BOOK II.
CHAPTER I. ON DROPSY.
DROPSY is indeed an affection unseemly to behold and
difficult to endure; for very few escape from it, and they more
by fortune and the gods, than by art; for all the greater ills
the gods only can remedy. For either the disease lurking in
a vital organ has changed the whole system to cachexy, or
the general system from some plague that has gone before
has changed the viscera to a Cacochymy, when both co-operate
with one another to increase the illness, and no part is
uninjured from which even a slight assistance might be rendered
to Nature. It is a cold and dense vapour converted into humidity,
resembling a mist in the universe; or, it is the conversion
of a humid and cold cause which changes the patient
to such a habit. For a fluid rolling about in the lower belly
we do not call Dropsy, since neither is the affection situated in
that place; but when the tumour, swelling, colour, and the
habit melting down to water, conspire in the disease, it both
is, and is called Dropsy. For, even should the water at any
time burst outwardly, or should one give vent to it, by
making an incision in the hypochondrium, the dropsical
affection will still remain confirmed; wherefore the primary
cause of it is cachexia.
There are many varieties, each having different names.
For if the watery suffusion float in the flanks, and, owing to
its fulness, when tapped it sound like a drum, the disease is
called
Tympanites. But if the water be confined in large
quantity in the peritonæum, and the intestines float in the
liquid, it gets the appellation of
Ascites. But if the lower
belly contain none of these, but the whole body swell, if in
connexion with a white, thick, and cold phlegm, the disease
is called
Phlegmatias; but if the fleshy parts are melted down
into a sanguineous, watery, or thin humour, then the species
of dropsy called
Anasarca is formed. The constitution of each
of them is bad; but the combination of them is much worse.
For sometimes the variety which forms in the lower belly
(
Ascites), is associated with that variety in which the fluid
is diffused all over the body. But the most dangerous is that
form in which Tympanites is mixed with Anasarca. For of
the dropsies that form in the lower belly, Tympanites is
particularly worse than Ascites. But of those affecting the
whole body, Leucophlegmatia is less than Anasarca. It is
mild then, so to speak of such hopeless diseases, when a
smaller affection is combined with another smaller one. But
it is much worse if one of the smaller enters into combination
with one of the greater. But if a complete mixture
of two great affections take place, the product thereof is a
greater evil.
The symptoms are very great and very easy to see, to touch,
and to hear; in Ascites, for example, to see the tumidity of
the abdomen, and the swelling about the feet; the face,
the arms, and other parts are slender, but the scrotum and
and prepuce swell, and the whole member becomes crooked,
from the inequality of the swelling:--To touch--by strongly
applying the hand and compressing the lower belly; for the
fluid will pass to other parts. But when the patient turns to
this side or that, the fluid, in the change of posture, occasions
swelling and fluctuation, the sound of which may be heard.
But if you press the finger firmly on any part, it becomes
hollow, and remains so for a considerable time. These are the
appearances of Ascites.
Tympanites may be recognised, not only from the sight of
the swelling, but also by the sound which is heard on percussion.
For if you tap with the hand, the abdomen sounds;
neither does the flatus (
pneuma) shift its place with the
changes of posture; for the flatus, even although that which
contains it should be turned upwards and downwards, remains
always equally the same; but should the flatus (
pneuma）
be converted into vapour and water (for Ascites may supervene
on Tympanites), it shifts its form, indeed, the one half
running in a fluid state, if the conversion be incomplete.
In Anasarca and Leucophlegmatia the lower belly is empty,
the patients are swelled in the face and arms; and likewise, in
these cases, whatever parts are empty in the others, in them
become full. For in Leucophlegmatia there is collected a
white, cold, and thick phlegm; with it the whole body is
filled, and the face is swollen, and also the neck and arms;
but the abdomen is full from the swelling; but the mammæ
are raised up into a swelling in the case of such youths as are
still in the happy period of life. But, in Anasarca, there is
wasting of the flesh to a fleshy humour, and a bloody ichor,
such as runs from ulcerations of the bowels, and such as flows
from bruises produced by the fall of weights, if the outer
skin be scarified. But the combination of the two has the
symptoms of both.
In all the species there are present paleness, difficulty of
breathing, occasional cough; they are torpid, with much languor
and loss of appetite; but if they take any food, however
small in quantity and free from flatulence, they become flatulent,
and have distension as if from repletion; skin dry, so
that it does not become moist even after the bath; they
are white and effeminate; but in Anasarca they are of a dark-green
colour, and have dark veins; in Ascites and Tympanites
these are prominent, both in the face, and in the wrists, and the
abdomen. But in Anasarca and Leucophlegmatia all the parts
are concealed by the swelling; sleep heavy; they are torpid,
with slight dejection of spirit; concern about trifles; fondness of
life; endurance not from good spirits and good hopes like those
in prosperity, but from the nature of the affection. It is not
possible exactly to state the cause; but this is a mighty wonder,
how in certain diseases, not altogether dangerous, the patients
are spiritless, dejected, and wish to die, but in others they
have good hopes and are fond of life. Diseases produce both
these contraries.
Dropsy sometimes is occasioned suddenly by a copious cold
draught, when, on account of thirst, much cold water is swallowed,
and the fluid is transferred to the peritonæum; by
which means the innate heat in the cavities is congealed, and
then the drops which formerly were converted into air and
dissipated, flow into the cavities. If this, therefore, happen,
the cure of these cases is easier before any of the viscera or the
whole person is affected. Moreover flatulent food, indigestion,
and the Buprestis
1 have sometimes occasioned dropsies.
It is an illness common to all, men and women, in every
period of life, only that certain ages are more exposed to
certain species of the disease; children to Anasarca and Leucophlegmatia;
young men until manhood are subject to swelling
about the lower belly (
Ascites?) Old persons are prone to
suffer all kinds, as being deficient in heat, for old age is cold;
but they are not exposed to collections of humours, and to
them, therefore, Tympanites is the familiar form.
All the species, indeed, are unfavourable; for dropsy, in all
its forms of disease, is bad. But of these, leucophlegmatia is
the more mild; for in it there are many and various chances
of good fortune, such as an evacuation of sweat, of urine, or
from the bowels, by which the dropsical habit is carried off.
But tympanites is of a difficult nature, and still more so
anasarca; for in this affection the physician would require to
change the whole person, a thing not easy for the gods themselves
to accomplish.
Sometimes the dropsy forms in a small space, such as the
head in hydrocephalus; or in the lungs alone; or in the liver,
or the spleen; or the womb in women; and this last is easier to
cure than any of the others, for provided its mouth relax from
its former constriction, if it contains a fluid, it discharges the
same outwardly, and if a flatus, it is dissipated. But if the
uterus suffer at all in anasarca, for the most part the whole
woman becomes dropsical.
This other form of dropsy is known: small and numerous
bladders, full of fluid, are contained in the place where ascites
is found; but they also float in a copious fluid, of which this
is a proof; for if you perforate the abdomen so as to evacuate
the fluid, after a small discharge of the fluid, a bladder
within will block up the passage; but if you push the instrument
farther in, the discharge will be renewed. This species,
then, is not of a mild character; for there is no ready passage
by which the bladders might escape. It is said, however, that
in certain cases such bladders have come out by the bowels.
I have never seen such a case, and therefore write nothing of
them; for I am unable to tell whether the discharge be from
the colon, or the stomach. What is the mode of their formation?
For the passage whereby all matters may be discharged
by the anus is patent; but the discharge of the water collected
about the loins by the bowels is incredible. For a wounded
intestine is not free from trouble and danger.
CHAPTER II. ON DIABETES.
DIABETES is a wonderful affection, not very frequent among
men, being a melting down of the flesh and limbs into urine.
Its cause is of a cold and humid nature, as in dropsy. The
course is the common one, namely, the kidneys and bladder;
for the patients never stop making water, but the flow is incessant,
as if from the opening of aqueducts. The nature of
the disease, then, is chronic, and it takes a long period to form;
but the patient is short-lived, if the constitution of the disease
be completely established; for the melting is rapid, the death
speedy. Moreover, life is disgusting and painful; thirst, unquenchable;
excessive drinking, which, however, is disproportionate
to the large quantity of urine, for more urine is
passed; and one cannot stop them either from drinking or
making water. Or if for a time they abstain from drinking,
their mouth becomes parched and their body dry; the viscera
seem as if scorched up; they are affected with nausea, restlessness,
and a burning thirst; and at no distant term they
expire. Thirst, as if scorched up with fire. But by what
method could they be restrained from making water? Or how
can shame become more potent than pain? And even if they
were to restrain themselves for a short time, they become
swelled in the loins, scrotum, and hips; and when they give
vent, they discharge the collected urine, and the swellings
subside, for the overflow passes to the bladder.
If the disease be fully established, it is strongly marked;
but if it be merely coming on, the patients have the mouth
parched, saliva white, frothy, as if from thirst (for the thirst
is not yet confirmed), weight in the hypochondriac region. A
sensation of heat or of cold from the stomach to the bladder
is, as it were, the advent of the approaching disease; they now
make a little more water than usual, and there is thirst, but
not yet great.
But if it increase still more, the heat is small indeed, but
pungent, and seated in the intestines; the abdomen shrivelled,
veins protuberant, general emaciation, when the quantity of
urine and the thirst have already increased; and when, at the
same time, the sensation appears at the extremity of the
member, the patients immediately make water. Hence, the
disease appears to me to have got the name of
diabetes, as if
from the Greek word
διαβήτης (
which signifies a siphon),
because the fluid does not remain in the body, but uses the
man's body as a ladder (
διαβάθρη), whereby to leave it.
2 They
stand out for a certain time, though not very long, for they
pass urine with pain, and the emaciation is dreadful; nor does
any great portion of the drink get into the system, and many
parts of the flesh pass out along with the urine.
The cause of it may be, that some one of the acute diseases
may have terminated in this; and during the crisis the diseases
may have left some malignity lurking in the part. It is not
improbable, also, that something pernicious, derived from the
other diseases which attack the bladder and kidneys, may
sometimes prove the cause of this affection. But if any one
is bitten by the dipsas,
3 the affection induced by the wound is
of this nature; for the reptile, the dipsas, if it bite one, kindles
up an unquenchable thirst. For they drink copiously, not as
a remedy for the thirst, but so as to produce repletion of the
bowels by the insatiable desire of drink. But if one be pained
by the distension of the bowels and feel uncomfortable, and
abstain from drink for a little, he again drinks copiously from
thirst, and thus the evils alternate; for the thirst and the drink
conspire together. Others do not pass urine, nor is there any
relief from what is drank. Wherefore, what from insatiable
thirst, an overflow of liquids, and distension of the belly, the
patients have suddenly burst.
CHAPTER III. ON THE AFFECTIONS ABOUT THE KIDNEYS.
THE kidneys are of a glandular nature, but redder in colour,
like the liver, rather than like the mammæ and testicles; for
they, too, are glands, but of a whiter colour. In shape they
resemble the testicles, but are broader, and, at the same time,
curved. Their cavities are small and like sieves, for the percolation
of the urine; and these have attached to each of them
nervous canals, like reeds, which are inserted into the shoulders
of the bladder on each side; and the passage of the urine from
each of the kidneys to the bladder is equal.
About it, the kidneys, and those passages, many and complicated
diseases are formed, partly acute, proving fatal by hemorrhage,
fevers, and inflammation, as has been described by me;
but partly chronic, others wearing out the patient by wasting,
and although not of a fatal character, incurable, and persisting
until death. Wherefore, the chronic are--abscesses, ulcers,
the formation of stones, and hemorrhoids. The ulcerations from
abscess in man are all very protracted, and difficult to cure.
The formation of stones is a long process, the stoppage of
them painful, for the passage of them is not easily accomplished;
and in addition to these, the retention of urine is
formidable. But if several small ones stop together in the
passage, or a large one be impacted; and if these occur to both
kidneys, so as to occasion retention of urine and distension of
the parts, the patients die in a few days. Nature, therefore,
did well in forming the cavity of the kidneys oblong, and of
equal size with the ureters, and even a little larger, so that if
a stone formed above, it might have a ready passage to the
bladder. On this account, also, the stones have an oblong
form, because, for the most part, they are consolidated in the
ureters; and such in that place as are of unequal thickness are
slender before, owing to the ureters being narrow, but thick
behind, because the kidneys verge downwards. They are
formed in the kidneys only, but when in a heated state; for
the stones have no fixed place in the ureters, but the gravel
floats downwards with the urine, and thus is both indicative of
the affection, and furnishes the
materiel of it. But if an unusually
large one at any time be detained in the pelvis of the kidney,
pains of the loins, about the regions of the
psoœ, as far as the
middle of the ribs, take place, and hence, in many cases, the
pain leads to mistake, as if it proceeded from pleurisy; heaviness
of the hips; painful flexion about the spine, so that they
stoop forward with difficulty; very painful tormina; at the same
time, the pains are heavy with a sense of twisting, for the
intestine is convoluted. But if the urine be retained in large
quantity, and with distension, the desire of making water
resembles the pains of labour; they are troubled with flatulence,
which cannot find vent; the fevers are pungent, and of
a dry nature. Tongue parched; the belly, also, dried up;
they are emaciated, and lose appetite; or if they take anything,
they cannot readily swallow or digest it. But if the
stone fall down into the ureters, there is shivering, as if from
rigor, the sensation as if from the passing of a stone with
violent exertion. And if it fall down into the bladder, there
is an abundant evacuation of watery urine, flatulent discharges
from the bowels, the stomach settled, eructations, rest from
former illnesses; and sometimes blood is poured out along with
the urine, from excoriation of the passage. Another painful
operation is the passage through the member; for if the stone
be larger than the urethra, it is detained for a long time, the
bladder is filled behind, and the ischuria is very painful, for
along with the bladder the ureters, also, are filled. The passage
of crooked stones is most difficult, for I have seen hooked
protuberances on certain of these concretions. But, for the
most part, they are oblong, being formed according to the
shape of the passages. In colour, some are white, clayey, as
is mostly the case with children; others are yellow, and saffron-coloured
in old persons, in whom the stones usually form in
the kidneys, whereas in children it is rather in the bladder.
The causes of the concretion are two-fold: in old persons, a
cold body and thick blood. For cold concretes thick fluids
more readily than heat, the proof of which is seen in the
Thermal springs; for when congealed, the water gets concreted
into a sort of chalk-stones. But in children, the copious
recrement of the blood, being overheated, gives origin to their
formation, like fire.
Such are the affections connected with the formation of
stones. Certain persons pass bloody urine periodically: this
affection resembles that from hemorrhoids, and the constitution
of the body is alike; they are very pale, inert, sluggish, without
appetite, without digestion; and if the discharge has taken
place, they are languid and relaxed in their limbs, but light
and agile in their head. But if the periodical evacuation do
not take place, they are afflicted with headache; their eyes
become dull, dim, and rolling: hence many become epileptic;
others are swollen, misty, dropsical; and others again are
affected with melancholy and paralysis. These complaints are
the offspring of the stoppage of a customary discharge of
blood. If, then, the blood flow pure and unmixed with urine,
for the most part the blood of the urine flows from the
bladder. Sometimes it is discharged in great quantity from
rupture of the kidneys; sometimes it is coagulated, and a
thrombus is formed of extravasated blood; sometimes it is
coagulated in the bladder, when dreadful ischuria comes on.
After the rupture there succeed ulcers, which are slow and
difficult to heal; the indication of which is a scab, or red film,
like a spider's web, or white pus passed in the urine, sometimes
pure and unmixed, and sometimes mixed up with the urine.
And by these symptoms we may also diagnose abcesses, if, in
addition, fevers and rigors supervene towards evening; pains
about the loins, pruritus; but if it burst, clots of a purulent
and fleshy nature, and now a discharge of white pus. But
the ulcers are pungent, sometimes clear, and sometimes foul.
This is indicated by the pus and the urine, whether fetid or
free of smell.
Spring, then, induces hemorrhages and abscesses; winter
and autumn, stones. But if along with the stones ulcers
be formed, the diseases indeed are incurable, there is speedy
emaciation and death.
CHAPTER IV. ON THOSE IN THE BLADDER.
OF the diseases in the bladder no one is mild: the acute
proving fatal by inflammation, wounds, spasm, and acute
fevers; while an ulcer, abcess, paralysis, or a large stone, are
chronic and incurable. For it (
a large stone?) can neither be
broken by a draught, nor by medicine, nor scraped outwardly,
nor cut without danger. For the small ones of the bladder
are to be cut out, but the other proves fatal the same day, or in
a few days, the patients dying from spasms and fevers; or, if
you do not cut him, retention of the urine takes place, and
the patient is consumed slowly with pains, fevers, and wasting.
But if the stone is not very large, there is frequent suppression
of urine; for by falling readily into the neck of the bladder, it
prevents the escape of the urine. Although it be safer to cut
in these cases than for the large stones, still the bladder is cut;
and although one should escape the risk of death, still there is
a constant drain of water; and although this may not be dangerous,
to a freeman the incessant flow of urine is intolerable,
whether he walk or whether he sleep; but is particularly disagreeable
when he walks. The very small ones are commonly
cut without danger. If the stone adhere to the bladder, it
may be detected with care; and, moreover, such cases prove
troublesome from the pain and weight, even when there is no
dysuria, but yet the patient may have difficulty of making
water. You may diagnose all cases of stone by the sediments
of sand in the urine, and, moreover, they have the genital
parts enlarged by handling them; for when they make water,
and there is a stone behind, they are pained, and grasp and
drag the genital parts, as if with the intention of tearing out the
stone along with the bladder. The fundament sympathises by
becoming itchy, and the anus is protruded with the forcing
and straining, from the sensation, as it were, of the passage of
the stone. For the bladder and anus lie close to one another,
and when either suffers, the other suffers likewise. Wherefore,
in inflammations of the rectum, the bladder is affected with
ischuria; and in acute pains of the bladder, the anus passes
nothing, even when the bowels are not much dried up. Such
are the sufferings connected with calculi.
Hemorrhage, although it may not prove fatal very speedily,
yet in the course of time has wasted many patients. But the
clots of blood produced by it are quickly fatal by inducing
ischuria, like as in stones; for even if the blood be thin, of a
bright colour, and not very coagulable, yet the bladder accumulates
it for a length of time, and its heating and boiling (as
it were) coagulates the blood, and thus a thrombus is formed.
Ischuria, then, is most peculiarly fatal. But on these symptoms
there supervene acute pain, acrid heat, a dry tongue, and
from these they die delirious.
If pain come on from a wound, the wound itself is dangerous;
but the sore, even if not fatal at first, becomes incurable
from fever or inflammation; for the bladder is thin, and of
a nervous nature, and such parts do not readily incarnate nor
cicatrise. Moreover, the urine is bilious, acrid, and corrosive.
The ordinary condition of the ulcer is this:--when the bladder
is filled, it is stretched; but when emptied, it contracts: it is
in the condition, then, of a joint in extension and flexion, and
no ulcer in a joint is easy of cure.
The bladder also suppurates from an abscess. The symptoms
of an abscess of the bladder are the same as in other cases; for
the abscess in forming is attended with inflammation, fevers,
and rigors. The dangers are the same. But if it discharges
urine which is thick, white, and not fetid, the ulcers from
them are mild; but if it spread, they pass urine which is feculent,
mixed with pus, and of a bad smell: of such persons the
death is not distant. The urine, indeed, is pungent, and the
evacuation thereof painful, and the pain darts to the extremity
of the member. All things, even those which are opposed to
one another, prove injurious to them; repletion and inanition,
inactivity and exercise, baths and abstinence from baths, food
and abstinence from food, sweet things and acid things; certain
articles being serviceable in certain cases, but proving
injurious in others, not being able to agree in any one.
CHAPTER V. ON GONORRHŒA.
GONORRHŒA is not, indeed, a deadly affection, but one that
is disagreeable and disgusting even to hear of. For if impotence
and paralysis possess both the fluids and genital organs, the semen
runs as if through dead parts, nor can it be stopped even in sleep;
for whether asleep or awake the discharge is irrestrainable, and
there is an unconscious flow of semen. Women also have this
disease, but their semen is discharged with titillation of the parts,
and with pleasure, and from immodest desires of connection
with men. But men have not the same prurient feelings; the
fluid which runs off being thin, cold, colourless, and unfruitful.
For how could nature, when congealed, evacuate vivifying
semen? And even young persons, when they suffer from this
affection, necessarily become old in constitution, torpid, relaxed,
spiritless, timid, stupid, enfeebled, shrivelled, inactive,
pale, whitish, effeminate, loathe their food, and become frigid;
they have heaviness of the members, torpidity of the legs, are
powerless, and incapable of all exertion. In many cases, this
disease is the way to paralysis; for how could the nervous
power not suffer when nature has become frigid in regard to
the generation of life? For it is the semen, when possessed of
vitality, which makes us to be men, hot, well braced in limbs,
hairy, well voiced, spirited, strong to think and to act, as the
characteristics of men prove. For when the semen is not possessed
of its vitality, persons become shrivelled, have a sharp
tone of voice, lose their hair and their beard, and become
effeminate, as the characteristics of eunuchs prove. But if any
man be continent in the emission of semen, he is bold, daring,
and strong as wild beasts, as is proved from such of the athletæ
as are continent. For such as are naturally superior in strength
to certain persons, by incontinency become inferior to their
inferiors; while those by nature much their inferiors by continency
become superior to their superiors: but an animal
becomes strong from nothing else than from semen. Vital
semen, then, contributes much to health, strength, courage,
and generation. From satyriasis a transition takes place to an
attack of gonorrhœa.
CHAPTER VI. ON THE STOMACHIC AFFECTIONS.
THE stomach is the president of pleasure and disgust, being
an important neighbour to the heart for imparting tone, good
or bad spirits, from the sympathy of the soul. This is the
primary power of the stomach. These things have been
described by me in another place. The offspring of pleasure
are, good digestion, good condition, and good colour of the
body; of disgust, their contraries, and also sometimes depression
of spirits, when proper nutrition is wanting; and in
melancholic patients, loathing of food. If, then, this organ be
diseased, there is dislike and abomination of articles of food,
not only if administered, but even if the food is not seen;
nay, the very remembrance of them is attended with nausea,
distress, water-brash, and heart-ache; and in certain cases
there is salivation and vomiting. Even when the body wastes,
provided their stomach remain empty, they bear this pain
more easily than that produced by the administration of food.
But if at any time they are compelled by necessity to take
food, the pain is worse than hunger; the act of masticating
in the mouth occasions sufferance, and to drink is a still
greater pain. And it is not that they suffer thus from suitable
food, and bear more unusual food well; owing to a change
from that which is natural to the opposite, there is a painful
sensation as to everything, an aversion to, and dislike of, all
kinds of food. Along with these there is pain between the
scapulæ, much greater after the administration of food or
drink; loathing, distress, sight dull, noises of the ears, heaviness
of the head, torpidity of the limbs, their joints sink
under them; palpitation in the hypochondriac region; phantasy,
as of the spine being moved towards the lower limbs;
they seem as if carried about, now this way and now that,
whether they stand, or lie down, like reeds or trees shaken by
a gale of wind; they belch out a cold and watery phlegm.
But if there be bile in bilious persons, they have dimness of
sight, and no thirst, even when owing to the food they appear
thirsty; are sleepless, torpid, drowsy, not from true sleep, but
like those in comatose affections; emaciated, very pale, feeble,
relaxed, imbecile, dispirited, timid, inactive, quick to passion,
very moody; for such persons at times have fallen into a state
of melancholy.
These mental emotions necessarily attend the affection when
in connection with the stomach; but certain people, recognising
the parts which sympathise, and from which the most
dreadful symptoms arise, reckon the stomach as the cause.
But the contiguity of the heart, which is of all organs the
first, is a strong confirmation of the truth of what I say; for
the heart is placed in the middle of the lungs, and this intermediate
space comprehends the stomach; and, moreover, both
are connected with the spine; and from this vicinity to the
heart arise the heart-ache, prostration of strength, and symptoms
of melancholy.
There are other, and, indeed, innumerable causes of this
disease; but the principal is, much pus poured forth by the
belly through the stomach. It is familiar to such persons as
from their necessities live on a slender and hard diet; and to
those who, for the sake of education, are laborious and persevering;
whose portion is the love of divine science, along
with scanty food, want of sleep, and the meditation on wise
sayings and doings--whose is the contempt of a full and
multifarious diet; to whom hunger is for food, water for
drink, and watchfulness in place of rest; to whom in place of
a soft couch, is a hammock on the ground without bed-clothes,
a mean coverlet, a porous mantle, and the only cover to whose
head is the common air; whose wealth consists in the abundant
possession and use of divine thought (for all these things they
account good from love of learning); and, if they take any
food, it is of the most frugal description, and not to gratify
the palate, but solely to preserve life; no quaffing of wine to
intoxication; no recreation; no roving or jaunting about; no
bodily exercise nor plumpness of flesh; for what is there from
which the love of learning will not allure one?--from country,
parents, brothers, oneself, even unto death. Hence, to them,
emaciation of the frame; they are ill-complexioned; even
in youth they appear old, and dotards in understanding; in
mind cheerless and inflexible; depraved appetite, speedy satiety
of the accustomed slender and ordinary food, and from want
of familiarity with a varied diet, a loathing of all savoury
viands; for if they take any unusual article of food, they are
injured thereby, and straightway abominate food of all kinds.
It is a chronic disease of the stomach. But inflammations,
defluxions, heart-burn, or pain thereof, are not called the
Stomachic affection.
Summer brings on this disease, whence springs the complete
loss of digestion, of appetite, and of all the faculties. With
regard to the period of life, old age; for in old men, even
without any disease, owing to their being near the close of
life, the appetite is nearly gone.
CHAPTER VII. ON THE CŒLIAC AFFECTION.
THE stomach being the digestive organ, labours in digestion,
when diarrhœa seizes the patient. Diarrhœa consists in the
discharge of undigested food in a fluid state; and if this does
not proceed from a slight cause of only one or two days' duration;
and if, in addition, the patient's general system be debilitated
by atrophy of the body, the Cœliac disease of a chronic
nature is formed, from atony of the heat which digests, and
refrigeration of the stomach, when the food, indeed, is dissolved
in the heat, but the heat does not digest it, nor convert
it into its proper chyme, but leaves its work half finished,
from inability to complete it; the food then being deprived
of this operation, is changed to a state which is bad in colour,
smell, and consistence. For its colour is white and without
bile; it has an offensive smell, and is flatulent; it is liquid,
and wants consistence from not being completely elaborated,
and from no part of the digestive process having been properly
done except the commencement.
Wherefore they have flatulence of the stomach, continued
eructations, of a bad smell; but if these pass downwards, the
bowels rumble, evacuations are flatulent, thick, fluid, or
clayey, along with the phantasy, as if a fluid were passing
through them; heavy pain of the stomach now and then, as
if from a puncture; the patient emaciated and atrophied, pale,
feeble, incapable of performing any of his accustomed works.
But if he attempt to walk, the limbs fail; the veins in the
temples are prominent, for owing to wasting, the temples are
hollow; but also over all the body the veins are enlarged,
for not only does the disease not digest properly, but it does
not even distribute that portion in which the digestion had
commenced for the support of the body; it appears to me,
therefore, to be an affection, not only of the digestion, but
also of the distribution.
But if the disease be on the increase, it carries back the
matters from the general system to the belly, when there is
wasting of the constitution; the patients are parched in the
mouth, surface dry and devoid of sweat, stomach sometimes
as if burnt up with a coal, and sometimes as if congealed with
ice. Sometimes also, along with the last scybala, there flows
bright, pure, unmixed blood, so as to make it appear that the
mouth of a vein has been opened; for the acrid discharge
corrodes the veins. It is a very protracted and intractable
illness; for, even when it would seem to have ceased, it relapses
again without any obvious cause, and comes back upon even a
slight mistake. Now, therefore, it returns periodically.
This illness is familiar to old persons, and to women rather
than to men. Children are subject to continued diarrhœa,
from an ephemeral intemperance of food; but in their case the
disease is not seated in the cavity of the stomach. Summer
engenders the disease more than any other of the seasons;
autumn next; and the coldest season, winter, also, if the heat
be almost extinguished. This affection, dysentery and lientery,
sometimes are engendered by a chronic disease. But, likewise,
a copious draught of cold water has sometimes given rise
to this disease.
CHAPTER VIII. ON COLICS.
PERSONS in colic are cut off speedily by volvulus and tormina.
There are very many causes of this affection. The
symptoms are, heaviness during abstinence from food, particularly
in the part most affected; much torpor; they are inactive,
lose appetite, become emaciated, sleepless, swollen in countenance.
And if the colon be affected in connection with the
spleen, they are of a dark-green colour; but of a light-green
when in connection with the liver, from the sympathy of the
nearest viscera. And if they take food, even in small quantity,
and such as is not flatulent, they become very flatulent,
and have a desire to pass wind, which, however, does not
find vent: forced eructations upwards, but without effect; or,
if any should be forcibly expelled, the flatus is fetid and acid
which escapes upwards. The kidneys and bladder sympathise,
with pain and ischuria; but in such cases the symptoms interchange
with one another. But a greater wonder than these,
--an unexpected pain has passed down to the testicles and cremasters;
and this sympathetic affection has escaped the observation
of many physicians, who have made an incision into
the cremasters, as if they were the particular cause of the
disease. But in these cases also the symptoms interchange
with one another.
From this disease are produced other diseases; abscesses and
ulcers, of no mild character; dropsies and phthisis, which are
incurable. For the disease is formed from cold and thick
humours, and a copious and glutinous phlegm; but, also, it
comes on with a frigid period of life, a cold season, and a cold locality, and during a hard winter.
CHAPTER IX. ON DYSENTERY.
OF the intestines, the upper being thin and bilious (
χολώδεα）
as far as the
cœcum, have got the Greek name
χολώδες. From
these proceed the lower, which are thick and fleshy, as far as
the commencement of the Rectum.
Wherefore ulcers form in all of them; and the varieties of
these ulcers constitute Dysentery: on this account, these diseases
are complex. For some of them erode the intestines
superficially, producing only excoriation; and these are innocuous;
but they are far more innocent if the affections be low
down. Or if the ulcers be yet a little deeper, they are no
longer of a mild character. But ulcers which are deep and
have not stopped spreading, but are of a phagedænic, painful,
spreading, and gangrenous character, are of a fatal nature; for
the small veins get corroded in the course of their spreading,
and there is an oozing of blood in the ulcers. Another larger
species of ulcers: thick edges, rough, unequal, callous, as we
would call a knot in wood: these are difficult to cure, for they
do not readily cicatrise, and the cicatrices are easily dissolved.
The causes of dysentery are manifold; but the principal are,
indigestion, continued cold, the administration of acrid things,
such as
myttôtos,
4 onions by themselves, garlic, food of old
and acrid flesh, by which dyspepsia is produced; also unaccustomed
liquids,
cyceon,
5 or
zythus6 (ale), or any similar
beverage produced in any country as a substitute for wine to
quench thirst. But also a blow, exposure to cold, and cold
drink, create ulcerations.
The dejections and the circumstances attendant on the ulcers
are different in different cases; for, if superficial, when from
above, the discharges are thin, bilious, devoid of odour except
that which they derive from the intestines; those from the
jejunum are rather more coloured, saffron-like, and fetid.
Those dejections which contain the food in a dissolved state
but rough, are sometimes fetid in smell when the ulcers are
gangrenous, and sometimes have the smell as if from scybala.
But in the ulcerations from the parts below, the discharges
are watery, thin, and devoid of smell. But if deeper they are
like ichor, reddish, of the colour of dark wine, or like the
washings of flesh; and these are sometimes by themselves and
sometimes with the fæces, these being dissolved in the surrounding
fluid, devoid of bile and of smell; or they are
evacuated in a consistent and dry state, lubricated with the
surrounding fluid. But if the ulcers be larger and smoother, in
those above they are bilious, and pinch the parts from which
they come and through which they pass (they even pinch the
anus), for the bile is acrid, more especially if from an ulcer;
and the bile is fatty, like grease. In the deeper ulcers below,
a thick clot of blood with phlegm, like flesh not very fat, or
like the scrapings of the bowels: nay, even entire portions are
mixed up with them; they are discharged white, thick, mucous,
like chopped tallow, along with the humour in which
they float: these proceed from the rectum: but sometimes
they are merely mucous, prurient, small, round, pungent,
causing frequent dejections and a desire not without a pleasurable
sensation, but with very scanty evacuations: this complaint
gets the appellation of
tenesmus. But from the colon
there are discharged pieces of flesh, which are red, large, and
have a much larger circumference. If the ulcers become deep,
and the blood thick and feculent, these are more fetid than
the former; but if the ulcers spread and are phagedænic, and
if nothing will stop them, above, in addition to being intensely
bilious, the dejections become saffron-like, frothy, feculent,
blackish, like woad or like leeks, thicker than the former,
fetid like a mortification; food now undigested, as if only
masticated by voracious teeth. But if the under parts are also
corroded, black clots of blood, thick, fleshy, very red, clotted,
sometimes, indeed, black, but at other times of all various
colours, fetid, intolerable; involuntary discharges of fluids.
And sometimes a substance of considerable length, in many
respects not to be distinguished from a sound piece of intestine,
has been discharged, and, to those ignorant of the matter,
has caused apprehension about the intestine: but the fact is
this,--the intestines, like the stomach, consist of two coats,
which lie close to one another in an oblique manner; when,
therefore, the connection between them is dissolved, the inner
coat, being separated to some length, protrudes externally,
while the outer one remains alone, incarnates, and gets cicatrised,
and the patients recover and live unharmed. It is the
lower gut alone which suffers thus, owing to its fleshy nature.
And, if blood be discharged from any vessel, it runs of a bright
red or black colour, pure, and unmixed with food or scybala;
and if a concretion is spread over it like broad spiders' webs,
it coagulates when cold, and no longer would be taken for a
secretion of blood; but being discharged with much flatulence
and noise, it has the appearance of being much larger than its
actual amount. Sometimes, also, a purulent abscess forms in
the colon, nowise different from the other internal ulcers;
for the symptoms, the pus, and the mode of recovery are the
same. But if there be hard secretions of matters resembling
flesh, as if pounded, and like rough bodies, the abscess is not
of a mild nature. Sometimes a copious discharge of water
takes place from the colon in the form of dysentery, which
has freed many patients from dropsy. In a word, such are
the ulcers in the intestines; and their forms and the secretions
from them as I have described.
I will now describe the symptoms accompanying each of
these states of disease, whether the ulcers be mild or malignant.
To speak in general terms, then, if the excoriation is
superficial, whether it be above or below, the patients are free
from pain and from fever, and get better without being confined
to bed, in various ways, by merely some slight changes of diet.
But if ulceration supervene, in the upper bowels there are tormina,
which are pungent, acrid, as if from the presence of a
small amount of hot bile; and occasionally there is suppuration:
indeed, for the most part, there is suppuration, or digestions
imperfectly performed, though there is no want of appetite.
But if the ulcers form in the lower part of the bowels, they are
much less dangerous than in those above, for the bowels there
are of a much more fleshy nature than those above. But if
those above become hollow and phagedænic, there are acute
fevers, of a latent kind, which smoulder in the intestines;
general coldness, loss of appetite, insomnolency, acid eructations,
nausea, vomiting of bile, vertigo: but if the discharge
become copious, and consist of more bilious matters, the tormina
become permanent, and the other pains increase; sometimes
there is prostration of strength, feebleness of the knees;
they have ardent fever, are thirsty, and anxious; black vomiting,
tongue dry, pulse small and feeble. Akin to these are
the fatal symptoms I have stated among those of malignant
ulcers; cardiac affections even to deliquium animi, from which
some never recover, but thus expire. These dangerous symptoms
are common also to erosions of the lower intestines if the
ulcers spread, and the discharge be not checked, only that the
tormina and pains are below the umbilicus where the ulcers
are situated. The forms of the secretions are such as I have
said; but if they be small at first, and there be a postponement
of their spreading for a long time, various changes take
place in the ulcers, some subsiding, and others swelling up,
like waves in the sea. Such is the course of these ulcers. But
if nature stand out, and the physician co-operate, the spreading
may, indeed, be stopped, and a fatal termination is not apprehended,
but the intestines remain hard and callous, and the
recovery of such cases is protracted.
In hemorrhage from the bowels, if it proceed from a large
vein or artery, it is sudden death; for neither is it possible to
introduce the hand so as to reach the ailment, nor to apply any
medicine to the sore. And even if the hemorrhage were
restrained by the medicine, the escape from death would not
be certain; for, in some cases, the falling off of a large eschar
widens the mouth of the vein, and when clots form within,
and remain there, the disease is incurable. It is necessary, then,
to cure hemorrhages in their commencement. Its approach, also,
for the most part is obvious, although not in all cases quite
apparent: anxiety attends, with restlessness, heaviness in the
part where the rupture is to take place, ruddiness of the
countenance if the blood has not yet burst forth. And if the
vein has burst lately, for the most part the symptoms are
alleviated; but if it has been a longer time ago, this takes
place more slowly, and with more difficulty. Such are the
ulcers in the intestines.
They occur in the season of summer; next in autumn; less
in spring; least of all in winter. Diarrhœa attacks children
and adolescents, but dysentery adults and young persons. In
old age convalescence is difficult, and cicatrization protracted.
Corroding sores are unusual in old persons, but yet hemorrhage
is in accordance with old age.
CHAPTER X. ON LIENTERY.
IF many thick and hard cicatrices form after dysenteries, and
broad and very deep ulcerations of the upper intestines, the
food passes from them to those below in a fluid state, without
separation of the nutritious part; for the cicatrix shuts up the
pores by which the nutriment is carried upwards. The patient,
therefore, is seized with atrophy, loss of colour and of strength.
The affection gets the appellation of Lientery, this name being
applied to a cicatrix of the intestines. And here the affection
is from ulcers. But sometimes the intestines do not acquire
cicatrization, but yet usage and habit reconcile the intestines to
the discharge. For, the heat in these parts, if congealed, neither
at times performs digestion, nor is the nutriment distributed
upwards; but being unchanged, owing to weakness, it fails to
undergo any part of the process. But if the purging, though
of vitiated matters, be temporary, and not confirmed, a simple
vomit after food will sometimes remove the disease. But if the
exciting cause be prolonged, and get confirmed, it does no
good.
A chronic disease, and cachexia so mild as not to confine
the patient to bed, will engender this disease. But dropsies
sometimes have terminated favourably in this disease; a change
from one evil to another, but still a better change.
CHAPTER XI. ON AFFECTIONS OF THE WOMB, OR HYSTERICS.
THE uterus in women is beneficial for purgation and parturition,
but it is the common source of innumerable and bad
diseases; for not only is it subject to ulcers, inflammation, and
the fluor, but, if the whole organ be suddenly carried upwards,
it quickly causes death. The fatal diseases of an acute nature
connected therewith have been described elsewhere: but the
chronic affections are, the two species of
fluor; hardness;
ulcers, part mild, but part malignant; prolapsus of the whole,
or of part.
The
fluor, then, is either of a red or white colour; its appearance
indicates this. It is the red if it consist of bright
red blood, and the varieties thereof; or livid, or black and
thin, or thick and coagulated, like a thrombus; or white, like
water; or a bright ochre colour, like bile: in thickness like a
thinnish or thin and fetid ichor. The white flux (or
fluor
albus) is like pus, and the true form like white whey; but a
clot of blood frequently runs off with the pus. But there is an
infinite variety of forms of it, as regards more or less quantity.
Its periods sometimes agree with those of the menstrual purgation,
but it does not continue the regular time as before; there
is not much blood, but it flows during many days; the interval
is for a few days, but is quite free from discharge. Another
variety as to the period: the first purgation is at the regular
time, but it occurs two or three times during each month.
Another variety: a continual flux; small, indeed, every day,
but by no means small during the whole month; for the
uterus never closes its mouth, labouring under relaxation, so
as to permit the flow of the fluid: but if it neither intermits
nor diminishes, they die of hemorrhage. The symptoms are,
the woman's colour in accordance with those of the discharge;
sleepless, loathes food, anxious, relaxed, especially in the red
flux, and subject to pains; the discharge fetid in both varieties,
but to a greater and less extent at different times; for the
white is worse if the putrefaction be unusually great; and
sometimes the red, if the erosion be exacerbated. In a word,
the black is the worst of all; the livid next; the pale, the
white, and the purulent, are more protracted, indeed, but less
dangerous. Of these the pale is worse indeed, but much
better when mixed with the customary discharge. Now the
customary discharge is red in all its varieties. But, indeed,
the red are worse in old women; but the white are not at all
so to the young; but even to them that which is customary is
less troublesome. Another white fluor: the menstrual discharge
white, acrid, and attended with an agreeable pruritus;
along with which the discharge of a white thick fluid, like
semen, is provoked. This species we call female gonorrhœa.
It is a refrigeration of the womb, which therefore becomes
incapable of retaining its fluids; hence, also, the blood changes
to a white colour, for it has not the purple colour of fire. The
stomach, also, is subject to the affection, and vomits phlegm;
and also the bowels are similarly affected in diarrhœa.
Ulcers, too, are formed in the womb; some broad and attended
with tingling, which, being close together, are, as it were, a
superficial excoriation; pus thick, without smell, scanty. These
ulcers are mild. But there are others deeper and worse than
these, in which the pains are slight, pus somewhat more abundant,
much more fetid, and yet, notwithstanding, these also
are mild. But if they become deeper, and the lips of the
sores hard or rough, if there is a fetid ichor, and pain stronger
than in the former case, the ulcer corrodes the uterus; but
sometimes a small piece of flesh is cast off and discharged, and
this sore not coming to cicatrization, either proves fatal after a
long time, or becomes very chronic. This sore gets the appellation
of
phagedæna. The sores also are dangerous if in these
cases the pain gets exacerbated, and the woman becomes
uneasy. From the sore there is discharged a putrid matter,
intolerable even to themselves; it is exasperated by touching
and by medicines, and irritated by almost any mode of treatment.
The veins in the uterus are swelled up with distension
of the surrounding parts. To the skilled, it is not difficult to
recognise by the touch, for it is not otherwise obvious. Febrile
heat, general restlessness, and hardness is present, as in malignant
diseases; the ulcers, being of a fatal nature, obtain also
the appellation of cancers. Another cancer: no ulceration
anywhere, swelling hard and untractable, which distends the
whole uterus; but there are pains also in the other parts which
it drags to it. Both these carcinomatous sores are chronic and
deadly; but the ulcerated is worse than the unulcerated, both
in smell and pains, in life and in death.
Sometimes the whole uterus has protruded from its seat,
and lodged on the woman's thighs; an incredible affliction! yet
neither has the uterus not been thus seen, nor are the causes
which produce it such as do not occur. For the membranes
which are inserted into the flanks, being the nervous (
ligamentous?)
supporters of the uterus, are relaxed; those at the fundus,
which are inserted into the loins, are narrow; but those at its
neck, on each side to the flanks, are particularly nervous and
broad, like the sails of a ship. All these, then, give way if
the uterus protrude outwardly, wherefore this
procidentia generally
proves fatal; for it takes place from abortion, great concussions,
and laborious parturition. Or if it do not prove
fatal, the women live for a long time, seeing parts which
ought not to be seen, and nursing externally and fondling the
womb. It would appear that, of the double membrane of the
womb, the internal lining coat is sometimes torn from the
contiguous one, for there are two transverse plates of the coat;
this, then, is thrown off with the flux, and in abortion and
laborious parturition, when it adheres to the placenta. For if
it be forcibly pulled, the coat of the uterus being stretched,
..... But if the woman do not die, it is either restored to
its seat, or but a small part appears externally, for the woman
conceals it with her thighs. Sometimes the mouth of the
womb only, as far as the neck, protrudes, and retreats inwardly
if the uterus be made to smell to a fetid fumigation; and the
woman also attracts it if she smells to fragrant odours. But
by the hands of the midwife it readily returns inwards when
gently pressed, and if anointed beforehand with the emollient
plasters for the womb.
CHAPTER XII. ON ARTHRITIS AND SCHIATICA.
ARTHRITIS is a general pain of all the joints; that of the
feet we call Podagra; that of the hip-joint, Schiatica; that of
the hand, Chiragra. The pain then is either sudden, arising
from some temporary cause; or the disease lies concealed
for a long time, when the pain and the disease are kindled
up by any slight cause. It is, in short, an affection of all
the nerves, if the ailment being increased extend to all; the
first affected are the nerves which are the ligaments of the
joints, and such as have their origin and insertion in the
bones. There is a great wonder in regard to them; there is
not the slightest pain in them, although you should cut or
squeeze them; but if pained of themselves, no other pain
is stronger than this, not iron screws, nor cords, not the
wound of a sword, nor burning fire, for these are often had
recourse to as cures for still greater pains; and if one cut
them when they are pained, the smaller pain of the incision
is obscured by the greater; and, if it prevail, they experience
pleasure in forgetting their former sufferings. The teeth and
bones are affected thus.
The true reason of this none but the gods indeed can truly
understand, but men may know the probable cause. In a
word, it is such as this; any part which is very compact is
insensible to the touch or to a wound, and hence it is not
painful to the touch or to a wound. For pain consists in an
exasperated sense, but what is compact cannot be exasperated,
and hence is not susceptible of pain. But a spongy part is
very sensible, and is exasperated by an injury. But since
dense parts also live by their innate heat, and possess sensibility
by this heat, if then the exciting cause be material,
such as either a sword, or a stone, the material part of the
patient is not pained, for it is dense by nature. But if an
intemperament of the innate heat seize it, there arises a
change of the sense; the heat therefore is pained by itself,
being roused within by the impression on the sense. The
pains then are from nature's being increased, or a redundance
thereof.
Arthritis fixes itself sometimes in one joint and sometimes
in another; sometimes in the hip-joints; and for the most part
in these cases the patient remains lame in it; and the other
joints it affects little, and sometimes does not go to the small
joints, as the feet and hands. If it seizes the greater members
which are able to contain the disease, it does not go beyond
these organs; but if it begin from a small one, the attack is
mild and unexpected. The commencement of ischiatic
disease is from the thigh behind, the ham, or the leg. Sometimes
the pain appears in the cotyloid cavity, and again extends
to the nates or loins, and has the appearance of anything
rather than an affection of the hip-joint. But the joints begin
to be affected in this way: pain seizes the great toe; then the
forepart of the heel on which we lean; next it comes into the
hollow of the foot, but the ankle swells last; and they blame
a wrong cause; some, the friction of a new shoe; others, a long
walk; another again, a stroke or being trod upon; but no one
will of his own accord tell the true one; and the true one
appears incredible to the patients when they hear of it. On
this account the disease gets to an incurable state, because at
the commencement, when it is feeble, the physician is not at
hand to contend with it; but if it has acquired strength from
time, all treatment is useless. In some, then, it remains in the
joints of the feet until death, but in others it spreads over the
compass of the whole body. For the most part, it passes from
the feet to the hands. For to the disease there is no great
interval between the hands and the feet, both being of a
similar nature, slender, devoid of flesh, and very near the external
cold, but very far from the internal heat; next the
elbow and the knee, and after these the hip-joint; which is the
transition to the muscles of the back and chest. It is incredible
how far the mischief spreads. The vertebræ of the
spine and neck are affected with the pain, and it extends to
the extremity of the os sacrum: there is a general pain of all
the parts of the groin, and a pain peculiar to each part thereof.
But likewise the tendons and muscles are intensely pained; the
muscles of the jaws and temples; the kidneys, and the bladder
next in succession. And, what a wonder! at last the nose,
the ears, and the lips, suffer; for every where there are nerves
and muscles. A certain person had pains in the sutures of
the head, and not knowing why he was pained there, he
pointed out the shapes of the sutures--the oblique, the straight,
the transverse--both behind and before, and stated that the
pain was narrow and fixed in the bones; for the disease spreads
over every commissure of the bones, in the same manner as
in the joints of a foot or of a hand. Callosities also form in
the joints; at first they resemble abscesses, but afterwards they
get more condensed, and the humour being condensed is
difficult to dissolve; at last they are converted into hard,
white tophi, and over the whole there are small tumours, like
vari and larger; but the humour is thick, white, and like hailstones.
For it is a cold disease of the whole (body), like hail;
and there appears to be a difference in regard to heat and
cold; for in certain cases there is delight in things otherwise
disagreeable. But, I fancy, that the cause is a refrigeration
of the innate heat, and that the disease is single; but if it
speedily give way, and the heat re-appears, there is need of refrigeration
and it delights in such things; this is called the hot
species. But if the pain remain internally in the nerves, and
the part not becoming heated subside, nor get swollen, I
would call this variety cold, for which there is need of hot
medicines to restore the heat, of which those very acrid are
most necessary. For heat excites the collapsed parts to
swelling, and calls forth the internal heat, when there is need
of refrigerants. In proof of this, the same things are not
always expedient in the same cases, for what is beneficial at
one time proves prejudicial in another; in a word, heat is
required in the beginning, and cold at the conclusion. Wherefore
Gout does not often become unremitting; but sometimes it
intermits a long time, for it is slight; hence a person subject
to Gout has won the race in the Olympiac games during the
interval of the disease.
Men then are more readily affected, but more slightly the
women; women more rarely than men, but more severely.
For what is not usual nor cognate, if from necessity it gets
the better engenders a more violent ailment. The most
common age is after thirty-five; but sooner or slower according
to the temperament and regimen of every one. The pains
then are dreadful, and the concomitants worse than the pains;
fainting even upon touch, inability of motion, loss of appetite,
thirst, restlessness. But, if they recover partly, as if escaped
from death, they live dissolutely, are incontinent, open-handed,
cheerful, munificent, and luxurious in diet; but partly, as if
they would (not?) again escape from death, they enjoy the
present life abundantly. In many cases the gout has passed
into dropsy, and sometimes into asthma; and from this succession there is no escape.
CHAPTER XIII. ON ELEPHAS, OR ELEPHANTIASIS.
THERE are many things in common as to form, colour, size,
and mode of life between the affection Elephas and the wild
beast the elephant; but neither does the affection resemble
any other affection, nor the animal any other animal. The
wild beast, the elephant, indeed, is very different from all
others; in the first place then, he is the greatest and the
thickest of animals; in size, he is as great as if you were to
put one animal on another, like a tower; in bulk, he is as
large as if you should place several other very large animals
side by side. But neither in shape is he much like unto any
other. Then, as to colour, they are all intensely black, and
that over their whole body. One horse, indeed, is very white,
like "the Thracian steeds of Rhesus"; others white-footed,
like "the white-footed horse of Menelaus"; and bay, like
"one hundred and fifty"; others are tawny, as "assuming the
shape of a horse having a tawny mane, he lay down with
her." And so it is with oxen, and dogs, and all other reptiles
and animals which live on the earth. But elephants are only
of a lurid colour, "like to night and death." With regard
to shape, they have a very black head, and unseemly face of
no marked form, upon a small neck, so that the head appears to
rest upon the shoulders, and even then it is not very conspicuous.
For the ears are large, broad, resembling wings, extending to
the collar-bone and breast-bone, so as to conceal the neck with
the ears, like ships with their sails. The elephant has wonderfully
white horns on a very dark body--others call them
teeth--these alone are most white, such as is nothing else of
even any other white animal; and these are not above the
forehead and temples, as is the nature of other horned
animals, but in the mouth and upper jaw, not indeed quite
straight forwards but a little bent upwards, so that it might
swallow in a straight direction, and lift a load in its flat teeth.
Moreover the horns are large, the medium length being as
much as a fathom, and some much larger; that is to say, as
long as two fathoms. And the upper jaw from its lip has a
long, ex-osseous, crooked, and serpent-like protuberance; and
there are two perforations at the extremity of this protuberance;
and these by nature are perforated all the way to the
lungs, so as to form a double tube, so that the animal uses this
pipe as a nostril for respiration, and likewise as a hand; for it
could take a cup if it please with this protuberance, and
can grasp it round and hold it firmly, and none could it
take by force from the animal, except another stronger
elephant. And with this also it seeks herbage for food; for
neither does it live by eating flesh with its mouth and small
teeth. For, its feet being long, raise the animal considerably
above the ground; but its neck also, as I have said, is small,
and therefore it cannot browse on the earth with its mouth;
and moreover the excrescence of the horns in front of the
mouth prevents the mouth from touching the herbage.
Wherefore it raises a great load with its protuberance; then
as if with a binder having bound the same with it, he can
convey it to his mouth; whence the ancients properly call
it
proboscis, for it collects food in front of the animal. But
neither is it able to drink from a lake or river with its mouth,
for the same reason. But, if it is thirsty, it introduces into the
water the extreme nostril of the proboscis, and then, as if
inhaling, it draws in much water, instead of air; and when it
has filled its nose, as it were a cup, it pours the same as a
stream of water into its mouth, and then it draws anew and
discharges again, until it fills its belly, as it were a vessel of
burden. It has a rough and very thick skin, containing
fissures with prominent edges, long channels, and other
hollow clefts, some transverse, others oblique, very deep, like
in all respects to a furrowed field. Other animals have naturally
hairs for a mane, but in the elephant this is merely
down. There are also innumerable other differences between
it and other animals; for, like man, it bends its leg backward
at the knee; and like woman, it has its dugs at the arm-pits.
But there is no necessity for me now to write concerning the
animal, except in so far as there is any discrepancy between
the animal and the disease, and in so far as the symptoms of
the patient resemble the nature of the animal. The disease
is also called
Leo, on account of the resemblance of the eyebrows,
as I shall afterwards explain; and
Satyriasis, from the
redness of the cheeks, and the irresistible and shameless impulse
ad coitum. Moreover it is also called the
Heracleian affection,
insomuch as there is none greater and stronger than
it.
Wherefore the affection is mighty in power, for it is the
most powerful of all in taking life; and also it is filthy and
dreadful to behold, in all respects like the wild animal, the
elephant. And from the disease there is no escape, for it
originates in a deadly cause; it is a refrigeration of the innate
heat, or rather a congelation like a great winter, when the
water is converted into snow, or hail, or ice, or frost. This is
the common cause of death, and of the affection.
But the commencement of the disease gives no great indication
of it; neither does it appear as if any unusual ailment
had come upon the man; nor does it display itself upon the
surface of the body, so that it might be immediately seen, and
remedies applied at the commencement; but lurking among
the bowels, like a concealed fire it smolders there, and having
prevailed over the internal parts, it afterwards blazes forth on
the surface, for the most part beginning, like a bad signal-fire,
on the face, as it were its watch-tower; but in certain
cases from the joint of the elbow, the knee, and knuckles of
the hands and feet. In this way the patient's condition is
hopeless, because the physician, from inattention and ignorance
of the patient's ailment, does not apply his art to the commencement
when the disease is very feeble. For, indeed,
they are merely torpid, as if from some light cause, drowsy,
inactive, dry in the bowels, and these symptoms are not very
unusual even in healthy persons. But upon the increase of
the affection, the respiration is fetid from the corruption within
of the breath (
pneuma). The air, or something external, would
seem to be the cause of this. Urine thick, muddy, like that
of cattle; the distribution of crude undigested food; and yet
of these things there is no perception nor regard; for neither
are they aware whether or not they digest, thus digestion or
indigestion is all one to them, since, for anything useful
and proper to them, digestion is not usual with them. The
distribution, however, is easy, the disease, as it were, greedily
attracting the food for its own nourishment; for this reason
the lower belly is very dry. Tumours prominent, not continuous
with one another anywhere, but thick and rough, and
the intermediate space cracked, like the skin of the elephant.
Veins enlarged, not from abundance of blood, but from thickness
of the skin; and for no long time is the situation of them
manifest, the whole surface being elevated equally in the
swelling. The hairs on the whole body die prematurely, on
the hands, the thighs, the legs, and again on the pubes; scanty
on the chin, and also the hairs on the head are scarce. And
still more frequently premature hoariness, and sudden baldness;
in a very short time the pubes and chin naked of hair, or if
a few hairs should remain, they are more unseemly than
where they are gone. The skin of the head deeply cracked;
wrinkles frequent, deep, rough; tumours on the face hard,
sharp; sometimes white at the top, but more green at the
base. Pulse small, dull, languid, as if moved with difficulty
through the mud; veins on the temples elevated, and also
those under the tongue; bowels bilious; tongue roughened
with
vari, resembling hailstones; not unusual for the whole
frame to be full of such (and thus also in unsound victims, the
flesh is full of these tubercles resembling hail). But if the
affection be much raised up from the parts within, and appear
upon the extremities,
lichens occur on the extremities of the
fingers; there is pruritus on the knees, and the patients rub
the itchy parts with pleasure.
7 And the
lichen sometimes
embraces the chin all round; it reddens the cheeks, but is
attended with no great swelling; eyes misty, resembling bronze;
eye-brows prominent, thick, bald, inclining downwards, tumid
from contraction of the intermediate space; colour livid or
black; eye-lid, therefore, much retracted to cover the eyes, as
in enraged lions; on this account it is named
leontium. Wherefore
it is not like to the lions and elephants only, but also in
the eye-lids "resembles swift night." Nose, with black protuberances,
rugged; prominence of the lips thickened, but lower
part livid; nose elongated; teeth not white indeed, but
appearing to be so under a dark body; ears red, black,
contracted, resembling the elephant, so that they appear to
have a greater size than usual; ulcers upon the base of the
ears, discharge of ichor, with pruritus; shrivelled all over the
body with rough wrinkles; but likewise deep fissures, like
black furrows on the skin; and for this reason the disease has
got the name of
elephas. Cracks on the feet and heels, as far
as the middle of the toes; but if the ailment still further
increase, the tumours become ulcerated, so that on the cheeks,
chin, fingers, and knees, there are fetid and incurable ulcers,
some of which are springing up on one part, while others
are subsiding on another. Sometimes, too, certain of the
members of the patient will die, so as to drop off, such as
the nose, the fingers, the feet, the privy parts, and the whole
hands; for the ailment does not prove fatal, so as to relieve
the patient from a foul life and dreadful sufferings, until he
has been divided limb from limb. For it is long-lived, like
the animal, the elephant. But if there be a sudden pain of
the limbs, it attacks much more grievously, spreading sometimes
to this part, and sometimes to that. Appetite for food
not amiss; taste indiscriminate, neither food nor drink affords
pleasure; aversion to all things from a painful feeling; atrophy;
libidinous desires of a rabid nature; spontaneous lassitude;
the figure of each of the limbs heavy, and even the small
limbs are oppressive to the patient. Moreover, the body is
offended with everything, takes delight neither in baths nor
abstinence from them, neither in food nor in abstinence from
it, neither in motion nor in rest, for the disease has established
itself in all the parts. Sleep slight, worse than insomnolency,
from its fantasies; strong dyspnœa, suffocation as if from
strangling. In this way certain patients have passed from life,
sleeping the sleep which knows no waking, even until death.
When in such a state, who would not flee;--who would
not turn from them, even if a father, a son, or a brother?
There is danger, also, from the communication of the ailment.
Many, therefore, have exposed their most beloved relatives in
the wilderness, and on the mountains, some with the intention
of administering to their hunger, but others not so, as wishing
them to die. There is a story that one of those who had come
to the wilderness, having seen a viper creep out of the earth,
compelled by hunger, or wearied out with the affection, as if
to exchange one evil for another, ate the viper alive, and did
not die until all his members had become putrid and dropped
off: and that another person saw a viper creep into a cask of
new wine, and after drinking of the same to satiety, vomit it
up, and discharge a great deal of its venom along with the
new wine; but when the viper was smothered in the new
wine, that the man drank of it largely and greedily, seeking
thus to obtain a rescue from life and the disease; but when he
had carried the drinking to satiety and intoxication, he lay
down on the ground, at first as if about to die; but when he
awoke from his sleep and intoxication, first of all his hair fell
off, next the fingers and nails, and all the parts melted away in
succession. But as the power was still in the semen, nature
formed the man again, as if from the act of generation: it
made other hairs to grow, and made new nails and clean flesh,
and put off the old skin, like the slough of a reptile; and
he was called back, like another new man, to a growth of
life. Thus goes the fable; not very probable, indeed, nor yet
entirely incredible; for that one ill should be overcome by
another is credible. And that from the existing spark nature
should renew the man, is not so incredible as to be held to be
a prodigy.
