---
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: 4 of 6
url: https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/4/
cite: "Aretaeus, tr. Francis Adams, On the Causes and Symptoms of Chronic Diseases · Περὶ αἰτίων καὶ σημείων χρονίων παθῶν, section 4. Scriptura (scriptura.si), https://scriptura.si/works/aretaeus-causes-and-symptoms-of-chronic-diseases/4/"
---

# 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.

## 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.