---
title: "On the Causes and Symptoms of Chronic Diseases · Περὶ αἰτίων καὶ σημείων χρονίων παθῶν"
author: "Aretaeus"
translator: "Francis Adams"
languages: [grc, en]
shelf: "Classical Greek"
url: https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/
cite: "Aretaeus, tr. Francis Adams, On the Causes and Symptoms of Chronic Diseases · Περὶ αἰτίων καὶ σημείων χρονίων παθῶν. Scriptura (scriptura.si), https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/"
---

# On the Causes and Symptoms of Chronic Diseases · Περὶ αἰτίων καὶ σημείων χρονίων παθῶν

*Aretaeus, tr. Francis Adams*

Epilepsy, melancholy, mania, asthma, consumption and the first clinical description of diabetes.

> Greek: ed. Francis Adams, from the Perseus Digital Library (canonical-greekLit, tlg0719.tlg002, CC BY-SA 4.0).

> English: Francis Adams, from the Perseus Digital Library (tlg0719.tlg002.perseus-eng2). Notes are not included.

> Rows follow the references the two texts share (books, chapters and sections), cut where both reach the end of a sentence.

## Contents

1. [Book I · chapters 1–7](https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/1.md)
2. [Book I · chapters 7–12](https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/2.md)
3. [Book I · chapters 13–16](https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/3.md)
4. [Book II · chapters 1–5](https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/4.md)
5. [Book II · chapters 6–11](https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/5.md)
6. [Book II · chapters 12–13](https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/6.md)

## 1. Book I · chapters 1–7

Source: https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/1/ · cite a paragraph as https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/1/#p-N

[¶0] 1. OF chronic diseases the pain is great, the period of wasting long, and the recovery uncertain; for either they are not dispelled at all, or the diseases relapse upon any slight error; for neither have the patients resolution to persevere to the end; or, if they do persevere, they commit blunders in a prolonged regimen. And if there also be the suffering from a painful system of cure,—of thirst, of hunger, of bitter and harsh medicines, of cutting or burning,—of all which there is sometimes need in protracted diseases, the patients resile as truly preferring even death itself. Hence, indeed, is developed the talent of the medical man, his perseverance, his skill in diversifying the treatment, and conceding such pleasant things as will do no harm, and in giving encouragement. But the patient also ought to be courageous, and co-operate with the physician against the disease. For, taking a firm grasp of the body, the disease not only wastes and corrodes it quickly, but frequently disorders the senses, nay, even deranges the soul by the intemperament of the body. Such we know mania and melancholy to be, of which I will treat afterwards. At the present time I shall give an account of cephalæa.

> Greek: 1. χρονίων νούσων πόνος μὲν πουλὺς, χρόνος δὲ μακρὸς συντήξιος, καὶ ἀβέβαιος ἡ ἄλθεξις. ἢ γὰρ οὐδʼ ἐξηλάθησαν ἐς τὸ πάμπαν, ἢ ἐπὶ σμικρῇ ἁμαρτωλῇ παλινδρομέουσι αἱ νοῦσοι. οὔτε γὰρ ἀτρεμέειν οἱ νοσέοντες τολμέουσι ἐς τέλος· ἀτὰρ ἠδὲ ἁμαρτάνουσι ἐν τῇσι μακρῇσι διαίτῃσι, κἢν ἀτρεμέωσι· ἢν δὲ καὶ πόνος ἔῃ ἐπιπόνου ἰήσιος, δίψης, λιμοῦ, φαρμάκων πικρῶν καὶ ὀδυνωδέων, ἢ τομῆς, ἢ καύσιος, ὧνπέρ ἐστι ἐν τῇσι δολιχῇσι νούσοισι χρέος, ὑποδιδρήσκουσι οἱ κάμνοντες, ὡς θανάτου δῆθεν αὐτέου ὀρεγόμενοι. ἔνθα δὴ ἀρετὴ διαείδεται ἀνδρὸς ἰητροῦ, καὶ μακροθυμίης, καὶ ποικιλίης, καὶ χάριτος ἀβλαβοῦς τῶν ἡδέων, καὶ παραιφάσιος· ἀτὰρ καὶ τὸν νοσέοντα χρὴ ἄλκιμον ἔμμεναι, καὶ ξυνίστασθαι τῷ ἰητρῷ κατὰ τοῦ νοσήματος. οὐ γὰρ τοῦ σώματος μοῦνον ἀπρὶξ λαβόμενον ταχὺ ἀνασμύχει τε καὶ δάπτει, ἀλλὰ ἐς πολλὰ καὶ τὴν αἰσθησίην ἐκτρέπει, ἀλλὰ καὶ τὴν ψυχὴν ἐκμαίνει ἀκρασίῃ τοῦ σώματος. τοιήνδε τὴν μανίην καὶ τὴν μελαγχολίην ἴσμεν, περὶ ὧν αὖθις ἐρέω· τανῦν δʼ ἀμφὶ κεφαλαίης φράσω.

[¶1] 2. IF the head be suddenly seized with pain from a temporary cause, even if it should endure for several days, the disease is called Cephalalgia. But if the disease be protracted for a long time, and with long and frequent periods, or if greater and more untractable symptoms supervene, we call it Cephalæa. There are infinite varieties of it; for, in certain cases, the pain is incessant and slight, but not intermittent; but in others it returns periodically, as in quotidian fevers, or in those which have exacerbations every alternate day: in others it continues from sunset to noon, and then completely ceases; or from noon to evening, or still further into night; this period is not much protracted. And in certain cases the whole head is pained; and the pain is sometimes on the right and sometimes on the left side, or the forehead, or the bregma; and these may all occur the same day in a random manner. But in certain cases, the parts on the right side, or those on the left solely, so far that a separate temple, or ear, or one eyebrow, or one eye, or the nose which divides the face into two equal parts; and the pain does not pass this limit, but remains in the half of the head. This is called Heterocrania, an illness by no means mild, even though it intermits, and although it appears to be slight. For if at any time it set in acutely, it occasions unseemly and dreadful symptoms; spasm and distortion of the countenance take place; the eyes either fixed intently like horns, or they are rolled inwardly to this side or to that; vertigo, deep-seated pain of the eyes as far as the meninges; irrestrainable sweat; sudden pain of the tendons, as of one striking with a club; nausea; vomiting of bilious matters; collapse of the patient; but, if the affection be protracted, the patient will die; or, if more slight and not deadly, it becomes chronic; there is much torpor, heaviness of the head, anxiety, and ennui. For they flee the light; the darkness soothes their disease: nor can they bear readily to look upon or hear anything agreeable; their sense of smell is vitiated, neither does anything agreeable to smell delight them, and they have also an aversion to fetid things: the patients, moreover, are weary of life, and wish to die. The cause of these symptoms is coldness with dryness. But if it be protracted and increase, as regards the pains, the affection becomes Vertigo.

> Greek: 2. ἢν ἀλγέῃ κεφαλὴ σχεδίως ἐπὶ προσκαίρῳ αἰτίῃ, κἢν ἐπὶ πλεῦνας, κεφαλαλγίη καλέεται. ἢν δὲ διεθίζῃ χρόνῳ μακρῷ τὸ ἄλγημα, καὶ περιόδοισι μακρῇσι καὶ πολλῇσι, καὶ προσεπιγίγνηται μέζω τε καὶ πλεῦνα δυσαλθῆ, κεφαλαίην κικλήσκομεν. ἰδέαι δὲ μυρίαι. τισὶ μὲν γὰρ ἀΐδιος ὁ πόνος καὶ σμικρὸς, ἀλλʼ οὐ διαλείπων· τισὶ δὲ ἐς περίοδον περιπλεῖ, ὅκως τοῖσι πυρεταίνουσι ἀμφημερινὸν παρʼ ἡμέρην· ἄλλοισι δʼ ἀπὸ δύσιος ἐς μεσημβρίην, καὶ τῇδε τέλεον ἀποπαύεται· ἢ ἀπὸ μεσημβρίης ἐς ἐσπέρην· ἢ ἐπίπροσθεν ἐς νύκτα. ἥδε ἡ περίοδος οὐ κάρτα δηθύνει· καὶ τοῖσι μὲν ἡ κεφαλὴ ἀλγέει πᾶσα· καὶ ἥδε ἄλλοτε μὲν ἐπὶ δεξιά· ἄλλοτε δὲ ἐπʼ ἀριστερά· ἢ μέτωπον, ἢ βρέγμα, καὶ ταῦτα ἐν τῇ αὐτῇ ἡμέρῃ Ῥεμβώδεα τρόπον. τοῖσι δὲ καὶ τὰ δεξιὰ μοῦνον, ἢ τὰ λαιὰ μοῦνον, ἐς ὅσον ὁρίζων κρόταφος, ἢ ὦς, ἢ καὶ ὀφρὺς μία, ἢ ὀφθαλμὸς εἷς, ἢ Ῥὶς μέσφι μέσου ἐς ἶσα τέμνει, ἐπέκεινα δὲ τὸ ἄλγημα οὐ περῇ ἀλλʼ ἐν ἡμίσεϊ μίμνει τῷ τῆς κεφαλῆς χωρίῳ. ἑτεροκρανίη τόδε μοῦνον καλέεται· οὐκ εὔηθες κακὸν, κἢν διαλείπῃ, κἢν σμικρὸν ἔμμεναι δοκέῃ· ἢν γὰρ ἐμπέσῃ κοτὲ ὀξέως, αἰσχρὰ καὶ δεινὰ πρήσσει· σπασμὸς καὶ διαστροφὴ τοῦ προσώπου γίγνεται· ὀφθαλμοὶ ἢ ἀτενέες κέρασι ἴκελοι πεπήγασι, ἢ τῇδε κἀκεῖσε σπασμώδε ες ἔνδον εἱλῶνται· σκοτόδινος· ὀφθαλμῶν ὑποβρύχιος πόνος ἄχρι μηνίγγων. ἱδρὼς ἄσχετος, τενόντων ἐξαπίνης ἄλγος, ὡσπερεί τινος πατάξαντος ξύλῳ· ναυτίη, ἔμετος χολωδέων, κατάπτωσις τοῦ ἀνθρώπου· ἢν δʼ ἐπιτείνῃ κοτὲ τὸ πάθος, ὥνθρωπος ἐτελεύτησε. ἢν δὲ σμικρότερονᾖ, καὶ ἐς ὄλεθρονἀσινὲς, χρονίζει, ὄκνος πουλὺς, καρηβαρίη, ἀπορίη, ζωὴ δύσφορος. καὶ γάρ πως φεύγουσι τὴν αὐγήν· σκότος δὲ πρηο̈́νει τουτέοισι τὴν νοῦσον· οὐ δὲ ἐσιδεῖν τι ἢ ἀκοῦσαι τερπνὸν εὔφοροι· κάκοδμοι τὴν ὄσφρησιν, καὶ οὔτε τι εὐῶδες αὐτέους τέρπει, ἐκτρέπονται δὲ καὶ τὰ κακώδεα· ἄχθονται τῷ βίῳ, θανατῶσι ὥνθρωποι. αἰτίη δὲ τουτέων ξὺν ξηρότητι ψύξις· ἢν δὲ δηθύνῃ καὶ ἐς μέζον ἕρπῃ ἐπὶ τοῖσι πόνοισι, τὸ πάθος σκότωμα γίγνεται.

[¶2] 3. IF darkness possess the eyes, and if the head be whirled round with dizziness, and the ears ring as from the sound of rivers rolling along with a great noise, or like the wind when it roars among the sails, or like the clang of pipes or reeds, or like the rattling of a carriage, we call the affection Scotoma (or Vertigo); a bad complaint indeed, if a symptom of the head, but bad likewise if the sequela of cephalæa, or whether it arises of itself as a chronic disease. For, if these symptoms do not pass off, but the vertigo persist, or if, in course of time, from the want of any one to remedy, it is completed in its own peculiar symptoms, the affection vertigo is formed, from a humid and cold cause. But if it turn to an incurable condition, it proves the commencement of other affections—of mania, melancholy, or epilepsy, the symptoms peculiar to each being superadded. But the mode of vertigo is, heaviness of the head, sparkles of light in the eyes along with much darkness, ignorance of themselves and of those around; and, if the disease go on increasing, the limbs sink below them, and they crawl on the ground; there is nausea and vomitings of phlegm, or of yellow or black bilious matter. When connected with yellow bile, mania is formed; when with black, melancholy; when with phlegm, epilepsy; for it is liable to conversion into all these diseases.

> Greek: 3. ἢν ζόφος τὰς ὄψιας σχῇ, καὶ δῖνος ἀμφὶ τὴν κεφαλὴν ἑλίσσηται, καὶ ὦτα βομβέῃ ὅκως Ῥεόντων καναχηδὸν ποταμῶν, ἢ οἷον ἄνεμος ἱστίοισι ἐγκυβερνῆ, ἢ αὐλῶν, ἢ καὶ συρίγγων ἐνοπὴ, ἢ τρισμοῦ ἁμάξης ἰαχὴ, ὀνομάζο μεν σκότωμα τὸ πάθος, κακὸν μὲν, κἢν σύμπτωμα κεφαλῆς, κακὸν δὲ, κἢν ἐκ διαδέξιος κεφαλαίης, ἢ ἐξ ἑωυτέης χρονίου νούσου φύῃ. ἢν γὰρ τάδε μὲν μὴ ἀπογίγνηται, μίμνῃ δὲ ἡ σκοτοδίνη, ἢ χρόνῳ μακρῷ τελεωθῇ τοῖσι ἰδίοισι συμπτώμασι οὔ τινος ἀκεομένου, πάθος τὸ σκότωμα γίγνεται, ἐπʼ αἰτίῃ ὑγρῇ τε καὶ ψυχρῇ· ἀλλὰ καὶ ἀρχὴ παθέων ἄλλων, ἢν ἐς ἀνήκεστον τραπῇ, μανίης, μελαγχολίης, ἐπιληψίης, προσεπιγιγνομένων ἑκάστῃ τῶν ἰδίων ξυμπτωμάτων· σκοτάματος δὲ ἡ ἰδέα, βάρος τῆς κεφαλῆς, ὀφθαλμῶν μαρμαρυγαὶ ἐπὶ πολλῷ τῷ σκοτώδεϊ· ἀγνωσίη ἑωυτέων τε καὶ τῶν πέλας· καὶ ἢν ἐπʼ αὐξήσει ἡ νοῦσος γίγνηται, τά τε γυῖα λύονται, καὶ ἕρπονται χαμαί· ναυτίη καὶ ἔμετος φλέγματ ος, ἢ χολωδέων, ξανθῶν, ἢ μελάνων. εὖτε ἐπὶ μὲν ξανθῇ χολῇ, μανίαι γίγνονται· ἐπὶ δὲ τοῖσι μέλασι, μελαγχολίη· ἐπὶ δὲ τῷ φλέγματι, ἡ ἐπιληψίη. πασῶν γὰρ ἥδε νούσων τροπή.

[¶3] 4. EPILEPSY is an illness of various shapes and horrible; in the paroxysms, brutish, very acute, and deadly; for, at times, one paroxysm has proved fatal. Or if from habit the patient can endure it, he lives, indeed, enduring shame, ignominy, and sorrow: and the disease does not readily pass off, but fixes its abode during the better periods and in the lovely season of life. It dwells with boys and young men; and, by good fortune, it is sometimes driven out in another more advanced period of life, when it takes its departure along with the beauty of youth; and then, having rendered them deformed, it destroys certain youths from envy, as it were, of their beauty, either by loss of the faculties of a hand, or by the distortion of the countenance, or by the deprivation of some one sense. But if the mischief lurk there until it strike root, it will not yield either to the physician or the changes of age, so as to take its departure, but lives with the patient until death. And sometimes the disease is rendered painful by its convulsions and distortions of the limbs and of the face; and sometimes it turns the mind distracted. The sight of a paroxysm is disagreeable, and its departure disgusting with spontaneous evacuations of the urine and of the bowels. But also it is reckoned a disgraceful form of disease; for it is supposed, that it is an infliction on persons who have sinned against the Moon: and hence some have called it the Sacred Disease, and that for more reasons than one, as from the greatness of the evil, for the Greek word ἱερὸς also signifies great; or because the cure of it is not human, but divine; or from the opinion that it proceeded from the entrance of a demon into the man: from some one, or all these causes together, it has been called Sacred. Such symptoms as accompany this disease in its acute form have been already detailed by me. But if it become inveterate, the patients are not free from harm even in the intervals, but are languid, spiritless, stupid, inhuman, unsociable, and not disposed to hold intercourse, nor to be sociable, at any period of life; sleepless, subject to many horrid dreams, without appetite, and with bad digestion; pale, of a leaden colour; slow to learn, from torpidity of the understanding and of the senses; dull of hearing; have noises and ringing in the head; utterance indistinct and bewildered, either from the nature of the disease, or from the wounds during the attacks; the tongue is rolled about in the mouth convulsively in various ways. The disease also sometimes disturbs the understanding, so that the patient becomes altogether fatuous. The cause of these affections is coldness with humidity.

> Greek: 4. ποικίλον ἠδὲ ἀλλόκοτον κακὸν ἡ ἐπιληψίη, θηριῶδες μὲν ἐν παροξυσμοῖσι καὶ κάτοξυ καὶ ὀλέθριον. ἔκτεινε γάρ κοτε παροξυσμὸς εἷς· ἢν δὲ μελέτῃσι φέρῃ ὥνθρωπος, ζῇ μὲν αἴσχεα καὶ ὀνείδεα καὶ ἄλγεα φέρων, Ῥηϊδίως δὲ οὐκ ἄπεισι ἡ νοῦσος, ἀλλὰ ἐν ἡλικίῃσί τε τῇσι κρείττοσι ἐνοικέει καὶ ὥρῃ τῇ ὡραίῃ. ξυνδιαιτᾶταί τε παισὶ καὶ μειρακίοισι. ἐξηλάθη δέ κοτε ὑπʼ εὐτυχίης, διʼ ἄλλης ἡλικίης μέζονος, εὖτε τῷ κάλλεϊ συνέξεισι τῆς ὥρης· ἀλλὰ καὶ τότε μετεξετέρους αἰσχροὺς ἀποδείξασα, ἀπόλλυσι τοὺς παῖδας φθόνῳ τοῦ κάλλεος, ἢ χειρὸς ἀκρασίῃ, ἢ προσώπου διαστροφῇ, ἢ πηρώσι τινὸς αἰσθήσιος· ἢν δὲ φωλεύσῃ τὸ κακὸν ἐς Ῥίζην, οὔτε ἰητρῷ οὔτε ἡλικίης μεταβολαῖς ἐς ἔξοδον πείθεται, ἀλλὰ ξυμβιοῖ μέσφι θανάτου. ποτὶ καὶ ἐπίπονος ἡ νοῦσος σπασμοῖσι καὶ διαστροφῇσι μελέων τε καὶ ὄψιος, ἔτρεψε δέ κοτε καὶ γνώμην ἐς μανίην. ἀτερπὴς μὲν ἡ τοῦ παροξυσμοῦ θέη, αἰσχρὴ δὲ καὶ ἡ ἀπόλειψις αὐτέου, ἐπὶ ἀφόδῳ καὶ οὔροισι καὶ αὐτομάτῳ κοιλίῃ. ἀλλὰ καὶ ἄδοξος ἡ ξυμμορφή· δοκέει γὰρ τοῖσι ἐς τὴν σελήνην ἀλιτροῖσι ἀφικνεῖ σθαι ἡ νοῦσος· τοὔνεκεν ἱερὴν κικλήσκουσι τὴν πάθην· ἀτὰρ καὶ διʼ ἄλλας προφάσιας, ἢ μέγεθος τοῦ κακοῦ· ἱερὸν γὰρ τὸ μέγα· ἢ ἰήσιος οὐκ ἀνθρωπίνης, ἀλλὰ θείης, ἢ δαίμονος δόξης ἐς τὸν ἄνθρωπον εἰσόδου, ἢ ξυμπάντων ὁμοῦ, τήνδε ἐκίκλησκον ἱερήν. ὁκόσα μὲν οὖν ὡς ἐπὶ ὀξείῃ γίγνεται τῇ νούσῳ, πρόσθεν μοι λέλεκται· ἢν δὲ ἐν χρόνῳ μίμνῃ, οὐδὲ ἐπὶ τοῖσι διαλείμμασι ἀσινέες, νωθροὶ, ἄθυμοι, κατηφέες, ἐξάνθρωποι, ἄμικτοι, οὐδὲ ἡλικίῃσι μειλίχιοι, ἄγρυπνοι, δυσόνειροι πολλοῖσι ἀλλοκότοισι, ἀπόσιτοι, πέψαι κακοὶ, ἄχροοι, μολιβδώδεες, δυσμαθέες νωθείῃ γνώμης τε καὶ αἰσθήσιος, βαρυήκοοι, ἦχοι, βόμβοι ἀνὰ τὴν κεφαλήν. γλῶσσα ἀσαφὴς καὶ παράφορος· ἢ ὑπὸ τῆς διαθέσιος τῆς νούσου, ἢ ὑπὸ τρωμάτων ἐν τῇσι καταλήψεσι, σπασμώδεες. γλῶσσα μὲν στρωφᾶται ἐν τῷ στόματι ποικίλως· ὑποτείνεται δέ κοτε καὶ τὴν διάνοιαν ἡ νοῦσος, ὡς τὰ πάντα μωραίνειν· ἀτὰρ καὶ τοῖσδε αἰτίη ξὺν ὑγρότητι ψύξις.

[¶4] 5. BLACK bile, if it make its appearance in acute diseases of the upper parts of the body, is very dangerous; or, if it pass downwards, it is not free from danger. But in chronic diseases, if it pass downward, it terminates in dysentery and pain of the liver. But in women it serves as a purgation instead of the menses, provided they are not otherwise in a dangerous condition. But if it be determined upwards to the stomach and diaphragm, it forms melancholy; for it produces flatulence and eructations of a fetid and fishy nature, and it sends rumbling wind downwards, and disturbs the understanding. On this account, in former days, these were called melancholics and flatulent persons. And yet, in certain of these cases, there is neither flatulence nor black bile, but mere anger and grief, and sad dejection of mind; and these were called melancholics, because the terms bile (χολὴ) and anger (ὀργὴ) are synonymous in import, and likewise black (μέλαινα), with much (πολλὴ) and furious (θηριώδης). Homer is authority for this when he says:— “Then straight to speak uprose The Atreidan chief, who `neath his sway a wide-spread empire held: Sore vexed was he; his mighty heart in his dark bosom swelled With rage, and from his eyes the fire like lightning-flashes broke.” The melancholics become such when they are overpowered by this evil. It is a lowness of spirits from a single phantasy, without fever; and it appears to me that melancholy is the commencement and a part of mania. For in those who are mad, the understanding is turned sometimes to anger and sometimes to joy, but in the melancholics to sorrow and despondency only. But they who are mad are so for the greater part of life, becoming silly, and doing dreadful and disgraceful things; but those affected with melancholy are not every one of them affected according to one particular form; but they are either suspicious of poisoning, or flee to the desert from misanthropy, or turn superstitious, or contract a hatred of life. Or if at any time a relaxation takes place, in most cases hilarity supervenes, but these persons go mad. But how, and from what parts of the body, the most of these complaints originate, I will now explain. If the cause remain in the hypochondriac regions, it collects about the diaphragm, and the bile passes upwards, or downwards in cases of melancholy. But if it also affects the head from sympathy, and the abnormal irritability of temper change to laughter and joy for the greater part of their life, these become mad rather from the increase of the disease than from change of the affection. Dryness is the cause of both. Adult men, therefore, are subject to mania and melancholy, or persons of less age than adults. Women are worse affected with mania than men. As to age, towards manhood, and those actually in the prime of life. The seasons of summer and of autumn engender, and spring brings it to a crisis. The characteristic appearances, then, are not obscure; for the patients are dull or stern, dejected or unreasonably torpid, without any manifest cause: such is the commencement of melancholy. And they also become peevish, dispirited, sleepless, and start up from a disturbed sleep. Unreasonable fear also seizes them, if the disease tend to increase, when their dreams are true, terrifying, and clear: for whatever, when awake, they have an aversion to, as being an evil, rushes upon their visions in sleep. They are prone to change their mind readily; to become base, mean-spirited, illiberal, and in a little time, perhaps, simple, extravagant, munificent, not from any virtue of the soul, but from the changeableness of the disease. But if the illness become more urgent, hatred, avoidance of the haunts of men, vain lamentations; they complain of life, and desire to die. In many, the understanding so leads to insensibility and fatuousness, that they become ignorant of all things, or forgetful of themselves, and live the life of the inferior animals. The habit of the body also becomes perverted; colour, a darkish-green, unless the bile do not pass downward, but is diffused with the blood over the whole system. They are voracious, indeed, yet emaciated; for in them sleep does not brace their limbs either by what they have eaten or drunk, but watchfulness diffuses and determines them outwardly. Therefore the bowels are dried up, and discharge nothing; or, if they do, the dejections are dried, round, with a black and bilious fluid, in which they float; urine scanty, acrid, tinged with bile. They are flatulent about the hypochondriac region; the eructations fetid, virulent, like brine from salt; and sometimes an acrid fluid, mixed with bile, floats in the stomach. Pulse for the most part small, torpid, feeble, dense, like that from cold. A story is told, that a certain person, incurably affected, fell in love with a girl; and when the physicians could bring him no relief, love cured him. But I think that he was originally in love, and that he was dejected and spiritless from being unsuccessful with the girl, and appeared to the common people to be melancholic. He then did not know that it was love; but when he imparted the love to the girl, he ceased from his dejection, and dispelled his passion and sorrow; and with joy he awoke from his lowness of spirits, and he became restored to understanding, love being his physician.

> Greek: 5. Μέλαιναχολὴ, ἐν μὲν ὀξέσι ἄνωθεν φανεῖσα, κάρτα ὀλέθριον· κάτω δὲ ἐξιοῦσα οὐ κάρτα ἀνώλεθρον· ἐν δὲ τοῖσι χρονίοισι, ἢν μὲν ὑπίῃ κάτω, ἐς δυσεντερίην καὶ ἥπατος πόνον τελευτᾷ· γυναιξὶ δὲ κάθαρσις ἀντὶ τῶν ἐπιμηνίων, ἢν τὰ ἄλλα ἀνώλεθροι ἔωσι· ἢν δὲ ἄνω Ῥέπῃ ἐς στόμαχον, ἢ ἐς φρένας, μελαγχολίην τεύχει. φῦσάν τε γὰρ ἐμποιέει καὶ ἐρυγὰς κακώδεας, ἰχθυώδεας· διαπέμπει δὲ καὶ κάτω φύσας ψοφώδεας, συντρέπει δὲ καὶ τὴν γνώμην. διὰ τόδε καὶ μελαγχολικοὺς καὶ φυσώδεας τούσδε ἐκίκλησκον οἱ πρόσθεν· μετεξετέροισι δὲ οὔτε φῦσα οὔτε μέλαινα χολὴ ἐγγίγνεται, ὀργὴ δὲ ἄκρητος καὶ λύπη καὶ κατηφείη δεινή. καὶ τούσδε οὖν μελαγχολικοὺς καλέομεν, χολῇ μὲν τῆς ὀργῆς συμφραζομένης· μελαίνῃ δὲ, πολλῆς καὶ θηριώδεος· τέκμαρ δὲ Ὅμηρος, ἔνθα φησὶ,
Τοῖσι δʼ ἀνέστη
Ἥρως Ἀτρείδης εὐρυκρείων Ἀγαμέμνων
Ἀχνύμενος· μενεος δὲ μέγα φρένες ἀμφὶ μελαιναι
Πίμπλαντʼ, ὄσσε δέ οἱ πυρὶ λαμπετόωντι ἐΐκτην.
τοιοίδε γιγνονται οἱ μελαγχολώδεες, εὖτʼ ἂν ὑπὸ τοῦ κακοῦ κτεινέωνται. ἔστι δὲ ἀθυμίη ἐπὶ μιῇ φαντασίῃ, ἄνευ τε πυρετοῦ· δοκέει τε δέ μοι μανίης τε ἔμμεναι ἀρχὴ καὶ μέρος ἡ μελαγχολίη. τοῖσι μὲν γὰρ μαινομένοισι ἄλλοτε μὲν ἐς ὀργὴν, ἄλλοτε δʼ ἐς θυμηδίην ἡ γνώμη τρέπεται, τοῖσι δὲ μελαγχολῶσι ἐς λύπην καὶ ἀθυμίην μοῦνον. ἀτὰρ καὶ μαίνονται μὲν ἐς τὰ πλεῖστα τοῦ βίου, ἀφρονέοντες καὶ δεινὰ καὶ αἰσχρὰ πρήσσοντες· μελαγχολῶσι δὲ οὐκ ἐπὶ ἑνὶ εἴδεϊ ἕκαστοι· ἀλλʼ ἢ πρὸς φαρμακίην ὕποπτοι, ἢ ἐς ἐρημίην φεύγουσι μισανθρωπίῃ, ἢ ἐς δεισιδαιμονίην τρέπονται, ἢ μῖσός ἐστι τοῦ ζῆν τουτέοισι. ἢν δὲ ἐξ ἀθυμίης ἄλλοτε καὶ ἄλλοτε διάχυσις γένηται, ἡδονὴ προσγίγνεται ἐπὶ τοῖσι πλείστοισι· οἱ δὲ μαίνονται. ὅκως δὲ, καὶ ἀπὸ κοίων χωρίων τὰ πολλὰ γίγνονται φράσω. ἢν μὲν ἐν τοῖσι ὑποχονδρίοισι μίμνῃ ἡ αἰτίη, ἀμφὶ τὰς φρένας εἱλέεται, καὶ διεξίει χολὴ ἄνωθεν, ἢ κάτωθεν μελαγχο λῶσιν· ἢν δὲ καὶ κεφαλὴν ἐς ξυμπαθείην ἄγῃ, καὶ ἀμείβεται τὸ παράλογον τῆς ὀξυθυμίης ἐς γέλωτα καὶ ἡδονὴν ἐς τὰ πολλὰ τοῦ βίου, οἱ δὲ μαίνονται αὔξῃ τῆς νούσου μᾶλλον ἢ ἀλλαγῇ πάθεος. ἐπʼ ἀμφοῖν δὲ ξηρότης αἰτίη. ἄνδρες μὲν οὖν μαίνονται καὶ μελαγχολῶσι, ἢ καὶ ἀνδρῶν ἐλάσσους· κάκιον δὲ ἀνδρῶν αἱ γυναῖκες ἐκμαίνονται· ἡλικίη, πρὸς ἀκμὴν, καὶ οἱ ἀκμάζοντες· ὥρη θέρος μὲν καὶ φθινόπωρον τίκτει, ἔαρ δὲ κρίνει. τεκμήρια μὲν οὖν οὐκ ἄσημα. ἢ γὰρ ἥσυχοι, ἢ στυγνοὶ, κατηφέες, νωθροὶ ἔασι ἀλόγως, οὔ τινι ἐπʼ αἰτίῃ, μελαγχολίης ἀρχή. ἔτι δὲ καὶ ὀργίλοι προσγίγνονται, δύσθυμοι, ἄγρυπνοι, ἐκ τῶν ὕπνων ἐκθορυβούμενοι. ἔχει δὲ αὐτέους καὶ τάρβος ἔκτοπον, ἢν ἐς αὔξησιν τὸ νόσημα φοιτῇ, εὖτε καὶ ὄνειροι ἀληθέες, δειματώδεες, ἐναργέες. ὁκόσα γὰρ ὑπὰρ ἐκτρέπονται ὁποίου ὦν κακοῦ, τάδε ἐνύπνιον ὁρέουσι ὥρμησε· πρὸς τὸ Ῥηΐδιον μεταγνῶναι εὔκολοι, αἰσχροὶ, σμικρολόγοι, ἄδωροι, καὶ μετʼ οὐ πολὺ ἁπλοῖ, ἄσωτοι, πολύδωροι, οὐκ ἀρετῇ ψυχῆς, ἀλλὰ ποικιλίῃ νοσήματος· ἢν δὲ ἐπὶ μᾶλλον τὸ κακὸν πιέζῃ, μῖσος, φυγανθρωπίη, ὀλόφυρσοι ἐς κενεὰ, ζωῆς κακήγοροι· ἔρανται δὲ θανάτου. πολλοῖσι δὲ ἐς ἀναισθησίην καὶ μώρωσιν ἡ γνώμη Ῥέπει, ὄκως ἀγνῶτες ἁπάντων, ἢ ἐπιλήσμονες ἑωυτέων, βίον ζώωσι ζωώδεα· ξυντρέπεται δὲ καὶ τοῦ σκήνεος ἐς πονηρὸν ἡ ἕξις· χροιὴ μελάγχλωρος, ἢν μὴ διεξίῃ κάτω ἡ χολὴ, ἀλλὰ ἀναχέηται ξὺν τῷ αἵματι ἐς τὸ πᾶν· βοροὶ μὲν, ἰσχνοὶ δέ· ὕπνος γὰρ αὐτέοισι τε πόσει οὔτε βρωτῷ συγκρατέει τὰ μέλεα· ἀγρυπνίη δὲ σκίδνησι ἐς τὴν ἔξω φορήν· τοιγαρο ῦν κοιλίη ξηρὴ οὐδὲν διεῖσα. ἢν δέ κοτε ἐκδιδῷ, ξηρὰ, στρογγύλα, ξὺν περιρρόῳ μέλανι, χολώδεα, οὖρα σμικρὰ, δριμέα, χολόβαφα· φυσώδεες καθʼ ὑποχόνδριον, ἐρυγαὶ κακώδεες, βρωμώδεες, ὡς ἐξ ἁλὸς ὀρυγμίη· ἀνέπλω κοτὲ καὶ ὑγρὸν δριμὺ ξὺν χολῇ. σφυγμοὶ ὡς ἐπίπαν σμικροὶ, νωθροὶ, ἀδρανέες, πυκνοὶ, ἴκελοι τῷ ψύχεϊ. λόγος ὅτι τῶν τοιῶνδέ τις ἀνηκέστως ἔχων, κούρης ἤρα τε καὶ τῶν ἰητρῶν οὐδὲν ὠφελούν των, ὁ ἔρως μιν ἰήσατο· δοκέω δʼ ἔγωγε ἐρᾶν μὲν αὐτὸν ἀρχῆθεν, κατηφέα δὲ καὶ δύσθυμον ὑπʼ ἀτυχίης τῆς κούρης ἔμμεναι, καὶ μελαγχολικὸν δοκέειν τοῖσι δημότῃσιν· οὗτος οὔτε μὴν ἦν ἔρωτα ἐγγιγνώσκων· ἐπεὶ δὲ τὴν ἔρωτα ξυνῆψε τῇ κούρῃ, παύεται τῆς κατηφείης, καὶ διασκίδνησι ὀργήν τε καὶ λύπην, χάρμῃ δὲ ἐξένηψε τῆς δυσθυμίης· καθίσταται γὰρ τὴν γνώμην ἔρωτι ἰητρῷ.

[¶5] 6. THE modes of mania are infinite in species, but one alone in genus. For it is altogether a chronic derangement of the mind, without fever. For if fever at any time should come on, it would not owe its peculiarity to the mania, but to some other incident. Thus wine inflames to delirium in drunkenness; and certain edibles, such as mandragora and hyoscyamus, induce madness: but these affections are never called mania; for, springing from a temporary cause, they quickly subside, but madness has something confirmed in it. To this mania there is no resemblance in the dotage which is the calamity of old age, for it is a torpor of the senses, and a stupefaction of the gnostic and intellectual faculties by coldness of the system. But mania is something hot and dry in cause, and tumultuous in its acts. And, indeed, dotage commencing with old age never intermits, but accompanies the patient until death; while mania intermits, and with care ceases altogether. And there may be an imperfect intermission, if it take place in mania when the evil is not thoroughly cured by medicine, or is connected with the temperature of the season. For in certain persons who seemed to be freed from the complaint, either the season of spring, or some error in diet, or some incidental heat of passion, has brought on a relapse. Those prone to the disease, are such as are naturally passionate, irritable, of active habits, of an easy disposition, joyous, puerile; likewise those whose disposition inclines to the opposite condition, namely, such as are sluggish, sorrowful, slow to learn, but patient in labour, and who when they learn anything, soon forget it; those likewise are more prone to melancholy, who have formerly been in a mad condition. But in those periods of life with which much heat and blood are associated, persons are most given to mania, namely, those about puberty, young men, and such as possess general vigour. But those in whom the heat is enkindled by black bile, and whose form of constitution is inclined to dryness, most readily pass into a state of melancholy. The diet which disposes to it is associated with voracity, immoderate repletion, drunkenness, lechery, venereal desires. Women also sometimes become affected with mania from want of purgation of the system, when the uterus has attained the development of manhood; but the others do not readily fall into mania, yet, if they do, their cases are difficult to manage. These are the causes; and they stir up the disease also, if from any cause an accustomed evacuation of blood, or of bile, or of sweating be stopped. And they with whose madness joy is associated, laugh, play, dance night and day, and sometimes go openly to the market crowned, as if victors in some contest of skill; this form is inoffensive to those around. Others have madness attended with anger; and these sometimes rend their clothes and kill their keepers, and lay violent hands upon themselves. This miserable form of disease is not unattended with danger to those around. But the modes are infinite in those who are ingenious and docile,—untaught astronomy, spontaneous philosophy, poetry truly from the muses; for docility has its good advantages even in diseases. In the uneducated, the common employments are the carrying of loads, and working at clay,—they are artificers or masons. They are also given to extraordinary phantasies; for one is afraid of the fall of the oilcruets..... and another will not drink, as fancying himself a brick, and fearing lest he should be dissolved by the liquid. This story also is told:—A certain joiner was a skilful artisan while in the house, would measure, chop, plane, mortice, and adjust wood, and finish the work of the house correctly; would associate with the workmen, make a bargain with them, and remunerate their work with suitable pay. While on the spot where the work was performed, he thus possessed his understanding. But if at any time he went away to the market, the bath, or on any other engagement, having laid down his tools, he would first groan, then shrug his shoulders as he went out. But when he had got out of sight of the domestics, or of the work and the place where it was performed, he became completely mad; yet if he returned speedily he recovered his reason again; such a bond of connection was there between the locality and his understanding. The cause of the disease is seated in the head and hypochondriac region, sometimes commencing in both together, and the one imparting it to the other. In mania and melancholy, the main cause is seated in the bowels, as in phrenitis it is mostly seated in the head and the senses. For in these the senses are perverted, so that they see things not present as if they were present, and objects which do not appear to others, manifest themselves to them; whereas persons who are mad see only as others see, but do not form a correct judgment on what they have seen. If, therefore, the illness be great, they are of a changeable temper, their senses are acute, they are suspicious, irritable without any cause, and unreasonably desponding when the disease tends to gloom; but when to cheerfulness, they are in excellent spirits; yet they are unusually given to insomnolency; both are changeable in countenance, have headache, or else heaviness of the head; they are sharp in hearing, but very slow in judgment; for in certain cases there are noises of the ears, and ringings like those of trumpets and pipes. But if the disease go on to increase, they are flatulent, affected with nausea, voracious and greedy in taking food, for they are watchful, and watchfulness induces gluttony. Yet they are not emaciated like persons in disease (embonpoint is rather the condition of melancholics) and they are somewhat pale. But if any of the viscera get into a state of inflammation, it blunts the appetite and digestion; the eyes are hollow, and do not wink; before the eyes are images of an azure or dark colour in those who are turning to melancholy, but of a redder colour when they are turning to mania, along with purplecoloured phantasmata, in many cases as if of flashing fire; and terror seizes them as if from a thunderbolt. In other cases the eyes are red and blood-shot. At the height of the disease they have impure dreams, and irresistible desire of venery, without any shame and restraint as to sexual intercourse; and if roused to anger by admonition or restraint, they become wholly mad. Wherefore they are affected with madness in various shapes; some run along unrestrainedly, and, not knowing how, return again to the same spot; some, after a long time, come back to their relatives; others roar aloud, bewailing themselves as if they had experienced robbery or violence. Some flee the haunts of men, and going to the wilderness, live by themselves. If they should attain any relaxation of the evil, they become torpid, dull, sorrowful; for having come to a knowledge of the disease they are saddened with their own calamity. ANOTHER SPECIES OF MANIA. Some cut their limbs in a holy phantasy, as if thereby propitiating peculiar divinities. This is a madness of the apprehension solely; for in other respects they are sane. They are roused by the flute, and mirth, or by drinking, or by the admonition of those around them. This madness is of divine origin, and if they recover from the madness, they are cheerful and free of care, as if initiated to the god; but yet they are pale and attenuated, and long remain weak from the pains of the wounds.

> Greek: 6. μανίης τρόποι εἴδεσι μὲν μυρίοι, γένεϊ δὲ μοῦνος εἷς· ἔκστασις γάρ ἐστι τὸ σύμπαν χρόνιος, ἄνευθεν πυρετοῦ· εἰ γάρ κοτε καὶ πυρετὸς ἐπιλάβοι, οὐκ ἀπὸ μανίης ἂν ἴδιος γίγνοιτο, ἀλλʼ ἐκ συντυχίης ἄλλης· ἐκφλέγει γὰρ καὶ οἶνος ἐς παραφορὴν ἐν μέθῃ· ἐκμαίνει δὲ καὶ τῶν ἐδεστῶν μετεξέτερα, ἢ μανδραγόρη, ἢ ὑοσκύαμος, ἀλλʼ οὔ τί πω μανίη τάδε κικλήσκεται. ἐπὶ γὰρ σχεδίου γιγνόμενα καθίστα ται θᾶττον· τὸ δὲ ἔμπεδον ἡ μανίη ἴσχει· τῇδε τῇ μανίῃ οὐδέν τι ἴκελον ἡ λήρησις, γήραος ἡ ξυμφορή. αἰσθήσιος γάρ ἐστι νάρκη, καὶ γνώμης νάρκωσις ἠδὲ τοῦ νοῦ ὑπὸ ψύξιος· μανίη δὲ θερμόν τι καὶ ξηρὸν τῇ αἰτίῃ, καὶ ταραχῶδ ες τῇσι πρήξεσι· ἡ μὲν γὰρ λήρησις ἀρχομέν η ἀπὸ γήραος οὔτε διαλείπει, καὶ ξυναποθνήσκει· μανίη δὲ καὶ διαλείπει καὶ μελεδῶνι ἐς τέλος ἀποπαύεται· διάλειψις δὲ ἀτελὴς, ἢν τῷ τῆς μανίης λόγῳ γίγνηται, οὐκ εἰκότως ἀκεομέν ου τοῦ κακοῦ ἰητρείῃ, ἢ τῆς ὥρης εὐκρασίῃ. μετεξετέρους γὰρ δοκέοντας ἀσινέας ἔμμεναι, ἡ ὥρη τὸ ἔαρ, ἢ ἁμαρτωλὴ διαίτης, ἢ ὀργὴ ἐκ συντυχίης ἐς ἀνάκλησιν ἤγαγε. καὶ γὰρ δὴ νοσέουσι οἱ φύσι ὀργίλοι, ὀξύθυμοι, Ῥέκται, εὐμαρέες, ἱλαροὶ, παιδιώδεες· ἀτὰρ καὶ οἷσι ἐς ἐναντίην ἰδέην ἡ φύσις Ῥέπει, ὁκόσοι νωθροὶ, ἐπίλυποι, βραδεῖς μὲν ἐκμαθεῖν, ἐπίμονοι δὲ προσκαμεῖν, ποτὶ καὶ μαθόντες, ἀμνήμονες, οἵδε καὶ μελαγχολῆσαι ἑτοιμότεροι, οἱ δὲ καὶ πρόσθεν ἐκμαίνονται. ἀτὰρ καὶ ἡλικίῃσι, οἷσι τὸ θερμὸν καὶ αἷμα πουλὺ, οἵδε μαίνονται. τοῖσι ἀμφὶ ἥβην καὶ νέοισι καὶ οἷσι πάντων ἡ ἀκμή· ὁκόσοισι δὲ τὸ θερμὸν ἐκ μελαίνης χολῆς ἐξάπτεται, τό τε εἶδος ἐς ξηρὸν τρέπεται, τουτέοισι μελαγχολῆσαι Ῥήϊστον· δίαιτα δὲ ἄγει, πουλυφαγίη, πλησμονὴ ἄμετρος, μέθη, λαγνείη, ἔρωτες ἀφροδισίων· ἐμάνησάν κοτε καὶ γυναῖκες ὑπὸ ἀκαθαρσίης τοῦ σκήνεος, εὖτε αὐτέῃσι ἀπηνδρώθησαν αἱ μῆτραι· ἄλλαι δὲ, οὐ μᾶλλον δὲ Ῥηϊδίως ἐκμαίνονται· μάλα δὲ χαλεπῶς ἐκμαίνονται. αἵδε αἱ προφάσιες. καὶ γὰρ ἄνδρα ἐξάπτουσι, ἢν ξυνήθη αἵματος ἔκκρισιν, ἢ χολῆς, ἢ ἱδρῶτος ἐπίσχῃ τις αἰτίη. καὶ οἷσι μὲν ἡδονὴ ᾖ ἡ μανίη, γελῶσι, παίζουσι, ὀρχεῦνται νυκτὸς καὶ ἡμέρης, καὶ ἐς ἀγορὴν ἀμφαδὸν, καὶ ἐστεμμένοι κοτὲ ὅκως ἐξ ἀγωνίης νικηφόροι ἔασιν· ἄλυπος τοῖσι πέλας ἡ ἰδέη· μετεξέτεροι δὲ ὑπὸ ὀργῆς ἐκμαίνονται. ἔσθʼ ὅτε ἐσθῆτάς τε ἐρρήξαντο, καὶ θεράποντας ἀπέκτειναν, καὶ ἑωυτέοισι χεῖρας ἐπήνεγκαν· ἥδε καὶ τοῖς πέλας οὐκ ἀκίνδυνος ἡ ξυμφορή· ἰδέαι δὲ μυρίαι, τοῖσι μέν γε εὐφυέσιτε καὶ εὐμαθέσι ἀστρονομίη ἀδίδακτος, φιλοσοφίη αὐτομάτη, ποίησις δῆθεν ἀπὸ μουσέων. ἴσχει γάρ τι καὶ ἐν νούσοισι εὔχρηστον ἡ εὐπαιδευσίη· τοῖσι δὲ ἀπαιδεύτοισι ἀχθοφορίη, πηλοεργίη, τέκτονες, ἢ λιθοξόοι· γίγνονται δὲ καὶ ἀλλόκοτοι φαντασίαι. ἐδεδίει γάρ τις ληκύθων ἔκπτωσιν … καὶ ἄλλος οὐκ ἔπινε, δοκέων ἑωυτὸν πλίνθον ἔμμεναι, ὡς μὴ τῷ ὑγρῷ λυθείη. Μυθολογέεται δὲ καὶ τόδε· τέκτων ἤδη ἐπὶ οἴκου μὲν σαόφρων ἐργάτης ἦν, μετρῆσαι ξύλον, κόψαι, ξύσαι, ξυγγομφῶσαι, ἁρμόσαι, ξυντελέσαι δόμον νηφαλέως, τοῖσι ἐργοδότῃσι ὁμιλῆσαι, ξυμβῆναι, ἀμεῖψαι τὰ ἔργα μισθοῦ δικαίου. ὁ δὲ ἐπὶ μὲν τοῦ χωρίου τοῦ ἔργου ὧδε εἶχε γνώμης· ἢν δὲ ἐξίῃ κοτὲ ἐς ἀγορὴν, ἐπὶ λουτρὸν, ἤ τινʼ ἑτέρην ἀνάγκην, τιθεὶς τὰ ὅπλα πρῶτον ἔστενεν, εἶτα ἐπῆγεν ὤμω ἐξιών· ἐπὴν δὲ ἀπῆλθε τῆς τε τῶν οἰκετῶν θέης καὶ τῆς τοῦ ἔργου πρήξιος καὶ τοῦ χωρίου, πάμπαν ἐξεμαίνετο· κἢν παλινδρομήσῃ ταχὺ, αὖθις ἐσωφρόνεε. καὶ ἥδε τοῦ χωρίου καὶ τῆς γνώμης ἡ ξυμβολή. ἴσχουσι δὲ τὴν αἰτίην τοῦ νοσήματος κεφαλὴ καὶ ὑποχόνδρια, ἄλλοτε μὲν ἅμα ἄμφω ἀρξάμενα, ἄλλοτε δὲ ἀλλήλοισι ξυντιμωροῦντα· τὸ δὲ κῦρος ἐν τοῖσι σπλάγχνοισί ἐστι ἐπὶ μανίῃ καὶ μελαγχολίῃ, ὅκωσπερ ἐν τῇ κεφαλῇ καὶ τοῖσι αἰσθήσεσι τὰ πολλὰ τοῖσι φρενιτικοῖσι. οἵδε μὲν γὰρ παραισθάνονται, καὶ τὰ μὴ παρεόντα ὁρέουσι δῆθεν ὡς παρεόντα, καὶ τὰ μὴ φαινόμενα ἄλλῳ κατʼ ὄψιν ἰνδάλλεται· οἱ δὲ μαινόμενοι ὁρέουσι μόνως ὡς χρὴ ὁρῆν· οὐ γιγνώσκουσι δὲ περὶ αὐτέων ὡς χρὴ γιγνώσκειν. ἢν οὖν μέγα ᾖ τὸ κακὸν, εὐκίνητοι, ὀξέες τὴν αἴσθησιν, ὕποπτοι, ὀργίλοι, οὐκ ἐπʼ αἰτίῃ τινὶ, δύσθυμοι μὲν ἀλόγως, οἷσι ἐς σκυθρωπὸν ἡ μανίη τρέπεται· οἷσι δὲ ἐς θυμηδίην, εὔθυμοι· ἀλλʼ οἵδε παραλόγως ἄγρυπνοι, ἄμφω ἀλλοιώδεες τὰς ὄψιας, κεφαλαλγέες, ἢ πάντως γε βάρος τῆς κεφαλῆς ξύνεστι· εὐήκοοι δὲ, ἀλλὰ βράδιστοι τὴν γνώμην. ἐπʼ ἐνίοισι γὰρ ἔασι δὴ ἦχοιὤτων, καὶ βόμβοι, μέχρι δή γε σαλπίγγων τε καὶ αὐλῶν· ἢν ἐς αὔξησιν ἡ νοῦσος γίγνηται, φυσώδεες, ἀσώδεες, βοροὶ καὶ λάβροι ἐν τῇ ἐδωδῇ. ἀγρυπνέουσι γάρ· ἀγρυπνίη δὲ βορόν· ἀτὰρ οὐδὲ ἰσχνοὶ ὡς νοσέοντες· μελαγχολών των μᾶλλον εὐσαρκίη· καὶ ὕπωχροι. ἢν δέ τι τῶν σπλάγχνων ἐν φλεγμασίῃ ᾖ γεγονὸς, τὴν ὄρεξιν ἢ τὴν θρέψιν ἀμβλύνει· ὀφθαλμοὶ κοῖλοι, οὐ σκαρδαμύττοντες· πρὸ τῶν ὀφθαλμῶν ἰνδάλματα κυάνεα, ἢ μέλανα, οἷσιν ἐς μελαγχολίην ἡ τροπή· ἐρυθρότερα δὲ οἷσιν ἐς μανίην, καὶ φοινίκεα φαντάσματα, πολλοῖσι μὲν ὡς ἀπαστράπτοντος πυρὸς, καὶ τάρβος αὐτέους ὡς ἀπὸ σκηπτοῦ λαμβάνει· μετεξετέροισι δὲ καὶ ἐνέρυθροι καὶ ὕφαιμοι ὀφθαλμοί. ἐπὶ κορυφῆς δὲ τοῦ κακοῦ ὀνειρώττουσι· ἀφροδισίων δὲ ἄσχετος ἐπιθυμίη, ἀτὰρ οὐδὲ ἐς τὸ ἄμφαδον αἰδὼς ἢ ὄκνος ὁμιλίης· νουθεσίῃ δὲ καὶ ἐπιπλήξει ἐς ὀργὴν ἐκριπισθέντες ἐς τὸ πάμπαν ἐκμαίνονται. τοὐντεῦ θεν ἄλλος ἄλλῃ μαίνεται· οἱ μὲν θέουσι ἀσχέτως, οὔτε ὅπως εἰδότες ἐς ταὐτὰ παλινδρομέουσι· οἱ δὲ ἐς δηρὸν τοῖσι πέλας ἀφικνέονται· ἄλλοι δʼ αὖ βοῶσι ὀλοφυρόμενοι ἁρπαγὴν, ἢ βίην. οἱ δὲ φυγανθρωπεύουσι ἐς ἐρημίην, σφίσι αὐτέοισι ὁμιλέοντες. εἰ δὲ ἐπʼ ἄνεσιν ἤκοιεν τοῦ κακοῦ, νωθροὶ, ἥσυχοι, ἐπίλυποι. ἐς ἐπιστασίην γὰρ τῆς νούσου ἀφικνεόμενοι, ἄχθονται τῇ ξυμφορῇ. Μανίης εἶδος ἕτερον. τέμνονταί τινες τὰ μέλεα, θεοῖς ἰδίοις, ὡς ἀπαιτοῦσι, χαριζόμενοι εὐσεβεῖ φαντασίῃ· καὶ ἔστι τῆς ὑπολήψιος ἡ μανίη μοῦνον, τὰ δὲ ἄλλα σωφρονέουσι. ἐγείρονται δὲ αὐλῷ καὶ θυμηδίῃ, ἢ μέθῃ, ἢ τῶν παρεόντων προτροπῇ. ἔνθεος ἥδε ἡ μανίη· κἢν ἀπομανῶσι, εὔθυμοι, ἀκηδέες, ὡς τελεσθέντες τῷ θεῷ, ἄχροοι δὲ καὶ ἰσχνοὶ, καὶ ἐς μακρὸν ἀσθενέες πόνοις τῶν τρωμάτων.

[¶6] 7. Apoplexy, Paraplegia, Paresis, Paralysis, are all generically the same. For they are all a defect of motion, or of touch, or of both; sometimes also of understanding, and sometimes of other sense. But apoplexy is a paralysis of the whole body, of sensation, of understanding and of motion; wherefore to get rid of a strong attack of apoplexy is impossible, and of a weak, not easy. But paraplegia is a remission of touch and motion, but of a part, either of the hand or of the leg. Paralysis for the most part is the remission (paresis) of motion only, and of energy. But if the touch alone is wanting—(but such a case is rare)—the disease is called Anæsthesia rather than paresis. And when Hippocrates says, “the leg on the same side was apoplectic,” he means to say that it was in a death-like, useless, and incurable state; for what is strong apoplexy in the whole body, that he calls paraplegia in the limb. Paresis, properly speaking, is applied to suppression or incontinence of urine in the bladder. But distortion of the eye-brows, and of the cheeks, and of the muscles about the jaws and chin to the other side, if attended with spasm, has got the appellation of Cynic spasm. Loss of tone in the knees, and of sensibility for a time, with torpor, fainting, and collapse, we call lipothymia. Wherefore, the parts are sometimes paralysed singly, as one eye-brow, or a finger, or still larger, a hand, or a leg;

> Greek: 7. ἀποπληξίη, παραπληγίη, πάρεσις, παράλυσις, ἅπαντα τῷ γένεϊ τωὐτά. ἢ γάρ κινήσιος, ἢ ἁφῆς, ἢ ἀμφοῖν ἐστι ἔκλειψις· κοτὲ καὶ γνώμης, κοτὲ καὶ τῆς ἄλλης αἰσθήσιος. ἀλλʼ ἀποπληξίη μὲν ὅλου τοῦ σκήνεος, καὶ τῆς αἰσθήσιός τε καὶ γνώμης καὶ κινήσιός ἐστι παράλυσις. τοιγαροῦν ἀποπληξίην λῦσαι ἰσχυρὴν μὲν ἀδύνατον, ἀσθενῆ δὲ οὐ Ῥηΐδιον. παραπληγίη δὲ πάρεσις μὲν ἁφῆς καὶ κινήσιος, ἀλλὰ μέρεος, ἢ χειρὸς, ἢ σκέλεος· παράλυσις δὲ ὡς ἐπίπαν κινήσιος μοῦνον, ἐνεργείης τε πάρεσις· ἢν δὲ ἁφὴ ἐκλείπῃ μούνη κοτέ, — σπάνιον δὲ τὸ τοιόνδε, — ἀναισθησίη μᾶλλον ἢ πάρεσις κικλήσκεται· ἢν δὲ ἀπόπληκτον ὁ Ἱπποκράτης εἴπῃ σκέλος τὸ κατʼ ἴξιν, ὡς νεκρῶδες, τὸ ἀχρεῖον καὶ τὸ ἀναλδὲς θέλει φράσαι. ὃ γὰρ ἐπὶ τῷ ξύμπαντι ἀποπληξίη ἐστὶ ἰσχυρὴ, τόδε ἐν τῷ σκέλεϊ παραπληγίην φράζει· κύστιος δὲ οὔρων σχέσιος ἢ ἀκρασίης, πάρεσις τὸ κύριον· βλεφάρων δὲ καὶ μήλων καὶ μυῶν τῶν ἐν γνάθοις, καὶ γένυος ἐπὶ θάτερα παραγωγὴ ἢν ἐπὶ σπασμῷ διαστρέφηται, κυνικὸς σπασμὸς ἡ κλῆσις· ἔκλυσιν δὲ γουνάτων καὶ αἰσθήσιος πρόσκαιρον νάρκην καὶ ἀψυχίην καὶ κατάπτωσιν, λιποθυμίην καλέομεν.

[¶7] and sometimes more together; and sometimes the right or the left only, or each by itself, or all together, either entirely or in a less degree; and the parts only which are distant, homonymous, and in pairs—the eyes, hands, and legs; and also the parts which cohere, as the nose on one side, the tongue to the middle line of separation, and the one tonsil, the isthmus faucium, and the parts concerned in deglutition to one half. I fancy, also, that sometimes the stomach, the bladder, and the rectum, as far as its extremity, suffers in like manner; but the internal parts, when in a paralytic state, are concealed from the sight. Their functions, however, are but half performed; and from this I conclude, that these parts are half affected, as being cut in twain by the disease. And, indeed, this thing teaches us a lesson in respect to the diversity of power and discrimination between the right side and the left. For the inherent cause is equal; and means which occasion the affection are common in both cases, whether cold or indigestion, and yet both do not suffer equally. For Nature is of equal power in that which is equally paired; but it is impossible that the same thing should happen where there is an inequality. If, therefore, the commencement of the affection be below the head, such as the membrane of the spinal marrow, the parts which are homonymous and connected with it are paralysed: the right on the right side, and the left on the left side. But if the head be primarily affected on the right side, the left side of the body will be paralysed; and the right, if on the left side. The cause of this is the interchange in the origins of the nerves, for they do not pass along on the same side, the right on the right side, until their terminations; but each of them passes over to the other side from that of its origin, decussating each other in the form of the letter X. To say all at once, whether all together or separate parts be affected with paralysis..... or of both; sometimes the nerves from the head suffer (these, generally, induce loss of sensibility, but, in a word, they do not readily occasion loss of sensibility; but if they sympathise with the parts which are moved, they may undergo, in a small degree, the loss of motion); and sometimes those which pass from muscle to muscle (from the spinal marrow to the muscles), these have the power of motion, and impart it to those from the head; for the latter possess the greater part of their motory power from them, but yet have it, to a small extent, of themselves: the former, too, principally suffer loss of motion, but rarely of themselves experience anæsthesia; indeed, as appears to me, not at all. And if the ligaments of nerves, which derive their origin from certain of the bones, and terminate in others, be loosened or torn, the parts become powerless, and are impeded in their movements, but do not become insensible.

> Greek: παρίεται ν, ἄλλοτε μὲν μέρεα καθʼ ἓν, ὀφρὺς μούνη, ἢ δάκτυλος, ἢ ἔτι μέζω, χεὶρ, σκέλος· ἄλλοτε δὲ ὁμοῦ πλεῦνα· καί ποτε δεξιὰ μοῦνον, ἢ ἀριστερ ὰ, ἢ ἰδίῃ καὶ ἰδίῃ, ἢ ξύμπαντα· ἐπʼ ἀκριβὲς, ἢ ἧσσον. οὐ τὰ διεστῶτα μοῦνον καὶ ὁμώνυμα καὶ ὁμόζυγα, ὀφθαλμοὶ, χεῖρες, σκέλος, ἀλλὰ καὶ τὰ ξυμφυέα, Ῥὶς ἐς τὸ ἶσον, καὶ γλῶσσα μέσφι τῶν ὁρίων τοῦ μέσου, καὶ παρίσθμιον ἓν, καὶ ἰσθμὸς, καὶ κατάποσις ἐς ἥμισυ. δοκέω δὲ ἐγώ κοτε καὶ στόμαχον, καὶ τὰ ἔντερα, καὶ κύστιν, καὶ τὸ παράμηκες ἔντερον ἄχρι τῆς ἀρχῆς τωὐτὸ πεπονθέναι· ἀλλὰ τὰ μὲν μέλεα τὰ ἐντὸς ἐκλυόμενα κρυπτὰ καὶ ἀφανέα· ἡμιτελέες δὲ καὶ αἱ ἐνέργειαι· τῇδέ μοι δοκέει καὶ ἡμιπαθέα ἔμμεναι τὰ μέρεα διχῆ ὑπὸ τῆς νοῦσου τετμημένα. τόδε μέντοι τὸ πρῆγμα δίδαγμα διαφορῆς δυνάμιός τε καὶ κρίσιος πρὸς ἀριστερὰ δεξιοῖς. ἴση μὲν γὰρ καὶ ἡ προσίζουσα αἰτίη, ξυναὶ δὲ ἀμφοῖν τοῦ πάθεος αἱ προφάσιες, ἤν τε ψύξις, ἤν τε ἀπεψίη, ἀλλὰ ἄμφω παθεῖν οὐκ ἶσα ἄν. ἰσόρροπος δὲ ἡ φύσις, ὡς ἐν ἰσορρόπῳ, τωὐτὸν δὲ ἐν ἀνίσοις ἀδύνατον. ἢν μὲν οὖν τῆς κεφαλῆς κάτω πάθῃ τις ἀρχὴ, ὁκοῖόν τι τοῦ νωτιαίου μυελοῦ ἡ μῆνιγξ, τὰ ὁμώνυμα καὶ ξυναφέα παραλύεται, δεξιὰ ἐπὶ δεξιοῖσι, καὶ ἐπʼ ἀριστεροῖσι λαιά. ἢν δὲ κατάρχῃ κεφαλὴ, ἐπὶ μὲν τοῖσι δεξιοῖσι τὰ λαιὰ παραλύεται, δεξιὰ δὲ ἐπʼ ἀριστεροῖσι. αἰτίη δὲ, τῶν ἀρχέων τῶν νεύρων ἡ ἐπαλλαγή. οὐ γὰρ κατʼ ἴξιν τὰ δεξιὰ ἐπὶ δεξιὰ ὁδοιπορέει, μέσφι περατῶνται, ἀλλʼ ἔμφυτα τῇ ἀρχῇ ἕκαστα εὐθὺς ἐπʼ ἐκεῖνα φοιτῇ, ἀλλήλοισι ἐπαλλαξάμενα εἰς χιασμὸν σχήματος· ἀθρόον δὲ εἰρῆσθαι, εἴτε ξύμπαντα ὁμοῦ, εἴτε μέρεα παρίεται, … ἢ ξυναμφοτέρων, νεῦρα δὲ ἄλλοτε μὲν τὰ ἀπὸ κεφαλῆς πάσχει· τάδε μέντοι ἐς ἀναισθησίην τρέπονται, ὡς ἔπος εἰπεῖν· οὐ γὰρ Ῥηϊδίως ἐς ἀκινησίην ἐξ ὡυτέων Ῥέπει τάδε· κἢν μὲν τοῖσι κινευμένοισι ξυμπαθήσῃ, πάσχει καὶ τάδε σμικρὴν ἀκινησίην· ἴσχει γὰρ καὶ τὴν κίνησιν ἐξ ὡυτέων, εἰ καὶ ἐπὶ ἧσσον φύσι· ἄλλοτε δὲ τὰ ἀπὸ μυῶν ἐς μύας περαιούμενα, τάδε τὸ κῦρος τῆς κινήσιος ἴσχει, καὶ τοῖσι ἀπὸ τῆς κεφαλῆς προσδιδοῖ. καὶ γὰρ αὐτὰ ἀπʼ ἐκείνων τὸ πλεῖστον τῆς κινήσιος ἴσχει· ἴσχει δὲ καὶ ἐξ ἑωυτέων καὶ ἔλαττον· τάδε μέντοι ἀκινησίην πάσχει μᾶλλον· σπάνιον δὲ εἴ κοτε ἐξ ἑωυτέων εἰς ἀναισθησίην τρέποντα ι, δοκεῖ καὶ μὴ εἰς τὸ πάμπαν· ἢν δὲ ξύνδεσμός τις νεύρων λυθῇ τῶν ἐξ ὀστέων πεφυκότων τινὸς, καὶ κραινόν των ἐς ὀστέα, ἢ Ῥαγέντος, ἀκρατέα τὰ μέρεα καὶ ἐπισυρόμενα, οὐκ ἀναίσθητα, γίγνεται.

## 2. Book I · chapters 7–12

Source: https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/2/ · cite a paragraph as https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/2/#p-N

[¶0] The varieties of paralysis are these: sometimes the limbs lose their faculties while in a state of extension, nor can they be brought back into the state of flexion, when they appear very much lengthened; and sometimes they are flexed and cannot be extended; or if forcibly extended, like a piece of wood on a rule, they become shorter than natural. The pupil of the eye is subject to both these varieties, for sometimes it is much expanded in magnitude, when we call it Platycoria; but the pupil is also contracted to a small size, when I call it Phthisis and Mydriasis. The bladder, also, is paralysed in respect to its peculiar functions; for either it loses its powers as regards distension, or it loses its retentive powers, or it becomes contracted in itself, when being filled with urine, it cannot expel the same. There are six causes of paralytic disorders; for they arise from a wound, a blow, exposure to cold, indigestion, venery, intoxication.

> Greek: εἴδεα δὲ παραπληκτικὰ τάδε. ἄλλοτε μὲν ἐς ἔκτασιν λέλυται τὰ μέλεα, οὐδὲ παλινδρομέει ἐς κάμψιν, εὖτε μήκιστα κῶλα φαίνεται· ἄλλοτε δὲ κυλλὰ γίγνεται, οὐδὲ ἐς μῆκος ἀποτείνεται· εἰ δὲ ἐκτανύσαι βιᾶται, ὅκως ξύλα ἐς κανόνα καταξέω ν, τὰ μέλεα βραχύτερα ἑωυτέων γίγνεται· τάδε πάσχει ἄμφω τὰ εἴδεα, καὶ ἡ ἐν τοῖς ὀφθαλμοῖσι παρθένος. καὶ γὰρ ἐκχέεται πολλὸν ἐς μέγεθος, εὖτε πλατυκορίην ὀνομάζομεν. ἀτὰρ ἠδὲ ξυνάγεται ἐς σμικρὸν ἡ κούρη, εὖτε φθίσιν ἣν ἠδὲ μυδρίησιν ἐγὼ κικλήσκω. ἀλλὰ καὶ κύστις παρίεται ἐπὶ τοῖσι ἰδίοισι ἔργοισι. ἢ γὰρ εἰς ἔκτασιν λύεται, ἢ ἀκρατὶ τὰ οὖρα ἐκχέει, ἢ ξυνειλέεται ἐς ἑωυτέην, εὖτε, ὅταν πλησθῇ οὔρου, οὐ διΐησιν.

[¶1] But so likewise the vehement affections of the soul, such as astonishment, fear, dejection of spirits, and, in children, frights. Great and unexpected joy has also occasioned paralysis, as, likewise, unrestrained laughter, even unto death. These, indeed, are the primary causes; but the ultimate and vital cause is refrigeration of the innate heat. It suffers from humidity, or dryness, and is more incurable than the other; but if also in connection with a wound, and complete cutting asunder of a nerve, it is incurable. In respect to age, the old are peculiarly subject, and difficult to cure; in children, the cases are easily restored. As to seasons, the winter; next, the spring; afterwards, the autumn; least of all, the summer. Of habits, those naturally gross, the humid, indolent, brutish.

> Greek: αἰτίαι δὲ παρέσιος μὲν ἕξ· ἄρχονται δὲ τρώματι, πληγῇ, ψύξι, ἀπεψίῃ, λαγνείῃ, οἰνοφλυγίῃ· ἀτὰρ καὶ ψυχῆς ἀκρατέα πάθεα, ἐκπλήξιες, φόβοι, δυσθυμίαι· ἀτὰρ καὶ παιδίοισι δείματα. παρέλυσέ κοτε καὶ χάρμα ἀδόκητον καὶ μέγα, καὶ γέλως ἄσβεστος μέχρι θανάτου. ἀλλὰ τάδε μὲν ἀρχὴ πρώτη· ὑστάτη δὲ καὶ καιρίη, ψύξις ἐμφύτου θερμοῦ· ἐπὶ ὑγρότητι ἢ ξηρότητι πάσχει ἥδε, καὶ δυσαλθὴς τῆς ἑτέρης μᾶλλον· ἀτὰρ καὶ ἐπὶ τρώματι καὶ διακοπῇ νεύρου ἀναλθής· ἡλικίη, γέροντες, καὶ οἵδε δυσαλθέες· παιδίοισι δὲ εὐανάκλητοι· ὥρη, χειμὼν, ἔαρ δεύτερον, ἔπειτα μετόπωρον, θέρος ἥκιστα· ἕξεις, οἱ παχέες κατὰ φύσιν, ὑγροὶ, ἀργοὶ, ζωώδεες.

[¶2] When the affections are confirmed, they are made manifest by loss of motion, insensibility of heat and cold; and also of plucking the hair, of tickling, and of touching. It is rare indeed when in them the extremities are painful; but insensibility to pain is not worse as regards recovery. Wherefore the disease occurs suddenly; but if at any time it have prolonged onsets, there supervene heaviness, difficulty of motion, torpor, a sensation of cold, sometimes an excess of heat, short sleeps, greater phantasies, when they become suddenly paralytic.

> Greek: Τελεσθέντα μὲν οὖν τὰ πάθεα ἔκδηλα ἀκινησίῃ καὶ ἀναισθησίῃ θερμοῦ τε καὶ ψυχροῦ, ἀτὰρ καὶ τιλμῶν καὶ κνησμῶν καὶ ψαυσίων. σπάνιον εὖτε τοῖσι τὰ πέρατα ἀλγέει, ἀλλὰ ἐς ἀνάκλησιν οὐ κακίων ἡ ἀπονίη. γίγνεται μὲν οὖν ἐξαπίνης· ἢν δέ κοτε καὶ ἀρχὰς ἴσχῃ ἐπιμήκεας, βάρος, δυσκινησίη, νάρκη· ψύξιος αἴσθησις, ἄλλοτε θάλπεος ὑπερβολὴ, ὕπνοι σμικροὶ, φαντασίαι μέζονες, εὖτε ἀθρόον παρελύθησαν.

[¶3] But in the Cynic spasm, it is not usual for all parts of the face to be cramped; but those of the left side are turned to the right, and those of the right to the left, when there is a considerable distortion of the jaw to this side or to that, as if the jawbone were dislocated. And in certain of these cases, also, there is luxation at the joint, when in yawning the jaw is displaced to the opposite side: strabismus of the affected eye, and palpitation in the under eyelid; the upper eyelid also palpitates, sometimes along with the eye, and at other times alone. The lips are distended, each on its own side; but sometimes both being collapsed, they splutter; in others, they are closely compressed, and are suddenly separated so as to expel the common spittle with a noise. The tongue, also, is drawn aside;

> Greek: ἐπὶ δὲ κυνικῷ σπασμῷ ἅπαντα μὲν τὰ τοῦ προσώπου μέρεα σπᾶσθαι οὐ κάρτα ξύνηθες· ἐπὶ δεξιὰ δὲ τὰ ἀριστερὰ, καὶ ἐς ἀριστερὰ τὰ δεξιὰ φοιτῇ, εὖτε καὶ τῆς γένυος ἔνθα ἢ ἔνθα ἐπὶ πολλὸν ἡ παραγωγὴ, ὅκως ἐξ ἕδρης κινουμένης τῆς γνάθου. καὶ γὰρ καὶ τοῖσί κοτε ἐξέβη τὸ ἄρθρον, εὖτε μέγα χανόντων ἐπὶ τὸ ἕτερον ἡ γένυς παρήχθη· ἵλλωσις τοῦ ὀφθαλμοῦ τοῦ σιναροῦ μήλου, ξὺν τῇ ὑποκοιλίδι παλμός· πάλλεται δὲ καὶ τὸ ἄνω βλέφαρον, ἄλλοτε μὲν ξὺν τῷ ὀφθαλμῷ, ἄλλοτε δὲ μοῦνον· ξυντείνεται δὲ καὶ τὰ χείλεα ἰδίῃ ἑκάτερον· ἄλλοτε δὲ ἄμφω ξυμπεσόν τα παφλάζει. ἔστι δὲ οἷς μέμυκε κάρτα, ἀθρόον δὲ διΐσταται, καὶ τὸν ξυνήθεα πτυσμὸν ψοφέει.

[¶4] for it consists of a muscle and nerves, and at certain times, along its whole extent, it starts up to the palate, and makes an unusual sound. The uvula, also, is drawn aside; and if the mouth is shut, there is an unexpected noise within. And if you separate the mouth, you will perceive the uvula sometimes attached to the palate through its whole surface, and sometimes swiftly palpitating with force, like a bag-fish, when likewise a sound is produced. But there is apt to be deception in cynic spasms; for to the spectator it appears as if the parts unaffected were those possessed by the disease; for owing to the tension and colour of the affected parts, and the enlargement of the eye, they appear as if they were diseased. But in laughter, speaking, or winking, the true state of matters becomes manifest; for the parts affected are all drawn aside with a smack; the lip expresses no smile, and is motionless in talking; the eyelid is immoveable, the eye fixed, and the sense of touch is lost; while the sound parts speak, wink, feel, laugh.

> Greek: σπᾶται καὶ γλῶσσα· καὶ γὰρ ἥδε μῦς ἐστι καὶ νεῦρα· εὖτε πρὸς τὸν οὐρανὸν ἐς πλάτος ὅλη ἡ ξύμφυσις ἀθρόον ἀφήλατο, καὶ κλόνου πάταγον ἐποίησε. σπᾶται δὲ καὶ κίων, καὶ εἰ μὲν τὸ στόμα συνάγει, τἄνδοθεν ἀδόκητος ὁ πάταγος· ἢν δὲ διαστής ῃ τὸ στόμα, ὄψεαι τὴν κιονίδα, ἄλλοτε μὲν προσφυομένην ἐς πλάτος τῷ οὐρανῷ, ἄλλοτε δὲ ἀποπαλλομένην βίῃ ὠκέως σωλῆνι ὁμοίως, εὖτε καὶ ἤδη παταγεῖ. ἀπάτη δέ τοι ξύνεστι τοῖσι κυνικοῖσι σπασμοῖσι. δοκέει γὰρ τοῖσι θεωμένοισι τὰ ἀπάθεα τὴν νοῦσον ἴσχειν. τῇ γὰρ περιτάσει καὶ τῇ χροιῇ καὶ τῷ τοῦ ὀφθαλμοῦ μέζονι, ὑγιέα τὰ σιναρὰ φαίνεται. ἐλέγχεται δὲ καὶ ἐνγέλωτι καὶ λαλιῇ καὶ καταμύσει. τὰ μέν γε σιναρὰ σπᾶται πάντα πατάγῳ, χεῖλος ἀμειδὲς, ἀκίνητον ἢν λαλῇ, βλέφαρον οὐκ ἐπίτροχον, ὀφθαλμὸς ἀτενὴς, ἀναίσθητος ἡ ἁφή· τὰ δὲ ὑγιέα λαλεῖ, καταμύει, αἰσθάνεται, γελᾷ.

[¶5] 8. IF an ulcer form in the lungs from an abscess, or from a chronic cough, or from the rejection of blood, and if the patient spit up pus, the disease is called Pye and Phthisis. But if matter form in the chest or side, or be brought up by the lungs, the name is Empyema. But if, in addition to these symptoms, the lungs contract an ulcer, being corroded by the pus passing through it, the disease no longer gets the name of empyema, but takes that of Phthoe instead of it. It is accompanied with febrile heat of a continual character, but latent ceasing, indeed, at no time, but concealed during the day by the sweating and coldness of the body; for the characteristics of phthoe are, that a febrile heat is lighted up, which breaks out at night, but during the day again lies concealed in the viscera, as is manifested by the uneasiness, loss of strength, and colliquative wasting. For had the febrile heat left the body during the day, how should not the patient have acquired flesh, strength, and comfortable feeling? For when it retires inwardly, the bad symptoms are all still further exacerbated, the pulse small and feeble; insomnolency, paleness, and all the other symptoms of persons in fever. The varieties of the sputa are numerous: livid, black, streaked, yellowish-white, or whitish-green; broad, round; hard, or glutinous; rare, or diffluent; devoid of smell, fetid. There are all these varieties of pus. But those who test the fluids, either with fire or water, would appear to me not to be acquainted with phthoe; for the sight is more to be trusted than any other sense, not only with regard to the sputa, but also respecting the form of the disease. For if one of the common people see a man pale, weak, affected with cough, and emaciated, he truly augurs that it is phthoe (consumption). But in those who have no ulcer in the lungs, but are wasted with chronic fevers—with frequent, hard, and ineffectual coughing, and bringing up nothing, these, also, are called consumptive, and not without reason. There is present weight in the chest (for the lungs are insensible of pain),—anxiety, discomfort, loss of appetite; in the evening coldness, and heat towards morning; sweat more intolerable than the heat as far as the chest; expectoration varied, as I have described. Voice hoarse; neck slightly bent, tender, not flexible, somewhat extended; fingers slender, but joints thick; of the bones alone the figure remains, for the fleshy parts are wasted; the nails of the fingers crooked, their pulps are shrivelled and flat, for, owing to the loss of flesh, they neither retain their tension nor rotundity; and, owing to the same cause, the nails are bent, namely, because it is the compact flesh at their points which is intended as a support to them; and the tension thereof is like that of the solids. Nose sharp, slender; cheeks prominent and red; eyes hollow, brilliant and glittering; swollen, pale, or livid in the countenance; the slender parts of the jaws rest on the teeth, as if smiling; otherwise of a cadaverous aspect. So also in all other respects; slender, without flesh; the muscles of the arms imperceptible; not a vestige of the mammæ, the nipples only to be seen; one may not only count the ribs themselves, but also easily trace them to their terminations; for even the articulations at the vertebræ are quite visible; and their connections with the sternum are also manifest; the intercostal spaces are hollow and rhomboidal, agreeably to the configuration of the bone; hypochondriac region lank and retracted; the abdomen and flanks contiguous to the spine. Joints clearly developed, prominent, devoid of flesh, so also with the tibia, ischium, and humerus; the spine of the vertebræ, formerly hollow, now protrudes, the muscles on either side being wasted; the whole shoulder-blades apparent like the wings of birds. If in these cases disorder of the bowels supervene, they are in a hopeless state. But, if a favourable change take place, symptoms the opposite of those fatal ones occur. The old seldom suffer from this disease, but very rarely recover from it; the young, until manhood, become phthisical from spitting of blood, and do recover, indeed, but not readily; children continue to cough even until the cough pass into phthoe, and yet readily recover. The habits most prone to the disease are the slender; those in which the scapulæ protrude like folding doors, or like wings; in those which have prominent throats; and those which are pale and have narrow chests. As to situations, those which are cold and humid, as being akin to the nature of the disease.

> Greek: 8. ἢν ἕλκος ἐξ ἀποστάσιος ἐν τῷ πνεύμονι γένηται, ἢ ἐκ βηχὸς χρονίης, ἢ ἀναγωγῆς αἵματος, καὶ ἀναβήσσῃ πῦον, πύη, καὶ φθίσις κικλήσκεται· ἢν δὲ θώρηξ ἢ πλευρὸν ἐμπυήσῃ, ἐπανάγηται δὲ διὰ τοῦ πνεύμονος, ἐμπύη ἥδε τοὔνομα. ἢν δὲ ἐπὶ τοῖσι καὶ ὁ πνεύμων ἕλκος ἵσχῃ, ἀναβρωθεὶς ὑπὸ τοῦ διενεχθέντος πύου, τοὔνομα οὐκέτι ἐμπύη, ἀλλὰ φθόην μεταλαμβάνει· ξύνεστι δὲ καὶ πῦρ ξυνεχὲς, ὡς μὴ δοκέειν, λῆγον μὲν οὔκοτε, λῆθον δὲ διʼ ἡμέρης ἱδρῶτι καὶ ψύξι τοῦ σκήνεος. καὶ γὰρ καὶ τὰ ἴδια φθόης ἐστὶ, ἢν ἡ θέρμη ζωπυρῇ, καὶ ἐς νύκτα ἐκλάμπῃ, ἡμέρην δὲ αὖθις ἐν τοῖσι σπλάγχνοισι φωλεύει· δηλοῖ δὲ ἡ δυσφορίη, καὶ ἡ ἀδυναμίη, καὶ αἱ ξυντήξιες. ἢν γὰρ ἀπεδίδρησκε τοῦ σκήνεος διʼ ἡμέρης τὸ πῦρ, πῶς οὐκ ἂν ἐσαρκοῦ τό τε καὶ ἠδύνατο, καὶ εὐφόρως εἶχεν ὥνθρωπος; εὖτε γὰρ ἀνάγει, ἐπὶ μᾶλλον τὰ δεινὰ αὐξέεται. σφυγμοὶ σμικροὶ καὶ ἀμυδροὶ, ἀγρυπνὴ, ἄχροια, καὶ τἄλλα πάντα ὁκόσα οἱ πυρεταίνοντες· ἰδέαι δὲ ὑγρῶν μυρίαι, πελιδνῶν, μελάνων κατακορέων, ἢ ὠχρολεύκων, ἢ λευκοχλωρέων· πλατέων, στρογγύλων· σκληρῶν, δυσλύτων, ἢ μανῶν, λυομένων· ἢ ἀνόσμων, ἢ κακωδέων· ἅπαντα δὲ τάδε πύου ἔασι ἰδέαι. ὁκόσοι γὰρ ἢ πυρὶ ἢ ὕδατι τὰ ὑγρὰ τεκμαίρονται, οὐ κάρτα μοι δοκέουσι φθόην οἵδε γιγνώσκειν· πιστοτέρη γὰρ ἡ ὄψις ἁπάσης ἄλλης αἰσθήσιος, οὐ τῶν ἀναγομένων μοῦνον, ἀλλὰ καὶ τοῦ εἴδεος τοῦ νοσέοντος. ἢν γὰρ καὶ δημότης ἴδῃ τὸν ἄνθρωπον ὠχρὸν, ἀδρανῆ, ἀναβήσσοντα, ξυντετηκότα, ἀτρεκέα μαντεύεται φθόην· ἀτὰρ ἠδὲ ὁκόσοισι μὲν ἕλκος μὲν οὐκ ἔστι ἐν πνεύμονι, ξυντετήκασι δὲ πυρετοῖσι χρονίοισι, πυκνὰ δὲ καὶ σκληρὰ καὶ ἀτελέα βήσσουσι, καὶ ἀνάγουσι οὐδὲν, καὶ τούσδε φθισικοὺς κικλήσκουσι, οὐ πάνυ ἀσήμως. ξύνεστι δὲ τοῦ θώρηκος βάρος· πλεύμων γὰρ ἄπονος, ἄση, δυσφορίη, ἀποσιτίη, ἑσπέρῃ περίψυξις, καὶ θέρμη ἐς τὴν ἕω· ἱδρὼς ἄχρι θώρηκος τῆς θέρμης δυσφορώτερος· βηχὸς ἀναγωγαὶ ποικίλαι, ὁκοίας ἔλεξα. φωνὴ βραγχώδης· αὐχὴν ὑποσκόλιος, Ῥαδινὸς, οὐκ εὐπαράγωγος· ὁκοῖόν τι ξυντετα μένος· δάκτυλοι ἰσχνοὶ, τὰ δὲ ἄρθρα παχέα· ὀστέων μούνων ἡ ἰδέη· σμύχονται γὰρ καὶ σάρκες· ὄνυχες γρυποὶ δακτύλων, αἱ κοιλίαι Ῥυσαὶ καὶ πλατέες· ὑπʼ ἀσαρκίας γὰρ οὔτε τὴν περιταινίην οὔτε τὸ στρογγύλον ἴσχουσι. διὰ τόδε καὶ ὄνυχες γρυποί· ἥδε γὰρ ἡ ἀνακωχὴ, καὶ ἡ ὑπόστασις αὐτέων, ἥτις ἐν τῇσι κορυφῇσι πεπλησμένη εἵνεκεν αὐτῶν· ἔστι καὶ ὁ τόνος, ὥσπερ καὶ τὰ στερεά· Ῥὶς ὀξείη, ἰσχνὴ, μῆλα ὑπερίσχοντα καὶ ἐρυθρὰ, ὀφθαλμοὶ κοῖλοι, στιλπνοὶ, γανόωντες· οἰδαλέοι, καὶ ὠχροὶ, ἢ πελιδνοὶ τὰ πρόσωπα. γνάθων τὰ λεπτὰ τοῖσι ὀδοῦσι προσιζάνσει μειδιῶσι ἴκελον, τὰ πάντα νεκρώδεες. ὧδε καὶ τὰ πάντα ἴσχει· ἰσχνοὶ, ἄσαρκοι, βραχιόνων μύες ἄδηλοι, μαζῶν οὐδὲ ἴχνη, ἐκφανέες δὲ μοῦναι θηλαί. πλευρὰς οὐ καταλέξαι μοῦνον εὔσημον, ἀλλὰ καὶ ὅπη κραίνουσι, ἐσιδεῖν Ῥηΐδιον· οὐδὲ γὰρ αἱ πρὸς τοὺς σπονδύλους συναθρώσιες εὐξύγκρυπτοι· δῆλαι δὲ καὶ αἱ εἰς τὸ στέρνον ἐπιβολαί· τὰ μέσα τῶν πλευρέων κοῖλα, Ῥομβοειδέα. ὡς ἐς τὴν τῶν ὀστέων περιαγωγὴν ὑποχόνδρια λαγαρὰ, ἀνεσπασμένα, ἐπιγάστριον τῇ Ῥάχει προσφυὲς καὶ λαγών. ἄρθρα ἐναργῆ, ἔξαρθρα, ἀσαρκώδεα, καὶ ἡ κνήμη, ἰσχίον τε καὶ βραχίων. ὑπερίσχει ἡ ἄκανθα τῶν σπονδύλων ἡ πρόσθεν κοίλη τῶν ἑκατέρων ἐκτετηκότων μνῶν· ὡμοπλάται ἐκφανέες ὅλαι, ὅκως πτέρυγες ὀρνίθων. τουτέοισι ἢν κοιλίη ἐκταραχθῇ, ἀνέλπιστοι· ἢν δὲ ἐς ὑγείην τρέπηται, τὰ ἐναντία τοῖσι ὀλεθρίοισι ἐπιφοιτῇ. γηραιοὶ μὲν οὐ ξυνεχέες πάσχειν· διαδιδρήσκουσι δὲ ἥκιστα· νέοι δὲ μέχρι ἀκμῆς ἀπὸ αἵματος ἀναγωγῆς φθινώδεες γίγνονται, καὶ ὑγιάζον ται μὲν, οὐ Ῥηϊδίως δέ· παιδία ξυνεχῶς τῇ βηχὶ μέχρι φθόης κοτὲ Ῥηϊδίως ὑγιάζεται· ἕξιες δὲ Ῥαδινοὶ, σανιδώδεες, πτερυγώδεες, ἐξεχέβρογχοι, λευκοὶ, ἀραιότεροι τὸν θώρηκα· χῶραι δὲ ψυχραὶ καὶ ὑγραὶ, ὁκόσαι τῷ εἴδεϊ τοῦ πάθεος ἀδελφαί.

[¶6] 9. THOSE persons in whose cavities above, along the region of the chest, or, in those below the diaphragm, abscesses of matter form, if they bring it up, they are said to be affected with Empyema; but if the matter pass downwards, they are said to labour under Apostemes. And in the ulcers in the chest, or in the lungs, if phthoe supervene, or in the pleura, or the sternum, or anywhere below at the junction of the lungs with the spine — in all these cases the passage for the matter upwards is by the lungs. But in the viscera below the diaphragm, the liver, spleen, and kidneys, it is by the bladder; and in women by the womb. And I once made an opening into an abscess in the colon on the right side near the liver, and much pus rushed out, and much also passed by the kidneys and bladder for several days, and the man recovered. The common causes of all are a blow, indigestion, cold and the like. Of those in the chest also, chronic cough, pleuritis, peripneumony, and protracted defluxion; but also the determination of some acute diseases to any one of them. The humour is sometimes inert, weak, and rests on something else; sometimes bitingly acrid, and occasioning putrefactions even unto death. And there are many other varieties, as I shall presently declare. It is a wonder how from a thin, slender membrane, having no depth, like that which lines the chest, so much pus should flow; for in many cases there is a great collection. The cause is an inflammation from redundancy of blood, by which the membrane is thickened; but from much blood much pus is formed intermediately. But if it be determined inwards, the ribs being the bones in this region....... I have said above, that another species of phthisis would naturally occur. But if it point outwards, the bones are separated, for the top of the abscess is raised in one of the intercostal spaces, when the ribs are pushed to this side or to that. There are certain symptoms common to all, and certain ones peculiar to each. A heaviness rather than pain is a common symptom (for the lungs are insensible), weak fevers, rigor towards evening, sweats in the remission, insomnolency, swellings in the extremities of the feet, and fingers of the hands, which at one time abate and at another increase; uncomfortable feeling; loss of appetite; wasting of the whole body; and if the change be prolonged, the phthisical habit is formed; for Nature can no longer perform her office, for the digestion is not as before, nor is there the plump habit of body; the colour dark; respiration in all cases bad, but worse in those affecting the upper cavity; but also cough at first as long as the inflammation is urgent, when the pains also are greater, and rigor, and heat, and watchfulness, and dyspnœa still more; pulse small, sluggish, feeble; they are disordered in the intellect; distension of the thorax. But if it be already come to the formation of pus, all the the greatest symptoms take place. Expectoration small with greater cough, and from an urgent abscess, at first of pituitous matters, tinged with bile of a darker colour as if from soot, but likewise tinged with blood, and thick; but if about to burst, of fleshy and deep-seated matter. And, if it burst, there is danger of suffocation should much pus be suddenly poured forth; but if gradually, there is no danger. If then the pus is going to pass downwards, the upper part, where the abscess is situated, experiences sharp pain; discharges from the bowels fluid, at first watery with phlegm, afterwards bloody matter; and then again, substances resembling flesh floating in a fluid, if it has already burst. Pus follows them either by the bowels or the urine. Metastasis to the kidneys and bladder peculiarly favourable. The pus, whether it be carried upwards or downwards, is of various colours—pale, white, ash-coloured, or livid, black and fetid; or devoid of smell and very thick; or intermediate; or smooth and consistent; or rough and unequal, with fleshy substances floating in it, these being round or broad, readily separated or viscid. To say all in a word respecting the pus, such kinds as are white, concocted, devoid of smell, smooth, rounded, and are quickly coughed up, or pass downwards, are of a salutary character; but such as are very pale, bilious, and inconsistent, are bad. Of these by far the worst are the livid and black, for they indicate putrefaction and phagedenic ulcers. Along with these things, it will be proper to know also the habit and other concomitants of the disease. If at the time of the discharge, he feels comfortable, and gets rid of the fever; has good digestion, good colour, and a good appetite, if he coughs up readily, has a good pulse, and good strength; the patient is free from danger. But if fever supervene, and all the other symptoms turn worse, he is in a hopeless state. One ought also to consider the places in which the abscesses are seated. For where the matter forms in the sternum, it is slowly turned to a suppuration; for the parts are slender, devoid of flesh and cartilaginous; and such parts do not readily receive the superfluities of inflammation, but remain a long time without being formed into pus; for cartilage is of a cold nature, but the inflammations thereof are innocuous. The wasting of the constitution is bad; for the suppuration lasts a long time; the spleen, the liver, the lungs, and diaphragm pass more quickly into suppuration, but they are dangerous and fatal.

> Greek: 9. οἷσι ἐν τῇσι κοιλίῃσι τὰ ἄνω κατʼ ἴξιν τοῦ θώρηκος ἢ τὰ κάτω ὑπὸ τὸ διάφραγμα πύου ἀποστάσιες γίγνονται, ἢν μὲν ἀνάγωσι, ἔμπυοι οἵδε καλέονται· ἢν δὲ τὸ πῦον διεξίῃ κάτω, ἀποστηματίαι κικλήσκονται· καὶ ἐν μὲν θώρηκι ἐν τοῖσι ἕλκεσι, ἤτοι ἐν πλεύμονι, ἣν ἐκδέχεται φθόη, ἢ ὑπεζωκότι ἐν πλευρῷ, ἢ στέρνῳ, ἢ κάτωπη πρὸς τῇ ξυμφύσι τοῦ πνεύμονος κατὰ Ῥάχιν, ἤ πη τοῦ θώρηκος ἄλλῃ, — ξυμπάντων δὲ ἐς ἀναγωγὴν ὁδὸς τῷ πύῳ πνεύμων. ὑπὸ δὲ τὸ διάφραγμα ἐν τοῖσι σπλάγχνοισι, ἥπατι, σπληνὶ, νεφροῖσι, κύστις· ἐπὶ γυναικῶν δὲ καὶ ὑστέρη· ἔταμον δὲ καὶ ἐγὼ ἐν κώλῳ τινί κοτε ἀπόστασιν τὰ ἐπὶ δεξιὰ πρὸς ἥπατι· καὶ πολλόν τι ἐσσύθη ἔξω πῦον· πολλὸν δὲ καὶ διὰ νεφρῶν καὶ κύστιος ἐς ἡμέρας πλεῦνας ἐρρύη, καὶ περιεγένετο ὥνθρωπος. αἰτίαι δὲ ξυναὶ μὲν ἁπάντων πληγὴ, ἀπεψίη, ψύξις, ἠδὲ ὁκοῖα τοιάδε. τοῖσι δὲ ἐν θώρηκι, βὴξ χρονίη, καὶ πλευρῖτις, καὶ περιπνευμονίη, καὶ Ῥεῦμα χρόνιον· ἀτὰρ ἠδὲ ὀξείας νούσου ἐς ἕν τι τουτέων ἀπόσκηψις. τὸ δὲ ὑγρὸν ἄλλοτε μὲν ἀεργὸν, ἀδρανὲς, ἐγκέεταί τῳ ἄλλῳ· ἄλλοτε μὲν δριμὺ δαπτῶς, καὶ σηπεδόνας ἐμποιέον μέσφι θανάτου. καὶ γὰρ καὶ ἰδέαι μυρίαι, ὁκόσας αὖθις φράσω. θώϋμα δὲ ὅκως ἐξ ὑμένος λεπτοῦτε καὶ ἰσχνοῦ, βάθος οὐκ ἴσχοντος, τοῦ ὑπεζωκότος, τοσόνδε Ῥέει πῦον· πολλὸν γὰρ πολλοῖσι ξυνελέγη. αἰτίη δὲ φλεγμασίη ἀπὸ περιουσίης αἵματος, ἐφʼ ᾗ παχύνεται ὁ ὑμὴν, ἀτὰρ ἠδὲ ἐκ πολλοῦ αἵματος πολλὸν γίγνεται ἐν μέσῳ πῦον· κἢν μὲν εἴσω Ῥέπῃ, αἱ πλευραὶ τὰ ὀστέα κατὰ χώραν τὴν σφῶν αὐτέων, … φθίσιν ἔλεξα πρόσθεν ἑτέραν ἔμμεναι συμβεβῶ σαν κατὰ φύσιν· ἢν δὲ ἔξω Ῥέπῃ, διΐσταται τὰ ὀστέα. ἐς γὰρ ἕν τι τῶν μέσων πλευρῶν τῆς ἀποστάσιος ἡ κορυφὴ ἐγείρεται, εὖτε ἔνθα καὶ ἔνθα πλευρὰ παρωθέεται. σημήϊα δὲ τὰ μὲν ἁπάντων ξυνὰ, τὰ δὲ ἑκάστου ἴδια· βάρος ἢ πόνος γε ξυνόν· πνεύμων γὰρ ἄπονος· πυρετοὶ ἀμυδροὶ, Ῥίγεα πρὸς ἑσπέρην, ἱδρῶτες ἐπʼ ἀνέσι, ἀγρυπνίη, οἰδήματα ἐν ἄκροισι ποσὶ καὶ χειρῶν δακτύλοισι, ἄλλοτε καὶ ἄλλοτε καθιστάμενα, καὶ ἐπαιρόμενα· δυσφορίη, ἀποσιτίη, ἰσχνότη ς ὅλου· ἢν δὲ καὶ μῆκος ἴσχῃ ἡ μεταβολὴ, ἕξις φθινώδης. οὐ γὰρ ἔτι φύσις ἔργου ἔχεται. οὐ γὰρ πέψις ὁκοίη πρόσθεν, οὐκ εὐσαρκίη, χροιὴ ζοφώδης· ἀναπνοὴ πᾶσι μὲν κακὴ, κακίων δὲ οἷσι ἐς τὴν ἄνω κοιλίην. ἀτὰρ καὶ βὴξ τὰ πρῶτα, μέσφι ἂν ἡ φλεγμασίη πιέζει, εὖτε καὶ πόνοι μέζονες καὶ Ῥίγεα, καὶ θέρμη, καὶ ἀγρυπνίη, καὶ δύσπνοια ἔτι μᾶλλον· σφυγμοὶ σμικροὶ, νωθροὶ, ἀδρανέες, τὴν γνώμην παράληροι, διάτασις τοῦ θώρηκος. ἢν δὲ ἤδη εἰς γέννησιν ἥκῃ πύου, πάντα μέγιστα· ἀναγωγὴ δὲ σμικρὴ ἐπὶ βηχὶ μέζονι, καὶ ἐξ ἀποστάσιος βιαίης. τὰ πρῶτα φλεγματωδέ ων χολοβάφων ἐπὶ τὸ μελάντερον, ὅκως ἐξ αἰθάλης· ἔτι δὲ διαίμων καὶ παχέων· ἢν δὲ καὶ Ῥαγήσεσθαι μέλλῃ, καὶ σαρκοειδέων βαθέων· καὶ ἢν Ῥαγῇ, κίνδυνος μὲν πνίξιος, ἢν πολλὸν καὶ ἀθρόον ἐκχυθῇ πῦον· ἢν δʼ οὖν ἐκρέῃ σχέδην, ἀτρεκέει· πῦον ἢν κάτω περῆσαι θέλῃ, τὰ μὲν ἄνω μέρεα ἔνθα ἡ ἀπόστασις, ὀξὺς πόνος, κοιλίη ὑγρὴ, τὰ πρῶτα ὑδατώδεα ξὺν φλεγματώδεσι· ἔπειτα περίρροια αἱματωδέων, καὶ αὖθις σαρκοει δέων, ἢν ἤδη Ῥαγῇ. ἕπεται δὲ τουτέοισι πῦον, ἢ διὰ κοιλίης, ἢ οὔρων· ἀγαθαὶ δὲ πάντων μᾶλλον, αἱ ἐς νεφροὺς καὶ κύστιας μεταλήψιες. φέρεται δὲ, ἤν τε ἄνω, ἤν τε κάτω, χρόος πύου ποικίλον, ὠχρὸν, ἢ λευκὸν, ἢ τεφρίζον, ἢ πελιδνὸν, ἢ μέλαν, καὶ κακῶδες· ἢ ἄνοσμον καὶ παχύτατον· ἢ μέσως ἴσχον, ἢ λεῖον, ὁμαλὸν, ἢ τρηχὺ, ἀνώμαλον, καὶ σαρκοει δέα τὰ ἐμπλόωντα, στρογγύλα, ἢ πλατέα, Ῥηϊδίως ἀποπλυνόμενα, ἢ ἰξώδεα· ἀθρόον δὲ περὶ πύου εἰρῆσθαι, ὁκόσα μὲν λευκὰ, πέπονα, ἄνοσμα, λεῖα, στρογγύλα, καὶ ἀναβήσσεται θᾶσσον, ἢ ὑποφέρεται, περιεστηκότα· ὁκόσα δὲ ἔξωχρα, χολώδεα, ἀνώμαλα, μοχθηρά. πολλὸν δὲ τουτέων κακίω, τὰ πελιδνὰ καὶ μέλανα. σηπεδόνα γὰρ καὶ ἀνεσθιόμενα σημαίνουσι τὰ ἕλκεα. Προσξυν ιέναι δὲ τουτέοισι καὶ τὴν ἕξιν, καὶ τὰ ξυνομαρτέοντατῇ νούσῳ. ἢν γὰρ ἐπὶ τῇ ἐκκρίσι εὐφόρως φέρῃ, ἄπυρος γίγνηται, εὖτε πέσσῃ, εὔχρους, εὔσιτος· ἢrend="indent"ν ἀναβήσσῃ εὐμαρῶς, εὔσφυκτος, εὔτονος γίγνηται, ἀνώλεθρος ὁ νοσέων· ἢν δὲ ἐπιπυρεταίνῃ, καὶ πάντα ἐς κακὸν τρέπηται, ἀνέλπιστος. προσξυνιέναι δὲ καὶ τὰ χωρία, ἔνθα αἱ ἀποστάσιες· ὁκόσοισι γὰρ ἐν τῷ στέρνῳ τὸ ἐμπύημα γίγνεται, βραδέως ἀφίσταται. ψιλὰ γὰρ καὶ ἄσαρκα καὶ χονδρώδεα τὰ μέρεα· τὰ δὲ τοιάδε οὐ Ῥηϊδίως δέχεται φλεγμον ῆς περιουσίην· ἀνεκπύητα δὲ μίμνει πουλὺν χρόνον· ψυχρὸν γὰρ οἱ χόνδροι, ἀλλὰ τῶνδε ἀσινέες μὲν αἱ φλεγμοναί, τῆς ἕξιος δὲ κακαὶ συντήξιες, μακρὸν γὰρ διαπυΐσκει χρόνον. σπλὴν καὶ ἧπαρ καὶ πνεύμων καὶ διάφραγμα ὀξύτερα μὲν ἐς ἐμπύησιν, ἐπικίνδυνα δὲ καὶ θανατώδεα.

[¶7] 10. WHEN, in cases of peripneumonia, the patients survive, though the inflammation be not discussed, those who escape the acute stage of the affection have suppurations. The symptoms, then, of an incipient and of a formed abscess have been stated by me under Empyema. If formed, then, there is no necessity for the same harsh measures and pains to procure the rupture and discharge of it as in the solid parts of the body, as it is readily brought up; for the distension of its pores is required rather than of the solid texture of its parts; for the lungs being a porous body and full of perforations like a sponge, it is not injured by the humour, but transmits it from pore to pore, until it reach the trachea. Thus the fluid finds a ready outlet, the pus being a flexible and slippery substance, and the respiration blows the breath (pneuma) upwards. For the most part they recover, unless at any time one be suffocated by the copious influx of the fluid, when, owing to the quantity of the pus, the trachea does not admit the air. Others die a protracted death, after the manner of those labouring under phthisis and empyema. The pus is white and frothy, being mixed with saliva, but sometimes ash-coloured or blackish. And sometimes one of the bronchia has been spit up in a case of large ulceration, if the abscess is deep, when portions of the viscus are also brought up. Hoarse, breathing short, voice heavy-toned, their chest becomes broad, and yet they stand in need of its being still broader, owing to the collection of fluid; the dark parts of the eyes glancing, the whites are very white and fatty; cheeks ruddy; veins in the forehead protuberant. There is a marvel in connection with these cases, how the strength is greater than the condition of the body, and the buoyancy of spirits surpasses the strength.

> Greek: 10. εὖτε ὁκόσοισι περιπνευμον ικοῖσι ἂν φλέγμα ἔῃ, καὶ μὴ διαχέηται, περιγίγνονται· οἱ δὲ διαδιδρήσκοντες τὸ κάτοξυ τοῦ πάθεος ἔμπυοι γίγνονται. τὰ μὲν οὖν μελλούσης ἢ τετελες μένης ἀποστάσιος σημεῖα ἐν τοῖσι ἐμπύοισι ἔλεξα· ἢν δὲ τελεσθῇ, οὐ βίης καὶ πόνων ἐς ἀπόρρηξιν καὶ ἀναγωγὴν χρέος, ὅπωσπερ ἐν τοῖσι σώμασι· ἀλλὰ γὰρ Ῥηϊδίως ἀναφέρεται, διατάσιος μᾶλλον τῶν ἀραιωσίων γενομένης, ἤπερ ἕξιος σωμάτων. μανὸς γὰρ καὶ πολύτρητος ὁ πνεύμων, σπογγίῃ ἴκελος, οὐ χαλεπαίνων τῷ ὑγρῷ, ἄλλην ἀπʼ ἄλλης εὐρυχωρίην ἀμείβοντι, μέσφι τῆς τρηχείης ἀρτηρίης ἥκειν. περίοδοι δὲ τῷ ὑγρῷ Ῥηΐδιαι. εὐκαμπὲς γὰρ ἠδὲ ὀλισθηρὸν πῦον. ἀτὰρ καὶ ἡ ἀναπνοὴ ἄνω τὸ πνεῦμα φυσῇ. περιγίγνονται δὲ τὰ πολλὰ, εἰ μή κοτέ τις ἀπεπνιγῆ ἀθρόῃ ἑλκύσι τοῦ ὑγροῦ, τῆς ἀρτηρίης οὐ δεχομένης τὸν ἠέρα πλήθεϊ τοῦ πύου. θνήσκου σι δὲ μετεξέτεροι χρόνῳ τὸν φθινώδεα καὶ τὸν ἐμπυϊκῶν τρόπον· τὰ δὲ πῦα λευκὰ, ἔπαφρα, σιάλῳ μεμιγμένα· ἄλλοτε δʼ αὖ τεφροειδέα, ἢ ὑπομελανίζοντα· καὶ βρογχίον κοτὲ ἀνεπτύσθη ἐπὶ ποικίλῳ ἕλκεϊ, ἢν βάθος ἴσχῃ ἡ ἀπόστασις, εὖτε καὶ ἀπορρῶγες ἀναφέρονται τοῦ σπλάγχνου. βραγχώδεες, βραχύπνοοι, βαρύφωνοι, τὰ στήθεά σφιν εὐρέα γίγνεται, καὶ εὐρυτέρων τῆς ὑγρασίης δέονται. ὀφθαλμῶν τὰ μέλανα στιλπνά· τὰ δὲ λευκὰ, λευκότα τα καὶ πίονα· μῆλα ἐρευθῆ, φλέβες ἐν τῷ προσώπῳ κυρταί. θώϋμα δὲ ἐπὶ τουτέων. τόνος μὲν γὰρ εὐσαρκίης μείζων, εὐψυχίν δὲ τόνου δυνατωτέρη.

[¶8] 11. IF from running, gymnastic exercises, or any other work, the breathing become difficult, it is called Asthma (ἆσθμα); and the disease Orthopnœa (ὀρθόπνοια) is also called Asthma, for in the paroxysms the patients also pant for breath. The disease is called Orthopnœa, because it is only when in an erect position (ὀρθίῳ σχήματι) that they breathe freely; for when reclined there is a sense of suffocation. From the confinement in the breathing, the name Orthopnœa is derived. For the patient sits erect on account of the breathing; and, if reclined, there is danger of being suffocated. The lungs suffer, and the parts which assist in respiration, namely the diaphragm and thorax, sympathise with them. But if the heart be affected, the patient could not stand out long, for in it is the origin of respiration and of life. The cause is a coldness and humidity of the spirit (pneuma); but the materiel is a thick and viscid humour. Women are more subject to the disease than men, because they are humid and cold. Children recover more readily than these, for nature in the increase is very powerful to heat. Men, if they do not readily suffer from the disease, die of it more speedily. There is a postponement of death to those in whom the lungs are warmed and heated in the exercise of their trade, from being wrapped in wool, such as the workers in gypsum, or braziers, or blacksmiths, or the heaters of baths. The symptoms of its approach are heaviness of the chest; sluggishness to one’s accustomed work, and to every other exertion; difficulty of breathing in running or on a steep road; they are hoarse and troubled with cough; flatulence and extraordinary evacuations in the hypochondriac region; restlessness; heat at night small and imperceptible; nose sharp and ready for respiration. But if the evil gradually get worse, the cheeks are ruddy; eyes protuberant, as if from strangulation; a a râle during the waking state, but the evil much worse in sleep; voice liquid and without resonance; a desire of much and of cold air; they eagerly go into the open air, since no house sufficeth for their respiration; they breathe standing, as if desiring to draw in all the air which they possibly can inhale; and, in their want of air, they also open the mouth as if thus to enjoy the more of it; pale in the countenance, except the cheeks, which are ruddy; sweat about the forehead and clavicles; cough incessant and laborious; expectoration small, thin, cold, resembling the efflorescence of foam; neck swells with the inflation of the breath (pneuma); the præcordia retracted; pulse small, dense, compressed; legs slender: and if these symptoms increase, they sometimes produce suffocation, after the form of epilepsy. But if it takes a favourable turn, cough more protracted and rarer; a more copious expectoration of more fluid matters; discharges from the bowels plentiful and watery; secretion of urine copious, although unattended with sediment; voice louder; sleep sufficient; relaxation of the præcordia; sometimes a pain comes into the back during the remission; panting rare, soft, hoarse. Thus they escape a fatal termination. But, during the remissions, although they may walk about erect, they bear the traces of the affection.

> Greek: 11. εἰ ἀπὸ δρόμου καὶ γυμνασίων καὶ παντὸς ἔργου δυσπνοεῖ ἡ ἀναπνοὴ, ἆσθμα καλεῖται· καὶ ἡ νοῦσος δὲ ὀρθόπνοια, καὶ ἥδε κικλήσκεται ἆσθμα· ἐν γὰρ τοῖσι παροξυσμοῖσι ἀσθμαίνουσι καὶ οἵδε. ὀρθόπνοιαν δὲ ἐκάλεον, οὕνεκεν ὀρθίῳ σχήματι μοῦνον ἀναπνέουσι εὐφόρως· πνὶξ γὰρ ἐν κατακλίσι. εἵνεκεν τοῦ τόνου τοῦ ἐπὶ τῷ πνεύματι ὀρθόπνοια τοὔνομα. ὄρθιος γὰρ ἀνατέταται ἐς ἀναπνοὴν, κἢν ὕπτιος κατακλινθῇ ὥνθρωπος, κίνδυνος πνιγῆναι. πάσχει δὲ πλεύμων· ξυμπαθέει δὲ καὶ τὰ ξυντελοῦντα ἐς ἀναπνοὴν, διάφραγμα, θώρηξ· ἢν δὲ καρδίη πάθῃ, οὔκοτε ἐς πολλὸν διαρκέσειε. τῇδε γὰρ ἡ τῆς ἀναπνοῆς καὶ τῆς ζωῆς ἀρχή. αἰτίη δὲ ψύξις καὶ ὑγρότης τοῦ πνεύματος· ὕλη δὲ ὑγρὰ, παχέα, κολλώδεα· εὐπαθέες δὲ γυναῖκες ἀνδρῶν μᾶλλον, ὅτι περ ὑγραί τε καὶ ψυχραί· οἱ δὲ παῖδες τούτων περιγίγνονται Ῥηΐτερον, ἡ γὰρ φύσις ἐν αὐξήσι θερμῆναι δυνατωτάτη. ἄνδρες δὲ εἰ καὶ μὴ Ῥηΐδιοι παθεῖν, ἀλλὰ θνήσκουσι θᾶσσον. ἀμβολὴ δὲ θανάτου ὅσοισι ἐν ἔργου πρήξι, ἢ ἐν εἰρίοισι πλεύμων θάλπεται καὶ διαίθεται, ὁκοῖόν τι τοῖσι τῆς τιτάνου ἐργάτῃσι, ἢ χαλκεῦσι, ἢ σιδηρεῦσι, ἢ καὶ λουτρῶν πυρσευτῆρσι. Μελλησμοῦ δὲ σημήϊα, βάρος τοῦ θώρηκος, ὄκνος ἐς τὸ ξύνηθες ἔργον, ἀτὰρ ἠδὲ ἐς ἅπασαν πρῆξιν, δύσπνοια ἐν δρόμῳ, ἢ πρὸς ὁδὸν ὀρθήν· βραγχώδεες καὶ βηχώδεες, φῦσα ἐν τοῖσι ὑποχονδρίοισι καὶ ἐρυγαὶ παράλογοι, ἀγρυπνίη, θερμασίη νύκτωρ σμικρὴ, ἀσαφής· Ῥὶς ὀξείη, ἐς ἀναπνοὴν ἑτοίμη. ἢν δὲ ἐπὶ μέζον τὸ κακὸν ἕρπῃ, μῆλα ἐρυθρά· ὀφθαλμοὶ προπετέες, ὡς ἐπʼ ἀγχόνῃ, Ῥωγμὸς ἐν ἐγρηγόρσι· πολλὸν δὲ μέζον τὸ κακὸν ἐν ὕπνῳ· ὑγρὴ καὶ ἄηχος ἡ φωνή· πολλοῦ καὶ ψυχροῦ ἠέρος ἐπιθυμίη· ἐς τὸ ὕπαιθρον ἴενται, πᾶς γὰρ αὐτέοισι οἶκος ἐς ἀναπνοὴν οὐ διαρκής· ἀναπνέουσι ὄρθιοι, ὅκως ἅπαντα σπάσαι τὸν ἑλκόμενον ἠέρα ποθέοντες, ὑπʼ ἀπορίης δὲ τοῦ ἠέρος καὶ διοίγουσι τὸ στόμα, ὡς τῷδε μέζονι χρεόμενοι· ὠχροὶ τὰ πρόσωπα, πλὴν τῶν μήλων. τάδε γὰρ ἐρευθῆ. ἱδρῶς περὶ μέτωπον καὶ κληϊδας· βὴξ συνεχὴς, βιαίη· ἀναγωγὴ σμικρὴ, λεπτὴ, ψυχρὴ, ἰκέλη ὁκοῖόν τι καὶ ἀφροῦ ἐπάνθισμα. τράχηλος οἰδέει πνεύματος πρήσι. ὑποχόνδρια ἀνεσπασμένα. σφυγμοὶ σμικροὶ, πυκινοὶ, πιεζεύμενοι· ἰσχνὰ σκέλεα· κἢν ὑπερταθῇ τάδε, ἀπέπνιξέ κοτε ἐπιληπτικῷ τρόπῳ. ἢν δὲ ἐς ἀγαθὸν τρέπηται, βὴξ μακροτέρη καὶ ἀραιοτέρη. ἀναγωγὴ πλεύνων τε πύων καὶ ὑγροτέρων· κοιλίης τάραχος πολλῶν ὑδατωδέων· οὔρων ἔκκρισις πολλὴ, κἢν ἐς ὑπόστασιν μηδέκω ἥκῃ· φωνὴ γεγωνοτέρη, ὕπνοι αὐταρκέες, ὑποχονδρίων ἄνεσις· ἧκέ ποτε πόνος ἐς μετάφρενον ἐπʼ ἀνέσι. ἆσθμα ἀραιὸν, λεῖον, κερχνῶδες. ὧδε μὲν οὖν διαδιδρήσκουσι τὸν ὄλεθρον ἐν δὲ τῇσι ἐπανέσεσι, κἢν περιΐωσι ὀρθοστάδην, τοῦ πάθεος φέρουσι ξύμβολα.

[¶9] 12. PNEUMODES is a species of asthma; and the affection is connected with the lungs as is the case in asthma. The attendant symptoms are common, and there is but little difference; for dyspnœa, cough, insomnolency, and heat are common symptoms, as also loss of appetite and general emaciation. Moreover, the disease is protracted for a time, yet not longer than one year; for, if the autumn begin it, the patients die in the spring or in the summer; or if the winter, they terminate their life towards the autumn. Old persons also are at certain times readily seized; and being seized with rigors, it requires but a slight inclination of the scale to lay them on the bed of death. All labour in particular under want of breath; pulse small, frequent, feeble. But these symptoms are also common to asthma; they have this as peculiar; they cough as if going to expectorate, but their effort is vain, for they bring up nothing; or if anything is forcibly separated from the lungs, it is a small, white, round substance, resembling a hailstone. The thorax is broader, indeed, than natural, but not altered in shape, and is free from ulceration; yet, though the lungs be free from suppuration, they are filled with humours, which are, as it were, compacted. The intervals of the paroxysms in this affection are greater. Some, indeed, die speedily of suffocation before anything worse is transferred to the general system. In other cases the affection terminates in dropsy about the loins, or in anasarca.

> Greek: 12. ἄσθματος ἰδέη τὸ πνευμῶδες, καὶ ἀπὸ τοῦ πνεύμονος τὸ πάθος ὅκως ἐπʼ ἄσθματι. ξυνὰ γὰρ καὶ τὰ παρεόντα· σμικρὸν δὲ καὶ τὸ διάφορον. δύσπνοια μὲν γὰρ καὶ βὴξ καὶ ἀγρυπνίη καὶ θέρμη ξυνά· καὶ ἀποσιτίη καὶ ἰσχνότης ὅλου. καὶ γὰρ ἐς χρόνον τὸ κακὸν ἀποτείνεται, πλὴν οὐ περαιτέρω ἑνὸς ἔτεος. ἤν τε γὰρ τὸ μετόπωρον ἄρξῃ, εἰς τὸ ἔαρ ἢ τὸ θέρος ἀπογίγνονται· ἤν τε χειμὼν, ἐς τὸ μετόπωρον τελευτῶσι τὸν βίον. κοτὲ καὶ γέροντες ἁλῶναι Ῥηΐδιοι καὶ ἀπόφρικτοι ἁλόντες, ὅσον βραχείης Ῥοπῆς ἐς εὐνὴν θανάτου χρέος· ἄγχιστα ἅπαντες ἄπνοοι, σφυγμοὶ σμικροὶ, πυκνοὶ, ἀμυδροί. ἀλλὰ τάδε μὲν ξυνὰ πρὸς τὸ ἆσθμα· ἰδίᾳ δὲ ἀναβήσσουσι ὡς ἀνάξοντες. ματαιοπονέουσι δέ· οὐδὲν γὰρ ἀνάγουσι. εἰ δέ τι τοῦ πλεύμονος ἀπορραγείη βίῃ, σμικρὸν, λευκὸν, στρογγύλον, χαλαζῶδες· θώρηξ εὐρύτερος μὲν, ἀδιάστροφος, ἠδὲ ἀνέλκωτος· ἢν δὲ ἀνεκπύητος ὁ πνεύμων ᾖ, ὑγρῶν δὲ ὁκοῖόν τι πεπηγότων ἔμπλεως, διαλήψιες τῶν παροξυσμῶν τοῦδε μέζονες. οἱ μὲν οὖν ἀπεπνίγησαν θᾶσσον, πρίν τι κάκιον ἐς τὸ πᾶν ἀποσκῆψαι· μετεξετέροισι δὲ ἐς ὕδερον περὶ λαγόνα ἢ ἀνὰ σάρκα τὸ πάθος τελευτᾷ.

## 3. Book I · chapters 13–16

Source: https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/3/ · cite a paragraph as https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/3/#p-N

[¶0] 13. IN the formation of the body, the liver and spleen are equally balanced; for these viscera are equal in number, the one on the right side and the other on the left. They are unequal, however, in power, as regards health and diseases. In health, indeed, inasmuch as the liver has the power of nutrition, for “the roots of all the veins unite to form the liver”: but in diseases it has much greater power to restore health and occasion death. As far, then, as the liver is superior in health, so much the worse is it in diseases, for it experiences more sudden and violent inflammations, and has more frequent and more fatal abscesses. In scirrhus, too, it proves fatal more quickly and with greater pain than the spleen. Those things which relate to inflammations thereof I have described among the acute affections. If it be converted into pus, a sharp pain possesses the parts as far as the clavicle and the tops of the shoulders, for the diaphragm from which the liver is suspended is dragged down by the weight, and the diaphragm drags the membrane lining the ribs to which it is attached, and this membrane (the pleura) is stretched up to the clavicle and top of the shoulders, which also are dragged down. Along with the abscess there is acrid heat and rigors; cough dry and very frequent; colour grass-green; and if the patients be intensely jaundiced, it is of the white kind; sleep not quite clear of phantasies; on the main, their understanding settled; or if, from any temporary cause, there be delirium, it quickly passes off; swelling under the nipples or sides, which deceives many, as if it proceeded from the peritoneum. But if there be swelling and pain on pressure below the false ribs, the liver is swelled; for it is filled by a collection of fluid. But if the collection is not below the bone, it is a symptom of the membrane (the peritoneum) being affected, and its boundaries are distinctly circumscribed; for the hand applied in pressure, after passing the circumference of the liver, sinks down into an empty space in the abdomen. But the hardness of the peritoneum is undefined, and no process at its extremity is apparent. If the process incline inwardly, nature is far superior to the physician; for it is either turned upon the bowels or the bladder, and far the least dangerous is the passage by the bladder: but if it incline outwards, it is bad not to make an incision, for otherwise the liver is corroded by the pus, and death is not long deferred. But, if you intend to make an incision, there is danger of hemorrhage, from which the patient may die suddenly; for hemorrhage in the liver cannot be checked. But if you are reduced to the necessity of making an incision, heat a cautery in the fire to a bright heat, and push it down to the pus, for it at the same time cuts and burns: and if the patient survive, there will run out a white, concocted, smooth, not fetid, very thick pus, by which the fever and other bad symptoms are diminished, and altogether the health is restored. But if the pus passes into the intestines, the belly has watery discharges at first, but afterwards they resemble the washings of flesh, and, again, they are like those in dysentery proceeding from ulcerations; but sometimes a bloody ichor, or thrombus is passed. Bile also is discharged, intensely yellow, or leekgreen, and, lastly, before death, black. But if the abscess do not suppurate, and the discharges from the bowels are fetid like putrefaction, the food passes undigested, owing to the stomach and intestines having lost their tone; for thus the liver, even though now in good condition, does not perform digestion; along with these symptoms there is acrid heat, and altogether there is a turn to the worse; colliquative wasting of the flesh, pulse small, difficulty of breathing, when at no distance of time their life is at an end. In certain cases, the dysentery and the ulceration have healed, but the disease changed to dropsy. But if all these symptoms abate, if pus that is white, smooth, consistent, and inodorous, is discharged, and the stomach digests the food, there may be good hopes of the patient. But the best thing is for it to be discharged by the urine; for the passage by it is safer and less troublesome than the other. But if, after the inflammation, the liver does not suppurate, the pain does not go off, its swelling, changing to a hard state, settles down into scirrhus; in which case, indeed, the pain is not continued, and when present is dull; and the heat is slight; there is loss of appetite; delight in bitter tastes, and dislike of sweet; they have rigors; are somewhat pale, green, swollen about the loins and feet; forehead wrinkled; belly dried up, or the discharges frequent. The cap of these bad symptoms is dropsy. In the dropsy, provided there is a copious discharge of thick urine, having much re-crementitious sediment, there is a hope that the dropsical swelling may run off; but if the urine be thin, without sediment, and scanty, it conspires with the dropsy. But if nature change to her pristine state, and burst upon the bowels, along with copious watery discharges, it has also sometimes cured the dropsy. This mode of cure, however, is dangerous; for what from the copious evacuations, and the extreme prostration, the patients have sometimes died of weakness, as from hemorrhage. Sweating, if copious, carries off the disease with less danger, for dropsical persons generally have not a moist skin. Such is the termination of the affections in the liver. But if the liver suppurate..... children, and those till manhood; women less so. The causes are intemperance, and a protracted disease, especially from dysentery and colliquative wasting; for it is customary to call these persons tabid who die emaciated from ulcers of the liver.

> Greek: 13. Ἥπαρ σπληνὶ ἐς γένεσιν μὲν ἰσόρροπον· δεξιὰ γὰρ ἠδὲ ἐπʼ ἀριστερὰ τὰ σπλάγχνα ἰσάριθμα τῇ φύσι· ἄνισοι δὲ ἐς δύναμιν καὶ ἐν ὑγείῃ καὶ ἐν νούσοισι. ἐν ὑγείῃ μὲν, ὅτιπερ τὸ κράτος τῆς τροφῆς τὸ ἧπαρ ἴσχει· Ῥίζωσις γὰρ φλεβῶν ἧπαρ· ἀτὰρ ἐν νούσοισι καὶ ἐς ὑγείην πολλόν τι ἰσχυροτέρην ἔχει καὶ τοῦ θανάτου τὴν αἰτίην. ὁκόσον οὖν ἧπαρ ἐς ὑγείην κρέσσον, τοσόνδε κάκιον ἐν νούσοισι. καὶ γὰρ ἐπιφλεγμαίνει θᾶσσόν τε καὶ βιαιότερον, καὶ ἀφίσταται ξυνεχέστερόν τε καὶ ὀλεθριώτερον. ἐπὶ σκίρρῳ δὲ ὠκύτερον σπληνὸς καὶ περιαλγέστερον κτείνει. τὰ μὲν οὖν τῆς φλεγμασίης ἐν τοῖσι ὀξέσι ἔλεξα. ἢν δὲ ἐς πῦον τρέπηται, ὀδύνη ὁξεῖα ἴσχει μέσφι κλειδὸς, ἢ ἄκρου ὤμου. ὑπὸ γὰρ τοῦ ἄχθεος ἕλκεται τὸ διάφραγμα, ἐξ οὗ τὸ ἧπαρ ἤρτηται· τὸ δὲ διάφραγμα τὸν ὑπὸ τῇσι πλευρῇσι ὑμένα βρίθει· ξυνῆπται γὰρ αὐτέῳ· ὁ δὲ ἐπὶ τὴν κληῖ¨δα ἠδὲ ἄκρω τῶν ὤμων ἀποτέταται, καὶ τάδε ξυνεφέλκεται κάτω. πῦρ δριμὺ ξὺν Ῥίγεσι ἐπὶ τῇ ἀποστάσει, βὴξ ξηρὴ, οὐ μάλα πυκινὴ, χροιὴ χλοήβαφος. ἢν δὲ κατακορ έως ἔωσιν ἰκτερώδεες, τοῦ λευκοχρόου εἴδεος· ὕπνοι καθαροὶ φαντασίης οὐ μάλα. νηφαλέοι μὲν ἐς πάντα· ἐς ἓν δέ τι τῶν προσκαίρων ἐξαπίνης παρακοπαὶ, καὶ κατεστάθησαν εὐθέως· ὄγκος ὑπὸ τιτθῇσι ἢ πλευρῇσι, ἀπάτη δὲ πολλοῖσι ὅκως περιτοναίου γίγνεται. ἀλλʼ ἢν μὲν ᾖ ὑπὸ τὰς νόθας ὄγκος καὶ ὀδύνη πιεζευμένοις, τὸ ἧπαρ οἰδέει· ἔμπλεων γὰρ ὑγρασίης· ἢν δὲ μὴ ὑπὸ τὸ ὀστέον μίμνωσι οἰδέει[], τοῦ ὑμένος τὸ σημεῖον· καὶ τοῦ μὲν περιγραφῇ καὶ τὰ ὅρια δῆλα· μετὰ γὰρ τὴν περιαγωγὴν τῶν λοβῶν ἐς λαγαρὸν τὸ ἐπιγάστριον πιέζουσα χεὶρἱζάνει· περιτοναίου δὲ ἀόριστος ἡ σκληρίη καὶ τοῦ πέρατος ἡ ἀπόφυσις ἀφανής. ἢν μὲν εἴσω ἡ ἀπόστασις Ῥέπῃ, πολλόν τι κρέσσον ἡ φύσις ἰητροῦ· ἢ γὰρ ἐς ἔντερα, ἢ ἐπὶ κύστιν τρέψει τὸ πῦον· ἀσινεστέρη δὲ πολλὸν ἡ ἐς κύστιν ὁδός. ἢν δὲ ἔξω Ῥέπῃ, κακὸν μὲν μὴ τάμνειν. ἤν τε γὰρ οὕτως ἔῃ, ἀνεσθίε ται ὑπὸ τοῦ πύου τὸ ἧπαρ, καὶ οὐκ ἐς ἀμβολὴν ὁ θάνατος. ἢν δὲ θέλῃς τάμνειν, αἱμορραγῆσαι κίνδυνος, καὶ αὐτίκα τὸν ἄνθρωπον ἐκθανεῖν. ἄσχετος γὰρ αἱμορραγίη ἐφʼ ἥπατι. ἢν οὖν ἐς ἀνάγκην τομῆς κατίῃς κοτὲ, καυτῆρα ἔμπυρον διαφανέα πυρῶσαι, καὶ διῶσαι μέσφι τοῦ πύου. τωὐτὸ γάρ σοι τέμνει τε καὶ καίει. καὶ ἢν περιγίγνηται, πῦον ἐκρεύσει λευκὸν, πέπον, λεῖον, κακῶδες, ὅτι παχύ· τοῖσδε καὶ πυρετοὶ καὶ τὰ δεινὰ ξυνδιδοῖ· Ῥηϊδίως τε ἀλθέξεται πάντα. ἢν δὲ ἐς ἔντερον τὸ πῦον ἐγχέηται, ἡ γαστὴρ πρώτιστα μὲν ὑδατώδεα διαρρέει· ἔπειτα κρεῶν πλύμασι ἴκελα· αὖθις αὖ δυσεντεριώδεα ὁκοῖα ἐφʼ ἕλκεσι. ἀτὰρ καὶ αἱμάλωψ κοτὲ καὶ θρόμβος ἠνέχθη. φέρεται καὶ χολὴ ξανθὴ κατακορὴς, ἢ πρασοειδὴς, καὶ ὑστάτη ἐς ὄλεθρον μέλαινα. ἢν δὲ ἀνεκπύητον τὸ ἕλκος γίγνηται, καὶ κακώδεα ἡ γαστὴρ ὁκοῖόν τι σηπεδόνα ὑπάγει, τροφὴ ἄπεπτος διεκθέει ὑπʼ ἀκρασίη ς κοιλίης τε καὶ ἐντέρων. οὐ πέπτει γὰρ αὖθις εὖ ἔχον τὸ ἧπαρ· πῦρ τε ἐπὶ τοῖσδε δριμὺ, καὶ πάντως ἐς κακὸν ἡ τροπή. σαρκῶν ξυντήξιες, σφυγμοὶ σμικροὶ, δύσπνοοι, εὖτε οὐκ εἰς μακρὸν ἐτελεύτ ησαν τὸν βίον. μετεξετέροισι δὲ ἡ δυσεντερίη μὲν καὶ τὸ ἕλκος ἰήθη, ἐς ὕδρωπα δὲ κατέστρεψε ἡ νοῦσος. ἢν δὲ ἅπαντα ξυνδιδῷ, πῦον λευκὸν, λεῖον, ὁμαλὸν, ἄνοσμον γὰρ ἐκρέει, ἡ γαστὴρ πέττειτε τὰ σιτία, εὔελπις ὥνθρωπος. ἄριστον δὲ διʼ οὔρων κεκρίσθαι· ἀσφαλεστέρη δὲ καὶ ἀσινεστέρη ἡ τῇδε τοῦ πύου ὁδός. ἢν δὲ ἀπὸ τῆς φλεγμονῆς ἀνεκπύητον ᾖ τὸ ἧπαρ, ἄπονον μὲν οὐ γίγνεται, τὸν ὄγκον τε τὸν σκληρὸν ἷζον εἰς σκίρρον ἱδρύεται. εὖτε πόνος μὲν οὐ ξυνεχὴς, νωθὴς δὲ κἢν παρῇ· ἀραιὴ δὲ καὶ θέρμη· ἀποσιτίη, πικρῶν γευμάτων ἡδονὴ, γλυκέων ἀηδίη, Ῥιγώδεες, ὑπόλευκοι, χλωροὶ, οἰδαλέοι ὀσφὺν καὶ πόδας. πρόσωπα Ῥυσὰ, γαστὴρ ξηρὴ, διαχωρήσιες πυκιναί. κορυφὴ γὰρ τῶν κακῶν ὕδρωψ. ἐπὶ τῷ ὕδρωπι, ἢν μὲν οὖρα πολλὰ, παχέα, ἐπίδοσιν ἔχοντα πολλὴν ἰλυώδεα καταρραγῇ, ἐλπὶς ἐκρεῦσαι τὸν ὕδερον· ἢν δε λεπτὰ καὶ ἀνυπόστα τα καὶ ὀλίγα, τῷ ὕδρωπι τιμωρέει· ἢν δὲ μεταβάλλῃ εἰς τὸ ἀρχαῖον ἡ φύσις, καὶ καταρρα γῇ κοτε εἰς κοιλίην, ἐπὶ πολλοῖσι ὑδατώδεσι καὶ τὸν ὕδρωπα ἰησατο· σφαλερὴ δὲ ἡ τοιαύτη ἐπικουρίη· ἐπὶ γὰρ τῇσι ἀθρόῃσι κενώσεσι ἠδὲ τῇσι ἐσχάτῃσι ξυμπτώσεσι ἐξέθανόν κοτε ὑπʼ ἀδυναμίης οἱ κάμνοντες, ὅκως ἐξ αἱμορραγίης. ἀσινέστερον δὲ λύει ἱδρὼς, ἢν πολὺς ἐκρυῇ. οὐ πάνυ γὰρ ἰκμαλέοι οἱ ὑδρωπιώδεες. ἥδε τῶν ἐν ἥπατι παθέων ἡ τελευτὴ γίγνεται. ἢν δὲ ἐμπυέῃ τὸ ἧπαρ, … μείρακες καὶ οἱ μέσφι ἀκμῆς, ἧσσον γυναῖκες· προφάσιες δὲ ἀκρασίη καὶ νοῦσος μακρὴ, μάλιστα ἐπὶ δυσεντερίῃ καὶ ξυντήξεσι. καὶ γὰρ δὴ καὶ τούσδε ἐκίκλησκον ξυντηκτικοὺς, τοὺς ἐπὶ ἕλκεσι ἥπατος ἰσχνοὺς ἀποθνήσκοντας.

[¶1] 14. SCIRRHUS, a chronic disease, is habitual to the spleen (suppuration does not readily occur in it, and yet it does occur sometimes), when the pain is not severe, but swelling much greater than the pain; for it has been seen swelled on the right side as far as the liver in the whole common space between them, hence many have been deceived in supposing that it is not an affection of the spleen, but of the membrane, for it appears to them that the peritonæum is inflamed. It is hard and unyielding as stone. Such the spleen generally becomes in scirrhus, when also it is attended with great discomfort. But if it suppurate, it is soft to the touch, yielding to pressure at its top, when there is a formation of pus; but when it is not suppurated it does not yield. Sometimes it hangs entire in the abdomen, being moved about to this side and to that, whilst it remains a small body, and has space to float in. Nausea, restlessness, especially about the time of breaking. The symptoms of distension are, fevers, pains, and rigors (for generally they are free of rigors, and of pain when the heat is small, and hence abscess about the spleen is sometimes latent); for the viscus is porous and insensible even in health: they are swollen, dropsical, of a dark-green colour, along with disquietude, dyspnœa as if from weight of the chest, for the evil is well marked. Even to its upper parts the abdomen is filled with a flatus (pneuma), thick, misty, humid in appearance but not in reality; much desire of coughing comes on, and their expectoration is small and dry. If there be watery discharges from the bowels, they at first bring some slight relief; but if they increase, they waste the patient, and yet nevertheless they do good. But, if it should break, pure concocted pus is never discharged, but whitish and ashy, sometimes feculent, or livid. If the abscess become deeper, the fluid is dark, when likewise some of the juice of the melted spleen is discharged. In certain cases, entire portions of the spleen have been brought up, for the spleen is of a soluble nature. And if the ulcer does not heal, but remains for a long time, they lose appetite, become cachectic, swollen, unseemly to look at, having many ulcers on all parts of the body, especially on the legs, where the sores are round, livid, hollow, foul, and difficult to heal. Wasted thereby, they expire. In a small tumour, with hardness and resistance, pain is wanting; on this account they live a long time. But if overpowered by the affection, dropsy, phthisis, and wasting of the body necessarily supervene; and this form of death removes them from life. Children, then, and young persons are most readily affected, and most readily escape from it. Old persons, indeed, do not often suffer, but they cannot escape; but certain elderly persons have been cut off by latent disease of the spleen; for, even with a small swelling, the scale of death has turned with them. A protracted and consumptive disease induces these affections, and in young persons inactivity especially, when, after contention and many exercises, the body has become inactive. As to localities, the marshy; as to waters, the thick, saltish, and fetid. Of the seasons, autumn is pecularly malignant.

> Greek: 14. σπληνὶ ξύνηθες χρόνιον νόσημα, σκίρρος. ἔμπυος δὲ οὐ Ῥηϊδίως, γίγνεται δʼ οὖν. εὖτε πόνος μὲν οὐ τρηχὺς, ὄγκος δὲ πουλὺς τῆς ἐπιπονίης μέζων· ἐπὶ δεξιὰ γὰρ ὤφθη μέσφι τοῦ ἥπατος ὅλῃ τῇ κοινωνί ῃ ἐποιδέων. τοὔνεκεν πολλοῖσι ἀπάτη γίγνεται, ὡς τοιοῦδε οὐκ ἐόντος σπληνὸς, ἀλλὰ τοῦ ὑμένος πάθεος. τὸ γὰρ περιτόναιον φλεγμάινειν σφίσι δοκέει. ἀπηνὴς δὲ καὶ ἀτέραμνος ὅκως λίθος. τοιόσδε τὰ πολλὰ ἐπὶ σκίρρῳ γίγνεται σπλὴν, εὖτε καὶ ἀπορίη ξύνεστι παντελής. ἢν δὲ καὶ ἐμπυΐσκῃ, εὐαφὴς μὲν, εἴκων ἐπὶ τῇ θίξι κατὰ κορυφὴν, ἔνθα ἡ τοῦ πύου γέννα· ὅπη δὲ ἀνεκπύητος, οὐκ εἴκει. ἄλλοτε δὲ τῇ κοιλίῃ ἅπας ἐπαιώρηται, τῇδε κἀκεῖσε πρὸς τὰς ἀπώσιας φερόμενος, ἔς τʼ ἂν σμικρότερος ἐὼν χώρην ἐς τὸ ἐμπλώειν ἴσχῃ. ναυτίη, ἀπορίη, μάλιστα πρὸς τῇσι Ῥήξεσι. ἐπὶ δὲ τάσιος σημήϊα, πυρετοὶ, πόνοι καὶ Ῥίγεα. τὰ πολλὰ γὰρ ἔασι ἄρριγοι δὲ ἐπὶ βραχείῃ θέρμῃ καὶ ἀνώδυνοι, τῇδε καὶ λέληθέ κοτε ἐς σπλῆνα ἀπόστασις. μανὸν γὰρ καὶ ἐπαναίσθητον καὶ ἐν ὑγείῃ τὸ σπλάγχνον· οἰδαλέοι, ὑδερώδεες, μελάγχλωροι, ξὺν δυσφορίῃ ἡ δύσπνοια ὡς ἀπὸ βάρεος τοῦ θώρηκος. ἐπίδηλον γὰρ τὸ κακόν· ἄχρι τῶν ἄνω γαστὴρ πίμπλαται ὑπὸ πνεύματος παχέος, ὁμιχλώδεος, ὑγροῦ ὡς δοκέειν, οὐκ ἔτʼ ἐόντος ὑγροῦ· βῆξαι πολλὸν θυμὸς ἐγγίγνεται, καὶ βραχέα ξηρὰ βήσσουσι. κοιλίη ἤν τι κάτω φέρῃ ὑδατώδεα, τὸ πρῶτον σμικρὸν ἐπικουφίζουσα· εἰ δὲ ἐπὶ μᾶλλον ἐκδιδῷ, ξυντήκει μὲν τὸν ἄνθρωπον· ὠφελέει δὲ οὐδὲν ἧττον. ἢν δὲ καὶ ἐκραγῇ, πῦον μὲν καθαρὸν, πέπον ὄυκοτε ἐσσύθη, ὑπόλευκον δὲ καὶ τεφροειδὲς, ἄλλοτε δὲ τρυγῶδες ἢ πελιδνόν· ἢν δὲ καὶ βαθυτέρη ἡ ἀπόστασις γένηται, καὶ μέλαν τὸ ὑγρόν· εὖτε καὶ τοῦ χυμοῦτι τοῦ σπληνὸς ἔξεισι συντακέντος. μετεξετέροισι δὲ καὶ ὅλα μέλεα τοῦ σπληνὸς ἠνέχθη· εὔλυτος γὰρ καὶ φύσι σπλήν· ἢν δὲ καὶ μὴ καθίστηται τὸ ἕλκος, μίμνῃ δὲ ἐς πολλὸν χρόνον, ἀπόσιτοι, καχέκται, οἰδαλέοι, ἰδεῖν ἀπρεπέες, πολυελκέες πάντη· μάλιστα δὲ ἐς κνήμας· στρογγύλα, πελιδνὰ, κοῖλα, Ῥυπαρὰ, δυσαλθέα τὰ ἕλκεα· τῇδε ἐπιξυντακέντες ὤλοντο. ἐπὶ δὲ σμικρῷ ὄγκῳ μετὰ σκληρίης, ἀντιτυπίης, ἀπονίη· διὰ τόδε πολλὸν χρόνον ζῶσι οἵδε· εἰ δὲ τοῦ πάθεος ἥττηντο, χρεὼν ὕδρωψ, ἢ φθίσις, καὶ τοῦ σκήνεος τηκεδὼν ἐπιγίγνεται· ἀτὰρ ἠδὲ οὗτος ὁ τρόπος τοῦ ὀλέθρου σφέας τοῦ ζῆν ἐξάγει. παιδία μὲν οὖν καὶ νέοι παθεῖν τε Ῥηΐτεροι καὶ ἀπαλλαγῆναι Ῥηΐτεροι· γέροντες δὲ οὐκ εὐπαθέες μὲν, διαδρῆναι δὲ ἀδύνατοι· ἀτὰρ καὶ πρεσβῦται ἔλαθόν τινες ὑπὸ σπληνὸς διαφθαρέντες. καὶ γὰρ καὶ ἐπὶ σμικρῷ ὄγκῳ τοῦ ὀλίθρου σφίσιν ἡ Ῥοπή· φέρει δὲ καὶ νοῦσος μακρὴ, φθινώδης, καὶ νέοισι ἀργίη μάλιστα, ὁκόσοισι ἀπʼ ἀγωνίης, ἢ γυμνασίων πολλῶν, ἄπονοντὸ σῶμα. χωρία ἑλώδεα, ὕδατα παχέα, ἁλμυρὰ, βρωμώδεα· ὡρῶν, τὸ θηριῶδες μετόπωρον.

[¶2] 15. If a distribution of bile, either yellow, or like the yolk of an egg, or like saffron, or of a dark-green colour, take place from the viscus, over the whole system, the affection is called Icterus, a dangerous complaint in acute diseases, for not only when it appears before the seventh day does it prove fatal, but even after the seventh day it has proved fatal in innumerable instances. Rarely the affection has proved a crisis to a fever towards the end, but itself is not readily discussed. It is formed not only from a cause connected with the liver, as certain physicians have supposed, but also from the stomach, the spleen, the kidneys, and the colon. From the liver in this manner: if the liver become inflamed or contract scirrhus, but remain unchanged with regard to its functional office, it produces bile, indeed, in the liver, and the bladder, which is in the liver, secretes it; but if the passages which convey the bile to the intestine, be obstructed from inflammation or scirrhus, the bladder gets over-distended, and the bile regurgitates; it therefore becomes mixed with the blood, and the blood, passing over the whole system, carries the bile to every part of the body, which acquires the appearance of bile. But the hardened fæces are white and clayey, as not being tinged with bile, because the bowels are deprived of this secretion. Hence also the belly is very much dried up; for it is neither moistened nor stimulated by the bile. The colour in this species is whitish-green. If jaundice make its appearance in connection with the spleen, it is dark-green, for its nutriment is black, because the spleen is the strainer of the black blood, the impurities of which it does not receive nor elaborate when diseased, but they are carried all over the body with the blood. Hence patients are dark-green from icterus in connection with the spleen; but the colour is darker than usual in the customary discharges from the bowels, for the superfluity of the nutriment of the spleen becomes recrement from the bowels. And icterus also is formed in connection with the colon and stomach, provided their powers of digestion be vitiated; for digestion takes place even in the colon, and from it a supply of nutriment is sent upwards to the liver. Provided, then, the liver receive its other food in a cruder state than usual, it indeed goes through its own work, but leaves that of the other undone; for in distribution it diffuses the blood which carries the marks of the inactivity of the colon to all parts of the body. The indigestion in this case is connected with the formation of the bile in the colon. Thus icterus may be formed in any viscus, not only of those which send nutriment to the liver, but also of those which receive it from the liver. For nature sends nutriment to all parts, not only by ducts perceptible to the senses, but much more so by vapours, which are readily carried from all parts to all, nature conducting them even through the solid and dense parts. Wherefore these vapours become tinged with bile, and discolour any part of the body in which they get lodged. Moreover, in jaundice connected with the colon, the evacuations are not white; for the liver is not disordered as regards the function of bile, and is not impeded in the transmission of bile to the intestines. The general system, likewise, is most powerful in producing icterus; for the cause is seated in the whole body. It is of this nature: in every part there is heat for concoction; in every part for the creation and secretion of humours, different in different places, but in each that which is peculiar to it: in flesh, indeed, sweat; in the eyes, tears; in the joints and nose, mucus; in the ears, wax. If the heat, then, fails in the performance of each of its operations, it is itself converted into that which is acrid and fiery; but all the fluids become bile, for the products of heat are bitter, and stained with bile. But if indigestion happens in the blood, the blood assumes the appearance of bile, but is distributed as nourishment to all parts, wherefore bile appears everywhere. For it is a dire affection, the colour being frightful in appearance, and the patients of a golden colour; for the same thing is not becoming in a man which is beautiful in a stone. It is superfluous in me to tell whence the name is derived, further than that it is derived from certain four-footed and terrestrial animals, called ἰκτίδες, whose eyes are of this colour. There are two species of the affection; for the colour of the whitish-green species either turns to yellow and saffron, or to livid and black. The cause of these is the same as the cause of the two kinds of bile; for, of the latter, one species—namely, the light-coloured—is yellow, thin, and transparent; but this species is also sometimes tinged so as to resemble saffron or the yolk of an egg. The other is of a darker character, like leeks, woad, or wholly black. There are innumerable intermediate varieties of colour, these being connected with the heat and humours. The viscera, also, co-operate in this; for the viscus is either a bright-red, like the liver, or dark-red, like the spleen. When, therefore, the icterus is connected with any viscus, if from the liver, it bears traces of this viscus, and if from the spleen, of it; and so, also, with regard to all the others. But if it possesses no appearance of any, it is an affection of the general habit. These appear manifest in the white of the eyes especially, and in the forehead about the temples; and in those naturally of a white complexion, even from a slight attack, the increased colour is visible. In cases, therefore, of black icterus, the patients are of a dark-green colour, are subject to rigors, become faintish, inactive, spiritless; emit a fetid smell, have a bitter taste, breathe with difficulty, are pinched in the bowels; alvine evacuations like leeks, darkish, dry, passed with difficulty; urine deeply tinged with black; without digestion, without appetite; restless, spiritless, melancholic. In the whiter species, the patients are of a light-green colour, and more cheerful in mind; slow in beginning to take food, but eat spiritedly when begun; of freer digestion than those of the former species; alvine discharges, white, dry, clayey; urine bright-yellow, pale, like saffron. In both cases the whole body is itchy; heat at the nostrils, small, indeed, but pungent; the bilious particles prickly. The taste of bitter things is not bitter; and yet, strange to tell, it is not sweet; but the taste of sweet things is bitter. For in the mouth the bile lodged in the tongue, prevailing over the articles of food, sophisticates the sensation; for the tongue, having imbibed the bile, does not perceive them, while, during the season of abstinence from food, the bile remains torpid, neither is the tongue unpleasantly affected with that to which it is habituated; but the bile, if heated up by the tastes of the articles of food, impresses the tongue. When, therefore, the food is bitter, the sensation is of the bitter things; but when sweet, of the bilious. For the sensation of the bile anticipates the other, and thus deceives those who suppose that bitter things appear sweet; for it is not so, but because it is not exacerbated by the bitter lodged in it from being habituated to the disease, the phantasy of sweet is created; and there is the same condition in sweet and bitter tastes; for the bile is the screen of the fallacious tastes. When, therefore, it appears without inflammation of any viscus, it is usually not dangerous, though protracted; but if prolonged, and the viscus gets inflamed, it terminates most commonly in dropsy and cachexia. And many have died emaciated, without dropsy. It is familiar to adolescents and young men, and to them it is less dangerous; it is not altogether unusual also with children, but in them it is not entirely free from danger.

> Greek: 15. ἢν χολῆς ξανθῆς, λεκιθώδεος, ἢ κροκοει δέος, ἢ τῆς μελαγχλώρου, ἐς τὸ παντελὲς ἀνάχυσις ἀπὸ τοῦ σπλάγχνου γένηται, τὸ πάθος ἴκτερος κικλήσκεται, χαλεπὸν μὲν ἐν ὀξέσι· οὐ γὰρ μόνον πρὸ ἑβδόμης κτείνει φανὲν, ἀλλὰ καὶ μετὰ ἑβδόμην ἔκτεινε μυρίους· σπανίως δὲ εὖτε ἔκρινε πυρετὸν ἐς τέλος τὸ πάθος, ἀλλʼ αὐτὸς οὐ Ῥηϊδίως λύεται. Ξυνίστα ται δὲ οὐκ ἐπʼ αἰτίῃ μοῦνον ἥπατος, ὅκως τισὶ τῶν ἰητρῶν δοκέει, ἀλλὰ κοιλίῃ καὶ σπληνὶ καὶ νεφροῖσι καὶ κώλῳ· καὶ ἐφʼ ἥπατι μὲν ὧδε· ἢν φλεγμαίνῃ μὲν ἢ σκίρρον ἴσχῃ τὸ ἧπαρ, ἄτρεπτον δὲ τὸ ἐς ἐργασίην ἔῃ, τίκτει μὲν ἐν τῷ ἥπατι χολὴν, καὶ διακρίνει τήνδε ἡ ἐν ἥπατι οὖσα κύστις· ἀλλʼ ἢν αἱ φέρουσαι ἐς τὸ ἔντερον τὴν χολὴν ὁδοὶ ὑπὸ τῆς φλεγμασίης, ἢ τοῦ σκίρρου φραχθῶσι, πλημμυρῇ δὲ ἡ κύστις, παλίσσυτος ἡ χολή· τῷ αἵματι οὖν μίσγεται. τὸ δὲ αἷμα, ἐς πᾶν τὸ σκῆνος φοιτέον, ἄγει τὴν χολὴν παντὶ τῷ σώματι· γίγνεται δʼ ἡ ἰδέη χολῆς· λευκὰ δὲ καὶ ἀργιλώδεα τὰ σκύβαλα· οὐ γὰρ γίγνεται χολήβαφα, ὅτι περ οὐκ ἴσχει τοῦ χυμοῦ τὴν ἐπιρροήν· τῇδε καὶ γαστὴρ ἐπίξηρος· οὔτε γὰρ ὑγραίνεται οὔτε δάκνεται χολῇ· χροιὴ δὲ τοῦ λευκοχλώρου εἴδεος. ἐπὶ σπληνὶ δὲ ἢν ἴκτερος φανῇ, μελάγχλωρος· μέλαινα γὰρ αὐτέου ἡ τροφὴ, ὅτιπερ ἐκμαγεῖόν ἐστιν αἵματος μέλανος, οὗ τὴν ἀκαθαρσίην ἐοῦσαν οὐ δέχεται, οὐδὲ ἐκπονέει νοσέων ὁ σπλήν· ἡ δὲ ξὺν τῷ αἵματι πάντη φοιτῇ. διὰ τόδε μελάγχλωροι ἀπὸ σπληνὸς ἰκτέρου· ἀτὰρ καὶ ἐπὶ τοῖσι σκυβάλοισι τοῖσι ξυνήθεσι, ἔτι καὶ μελαντέρη χροιή. τῆς γὰρ σπληνὸς τροφῆς τὸ περιττὸν ἐς ἔξοδον περίττωμα γίγνεται. καὶ ἐπὶ κώλῳ καὶ γαστρὶ ἴκτερος, ἤνπερ εἰς πέψιν ἡ γαστὴρ καὶ τὸ κῶλον κακωθῇ· καὶ γὰρ καὶ ἐν κώλῳ πέψις, καὶ ἀπὸ τοῦδε ἡ ἐς τὸ ἧπαρ ἀναγωγὴ τροφῆς. ἢν οὖν ὠμοτέρην τὸ ἧπαρ τὴν ἄλλην τροφὴν λάβῃ, τὴν μὲν ἰδίην ἐργασίην πονέει, τὴν δὲ ὀθνείην ἐᾷ. τὸ γὰρ ἐν τῇ ἀναδόσι αἷμα τὴν ἀεργίην τὴν τοῦ κώλου ἐπέχον διασπείρει παντὶ χεόμενον· ἀπεψίη δὲ ἡ ἐν κώλῳ χολῆς ἐστι ἐργασίη. ὧδε καὶ ἐπὶ παντὶ γίγνεσθαι σπλάγχνῳ δυνατὸν ἴκτερον, οὐ μόνον τῶν ἐς τὸ ἧπαρ πεμπόντων τροφὴν, ἀλλὰ κἢν ἀπὸ ἥπατος λαμβάνῃ. οὐ γὰρ ὀχετοῖσι αἰσθητοῖσι μοῦνον ἡ φύσις παντὶ διαπέμπει τὴν τροφὴν, ἀλλὰ πολλῷ πλέον ἀτμοῖσι, οἵπερ ἀπὸ παντὸς εἰς πᾶν ἐνεχθῆναι Ῥηΐδιοι, τῆς φύσιος αὐτοὺς καὶ διὰ στερεῶν καὶ πυκινῶν ἀγούσης· γίγνονται οὖν οἱ ἀτμοὶ χολόβαφοι, καὶ χρώζουσι, ᾗ ἂν ἵζωσι τοῦ σώματος. οὐ μὴν ἐπὶ κώλῳ ἡ τῆς κοιλίης ἔκκρισις λευκή. ἀσινὲς γὰρ τὸ ἧπαρ ἐς γένεσιν, καὶ ἐκροὴν ἴσχει ἐπὶ ἔντερα χολῆς. δυνατωτάτη δὲ καὶ ἡ ἐπὶ τῷ παντὶ ἕξις ἴκτερον τεκεῖν. ἴσχει γὰρ καὶ ἐν ὅλῳ τὴν αἰτίην. ἔστι δὲ τοιήδε· παντὶ μὲν τὸ θερμὸν ἐς πέψιν, παντὶ δὲ ὑγρῶν γέννα καὶ διάκρισις, ἄλλων μὲν ἄλλη, ἑκάστῳ δὲ οἰκείη· ἐν σαρκὶ μὲν ἱδρῶς, ἐν ὀφθαλμοῖσι δὲ δάκρυον, ἐν ἄρθροισι δὲ καὶ Ῥινὶ μύξη, ἐν ὠσὶ κυψελίς. ἢν οὖν ἐς ἕκαστον ἔργον τὸ θερμὸν ἐγκάμῃ, αὐτὸ μὲν ἐς δριμὺ καὶ πυρῶδες ἐτράπη· τὰ δὲ ὑγρὰ πάντα γίγνεται χολή· πυρὸς γὰρ ἔργα πικρὰ καὶ χολόβαφα. ἢν δὲ καὶ ἐν αἵματι ἀπεψίη ξυμβῇ, γίγνεται τὸ αἷμα χολοειδὲς, σκίδναται δὲ παντὶ τρέφον· διὰ τόδε παντὶ φαίνεται χολή· δεινὸν μὲν γὰρ τὸ πάθος, φοβερὴ δὲ ἡ χρόη εἴδεϊ, καὶ χρυσοει δέες ἔασι τὴν χροιήν· οὐ γὰρ ἀνθρώπῳ εὐπρεπὲς ὅ γε ἐν λίθῳ καλὸν ἔῃ· περιττὸν δέ μοι φράζειν καὶ πόθεν τοὔνομα, πλὴν ὁκόσον τῶν χερσαίων ἰκτίδων τῶν τετραπόδων θηρίων, τοιοῖσι δὲ ἔασι οἱ ὦπες ὁ ῖοίδε. εἴδεα τοῦ πάθεος δοιά. ἢ γὰρ ἐς τὸ ξανθὸν καὶ τὸ κροκῶδες ἐτράπη τοῦ λευκοχλώρου εἴδεος, ἢ ἐς τὸ πελιδνὸν καὶ μέλαν. τῶνδε μέντοι ἡ αἰτίη ἡ δὴ καὶ χολῶν ἐστι αἰτίη· καὶ γὰρ καὶ τῆσδε ἡ μὲν ξανθὴ, λεπτὴ, διειδὴς, λευκοτέρου εἴδεος, ἡ δὲ κατακορὴς, ὡς κρόκον, ἢ λέκιθον φάναι, τοῦ αὐτοῦ εἴδεος. δευτέρη δὲ μελαντέρης χροιῆς, πρασίζουσα, ἰσσατώδης, μέλαινα· μυρίαι δὲ ἐν μέσῳ τῶν χροιῶν παραλλαγαί· παρὰ δὲ τὸ θερμὸν τουτέων καὶ τὰ ὑγρὰ ἡ τροπή. ἀλλὰ καὶ τὰ σπλάγχνα τοῦδέ ἐστι αἴτια· ἢν ᾖ ξανθὸν, ὡς τὸ ἧπαρ· ἢ πελιδνὸν, ὡς ὁ σπλήν· ἢν μὲν ἐπὶ σπλάγχνῳ τινὶ ἴκτερος γένηται, ἐπὶ ἥπατι μὲν, τὰ ἥπατος προφανέα· ἐπὶ δὲ σπληνὶ, τὰ σπληνός. ἕκαστα δὲ τὰ τῶν ἄλλων ἑκάστου· ἢν δὲ μηδενὸς φαίνηται, τῆς ὅλης ἕξιός ἐστι ἡ πάθη. διαφανῆ δὲ κατὰ τὰ λευκὰ ἐν τοῖσι ὀφθαλμοῖσι· μετώπου δὲ, πρὸς κροτάφοισι μᾶλλον· τοῖσι λευκοῖσι φύσι, καὶ ἐπὶ σμικρῷ ἰκτέρῳ ἡ χροιὴ μέζων ἐπανθέει. Ὁκόσοισι μὲν οὖν μέλας ὁ ἴκτερος, χροιῇ μελάγχλωροι, Ῥιγώδεες, ἀδρανέες, ὄκνῳ εἴκοντες, ἄθυμοι, βρωμώδεες δὲ τὴν ὀσμὴν, πικροὶ δὲ τὴν γεῦσιν, τὴν ἀναπνοὴν οὐκ εὔκολοι, γαστρὶ δακνώδεες, διαχωρήματα πρασοειδέα, ὑπομέλανα, ξηρὰ, μόλις διαχωρούμενα, οὖρα κατακορέα ἐπὶ τὸ μελάντερον. ἄπεπτοι, ἀπόσιτοι, ἄγρυπνοι, ἄθυμοι, μελαγχολώδεες. ἐπὶ δὲ τὸ λευκότερον, χροιῇ μὲν λευκόχλωροι, γνώμῃ δὲ φαιδρότεροι· σιτίων ἄρξασθαι μὲν ὀκνηροὶ, ἐμφαγεῖν δὲ οὐκ ἀγενεῖς, πέψαι Ῥηΐδιοι τῶν πρόσθεν μᾶλλον· διαχωρέουσι λευκὰ, ξηρὰ, ἀργιλώδεα· οὐρέουσι ξανθὰ, ὠχρὰ, κροκοειδέα. ἀμφοῖν δὲ τὸ ξύμπαν σῶμα κνησμῶδες· θέρμη ἀνὰ Ῥῖνας σμικρὴ μὲν, δακνώδη ς δέ. ἀμύσσον τὸ χολῶδες· γεῦσις μὲν πικρῶν οὐ πικρὴ, τὸ θωῦμα, οὐ μὴν γλυκέη· γλυκέων δὲ πικρή. ἡ γὰρ ἐν τῷ στόματι χολὴ ἐνίζουσα τῇ γλώσσῃ, ἐπίπροσθεν τῶν ἐδεστῶν ἐντυγχάνουσα, τὴν αἴσθησιν σοφίζεται τήνδε. ἡ γὰρ γλῶσσα ἀναπιοῦσα τῆς χολῆς τῆσδε, οὐκ ἐκείνων αἰσθάνεται· καὶ τὸν μὲν πρόσθεν τὸν τῆς ἀποσιτίης χρόνον ἀτρεμέει ἡ χολὴ, ἀτὰρ οὐδὲ ἡ γλῶσσα τῷ ἤθεϊ ἄχθεται· ἢν δὲ ἀναζέσῃ γεύμασι ἐπίπροσθεν τῶν ἐδεστῶν τὴν γλῶσσαν ἥδε κινέει. ἤν τε οὖν πικρὸν ἔῃ σιτίον, πικρῶν αἴσθησις· ἤν τε γλυκὺ, χολώδεος· φθάνει γὰρ ἡ αἴσθησις τῆς χολῆς· ἀπάτη δὲ ξύνεστι τοῖσι ἡγευμένοισι τὰ πικρὰ γλυκέα φαίνεσθαι. οὐ γὰρ οὕτως ἔχει. ἀλλʼ ὅτι μὴ ἐπὶ τῷ ἰζαίνοντι πικρῷ πικράζεται, μόνον διὰ τὸ ξύνηθες τῆς νούσου, φαντασίη γλυκάζοντος γίγνεται. ἡ ὠυτὴ δὲ κατάστασις καὶ ἐν γλυκέσι καὶ πικροῖσι γεύμασι· ἀπατηλῶν ἄρα γευμάτων προκάλυμμα ἡ χολή. ἢν μὲν οὖν μὴ ξύν τινος σπλάγχνου θερμασίῃ φανῇ, ἀσινὲς μὲν ὡς ἐπίπαν, μακρότερον δέ· ἢν δὲ καὶ ἐγχρονίσῃ καὶ ἐπιφλεγμαίνῃ σπλάγχνον, ἐς ὕδρωπα τὰ πολλὰ καὶ καχεξίην τελευτᾷ. πολλοὶ δὲ καὶ δίχα ὕδρωπος ἐκτακέντες ὤλοντο. ξύνηθες δὲ μειρακίοισι, νέοισι, καὶ τοῖσι δὲ ἀσινέστερον· παιδίοισι δὲ, οὐκ ἄηθες πάγχυ· οὐ πάντη δὲ ἀσφαλές.

[¶3] 16. CACHEXIA arises as the conversion of nearly all diseases; for almost all diseases are its progenitors. But it likewise is formed by itself, separately from all others, as an original affection of the noxious kind, by deriving its increase from the administration of many and improper medicines. And “a bad habit” for a season is common to all complaints, with many symptoms; and of this its name is significant. There is emaciation, paleness, swelling, or whatever else happens for the time to be prevalent in the body. But cachexia is the form of one great affection, and gives its name to the same. For “the good habit of the patient” (Euhexia) in all respects, as regards digestion, the formation of blood for distribution, and every natural operation whence arise good breathing, good strength, and good colour, constitutes the pristine state of good health. But if its nature become changed to the weakness of cacochymy, this constitutes cachexia. This disease is difficult to cure, and is a very protracted illness; for it is engendered during a protracted space of time, and not from one infirmity of the body, nor in connection with only one viscus; for it is formed by the conversion of all into a vitiated state. Wherefore those diseases which are its offspring are incurable, as dropsy, phthisis, or wasting; for, indeed, the causes of cachexia are akin to those of wasting. The disease is a protracted and continuous dysentery, and the relapses of diseases in certain cases. Generally there is sufficient appetite, and plenty of food is taken; but the distribution thereof takes place in a crude and undigested condition, for the operation of digestion is not performed upon the food. The cause of it also may be the suppression of the hemorrhoidal discharge, or the omission of customary vomiting, inactivity as regards exercises, and indolence as to great labours. When each of its attendants has ceased to return, there is heaviness of the whole body, now and then paleness, flatulence of the stomach, eyes hollow, sleep heavy, and inactivity. But these symptoms occurring in an erratic form conceal the existence of the disease; but if they remain and strike root, nor readily give way, they are significant of a mighty illness. When in an erect posture, then they become swollen in their feet and legs; but, when reclining, in the parts they lay upon; and if they change their position, the swelling changes accordingly, and the course of the cold humour is determined by its weight. For when the heat evaporates the humidity, if it be not diffused, the humidity again runs in a liquid state. They have an appetite for much food, and are very voracious; the distribution is more expeditious than the digestion, of matters that are crude rather than undigested; but digestion is not at all performed, nor is it digested in the whole body by nature. For the weakness of the heat in the belly and in the system is the same, neither is good and well-coloured blood formed. And when the whole body is filled with crudities, and the desire as to food is gone, the cachexy having now extended to the stomach, and the affection having now attained its summit, they become swollen, inactive, and spiritless towards every exertion. The belly is dried up, and, for the most part, the alvine discharges are without bile, white, hard, and undigested. They are parched in person, without perspiration, troubled with itchiness; sleep at no time settled, but drowsiness in the reclining position; respiration slow; pulse obscure, feeble, frequent, and very frequent upon any, even a very small, exertion; respiration in these cases asthmatic; veins on the temples elevated, with emaciation of the parts around; but at the wrists the veins much larger and tumid; blood of a dark-green colour. Along with these, phthisis or tabes induces anasarca or ascites, and from their progeny there is no escape. With regard to the ages which induce this disease, in the first place, old age, in which there is no recovery; children are readily affected, and more readily recover; adults are not very much exposed to the affection, but have by no means easy recoveries. No one season produces this disease, nor does it terminate in any one; but autumn indeed conceives it, winter nurses it, spring brings it to its full growth, and summer despatches it.

> Greek: 16. ξυμπάντων ὁμοῦ παθέων καχεξίη τροπή. ἅπασαι γὰρ αἱ νοῦσοι τῆσδε ἀποτόκοι. ἀτὰρ καὶ ἥδε μούνη ἄνευθεν τῶν ἄλλων, φαρμάκων ἐπίδοσιν ἔχουσα πολλὴν, ἰλυώδεα κατὰ πρώτιστα γίγνεται πάθος. καὶ ἕξις μὲν κακὴ σχέδιος ξυνὴ πάντων, καὶ ξυμπτώματα πολλὰ, καὶ οὔνομα τόδε ξύμβολον· ἰσχνότης δὲ ἢ ὦχρος ἢ οἷδος καὶ εἴ τι ἕτερον πρόσκαιρον ἀνὰ τὸ σῶμα· καχεξίη δὲ ἑνὸς μεγάλου πάθεος ἰδέη, καὶ τοῦδε τοὔνομα· ἡ γὰρ τοῦ ἀνθρώπου ἐς τὰ πάντα εὐεξίη, καὶ ἡ ἐς πέψιν ἢ ἐς ἀνάδοσιν αἵματος γέννα· ἠδὲ πᾶν ἔργον φύσιος, ἐφʼ οἷσι εὔπνοια, εὐτονίη, εὐχροίη, τὸ πρόσθεν ὑγείη. ἢν δὲ ἐς ἀσθενίην κακοχυμίης ἡ φύσις τραπῇ, τόδε ἐστὶν ἡ καχεξίη. Ἡ νοῦσος ἥδε δυσαλθὴς, ἠδὲ μήκιστον κακόν. καὶ γὰρ τίκτεται χρόνῳ μακρῷ, καὶ οὐδὲ ἐπὶμιῇ τοῦ σώματος κακίῃ, καὶ οὐδὲ ἐπὶ σπλάγχνῳ ἑνί· ἀλλὰ γὰρ τῶν ἁπάντων τροπῇ ἐς πονηρόν. τοιγαροῦν τὰ ἀπότοκα τοῦδε νοσήματα ἄφυκτα γίγνεται, ὕδρωπες, ἢ φθίσιες, ἢ ξυντήξιες. καὶ γάρ τοι καὶ τῆς καχεξίης προφάσιες ἀδελφαὶ τῆς ξυντήξιος ἔασι· ἡ δὲ νοῦσος μακρὴ δυσεντερίη ξυνεχής· νούσων ὑποστροφσαὶ ἐνίοισι. εὐσιτίη μὲν γὰρ, — καί τοι καὶ προσφέρονται πολλά, — ὠμῶν δὲ καὶ ἀτρέπτων ἡ ἀνάδοσις. ἐργασίη γὰρ τροφῆς ἡ ἐς πέψιν, ἄπορος. αἰτίη δὲ καὶ αἱμορροΐδων Ῥόου ἐπίσχεσις, ἢ ἐμέτων ξυνήθων ἀπαλλαγή· γυμνασίων ἀργίη, αὐασμὸς ἱδρώτων, καὶ μεγάλων πόνων Ῥαθυμίη· εὖτε τῶν παρεόντων ἕκαστον, ὡς τὸ μηδὲν, οὐκ ἐπιστρέφει, βάρος τοῦ σκήνεος, ὦχρος ἄλλοτε καὶ ἄλλοτε, γαστὴρ φυσώδης, ὀφθαλμοὶ κοῖλοι, ὕπνοι βαρέες, νωθροί. ἀλλὰ τάδε, Ῥεμβώδεα μὲν γιγνόμενα, νούσου ἀπιστίην ἴσχει· ἢν δὲ Ῥιζώσαν τα μίμνῃ, μηδὲ ἀπιέναι ἐθέλῃ, μεγάλου κακοῦ ἐστι σύμβολα. ἑσταότες μὲν οἰδαλέοι πόδας τε καὶ κνήμας, κατακλινόμενοι δὲ τὰ κεκλιμένα μορία· κἢν ἐναλλάξῃ τὴν κατάκλισιν, τὸ οἶδος ἐπʼ ἐκεῖνα φοιτῇ· ὑγροῦ τε καὶ ψυχροῦ ἐς τὸ βάρος περίοδος. ἢν γὰρ ἡ θέρμη τὸ ὑγρὸν ἐξατμίζῃ, τοῦδε οὐκ ἀναχεομένου, εἶτα καταρρέει. εὔσιτοι μὲν πολλῶν σιτίων, ἀδηφάγοι κάρτα. ἀνάδοσις ταχυτέρη πέψιος, ὠμοτέρων μᾶλλον ἢ ἀπέπτων. ἐξανέργαστον δὲ ἡ θρέψις. ἀλλὰ τόδε οὐκ ἐν τῷ ὅλῳ πέσσεται ὑπὸ τῆς φύσιος. ἡ γὰρ ἐν τῇ κοιλίῃ τοῦ θερμοῦ ἀτονίη, καὶ ἐν τῷ σκήνεϊ, ὁμοίη. τοιγαροῦν οὐδὲ χρηστὸν, οὐδὲ εὔχρουν αἷμα γίγνεται. καὶ ἐπὴν ὠμῶν ὅλον τὸ σῶμα πλησθῇ, καὶ ἡ ἐς τὰ σιτία ὄρεξις οἴχηται, καὶ τῆς καχεξίης ὧδε μέσφι στομάχου νεμομένης, καὶ τοῦ πάθεος κορυφὴν ἴσχοντο ς ἤδη, οἰδαλέοι μὲν, ἀδρανέες δὲ, καὶ ἐς πᾶσαν πρῆξιν ἄθυμοι. κοιλίη δὲ ξηροτέρη. ἄχολα τὰ πολλὰ καὶ λευκὰ, τρηχέα, καὶ ὠμὰ διαχωρέουσι. τὸ σκῆνος αὖοι, ἀνίδρωτες, κνησμώδεες, ὕπνος ἑδραῖος μὲν οὐδαμῆ, κεκλιμένῳ δὲ νυσταγμός. βραδύπνοοι, σφυγμοὶ ἀμαυροὶ, ἀσθενέες, πυκνοί· πυκνότατοι δὲ ἐπὶ πάσῃ καὶ σμικρῇ πρήξι. ἆσθμα δὲ ἐπὶ τοῖσδε ἡ ἀναπνοή· φλέβες ἐπὶ τοῖσι κροτάφοισι ἐπῃρμέναι ἀσαρκίῃ τῶν πέριξ, ἀτὰρ καὶ ἐπὶ τοῖσι καρποῖσι πολὺ μέζονες διοιδέουσαι, μελάγχλωρον τὸ αἷμα. ἐπὶ τοῖσδε φθίσις, ἢ σύντηξις ἀνὰ σάρκα ὕδρωπα, ἤ τινα ἀσκίτην ἤγαγε. καὶ τῶνδε ἄφυκτος ἡ γέννα. φέρουσι δὲ ἡλικίαι, γῆρας, καὶ οὐκ ἀποδιδρήσκουσι· παῖδες ταχὺ παθεῖν τε εὔκολοι καὶ ἀπαλλαγῆναι Ῥηΐτεροι· ἀκμάζοντες οὐ πάγχυ μὲν παθεῖν ἕτοιμοι· οὐ πάμπαν δὲ ἀπαλλαγῆναι εὔκολοι. ὥρη δὲ οὔ μίη φέρει τόδε, οὐδὲ ἐς μίην τελευτᾷ· ἀλλὰ φθινόπωρον μὲν κύει, χειμὼν τιθηνεῖ, ἔαρ δὲ ἐς κορυφὴν τελεσφορεῖ, θέρος δὲ κτείνει.

## 4. Book II · chapters 1–5

Source: https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/4/ · cite a paragraph as https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/4/#p-N

[¶0] 1. DROPSY is indeed an affection unseemly to behold and difficult to endure; for very few escape from it, and they more by fortune and the gods, than by art; for all the greater ills the gods only can remedy. For either the disease lurking in a vital organ has changed the whole system to cachexy, or the general system from some plague that has gone before has changed the viscera to a Cacochymy, when both co-operate with one another to increase the illness, and no part is uninjured from which even a slight assistance might be rendered to Nature. It is a cold and dense vapour converted into humidity, resembling a mist in the universe; or, it is the conversion of a humid and cold cause which changes the patient to such a habit. For a fluid rolling about in the lower belly we do not call Dropsy, since neither is the affection situated in that place; but when the tumour, swelling, colour, and the habit melting down to water, conspire in the disease, it both is, and is called Dropsy. For, even should the water at any time burst outwardly, or should one give vent to it, by making an incision in the hypochondrium, the dropsical affection will still remain confirmed; wherefore the primary cause of it is cachexia.

> Greek: 1. ὕδρωψ ἀτερπὲς μὲν ἐσιδεῖν πάθος, χαλεπὸν δὲ καὶ παθεῖν. διαδιδρήσκουσι γὰρ τόδε πάγχυ παῦροι ὑπʼ εὐτυχίης, καὶ θεῶν μᾶλλον ἢ τέχνης· τὰ γὰρ μέζονα πάντα ἰῶνται μοῦνοι θεοί. ἢ γὰρ ἐν σπλάγχνῳ καιρίῳ νόσημα φωλεῦσαν ἔτρεψε ἐς καχεξίην τὸ πᾶν, ἢ τὸ ξύμπαν σκῆνος λοιμοῦ κατάρξαντος ἐς κακοχυμίην ἤμειψε τὰ σπλάγχνα· εὖτε ἀλλήλοισι ἄμφω ἐς τὸ κακὸν ξυντιμωρέει, ἀσινὲς δὲ οὐδὲν, ἐξ οὗπερ καὶ σμικρὴ τῇ φύσι γίγνοιτο ἂν ἐπικουρίη· ἔστι δὲ ἐς ἐπομβρίην Ῥεῦμα ψυχρὸν, παχὺ, ὁκοῖον ἡ ὀμίχλη τῷ παντί. ἢ τροπὴ ὑγρῆς καὶ ψυχρῆς αἰτίης, ἐς τοιήνδε ἕξιν ἑτεροιούσης τὸν ἄνθρωπον. οὐ γὰρ τὸ ἐν τῇ κολίῃ τῇ κάτω ἁλιζόμενον ὑγρὸν ὕδρωπα καλέομεν, ἐπεὶ οὐδὲ τὸ πάθος τῇδέ ἐστι, ἀλλʼ ὅτε ξυμπαρομαρτέει τῇ νούσῳ ὁ ὄγκος, τὸ οἶδος, ἡ χροιὴ, ἠδὲ ἐς τὸ ὕδωρ ξυντήκουσα ἕξις, ὕδρωψτέ ἐστι καὶ καλέεται. κἢν γὰρ ἐκραγῇ κοτε τὸ ὕδωρ αὐτομάτως ἔξω, ἢ ταμών τις τὸ ὑποχόνδριον ἐκχέῃ, ἐφʼ ἕδρης ἔασι οἱ ὑδρωπιώδεες. ἡ μὲν οὖν πρωτίστη αἰτίη καχεξίη.

[¶1] There are many varieties, each having different names. For if the watery suffusion float in the flanks, and, owing to its fulness, when tapped it sound like a drum, the disease is called Tympanites. But if the water be confined in large quantity in the peritonæum, and the intestines float in the liquid, it gets the appellation of Ascites. But if the lower belly contain none of these, but the whole body swell, if in connexion with a white, thick, and cold phlegm, the disease is called Phlegmatias; but if the fleshy parts are melted down into a sanguineous, watery, or thin humour, then the species of dropsy called Anasarca is formed. The constitution of each of them is bad; but the combination of them is much worse. For sometimes the variety which forms in the lower belly (Ascites), is associated with that variety in which the fluid is diffused all over the body. But the most dangerous is that form in which Tympanites is mixed with Anasarca. For of the dropsies that form in the lower belly, Tympanites is particularly worse than Ascites. But of those affecting the whole body, Leucophlegmatia is less than Anasarca. It is mild then, so to speak of such hopeless diseases, when a smaller affection is combined with another smaller one. But it is much worse if one of the smaller enters into combination with one of the greater. But if a complete mixture of two great affections take place, the product thereof is a greater evil.

> Greek: ἰδέαι δὲ πλεῦναι, ἧς ἀτὰρ ὄνομα ἕτερον καὶ ἕτερον. ἢν μὲν γὰρ ἡ παρέγχυσις ἔνυγρος ἐν τῇσι λαγόνεσι ἐμπλώῃ, καὶ ἀπὸ τῆς πρήσιος ἐν τοῖσι πατάγοισι δοκέῃ πως τυμπάνῳ, τυμπανίης κικλήσκεται. ἢν δὲ ὕδωρ ἅλις ἐς τὸ περιτόναιον ἐμπεριέχηται, ἐμπλώῃ δὲ τῷ ὑγρῷ τὰ ἔντερα, καλέομεν ἐπίκλησιν ἀσκίτην. ἢν δὲ αἱ λαγόνες μὲν μηδὲν τουτέων ἴσχωσι, τὸ πᾶν δὲ παροιδαίνῃ σκῆνος, ἢν μὲν ἐπὶ λευκῷ φλέγματι καὶ παχέϊ καὶ ψυχρῷ, φλεγματίης καλέεται. ἢν δὲ ἐς χυμὸν αἱμάλωπα, ὑδατώδεα, λεπτὸν, συντακῶσι αἱ σάρκες, ἀνὰ σάρκα γίγνεται ὕδρωψ· κακὴ μὲν ἡ ἑκάστου ξύστασις. κακίων δὲ πολλόν τι ἡ τῶνδε ἐπιμιξίη. τῶνδε γὰρ ἀμφὶ τὰς λαγόνας εἷς ἑνὶ τῶν ἀνὰ τὸ πᾶν ξυμβῇ γέ κοτε· χαλεπώτατος δὲ, ἢν ὁ τυμπανία ς τῷ ἀνὰ σάρκα μιχθῇ. καὶ γὰρ ἰδίῃ τῶν μὲν ἀμφὶ τὰς λαγόνας, ἀσκίτου τυμπανίας χερείων, τῶν δὲ ὅλου τοῦ σκήνεος ὁ λευκοφλ εγματίας τοῦ ἀνὰ σάρκα μείων· ἐπιεικὴς μὲν ὦν, ἐν ἀπελπίστοισι, ἢν ὁ μείων ξυστῇ τῷ μείονι· κακίων δὲ εἴ τις τῶν μειόνων ἑνὶ τῶν μεζόνων ἐς τὠυτὸ ξυμβῇ· ἢν δὲ ἐς ἄκρας ἡ μίξις ἅμʼ ἥκηται δυοῖν μεγάλοιν, μέζον κακὸν τὸ ἔκγονον. σημεῖα δὲ μέγιστα καὶ Ῥήϊστα ἰδεῖν καὶ θιγέειν καὶ εἰσακοῦσαι·

[¶2] The symptoms are very great and very easy to see, to touch, and to hear; in Ascites, for example, to see the tumidity of the abdomen, and the swelling about the feet; the face, the arms, and other parts are slender, but the scrotum and and prepuce swell, and the whole member becomes crooked, from the inequality of the swelling:—To touch—by strongly applying the hand and compressing the lower belly; for the fluid will pass to other parts. But when the patient turns to this side or that, the fluid, in the change of posture, occasions swelling and fluctuation, the sound of which may be heard. But if you press the finger firmly on any part, it becomes hollow, and remains so for a considerable time. These are the appearances of Ascites.

> Greek: ἐπὶ μὲν τῷ ἀσκίτῃ ἰδέειν ὄγκον ἐν τῇσι λαγόσι, οἶδος ἀμφὶ τὼ πόδε· πρόσωπα δὲ καὶ βραχίονες καὶ τὰ ἄλλα ἰσχνὰ, οἰδέουσι ὄρχιές τε καὶ πόσθη, καὶ ὁ ξύμπας καυλὸς σκολιὸς ἐξ ἀνίσου τοῦ οἴδεος. θίγειν ἠδὲ ἐρείσαν τά πη τὴν χεῖρα κατὰ λαγόνα εἰσωθεῖν· τὸ γὰρ ὑγρὸν ἐπὶ τὰ ἄλλα μέρεα μεταρρέει· ἀτὰρ καὶ ἐν τῇσι τοῦ ἀνθρώπου τῇδε ἢ τῇδε ἐπιστροφῇς ι, ἐς τὰς μετακλίσιας τὸ ὑγρὸν, ὄγκον τε καὶ κλύδωνα ποιέει, ἐσακούειν τε καὶ τοῦ κλύδωνος· ἀλλὰ κἤνπη τὸν δάκτυλον ἐρείσῃς, ὁ χῶρος γίγνεται κοῖλος, ἐς χρόνον τε πουλὺν μίμνει κοῖλος.

[¶3] Tympanites may be recognised, not only from the sight of the swelling, but also by the sound which is heard on percussion. For if you tap with the hand, the abdomen sounds; neither does the flatus (pneuma) shift its place with the changes of posture; for the flatus, even although that which contains it should be turned upwards and downwards, remains always equally the same; but should the flatus (pneuma) be converted into vapour and water (for Ascites may supervene on Tympanites), it shifts its form, indeed, the one half running in a fluid state, if the conversion be incomplete.

> Greek: τάδε μὲν τὰ ἀσκίτου. τυμπανίης δὲ πρὸς τῇ τοῦ ὄγκου θέῃ καὶ ἀκοῦσαί ἐστι δονέων. ἢν γὰρ πατάξῃς τῇ χειρὶ, τὸ ἐπιγάστριον δονέει, οὐδὲ μεταχωρέει τὸ πνεῦμα ἐν τῇσι ἐπιστροφῇσι. πνεῦμα γὰρ, κἢν μετακλιθῇ τὸ ἀμπέχον ἄνω τε καὶ κάτω, ἴσον πάντη μένει· ἢν δὲ ἐς ὀμίχλην καὶ ὕδωρ τρέπηται τὸ πνεῦμα, (καὶ γὰρ ἀσκίτης ἀπὸ τυμπανίου,) ἀμείβεται μὲν, ἢν μὴ ἐς τέλος τραπῇ κοτε, ἡμιτελὴς μεταρρέων.

[¶4] In Anasarca and Leucophlegmatia the lower belly is empty, the patients are swelled in the face and arms; and likewise, in these cases, whatever parts are empty in the others, in them become full. For in Leucophlegmatia there is collected a white, cold, and thick phlegm; with it the whole body is filled, and the face is swollen, and also the neck and arms; but the abdomen is full from the swelling; but the mammæ are raised up into a swelling in the case of such youths as are still in the happy period of life. But, in Anasarca, there is wasting of the flesh to a fleshy humour, and a bloody ichor, such as runs from ulcerations of the bowels, and such as flows from bruises produced by the fall of weights, if the outer skin be scarified. But the combination of the two has the symptoms of both.

> Greek: Ὁδὲ ἀνὰ σάρκα ἠδὲ τοῦ λευκοῦ φλέγματος, τὰς μὲν λαγόνας ἴοχοσι κενεὰς, οἰδαλέο ἔασι καὶ πρόσωπα καὶ βραχίον ας· ἀτὰρ ἠδὲ ὁκόσα τοῖσι ἄλλοισι κενεὰ, τοῖσδε γίγνεται πλήρεα φλέγμα μεν γὰρ λευκὸν ἐπὶ τῷ λευκῷ φλεγματίᾳ συνίσταται, ψυχρόν τε καὶ παχύ· τοῦδε ἐμπίπλαται τὸ πᾶν, οἰδαίνει δὲ τὸ πρόσωπον, αὐχήν τε καὶ βραχίονες· παχὺ δὲ τὸ ἐπιγάστριο ν ἀπὸ τοῦ οἴδεος· μαζοὶ δὲ ἐς ὄγκον αἴρονται, ὁκόσοι νέοι ἀκμὴν ὄντες ἐν εὐτυχίῃ τῆς ἡλικίης· ἐπὶ δὲ τῷ ἀνὰ σάρκα τηκεδὼν τῆς σαρκὸς ἐς χυμὸν σαρκοει δέα, ἰχώρτε αἱμάλωπος, ὁκοῖος Ῥέει ἀπὸ ἐντέρων ἕλκεσι· τοιόσδε καὶ ἐπὶ θλάσμασι ἀπὸ βάρεος ἐμπεσόντος, ἢν τάμῃς τι ἐπιπολῆς, ὁ χυμὸς ἐκρέει·

[¶5] In all the species there are present paleness, difficulty of breathing, occasional cough; they are torpid, with much languor and loss of appetite; but if they take any food, however small in quantity and free from flatulence, they become flatulent, and have distension as if from repletion; skin dry, so that it does not become moist even after the bath; they are white and effeminate; but in Anasarca they are of a dark-green colour, and have dark veins; in Ascites and Tympanites these are prominent, both in the face, and in the wrists, and the abdomen. But in Anasarca and Leucophlegmatia all the parts are concealed by the swelling; sleep heavy; they are torpid, with slight dejection of spirit; concern about trifles; fondness of life; endurance not from good spirits and good hopes like those in prosperity, but from the nature of the affection. It is not possible exactly to state the cause; but this is a mighty wonder, how in certain diseases, not altogether dangerous, the patients are spiritless, dejected, and wish to die, but in others they have good hopes and are fond of life. Diseases produce both these contraries.

> Greek: ἡ δὲ τῶν δυοῖν ἐπιμιξίη ἀμφοῖν ἴσχει τὰ σημήϊα. ξύμπασι δὲ ὁμοῦ ξύνεστι, ὦχρος, δύσπνοια, βὴξ, ἄλλοτε καὶ ἄλλοτε νωθέες, ὄκνος πουλὺς, ἀπόσιτοι· ἢν δέ τι προσαίρωνται, κἢν βραχὺ καὶ ἄφυσον, φυσώδεες, διατάσιες ὡς ἀπὸ πλησμονῆς· ἄνικμοι, διὸ οὐδὲ ἐπὶ λουτροῖσι ἰκμαλέοι. λευκοὶ, γυναικώδεες· οἱ δὲ ἀνὰ σάρκα, μελάγχλωροι, μελανόφλεβες. ἀσκίτῃσι μὲν καὶ τυμπανίῃσι ἐπιφανέες καὶ ἐν προσώπῳ καὶ καρποῖσι καὶ ἐπιγαστρίῳ. ἐπὶ δὲ τοῖσι ἀνὰ σάρκα καὶ τῷ φλεγματίῃ οἴδεϊ ἅπαντα κρύπτεται, ὕπνοι βαρέες, νωθροὶ, σμικροὶ, ἀψυχίη, σμικρολογίη, φιλοζωΐη. καρτερίη οὐκ ἀπʼ εὐθυμίης καὶ εὐελπιστίης ὅκως τοῖσι ἐν εὐτυχίῃ, ἀλλʼ ἐξ αὐτέου τοῦ πάθεος· οὔτι φατὸν τὴν αἰτίην, θωυμάσαι δὲ τόδε μέγα, ἐπὶ μέν γε ἄλλοισι οὐ πάμπαν ὀλεθρίοισι οἱ νοσέοντες ἄθυμοι, κατηφέεσς, ἐράται τοῦ θανάτου· ἐπὶ δὲ τισι εὐέλπιδες καὶ φιλόζωοι γίγνονται. ἄμφω δὲ τὰ ἐναντία τίκτουσι αἱ νοῦσοι.

[¶6] Dropsy sometimes is occasioned suddenly by a copious cold draught, when, on account of thirst, much cold water is swallowed, and the fluid is transferred to the peritonæum; by which means the innate heat in the cavities is congealed, and then the drops which formerly were converted into air and dissipated, flow into the cavities. If this, therefore, happen, the cure of these cases is easier before any of the viscera or the whole person is affected. Moreover flatulent food, indigestion, and the Buprestis have sometimes occasioned dropsies.

> Greek: γίγνεται ὕδρωψ καὶ ἐξαπίνης κοτὲ ἐπʼ ἀθρόῃ ψυχροποσίῃ, ἢν ὑπὸ δίψιος· χανδὸν πολὺ ψυχρὸν ἐγχέ ὕδωρ, οἶτα τὸ ὑγρὸν ἐς περιτόναιον ἐνεχθῇ διʼ ἃ δὲ τῇσ͵ʹ κοιλίῃσι τὸ ἔμφυτον θερμὸν κατεψύχθη, ἔπειτα εἰς τοὺς κενεῶνας σταγόνες ἐκρέουσι, αἳ πρόσθεν εἰς διαπνοὴν ἐξηερούμεναι διεφοροῦντο. τόδε οὖν εἰ γίγνεται, Ῥηϊτέρη ἡ τ ῶνδε ἴησις, πρίν τι τῶν σπλάγχνων ἢ ὅλον τὸν ἄνθρωπον παθεῖν. ἀτὰρ ἠδὲ ἔδεσμα φυσῶδες καὶ ἀπεψίη καὶ βούπρηστις ἔτεκον ὕδρωπας.

[¶7] It is an illness common to all, men and women, in every period of life, only that certain ages are more exposed to certain species of the disease; children to Anasarca and Leucophlegmatia; young men until manhood are subject to swelling about the lower belly (Ascites?) Old persons are prone to suffer all kinds, as being deficient in heat, for old age is cold; but they are not exposed to collections of humours, and to them, therefore, Tympanites is the familiar form.

> Greek: ἔστι δὲ ξυνὸν πάντων τὸ κακὸν, ἀνδρῶν, γυναικῶν, ἡλικίης πάσης, ὁκόσον ἄλλοι ἐς ἄλλο εἶδος ἔασι ὡραῖοι, ἀνὰ σαρκα παῖδες ἠδὲ τοῦ λευκοῦ φλέγματος· νέοι δὲ μέχρι ἀκμῆς, οἱ κατὰ λαγόνας πλήσμιοι· γέροντες μὲν πάντα παθέεειν ἐτοῖμοι, ἀπόθερμοι· ψυχρὸν γὰρ τὸ γῆρας· ἀλλʼ ἐς ὑγροῦ πλῆθος ἔασι ἀναίτιοι. τοῖσδε οὖν τυμπανίης ξυνήθης.

[¶8] All the species, indeed, are unfavourable; for dropsy, in all its forms of disease, is bad. But of these, leucophlegmatia is the more mild; for in it there are many and various chances of good fortune, such as an evacuation of sweat, of urine, or from the bowels, by which the dropsical habit is carried off. But tympanites is of a difficult nature, and still more so anasarca; for in this affection the physician would require to change the whole person, a thing not easy for the gods themselves to accomplish.

> Greek: ἅπαντα μὲν οὖν πονηρὰ τὰ εἴδεά ἐστι· ὕδρωψ γὰρ πάντων τῶν νοσημάτων κακόν· ἀλλὰ τουτέων λευκοφλεγματίης μὲν εὐηθέστερος. πολλὴ γὰρ καὶ ποικίλη ἐπὶ τοῦδε ἡ εὐτυχίη ἱδρῶτος ἢ οὔρων, ἢ κοιλίη κοτὲ ἐπʼ αὐτέοις κατερράγη, λυομένης ἤδη τῆς τοῦ ὕδρωπος ἕξιος. χαλεπὴ δὲ τυμπανίης, καὶ τοῦδε ὁ ἀνὰ σάκρα μᾶλλον· τὸν δὲ ἰητρὸν ἐν τῷδε πάθεϊ ὅλον χρὴ τὸν ἄνθρωπον ἀλλάξαι. τόδε μέντοι οὐδὲ θεοῖσι Ῥηΐτερον.

[¶9] Sometimes the dropsy forms in a small space, such as the head in hydrocephalus; or in the lungs alone; or in the liver, or the spleen; or the womb in women; and this last is easier to cure than any of the others, for provided its mouth relax from its former constriction, if it contains a fluid, it discharges the same outwardly, and if a flatus, it is dissipated. But if the uterus suffer at all in anasarca, for the most part the whole woman becomes dropsical.

> Greek: Ὑδεριᾷ δὲ καὶ ἐν σμικρῷ κοτε ἄνθρωπος, ἢ κεφαλὴν ἐπὶ ὑδροκεφάλῳ, ἢ πνεύμονα μοῦνον, ἢ ἧπαρ, ἢ σπλῆνα, καὶ ἐπὶ γυναικῶν ὑστέρη. καὶ τῶν ἄλλων ἥδε εὐαλθεστέρη. ἢν γὰρ τὸ στόμιον ἀνῇ ἐκ τῆς πρόσθεν μύσιος, ὑγρὸν μὲν εἰ ἔχοι, ἐκχέει ἔξω. ἢν δὲ πνεῦμα, ἐξεφυσήθη τόδε· ἢν δέ τι ἀνὰ σάρκα ἡ ὑστέρη πάθῃ, ὡς ἐπίπαν ὅλη ἡ ἄνθρωπος ὑδεριᾷ.

[¶10] This other form of dropsy is known: small and numerous bladders, full of fluid, are contained in the place where ascites is found; but they also float in a copious fluid, of which this is a proof; for if you perforate the abdomen so as to evacuate the fluid, after a small discharge of the fluid, a bladder within will block up the passage; but if you push the instrument farther in, the discharge will be renewed. This species, then, is not of a mild character; for there is no ready passage by which the bladders might escape. It is said, however, that in certain cases such bladders have come out by the bowels. I have never seen such a case, and therefore write nothing of them; for I am unable to tell whether the discharge be from the colon, or the stomach. What is the mode of their formation? For the passage whereby all matters may be discharged by the anus is patent; but the discharge of the water collected about the loins by the bowels is incredible. For a wounded intestine is not free from trouble and danger.

> Greek: ἰδέη τις ἑτέρη ὕδρωπος ἥδε γιγνώσκεται, κύστιες σμικραὶ, συχναὶ, πλήρεες ὑγροῦ, ἐγκέονται τῷ χωρίῳ ἔνθα ὁ ἀσκίτης ξυνίσταται· ἀτὰρ ἢν ἐμπλέωσι τῷ πολλῷ ὑγρῷ· τέκμαρ δέ· ἢν γὰρ τετρήνας τὸ ἐπιγάστριον ἐκχέῃς ἐπὶ βραχείῃ φορῇ τοῦ ὑγροῦ, ἔνδοθεν ἂν ἐπέφραξεν ἡ κύστις, κἢν τὸ ὄργανον διώσῃ, αὖθις ἐκρέεει· τόδε μέντοι τὸ εἶδος οὐκ εὔηθες. πόθεν γὰρ ἂν ἐκπέσωσι αἱ κύστιες, ὁδὸς οὐκ εὔπορος· λόγος δὲ μετεξετέροισι ὅτι ἧκόν κοτε διʼ ἐντέρων τοιαίδε κύστιες· ἐγὼ δὲ οὐκ ὤπωπα, διὰ τόδε νῦν οὐδὲν γράφω· οὐδὲ γὰρ περὶ αὐτέων ὅ τι λέξω ἔχω· εἴτε γὰρ ἐκ τοῦ κώλου, ἢ τῆς γαστρὸς ἡ φορὴ, τίς ὁ τρόπος τῆς ξυστάσιος; ὁδὸς γὰρ ἐς ἔξοδον ἁπάντων διʼ ἕδρης εὔροος· ἡ δὲ αὐτοῦ τοῦ ὑγροῦ τῆς ἐν λαγόνι ξυλλογῆς, ἄπιστος ἡ τῶν ἐντέρων Ῥαγή. οὐ γὰρ ἀσινὲς οὐδʼ ἀνώλεθρον τρωθὲν ἔντερον.

[¶11] 2. DIABETES is a wonderful affection, not very frequent among men, being a melting down of the flesh and limbs into urine. Its cause is of a cold and humid nature, as in dropsy. The course is the common one, namely, the kidneys and bladder; for the patients never stop making water, but the flow is incessant, as if from the opening of aqueducts. The nature of the disease, then, is chronic, and it takes a long period to form; but the patient is short-lived, if the constitution of the disease be completely established; for the melting is rapid, the death speedy. Moreover, life is disgusting and painful; thirst, unquenchable; excessive drinking, which, however, is disproportionate to the large quantity of urine, for more urine is passed; and one cannot stop them either from drinking or making water. Or if for a time they abstain from drinking, their mouth becomes parched and their body dry; the viscera seem as if scorched up; they are affected with nausea, restlessness, and a burning thirst; and at no distant term they expire. Thirst, as if scorched up with fire. But by what method could they be restrained from making water? Or how can shame become more potent than pain? And even if they were to restrain themselves for a short time, they become swelled in the loins, scrotum, and hips; and when they give vent, they discharge the collected urine, and the swellings subside, for the overflow passes to the bladder. If the disease be fully established, it is strongly marked; but if it be merely coming on, the patients have the mouth parched, saliva white, frothy, as if from thirst (for the thirst is not yet confirmed), weight in the hypochondriac region. A sensation of heat or of cold from the stomach to the bladder is, as it were, the advent of the approaching disease; they now make a little more water than usual, and there is thirst, but not yet great. But if it increase still more, the heat is small indeed, but pungent, and seated in the intestines; the abdomen shrivelled, veins protuberant, general emaciation, when the quantity of urine and the thirst have already increased; and when, at the same time, the sensation appears at the extremity of the member, the patients immediately make water. Hence, the disease appears to me to have got the name of diabetes, as if from the Greek word διαβήτης (which signifies a siphon), because the fluid does not remain in the body, but uses the man’s body as a ladder (διαβάθρη), whereby to leave it. They stand out for a certain time, though not very long, for they pass urine with pain, and the emaciation is dreadful; nor does any great portion of the drink get into the system, and many parts of the flesh pass out along with the urine. The cause of it may be, that some one of the acute diseases may have terminated in this; and during the crisis the diseases may have left some malignity lurking in the part. It is not improbable, also, that something pernicious, derived from the other diseases which attack the bladder and kidneys, may sometimes prove the cause of this affection. But if any one is bitten by the dipsas, the affection induced by the wound is of this nature; for the reptile, the dipsas, if it bite one, kindles up an unquenchable thirst. For they drink copiously, not as a remedy for the thirst, but so as to produce repletion of the bowels by the insatiable desire of drink. But if one be pained by the distension of the bowels and feel uncomfortable, and abstain from drink for a little, he again drinks copiously from thirst, and thus the evils alternate; for the thirst and the drink conspire together. Others do not pass urine, nor is there any relief from what is drank. Wherefore, what from insatiable thirst, an overflow of liquids, and distension of the belly, the patients have suddenly burst.

> Greek: 2. θώϋμα τὸ διαβήτεω πάθος, οὐ κάρτα ξύνηθες ἀνθρώποισι· σαρκῶν καὶ μελέων ἐς οὖρον ἡ ξύντηξις· ὑγρὴ καὶ ψυχρὴ, ὅκως ἐν ὕδρωψι, αἰτίη. ὁδὸς δὲ ἡ ξυνήθης, νεφροί τε καὶ κύστις. οὐ γὰρ διαλείπουσι οὐρέοντες, ἀλλὰ ὅκωσπερ ἐξ ἀφέσιος ὀχετῶν ἄπαυστος ἡ φορή. χρονίη μὲν ἡ τῆς νούσου φυὴ, μακρῷ κυΐσκεται χρόνῳ· βραχύβιος δὲ ὥνθρωπος, ἢν ἡ κατάστασις τελεσθῇ· ὀξείη γὰρ ἡ τηκεδὼν, ταχὺς δὲ ὁ θάνατος, ποτὶ καὶ βίος αἰσχρὸς καὶ ἐπίπονος· δίψος ἀκρατές· πολυποσίη ἀνισόμε τρος οὔροισι πολλοῖσι· πλεῖον γὰρ ἐκρεῖ τὸ οὖρον, καὶ οὐκ ἂν ἐπίσχοι τις αὐτέους, οὔτε πίνοντας οὔτε οὐρέοντας. ἢν δὲ ἐπʼ ἀκαρὲς ἀντίσχωσι, ἢν μὲν τοῦ πιεῖν, ἄνικμοι μὲν τὸ στόμα, αὐαλέοι δὲ τὸ σκῆνος· τὰ δὲ σπλάγχνα καίεσθαι δοκέουσι, ἀσώδεες, ἄποροι, οὐκ ἐς μακρὸν θνήσκουσι· πυριφλεγέες δίψαι. ἀπουρέειν δὲ τίς ἂν ἐπίσχοι τρόπος; ἢ τίς αἰσχύνη πόνου κρέσσων; ἀλλὰ κἢν ἐς μικρὸν ἐγκρατέες γένωνται, παροιδέουσι ὀσφὺν, ὄρχιας καὶ ἰσχία· κἢν ἀνῶσι, ἐκχέουσι μὲν τὸ οὖρον ἁλέν· τὰ δʼ ἐποιδέον τα ἐξαρύεται. ξυνδίδοται γὰρ ἐς κύστιν ἡ πλημμύρα. κἢν μὲν τελεσθῇ τὸ κακὸν, εὔσημον· ἐπὴν δὲ μέλλῃ, ἄνικμοι τὸ στόμα, σίαλος λευκὸς, ἀφρώδης, ὅκως ἀπὸ δίψεος, καὶ οὐδέκω δίψος, ὑποχονδρίων βάρος· αἴσθησις ἀπὸ τῆς γαστρὸς ἐς κύστιν θέρμης, ἢ ψύξιος, ὅκως πρόσοδος παρέοντος τοῦ νοσήματος ἀτὰρ ἠδὲ οὐρέουσι τοῦ ξυνήθεος μικρόντι μᾶλλον· δίψος τε, ἀλλʼ οὐδέκω μέγα. ἢν δὲ ἐπὶ μᾶλλον αὔξηται, θέρμανσις μικρὴ μὲν, δακνώδης δὲ, ἐνίζουσα τοῖσι σπλάγχνοισι· ἐπιγάστριον Ῥυσσοὶ, ἐπίφλεβοι, ἰσχνοὶ δὲ τὴν ὅλην ἕξιν, εὖτε καὶ ἡ οὔρησις καὶ τὸ δίψος ἐπαυξέα γίγνεται ἤδη κοτέ· κἢν ἐς ἄκρον τὸν καυλὸν ἡ συναίσθησις φανῇ, εὐθὺς οὐρέους ι. τῇδέ μοι δοκέει καλέεσθαι διαβήτης ἐπίκλησιν, ὁκοῖόντι διαβήτης ἐὼν, οὕνεκεν ἐν τῷ σκήνεϊ τὸ ὑγρὸν οὐ μίμνει, ἀλλὰ ὅκως διαβάθρσῃ τῷ ἀνθρώπῳ ἐς ἔξοδον χρέεται. διαρκέουσι δὲ ἐς χρόνον τινὰ, εἰ καὶ μὴ κάρτα πολλὸν, ὅτι πινεῦντς οὐρέουσι, τηκεδὼν δὲ γίγνεται δεινή· οὔτε γάρ τι ἐκ τῆς πόσιος μέγα ἐς τὸ σκῆνος ἔρχεται, καὶ ξυναπέρχεται τῶν σαρκῶν ἐς τὰ οὖρα μυρία. αἰτίη δὲ, ὀξεῶν νούσων τις ἀπέσκηψεν ἐς τόδε, καὶ ἐν κρίσι κρύβδην τὸ κακόηθες ἐγκατέλιπον αἱ νοῦσοι. οὐκ ἀδόκητον καὶ δηλητήριόν κοτε τήνδε τὴν αἰτίην ἴσχειν τῶν ὁκόσα κύστι καὶ νεφροῖσι ἐνσκήπτει· ἀτὰρ εἰ ἐδάκη τις ὑπὸ τῆς διψάδος, τοιήδε τοῦ ἕλκεος ἡ πάθη· διψὰς δὲ τὸ ἑρπετὸν θηρίον, ἢν δάκῃ τινὰ, ἄσχετον δίψος ἐξάπτει. πίνουσίτε ἄδην οὐκ ἐς δίψεος ἄκος, ἀλλʼ ἐς τὴν τῆς κοιλίης πλημμύραν ἀκορίῃ ποτοῦ· ἢν δὲ ἀλγέῃ τις περιτάσι τῆς κοιλίης, καὶ ἀχθέῃ, καὶ τὸ ὑγρὸν ἐπίσχῃ ἐς μικρὸν, αὖθις ἄδην πίνουσι διψῶντες, καὶ ἥδε τῶν κακῶν ἡ ἀμοιβή. συντιμωρέει γὰρ ἀλλήλοισι δίψος καὶ ποτόν. ἄλλοι δὲ οὐκ οὐρέουσι. οὐδέ τις ἄλλη τοῦ πινομένου διαπνοή. τοιγαροῦν ἀκορίῃ μὲν τοῦ ποτοῦ, πλημμύρῃ δὲ ὑγροῦ, περιτάσι δὲ τῆς κοιλίης, ἐξερράγησαν ἀθρόως.

[¶12] 3. THE kidneys are of a glandular nature, but redder in colour, like the liver, rather than like the mammæ and testicles; for they, too, are glands, but of a whiter colour. In shape they resemble the testicles, but are broader, and, at the same time, curved. Their cavities are small and like sieves, for the percolation of the urine; and these have attached to each of them nervous canals, like reeds, which are inserted into the shoulders of the bladder on each side; and the passage of the urine from each of the kidneys to the bladder is equal. About it, the kidneys, and those passages, many and complicated diseases are formed, partly acute, proving fatal by hemorrhage, fevers, and inflammation, as has been described by me; but partly chronic, others wearing out the patient by wasting, and although not of a fatal character, incurable, and persisting until death. Wherefore, the chronic are—abscesses, ulcers, the formation of stones, and hemorrhoids. The ulcerations from abscess in man are all very protracted, and difficult to cure. The formation of stones is a long process, the stoppage of them painful, for the passage of them is not easily accomplished; and in addition to these, the retention of urine is formidable. But if several small ones stop together in the passage, or a large one be impacted; and if these occur to both kidneys, so as to occasion retention of urine and distension of the parts, the patients die in a few days. Nature, therefore, did well in forming the cavity of the kidneys oblong, and of equal size with the ureters, and even a little larger, so that if a stone formed above, it might have a ready passage to the bladder. On this account, also, the stones have an oblong form, because, for the most part, they are consolidated in the ureters; and such in that place as are of unequal thickness are slender before, owing to the ureters being narrow, but thick behind, because the kidneys verge downwards. They are formed in the kidneys only, but when in a heated state; for the stones have no fixed place in the ureters, but the gravel floats downwards with the urine, and thus is both indicative of the affection, and furnishes the materiel of it. But if an unusually large one at any time be detained in the pelvis of the kidney, pains of the loins, about the regions of the psoœ, as far as the middle of the ribs, take place, and hence, in many cases, the pain leads to mistake, as if it proceeded from pleurisy; heaviness of the hips; painful flexion about the spine, so that they stoop forward with difficulty; very painful tormina; at the same time, the pains are heavy with a sense of twisting, for the intestine is convoluted. But if the urine be retained in large quantity, and with distension, the desire of making water resembles the pains of labour; they are troubled with flatulence, which cannot find vent; the fevers are pungent, and of a dry nature. Tongue parched; the belly, also, dried up; they are emaciated, and lose appetite; or if they take anything, they cannot readily swallow or digest it. But if the stone fall down into the ureters, there is shivering, as if from rigor, the sensation as if from the passing of a stone with violent exertion. And if it fall down into the bladder, there is an abundant evacuation of watery urine, flatulent discharges from the bowels, the stomach settled, eructations, rest from former illnesses; and sometimes blood is poured out along with the urine, from excoriation of the passage. Another painful operation is the passage through the member; for if the stone be larger than the urethra, it is detained for a long time, the bladder is filled behind, and the ischuria is very painful, for along with the bladder the ureters, also, are filled. The passage of crooked stones is most difficult, for I have seen hooked protuberances on certain of these concretions. But, for the most part, they are oblong, being formed according to the shape of the passages. In colour, some are white, clayey, as is mostly the case with children; others are yellow, and saffron-coloured in old persons, in whom the stones usually form in the kidneys, whereas in children it is rather in the bladder. The causes of the concretion are two-fold: in old persons, a cold body and thick blood. For cold concretes thick fluids more readily than heat, the proof of which is seen in the Thermal springs; for when congealed, the water gets concreted into a sort of chalk-stones. But in children, the copious recrement of the blood, being overheated, gives origin to their formation, like fire. Such are the affections connected with the formation of stones. Certain persons pass bloody urine periodically: this affection resembles that from hemorrhoids, and the constitution of the body is alike; they are very pale, inert, sluggish, without appetite, without digestion; and if the discharge has taken place, they are languid and relaxed in their limbs, but light and agile in their head. But if the periodical evacuation do not take place, they are afflicted with headache; their eyes become dull, dim, and rolling: hence many become epileptic; others are swollen, misty, dropsical; and others again are affected with melancholy and paralysis. These complaints are the offspring of the stoppage of a customary discharge of blood. If, then, the blood flow pure and unmixed with urine, for the most part the blood of the urine flows from the bladder. Sometimes it is discharged in great quantity from rupture of the kidneys; sometimes it is coagulated, and a thrombus is formed of extravasated blood; sometimes it is coagulated in the bladder, when dreadful ischuria comes on. After the rupture there succeed ulcers, which are slow and difficult to heal; the indication of which is a scab, or red film, like a spider’s web, or white pus passed in the urine, sometimes pure and unmixed, and sometimes mixed up with the urine. And by these symptoms we may also diagnose abcesses, if, in addition, fevers and rigors supervene towards evening; pains about the loins, pruritus; but if it burst, clots of a purulent and fleshy nature, and now a discharge of white pus. But the ulcers are pungent, sometimes clear, and sometimes foul. This is indicated by the pus and the urine, whether fetid or free of smell. Spring, then, induces hemorrhages and abscesses; winter and autumn, stones. But if along with the stones ulcers be formed, the diseases indeed are incurable, there is speedy emaciation and death.

> Greek: 3. νεφροὶ τὴν φυὴν μὲν ἀδενώδεες, χροιὴν δὲ ἐρυθρότεροι, ὁκοῖόν τι ἧπαρ, μᾶλλον ἢ μαζοὶ καὶ ὄρχιες. καὶ γὰρ καὶ οἵδε ἀδένες, ἀλλὰ λευκότεροι. σχῆμα δὲ διδύμοισι ἴκελοι, πλατέες μᾶλλον ἔασι ἅμα καὶ καμπύλοι. κοιλίαι δὲ σμικραὶ ἠθμοειδέες ἐς τὴν τῶν οὔρων διήθησιν. ἐκπεφύκασι δὲ ὀχετοὶ νευρώδεες, ὁκοῖόν τι αὐλοὶ ἀφʼ ἑκατέρου. ἐμπεφύκασι δὲ οἵδε τοῖσι ὤμοισι τῆς κύστιος ἑκάτερθεν. ἴση δὲ τῶν οὔρων ἀπὸ νεφρῶν ἡ ὁδὸς ἐς κύστιν. ἀμφὶ δὲ τήνδε, τοὺς νεφροὺς, καὶ τοὺς πόρους τούσδε, πολλὰ καὶ ποικίλα γίγνεται πάθεα, τὰ μὲν ὀξέα, ἐν αἱμορραγίῃ καὶ πυρετοῖσι, καὶ φλεγμονῇσι κτείνον τα, ὁκόσα μοι λέλεκται· τὰ δὲ χρόνια τηκεδόνι λύοντα τὸν ἄνθρωπον, ἀνώλεθρα μὲν, ἀναλθέα δὲ καὶ ξυναποθνήσκοντα· χρόνια οὖν, ἀποστάσιες, ἕλκεα, λίθων γέννα, αἱμορροΐδες. ἕλκεα μὲν ἐξ ἀποστάσιος μήκιστα, ἠδὲ δυσαλθέ απάντα τοῦ ἀνθρώπου. τῶν λίθων δὲ χρονίη μὲν ἡ γέννα· ὀδυνώδεες σφηνώσιες. οὐ γὰρ Ῥηΐστη ἡ διέξοδος· χαλεπὴ δὲ πρὸς τοῖσι καὶ ἡ τῶν οὔρων ἐπίσχεσις. ἀλλʼ εἰ εἰσὶ πολλοὶ σμικροὶ, ἀλληλουχίῃ μίμνουσι, ἢ εἷς μέγας ἐμφραχθῇ, καὶ ἐπʼ ἀμφοῖντοῖν νεφροῖν ξυμβῇ τάδε, ἐς οὔρων σχέσιν καὶ διάτασιν, ὀλιγήμεροι θνήσκουσι. εὖ γε μέντοι ἡ φύσις ἐπιμήκεα καὶ ἰσομεγέθεα τοῖσι οὐρητῆρσι τὴν κοιλίην τῶν νεφρῶν τεύξασα, σμικρὸν ἄρα μέζονα, ὅκως ἂν, ἢν ἄνω συστῇ λίθος, Ῥηΐστην ὁδὸν τὴν ἐς κύστιν ἴσχῃ. διὰ τόδε καὶ ἐπιμήκεες οἱ λίθοι γίγνονται· πρὸς γὰρ τοῖσι οὐρητῆρσι τὰ πολλὰ πήγνυνται· καὶ ὁκόσοι τῇδε ἐς πάχος ἄνισοι, λεπτοὶ μὲν ἔασι τὰ πρόσω, διὰ τοὺς οὐρητῆρας στενοτέρους ἐόντας· παχέες δὲ τὰ ὀπίσω διὰ τὸ τοὺς νεφροὺς κάτω Ῥεῖν. ἐγγίγνονται δὲ τοῖσι νεφροῖσι μοῦνον, ἀλλὰ τοῖσι διαπύροισι. οὐδὲ ἕδρην γὰρ ἐν τοῖσι οὐρητῆρσι οὐκ ἴσχουσι οἱ λίθοι, ἀλλὰ τὰ ψαμμία σὺν τοῖσι οὔροισι κάτω διαπλέει· τάπερ καὶ σημήϊα καὶ ὕλη τοῦ πάθεος γίγνεται· ἢν δὲ ἐμφραχθῇ κοτε τῇ κοιλίῃ μέζων τελεσθεὶς, πόνοι τῆς ὀσφύος ἀμφὶ τὰς ψόας μέσφι τῶν μέσων πλευρέων. πολλοῖσι γοῦν ἀπάτη πόνου, ὡς ἀπὸ πλευρίτιδος· βάρος ἰσχίου, κατὰ Ῥάχιν δυσκαμπέες ὡς ξυννεῦσαι χαλεπῶς· ἐπώδυνοι στρόφοι, βαρέες, ἀνείλυστοι. τὸ γὰρ ἔντερον ἑλικοειδές. ἢν καὶ πλημμύρῃ τὸ οὖρον, καὶ διατάσιες, προθυμίη ἀπουρήσιος ὅκωσπερ ὠδίνων. φυσώδεες, ἀδιέξοδοι δὲ αἱ φῦσαι· πυρετοὶ δακνώδεες, ἐπίξηροι. αὐαλέη μὲν γλῶσσα, ξηρὴ δὲ ἡ κοιλίη· ἰσχνοὶ, ἀπόσιτοι· κἤν τι προσαίρωνται, οὔτε πέψαι οὔτε ἀναλαβεῖν Ῥηΐδιοι. ἢν δὲ ἐς τὸν οὐρητῆρα ὁ λίθος ἐμπέσῃ, βρασμὸς ὡς ἀπὸ Ῥίγεος, αἴσθησις τοῦ λίθου ὁδοιπορέοντος ξὺν ὠσμῷ βιαίῳ· κἢν ἐς τὴν κύστιν ἐμπέσῃ, οὔρων ἅλις ὑδατωδέων ἔκχυσις, κοιλίης ἔξοδοι φυσώδεες, στομάχου κατάστασις, ἐρεύξιες, ἀνάπαυσις τῶν πρόσθεν κακῶν· προσεχύθη κοτὲ καὶ πρὸς τῶν οὔρων αἷμα, ἀναδορῇ τοῦ πόρου· ἀγωνίη δὲ δευτέρη τοῦ λίθου ἡ διὰ τοῦ καυλοῦ διέξοδος. ἢν γὰρ μέζων τῆς οὐρήθρης ἔῃ, ἐνίσχεται πολλὸν χρόνον, καὶ πλημμυρεῖ ἡ κύστις, καὶ ἰσχουρίη νῦν ἐπαλγεστέρη· ξὺν γὰρ τῇδε καὶ οὐρητῆρες πίμπρανται· χαλεπωτάτη δὲ ἡ τῶν σκολιῶν ἔξοδος. καὶ γὰρ ἀγκιστροει δέας ὤπωπα, καὶ ἐπὶ τοῖς πόροις ἐπιπωρώσιας. ἐπιμήκεες δὲ τὰ πολλὰ διαπλασσόμενοι ὑπὸ τῆς τῶν πόρωνἴξιος. χροιῇ δὲ ἄλλοι μὲν λευκοὶ, ἀργιλώδεες, τὰ πολλὰ παιδίοισι· ἄλλοι δὲ ξανθοὶ, κροκοειδέες, γέρουσι, οἷσί περ καὶ ἐν νεφροῖσι οἱ λίθοι ξυνήθεες. ἐν κύστι γὰρ παιδίοισι μᾶλλον. διτταὶ δὲ αἱ αἰτίαι τῆς πήξιος. γέρουσι μὲν τὸ σῶμα ψυχρὸν, παχὺ τὸ αἷμα· ψυχρὸν δὲ τὰ πάχεα θᾶσσον πήγνυσι. τέκμαρ δὲ, τῶν ὑδάτων τῶν θερμῶν φύσι αἱ πηγαί· ἀποψυχθέντα γὰρ, εἰς πωρωειδέα λίθον πήγνυται. παιδίοισι δὲ πολλὸν ὑπὸ τοῦ αἵματος τὸ ἰλυῶδες ἑψηθὲν, γενέσιος, ὅκως πῦρ, τὴν ἕδρην ἴσχει. λίθων μὲν οὖν ἀμφὶ γενέσιος τοιάδε πάθη. μετεξέτεροι ἐν περιόδοισι οὐρέουσι αἷμα· τοῖσι ἀπὸ αἱμορροΐδων ἰκέλη ἥδε ἡ ξυμφορή· ὁμοίη δὲ καὶ ἡ τοῦ σκήνεος κατάστασις, ἔξωχροι, νωθροὶ, ἄπρηκτοι, ἀπόσιτοι, ἄπεπτοι· κἢν μὲν ἐκκριθῇ, ἔκλυτοι, πάρετοι τὰ μέλεα· κεφαλὴν δὲ κοῦφοι καὶ ἐλαφρότεροι· ἢν δὲ ἐς τὴν περίοδον μηδὲν ἐκρυῇ, κεφαλαλγέες, ἀμαυροὶ τὰς ὄψιας, σκοτώδεες, ἀμφιδινεύμενοι· ἐντεῦθεν ἐπίληπτοι μυρίοι· ἄλλοι οἰδαλέοι, ἀπαχλυούμενοι, ὑδρωπιώδεες· ἄλλοι δὲ μελαγχολώδεες ἢ παράλυτοι. ἐπισχέσιος γὰρ αἱμορροίης ξυνήθεος ἀπότοκατάδε. ἢν μὲν οὖν ἐκρέῃ τὸ αἷμα καθαρὸν, ἀμιγὲς οὔροισι, τὰ πολλὰ ἐκρέει ἀπὸ κύστιος τῶν οὔρων τὸ αἷμα. φέρεταί κοτε καὶ ἀπὸ Ῥήξιος τῶν νεφρῶν πολὺ ἀθρόον· ἀτὰρ ἠδὲ πάγον ἴσχει, καὶ γίγνονται θρόμβοι ὡς ἔξω χυθέν· ἐπάγη κοτὲ καὶ ἐν κύστι, εὖτε ἰσχουρίη γίγνεται δεινή. ἐπὶ δὲ τῇ Ῥαγῇ ἕλκεα συμβαίνει χρόνια καὶ δυσαλθέα. τέκμαρ δὲ ἐφελκὶς, ἢ ὑμένιον, εὖτε ἀράχνιον, ἐρυθρὸν ἐκκριθὲν, ἢ πῦον λευκὸν οὐρηθὲν, ἄλλοτε μὲν καθαρὸν, ἀμιγὲς, ἄλλοτε δὲ οὔροισι ξυμμεμιγμένον· τοῖσδε χρὴ καὶ ἀποστάσιας διαγιγνώσκειν, ἢν προσγένωνται πυρετοὶ ἐς ἑσπέρην καὶ Ῥίγεα· πόνοι ἀμφὶ τὴν ὀσφὺν, κνησμοί· ἢν δὲ καὶ ἐκραγῇ, θρόμβοι πυώδεες, σαρκοειδέες, ἀτὰρ ἠδὲ λευκοῦ πύου ἀπόστασις· τὰ δὲ ἕλκεα, δακνώδεα, ἄλλοτε μὲν καθαιρόμενα, ἄλλοτε δὲ Ῥυπαρὰὄντα. δηλοῖ δὲ τὸ πῦον, ἀτὰρ ἠδὲ οὖρα κάκοδμα, ἢ ἄνοδμα· ἔαρ μὲν οὖν αἱμορραγίας τίκτει καὶ ἀποστάσιας· χειμὼν δὲ καὶ φθινόπωρον, λίθους· ἢν δὲ ἐπὶ λίθοισι ἕλκεα γένηται, ἀναλθέες μὲν αἱ νοῦσοι, ταχείη τηκεδὼν καὶ θάνατος.

[¶13] 4. OF the diseases in the bladder no one is mild: the acute proving fatal by inflammation, wounds, spasm, and acute fevers; while an ulcer, abcess, paralysis, or a large stone, are chronic and incurable. For it (a large stone?) can neither be broken by a draught, nor by medicine, nor scraped outwardly, nor cut without danger. For the small ones of the bladder are to be cut out, but the other proves fatal the same day, or in a few days, the patients dying from spasms and fevers; or, if you do not cut him, retention of the urine takes place, and the patient is consumed slowly with pains, fevers, and wasting. But if the stone is not very large, there is frequent suppression of urine; for by falling readily into the neck of the bladder, it prevents the escape of the urine. Although it be safer to cut in these cases than for the large stones, still the bladder is cut; and although one should escape the risk of death, still there is a constant drain of water; and although this may not be dangerous, to a freeman the incessant flow of urine is intolerable, whether he walk or whether he sleep; but is particularly disagreeable when he walks. The very small ones are commonly cut without danger. If the stone adhere to the bladder, it may be detected with care; and, moreover, such cases prove troublesome from the pain and weight, even when there is no dysuria, but yet the patient may have difficulty of making water. You may diagnose all cases of stone by the sediments of sand in the urine, and, moreover, they have the genital parts enlarged by handling them; for when they make water, and there is a stone behind, they are pained, and grasp and drag the genital parts, as if with the intention of tearing out the stone along with the bladder. The fundament sympathises by becoming itchy, and the anus is protruded with the forcing and straining, from the sensation, as it were, of the passage of the stone. For the bladder and anus lie close to one another, and when either suffers, the other suffers likewise. Wherefore, in inflammations of the rectum, the bladder is affected with ischuria; and in acute pains of the bladder, the anus passes nothing, even when the bowels are not much dried up. Such are the sufferings connected with calculi. Hemorrhage, although it may not prove fatal very speedily, yet in the course of time has wasted many patients. But the clots of blood produced by it are quickly fatal by inducing ischuria, like as in stones; for even if the blood be thin, of a bright colour, and not very coagulable, yet the bladder accumulates it for a length of time, and its heating and boiling (as it were) coagulates the blood, and thus a thrombus is formed. Ischuria, then, is most peculiarly fatal. But on these symptoms there supervene acute pain, acrid heat, a dry tongue, and from these they die delirious. If pain come on from a wound, the wound itself is dangerous; but the sore, even if not fatal at first, becomes incurable from fever or inflammation; for the bladder is thin, and of a nervous nature, and such parts do not readily incarnate nor cicatrise. Moreover, the urine is bilious, acrid, and corrosive. The ordinary condition of the ulcer is this:—when the bladder is filled, it is stretched; but when emptied, it contracts: it is in the condition, then, of a joint in extension and flexion, and no ulcer in a joint is easy of cure. The bladder also suppurates from an abscess. The symptoms of an abscess of the bladder are the same as in other cases; for the abscess in forming is attended with inflammation, fevers, and rigors. The dangers are the same. But if it discharges urine which is thick, white, and not fetid, the ulcers from them are mild; but if it spread, they pass urine which is feculent, mixed with pus, and of a bad smell: of such persons the death is not distant. The urine, indeed, is pungent, and the evacuation thereof painful, and the pain darts to the extremity of the member. All things, even those which are opposed to one another, prove injurious to them; repletion and inanition, inactivity and exercise, baths and abstinence from baths, food and abstinence from food, sweet things and acid things; certain articles being serviceable in certain cases, but proving injurious in others, not being able to agree in any one.

> Greek: 4. τῶν ἐν τῇ κύστι νούσων οὐδὲν εὔηθες· τὰ μὲν ὀξέα φλεγμασίῃ καὶ τρώμασι, σπασμῷ καὶ πυρετοῖσι ὀξέσι κτείνοντα· ἕλκος δὲ καὶ ἀποστάσιες, ἢ παράλυσις, ἢ λίθος μέγας χρόνια μὲν, ἀναλθῆ δέ. οὔτε γὰρ θρύπτεται, ἢ πόσι, ἢ φαρμακῳ, ἢ ἀμφιθρύπτοιτο, οὔτε ἀσινέως τέμνεται. χρὴ γὰρ καὶ τὰ λεπτὰ τῆς κύστιος ξυντάμνειν· τὸ δὲ αὐτῆμαρ ἔκτεινε, ἢ ὀλίγαις ἡμέρῃσι, σπασμοῖσι καὶ πυρετοῖσι θνήσκουσι· ἢν δὲ μὴ τάμῃς, εἰς οὔρων σχέσιν, καὶ πόνοισι, καὶ πυρετοῖσι ἢ τηκεδόσι σμύχεται ὥνθρωπος· ἢν δὲ μὴ κάρτα μέγας ὁ λίθος ἔῃ, σχέσιες μὲν οὔρων ξυνεχέστεραι. ἐς γὰρ τὸν αὐχένα Ῥηϊδίως ἐμπίπτων ἀποέργει οὔρων ἔξοδον. τάμνειν δὲ εἰ καὶ τῶν μεζόνων ἀσφαλέστεροι, ἀλλὰ τέμνεται κύστις, κἤν τις τὸν τοῦ θανάτου κίνδυνον ἐκφύγῃ, Ῥυάδος γίγνεταί οἱ πάθος· κἤν ἀκίνδυνον ἔῃ, ἀλλʼ οὐ φορητὸν ἐλευθέροισι ἀένναον ἐκρέειν οὖρον, κἢν βαδίζῃ, κἢν εὕδῃ, ἀτερπὲς δὲ ἢν βαδίζῃ. οἱ δὲ κάρτα σμικροὶ τὰ πολλὰ τάμνονται ἀσινέως· ἢν δὲ ξυμπεφύκῃ τῇ κύστι λίθος, διάδηλος μὲν τῇσι μελεδώνεσι, ἀτὰρ οὐδὲ ἀσινεῖς πόνοισι καὶ βάρεϊ, κἢν ἂν ᾖ δυσουρίης ἄτερ· ἢν δὲ μὴ, καὶ δυσουρέει. ξύμπαντας δὲ τοὺς λίθους διαγνοίης ἂν τῇσι τῶν ψαμμίωνἐν τοῖσι οὔροισι ὑποστάσεσι· ἀτὰρ ἠδὲ πρόκωποιτὰ αἰδοῖα γίγνονται. εὖτε γὰρ ἀπουρέουσι, καὶ ὕπεστι καὶ ὁ λίθος, ὀδυνέονται, καὶ ἀμφαφόωσι, καὶ ἕλκουσι τὰ αἰδοῖα, ὅκως τὸν λίθον ξὺν τῇ κύστι ἐξαιρεύμενοι· ξυμπαθεῖ δὲ καὶ ἕδρη κνησμώδης γιγνομένη· προπετὴς δὲ καὶ ἀρχὸς βίῃ καὶ ἐντάσεσι, φαντασίῃ ὡς ἐκκρίσιος δῆθεν τοῦ λίθου. ἄμφω γὰρ συγκέονται ἀλλήλοισι ἕδρη τε καὶ κύστις. ὧν ἑκατέρου πάσχοντος πάσχει καὶ θάτερον … διὰ τόδε καὶ ἐπὶ φλεγμασίῃ ἀρχοῦ, ἰσχουρέει κύστις, καὶ ἐπὶ τῇσι τῆς κύστιος ἀκίσι οὐ διΐησιἕδρη, κἢν μὴ ἐπίξηρος ἡ γαστὴρ ἔῃ. τοῖα μὲν ἄλγεα τὰ λίθων. αἱμορραγίη δὲ κἢν μὴ κάρτα ὀξέως κτείνῃ, χρόνῳ δὲ ἐξέλυσε μυρίους· οἱ δὲ ἀπʼ αὐτέης θρόμβοι, ἰσχουρίῃ ὀξέως ὀλέθριοι, ὅκωσπερ οἱ λίθοι· καὶ γὰρ ἢν τὸ αἷμα λεπτόν τε καὶ ξανθὸν καὶ μὴ πάγχυ ᾖ εὐπαγὲς, ἀλλʼ ἡ κύστις ἐς πολλὸν ἀλίζει χρόνον, καὶ ἥδε θερμαίνουσα καὶ ἑψοῦσα πηγνύει, καὶ ὧδε γίγνεται θρόμβος. ἰσχουρίη μὲν οὖν δυνατωτάτη κτεῖναι. προσεπιγίγνεται δὲ τουτέοι σι ἄλγος ὀξὺ, πῦρ δριμὺ, γλῶσσα ξηρὴ, καὶ ἐπὶ τοῖσδε παράφοροι θνήσκουσι. ἢν δὲ ἐπὶ τρώματι ἄλγος ἐκφανῇ, τρῶμα μὲν ὀλέθριον· τὸ δὲ ἕλκος κἢν μὴ ἀρχῆθεν κτείνῃ, πυρετοῖς ἢ φλεγμον ῇ ἀνήκεστον γίγνεται· λεπτὴ μὲν τὸ πάχος κύστις· νεῦρον δὲ τὴν φυήν· τάπερ οὐδὲ σαρκοῦται οὔτε Ῥηϊδίως ἐπωτειλοῦται. ποτὶ καὶ τὸ οὖρον χολῶδες, δριμὺ, δακνῶδες· τοῦ ἕλκεος ἡ ξυνὴ δίαιτα ἤδε ἐν μὲν τῇσι πληρώσεσι διατέταται· ἢν δὲ κενωθῇ, ξυνίζει· πάσχει οὖν ἄρθρου πάθεϊ ἐν ἐκτάσιτε καὶ κάμψι· ἄρθρῳ δὲ οὐκ εὐαλθὲς ἕλκος οὐδέν. καὶ ἔμπυος δὲ ἐξ ἀποστάσιος γίγνεται· κύστιος σημήϊα, τάπερ ἐπʼ ἄλλοισι· ἐπὶ φλεγμασίῃ γὰρ, καὶ ἐπὶ πυρετοῖσι, καὶ Ῥίγεσι, ἡ ἀπόστασις· κίνδυνοι οἱ ὠυτοί· πῦον δὲ ἀλλʼ εἰ παχὺ, λευκὸν, οὐ κάκοδμον ἐκδιδοῖ, εὐηθέα τὰ ἀπὸ τῶνδε ἕλκεα· ἢν δὲ ἐπινέμηται, τρυγώδεα, μυξοποιὰ, κάκοδμα οὐρέουσι· τῶν τοιῶνδε οὐ βραδύνει θάνατος· δακνώδε α μὲν τὰ οὖρα· ὀδυνηρὰ δὲ ἡ πρόεσις αὐτῶν, διαΐσσει δὲ ἡ ὀδύνη μέσφι ἄκρων τοῦ καυλοῦ· βλάπτει δὲ αὐτέους πάντα καὶ τἀναντία· καὶ πλησμονὴ καὶ κένωσις, καὶ ἀργίη καὶ κίνησις, καὶ λουτρὰ καὶ ἀλουσίη, καὶ τροφὴ καὶ ἀτροφίη, καὶ γλυκέα καὶ ὀξέα, ἄλλων ἄλλα μὲν ὠφελεύντων, ἄλλα δὲ βλαπτόντων, εἰς ἓν ξυμβῆναι μὴ δυναμένων.

[¶14] 5. GONORRHŒA is not, indeed, a deadly affection, but one that is disagreeable and disgusting even to hear of. For if impotence and paralysis possess both the fluids and genital organs, the semen runs as if through dead parts, nor can it be stopped even in sleep; for whether asleep or awake the discharge is irrestrainable, and there is an unconscious flow of semen. Women also have this disease, but their semen is discharged with titillation of the parts, and with pleasure, and from immodest desires of connection with men. But men have not the same prurient feelings; the fluid which runs off being thin, cold, colourless, and unfruitful. For how could nature, when congealed, evacuate vivifying semen? And even young persons, when they suffer from this affection, necessarily become old in constitution, torpid, relaxed, spiritless, timid, stupid, enfeebled, shrivelled, inactive, pale, whitish, effeminate, loathe their food, and become frigid; they have heaviness of the members, torpidity of the legs, are powerless, and incapable of all exertion. In many cases, this disease is the way to paralysis; for how could the nervous power not suffer when nature has become frigid in regard to the generation of life? For it is the semen, when possessed of vitality, which makes us to be men, hot, well braced in limbs, hairy, well voiced, spirited, strong to think and to act, as the characteristics of men prove. For when the semen is not possessed of its vitality, persons become shrivelled, have a sharp tone of voice, lose their hair and their beard, and become effeminate, as the characteristics of eunuchs prove. But if any man be continent in the emission of semen, he is bold, daring, and strong as wild beasts, as is proved from such of the athletæ as are continent. For such as are naturally superior in strength to certain persons, by incontinency become inferior to their inferiors; while those by nature much their inferiors by continency become superior to their superiors: but an animal becomes strong from nothing else than from semen. Vital semen, then, contributes much to health, strength, courage, and generation. From satyriasis a transition takes place to an attack of gonorrhœa.

> Greek: 5. Ἀνώλεθρονμὲν ἡ γονόρροια, ἀτερπὲς δὲ καὶ ἀηδὲς μέσφι ἀκοῆς. ἢν γὰρ ἀκρασίη καὶ πάρεσις τὰ ὑγρὰ ἴσχῃ καὶ γόνιμα μέρεα, ὅκως διʼ ἀψύχων Ῥέει ἡ θορὴ, οὐδὲ ἐπίσχειν αὐτέην ἐστὶ οὐδὲ ἐν ὕπνοισι. ἀλλὰ γὰρ ἢν τε εὕδῃ, ἤν τε ἐγρηγορέῃ, ἀνεπίσχετος ἡ φορὴ, ἀναίσθητος δὲ ἡ Ῥοὴ τοῦ γόνου γίγνεται· νοσέουσι δὲ καὶ γυναῖκες τήνδε τὴν νοῦσον, ἀλλʼ ἐπὶ κνησμοῖσιτῶν μορίων καὶ ἡδονῇ προχέεταιτῇσι ἡ θορὴ, ἀτὰρ καὶ πρὸς ἄνδρας ὁμιλίῃ ἀναισχύντῳ· ἄνδρες δὲ οὐδʼ ὅλως ὀδάξονται· τὸ δὲ Ῥέον ὑγρὸν, λεπτὸν, ψυχρὸν, ἄχρουν, ἄγονον. πῶς γὰρ ζωογόνον ἐκπέμψαι σπέρμα ψυχρὴ οὖσα ἡ φύσις; ἢν δὲ καὶ νέοι πάσχωσι, γηραλέους χρὴ γενέσθαι πάντας τὴν ἕξιν, νωθώδεας, ἐκλύτους, ἀψύχους, ὀκνέοντας, κωφοὺς, ἀσθενέας, Ῥικιους, ἀπρηκτους, ἐπώχρους, λευκοὶς, γυναικώδεας, ἀποσίτους, ψυχροὺς· μελέων βάρεα, καὶ νάρκας σκελέων, ἀκρατεας, καὶ ἐς παντα παρέτους, ἥδε ἡ νοῦσος ὁδὸς ἐς παράλυσιν πολλοῖσι γίγνεται. πῶς γὰρ οὐκ ἂν τῶν νεύρων ἤδη ἡ δύναμις πάθοι, τῆς ἐς ζωῆς γένεσιν φύσιος ἀπεψυγμέ νης; καὶ ἡμέας ἄνδρας ποιέει ζωοῦσα ἡ θορὴ, θερμοὺς, ἐνάρθρους, λασίους, εὐφώνους, εὐθύμους, κραταιοὺς νοῆσαί τε καὶ Ῥέξαι· δηλοῦσι οἱ ἄνδρες. οἷσι δὲ οὐκ ἔνεστι ζωοῦσα ἡ θορὴ, Ῥικνοὶ, ἀσθενέες, ὀξύφωνοι, ἄτριχες, ἀγένειοι, γυναικώδεις· δηλοῦσι οἱ εὐνοῦχοι. ἢν δέ τις ἀνὴρ καὶ ἐγκρατὴς ἔῃ τῆς θορῆς, κραταιὸς, εὔτολμος, ἀλκήεις μέσφι θηρίων· τέκμαρ δὲ ἀθλητῶν οἱ σαόφρονες. καὶ γὰρ καὶ οἱ φύσι τινῶν κρέσσονες, ὑπʼ ἀκρασίης πολλὸν τῶν χειρόνων γίγνονται χερείονες. πολλὸν δὲ οἱ φύσι χερείους ὑπʼ ἐγκρατί ης γίγνονται κρεσσόνων κρέσσονες. ἀτὰρ οὐδὲ ζῷον ἐξ ἄλλου τευ γίγνεται κραταιὸ ν ἢ θορῆς. μέγα οὖν καὶ ἐς ὑγείην, καὶ ἐς ἀλκὴν, καὶ ἐς εὐψυχίην, καὶ ἐς γένεσιν ζωοῦσα ἠ θορή. ἀπὸ σατυριήσεως ἐς γονορροιής ἀπόσκηψιν ἡ κατάστασις.

## 5. Book II · chapters 6–11

Source: https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/5/ · cite a paragraph as https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/5/#p-N

[¶0] 6. THE stomach is the president of pleasure and disgust, being an important neighbour to the heart for imparting tone, good or bad spirits, from the sympathy of the soul. This is the primary power of the stomach. These things have been described by me in another place. The offspring of pleasure are, good digestion, good condition, and good colour of the body; of disgust, their contraries, and also sometimes depression of spirits, when proper nutrition is wanting; and in melancholic patients, loathing of food. If, then, this organ be diseased, there is dislike and abomination of articles of food, not only if administered, but even if the food is not seen; nay, the very remembrance of them is attended with nausea, distress, water-brash, and heart-ache; and in certain cases there is salivation and vomiting. Even when the body wastes, provided their stomach remain empty, they bear this pain more easily than that produced by the administration of food. But if at any time they are compelled by necessity to take food, the pain is worse than hunger; the act of masticating in the mouth occasions sufferance, and to drink is a still greater pain. And it is not that they suffer thus from suitable food, and bear more unusual food well; owing to a change from that which is natural to the opposite, there is a painful sensation as to everything, an aversion to, and dislike of, all kinds of food. Along with these there is pain between the scapulæ, much greater after the administration of food or drink; loathing, distress, sight dull, noises of the ears, heaviness of the head, torpidity of the limbs, their joints sink under them; palpitation in the hypochondriac region; phantasy, as of the spine being moved towards the lower limbs; they seem as if carried about, now this way and now that, whether they stand, or lie down, like reeds or trees shaken by a gale of wind; they belch out a cold and watery phlegm. But if there be bile in bilious persons, they have dimness of sight, and no thirst, even when owing to the food they appear thirsty; are sleepless, torpid, drowsy, not from true sleep, but like those in comatose affections; emaciated, very pale, feeble, relaxed, imbecile, dispirited, timid, inactive, quick to passion, very moody; for such persons at times have fallen into a state of melancholy. These mental emotions necessarily attend the affection when in connection with the stomach; but certain people, recognising the parts which sympathise, and from which the most dreadful symptoms arise, reckon the stomach as the cause. But the contiguity of the heart, which is of all organs the first, is a strong confirmation of the truth of what I say; for the heart is placed in the middle of the lungs, and this intermediate space comprehends the stomach; and, moreover, both are connected with the spine; and from this vicinity to the heart arise the heart-ache, prostration of strength, and symptoms of melancholy. There are other, and, indeed, innumerable causes of this disease; but the principal is, much pus poured forth by the belly through the stomach. It is familiar to such persons as from their necessities live on a slender and hard diet; and to those who, for the sake of education, are laborious and persevering; whose portion is the love of divine science, along with scanty food, want of sleep, and the meditation on wise sayings and doings—whose is the contempt of a full and multifarious diet; to whom hunger is for food, water for drink, and watchfulness in place of rest; to whom in place of a soft couch, is a hammock on the ground without bed-clothes, a mean coverlet, a porous mantle, and the only cover to whose head is the common air; whose wealth consists in the abundant possession and use of divine thought (for all these things they account good from love of learning); and, if they take any food, it is of the most frugal description, and not to gratify the palate, but solely to preserve life; no quaffing of wine to intoxication; no recreation; no roving or jaunting about; no bodily exercise nor plumpness of flesh; for what is there from which the love of learning will not allure one?—from country, parents, brothers, oneself, even unto death. Hence, to them, emaciation of the frame; they are ill-complexioned; even in youth they appear old, and dotards in understanding; in mind cheerless and inflexible; depraved appetite, speedy satiety of the accustomed slender and ordinary food, and from want of familiarity with a varied diet, a loathing of all savoury viands; for if they take any unusual article of food, they are injured thereby, and straightway abominate food of all kinds. It is a chronic disease of the stomach. But inflammations, defluxions, heart-burn, or pain thereof, are not called the Stomachic affection. Summer brings on this disease, whence springs the complete loss of digestion, of appetite, and of all the faculties. With regard to the period of life, old age; for in old men, even without any disease, owing to their being near the close of life, the appetite is nearly gone.

> Greek: 6. στόμαχος ἡδονῆς καὶ ἀηδίης ἡγεμών· καρδίης καίριον γειτόνευμα ἐς τόνον καὶ θυμὸν, ἢ ἀθυμίην, τῆς ψυχῆς συμπαθείῃ· ἥδε στομάχου πρώτιστα δύναμις. τάδε μὲν οὖν μοι ἄλλῃ λέλεκται. ἀπότοκοι ἡδονῆς μὲν, εὐπεψίη, εὐσαρκίη, εὐχροίη τοῦ σώματος· ἀηδίης δὲ τουτέων τἀναντία, κοτὲ καὶ ἀθυμίη μὴ ἔχων τροφὴν, μελαγχολώδεσι δὲ κἀποσιτίη. ἢν οὖν ὅδε νοσέῃ, μῖσος καὶ ἀποστροφὴ τῶν γευμάτων, οὐκ ἢν προσαίρωνται μόνον, ἀλλὰ κἢν ἀθέητα μὲν ᾖ τὰ σιτία. ἀναπεμπάζονται δὲ ναυτίῃ, ἢ ἀπορίῃ, ἢ πλάδῳ, ἢ καρδιαλγίῃ· καὶ σιαλοχόοι δὲ, καὶ ἔμετοι ἐνίοις. κἢν ὁμῶς τὸ σῶματείρῃ, ἢν γαστὴρ μείνῃ κενεὴ τῶνδε, τόνδε πόνον Ῥηΐτερον φέρει τῆς προσάρσιος. ἢν δὲ καὶ ὑπʼ ἀνάγκης κοτὲ ἐς τὴν ἐδωδὴν ἴῃ, πολλὸν κάκιον ὅδε πόνος τοῦ λιμοῦ· ἐν τῷ στόματι λεῆναι ἄλγος, καταπιεῖν μέζων ὀδύνη· ἀτὰρ καὶ οὐχὶ πρὸς μὲν τὰ οἰκεῖα τοιῶσδε· ἐς δὲ τὰ ἀλλόκοτα χρηστῶς, ἀλλαγῇ τῶν κατὰ φύσιν ἐς τὸ ἔμπαλιν· ἀχθηδὼν ἐς πάντα, καὶ φυγὴ καὶ μῖσος σιτίων· ἐπὶ δὲ τοῖσι μεσσηγὺ τῶν ὠμοπλατέων χωρίοισιν ἄλγος· πολὺ δὲ καὶ μέζον, ἢν προσφέρωνται καὶ καταπίνωσι· ἄση, ἀπορίη, ὄψιες ἀμαυραὶ, ὤτων ἦχοι, βάρεα κεφαλῆς, νάρκη μελέων. καὶ τὰ γυῖα λύονται· παλμὸς ἐν τοῖσι ὑποχονδρίοισι, φαντασίη τῆς Ῥάχιος ἐς τὼ σκέλεε κινευμένης, ἄλλοτε ἄλλῃ τῇδε κἀκεῖσε φέρεσθαι δοκέουσι, κἢν ἑστήκωσι, κἢν κατακέωνται, ὅκως ὑπὸ αὔρης ἀνέμων κάλαμοι, ἢ δένδρεα· φλέγμα ψυχρὸν, ὑδαρὲς ἀποβλύζουσι. ἐπὴν δὲ καὶ χολὴ ᾖ πικροχόλοισι, σκοτώδεες, ἄδιψοι κἢν ἐπʼ ἐδέσμασι διψῆν δοκέωσι, ἄγρυπνοι, νωθροὶ, νυσταλέοι, οὐχ ὕπνῳ ἀτρεκέϊ· κωματώδεσι δʼ ὁμοιοπαθέες, ἰσχνοὶ, ἔξωχροι, ἀσθενέες, ἔκλυτοι, λειποδρανέες, ἄψυχοι, δειλοὶ, ἡσύχιοι· ἐξαπίνης δὲ ὀργίλοι· κάρτα μελαγχολώδεες. καὶ γὰρ ἐξώκειλάν κοτε ἐς μελαγχολίην οἱ τοιοίδε. τάδε μέντοι τῆς ψυχῆς, τοῦ στομάχου ἐνδιδόντος, εἶναι δεῖ τὴν πάθην· οἱ δὲ δὴ ἄνθρωποι οὐκ εἰδότες τὰ ξυμπαθέα μέρεα, ἐφʼ οἷσι τὰ δεινότα τα γίγνεται, τὸν στόμαχον αἴτιον ἡγοῦνται· μέγα δὲ ἐς πίστιν ὧν λέγω ἡ ξυνάφεια τῆς καρδίης, ἔνθα πάντων ἡ ἀρχή. μέσον γὰρ ἐνίζει τῷ πνεύμονι ἡ καρδίη, ἡ δὲ τούτων μεσότης τὸν στόμαχον συνάπτει· ἄμφω δὲ προσπεφύκασιτῇ Ῥάχι· διὰ τόδε πρὸς τὴν καρδίην γειτόνημα, καὶ καρδιαλγίη, καὶ τὰ μελαγχολώδεα. αἰτίαι δὲ τῆς νούσου, καὶ ἄλλαι μὲν μυρίαι, καιρίη δὲ, πῦον συχνὸν ἀπὸ κοιλίης διὰ στομάχου χυθέν. ξύνηθες δὲ καὶ τοῖς ὑπό τε ἀνάγκαις ἐκδεδιῃ τημ ένοις λεπτῇ καὶ σκληροτέρῃ διαίτῃ, ἀτὰρ καὶ τοῖσι ἐς παιδείην πονεῦσι, καὶ ἐς τήνδε τλήμοσι, οἷσι θείης μὲν μαθήσιος ποθὴ, ὀλιγοσιτίη δὲ καὶ ἀγρυπνίη, καὶ μελεδώνη λόγων τε καὶ πρηγμάτων σοφῶν· οἷσι ὑπεροψίη μὲν διαίτης ἁδρῆς καὶ ποικίλης, λιμὸς δὲ ἡ τροφὴ, καὶ ὕδωρ ποτὸν, καὶ ἐν ὕπνῳ ἀϋπνίη. οἷσι μαλθακὴ μὲν εὐνὴ ἄστρωτος χαμαὶ, ἀμφίβλημα δὲ εὐτελὲς, ἀμπεχόνη ἀραιὴ, τὸ δὲ τοῦδε κράνος ὁ κοινὸς ἀὴρ, πλοῦτος δὲ ἐννοίης θείης περιουσίη τε καὶ χρῆσις. τάδε γὰρ αὐτέοισι ἀγαθὰ γίγνεται ἔρωτι παιδείης· καὶ εἰ προσαίρονται, εὐτελὲς μὲν σιτίον, οὐδὲ ἐς κόρον ἐδωδῆς, ἀλλʼ ἐς ζωὴν μοῦνον· οὐκ ἐπʼ οἴνῳ θώρηξις, οὐ θυμηδίη· οὐ Ῥέμβος καὶ περίοδοι, οὐ σωμάτων ἄσκησις, οὐδὲ σαρκῶν περιβολή. τίνος γὰρ οὐκ ἂν ἀπάγοι παιδείης ἔρως; πατρίδος, τοκήων, κασιγνήτων, ἑωυτῶν μέσφι θανάτου. τοῖσδε οὖν τηκεδὼν μὲν τοῦ σκήνεος, ἄχροοι τὴν μορφὴν, καὶ ἐν νεότητι γηραλέοι, καὶ ὑπʼ ἐννοίης κωφοὶ, ψυχὴν δὲ ἀμειδέες, ἀμείλιχοι· στομάχου δὲ κακοσιτίη· ταχὺς ὁ κόρος τῆς ξυνήθεος εὐτελέος καὶ ἑτοίμου τροφῆς, ἀηθείῃ δὲ ποικίλης ἐδωδῆς ὄκνος δὲ πάντων γευμάτων. ἢν δὲ καὶ λάβωσίτι τῶν ξένων, βλάβη, ἀπόστροφοι εὐθὺς ἐς πάντα. ἥδε ἐστὶ στομάχου χρονιη νοῦσος· φλεγμοναὶ δὲ καὶ Ῥεύματα, καὶ καρδιωγμὸς, ἢ πόνος, στομαχικὸν οὐ κικλήσκεται πάθος. θέρος ἄγει τήνδε νοῦσον· ἔνθα καὶ πέψιος καὶ ὀρέξιος καὶ πάντων ἀδυναμίη. ἡλικίη δὲ γῆρας, οἷσι καὶ δίχα πάθεος διὰ τὸ τοῦ βίου τέλος, καὶ ἡ ὄρεξις ἐς τέρμα ἥκει.

[¶1] 7. THE stomach being the digestive organ, labours in digestion, when diarrhœa seizes the patient. Diarrhœa consists in the discharge of undigested food in a fluid state; and if this does not proceed from a slight cause of only one or two days’ duration; and if, in addition, the patient’s general system be debilitated by atrophy of the body, the Cœliac disease of a chronic nature is formed, from atony of the heat which digests, and refrigeration of the stomach, when the food, indeed, is dissolved in the heat, but the heat does not digest it, nor convert it into its proper chyme, but leaves its work half finished, from inability to complete it; the food then being deprived of this operation, is changed to a state which is bad in colour, smell, and consistence. For its colour is white and without bile; it has an offensive smell, and is flatulent; it is liquid, and wants consistence from not being completely elaborated, and from no part of the digestive process having been properly done except the commencement. Wherefore they have flatulence of the stomach, continued eructations, of a bad smell; but if these pass downwards, the bowels rumble, evacuations are flatulent, thick, fluid, or clayey, along with the phantasy, as if a fluid were passing through them; heavy pain of the stomach now and then, as if from a puncture; the patient emaciated and atrophied, pale, feeble, incapable of performing any of his accustomed works. But if he attempt to walk, the limbs fail; the veins in the temples are prominent, for owing to wasting, the temples are hollow; but also over all the body the veins are enlarged, for not only does the disease not digest properly, but it does not even distribute that portion in which the digestion had commenced for the support of the body; it appears to me, therefore, to be an affection, not only of the digestion, but also of the distribution. But if the disease be on the increase, it carries back the matters from the general system to the belly, when there is wasting of the constitution; the patients are parched in the mouth, surface dry and devoid of sweat, stomach sometimes as if burnt up with a coal, and sometimes as if congealed with ice. Sometimes also, along with the last scybala, there flows bright, pure, unmixed blood, so as to make it appear that the mouth of a vein has been opened; for the acrid discharge corrodes the veins. It is a very protracted and intractable illness; for, even when it would seem to have ceased, it relapses again without any obvious cause, and comes back upon even a slight mistake. Now, therefore, it returns periodically. This illness is familiar to old persons, and to women rather than to men. Children are subject to continued diarrhœa, from an ephemeral intemperance of food; but in their case the disease is not seated in the cavity of the stomach. Summer engenders the disease more than any other of the seasons; autumn next; and the coldest season, winter, also, if the heat be almost extinguished. This affection, dysentery and lientery, sometimes are engendered by a chronic disease. But, likewise, a copious draught of cold water has sometimes given rise to this disease.

> Greek: 7. κοιλίη, σπλάγχνον πεπτήριον, κάμνει τὴν πέψιν, ὁκότε διάρροια τὸν ἄνθρωπον ἴσχει· καὶ ἔστιν ὑγρῆς τροφῆς ἀπέπτου ἡ διάρροια· ἀλλʼ ἢν μὴ ἐπὶ σχεδίου τῆς αἰτίης γίγνοιτο τόδε ἐς μίην ἢ δευτέρην ἡμέρην μούνην, πρὸς δὲ καὶ ὅλος ὁ ἄνθρωπος ἀσθενέει, ἀτροφίῃ τοῦ σκήνεος, χρονίη νοῦσος ἡ κοιλιακ ὴ γίγνεται, ἀτονίῃ τοῦ πέσσοντος θερμοῦ, καὶ ψύξι τῆς κοιλίης· εὖτε λύεται μὲν ἐς θερμὸν ἡ τροφή· ἀλλʼ οὐκ ἐκπέσσει θερμὸν, οὐδὲ ἐς χυμὸν οἰκεῖον τρέπει, ἡμιτελέα δὲ λείπει ἀδρανείῃ τοῦ τέλεος. ἡ δὲ ἀφεθεῖσα τῆς ἐργασίης ἐς κακὸν ἀλλοιοῦται καὶ χροιῇ καὶ ὀδμῇ καὶ συστάσι. λευκὴ μὲν γὰρ καὶ ἄχολος ἡ χροιὴ, κάκοδμα δὲ καὶ βορβορώδεα· ὑγρὴ δὲ καὶ ἀσύστατος ἀπραγίῃ, μούνην δὲ ἀρετὴν ἴσχουσα τῆς πέψιος τὴν ἀρχήν. διὰ τόδε φυσώδεες ἐς τὴν γαστέρα, ἐρυγαὶ ξυνεχέες, κακώδεες, ἢν δὲ καὶ κάτω περήσωσι, τρύζει μὲν τὰ ἔντερα, φῦσαι δὲ διεξιᾶσι δασεῖαι, ὑγραὶ, ἀργιλώδεες· φαντασίαι δὲ ἐπʼ αὐτέοισι ὡς διεκθέοντος ὑγροῦ· πόνος τῆς κοιλίης βαρὺς, ὁκοῖον νύγμα, ἄλλοτε καὶ ἄλλοτε· ἰσχνὸς δὲ καὶ ἄτροφος ὥνθρωπος, ὠχρὸς, ἀδρανής· οὐδέν τι πρῆξαι τῶν συνήθων εὔτονος. ἀλλὰ κἢν βαδίζῃ, λύεται τὰ μέλεα, φλέβες κροτάφων ἐπηρμέναι, ἀτροφίῃ γὰρ κοιλοκρόταφοι, ἐπίφλεβοι δὲ καὶ παντὶτῷ σώματι. οὐ γὰρ οὐ πέσσει μοῦνον ἡ νοῦσος, ἀλλʼ οὐδὲ τὴν ἀρχὴν ἐς τὸν ὄγκον ἀναδιδοῖ. δοκέει γάρ μοι οὐ τῆς πέψιος μοῦνον, ἀλλὰ καὶ τῆς ἀναφορῆς τὸ πάθος ἔμμεναι. ἦν δὲ καὶ ἐπʼ αὐξήσει ἡ νοῦσος γίγνηται, ἄγει καὶ τὰ ἀπὸ τοῦ παντὸς εἰς τὴν κοιλίην πάλιν, εὖτε ἤδη τηκεδὼν τῆς ἕξιος. αὐαλέοι δὲ τὸ στόμα, ἄνικμοι δὲ τὴν ἐπιπολὴν, ἀνίδρωτες, κοιλίη ἄλλοτε πυριφλεγὴς ὡς ἀπʼ ἄνθρακος, ἄλλοτε δὲ ὡς ἀπὸ κρυστάλλου ψυχροστ αγής. κοτὲ δὲ καὶ αἷμα τοῖσι ἐσχάτοισι ἐν σκυβάλοισι ἐπιρρέει ξανθὸν, ἄκρητον, ἀμιγὲς, ὡς δοκέειν φλεβὸς στόμιον ἀνεῶχθαι. ἀνεσθίει γὰρ τὸ δριμὺ τὰς φλέβας. μήκιστον καὶ δυσαλθὲς κακὸν, καὶ γὰρ ἢν δοκέῃ πεπαῦσθαι, ἄνευ φανερῆς προφάσιος παλινδρο μέει ἐσαῦθις ἠδὲ καὶ ἐπὶ σμικρῇ ἁμαρτωλῇ παλίνορσος ἥκει. ἐς περίοδον γοῦν ἤδη φοιτῇ. γέρουσι ξύνηθες τὸ κακὸν, καὶ γυναιξὶ μᾶλλον ἢ ἀνδράσι. παιδίοισι δὲ διάρροια μὲν ξυνεχὴς, ἐφημέρῳ ἀκρασίῃ τροφῆς. ἀλλʼ οὐ κοιλίης κύτεϊ ἡ νοῦσος. τίκτει δὲ θέρος τῶν ἄλλων ὡρέων μᾶλλον· μετόπωρον δεύτερον, χειμὼν δὲ ὁ ψυχρότατος, ἢν ἀγχοῦ σβέσιος τὸ θερμὸν ἥκῃ· ἐπὶ χρονίῃ δὲ νούσῳ καὶ ἥδε καὶ δυσεντερίη καὶ λειεντερίη τίκτεται. ἀλλὰ καὶ χανδὸν ψυχροποσίη κοτὲ ξυνέστησε τὴν νοῦσον.

[¶2] 8. PERSONS in colic are cut off speedily by volvulus and tormina. There are very many causes of this affection. The symptoms are, heaviness during abstinence from food, particularly in the part most affected; much torpor; they are inactive, lose appetite, become emaciated, sleepless, swollen in countenance. And if the colon be affected in connection with the spleen, they are of a dark-green colour; but of a light-green when in connection with the liver, from the sympathy of the nearest viscera. And if they take food, even in small quantity, and such as is not flatulent, they become very flatulent, and have a desire to pass wind, which, however, does not find vent: forced eructations upwards, but without effect; or, if any should be forcibly expelled, the flatus is fetid and acid which escapes upwards. The kidneys and bladder sympathise, with pain and ischuria; but in such cases the symptoms interchange with one another. But a greater wonder than these, —an unexpected pain has passed down to the testicles and cremasters; and this sympathetic affection has escaped the observation of many physicians, who have made an incision into the cremasters, as if they were the particular cause of the disease. But in these cases also the symptoms interchange with one another. From this disease are produced other diseases; abscesses and ulcers, of no mild character; dropsies and phthisis, which are incurable. For the disease is formed from cold and thick humours, and a copious and glutinous phlegm; but, also, it comes on with a frigid period of life, a cold season, and a cold locality, and during a hard winter.

> Greek: 8. Κωλικοὶ δὴ κτείνον ται εἰλεῷ καὶ στρόφῳ ὀξέως. πάνυ μὲν οὖν αἴτια μυρία ἴσχει τῆς διαθέσιος· σημήϊα, βάρος μὲν ἐπʼ ἀσιτίῃ, ἔνθα δὴ τὸ πάθος μάλιστά γε κραίνει· ὄκνος πουλὺς, νωθέες, ἀπόσιτοι, ἰσχνοὶ, ἄγρυπνοι, οἰδαλέοι πρόσωπα· κἢν μὲν πρὸς τῷ σπληνὶ νοσέῃ κῶλον, μελάγχλωροι. λευκόχλωροι δὲ, ὁκόσοις πρὸς ἥπατι, ξυμπαθείῃ τῶν ἄγχιστα σπλάγχνων· ἢν δὲ προσαίρωνται τροφὴν, καὶ ἐπὶ σμικρῇ καὶ ἀφύσῳ κάρτα φυσώδεες, καὶ προθυμίη μὲν ἐς διαπνοὴν, ἀδιέξοδοι δὲ φῦσαι, ἐρυγαί τε ἄνω βιώμεναι, ἀτὰρ καὶ αἵδε ἀτελέες. ἢν δέ πηπερήσῃ βίᾳ, φῦσαι βρωμώδεες μὲν αἱ ἄνω καὶ ὀξυρεγμιώδεες· νεφροὶ καὶ κύστις ξυμπαθέα πόνῳ καὶ ἰσχουρίῃ· τουτέοισι ἄλλα ἀντʼ ἄλλων. θωῦμα δὲ τουτέων μέζον, ἐς ὄρχιας καὶ κρεμαστῆρας ἀδόκητον ἄλγος ἐπιφοιτῇ· πολλοὺς τῶν ἰητρῶν ἥδε ἡ ξυμπαθείη λήθει. καὶ γὰρ καὶ ἐξέταμόν κοτε τοὺς κρεμαστῆρας, ὡς ἰδίην ἔχοντας αἰτίην. ἀλλὰ γὰρ καὶ τουτέοισι ἀντʼ ἄλλων ἄλλα. γίγνονται δὲ καὶ ἀπότοκοι τοῦδε νοῦσοι, ἀποστάσιες μὲν καὶ ἕλκεα οὐκ εὐήθεα· ὕδεροι δὲ καὶ φθίσιες, ἀναλθέα. ἐπὶ γὰρ ψύξι καὶ χυμοῖσι παχέσι καὶ φλέγματι πολλῷ κολλώδεϊ ξυνίσταται ἡ νοῦσος· ἀτὰρ καὶ ἡλικίῃ καὶ ὥρῃ ψυχρῇ ἐπιφοιτῇ, χώρῃ, καὶ χείματι καρτερῷ.

[¶3] 9. OF the intestines, the upper being thin and bilious (χολώδεα) as far as the cœcum, have got the Greek name χολώδες. From these proceed the lower, which are thick and fleshy, as far as the commencement of the Rectum.

> Greek: 9. ἐντέρων τὰ μὲν ἄνω λεπτὰ καὶ χολώδεα μέσφι τοῦ τυφλοῦ, χολάδες ἐπίκλην· ἀπὸ δὲ τουτέων τὰ κάτω παχέα καὶ σαρκώδεα μέσφι τῆς ἀρχῆς τοῦ εὐθέος ἐντέρου.

[¶4] Wherefore ulcers form in all of them; and the varieties of these ulcers constitute Dysentery: on this account, these diseases are complex. For some of them erode the intestines superficially, producing only excoriation; and these are innocuous; but they are far more innocent if the affections be low down. Or if the ulcers be yet a little deeper, they are no longer of a mild character. But ulcers which are deep and have not stopped spreading, but are of a phagedænic, painful, spreading, and gangrenous character, are of a fatal nature; for the small veins get corroded in the course of their spreading, and there is an oozing of blood in the ulcers. Another larger species of ulcers: thick edges, rough, unequal, callous, as we would call a knot in wood: these are difficult to cure, for they do not readily cicatrise, and the cicatrices are easily dissolved.

> Greek: ἐγγίγνεται οὖν ἐν ἅπασι ἕλκεα· δυσεντερίη δὲ τῶνδε τῶν ἑλκέων αἱ ἰδέαι. διὰ τόδε ποικίλαι ἔασι αἱ νοῦσοι. τὰ μὲν γὰρ ἐπιπολῆς ξέει ἔντερα, ἀναδορὴν μούνην ποιεύμενα, καὶ ἔστιν ἀσινέα. ἀτὰρ δὲ ἀσινέστερα πολλὸν, ἢν κάτω ᾖ τὰ πάθη· ἀλλʼ ἢν δὲ σμικρῷ μὲν ἔτι βαθύτερα τὰ ἕλκεα, οὐκ εὐήθεα δὲ καὶ τάδε. ἄλλα βαθέα καὶ οὐχ ἱστάμενα, ἀλλʼ ἐσθιόμενα, ὀδυνώδεα, ἕρποντα, καὶ ἐπισφακελίζοντα, θανατώδεα. ἀτὰρ καὶ φλέβια ἐπὶ τῇσι νομῇσι γίγνονται περίβρωτα, ἔν τε τοῖσι ἕλκεσι καὶ στάξιες αἱμορραγίας· τὸ μέζον ἄλλο εἶδος ἑλκέων· ὀχθώδεα, τρηχέα, ἀνώμαλα, τυλαίνια, ὡς ἐν ξύλῳ ὄζον εἴπομεν. δυσαλθέα τάδε, οὔτε γὰρ ὠτειλὴν Ῥηϊδίως ἴσχει, Ῥηΐτερόν τε γὰρ λύονται.

[¶5] The causes of dysentery are manifold; but the principal are, indigestion, continued cold, the administration of acrid things, such as myttôtos, onions by themselves, garlic, food of old and acrid flesh, by which dyspepsia is produced; also unaccustomed liquids, cyceon, or zythus (ale), or any similar beverage produced in any country as a substitute for wine to quench thirst. But also a blow, exposure to cold, and cold drink, create ulcerations.

> Greek: αἰτίαι δὲ δυσεντερίης μυρίαι, ἐπίκαιροι δὲ, ἀπεψίαι, ψύξιες συνεχέες, δριμέων πρόσαρσις, μυττωτῶν, κρομμύου αὐτοῦ, σκορόδου, κρεῶν παλαιῶν δριμέων ἐδωδή. ἐφʼ οἷσι ἀπεψίη· ὑγρὸν ἄηθες, κυκεὼν, ἢ βρυτέων πόμα, ἢ οἷα κατὰ χώρην ἑκάστην ἀντὶ οἴνου γίγνεται δίψεος ἄκεα. ἀτὰρ καὶ πληγὴ καὶ ψύξις καὶ ψυχροποσίη τίκτουσι ἕλκεα.

[¶6] The dejections and the circumstances attendant on the ulcers are different in different cases; for, if superficial, when from above, the discharges are thin, bilious, devoid of odour except that which they derive from the intestines; those from the jejunum are rather more coloured, saffron-like, and fetid. Those dejections which contain the food in a dissolved state but rough, are sometimes fetid in smell when the ulcers are gangrenous, and sometimes have the smell as if from scybala. But in the ulcerations from the parts below, the discharges are watery, thin, and devoid of smell. But if deeper they are like ichor, reddish, of the colour of dark wine, or like the washings of flesh; and these are sometimes by themselves and sometimes with the fæces, these being dissolved in the surrounding fluid, devoid of bile and of smell; or they are evacuated in a consistent and dry state, lubricated with the surrounding fluid. But if the ulcers be larger and smoother, in those above they are bilious, and pinch the parts from which they come and through which they pass (they even pinch the anus), for the bile is acrid, more especially if from an ulcer; and the bile is fatty, like grease. In the deeper ulcers below, a thick clot of blood with phlegm, like flesh not very fat, or like the scrapings of the bowels: nay, even entire portions are mixed up with them; they are discharged white, thick, mucous, like chopped tallow, along with the humour in which they float: these proceed from the rectum: but sometimes they are merely mucous, prurient, small, round, pungent, causing frequent dejections and a desire not without a pleasurable sensation, but with very scanty evacuations: this complaint gets the appellation of tenesmus. But from the colon there are discharged pieces of flesh, which are red, large, and have a much larger circumference. If the ulcers become deep, and the blood thick and feculent, these are more fetid than the former; but if the ulcers spread and are phagedænic, and if nothing will stop them, above, in addition to being intensely bilious, the dejections become saffron-like, frothy, feculent, blackish, like woad or like leeks, thicker than the former, fetid like a mortification; food now undigested, as if only masticated by voracious teeth. But if the under parts are also corroded, black clots of blood, thick, fleshy, very red, clotted, sometimes, indeed, black, but at other times of all various colours, fetid, intolerable; involuntary discharges of fluids. And sometimes a substance of considerable length, in many respects not to be distinguished from a sound piece of intestine, has been discharged, and, to those ignorant of the matter, has caused apprehension about the intestine: but the fact is this,—the intestines, like the stomach, consist of two coats, which lie close to one another in an oblique manner; when, therefore, the connection between them is dissolved, the inner coat, being separated to some length, protrudes externally, while the outer one remains alone, incarnates, and gets cicatrised, and the patients recover and live unharmed. It is the lower gut alone which suffers thus, owing to its fleshy nature. And, if blood be discharged from any vessel, it runs of a bright red or black colour, pure, and unmixed with food or scybala; and if a concretion is spread over it like broad spiders’ webs, it coagulates when cold, and no longer would be taken for a secretion of blood; but being discharged with much flatulence and noise, it has the appearance of being much larger than its actual amount. Sometimes, also, a purulent abscess forms in the colon, nowise different from the other internal ulcers; for the symptoms, the pus, and the mode of recovery are the same. But if there be hard secretions of matters resembling flesh, as if pounded, and like rough bodies, the abscess is not of a mild nature. Sometimes a copious discharge of water takes place from the colon in the form of dysentery, which has freed many patients from dropsy. In a word, such are the ulcers in the intestines; and their forms and the secretions from them as I have described.

> Greek: αἱ δὲ ἐκκρίσιες καὶ τὰ ξυνεόντα τοῖσι ἕλκεσι ἕτερα καὶ ἕτερα, ἐπʼ ἄλλοισι καὶ ἄλλοισι. ἢν μὲν γὰρ ἐπιπολῆς ἔῃ, ἄνωθεν μὲν λεπτὰ, χολώδεα, ἄνοσμα, πλὴν ὁκόσον ἀπʼ ἐντέρων. τὰ δὲ ἀπὸ τῆς νήστιος κατακορέα μᾶλλον, κροκοειδέα, κακώδεα· τὰ δὲ καὶ ξὺν τῇ τροφῇ λελυμέν ῃ μὲν, ἀλλὰ τρηχείῃ, ἄλλοτε κάκοδμόν ἐστι, τὰ δὲ ἕλκεα σηπεδώνεα ἄλλοτε δὲ ἴσχει, ὡς ἀπὸ σκυβάλων μοῦνον τὴν ὀσμήν· ἀπὸ δὲ τῶν κάτω ἐπὶ τοῖσι ἕλκεσι, ὑδατώδεα, λεπτὰ, ἄνοσμα· ἢν δὲ ἐπὶ μᾶλλον βαθέα, ἰχωροειδέα, ὑπέρυθρα, οἰνώδεα, ἢ ὅκως κρεῶν πλύμα. ἄλλοτε μὲν ἰδίῃ τάδε, ἄλλοτε δὲ ξὺν τοῖσι κοπρίοισι· καὶ τάδε ὑγρὰ λελυμένα τῷ περιρρόῳ, ἄχολα, ἄνοσμα· ἢ ξυνεστῶτα, ξηρὰ ἐξίασι, ὀλισθηρὰ τῷ περιρρόῳ· ἢν δὲ μέζω καὶ λειότερα ᾖ τὰ ἕλκεα, ἐπὶ μὲν τοῖσι ἄνω, χολώδεα, καὶ ἀφʼ ὧν καὶ διʼ ὧν ἔρχεται — καὶ γὰρ τὴν ἕδρην, — δάκνει. δριμεῖα γὰρ ἡ χολὴ, καὶ ἐπὶ μᾶλλον ἢν ἀφʼ ἕλκεος· καὶ ἡ χολὴ δὲ πίων ὅκως λίπας. ἐπὶ δὲ τοῖσι βαθυτέροις τοῖσι κάτω αἱμάλωψ παχὺς σὺν φλέγματι, σαρκοειδέα οὐ κάρτα πίονα, ξυσματώδεα, ὡς ἀπʼ ἐντέρων εἶναι. ἀτὰρ καὶ ὅλα συμμέμικται μέρεα· φέρεται λευκὰ, παχέα, μυξώδεα, στέατι ξυγκοπέντι ἴκελα, ξὺν τῷ περιρρόῳ. τάδε μέντοι ἀπὸ τοῦ εὐθέος τοῦ παραμήκεος ἐντέρου. ἄλλοτε δὲ μυξώδεα μοῦνον, ὀδαξώδεα, σμικρὰ, στρογγύλα, δακνώδεα, ἐξαναστάσιας πυκινὰς, καὶ προθυμίην ξὺν ἡδονῇ ποιεύμενα, ἐκκρίσιας δὲ κάρτα σμικράς· τεινασμὸς τοῦδε ἡ ἐπίκλησις. ἀπὸ δὲ τοῦ κώλου φέρονται καὶ σάρκες ἐξέρυθροι καὶ μεγάλαι, περιγραφὴν πολλὸν μέζονα ἔχουσαι· εἰ δὲ βαθέα γίγνεται τὰ ἕλκεα, καὶ αἷμα παχὺ, τρυγῶδες, τάδε κάκοδματῶν πρόσθεν μᾶλλον. ἐπην δὲ ἕρπῃ καὶ ἐσθίῃ τὰ ἕλκεα, καὶ ἴσχηται μηδαμᾶ ἐπὶ μηδενὶ, ἄνωθεν μὲν πρὸς τοῖσι χολώδεσι τοῖσι κατακορέσι, κροκώδεα, καὶ ἔπαφρα, τρυγίζοντα, καὶ μέλανα, ἰσατώδεα, πρασοειδέα, παχύτερατῶν πρόσθεν, κακώδεα, ὅκως ἡ σηπεδὼν, διαχωρέει. τροφὴ νῦν ἀπεπτοτέρη, ὡς ὑπὸ ὀδόντων λάβρων τετριμμένη μοῦνον. ἢν δὲ τὰ κάτω ἀνεσθίηται, αἱμάλωπες μέλανες, παχέα, σαρκοειδέα, ἐξέρυθρα, θρομβώδεα, ἄλλοτε μὲν μέλανα, ἄλλοτε δὲ παντοίως ποικίλα, κάκοδμα, οὐ φορητὰ, ἀφέσιες τῶν ὑγρῶν ἀβούλητοι· ἀπελύθη κοτὲ καὶ εὔμηκες ἄκριτον κατὰ πλεῦνα, ὅκως ὑγιὲς τὸ ἔντερον, καὶ δέος παρέσχεν ἀμφὶ ἔντερον τοῖσι ἀγνοοῦσι τοῦ πρήγματος. τὸ δέ ἐστι τοιόνδε. τῶν ἐντέρων, ὅκως τῆς κοιλίης, χιτῶνες ἔασι δοιοί· ἀτὰρ καὶ ἀλλήλοισι ἐπιβάλλουσι οἵδε λοξοί. ἢν οὖν ἡ διπλόη λυθῇ, ὁ μὲν ἐντὸς χιτὼν ἀποστὰς ἐς μῆκος ἔξω χωρέει, ὁ δὲ ἐκτὸς μίμνει μοῦνος, καὶ σαρκοῦται, καὶ ἐπωτειλοῦται, καὶ ἀλθέξονται, καὶ ζώωσι ἀσινέες. πάσχει δὲ τὸ κάτω μοῦνον, αἰτίη δὲ τῶν χιτώνων τὸ σαρκοειδές. ἢν δὲ αἷμα ἀπό τευ ἀγγείου φέρηται ξανθὸν, ἢ μέλαν, καθαρὸν Ῥέει, ἀμιγὲς τροφῆς, ἢ σκυβάλων ἄτερ. εἰ δὲ ἐπίπαγοςἐπιπετάννυτο πλατέσι ἀραχνίοισι ἴκελος θρομβοῦται, ἢν ψυχθῇ· οὐδὲ γὰρ ἡ πίστις αἵματος ἔκκρισις· τῷ δὲ Ῥοίζῳ πολλῷ ξὺν πνεύματι μέζων τῆς περιστάσιος ἡ φαντασίη τῆς ἐκκρίσιος. γίγνεταί κοτε καὶ ἐν κώλῳ πύου ἀπόστασις, οὐδέν τι τῶν ἄλλων τῶν ἐντὸς ἑλκέων ξενοπρεπεστέρη. καὶ γὰρ τὰ σημήϊα καὶ τὸ πῦον καὶ ἡ ἄλθεξις τῶν ἑλκέων ἡ ὠυτή. ἢν δὲ ἐκκρίσιες σκληραὶ τῶν σαρκοει δέων ἔωσι, τετριμμέναι, τρηχέσι σώμασι ἴκελαι, ἡ ἀπόστασις οὐ τοῦ εὐήθεος τρόπου· ῥέει κοτὲ πολλὸν ἀπὸ τοῦ κώλου ὕδωρ, δυσεντεριώδεα τρόπον. ὕδρωπος τόδε μυρίους ἐρρύσατο. τὰ μὲι ἕλκεα, ὡς ἔπος εἰπεῖν, τὰ ἐν τοῖσι ἐντέροισι τοιάδε·

[¶7] I will now describe the symptoms accompanying each of these states of disease, whether the ulcers be mild or malignant. To speak in general terms, then, if the excoriation is superficial, whether it be above or below, the patients are free from pain and from fever, and get better without being confined to bed, in various ways, by merely some slight changes of diet. But if ulceration supervene, in the upper bowels there are tormina, which are pungent, acrid, as if from the presence of a small amount of hot bile; and occasionally there is suppuration: indeed, for the most part, there is suppuration, or digestions imperfectly performed, though there is no want of appetite. But if the ulcers form in the lower part of the bowels, they are much less dangerous than in those above, for the bowels there are of a much more fleshy nature than those above. But if those above become hollow and phagedænic, there are acute fevers, of a latent kind, which smoulder in the intestines; general coldness, loss of appetite, insomnolency, acid eructations, nausea, vomiting of bile, vertigo: but if the discharge become copious, and consist of more bilious matters, the tormina become permanent, and the other pains increase; sometimes there is prostration of strength, feebleness of the knees; they have ardent fever, are thirsty, and anxious; black vomiting, tongue dry, pulse small and feeble. Akin to these are the fatal symptoms I have stated among those of malignant ulcers; cardiac affections even to deliquium animi, from which some never recover, but thus expire. These dangerous symptoms are common also to erosions of the lower intestines if the ulcers spread, and the discharge be not checked, only that the tormina and pains are below the umbilicus where the ulcers are situated. The forms of the secretions are such as I have said; but if they be small at first, and there be a postponement of their spreading for a long time, various changes take place in the ulcers, some subsiding, and others swelling up, like waves in the sea. Such is the course of these ulcers. But if nature stand out, and the physician co-operate, the spreading may, indeed, be stopped, and a fatal termination is not apprehended, but the intestines remain hard and callous, and the recovery of such cases is protracted.

> Greek: ἀτὰρ ἠδὲ καὶ ἡ τῶνδε ἰδέη, καὶ αἱ ἀπὸ τῶνδε ἐκκρίσιες, ὁκόσας ἔλεξα. φράσω δὲ καὶ τὰ ξυνεόντα ἑκάστοισι τῶν νοσεόντων, ἤν τε εὐήθεα, ἤν τε σιναρὰ ᾖ τὰ ἕλκεα. ἀθρόον μὲν οὖν εἰρήσθω, ἢν ἐπιπολῆς ἀναδορὴ, ἤν τε ἄνω, ἤν τε κάτω ἔῃ, ἄπυροι, ἄπονοι, ὀρθοστάδην ὑγιαζόμενοι, σμικρῆσι τῇσι διαίτῃσι ἑτεροίως. ἢν δὲ ἕλκος ἐγγένηται, ἐπὶ μὲν τοῖσι ἄνω στρόφος δακνώδης, δριμὺς, ὡς ἀπὸ χολῆς θερμῆς σμικρῆς, ἔμπυοι ἄλλοτε καὶ ἄλλοτε· τὸ δὲ πλέον, ἔμπυοι. ἢ πέψιες ἡμιτελέες, οὐκ ἀπόσιτοι· ἢν δὲ τοῖσι κάτω ἕλκεα γένηται, πολλόν τι ἀσινέστερα τῶν ἄνω· καὶ γὰρ τὰ ἔντερα πολλόν τι μᾶλλον τῶν ἄλλων σαρκοειδέα. ἢν δὲ κοῖλα καὶ ἀνεσθίοντα ἐς τὰ ἄνω γένηται, πυρετοὶ ὀξέες, ἀλαμπέες, ἐν τοῖσι σπλάγχνοισι ὑποβρύχιοι, περίψυξι ς, ἀποσιτίη, ἀγρυπνίη· ἐρυγαὶ κακώδεες, ναυτίη, χολῆς ἔμετοι, σκοτοδίνη· ἢν δὲ πολλὴ μὲν ἡ φορὴ, χολωδεστέρων δὲ γίγνηται, ἐπίμονοι στρόφοι, καὶ ἄλλοι πόνοι μᾶλλον· ποτὶ καὶ ἐκλύσιες δυνάμιος, ὑπολύσιες γουνάτων, καυσώδεες, διψαλέοι, ἀσώδεες, ναυτίη μελάνων, γλῶσσα ξηρὴ, σφυγμοι σμικροὶ, ἄτονοι. τουτέων ἀδελφὰ, ὀκόσαἐπὶ τοῖσι κακοειδέσι ἕλκεσι ἔλεξα τὰ θανατώδεα. καρδιώσσουσι μέσφι λειποθυμίης. μετεξέτεροι δὲ οὐδὲ ἐς ἀνάκτησιν ἐπαλινδρόμησαν· ἀλλʼ οὕτως ἐξέθανον· τάδε τὰ δεινὰ ξυνὰ καὶ τῇσι ἀπὸ τῶν κάτω ἐντέρων διαβρώσεσι, ἢν νέμηται μὲν τὰ ἕλκεα, ἄσχετος δὲ ἡ φορή· πλὴν ὁκόσον οἱ στρόφοι καὶ οἱ πόνοι ὑπὸ τὸν ὀμφαλὸν κάτω, ἔνθα τὰ ἕλκεα. ἰδέαι δὲ αἵδε τῶν ἐκκρίσεων, ὁκοίας ἔλεξα. ἢν δὲ ἐπὶ τοῖσι πρώτοισι σμικρὰ ᾖ, ἀνακωχὴ δὲ εἰς μακρὸν ᾖ νομῆς, ἄλλα ἐπʼ ἄλλοις ἕλκεα γίγνεται, τῶν μὲν πρηϋνομέ νων, ἄλλων δὲ κορυφουμένων, ὅκως ἐν θαλάσσῃ κύματα. τοιόνδε τὸ τῶν ἑλκέων χύμα. ἢν δὲ καί κοτε ἐπαρκέσῃ μὲν ἡ φύσις, συνασκήσῃ δὲ καὶ ὁ ἰητρὸς, πέπαυται μὲν ἡ νομὴ, καὶ θάνατον οὐκ ὀρρωδέει, σκληρὰ δὲ καὶ ὀχθώδεα μίμνει τὰ ἔντερα, καὶ τῶνδε ἐς μακρὸν ἡ ἄλθεξις.

[¶8] In hemorrhage from the bowels, if it proceed from a large vein or artery, it is sudden death; for neither is it possible to introduce the hand so as to reach the ailment, nor to apply any medicine to the sore. And even if the hemorrhage were restrained by the medicine, the escape from death would not be certain; for, in some cases, the falling off of a large eschar widens the mouth of the vein, and when clots form within, and remain there, the disease is incurable. It is necessary, then, to cure hemorrhages in their commencement. Its approach, also, for the most part is obvious, although not in all cases quite apparent: anxiety attends, with restlessness, heaviness in the part where the rupture is to take place, ruddiness of the countenance if the blood has not yet burst forth. And if the vein has burst lately, for the most part the symptoms are alleviated; but if it has been a longer time ago, this takes place more slowly, and with more difficulty. Such are the ulcers in the intestines.

> Greek: αἱμορραγίῃ δὲ ἀπʼ ἐντέρων, ἢν μὲν μεγάλης φλεβὸς ἢ ἀρτηρίης ἔῃ, ὠκὺς ὁ θάνατος. οὐδὲ γὰρ οὐδὲ τὴν χεῖρα δυνατὸν ἔσω ἐσμάσασθαι, καὶ τοῦ ἄλγεος θιγεῖν, ἢ φάρμακον αὐτῷ τῷ ἕλκεϊ προσβάλλειν. καί τοι καὶ εἰ ἐπίσχοιτο ἡ αἱμορραγίη φαρμάκῳ, οὐκ ἀτρεκὴς τοῦ θανάτου ἡ φυγή. μετεξετέροισι γὰρ μεγάλης ἐσχάρης ἔκπτωσις τῆς φλεβὸς τὸ στόμιον ἐς μέζον εὐρύνει· εὖτε καὶ θρόμβοι ἔνδον ἐγγίγνονται καὶ μίμνουσι ἔσω, ἄφυκτος ἡ νοῦσος. χρὴ οὖν ἀρχομένῃσι αἱμορραγίῃσι ἀρήγειν. δήλη δὲ ὡς ἐπίπαν γίγνεται μέλλουσα, εἰ καὶ μὴ πάμπαν εὔσημος· ἄση ξύνεστι, ἀπορίη, βάρος τοῦ τόπου, ἔνθα Ῥήσσεται, ἐρύθημα τοῦ προσώπου, ἢν μηδέκω Ῥαγῇ· κἢν μὲν ἡ φλὲψ νεορραγὴς ἔῃ, ὡς ἐπίπαν μαλθάσσεται πάμπαν. ἢν δὲ πρόσω ᾖ χρόνου, χαλεπώτερον καὶ βραδύτερον. τοιάδε μὲν τὰ ἐν ἐντέροις ἕλκεα.

[¶9] They occur in the season of summer; next in autumn; less in spring; least of all in winter. Diarrhœa attacks children and adolescents, but dysentery adults and young persons. In old age convalescence is difficult, and cicatrization protracted. Corroding sores are unusual in old persons, but yet hemorrhage is in accordance with old age.

> Greek: γίγνεται δὲ θέρεος ὥρῃ· δεύτερον φθινοπώρου, ἧσσον ἦρος, ἥκιστα χειμῶνος. καὶ διάρροιαι μὲν, παιδίοισι καὶ μειρακίοισι· δυσεντερίη δὲ ἀκμάζουσι καὶ νέοισι· γῆρας δὲ δυσαλθὲς καὶ ἐς ὠτειλήν χρόνιον· τὰ δὲ ἀνεσθιόμενα γέρουσι ἀήθεα· ἀτὰρ καὶ αἱμορραγίη ξύμφωνος γήρᾳ.

[¶10] 10. IF many thick and hard cicatrices form after dysenteries, and broad and very deep ulcerations of the upper intestines, the food passes from them to those below in a fluid state, without separation of the nutritious part; for the cicatrix shuts up the pores by which the nutriment is carried upwards. The patient, therefore, is seized with atrophy, loss of colour and of strength. The affection gets the appellation of Lientery, this name being applied to a cicatrix of the intestines. And here the affection is from ulcers. But sometimes the intestines do not acquire cicatrization, but yet usage and habit reconcile the intestines to the discharge. For, the heat in these parts, if congealed, neither at times performs digestion, nor is the nutriment distributed upwards; but being unchanged, owing to weakness, it fails to undergo any part of the process. But if the purging, though of vitiated matters, be temporary, and not confirmed, a simple vomit after food will sometimes remove the disease. But if the exciting cause be prolonged, and get confirmed, it does no good. A chronic disease, and cachexia so mild as not to confine the patient to bed, will engender this disease. But dropsies sometimes have terminated favourably in this disease; a change from one evil to another, but still a better change.

> Greek: 10. ἢν ἐπὶ δυσεντερίῃσι καὶ ἕλκεσι πλατέσι καὶ κάρτα βαθέσι τῶν ἄνω ἐντέρων ὠτειλαὶ ἐγγίγνωνται πυκναὶ, παχεῖαι, στερέμνιοι, τὰ σιτία ἐκ τῶνδε ἐς τὰ κάτω διεκθέει, ὑγρὰ, ἀδιάκρι τα τοῦ τροφίμου· τὸ γὰρ τῶν ἐντέρων ἀραιὸν διʼ οὗπερ ἐς τὴν ἄνω φορὴν ἡ τροφὴ ἀναΐσσει, ἀπέκλεισεν ἡ ὠτειλή. ἀτροφίη οὖν τὸν ἄνθρωπον ἴσχει καὶ ἀχροίη, καὶ ἀτονίη. ἐπικλην τὸ πάθος λειεντερίη ἴσχει, — τὸ ἐπὶ τῇ οὐλῇ λέγω τῶν ἐντέρων, — τοὔνομα. καὶ νῦν μὲν ἐξ ἑλκέων ἐστὶ ἡ πάθη· ἄλλοτε δὲ ἔντερα μὲν ὠτειλὴν οὐκ ἴσχει· ἔθος δὲ καὶ μελέτη διαρρυεῖσα ἐκδιδάσκει τὰ ἔντερα. τὸ γὰρ ἐν τουτέοισι θερμὸν ἢν καταψυχθέν κοτε μήτε καταπέσσῃ, μήτε ἐς τὴν ἀναφορὴν ἀναΐσσῃ, ἄκρατον δὲ ὑπʼ ἀσθενίης ἔῃ, διαδιδρήσκει πᾶν ἔργον ἡ τροφή. ἀλλʼ ἢν μὲν σχέδιος καὶ μὴ ἑδραίη γένηται ἡ κάθαρσις, ἀλλὰ φαύλη, ἁπλοῦς ἔμετος ἀπὸ σιτίων ἔλυσε τὴν νοῦσον. ἢν δὲ προσοκείλῃ χρόνῳ, καὶ ἐν ἕδρῃ ἵζῃ ἡ αἰτίη τουτέων, οὐδὲν ὠφελέει. τίκτει δὲ καὶ χρονίη νοῦσος, καὶ ὀρθοστάδην καχεξίη· ἀτὰρ καὶ ὕδρωπές κοτε ἐς τόδε ἀπέσκηψαν εὐτυχῶς, ἐς κακὸν μὲν ἐκ κακοῦ, ἀλλὰ κρέσσων ἡ διαδοχή.

[¶11] 11. THE uterus in women is beneficial for purgation and parturition, but it is the common source of innumerable and bad diseases; for not only is it subject to ulcers, inflammation, and the fluor, but, if the whole organ be suddenly carried upwards, it quickly causes death. The fatal diseases of an acute nature connected therewith have been described elsewhere: but the chronic affections are, the two species of fluor; hardness; ulcers, part mild, but part malignant; prolapsus of the whole, or of part. The fluor, then, is either of a red or white colour; its appearance indicates this. It is the red if it consist of bright red blood, and the varieties thereof; or livid, or black and thin, or thick and coagulated, like a thrombus; or white, like water; or a bright ochre colour, like bile: in thickness like a thinnish or thin and fetid ichor. The white flux (or fluor albus) is like pus, and the true form like white whey; but a clot of blood frequently runs off with the pus. But there is an infinite variety of forms of it, as regards more or less quantity. Its periods sometimes agree with those of the menstrual purgation, but it does not continue the regular time as before; there is not much blood, but it flows during many days; the interval is for a few days, but is quite free from discharge. Another variety as to the period: the first purgation is at the regular time, but it occurs two or three times during each month. Another variety: a continual flux; small, indeed, every day, but by no means small during the whole month; for the uterus never closes its mouth, labouring under relaxation, so as to permit the flow of the fluid: but if it neither intermits nor diminishes, they die of hemorrhage. The symptoms are, the woman’s colour in accordance with those of the discharge; sleepless, loathes food, anxious, relaxed, especially in the red flux, and subject to pains; the discharge fetid in both varieties, but to a greater and less extent at different times; for the white is worse if the putrefaction be unusually great; and sometimes the red, if the erosion be exacerbated. In a word, the black is the worst of all; the livid next; the pale, the white, and the purulent, are more protracted, indeed, but less dangerous. Of these the pale is worse indeed, but much better when mixed with the customary discharge. Now the customary discharge is red in all its varieties. But, indeed, the red are worse in old women; but the white are not at all so to the young; but even to them that which is customary is less troublesome. Another white fluor: the menstrual discharge white, acrid, and attended with an agreeable pruritus; along with which the discharge of a white thick fluid, like semen, is provoked. This species we call female gonorrhœa. It is a refrigeration of the womb, which therefore becomes incapable of retaining its fluids; hence, also, the blood changes to a white colour, for it has not the purple colour of fire. The stomach, also, is subject to the affection, and vomits phlegm; and also the bowels are similarly affected in diarrhœa. Ulcers, too, are formed in the womb; some broad and attended with tingling, which, being close together, are, as it were, a superficial excoriation; pus thick, without smell, scanty. These ulcers are mild. But there are others deeper and worse than these, in which the pains are slight, pus somewhat more abundant, much more fetid, and yet, notwithstanding, these also are mild. But if they become deeper, and the lips of the sores hard or rough, if there is a fetid ichor, and pain stronger than in the former case, the ulcer corrodes the uterus; but sometimes a small piece of flesh is cast off and discharged, and this sore not coming to cicatrization, either proves fatal after a long time, or becomes very chronic. This sore gets the appellation of phagedæna. The sores also are dangerous if in these cases the pain gets exacerbated, and the woman becomes uneasy. From the sore there is discharged a putrid matter, intolerable even to themselves; it is exasperated by touching and by medicines, and irritated by almost any mode of treatment. The veins in the uterus are swelled up with distension of the surrounding parts. To the skilled, it is not difficult to recognise by the touch, for it is not otherwise obvious. Febrile heat, general restlessness, and hardness is present, as in malignant diseases; the ulcers, being of a fatal nature, obtain also the appellation of cancers. Another cancer: no ulceration anywhere, swelling hard and untractable, which distends the whole uterus; but there are pains also in the other parts which it drags to it. Both these carcinomatous sores are chronic and deadly; but the ulcerated is worse than the unulcerated, both in smell and pains, in life and in death. Sometimes the whole uterus has protruded from its seat, and lodged on the woman’s thighs; an incredible affliction! yet neither has the uterus not been thus seen, nor are the causes which produce it such as do not occur. For the membranes which are inserted into the flanks, being the nervous (ligamentous?) supporters of the uterus, are relaxed; those at the fundus, which are inserted into the loins, are narrow; but those at its neck, on each side to the flanks, are particularly nervous and broad, like the sails of a ship. All these, then, give way if the uterus protrude outwardly, wherefore this procidentia generally proves fatal; for it takes place from abortion, great concussions, and laborious parturition. Or if it do not prove fatal, the women live for a long time, seeing parts which ought not to be seen, and nursing externally and fondling the womb. It would appear that, of the double membrane of the womb, the internal lining coat is sometimes torn from the contiguous one, for there are two transverse plates of the coat; this, then, is thrown off with the flux, and in abortion and laborious parturition, when it adheres to the placenta. For if it be forcibly pulled, the coat of the uterus being stretched,..... But if the woman do not die, it is either restored to its seat, or but a small part appears externally, for the woman conceals it with her thighs. Sometimes the mouth of the womb only, as far as the neck, protrudes, and retreats inwardly if the uterus be made to smell to a fetid fumigation; and the woman also attracts it if she smells to fragrant odours. But by the hands of the midwife it readily returns inwards when gently pressed, and if anointed beforehand with the emollient plasters for the womb.

> Greek: 11. τῇσι γυναιξὶ ὑστέρη ἀγαθὴ μὲν ἐς κάθαρσιν καὶ τόκον, ξυμφορὴ δὲ νούσων μυρίων τε καὶ κακῶν. οὐ γὰρ ἑλκέων ἢ φλεγμασίης ἢ Ῥοῦ μοῦνον, ἀλλὰ κἢν ἐξαπίνης ὅλη ἄνω κινέηται, ὠκέως κτείνει. γεγράφαται μὲν οὖν ἐν ἄλλοισι, ὁκοῖα τῶν ἀπʼ αὐτέης ἦν ὀλέθρια ὀξέα. τὰ δὲ χρόνια Ῥόος διπλόος, σκληρίη, ἕλκεα, τὰ μὲν ἀσινέα, τὰ δὲ κακοήθεα· πρόπτωσις ὅλης, ἢ μέρεος. ῥόος μἒν οὖν, ἐρυθρὸς, ἢ λευκόχροος· ἰδέα δηλοῖ. ἐρυθρὸς μὲν, ἢν αἷμα ξανθὸν, καὶ αἱ τοῦδε ἰδέαι, ἢ πελιδνὸν ἢ μέλαν, καὶ λεπτὸν, ἢ παχὺ καὶ πεπηγὸς, οἷον θρόμβοι· λευκὸς ὡς ὕδωρ, ἢ ὠχρόξανθος ὡς χολή. παχὺς δὲ ὅκως ὑπόλεπτος, ἢ λεπτὸς ἰχὼρ καὶ κάκοδμος. λευκὸς δὲ ὡς πῦον, ὁ δὲ ἀτρεκὴς, ὡς λευκὸς ὄρρος· ἀτὰρ καὶ αἱμάλωψ κοτε τῷ πύῳ συνεκρέει. μυρίαι δὲ ἄλλαι παρὰ τὸ μᾶλλον τουτέων καὶ ἧττον ἰδέαι. περίοδος δὲ ἄλλοτε μὲν ἡ ἐπὶ μῆνα κάθαρσις, ἀλλʼ οὐκ ἐς τὴν ἀρχαίην ξυνίσταται προθεσμίην. οὐ πολλὸν μὲν τὸ αἷμα, ἐν ἡμέρῃσι δὲ πολλῇσι ἐκρέει· ὀλιγήμερος δὲ ἡ διάλειψις, ἀλλὰ καθαρή. ἄλλος περιόδου τρόπος, εἰς προθεσμί ην δὲ καὶ οὐκ ἐς πλῆθος περὶ πλεῖστον ἡ πρώτη κάθαρσις· δὶς δὲ καὶ τρὶς καθαίρονται ἀνὰ πάντα τὸν μῆνα· ἄλλη ἰδέη, ἄσχετος μὲν ἡ Ῥοὴ καὶ σμικρὴ ἐφʼ ἡμέρης ἑκάστης, ἀλλὰ εἰς τὸν ὅλον μῆνα οὐ πάγχυ βαιή. οὐδὲ γὰρ ὑστέρη μύει τὸ στόμα, ἀλλὰ οἴγνυται, πάρεσιν ἐς Ῥύσιν ὑγρότητος πάσχουσα· εἰ δὲ μήτε διαλείπει μήτε σμικρὸν ἐκρέει, αἱμορραγίῃ θνήσκουσι. σημήϊα δὲ, πρὸς τῇσι χροιῇσι τοῦ Ῥόου ἡ χροιὴ τῆς ἀνθρώπου· ἄγρυπνοι, ἀπόσιτοι, ἀσσώδεες, ἔκλυτοι ἐπὶ τὸ ἐρυθρὸν μᾶλλον, καὶ ὀδυνώδεες, καὶ κάκοδμον ἐπʼ ἀμφοῖν τὸ Ῥεῦμα· ἀλλὰ μᾶλλον καὶ ἧσσον ἄλλοτε καὶ ἄλλοτε. ὁ μὲν γὰρ λευκὸς κακίων, ἢν μέζων που ἡ σηπεδὼν ἔῃ· ἄλλοτε δὲ ὁ ἐρυθρὸς, ἢν ἀγριαίνῃ ἡ διάβρωσις. ἀθρόον δὲ εἰρήσθω, μέλας μὲν ἁπάντων κακίων, πελιδνὸς δεύτερον, ὠχρὸς δὲ καὶ λευκὸς καὶ πυώδης, μακρότεροι μὲν, ἧσσον δὲ κινδυνώδεες. τούτων δὲ αὐτέων ὁ ὠχρὸς κακίων μὲν, πολλὸν δὲ κρέσσων ὁ τῷ συνήθεϊ μεμιγμένος. ξυνήθης δὲ ἐρυθρὸς μὲν καὶ τὰ τοῦδε εἴδεα· τὸ δὲ ἀληθὲς γεραιτέρῃσι κακίονες οἱ ἐρυθροί· ἥκιστα δὲ νεήνισι οἱ λευκοί. ἀτὰρ καὶ ἀσινέστεροι ταύτῃσι οἱ ξυνήθεες· ἄλλος Ῥόος λευκὸς, ἡ ἐπιμήνιος κάθαρσις λευκὴ, δριμεῖα, καὶ ὀδαξώδης ἐς ἡδονήν· ἐπὶ δὲ τοῖσι καὶ ὑγροῦ λευκοῦ, παχέος, γονοειδέος πρόκλησις. τόδε τὸ εἶδος γονόρροιαν γυναικείαν ἐλέξαμεν. ἔστι δὲ τῆς ὑστέρης ψύξις, οὕνεκεν ἀκρατὴς τῶν ὑγρῶν γίγνεται· ἀτὰρ καὶ τὸ αἷμα ἐς χροιὴν λευκὴν ἀμείβει. τοῦ γὰρ πυρὸς οὐκ ἴσχει τὸ φοινίσσον. τήνδε τὴν πάθην καὶ στόμαχος νοσέει καὶ ἐμέει φλέγμα· ἀτὰρ καὶ ἔντερα ὁμοίην ἴσχει, εὖτε τὴν διάρροιαν νοσέει. γίγνεται ἕλκεα καὶ ἐν ὑστέρῃ, τὰ μὲν πλατέα, κνησμώδεα, ἅπερ ἅλια, ὅκως ἀναδορή τις ἐπιπολῆς, πῦον παχὺ, ἄνοσμον, ὀλίγον. εὐήθεα τάδε τὰ ἕλκεα· ἄλλα τουτέων βαθύτερα καὶ κακίονα, οἷς πόνοι σμικροὶ, πῦον ὀλίγῳ πλεῖον, μᾶλλον κάκοδμα, ἀλλʼ ἔμπης εὐήθεα καὶ τάδε. ἢν δὲ ἐπὶ μᾶλλον βαθέα γίγνηται, καὶ τὰ χείλεα τῶν ἕλκεων ἀπηνέα ἢ τρηχέα, ἰχώρ τις κακώδης, καὶ πόνος τῶν πρόσθεν μέζων, ἀνεσθίει δὲ τὴν ὑστέρην τὸ ἕλκος· ἐξήκει δέ κοτε καὶ ἀπολυθέντι σαρκίον· μὴ εἰς ὠτειλὴν ἰὸν μήκιστον κτάνει τόδε, ἢ χρόνιον γίγνεται κάρτα. τόδε καὶ φαγέδαινα κικλήσκεται. ὀλέθρια δὲ τὰ ἕλκεα, ἢν πρὸς τοῖσι ἄλγος ὀξύνῃ, καὶ ἡ ἄνθρωπος ἀπορῇ. σηπεδὼν δὲ ἀπὸ τοῦ ἕλκεος Ῥέει οὔτε αὐτέῃσι φορητὴ, ἀγριαίνει ψαύσεσί τε καὶ φαρμάκοισι, καὶ χαλεπαίνει πως καὶ ἰητρίῃ· φλέβες δὲ ἐν ὑστέρῃ ἐς ὄγκον αἴρονται ξὺν περιτάσεσι τῶν πέλας· ἔστι δὲ πεπνυμένοισι οὐκ ἄσημον τῇ ἁφῇ. οὐ γὰρ ἄλλως δῆλον· πῦρ δὲ καὶ ἄση τοῦ παντὸς καὶ σκληρίη ξύνεστιν, ᾗπερ τοῖσι θηριώδεσι, θανατώδεα ὄντα ἕλκεα, ἀτὰρ καὶ ἐπίκλησιν ἴσχει καρκίνων. ἄλλος καρκίνος· ἕλκος μὲν οὐδαμῆ, ὄγκος δὲ σκληρὸς, ἀτέραμνος· ξυντιταίνει δὲ τὴν ὑστέρην ὅλην, ἀτὰρ καὶ ἄλγεα κατὰ τὰ ἄλλα ὅσα ἐφέλκει· ταῦτα δὲ ἄμφω τὰ καρκινώ δεα καὶ χρόνια καὶ ὀλέθρια· πολλὸν δὲ τὸ ἕλκος τοῦ ἀνελκώτου κάκιον καὶ ὀσμῇ, καὶ πόνοισι, καὶ ζωῇ, καὶ θανάτῳ. ἐξίσταταί κοτε τῆς ἕδρης ἡ ὑστέρη ὅλη, καὶ ἐπὶ τοῖσι μηροῖσι τῆς γυναικὸς ἱζάνει· ἄπιστος ἡ ξυμφορὴ, ἀλλʼ οὐκ ἀθέητος ἡ ὑστέρη, οὐδὲ ἀγέννητος ἡ αἰτίη. ξυνδίδουσι γὰρ οἱ ὑμένες, οἱ πρὸς τοὺς λαγόνας, ὀχῆες τῆς ὑστέρης ἐόντες νευρώδεες· οἱ μὲν κατὰ πυθμένα πρὸς τὴν ὀσφὺν λεπτοί· οἱ δὲ κατʼ αὐχένα ἔνθα καὶ ἔνθα πρὸς τοὺς λαγόνας· οἱ δὲ μάλιστα νευρώδεες, πλατέες ὅκως νεὼς λαίφεα. πάντες οὖν ξυνδίδουσι οἵδε, ἢν ἔξω ἡ ὑστέρη ἀΐσσῃ. κτείνει μὲν οὖν τὰ πολλὰ ἔκπτωσις ἥδε. γίγνεται γὰρ ἐπὶ ἀμβλωσμ ῷ, καὶ σεισμοῖσι μεγάλοισι, καὶ βιαίῳ τόκῳ· ἢν δὲ μὴ κτάνῃ, ἐς μακρὸν αἵδε ζώουσιν, ὁρέουσαι τὰ μὴ θεητὰ καὶ τιθηνοῦσαι ἔξω καὶ βαυκαλῶσαι τὴν ὑστέρην. δοκέει δέ κοτε τῆς διπλόης τῆς ὑστέρης ὁ ἔνδον ὑπεζωκὼς χιτὼν, ἀποσπᾶσθαι τοῦ ξυναφέος. δοιαὶ γὰρ αἱ σχίδες μὲν αἱ ἐπηλλαγμέναι χιτῶνος· ὅδε οὖν ἀφίσταται μὲν καὶ Ῥεύματι, καὶ ἐντρωσμῷ καὶ βιαίῳ τόκῳ, εὖτε ἐπὶ τῷ χορίῳ προσπέφυκεν αὐτέη. ἢν γὰρ τόδε ἕλκηταιβίῃ, συνεκπεράσας ὁ τῆς ὑστέρης χιτὼν … ἀλλὰ ἢν μὴ ἐκθάνῃ ἡ γυνὴ, παλίνορσος τὸ αὐτὸ συνήφθη κοτὲ στάθμῃ, ἢ σμικρὸν ἔξω φαίνεται· σκέπει γὰρ τοῖσι μηρίοισι ἡ γυνή. προσπίπτει κοτὲ τὸ στόμιον τῆς ὑστέρης μοῦνον μέσφι τοῦ αὐχένος, ἀλλʼ αὖθις εἴσω δύεται, ἢν ὀσφραίνηται ἡ ὑστέρη θυμιήσι κακώδεϊ. ἕλκει δὲ αὐτέην καὶ ἡ γυνὴ, ἢν ὀσφραίνηται θυμιητῶν εὐωδέων. ἀτὰρ καὶ χερσὶ μαίης ἀτρέμα εἴσω θέει, ἡσυχῆ πιεζευμένη καὶ χριομένη πρόσθεν τοῖσι ὑστέρης μειλίγμασι.

## 6. Book II · chapters 12–13

Source: https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/6/ · cite a paragraph as https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/6/#p-N

[¶0] 12. ARTHRITIS is a general pain of all the joints; that of the feet we call Podagra; that of the hip-joint, Schiatica; that of the hand, Chiragra. The pain then is either sudden, arising from some temporary cause; or the disease lies concealed for a long time, when the pain and the disease are kindled up by any slight cause. It is, in short, an affection of all the nerves, if the ailment being increased extend to all; the first affected are the nerves which are the ligaments of the joints, and such as have their origin and insertion in the bones. There is a great wonder in regard to them; there is not the slightest pain in them, although you should cut or squeeze them; but if pained of themselves, no other pain is stronger than this, not iron screws, nor cords, not the wound of a sword, nor burning fire, for these are often had recourse to as cures for still greater pains; and if one cut them when they are pained, the smaller pain of the incision is obscured by the greater; and, if it prevail, they experience pleasure in forgetting their former sufferings. The teeth and bones are affected thus. The true reason of this none but the gods indeed can truly understand, but men may know the probable cause. In a word, it is such as this; any part which is very compact is insensible to the touch or to a wound, and hence it is not painful to the touch or to a wound. For pain consists in an exasperated sense, but what is compact cannot be exasperated, and hence is not susceptible of pain. But a spongy part is very sensible, and is exasperated by an injury. But since dense parts also live by their innate heat, and possess sensibility by this heat, if then the exciting cause be material, such as either a sword, or a stone, the material part of the patient is not pained, for it is dense by nature. But if an intemperament of the innate heat seize it, there arises a change of the sense; the heat therefore is pained by itself, being roused within by the impression on the sense. The pains then are from nature’s being increased, or a redundance thereof. Arthritis fixes itself sometimes in one joint and sometimes in another; sometimes in the hip-joints; and for the most part in these cases the patient remains lame in it; and the other joints it affects little, and sometimes does not go to the small joints, as the feet and hands. If it seizes the greater members which are able to contain the disease, it does not go beyond these organs; but if it begin from a small one, the attack is mild and unexpected. The commencement of ischiatic disease is from the thigh behind, the ham, or the leg. Sometimes the pain appears in the cotyloid cavity, and again extends to the nates or loins, and has the appearance of anything rather than an affection of the hip-joint. But the joints begin to be affected in this way: pain seizes the great toe; then the forepart of the heel on which we lean; next it comes into the hollow of the foot, but the ankle swells last; and they blame a wrong cause; some, the friction of a new shoe; others, a long walk; another again, a stroke or being trod upon; but no one will of his own accord tell the true one; and the true one appears incredible to the patients when they hear of it. On this account the disease gets to an incurable state, because at the commencement, when it is feeble, the physician is not at hand to contend with it; but if it has acquired strength from time, all treatment is useless. In some, then, it remains in the joints of the feet until death, but in others it spreads over the compass of the whole body. For the most part, it passes from the feet to the hands. For to the disease there is no great interval between the hands and the feet, both being of a similar nature, slender, devoid of flesh, and very near the external cold, but very far from the internal heat; next the elbow and the knee, and after these the hip-joint; which is the transition to the muscles of the back and chest. It is incredible how far the mischief spreads. The vertebræ of the spine and neck are affected with the pain, and it extends to the extremity of the os sacrum: there is a general pain of all the parts of the groin, and a pain peculiar to each part thereof. But likewise the tendons and muscles are intensely pained; the muscles of the jaws and temples; the kidneys, and the bladder next in succession. And, what a wonder! at last the nose, the ears, and the lips, suffer; for every where there are nerves and muscles. A certain person had pains in the sutures of the head, and not knowing why he was pained there, he pointed out the shapes of the sutures—the oblique, the straight, the transverse—both behind and before, and stated that the pain was narrow and fixed in the bones; for the disease spreads over every commissure of the bones, in the same manner as in the joints of a foot or of a hand. Callosities also form in the joints; at first they resemble abscesses, but afterwards they get more condensed, and the humour being condensed is difficult to dissolve; at last they are converted into hard, white tophi, and over the whole there are small tumours, like vari and larger; but the humour is thick, white, and like hailstones. For it is a cold disease of the whole (body), like hail; and there appears to be a difference in regard to heat and cold; for in certain cases there is delight in things otherwise disagreeable. But, I fancy, that the cause is a refrigeration of the innate heat, and that the disease is single; but if it speedily give way, and the heat re-appears, there is need of refrigeration and it delights in such things; this is called the hot species. But if the pain remain internally in the nerves, and the part not becoming heated subside, nor get swollen, I would call this variety cold, for which there is need of hot medicines to restore the heat, of which those very acrid are most necessary. For heat excites the collapsed parts to swelling, and calls forth the internal heat, when there is need of refrigerants. In proof of this, the same things are not always expedient in the same cases, for what is beneficial at one time proves prejudicial in another; in a word, heat is required in the beginning, and cold at the conclusion. Wherefore Gout does not often become unremitting; but sometimes it intermits a long time, for it is slight; hence a person subject to Gout has won the race in the Olympiac games during the interval of the disease. Men then are more readily affected, but more slightly the women; women more rarely than men, but more severely. For what is not usual nor cognate, if from necessity it gets the better engenders a more violent ailment. The most common age is after thirty-five; but sooner or slower according to the temperament and regimen of every one. The pains then are dreadful, and the concomitants worse than the pains; fainting even upon touch, inability of motion, loss of appetite, thirst, restlessness. But, if they recover partly, as if escaped from death, they live dissolutely, are incontinent, open-handed, cheerful, munificent, and luxurious in diet; but partly, as if they would (not?) again escape from death, they enjoy the present life abundantly. In many cases the gout has passed into dropsy, and sometimes into asthma; and from this succession there is no escape.

> Greek: 12. ξυνὸς μὲν ἁπάντων τῶν ἄρθρων πόνος ἡ ἀρθρῖτις· ἀλλὰ ποδῶν μὲν ποδάγρην καλέομεν, ἰσχιάδα δὲ ἰσχίων, χειράγρην δὲ χειρῶν· ἤν γε μὲν σχέδιος ᾖ ἐπί τινι τῶν προσκαίρων αἰτίων ὁ πόνος, ἢ κρύβδην δὲ μελετήσῃ πολλὸν χρόνον ἡ νοῦσος, εὖτε ἐπὶ προφάσι σμικρῇ ὁ πόνος καὶ ἡ νοῦσος ἐξήφθη· ἔστι δὲ ἁπάντων ξυλλήβδην τῶν νεύρων ἡ πάθη, ἢν αὐξηθὲν τὸ κακὸν ἅπασι ἐπιφοιτῇ· ἀρχὴ δὲ νεῦρα τὰ δεσμὰ τῶν ἄρθρων, καὶ ὁκόσα ἐξ ὀστέων πέφυκεκαὶ ἐν ὀστέοισι ἐμφύνει. θώϋμα δὲ τουτέων μέγα. οὐ πονέει μὲν γὰρ θρὶξ, οὐδʼ ἂν τέμνῃ τις ἢ θλίβῃ· ἢν δὲ ἐξ ἑωυτέων πονῇ, οὐδὲ ἕτερον ἀλγέει τοῦδε δυνατώτερον, οὐ σιδηρὰ σφίγγοντα, οὐ δεσμὰ, οὐ τιτρῶσκον ξίφος, οὐ καῖον πῦρ. καὶ γὰρ καὶ ταῦτα ἐπαναιροῦνται ὡς μεζόνων πόνων ἄκεα· καὶ ἢν τάμῃ τις αὐτὰ πονεῦντα, ἀμαυροῦται ὁ τῆς τομῆς πόνος σμικρὸς ὑπὸ τοῦ μέζονος· ἢν δὲ ὅδε κρατέῃ, ἡδονὴ σφέας λάζυται ἐπιλήθουσα τῶν πάρος· πάσχουσι δὲ τοῦτο ὀδόντες καὶ ὀστέα. αἰτίην δὲ ἀτρεκέα μὲν ἴσασι μοῦνοι θεοὶ, ἐοικυῖαν δὲ καὶ ἄνθρωποι· ἔστι δὲ ὡς ἔπος εἰπεῖν τοιόνδε. τὸ μὲν κάρτα πυκνὸν ἀναίσθη τον ψαύσιος καὶ τρώσιος, τῇδε καὶ ἄπονον ψαύσι καὶ τρώσι. ἄλγος γὰρ τρηχείᾳ ἐν αἰσθήσι, τὸ δὲ πυκινὸν ἀτρήχυν τον· διὰ τόδε καὶ ἄπονον· τὸ δὲ ἀραιὸν, εὐαισθη τὸν, καὶ τρηχύνεται τρώματι. ἀλλʼ ἐπεὶ καὶ τὰ πυκνὰ ζῇ ἐμφύτῳ θέρμῃ, καὶ αἴσθεται τῇδε τῇ θέρμῃ· εἰ μὲν οὐσιώδης ἡ δρῶσα αἰτίη ἔοι, οἷον ἠ μάχαιρα ἢ λίθος, τὸ οὐσιῶδες τοῦ πάσχοντος οὐκ ἀλγέει· πυκνὸν γὰρ τὴν φυήν. ἢν δὲ τῆς ἐμφύτου θέρμης δυσκρασίη λάβηται, αἰσθήσιος γίγνεται τροπή. τοῦτο ὦν ἐξ ἑωυτέης πονέει ἡ θέρμη, ἐκ τῆς κατʼ αἴσθησιν ἔσωθεν ἐγείρεται ὤσιος. φύσιος δὲ τῆς ἐς μέζω, ἢ περιουσίης, τὰ ἄλγεα. Ἐγχρίμπτεται δὲ ἡ ἀρθρῖτις ἄλλοτε ἐς ἄλλα ἄρθρα, τοῖς μὲν ἐς ἰσχία, καὶ τὰ πολλὰ τῇδε ἐπιμίμνει γυιὸς, ἅσσα τε μέλεά κοτε μικρὸν, εὖτε οὐδὲ ἐπὶ τὰ σμικρὰ φοιτῇ, πόδας τε καὶ χεῖρας. ἢν γὰρ μειζόνων λάβηται μελέων χωρῆσαι τὴν νοῦσον δυναμένων, οὐχ ὑπερβαίνει τὰ ὄργανα· ἢν δὲ ἀπὸ τοῦ σμικροῦ ἄρξηται, ἔστι εὐήθης καὶ ἀδόκητος ἡ εἰσβολή. ἰσχιάδος μὲν ἀπὸ μηροῦκατόπιν, ἢ ἰγνύος, ἢ κνήμης, ἡ ἀρχή. ἄλλοτε δὲ ἐπὶ τῇ κοτύλῃ τὸ ἄλγημα φαίνεται, αὖθις ἐς γλουτὸν ἢ ὀσφὺν ὀκέλλει, καὶ πάντα μᾶλλόν ἐστιν ἢ δόκησις ἰσχίου. ἀτὰρ καὶ τὰ ἄρθρα ὧδέ πως ἄρχεται· τοῦ ποδὸς τὸν μέγαν δάκτυλον ὰλγέει, αὖθις τὴν ἐπιπρόσω πτέρνην, ᾗ ποτε στηριζόμεθα· ἔπειτα ἐς τὸ κοῖλον ἧκε· τὸ δὲ σφυρὸν ἐξῴδησε ὕστατον. πρόφασιν δὲ αἰτιῶνται ἀναίτιον, οἱ μὲν κρηπῖδος καινῆς τρίβον, οἱ δὲ μακρὴν περίοδον· ἄλλος δὲ πληγὴν ἢ πάτημα· οὐδεὶς δὲ φράσει τὴν οἴκοθεν οὖσαν, ἀτὰρ καὶ ἀκούσασι τοῖσι πάσχουσι τὸ ἀτρεκὲς ἔδοξε ἄπιστον· διὰ τόδε ἐς ἀνήκεστον ἐτράπη, ὅτιπερ τῇσι ἀρχῇσι ὁκότε ἀσθενεστάτη ἐστὶ ἡ νοῦσος, ὁ ἰητρὸς οὐκ ἐνίσταται· ἢν δὲ χρόνῳ κρατυνθῇ, ἀνόνητος ἡ μελέτη. τισὶ μὲν οὖν ἐς ποδῶν ἄρθρα μίμνει μέσφι θανάτου, τισὶ δὲ νέμεται ἐς τὴν τοῦ παντὸς σκήνεος περίοδον· τὰ πολλὰ δὲ ἀπὸ τῶν ποδῶν ἐς χεῖρας ἤϊξε. οὐ γὰρ μεγάλα τὰ ὅρια τῇ νούσῳ χειρῶν τε καὶ ποδῶν, ὅτι ἄμφω ὁμοφυέα, ἰσχνὰ καὶ ἄσαρκα καὶ ἐγγυτάτω τοῦ ἔξω ψύχεος· ἀπωτάτω δὲ τοῦ ἔσω θάλπεος. αὖθις ἀγκὼν καὶ γόνυ· ἐπὶ δὲ τοῖσι κοτύλαι, περίστροφος ἥδε μετάβασις ἐς νώτου μύας καὶ θώρηκος. ἄπιστον εἰς ὅσον ἕρπει τὸ κακόν. σπόνδυλοι ἀλγέουσι Ῥάχεός τε καὶ αὐχένος, καὶ ἐς ἄκρον ἐρείδει τοῦ ἱεροῦ ὀστέου· καὶ ξυμπάντων τοῦ βουβῶνος καὶ ἰδίῃ ἡ ἑκάστου ὀδύνη. ἀτὰρ οἱ δὲ τένοντες ἠδὲ μύες ξὺν ἐντάσι ἀλγέουσι. γνάθων καὶ κροτάφων μύες· νεφρῶν καὶ κύστιος ἡ διαδοχή. ὢ τοῦ θώματος, ἐπὶ πᾶσι πάσχει Ῥῖνας, καὶ ὦτα, καὶ χείλεα, πάντη γὰρ νεῦρα καὶ μύες· τῆς κεφαλῆς ἤλγεέ τις Ῥαφὰς, οὐκ εἰδὼς μὲν ὅ τι πονέει, ἐδείκνυε τῶν Ῥαφῶν τὰ εἴδεα, λοξὴν, εὐθείην, ἐπικάρσιον, ὀπίσω τε καὶ πρόσω· ἰσχνὴν δὲ τὴν ὀδύνην καὶ τοῖσι ὀστέοισι ἐμπεπαρμένην. πᾶσαν γὰρ ὀστέων ξυμβολὴν νέμεται ἡ νοῦσος, ὅκως ποδὸς ἢ χειρὸς ἄρθρον. γίγνονται δὲ τῶν ἄρθρων καὶ ἐπιπωρώσιες· τὰ πρῶτα μὲν ὁκοῖον ἀποστάσιες ἴσχουσι· ἐπὶ δὲ μᾶλλον πυκνοῦνται, καὶ πηγνυμένου τοῦ ὑγροῦ ἀπηνέες αἱ ἀφέσιες· τέλος δὲ πῶροι στερροὶ, λευκοὶ ξυνίστανται· ἐς δὲ πᾶν ὄγκοι σμικροὶ ὁκοῖον ἴονθοι καὶ μέζονες· ὑγρὸν δὲ παχὺ, λευκὸν, χαλαζῶδες. καὶ γὰρ τοῦ παντὸς ἡ νοῦσος ψυχρὴ ὅκως χάλαζα· δοκέει δὲ θέρμης ἢ ψύξιος ἴσχειν διαφορήν. καὶ γάρ τισι τῶν αὖ βδελυκτῶν ἡδονή· ἐμοὶ δὲ ἁνδάνει μίην μὲν αἰτίην τὴν ἔμφυτον ψύξιν ἔμμεναι, μίην δὲ καὶ πάθην· ἀλλʼ ἢν μὲν εὐθέως ἐπιδώῃ καὶ θέρμη φανῇ, ἐμψύξιος χρέος καὶ τοῖσι τέρπεται. ὀνομάζουσι δὲ θέρμην τήνδε· ἢν δὲ ὁ πόνος ἐν τοῖσι νεύροισι εἴσω μίμνῃ, ξυμπεπτώκῃ δὲ τὸ ἄρθρον ἄθερμον, μηδὲ ἐποιδέῃ, ψυχρὴν τήνδε φαίην ἔμμεναι, ἐφʼ ἧς θερμῶν φαρμάκων ἐς ἀνάκλησιν θέρμης χρέος. χρὴ δὲ τάδε πολλὰ τῶν κάρτα δριμέων, θερμασίη γὰρ τά τε ξυμπεπτωκότα μέρεα εἰς ὄγκον ἤγειρε, καὶ τὴν ἔσω θέρμην ἐς ἀνάκλησιν ἤγαγε· εὖτε τῶν ψυχρῶν χρέος. πίστις· τοῖσι γὰρ αὐτέοισι οὐ τὰ αὐτὰ ξυμφέρει· καὶ γὰρ ὅ κοτε ξυνήνεγκε, τοῦτʼ ἔβλαψεν ἄλλοτε· ὡς δὲ ἔπος εἰπεῖν, θέρμης ἐπὶ τῇ ἀρχῇ, ψύξιος δὲ ἐπὶ τῷ τέλει χρέος. ξυνεχὴς μὲν οὖν ποδάγρη οὐ Ῥηϊδίως γίγνεται, διαλείπει δὲ ἔσθʼ ὅπη χρόνον μακρόν, λεπτὴ γάρ· καὶ Ὀλυμπίασι ἐνίκησε ποδαγρὸς ἐπʼ ἀνέσι δρόμον. ἀλλʼ ἄνδρες μὲν παθεῖν Ῥηΐτεροι, γυναικῶν δὲ ἐλαφρότερον· γυναῖκες δὲ ἀραιότερον μὲν ἀνδρῶν, χαλεπώτερον δέ. τὸ γὰρ μὴ ἐν ἔθεϊ μηδὲ οἰκεῖον, ἢν ὑπὸ ἀνάγκης κρέσσον γένηται, βιαστὴν μέζονα τίκτει τὴν ξυμφορήν· ἡλικίη τὰ πολλὰ μὲν ἀπὸ ἐτέων πέντε καὶ τριήκοντα. θᾶσσον δὲ καὶ βράδιον ἐκ τῆς ἑκάστου φύσιος καὶ διαίτης. δεινοὶ μὲν οὖν οἱ πόνοι, καὶ τὰ παρεόντα πόνων μέζονα· λειποθυμίη ἐπὶ τῇσι ψαύσεσι, ἀκινησίη, ἀποσιτίη, δίψος, ἀγρυπνίη· ἢν δὲ ἐπανέλθωσι, τοῦτο μὲν, ὅκως ἐκ θανάτου πεφευγότες, ἄνετοι τὸν βίον, ἀκρατέες, ἁπλοῖ, εὔθυμοι, δωροδόκοι, καὶ ἐς τὴν δίαιταν ἁβροί· τοῦτο δὲ ὡς ἐκ θανάτου αὖθις ἐσόμενοι ἄδην χρέονται τῇ παρούσῃ ζωῇ. ἀπέσκηψε πολλοῖσι ἐς ὕδρωπα ἡ ποδάγρη, ἄλλοτε δὲ ἐς ἆσθμα· καὶ τῶνδε ἄφυκτος ἡ διαδοχή.

[¶1] 13. THERE are many things in common as to form, colour, size, and mode of life between the affection Elephas and the wild beast the elephant; but neither does the affection resemble any other affection, nor the animal any other animal. The wild beast, the elephant, indeed, is very different from all others; in the first place then, he is the greatest and the thickest of animals; in size, he is as great as if you were to put one animal on another, like a tower; in bulk, he is as large as if you should place several other very large animals side by side. But neither in shape is he much like unto any other. Then, as to colour, they are all intensely black, and that over their whole body. One horse, indeed, is very white, like “the Thracian steeds of Rhesus”; others white-footed, like “the white-footed horse of Menelaus”; and bay, like “one hundred and fifty”; others are tawny, as “assuming the shape of a horse having a tawny mane, he lay down with her.” And so it is with oxen, and dogs, and all other reptiles and animals which live on the earth. But elephants are only of a lurid colour, “like to night and death.” With regard to shape, they have a very black head, and unseemly face of no marked form, upon a small neck, so that the head appears to rest upon the shoulders, and even then it is not very conspicuous. For the ears are large, broad, resembling wings, extending to the collar-bone and breast-bone, so as to conceal the neck with the ears, like ships with their sails. The elephant has wonderfully white horns on a very dark body—others call them teeth—these alone are most white, such as is nothing else of even any other white animal; and these are not above the forehead and temples, as is the nature of other horned animals, but in the mouth and upper jaw, not indeed quite straight forwards but a little bent upwards, so that it might swallow in a straight direction, and lift a load in its flat teeth. Moreover the horns are large, the medium length being as much as a fathom, and some much larger; that is to say, as long as two fathoms. And the upper jaw from its lip has a long, ex-osseous, crooked, and serpent-like protuberance; and there are two perforations at the extremity of this protuberance; and these by nature are perforated all the way to the lungs, so as to form a double tube, so that the animal uses this pipe as a nostril for respiration, and likewise as a hand; for it could take a cup if it please with this protuberance, and can grasp it round and hold it firmly, and none could it take by force from the animal, except another stronger elephant. And with this also it seeks herbage for food; for neither does it live by eating flesh with its mouth and small teeth. For, its feet being long, raise the animal considerably above the ground; but its neck also, as I have said, is small, and therefore it cannot browse on the earth with its mouth; and moreover the excrescence of the horns in front of the mouth prevents the mouth from touching the herbage. Wherefore it raises a great load with its protuberance; then as if with a binder having bound the same with it, he can convey it to his mouth; whence the ancients properly call it proboscis, for it collects food in front of the animal. But neither is it able to drink from a lake or river with its mouth, for the same reason. But, if it is thirsty, it introduces into the water the extreme nostril of the proboscis, and then, as if inhaling, it draws in much water, instead of air; and when it has filled its nose, as it were a cup, it pours the same as a stream of water into its mouth, and then it draws anew and discharges again, until it fills its belly, as it were a vessel of burden. It has a rough and very thick skin, containing fissures with prominent edges, long channels, and other hollow clefts, some transverse, others oblique, very deep, like in all respects to a furrowed field. Other animals have naturally hairs for a mane, but in the elephant this is merely down. There are also innumerable other differences between it and other animals; for, like man, it bends its leg backward at the knee; and like woman, it has its dugs at the arm-pits. But there is no necessity for me now to write concerning the animal, except in so far as there is any discrepancy between the animal and the disease, and in so far as the symptoms of the patient resemble the nature of the animal. The disease is also called Leo, on account of the resemblance of the eyebrows, as I shall afterwards explain; and Satyriasis, from the redness of the cheeks, and the irresistible and shameless impulse ad coitum. Moreover it is also called the Heracleian affection, insomuch as there is none greater and stronger than it.

> Greek: 13. ἐλέφαντι τῷ πάθεϊ καὶ τῷ θηρίῳ τῷ ἐλέφαντι ξυνὰ μυρία καὶ ἰδέῃ καὶ χροιῇ καὶ μεγέθεϊ καὶ βιοτῇ· ἀτὰρ οὐδὲ ἄλλῳ τῳ ἴκελα, οὔτε τὸ πάθος πάθεϊ, οὔτε τὸ ζῷον ζῴῳ· ἐλέφας μέν γε τὸ θηρίον καὶ κάρτα διαφέρον· πρώτιστα μέν γε μέγιστον καὶ πάχιστον· μεγέθεϊ μὲν ὁκόσον ἂν ζῷον ἐπʼ ἄλλῳ ζῴῳ πυργηδὸν ἀναθείης μέγα· πάχιστον δὲ ἐς πλεῦνα ζῷα πάχιστα, εἰ παράλληλα ξυνθείης. ἀτὰρ οὐδὲ ἰδέην κάρτα τῳ ἴκελον· χροιὴν μὲν μέλανες κατακορ έως ἅπαντες καὶ διʼ ὅλου τοῦ σκήνεος. ἵππος μέν γε ἄλλος μὲν λευκότατος, ὅκως οἱ Θρήϊκες Ῥήσου· ἄλλοι δὲ πόδαργοι, ὅκως Μενέλεω πόδαργος. οἱ δὲ ξανθοὶ, ὅκως ἑκατὸν καὶ πεντήκον τα· ἄλλοι δὲ κυάνεοι· ἵππῳ εἰσάμενος παρελέξα το κυανοχαίτῃ. ὧδε καὶ βόες, ὧδε καὶ κύνες, ἠδὲ ὁκόσα ἀνὰ τὴν γῆν ἑρπετὰ καὶ ζῷα φέρβεται. ἐλέφαντες δὲ μοῦνοι, ζοφοειδέες τὴν χροιήν· νυκτὶ δὲ καὶ θανάτῳ ἴκελοι· ἰδέην δὲ, κάρηνα μὲν μελάντα τα κατέχων καὶ πρόσωπα ἄσημα, ἀΐδηλα τὴν μορφὴν, ἐπʼ αὐχένι σμικρῷ, ὡς δοκέειν τὴν κεφαλὴν ἐπὶ τοῖσι ὤμοισι ἱζάνειν· καὶ ὧδε οὐκ ἔκδηλον. ὦτα γὰρ μεγάλα, πλατέα, πτερυγώδεα, μέσφι κληΐδων τε καὶ στέρνου, ὥστε κρύψαι τὸν αὐχένα τοῖσι ὠσὶ, ὅκως νῆες λαίφεσι. κέρατα δὲ θώϋμα διάλευκα ὁ ἐλέφας ἐπὶ μελαντάτῳ· μετεξέτεροι τάδε ὀδόντας κικλήσκουσι· τάδε μοῦνα λευκότα τα, ὅκως οὐδενὸς ἄλλου τε οὐδὲν οὐδὲ λευκοῦ ζῴου· καὶ τάδε οὐχ ὑπὲρ μέτωπα καὶ κροτάφους, ὅκως τοῖσι κερασφόροισι ἡ φυή· ἀλλὰ κατὰ στόμα καὶ τὴν ἄνω γνάθον, ὄρθια μὲν ἐς τὸ πρόσθεν οὐ κάρτα· ἀλλὰ ἄνω σμικρόν τι καμπύλα· ὅκως δατύσσεσθαι ἐκ τοῦ ὀρθίου ἐνείη, καὶ ἄρασθαι ἄχθος ἐν τοῖσι ὀδοῦσι σιμοῖς. μεγάλα δὲ τὰ κέρατα, μῇκος μὲν ὁκόσον ὀργυιὴν οἱ μέσοι. ἄλλοι δὲ πολλόν τι τουτέων μέζους μέσφιδιπλῶν· προβολὴν δʼ ἴσχει ἡ ἄνω γνάθος ἀπὸ τοῦ χείλεος μακρὴν, ἀνόστεον, σκολιὴν, ἑρπετώδεα. δοιαὶ δὲ ἐπὶ τὸ ἄκρον τῆς προβολῆς ἔασι ἐκτρήσιες· καὶ τάσδε διαμπερὲς μέσφι τοῦ πνεύμονος ἐτέτρηνεν ἡ φύσις, ὅκως αὐλὸν διφυέα· χρέεται δὲ τὸ ζῷον ἐς ἀναπνοὴν, ὅκως Ῥινὶ τῇδε τῇ σύριγγι· ἀτὰρ καὶ χερσὶ τῇδε· καὶ κωθωνίην τε γὰρ λάζοιτο, ὁκότε θέλει, τῇ προβολῇ· ἀμφιλαμβάνει τε καὶ ἴσχει κραταιῶς, καὶ οὐκ ἄν τις ἀφέλοιτο αὐτέου βίῃ, ἢν μὴ κρέσσων ἄλλος ἐλέφας· ἀτὰρ καὶ ποίην ἐς νομὴν τῇδε μαστεύει, οὐδὲ τῷ στόματι καὶ τοῖσι σμικροῖσι ὀδοῦσι ἔσθων σάρκας ζῇ· πόδες γὰρ εὐμήκεες ὕπερθεν τῆς γῆς πολλὸν τὸ ζῷον ἀνέχοντες· ἀτὰρ καὶ σμικρὸς αὐχὴν ὅκως ἔλεξα. οὔκουν δύναται τῷ στόματι εἰς τὴν γῆν νέμεσθαι. ποτὶ καὶ ἡ τῶν κεράτων πρὸ τοῦ στόματος ἔκφυσις εἴργει τῆς ποίης ἅπτεσθαι τὸ στόμα. τοιγαρο ῦν ἀνιμᾶται τῇ προβολῇ φόρτον μέγαν· ἔπειτα, ὅκως ἀμαλλοδετῆρι, τῇδε ξυνδήσας ἐντίθησι πολλὸν τῇ κοιλίῃ· εὖτε οἱ πρῶτοι προβοσκίδα τήνδε καλέουσι. ἐπίπροσθεν γὰρ τοῦ ζῴου τῇδε βόσκεται. ἀτὰρ οὐδὲ πιεῖν ἀπὸ λίμνης ἢ ποταμοῦ τῷ στόματι θέμις· ἡ ὠυτὴ γὰρ αἰτίη. ἀλλὰ ἢν διψῇ, ἐντίθεται μὲν τῷ ὕδατι τῆς προβοσκίδος ἄκρην τὴν Ῥῖνα· ἔπειτα ὅκως ἀναπνέων, ἀντὶ τοῦ ἠέρος, τοῦ ὕδατος ἕλκει πολλόν· ἐπὴν δὲ πλήσῃ, ὅκως κώθωνα, τὴν Ῥῖνα, τῷ στόματι ποταμηδὸν ἐγχέει· εἶτα αὖθις ἕλκει καὶ αὖθις ἐγχέει, ἔς τʼ ἂν πλήσῃ ὅκως φορτίδος νηὸς τὴν γαστέρα. ῥινὸν τρηχὺν καὶ πάχιστον, ὀχθώδεας Ῥωγμοὺς ἴσχοντα, αὐλῶνας ἐπιμήκεας, ἑτέρας ἐντομὰς κοίλας, ἐπικαρσίους, ἄλλας δὲ λοξὰς, βαθείας κάρτα, ἴκελον τὸ ξύμπαν τριπόλῳ νειῷ. τρίχες δὲ ἄλλοισι μὲν ζῴοισι φύσι ἠδὲ καὶ χαῖται· ἐλέφαντι δὲ τόδε ἐστὶ ὁ χνοῦς· μυρίαι δὲ καὶ ἄλλαι παραλλαγαὶ πρὸς τὰ ἀλλὰ ζῷα· καὶ γὰρ ὀπίσω κοτὲ κατὰ γόνυ κάμπτει, ὅκως ἄνθρωπος, καὶ μαζὸν πρὸς τῇσι μασχάλῃσι ἴσχει ὅκως γυναῖκες· ἀλλʼ οὔτι μοι χρέος τανῦν ἀμφὶ τοῦ ζῴου γράφειν, πλὴν ὁκόσον ἔξαλλόν τι καὶ ἡ νοῦσος ὁ ἐλέφας καὶ ὁκόσα ἴκελα ἡ ἰδέη τοῦ νοσοῦντος ἴσχει τῇ τοῦ ζῴου φυῇ· ἐκίκλησκον δὲ καὶ λέοντα τὸ πάθος, τοῦ ἐπισκυνίου τῆς ὁμοιότητος εἵνεκεν, ἣν ὕστερον φράσω· ἠδὲ σατυρίησιν τῶν τε μήλων τοῦ ἐρυθήματος καὶ τῆς ἐς συνουσίην ὁρμῆς ἀσχέτουτε καὶ ἀναισχύντου. ἀτὰρ καὶ ἡράκλειον ὅτι τοῦδε μέζον οὐδὲν οὐδὲ ἀλκιμώτερον.

[¶2] Wherefore the affection is mighty in power, for it is the most powerful of all in taking life; and also it is filthy and dreadful to behold, in all respects like the wild animal, the elephant. And from the disease there is no escape, for it originates in a deadly cause; it is a refrigeration of the innate heat, or rather a congelation like a great winter, when the water is converted into snow, or hail, or ice, or frost. This is the common cause of death, and of the affection.

> Greek: μέγα μὲν οὖν τὸ πάθος ἐς δύναμιν· κτεῖναι γὰρ πάντων μᾶλλον δυνατώτατον· ἀτὰρ καὶ ἰδέσθαι αἰσχρὸν καὶ δειματῶδες τὰ πάντα ὡς ἐλέφας τὸ θηρίον· ἀλλʼ ἄφυκτος ἡ νοῦσος· τίκτεται γὰρ θανάτου ἐπʼ αἰτίῃ. ψύξις ἐστὶ τοῦ ἐμφύτου θερμοῦ οὐ μικρά γε, ἢ καὶ πάγος, ὡς ἕν τι μέγα χεῖμα, εὖτε τὸ ὕδωρ τρέπεται ἐς χιόνα, ἢ καὶ χάλαζαν, ἢ κρύσταλλον, ἢ πάγον.

[¶3] But the commencement of the disease gives no great indication of it; neither does it appear as if any unusual ailment had come upon the man; nor does it display itself upon the surface of the body, so that it might be immediately seen, and remedies applied at the commencement; but lurking among the bowels, like a concealed fire it smolders there, and having prevailed over the internal parts, it afterwards blazes forth on the surface, for the most part beginning, like a bad signal-fire, on the face, as it were its watch-tower; but in certain cases from the joint of the elbow, the knee, and knuckles of the hands and feet. In this way the patient’s condition is hopeless, because the physician, from inattention and ignorance of the patient’s ailment, does not apply his art to the commencement when the disease is very feeble. For, indeed, they are merely torpid, as if from some light cause, drowsy, inactive, dry in the bowels, and these symptoms are not very unusual even in healthy persons. But upon the increase of the affection, the respiration is fetid from the corruption within of the breath (pneuma). The air, or something external, would seem to be the cause of this. Urine thick, muddy, like that of cattle; the distribution of crude undigested food; and yet of these things there is no perception nor regard; for neither are they aware whether or not they digest, thus digestion or indigestion is all one to them, since, for anything useful and proper to them, digestion is not usual with them. The distribution, however, is easy, the disease, as it were, greedily attracting the food for its own nourishment; for this reason the lower belly is very dry. Tumours prominent, not continuous with one another anywhere, but thick and rough, and the intermediate space cracked, like the skin of the elephant. Veins enlarged, not from abundance of blood, but from thickness of the skin; and for no long time is the situation of them manifest, the whole surface being elevated equally in the swelling. The hairs on the whole body die prematurely, on the hands, the thighs, the legs, and again on the pubes; scanty on the chin, and also the hairs on the head are scarce. And still more frequently premature hoariness, and sudden baldness; in a very short time the pubes and chin naked of hair, or if a few hairs should remain, they are more unseemly than where they are gone. The skin of the head deeply cracked; wrinkles frequent, deep, rough; tumours on the face hard, sharp; sometimes white at the top, but more green at the base. Pulse small, dull, languid, as if moved with difficulty through the mud; veins on the temples elevated, and also those under the tongue; bowels bilious; tongue roughened with vari, resembling hailstones; not unusual for the whole frame to be full of such (and thus also in unsound victims, the flesh is full of these tubercles resembling hail). But if the affection be much raised up from the parts within, and appear upon the extremities, lichens occur on the extremities of the fingers; there is pruritus on the knees, and the patients rub the itchy parts with pleasure. And the lichen sometimes embraces the chin all round; it reddens the cheeks, but is attended with no great swelling; eyes misty, resembling bronze; eye-brows prominent, thick, bald, inclining downwards, tumid from contraction of the intermediate space; colour livid or black; eye-lid, therefore, much retracted to cover the eyes, as in enraged lions; on this account it is named leontium. Wherefore it is not like to the lions and elephants only, but also in the eye-lids “resembles swift night.” Nose, with black protuberances, rugged; prominence of the lips thickened, but lower part livid; nose elongated; teeth not white indeed, but appearing to be so under a dark body; ears red, black, contracted, resembling the elephant, so that they appear to have a greater size than usual; ulcers upon the base of the ears, discharge of ichor, with pruritus; shrivelled all over the body with rough wrinkles; but likewise deep fissures, like black furrows on the skin; and for this reason the disease has got the name of elephas. Cracks on the feet and heels, as far as the middle of the toes; but if the ailment still further increase, the tumours become ulcerated, so that on the cheeks, chin, fingers, and knees, there are fetid and incurable ulcers, some of which are springing up on one part, while others are subsiding on another. Sometimes, too, certain of the members of the patient will die, so as to drop off, such as the nose, the fingers, the feet, the privy parts, and the whole hands; for the ailment does not prove fatal, so as to relieve the patient from a foul life and dreadful sufferings, until he has been divided limb from limb. For it is long-lived, like the animal, the elephant. But if there be a sudden pain of the limbs, it attacks much more grievously, spreading sometimes to this part, and sometimes to that. Appetite for food not amiss; taste indiscriminate, neither food nor drink affords pleasure; aversion to all things from a painful feeling; atrophy; libidinous desires of a rabid nature; spontaneous lassitude; the figure of each of the limbs heavy, and even the small limbs are oppressive to the patient. Moreover, the body is offended with everything, takes delight neither in baths nor abstinence from them, neither in food nor in abstinence from it, neither in motion nor in rest, for the disease has established itself in all the parts. Sleep slight, worse than insomnolency, from its fantasies; strong dyspnœa, suffocation as if from strangling. In this way certain patients have passed from life, sleeping the sleep which knows no waking, even until death.

> Greek: ἥδε ἐστὶ ἡ ξυνὴ θανάτου καὶ τοῦ πάθεος αἰτίη, ἀτὰρ οὐδὲ ἴσχει τέκμαρ οὐδὲν ἡ ἀρχὴ τῆς νούσου μέγα· οὐδέ τι ξενοπρεπὲς κακὸν τὸν ἄνθρωπον ἐπιφοιτῇ· οὐδὲ ἐπὶ τοῖσι ἐπιπολῆς τοῦ σκήνεος φαντάζεται, ὡς ἰδεῖν τε εὐθὺς καὶ ἀρχομένῳ ἀρῆξαι. ἀλλὰ τοῖσι σπλάγχνοισι ἐμφωλεῦσαν ὅκως ἀΐδηλον πῦρ, ἤδη τύφεται, καὶ τῶν εἴσω κρατῆσαν αὖθίς κοτε ἐπιπολαίως ἐξάπτεται, τὰ πολλὰ μὲν ὅκως ἀπὸ σκοπιῆς τοῦ προσώπου ἀρχόμενον τηλεφαν ὲς πῦρ κακόν. μετεξετέροισι δὲ ἀπὸ τοῦ ἄκρου ἀγκῶνος, γούνατος, κονδύλων χειρῶν τε καὶ ποδῶν. τῇδε καὶ ἀνέλπιστοι οἱ ἄνθρωποι, ὅτι περ ὁ ἰητρὸς οὐ πρὸς τὰς ἀρχὰς τὰς ἀσθενεστάτας τοῦ πάθεος τῇ τέχνῃ χρέεται, Ῥαθυμίῃ καὶ ἀγνοίῃ τῶν καμνόντων τῆς ξυμφορῆς. νωθέες μὲν γὰρ, ὡς ἀπὸ σχεδίου προφάσιος, ὑπναλέοι, ἡσύχιοι, τὴν κοιλίην ἐπίξηροι. τάδε καὶ τοῖσι ὑγιαίνουσι κάρτα οὐκ ἀήθεα· ἐπὶ δὲ τῇσι αὐξήσεσι τοῦ πάθεος ἀναπνοὴ βρωμώδης ἐκ τῆς ἔνδον διαφθορῆς τοῦ πνεύματος. τοιάδε ὁ ἀὴρ, ἤ τι τῶν ἔξωθεν αἰτίην ἴσχειν δοκέει· οὖρα παχέα, λευκὰ, θολερὰ, οἷον ὑποζυγίου. ἀπὸ σιτίων ὠμῶν τε καὶ ἀπέπτων ἡ ἀνάδοσις, καὶ οὔτε τουτέων ἐστὶ αἴσθησίς τε καὶ μελέτη. οὐδὲ γὰρ οὐδʼ ἢν μὴ πέψωσι γιγνώσκουσι· ὁμοίη ἀπεψίη καὶ πέψις ἥδε· εἰς χρηστὸν γὰρ ἢ οἰκεῖον, οὐ ξυνήθης αὐτέοισι ἡ πέψις. ἀνάδοσις δὲ Ῥηϊδίη, ὅκως ἐς τὴν ἑωυτέων τροφὴν ἁρπάγδην ἕλκοντος τοῦ πάθεος. διὰ τόδε ἐπίξηροι τὴν κάτω κοιλίαν· ὄχθοι ἐπανιστάμενοι, ἄλλοι παρʼ ἄλλους ξυνεχέες μὲν οὐδέκω, παχέες δὲ καὶ τρηχέες, καὶ τὸ μεσηγὺτῶν ὄχθων ἔρρηκται, ὅκως τὸν Ῥινὸν ἐλέφας. εὐρεῖαι δὲ φλέβες οὐ πλημμύρῃ τοῦ αἵματος, ἀλλὰ τῷ τοῦ δέρματος πάχεϊ· οὐκ ἐς πολλὸν δὲ καὶ ἕδρα δήλη, τοῦ παντὸς εἰς ἶσον ὄχθον ἐγειρομένου· τρίχες ἐν μὲν τῷ παντὶ προτεθνήσκουσι, χερσὶ, μηροῖσι, κνήμῃσι, αὖθις, ἥβῃ, γενείοισι ἀραιαὶ, ψεδναὶ δὲ καὶ ἐπὶ τῇ κεφαλῇ κόμαι· τὸ δὲ μᾶλλον πρόωροι πολιοὶ καὶ φαλάκρωσις ἀθρόη. οὐκ εἰς μακρὸν δὲ ἥβη καὶ γένειον ψιλά· εἰ δὲ καὶ ἐπιμίμνοιεν παυραὶ τρίχες, ἀπρεπέστεραι τῶν ἀποιχομένων· δέρμα τῆς κεφαλῆς κατερρωγὸς εἰς βάθος· Ῥυτίδες δὲ συχναὶ, βαθεῖαι, τρηχεῖαι· ὄχθοι ἐς τὸ πρόσωπον σκληροὶ, ὀξέες· ἄλλοτε μὲν ἐς κορυφὴν λευκοί· ποιωδέστεροι δὲ τὴν βάσιν· σφυγμοὶ σμικροὶ, βαρέες, νωθροὶ, ὅκως διʼ ἰλύος μόλις κινεύμενοι· φλέβες κροτάφων ἐπηρμέναι, καὶ ὑπὸ τῆς γλώσσης· κοιλίαι χολώδεες. γλῶσσα χαλαζώδεσι ἰόνθοισι τρηχεῖα· οὐκ ἀδόκητον καὶ τὸ ξύμπαν σκῆνος ἔμπλεων τοιῶνδε ἔμμεναι. καὶ γὰρ καὶ τοῖσι κακοχύμοισι ἱερείοισι τὰ κρέα χαλάζης ἐστὶ ἔμπλεα· ἢν δὲ πολλὸν αἴρηταί τι ἀπὸ τῶν ἔνδοθεν, ἡ πάθη καὶ ἐπὶ τοῖσι ἄκροισι φαίνηται, λειχῆνες ἐπὶ τοῖσι ἄκροισι δακτύλοισι, γούνασι κνησμοὶ, καὶ τῶν κνησμῶν ἅπτονται μεθʼ ἡδονῆς· ἀμπίσχει δὲ ὁ λειχὴν καὶ γένειόν κοτε ἐν κύκλῳ· ἐρεύθει δὲ καὶ μῆλα ξὺν ὄγκῳ οὐ κάρτα μεγάλῳ· ὀττίες ἀχλυώδεες, χαλκώδεες· ὀφρύες προβλῆτες, παχεῖαι, ψιλαὶ, βρίθουσαι κάτω, μεσοφρύων ξυνηγμένων ὀχθώδεες· χρῶμα πελιδνὸν ἢ μέλαν. ἐπισκύνιον οὖν μέγα ἕλκεται καλύπτειν ὄσσε, ὅκως τοῖς θυμουμένοις, ἢ λέουσι· διὰ τόδε καὶ λεόντιον κικλήσκεται. τοιγαροῦν οὐ λέουσι οὐδὲ ἐλέφαντι μοῦνον, ἀλλὰ καὶ νυκτὶ θοῇ ἀταλάντος ὑπώπια. Ῥὶς, σὺν ὄγκοισι μέλασι, ὀκριοειδέες, χειλέων προβολὴ παχείη· τὸ δὲ κάτω πελιδνόν· ἔκρινες· ὀδόντες οὐ λευκοὶ μὲν, δοκέοντες δὲ ὑπὸ μέλανος, ὦτα ἐρυθρὰ, μελανόεντα, κεκλεισμένα, ἐλεφαντώδεα, ὡς δοκέειν μέγεθος ἴσχειν μέζον τοῦ ξυνήθεος· ἕλκεα ἐπὶ τῇσι βάσεσι τῶν ὤτων, ἰχῶρος Ῥύσις, κνησμώδεα· Ῥυσοὶ τὸ πᾶν σκῆνος Ῥυτίσι τρηχείῃσι· ἀτὰρ καὶ ἐντομαὶ βαθεῖαι, ὁκοῖον αὔλακες μέλανες τῶν Ῥινῶν. διὰ τοῦτο καὶ ὁ ἐλέφας τοῦ πάθεος τοὔνομα· ἰχνέων καὶ πτερνέων μέσφι τῶν μέσων τῶν δακτύλων Ῥήξιες. ἢν δὲ ἐπὶ μᾶλλον αὔξῃ τὸ κακὸν, ἑλκώδεες τοὺς ὄχθους, μήλων, γενείου, δακτύλων, γονάτων, κάκοδμα καὶ ἀναλθέα τὰ ἕλκεα. ἄλλα γὰρ ἐπʼ ἄλλοισι ἐξανίσταται, ἐπʼ ἄλλοισι ἄλλα πρηο̈́νεται. ἤδη κοτὲ καὶ τῶν μελέων προαποθνήσκει τοῦ ἀνθρώπου ἄχρι ἐκπτώσιος, Ῥίς, δάκτυλοι, πόδες, αἰδοῖα καὶ ὅλαι χεῖρες. οὐδὲ γὰρ θανατοῖ τὸ κακὸν εἰς ἀπαλλαγὴν βίου αἰσχροῦ καὶ ἀλγέων δεινῶν πρόσθεν ἢ ἐς μέλεα διατμηθῆναι τὸν ἄνθρωπον· ἀλλὰ μακρόβιόν ἐστι, ὅκως ἐλέφας τὸ ζῷον. ἢν δὲ καὶ ἄλγος ἀρτίως ἔῃ τῶν μελέων, πολλόν τι ἐπικόπτει βαρύτερον, ἄλλῃ καὶ ἄλλῃ πλανεύμενον· σιτίων ὄρεξις οὐκ ἀγεννὴς, ἄποιος ἡ γεῦσις, οὐδὲ τερπνὸν ἡ ἐδωδὴ καὶ ἡ πόσις· ἁπάντων δὲ ὑπʼ ἀχθηδόνος, μῖσος, ἀτροφίη, ἐπιθυμίη λυσσώδης· κόποι αὐτόματοι, μελέων ἑκάστου ἰδέη βαρεῖα, καὶ τὸν ἄνθρωπον ἀχθέει καὶ τὰ σμικρὰ μέλεα· ἀτὰρ καὶ τὸ σῶμα πρὸς ἅπαντα ἄχθεται, οὐ λουτροῖσι τέρπεται οὐκ ἀλουσίῃ, οὐ τροφῇ, οὐκ ἀσιτίῃ, οὐ κινήσι, οὐκ ἠρεμίῃ. πᾶσι γὰρ ἐφέστηκ εν ἡ νοῦσος. ὕπνος λεπτὸς, ἀγρυπνίης κακίων φαντασίῃ· δύσπνοια καρτερή· πνῖγες ὡς ἀπʼ ἀγχόνης. ὧδε γοῦν τινὲς κατέστρεψαν τὸν βίον, νήγρετον ὕπνον ἐς θάνατον εὕδοντες.

[¶4] When in such a state, who would not flee;—who would not turn from them, even if a father, a son, or a brother? There is danger, also, from the communication of the ailment. Many, therefore, have exposed their most beloved relatives in the wilderness, and on the mountains, some with the intention of administering to their hunger, but others not so, as wishing them to die. There is a story that one of those who had come to the wilderness, having seen a viper creep out of the earth, compelled by hunger, or wearied out with the affection, as if to exchange one evil for another, ate the viper alive, and did not die until all his members had become putrid and dropped off: and that another person saw a viper creep into a cask of new wine, and after drinking of the same to satiety, vomit it up, and discharge a great deal of its venom along with the new wine; but when the viper was smothered in the new wine, that the man drank of it largely and greedily, seeking thus to obtain a rescue from life and the disease; but when he had carried the drinking to satiety and intoxication, he lay down on the ground, at first as if about to die; but when he awoke from his sleep and intoxication, first of all his hair fell off, next the fingers and nails, and all the parts melted away in succession. But as the power was still in the semen, nature formed the man again, as if from the act of generation: it made other hairs to grow, and made new nails and clean flesh, and put off the old skin, like the slough of a reptile; and he was called back, like another new man, to a growth of life. Thus goes the fable; not very probable, indeed, nor yet entirely incredible; for that one ill should be overcome by another is credible. And that from the existing spark nature should renew the man, is not so incredible as to be held to be a prodigy.

> Greek: τοιούσδε οὖν ἐόντας τίς οὐκ ἂν φύγοι ἢ τίς οὐκ ἂν ἐκτραπείη, κἤν υἱὸς, ἢ πατὴρ ἔῃ, κἢν κασίγνητος τύχῃ; δέος καὶ ἀμφὶ μεταδόσιος τοῦ κακοῦ. πολλοὶ γοῦν ἐπʼ ἐρημίης καὶ ἐς ὄρεα τοὺς φιλτάτους ἐξέθεσαν, οἱ μὲν ἐς χρόνον ἐπαρήγοντες τῷ λιμῷ, οἱ δὲ ἥκιστα, ὡς σφέας ἐθέλοντες ἐκθανεῖν. λόγος δὲ ὡς τῶν ἐπʼ ἐρημίης ἀφιγμένων τις ἐξερπύσαντα ἐκ τῆς γῆς ἔχιν ἰδὼν, ὑπʼ ἀνάγκης τοῦ λιμοῦ ἢ τῷ πάθεϊ ἀχθεσθεὶς, ὡς ἀμείψασθαι τὸ κακὸν κακῷ, ζῶντος ἐνέφαγε τοῦ ἔχιος, καὶ οὐ πρόσθεν ἐτελεύτησε πρὶν ἢ πάντα αὐτῷ διασαπῆναι καὶ ἀποστῆναι τὰ μέλεα. ἄλλον δὲ ἰδεῖν ἔχιν εἰς πίθον γλεύκεος ἑρπύσαντα, πιόντα τε τοῦ γλεύκεος εἰς κόρον ἀποβλύσαι, πολλὸν δὲ καὶ τοῦ ἰοῦ συνεκχεῖν τῷ γλεύκεϊ· ἐπεὶ δὲ ἀπεπνίγη τὸ θηρίον ἐν τῷ γλεύκεϊ, χανδὸν καὶ πολλὸν τοῦ γλεύκεος πιεῖν τὸν ἄνθρωπον, ἀπαλλαγὴν τοῦ βίου καὶ τοῦ πάθεος διζήμενον· ὡς δὲ ἐς κόρον ἧκε καὶ μέθην, ἔκειτο μὲν χαμαὶ τὰ πρῶτα ὅκως ἀποθνήσκων· ἐπεὶ δὲ ἐκ τοῦ κάρου καὶ τῆς μέθης ἐξήγρετ ο, περιερρύησαν μὲν τὰ πρῶτα αἱ κόμαι, ἔτι δὲ δάκτυλοίτε καὶ ὄνυχες· ἑξῆς δὲ περιτετήκεισαν πάντα. ἐπεὶ δὲ ἔτι ἐν σπέρματι ἡ δύναμις ἦν, ἐκηροπλάστεεν αὖθις, ὅκως ἐκ γενετῆς, τὸν ἄνθρωπον ἡ φύσις· ἐξέθρεψε μὲν ἄλλας κόμας καὶ ὄνυχας νέους καὶ σάρκα καθαρὴν, καὶ ἐξέδυ μὲν τὸν παλαιὸν Ῥινὸν, ὡς γῆρας ἑρπετοῦ· ἐπανεκλήθη δὲ ἐς φῦμα ζωῆς, ὅκως ἄλλος ἄνθρωπος. ὧδε μὲν οὖν ὁ μῦθος, οὐ κάρτα μὲν ἀτρεκὴς, οὐ πάγχυ δὲ ἄπιστος. κακὸν γὰρ κακῷ βλαφθῆναι πιστόν. τὴν φύσιν δὲ ἐπὶ τῷ ἐόντι ζωπύρῳ ἀνανεῶσαι τὸν ἄνθρωπον, οὐκ ἄπιστον ἐς τέρατος ἰδέην.