Infectious and Epidemic Disease in History

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

Week 1.  Crowds

adapted excerpts from Books I and III
Of the Epidemics (400 BCE)
by Hippocrates (460-377 BCE)



In Thasos, during autumn, about the time of the equinox to near the setting of the Pleiades, the rains were abundant, constant, and soft, with southerly winds.

The winter was southerly, the northerly winds faint, droughts; on the whole, the winter had the character of spring. 

The spring was southerly, cool, rains small in quantity. 

Summer was generally cloudy.  No rain.  The Etesian winds few, light and irregular.

Ardent Fevers and Swellings about the Ears
The whole constitution of the season being thus inclined to the southerly, and with droughts early in the spring, from the preceding opposite and northerly state, ardent fevers occurred in a few instances, and these very mild, being rarely attended with hemorrhage, and never proving fatal.  Swellings appeared about the ears [mumps], in many on either side, and in the greatest number on both sides, being unaccompanied by fever so as not to confine the patient to bed; in all cases they disappeared without giving trouble, neither did any of them suppurate [fester; fill with pus], as is common in swellings from other causes.  They were of a lax, large, diffused character, without inflammation or pain, and they went away without any critical sign.  They seized children, adults, and mostly those who frequented the wrestling school and gymnasium, but seldom attacked women.  Many had dry coughs without expectoration, and accompanied with hoarseness of voice.  In some instances earlier, and in others later, inflammations with pain seized sometimes one of the testicles, and sometimes both; some of these cases were accompanied with fever and some not; the greater part of these were attended with much suffering.  In other respects they were free of disease, so as not to require medical assistance.

Early in the beginning of spring, and through the summer, and towards winter, many of those who had been long gradually declining, took to bed with symptoms of consumption; in many cases formerly of a doubtful character the disease then became confirmed; these were those whose constitution inclined to be consumptive.  Many, in fact most of them, died; and of those confined to bed, I do not know if a single individual who survived for any length of time; they died more suddenly than is common in such cases.  But other diseases, though of a protracted character and accompanied by fever, were easily treated and did not prove fatal.  Consumption was the worst of the diseases that occurrred, and the only one that proved fatal to many persons.

Most were affected by these diseases in the following manner--

  • fevers with shivering, 
  • [fevers] of the continual type, acute, having no complete intermissions, but of the form of the semi-tertians, being milder the one day, and the next having an exacerbation, and increasing in violence [a tertian fever is one that recurs every other day -- every third day counting the first day of onset as day one; a semi-tertian fever is one that never really subsides, but varies in its intensity every other day]
  • constant sweats, but not diffused over the whole body;
  • extremities very cold, and warmed with difficulty;
  • bowels disordered, with bilious, scanty, unmixed, thin, pungent stools causing the patient to get up often;
  • urine thin, colorless, unconcocted, or thick, with a deficient sediment, not settling favorably, but casting down a crude and unseasonable sediment;
  • sputa small, dense, concocted, but brought up little by little and with difficulty; and in those who encountered the most violent symptoms there was no concoction at all, but they continued throughout spitting crude matters;
  • in the majority of cases, the back of the throat was painful from first to last, having redness with inflammation; defluxions thin, small and acrid [having an irritating taste or smell];
  • patients were soon wasted and became worse, having no appetite for any kind of food throughout;
  • no thirst;
  • most persons delirious when near death.

Continual Fevers
In the course of the summer and autumn many fevers of the continual type, but not violent; they attacked persons who had been long indisposed, but who were otherwise not in an uncomfortable state--
  • in most cases the bowels were moderately disordered, and they did not suffer thereby in any manner worth mentioning;
  • urine generally well-colored, clear, thin, and after a time becoming concocted near the crisis [turning point in the disease, whether for the better, or the worse];
  • not much cough, nor was it troublesome;
  • no lack of appetite;
  • slight sweats, with varied and irregular paroxysms [convulsions; sudden attacks], in general not intermitting, but having exacerbations in the tertian form.

The earliest crisis which occurred was about the twentieth day, in most about the fortieth, and in many about the eightieth.  But there were cases in which it did not end this way at all, but in an irregular manner, and without any crisis.  In most of these, the fevers relapsed after a brief interval; and from these relapses they came to a crisis in the same periods.  Many of these cases were so prolonged that the disease lasted until the approach of winter.  Of all those which are described under this constitution, only the consumptives were of a fatal character; for in all the others the patients bore up well, and did not die of the other fevers.


In Thasos, early in autumn, the winter suddenly set in rainy before the usual time, with much northerly and southerly winds.  These things all continued so until the setting of the Pleiades. 

The winter was northerly, the rains frequent, in torrents, and large, with snow, but with a frequent mixture of fair weather.  With all this, however, the cold weather was not exceptionally unseasonable.  After the winter solstice, and at the time when the zephyr [soft gentle wind out of the west] usually begins to blow, severe winterly storms out of season, with much northerly wind, snow, continued and copious rains; the sky tempestuous and clouded; these things were protracted, and did not remit until the [vernal] equinox.

The spring was cold, northerly, rainy, and clouded.

The summer was not very sultry, the Etesian winds blew constant, but quickly afterwards, about the rising of Arcturus, there were again many rains with north winds.

Runny Eyes
The whole season being wet, cold, and northerly, people were, for the most part, healthy during winter; but early in the spring very many, indeed, the greater part, suffered illness--
  • inflammations of the eyes marked with rheum [watery discharge], pains, and unconcocted discharges [anything expelled by the body that has not been changed by a normal bodily process, like digestion or metabolism];
  • small gummy sores, in many cases causing distress when they broke out.

In most instances they relapsed, and they did not cease until late in autumn.

Intestinal Disorders
During summer and autumn there were--
  • dysenteric affections;
  • attacks of tenesmus [straining unsuccessfully to urinate or defecate];
  • lientery;
  • bilious diarrhea, with thin, copious, watery, undigested, and acrid stools;
  • many had copious defluxions, with pain, of a bilious, watery, slimy, purulent [pus-like] nature, attended with strangury [urinating drip by drip], not connected with disease of the kidneys, but one complaint succeeding the other;
  • vomitings of bile, phlegm, and undigested food;
  • sweats;
  • in all cases a redundance of humors.

In many instances these complaints were unattended with fever, and did not prevent the patients from walking about, but some cases were febrile, as will be described.  In some all those described below occurred with pain.

Consumption and Fevers
During autumn, and at the commencement of winter, there were--
  • consumption;
  • [different kinds of fever]:
    • continual fevers;
    • in a few cases, ardent;
    • some diurnal [by day];
    • others nocturnal [by night];
    • semi-tertians [unrelenting, but varying in intensity every other day];
    • true tertians [recurring every other day];
    • quartans [recurrences interrupted by two non-feverish days];
    • irregular fevers.

The Fevers
All these fevers described attacked great numbers--
  • The ardent fevers attacked the smallest numbers, and the patients suffered the least from them, for there were no hemorrhages, except a few and to a small amount, nor was there delirium; all the other complaints were slight; in these the crises were regular, in most instances, with the intermittents, in seventeen days; and I know no instance of a person dying of ardent fever, nor becoming delirious.
  • The tertians were more numerous than the ardent fevers, and attended with more pain; but these all had four periods in regular succession from the first attack, and they had a complete crisis in seven, without a relapse in any instance.
  • The quartans attacked many at first, in the form of regular quartans, but in no few cases a transition from other fevers and diseases into quartans took place; they were protracted, as is wont with them, indeed, more so than usual.
  • Quotidian [daily], nocturnal, and irregular fevers attacked many persons, some of whom continued to keep up, and others were confined to bed.  In most instances these fevers were prolonged under the Pleiades and till winter.

[The effects of the fevers--]

  • Many persons, especially children, had convulsions from the start; and they had fever, and the convulsions supervened upon the fevers; in most cases they were protracted, but free from danger, except those who were in a deadly state from other complaints.
    Fevers that were continual in the main, and with no intermissions, but having exacerbations in the tertian form--remissions the one day and exacerbations the next--were the most violent of all those which occurred at that time, and the most protracted.  They were accompanied with the greatest pains, beginning mildly, always on the whole increasing, and being exacerbated, and they always turned worse, having small remissions.   After an abatement, they generated more violent paroxysms, and grew worse, for the most part, on the critical days.
  • Shivering, in all cases, took place in an irregular and uncertain manner, very rare and weak in them, but greater in all other fevers; frequent sweats, but most seldom in them, bringing no alleviation, but, on the contrary, doing mischief.
  • Much cold of the extremities in them, and these were warmed with difficulty.
  • Sleeplessness, for the most part, especially in these fevers, and again a disposition to coma.
  • The bowels, in all diseases, were disordered, and in a bad state, but worst of all in these.
  • The urine, in most of them, was either thin and crude, yellow, and after a time with slight symptoms of concoction in a critical form, or having the proper thickness, but muddy, and neither settling nor subsiding; or having small and bad, and crude sediments; these being the worst of all.
  • Coughs attended these fevers, but I cannot state that any harm or good ever resulted from the cough.

Most of these [fevers] were protracted and troublesome, went on in a very disorderly and irregular form, and, for the most part, did not end in a crisis, either in the fatal cases or in the others; for if it left some of them for a season it soon returned again.

  • In a few instances the fever ended with a crisis; in the earliest of these about the eightieth day.  Some of these relapsed, so that most of them were not free from the fever during the winter; but the fever left most of them without a crisis, and these things happened alike to those who recovered and to those who did not.
  • There was a marked absence of crisis and much variety in these diseases.  The greatest and worst symptom that attended most of them was a complete loss of appetite, especially with those who had otherwise fatal symptoms; but they were not unseasonably thirsty in such fevers.
  • After a length of time, with much suffering and great wasting, abscesses were formed in these cases, either unusually severe, so that the patients could not endure them, or unusually slight, so that they did no good, but soon relapsed and speedily got worse.
  • The diseases which attacked them were in the form of dysenteries, tenesmus, lientery, and fluxes; but, in some cases, there were dropsies, with or without these complaints.  Whatever attacked them violently speedily cut them off, or again, did them no good.
  • Small rashes, and not corresponding to the violence of the disease, and quickly disappearing, or swellings occurred about the ears, which were not resolved, and brought on no crisis.  In some they were appeared in the joints, and especially to the hip-joint, terminating critically with a few, and quickly again increasing to its original state.

People died of all these diseases, but mostly of these fevers, and notably newly-weaned infants, children up to eight or ten years of age, and those before puberty.

These things occurred to those affected with the complaints described above, and to many persons at first without them--

  • The only favorable symptom, and the greatest of those which occurred, and what saved most of those who were in the greatest dangers, was the conversion of it to a strangury, and when, in addition to this, abscesses were formed.  The strangury attacked, most especially, persons of the ages I have mentioned, but it also occurred in many others, both those who were not confined to bed and those who were.  There was a speedy and great change in all these cases.
  • For the bowels, if they happened previously to have watery stools of a bad character, became regular, their appetite increased, and the fevers were mild afterwards.  But, with regard to the strangury itself, the symptoms were protracted and painful.  Their urine was copious, thick, of various characters, red, mixed with pus, and was passed with pain.  These all recovered, and I did not see a single instance of death among them.

With regard to the dangers of these cases, one must always attend to the seasonable concoction of all the evacuations, and to the favorable and critical abscesses.  The concoctions indicate a speedy crisis and recovery of health; crude and undigested stools, and those which are converted into bad abscesses, indicate either want of crisis, or pains, or prolongation of the disease, or death, or relapses; which of these it is to be must be determined from other circumstances.

The physician must be able to tell the antecedents, know the present, and foretell the future--must mediate these things, and have two special objects in view with regard to disease, namely, to do good or to do no harm.  The art consists in three things -- the disease, the patient, and the physician.  The physician is the servant of the art, and the patient must combat the disease along with the physician....


In Thasos, a little before and during the season of Arcturus, there were frequent and great rains, with northerly winds.  About the [autumnal] equinox, and till the setting of the Pleiades, there were a few southerly rains. 

The winter -- northerly and parched, cold, with great winds and snow.  Great storms about the [vernal] equinox, 

The spring -- northerly, dryness, rains few and cold. 

About the summer solstice, scanty rains, and great cold until near the season of the Dog-star.  After the Dog-days [period following the rising of Sirius], until the season of Arcturus, the summer hot, great droughts, not in intervals, but continued and severe:  no rain; the Etesian winds blew; about the season of Arcturus southerly rains until the [autumnal] equinox.

In this state of things, during winter, paraplegia [paralysis of the lower half of the body] set in, and attacked many, and some died speedily; and otherwise the disease prevailed much in an epidemical form, but persons remained free from all other diseases.

Ardent fevers
Early in the spring, ardent fevers commenced and continued through the summer until the equinox.  Those then that were attacked immediately after the commencement of the spring and summer, for the most part recovered, and but few of them died.

Fatal Fevers
But when the autumn and the rains had set in, they were of a fatal character, and the greater part then died.  When in these attacks of ardent fevers there was a proper and copious hemorrhage from the nose, they were generally saved by it, and I do not know a single person who had a proper hemorrhage who died in this constitution.  Philiscus, Epaminon, and Silenus, indeed, who had a trifling epistaxis [nosebleed] on the fourth and fifth day, died.  Most of those taken with had a feverish chill about the time of the crisis, and notably those who had no hemorrhage; these had also shivering associated.

Digestive Disorders
Some were attacked with jaundice on the sixth day, but these were benefited either by an urinary purgation, or a disorder of the bowels, or a copious hemorrhage, as in the case of Heraclides, who was lodged with Aristocydes:  this person, though he had the hemorrhage from the nose, the purgation by the bladder, and disorder of the bowels, experienced a favorable crisis on the twentieth day, unlike the servant of Phanagoras, who had none of these symptoms, and died.

The hemorrhages attacked most persons, but especially young persons and those in the prime of life, and the greater part of those who had not the hemorrhage died:  elderly persons had jaundice or disorder of the bowels, such as Bion, who was lodged with Silenus.

Dysenteries were epidemical during the summer, and some of those cases in which the hemorrhage occurred, terminated in dysentery, as happened to the slave of Eraton, and to Mullus, who had a copious hemorrhage, which settled down into dysentery, and they recovered.  The blood was abundant in many cases, since in those who had not the hemorrhage about the crisis, but the swellings about the ears disappeared, after their disappearance there was a sense of weight in the left flank extending to the extremity of the hip, and pain setting in after the crisis, with a discharge of thin urine; they began to have small hemorrhages about the twenty-fourth day, and the swelling was converted into the hemorrhage.  In the case of Antiphon, the son of Critobulus' son, the fever ceased and came to a crisis about the fortieth day.

Women's Health
Many women were seized, but fewer than of the men, and there were fewer deaths among them--
  • most had difficult childbirth and after labor they were taken ill, and these most especially died, as, for example, the daughter of Telebolus died on the sixth day after delivery;
  • most had the menstrual discharge during the fever; 
  • many girls had it then for the first time; 
  • in certain individuals both the hemorrhage from the nose and the menses appeared; thus, in the case of the virgin daughter of Daetharses, the menses then took place for the first time, and she had also a copious hemorrhage from the nose (I knew no instance of any one dying when one or other of these took place properly);
  • all those who were pregnant had abortions, as far as I observed;
  • urine in most cases was of the proper color, but thin, and having scanty sediments; 
  • in most the bowels were disordered with thin and bilious stools; 
  • many, after passing through the other crises, terminated in dysenteries... 

On the Fatal Fevers
About the [autumnal] equinox, and until the season of the Pleiades, and at the approach of winter, many ardent fevers set in; but great numbers at that season were seized with phrenitis, and many died; a few cases also occurred during the summer.

These then made their attack at the commencement of ardent fevers, which were attended with fatal symptoms--

  • immediately upon their setting in, there were acute fever and shivering, sleeplessness, thirst, nausea, slight sweats about the forehead and collarbones, but no general perspiration; 
  • they had much delirious talking, fears, despondency, great coldness of the extremities, in the feet, but more especially in their hands:  the paroxysms were on the even days; and in most cases, on the fourth day, the most violent pains set in, with sweats, generally coldish, and the extremities could not be warmed, but were livid and rather cold, and they had then no thirst; 
  • in them the urine was black, scanty, thin, and the bowels were constipated; 
  • there was an hemorrhage from the nose in no case in which these symptoms occurred, but merely a trifling epistaxis; 
  • and none of them had a relapse, but they died on the sixth day with sweats.

In the phrenitic cases, all the symptoms which have been described did not occur, but in them the disease mostly came to a crisis on the eleventh day, and in some on the twentieth.  In those cases in which the phrenitis did not begin immediately, but about the third or fourth day, the disease was moderate at the commencement, but assumed a violent character about the seventh day.

There was a great number of diseases, and of those affected, they who died were principally infants, young persons, adults having smooth bodies, white skins, straight and black hair, dark eyes, those living recklessly and luxuriously; persons with shrill, or rough voices, who stammered and were passionate, and women more especially died from this form.

In this constitution, four symptoms in particular proved beneficial--

  • hemorrhage from the nose; 
  • copious discharge by the bladder of urine, having an abundant and proper sediment; 
  • a bilious disorder of the bowels at the proper time;
  • an attack of dysentery.

In many cases it happened that the crisis did not take place by any one of the symptoms which have been mentioned, but the patient passed through most of them, and appeared to be in an uncomfortable way, and yet all who were attacked with these symptoms recovered.

All the symptoms I have described occurred also to women and girls; and whoever of them had any of these symptoms in a favorable manner, or the menses appeared abundantly, were saved thereby, and had a crisis, so that I do not know a single female who had any of these favorably that died.  But the daughter of Philo, who had a copious hemorrhage from the nose, and took supper unseasonably on the seventh day, died....

Ardent Fevers and Frenzies
During the winter, about the winter solstices, and until the [vernal] equinox, the ardent fevers and frenzies prevailed, and many died.  The crisis, however, changed, and happened to the greater number on the fifth day from the commencement, left them for four days and relapsed; and after the return, there was a crisis on the fifth day, making in all fourteen days.  The crisis took place thus in the case of most children, also in elder persons.


The circumstances from which we form a judgment of the diseases are by attending to the general nature of all, and the peculiar nature of each individual--

  • to the disease, the patient, and the applications;
  • to the person who applies them, as that makes a difference for better or for worse;
  • to the whole constitution of the season, and particularly to the state of the heavens, and the nature of each country;
  • to the patient's habits, regimen, and pursuits;
  • to his conversation, manners, taciturnity, thoughts, sleep, or absence of sleep, and sometimes his dreams, what and when they occur;
  • to his picking and scratching;
  • to his tears;
  • to the stools, urine, sputa, and vomit;
  • to the changes of diseases from the one into the other;
  • to the deposits, whether of a deadly or critical character;
  • to the sweat, coldness, shivering, cough, sneezing, hiccup, respiration, belching, flatulence, whether passed silently or with a noise;
  • to hemorrhages and hemorrhoids.

From these, and their consequences, we must form our judgment.


Fevers are--

the continual Some hold during the day and have a remission at night, and others hold a remission during the day.  The most acute, strongest, most dangerous, and fatal diseases, occur in the continual fever.
semi-tertians In what is called the semi-tertian, other acute diseases are apt to occur, and it is the most fatal of all others, and moreover consumptive persons, and those laboring under other protracted diseases, are apt to be attacked by it.
tertians The true tertian comes quickly to a crisis, and is not fatal.
quartans The least dangerous of all, and the mildest and most protracted, is the quartan, for it is not only such from itself, but it also carries off other great diseases.
quintans The quintan is the worst of all, for it proves fatal when it precedes an attack of consumption, and when it supervenes on persons who are already consumptive.
septans The septan is protracted, but not fatal;
nonans the nonan more protracted, and not fatal.
  • The nocturnal fever is not very fatal, but protracted; the diurnal is still more protracted, and in some cases passes into consumption.
  • There are peculiar modes, and constitutions, and paroxysms, in every one of these fevers; for example,--the continual, in some cases at the very commencement, grows, as it were, and attains its full strength, and rises to its most dangerous pitch, but is diminished about and at the crisis; in others it begins gentle and suppressed, but gains ground and is exacerbated every day, and bursts forth with all its heat about and at the crisis; while in others, again, it commences mildly, increases, and is exacerbated until it reaches its acme, and then remits until at and about the crisis.

These varieties occur in every fever, and in every disease.

From these observations one must regulate the regimen accordingly.  There are many other important symptoms allied to these, part of which have been already noticed, and part will be described afterwards, from a consideration of which one may judge, and decided in each case, whether the disease be acute, and whether it will end in death or recovery; or whether it will be protracted, and will end in death or recovery; and in what cases food is to be given, and in what not; and when and to what amount, and what particular kind of food is to be administered.


Those diseases which have their paroxysms on even days have their crises on even days; and those which have their paroxysms on uneven days have their crises on uneven days.

The first period of those which have the crisis on even days, is the 4th, 6th, 8th, 10th, 14th, 20th, 30th, 40th, 60th, 80th, 100th; and the first period of those which have their crises on uneven days, is the 1st, 3rd, 5th, 7th, 9th, 11th, 17th, 21th, 27th, 31st.

It should be known, that if the crisis take place on any other day than on those described, it indicates that there will be a relapse, which may prove fatal.  But one ought to pay attention, and know in these seasons what crises will lead to recovery and what to death, or to changes for the better or the worse.  Irregular fevers, quartans, quintans, septans, and nonans should be studied, in order to find out in what periods their crises take place.




The year was southerly, rainy; no winds throughout.  Droughts having prevailed during the previous seasons of the year, the south winds towards the rising of Arcturus were attended with much rain. 

Autumn gloomy and cloudy, with copious rains. 

Winter southerly, damp, and soft.  But long after the [winter] solstice, and near the [vernal] equinox, much wintery weather out of season; and when now close to the equinox, northerly, and winterly weather for no long time. 

The spring again southerly, calm, much rain until the dog-days. 

Summer fine and hot; great suffocating heats.  The Etesian winds blew small and irregular; again, about the season of Arcturus, much rains with north winds.

The year being southerly, damp, and soft towards winter, all were healthy, except those affected with consumption.

Widespread Fatal Disease
Early in spring, along with the prevailing cold--
  • there were many cases of erysipelas [acute infectious disease of the skin or mucous membranes], some from a manifest cause, and some not; of a malignant nature, and proved fatal to many; 
  • many had sore-throat and loss of speech;
  • many cases of ardent fever; 
  • frenzy;
  • small white pustules in the mouth; 
  • tumors on the genitals; 
  • ophthalmia; 
  • anthrax;
  • disorder of the bowels; 
  • anorexia -- with thirst and without it; 
  • disordered urine, large in quantity, and bad in quality; 
  • persons affected with coma for a long time, and then falling into a state of sleeplessness;
  • many cases of failure of crisis;
  • many of unfavorable crisis; 
  • many of dropsy; and 
  • consumption.

Such were the diseases then epidemic.  There were patients affected with every one of the species which have been mentioned, and many died.  The symptoms in each of these cases were as follows:

Skin Eruptions
In many cases erysipelas, from some obvious cause, such as an accident, and sometimes from even a very small wound, broke out all over the body, especially, in persons about sixty years of age, about the head, if such an accident was neglected in the slightest degree; and this happened in some who were under treatment; great inflammation took place, and the erysipelas quickly spread all over.

In the most of them the abscesses ended in suppurations, and there was great sloughing off of the flesh, tendons, and bones; and the defluxion which seated in the part was not like pus, but a sort of putrefaction, and the running was large and of various characters.  Those cases in which any of these things happened about the head were accompanied with falling off of the hairs of the head and chin, the bones were laid bare and separated, and there were excessive runnings; and these symptoms happened in fevers and without fevers.  But these things were more formidable in appearance than dangerous; for when the concoction in these cases turned to a suppuration, most of them recovered; but when the inflammation and erysipelas disappeared, and when no abscess was formed, a great number of these died.

In like manner, the same things happened to whatever part of the body the disease wandered, for in many cases both forearm and arm dropped off; and in those cases in which it fell upon the sides, the parts there, either before or behind, got into a bad state; and in some cases the whole femur [thigh bone] and bones of the leg and whole foot were laid bare.

But of all such cases, the most dangerous were those which took place about the pubes [abdominal region covered by pubic hair] and genital organs.  Such was the nature of these cases when attended with sores, and proceeding from an external cause; but the same things occurred in fevers, before fevers, and after fevers.  But those cases in which an abscess was formed, and turned to a suppuration, or a seasonable diarrhea or discharge of good urine took place, were relieved thereby:  but those cases in which none of these symptoms occurred, but they disappeared without a crisis, proved fatal.  The greater number of these erysipelatous cases took place in the spring, but were prolonged through the summer and during autumn.

In certain cases there was much disorder, and tumors in the throat, and inflammations of the tongue, and abscesses about the teeth.  And many were attacked with impairment or loss of speech; at first, those in the early stages of consumption, but also persons in ardent fever and in delirium.

Fatal Fevers
The cases of ardent fever and phrenitis occurred early in spring after the cold set in, and great numbers were taken ill at that time, and these cases were attended with acute and fatal symptoms.

The constitution of the ardent fevers which then occurred was as follows:  at the onset they were affected with coma, nausea, and shivering; fever acute, not much thirst, nor delirium, slight epistaxis, the paroxysms for the most part on even days; and, about the time of the paroxysms, forgetfulness, loss of strength and of speech, the extremities, that is to say, the hands and feet, at all times, but more especially about the time of the paroxysms, were colder than natural; they slowly and imperfectly became warmed, and again recovered their recollection and speech.

They were constantly affected either with coma, in which they got which they got no sleep, or were sleepless, attended with pains; most had disorders of the bowels, attended with undigested, thin, and copious stools; urine copious, thin, having nothing critical nor favorable about it; neither was there any other critical appearance in persons affected thus; for neither was there any proper hemorrhage, nor any other of the accustomed evacuations, to prove a crisis.

They died, as it happened, in an irregular manner, mostly about the crisis, but in some instances after having lost their speech for a long time, and having had copious sweats.

These were the symptoms which marked the fatal cases of ardent fever; similar symptoms occurred in the phrenitic cases; but these were particularly free from thirst, and none of these had wild delirium as in other cases, but they died oppressed by a bad tendency to sleep, and stupor.

But there were also other fevers--

  • Many had their mouths affected with small white pustules.
  • There were also many defluxions about the genital parts, and ulcerations and boils--external and internal--about the groins.
  • Chronic and painful watery inflammations of the eye; growths on the eyelids--external and internal--called fici ["figs"], which destroyed the sight of many persons.
  • There were growths, in many other instances, on sores, especially those on the genitals.
  • There were many attacks of carbuncle [painful bacterial infection deep beneath the skin having a network of pus-filled boils] through the summer, and other affections called "the putrefaction"; also large pustules, and large tetters [itching skin diseases].

Digestive Disorders
Many serious complaints attacked many persons in the region of the belly--
  • tenesmus, accompanied with pain, attacked many, but more especially children, and all who had not attained to puberty; and the most of these died;
  • many cases of lientery and of dysentery; but these were not attended with much pain; 
  • stools bilious, fatty, thin, and watery; 
  • in many instances the disease terminated in this way, with and without fever; 
  • there were painful tormina and malignant colic; 
  • copious evacuations of the contents of the guts, and yet much remained behind; 
  • the passages did not carry off the pains, but yielded with difficulty to the means administered; 
  • for in most cases purgings were harmful to those affected in this manner; 
  • many died speedily, but many others held out longer.

In a word, all died, both those who had acute attacks and those who had chronic, most especially from affections of the belly, for it was the belly which carried them all off.

All persons had loss of appetite in all the afore-mentioned complaints to a degree such as I never met with before, and persons in these complaints most especially, and those recovering from them, and in all other diseases of a mortal nature.  Some were troubled with thirst, and some not; and both in febrile complaints and in others no one drank unseasonably or disobeyed injunctions.

The urine in many cases was not in proportion to the drink administered, but greatly in excess; and the badness of the urine voided was great, for it had not the proper thickness, nor concoction, nor purged properly; for in many cases purgings by the bladder indicate favorably, but in the greatest number they indicated a wasting of the body, disorder of the bowels, pains, and an absence of crisis.

Persons laboring under phrenitis and ardent fever were particularly disposed to coma; but also in all other great diseases which occurred along with fever.  In the main, most cases were attended either by heavy coma, or by short and light sleep.

And many other forms of fevers were then epidemic, of tertian, of quartan, of nocturnal, of continual, of chronic, of erratic, of fevers attended with nausea, and of irregular fevers.

All these were attended with much disorder, for the bowels in most cases were disordered, accompanied with shivering, sweats not of a critical character, and with the state of the urine as described.

In most instances the disease was protracted, for neither did the deposits which took place prove critical as in other cases; for in all complaints and in all cases there was difficulty of crisis, want of crisis, and protraction of the disease, but most especially in these.

A few had the crisis about the eightieth day, but in most instances recovery followed no rule.  A few of them died of dropsy without being confined to bed.  And in many other diseases people were troubled with swelling, especially consumptives.

The severest and most dangerous disease, and the one that proved fatal to the greatest number, was consumption.

With many persons it began in the winter, and of these some were confined to bed, and others bore up on foot; the most of those died early in spring who were confined to bed; of the others, the cough left not a single person, but it became milder through the summer; during the autumn, all these were confined to bed, and many of them died, but in the greater number of cases the disease was long protracted.

Most of these were suddenly attacked with these diseases, having frequent feverish chills, often continual and acute fevers; unseasonable, copious, and cold sweats throughout; great coldness, from which they had great difficulty in being restored to heat; the bowels variously constipated, and again immediately in a loose state, but towards the termination in all cases with violent looseness of the bowels; a determination downwards of all matters collected about the lungs; urine excessive, and not good; malignant wasting.

The coughs throughout were frequent, and copious, digested, and liquid, but not brought up with much pain; and even when they had some slight pain, in all cases the purging of the matters about the lungs went on mildly.

The throats were not very irritable, nor were they troubled with any saltish humors; but there were viscid, white, liquid, frothy, and copious defluxions from the head.

But by far the greatest mischief attending these and the other complaints, was the loss of appetite, as has been described.  For neither had they any relish for drink along with their food, but continued without thirst.  There was heaviness of the body, disposition to coma, in most cases swelling, which ended in dropsy; they shivered, and were delirious towards death.

The physical characteristics of the consumptives were -- skin smooth, whitish, lentil-colored, reddish; blue eyes; a leucophlegmatic [white phlegmed] condition; and shoulder blades that project like wings.

Women were affected the same as men.

Individuals with a melancholic temperament suffered principally from phrenitic and dysenteric affections.

Tenesmus troubled young persons of a phlegmatic temperament.

Chronic diarrhea, acrid and thick stools, attacked those who were bilious.

To all those which have been described, the season of spring was their worst enemy, proving fatal to the greatest numbers:  the summer was the most favorable to them, and the fewest died then; in autumn, and under the Pleiades, again there died great numbers.

It appears to me, according to the reason of things, that the coming on of summer should have done good in these cases; for winter coming on cures the diseases of summer, and summer coming on removes the diseases of winter.  And yet the summer in question was not of itself well constituted, for it became suddenly hot, southerly, and calm; nevertheless, it proved beneficial by producing a change on the other constitution.

I look upon it as being a great part of the art to be able to judge properly of that which has been written.  For he that knows and makes a proper use of these things, would appear to me not likely to commit any great mistake in the art.  He ought to learn accurately the constitution of every one of the seasons, and of the diseases; whatever that is common in each constitution and disease is good, and whatever is bad; whatever disease will be protracted and end in death, and whatever will be protracted and end in recovery; which disease of an acute nature will end in death, and which in recovery.  From these it is easy to know the order of the critical days, and prognosticate from them accordingly.  And to a person who is skilled in these things, it is easy to know to whom, when, and how aliment ought to be administered....



Go to:
  • The History of the Peloponnesian War by Thucydides (460-400 BCE)
  • The Lives of the Noble Grecians and Romans by Plutarch (460-400 BCE)
  • On Airs, Waters, and Places by Hippocrates (460-377 BCE)
  • History of the Wars by Procopius (c. 500-560 CE)
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