of the epidemics-第2章

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continual　fevers；　and；　in　a　few　cases；　ardent；　some　diurnal；　others



nocturnal；　semi…tertians；　true　tertians；　quartans；　irregular　fevers。



　　2。　All　these　fevers　described　attacked　great　numbers。　All　these



fevers　attacked　the　smallest　numbers；　and　the　patients　suffered　the



least　from　them；　for　there　were　no　hemorrhages；　except　a　few　and　to



a　small　amount；　nor　was　there　delirium；　all　the　other　complaints



were　slight；　in　these　the　crises　were　regular；　in　most　instances；　with



the　intermittents；　in　seventeen　days；　and　I　know　no　instance　of　a



person　dying　of　causus；　nor　becoming　phrenitic。　The　tertians　were　more



numerous　than　the　ardent　fevers；　and　attended　with　more　pain；　but



these　all　had　four　periods　in　regular　succession　from　the　first



attack；　and　they　had　a　complete　crisis　in　seven；　without　a　relapse



in　any　instance。　The　quartans　attacked　many　at　first；　in　the　form　of



regular　quartans；　but　in　no　few　cases　a　transition　from　other　fevers



and　diseases　into　quartans　took　place；　they　were　protracted；　as　is



wont　with　them；　indeed；　more　so　than　usual。　Quotidian；　nocturnal；



and　wandering　fevers　attacked　many　persons；　some　of　whom　continued



to　keep　up；　and　others　were　confined　to　bed。　In　most　instances　these



fevers　were　prolonged　under　the　Pleiades　and　till　winter。　Many



persons；　and　more　especially　children；　had　convulsions　from　the



commencement；　and　they　had　fever；　and　the　convulsions　supervened



upon　the　fevers；　in　most　cases　they　were　protracted；　but　free　from



danger；　unless　in　those　who　were　in　a　deadly　state　from　other



complaints。　Those　fevers　which　were　continual　in　the　main；　and　with　no



intermissions；　but　having　exacerbations　in　the　tertian　form；　there



being　remissions　the　one　day　and　exacerbations　the　next；　were　the　most



violent　of　all　those　which　occurred　at　that　time；　and　the　most



protracted；　and　occurring　with　the　greatest　pains；　beginning　mildly；



always　on　the　whole　increasing；　and　being　exacerbated；　and　always



turning　worse；　having　small　remissions；　and　after　an　abatement



having　more　violent　paroxysms；　and　growing　worse；　for　the　most　part；



on　the　critical　days。　Rigors；　in　all　cases；　took　place　in　an　irregular



and　uncertain　manner；　very　rare　and　weak　in　them；　but　greater　in　all



other　fevers；　frequent　sweats；　but　most　seldom　in　them；　bringing　no



alleviation；　but；　on　the　contrary；　doing　mischief。　Much　cold　of　the



extremities　in　them；　and　these　were　warmed　with　difficulty。



Insomnolency；　for　the　most　part；　especially　in　these　fevers；　and　again



a　disposition　to　coma。　The　bowels；　in　all　diseases；　were　disordered；



and　in　a　bad　state；　but　worst　of　all　in　these。　The　urine；　in　most　of



them；　was　either　thin　and　crude；　yellow；　and　after　a　time　with



slight　symptoms　of　concoction　in　a　critical　form；　or　having　the　proper



thickness；　but　muddy；　and　neither　settling　nor　subsiding；　or　having



small　and　bad；　and　crude　sediments；　these　being　the　worst　of　all。



Coughs　attended　these　fevers；　but　I　cannot　state　that　any　harm　or　good



ever　resulted　from　the　cough。



　　3。　The　most　of　these　were　protracted　and　troublesome；　went　on　in　a



very　disorderly　and　irregular　form；　and；　for　the　most　part；　did　in　a



crisis；　either　in　the　fatal　cases　or　in　the　others；　for　if　it　left



some　of　them　for　a　season　it　soon　returned　again。　In　a　few　instances



the　lever　terminated　with　a　crisis；　in　the　earliest　of　these　about　the



eightieth　day；　and　some　of　these　relapsed；　so　that　most　of　them　were



not　free　from　the　fever　during　the　winter；　but　the　fever　left　most



of　them　without　a　crisis；　and　these　things　happened　alike　to　those　who



recovered　and　to　those　who　did　not。　There　being　much　want　of　crisis



and　much　variety　as　to　these　diseases；　the　greatest　and　worst



symptom　attended　the　most　of　them；　namely；　a　loathing　of　all



articles　of　food；　more　especially　with　those　who　had　otherwise　fatal



symptoms；　but　they　were　not　unseasonably　thirsty　in　such　fevers。　After



a　length　of　time；　with　much　suffering　and　great　wasting；　abscesses



were　formed　in　these　cases；　either　unusually　large；　so　that　the



patients　could　not　support　them；　or　unusually　small；　so　that　they



did　no　good；　but　soon　relapsed　and　speedily　got　worse。　The　diseases



which　attacked　them　were　in　the　form　of　dysenteries；　tenesmus；



lientery；　and　fluxes；　but；　in　some　cases；　there　were　dropsies；　with　or



without　these　complaints。　Whatever　attacked　them　violently　speedily



cut　them　off；　or　again；　did　them　no　good。　Small　rashes；　and　not



corresponding　to　the　violence　of　the　disease；　and　quickly



disappearing；　or　swellings　occurred　about　the　ears；　which　were　not



resolved；　and　brought　on　no　crisis。　In　some　they　were　determined　to



the　joints；　and　especially　to　the　hip…joint；　terminating　critically



with　a　few；　and　quickly　again　increasing　to　its　original　habit。



　　4。　People　died　of　all　these　diseases；　but　mostly　of　these　fevers；



and　notably　infants　just　weaned；　and　older　children；　until　eight　or



ten　years　of　age；　and　those　before　puberty。　These　things　occurred　to



those　affected　with　the　complaints　described　above；　and　to　many



persons　at　first　without　them。　The　only　favorable　symptom；　and　the



greatest　of　those　which　occurred；　and　what　saved　most　of　those　who



were　in　the　greatest　dangers；　was　the　conversion　of　it　to　a　strangury；



and　when；　in　addition　to　this；　abscesses　were　formed。　The　strangury



attacked；　most　especially；　persons　of　the　ages　I　have　mentioned；　but



it　also　occurred　in　many　others；　both　of　those　who　were　not　confined



to　bed　and　those　who　were。　There　was　a　speedy　and　great　change　in



all　these　cases。　For　the　bowels；　if　they　happened　previously　to　have



watery　discharges　of　a　bad　character；　became　regular；　they　got　an



appetite　for　food；　and　the　fevers　were　mild　afterwards。　But；　with



regard　to　the　strangury　itself；　the　symptoms　were　protracted　and



painful。　Their　urine　was　copious；　thick；　of　various　characters；　red；



mixed　with　pus；　and　was　passed　with　pain。　These　all　recovered；　and　I



did　not　see　a　single　instance　of　death　among　them。



　　5。　With　regard　to　the　dangers　of　these　cases；　one　must　always　attend



to　the　seasonable　concoction　of　all　the　evacuations；　and　to　the



favorable　and　critical　abscesses。　The　concoctions　indicate　a　speedy



crisis　and　recovery　of　health；　crude　and　undigested　evacuations；　and



those　which　are　converted　into　bad　abscesses；　indicate　either　want



of　crisis；　or　pains；　or　prolongation　of　the　disease；　or　death；　or



relapses；　which　of　these　it　is　to　be　must　be　determined　from　other



circumstances。　The　physician　must　be　able　to　tell　the　antecedents；



know　the　present；　and　foretell　the　future…　must　mediate　these



things；　and　have　two　special　objects　in　view　with　regard　to　disease；



namely；　to　do　good　or　to　do　no　harm。　The　art　consists　in　three　things…



the　disease；　the　patient；　and　the　physician。　The　physician　is　the



servant　of　the　art；　and　the　patient　must　combat　the　disease　along　with



the　physician。



　　6。　Pains　about　the　head　and　neck；　and　heaviness　of　the　same　along



with　pain；　occur　either　without　fevers　or　in　fevers。　Convulsions



occurring　in　persons　attacked　with　frenzy；　and　having　vomitings　of



verdigris…green　bile；　in　some　cases　quickly　prove　fatal。　In　ardent



fevers；　and　in　those　other　fevers　in　which　there　is　pain　of　the



neck；　heaviness　of　the　temples；　mistiness　about　the　eyes；　and



distention　about　the　hypochondriac　region；　not　unattended　with　pain；



hemorrhage　from　the　nose　takes　place；　but　those　who　have　heaviness



of　the　whole　head；　cardialgia　and　nausea；　vomit　bilious　and



pituitous　matters；　children；　in　such　affections；　are　generally



attacked　with　convulsions；　and　women　have　these　and　also　pains　of



the　uterus；　whereas；　in　elder　persons；　and　those　in　whom　the　heat　is



already　more　subdued；　these　cases　end　in　paralysis；　mania；　and　loss　of



sight。