Infectious and Epidemic Disease in History

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

Week 3.  Context

excerpts from
Al'-Arjuzat fi' t-tibb
(Poem on Medicine)
by 'Abu 'Ali al-Husain ibn 'Abd Allah ibn Sina,
known to Europeans as Avicenna (c.980-1037)

Preface in Prose

The Sheikh, the Prince of Physicians, 'Abu 'Ali al-Husain ibn 'Abd Allah ibn Sina stated:

It was customary for philosophers and men of knowledge of ancient times to serve kings, amirs, caliphs, viziers, judges and jurists by drawing up for them writings in prose and poetry, volumes consecrated to the arts and sciences and especially medical poems.

As for physicians, they often write poems in rajaz and make collections which permit us to distinguish the eloquent man from the one who is not, the skillful from the incompetent. Thus, it is that kings became acquainted with the precepts of medicine and philosophical methods.

I have seen that in certain countries medical art did not promote discussion meetings, nor polemics, as much in hospitals as in schools; I have seen people, unprovided with a scientific foundation, without any idea of its laws and deprived of any ethical formation, busy themselves with medicine without having studied it. Thus, men without thorough knowledge have pushed themselves forward and have considered themselves teachers. Now, I cast myself upon the footsteps of the ancients and the philosophers and I have served his Excellency, our Majesty the Vizier, the Jurist, the Judge, the Illustrious, whose position is exalted (may Allah prolong his life, allow his power and his glory to continue and overthrow his jealous subjects and his enemies); I have served him with this 'Arjuzat , a poem which deals with every part of medicine.

I have divided this 'Arjuzat in a remarkable manner; I have dressed it with a complete raiment and adorned it with a gown of beauty.

It is drawn up in a very simple style, in convenient versification, so that it may be easy, less difficult to understand.

When Our Majesty looks at it with all his acuteness of mind and it takes a place among his books in a small form, he will make use of it in order to acquire this magnificent science. Then, he will know how to discern the true practitioner from the despicable mob, the apprentice from the perfect savant, and the erudite from the blockhead.

I beseech Allah to help me in one of those works which bring us nearer to Him and lift their author to His eyes.

It is from Him that I beg His help and in Him that I place my confidence....

Preface in Verse

...The arts and speech distinguish man from animal.  The best of men do good by accompanying it with courteous words, preoccupying themselves with the body, granting to it its rightful mirth.  Poets are the princes of the Word; physicians rule over the Body.  The eloquence of the former rejoices the soul; the devotion of the latter cures illnesses.  In this poem is included all Theoretical and Practical Medicine.  And here I am, putting into verse all I know of this science.


Medicine is the preservation of health and the cure of disease which arises from conscious causes which exist within the body.

A first division will be:  Theory and Practice.  Theory within itself is divided into three sections.  There are seven natural components and six vital factors.  Indeed, they are found in books.  They are the diseases, the symptoms and the causes.  Practice is divided into two actions: one performed with the hands, the other with medicine and dietary regimens.


I.  Elements

The elements are the constitutive factors of bodies.  The opinion of Hippocrates on the subject of the elements is accurate; there are four of them:  water, fire, earth, air.  The proof of the accuracy of this notion is that after death, the body returns to them through necessity.  Moreover, if it were composed of only a single element, one would not know how to observe any living being touched by illness.

II.  Temperaments

After that, perfect knowledge of the temperaments aids in the treatment of illness.  The temperament has four aspects which the physician will separate or join together.  It may be warm, cold, dry or moist, expressions perceptible by touch.  These qualities are found in the elements [earth, water, air, fire], in the seasons, in the kingdoms [animal, vegetable, mineral], and in places.

The raw material is the primordial constitutive source of bodies.  Warmth is in fire and air, cold in earth and water, dryness between fire and earth, moisture between water and air.  These qualities are also found in the elements which are of different natures and which make up bodies by their arrangements.  These qualities are different in that there will be only one and they group themselves without opposing each other.

We have an idea of the temperament of someone because of this arrangement of elements and thus, we give him the classification of that which predominates.  The temperament is said to be balanced when it includes the four qualities.  They exist in man according to certain proportions which serve as a pattern and model.

Every man, in whom the qualities are not in equilibrium and which lead him towards one extreme, is not void of the others because of that, but they do not exist in comparable proportion. He carries the classification of the dominant one:  he is said to be of a given temperament of fire, earth, water or air.  Behold medical nomenclature!...

III.  Humors

The body is made up of humors of different colors and of different temperaments.  They are phlegm, yellow bile, blood and black bile.

Natural phlegm is tasteless and mixed with cold; there is a variety known under the name of glassy, thick and of a cold temperament; another is sweet which is not void of warmth; there is also one called salty which leans towards warmth and dryness; another is acid and is the coldest; it is found in the sick stomach.

Yellow bile allows several shades; one is known under the name of smoky; another is like the verdigris and the leek, which is the healthiest; another is like egg yolk and is not unhealthy; still another is a reddish color and is found in the gall bladder.  Warmth is attributed to all.

It is likely that the seat of black bile is in the spleen.

The origin of the blood is in the liver; the veins transport it throughout the entire body.  There is also some blood in the heart; it has a warm, moist character.  The nature of the blood is perplexing; otherwise, it is not normal.  It results from the mixture and the combustion of other humors.

IV. Organs

The essential organs of the body are four in number; the others are only ramifications of them.

  • One of them is the liver:  the nutrition of the body depends upon it.
  • The heart itself gives life; without it, man would be a plant; it is the source of natural warmth which follows the two large arteries.
  • The brain, by way of the spinal cord and some nerves, prevents the heart from catching fire.  It is from the latter that the motor influx of the joints leaves.
  • The testicles themselves are the organs of reproduction; through them, the species perpetuate themselves; their absence causes them to disappear.

The skin, flesh, different kinds of glands are the agents of the functions of the body.  The bones, membranes, ligaments are the supports and protection of it.  So that form and constitution be perfected, there are auxiliary organs of the principal one.  The fingernails are tools for the extremities; hair eliminates the residues and ornaments the body.

V.  Inspirations

The natural spirit is formed from a perfect and unspotted vapor.  The animal spirit which is found in the heart maintains life.  The vital spirit has the brain for a substratum and matures in the meninges.  These different varieties are perfected in the cerebral convolutions; that is, likewise, the seat of feeling and thought.  Each one of these spirits has strictly its own properties.

VI.  Forces

There are seven forces in human nature, different in appearance:

  • one acts on the seed without giving it form;
  • another gives the body of the embryo its shape, its size and its organs;
  • another is attractive and maturing;
  • another restrains and expels;
  • a fifth distributes to the parts of the body what they need for food;
  • the vital force is duple; likewise, its action: one acts on the pulse through dilatation and constriction of the arteries;
  • its sister governs the feelings which involve actions, love, hate, baseness or elevation of the soul.

There are nine properties in the soul.  Five of them are related: hearing, sight, smell, taste, and touch in its entirety; one goes to the nerves; through it man moves his joints; another represents objects as seen in a mirror; another governs thought; the last, memory.

VII.  Actions

Conditioned by forces, actions are equal in number to the former....


I.  Air

The sun influences the air:  this is true for the seasons and for the phases of the moon.  It acts on climates with which we have already dealt.

The atmosphere changes its condition under the influence of the stars at their rising and setting.  When the sun draws near, it puts fire into the air, whence shooting stars.  It is similarly true that after this star has disappeared, the atmosphere has already become cool.  If stars of evil omen appear, they decree death for men.  If, on the contrary, they are of good omen, they determine absolute health.

If a town is built upon a mountain, it is cold because of this.  In a flat, low area, it is warmer; facing the south, it is warmer when the wind blows from the south.  When back to back with the mountains on the south side, the north wind will chill it.  Facing the west, its air will be heavier; contrariwise, on the east, the air will be lighter.

The seas have an opposite influence.  That is what scientists have reported.  Winds modify the atmosphere just as do the phases of the moon.  The south wind possesses warmth and moisture for which reason it spoils things easily.  The north wind possesses coldness and dryness; it brings on a cough.  The east wind possesses warmth and tenuity; the west wind, coldness and heaviness.

Each region is moist in which soil is wet and around which marshes are found.  If there are fresh water lakes around the town, it is moist.  On the contrary, the air is dry in the vicinity of rocks and salty terrains.

The residence provided with numerous openings receives all winds; it is very cold in winter, very warm in summer.  It is just the opposite for a subterranean residence....

II.  Food and Beverage

Be aware that it is food which ought to cause growth.  For adults, it replaces instantly that which, being dissolved in the body, would decrease in quantity.  The most commendable is the one which forms a pure blood when being transformed; for example, a good loaf of semolina, the meat of young chickens.  Likewise, the vegetable beet agrees with sick people.  Among foods certain ones are thick; example:  semolina and two-year-old lambs with flavorful meat.  The fish caught in rocky waters is a thick food which agrees with people who have to work hard.  Among foods, there are some which, by themselves unpleasant to taste, are useful such as mustard, onion and garlic.  In reality, they generate yellow bile; they are sometimes used as medicine.  There are some which produce black bile and may make certain people sick; for example, old goats, old bulls, bread made from wheat with its impurities; that is dangerous.  There are also those which create phlegm; for example, large fish and milk.

Fresh river waters preserve their original moisture.  They cause the elimination of residues and carry nourishment within the vessels.  The best is rain water for it contains nothing harmful.  Among all waters certain ones have lost their primitive qualities and have assumed those of the substance which is mixed in it.  Wine, date wine and milk nourish the body.  There are some which lend their temperament to the body; for example, oxymel when it is assimilated.

III.  Sleep and Wakefulness

Sleep is the rest of the forces of the body, motor as well as sensory.  In reality, it warms the interior, whence more complete digestion of food.  However, if it is prolonged, unhealthy humors fill the interior of the head.  It moistens the body, relaxes and destroys the warmth which enlivens it.  The state of moderate wakefulness causes the senses to function; it makes them active; it gives energy in action and thus, rids the body of its residues; but if it is prolonged, it becomes a restlessness which generates affliction and sadness; in reality, it debilitates the soul and the body, alters the complexion and the colors, makes the eyes sunken, disturbs digestion, lessens judgment and is emaciating.

IV.  Movement and Rest

Among physical exercises, there are some moderate ones; it is to them that one ought to devote himself.  They balance the body by expelling residues and impurities and are factors of good nutrition for adults and of happy growth for the young.  Unmoderated exercise is an overload, alters the forces of the soul, leads to lassitude, consumes natural warmth, empties the body of its moisture, weakens nerves through the violence of pain and causes the body to age before its time.  There is no illusion about prolonged rest:  no advantages in its excess; it fills up the body with noxious humors and it does not place it in a state from which to benefit from its nourishment.

V.  Elimination and Obstruction

The body needs elimination for all its organs and for the brain.  Phlebotomy and drugs, taken in the spring, are very useful for people.  The emetic ought to be administered in the summer and the black bile expelled in the autumn.  Gargle and cleanse your teeth in order to have your dentition and palate clean.  Provoke urines; otherwise, fear dropsy.  Expel the menstrua under pain of putrefaction.  Use the purgative because with that, you will avoid the colic.  Make use of baths in order to carry away impurities.  Do not be slothful to make the residues come out of the pores and to rid the body of its uncleanliness.  Allow sexual relations for young people:  through them they will avoid masturbation.  On the other hand, forbid them for the weak, old and debilitated people.  Promise gout and pains for those who cohabit after the meal.  The abuse of intercourse weakens the body and gives as a reward all kinds of illnesses.

VI.  Sensations

Rage causes warmth; sometimes it brings on illnesses.  Fright brings on cold; sometimes it is such that it causes death.  A great joy makes the body prosperous.  There are some noxious ones which generate too much obesity.  Sadness may be fatal to the emaciated; it is useful for those who wish to lose weight....


I.  Causes

The causes are divided into external -- those which reach the surface of the body -- for example, fire or snow, a blow suffered, a split made by jumping, and into internal -- which are of different kinds -- for example, decomposition which brings on the so-called putrid fever.  There are also antecedent causes which correspond to every state of retention in the body.

A. Alteration of the humors

Among the causes of illness, one admits that the temperament of an organ may be altered by the overflow of humors in it.  It is necessary to face the power of thrust of the humor, the weakness of the receiver, the quantity of that evil humor and also the calibre of the vessels, the weakness of nutrition.  That suffices to explain everything.  Then, you will see, if it is dominated by that humor, that the organ may change temperament towards its opposite.

Whatever causes warmth brings great torments to the human body.  Warmth may be inherent; for example, in garlic; it may be real; for example, in warm wind.  Among these causes are the torments of the soul, like anger, and the movements of the body, like fatigue.  Decomposition, lack of nourishment and everything which closes the pores of the skin like cold air.

Everything which brings cold to the organism may succeed in causing a break of continuity.  There exists an inherent coldness; for example, in henbane if it is absorbed and a real cold, such as that of snow.  Great hunger weakens the vital breath as the lamp lacks oil.  Eating to repletion, in an exaggerated manner, smothers warmth.  Violent and prolonged movements expel the vital breath and the body becomes cold.  Rest by itself cools the body in the same manner that smoke extinguishes the flame.  Excess thickness of the body retains warmth, leading to its own extinction.  The emaciated body becomes cold to the point that you believe it radiates its heat.

There are five kinds of moistures; they are described and counted.  Lukewarm fresh water brings true moisture by aiding the body.  Inherently, the use of milk, fish and fresh cheese brings the moist element as does the rest of the body with excessive eating and accumulation of humors.

There exist five causes of dryness understood by the mind and perceived by the senses.  In reality, certain ones dry:  the north wind, for example; others have an inherent dryness, such as mustard.  Hunger consumes the moisture of the body and, likewise, all violent movements and disturbances and also excess elimination as in diarrhea.

B. Physical alterations

The causes of the excess of volume of organs are the formative power and alimentation.  The causes of atrophy of organs are the opposite of the aforementioned ones.  The cause of alteration of forms are the following:  a bad constitution of the uterus or the paucity of readiness of sperm, or difficult expulsion of the fetus, whence alteration of its form by torsion; sometimes, it is the wet nurse who does not know how to swaddle the infant or to nurse him or to put him to bed correctly, or feeds him too much; sometimes weaning will be imperfect; sometimes his weakness causes the infant left to himself to fall; then, he may break a leg or thigh; falling on his nose may leave it flattened; medicine can do nothing for it; if following a fracture one does not have the patience to wait for healing, consolidation will never be perfect; sometimes it is the too great abundance of humors, elephantiasis or the opposite in chronic phthisis [wasting disease], torsion of the mouth made by relaxing the nerves or by their contracture which causes the head to lean to one side; scars of abscesses and ulceration sometimes change the external appearance.

I have thought at great length in order to summarize the different causes of the occlusions of ducts.  They are the exaggeration of the force of retention and the weakness of that of expulsion.  Cold closes the ducts; dryness does it just as strongly and so does ligation.  An abscess may compromise them; likewise, torsion and also astringent medication.  That may happen after scarring of a wound or by vegetation or by the growth of a fleshy tumor; likewise, an accumulation of humors, pus, blood, curdled milk or water; this also occurs with abscesses, worms, stones, dry stools and gases....

Everything which increases the number of organs or limbs comes from the excess of materials.  If the material is good, for example, one has an extra finger; if it is bad, it is, for example, a ranula [small cyst on the tongue].  Whatever decreases the number comes from the opposite of what I have stated above.

Whatever causes moisture to disappear causes roughness, such as a humor, smoke, powder, astringent food and certain drugs; a viscous humor and everything which is fat produce flexibility.

Elements which are normally separated may reunite; an example is the joining of a surface wound of a limb with the wound of a neighboring limb.  That comes from the exaggeration of the force of mutation and of the weakness of that of formation.  It is the break of continuity which separates that which ought to be united normally in form as well as in position.  This is true for all organs; here are the causes of this mishap.

This may be a burning, decaying, corrosive or penetrating humor, a weight which demolishes or destroys or a viscous humor which separates articulations, an unfortunate leap which fractures, a wounding stone which causes a fracture; there are also corrosive and destructive medications; the scalpel and the air which causes splitting by expanding and fire which acts upon the skin.

II.  Symptoms

Certain illnesses are recognized through what the body produces, by what supervenes in it, by what is expelled:  sputum, stools, sweat, urine.  A normal function may be disturbed in three different manners:  weakness, complete arrest and alteration.  Each one has its own explanation.  Weakness of function; example, for sight it is the decrease in light perception; the arrest of that function is blindness; alteration of function consists in seeing that which does not exist.  Judge all organ disturbances by analogy with this example.

Symptoms are obtained through the physical examination of the body at certain moments.  There are some visible ones, such as jaundice and edema; there are some perceptible to the ear, such as the gurgling of the abdomen in dropsy; the foul odor strikes at the sense of smell; for example, that of purulent ulcers; there are some accessible to taste, such as the acidity of the mouth; touch recognizes certain ones: the firmness of cancer!

Symptoms obtained from the products eliminated from the body are accessible to the five senses.  Urine may be red or black.  Sputum may be bloody or frothy.  There are some which signify an expulsion:  flatulence, sneezing, hiccoughs.  Vomitus may be acid, bitter or astringent.  If urine is fetid, that indicates an ulcer of the bladder.  As for sweat, it may be cold, thin or viscous.  These symptoms are signs of illness for the patient and also are indications for the physician.  I have summarized them above and now am going to delve into the details.

Every symptom has a value in the past, present and for the future.  Example of past symptoms:  the moisture of perspiring.  By itself one of these signs is inadequate and cannot sway our opinion.  That which indicates something of the present and of the future is absolutely necessary and serves as a foundation for our medicine.  Among the symptoms, there are generalized ones and localized ones.  I shall speak of the latter further along in the section on "Practice."

III.  Signs

Every general sign refers to noble organs:  liver, brain and heart are undeniably the principal ones.

A. From the functions of the brain

The healthy mind possesses an accurate imagination, reasoning and memory; normal movement and feeling indicate the integrity of the brain; their alteration signifies its illness.

B. From the functions of the heart

When the heart functions well as regards its beating, it is the a sign of good health; the abnormal pulse indicates its alteration.  It specifies afflictions and illnesses because of different kinds of disturbances.

The kinds are ten in number, enumerated only for skillful physicians:  the first, by measuring its amplitude, indicates excess or equilibrium; the full one presents important proportions during the examination; it gives information about the power of the heart; the weak one is just the opposite as regards the force; there are a long and a short, a narrow and a full, a superficial and a deep.

The frequency of the pulse is in harmony with different characteristics.  There is a quick and rapid one which indicates power and warmth; there is a slow and relaxed one which indicates weakness and cold.

Measurement of the interval between beatings determines several possible varieties.  Constant, without stopping, indicates weakness and warmth; intermittent, on the other hand, indicates softness and cold.

Its strength allows the recognition of two varieties:  a strong one which thumps and its opposite, weak, which beats lightly....

Be aware that different pulses exist according to ages, seasons, regions, temperaments of individuals, men and women, and their complexion.  Warmth causes a rapid pulse just as do youth and being a male, and also southern countries, weakness, pregnancy and summer.  In the cold country, the pulse is slow; likewise, for old men and during the winter, and also for women, obese people with weak flesh and in the northern countries.  Every state of dryness causes firmness of the pulse; every state of moisture, its softness.  Every pulse of a balanced temperament is also that way and, likewise, that of the spring.  In the country of the fourth climate, the pulse is balanced.  The pulse of the child is rapid and soft; that of the adult is slow and firm; the pulse of the one whose body is loaded with humors is full; after evacuation, the pulse is empty and confined.

C. From expectoration

The chest and lungs are organs of respiration; if they are healthy, life is secure; if their function is abnormal, the heart becomes inflamed.  It is expectoration which marks illness of the chest.  An illness which has not yet matured has no expectoration; the appearance of maturation is shown by a very fluid expectoration.  If it is average, that indicates that the illness is in the middle of its phase of ascension; very abundant and thick, that signifies the end of the development; fluid expectoration shows that the causal humor is itself acute which means that drainage will be rapid.  It is just the opposite if it is thick; black sputum marks the violence of inflammation; green sputum, a porraceous [greenish] bile; that with a bright yellow tinge, an egg-yellow bile.  White indicates phlegm; the red, blood.  Fetid sputum proves decomposition within the lung; the absence of offensiveness removes that idea.  If the sputum has a round form and if the patient is febrile, realize that there is an effusion.  If there is no fever, one is dealing with phthisis.  Mature sputum is rejected without cough, and is white, thick, homogeneous and without odor in the beginning.

D. From the function of the liver

It is in the liver that the humors are born; from there they are spread throughout the body.  Every organ functions because of it and it alone has no need of the others.  The vital spirit is born in the vapor of the liver; the body is healthy according to its state.  If the humors are healthy, the body is; the former are if the liver is in good state.  Water carries food to it and the water is mixed with the predominant humor and, with its expulsion in the urine, shows that it contained residues.  Urine has different colors and everything that the humors have left in it appears to us as a sediment.  It is apparent, from what I have stated and wise men witness it, that urine is a faithful guide for the knowledge of the illness.

E. From urine

While urine witnesses the quantity of ingested food and drink, it is a sign of bad digestion, phlegm, cold, restlessness or of hepatic obstruction.  Somewhat yellow, it indicates the presence of a certain quantity of bile.  The color of fire, that means the presence of a great deal of yellow bile.  Very yellow and tinted with red, it proves a super abundance of yellow bile.  Dark red urine of the one who has not ingested saffron and who has had neither fever nor colic contains blood.  When found black after having been dark, it signifies that the patient has suffered a great chill.  Black after having been very red indicates a poor combustion of humors.  Judge the illness according to the odor of urine on the condition that the patient has not ingested a coloring food, certain vegetables, cassia fistul a [dried pods of the Cassia fistula, or Golden Shower tree] and that which may tint like murri [acidic condiment made of wheat, barley and other ingredients].

The tenuity of the urine indicates inadequacy of digestion.  Sometimes it is fluid after indigestion or obstruction of the liver or because of a tumor.  The thickness of the urine indicates good digestion or the abundance of phlegm in the body.

The white sediment indicates recovery; yellow, it marks acuteness of the bile; if it is red like the bloodwort, it is a question of disease of the blood.  If a similar sediment continues without modification, that indicates an abscess of the liver.  Black after having been dark red and that after loss of strength, going to the bottom after having floated, that means the soul is about to escape; the patient can no longer benefit from the prayers of a sorcerer; death is at hand through the excess of humoral combustion.  If the sediment appears black after having been dark and if it does not occur in the course of an acute illness, especially if this appearance coincides with a favorable sign, and if the origin of the illness is in black bile, it indicates the end of the illness.

If a cloud appears floating in the upper portion of the vial, it indicates crudeness of the illness.  If a certain maturity exists in the urine, wind is causing the sediment to reascend to the surface.  If the sediment is half-way up, be aware that the wind is in small quantity.  If it is white, after having been yellow, coherent without being thick, falls to the bottom, appears with a changeable color, it marks the maturity of the illness.

An ephemeral sediment indicates the weakness of the patient.  If there are elements similar to barley meal in the urine, one is dealing with scrapings of the vessels.  If the sediment looks like bran and has a bad odor, it indicates ulceration within the ducts; like metal filings, it proves the elimination of portions of organs.  If pus appears in the vial, it marks the opening of a collection.  If the sediment has decomposed blood, there is a phlegmonous tumor.  If it goes to the bottom, resembles sperm, it comes from an immature lymph swelling.  If one sees sand in it, be aware that there is a calculus.

If the urine has no odor, it is that the food has not been digested or has been ingested raw.  The degree of decomposition agrees with the intensity of the odor of the urine.  If this odor is dreadful, be aware that the illness is in the bladder.  Thus, I have reported on the different kinds of urine; guide yourself by what I have stated about their composition.

F. From the examination of stools

The stools give information about the state of the stomach, sometimes about the intestine and the liver.  If they are sparse, it is that nourishment has been carried toward the organs, or that the repelling force is weak, the drawing force strong because of an illness.  If they are white, there is an obstruction of the biliary tracts or a tumor; jaundice is the visible witness, the urine equally yellow; or the body is in a very bad state following an illness due to phlegm or too cold a temperament.  If the stools are red or fire colored, that indicates an excess of yellow bile.  If they are porraceous or verdigris, there is a developing illness.  Black, they show evidence of a chronic and violent chill within the body of the patient and if that is produced during an acute illness, death is at hand.  Hard stools show the power of the force of assimilation, a burning heat or a constringent food.  Soft and light, they mark the paucity of the force of assimilation, there is coldness within the body which is changing it or the food was a laxative.  If the stools are delayed, it is a sign of digestion difficulty at the level of the intestines, weakness of the force of expulsion, of coldness or that the intestines are retaining them.  Expelled rapidly, they prove that the food is slippery and does not linger, that the moisture of the humors is cast into the stools abundantly, that the mesentery [membrane in the abdominal cavity that supports the intestines and attaches them to the spinal wall] has no drawing force or that the intestine is affected; one may be dealing with ulcers, indigestion or even another illness.  If they are expelled with noise, that means an excess of intestinal gas.  If they contain pus, that marks intestinal tumors.  If there is blood with expulsion, that means excoriation.  If they are fetid, there is a serious putrefaction.  If they seem to be coated with oil, that indicates liquefaction of the body fat. Their sour-wine odor means acid phlegm.

G. From sweat

An abundant sweat is a symptom of moist illnesses.  It is a sign of a strong temperament; that is not true of intermittent sweating.  A very abundant perspiration coinciding with a progressive weakening of the patient means the diminution of strength of his being and his death is at hand.  In the course of illnesses, a light perspiration indicates closure of the pores, thickness of the humors, debility of the expulsive force, lack of maturation of food and softness of the body of the patient.

If in the course of an illness sweat is white, this illness is phlegmatic; yellow, for yellow bile; black, for atrabile; red, it indicates an illness of the blood; its flavor may also be a guide.  A thin perspiration means thinness of the humors; similarly, its thickness.  If it affects the whole body, it is a good sign; localized, it is troublesome.  If it appears at an opportune time or at a period of crisis, it is an excellent and commendable sign; in the opposite case, it is far from being good.

IV.  Prognosis

If among the humors the blood carries predominance, sleep and migraine are exaggerated, vessels turgid and red, sometimes thought revolts; there is a heaviness of the head, weakness of sensation, carelessness, warmth to the touch, heaviness of the shoulders, yawning; sometimes heaviness of the flanks; nose bleeding, the desire to stretch out, relaxing of the abdomen, search for a life of well-being, dreams, varied joys, and of all colors, gaiety, longings for phlebotomy, unusual ruddiness of the eyes, furuncles and pustules, dreams of sweet things, a sugar flavor in the mouth, as if the patient had just eaten some, appear.  If these symptoms are seen in the spring or during the prime of youth, they indicate diseases of the blood....

If bile is predominant, the shade of the body is yellow, the appetite weak, the mouth bitter.  There are gastric burning, vomiting of bile, a powerful diarrhea, restlessness, sunken eyes, dry mouth and tongue.  Between times the urine is yellow, the patient has episodes of syncope [fainting], some goose-bumps, is sad, is thirsty without appetite and dreams of flames; his pulse is week, his body febrile. Frequent warm baths are the cause of this state as are sojourns in southern countries, youth and the prolonged misuse of spiced foods, especially in the summer.

If black bile predominates, the body is wan, thoughts sullen, appetite reduced, an acid flavor in the mouth.  On examination, anguish, rigidness of the face, pulse firm in its slowness; the patient is constipated, presents black spots, sadness, restlessness without agitation.  Urines are white, not very dense, crude; similarly, the stools are not digested.  The causes are dry food, anxiety, permanent sadness and misery.  In his dreams, the patient sees dangers and completely frightening things.  This affects the mature age in autumn, in northern countries and the weakened man.

If phlegm predominates, the head is heavy, the sleep prolonged; there is a laziness of movements, little appetite; plethora is in harmony with the force of the individual; he is slow in his gait, his intelligence is slow, he leans towards an unusual softness, foams, has a swollen face, his shade is dull; the pulse is slow and thick; urine dense, strong and crude; thirst is reduced except when the phlegm is salty or decayed.  The cause of this state is cold and moist food, old age, winter, sedentarity, lack of warm baths, sometimes gluttony, the sojourn in a country damp because of its water flow; in his sleep, the phlegmatic person dreams of seas, complains of nightmares and his chyme [digested matter as it leaves the stomach] is not digested well.  If you see these exact symptoms, messengers of illness in individuals in good health, endeavor to make them disappear....

V.  Duration of illnesses

Every illness has its duration:  the short one is called acute; it kills in a short while or ends with a favorable crisis; it matures rapidly; its periods are very close together and teeming in accidents.  You will recognize it by the abruptness of its beginning.  Then, allow your patient an accommodating diet; do not give him too much nourishment for his strength nor any too small and unsubstantial; otherwise, you will change everything from the beginning and it will not come to an end.  On the other hand, let the food be measured wisely for him like provisions for a traveler.  If you see any danger signals appear, of malignancy or pain, if the strength of the patient declines, if his reasoning is disturbed, if he raves, if he does not sustain his illness, warn him of his probable death before the end of the development.  Be aware that death is foreseen by grievous signs and by bilious manifestations.

There exist illnesses of long duration, called chronic, which only change the organism slowly but which kill by consumption, phthisis, hemorrhage, anemia; they may heal after a long development and end by maturity and dissolution. You will recognize them by the lack of the seriousness of symptoms and by the fact that they are cold; do not feed your patient inadequately: he will lose strength.  Between these two kinds of illnesses, there is one of intermediate duration, neither short nor long, for which the diet should be medium in strength and amount.

VI.  Crisis

Be aware that the crisis is a brutal and rapid change which is produced in the course of acute illnesses and means the battle between the latter and the patient.  It resolves in a short while, be it death or be it healing.  Between the strength of the patient and the illness exists such a violent hostility that it is a veritable war; if the strength has it, the crisis is favorable whence survival and safety; if the illness has the victory, it means death....

  • If you see a tenacious, serious illness of the blood show troublesome symptoms with the cerebral accidents afterwards affecting all the senses, if blushing and nasal pruritus [intense itching] appear, the end of the crisis will be marked by a nose bleed.
  • If accidents occur on the lower part of the body, continuous pains around the umbilicus, retention of the menstrual flow, the end will be the appearance of menstruation.
  • If there are no pains of the upper portion of the body but under the sides, if the patient complains of his liver and the pain radiates towards the anus, you will make no error by announcing healing after a hemorrhoidal flow.
  • If the illness comes from yellow bile and during the period of decline a swelling of the head appears, migraine with pains, do not be impatient: the crisis will end with a nose bleed.
  • If mishaps lie at the level of the stomach of a patient who suffers with his liver, with nausea and syncope, the crisis will end with vomiting.
  • If there is no headache but the patient suffers with his abdomen, with swelling of the umbilicus and if there is constipation, be on guard: the crisis will end with an intestinal flow.
  • If there are no colic, no serious symptoms, few disturbances, no restlessness, no perspiration, if the illness develops without acuity, with suprapubic pains, remember from me this precise opinion:  the crisis will be urinary.
  • If the patient urinates without retention, does not complain about his pubis, if the pores of his skin are open and if there are no violent pains, nor dryness, nor restlessness, the crisis will be manifested by sweating.
  • If there are pains at the crossroads of lymph nodes, the crisis will occur with their suppuration [removal of pus].

Treat your patient with the conduct inspired by the signs indicating death or survival....

Go to:
  • Regimen Sanitatis Salernitanum (ca. 11th c.) commonly attributed to "John of Milano", English translation (1608) by Sir John Harington (1561-1612) accompanied by excerpts from The English physitian: or an astrologo-physical discourse of the vulgar herbs of this nation (1652), by Nicholas Culpeper (1616-1655):
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