Epidemics, Fourteen

HISTORY 135F

Infectious and Epidemic Disease in History

Department of History
University of California, Irvine
Instructor: Dr. Barbara J. Becker

Fourteen Cases of Disease
from Book I
Of the Epidemics (400 BCE)
by Hippocrates (460-377 BCE)

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Case I. Philiscus, who lived by the Wall:

Day 1	took to bed of acute fever; he sweated; towards night was uneasy
Day 2	all the symptoms were exacerbated; late in the evening had a proper stool from a small clyster [enema]; the night quiet
Day 3	early in the morning and until noon, he appeared to be free from fever; towards evening, acute fever, with sweating, thirst, tongue parched; passed black urine; night uncomfortable, no sleep; he was delirious on all subjects
Day 4	all the symptoms exacerbated, urine black; night more comfortable, urine of a better color
Day 5	about mid-day, had a slight trickling of pure blood from the nose; urine varied in character, having floating in it round bodies, resembling semen, and scattered, but which did not fall to the bottom; a suppository having been applied, some scanty flatulent matters were passed; night uncomfortable, little sleep, talking incoherently; extremities altogether cold, and could not be warmed; urine, black; slept a little towards day; loss of speech, cold sweats; extremities livid
Day 6	about the middle of the day he died

The respiration throughout, like that of a person recollecting himself, was rare, and large, and spleen was swelled upon in a round tumor, the sweats cold throughout, the paroxysms on the even days.

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Case II. Silenus lived on the Broadway, near the house of Evalcidas. From over-exertion, drinking, and exercises at the wrong time, he was seized with fever. He began with having pain in the loins; he had heaviness of the head, and there was stiffness of the neck.

Day 1	the stools were bilious, unmixed, frothy, high colored, and copious; urine black, having a black sediment; he was thirsty, tongue dry; no sleep at night
Day 2	acute fever, stools more copious, thinner, frothy; urine black, an uncomfortable night, slight delirium
Day 3	all the symptoms exacerbated; an oblong distention, of a softish nature, from both sides of the hypochondrium to the navel; stools thin, and darkish; urine muddy, and darkish; no sleep at night; much talking, laughter, singing, he could not restrain himself
Day 4	in the same state
Day 5	stools bilious, unmixed, smooth, greasy; urine thin, and transparent; slight absence of delirium
Day 6	slight perspiration about the head; extremities cold and livid; much tossing about; no passage from the bowels, urine suppressed, acute fever
Day 7	loss of speech; extremities could no longer be kept warm; no discharge of urine
Day 8	a cold sweat all over; red rashes with sweat, of a round figure, small, like vari [pockmarks], persistent, not subsiding; by means of a slight stimulus, a copious stools, of a thin and undigested character, with pain; urine acrid, and passed with pain; extremities slightly heated; sleep slight, and comatose; speechless; urine thin, and transparent
Day 9	in the same state
Day 10	no drink taken; comatose, sleep slight; stools the same; urine abundant, and thickish; when allowed to stand, the sediment white, looking as though it contained flour; extremities again cold
Day 11	he died

From the beginning, and throughout, the respiration was slow and large; there was a constant throbbing in the hypochondrium; his age was about twenty.

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Case III. Herophon was seized with an acute fever; stools at first were scanty, and attended with tenesmus; but afterwards they were passed of a thin, bilious character, and frequent; there was no sleep; urine black, and thin.

Day 5	in the morning, deafness; all the symptoms exacerbated; spleen swollen; distention of the hypochondrium; stools scanty, and black; he became delirious
Day 6	delirious; at night, sweating, coldness; the delirium continued
Day 7	he became cold, thirsty, was disordered in mind; at night recovered his senses; slept
Day 8	feverish; the spleen diminished in size; quite collected; had pain at first about the groin, on the same side as the spleen; had pains in both legs; night comfortable; urine better colored, had a scanty sediment
Day 9	sweated; the crisis took place; fever remitted
Day 14	fever relapsed, spleen immediately became swollen; acute fever; deafness again
Day 16	the spleen diminished; deafness less; legs painful; sweated during the night
Day 17	crisis took place; had no disorder of the senses during the relapse

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Case IV. In Thasos, the wife of Philinus, having been delivered of a daughter, the discharge being natural, and other matters going on mildly, on the fourteenth day after delivery was seized with fever, attended with shivering; was pained at first in the cardiac region of the stomach and right hypochondrium; pain in the genital organs; lochial discharge [uterine discharge following childbirth] ceased. Upon the application of a pessary [device worn in the vagina to support a displaced uterus, or to prevent conception] all these symptoms were alleviated; pains of the head, neck, and loins remained; no sleep; extremities cold; thirst; bowels in a hot state; stools scanty; urine thin, and colorless at first.

Day 6	towards night, senses much disordered, but again were restored
Day 7	thirsty; the stools bilious, and high colored
Day 8	shivered; acute fever; much spasm, with pain; talked much, incoherently; upon the application of a suppository, rose to stool, and passed copious stools, with a bilious flux; no sleep
Day 9	spasms
Day 10	slightly recollected
Day 11	slept; had perfect recollection, but again immediately wandered; passed a large quantity of urine with spasms, (the attendants seldom putting her in mind), it was thick, white, like urine which has been shaken after it has stood for a considerable time until it has subsided, but it had no sediment; in color and consistence, the urine resembled that of cattle, as far as I observed
Day 14	twitchings over the whole body; talked much; slightly collected, but presently became again delirious
Day 17	became speechless
Day 20	died

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Case V. The wife of Epicrates, who was lodged at the house of Archigetes, being near the term of delivery, was seized with a violent shivering, and, as was said, she did not become heated; next day the same. On the third, she was delivered of a daughter, and everything went on properly. On the day following her delivery, she was seized with acute fever, pain in the cardiac region of the stomach, and in the genital parts. Having had a suppository, was in so far relieved; pain in the head, neck, and loins; no sleep; stools scanty, bilious, thin, and unmixed; urine thin, and blackish.

Day 6	towards the night of the sixth day from the time she was seized with the fever, became delirious
Day 7	all the symptoms exacerbated; sleeplessness, delirium, thirst; stools bilious, and high colored
Day 8	feverish chills; slept more
Day 9	the same
Day 10	her limbs painfully affected; pain again of the cardiac region of the stomach; heaviness of the head; no delirium; slept more; bowels constipated
Day 11	passed urine of a better color, and having an abundant sediment; felt lighter
Day 14	shivered; acute fever
Day 15	had a copious vomiting of bilious and yellow matters; sweated; fever gone; at night acute fever; urine thick, sediment white
Day 17	an exacerbation; night uncomfortable; no sleep; delirium
Day 18	thirsty; tongue parched; no sleep; much delirium; legs painfully affected
Day 20	in the morning, had a slight shivering; was comatose; slept tranquilly; had slight vomiting of bilious and black matters; towards night deafness
Day 21	weight generally in the left side, with pain; slight urine thick, muddy, and reddish; when allowed to stand, had no sediment; in other respects felt lighter; fever not gone; throat painful from the commencement, and red; uvula [small fleshy protuberance that hangs down at the back of the throat] retracted; defluxion remained acrid, pungent, and saltish throughout
Day 27	free of fever; sediment in the urine; pain in the side
Day 31	attacked with fever, bilious diarrhea
Day 40	slight bilious vomiting
Day 80	had a complete crisis, and was freed from the fever

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Case VI. Cleonactides, who was lodged above the Temple of Hercules, was seized with a fever in an irregular form; was pained in the head and left side from the commencement, and had other pains resembling those produced by fatigue; paroxysms of the fevers inconstant and irregular; occasional sweats; the paroxysms generally attacked on the critical days.

Day 24	cold in the extremities of the hands, vomitings bilious, yellow, and frequent, soon turning to a verdigris-green color; general relief
Day 30	began to have hemorrhage from both nostrils, and this continued in an irregular manner until near the crisis; no loss of appetite, no thirst throughout, nor was troubled with sleeplessness; urine thin, and not devoid of color; passed reddish urine, having a copious red sediment; was relieved, but afterwards the characters of the urine varied, sometimes having sediment, and sometimes not
Day 60	the sediment in the urine copious, white, and smooth; all the symptoms improved; intermission of the fever; urine thin, and well colored
Day 70	fever gone for ten days
Day 80	had a feverish chill, was seized with acute fever, sweated much; a red, smooth sediment in the urine; and a perfect crisis

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Case VII. Meton was seized with fever; there was a painful weight in the loins.

Day 1	after drinking water pretty copiously, had proper stools
Day 3	heaviness of the head, stools thin, bilious, and reddish
Day 4	all the symptoms exacerbated; had twice a scanty trickling of blood from the right nostril; passed an uncomfortable night; stools like those on the third day; urine darkish, had a darkish cloud floating in it, of a scattered form, which did not subside
Day 5	a copious hemorrhage of pure blood from the left he sweated, and had a crisis

After the fever restless, and had some delirium; urine thin, and darkish; had an affusion of warm water on the head; slept and recovered his senses. In this case there was no relapse, but there were frequent hemorrhages after the crisis.

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Case VIII. Erasinus, who lived near the Canal of Bootes, was seized with fever after supper; passed the night in an agitated state.

Day 1	quiet, but in pain at night
Day 2	symptoms all exacerbated; at night delirious
Day 3	was in a painful condition; great incoherence
Day 4	in a most uncomfortable state; had no sound sleep at night, but dreaming and talking; then all the appearances worse, of a formidable and alarming character; fear, impatience
Day 5	in the morning, was composed, and quite coherent, but long before noon was furiously mad, so that he could not constrain himself; extremities cold, and somewhat livid; urine without sediment; died about sunset

The fever in this case was accompanied by sweats throughout; the sweats throughout; the hypochondrium swollen, distended and painful; the urine was black, has round substances floating in it, which did not subside; the stools were not stopped; thirst throughout not great; much spasms with sweats about the time of death.

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Case IX. Criton, in Thasos, while still on foot, and going about, was seized with a violent pain in the great toe.

Day 1	took to bed, had shivering and nausea, recovered his heat slightly, at night was delirious
Day 2	swelling of the whole foot, and abnormally red about the ankle, with distention, and small blisters; acute fever; he became furiously deranged; stools bilious, unmixed, and rather frequent; he died

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Case X. The Clazomenian who was lodged by the Well of Phrynichides was seized with fever. He had pain in the head, neck, and loins from the beginning, and immediately afterwards deafness; no sleep, acute fever, hypochondria elevated with a swelling, but not much distention; tongue dry.

Day 4	towards night, he became delirious
Day 5	in an uneasy state
Day 6	all the symptoms exacerbated
Day 11	a slight remission; from the commencement to the fourteenth day the stools thin, copious, and of the color of water, but were well supported; the bowels then became constipated. Urine throughout thin, and well colored, and had many substances scattered through it, but no sediment
Day 16	urine somewhat thicker, which had a slight sediment; somewhat better, and more collected
Day 17	urine again thin; swellings about both his ears, with pain; no sleep, some incoherence; legs painfully affected
Day 20	free of fever, had a crisis, no sweat, perfectly collected
Day 27	violent pain of the right hip; it speedily went off. The swellings about the ears subsided, and did not suppurate, but were painful.
Day 31	a diarrhea attended with a copious discharge of watery matter, and symptoms of dysentery; passed thick urine; swellings about the ears gone
Day 40	had pain in the right eye, sight dull; it went away

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Case XI. The wife of Dromeades having been delivered of a female child, and all other matters going on properly, on the second day after was seized with shivering and acute fever.

Day 1	began to have pain about the hypochondrium; had nausea and incoherence, and for some hours afterwards had no sleep; respiration rare, large, and suddenly interrupted
Day 2	stools proper; urine thick, white, muddy, like urine which has been shaken after standing for some time, until the sediment had fallen to the bottom; it had no sediment; she did not sleep during the night
Day 3	about noon, had shivering, acute fever; urine the same; pain of the hypochondria, nausea, an uncomfortable night, no sleep; a coldish sweat all over, but heat quickly restored
Day 4	slight alleviation of the symptoms about the hypochondria; heaviness of the head, with pain; somewhat comatose; slight epistaxis, tongue dry, thirst, urine thin and oily; slept a little, upon awaking was somewhat comatose; slight coldness, slept during the night, was delirious
Day 6	in the morning, had shivering, but soon recovered her heat, sweated all over; extremities cold, was delirious, respiration rare and large; shortly afterwards spasms from the head began, and she immediately expired

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Case XII. A man, in a heated state, took supper, and drank more than enough; he vomited the whole during the night; acute fever, pain of the right hypochondrium, a softish inflammation from the inner part; passed an uncomfortable night; urine at the commencement thick, red, but when allowed to stand, had no sediment, tongue dry, and not very thirsty.

Day 4	acute fever, pains all over
Day 5	urine smooth, oily, and copious; acute fever
Day 6	in the evening, very incoherent, no sleep during the night
Day 7	all the symptoms exacerbated; urine of the same characters; much talking, and he could not contain himself; the bowels being stimulated, passed a watery stool with intestinal worms: night equally painful
Day 8	in the morning had shivering; acute fever, hot sweat, appeared to be free of fever; did not sleep long; after the sleep a chill, excessive secretion of saliva; in the evening, great incoherence; after a little, vomited a small quantity of dark bilious matters
Day 9	coldness, much delirium, did not sleep
Day 10	pains in the limbs, all the symptoms exacerbated; he was delirious
Day 11	he died

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Case XIII. A woman, who lodged on the Quay, being three months gone with child, was seized with fever, and immediately began to have pains in the loins.

Day 3	pain of the head and neck, extending to the clavicle, and right hand; she immediately lost the power of speech; was paralyzed in the right hand, with spasms, after the manner of paraplegia; was quite incoherent; passed an uncomfortable night; did not sleep; disorder of the bowels, attended with bilious, unmixed, and scanty stools
Day 4	recovered the use of her tongue; spasms of the same parts, and general pains remained; swelling in the hypochondrium, accompanied with pain; did not sleep, was quite incoherent; bowels disordered, urine thin, and not of a good color
Day 5	acute fever; pain of the hypochondrium, quite incoherent; stools bilious; towards night had a sweat, and was freed from the fever
Day 6	recovered her reason; was every way relieved; the pain remained about the left clavicle; was thirsty, urine thin, had no sleep
Day 7	trembling, slight coma, some incoherence, pains about the clavicle and left arm remained; in all other respects was alleviated; quite coherent
Day 8	free from fever
Day 9	free from fever
Day 10	free from fever
Day 11	had a relapse, with shivering and fever
Day 14	vomited pretty abundantly bilious and yellow matters, had a sweat, the fever went off, by coming to a crisis

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Case XIV. Melidia, who lodged near the Temple of Juno, began to feel a violent pain of the head, neck, and chest. She was straightway seized with acute fever; a slight appearance of the menses; continued pains of all these parts.

Day 6	was affected with coma, nausea, and shivering; redness about the cheeks; slight delirium
Day 7	had a sweat; the fever intermitted, the pains remained
--	a relapse; little sleep; urine throughout of a good color, but thin; the stools were thin, bilious, acrid, very scanty, black, and fetid; a white, smooth sediment in the urine
Day 11	had a sweat, and experienced a perfect crisis

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