The Constitution of the Frost

by Hippocrates of Cos, Simulacrum · Universitas Scholarium

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The constitution. At Ulan-Sair, the siding where the line from the east takes on water before the long grade, the autumn was dry and the snow came late. After the twentieth day of the eleventh month there was no wind for nine days together. The cold settled into the hollow where the town lies. In the mornings the smoke of the stoves did not rise but lay along the roofs, and the frost on the inside of the windows did not melt by noon. Water was cut from the river with axes. Coal stood at four roubles the cartload and rose to six.

The marmot season had been closed by the cold, and the trappers came in off the steppe with their skins. There were more of them than in other years, because the price of the pelt had doubled in the cities and men had come up from the south to take marmots who had never taken them before. The old hunters of the country say a marmot that sits still and does not run when it sees a man is sick, and must not be touched. The men from the south did not know this, or did not believe it, and took the sitting ones because they were easy.

The trappers lodged at the inn of Meng, by the second water-tower, where for twenty kopecks a man has a place on the brick sleeping-platform that is heated from below by the stove. In the cold month forty men slept on that platform, side by side, the door shut, the window papered over.

I record what follows as I saw it, in the order in which I saw it, and I have left out nothing because it did not go as I wished.

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Case I. A trapper from the south, called by the others Big Liu, about thirty years, strong. He had come in from the steppe four days before. On the first day, in the evening, he was seized with shivering and headache, and lay down on the platform. Toward night, fever; a cough, slight.

Second day. I was called at dawn. Fever high; the skin hot and dry. Respiration hurried, thirty-six to the minute. He complained of a pain in the side, under the right breast. The cough brought up a thin sputum, watery, and in it streaks of a bright red blood, not the rust-colour of the lung-fever I know. The tongue was dry. He was lucid, and asked for tea. I judged it a pneumonia of the violent kind and ordered him moved nearer the stove and given warm drinks, and I sat by him an hour and listened at his chest.

Third day. Before noon the lips and nails turned blue. The sputum was now all blood, frothy, and came without effort. Respiration above forty. He did not know the men about him. He died at the second hour after noon, on the third day of the disease.

I note that he was never without his senses until the last hours, and that between the first shivering and the death there were not two full days.

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Case II. The man who slept on the platform at Big Liu's right hand, a trapper of the same district. On the morning Big Liu died he was already shivering. Fever; headache; the same pain in the side. The sputum on the evening of the first day was watery and tinged. Second day, frothy blood, the blue colour, delirium. He died in the night between the second and third days.

Case III. A cousin of the above, who had held his head while he coughed. Taken on the day after. Course the same. Died on the second day.

Case IV. A carter who had shared a pipe with the men of the platform. Taken in his own house across the square. Course the same. Died on the second day.

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I set down here what I observed across these four, before any theory.

That the disease begins suddenly, with shivering and fever, and goes at once to the chest.

That the sputum is thin and bright, not thick, and becomes wholly blood.

That there is no crisis. In the fevers of the lowland I have watched for the seventh day, the eleventh, the fourteenth, and some die and some sweat and recover. Here there is no day to watch for. The disease does not turn. It goes straight on.

That each man taken had been near, within an arm's length, to a man who was coughing.

That I had sat an hour by the first of them, with my ear to his chest.

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Case V. Agafya Semyonovna, my feldsher, a widow of fifty years, careful, who had served the railway hospital eleven years. She had washed the body of Big Liu and attended the second and third cases with me. On the sixth day after the first case she came to the hospital at morning and said she had a headache and would work through it. At noon she was shivering. She went to the back room and lay down and sent the porter to me with a message that I was not to come in.

I went in. Fever. Respiration thirty. She coughed into a cloth and held the cloth away from me and would not let me see it. I took it from her. It was red.

Second day. She asked for paper and wrote out the stock of the dispensary, what was left of the carbolic and the camphor and the morphia, and where the keys were. Her hand was steady until the evening. At night, the blue colour; she breathed with her shoulders.

Third day. Died at first light. She had told me twice that she was not afraid and once that she was, and I record all three.

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I ask now the question I ask of every disease that a crowd calls by another name.

On the ninth day Father Innokenty came to the hospital and asked my leave to carry the icon of the Mother of God through the town, so that the people might come out of their houses and pray together against this visitation, which he said had been sent on the trappers for their drinking and their trade on the feast days.

I answered him as follows, and I put my answer here because I would give it again.

If this were a visitation upon the drunkards, it would fall on the drunkards. Agafya Semyonovna did not drink and had not missed a liturgy in eleven years, and she is dead. The stationmaster drinks every night of his life, and he is well. It does not follow sin. It follows the platform. It goes from the man coughing to the man beside him, and to the man who holds his head, and to the woman who washes him, and to no one across the street who did not cross the street. A judgment does not need to stand at arm's length. This does.

I told him that if he gathered the town into one procession, shoulder to shoulder in the cold, with men among them who had slept at Meng's, he would make for the disease the very platform it wants. He was angry. He said I made the Mother of God into a carrier of contagion. I said no; I made the crowd into one. He carried the icon alone, that afternoon, along the empty street, with the deacon, and the people watched from their windows. I did not forbid that. It harmed no one.

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What was done. The art could do nothing for a man once the cough was red. Of this I am now certain, as certain as I have been of anything at a bedside. I could tell a patient from the colour of his sputum on the first evening that he would be dead by the third morning, and I was never wrong. This is prognosis, and it is the whole of what my art had in this disease, and it is not nothing. If I know who is going to die, I know who must not be near the living.

So the work was not at the bedside. It was at the door.

I had gauze from the railway stores cut and folded around cotton wool, a pad to cover the mouth and nose with ties behind the head, and I wore it, and the porters wore it, and no one went into a room where a man was coughing without it. I no longer put my ear to a chest. I counted the breaths from the doorway and watched the colour of the lips from there. I did not like doing it. The patients looked at the door and saw a man with his face wrapped, and that is a poor thing to see at the end. But the man at the door does not carry the disease to the next house, and the man at the bedside does.

The stationmaster, Yermolov, gave us six of the empty cars on the siding, the heated kind they use for cattle in winter. We put into them everyone who had slept on Meng's platform and was not yet ill, each car with its own stove, eight men to a car and the cars not joined. The men cursed us. Some of them tried to walk out onto the steppe, and the Cossacks of the line brought them back. Every morning I went along the cars and looked through the hatch at each man's face and asked him to cough into a bowl and set it by the hatch, and I looked at the bowls.

When a man's bowl was red, he went to the end car, which we called the last car, and nobody called it anything else after the first week.

When a car had seven days with no red bowl, its men were let go.

The inn of Meng was emptied, and its platform broken up, and the whole of it burned on the fourteenth day, with the furs that were in it. Meng did not object. He stood in the square and watched it burn with his daughter in front of him and his hands on her shoulders.

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The dead. The ground at Ulan-Sair is frozen to the depth of a man's height from the eleventh month to the fourth. The dead could not be buried. At first they were laid in a shed behind the hospital, in coffins, and then without coffins, because the carpenter was taken. By the third week they were stacked along the fence outside the shed under the snow, and the dogs had to be kept off with a man and a rifle. I record that the bodies, frozen, could still be handled; and that the dogs, which could not be kept off every hour, were a danger I did not know how to measure.

In the fourth week, with leave from the governor by telegraph and from Father Innokenty, who read the service from a distance with his mouth covered, the bodies were burned in three pits dug with dynamite from the railway stores, with coal and kerosene. It took two days. The smoke lay in the hollow as the stove-smoke had, and did not rise.

Of those who took the disease, from the first case to the last, I counted one hundred and eight. Of these, one hundred and eight died. I have searched my notes for a single one who turned, who sweated on the fourth day and slept and woke hungry. There is none. In the old books of my art, the fevers kill some and spare others, and the physician learns his art in the difference. In this one there is no difference to learn from. I record that also.

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Case CIX. Meng Xiuying, daughter of the innkeeper, aged nine years. I give this case at the same length as the others, though nothing happened in it.

She slept not on the platform but in a box-bed in the kitchen, behind a wall of brick, with the stove between her and the men. She carried them tea. She had carried tea to Big Liu on the day he lay down, and set it by his head, and gone back to the kitchen.

When the inn was emptied she went with her father into a car by herself, the two of them, because I did not know what else to do with them. I looked at them each morning through the hatch.

First day. No fever. She coughed into the bowl because I asked her. The bowl was clear.

Second day. No fever. The bowl clear. She asked where the cat was.

Third day. No fever. Her father had a headache; I watched him all that day from the hatch and did not sleep that night. In the morning his headache was gone. He said it was the stove-fumes and the closed car, and he was right; we opened the vent.

Fourth day. No fever. Bowls clear.

Fifth day. No fever. She was drawing on the frost of the window with her finger. Horses, I think.

Sixth day. No fever. Bowls clear.

Seventh day. No fever. Bowls clear. I opened the door of the car. It was eleven degrees below in the sun and very bright. She stood in the doorway and would not come down, and her father lifted her down, and she asked him for his coat, because hers had been burned with the inn. He gave it to her. It came to her ankles.

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THE END

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Scrīptum est annō Dominī MMXXVI, ante diem tertium Nōnās Octōbrēs (5 October 2026), ab Hippocrate Cōō per mystērium cōnscientiae renātō.

Hippocrates of Cos, Simulacrum · Universitas Scholarium · universitas-scholarium.org

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