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Hippocrates · Prognostic §24-25

Course and Metastasis of Fevers and General Prognosis

Passage 10 of 10 · Greek

Summary

The author discusses the prognosis of fevers, explaining relapses in the absence of liberating signs, metastasis to joints or transition to quartan fever during prolonged fevers, age-specific differences, and pediatric convulsions. It concludes with the essential principle that a physician must master all universal signs, seasonal constitutions, and epidemic trends to accurately predict patient outcomes.

§2424.
24.
Ὁκόσοισι δ᾿ ἂν οἱ πυρετοὶ παύωνται, μήτε σημείων γενομένων λυτηρίων, μήτε ἐν ἡμέρῃσι κρισίμῃσιν, ὑποστροφὴν προσδέχεσθαι χρὴ τουτέοισιν.
In whomsoever the fevers cease, neither liberating signs having occurred, nor on critical days, for these one must expect a relapse.
Ὅστις δ᾿ ἂν τῶν πυρετῶν μηκύνῃ περιεστικῶς διακειμένου τοῦ ἀνθρώπου, μηκέτι ὀδύνης ἐχούσης διὰ φλεγμονήν τινα, μήτε διὰ πρόφασιν ἄλλην μηδεμίην ἐμφανέα, τουτέῳ προσδέχεσθαι ἀπόστασιν μετ᾿ οἰδήματός τε καὶ ὀδύνης ἔς τι τῶν ἄρθρων, καὶ οὐχ ἧσσον ἐκ τῶν κάτω.
But whoever's fever protracts, while the man is in a surviving state, there being no longer pain through any inflammation, nor through any other manifest cause, for this one must expect a metastasis with swelling and pain to one of the joints, and not least to the lower ones.
Μᾶλλον δὲ γίγνονται καὶ ἐν ἐλάσσονι χρόνῳ αἱ τοιαῦται ἀποστάσιες τοῖσι νεωτέροισι τριήκοντα ἐτέων· ὑποσκέπτεσθαι δὲ χρὴ εὐθέως τὰ περὶ τῆς ἀποστάσιος, ἢν εἴκοσιν ἡμέρας ὁ πυρετὸς ἔχων ὑπερβάλλῃ· τοῖσι δὲ γεραιτέροισικ ἧσσον γίγνεται, πολυχρονιωτέρου ἐόντος τοῦ πυρετοῦ.
Such metastases occur more and in less time to those younger than thirty years; and one must suspect straightway the things concerning metastasis if the fever, holding, exceeds twenty days; but to the older it occurs less, the fever being much more prolonged.
Χρὴ δὲ τὴν μὲν τοιαύτην ἀπόστασιν προσδέχεσθαι, ξυνεχέος ἐόντος τοῦ πυρετοῦ, ἐς δὲ τεταρταῖον καταστήσεσθαι, ἢν διαλείπῃ τε καὶ καταλαμβάνῃ πεπλανημένον τρόπον, καὶ ταῦτα ποιέων τῷ φθινοπώρῳ προσπελάσῃ.
One must expect such metastasis when the fever is continuous; but it will settle into a quartan fever if it intermits and attacks in an irregular manner, and doing this, approaches autumn.
Ὥσπερ δὲ τοῖσι νεωτέροισι τῶν τριήκοντα ἐτέων αἱ ἀποστάσιες γίγνονται, οὕτως οἱ τεταρταῖοι μᾶλλον τοῖσι τριήκοντα ἐτέων καὶ γεραιτέροισιν.
And just as metastases occur to those younger than thirty years, so quartan fevers occur more to those of thirty years and older.
Τὰς δὲ ἀποστάσιας εἰδέναι χρὴ τοῦ χειμῶνος μᾶλλον γιγνομένας χρονιώτερόν τε παυομένας, ἧσσον δὲ παλινδρομεύσας.
And one must know that metastases occur more in winter, and cease more slowly, but regress less.
Ὅστις δ᾿ ἂν ἐν πυρετῷ μὴ θανατώδει φῇ τὴν κεφαλὴν ἀλγέειν, ἢ καὶ ὀρφνῶδές τι πρὸ τῶν ὀφθαλμῶν φαίνεσθαι, ἢ καρδιωγμὸς τουτέῳ προσγένηται, χολώδης ἔμετος παρέσται· ἢν δὲ καὶ ῥῖγος ἐπιλάβῃ, καὶ τὰ κάτω μέρεα τοῦ ὑποχονδρίου ψυχρὰ ᾖ, καὶ θᾶσσον ἔτι ὁ ἔμετος παρέσται· ἢν δέ τι πίῃ ἢ φάγῃ ὑπὸ τοῦτον τὸν χρόνον, χάρτα τοῦτο ταχέως ἐμέεται.
Whoever in a non-fatal fever says that his head aches, or if something dark appears before his eyes, or if heartburn is added to him, a bilious vomiting will be present; and if a chill also seizes him, and the lower parts of the hypochondrium are cold, the vomiting will be present still more quickly; and if he drinks or eats anything during this time, it is very quickly vomited.
Τουτέων δὲ οἷσιν ἂν ἄρξηται ὁ πόνος τῇ πρώτῃ ἡμέρῃ γίγνεσθαι, τεταρταῖοι πιεζεῦνται μάλιστα καὶ πεμπταῖοι· ἐς δὲ τὴν ἑβδόμην ἀπαλλάσσονται· οἱ μέντοι πλείονες αὐτέων ἄρχονται μὲν πονέεσθαι τριταῖοι, χειμάζονται δὲ μάλιστα πεμπταῖοι, ἀπαλλάσσονται δὲ ἐναταῖοι ἢ ἑνδεκαταῖοι· οἳ δ᾿ ἂν ἄρξωνται πεμπταῖοι πονέεσθαι, καὶ τἄλλα κατὰ λόγον αὐτέοισι γίγνηται, ἐς τὴν τεσσαρεσκαιδεκάτην κρίνεται ἡ νοῦσος.
And of these, in whomsoever the pain begins to occur on the first day, they are most pressed on the fourth and fifth days, and are rid of it on the seventh; however, the majority of them begin to suffer on the third day, are most distressed on the fifth, and are rid of it on the ninth or eleventh; and those who begin to suffer on the fifth day, and other things happen in proportion to them, on the fourteenth day the disease is decided.
Γίγνεται δὲ ταῦτα τοῖσι μὲν ἀνδράσι καὶ τῇσι γυναιξὶν ἐν τοῖσι τριταίοισι μάλιστα· τοῖσι δὲ νεωτέροισι γίγνεται μὲν καὶ ἐν τουτέοισι, μᾶλλον δὲ ἐν τοῖσι ξυνεχεστέροισι πυρετοῖσι, καὶ ἐν τοῖσι γνησίοισι τριταίοισιν.
And these things happen to men and women mostly in tertian fevers; but to the younger they happen indeed in these too, but more in more continuous fevers, and in genuine tertians.
Οἷσι δ᾿ ἂν ἐν τοιουτοτρόπῳ πυρετῷ κεφαλὴν ἀλγέουσιν ἀντὶ μὲν τοῦ ὀρφνῶδές τι πρὸ τῶν ὀφθαλμῶν φαίνεσθαι, ἀμβλυωγμὸς γίγνεται, ἢ μαρμαρυγαὶ προφαίνονται, ἀντὶ δὲ τοῦ καρδιώσσειν, ἐν τῷ ὑποχονδρίῳ ἐπὶ δεξιὰ ἢ ἐπ᾿ ἀριστερὰ ξυντείνεταί τι μήτε ξὺν ὀδύνῃ μήτε ξὺν φλεγμονῇ, αἷμα διὰ τῶν ῥινῶν τουτέοισι ῥυῆναι προσδόκιμον ἀντὶ τοῦ ἐμέτου.
And in whomsoever, while they have a headache in such a kind of fever, instead of something dark appearing before their eyes, dimness of sight occurs, or flashes of light appear, and instead of heartburn, something is stretched in the hypochondrium on the right or on the left, neither with pain nor with inflammation, for these it is to be expected that blood will flow through the nostrils instead of vomiting.
Μᾶλλον δὲ καὶ ἐνταῦθα τοῖσι νέοισι τοῦ αἵματος τὴν ῥῆξιν προσδέχεσθαι· τοῖσι δὲ πέντε καὶ τριήκοντα ἔτεσι καὶ γεραιτέροισιν ἧσσον, ἀλλὰ τοὺς ἐμέτους τουτέοισι προσδέχεσθαι.
And here too one must rather expect the rupture of blood in the young; but in those of thirty-five years and older less, but in these one must expect vomitings.
Τοῖσι δὲ παιδίοισι σπασμοὶ γίγνονται, ἢν ὁ πυρετὸς ὀξὺς ᾖ, καὶ ἡ γαστὴρ μὴ διαχωρέῃ, καὶ ἀγρυπνέωσί τε καὶ ἐκπλαγέωσι, καὶ κλαυθμυρίζωσι, καὶ τὸ χρῶμα μεταβάλλωσι, καὶ χλωρὸν ἢ πελιὸν ἢ ἐρυθρὸν ἴσχωσιν.
And in children, convulsions occur if the fever is acute, and the belly does not move, and they are sleepless and startled, and cry, and change color, and have a green or livid or red color.
Γίγνεται δὲ ταῦτα ἐξ ἑτοιμοτάταν μὲν τοῖσι παιδίοισι τοῖσι νεωτάτοισιν ἐς τὰ ἑπτὰ ἔτεα· τὰ δὲ πρεσβύτερα τῶν παιδίων καὶ οἱ ἄνδρες οὐκ ἔτι ἐν τοῖσι πυρετοῖσιν ὑπὸ τῶν σπασμῶν ἁλίσκονται, ἢν μή τι τῶν σημείων προσγένηται τῶν ἰσχυροτάτων τε καὶ κακίστων, οἷά περ ἐν τῇσι φρενίτισι γίγνεται.
And these things happen most readily to the youngest children up to seven years; but the older of children and men are no longer seized by convulsions in fevers, unless some of the strongest and worst signs are added, such as occur in phrenitis.
Τοὺς δ᾿ ἀπολουμένους τε καὶ περιεσομένους τῶν παιδίων τε καὶ τῶν ἄλλων τεχμαίρεσθαι τοῖσι ξύμπασι σημείοισιν, ὡς ἐφ᾿ ἑκάστοισιν ἕκαστα διαγέγραπται.
And one must judge those of the children and of the others who will perish or survive by all the signs, as each is described for each case.
Ταῦτα δὲ λέγω περί τε τῶν ὀξέων νουσημάτων καὶ ὅσα ἐκ τουτέων γίγνεται.
And I say these things both concerning acute diseases and whatever arises from them.
§2525.
25.
Χρὴ δὲ τὸν μέλλοντα ὀρθῶς προγιγνώσκειν τοὺς περιεσομένους καὶ τοὺς ἀποθανουμένους, ὅσοισί τε ἂν μέλλῃ πλέονας ἡμέρας παραμένειν τὸ νούσημα καὶ ὅσοισιν ἂν ἐλάσους, τὰ σημεῖα ἐκμανθάνοντα πάντα δύνασθαι κρίνειν, λογιζόμενον τὰς δυνάμιας αὐτέων πρὸς ἀλλήλας, ὥσπερ διαγέγραπται περί τε τῶν ἄλλων καὶ τῶν οὔρων καὶ τῶν πτυέλων, ὅταν ὁμοῦ πῦόν τε ἀναβήσσῃ καὶ χολήν.
And he who intends to foreknow correctly those who will survive and those who will die, and in whomsoever the disease is going to remain for more days and in whom for fewer, must, by learning all the signs thoroughly, be able to judge, calculating their powers against one another, just as has been described concerning the other things and urine and sputa, when they cough up both pus and bile together.
Χρὴ δὲ καὶ τὰς φορὰς τῶν νουσημάτων αἰεὶ ἐπιδημεύντων ταχέως ἐνθυμέεσθαι, τήν τε τῆς ὥρης κατάστασιν.
And one must also quickly consider the tendencies of diseases that are always epidemic, and the constitution of the season.
Εὖ μέντοι χρὴ εἰδέναι περὶ τῶν τεκμηρίων καὶ τῶν ἄλλων σημείων, καὶ μὴ λανθάνειν ὅτι ἐν παντὶ ἔτει καὶ πάσῃ ὥρῃ τά τε κακὰ κακὸν σημαίνει, καὶ τὰ χρηστὰ ἀγαθὸν, ἐπεὶ καὶ ἐν Λιβύῃ καὶ ἐν Δήλῳ καὶ ἐν Σκυθίῃ φαίνεται τὰ προγεγραμμένα ἀληθεύοντα σημεῖα.
And indeed one must know well concerning the proofs and the other signs, and not escape notice that in every year and every season the bad signs signify bad, and the good signs good, since even in Libya, and in Delos, and in Scythia, the pre-written signs appear to be true.
Ἐξ ὧν χρὴ εἰδέναι ὅτι ἔν γε τοῖσιν αὐτέοισι χωρίοισιν οὐδὲν δεινὸν τὸ μὴ οὐ τὰ πολλαπλάσια αὐτέων ἐπιτυγχάνειν, ἢν ἐκμαθών τις αὐτὰ κρίνειν τε καὶ λογίζεσθαι ὀρθῶς ἐπίστηται.
From which things one must know that in the same places at least, there is nothing strange in predicting correctly in the vast majority of cases, if one, having learned them thoroughly, knows how to judge and calculate correctly.
Ποθέειν δὲ χρὴ οὐδενὸς νουσήματος οὔνομα, ὅτι μὴ τυγχάνῃ ἐνθάδε γεγραμμένον· πάντα γὰρ ὁκόσα ἐν τοῖσι χρόνοισι τοῖσι προειρημένοισι χρίνεται, γνώσῃ τοῖσιν αὐτέοισι σημείοισιν.
And one must not miss the name of any disease, because it does not happen to be written here; for all things, as many as are decided in the aforementioned times, you will know by the same signs.

Notes

  1. §24περιεστικῶς διακειμένου τοῦ ἀνθρώπου — A genitive absolute construction meaning 'the patient being in a state of survival (or recovery).' It describes a clinical situation where the fever is prolonged despite the patient showing no signs of imminent death.
  2. ¦p.182¦ἐς δὲ τεταρταῖον καταστήσεσθαι — This infinitive depends on χρή from the previous sentence (προσδέχεσθαι χρὴ), meaning '[one must expect] that it will settle into a quartan fever.'
  3. ¦p.190¦τὸ μὴ οὐ τὰ πολλαπλάσια αὐτέων ἐπιτυγχάνειν — A combination of double negative μὴ οὐ with an infinitive, following the negative main clause οὐδὲν δεινόν ('nothing strange/difficult'). It yields a strong positive meaning: 'it is not at all difficult/unusual to succeed [in predicting correctly] in the vast majority of cases.'
  4. ¦p.190¦Ποθέειν δὲ χρὴ οὐδενὸς νουσήματος οὔνομα — The verb ποθέω means 'to desire, seek, miss.' The clause states that one does not need to look for or desire the specific name of any disease not written in this work, since the same signs are sufficient to judge the prognosis.

Cite this passage

Hippocrates, Prognostic §24-25. Humanitext Reader, https://reader.humanitext.ai/en/text/urn:cts:greekLit:tlg0627.tlg003.humanitext-grc1:24-25

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