdominal pain; or, while the body is still vigorous, an unaccustomed grinding of the teeth. If also there has been congestion which has subsided without the formation of pus, whilst fever persists, there is brought about danger first of delirium, then of death. Acute pain in ear with continuous severe fever also often disturbs the mind; from which affection younger patients die at times within seven days; older ones later, for they experience neither such high fever, nor are equally delirious, hence they hold out until this condition is converted into pus. The breasts of a woman, when they become suffused with blood, also indicate that delirium is about to supervene. But in those in whom fevers are prolonged, there will be an abscess somewhere or pains in the joints. When during fever the breathing in the throat becomes impeded, spasms are impending. If angina subsides suddenly, the malady has passed into the lung; and it is then often fatal within seven days. If that does not happen, it follows that somewhere there is suppuration. Again after a prolonged looseness of the bowels there arise dysenteries, and after these intestinal lubricity; phthisis after excessive runnings from the nose; lung diseases after pain in the side; and from these madness; after ardent fevers rigor or spasm of sinews; after a head wound, delirium; when wakefulness tortures, spasms of sinews; when in wounds blood-vessels throb violently, haemorrhage. But suppuration is induced by many diseases; for if fever continues for a long while without pain and without evident cause, suppuration is developing in some part — in younger patients, however; for generally in the elderly from a self-same malady a quartan fever is developed. Suppuration is likewise being produced if the parts below the ribs are hard and painful, and have not carried off the patient by the twentieth day, or nose-bleeding has not occurred, and this chiefly in the case of adolescents, especially if from the commencement there has been dimness of vision, or headache; but in these cases something is abscessing in the lower parts of the abdomen. Or if the parts below the ribs present a soft swelling which persists and does not subside within sixty days, and fever holds all that time; but in these cases an abscess is being produced in the upper parts of the abdomen. And if it is not produced in the actual viscera, it breaks out around the ears. Whilst every swelling of long standing is generally an expectant abscess, it tends more to this in the region in front of the heart, than in the abdomen, and in the abdomen rather above than below the navel. Something is abscessing, either in the jaws or in the joints, if there is with the fever also a feeling of lassitude. At times too the urine remains thin and unconcocted for so long that other signs are salutary, and from this condition an abscess often occurs below the transverse membrane which the Greeks call diaphragma. Pain in the lung again, when not terminated by expectoration or by blood-letting, or by regulation of the diet, may excite some abscesses in it about the twentieth, thirtieth, fortieth, occasionally sixtieth day. But we will count from the day when there is first fever or shivering or sense of weight in that part. These abscesses originate sometimes from the lung, sometimes from the opposite side. Whichever side is affected the suppuration gives rise to pain in inflammation; it is hotter there, and if the patient lies on the sound side he seems to oppress it by some weight. Further, any suppuration, not yet evident to the eye, can be detected as follows: if the fever does not remit, but whilst diminishing by day, increases at night, there is profuse sweating, a desire to cough, yet hardly anything is expectorated in coughing; the eyes are sunken, the cheeks flushed, the veins under the tongue pale; the finger nails become curved, the fingers hot, especially at their tips; there are swellings in the feet; there is greater difficulty in breathing, and distaste for food; pustules spring up all over the body. But if there was pain from the commencement with cough and difficult breathing, the abscess will burst before or about the twentieth day; if these signs happen later they necessarily have to develop, but the less quickly they come to a head, the later the relief. In a grave disease the feet, toes and nails also tend to blacken; and when death does not follow, and the rest of the body recovers, nevertheless the feet fall off.
20	Sequitur , ut in quoque morbi genere proprias notas explicem , quae uel spem uel periculum ostendant . Ex uesica dolenti si purulenta urina processit , inque ea leue et album subsedit , metum detrahit . In pulmonis morbo si sputo ipso leuatur dolor , quamuis id purulentum est tamen aeger facile spirat , facile excreat , morbum ipsum non difficulter fert , potest ei secunda ualetudo contingere . Neque inter initia terreri conuenit , si protinus sputum mixtum est rufo quodam et sanguine , dummodo statim edatur . Laterum dolores suppuratione facta , deinde intra quadragesimum diem purgata , finiuntur . Si in iocinere uomica est , et ex ea fertur pus purum et album , salus facilis est : id enim malum in tunica est . Ex suppurationibus uero eae tolerabiles sunt , quae in exteriorem partem feruntur et acuuntur . At ex iis , quae intus procedunt , eae leuiores , quae contra se cutem non adficiunt , eamque et sine dolore esse et eiusdem coloris , cuius reliquae partes sunt , sinunt esse . Pus quoque , quacumque parte erumpit , si est leue , album , unius coloris , sine ullo metu est , et quo effuso febris protinus conquieuit desieruntque urguere cibi fastidium et potionis desiderium . Si quando etiam suppuratio descendit in crura , sputumque eiusdem factum pro rufo purulentum est , periculi minus est . At in tabe eius , qui saluus futurus est , sputum esse debet album , aequale totum , eiusdemque coloris , sine pituita ; eique etiam simile esse oportet , si quid in nares a capite destillat . Longe optimum est febrem omnino non esse ; secundum est tantulam esse , ut neque cibum inpediat neque crebram sitim faciat . Aluus in hac ualetudine ea tuta est , quae cotidie , quae coacta , quae conuenientia iis , quae adsumuntur , reddit ; corpus id , quod minime tenue maximeque lati pectoris atque saetosi est , cuiusque cartilago exigua et carnosa est . Super tabem si mulieri suppressa quoque menstrua fuerunt , et circa pectus atque scapulas dolor mansit subitoque sanguis erupit , leuari morbus solet : nam et tussis minuitur , et sitis atque febricula desinunt . Sed isdem fere , nisi redit sanguis , uomica erumpit ; quae quo cruentior , eo melior est . Aqua autem inter cutem minime terribilis est , quae nullo antecedente morbo coepit ; deinde , quae longo morbo superuenit , utique si firma uiscera sunt , si spiritus facilis , si nullus dolor , si sine calore corpus est , aequaliterque in extremis partibus macrum est , si mollis uenter , si nulla tussis , nulla sitis , si lingua ne super somnum quidem inarescit ; si cibi cupiditas est , si uenter medicamentis mouetur , si per se excernit mollia et figurata , si extenuatur ; si urina et uini mutatione et epotis aliquibus medicamentis mutatur ; si corpus sine lassitudine est et morbum facile sustinet : siquidem in quo omnia haec sunt , is ex toto tutus est ; in quo plura ex his sunt , is in bona spe est . Articulorum uero uitia , ut podagrae cheragraeque , si iuuenes temptarunt neque callum induxerunt , solui possunt ; maximeque torminibus leniuntur et quocumque modo uenter fluit . Item morbus comitialis ante pubertatem ortus non aegre finitur ; et in quo ab una parte corporis uenientis accessionis sensus incipit , optimum est a manibus pedibusue initium fieri , deinde a lateribus ; pessimum inter haec a capite . Atque in his quoque ea maxime prosunt , quae per deiectiones excernuntur . Ipsa autem deiectio sine ulla noxa est , quae sine febre est , si celeriter desinit , si cont acto uentre nullus motus eius sentitur , si extremam aluum spiritus sequitur . Ac ne tormina quidem periculosa sunt , si sanguis et strigmenta descendunt , dum febris ceteraeque accessiones huius morbi absint , adeo ut etiam grauida mulier non solum reseruari possit , sed etiam partum reseruare ; prodestque in hoc morbo , si iam aetate aliquis processit . Contra intestinorum leuitas facilius a teneris aetatibus depellitur , utique si ferri urina et ali cibo corpus incipit . Eadem aetas prodest et in coxae dolore et umerorum et omni resolutione neruorum ; ex quibus coxa , si sine torpore est , si leuiter friget , quamuis magnos dolores habet , tamen et facile et mature sanatur , resolutumque membrum , si nihilo minus alit ur, fieri sanum potest . Oris resolutio etiam aluo cita finitur ; omnisque deiectio lippienti prodest . At uarix ortus uel per ora uenarum subita profusio sanguinis uel tormina insaniam tollunt . Vmerorum dolores , qui ad scapulas uel manus tendunt , uomitu atrae bilis soluuntur ; et quisquis dolor deorsum tendit , sanabilior est . Singultus sternumento finitur . Longas deiectiones supprimit uomitus . Mulier sanguinem uomens profusis menstruis liberatur . Quae menstruis non purgatur , si sanguinem ex naribus fudit , omni periculo uacat . Quae locis laborat aut difficulter partum edit , sternumento leuatur . Aestiua quartana fere breuis est . Cui calor et tremor est , saluti delirium est . Lienosis bono tormina sunt . Denique ipsa febris , quod maxime mirum uideri potest , saepe praesidio est . Nam et praecordiorum dolores , si sine inflammatione sunt , finit ; et iocineris dolori succurrit ; et neruorum distentionem rigoremque , si postea coepit , ex toto tollit ; et ex difficultate urinae morbum tenuioris intestini ortum , si urinam per calorem mouet , leuat . At dolores capitis , quibus oculorum caligo et rubor cum quadam frontis prurigine accedunt , sanguinis profusione uel fortuita uel etiam petita summouentur . Si capitis ac frontis dolores ex uento uel frigore aut aestu sunt , grauedine et sternumentis finiuntur . Febrem autem ardentem , quam Graeci causoden uocant , subitus horror exsoluit . Si in febre aures obtunsae sunt , si sanguis naribus fluxit , aut uenter resolutus est , illud malum desinit ex toto . Nihil plus aduersus surditatem quam biliosa aluus potest . Quibus in fistula urinae ueluti minutiores abscessus , quos ΦΥΜΑΤΑ uocant , esse coeperunt , is , ubi pus ea parte profluxit , sanitas redditur . * * * Ex quibus cum pleraque per se proueniant , scire licet inter ea quoque , quae ars adhibet , naturam plurimum posse . Contra si ue sica cum febre continenti dolet , neque uenter quicquam reddit , malum atque mortiferum est ; maximeque id periculum est pueris a septimo anno ad quartum decimum . In pulmonis morbo , si sputum primis diebus non fuit , deinde a septimo die coepit et ultra septimum mansit , periculosum est ; quantoque magis mixtos neque inter se diductos colores habet , tanto deterius . Et tamen nihil peius est quam sincerum id edi , siue rufum est siue cruentum siue album siue glutinosum siue pallidum siue spumans ; nigrum tamen pessimum est . In eodem morbo periculosa sunt tussis , destillatio , etiam quod alias salutare habetur , sternumentum ; periculosissimumque est , si haec secuta subita deiectio est . Fere uero quae in pulmonis , eadem in lateris dolore et mitiora signa et asperiora esse consuerunt . Ex iocinere si pus cruentum exit , mortiferum est . At ex suppurationibus eae pessimae sunt , quae intus tendunt , sic ut exteriorem quoque cutem decolorent : ex is deinde , quae in exteriorem partem prorumpunt , eae pessimae , quae maximae quaeque planissimae sunt . Quod si , ne rupta quidem uomica uel pure extrinsecus emisso , febris quieuit , aut quamuis quierit , tamen repetit , item si sitis est , si cibi fastidium , si uenter liquidus , si pus est liuidum et pallidum , si nihil aeger excreat nisi pituitam spumantem , periculum certum est . Atque ex is quidem suppurationibus , quas pulmonum morbi concitarunt , fere senes moriuntur : ex ceteris iuniores . At in tabe sputum mixtum , purulentum , febris adsidua , quae et cibi tempora eripit et siti adfligit , in corpore tenui subesse periculum testantur . Si quis etiam in eo morbo diutius traxit , ubi capilli fluunt , ubi urina quaedam araneis similia subsidentia ostendit , atque in iis odor foedus est , maximeque ubi post haec orta deiectio est , protinus moritur , utique si tempus autumni est , quo fere qui cetera parte anni traxerunt , resoluuntur . Item pus expuisse in hoc morbo , deinde ex toto spuere desisse mortiferum est . Solent etiam in adulescentibus ex eo morbo uomicae fistulaeque oriri ; quae non facile sanescunt , nisi si multa signa bonae ualetudinis subsecuta sunt . Ex reliquis uero minime facile sanantur uirgines aut eae mulieres , quibus super tabem menstrua suppressa sunt . Cui uero sano subitus dolor capitis ortus est , dein somnus oppressit , sic ut stertat neque expergiscatur , intra septimum diem pereundum est ; magis si eum aluus cita non antecesserit , si palpebrae dormientis non coeunt , si album oculorum apparet . Quos tamen ita mors sequitur , si id malum non est febre discussum . At aqua inter cutem , si ex acuto morbo coepit , ad sanitatem raro perducitur , utique si contraria iis , quae supra posita sunt , subsecuntur . Aeque in ea quoque tussis spem tollit , item , si sanguis sursum deorsumque erupit et aqua medium corpus inplevit . Quibusdam etiam in hoc morbo tumores oriuntur , deinde desinunt , deinde rursus adsurgunt : hi tutiores quidem sunt , quam qui supra conprehensi sunt , si adtendun t ; sed fere fiducia secundae ualetudinis opprimuntur . Illud iure aliquis mirabitur , quomodo quaedam simul et adfligant nostra corpora , et parte aliqua tueantur : nam siue aqua inter cutem quem impleuit , siue in magno abscessu multum puris coit , simul id omne effudisse aeque mortiferum est , ac si quis sani corporis uulnere factus exsanguis est . Articulis uero qui sic dolent , ut super eos ex callo quaedam tubercula innata sint , numquam liberantur : quaeque eorum uitia uel in senectute coeperunt , uel ad senectutem ab adulescentia pervenerunt , ut aliquando leniri possunt , sic numquam ex toto finiuntur . Morbus quoque comitialis post annum XXV ortus aegre curatur , multoque aegrius is , qui post XL annum coepit , adeo ut in ea aetate aliquid in natu ra spei , uix quicquam in medicina sit . In eodem morbo si simul totum corpus adficitur , neque ante in partibus aliquis uenientis mali sensus est , sed homo inprouiso concidit , cuiuscumque is aetatis est , uix sanescit : si uero aut mens laesa est , aut neruorum facta resolutio , medicinae locus non est . Deiectionibus quoque si febris accessit , si inflammatio iocineris aut praecordiorum aut uentris , si inmodica sitis , si longius tempus , si aluus uaria , si cum dolore est , etiam periculum mortis subest , maximeque si inter haec tormina ue ra esse coeperunt ; isque morbus maxime pueros absumit usque ad annum decimum : ceterae aetates facilius sustinent . Mulier quoque gravida eiusmodi casu rapi potest ; atque , etiamsi ipsa conualuit , tamen partum perdit . Quin etiam tormina ab atra bile orsa mortifera sunt , aut si sub his extenuato iam corpore subito nigra aluus profluxit . At intestinorum leuitas periculosior est , si frequens deiectio est , si uenter omnibus horis et cum so no et sine hoc profluit ; si similiter noctu et interdiu , si , quod excernitur , aut crudum est aut nigrum et praeter id etiam leue et mali odoris ; si sitis urget , si post potionem urina non redditur ( quod euenit , quia tunc liquor omnis non in uesicam sed intestina descendit ) ; si os exulceratur , rubet facies et quasi maculis quibusdam colorum omnium distinguitur ; si uenter est quasi fermentatus , pinguis atque rugosus , si cibi et * * cupiditas non est ; inter quae cum euidens mors sit , multo euidentior est , si iam longum quoque id uitium est , id maxime etiam , si in corpore senili est . Si uero in tenuiore intestino morbus est , uomitus , singultus , neruorum distentio , delirium mala sunt . At in morbo arquato durum fieri iecur perniciosissimum est . Quos lienis male habet , si tormina prenderunt , deinde inuersa sunt uel in aquam inter cutem uel intestinorum leuitatem , uix ulla medicina periculo subtrahit . Morbus intestini tenuioris * * nisi resolutus est , intra septimum diem occidit . Mulier ex partu si cum febre uehementibus etiam et adsiduis capitis doloribus premitur , in periculo mortis est . Si dolor atque inflammatio est in iis partibus , quibus uiscera continentur , frequenter spirare signum malum est . Si sine causa longus dolor capitis est , et in ceruices ac scapulas transit , rursusque in caput reuertitur , aut a capite ad ceruices scapulasque peruenit , perniciosus est , nisi uomicam aliquam excitauit , sic ut pus extussiretur , aut nisi sanguis aliqua parte prorupit , aut nisi in capite multa porrigo totoue corpore pustulae ortae sunt . Aeque magnum malum est , ubi torpor atque prurigo peruagantur , modo per totum caput , modo in parte , aut sensus alicuius ibi quasi frigoris est , eaque ad summam quoque linguam perueniunt . Et cum in isdem abscessibus auxilium sit , eo difficilior sanitas est , quo minus saepe sub his malis illi subsecuntur . In coxae uero doloribus si uehemens torpor est , frigescitque crus et coxa , aluus nisi coacta non reddit , idque quod excernitur muccosum est , iamque aetas eius hominis XL annum excessit , is morbus erit longissimus minimeque ann uus, neque finiri poterit nisi aut uere aut autumno . Difficilis aeque curatio est in eadem aetate , ubi umerorum dolor uel ad manus peruenit uel ad scapulas tendit torporemque et dolorem creat , neque bilis uomitu leuatur . Quacumque uero corporis parte membrum aliquod resolutum est , si neque mouetur et emacrescit , in pristinum habitum non reuertitur , eoque minus , quo uetustius id uitium est , et quo magis in corpore senili est . Omnique resolutioni neruorum ad medicinam non idonea tempora sunt hiemps et autumnus : aliquid sperari potest uere et aestate ; is morbus mediocris uix sanatur , uehemens sanari non potest . Omnis etiam dolor minus medicinae patet , qui sursum procedit . Mulieri grauidae si subito mammae emacuerunt , abortus periculum est . Quae neque peperit neque grauida est , si lac habet , a menstruis defecta est . Quartana aestiua breuis , autumnalis fere longa est maximeque quae coepit hieme adpropinquante . Si sanguis profluit , dein secuta est dementia cum distentione neruorum , periculum mortis est , itemque si medicamentis purgatum et adhuc inanem neruorum distentio oppressit , item si in magno alui dolore extremae partes frigent . Neque is ad uitam redit , qui ex suspendio spumante ore detractus est . Aluus nigra , sanguini atro similis , repentina , siue cum febre siue etiam sine hac est , perniciosa est .	8 It follows now that I have to explain the special signs which in any particular affection indicate either hope or danger. When there is pain in the bladder, if purulent urine is discharged which has in it a sediment slimy and white, it allays apprehension. In pulmonary disease a patient may possibly regain health, if expectoration, although purulent, relieves pain, so long as he breathes and expectorates freely, and bears the disease without difficulty. Nor is there cause for alarm at an early stage, if the expectoration is mixed with something reddish and with blood, so long as it is expectorated at once. Pain in the side ends if the suppuration which has arisen is cleared off within forty days. If there is an abscess in the liver, and the pus let out is uniform and white, in that case recovery is easy, because the mischief is enclosed in a capsule. Among suppurations too those are tolerable which point and discharge outwards. And of those which move inwards, those are the most favourable which do not affect the overlying skin, but leave it free from pain, and of the same colour as the surroundings. Pus indeed causes no fear, wherever it breaks out, when slimy and uniformly white, and if the fever subsides at once upon its discharge, and distaste for food and thirst cease to be troublesome. Also whenever suppuration descends into the legs, and the patient's expectoration from being reddish becomes purulent, there is less danger. But in phthisis, he that is to recover should have his expectoration white, uniform in consistency and colour, unmixed with phlegm; and that which drips into the nose from the head should have similar characters. It is the best by far for there to be no fever; second best when the fever is so slight as not to impair the appetite or cause frequent thirst. In this affection the patient's state is favourable: when the bowels are moved once a day, the motions being formed and in amount corresponding to the food consumed; the body least attenuated, the chest most broad and hairy; its cartilages small, and covered with flesh. If supervening on phthisis, a woman's menses also become suppressed and pain is continuous over her chest and shoulders, a sudden eruption of blood customarily relieves the disease; for the cough becomes less, and the thirst and slight fever subside. But generally in these cases, unless the haemorrhage recurs, an abscess bursts, and the more blood comes from it the better. Dropsy is the least alarming when it has commenced without being preceded by any disease; next when it has supervened upon a long illness, certainly if the viscera are sound, if the breathing is easy, if there is no pain, if the body is not hot, and the extremities are wasted uniformly, if the abdomen is soft, if there is no cough, no thirst, if the tongue is not much parched even after sleep; if there is desire for food, if the bowels are moved by medicaments, if the motions when spontaneous are soft and formed, if the size of the abdomen are reduced; if the urine is altered both by a change of the wine and of certain medicinal draughts; if there is no lassitude and the disorder is easily borne: a patient who presents all these signs is thoroughly safe, and that case is hopeful which exhibits the greater number of them. Joint-disorders, too, such as foot and hand aches, if they attack young people and have not induced callosities, can be resolved; for the most part they are removed by dysenteries and fluid motions, whatever the sort. Epileptic fits again are not difficult to bring to an end, when they have commenced before puberty, and whenever the sensation of the coming fit begins in some one part of the body. It is best for it to begin from the hands or feet, next from the flanks, worst of all from the head. In such patients, also, the most favourable signs are when the disease can be discharged in the stools. Diarrhoea is itself harmless, when there is no fever, if it is quickly over, if on touching the abdomen no movements are to be felt, if wind follows the last of the motion. Even dysenteries are not a danger although blood or shreds are passed, as long as fever and other accessories of this malady are absent, so that even a pregnant woman can not only be preserved herself, but the foetus preserved also. It is helpful in this malady if the patient's age is already mature. Intestinal lubricity on the other hand is more easy got rid of in childhood, certainly if urine begins to be passed and the body to be nourished by the food. The same age has the advantage in cases both of hip and shoulder pains, and of all forms of para- lysis; in such the hip may be cured easily and early, if it is not numbed, if slightly cool, even though the pains are severe, and a paralysed limb can be restored if its nutrition is not at all impaired. Paralysis of the face may be even ended by a quick motion; and any purging benefits runnings of the eyes. But madness is relieved rather by the formation of varicose veins or by a sudden effusion of blood from haemorrhoids or by dysentery. Shoulder pains spreading to the shoulder-blades or hands are relieved by a vomit of black bile; and pain of any kind which moves downwards is the more curable. Sneezing puts an end to hiccough. Prolonged diarrhoeas are suppressed by vomiting. In a woman a vomiting of blood is relieved by menstruation; when not cleared up by menstruation, nose-bleeding removes all danger. A woman in trouble with her womb or labour difficulty is relieved by sneezing. Quartan fever in summer is mostly short. In a case of ardent fever with a tremor, delirium is salutary. For enlargement of the spleen dysenteries are good. Then again fever itself is in the end often a protection, which may appear very strange. For it brings to an end pains over the heart if there is no inflammation; and it also relieves a painful liver; and if it begins after spasm and rigor, it gives entire relief; and it removes the disease of the small intestine arising from urinary difficulty, if by its heat it promotes urination. Now pains in the head, accompanied by dimness of vision and redness of the eyes, along with some itching of the forehead, may be relieved by a haemorrhage, whether fortuitous or procured. Pains in the head and forehead due to wind or to cold or to heat are terminated by running from the nose and sneezings. The ardent fever, however, which the Greeks call causodes, is got rid of by a sudden shivering. During a fever, if the ears have become dulled, that trouble is entirely removed by a flux of blood from the nose, or by loose motions from the bowel. Against deafness nothing can be more efficacious than a bilious stool. Those who have begun to suffer from the smaller kinds of abscesses in the urethra which they call phumata, get well when pus has come away from that part. . . . and since they mostly arise of themselves, we may know that even where the resources of art are applied, nature can do the most. On the other hand, pain in the bladder with persistent fever, when nothing is passed by the bowel, is a fatal evil; the danger is greatest in boys from the seventh to the fourteenth year. In pulmonary disease, if there was no expectoration during the first days, if it then begins from the seventh day and persists beyond a further seven days, it is dangerous. And the more the sputum has an undistinguishable admixture of colours, the worse it is. But nevertheless nothing is worse than for the expectoration emitted to be homogeneous, whether reddish, or clotted, or white, or glutinous, or pallid, or frothy; worst of all, however, is the black. In this same disease the following are signs of danger: cough, catarrh, and even sneezing, which in other maladies is held salutary; and a sudden diarrhoea following upon the above is a most dangerous sign. Generally too the same signs hold good for pain in the side as for that in the lung, both the more favourable as well as the graver signs. If the pus discharged from the liver is bloody, it is a deadly sign. Now of suppurations the worst are those which tend inwards, whilst also discolouring the overlying skin: of those again which burst externally, the worst are those which are largest and most widespread. But even after the abscess has ruptured, or the pus has been let outwards, there is danger for certain if the fever does not subside, or although it subsides, nevertheless recurs; or further if there is thirst, if distaste for food, if liquid motions, if the pus is livid and pallid, if the patient expectorates nothing but frothy phlegm. And of such suppurations, old people die mostly of those excited by lung diseases; younger people of other kinds. But that in phthisis danger threatens a thin man is signified as follows: the expectoration is purulent with admixtures, a persistent fever robs him of his appetite at meal-times and afflicts him with thirst. Death is at hand if, after the patient has dragged on for a long while, the hair falls out, the urine exhibits sediment like cobwebs and has a foul odour, and most of all when upon the above diarrhoea supervenes; especially if it is the autumn season, when patients who have lasted through the rest of the year are generally undone. Moreover, in this disease, after pus has been expectorated, it is fatal for there to be an entire cessation of spitting. In the course of phthisis, even in adolescents, abscesses followed by fistulae arise in the lung; and unless numerous signs of convalescence follow, they do not readily heal. But as regards others, the least easily cured are girls, or those women in whom suppression of menses has supervened upon the phthisis. When again in a man who has been healthy there arises suddenly pain in the head, next he is so overcome by sleep that he snores and cannot be awaked, he will die by the seventh day; the more so, if a loose motion has not preceded, if the eyelids of the sleeper are unclosed and the whites of the eyes show. And in these cases death follows except if the malady has been dispersed by fever. Again dropsy, if caused by an acute disease, is seldom conducted to a cure, at any rate when signs supervene the reverse of those noted above. Likewise too in this disease a cough takes away hope as is also the case if there is an outburst of blood whether upwards or downwards and water fills the middle of the body. In some also in this disease swellings arise, then subside, and again recur: such patients are in a somewhat safer state than those mentioned above, if they give attention; but generally they are undone by over-confidence in their health. Here we may wonder with good reason why there should be occurrences which cause our bodies harm, and yet at the same time in a measure are beneficial: for whether it is dropsical fluid which has filled a patient up, or whether it is a quantity of pus which has collected in a large abscess, evacuation all at once is as fatal to him, as if a healthy man loses blood by a wound. Those too who suffer in their joints, so that growths of hard stuff are formed upon them, are never relieved entirely: all these damages, whether they have begun in old age, or have lasted from youth up to old age, although there is a possibility of some alleviation, are never entirely cured. Also fits which have arisen after the twenty-fifth year are hard to relieve, much harder when they begin after the fortieth; hence at this age, whilst there may be some hope from nature, there is scarcely any from the Art of Medicine. In this affection, if the whole body is affected all together, and there has not been beforehand in any part some feeling of an oncoming ill, but the patient falls down unexpectedly, he scarcely ever gets well, be his age what it may: further, if either the mind is diseased, or paralysis has been set up, there is no opportunity for the Art of Medicine. Again in cases of diarrhoea, danger of death is at hand: if there is fever in addition, if there is inflammation of the liver or of the parts over the heart or of the stomach, if excessive thirst, if the affection is prolonged; if the stools are varied and passed with pain, and especially if with these signs true dysenteries set in; and this disease carries off mostly children up to the age of ten; other ages bear it more easily. Also a pregnant woman can be swept away by such an event, and even if she herself recovers, yet she loses the child. Dysenteries are fatal, moreover, when originated by black bile, or if a black motion suddenly issues from a body already wasted by dysentery. Now intestinal lubricity is the more dangerous, if there is a frequent motion, if there is a flux from the bowel at all hours, with or without noise, if the same condition continues by night and in the day-time, if what is passed is either undigested or black, and besides that also slimy and foul; if there is urgent thirst, if urine is not passed after a drink (which happens because then all fluid passes down, not into the bladder, but into the intestine); if the mouth becomes ulcerated, the face reddened and marked as if by kinds of spots of all colours; if the belly is as though in a state of fermentation, fatty and wrinkled, also if there is no desire for food . . . ; while death is imminent in these circumstances, it is much more imminent if also this disease has already lasted a long while, especially if it be in an old patient. If again there is disease in the smaller intestine, vomiting, hiccough, spasm, delirium are bad signs. In jaundice again it is most pernicious for the liver to become hard. If dysentery has seized upon those with disease of the spleen which has then turned into dropsy or into leientery, scarcely any medical treatment can save them from danger. The disease of the smaller intestine, unless resolved, kills within seven days. A woman after childbirth is in danger of death, if also oppressed by violent and persistent pain in the head along with fever. To breathe rapidly is a bad sign if there is pain and inflammation in those parts which contain viscera. A prolonged pain in the head, if without cause it shifts to the neck and shoulders, and again returns to the head, or if it spreads from the head to reach the neck and shoulders, is most pernicious, unless it induces some abscess so that pus is coughed up, or unless there is an outburst of blood from some part, or unless there is upon the head an eruption of much scurf or of pimples all over the body. Equally severe is this malady when a numbness or an itching wanders, now all over the head, now over part of it, or there is felt there a sensation as of something cold, and when these symptoms extend to the tip of the tongue. And since the abscesses described above are beneficial, recovery is more difficult, in proportion as they supervene less often upon such maladies. When there are pains in the hips, if there is great numbness, and both the leg and hip become cold, if there is no movement of the bowel except forced, and the stool passed is mucous, and if the patient is already over forty, there will be a very prolonged illness, lasting at least a year, nor will it possibly come to an end except either in spring or in autumn. Treatment is likewise difficult at that age when pain in the shoulders either spreads to the hands or extending to the shoulder-blades gives rise to numbness and pain there, which is not relieved by a vomit of bile. Whatever too the part of the body, any limb which becomes paralysed if it is not moved and wastes, will not be restored to its former state, and the less so the longer the paralysis has been, and the older the patient. And for the cure of all cases of paralysis, winter and autumn are not favourable seasons; there is possibly hope in spring and summer; even when mild this disease is scarcely curable, a severe attack cannot be cured. All pain also becomes less amenable to treatment as it spreads upwards. In a pregnant woman, if the breasts suddenly shrivel up, there is danger of abortion. A woman has a defective menstruation who has milk in her breasts, not having just borne a child, or being pregnant. Quartan fever, whilst brief in summer, is generally prolonged in autumn, and especially so when beginning at the approach of winter. There is danger of death if haemorrhage is followed by dementia and by spasm; the same is the case when, after purgation by medicaments, and, with the bowel still empty, there is an attack of spasm, as also if with great pain in the bowel the extremities become cold. He does not return to life who has been taken down from hanging with foam around the mouth. A black stool resembling black blood, passed suddenly, whether accompanied by fever, or even without fever, is dangerous.