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.
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.
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.
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.
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.
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.
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.
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.