第8章

Sect。III

1。Theyearwassoutherly,rainy;nowindsthroughout。Droughtshavingprevailedduringthepreviousseasonsoftheyear,thesouthwindstowardstherisingofArcturuswereattendedwithmuchrain。

Autumngloomyandcloudy,withcopiousrains。Wintersoutherly,damp,andsoft。Butlongafterthesolstice,andneartheequinox,muchwinteryweatheroutofseason;andwhennowclosetotheequinox,northerly,andwinterlyweatherfornolongtime。Thespringagainsoutherly,calm,muchrainuntilthedog—days。Summerfineandhot;

greatsuffocatingheats。TheEtesianwindsblewsmallandirregular;

again,abouttheseasonofArcturus,muchrainswithnorthwinds。

2。Theyearbeingsoutherly,damp,andsofttowardswinter,allwerehealthy,exceptthoseaffectedwithphthisis,ofwhomweshallwriteafterwards。

3。Earlyinspring,alongwiththeprevailingcold,thereweremanycasesoferysipelas,somefromamanifestcause,andsomenot。

Theywereofamalignantnature,andprovedfataltomany;manyhadsore—throatandlossofspeech。Thereweremanycasesofardentfever,phrensy,aphthousaffectionsofthemouth,tumorsonthegenitalorgans;ofophthalmia,anthrax,disorderofthebowels,anorexia,withthirstandwithoutit;ofdisorderedurine,largeinquantity,andbadinquality;ofpersonsaffectedwithcomaforalongtime,andthenfallingintoastateofinsomnolency。Thereweremanycasesoffailureofcrisis,andmanyofunfavorablecrisis;manyofdropsyandofphthisis。Suchwerethediseasesthenepidemic。Therewerepatientsaffectedwitheveryoneofthespecieswhichhavebeenmentioned,andmanydied。Thesymptomsineachofthesecaseswereasfollows:

4。Inmanycaseserysipelas,fromsomeobviouscause,suchasanaccident,andsometimesfromevenaverysmallwound,brokeoutalloverthebody,especially,inpersonsaboutsixtyyearsofage,aboutthehead,ifsuchanaccidentwasneglectedintheslightestdegree;andthishappenedinsomewhowereundertreatment;greatinflammationtookplace,andtheerysipelasquicklyspreadallover。

inthemostofthemabscessedendedinsuppurations,andthereweregreatfallingsoff(sloughing)oftheflesh,tendons,andbones;andthedefluxionwhichseatedinthepartwasnotlikepus,butasortofputrefaction,andtherunningwaslargeandofvariouscharacters。

Thosecasesinwhichanyofthesethingshappenedabouttheheadwereaccompaniedwithfallingoffofthehairsoftheheadandchin,theboneswerelaidbareandseparated,andtherewereexcessiverunnings;andthesesymptomshappenedinfeversandwithoutfevers。

Butthesethingsweremoreformidableinappearancethandangerous;

forwhentheconcoctioninthesecasesturnedtoathesecasesturnedtoasuppuration,mostofthemrecovered;butwhentheinflammationanderysipelasdisappeared,andwhennoabscesswasformed,agreatnumberofthesedied。Inlikemanner,thesamethingshappenedtowhateverpartofthebodythediseasewandered,forinmanycasesbothforearmandarmdroppedoff;andinthosecasesinwhichitfelluponthesides,thepartsthere,eitherbeforeorbehind,gotintoabadstate;andinsomecasesthewholefemurandbonesofthelegandwholefootwerelaidbare。Butofallsuchcases,themostformidablewerethosewhichtookplaceaboutthepubesandgenitalorgans。Suchwasthenatureofthesecaseswhenattendedwithsores,andproceedingfromanexternalcause;butthesamethingsoccurredinfevers,beforefevers,andafterfevers。fevers。Butthosecasesinwhichanabscesswasformed,andturnedtoasuppuration,oraseasonablediarrheaordischargeofgoodurinetookplace,wererelievedthereby:butthosecasesinwhichnoneofthesesymptomsoccurred,buttheydisappearedwithoutacrisis,provedfatal。Thegreaternumberoftheseerysipelatouscasestookplaceinthespring,butwereprolongedthroughthesummerandduringautumn。

5。Incertaincasestherewasmuchdisorder,andtumorsaboutthefauces,andinflammationsofthetongue,andabscessesabouttheteeth。Andmanywereattackedwithimpairmentorlossofspeech;atfirst,thoseinthecommencementofphthisis,butalsopersonsinardentfeverandinphrenitis。

6。Thecasesofardentfeverandphrenitisoccurredearlyinspringafterthecoldsetin,andgreatnumbersweretakenillatthattime,andthesecaseswereattendedwithacuteandfatalsymptoms。Theconstitutionoftheardentfeverswhichthenoccurredwasasfollows:atthecommencementtheywereaffectedwithcoma,nausea,andrigors;feveracute,notmuchthirst,nordelirium,slightepistaxis,theparoxysmsforthemostpartonevendays;and,aboutthetimeoftheparoxysms,forgetfulness,lossofstrengthandofspeech,theextremities,thatistosay,thehandsandfeet,atalltimes,butmoreespeciallyaboutthetimeoftheparoxysms,werecolderthannatural;theyslowlyandimperfectlybecamewarmed,andagainrecoveredtheirrecollectionandspeech。Theywereconstantlyaffectedeitherwithcoma,inwhichtheygotwhichtheygotnosleep,orwithinsomnolency,attendedwithpains;mosthaddisordersofthebowels,attendedwithundigested,thin,andcopiousevacuations;urinecopious,thin,havingnothingcriticalnorfavorableaboutit;neitherwasthereanyothercriticalappearanceinpersonsaffectedthus;forneitherwasthereanyproperhemorrhage,noranyotheroftheaccustomedevacuations,toproveacrisis。Theydied,asithappened,inanirregularmanner,mostlyaboutthecrisis,butinsomeinstancesafterhavinglosttheirspeechforalongtime,andhavinghadcopioussweats。Thesewerethesymptomswhichmarkedthefatalcasesofardentfever;similarsymptomsoccurredinthephreniticcases;butthesewereparticularlyfreefromthirst,andnoneofthesehadwilddeliriumasinothercases,buttheydiedoppressedbyabadtendencytosleep,andstupor。

7。Buttherewerealsootherfevers,aswillbedescribed。Manyhadtheirmouthsaffectedwithaphthousulcerations。Therewerealsomanydefluxionsaboutthegenitalparts,andulcerations,boils(phymata),externallyandinternally,aboutthegroins。Wateryophthalmiesofachroniccharacter,withpains;fungousexcrescencesoftheeyelids,externallyandinternally,calledfig,whichdestroyedthesightofmanypersons。Therewerefungousgrowths,inmanyotherinstances,onulcers,especiallyonthoseseatedonthegenitalorgans。Thereweremanyattacksofcarbuncle(anthrax)throughthesummer,andotheraffections,whicharecalled\"theputrefaction\"

(seps);alsolargeecthymata,andlargetetters(herpetes)inmanyinstances。

8。Andmanyandseriouscomplaintsattackedmanypersonsintheregionofthebelly。Inthefirstplace,tenesmus,accompaniedwithpain,attackedmany,butmoreespeciallychildren,andallwhohadnotattainedtopuberty;andthemostofthesedied。Thereweremanycasesoflienteryandofdysentery;butthesewerenotattendedwithmuchpain。Theevacuationswerebilious,andfatty,andthin,andwatery;

inmanyinstancesthediseaseterminatedinthisway,withandwithoutfever;therewerepainfultorminaandvolvuliofamalignantkind;

copiousevacuationsofthecontentsoftheguts,andyetmuchremainedbehind;andthepassagesdidnotcarryoffthepains,butyieldedwithdifficultytothemeansadministered;forinmostcasespurgingswerehurtfultothoseaffectedinthismanner;manydiedspeedily,butinmanyotherstheyheldoutlonger。Inaword,alldied,boththosewhohadacuteattacksandthosewhohadchronic,mostespeciallyfromaffectionsofthebelly,foritwasthebellywhichcarriedthemalloff。

9。Allpersonshadanaversiontofoodinalltheafore—mentionedcomplaintstoadegreesuchasInevermetwithbefore,andpersonsinthesecomplaintsmostespecially,andthoserecoveringfromthem,andinallotherdiseasesofamortalnature。Someweretroubledwiththirst,andsomenot;andbothinfebrilecomplaintsandinothersnoonedrankunseasonablyordisobeyedinjunctions。

10。Theurineinmanycaseswasnotinproportiontothedrinkadministered,butgreatlyinexcess;andthebadnessoftheurinevoidedwasgreat,forithadnottheproperthickness,norconcoction,norpurgedproperly;forinmanycasespurgingsbythebladderindicatefavorably,butinthegreatestnumbertheyindicatedameltingofthebody,disorderofthebowels,pains,andawantofcrisis。

11。Personslaboringunderphrenitisandcaususwereparticularlydisposedtocoma;butalsoinallothergreatdiseaseswhichoccurredalongwithfever。Inthemain,mostcaseswereattendedeitherbyheavycoma,orbyshortandlightsleep。

12。Andmanyotherformsoffeverswerethenepidemic,oftertian,ofquartan,ofnocturnal,ofcontinual,ofchronic,oferratic,offeversattendedwithnausea,andofirregularfevers。Allthesewereattendedwithmuchdisorder,forthebowelsinmostcasesweredisordered,accompaniedwithrigors,sweatsnotofacriticalcharacter,andwiththestateoftheurineasdescribed。Inmostinstancesthediseasewasprotracted,forneitherdidthedepositswhichtookplaceprovecriticalasinothercases;forinallcomplaintsandinallcasestherewasdifficultyofcrisis,wantofcrisis,andprotractionofthedisease,butmostespeciallyinthese。Afewhadthecrisisabouttheeightiethday,butinmostinstancesit(thedisease?)leftthemirregularly。Afewofthemdiedofdropsywithoutbeingconfinedtobed。Andinmanyotherdiseasespeopleweretroubledwithswelling,butmoreespeciallyinphthisicalcases。