On Crises — First Draft Translation

ON CRISES. Concerning swift crises toward the better: most of the signs are the same as those pointing toward health. 1 For the best sweats, which also most quickly stop fever, are those occurring on the critical days and completely releasing the patient from fever; good also are those that come over the whole body and will cause the disease to be borne more easily; but those that accomplish none of these things are of no benefit when they occur. The stool should thicken as the disease moves toward crisis; let it be somewhat reddish and not strongly foul-smelling; and it is also favorable for worms to be expelled as the crisis approaches. 3 The best urine is that which has the whitest sediment, smooth and even, throughout the entire time until the disease is decided; for it signifies that the illness will be safe and brief. If, when sweat has come on, the disease subsides, and the urine is seen to be reddish, having a white sediment, these patients have a relapse of fever on the same day, yet this too is decided safely within five days. In those who are going to recover in the shortest time, the greatest signs appear all at once; for they remain free of distress and out of danger, they sleep through the nights, and they display the other signs pointing to safety. 5 In those with fever that is not fatal, who have headache and the other signs of survival, bile is dominant. Those in whom the suffering begins in the first days are pressed harder on the fourth and fifth day; but by the seventh they are released from fever. 7 Fevers are decided on the same numbered days both from which people die and from which they survive; for the most benign fevers, with the safest signs, cease by the fourth day or before; and the most deadly, occurring with the most dreadful signs, kill by the fourth day or before; so the first type of onset ends thus. The second type cycles around to seven, the third to the eleventh, the fourth to the fourteenth, the fifth to the seventeenth, the sixth to the twentieth; these then, in the most acute cases, proceed by additions of four up to twenty. But none of these can be counted exactly in whole days; for neither can years and months be measured in whole days by nature. In burning fevers (kausioi), good signs appearing—such as are described among those pointing to health—if lesser, indicate remission by the third day; if thicker, tomorrow; if very thick, on the same day. 9 In burning fevers, if jaundice supervenes after the seventh day, it is clear the condition will be without sweat; for the disease is no longer inclined to produce sweating, nor to discharge any other way, but the patient becomes healthy. Necessarily, when the heat withdraws and draws the moisture toward itself, a crisis of the fever must occur through the urines that are being separated out, or through the evacuations of the belly, or a flow of blood from the nostrils, or copious urination, or severe diarrhea, or sweat, or vomiting, or in a woman also through the path of the menses; these most of all bring about crisis, or whatever is close to these; other things also bring about crises, though less than these. 11 If jaundice supervenes on the seventh day or later in a burning fever, and there is difficulty, with the departure of much saliva; and in burning fevers and in the others, if the fever releases when none of these signs has occurred, crises of the following kind must necessarily occur in their stead: either the dispersal of large swellings (phymata), or severe pains from the dispersal, or wastings of the fluids from the heat. Crises and remissions of those things indicating burning fever—the disease is more prolonged; of the severe ones—death for the most part; the remaining burning fevers resolve safely on the seventh or fourteenth day. It also tends to shift into lingering fever (lipyria), and takes hold for as many as forty days and exhibits exhipiasis [ἐξηπιαλοῦται: rare term of uncertain meaning, perhaps remittent ague-like episodes]; and the lingering fever takes hold and releases on the same day; headache also occurs; but if the lingering fever does not release the patient within forty days, but the patient is oppressed and has pain in the head and speaks incoherently, purge him thoroughly. When a burning fever is ending, if jaundice supervenes, it is no longer inclined to produce sweating, nor to discharge any other way, but the patient becomes healthy. Tertian fever is decided, for the most part, in seven cycles. 13 In those in whom jaundice occurs on the seventh, or ninth, or fourteenth day during unbearable fevers, this is good, provided the right hypochondrium does not become hard; if it does, the case is doubtful. Acute diseases are decided in fourteen days for the most part. 15 Sweats in those with fever, if they occur on the third, fifth, seventh, ninth, eleventh, fourteenth, twenty-first, and thirtieth days—these sweats decide diseases; those occurring otherwise indicate suffering. The pepsis (concoction / ripening) of urines, maturing little by little, if they have matured on the critical days, resolves the disease. 16 Wounds should be taken as the model for urines; for wounds, if they are being cleansed by white pus, indicate swift healing; but if they change to thin serum (ichor), they become malignant; and in the same way urines too give indication. If from distress they become thin, one must reckon from the cause (prophasis) by which the disease was established, and observe when this ceases; since, if this persists while the other signs supervene as they should, one must consider that there will be no release from the disease. If the head is in pain and from this a fever supervenes, and does not cease, nor does the pain cease, the fever is not at a crisis-point. In a prolonged crisis still moving toward the better, most of the same signs apply to these as those pointing toward health. Swellings (oidêmata) in the hypochondria that are soft, painless, and yielding when you touch them make the crises more prolonged, yet less fearful than those swellings (phymata) opposite to these; and the same applies to swellings in the rest of the belly. 18 If of the urines what is passed is clear but has a sediment that is white and smooth, the crisis is more prolonged, or at any rate less certain than the best urine; but if at some point the urine is reddish and the sediment reddish and smooth, this is more prolonged than the former but very favorable for survival. As many diseases of the gouty type as occur, these settle into a non-inflamed state within forty days. 20 Those things decided toward death within a day and a night are signs of weakness, such as those of drug-taking, of disturbance of the belly both upward and downward, of nausea, and of the other such things; if then the signs release from these within a day and a night—otherwise, consider them deadly. The worst of sweats are those that are cold and occurring about the neck; for these give advance warning of deaths and prolongation of diseases. 22 Variegated stools are more prolonged than black and the other deadly stools, yet no less destructive; they are of this kind: scrapings-like, bilious, bloody, leek-green, black—and sometimes all pass together, sometimes each in turn separately. If urine is sometimes passed clear and sometimes with a sediment that is white and smooth, these are more prolonged and less certain than the best urine. 23 If the urine is reddish and thin for a long time, there is danger that the person may not be able to hold out until the urine is concocted; and if there are otherwise signs that the patient will survive, expect that a deposit (apostasis) will shift into the regions below the diaphragm. If in fevers the urine undergoes changes, it indicates a prolonged course, and the patient must necessarily change both for the worse and toward the other way. 25 If urines at the beginning are not consistent but become thick from thin and then completely thin again, such cases are hard to decide and unstable. Cold sweats together with acute fever are deadly; with milder fever they indicate prolongation of the disease. 27 And wherever in the body there is heat or cold—wherever this is present, there is the disease. And wherever throughout the whole body swift changes occur—if the body grows cold or again grows warm, or the color changes from one to another—these indicate prolongation of disease. 29 And if in a feverish patient sweat supervenes without the fever ceasing, it is bad; for the disease is prolonged and it indicates moisture. Cold sweats supervening in a feverish patient indicate a long fever. 31 Copious sweat occurring without measure in a healthy person indicates disease—in summer less severe, in cold more severe. In those whose stools, if you let them stand and settle, have beneath them something like scrapings—if little, the disease is slight; if much, the disease is great; for these it is beneficial to flush out the belly. 32 In those who have black bile beneath in the lower evacuation, if more, the disease is greater; if less, lesser. If the veins are pulsing and the face is robust, and the hypochondria are not soft but swollen up, the disease is chronic and is not resolved without convulsion, or a large flow of blood from the nostrils, or severe pain. 34 Palpitations in the hands are a sign of prolonged fever, or of swift crisis toward the worse; and in these cases most of the signs are the same as those pointing toward death. In those who are going to die in the shortest time, the greatest signs appear from the beginning; for they breathe with difficulty, do not sleep through the nights, and display signs of danger. 36 If in a continuous fever the patient suffers on the fourth day and the seventh, and it is not decided on the eleventh, it is mostly destructive. Those who are seized by tetanus die within four days; if they escape these, they become healthy. 38 In burning fevers, if jaundice and hiccup supervene on the fifth day, it is deadly. Relapses occur in those who, having become fever-free, are beset by strong sleeplessness, or disturbed sleep, or bodily weakness, or pains in each of the limbs; and in those whose fevers cease without either resolving signs having occurred or without occurring on critical days; and if, when the fever has ceased and sweat has supervened, the patient passes reddish urine having a white sediment, expect a relapse of fever for these patients on the same day; these relapses are decided safely on the fifth day. 39 And if, when a crisis has occurred, the patient passes red urine having a red sediment, a relapse of fever occurs for these patients on the same day as well, and few of them are saved. When the burning fever relapses, it mostly produces sweating; and if having relapsed it takes as many days as the first attack, fever relapses also a third time, unless it releases after having relapsed on an odd day. For the most part, if the urines are unconcocted and the other signs are not according to reason (logos), the disease relapses [on a non-critical day; text here is uncertain, with editorial supplements: μὴ and ἀφῇ bracketed in the source]; though sometimes it also relapses on a critical day, while these signs remain as such. For those with parotid swellings that form around the time of crisis but do not suppurate, when these patients are recovering, relapse occurs according to the pattern of relapses, with a similar cycle; for these patients there is hope that a deposit (apostasis) will occur to the joints, or thick urine—such as the white urine in the laborious quartan fevers—delivers from the deposit; in some of these also hemorrhages occur from the nostrils, and it is resolved very quickly; and in these patients the disease is healed as pus is discharged. 41 In those held by melancholic conditions together with frenitic conditions, hemorrhoids arising are good. Those who are mad, either spontaneously or as diseases are resolving, in these patients madness is resolved by pain entering the feet or the chest, or by a severe cough arising; if none of these occurs, when the madness resolves, loss of sight results. 43 Those who babble with their tongue, being unable to control their lips—if this ceases, they become suppurating internally (empyoi), or severe pain in the lower regions resolves it, or a curvature of the spine, or much blood flowing from the nostrils, or madness. When the great disease has become habitual, resolution comes through: pain in the hips, or distortion of the eyes, or blindness, or swelling of the testicles, or prominence of the nipples. 45 A flow of blood from the nostrils resolves a burning fever. In a burning fever, if shivering takes hold, it tends to produce sweating. 47 In one held by a burning fever, when shivering supervenes, resolution. Those in whom tremors arise in burning fevers—derangement (parakopê) resolves it. 49 In those whose ears become deaf during fevers, if the fever is not resolved, madness necessarily follows; blood flowing from the nostrils resolves it, or the belly being violently disturbed with bilious matter, or dysentery supervening, or pain in the hips or knees. In those in whom shivering supervenes during fevers, the fever is resolved. 51 In those in whom sudden pains occur, the hypochondrium is raised upward; and if the pains occur around the false rib and around the legs, for these patients resolution is phlebotomy and purging downward; for a strong fever does not take hold when the regions are weakened. In one held by dropsy, if watery fluid flows through the veins into the bladder or belly, resolution. 53 If in one held by white phlegm a severe diarrhea supervenes, resolution. In one held by severe diarrhea, vomiting supervening spontaneously is resolution. 55 Those who are seized by diarrhea for a long time together with cough do not recover, unless severe pains fall into the feet; or a distortion of nature tends to occur, when diarrhea is no longer passing, or an empty evacuation takes hold at every attempt; for winds (physai) arising from within supervene; it is then evident they have no moisture remaining, so that, if necessary, one can safely give food to the patient in this condition. When ileus supervenes, give cold unmixed wine to drink in large quantity, little by little, until sleep or pain in the legs comes; fever also resolves it, or dysentery. 57 In one suffering severe pain in the head and being diseased, if pus flows either through the ears or through the nostrils, the disease is resolved. In those who are healthy and pains suddenly arise in their heads, and they immediately become voiceless and snore—they die within seven days, if fever does not take hold. 59 For one suffering severe pain in the head, apply a cupping-vessel to whatever of the upper regions is distressed; pain into the hips and knees and panting (asthma), whichever of these occurs, resolves it. For one with eye-inflammation, being seized by diarrhea is good. 61 In one held by convulsion or tetanus, fever supervening resolves the disease. In one held by fever, if convulsion takes hold, the fever ceases on the same day, or the next, or the third. 63 When one is tensed in hands and feet, it produces madness. If the veins in the hands are pulsing and the face is robust, and the hypochondria are not soft but swollen up, the disease is chronic; it is not resolved without convulsion, or much blood from the nostrils, or pain into the hips.