16. One should estimate when the commencement of the suppuration will take place, by calculating from the day on which the patient was first seized with fever, or if he had a rigor, and if he says, that there is a weight in the place where he had pain formerly, for these symptoms occur in the commencement of suppurations. One then may expect the rupture of the abscesses to take place from these times according to the periods formerly stated. But if the empyema be only on either side, one should turn him and inquire if he has pain on the other side; and if the one side be hotter than the other, and when laid upon the sound side, one should inquire if he has the feeling of a weight hanging from above, for if so, the empyema will be upon the opposite side to that on which the weight was felt.
16. 16. ἐπισκέπτεσθαι δὲ χρὴ τὴν ἀρχὴν τοῦ ἐμπυήματος ἔσεσθαι λογιζόμενον ἀπὸ τῆς ἡμέρης ἧς τὸ πρῶτον ὁ ἄνθρωπος ἐπύρεξεν, ἢ εἴ ποτε αὐτὸν ῤῖγος ἔλαβε, καὶ εἰ φαίη ἀντὶ τῆς ὀδύνης αὐτέῳ βάρος γεγενῆσθαι ἐν τῷ τόπῳ ἐν ᾧ ἤλγεεν· ταῦτα γὰρ ἐν ἀρχῆσι γίγνεται τῶν ἐμπυημάτων. ἐξ οὖν τουτέων τῶν χρόνων τὴν ῤῆξιν χρὴ προσδέχεσθαι τῶν ἐμπυημάτων ἔσεσθαι ἐς τοὺς χρόνους τοὺς προειρημένους. εἰ δὲ εἴη τὸ ἐμπύημα ἐπὶ θάτερα μοῦνον, στρεφειν τε καὶ καταμανθάνειν χρὴ ἐπὶ τουτέοισι, μή τι ἔχῃ ἄλγημα ἐν τῷ ἑτέρῳ πλευρῷ· καὶ ἢν θερμότερον ᾖ τὸ ἕτερον τοῦ ἑτέρου, κατακλινομένου ἐπὶ τὸ ὑγιαῖνον πλευρὸν, ἐρωτᾷν εἴ τι αὐτέῳ δοκέει βαρὺ ἀποκρέμασθαι ἐκ τοῦ ἄνωθεν. εἰ γὰρ εἴη τοῦτο, ἐπὶ θάτερόν ἐστι τὸ ἐμπύημα, ἐπὶ ὁκοῖον ἂν πλευρὸν τὸ βάρος γίγνηται.
17. Empyema may be recognized in all cases by the following symptoms: In the first place, the fever does not go off, but is slight during the day, and increases at night, and copious sweats supervene, there is a desire to cough, and the patients expectorate nothing worth mentioning, the eyes become hollow, the cheeks have red spots on them, the nails of the hands are bent, the fingers are hot especially their extremities, there are swellings in the feet, they have no desire of food, and small blisters (phlyctaenae) occur over the body. These symptoms attend chronic empyemata, and may be much trusted to; and such as are of short standing are indicated by the same, provided they be accompanied by those signs which occur at the commencement, and if at the same time the patient has some difficulty of breathing. Whether they will break earlier or later may be determined by these symptoms; if there be pain at the commencement, and if the dyspnoea, cough, and ptyalism be severe, the rupture may be expected in the course of twenty days or still earlier; but if the pain be more mild, and all the other symptoms in proportion, you may expect from these the rupture to be later; but pain, dyspnoea, and ptyalism, must take place before the rupture of the abscess. Those patients recover most readily whom the fever leaves the same day that the abscess bursts,—when they recover their appetite speedily, and are freed from the thirst,—when the alvine discharges are small and consistent, the matter white, smooth, uniform in color, and free of phlegm, and if brought up without pain or strong coughing. Those die whom the fever does not leave, or when appearing to leave them it returns with an exacerbation; when they have thirst, but no desire of food, and there are watery discharges from the bowels; when the expectoration is green or livid, or pituitous and frothy; if all these occur they die, but if certain of these symptoms supervene, and others not, some patients die and some recover, after a long interval. But from all the symptoms taken together one should form a judgment, and so in all other cases.
17. 17. τοὺς δὲ ξύμπαντας ἐμπύους γιγνώσκειν χρὴ τοισίδε τοῖσι σημείοισι. πρῶτον μὲν, ὁ πυρετὸς οὐκ ἀφίησιν, ἀλλὰ τὴν μὲν ἡμέρην λεπτὸς ἴσχει, τὴν δὲ νύκτα πλείων, καὶ ἱδρῶτες πολλοὶ ἐπιγίγνονται, βῆξαί τε θυμὸς ἐγγίγνεται αὐτέοισιν, καὶ ἀποπτύουσιν οὐδὲν ἄξιον λόγου, καὶ οἱ μὲν ὀφθαλμοὶ ἔ κοιλοι γίγνονται, αἱ δὲ γνάθοι ἐρυθήματα ἴσχουσι, καὶ οἱ μὲν ὄνυχες τῶν χειρῶν γρυποῦνται, οἱ δὲ δάκτυλοι θερμαίνονται, καὶ μάλιστα οἱ ἄκροι, καὶ ἐν τοῖσι ποσὶν οἰδήματα γίγνεται, καὶ σιτίων οὐκ ἐπιθυμέουσι, καὶ φλύκταιναι γίγνονται ἀνὰ τὸ σῶμα. ὁκόσα μὲν οὖν ἐγχρονίζει τῶν ἐμπυημάτων, ἔχει τὰ σημεῖα ταῦτα, καὶ πιστεύειν αὐτέοισι χρὴ κάρτα· ὁκόσα δὲ ὀλιγοχρόνιά ἐστι, τουτέοισιν ἐπισημαίνεται, ἤν τι ἐπιφαίνηται, οἷα καὶ τοῖσιν ἐν ἀρχῇσι γιγνομένοισιν, ἅμα δὲ καὶ ἤν τι δυσπνούστερος ᾖ ὁ ἄνθρωπος. τὰ δὲ ταχύτερον αὐτέων καὶ βραδύτερον ῤηγνύμενα τοισίδε γιγνώσκειν χρή· ἢν μὲν ὁ πόνος ἐν ἀρχῇσι γίγνηται, καὶ ἡ δύσπνοια καὶ ἡ βὴξ καὶ ὁ πτυαλισμὸς διατείνῃ, ἐς τὰς εἴκοσιν ἡμέρας προσδέχεσθαι τὴν ῤῆξιν, ἢ καὶ ἔτι πρόσθεν· ἢν δὲ ἡσυχαίτερος ὁ πόνος ᾖ, καὶ τἄλλα πάντα κατὰ λόγον, τουτέοισι προσδέχεσθαι τὴν ῤῆξιν ἐς ὕστερον· γίγνεσθαι δὲ ἀνάγκη καὶ πόνον καὶ δύσπνοιαν καὶ πτυαλισμὸν πρὸ τῆς τοῦ πύου ῤήξιος. περιγίγνονται δὲ τουτέων μάλιστα μὲν οὕς ἂν ἀφῇ ὁ πυρετὸς αὐθημερὸν μετὰ τὴν ῤῆξιν, καὶ σιτίων ταχέως ἐπιθυμέωσι, καὶ δίψης ἀπηλλαγμένοι ἔωσι, καὶ ἡ γαστὴρ σμικρά τε καὶ ξυνεστηκότα ὑποχωρέῃ, καὶ τὸ πῦον λευκόν τε καὶ λεῖον καὶ ὁμόχροον ᾖ καὶ φλέγματος ἀπηλλαγμένον, καὶ ἄτερ πόνου τε καὶ βηχὸς ἰσχυρῆς ἀνακαθαίρηται. ἄριστα μὲν οὕτω καὶ τάχιστα ἀπαλλάσσουσιν· ἢν δὲ μὴ, οἷσιν ἂν ἐγγυτάτω τουτέων γίγνηται. ἀπόλλυνται δὲ οὓς ἂν ὅ τε πυρετὸς μὴ ἀφῇ, ἢ δοκέων αὐτέους ἀφιέναι, αὖθις φαίνηται ἀναθερμαινόμενος, καὶ δίψαν μὲν ἔχωσι, σιτίων δὲ μὴ ἐπιθυμέωσι, καὶ ἡ κοιλίη ὑγρὴ ᾖ, καὶ τὸ πῦον χλωρὸν ἢ πελιὸν πτύῃ, ἢ φλεγματῶδες καὶ ἀφρῶδες· ἢν ταῦτα πάντα γίγνηται, ἀπόλλυνται· ὁκόσοισι δʼ ἂν τουτέων τὰ μὲν ἐπιγένηται, τὰ δὲ μὴ, οἱ μὲν αὐτέων ἀπόλλυνται, οἱ δὲ ἐν πολλῷ χρόνῳ περιγίγνονται. ἀλλʼ ἐκ πάντων τῶν τεκμηρίων τῶν ἐόντων ἐν τουτέοισι σημαίνεσθαι, καὶ τοῖσιν ἄλλοισι πᾶσιν.
18. When abscesses form about the ears, after peripneumonic affections, or depositions of matter take place in the inferior extremities and end in fistula, such persons recover. The following observations are to be made upon them: if the fever persist, and the pain do not cease, if the expectoration be not normal, and if the alvine discharges be neither bilious, nor free and unmixed; and if the urine be neither copious nor have its proper sediment, but if, on the other hand, all the other salutary symptoms be present, in such cases abscesses may be expected to take place. They form in the inferior parts when there is a collection of phlegm about the hypochondria; and in the upper when the hypochondria continue soft and free of pain, and when dyspnoea having been present for a certain time, ceases without any obvious cause. All deposits which take place in the legs after severe and dangerous attacks of pneumonia, are salutary, but the best are those which occur at the time when the sputa undergo a change; for if the swelling and pain take place while the sputa are changing from yellow and becoming of a purulent character, and are expectorated freely, under these circumstances the man will recover most favorably and the abscess becoming free of pain, will soon cease; but if the expectoration is not free, and the urine does not appear to have the proper sediment, there is danger lest the limb should be maimed, or that the case otherwise should give trouble. But if the abscesses disappear and go back, while expectoration does not take place, and fever prevails, it is a bad symptom; for there is danger that the man may get into a state of delirium and die. Of persons having empyema after peripneumonic affections, those that are advanced in life run the greatest risk of dying; but in the other kinds of empyema younger persons rather die. In cases of empyema treated by the cautery or incision, when the matter is pure, white, and not fetid, the patient recovers; but if of a bloody and dirty character, he dies.
18. 18. Ὁκόσοισι δὲ ἀποστάσιες γίγνονται ἐκ τῶν περιπλευμονικῶν νουσημάτων παρὰ τὰ ὦτα, καὶ ἐκπυέουσιν, ἢ ἐς τὰ κάτω χωρία, καὶ συριγγοῦνται, οὗτοι περιγίγνονται. ἐπισκέπτεσθαι δὲ χρὴ τὰ τοιαῦτα ὧδε· ἢν ὅ τε πυρετὸς ἔχῃ, καὶ ἡ ὀδύνη μὴ παύηται, καὶ τὸ πτύελον μὴ ἐκχωρέῃ κατὰ λόγον, μηδὲ χολώδεες αἱ τῆς κοιλίης διαχωρήσιες, μηδὲ εὔλυτοί τε καὶ ἄκρητοι γίγνοιντο, καὶ μηδὲ τὸ οὖρον πουλύ τε κάρτα καὶ πολλὴν ὑπόστασιν ἔχον, ὑπηρετέηται δὲ πεοιεστικῶς ὑπὸ τῶν λοιπῶν πάντων τῶν περιεστικῶν σημείων, τουτέοισι χρὴ τὰς τοιαύτας ἀποστάσιας ἐλπίζειν ἔσεσθαι. γίγνονται δὲ αἱ μὲν ἐς τὰ κάτω χωρία, οἷσιν ἂν περὶ τὰ ὑποχόνδρια τοῦ φλέγματός τι ἐγγένηται· αἱ δὲ ἄνω, οἷσι τὸ ὑποχόνδριον λαπαρόν τε καὶ ἀνώδυνον διατελέῃ, δύσπνοος δέ τινα χρόνον γενόμενος παύσηται, ἄτερ φανερῆς προφάσιος ἄλλης. αἱ δὲ ἀποστάσιες αἱ ἐς τὰ σκέλεα ἐν τῇσι περιπλευμονίῃσι τῇσιν ἰσχυρῇσί τε καὶ ἐπικινδύνοισι λυσιτελέες μὲν πᾶσαι, ἄρισται δὲ αἱ τοῦ πτυέλου ἐν μεταβολῇ ἐόντος γιγνόμεναι· εἰ γὰρ τὸ οἴδημα καὶ ἡ ὀδύνη γίγνοιτο, τοῦ πτυέλου ἀντὶ ξανθοῦ πυώδεος γενομένου καὶ ἐκχωρέοντος ἔξω, οὕτως ἂν ἀσφαλέστατα ὅ τε ἄνθρωπος περιγίγνοιτο, καὶ ἡ ἀπόστασις ἀνώδυνος τάχιστα παύσαιτο· εἰ δὲ τὸ πτύελον μὴ ἐκχωρέοι καλῶς, μηδὲ τὸ οὖρον ὑπόστασιν ἀγαθὴν ἔχον φαίνοιτο, κίνδυνος χωλὸν γενέσθαι τὸ ἄρθρον ἢ πολλὰ πρήγματα παρασχεῖν. ἢν δὲ ἀφανίζωνται καὶ παλινδρομέωσιν αἱ ἀποστάσιες, τοῦ πτυέλου μὴ ἐκχωρέοντος, καὶ τοῦ πυρετοῦ ἔχοντος, δεινόν· κίνδυνος γὰρ μὴ παραφρονήσῃ καὶ ἀποθάνῃ ὁ ἄνθρωπος. τῶν δὲ ἐμπύων τῶν ἐκ τῶν περιπλευμονικῶν οἱ γεραίτεροι μᾶλλον ἀπόλλυνται· ἐκ δὲ τῶν ἄλλων ἐμπυημάτων οἱ νεώτεροι μᾶλλον ἀποθνήσκουσι. ὁκόσοι δὲ τῶν ἐμπύων καίονται ἢ τέμνονται, οἷσιν ἂν καθαρὸν μὲν το πῦον ᾖ καὶ λευκὸν καὶ μὴ δυσῶδες, σώζονται· οἷσι δὲ ὕφαιμόν τε καὶ βορβορῶδες, ἀπόλλυνται.
19. Pains accompanied with fever which occur about the loins and lower parts, if they attack the diaphragm, and leave the parts below, are very fatal. Wherefore one ought to pay attention to the other symptoms, since if any unfavorable one supervene, the case is hopeless; but if while the disease is determined to the diaphragm, the other symptoms are not bad, there is great reason to expect that it will end in empyema. When the bladder is hard and painful, it is an extremely bad and mortal symptom, more especially in cases attended with continued fever; for the pains proceeding from the bladder alone are to kill the patient; and at such a time the bowels are not moved, or the discharges are hard and forced. But urine of a purulent character, and having a white and smooth sediment, relieves the patient. But if no amendment takes place in the characters of the urine, nor the bladder become soft, and the fever is of the continual type, it may be expected that the patient will die in the first stages of the complaint. This form attacks children more especially, from their seventh to their fifteenth year.
19. 19. αἱ δὲ ξὺν πυρετῷ γιγνόμεναι ὀδύναι περὶ τὴν ὀσφῦν τε καὶ τὰ κάτω χωρία, ἢν τῶν φρενῶν ἅπτωνται, τὰ κάτω ἐκλείπουσαι, ὀλέθριαι κάρτα. προσέχειν οὖν δεῖ τὸν νόον τοῖσιν ἄλλοισι σημείοισιν, ὡς ἤν τι καὶ τῶν ἄλλων σημείων ἐπιφαίνηται πονηρὸν, ἀνέλπιστος ὁ ἄνθρωπος· ἢν δὲ, ἀναΐσσοντος τοῦ νουσήματος ὡς πρὸς τὰς φρένας, τἄλλα σημεῖα μὴ πονηρὰ ἐπιγίγνηται, ἔμπυον ἔσεσθαι τοῦτον πολλαὶ ἐλπίδες. κύστιες δὲ σκληραί τε καὶ ἐπώδυνοι δειναὶ μὲν παντελῶς καὶ ὀλέθριαι· ὀλεθριώτεραι δὲ ὁκόσαι ξὺν πυρετῷ ξυνεχεῖ γίγνονται· καὶ γὰρ οἱ ἀπʼ αὐτέων τῶν κύστιων πόνοι ἱκανοὶ ἀποκτεῖναι· καὶ αἱ κοιλίαι οὐ διαχωρέουσιν ἐν τουτέῳ τῷ χρόνῳ, εἰ μὴ σκληρά τε καὶ πρὸς ἀνάγκην· λύει δέ οὖρον πυῶδις οὐρηθὲν, λευκὴν καὶ λείην ἔχον τὴν ὑπόστασιν. ἢν δὲ μήτε τὸ οὖρον μηδὲν ἐνδιδοίη, μήτε ἡ κύστις μαλάσσοιτο, ὅ τε πυρετος ξυνεχὴς ᾖ, ἐν τῇσι πρώτῃσι περιόδοισι τοῦ νουσήματος ἐλπὶς τὸν ἀλγέοντα ἀπολέσθαι. ὁ δὲ τρόπος οὗτος ἅπτεται τῶν παιδίων μάλιστα τῶν ἑπταετέων, ἕως ἂν ἐς τὰ πεντεκαίδεκα ἔτεα γένωνται.
20. Fevers come to a crisis on the same days as to number on which men recover and die. For the mildest class of fevers, and those originating with the most favorable symptoms, cease on the fourth day or earlier; and the most malignant, and those setting in with the most dangerous symptoms, prove fatal on the fourth day or earlier. The first class of them as to violence ends thus: the second is protracted to the seventh day, the third to the eleventh, the fourth to the fourteenth, the fifth to the seventeenth, and the sixth to the twentieth. Thus these periods from the most acute disease ascend by fours up to twenty. But none of these can be truly calculated by whole days, for neither the year nor the months can be numbered by entire days. After these in the same manner, according to the same progression, the first period is of thirty-four days, the second of forty days, and the third of sixty days. In the commencement of these it is very difficult to determine those which will come to a crisis after a long interval; for these beginnings are very similar, but one should pay attention from the first day, and observe further at every additional tetrad, and then one cannot miss seeing how the disease will terminate. The constitution of quartans is agreeable to the same order. Those which will come to a crisis in the shortest space of time, are the easiest to be judged of; for the differences of them are greatest from the commencement, thus those who are going to recover breathe freely, and do not suffer pain, they sleep during the night, and have the other salutary symptoms, whereas those that are to die have difficult respiration, are delirious, troubled with insomnolency, and have other bad symptoms. Matters being thus, one may conjecture, according to the time, and each additional period of the diseases, as they proceed to a crisis. And in women, after parturition, the crises proceed agreeably to the same ratio.
20. 20. οἱ δὲ πυρετοὶ κρίνονται ἐν τῇσιν αὐτέῃσιν ἡμέρῃσι τὸν ἀριθμὸν, ἐξ ὧν τε περιγίγνονται οἱ ἄνθρωποι καὶ ἐξ ὧν ἀπόλλυνται. οἵ τε γὰρ εὐηθέστατοι τῶν πυρετῶν καὶ ἐπὶ σημείων ἀσφαλεστάτων βεβῶτες τεταρταῖοι παύονται, ἢ πρόσθεν· οἵ τε κακοηθέστατοι καὶ ἐπὶ σημείων δεινοτάτων γιγνόμενοι τεταρταῖοι κτείνουσιν, ἢ πρόσθεν. ἡ μὲν οὖν πρώτη ἔφοδος αὐτέων οὕτω τελευτᾷ· ἡ δὲ δευτέρη ἐς τὴν ἑβδόμην περιάγεται· ἡ δὲ τρίτη ἐς τὴν ἑνδεκάτην· ἡ δὲ τετάρτη ἐς τὴν τεσσαρεσκαιδεκάτην· ἡ δὲ πέμπτη ἐς τὴν ἑπτακαιδεκάτην· ἡ δὲ ἕκτη ἐς τὴν εἰκοστήν. αὗται μὲν οὖν ἐκ τῶν ὀξυτάτων νουσημάτων διὰ τεσσάρων ἐς τὰς εἴκοσιν ἐκ προσθέσιος τελευτῶσιν. οὐ δύναται δὲ ὅλῃσιν ἡμέρῃσιν οὐδὲν τουτέων ἀριθμέεσθαι ἀτρεκέως· οὐδὲ γὰρ ὁ ἐνιαυτός τε καὶ οἱ μῆνες ὅλῃσιν ἡμέρῃσι πεφύκασιν ἀριθμέεσθαι. μετὰ δὲ ταῦτα ἐν τῷ αὐτέῳ τρόπῳ κατὰ τὴν αὐτέην πρόσθεσιν ἡ πρώτη περίοδος τεσσάρων καὶ τριήκονθʼ ἡμερέων, ἡ δὲ δευτέρη τεσσαράκοντα ἡμερέων, ἡ δὲ τρίτη ἑξήκονθʼ ἡμερέων. τουτέων δʼ ἐν ἀρχῇσίν ἐστιχαλεπώτατον διαγιγνώσκειν τὰ μέλλοντα ἐν πλείστῳ χρόνῳ κρίνεσθαι· ὁμοιόταται γὰρ αἱ ἀρχαί εἰσιν αὐτέων· ἀλλὰ χρὴ ἀπὸ τῆς πρώτης ἡμέρης ἐνθυμέεσθαι, καὶ καθʼ ἑκάστην τετράδα προστιθεμένην σκέπτεσθαι· καὶ οὐ λήσεται ὅπη τρέψεται τὸ νούσημα. γίγνεται δὲ ἡ τῶν τεταρταίων κατάστασις ἐκ τοῦ τοιούτου κόσμου. τὰ δὲ ἐν ἐλαχίστῳ χρόνῳ μέλλοντα κρίνεσθαι, εὐπετέστερα γιγνώσκεσθαι· μέγιστα γὰρ τὰ διαφέροντα ἀπʼ ἀρχῆς αὐτέων ἐστίν· οἱ μὲν γὰρ περιεσόμενοι εὔπνοοί τε καὶ ἀνώδυνοί εἰσι, καὶκοιμῶνται τὰς νύκτας, τά τε ἄλλασημεῖα ἔχουσιν ἀσφαλέστατα· οἱ δὲ ἀπολούμενοι δύσπνοοι γίγνονται, ἀλλοφάσσοντες, ἀγρυπνέοντες, τά τε ἄλλα σημεῖα κάκιστα ἔχοντες. ὡς οὖν τουτέων οὕτω γιγνομένων ξυμβάλλεσθαι χρὴ, κατά τε τὸν χρόνον, κατά τε τὴν πρόσθεσιν ἑκάστην ἐπὶ τὴν κρίσιν ἰόντων τῶν νουσημάτων. κατὰ δὲ τὸν αὐτὸν λόγον καὶ τῇσι γυναιξὶν αἱ κρίσιες ἐκ τῶν τόκων γίγνονται.
21. Strong and continued headaches with fever, if any of the deadly symptoms be joined to them, are very fatal. But if without such symptoms the pain be prolonged beyond twenty days, a discharge of blood from the nose or some abscess in the inferior parts may be anticipated; but while the pain is recent, we may expect in like manner a discharge of blood from the nose, or a suppuration, especially if the pain be seated above the temples and forehead; but the hemorrhage is rather to be looked for in persons younger than thirty years, and the suppuration in more elderly persons.
21. 21. κεφαλῆς δὲ ὀδύναι ἰσχυραί τε καὶ ξυνεχέες ξὺν πυρετῷ· ἢν μέν τι τῶν θανατωδέων σημείων προσγίγνοιτο, ὀλέθριον κάρτα. εἰ δὲ ἄτερ τῶν τοιούτων σημείων ἡ ὀδύνη ὑπερβάλλοι εἴκοσιν ἡμέρας, ὅ τε πυρετὸς ἔχοι, ὑποσκέπτεσθαι χρὴ αἵματος ῤῆξιν διὰ ῤινῶν, ἢ ἄλλην τινὰ ἀπόστασιν ἐς τὰ κάτω χωρία· ἔστʼ ἂν δὲ ἡ ὀδύνη ᾖ νεαρὰ, προσδέχεσθαι χρὴ ὡσαύτως αἵματος ῤῆξιν διὰ ῤινῶν, ἢ ἐκπύησιν, ἄλλως τε ἢν ἡ ὀδύνη περὶ τοὺς κροτάφους καὶ τὸ μέτωπον ᾖ· μᾶλλον δὲ χρὴ προσδέχεσθαι τοῦ μὲν αἵματος τὴν ῤῆξιν τοῖσι νεωτέροισι πέντε καὶ τριήκοντα ἐτέων, τοῖσι δὲ γεραιτέροισι τὴν ἐκπύησιν.
22. Acute pain of the ear, with continual and strong fever, is to be dreaded; for there is danger that the man may become delirious and die. Since, then, this is a hazardous spot, one ought to pay particular attention to all these symptoms from the commencement. Younger persons die of this disease on the seventh day, or still earlier, but old persons much later; for the fevers and delirium less frequently supervene upon them, and on that account the ears previously come to a suppuration, but at these periods of life, relapses of the disease coming on generally prove fatal. Younger persons die before the ear suppurates; only if white matter run from the ear, there may be hope that a younger person will recover, provided any other favorable symptom be combined.
22. 22. ὠτὸς δὲ ὀξείη ὀδύνη ξὺν πυρετῷ ξυνεχεῖ τε καὶ ἰσχυρῷ δεινόν· κίνδυνος γὰρ παραφρονῆσαι τὸν ἄνθρωπον καὶ ἀπολέσθαι. ὡς οὖν τουτέου τοῦ τόπου σφαλεροῦ ἐόντος, ταχέως δεῖ προσέχειν τὸν νόον τοῖσι σημείοισι πᾶσιν ἀπὸ τῆς πρώτης ἡμέρης. ἀπόλλυνται δὲ οἱ μὲν νεώτεροι τῶν ἀνθρώπων ἑβδομαῖοι καὶ ἔτι θᾶσσον ὑπὸ τουτέου τοῦ νουσήματος· οἱ δὲ γέροντες πολλῷ βραδύτερον· οἵ τε γὰρ πυρετοὶ καὶ αἱ παραφροσύναι ἧσσον αὐτέοισιν ἐπιγίγνονται, καὶ τὰ ὦτα διὰ τοῦτο φθάνει ἐκπυΐσκεσθαι· ἀλλὰ ταύτῃσι μὲν τῇσιν ἡλικίῃσιν ὑποστροφαὶ τοῦ νουσήματος ἐπιγιγνόμεναι ἀποκτείνουσι τοὺς πλείστους. οἱ δὲ νεώτεροι, πρὶν ἐκπυῆσαι τὸ οὖς, ἀπόλλυνται· πλὴν ἀλλʼ ἤν γε ῤυῇ πῦον λευκὸν ἐκ τοῦ ὠτὸς, ἐλπὶς τῷ νεωτέρῳ περιγενέσθαι, ἤν γε καὶ ἄλλο τι αὐτέῳ ἐπιγένηται χρηστὸν σημεῖον.
23. Ulceration of the throat with fever, is a serious affection, and if any other of the symptoms formerly described as being bad, be present, the physician ought to announce that his patient is in danger. Those quinsies are most dangerous, and most quickly prove fatal, which make no appearance in the fauces, nor in the neck, but occasion very great pain and difficulty of breathing; these induce suffocation on the first day, or on the second, the third, or the fourth. Such as, in like manner, are attended with pain, are swelled up, and have redness (erythema) in the throat, are indeed very fatal, but more protracted than the former, provided the redness be great. Those cases in which both the throat and the neck are red, are more protracted, and certain persons recover from them, especially if the neck and breast be affected with erythema, and the erysipelas be not determined inwardly. If neither the erysipelas disappear on the critical day, nor any abscess form outwardly, nor any pus be spit up, and if the patient fancy himself well, and be free from pain, death, or a relapse of the erythema is to be apprehended. It is much less hazardous when the swelling and redness are determined outwardly; but if determined to the lungs, they superinduce delirium, and frequently some of these cases terminate in empyema. It is very dangerous to cut off or scarify enlarged uvulae while they and red and large, for inflammations and hemorrhages supervene; but one should try to reduce such swellings by some other means at this season. When the whole of it is converted into an abscess, which is called Uva, or when the extremity of the variety called Columella is larger and round, but the upper part thinner, at this time it will be safe to operate. But it will be better to open the bowels gently before proceeding to the operation, if time will permit, and the patient be not in danger of being suffocated.
23. 23. φάρυγξ δὲ ἑλκουμένη ξὺν πυρετῷ δεινόν· ἀλλʼ ἤν τι καὶ ἄλλο σημεῖον γένηται τῶν προκεκριμένων πονηρῶν εἶναι, προλέγειν δεῖ ὡς ἐν κινδύνῳ ἐόντος τοῦ ἀνθρώπου. αἱ δὲ κυνάγχαι δεινόταται μέν εἰσι, καὶ τάχιστα ἀναιρέουσιν, ὁκόσαι μήτε ἐν τῇ φάρυγγι μηδὲν ἔκδηλον ποιέουσι, μήτε ἐν τῷ αὐχένι, πλεῖστον δὲ πόνον παρέχουσι καὶ ὀρθόπνοιαν· αὗται γὰρ καὶ αὐθημερὸν ἀποπνίγουσι, καὶ δευτεραῖαι, καὶ τριταῖαι, καὶ τεταρταῖαι. ὅσαι δὲ τὰ μὲν ἄλλα παραπλησίως πόνον παρέχουσιν, ἐπαίρονται δὲ, καὶ ἐρυθήματα ἐν τῇ φάρυγγι ποιέουσιν, ὀλέθριαι μὲν κάρτα, χρονιώτεραι δὲ μᾶλλον τῶν πρόσθεν, ἢν τὸ ἐρύθημα μέγα γίγνηται. Ὁκόσοισι δὲ ξυνεξερευθείη ἡ φάρυγξ καὶ ὁ αὐχὴν, αὗται δὴ χρονιώτεραι, καὶ μάλιστα ἐξ αὐτέων τινὲς περιφεύγουσιν, ἢν ὅ τε αὐχὴν καὶ τὸ στῆθος ἐρύθημα ἔχῃ, καὶ μὴ παλινδρομέῃ τὸ ἐρυσίπελας ἔσω. ἢν δὲ μήτε ἐν ἡμέρῃσι κρισίμῃσιν ἀφανίζηται τὸ ἐρυσίπελας, μήτε φύματος ξυστραφέντος ἐν τῷ ἔξω χωρίῳ, μήτε πῦον ἀποβήσσῃ, ῤηϊδίως τε καὶ ἀπόνως ἔχειν δοκέῃ, θάνατον σημαίνει, ἢ ὑποστροφὴν τοῦ ἐρυθήματος. ἀσφαλέστερον δὲ τὸ οἴδημα καὶ τὸ ἐρύθημα ὡς μάλιστα ἔξω τρέπεσθαι· ἢν δὲ ἐς τὸν πλεύμονα τραπείη, παράνοιάν τε ποιέει, καὶ ἔμπυοι ἐξ αὐτέων τινὲς ὡς τὰ πολλὰ γίγνονται. οἱ δὲ γαργαρεῶνες ἐπικίνδυνοι καὶ ἀποτάμνεσθαι καὶ ἀποσχάζεσθαι, ἔστʼ ἂν ἐρυθροί τε ἔωσι καὶ μεγάλοι· καὶ γὰρ φλεγμοναὶ ἐπιγίγνονται τουτέοισι καὶ αἱμοῤῥαγίαι· ἀλλὰ χρὴ τὰ τοιαῦτα τοῖσιν ἄλλοισι μηχανήμασι πειρῆσθαι κατισχναίνειν ἐν τουτέῳ τῷ χρόνῳ. ὁκόταν δὲ ἀποκριθῇ πᾶν, ὃ δὴ σταφυλὴν καλέουσι, καὶ γένηται τὸ μὲν ἄκρον τοῦ γαργαρεῶνος μεῖζόν τε καὶ περιφερὲς, τὸ δὲ ἀνωτέρω λεπτότερον, ἐν τουτέῳ τῷ καιρῷ ἀσφαλὲς διαχειρίζειν. ἄμεινον δὲ καὶ τὴν κοιλίην ὑποκενώσαντα τῇ χειρουργίῃ χρέεσθαι, ἢν ὅ τε χρόνος ξυγχωρέῃ, καὶ μὴ ἀποπνίγηται ὁ ἄνθρωπος.
24. When the fevers cease without any symptoms of resolution occurring, and not on the critical days, in such cases a relapse may be anticipated. When any of the fevers is protracted, although the man exhibits symptoms of recovery, and there is no longer pain from any inflammation, nor from any other visible cause, in such a case a deposit, with swelling and pain, may be expected in some one of the joints, and not improbably in those below. Such deposits occur more readily and in less time to persons under thirty years of age; and one should immediately suspect the formation of such a deposit, if the fever be protracted beyond twenty days; but to aged persons these less seldom happen, and not until the fever be much longer protracted. Such a deposit may be expected, when the fever is of a continual type, and that it will pass into a quartan, if it become intermittent, and its paroxysms come on in an irregular manner, and if in this form it approach autumn. As deposits form most readily in persons below thirty years of age, so quartans most commonly occur to persons beyond that age. It is proper to know that deposits occur most readily in winter, that then they are most protracted, but are less given to return. Whoever, in a fever that is not of a fatal character, says that he has pain in his head, and that something dark appears to be before his eyes, and that he has pain at the stomach, will be seized with vomiting of bile; but if rigor also attack him, and the inferior parts of the hypochondrium are cold, vomiting is still nearer at hand; and if he eat or drink anything at such a season, it will be quickly vomited. In these cases, when the pain commences on the first day, they are particularly oppressed on the fourth and the fifth; and they are relieved on the seventh, but the greater part of them begin to have pain on the third day, and are most especially tossed on the fifth, but are relieved on the ninth or eleventh; but in those who begin to have pains on the fifth day, and other matters proceed properly with them, the disease comes to a crisis on the fourteenth day. But when in such a fever persons affected with headache, instead of having a dark appearance before their eyes, have dimness of vision, or flashes of light appear before their eyes, and instead of pain at the pit of the stomach, they have in their hypochondrium a fullness stretching either to the right or left side, without either pain or inflammation, a hemorrhage from the nose is to be expected in such a case, rather than a vomiting. But it is in young persons particularly that the hemorrhage is to be expected, for in persons beyond the age of thirty-five, vomitings are rather to be anticipated. Convulsions occur to children if acute fever be present, and the belly be they cannot sleep, are agitated, and moan, and change color, and become green, livid, or ruddy. These complaints occur most readily to children which are very young up to their seventh year; older children and adults are not equally liable to be seized with convulsions in fevers, unless some of the strongest and worst symptoms precede, such as those which occur in frenzy. One must judge of children as of others, which will die and which recover, from the whole of the symptoms, as they have been specially described. These things I say respecting acute diseases, and the affections which spring from them.
24. 24. Ὁκόσοισι δʼ ἂν οἱ πυρετοὶ παύωνται, μήτε σημείων γενομένων λυτηρίων, μήτε ἐν ἡμέρῃσι κρισίμῃσιν, ὑποστροφὴν προσδέχεσθαι χρὴ τουτέοισιν. ὅστις δʼἂν τῶν πυρετῶν μηκύνῃ περιεστικῶς διακειμένου τοῦ ἀνθρώπου, μηκέτι ὀδύνης ἐχούσης διὰ φλεγμονήν τινα, μήτε διὰ πρόφασιν ἄλλην μηδεμίην ἐμφανέα, τουτέῳ προσδέχεσθαι ἀπόστασιν μετʼ οἰδήματός τε καὶ ὀδύνης ἔς τι τῶν ἄρθρων, καὶ οὐχ ἧσσον ἐκ τῶν κάτω. μᾶλλον δὲ γίγνονται καὶ ἐν ἐλάσσονι χρόνῳ αἱ τοιαῦται ἀποστάσιες τοῖσι νεωτέροισι τριήκοντα ἐτέων· ὑποσκέπτεσθαι δὲ χρὴ εὐθέως τὰ περὶ τῆς ἀποστάσιος, ἢν εἴκοσιν ἡμέρας ὁ πυρετὸς ἔχων ὑπερβάλλῃ· τοῖσι δὲ γεραιτέροισιν ἧσσον γίγνεται, πολυχρονιωτέρου ἐόντος τοῦ πυρετοῦ. χρὴ δὲ τὴν μὲν τοιαύτην ἀπόστασιν προσδέχεσθαι, ξυνεχέος ἐόντος τοῦ πυρετοῦ, ἐς δὲ τεταρταῖον καταστήσεσθαι, ἢν διαλείπῃ τε καὶ καταλαμβάνῃ πεπλανημένον τρόπον, καὶ ταῦτα ποιέων τῷ φθινοπώρῳ προσπελάσῃ. ὥσπερ δὲ τοῖσι νεωτέροισι τῶν τριήκοντα ἐτέων αἱ ἀποστάσιες γίγνονται, οὕτως οἱ τεταρταῖοι μᾶλλον τοῖσι τριήκοντα ἐτέων καὶ γεραιτέροισιν. τὰς δὲ ἀποστάσιας εἰδέναι χρὴ τοῦ χειμῶνος μᾶλλον γιγνομένας χρονιώτερόν τε παυομένας, ἧσσον δὲ παλινδρομεύσας. ὅστις δʼ ἂν ἐν πυρετῷ μὴ θανατώδει φῇ τὴν κεφαλὴν ἀλγέειν, ἢ καὶ ὀρφνῶδές τι πρὸ τῶν ὀφθαλμῶν φαίνεσθαι, ἢ καρδιωγμὸς τουτέῳ προσγένηται, χολώδης ἔμετος παρέσται· ἢν δὲ καὶ ῤῖγος ἐπιλάβῃ, καὶ τὰ κάτω μέρεα τοῦ ὑποχονδρίου ψυχρὰ ᾖ, καὶ θᾶσσον ἔτι ὁ ἔμετος παρέσται· ἢν δέ τι πίῃ ἢ φάγῃ ὑπὸ τοῦτον τὸν χρόνον, κάρτα τοῦτο ταχέως ἐμέεται. τουτέων δὲ οἷσιν ἂν ἄρξηται ὁ πόνος τῇ πρώτῃ ἡμέρῃ γίγνεσθαι, τεταρταῖοι πιεζεῦνται μάλιστα καὶ πεμπταῖοι· ἐς δὲ τὴν ἑβδόμην ἀπαλλάσσονται· οἱ μέντοι πλείονες αὐτέων ἄρχονται μὲν πονέεσθαι τριταῖοι, χειμάζονται δὲ μάλιστα πεμπταῖοι, ἀπαλλάσσονται δὲ ἐναταῖοι ἢ ἑνδεκαταῖοι· οἳ δʼἂν ἄρξωνται πεμπταῖοι πονέεσθαι, καὶ τἄλλα κατὰ λόγον αὐτέοισι γίγνηται, ἐς τὴν τεσσαρεσκαιδεκάτην κρίνεται ἡ νοῦσος. γίγνεται δὲ ταῦτα τοῖσι μὲν ἀνδράσι καὶ τῆσι γυναιξὶν ἐν τοῖσι τριταίοισι μάλιστα· τοῖσι δὲ νεωτέροισι γίγνεται μὲν καὶ ἐν τουτέοισι, μᾶλλον δὲ ἐν τοῖσι ξυνεχεστέροισι πυρετοῖσι, καὶ ἐν τοῖσι γνησίοισι τριταίοισιν. οἷσι δʼ ἂν ἐν τοιουτοτρόπῳ πυρετῷ κεφαλὴν ἀλγέουσιν ἀντὶ μὲν τοῦ ὀρφνῶδές τι πρὸ τῶν ὀφθαλμῶν φαίνεσθαι, ἀμβλυωγμὸς γίγνεται, ἢ μαρμαρυγαὶ προφαίνονται, ἀντὶ δὲ τοῦ καρδιώσσειν, ἐν τῷ ὑποχονδρίῳ ἐπὶ δεξιὰ ἢ ἐπʼ ἀριστερὰ ξυντείνεταί τι μήτε ξὺν ὀδύνῃ μήτε ξὺν φλεγμονῇ, αἷμα διὰ τῶν ῤινῶν τουτέοισι ῤυῆναι προσδόκιμον ἀντὶ τοῦ ἐμέτου. μᾶλλον δὲ καὶ ἐνταῦθα τοῖσι νέοισι τοῦ αἵματος τὴν ῤῆξιν προσδέχεσθαι· τοῖσι δὲ πέντε καὶ τριήκοντα ἔτεσι καὶ γεραιτέροισιν ἧσσον, ἀλλὰ τοὺς ἐμέτους τουτέοισι προσδέχεσθαι. τοῖσι δὲ παιδίοισι σπασμοὶ γίγνονται, ἢν ὁ πυρετὸς ὀξὺς ᾖ, καὶ ἡ γαστὴρ μὴ διαχωρέῃ, καὶ ἀγρυπνέωσί τε καὶ ἐκπλαγέωσι, καὶ κλαυθμυρίζωσι, καὶ τὸ χρῶμα μεταβάλλωσι, καὶ χλωρὸν ἢ πελιὸν ἢ ἐρυθρὸν ἴσχωσιν. γίγνεται δὲ ταῦτα ἐξ ἑτοιμοτάτου μὲν τοῖσι παιδίοισι τοῖσι νεωτάτοισιν ἐς τὰ ἑπτὰ ἔτεα· τὰ δὲ πρεσβύτερα τῶν παιδίων καὶ οἱ ἄνδρες οὐκ ἔτι ἐν τοῖσι πυρετοῖσιν ὑπὸ τῶν σπασμῶν ἁλίσκονται, ἢν μή τι τῶν σημείων προσγένηται τῶν ἰσχυροτάτων τε καὶ κακίστων, οἷά περ ἐν τῃσι φρενίτισι γίγνεται. τοὺς δʼἀπολουμένους τε καὶ περιεσομένους τῶν παιδίων τε καὶ τῶν ἄλλων τεκμαίρεσθαι τοῖσι ξύμπασι σημείοισιν, ὡς ἐφʼ ἑκάστοισιν ἕκαστα διαγέγραπται. ταῦτα δὲ λέγω περί τε τῶν ὀξέων νουσημάτων καὶ ὅσα ἐκ τουτέων γίγνεται.
25. He who would correctly beforehand those that will recover, and those that will die, and in what cases the disease will be protracted for many days, and in what cases for a shorter time, must be able to form a judgment from having made himself acquainted with all the symptoms, and estimating their powers in comparison with one another, as has been described, with regard to the others, and the urine and sputa, as when the patient coughs up pus and bile together. One ought also to consider promptly the influx of epidemical diseases and the constitution of the season. One should likewise be well acquainted with the particular signs and the other symptoms, and not be ignorant how that, in every year, and at every season, bad symptoms prognosticate ill, and favorable symptoms good, since the aforesaid symptoms appear to have held true in Libya, in Delos, and in Scythia, from which it may be known that, in the same regions, there is no difficulty in attaining a knowledge of many more things than these; if having learned them, one knows also how to judge and reason correctly of them. But you should not complain because the name of any disease may happen not to be described here, for you may know all such as come to a crisis in the aforementioned times, by the same symptoms.
25. 25. χρὴ δὲ τὸν μέλλοντα ὀρθῶς προγιγνώσκειν τοὺς περιεσομένους καὶ τοὺς ἀποθανουμένους, ὅσοισί τε ἂν μέλλῃ πλέονας ἡμέρας παραμένειν τὸ νούσημα καὶ ὅσοισιν ἂν ἐλάσσους, τὰ σημεῖα ἐκμανθάνοντα πάντα δύνασθαι κρίνειν, λογιζόμενον τὰς δυνάμιας αὐτέων πρὸς ἀλλήλας, ὥσπερ διαγέγραπται περί τε τῶν ἄλλων καὶ τῶν οὔρων καὶ τῶν πτυέλων, ὅταν ὁμοῦ πῦόν τε ἀναβήσσῃ καὶ χολήν. χρὴ δὲ καὶ τὰς φορὰς τῶν νουσημάτων αἰεὶ ἐπιδημεύντων ταχέως ἐνθυμέεσθαι, τήν τε τῆς ὥρης κατάστασιν. εὖ μέντοι χρὴ εἰδέναι περὶ τῶν τεκμηρίων καὶ τῶν ἄλλων σημείων, καὶ μὴ λανθάνειν ὅτι ἐν παντὶ ἔτει καὶ πάση ὥρῃ τά τε κακὰ κακὸν σημαίνει, καὶ τὰ χρηστὰ ἀγαθὸν, ἐπεὶ καὶ ἐν Λιβύῃ καὶ ἐν Δήλῳ καὶ ἐν Σκυθίῃ φαίνεται τὰ προγεγραμμένα ἀληθεύοντα σημεῖα. ἐξ ὧν χρὴ εἰδέναι ὅτι ἔν γε τοῖσιν αὐτέοισι χωρίοισιν οὐδὲν δεινὸν τὸ μὴ οὐ τὰ πολλαπλάσια αὐτέων ἐπιτυγχάνειν, ἢν ἐκμαθών τις αὐτὰ κρίνειν τε καὶ λογίζεσθαι ὀρθῶς ἐπίστηται. Ποθέειν δὲ χρὴ οὐδενὸς νουσήματος οὔνομα, ὅ τι μὴ τυγχάνῃ ἐνθάδε γεγραμμένον· πάντα γὰρ ὁκόσα ἐν τοῖσι χρόνοισι τοῖσι προειρημένοισι κρίνεται, γνώσῃ τοῖσιν αὐτέοισι σημείοισιν.