§4#2ἀλλ’ οὐδὲ τὸ μάλιστα ἐξαίφνης εἰσβάλλον ἀκμάζον εἴποι τις ἂν, τὴν ἀποπληξίαν· οὐδὲ γὰρ ἀκριβῶς ἐστι τὸ τοιοῦτον, ἀλλ’ ἐν μὲν βραχεῖ χρόνῳ διεξέρχεται τήν τε ἀρχὴν καὶ τὴν ἀνάβασιν, οὐ μὴν ἄναρχόν γέ ἐστιν, οὐδ’ εὐθὺς εἰσβάλλει τελεώτατα, ὥσπερ οὐδὲ ὁ τῆς ἐπιληψίας παροξυσμός·
But one would not even say that apoplexy, the disease which invades most suddenly of all, is at its peak; for such a thing is not strictly so, but in a very short time it goes through both its beginning and its increase, yet it is certainly not without a beginning, nor does it immediately invade in its most complete state, just as the paroxysm of epilepsy does not either.
οὐδεὶς γὰρ οὕτως ἁλίσκεται ἐξαίφνης τῷ συμπτώματι, καθάπερ οἱ τὸν τράχηλον ἀφαιρούμενοι, καίτοι καὶ τούτων ἡ τομὴ πρῶτόν τινα χρόνον ἔχει καὶ δεύτερον καὶ τρίτον καὶ τέταρτον, ὥσπερ εἰ καὶ χειρουργός τις ὁτιοῦν τέμνοι.
For no one is seized so suddenly by the symptom as those who are decapitated, although even for them, the cutting has a certain first, second, third, and fourth moment, just as if a surgeon were cutting anything whatsoever.
ἀλλὰ γὰρ, εἰ βούλει, συγχωρείσθω χωρὶς χρόνου τήν τε ἐπιληπτικὴν καὶ τὴν ἀποπληκτικὴν γίνεσθαι κατάπτωσιν, ἵν’ ὅ γε ἐξ ἀρχῆς προὐθέμην διέλθω.
But indeed, if you wish, let it be granted that both the epileptic and the apoplectic collapse occur without time, so that I may go through what I proposed from the beginning.
τουτὶ μὲν γὰρ αὐτὸ σύμπτωμά ἐστιν ἡ γινομένη κατάπτωσις, ἡ νόσος δὲ οὐ τοῦτό ἐστιν, ἀλλὰ χρὴ πάντως αὐτὴν, ὡς ἀπεδείξαμεν, εἶναί τινα διάθεσιν σώματος.
For this very thing, the occurring collapse, is a symptom, but the disease is not this; rather, it is entirely necessary for it, as we demonstrated, to be a certain disposition of the body.
εἰ δὲ οὐκ ἔχομεν εἴτε γεννωμένης αὐτῆς, εἴτε αὐξανομένης γνώρισμά τι, τὸν μὲν ἀκόλουθον λόγον οὐκ ἀνατρέπει τοῦτο, καθ’ ὃν ἐλέγομεν παντὶ νοσήματι ἀναγκαῖον εἶναι διὰ τῆς ἀναβάσεως ἐπὶ τὴν ἀκμὴν ἀφικνεῖσθαι, δύσγνωστον δὲ ἐνίοτε καὶ πολλοῖς ἄγνωστον τῶν νοσημάτων ὁμολογεῖ εἶναι τὴν αὔξησιν.
And if we do not have any sign either of its being born or of its increasing, this does not overturn the consequent argument, according to which we said that it is necessary for every disease to arrive at its peak through its increase, but it agrees that the increase of diseases is sometimes hard to recognize and unknown to many.
ὅτι δὲ ἀληθές ἐστιν ὃ λέγω, πείσαιμι ἄν σε βραχυτάτῳ λόγῳ τῷδε.
And that what I say is true, I could persuade you by this very short argument.
σκιῤῥώδεις ὄγκους ἐθεασάμην πολλάκις ἐν σκέλεσιν εὐθέως ἐξ ἀρχῆς συνισταμένους ἄνευ τοῦ προηγήσασθαι φλεγμονὴν, καὶ τρισί γε ἐνίοτε καὶ τέτταρσιν ἔτεσιν αὐξανομένους κατὰ βραχὺ, χωρὶς τοῦ παρεμποδίζειν αἰσθητῶς τὰς ἀναγκαίας τοῦ σκέλους ἐνεργείας· ἐν δὲ τῷ χρόνῳ διὰ μέγεθος ἀξιόλογον ὕστερόν ποτε καὶ τὴν βάδισιν ἐνοχλοῦντας.
I have often observed scirrhous tumors in the legs forming straight from the beginning without inflammation preceding, and increasing gradually sometimes for three and even four years, without perceptibly hindering the necessary activities of the leg; but in time, on account of their considerable size, later at some point even troubling walking.
ἐπινόησον τοίνυν, οὐ γὰρ ἀδύνατον, ἐν τοῖς σιμοῖς τοῦ ἥπατος ἤδη τινὰ ὄγκον συνίστασθαι σκιῤῥώδη· καὶ λήσεται μέχρι τινὸς τούτου ἡ σύστασις, ὕστερον μέντοι τὰ τῆς διαθέσεως αὐτῆς ἔσται φανερώτερα, μηδὲ τότε δυναμένων ἡμῶν ἐξευρεῖν, ἐφ’ ᾗ διαθέσει τοῦτο συμβαίνει· χρόνῳ δὲ ὕστερον ἤδη που καὶ παρέγχυσις ὑδερικὴ συμβήσεται, μηδὲ τότε πρὸς τὴν ἁφὴν διασημαίνοντος τοῦ σκιῤῥώδους ὄγκου· ἀλλ’ ὕστερόν γε φανεὶς ἀξιόλογος ἀνέμνησεν ἡμᾶς τῆς ἔμπροσθεν ἀγνοίας.
Conceive, therefore, for it is not impossible, that some scirrhous tumor is already forming in the concave parts of the liver; and the formation of this will escape notice up to a certain point, however, later the things of this disposition itself will be more manifest, not even then being able for us to find out on what disposition this happens; and in time, later, already perhaps a dropsical effusion will also happen, even then the scirrhous tumor not making itself known to the touch; but having later appeared considerable, it reminded us of our former ignorance.
οὐκ ὀλίγους γοῦν ἐγὼ τεθέαμαι κατὰ τὴν τοιαύτην ὁδὸν τῶν συμπτωμάτων ἐν ὀλίγῳ χρόνῳ προφήναντας ὄγκον οὐ σμικρὸν ἐν ἥπατι σκιῤῥώδει, συνιστάμενον μὲν ἐκ πολλοῦ, λανθάνοντα δὲ διὰ τὴν αὐτοῦ σμικρότητα καὶ εὐτροφίαν τῶν καθ’ ὑποχόνδριον μυῶν.
At any rate, I have seen not a few along such a path of symptoms who in a short time displayed no small tumor in a scirrhous liver, forming indeed from long ago, but escaping notice on account of its smallness and the well-nourished state of the muscles in the hypochondrium.
ἀλλ’ ὅταν αὐξανόμενος ὁ σκίῤῥος ἅμα μὲν ἐπαναβῇ τοῖς κύρτοις τοῦ ἥπατος, ἅμα δὲ ἀτροφίας αἴτιος γένηται τοῖς τε ἄλλοις τοῦ ζώου μορίοις καὶ τοῖς καθ’ ὑποχόνδριον μυσὶν, ἐξ ἀμφοτέρων τούτων ἐναργῶς ἐν ὀλίγῳ χρόνῳ διαγνώσεις, αὐτοῦ ἤδη ὑπάρξαντος ἀξιολόγου μεγέθους.
But when the increasing scirrhus on the one hand ascends to the convex parts of the liver, and on the other hand becomes the cause of atrophy both to the other parts of the animal and to the muscles in the hypochondrium, from both of these you will clearly diagnose it in a short time, it having already attained a considerable size.
τὰ μὲν δὴ τοιαῦτα πάντα συνῆπται τῇ τῶν πεπονθότων μορίων ἐπισκέψει, περὶ ἧς οὐ πρόκειται μὲν ἐν τῷ παρόντι σκοπεῖσθαι, δεδήλωται δὲ ὑπὲρ τῆς κοινωνίας αὐτῶν οὐκ ἀχρήστως.
All such things indeed are connected with the inquiry into the affected parts, about which it is not proposed to consider at present, but has been explained, not uselessly, concerning their association.
ἐπὶ δὲ τὸν ἐξ ἀρχῆς λόγον ἰέναι καιρός.
But it is time to go back to the original argument.
ἑκάστου τῶν νοσημάτων ἴδιός ἐστι χρόνος ὁ τῆς γενέσεως, ἐνίοτε μὲν αἰσθητὸς, ἐνίοτε δὲ οὐκ αἰσθητός· ἀφ’ οὗ πάλιν ὁ τῆς αὐξήσεως οὐχ ὁμοίως ἐπὶ πάντων αἰσθητὸς οὐδὲ οὗτος· οἷς ὁ τῆς ἀκμῆς ἕπεται πάντως αἰσθητὸς, ὁμολογούντων ἡμῶν ἔστιν ὅτε μηδὲν ἔχειν ἐναργὲς γνώρισμα τῆς ἀρχῆς τοῦ πάθους καὶ τῆς αὐξήσεως.
Of each of the diseases there is a particular time, that of origin, sometimes perceptible, and sometimes not perceptible; from which again that of increase is not equally perceptible in all cases, nor is this one; after which the time of the peak follows, in all cases perceptible, while we admit that sometimes we have no clear sign of the beginning of the affection and of its increase.
ἐπὶ τούτων οὖν, ὡς πρὸς τὴν χρείαν τῆς τέχνης, ἀληθῶς τις ἐρεῖ τὸν τῆς ἀκμῆς μόνον ὑπάρχειν καιρόν· εἰ δὲ καὶ σώζεσθαι μέλλοιεν, ἕπεσθαι πάντως αὐτῷ τὸν τῆς παρακμῆς, αἰσθητὸν καὶ τοιοῦτον, ὡς ἂν ἐν χρόνῳ συνιστάμενον οὐκ ἀπλατεῖ.
In these cases therefore, as far as the utility of the art is concerned, one will truly say that only the season of the peak exists; and if they are also to be saved, that that of the decline follows it in all cases, perceptible and such as being formed in a time not without breadth.
καὶ γὰρ εἰ ἢ δι’ αἱμοῤῥαγίας, ἢ δι’ ἱδρώτων τις ὀξέως κριθείη, χρόνος γοῦν τις ὑπάρχει καὶ τούτῳ αἰσθητὸς ὁ τῆς παρακμῆς· εἰ δ’ ἐλάττονος τούτου καθ’ ἕτερα νοσήματα γινομένου, τρισὶν ἢ τέτταρσιν ἢ καὶ πλέοσιν ἡμέραις παρακμάζοντος, τοῦτο οὐδὲν τὸν ἔμπροσθεν λόγον φαίνεται παραβλάπτον, οὐδὲ διαβάλλει τὸ κεφάλαιον τῆς ἀποφάσεως, ἀλλ’ ἔτι μένει, τὸ πάντων τῶν νοσημάτων, ὅσα λύεται, καθάπερ ἀκμὴν, οὕτω δὴ καὶ παρακμὴν ὑπάρχειν τινά.
For even if someone should be judged acutely either through hemorrhage or through sweats, at least some perceptible time of decline exists also for this one; and if this occurs as less in other diseases, declining in three or four or even more days, this seems to harm the previous argument in no way, nor does it discredit the main point of the assertion, but it still remains, namely, that for all diseases, as many as are resolved, just as there is a peak, so indeed there is also a certain decline.