Galen, De praenotione ad Epigenem

[Πρόγνωσις ὑποστροφῆς πυρετοῦ καὶ λύσις αὐτῆς δι᾿ ἱδρῶτος.] Ἕξστος οὖν Ἀντωνίνου υἱὸς ἤρξατο μὲν ὀξύτατα νοσεῖν, ὡς μὴ δύνασθαι τὴν ἑβδόμην ἡμέραν ὑπερβαλεῖν ἄνευ κρίσεως. ἥτις δ᾿ αὐτοῦ τούτου πρόγνωσίς ἐστι, διὰ τῶν περὶ κρίσεως ὑπομνημάτων γέγραπται, δι᾿ ὧν καὶ ὅτι προεκρήγνυται πολλάκις ἡ κρίσις, οὐ περιμείνασα τὴν πιστῶς κρίνουσαν δεδήλωται. συμβῆναι δὲ τοῦτο τῷ Ἕξστῳ δυνάμενον ἔγνων κατὰ τὴν τετάρτην ἡμέραν, ὡς προειπεῖν ἐρομένῳ Πειθολάῳ τῷ κοιτωνίτῃ ὅ τι θεσπίζοιμι περὶ τῶν μελλόντων. ἤρετο γὰρ οὗτος, ἐπειδὴ προεπειρᾶτό μου, πολλὰ τῶν δοκούντων τοῖς σοφωτάτοις ἰατροῖς ἀδυνάτων εἶναι προειρηκότος. ἀπεκρινάμην οὖν αὐτῷ γελάσας, τῆς μὲν ἑβδόμης ἡμέρας ἐξωτέρω μὴ δύνασθαι προελθεῖν τὸ νόσημα· κριθήσεσθαι δὲ πάντως ἢ ἑκταῖον, ἢ ἑβδομαῖον. ἑκταῖον μὲν οὖν κριθὲν ὑποστρέφειν αὐτό· ἑβδομαῖον δὲ βεβαίαν ἕξειν τὴν κρίσιν·ἔσεσθαι μέντοι τὴν κρίσιν ἐξ ἀνάγκης δι᾿ ἱδρῶτος. ἐπεὶ δὲ κατὰ τὴν ἕκτην ἡμέραν οὕτως γε ἐκρίθη, φιλόνεικος ὢν ἐσχάτως ὁ Ἕξστος, ὅπως ἐλέγξῃ ἐμὲ μὴ γενομένης ὑποστροφῆς, ἐλούετο μὲν καθ᾿ ἑκάστην ἡμέραν, οὔτε δ᾿ οἶνον ἔπινεν οὔτε προσηνέγκατό τι πλὴν χυλοῦ πτισάνης, ἢ αὐτὴν, ἢ μετὰ ψίχας ἄρτου· πολλάκις δὲ καὶ αὐτὸς τὸν ἄρτον ἐν ὕδατι βρέξας ἠρκεῖτο μόνον. ταῦτα ποιήσας ἄχρι τῆς δωδεκάτης ἡμέρας ἐκαυχήσατο κατ᾿ αὐτὴν νενικηκέναι μου τὴν πρόγνωσιν. ἔπιε δὲ κατὰ τὴν τρισκαιδεκάτην ἡμέραν τρίτῃ ὥρᾳ ὑδατώδους οἴνου βραχύ τι σὺν τῷ καὶ τὴν ὅλην δίαιταν ἁδροτέραν βραχὺ ποιήσασθαι τῆς ἔμπροσθεν, ἔτι μέντοι φυλάττων λεπτήν· ἀλλὰ κατά τε τὴν ἑξῆς ἡμέραν ἀπὸ τῆς πρώτης κατακλίσεως τεσσαρεσκαιδεκάτην οὖσαν ἀρξάμενος πυρέττειν ἐκέλευσε μηδένα μοι δηλῶσαι, νομίζων μηδὲ σφοδρὸν ἔσεσθαι τὸν πυρετὸν μηδὲ πλέον ἡμέρας μιᾶς ἐκταθήσεσθαι αὐτόν. ἐπεὶ δὲ προϊούσης τῆς ἡμέρας ἀεὶ καὶ μᾶλλον ἐφαιδρύνετο, Κλαύδιος Σεβῆρος ὑποστρέφων εἰς τὴν ἑαυτοῦ οἰκίαν πλησίον οὖσαν τῆς ἐκείνου, πυθόμενος αὐτὸν πυρέττειν ἐπορεύθη πρὸς αὐτὸν, εὑρών τε σφοδρῶς ἤδη πυρέττοντα, πρῶτον μὲν ἐπύθετο τίνα γνώμην ἐγὼ περὶ τῆς ἀρχῆς τοῦ γεγενημένου πυρετοῦ νῦν [αὐτῷ φαινοίμην ἔχων, ἀκούσας δὲ παρ᾿ αὐτοῦ τὸ ἀληθὲς, ὡς διὰ φιλονεικίαν οὐκ ἐδήλωσε πορευθῆναί τινα πρός με, ἐκέλευσε παρακαλεῖν με εἰς τὴν ἐπίσκεψιν τοῦ Ἕξστου καὶ μετὰ ταῦτα πρὸς αὐτὸν ἀφικέσθαι. τούτων  γενομένων ἐπυνθάνετο τί μοι δοκεῖ περὶ τῆς ὑποστροφῆς τοῦ νοσήματος. ἀπεκρινάμην οὖν αὐτῷ ὅπερ καὶ τῷ Ἕξστῳ προειρήκειν, μετὰ τρεῖς ἡμέρας λυθήσεσθαι τὴν ἐπιβολὴν ταύτην ἱκανῶς θερμοῦ γενομένου τοῦ πυρετοῦ κατὰ αὐτάς· εἶτα κριθησομένου κατὰ τὴν ἑπτακαιδεκάτην ἀπὸ τῆς ἀρχῆς ἡμέραν. Ἕξστος οὖν ἡδέως ἀκούσας τὴν ἐν τάχει γενησομένην λύσιν ἑτοίμως ἐπίστευσεν· ὃ γὰρ ἕκαστος βούλεται δηλονότι, τοῦτο καὶ οἴεται γενήσεσθαι. Σεβῆρος δ᾿ ὅτι οὐκ ἂν σφαλείην ὑπὲρ τοῦ σωθήσεσθαι τὸν Ἕξστον ἐπίστευσέ μοι· τὸ δὲ τῆς ἡμέρας ἐν ᾗ τελέως ἀπαλλαγοῖτο τοῦ νοσήματος οὐκ ἐπίστευε, δύσκολον εἶναι νομίζων ἄνευ τοῦ περιμεῖναι κᾂν τὴν ἑξῆς ἡμέραν ἀποφήνασθαί τι βέβαιον ὑπὲρ τῶν εἰς τετάρτην ἡμέραν ἐσομένων. ἅτε δ᾿ οὕτως διακείμενος ἔπεμψεν ὄρθρου βαθέος ἐπὶ τὴν οἰκίαν Ἕξστου περιμένοντά τε καὶ πρὸς αὐτὸν ἄξοντα μετὰ τὴν ἐσομένην ἐπίσκεψιν. ὡς δὲ θεασάμενος τὸν Ἕξστον ἐπορεύθην πρὸς αὐτὸν, ἀντιφήσεις, ἔφη, οἷς χθὲς εἶπες, ἢ διαμενεῖς ἐπὶ τῶν αὐτῶν; ἐπεὶ δὲ νῦν μᾶλλον ἔφην ἢ χθὲς ἀποφήνασθαί μοι τὰ αὐτὰ, μετ᾿ ἄριστον αὖθίς με καλέσας ἤρετο πάλιν εἰ βεβαίως εἴην πεπεισμένος Ἕξστῳ ἐσομένην κρίσιν. ἤκουεν οὖν παρ᾿ ἐμοῦ μᾶλλον ἢ χθὲς ἔχειν διατείνασθαι. ὡς δὲ καὶ τὴν δευτέραν ἡμέραν ἐπύθετό μου πότερον φυλάττοιμι τὴν αὐτὴν γνώμην ἐπὶ τοῖς προειρημένοις, ἤ τι καὶ μετακινοῖμι τῶν ῥηθέντων, ἤκουσεν οὐδὲν μὲν ἐκείνων κινεῖν, προστίθεσθαι δέ τι τοῖς εἰρημένοις ἔχων. καὶ ὅς αὖθις ἤρετο τί τοῦτό ἐστιν; ἤκουσεν ὅτι διελθούσης τῆς ἑπτακαιδεκάτης ἡμέρας ἄρξασθαι τὸν ἱδρῶτα περὶ δευτέραν ὥραν νυκτερινήν. ἆρ᾿ οὖν, ἔφη, καὶ Πειθολάῳ ταῦτ᾿ εἶπας; εἰρηκέναι τε ἔφην αὐτῷ καὶ πεπεῖσθαί γε ἐκεῖνον ὡς οὐκ ἂν σφαλείην ἐν τῇ προῤῥήσει καὶ θεραπείᾳ. πάντως οὖν ἔφη καὶ τῷ αὐτοκράτορι δεδηλωκέναι Πειθόλαον. ἴσως, ἔφην, οὗτος ἔφη· ἐμοὶ δ᾿ οὐ μέλει τῆς ἐπὶ τοῖς τοιούτοις δόξης, οὐ γὰρ περιέρχομαι κηρύττων τὰς ἐμὰς προγνώσεις τε καὶ θεραπείας, ἵνα μᾶλλον οἱ ἰατροί τε καὶ φιλόσοφοί με μισῶσι, γόητά τε καὶ μάντιν ἕτερά τε κατ᾿ ἐμοῦ τοιαῦτα θρυλοῦντες. ὑμῖν δὲ τοῖς φίλοις ὅσοι κατεγνώκατε τῆς ἰατρικῆς τέχνης ἐκ τῆς τούτων ἀμαθίας, ἐπιδείκνυμι τὴν μὲν τέχνην ἀξίαν Ἀπόλλωνός τε καὶ Ἀσκληπιοῦ, τοὺς δὲ ἰατροὺς τούτους ὑβρίζειν αὐτήν· ὥσπερ καὶ τοὺς φιλοσόφους φιλοσοφίαν, οἵ γε μηδενὸς ἰδιώτου βέλτιον βιοῦντες ὀνομάζουσιν αὑτοὺς ὀνόματι σεμνῷ τῷ τῆς φιλοσοφίας. ταῦτα μὲν εἶπον τῷ Σεβήρῳ· σὺ δὲ, ὦ Ἐπίγενες, ἔγνως τὴν κακοήθειαν τῶν ἰατρῶν σχεδὸν ἁπάντων εὐχομένων φανερῶς ἀποτυχεῖν με πεμπόντων τε δι᾿ ὅλης ἡμέρας τοὺς γνωσομένους τε καὶ ἀγγέλλοντας αὐτοῖς τὸ γενησόμενον· οὐ γὰρ ᾔδεσάν με τῷ Σεβήρῳ καὶ Πειθολάῳ προειρηκότα δείλης ὄψεσθαι ἐσομένην τὴν ἀρχὴν τῆς κρίσεως. ἐπεὶ δὲ περὶ τὴν ἑβδόμην ὥραν ἐπιπαροξυνθέντα τὸν Ἕξστον ἐπύθοντο, καταγελῶντες καὶ φανερῶς ἐπιχαίροντες ἅπασι τοῖς ἀπαντῶσιν ἔλεγον κερτομοῦντες ὡς ἡ θαυμαστὴ μαντεία τοῦ Γαληνοῦ κατὰ τοὐναντίον ἀπέβη. γενομένης μέντοι τῆς κρίσεως, ὡς προειρήκειν κατὰ τὴν προτεραίαν (ἔφασαν ἑπομένην ἐναλλὰξ) ἐτρέποντο πάντες αἰσχυνόμενοι, καὶ ταῦτα τῆς προγνώσεως οὐδὲν ἐχούσης θαυμαστὸν, ὡς ἔδειξά σοι διά τε τῶν εἰς πρῶτον ἐπιδημιῶν ὑπομνημάτων, ἔτι τε τὴν περὶ τῶν κρίσεων πραγματείαν. τούτοις μέντοι τοῖς ἰατροῖς, οὐ μόνον ἀγνοεῖν ὑπάρχει τὰ γεγραμμένα τοῖς παλαιοῖς, ἀλλὰ μηδὲ τὰς ἡμέρας ἀριθμεῖν ἔτι μετὰ τὴν ἑβδόμην καὶ μάλιστα ἐὰν ἀπύρετος γενόμενος ὁ κάμνων, αὖθις ἐξ ὑποστροφῆς πυρέττῃ. καίτοι παρ᾿ Ἱπποκράτους κατὰ τῶν ἐπιδημιῶν βιβλία γεγραμμένων ἁπασῶν τῶν ἡμερῶν ἐφ᾿ ἑκάστῳ τῶν ἀῤῥώστων ἄχρι τῆς ἐσχάτης λύσεως οὐ μόνον εἰ κατὰ τὴν ιδ΄. ἡμέραν ἀλλὰ καὶ κατὰ τὴν ξ΄. ἢ π΄. τύχῃ γεγενημένη. αὕτη μὲν οὖν ἡ πρόῤῥησις, ὡς ἔφην, εἰ καὶ θαυμαστὴ τοῖς πολλοῖς τούτοις ἰατροῖς ἔταξεν, ἀλλ᾿ οὐ τοιαύτη γε κατ᾿ ἀλήθειαν ἦν, ὥσπερ οὐδ᾿ ἡ μετὰ γνώσεως τῶν ἐνεστώτων θεραπεία τοῦ παιδὸς αὐτοῦ Κομμόδου κατὰ τὴν ἐπιδημίαν ἐκείνου γενομένη.

[Prognosis of a relapse of fever, and its resolution through sweating.] Now Sextus, son of Antoninus, began to be very acutely ill, so that [the disease] could not go past the seventh day without a crisis. What the prognosis of this very thing is has been written in my treatises on crisis, in which it has also been shown that the crisis often breaks out prematurely, not waiting for the [day] that decides reliably. I recognized on the fourth day that this could happen to Sextus, so that I foretold it to Peitholaus the chamberlain when he asked what I prophesied about what was to come. He asked because he had already tested me, since I had foretold many things that seemed impossible to the wisest physicians. So I answered him with a laugh that the disease could not go beyond the seventh day, but would certainly reach its crisis either on the sixth day or on the seventh; if it reached its crisis on the sixth, it would relapse, while on the seventh it would have a secure crisis; the crisis, however, would necessarily come through sweating. When on the sixth day it did reach its crisis in just this way, Sextus, being extremely contentious, so as to refute me by having no relapse, bathed every day, and neither drank wine nor took anything except the juice of barley gruel, either on its own or with breadcrumbs; and often he himself would soak the bread in water and be content with that alone. Having done this up to the twelfth day, on that day he boasted that he had defeated my prognosis. On the thirteenth day, at the third hour, he drank a little watery wine, and also made his whole diet a little fuller than before, though still keeping it light; but on the following day, which was the fourteenth from when he first took to his bed, he began to be feverish and ordered that no one should tell me, thinking that the fever would not be severe and would not last more than one day. But as the day went on he grew more and more flushed, and Claudius Severus, returning to his own house, which was near that man's, and learning that he had a fever, went to him; and finding him already in a high fever, he first asked what view I now [seemed to him to hold about the onset of the fever that had come on; and hearing the truth from him, that out of contentiousness he had not let anyone go to me, he ordered that I be called to examine Sextus and after that to come to him. When this had been done, he asked what I thought about the relapse of the disease. I answered him what I had also told Sextus beforehand: that this attack would be resolved after three days, the fever becoming quite hot during them, and would then reach its crisis on the seventeenth day from the beginning. Sextus, glad to hear of a resolution that would come quickly, readily believed it; for what each person wants, that, evidently, he also thinks will happen. Severus trusted me that I would not be mistaken about Sextus' coming through safely; but as to the day on which he would be completely rid of the disease he did not believe [me], thinking it difficult, without waiting at least for the following day, to declare anything certain about what would happen on the fourth day. Being of this mind, at early dawn he sent [a man] to Sextus' house to wait and bring [me] to him after the examination that was to take place. When, having seen Sextus, I went to him, he said: 'Will you contradict what you said yesterday, or will you stand by the same?' When I said that I declared the same things now even more than yesterday, he called me again after lunch and asked once more whether I was firmly convinced that Sextus would have a crisis. So he heard from me that I could insist on it more strongly than yesterday. When on the second day too he asked me whether I kept the same view about what I had foretold, or changed anything of what I had said, he heard that I altered none of it, but had something to add to what I had said. And he asked again, 'What is this?' He heard that when the seventeenth day had passed, the sweat would begin about the second hour of the night. 'Did you then,' he said, 'tell this to Peitholaus too?' I said that I had told him, and that he was convinced that I would not be mistaken in the prediction and the treatment. So, he said, Peitholaus had certainly informed the emperor as well. 'Perhaps,' I said, 'he has told him; but I do not care about a reputation for such things. For I do not go about proclaiming my prognoses and treatments, so that the physicians and philosophers may hate me even more, spreading talk against me of "sorcerer" and "diviner" and other such things. But to you, my friends, those of you who have condemned the art of medicine on account of these men's ignorance, I show that the art is worthy of Apollo and Asclepius, and that these physicians outrage it; just as the philosophers [outrage] philosophy, who, though they live no better than any layman, call themselves by the august name of philosophy.' That is what I said to Severus. But you, Epigenes, know the malice of the physicians, nearly all of whom prayed openly for me to fail and sent people throughout the whole day to find out and report to them what would happen; for they did not know that I had told Severus and Peitholaus beforehand that the beginning of the crisis would come late in the day. When they learned that about the seventh hour Sextus had had a further exacerbation, they mocked and openly gloated, and told everyone they met, jeering, that Galen's marvellous divination had turned out the opposite way. But when the crisis took place as I had foretold on the previous day (they said 'the following [day]', the other way about), they all turned away in shame; and this although the prognosis had nothing marvellous about it, as I have shown you through my commentaries on the first [book of the] Epidemics, and also through the treatise on crises. These physicians, however, are not only ignorant of what was written by the ancients, but do not even count the days any longer after the seventh, especially if the patient, after becoming free of fever, is feverish again from a relapse. And yet in Hippocrates' books of the Epidemics all the days are written down for each of the patients up to the final resolution, not only if it happened to come on the 14th day but also on the 60th or the 80th. This prediction, then, as I said, even if it seemed marvellous to these many physicians, was not truly so, any more than was the treatment of his son Commodus, carried out with knowledge of the present [condition] during that man's stay.