---
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"
section: 1 of 6
url: https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/1/
cite: "Aretaeus, tr. Francis Adams, On the Causes and Symptoms of Chronic Diseases · Περὶ αἰτίων καὶ σημείων χρονίων παθῶν, section 1. Scriptura (scriptura.si), https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/1/"
---

# 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.

## 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.