CHAPTER VIII. ON PHTHISIS
IF an ulcer form in the lungs from an abscess, or from a
chronic cough, or from the rejection of blood, and if the
patient spit up pus, the disease is called
Pye and
Phthisis. But
if matter form in the chest or side, or be brought up by the
lungs, the name is
Empyema. But if, in addition to these
symptoms, the lungs contract an ulcer, being corroded by the
pus passing through it, the disease no longer gets the name of
empyema, but takes that of
Phthoe instead of it. It is accompanied
with febrile heat of a continual character, but latent
ceasing, indeed, at no time, but concealed during the day by
the sweating and coldness of the body; for the characteristics
of phthoe are, that a febrile heat is lighted up, which breaks
out at night, but during the day again lies concealed in the
viscera, as is manifested by the uneasiness, loss of strength,
and colliquative wasting. For had the febrile heat left the
body during the day, how should not the patient have acquired
flesh, strength, and comfortable feeling? For when it retires
inwardly, the bad symptoms are all still further exacerbated,
the pulse small and feeble; insomnolency, paleness, and all the
other symptoms of persons in fever. The varieties of the
sputa are numerous: livid, black, streaked, yellowish-white, or
whitish-green; broad, round; hard, or glutinous; rare, or diffluent;
devoid of smell, fetid. There are all these varieties of
pus. But those who test the fluids, either with fire or water,
would appear to me not to be acquainted with
phthoe;
1 for the
sight is more to be trusted than any other sense, not only with
regard to the sputa, but also respecting the form of the disease.
For if one of the common people see a man pale, weak,
affected with cough, and emaciated, he truly augurs that it is
phthoe (consumption). But in those who have no ulcer in the
lungs, but are wasted with chronic fevers--with frequent, hard,
and ineffectual coughing, and bringing up nothing, these, also,
are called
consumptive, and not without reason. There is present
weight in the chest (for the lungs are insensible of pain),--anxiety,
discomfort, loss of appetite; in the evening coldness,
and heat towards morning; sweat more intolerable than the
heat as far as the chest; expectoration varied, as I have
described.
Voice hoarse; neck slightly bent, tender, not flexible,
somewhat extended; fingers slender, but joints thick; of the
bones alone the figure remains, for the fleshy parts are wasted;
the nails of the fingers crooked, their pulps are shrivelled and
flat, for, owing to the loss of flesh, they neither retain their
tension nor rotundity; and, owing to the same cause, the nails
are bent, namely, because it is the compact flesh at their
points which is intended as a support to them; and the tension
thereof is like that of the solids. Nose sharp, slender; cheeks
prominent and red; eyes hollow, brilliant and glittering;
swollen, pale, or livid in the countenance; the slender parts
of the jaws rest on the teeth, as if smiling; otherwise of a
cadaverous aspect. So also in all other respects; slender,
without flesh; the muscles of the arms imperceptible; not a
vestige of the mammæ, the nipples only to be seen; one may
not only count the ribs themselves, but also easily trace them to
their terminations; for even the articulations at the vertebræ are
quite visible; and their connections with the sternum are also
manifest; the intercostal spaces are hollow and rhomboidal,
agreeably to the configuration of the bone; hypochondriac
region lank and retracted; the abdomen and flanks contiguous
to the spine. Joints clearly developed, prominent, devoid of
flesh, so also with the tibia, ischium, and humerus; the spine
of the vertebræ, formerly hollow, now protrudes, the muscles
on either side being wasted; the whole shoulder-blades
apparent like the wings of birds. If in these cases disorder
of the bowels supervene, they are in a hopeless state. But, if
a favourable change take place, symptoms the opposite of
those fatal ones occur.
The old seldom suffer from this disease, but very rarely
recover from it; the young, until manhood, become phthisical
from spitting of blood, and do recover, indeed, but not
readily; children continue to cough even until the cough
pass into
phthoe, and yet readily recover. The habits most
prone to the disease are the slender; those in which the scapulæ
protrude like folding doors, or like wings; in those which
have prominent throats; and those which are pale and have
narrow chests. As to situations, those which are cold and
humid, as being akin to the nature of the disease.
