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Full download Fundamentals of Trace and Log Analysis A Pattern-Oriented Approach to Monitoring, Diagnostics, and Debugging 1st Edition Dmitry Vostokov pdf docx

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Fundamentals
of Trace and
Log Analysis
A Pattern-Oriented Approach to
Monitoring, Diagnostics, and
Debugging

Dmitry Vostokov
Fundamentals of
Trace and Log
Analysis
A Pattern-Oriented Approach
to Monitoring, Diagnostics,
and Debugging

Dmitry Vostokov
Fundamentals of Trace and Log Analysis: A Pattern-Oriented Approach to
Monitoring, Diagnostics, and Debugging
Dmitry Vostokov
Dalkey, Dublin, Ireland

ISBN-13 (pbk): 978-1-4842-9895-4 ISBN-13 (electronic): 978-1-4842-9896-1


https://doi.org/10.1007/978-1-4842-9896-1

Copyright © 2023 by Dmitry Vostokov


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Table of Contents
About the Author���������������������������������������������������������������������������������xi

About the Technical Reviewer�����������������������������������������������������������xiii

Introduction����������������������������������������������������������������������������������������xv

Chapter 1: Introduction������������������������������������������������������������������������1
Software Trace/Log�����������������������������������������������������������������������������������������������3
Process�����������������������������������������������������������������������������������������������������������������4
Thread�������������������������������������������������������������������������������������������������������������������4
Adjoint Thread�������������������������������������������������������������������������������������������������������5
Component/Module/Source����������������������������������������������������������������������������������7
File and Function��������������������������������������������������������������������������������������������������8
Trace Message������������������������������������������������������������������������������������������������������9
Stack Trace�����������������������������������������������������������������������������������������������������������9
Minimal Trace Graphs�����������������������������������������������������������������������������������������10
Pattern-Oriented Analysis�����������������������������������������������������������������������������������12
Pattern Classification������������������������������������������������������������������������������������������13
Summary������������������������������������������������������������������������������������������������������������14

Chapter 2: Vocabulary Patterns����������������������������������������������������������15


Basic Facts����������������������������������������������������������������������������������������������������������15
Basic Facts Taxonomy�����������������������������������������������������������������������������������������17
Vocabulary Index�������������������������������������������������������������������������������������������������17
Summary������������������������������������������������������������������������������������������������������������19

v
Table of Contents

Chapter 3: Error Patterns��������������������������������������������������������������������21


Error Message�����������������������������������������������������������������������������������������������������21
Exception Stack Trace�����������������������������������������������������������������������������������������23
Periodic Error������������������������������������������������������������������������������������������������������24
False Positive Error���������������������������������������������������������������������������������������������25
Error Distribution�������������������������������������������������������������������������������������������������25
Summary������������������������������������������������������������������������������������������������������������27

Chapter 4: Trace As a Whole���������������������������������������������������������������29


Partition��������������������������������������������������������������������������������������������������������������30
Circular Trace������������������������������������������������������������������������������������������������������32
Message Density�������������������������������������������������������������������������������������������������34
Message Current�������������������������������������������������������������������������������������������������35
Trace Acceleration�����������������������������������������������������������������������������������������������37
No Trace Metafile������������������������������������������������������������������������������������������������38
Empty Trace��������������������������������������������������������������������������������������������������������39
Missing Component��������������������������������������������������������������������������������������������40
Guest Component������������������������������������������������������������������������������������������������42
Truncated Trace���������������������������������������������������������������������������������������������������43
Visibility Limit������������������������������������������������������������������������������������������������������45
Sparse Trace�������������������������������������������������������������������������������������������������������46
Summary������������������������������������������������������������������������������������������������������������47

Chapter 5: Large-Scale Patterns���������������������������������������������������������49


Characteristic Message Block�����������������������������������������������������������������������������49
Background Components������������������������������������������������������������������������������������51
Foreground Components�������������������������������������������������������������������������������������53
Layered Periodization�����������������������������������������������������������������������������������������54

vi
Table of Contents

Focus of Tracing��������������������������������������������������������������������������������������������������55
Event Sequence Order����������������������������������������������������������������������������������������57
Trace Frames������������������������������������������������������������������������������������������������������58
Summary������������������������������������������������������������������������������������������������������������60

Chapter 6: Activity Patterns���������������������������������������������������������������61


Thread of Activity������������������������������������������������������������������������������������������������61
Adjoint Thread of Activity������������������������������������������������������������������������������������63
No Activity�����������������������������������������������������������������������������������������������������������64
Activity Region����������������������������������������������������������������������������������������������������65
Discontinuity�������������������������������������������������������������������������������������������������������67
Time Delta�����������������������������������������������������������������������������������������������������������68
Glued Activity������������������������������������������������������������������������������������������������������69
Break-in Activity��������������������������������������������������������������������������������������������������71
Resume Activity��������������������������������������������������������������������������������������������������72
Summary������������������������������������������������������������������������������������������������������������74

Chapter 7: Message Patterns�������������������������������������������������������������75


Significant Event�������������������������������������������������������������������������������������������������76
Defamiliarizing Effect������������������������������������������������������������������������������������������78
Anchor Messages������������������������������������������������������������������������������������������������79
Message Interleave���������������������������������������������������������������������������������������������81
Diegetic Messages����������������������������������������������������������������������������������������������83
Message Change�������������������������������������������������������������������������������������������������84
Implementation Discourse����������������������������������������������������������������������������������86
Message Invariant�����������������������������������������������������������������������������������������������86
UI Message���������������������������������������������������������������������������������������������������������88
Original Message������������������������������������������������������������������������������������������������89

vii
Table of Contents

Linked Messages������������������������������������������������������������������������������������������������90
Gossip�����������������������������������������������������������������������������������������������������������������93
Abnormal Value���������������������������������������������������������������������������������������������������94
Message Context������������������������������������������������������������������������������������������������95
Marked Messages�����������������������������������������������������������������������������������������������97
Fiber Bundle��������������������������������������������������������������������������������������������������������98
Incomplete History��������������������������������������������������������������������������������������������100
Opposition Messages����������������������������������������������������������������������������������������100
Summary����������������������������������������������������������������������������������������������������������101

Chapter 8: Block Patterns�����������������������������������������������������������������103


Macrofunction���������������������������������������������������������������������������������������������������103
Periodic Message Block������������������������������������������������������������������������������������104
Intra-correlation������������������������������������������������������������������������������������������������106
Summary����������������������������������������������������������������������������������������������������������108

Chapter 9: Trace Set Patterns�����������������������������������������������������������109


Master Trace�����������������������������������������������������������������������������������������������������109
Bifurcation Point�����������������������������������������������������������������������������������������������111
Inter-correlation������������������������������������������������������������������������������������������������114
Relative Density������������������������������������������������������������������������������������������������115
News Value�������������������������������������������������������������������������������������������������������116
Impossible Trace�����������������������������������������������������������������������������������������������118
Split Trace���������������������������������������������������������������������������������������������������������119
Summary����������������������������������������������������������������������������������������������������������120

viii
Table of Contents

Chapter 10: Data Patterns����������������������������������������������������������������121


Data Flow����������������������������������������������������������������������������������������������������������121
Back Trace���������������������������������������������������������������������������������������������������������124
Counter Value����������������������������������������������������������������������������������������������������125
Data Association�����������������������������������������������������������������������������������������������126
Data Selector����������������������������������������������������������������������������������������������������128
Null Reference��������������������������������������������������������������������������������������������������130
Signal����������������������������������������������������������������������������������������������������������������132
Visitor Trace������������������������������������������������������������������������������������������������������134
Watch Thread����������������������������������������������������������������������������������������������������136
State Dump�������������������������������������������������������������������������������������������������������137
Summary����������������������������������������������������������������������������������������������������������138

Index�������������������������������������������������������������������������������������������������139

ix
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exciting offers!
About the Author
Dmitry Vostokov is an internationally recognized expert, speaker,
educator, scientist, inventor, and author. He founded the pattern-
oriented software diagnostics, forensics, and prognostics discipline
(Systematic Software Diagnostics) and Software Diagnostics Institute
(DA+TA: DumpAnalysis.org + TraceAnalysis.org). Vostokov has also
authored multiple books on software diagnostics, anomaly detection
and analysis, software and memory forensics, root cause analysis and
problem solving, memory dump analysis, debugging, software trace and
log analysis, reverse engineering, and malware analysis. He has over 30
years of experience in software architecture, design, development, and
maintenance in various industries, including leadership, technical, and
people management roles. In his spare time, he presents multiple topics
on Debugging.TV and explores Software Narratology and its further
development as Narratology of Things and Diagnostics of Things (DoT),
Software Pathology, and Quantum Software Diagnostics. His current
interest areas are theoretical software diagnostics and its mathematical
and computer science foundations, application of formal logic, artificial
intelligence, machine learning, and data mining to diagnostics and
anomaly detection, software diagnostics engineering and diagnostics-
driven development, diagnostics workflow, and interaction. Recent
interest areas also include cloud-native computing, security, automation,
functional programming, applications of category theory to software
development and big data, and artificial intelligence diagnostics.

xi
About the Technical Reviewer
Vijender Singh, a multicloud professional
with over six years of expertise, holds an MSc
with distinction from Liverpool John Moores
University, where his research centered on
keyphrase extraction. He boasts an impressive
collection of certifications, including MLPE
GCP, five Azure certifications, two AWS
certifications, and TensorFlow certification.
Vijender’s role as a technical reviewer for
numerous books reflects his commitment to
improving the future.
LinkedIn: www.linkedin.com/in/vijendersingh412

xiii
Introduction
This book will help you analyze traces and logs from different software
environments and communicate analysis results using a pattern language
that covers everything from a small debugging log to a distributed trace
with billions of messages from hundreds of computers, thousands of
software components, threads, and processes.
The book begins with the basic terminology of operating systems and
programming, the foundation for understanding trace and log analysis.
It then talks about patterns that help describe problems from a user’s
view and patterns for errors and failures. Then, the book covers a range of
trace patterns that group messages and explores how logs depict software
activities. It even looks at specific message patterns and how they connect
in a single trace. Toward the end, the book goes over patterns for multiple
traces and logs and how to understand them as data. In this way, you can
use similar methods to find problems across a wide variety of software. It
also guides you on analyzing issues on systems such as Windows, macOS,
Linux, Android, iOS, and other types of computers, including those in
networks and the Internet of Things, regardless of their system differences.
Upon completing this book, you will be able to navigate the
complexities of trace and log analysis and apply uniform diagnostics and
anomaly detection pattern language across diverse software environments
to help you troubleshoot, debug, and fix issues.
The book will be useful for software technical support engineers,
system and network administrators, software developers, testers, DevOps
and DevSecOps, digital forensics and malware analysts, security incident
response engineers, data analysts, and data mining practitioners.

xv
CHAPTER 1

Introduction
We start this chapter with a few words about the need for this book. Almost
20 years ago, I started doing Windows software diagnostics full time as
a member of the technical support and escalation team at a large global
software vendor. In addition to crash and hang dump analysis, the job
required analysis of software traces similar to that of Process Monitor1
log format with messages from hundreds of processes and thousands of
threads totaling millions of lines (Figure 1-1). Gradually I became aware
that we need a similar pattern-driven system as I devised for memory
dump analysis.2 However, after a few patterns, such as Periodic Error, I
was stuck devising more. At this time, through my voracious independent
reading, I accidentally became acquainted with narratology,3 a discipline
that studies narration and narrative stories. So this became the foundation
for what I later named Software Narratology, a new approach to the study
of software narrative, stories of computation. Viewing software traces as
narratives helped devise general analysis patterns to structure trace and
log analysis independent of OS and products. Although this book teaches
some analysis patterns in a Windows context, you can apply them to your
specific environment and product domain problems. Some examples are

1
https://learn.microsoft.com/en-gb/sysinternals/downloads/procmon
2
Dmitry Vostokov, Encyclopedia of Crash Dump Analysis Patterns: Detecting
Abnormal Software Structure and Behavior in Computer Memory, Third Edition,
2020 (ISBN-13: 978-1912636303)
3
https://en.wikipedia.org/wiki/Narratology

© Dmitry Vostokov 2023 1


D. Vostokov, Fundamentals of Trace and Log Analysis,
https://doi.org/10.1007/978-1-4842-9896-1_1
Chapter 1 Introduction

illustrated with Process Monitor and Event Tracing for Windows4 because
they are widely used and not tied to specific products. In addition to native
logging, Linux has LTTng5 tracing. All these tracing frameworks produce
trace and log files with conceptually similar formats.

Figure 1-1. A Process Monitor log example

First, we review the essential fundamentals necessary for software


trace and log analysis. Then we learn about software trace analysis
patterns that were classified into several categories. We cover more than 60
basic analysis patterns. Additional patterns can be found in the frequently
updated reference.6 One note: this book is about software trace and log
analysis and not about software trace implementation, internals, and
collection methods and tools.
The basic concepts we review in this chapter include processes,
threads, components (or modules), source code files, source code or API
functions, and stack traces (or backtraces). One additional concept stays

4
https://learn.microsoft.com/en-us/windows/win32/etw/
about-event-tracing
5
https://lttng.org/
6
Dmitry Vostokov, Trace, Log, Text, Narrative, Data: An Analysis Pattern Reference
for Information Mining, Diagnostics, Anomaly Detection, Fifth Edition, 2023
(ISBN-13: 978-1912636587)

2
Chapter 1 Introduction

out. It is called Adjoint Thread, and we introduce and discuss it after


we review threads. Together with threads, adjoint threads are absolutely
essential for software trace analysis.

Software Trace/Log
What is a software trace or log, actually? For our purposes, it is just a
sequence of formatted messages sent from running software. They are
usually arranged by time and can be considered as a software narrative
story (Figure 1-2). In this training, we confine ourselves to the analysis of
such logs and what patterns to look for.

Figure 1-2. A software trace or log in the most general form

3
Chapter 1 Introduction

Process
An operating system process is a container for resources such as memory,
files, and synchronization objects. Even the OS kernel itself can be
considered a process itself (in Windows, it is usually called just System).
Each process has its own process identifier, PID (process ID). In Windows,
it belongs to a user session; for example, there can be several users logged
into Windows. Each process has its own image name, such as notepad.
exe, and a list of associated loaded DLL (dynamic-link library) modules
(or shared libraries in Linux/macOS). An image name is also a module.
It is important to remember that there can be several processes running,
each having the same image name, for example, two instances of notepad.
exe. The list of DLLs in both instances, most of the time, is identical. At the
same time, it is possible that one image name covers completely different
processes because, on the startup, a process loads different modules
for different purposes. Here an example is the svchost executable. On a
running Windows system, you can find many such svchost processes.
When we analyze software logs, we can filter messages related to a specific
PID or image name to find any abnormal behavior according to the
expected message flow. A typical example here: after the middle of the full
trace, we no longer see any more messages from the specific PID, not even
any termination or graceful process end messages.

Thread
In Windows and macOS, a thread is an execution unit with its own ID and
is owned by some process, for example, calculator.exe. In Linux, threads
are almost the same as processes but share the same virtual memory.
Remember that trace messages come from some thread because we need
to execute some code to emit a trace message. Each thread is executed on
some CPU and, in general, can have its CPU changed during execution
history. Filtering by threads, for example, allows us to find any anomalous

4
Chapter 1 Introduction

behavior, such as blocked execution activity and various execution delays.


In Figure 1-3, we see a discontinuity for TID 2 and a delay in TID 1.

Figure 1-3. An illustration of different threads

Adjoint Thread
If a thread is a linear ordered flow of activities associated with a particular
TID (thread ID), as seen from a trace message perspective through time,
we can also extend this flow concept and consider a linear flow of activities
associated with some other parameter such as PID, CPU, or message text.
Such messages have different TIDs associated with them but have some
chosen constant parameter or column value in a trace viewing tool. The
name adjoint comes from the fact that in threads of activity, TID stays the
same, but other message attributes vary; in adjoint threads, we have the
opposite. In Windows Process Monitor, we use exclusive and inclusive
filtering to form adjoint threads. By applying complex filtering criteria, we
get Adjoint Threads from other adjoint threads, for example, an adjoint

5
Chapter 1 Introduction

thread with specific PID and file activity formed after an inspection of
an adjoint thread with the same image name, such as POWERPNT.EXE
(Figure 1-4).

Figure 1-4. An illustration of Adjoint Thread using Process Monitor

6
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Chapter 1 Introduction

Component/Module/Source
Trace messages come from a thread that belongs to a PID, but the code
to emit them resides in source code files. Some source code files, such as
static library code, can also be reused and included in different modules
(Figure 1-5). Such DLL modules or shared libraries can also be loaded
into different processes. Therefore, source or module (in a simpler) case is
another grouping of messages based on subsystem and functional division
that may include several source code files. By module or source filtering,
we can see subsystem activities.

Figure 1-5. An illustration of the same source code used in


different modules

7
Chapter 1 Introduction

File and Function


Source code consists of files, and each file has some functions inside
that do the actual tracing. With a file or function filtering (selecting only
­messages that belong to particular files or functions), we can see the
flow of certain functionality that is more fine-grained than the source or
module Adjoint Thread of Activity (Listing 1-1 and Figure 1-6).

Listing 1-1. An example of file and function

// MainApp.c
foo () {
  trace("foo: entry");
  // do stuff
  trace("foo: exit");
}

Figure 1-6. An illustration of file and function filtering

8
Random documents with unrelated
content Scribd suggests to you:
pronouncing that it is pleuritis, for example, or pneumonia, or the
like. But how often does it happen, that the complaint in question is
an aggregate of symptoms, produced by peculiarities of constitution,
and incidental circumstances, which, taken together, constitute an
ensemble which does not well admit of being referred to any one of
the general forms of disease described in our nosological systems?
Now, I say the most wonderful feature in the cases related by
Hippocrates, is that they are descriptive of the symptoms observed
in certain diseased individuals, instead of being, what most modern
cases are, symptoms drawn to correspond with certain ideal forms of
disease. What, in my opinion, likewise adds very much to the value
of these cases is, that (as Galen somewhere remarks in his
Commentary) the author never aimed to make his Books of
Epidemics a work on Therapeutics, and hence, in noting morbid
phenomena, his mind in not warped by any particular hypothesis,
nor by any selfish interest, in order to place some favorite mode of
practice, advocated by himself, in a favorable light. May I be
permitted here to remark, that the reader will be much struck with
our author’s admirable talent for describing the phenomena of
disease as they are actually presented to us, if he will compare the
case related by him in these two books with those of almost any
modern authority whatever;—for example, with those related by the
late Dr. James Hamilton, in his celebrated work on Purgative
Medicines. In the latter, you look in vain for the strongly-marked
features which present themselves in all the cases related by our
author,—for a description of the condition of the hypochondriac
region,—of the state of the animal heat in the extremities,—of the
minute characters of the alvine and urinary discharges,—of the
respiration,—of the patients’ position in bed,—and many other
symptoms, which are invariably noticed by Hippocrates. And what
reasonable person will venture to deny, that the symptoms I have
just now mentioned are most important features in every febrile
disease, and that no one can be said to have a sufficient view of
such a case, who does not take these into account? To confine our
attention at present to only one of these symptoms,—can it ever be
a matter of indifference what are the physical characters of so
important an excretion as the urine? that is to say, whether the
grosser particles of it, which usually fall to the bottom, be present in
the urine or not? Yet in all the seventeen cases related in the
modern work just now referred to, the characters of the urine are
not given in a single instance. And although the object of the writer
is to enforce his own peculiar views, as to the utility of purgative
medicines in this disease, he scarcely ever gives the minute
characters of the alvine discharges, as is uniformly the case with
Hippocrates; or if they are noticed at all, it is in so confused a
manner that the reader is at a loss to determine whether they are
produced by the disease, or by the medicines which have been
administered. For the issue of the case no obvious cause is stated,
but the reader is expected to draw the conclusion that, as purgatives
were freely given, and a considerable proportion of the cases did
well,—(agreeably to the hackneyed rule, post quod, ergo propter
quod,)—the purgatives brought about the fortunate result. Had the
cases been fully and circumstantially detailed, it might have been
found that, as in those related by Hippocrates, recovery was
preceded by a critical discharge of urine, accompanied with a
copious sediment; and then the more probable inference would have
been, that the amendment was referable to it, and not to the
purgative medicines which were administered. It is, I regret to say, a
notable example of the want of logical training in the education of
professional men, in the present age, that inferences regarding a
peculiar method of practice were allowed to be founded upon
narratives of observations so defective and one-sided as those I
refer to.

I cannot quit the present subject of discussion, without saying a


few words in reference to what must strike the reader as a singular
feature in the cases related in the books of the Epidemics; I mean
the general omission of any mention of treatment. The reader will
find in our annotations various remarks of Galen on this head, from
which he will learn that the Great Commentator inclines to the
opinion, that in all these cases the usual routine of practice was
followed, but that no mention is made of medicines, unless when
there was some deviation from the established rules. For example, in
a certain febrile case, it is stated that the patient was bled on the
eighth day, and Galen contends that venesection is noticed in this
instance, merely because it was contrary to the established rule of
not bleeding after the fourth day; for that if the practice had been in
accordance with the general rule, it would not have been noticed at
all. Now it must be admitted, that this supposition is by no means
improbable, and that examples of this usage are not wanting, even
in the modern literature of medicine. To give an example, which just
occurs to me; in not a few of the cases of cerebral disease related
by Dr. Abercrombie, in his work “On the Brain,” there is no allusion
whatever to remedies, although no one, who recollects the vigorous
system of treatment then pursued by the profession in “Modern
Athens,” will doubt for a moment that they must have been applied.
As this eminent authority, then, when he believed that the treatment
had no perceptible effect on the course which the disease ran,
thought himself warranted in omitting all mention of it, it might be
supposed, in like manner, that Hippocrates may have passed over
the remedies applied, from some such motive or consideration. But
another reason for the absence of remedies in these Reports may be
readily supposed. May not Hippocrates have been at first quite
undecided what was the proper plan of treatment to be adopted in
those cases, and thought it the wisest course to attempt nothing
rashly, but to be for a season the quiet spectator of the course which
the diseases in question were naturally disposed to run, before
attempting to interfere in the struggle between morbific agents with
which he was imperfectly acquainted, and their great physician, as
he held Nature to be?[604] And however much the advocates for a
bold system of treating diseases may be disposed to deride this
expectant method, which Asclepiades contemptuously denominated
“the contemplation of death,”[605] it does not want the sanction of a
name which is second only to Hippocrates in the literature of
epidemical fevers. Sydenham admits, that with all the diligence
which he had applied to the study of these diseases, he was always
greatly puzzled what plan of treatment to adopt at the first breaking
out of a new epidemic, and that it was only “ingenti adhibita cautela
intentisque animi nervis,” that he could make up his mind what
course of treatment to adopt in such an emergency. Need it be
wondered at, then, that two thousand years earlier the modest mind
of our great author should have hesitated for a time, before deciding
how to act under similar circumstances? I must own, therefore, that
I have long inclined to the opinion, that, distracted with the
conflicting plans of treatment adopted by his contemporaries,
Hippocrates at first did little or nothing in the treatment of
epidemical fevers, and that it was only after a patient study of their
symptoms, and many cautious trials, that he ventured to lay down
those excellent rules of treatment which he has described so
admirably in his work “On Regimen in Acute Diseases.” This,
however, is merely my individual opinion, and the reader must
receive it as such.
M. Littré, in the Argument prefixed to his translation of the
Epidemics, enters very fully into the discussion of the question
regarding the nature of the diseases which are treated of in the
course of this work. This is a task, however, which I deem it
superfluous to undertake at any length, as I have stated my opinions
on this subject in the Commentaries on the Second Book of Paulus
Ægineta, and after maturely weighing what has been elicited by
subsequent inquirers, I find no cause to retract any of the opinions
which are there advanced. That the causus of Hippocrates, and the
other ancient authorities, was not the typhus of the more temperate
parts of Europe, but a bilious fever, of the remittent type, must be
quite apparent to every person at all acquainted with the medical
literature of febrile diseases. M. Littré’s researches lead him to
exactly the same conclusion, and much deference is due to his
judgment in this case, as it must be admitted that a French
physician is now very favorably situated for contrasting the diseases
of temperate and hot climates, owing to the familiar intercourse
which at present subsists between Paris and Algiers. Of all the
materials which he has collected from the observations of French
physicians in Algeria, the most interesting are those which he draws
from a work on Fevers, by M. Maillot. The description which is there
given of “la fièvre algide,” is so striking, and is so much calculated to
illustrate the nature of the fevers which are treated of in this work of
Hippocrates, that I shall not scruple to quote it entire.
“La fièvre algide (dit M. Maillot) n’est pas généralement, comme
on le dit, la prolongation indéfinie du stade de froid; je l’ai vue
rarement débuter de la sorte. Il y a même entre ces deux états une
contraste frappante. Dans le premier stade des fièvres
intermittentes, la sensation du froid est hors de toute proportion
avec l’abaissement réel de la température de la peau, tandis que,
dans la fièvre algide, le froid n’est pas perçu par le malade, alors que
la peau est glacée. C’est ordinairement pendant la réaction que
commencent les symptômes qui la caractérisent; souvent ils
surviennent tout à coup au milieu d’une réaction qui paraissait
franche. Au trouble de la circulation succède en peu d’instants et
presque sans transition le ralentissement du pouls, qui devient
bientôt très rare, fuit sous le doigt et disparaît; l’abaissement de la
température du corps va vite et suit la progression promptement
décroissante de la circulation; les extrémitiés, la face, le torse, se
refroidissent successivement; l’abdomen seul conserve encore
quelque temps un peu de chaleur; le contact de la peau donne la
sensation de froid que procure le marbre. Les lèvres sont décolorées,
l’haleine froide, la voix cassée, les battemens du cœur rares,
incomplets, appréciables seulement par l’auscultation; les facultés
intellectuelles sont intactes, et le malade se complaît dans cet état
de repos, surtout lorsqu’il succède à une fièvre violente, la
physionomie est sans mobilité, l’impassibilité la plus grande est
peinte sur son visage; ses traits sont morts. La marche de cette
fièvre est très insidieuse; il n’est peut-être personne, dont elle n’ait
surpris la vigilance, avant d’être familiarisé avec l’observation des
accidens de cette nature, on prend souvent pour une très grande
amélioration due aux déplétions sanguines, le calme qui succède aux
accidents inflammatoires; et plus d’une fois, dans de semblables
circonstances, on n’a été détrompé que par la mort soudaine du
malade. Toutes les fois qu’à une réaction plus on moins forte, on
verra succéder tout à coup un ralentissement du pouls, avec pâleur
de la langue et décoloration des lèvres, on ne devra hésiter à
diagnostiquer une fièvre algide. La temporisation ici donne la mort,
en quelques heures. Dans quelques cas très rares, j’ai cependant vu
cet état algide se prolonger trois ou quatre jours. Le malade expire
en conservant toutes ses facultés intellectuelles,[606] il s’éteint
comme par un arrêt de l’innervation. Lorsque la mort n’est pas le
terme de cet état morbide si grave, le pouls se relève; la peau
reprend sa chaleur naturelle; quelquefois alors la réaction détermine
une irritation de l’encéphale ou des voies digestives; mais rarement
elle est assez intense pour qu’on soit obligé de la combattre par des
déplétions sanguines.”[607] I shall add a remark, which M. Littré
gives on the same authority: “J’ai tenu à mentionner ici l’impression
qu’éprouva M. Maillot au début de sa pratique en Algérie, et qui est
si instructive; car, aller subitement de France exercer la médecine
dans un pays chaud, ou lire les observations d’Hippocrate, c’est tout
un: l’impression est la même, le changement de scène est aussi
grand.”[608]
I cannot help remarking in this place, however, that it appears to
me singular, that M. Littré should represent the febris algida as being
confined to southern climates, and should speak of it as being
unknown in Paris; for, at all events, there seems to be no doubt that
it prevails in a more northerly region, namely, in Holland. It is thus
described by the celebrated Franciscus de le Boe (or Sylvius), who
was professor of practical medicine at Leyden about the middle of
the 17th century: “Febres algidæ observantur nonnunquam, non
tantum frigore præsertim, sed frigore tantum molestæ: adeo ut
aliquando et frequentius levis, aliquando et rarius nullus sequatur
calor. Tales, etiam semper algidas in Nosocomio academico
habuimus ita manifestas, ut non tantum incipiente, atque
augescente, sed etiam vigente et déclinante, imò cessante
paroxysmo, id est, semper tum suo, tum adstantium, tum
medicorum sensu moleste ubique frigerent, nunquam teperent,
minus calerent ullibi ægri. Suntque hæ algidæ graviores semper
forsan quotidianæ.”[609] The febris algida is also named “rigor
without heat,” by the Greek authorities, and “frigus quod non calefit”
by the Arabians, who, like Sylvius, as quoted above, regard it as a
variety of the quotidian intermittent. See Paulus Ægineta, Book II.,
26.
M. Littré[610] quotes the remark of an excellent English authority
on fever, J. Johnson,[611] that it is singular the effects of marsh
effluvia should have escaped the observation of Hippocrates, more
especially as the remittent and intermittent fevers, of which he
treats so fully, are mostly derived from this source. Now I must say,
that I am not aware of there being any passages in the works of
Hippocrates where the effects of marsh effluvia in engendering such
fevers are distinctly noticed; but if Hippocrates was ignorant of this
fact, in the etiology of fevers, it was well known to Galen, as may be
seen on reference to his very interesting work “On the Difference of
Fevers.”[612] The Arabians also were familiar with the fact. See
Avicenna, iv., 1, 2, 1.
In the treatise “On Airs,” which, although not admitted by us into
the list of genuine works, has considerable pretension to be so
regarded, the causes of fever are treated of with great precision,
and there the pestilential fevers are said to derive their origin from
miasma, but whether or not under this term be included marsh
effluvia, cannot be determined. But perhaps a better reason might
be assigned for there being little or no allusion to malaria in the
works of Hippocrates, namely, that after all, this was not the cause
of the epidemical diseases which he describes. The following extract
from a work of very high authority on fever is well deserving of
consideration in this place: “A question has arisen as to whether or
not the inflammatory states of fever, in warm countries, are caused
by malaria, or by the other causes now instanced (excess of heat,
etc.). There can be no doubt that malaria very frequently produces
in the plethoric, young, and robust, who have recently arrived in a
hot climate, fever of an inflammatory and continued kind; but it
must also be conceded that this fever chiefly occurs, even in persons
thus constituted, during the dry season, and at times and in places
where the existence of malaria is doubtful, or, at least, by no means
proved. It is notoriously admitted that the inflammatory states of
continued fever, in both the East and West Indies, appear among
those soldiers, sailors, and civilians, who have not been long in a
warm country, and who have not suffered from disease since their
arrival; and that they take place chiefly during the dry and warm
seasons, and in situations where the usual affects of malaria are
never observed. This is the result of the experience of Jackson,
Annesley, Boyle, Twining, Conwell, and the other experienced
practitioners in warm countries. It agrees with my own observations,
and is even admitted by Dr. Fergusson, who has gone much further
than any one else in assigning malaria as the cause of intertropical
fevers.”[613] I may mention, moreover, that Hippocrates and his
contemporaries were evidently not ignorant of the fact, that the
atmosphere in the vicinity of marshes and large rivers is
unwholesome to the inhabitants of warm climates. See De Diæta, ii,
2.
The following are part of the conclusions which M. Littré draws
from his investigations into the nature of the fevers described by
Hippocrates. I quote them as being strongly confirmatory of the
opinions delivered by me in the Commentary on the Second Book of
Paulus Ægineta.
“Les fièvres décrites dans les Epidémies d’Hippocrate différent de
nos fièvres continués.
“Les fièvres décrites dans les Epidémies ont, dans leur apparence
générale, une similitude très grande avec celles des pays chauds.
“La similitude n’est pas moins grande dans les détails que dans
l’ensemble.
“Dans les unes comme dans les autres les hypochondres sont
pour un tiers des cas, le siége d’une manifestation toute spéciale.
“Dans les unes comme dans les autres, il y a une forte tendence
ou réfroidissement du corps, à la sueur froide et à la lividité des
extrémités.”
On almost all the other diseases treated of in these books, M.
Littré’s opinions, in like manner, exactly coincide with those delivered
by me in the above-mentioned work. Thus he arrives at the
conclusion, that the Phrenitis and Lethargus of Hippocrates were
varieties of the Causus. Compare Paulus Ægineta, Book III., 6, 9. He
refers them to les fièvres pernicieuses comateuses pseudo-continués
et les fièvres pernicieuses dolorantes pseudo-continués of M. Maillot.
It would appear from the extracts which he quotes from a work of
M. Roux, on the Diseases of Morea, that a similar tendency to pass
into phrenitis and lethargy is still observable in the land of Greece.
The fevers of the East Indies also, as described by Dr. Twining,[614]
appear to partake very much of the same character. In a word, the
conclusions to which a patient study of modern authorities on the
subject have brought me amount to this; that the fevers described
by Hippocrates in his “Epidemics,” are exactly the same as those
which are now described as still prevailing in the land of Greece: that
they correspond very well with those described by Cleghorn as
occurring in Majorca; differ but little from those described by Pringle,
Monro, and Sylvius, as happening in the Low Countries, and differ
from those described by Twining, as happening in Bengal, only in a
few particulars.
From the analysis of their contents given above it will readily be
understood that the subject-matters of these two books are not
arranged methodically. Indeed it is quite obvious from the nature of
the work that the matters which are treated of in it had never been
methodized by the author. Certainly then, as proposed by Desmair,
[615] it would be a much more natural arrangement to give the four
Constitutions of the season first, and then to give the forty-two
cases together. But the present arrangement being of old standing,
no editor has thought himself warranted to depart from it.
There are two important professional subjects of which it may
appear surprising that there is no mention in the “Books of the
Epidemics,” I mean sphygmology and contagion. Galen repeatedly
declares it as his opinion, that Hippocrates paid no attention to the
characters of the arterial pulse, and that the subject was not at all
studied until after his time; and as far as I can see there is no
ground for calling in question this opinion of Galen. Herophilus, in
fact, would appear to have been the first person that made any
progress in this study. It is more remarkable that Hippocrates should
omit all allusion to the other subject, more especially as the
contagiousness of certain diseases would appear to have been the
popular belief of his age. Thus his contemporary, Thucydides, in
describing the plague, expresses himself in such terms as puts it
beyond a doubt that he regarded the disease as being of a
contagious nature. And another contemporary, Isocrates, makes
such observations on a certain case of empyema, by which he
evidently means phthisis pulmonalis, as to show that it also was
regarded as being communicable.[616] How the omission is to be
accounted for I do not know, but certain it is that not the least
reference to contagion, in any shape, is to be found in any of the
Hippocratic treatises.
BOOK I.—OF THE EPIDEMICS.

Sec. I.—Constitution First.

1. In Thasus,[617] about the autumnal equinox, and under the


Pleiades,[618] the rains were abundant, constant, and soft, with
southerly winds; the winter southerly, the northerly winds faint,
droughts; on the whole, the winter having the character of spring.
The spring was southerly, cool, rains small in quantity. Summer, for
the most part, cloudy, no rain, the Etesian winds, rare and small,
blew in an irregular manner. The whole constitution of the season
being thus inclined to the southerly, and with droughts early in the
spring, from the preceding opposite and northerly state, ardent
fevers occurred in a few instances, and these very mild, being rarely
attended with hemorrhage, and never proving fatal.[619] Swellings
appeared about the ears, in many on either side, and in the greatest
number on both sides, being unaccompanied by fever so as not to
confine the patient to bed; in all cases they disappeared without
giving trouble, neither did any of them come to suppuration, as is
common in swellings from other causes. They were of a lax, large,
diffused character, without inflammation or pain, and they went
away without any critical sign. They seized children, adults, and
mostly those who were engaged in the exercises of the palestra and
gymnasium, but seldom attacked women. Many had dry coughs
without expectoration, and accompanied with hoarseness of voice.
In some instances earlier, and in others later, inflammations with
pain seized sometimes one of the testicles, and sometimes both;
[620] some of these cases were accompanied with fever and some
not; the greater part of these were attended with much suffering. In
other respects they were free of disease, so as not to require
medical assistance.[621]
2. Early in the beginning of spring, and through the summer, and
towards winter, many of those who had been long gradually
declining, took to bed with symptoms of phthisis; in many cases
formerly of a doubtful character the disease then became confirmed;
in these the constitution inclined to the phthisical.[622] Many, and, in
fact, the most of them, died; and of those confined to bed, I do not
know if a single individual survived for any considerable time; they
died more suddenly than is common in such cases. But other
diseases, of a protracted character, and attended with fever, were
well supported, and did not prove fatal: of these we will give a
description afterwards. Consumption was the most considerable of
the diseases which then prevailed, and the only one which proved
fatal to many persons. Most of them were affected by these diseases
in the following manner: fevers accompanied with rigors, of the
continual type, acute, having no complete intermissions, but of the
form of the semitertians, being milder the one day, and the next
having an exacerbation, and increasing in violence; constant sweats,
but not diffused over the whole body; extremities very cold, and
warmed with difficulty; bowels disordered, with bilious, scanty,
unmixed, thin, pungent, and frequent dejections. The urine was thin,
colourless, unconcocted, or thick, with a deficient sediment, not
settling favorably, but casting down a crude and unseasonable
sediment. Sputa small, dense, concocted, but brought up rarely and
with difficulty; and in those who encountered the most violent
symptoms there was no concoction at all, but they continued
throughout spitting crude matters. Their fauces, in most of them,
were painful from first to last, having redness with inflammation;
defluxions thin, small and acrid; they were soon wasted and became
worse, having no appetite for any kind of food throughout; no thirst;
most persons delirious when near death. So much concerning the
phthisical affections.[623]
3. In the course of the summer and autumn many fevers of the
continual type, but not violent;[624] they attacked persons who had
been long indisposed, but who were otherwise not in an
uncomfortable state. In most cases the bowels were disordered in a
very moderate degree, and they did not suffer thereby in any
manner worth mentioning; the urine was generally well coloured,
clear, thin, and after a time becoming concocted near the crisis.
They had not much cough, nor was it troublesome; they were not
deficient in appetite, for it was necessary to give them food, (on the
whole, persons labouring under phthisis were not affected in the
usual manner).[625] They were affected with fevers, rigors, and
deficient sweats, with varied and irregular paroxysms, in general not
intermitting, but having exacerbations in the tertian form. The
earliest crisis which occurred was about the twentieth day, in most
about the fortieth, and in many about the eightieth. But there were
cases in which it did not leave them thus at all, but in an irregular
manner, and without any crisis; in most of these the fevers, after a
brief interval, relapsed again; and from these relapses they came to
a crisis in the same periods; but in many they were prolonged so
that the disease was not gone at the approach of winter. Of all those
which are described under this constitution, the phthisical diseases
alone were of a fatal character; for in all the others the patients bore
up well, and did not die of the other fevers.[626]
Sec. II.—Constitution Second.

1. In Thasus, early in autumn, the winter suddenly set in rainy


before the usual time, with much northerly and southerly winds.
These things all continued so during the season of the Pleiades, and
until their setting.[627] The winter was northerly, the rains frequent,
in torrents, and large, with snow, but with a frequent mixture of fair
weather. These things were all so, but the setting in of the cold was
not much out of season. After the winter solstice, and at the time
when the zephyr usually begins to blow, severe winterly storms out
of season, with much northerly wind, snow, continued and copious
rains; the sky tempestuous and clouded; these things were
protracted, and did not remit until the equinox. The spring was cold,
northerly, rainy, and clouded; the summer was not very sultry, the
Etesian winds blew constant, but quickly afterwards, about the rising
of Arcturus, there were again many rains with north winds. The
whole season being wet, cold, and northerly, people were, for the
most part, healthy during winter; but early in the spring very many,
indeed, the greater part, were valetudinary. At first ophthalmies set
in, with rheums, pains, unconcocted discharges, small concretions,
generally breaking with difficulty, in most instances they relapsed,
and they did not cease until late in autumn.[628] During summer and
autumn there were dysenteric affections, attacks of tenesmus and
lientery, bilious diarrhœa, with thin, copious, undigested, and acrid
dejections, and sometimes with watery stools; many had copious
defluxions, with pain, of a bilious, watery, slimy, purulent nature,
attended with strangury, not connected with disease of the kidneys,
but one complaint succeeding the other; vomitings of bile, phlegm,
and undigested food, sweats, in all cases a redundance of humors.
In many instances these complaints were unattended with fever, and
did not prevent the patients from walking about, but some cases
were febrile, as will be described. In some all those described below
occurred with pain. During autumn, and at the commencement of
winter, there were phthisical complaints, continual fevers; and, in a
few cases, ardent; some diurnal, others nocturnal, semitertians, true
tertians, quartans, irregular fevers. All the fevers which are
described attacked great numbers. The ardent 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.[629] The tertians were more
numerous than the ardent fevers, and attended with more pain;[630]
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;[631] 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,[632] 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. The most of these were protracted and
troublesome, went on in a very disorderly and irregular form, and,
for the most part, did not end 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 fever 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.[633] 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. Persons died of all these
diseases, but mostly of these fevers, and especially 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.[634] 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.[635] 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
meditate these things, and have two special objects in view with
regard to diseases, 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.[636]
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,[637] 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.
Third Constitution.

7. In Thasus, a little before and during the season of Arcturus,


[638] there were frequent and great rains, with northerly winds.
About the equinox, and till the setting of the Pleiades, there were a
few southerly rains: the winter northerly and parched, cold, with
great winds and snow. Great storms about the equinox, the spring
northerly, dryness, rains few and cold. About the summer solstice,
scanty rains, and great cold until near the season of the Dog-star.
[639] After the Dog-days, until the season of Arcturus, the summer
hot, great droughts, not in intervals, but continued and severe: no
rain; the Etesian winds blew; about the season of Arcturus southerly
rains until the equinox.
8. In this state of things, during winter, paraplegia set in, and
attacked many, and some died speedily; and otherwise the disease
prevailed much in an epidemical form, but persons remained free
from all other diseases.[640] Early in the spring, ardent fevers
commenced and continued through the summer until the equinox.
Those then that were attacked immediately after the
commencement of the spring and summer, for the most part
recovered, and but few of them died. But when the autumn and the
rains had set in, they were of a fatal character, and the greater part
then died.[641] When in these attacks of ardent fevers there was a
proper and copious hemorrhage from the nose, they were generally
saved by it, and I do not know a single person who had a proper
hemorrhage who died in this constitution. Philiscus, Epaminon, and
Silenus, indeed, who had a trifling epistaxis on the fourth and fifth
day, died.[642] The most of those seized with the disease had a rigor
about the time of the crisis, and especially those who had no
hemorrhage; these had also the rigor associated. Some were
attacked with jaundice on the sixth day,[643] but these were
benefited either by an urinary purgation, or a disorder of the bowels,
or a copious hemorrhage, as in the case of Heraclides, who was
lodged with Aristocydes: this person, though he had the hemorrhage
from the nose, the purgation by the bladder, and disorder of the
bowels, experienced a favorable crisis on the twentieth day, not like
the servant of Phanagoras, who had none of these symptoms, and
died. The hemorrhages attacked most persons, but especially young
persons and those in the prime of life, and the greater part of those
who had not the hemorrhage died:[644] elderly persons had jaundice
or disorder of the bowels, such as Bion, who was lodged with
Silenus. Dysenteries were epidemical during the summer, and some
of those cases in which the hemorrhage occurred, terminated in
dysentery, as happened to the slave of Eraton, and to Mullus, who
had a copious hemorrhage, which settled down into dysentery, and
they recovered. This humor was redundant in many cases, since in
those who had not the hemorrhage about the crisis, but the risings
about the ears disappeared, after their disappearance there was a
sense of weight in the left flank extending to the extremity of the
hip, and pain setting in after the crisis, with a discharge of thin
urine; they began to have small hemorrhages about the twenty-
fourth day, and the swelling was converted into the hemorrhage. In
the case of Antiphon, the son of Critobulus, the fever ceased and
came to a crisis about the fortieth day. Many women were attacked,
but fewer than of the men, and there were fewer deaths among
them. But most of them had difficult parturition, and after labor they
were taken ill, and these most especially died, as, for example, the
daughter of Telebolus died on the sixth day after delivery.[645] Most
females had the menstrual discharge during the fever, and many
girls had it then for the first time: in certain individuals both the
hemorrhage from the nose and the menses appeared; thus, in the
case of the virgin daughter of Dætharses, the menses then took
place for the first time, and she had also a copious hemorrhage from
the nose, and I knew no instance of any one dying when one or
other of these took place properly. But all those in the pregnant
state that were attacked had abortions, as far as I observed. The
urine in most cases was of the proper color, but thin, and having
scanty sediments:[646] in most the bowels were disordered with thin
and bilious dejections; and many, after passing through the other
crises, terminated in dysenteries, as happened to Xenophanes and
Critias. The urine was watery, copious, clear, and thin; and even
after the crises, when the sediment was natural, and all the other
critical symptoms were favorable, as I recollect having happened to
Bion, who was lodged in the house of Silenus, and Critias, who lived
with Xenophanes, the slave of Areton, and the wife of Mnesistratus.
But afterwards all these were attacked with dysentery. It would be
worth while to inquire whether the watery urine was the cause of
this.[647] About the season of Arcturus many had the crisis on the
eleventh day, and in them the regular relapses did not take place,
but they became comatose about this time, especially children; but
there were fewest deaths of all among them.
9. About the equinox, and until the season of the Pleiades, and at
the approach of winter, many ardent fevers set in; but great
numbers at that season were seized with phrenitis, and many died;
[648] a few cases also occurred during the summer. These then made
their attack at the commencement of ardent fevers, which were
attended with fatal symptoms; for immediately upon their setting in,
there were acute fever and small rigors, insomnolency, aberration,
thirst, nausea, insignificant sweats about the forehead and clavicles,
but no general perspiration; they had much delirious talking, fears,
despondency, great coldness of the extremities, in the feet, but more
especially in their hands: the paroxysms were on the even days; and
in most cases, on the fourth day, the most violent pains set in, with
sweats, generally coldish, and the extremities could not be warmed,
but were livid and rather cold, and they had then no thirst; in them
the urine was black, scanty, thin, and the bowels were constipated;
there was an hemorrhage from the nose in no case in which these
symptoms occurred, but merely a trifling epistaxis; and none of
them had a relapse, but they died on the sixth day with sweats.[649]
In the phrenitic cases, all the symptoms which have been described
did not occur, but in them the disease mostly came to a crisis on the
eleventh day, and in some on the twentieth. In those cases in which
the phrenitis did not begin immediately, but about the third or fourth
day, the disease was moderate at the commencement, but assumed
a violent character about the seventh day. There was a great
number of diseases, and of those affected, they who died were
principally infants, young persons, adults having smooth bodies,
white skins, straight and black hair, dark eyes, those living recklessly
and luxuriously; persons with shrill, or rough voices, who stammered
and were passionate, and women more especially died from this
form. In this constitution, four symptoms in particular proved
salutary; either a hemorrhage from the nose, or a copious discharge
by the bladder of urine, having an abundant and proper sediment, or
a bilious disorder of the bowels at the proper time, or an attack of
dysentery.[650] And in many cases it happened, that the crisis did
not take place by any one of the symptoms which have been
mentioned, but the patient passed through most of them, and
appeared to be in an uncomfortable way, and yet all who were
attacked with these symptoms recovered. All the symptoms which I
have described occurred also to women and girls; and whoever of
them had any of these symptoms in a favorable manner, or the
menses appeared abundantly, were saved thereby, and had a crisis,
so that I do not know a single female who had any of these
favorably that died. But the daughter of Philo, who had a copious
hemorrhage from the nose, and took supper unseasonably on the
seventh day, died. In those cases of acute, and more especially of
ardent fevers, in which there is an involuntary discharge of tears,
you may expect a hemorrhage from the nose, unless the other
symptoms be of a fatal character, for in those of a bad description,
they do not indicate a hemorrhage, but death. Swellings about the
ears, with pain in fevers, sometimes when the fever went off
critically, neither subsided nor were converted into pus; in these
cases a bilious diarrhœa, or dysentery, or thick urine having a
sediment, carried off the disease, as happened to Hermippus of
Clazomenæ. The circumstances relating to crises, as far as we can
recognize them, were so far similar and so far dissimilar. Thus two
brothers became ill at the same hour (they were brothers of
Epigenes, and lodged near the theatre), of these the elder had a
crisis on the sixth day, and the younger on the seventh, and both
had a relapse at the same hour; it then left them for five days, and
from the return of the fever both had a crisis together on the
seventeenth day. Most had a crisis on the sixth day; it then left them
for six days, and from the relapse there was a crisis on the fifth day.
[651] But those who had a crisis on the seventh day, had an
intermission for seven days; and the crisis took place on the third
day after the relapse. Those who had a crisis on the sixth day, after
an interval of six days were seized again on the third, and having left
them for one day, the fever attacked them again on the next and
came to a crisis, as happened to Evagon the son of Dætharses.
Those in whom the crisis happened on the sixth day, had an
intermission of seven days, and from the relapse there was a crisis
on the fourth, as happened to the daughter of Aglaïdas. The greater
part of those who were taken ill under this constitution of things,
were affected in this manner, and I did not know a single case of
recovery, in which there was not a relapse agreeably to the stated
order of relapses; and all those recovered in which the relapses took
place according to this form: nor did I know a single instance of
those who then passed through the disease in this manner who had
another relapse. In these diseases death generally happened on the
sixth day, as happened to Epaminondas, Silenus, and Philiscus the
son of Antagoras. Those who had parotid swellings experienced a
crisis on the twentieth day, but in all these cases the disease went
off without coming to a suppuration, and was turned upon the
bladder. But in Cratistonax, who lived by the temple of Hercules, and
in the maid servant of Scymnus the fuller, it turned to a suppuration,
and they died. Those who had a crisis on the seventh day, had an
intermission of nine days, and a relapse which came to a crisis on
the fourth day from the return of the fever, as was the case with
Pantacles, who resided close by the temple of Bacchus. Those who
had a crisis on the seventh day, after an interval of six days had a
relapse, from which they had a crisis on the seventh day, as
happened to Phanocritus, who was lodged with Gnathon the painter.
During the winter, about the winter solstices, and until the equinox,
the ardent fevers and frenzies prevailed, and many died. The crisis,
however, changed, and happened to the greater number on the fifth
day from the commencement, left them for four days and relapsed;
and after the return, there was a crisis on the fifth day, making in all
fourteen days. The crisis took place thus in the case of most
children, also in elder persons. Some had a crisis on the eleventh
day, a relapse on the fourteenth, a complete crisis on the twentieth;
but certain persons, who had a rigor about the twentieth, had a
crisis on the fortieth. The greater part had a rigor along with the
original crisis, and these had also a rigor about the crisis in the
relapse. There were fewest cases of rigor in the spring, more in
summer, still more in autumn, but by far the most in winter; then
hemorrhages ceased.
Sec. III.
10. With regard to diseases, the circumstances from which we
form a judgment of them are,—by attending to the general nature of
all, and the peculiar nature of each individual,—to the disease, the
patient, and the applications,—to the person who applies them, as
that makes a difference for better or for worse,—to the whole
constitution of the season, and particularly to the state of the
heavens, and the nature of each country;—to the patient’s habits,
regimen, and pursuits;—to his conversation, manners, taciturnity,
thoughts, sleep, or absence of sleep, and sometimes his dreams,
what and when they occur;—to his picking and scratching;[652]—to
his tears;—to the alvine discharges, urine, sputa, and vomitings; and
to the changes of diseases from the one into the other;—to the
deposits, whether of a deadly or critical character;—to the sweat,
coldness, rigor, cough, sneezing, hiccup, respiration, eructation,
flatulence, whether passed silently or with a noise;—to hemorrhages
and hemorrhoids;—from these, and their consequences, we must
form our judgment.[653]
11. Fevers are,—the continual, some of which hold during the
day and have a remission at night, and others hold during the night
and have a remission during the day;[654] semitertians, tertians,
quartans, quintans, septans, nonans. The most acute, strongest,
most dangerous, and fatal diseases, occur in the continual fever. The
least dangerous of all, and the mildest and most protracted, is the
quartan, for it is not only such from itself, but it also carries off other
great diseases.[655] In what is called the semitertian, other acute
diseases are apt to occur, and it is the most fatal of all others, and
moreover phthisical persons, and those laboring under other
protracted diseases, are apt to be attacked by it.[656] The nocturnal
fever is not very fatal, but protracted; the diurnal is still more
protracted, and in some cases passes into phthisis. The septan is
protracted, but not fatal; the nonan more protracted, and not fatal.
The true tertian comes quickly to a crisis, and is not fatal; but the
quintan is the worst of all, for it proves fatal when it precedes an
attack of phthisis, and when it supervenes on persons who are
already consumptive.[657] There are peculiar modes, and
constitutions, and paroxysms, in every one of these fevers; for
example,—the continual, in some cases at the very commencement,
grows, as it were, and attains its full strength, and rises to its most
dangerous pitch, but is diminished about and at the crisis; in others
it begins gentle and suppressed, but gains ground and is
exacerbated every day, and bursts forth with all its heat about and
at the crisis; while in others, again, it commences mildly, increases,
and is exacerbated until it reaches its acmé, and then remits until at
and about the crisis.[658] These varieties occur in every fever, and in
every disease. From these observations one must regulate the
regimen accordingly. There are many other important symptoms
allied to these, part of which have been already noticed, and part
will be described afterwards, from a consideration of which one may
judge, and decide in each case, whether the disease be acute, and
whether it will end in death or recovery; or whether it will be
protracted, and will end in death or recovery; and in what cases food
is to be given, and in what not; and when and to what amount, and
what particular kind of food is to be administered.
12. Those diseases which have their paroxysms on even days
have their crises on even days; and those which have their
paroxysms on uneven days have their crises on uneven days. The
first period of those which have the crisis on even days, is the 4th,
6th, 8th, 10th, 14th, 20th, 30th, 40th, 60th, 80th, 100th; and the
first period of those which have their crises on uneven days, is the
let, 3d, 5th, 7th, 9th, 11th, 17th, 21st, 27th, 31st. It should be
known, that if the crisis take place on any other day than on those
described, it indicates that there will be a relapse, which may prove
fatal. But one ought to pay attention, and know in these seasons
what crises will lead to recovery and what to death, or to changes
for the better or the worse. Irregular fevers, quartans, quintans,
septans, and nonans should be studied, in order to find out in what
periods their crises take place.

13. Fourteen Cases of Disease.[659]


Case I.—Philiscus, who lived by the Wall, took to bed on the first
day of acute fever; he sweated; towards night was uneasy. On the
second day all the symptoms were exacerbated; late in the evening
had a proper stool from a small clyster; the night quiet. On the third
day, early in the morning and until noon, he appeared to be free
from fever; towards evening, acute fever, with sweating, thirst,
tongue parched; passed black urine; night uncomfortable, no sleep;
he was delirious on all subjects. On the fourth, all the symptoms
exacerbated, urine black; night more comfortable, urine of a better
color. On the fifth, about mid-day, had a slight trickling of pure blood
from the nose; urine varied in character, having floating in it round
bodies, resembling semen, and scattered, but which did not fall to
the bottom; a suppository having been applied, some scanty
flatulent matters were passed; night uncomfortable, little sleep,
talking incoherently; extremities altogether cold, and could not be
warmed; urine black; slept a little towards day; loss of speech, cold
sweats; extremities livid; about the middle of the sixth day he died.
The respiration throughout, like that of a person recollecting himself,
was rare, and large, and spleen was swelled upon in a round tumor,
the sweats cold throughout, the paroxysms on the even days.[660]
Case II.—Silenus lived on the Broad-way, near the house of
Evalcidas. From fatigue, drinking, and unseasonable exercises, he
was seized with fever. He began with having pain in the loins; he
had heaviness of the head, and there was stiffness of the neck. On
the first day the alvine discharges were bilious, unmixed, frothy, high
colored, and copious; urine black, having a black sediment; he was
thirsty, tongue dry; no sleep at night. On the second, acute fever,
stools more copious, thinner, frothy; urine black, an uncomfortable
night, slight delirium. On the third, all the symptoms exacerbated;
an oblong distention, of a softish nature, from both sides of the
hypochondrium to the navel; stools thin, and darkish; urine muddy,
and darkish; no sleep at night; much talking, laughter, singing, he
could not restrain himself. On the fourth, in the same state. On the
fifth, stools bilious, unmixed, smooth, greasy; urine thin, and
transparent; slight absence of delirium. On the sixth, slight
perspiration about the head; extremities cold and livid; much tossing
about; no passage from the bowels, urine suppressed, acute fever.
On the seventh, loss of speech; extremities could no longer be kept
warm; no discharge of urine. On the eighth, a cold sweat all over;
red rashes with sweat, of a round figure, small, like vari, persistent,
not subsiding; by means of a slight stimulus, a copious discharge
from the bowels, of a thin and undigested character, with pain; urine
acrid, and passed with pain; extremities slightly heated; sleep slight,
and comatose; speechless; urine thin, and transparent. On the ninth,
in the same state. On the tenth, no drink taken; comatose, sleep
slight; alvine discharges the same; urine abundant, and thickish;
when allowed to stand, the sediment farinaceous and white;
extremities again cold. On the eleventh, he died. At the
commencement, and throughout, the respiration was slow and
large; there was a constant throbbing in the hypochondrium; his age
was about twenty.[661]
Case III.—Herophon was seized with an acute fever; alvine
discharges at first were scanty, and attended with tenesmus; but
afterwards they were passed of a thin, bilious character, and
frequent; there was no sleep; urine black, and thin. On the fifth, in
the morning, deafness; all the symptoms exacerbated; spleen
swollen; distention of the hypochondrium; alvine discharges scanty,
and black; he became delirious. On the sixth, delirious; at night,
sweating, coldness; the delirium continued. On the seventh, he
became cold, thirsty, was disordered in mind; at night recovered his
senses; slept. On the eighth, was feverish; the spleen diminished in
size; quite collected; had pain at first about the groin, on the same
side as the spleen; had pains in both legs; night comfortable; urine
better colored, had a scanty sediment. On the ninth, sweated; the
crisis took place; fever remitted. On the fifth day afterwards, fever
relapsed, spleen immediately became swollen; acute fever; deafness
again. On the third day after the relapse, the spleen diminished;
deafness less; legs painful; sweated during the night; crisis took
place on the seventeenth day; had no disorder of the senses during
the relapse.[662]
Case IV.—In Thasus, the wife of Philinus, having been delivered of
a daughter, the lochial discharge being natural, and other matters
going on mildly, on the fourteenth day after delivery was seized with
fever, attended with rigor; was pained at first in the cardiac region of
the stomach and right hypochondrium; pain in the genital organs;
lochial discharge ceased. Upon the application of a pessary all these
symptoms were alleviated; pains of the head, neck, and loins
remained; no sleep; extremities cold; thirst; bowels in a hot state;
stools scanty; urine thin, and colorless at first. On the sixth, towards
night, senses much disordered, but again were restored. On the
seventh, thirsty; the evacuations bilious, and high colored. On the
eighth, had a rigor; acute fever; much spasm, with pain; talked
much, incoherently; upon the application of a suppository, rose to
stool, and passed copious dejections, with a bilious flux; no sleep.
On the ninth, spasms. On the tenth, slightly recollected. On the
eleventh, slept; had perfect recollection, but again immediately
wandered; passed a large quantity of urine with spasms, (the
attendants seldom putting her in mind,) it was thick, white, like urine
which has been shaken after it has stood for a considerable time
until it has subsided, but it had no sediment; in color and
consistence, the urine resembled that of cattle, as far as I observed.
About the fourteenth day, startings over the whole body; talked
much; slightly collected, but presently became again delirious. About
the seventeenth day became speechless, on the twentieth died.[663]
Case V.—The wife of Epicrates, who was lodged at the house of
Archigetes, being near the term of delivery, was seized with a violent
rigor, and, as was said, she did not become heated;[664] next day
the same. On the third, she was delivered of a daughter, and
everything went on properly. On the day following her delivery, she
was seized with acute fever, pain in the cardiac region of the
stomach, and in the genital parts. Having had a suppository, was in
so far relieved; pain in the head, neck, and loins; no sleep; alvine
discharges scanty, bilious, thin, and unmixed; urine thin, and
blackish. Towards the night of the sixth day from the time she was
seized with the fever, became delirious. On the seventh, all the
symptoms exacerbated; insomnolency, delirium, thirst; stools bilious,
and high colored. On the eighth, had a rigor; slept more. On the
ninth, the same. On the tenth, her limbs painfully affected; pain
again of the cardiac region of the stomach; heaviness of the head;
no delirium; slept more; bowels constipated. On the eleventh,
passed urine of a better color, and having an abundant sediment;
felt lighter. On the fourteenth had a rigor; acute fever. On the
fifteenth, had a copious vomiting of bilious and yellow matters;
sweated; fever gone; at night acute fever; urine thick, sediment
white.[665] On the seventeenth, an exacerbation; night
uncomfortable; no sleep; delirium. On the eighteenth, thirsty;
tongue parched; no sleep; much delirium; legs painfully affected.
About the twentieth, in the morning, had a slight rigor; was
comatose; slept tranquilly; had slight vomiting of bilious and black
matters; towards night deafness. About the twenty-first, weight
generally in the left side, with pain; slight cough; urine thick, muddy,
and reddish; when allowed to stand, had no sediment; in other
respects felt lighter; fever not gone; fauces painful from the
commencement, and red; uvula retracted; defluxion remained acrid,
pungent, and saltish throughout. About the twenty-seventh, free of
fever; sediment in the urine; pain in the side. About the thirty-first,
was attacked with fever, bilious diarrhœa; slight bilious vomiting on
the fortieth. Had a complete crisis, and was freed from the fever on
the eightieth day.[666]
Case VI.—Cleonactides, who was lodged above the Temple of
Hercules, was seized with a fever in an irregular form; was pained in
the head and left side from the commencement, and had other pains
resembling those produced by fatigue: paroxysms of the fevers
inconstant and irregular; occasional sweats; the paroxysms generally
attacked on the critical days. About the twenty-fourth was cold in the
extremities of the hands, vomitings bilious, yellow, and frequent,
soon turning to a verdigris-green color; general relief. About the
thirtieth, began to have hemorrhage from both nostrils, and this
continued in an irregular manner until near the crisis; did not loathe
food, and had no thirst throughout, nor was troubled with
insomnolency; urine thin, and not devoid of color. When about the
thirtieth day, passed reddish urine, having a copious red sediment;
was relieved, but afterwards the characters of the urine varied,
sometimes having sediment, and sometimes not. On the sixtieth, the
sediment in the urine copious, white, and smooth; all the symptoms
ameliorated; intermission of the fever; urine thin, and well colored.
On the seventieth, fever gone for ten days. On the eightieth had a
rigor, was seized with acute fever, sweated much; a red, smooth
sediment in the urine; and a perfect crisis.[667]
Case VII.—Meton was seized with fever; there was a painful
weight in the loins. Next day, after drinking water pretty copiously,
had proper evacuations from the bowels. On the third, heaviness of
the head, stools thin, bilious, and reddish. On the fourth, all the
symptoms exacerbated; had twice a scanty trickling of blood from
the right nostril; passed an uncomfortable night; alvine discharges
like those on the third day; urine darkish, had a darkish cloud
floating in it, of a scattered form, which did not subside. On the fifth,
a copious hemorrhage of pure blood from the left nostril; he
sweated, and had a crisis. After the fever restless, and had some
delirium; urine thin, and darkish; had an affusion of warm water on
the head; slept and recovered his senses. In this case there was no
relapse, but there were frequent hemorrhages after the crisis.[668]
Case VIII.—Erasinus, who lived near the Canal of Bootes, was
seized with fever after supper; passed the night in an agitated state.
During the first day quiet, but in pain at night. On the second,
symptoms all exacerbated; at night delirious. On the third, was in a
painful condition; great incoherence. On the fourth, in a most
uncomfortable state; had no sound sleep at night, but dreaming and
talking; then all the appearances worse, of a formidable and
alarming character; fear, impatience. On the morning of the fifth,
was composed, and quite coherent, but long before noon was
furiously mad, so that he could not constrain himself; extremities
cold, and somewhat livid; urine without sediment; died about
sunset. The fever in this case was accompanied by sweats
throughout; the hypochondria were in a state of meteorism, with
distention and pain; the urine was black, had round substances
floating in it, which did not subside; the alvine evacuations were not
stopped; thirst throughout not great; much spasms with sweats
about the time of death.[669]
Case IX.—Criton, in Thasus, while still on foot, and going about,
was seized with a violent pain in the great toe; he took to bed the
same day, had rigors and nausea, recovered his heat slightly, at
night was delirious. On the second, swelling of the whole foot, and
about the ankle erythema, with distention, and small bullæ
(phlyctænæ); acute fever; he became furiously deranged; alvine
discharges bilious, unmixed, and rather frequent. He died on the
second day from the commencement.[670]
Case X.—The Clazomenian who was lodged by the Well of
Phrynichides was seized with fever. He had pain in the head, neck,
and loins from the beginning, and immediately afterwards deafness;
no sleep, acute fever, hypochondria elevated with a swelling, but not
much distention; tongue dry. On the fourth, towards night, he
became delirious. On the fifth, in an uneasy state. On the sixth, all
the symptoms exacerbated. About the eleventh a slight remission;
from the commencement to the fourteenth day the alvine discharges
thin, copious, and of the color of water, but were well supported; the
bowels then became constipated. Urine throughout thin, and well
colored, and had many substances scattered through it, but no
sediment. About the sixteenth, urine somewhat thicker, which had a
slight sediment; somewhat better, and more collected. On the
seventeenth, urine again thin; swellings about both his ears, with
pain; no sleep, some incoherence; legs painfully affected. On the
twentieth, free of fever, had a crisis, no sweat, perfectly collected.
About the twenty-seventh, violent pain of the right hip; it speedily
went off. The swellings about the ears subsided, and did not
suppurate, but were painful. About the thirty-first, a diarrhœa,
attended with a copious discharge of watery matter, and symptoms
of dysentery; passed thick urine; swellings about the ears gone.

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