Articella (The Little Art of Medicine)

is the intent. For when physicians say: "This fever is greater or stronger than the previous one," the same meaning is intended to be understood. However, this fever, whether it is greater or stronger, sometimes begins earlier than is usual, sometimes lasts longer, and sometimes remains or begins as it usually does. This does not pertain to the magnitude or the strength, but rather to the brevity or the length. This period, which I say exists between the beginning and the status the peak or critical phase of the disease, is more troublesome than other crises; this period is better in the decline. Those which hasten before their usual time, or last longer than usual, or are greater or stronger—whether the fever is quotidian, tertian, or quartan—render the disease long or short. Therefore, by this reasoning, the increments of the disease are to be observed. If, therefore, the interpolation of the fever begins before the first day, and by lingering longer it strengthens itself, the augmentation is stronger, the crisis swifter, and the status nearer. For it is not fitting that the augmentation be stronger and the status more remote. If the interpolation is lessened according to the aforementioned degrees, the status is judged to be more remote, from which it is made clear when the status will come and when the accession of the disease will occur. Once the first is known—namely, through the ordering of the diet in the entire course of the disease—the accession being known, it is known at what hour of any given day food should be given. Hippocrates original: "hypo." began to order the diet for any sick person, and he intends by this that it be known how much and when it should be given. Undoubtedly, he called the increments of the cycles nothing other than the return of the disease to what it had been. However, he said "from those things appearing afterward," hinting that the interpolations of the fever and the essence of the disease are to be understood—whether those appearances are called significations or accidents, which, when they exist with the disease or follow it, some signify a crisis, some a digestion, others the removal of the same, and others signify perdition. Therefore, those things that appear with the disease begin with it. Those that follow sometimes appear with the disease, sometimes after, and sometimes with neither, since they are not inseparable accidents of the disease, nor do they inhere substantially; these are certain qualities that occur separably. However, these accidents that signify a crisis, when they do not begin at the certain inception of the disease, yet they appear at their own inception in the second and third consideration, which I happen to explain after this. Sometimes the same accidents are not appearing in the beginning of the disease, but in the augmentation or status. Moreover, the signs of this digestion do not appear at certain beginnings, but you will consider them in the second and third. Signs of removed digestion sometimes begin with the disease at its inception, but sometimes afterward; and similarly, the significations of death are those that appear afterward. I explained those appearing at the beginning of the disease in the book of crises. The "beginning of an incipient disease" is spoken of, the time of which is indivisible. "Beginning" is also spoken of as a part of the whole time of the disease, such as when the disease has a beginning, an augmentation, a status, and a decline. "Beginning" is also spoken of as that which is between the beginning and the three days following. In the same book, we have shown the power of all the accidents we mentioned, in which we inserted many Hippocratic things necessary to this work, and many things concerning the powers briefly, which whoever wishes to understand, let him fly to that book. When, however, he wished to signify the appearances after the essence of the disease, he introduced pleurisy as a likeness. For just as in pleurisy, if sputum appears continuously, the disease becomes short; if it does so later, it is prolonged. You will understand this more clearly if what Hippocrates said in the third book of Epidemics is placed here: "Antias," he says, "from the city of Amadia, or a neighbor of Andria, opposite the region of Boxochia, who, suffering from a continuous fever, felt pain in the right side, coughing dryly. And he did not cough up anything in the beginning of the disease, being thirsty and suffering from vigils. The urine, however, was praiseworthy in color, abundant, and thin. On the sixth day, he suffered alienation delirium. Although he was warmed many times, yet the pain was not alleviated; rather, on the seventh day, the pain was greater, the fever increased, the pain not diminishing, but with coughing also much

hindering him and causing difficulty in breathing. On the eighth day, he was phlebotomized bled from the inner part of the arm, and according to what was necessary, much blood was removed, from which the pain was alleviated, yet the dry cough remained. On the eleventh day, when he had perspired a little on the head, the cough and fever were softer, and the expectoration was more moist. On the seventeenth day, he began to expectorate more digestibly, thus alleviating the pain. On the twentieth day, he perspired as the crisis arrived, the fever also ceasing, but yet he suffered thirst; however, the expectoration was unpraiseworthy, and thus the fever returned on the twenty-seventh day. So also he coughed much and expectorated digested matter. The humor residing in the urine appeared abundant and white; the thirst ceased and he slept. On the thirty-fourth day, he perspired over his whole body. Thus, the crisis being perfect, the fever subsided." The disease of this Antias was at first pleurisy, and because he could not expectorate from the beginning of the disease, the dry cough was prolonged until the eighth day, and thus the disease was prolonged until the thirty-fourth day, when, however, most pleurisies do not exceed the fourteenth day. If it exceeds that, it extends to the twentieth. But if the pleuritic patient had expectorated on the third day, for certain the crisis would have arrived on the seventh or ninth day, or at most the eleventh. If, therefore, he had expectorated on the third, the disease would not have passed the fourteenth, because just as in an aposteme abscess that is bursting, and not hidden under the skin, the verdigris-colored sweat is not accustomed to appear; so also it is thin in the beginning, but when it begins to digest, it is better and thicker; it proceeds thus: this expectoration in digestion is different. For one is digested more, another less. This, however, is manifested in apostemes arising in the mouth or eyes, remaining in the skin or under the skin. If the skin is perforated by an incision, much sweat flows out from there, as we said. If, however, it does not perforate, that verdigris-like matter is contained, which, as the aposteme hardens, is digested slowly. The same is to be understood about the pleuritic patient, since this disease is known to be of the genus of apostemes. It is necessary, therefore, that its maturations be considered. For if he expectorates nothing, the disease is in the finality of crudity, which is the first degree in a pleuritic patient; if a little and thinly, the disease is not in the finality of crudity and makes a second degree; but if he expectorates, he has become more thickened; then the disease will no longer be crude. And this degree is the third in pleurisy. And if the expectoration is finally and completely thickened, it will be the fourth degree in pleurisy, in which, if the sputum is thicker than it was and is perfectly cooked digested, and has appeared on the third or fourth day, it will be impossible for the disease to pass the seventh day. Therefore, the length and brevity of the disease are according to the appearance of the digestion. For just as in sputum appearing white on all the days of the sickness, the perfection of the final digestion is signified, so by the removal of the sputum, the removal of the whole digestion will be signified. And if the sputum becomes small and thin, a small digestion will be signified. But if the sputum has been pure, or slightly reddish, red, or citrine, they are not to be praised. Verdigris-colored, livid, or black are signs of perdition. Therefore, a good and praiseworthy signification of digestion will be that which undoubtedly hints that the disease will be finished swiftly, and conversely, it portends the worst perdition of the sick person swiftly. By the removal of the digestion, the future health will be able to be announced, if the strength of the sick person has been well observed. There are also other kinds of signs which Hippocrates called "critical," such as those signifying a crisis, as are fluxes of blood, sweat, and rigor, excessive solution of the bowels, excessive vomiting, excessive urine, headache without a preceding cause, trembling of the heart, and anguish of the spirit without a preceding cause, fluttering under the diaphragm, likewise vigils, alienations, languors, nocturnal rigors without cause, hasty heatings of fevers, sudden tears without blemish of the eyes, redness of the face, twitching of the lower lips, the sudden vision of blackness or brightness before oneself, redness of the cheeks or nostrils, an aposteme under the ears or in any places.