§7Αὐτὴ μὲν οὖν ἡ τομὴ τῶν εἰς ἀπυρεξίαν ληγόντων ἁπάντων ἐστὶ πυρετῶν, ἀμφημερινῶν, τριταίων, τεταρταίων, ὡς ἓξ ἐχόντων τὰ μέρη διαφέροντα ἀλλήλων ἰδέαις εὐσήμοις·
This division, then, is that of all fevers ending in apyrexia—quotidian, tertian, and quartan—as having six parts differing from one another in distinct characters.
ἑτέρα δὲ, τῶν μὴ διαλειπόντων, εἰς πέντε μέρη διαιρουμένων.
But the other division, of those which do not intermit, is divided into five parts.
εἰσὶ δὲ καὶ οὗτοι πάμπολλοι, τινὲς μὲν ἑκάστης ἡμέρας παροξυνόμενοι, τινὲς δὲ διὰ τρίτης·
And these too are very numerous, some having paroxysms every day, and others every other day.
οὐ μὴν οἵ γε διὰ τετάρτης πολλάκις, ἀλλ’ ἐν τῷ σπανίῳ, φαίνονται γινόμενοι· τὸ πλεῖστον γὰρ αὐτῶν γένος εἰς ἀπυρεξίαν παύεται.
However, those every third day do not appear often, but only rarely; for the greatest class of them ends in apyrexia.
διττὴ δὲ καὶ τούτων ἐστὶν ἡ ἰδέα τῶν εἰς ἀπυρεξίαν μὴ παυομένων, ἀμφημερινῶν, τριταίων, τεταρταίων.
And the character of these that do not end in apyrexia is twofold—quotidian, tertian, and quartan.
ἔνιοι μὲν γὰρ αὐτῶν καὶ τὸ μέγεθος ἀποτίθενται τοῦ σφυγμοῦ καὶ τὸ τάχος καὶ τὴν πυκνότητα καὶ τὴν σκληρότητα· τινὲς δὲ τὰ μὲν ἄλλα τρία πρὸς τὸ κατὰ φύσιν ἐπανάγουσι, φυλάττουσι δὲ ταχύτητα οἱ μὲν πλεῖον, οἱ δὲ ἧττον.
For some of them lose both the size of the pulse and its speed and frequency and hardness; but some bring the other three features back to the natural state, while preserving speed, some more, some less.
ἀλλ’ οὐ τοῦ νῦν παρόντος λόγου περὶ ἐκείνων διαιρεῖσθαι· πρόκειται γὰρ ἐξαριθμῆσαι τὰ μόρια τῆς περιόδου καθ’ ἕκαστον γένος νοσήματος.
But it is not of the present discourse to divide concerning those; for the purpose is to enumerate the parts of the period according to each kind of disease.
εἰρηκότες οὖν ὀλίγον ἔμπροσθεν, ὡς ἕξ εἰσι τὰ πάντα κατὰ τοὺς διαλείποντας πυρετοὺς, ἑξῆς διερχόμεθα τὰ μέρη τῶν μὴ διαλειπόντων, πέντε εἶναι λέγοντες, ὅταν τὰ μὲν ἄλλα παραπλησίως αὐτοῖς ὑπάρχῃ, μόνον δὲ λείπῃ τὸ τῆς ἀπυρεξίας.
Having said, therefore, a little before, that there are six in all in the case of intermitting fevers, we next go through the parts of those which do not intermit, saying that they are five, when the other things belong to them in a similar way, and only that of apyrexia is lacking.
ἡ δ’ ἐν τοῖς ἄλλοις μέρεσιν ὁμοιότης ἔξ ἀνάγκης ἐστὶ, τὸ τῆς εἰσβολῆς τῶν παροξυσμῶν μετὰ συστολῆς γίγνεσθαι, ὀνομάζω δ’ οὕτω τὸ μετὰ τοῦ ψύχεσθαι, τούτῳ γὰρ ἕπεται κατὰ τοὺς σφυγμοὺς εἴσω μᾶλλον κινεῖσθαι μετὰ μικρότητος, ἀποχωροῦντος εἰς τὰ σπλάγχνα τοῦ αἵματος, ᾧ πάλιν ἐξ ἀνάγκης ἕπεται τὸ τῆς ἀνωμαλίας, εἶθ’ ἑξῆς τὸ τῆς ἀναβάσεως, ἀκμῆς τε καὶ παρακμῆς.
And the similarity in the other parts is of necessity: that the onset of the paroxysms occurs with a contraction—and I call by this name that which is accompanied by chill, for there follows upon this, in the pulses, a movement more inward accompanied by smallness, as the blood retreats to the viscera, upon which again of necessity follows the irregularity, and then next the ascent, and the height and decline.
ἐφ’ ὧν μέντοι χωρὶς αἰσθητῆς συστολῆς εἰσβολὴ γίγνεται παροξυσμοῦ, τοὺς τρεῖς καιροὺς εἰς ἕνα μεταπίπτειν ἀναγκαῖόν ἐστι, καὶ γίγνεσθαι τὸ σύμπαν μέχρι τῆς ἀκμῆς ἀνάβασιν.
In those cases, however, where the onset of the paroxysm occurs without perceptible contraction, it is necessary for the three stages to fall into one, and for the whole up to the height to become an ascent.
ὅπου γὰρ οὐκ ἐγένετο συστολὴ, δῆλον ὡς οὐδ’ ἀνωμαλία.
For where no contraction occurred, it is clear that there was no irregularity either.
τὴν δὲ ἀκμὴν οὐδ’ ἄν ποτε εἶδον ἀπολείπουσαν, ἀλλ’ ἀεὶ διαμένουσαν αἰσθητὴν ἰσότητα κατὰ πάντας τοὺς πυρετοὺς ἐπί τινα χρόνον· εἰσβολὴν μέντοι μυριάκις ἐθεασάμην ἄνευ τῶν εἰρημένων τῆς ἀρχῆς συμπτωμάτων, ὧν τὸ μὲν κυριώτατον ἦν ἁπάσαις ὀλίγου δεῖν ταῖς ἀρχαῖς ἡ ψύξις συνοῦσα τῶν παροξυσμῶν, ὥσπερ καὶ ἡ ἐπὶ τὰ ἔσω τῶν ἀρτηριῶν κίνησις, ὑπὲρ ἧς εἴρηται μὲν ἐπιπλέον ἐν τῇ περὶ τῶν σφυγμῶν πραγματείᾳ, κατὰ δὲ τὸν ἐνεστῶτα λόγον ἀρκεῖ τῷ τάχει τῆς συστολῆς ἀφορίζειν αὐτήν.
But I have never seen the height lacking, but always remaining as a perceptible equality in all fevers for some time; yet I have observed the onset ten thousand times without the aforementioned symptoms of the beginning, of which the most principal was the chill accompanying the beginning of the paroxysms in almost all cases, as well as the inward movement of the arteries, concerning which more has been said in the treatise on pulses, but for the present discourse it is sufficient to define it by the speed of the contraction.
ὅσα δ’ ἄλλα συμπτώματά τε καὶ σημεῖα τῆς ἀρχῆς τῶν παροξυσμῶν ἐστιν ἴδια, προείρηται τὰ μὲν ἐπιγινόμενα τῇ περιψύξει, τὰ δ’ ἄλλα ἄλλως συμβαίνειν· σμικρότης μὲν τῶν σφυγμῶν καὶ ἀραιότης καὶ βραδυτὴς διαστολῆς ἐπὶ τῇ καταψύξει, ῥῖγος δ’ ἐπ’ ἄλλαις προφάσεσιν, ἃς ἐν ταῖς τῶν συμπτωμάτων αἰτίαις εἴπομεν.
And as for all the other symptoms and signs that are proper to the beginning of the paroxysms, it has been said before that some happen with the surrounding chill, and others in other ways; smallness of the pulses, rareness, and slowness of diastole follow upon the chill, while shivering follows upon other causes, which we have stated in the causes of symptoms.
ἀλλ’ ὅλον τὸ γένος τοῦτο τῶν παροξυσμῶν παντάπασιν, ὡς ἔφην, ἀπόλλυται, καὶ πολλοὺς πολλάκις ἡμεῖς ἐκωλύσαμεν ὑπὸ τῶν θαυμαστῶν τούτων ἰατρῶν ἤτοι γ’ ἐπὶ τὸ λουτρὸν πεμφθέντας, ἢ τροφὴν προσενέγκασθαι κελευθέντας, ὡς ὑπερβεβηκότας ἤδη τὰς ὑπόπτους ὥρας τοῦ παροξυσμοῦ.
But this whole class of paroxysms, as I said, is altogether lost sight of, and many times we have prevented many patients from being sent to the bath by these "wonderful" doctors, or from being ordered to take food, as if they had already passed the suspected hours of the paroxysm.
συμβαίνει δὲ αὐτοὺς ἀγνοοῦντας ἀκριβῶς ἅπτεσθαι τῆς ἀρτηρίας, ἐν τοῖς τοιούτοις σφάλμασι καθίστασθαι.
And it happens that they, not knowing how to touch the artery accurately, fall into such errors.
ἅπασι γὰρ τοῖς οὕτω παροξυνομένοις ἡ συστολὴ θάττων γίγνεται· γνωρίζειν δ’ αὐτὴν οὐ παντός ἐστιν, ἀλλὰ δεῖται μάλιστα τοῦτο τὸ ἔργον, εἴπερ τι καὶ ἄλλο τῆς τέχνης, ἀσκήσεως ἱκανῆς, ἣν οὐχ οὐχ οἷόν τε ποιήσασθαι, πρὶν τεχνωθῆναι τὸν εἰρημένον ὑφ’ ἡμῶν τρόπον ἐν τῷ πρώτῳ τῆς διαγνώσεως τῶν σφυγμῶν.
For in all those who have paroxysms in this way, the contraction becomes faster; but to recognize it is not for everyone, but this work requires, if indeed any other in the art does, sufficient practice, which it is not possible to obtain before being trained in the manner described by us in the first book of the diagnosis of pulses.
εἰ μὲν οὖν τις εἴη γνωστικὸς τῆς συστολῆς τῶν ἀρτηριῶν, ἐγχωρεῖ τούτῳ τίθεσθαι τοῦτ’ αὐτὸ τὸ μέρος τοῦ παροξυσμοῦ, καθ’ ὃ τὴν συστολὴν ὠκυτέραν ἐγνώρισε γεγενημένην ἄνευ τῆς διαστολῆς, ἀρχὴν τῆς περιόδου· τὸ δ’ ἐφεξῆς τῷδε ἐπανάβασιν, ἄχρι τῆς ἀκμῆς·
If, then, anyone should be capable of recognizing the contraction of the arteries, it is possible for him to set this very part of the paroxysm, during which he recognized that the contraction became faster without the diastole, as the beginning of the period; and the part following upon this as the ascent, up to the height.
εἰ δὲ μὴ γνωρίζοι μηδὲ τοῦτο, φαίνοιτο δὲ ἀθλίπτως αὐτῷ παντοίως ἡ εἰσβολὴ γεγενημένη, τὸ μέχρι τῆς ἀκμῆς μέρος τοῦ παροξυσμοῦ πᾶν ἐπανάβασιν, ἢ ἐπίδοσιν, ἢ αὔξησιν ὀνομάσει· τέμνων δ’ αὐτὴν εἰς πρῶτα καὶ τελευταῖα καὶ μέσα κατὰ τὸ μᾶλλόν τε καὶ ἦττον, οὐκ εἴδεσι διαφόροις, ὡς ἔμπροσθεν ἔλεγον ἐπὶ τῶν αἰσθητῶν περιψύξεων.
But if he should not recognize even this, and the onset should appear to him to have occurred altogether imperceptibly, he will call the whole part of the paroxysm up to the height "ascent," or "increase," or "growth"; dividing it into first, last, and middle parts according to more and less, not by different kinds, as I said before in the case of perceptible chills.
ἐν τοῖς τοιούτοις οὖν πυρετοῖς οἱ πάντες ἔσονται καιροὶ τρεῖς, αὔξησις, ἀκμὴ, μείωσις· οὐδὲν γὰρ χεῖρον οὐδὲ μείωσιν ὀνομάζειν τὸν καιρὸν ἐκεῖνον, ἐν ᾧ τοῦ μεγέθους ἀφαιρεῖταί τι τοῦ πυρετοῦ·
In such fevers, therefore, the periods will be three in all: increase, height, and decrease; for it is none the worse to call that period "decrease" in which some of the magnitude of the fever is subtracted.
ἐν ὅσοις δ’ οὐκ ἔστι περίοδος, οἷον καὶ τοῖς συνόχοις ὀνομαζομένοις, τούτοις τοῖς πυρετοῖς οὔτε παροξυσμὸς ὅλως τίς ἐστιν, οὔτε τὰ προειρημένα μέρη, τὰ μέντοι τῆς ὅλης νόσου μόρια κατὰ διαφέροντας χρόνους καὶ τούτοις ἐστὶν, ἑτέροις τρόποις διαγινωσκόμενα παρὰ τοὺς ἐν τοῖς παροξυσμοῖς καιροὺς, οὓς ὀλίγον ὕστερον ἐρῶ, καὶ μάλιστα ὅτι σφάλλονται πάντες ἐν αὐτοῖς ἰατροὶ, καίτοιγε Ἱπποκράτους ὀρθότατα διδάξαντος ὑπὲρ αὐτῶν.
But in those which have no period, such as those called "continuous," these fevers have neither any paroxysm at all nor the aforementioned parts, though the parts of the whole disease at different times exist in these too, being diagnosed in other ways than the periods in paroxysms, concerning which I shall speak a little later, and especially because all doctors err in them, although Hippocrates taught most correctly concerning them.