Front Page Titles (by Subject) PESTILENTIAL CONSTITUTION - The Writings of Hippocrates and Galen
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PESTILENTIAL CONSTITUTION - Hippocrates, The Writings of Hippocrates and Galen 
The Writings of Hippocrates and Galen. Epitomised from the Original Latin translations, by John Redman Coxe (Philadelphia: Lindsay and Blakiston, 1846).
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At this part, Fœsius begins with the account of the “Status Pestilens,” the χαταϛασις λοιμωδης, of Hippocrates. Haller calls it “Constitutio Temporis Pestilens,” and Clifton, “The Malignant State.” As this pestilential constitution has by many been considered as a description of the plague at Athens, as given by Thucydides, Clifton has shown, I think conclusively, that Hippocrates has no reference to it, in this detail. It may be interesting to many to read Thucydides’ account, with the objections of Clifton, in connexion with this part of the Third Epidemics.—Ed.
The year was southerly, showery, and perpetually calm: but, greater droughts than ordinary happening some time before, much rain fell about the rising of Arcturus with the southerly winds. The autumn was gloomy, cloudy, and very wet. The winter southerly, wet, and mild; but a considerable while after the solstice, near the equinox, the weather was very severe; and, even about the equinox, northerly winds set in, and snow that lasted not long. The spring was again southerly and calm. A great deal of rain fell continually to the rising of the Dog-star. The summer was serene and hot, attended with great suflocating heats. The Etesiæ blew faintly and by intervals. About the rising of Arcturus much rain fell again, with the wind northerly. The year being thus southerly, damp, and mild, the winter proved healthy to all but consumptive people, as we shall see by and by.
Early in the spring, with the cold weather that then set in, came a great many erysipelases, some from evident causes, others unaccountably; of a bad sort, and fatal to many. Many complained of pain in their throats, and impediments in their speech; of burning fevers, with frenzies, aphthas in the mouth, tubercles upon the private parts, inflammations of the eyes, carbuncles, disorders of the belly, aversions to food, with thirst in some, in others not; turbid urine, in abundance, and of a bad sort; comas for the most part, and again watchings; crises not at all in many, or with difficulty; dropsies, and consumptions not a few. These were the epidemical diseases, of which there were some ill of every kind, and many never recovered it. The manner of their illness was as follows.
Many had erysipelases (that came from evident causes), upon very slight and trifling wounds, all over the body, especially about the head in those who were near sixty, if they were but a little neglected. Many again, while under cure, had great phlegmons formed, round which the erysipelas spread considerably, and in a short time. In most of them the matter that was separated turned to suppuration, and great fallings off of flesh, tendons, and bones ensued. The humour that was collected there was not like pus, but a certain kind of putrefaction, with a copious running of great variety. Now, wherever any of these happened about the head, the hair of the whole head and chin came off, and the bones were laid bare, and fell off, attended with great discharges. These things happened sometimes with, sometimes without, a fever, and were more terrible than dangerous. For, wherever any of these disorders were digested and turned to suppuration, there most of them did well; but where the phlegmon and erysipelas went off without any such abscess, there many of them died. The like circumstances happened, whatever part of the body it fell upon in its way. In many a flux happened upon the arm and whole elbow. Where it fell upon the ribs, it affected them either before or behind. Some had the whole thigh, or the leg, or the foot, laid bare: but the most dangerous of these was, when they fell upon the pubes or private parts. This was the nature of their attack, when either ulcers, or any other cause, occasioned the erysipelas. Many of them had it in fevers, before fevers, and upon fevers. To these, where any of them went off by suppuration, or by a considerable purging, or a discharge of laudable urine, it proved critical; but where none of these happened, and they disappeared without any signs, it proved fatal. Thus the case stood among many with respect to the erysipelas in the spring, which continued also through the summer, and during the autumn. The tubercles in the throat were very troublesome too to some persons, and so were the inflammations of the tongue, and the abscesses of the teeth. The voice, when it was vitiated and obstructed, was likewise another sign to many, especially to those who began to be consumptive, and to those who had burning fevers and phrensies.
These fevers and phrensies began early in the spring after the cold weather that then happened, and a great number were laid up with them at that time. They also proved very acute and mortal. The state of the fevers was thus. At the beginning they were troubled with comas, nauseas, horrors, acute fevers, but little thirst, and no delirium. They also bled a little at the nose, and the paroxysms for the most part were upon equal days. About the time of the paroxysms came on loss of memory, great languidness, and loss of speech. The fingers and toes were always cold, but much more so about the paroxysms, and the warmth returned again slowly and imperfectly. They came to themselves again, and spoke; but either a continual coma, without sleep, was upon them, or painful watchings. A great many were troubled with crude thin stools in abundance. The urine was plentiful and thin, without any thing critical or beneficial in it; nor did any thing else of a critical kind happen to those who were thus affected; for they had neither a good hemorrhage, nor any critical separation of what is usual to pass off; but every one died, (as fate would have it,) in a vague and uncertain manner, about the time of the crisis for the most part; some held out a longer time, but died at last, without speaking, and many sweating. Thus the case was among those who were mortally ill; and there was but little difference in the phrensies. For they were entirely without thirst or madness, as in other phrensies, but were taken with a kind of stupid delirium, and died with the heaviness upon them. There were also other fevers, of which we shall take notice. Aphthas, and ulcers in the mouth, were frequent; and great fluxes upon the private parts, with ulcerations, tubercles, outwardly and inwardly; swellings in the groin; inflammations of the eyes that were humid, of long duration, and painful; besides little tumours upon the eyelids, outwardly and inwardly, called Συϰα, that destroyed the sight in many persons. The like happened upon other ulcers, and upon the private parts. There were also many carbuncles in the summer, and other large pustules of the putrid kind, called Σηψ; many large herpes’s or tetters, and many complaints in the belly too, that did a great deal of harm. In the first place many were seized with painful tenesmus’s, especially children, and those who were under the age of puberty, most of whom died. Many also had lienteries, and dysenteries, but these without much pain. The discharges were of the bilious, fat, thin, and watery kind; and in many the distemper took this turn, sometimes with, sometimes without, a fever. There were likewise cruel gripings and twistings of the guts, with intolerable pain. Many things that were in the body and suppressed were let out, but these discharges did not carry off the pains. What was administered met with great difficulty; for purges were very injurious to most. Of these that were thus affected many died in a short time, and many again held out longer. In a word, all that were ill, whether of acute or chronical complaints, died chiefly of disorders of the belly; for the belly was the general receiver of all. There was, as far as I could observe, an aversion to food in every body, in all the forementioned diseases. In many, especially of this sort, and the like; and among others of those who were mortally ill, some were thirsty, others not. Of those who had fevers and other disorders no one drank intemperately, but with respect to this regulated themselves as the physician would have them. The urine was much, and that not in proportion to the drink taken in, but vastly more; and that which came away was very bad in its quality; having neither thickness, nor digestion, nor was the body well cleansed by it. Whereas in many cases cleansings by the urine that are good are very beneficial. To the greatest part they now implied corruption or colliquation, disorder, pains, and the want of a crisis. Comas likewise happened, particularly in the phrensies and the burning fevers; not but they happened too in all the other capital diseases, where a fever attended; but in many, a heavy coma followed, or little and gentle sleeps, all the time.
Many other kind of fevers were also epidemical, such as tertians, quartans, nocturnals, continuals, chronicals, erratics, inconstants, and such as were attended with nauseas and inquietude. All these brought with them great uneasiness: for the belly was in most cases much disturbed, horrors came on, and sweats that were not critical. As to the urine, that was as we have already described it. A great many of them were likewise tedious; the abscesses, that happened here, not proving critical as at other times. Add to this, the crises were universally very difficult, and sometimes not at all; or proved very tedious, especially to these. A few of them were determined in about eighty days; but to the greatest part they went off at random. A few of these died of a dropsy, without being confined to their beds. Many were afflicted with tumours that came upon other diseases, and above all those who were consumptive. For the greatest, most difficult, and most fatal was the consumption. Many of these, beginning in the winter, obliged a great number to keep their beds, while some of them bore it standing. Early in the spring most of those who were laid up died, and none of the rest got rid of their coughs. They abated indeed in the summer, but in the autumn they were all laid up, many died, and most of them were ill a long time. The greatest number of these began to be extremely ill presently after these complaints, and had frequent horrors, continual acute fevers very often, and unseasonable sweats. Many were cold continually: the cold was great too, and they could hardly get warm again. The belly was bound many ways, and presently again became humid; all that oppressed the lungs passing downwards. A great deal of urine was made, but not good; bad colliquations appeared; coughs were frequent all along, and much came away digested and moist, and with tolerable ease. But if they were a little in pain, the discharge from the lungs was then very gentle in all. The throat was not much affected with acrid, nor did salt humours do any harm. What came from the head was viscid, white, moist, and frothy. But the greatest evil of all, in these and other cases, was, what we have taken notice of before, a dislike to food: for they had no pleasure in eating and drinking, but passed the time very free from thirst. There was also a heaviness in the body, and a coma. A great many swelled, and fell into dropsies, were troubled with horrors, and before they died grew delirious.
Those who fell into consumptions were the smooth, the whitish, the lentil-coloured, the reddish, the gray-eyed, the leucophlegmatic, and those whose shoulders stuck up behind. Nor did women of these kinds escape. The melancholic, and the sanguine suffered too. These were affected with burning fevers, phrensies, and dysenteries; the young men, with tenesmuses; the phlegmatic, with long diarrhœas; and the bilious, with sharp and fat purgings. To all the above-mentioned the most troublesome time was the spring, which proved fatal to great numbers; the summer was the easiest, and fewest died; but in the autumn, and during the Pleiades, a great many died of quartans.
The summer happening as it ought, is, in my opinion, of great service: for summer diseases cease upon the coming in of winter, and winter diseases upon the coming in of summer. Though the summer that then was, was not well-conditioned, but on a sudden hot and southerly and calm; yet changing to another constitution or season was of service. And indeed I look upon it to be a great part of the art to be able to consider properly what has been already wrote. For he who knows, and makes use of, these things, does not seem to me capable of any great mistakes in his profession. But then he ought to be well acquainted with the condition of every season, and also with the disease; the good that is common to the season or the disease, and which disease will be long and fatal, long and safe, acute and fatal, acute and safe; and likewise the order of the critical days. These things he ought to consider and predict from; because they are able to supply him. And he who is acquainted with these things will know whom, when, and how to diet, or manage the rest.