Epidemics, Sixteen

HISTORY 135F

Infectious and Epidemic Disease in History

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

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

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Case I. In Thasos, the Parian who lodged above the Temple of Diana was seized with an acute fever, at first of a continual and ardent type; thirsty, inclined to be comatose at first, and afterwards troubled with sleeplessness; bowels disordered at the beginning, urine thin.

Day 6	passed oily urine, was delirious
Day 7	all the symptoms were exacerbated; had no sleep, but the urine of the same characters, and the understanding disordered; stools bilious and fatty
Day 8	a slight epistaxis; small vomiting of verdigris-green matters; slept a little
Day 9	in the same state
Day 10	general improvement
Day 11	he sweated, but not over the whole body; he became cold, but immediately recovered his heat again
Day 14	acute fever; stools bilious, thin, and copious; substances floating in the urine; he became incoherent
Day 17	in a painful state, for he had no sleep, and the fever was more intense
Day 20	sweated all over; no fever, stools bilious; loss of appetite, comatose
Day 24	had a relapse
Day 34	no fever; no constipation; and he again recovered his heat
Day 40	no fever, briefly constipated, loss of appetite; had again slight symptoms of fever, and throughout in an irregular form; no fever at times; if the fever intermitted, and was alleviated for a little, it immediately relapsed again; he used much and improper food; sleep bad; about the time of the relapse he was delirious; passed thick urine at that time, but troubled, and of bad characters; bowels constipated, and again loose; slight fevers of a continual type; stools copious and thin
Day 120	he died

In this patient the bowels were constantly from the first either loose, with bilious, liquid, and copious stools, or constipated with hot and undigested faeces; the urine throughout bad; for the most part coma, or painful sleeplessness; continued loss of appetite. Ardent fever.

Explanation of the characters. It is probable that the weakness produced by the fever, the phrenitis, and affection of the hypochondrium caused death on the hundred and twentieth day.

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Case II. In Thasos, the woman who lodged near the Cold Water, on the third day after delivery of a daughter, the lochial discharge not taking place, was seized with acute fever, accompanied with shivering. But a considerable time before delivery she was feverish, confined to bed, and loathed her food. After the feverish chills, continual and acute fevers, with shivering.

Day 8	was very incoherent, and immediately afterwards became collected; bowels disordered, with copious, thin, watery, and bilious stools; no thirst
Day 11	was collected, but disposed to coma; urine copious, thin, and black; no sleep
Day 20	slight chills, and immediately afterwards was warm; slight incoherence; no sleep; with regard to the bowels, in the same condition; urine watery, and copious
Day 27	free from fever; bowels constipated; not long afterwards violent pain of the right hip-joint for a considerable time; fevers afterwards supervened; urine watery
Day 40	complaints about the hip-joint better; continued coughs, with copious, watery sputa; bowels constipated; aversion to food; urine the same; fever not leaving her entirely, but having paroxysms in an irregular form, sometimes present, sometimes not
Day 60	the coughs left her without a crisis, for no concoction of the sputa took place, nor any of the usual abscesses; jaw on the right side convulsively retracted; comatose, was again incoherent, and immediately became collected; utter aversion to food; the jaw became relaxed; stools small, and bilious; fever more acute, affected with fevered chills; on the following days lost her speech, and again became collected, and talked
Day 80	she died

In this case the urine throughout was black, thin, and watery; coma supervened; there was loss of appetite, despondency, sleeplessness; irritability, restlessness; she was of a melancholic turn of mind.

Explanation of the characters. It is probable that the suppression of the lochial discharge caused death on the day.

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Case III. In Thasos, Pythion, who was lodged above the Temple of Hercules, from labor, fatigue, and neglected diet, was seized with strong shivering and acute fever; tongue dry, thirsty, and bilious; had no sleep; urine darkish, a substance floating on the top of the urine, did not subside.

Day 2	about noon, coldness of the extremities, especially about the hands and head; loss of speech and of articulation; breathing short for a considerable time; recovered his heat; thirst; passed the night quietly; slight sweats about the head
Day 3	passed the day in a composed state; in the evening, about sunset, slight chills; nausea, agitation; passed the night in a painful state; had no sleep; small stools of compact faeces passed from the bowels
Day 4	in the morning, composed; about noon all the symptoms became exacerbated; coldness, loss of speech, and of articulation; became worse; recovered his heat after a time; passed black urine, having substances floating in it; the night quiet; slept
Day 5	seemed to be lightened, but a painful weight about the belly; thirsty, passed the night in a painful state
Day 6	in the morning, in a quiet state; in the evening the pains greater; had a paroxysm; in the evening the bowels properly opened by a small clyster; slept at night
Day 7	during the day, in a state of nausea, somewhat disturbed; passed urine of the appearance of oil; at night, much agitation, was incoherent, did not sleep
Day 8	in the morning, slept a little; but immediately coldness, loss of speech, respiration small and weak; but in the evening recovered his heat again; was delirious, but towards day was somewhat lightened; stools small, bilious, and unmixed
Day 9	affected with coma, and with nausea when roused; not very thirsty; about sunset he became restless and incoherent; passed a bad night
Day 10	in the morning, had become speechless; great coldness; acute fever; much perspiration; he died

His sufferings were on the even days.

Explanation of the characters. It is probable that the excessive sweats caused death on the tenth day.

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Case IV. The patient affected with phrenitis, having taken to bed on the first day, vomited largely of verdigris-green and thin matters; fever, accompanied with shivering, copious and continued sweats all over; heaviness of the head and neck, with pain; urine thin, substances floating in the urine small, scattered, did not subside; had copious stools; very delirious; no sleep.

Day 2	in the morning, loss of speech; acute fever; he sweated, fever did not leave him; palpitations over the whole body, at night, convulsions
Day 3	all the symptoms exacerbated; he died

Explanation of the characters. It is probable that the sweats and convulsions caused death.

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Case V. In Larissa, a man, who was bald, suddenly was seized with pain in the right thigh; none of the things which were administered did him any good.

Day 1	fever acute, of the ardent type, not agitated, but the pains persisted
Day 2	the pains in the thigh abated, but the fever increased; somewhat tossed about; did not sleep; extremities cold; passed a large quantity of urine, not of a good character
Day 3	the pain of the thigh ceased; derangement of the intellect, confusion, and much tossing about
Day 4	about noon, he died

An acute disease.

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Case VI. In Abdera, Pericles was seized with a fever of the acute, continual type, with pain; much thirst, nausea, could not retain his drink; somewhat swelled about the spleen, with heaviness of the head.

Day 1	had hemorrhage from the left nostril, but still the fever became more violent; passed much muddy, white urine, which when allowed to stand did not subside
Day 2	all the symptoms were exacerbated, yet the urine was thick, and more inclined to have a sediment; the nausea less; he slept
Day 3	fever was milder; abundance of urine, which was concocted, and had a copious sediment; passed a quiet night
Day 4	had a copious and warm sweat all over about noon; was free of fever, had a crisis, no relapse

An acute affection.

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Case VII. In Abdera, the young woman who was lodged in the Sacred Walk was seized with an ardent fever. She was thirsty, and could not sleep; had menstruation for the first time.

Day 6	much nausea, flushing, was chilly, and tossed about
Day 7	in the same state; urine thin,but of a good color; no disturbance about the bowels
Day 8	deafness, acute fever, sleeplessness, nausea, shivering, became collected; urine the same
Day 9	in the same state, and also on the following days; thus the deafness persisted
Day 14	disorder of the intellect; the fever abated
Day 17	a copious hemorrhage from the nose; the deafness slightly better; and on the following days, nausea, deafness, and incoherence
Day 20	pain of the feet; deafness and delirium left her; a small hemorrhage from the nose; sweat, apyrexia
Day 24	the fever returned, deafness again; pain of the feet remained; incoherence
Day 27	had a copious sweat, no fever; the deafness left her; the pain of her feet partly remained; in other respects had a complete crisis

Explanation of the characters. It is probable that the restoration of health on the twentieth day was the result of the evacuation of urine.

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Case VIII. In Abdera, Anaxion, who was lodged near the with Thracian Gates, was seized with an acute fever; pain of the right dry cough, without expectoration during the first days, thirst, sleeplessness; urine well colored, copious, and thin.

Day 6	delirious; no relief from the warm applications
Day 7	in a painful state, for the fever while the pains did not abate, and the cough was troublesome, and attended with shortness of breath
Day 8	I opened a vein at the elbow, and much blood, of a proper character, flowed; the pains were abated, but the dry coughs continued
Day 11	the fever diminished; slight sweats about the head; coughs, with more liquid sputa; he was relieved
Day 20	sweat, no fever; but after the crisis he was thirsty, and the expectorations were not good
Day 27	the fever relapsed; he coughed, and brought up much concocted sputa: sediment in the urine copious and white; he became free of thirst, and the respiration was good
Day 34	sweated all over, no fever, general crisis

Explanation of the characters. It is probable that the evacuation of the sputa brought about the recovery on the thirty-fourth day.

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Case IX. In Abdera, Heropythus, while still on foot, had pain in the head, and not long afterwards he took to bed; he lived near the High Street. Was seized with acute fever of the ardent type; vomitings at first of much bilious matter; thirst; great restlessness; urine thin, black, substances sometimes floating high in it, and sometimes not; passed the night in a painful state; paroxysms of the fever diversified, and for the most part irregular.

Day 14	deafness; the fever increased; urine the same
Day 20	and following days, much delirium
Day 30	copious hemorrhage from the nose, and became more collected; deafness continued, but less; the fever diminished; on the following days, frequent hemorrhages, at short intervals
Day 60	the hemorrhages ceased, but violent pain of the hip-joint, and increase of fever; not long afterwards, pains of all the inferior rule, that either the fever and deafness increased, or, pains of the inferior parts were increased
Day 80	all the complaints gave way, without leaving any behind; for the urine was of a good color, and had a copious sediment, while the delirium became less
Day 100	disorder of the bowels, with copious and bilious stools, and these continued for a considerable time, and again assumed the dysenteric form with pain; but relief of all the other complaints; on the whole, the fevers went off, and the deafness ceased
Day 120	had a complete crisis

Ardent fever.

Explanation of the characters. It is probable that the bilious stool brought about the recovery on the hundred and twentieth day.

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Case X. In Abdera, Nicodemus was seized with fever from venery [sexual intercourse] and drinking.

Day 1	at the commencement he was troubled with nausea and chest pain; thirsty, tongue was parched; urine thin and dark
Day 2	the fever exacerbated; he was troubled with shivering and nausea; had no sleep; vomited yellow bile; urine the same; passed a quiet night, and slept
Day 3	a general remission; amelioration; but about sunset felt again somewhat uncomfortable; passed an uneasy night
Day 4	shivering, much fever, general pains; urine thin, with substances floating in it; again a quiet night
Day 5	all the symptoms remained, but there was an amelioration
Day 6	some general pains; substances floating in the urine; very incoherent
Day 7	better
Day 8	all the other symptoms abated
Day 10	and following days, there were pains, but all less; in this case throughout, the paroxysms and pains were greater on the even days
Day 20	the urine white and thick, but when allowed to stand had no sediment; much sweat; seemed to be free from fever; but again in the evening he became hot, with the same pains, shivering, thirst, slightly incoherent
Day 24	urine copious, white, with an abundant sediment; a copious and warm sweat all over; no fever; the fever came to its crisis

Explanation of the characters. It is probable that the cure was owing to the bilious stools and the sweats.

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Case XI. In Thasos, a woman, of a melancholic turn of mind, from some accidental cause of sorrow, while still going about, became affected with loss of sleep, aversion to food, and had thirst and nausea. She lived near the Pylates, upon the Plain.

Day 1	at the commencement of night, frights, much talking, despondency, slight fever; in the morning, frequent spasms, and when they ceased, she was incoherent and uttered obscenities; pains frequent, great and continued
Day 2	in the same state; had no sleep; fever more acute
Day 3	the spasms left her; but coma, and disposition to sleep, and again awaked, started up, and could not contain herself; much incoherence; acute fever; on that night a copious sweat all over; no fever, slept, quite collected; had a crisis; the urine black, thin, substances floating in it generally round, did not fall to the bottom; about the crisis a copious menstruation

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Case XII. In Larissa, a young unmarried woman was seized with a fever of the acute and ardent type; sleeplessness, thirst; tongue sooty and dry; urine of a good color, but thin.

Day 2	in an uneasy state, did not sleep
Day 3	stools copious, watery, and greenish, and on the following days passed such with relief
Day 4	passed a small quantity of thin urine, having substances floating towards its surface, which did not subside; was delirious towards night
Day 6	a great hemorrhage from the nose; a chill, with a copious and hot sweat all over; no fever, had a crisis

In the fever, and when it had passed the crisis, the menses took place for the first time, for she was a young woman. Throughout she was oppressed with nausea and shivering; redness of the face; pain of the eyes; heaviness of the head; she had no relapse, but the fever came to a crisis. The pains were on the even days.

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Case XIII. Apollonius, in Abdera, was sick for some time without being confined to bed. His abdomen was swollen, and for a considerable time there was a constant pain about the liver, and then he became affected with jaundice; he was flatulent, and of a whitish complexion. Having eaten beef, and drunk unseasonably, he became a little heated at first, and took to his bed, and having used large quantities of goat's milk, both boiled and raw, with a bad diet otherwise, great mischief was occasioned by all these things; for the fever was exacerbated, and of the food taken scarcely any portion worth mentioning was passed from the bowels; the urine was thin and scanty; no sleep; grievous distension; much thirst; disposition to coma; painful swelling of the right hypochondrium; extremities altogether coldish; slight incoherence, forgetfulness of everything he said; he was beside himself.

Day 14	had a feverish chill, became heated, and was seized with furious delirium; loud cries, much talking, again composed, and then coma came on; afterwards the bowels disordered, with copious, bilious, unmixed, and undigested stools; urine black, scanty, and thin; much restlessness; stools of varied characters, either black, scanty, and verdigris-green, or fatty, undigested, and acrid; and at times the stools resembled milk
Day 24	enjoyed a calm; other matters in the same state; became somewhat collected; remembered nothing that had happened since he was confined to bed; immediately afterwards became delirious; every symptom rapidly getting worse
Day 30	acute fever; stools copious and thin; was delirious; extremities cold; loss of speech
Day 34	he died

In this case, as far as I saw, the bowels were disordered; urine thin and black; disposition to coma; sleeplessness; extremities cold; delirious throughout. Phrenitis.

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Case XIV. In Cyzicus, a woman who had brought forth twin daughters, after a difficult labor, and in whom the lochial discharge was insufficient, at first was seized with an acute fever, attended with chills; heaviness of the head and neck, with pain; sleeplessness from the commencement; she was silent, sullen, and disobedient; urine thin, and devoid of color; thirst, nausea for the most part; bowels irregularly disordered, and again constipated.

Day 6	towards night, talked much incoherently; had no sleep
Day 11	seized with wild delirium, and again became collected; urine black, thin, and again deficient, and of an oily appearance; copious, thin, and disordered stools
Day 14	frequent convulsions;extremities cold; not in anywise collected; suppression of urine
Day 16	loss of speech
Day 17	she died

Phrenitis.

Explanation of the characters. It is probable that death was caused, on the seventeenth day, by the affection of the brain consequent upon her labor and delivery.

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Case XV. In Thasos, the wife of Dealces, who was lodged upon the Plain, from sorrow was seized with an acute fever, attended with chills. From first to last she wrapped herself up in her bedclothes; still silent, she fumbled, picked, bored, and gathered hairs (from them); tears, and again laughter; no sleep; bowels irritable, but passed nothing; when directed, drank a little; urine thin and scanty; to the touch of the hand the fever was slight; coldness of the extremities.

Day 9	talked much incoherently, and again became composed and silent
Day 14	breathing rare, large, at intervals; and again hurried respiration
Day 16	looseness of the bowels from a stimulant clyster; afterwards she passed her drink, nor could retain anything, for she was completely insensible; skin parched and tense
Day 20	much talk, and again became composed; loss of speech; respiration hurried
Day 21	she died

Her respiration throughout was rare and large; she was totally insensible; always wrapped up in her bedclothes; either much talk, or completely silent throughout. Phrenitis.

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Case XVI. In Meliboea, a young man having become heated by drinking and much venery, was confined to bed; he was affected with shivering and nausea; sleeplessness and absence of thirst.

Day 1	much feces passed from the bowels along with a copious flux; and on the following days he passed many watery stools of a green color; urine thin, scanty, and deficient in color; respiration rare, large, at long intervals; softish distention of the hypochondrium, of an oblong form, on both sides; continued palpitation in the front walls of the abdomen throughout; passed urine of an oily appearance
Day 10	he had calm delirium, for he was naturally of an orderly and quiet disposition; skin parched and tense; stools either copious and thin, or bilious and fatty
Day 14	all the symptoms were exacerbated; he became delirious, and talked much incoherently
Day 20	wild delirium, restless tossing and twitching, passed no urine; small drinks were retained
Day 24	he died

Phrenitis.

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