On Critical Days — First Draft Translation

ON CRITICAL DAYS. I consider it a great part of the art to be able to examine correctly the things that have been set down; for whoever knows and makes use of these things would not, it seems to me, err greatly in the art. 1 One must learn thoroughly the condition of the seasons and of each disease: what is favorable and what is dangerous, whether in the condition of the season or in the disease; what disease is prolonged and deadly; what prolonged and survivable; what acute and deadly; what acute and survivable. The ordering of the critical days is to be considered from these, and foretelling is made easy from them; and further, from these one can know whom to put under a regimen, and when and how. The greatest sign, then, for those among the sick who are going to survive is if the burning fever is not contrary to nature — and similarly for the other diseases as well; for nothing that accords with nature is terrible or death-bringing. Second in importance is if the season itself does not ally with the disease; for for the most part the nature of the human being does not overcome the power of the whole environment. 2 Further, if the features of the face grow thin, and the veins in the hands and at the corners of the eyes and above the eyebrows become quiet, having not been quiet before. And if the voice becomes weaker and smoother, and the pneuma more sparse and finer — on the following day there will be a remission of the disease. These things then must be observed in relation to the crises: also whether the area beside the fork of the tongue is coated as though with white saliva; and if the same has occurred at the tip of the tongue, though less so. If these signs are slight, the remission of the disease comes on the third day; if the coating is yet more pronounced, tomorrow; if still more pronounced, the same day. Further: the whites of the eyes at the beginning of the disease are necessarily darkened if the disease is strong; these becoming clear indicates complete health — moderately becoming so means more slowly, strongly becoming so means more quickly. Acute diseases arise from bile when it flows down upon the liver and settles into the head. 3 The following things then happen: the liver swells and unfolds toward the diaphragm under the swelling, and pain immediately falls upon the head, especially in the temples; hearing in the ears is not sharp, and often vision in the eyes fails; and shivering and fever take hold. These things happen to the patient at the beginning of the disease with intervals, sometimes strongly, sometimes less so; but as the time of the disease advances, the suffering in the body is greater, the pupils of the eyes dilate, and he sees shadowy shapes; and if you bring a finger toward the eyes, he will not perceive it on account of not seeing — and you would know from this that he does not see, for he does not blink when the finger is brought toward him. And he picks threads off his garments whenever he sees them, thinking they are lice. And whenever the liver unfolds further toward the diaphragm, he becomes delirious; and he seems to see before his eyes reptiles and other animals of every kind, and armed soldiers fighting, and he thinks he himself is fighting with them, and speaks as though seeing such things, and tries to go out, and threatens if someone will not let him pass through; and if he gets up, he cannot lift his legs but falls. His feet are always cold; and whenever he sleeps, he starts up from sleep and sees frightening dreams. We know that he starts up from dreams and is frightened when he becomes lucid, for he recounts such dreams as he was also enacting with his body and saying aloud with his tongue. These then are what he suffers in this way. At times he also becomes speechless the whole day and night, drawing in much breath all at once. But when he ceases being delirious, he immediately becomes lucid, and if anyone questions him he answers correctly and recognizes everything said; then again a little later he lies in the same pains. This disease strikes most often when someone is away from home and if he walks along some deserted road; but it also takes hold in other circumstances. There are two or three kinds of tetanos; if it arises on a wound, the following things happen. 4 The jaws lock as though rigid as wood, and they cannot open the mouth; the eyes weep frequently and are drawn; the upper back is rigid; the legs cannot be bent, nor the hands nor the spine. When it is deadly, the drink and the food that the patient had previously eaten sometimes comes back out through the nostrils. Opisthotonos for the most part suffers the same things through excess, but occurs when the tendons at the back of the neck are affected; this happens either from synanche, or from the uvula, or from the surrounding throat tissue becoming suppurated; in some it also arises from the head when fevers have supervened, and convulsion follows; and in some already from wounds as well. 5 This patient is drawn backward, and from the pain the upper back and the chest are rigid, and he groans. He is convulsed violently, so that he is barely held by those present to keep him from falling out of the bed. Tetanos is less deadly than the preceding types. 6 It arises from the same causes, and the whole body is convulsed alike. Burning fever does not arise in those mentioned above in the same way; for it is by nature that every such person is compelled to be febrile. 7 Great thirst holds the person and a violent fever. The tongue cracks as it roughens and becomes dry; its color at first is pale, as is normal, but as time advances it darkens; and if it darkens at the beginning, the crises are faster; if later, they are more prolonged. Hip-joint pains arise in most people chiefly from the following: if one has been warmed in the sun for a long time and the hip joints have become thoroughly heated and the fluid present in the joints has been dried up by the heat. 8 That it is dried up and congealed is a great sign of this: the sick person cannot turn and move the joints on account of the pain in the joints and the locking together of the vertebrae. He suffers pain more in the lower back and the vertebrae at the sides of the hip joints and the knees; the pain settles longest in the groins, together with the hip joints, sharp and burning; and if anyone makes him stand up or moves him, he groans from the pain as loudly as he can. Sometimes convulsion also comes on, and shivering and fever. It arises from bile; it also arises from blood; and similar pains arise from all kinds of diseases, and shivering and a mild fever sometimes take hold. But one must attend to the matter in this way. Jaundice is acute and kills quickly; the whole color is strongly pomegranate-rind-like or more greenish-yellow, as with the greener lizards; the skin is similar to this, and in the urine a reddish sediment like a bitter-vetch grain settles out, and a mild fever and shivering hold him; sometimes he cannot bear wearing his garment but is bitten and itches, being without food in the mornings, within; and then the viscera most often growl. 9 And when one makes him get up or converses with him, he cannot bear it. This patient for the most part dies within fourteen days; if he escapes these, he recovers. Pneumonia does the following: a strong fever holds him, and the pneuma is rapid, and he breathes out hot air; and helplessness and weakness hold him, and restlessness, and pains around the shoulder blade, the collarbone, and the breast, and heaviness in the chest, and episodes of delirium. 10 At times he is even free of pain until he begins to cough, and this condition is more prolonged and harder than the other. The saliva he spits at first is white and foamy. The tongue is yellow, but as time advances it darkens; if it darkens at the beginning, the resolutions are faster; if later, more drawn out; and at the end the tongue also cracks, and if you place a finger on it, it adheres to the finger. The tongue signifies the resolution of the disease, just as it does similarly in pleuritis. These things the patient suffers a minimum of fourteen days, and at most twenty-one, and coughs violently throughout this time; and what is cleared together with the coughing is at first abundant and foamy saliva, but on the seventh and eighth days, when the fever is at its peak and the pneumonia is moist, it becomes thicker — if not, it does not. On the ninth and tenth days it is greenish-yellow and tinged with blood; on the twelfth through the fourteenth day it is abundant and purulent. Those whose natures and bodily dispositions are moist, and whose disease is strong, are in the greater danger; those whose nature and state of disease is dry, less so. Concerning critical days I have already spoken above; fevers resolve on the fourth day, the seventh, the eleventh, the fourteenth, the seventeenth, the twenty-first; beyond these, for chronic fevers, on the thirtieth, then the fortieth, then the sixtieth; but whenever the disease passes beyond these numbers, the condition of the fevers has already become chronic.