BOOK I.
CHAPTER V. ON THE PAROXYSM OF EPILEPTICS
* * * * sluggishness, vertigo, heaviness of the tendons, plethora
and distension of the veins in the neck; and much nausea
indeed after food, but also, not unfrequently, with abstinence,
there is a faint nausea; and phlegm is often vomited; want of
appetite and indigestion after little food: they have flatulence
and meteorism in the hypochondria. These symptoms, indeed,
are constant.
But, if it be near the accession of the paroxysm, there are
before the sight circular flashes of purple or black colours, or
of all mixed together, so as to exhibit the appearance of the
rainbow expanded in the heavens; noises in the ears; a heavy
smell; they are passionate, and unreasonably peevish. They
fall down then, some from any such cause as lowness of spirits,
but others from gazing intently on a running stream, a rolling
wheel, or a turning top. But sometimes the smell of heavy
odours, such as of the gagate stone (
jet), makes them fall
down. In these cases, the ailment is fixed in the head, and
from it the disorder springs; but, in others, it arises also from
the nerves remote from the head, which sympathise with the
primary organ. Wherefore the great fingers of the hands, and the
great toes of the feet are contracted; pain, torpor, and trembling
succeed, and a rush of them to the head takes place. If the
mischief spread until it reach the head, a crash takes place,
in these cases, as if from the stroke of a piece of wood, or of
stone; and, when they rise up, they tell how they have been
maliciously struck by some person. This deception occurs to
those who are attacked with the ailment for the first time.
But those to whom the affection has become habitual, whenever
the disease recurs, and has already seized the finger, or is
commencing in any part, having from experience a foreknowledge
of what is about to happen, call, from among those who
are present, upon their customary assistants, and entreat them
to bind, pull aside, and stretch the affected members; and
they themselves tear at their own members, as if pulling out
the disease; and such assistance has sometimes put off the
attack for a day. But, in many cases, there is the dread as of
a wild beast rushing upon them, or the phantasy of a shadow;
and thus they have fallen down.
In the attack, the person lies insensible; the hands are
clasped together by the spasm; the legs not only plaited
together, but also dashed about hither and thither by the
tendons. The calamity bears a resemblance to slaughtered
bulls; the neck bent, the head variously distorted, for sometimes
it is arched, as it were, forwards, so that the chin rests
upon the breast; and sometimes it is retracted to the back, as
if forcibly drawn thither by the hair, when it rests on this
shoulder or on that. They gape wide, the mouth is dry; the
tongue protrudes, so as to incur the risk of a great wound, or
of a piece of it being cut off, should the teeth come forcibly
together with the spasm; the eyes rolled inwards, the eyelids
for the most part are separated, and affected with palpitation;
but should they wish to shut the lids they cannot bring them
together, insomuch that the white of the eyes can be seen
from below. The eyebrows sometimes relaxed towards the
mesal space, as in those who are frowning, and sometimes
retracted to the temples abnormally, so that the skin about the
forehead is greatly stretched, and the wrinkles in the intersuperciliary
space disappear: the cheeks are ruddy and quivering;
the lips sometimes compressed together to a sharp point,
and sometimes separated towards the sides, when they are
stretched over the teeth, like as in persons smiling.
As the illness increases lividity of countenance also supervenes,
distension of the vessels in the neck, inability of speech
as in suffocation; insensibility even if you call loudly. The
utterance a moaning and lamentation; and the respiration a
sense of suffocation, as in a person who is throttled; the pulse
strong, and quick, and small in the beginning,--great, slow,
and feeble in the end, and irregular throughout; tentigo of
the genital organs. Such sufferings do they endure towards
the end of the attack.
But when they come to the termination of the illness, there
are unconscious discharges of the urine, and watery discharges
from the bowels, and in some cases an evacuation also of the
semen, from the constriction and compression of the vessels, or
from the pruriency of the pain, and titillation of the humours;
for in these cases the pains are seated in the nerves. The
mouth watery; phlegm copious, thick, cold, and, if you should
draw it forth, you might drag out a quantity of it in the form
of a thread. But, if with length of time and much pain, the
matters within the chest ferment, but the restrained spirit
(
pneuma) agitates all things, and there is a convulsion and disorder
of the same, a flood, as it were, of humours swells up to
the organs of respiration, the mouth, and the nose; and if
along with the humours the spirit be mixed, it appears like
the relief of all the former feelings of suffocation. They
accordingly spit out foam, as the sea ejects froth in mighty
tempests; and then at length they rise up, the ailment now
being at an end. At the termination, they are torpid in their
members at first, experience heaviness of the head, and loss
of strength, and are languid, pale, spiritless, and dejected,
from the suffering and shame of the dreadful malady.
CHAPTER VI. ON TETANUS
TETANUS, in all its varieties, is a spasm of an exceedingly
painful nature, very swift to prove fatal, but neither easy to be
removed. They are affections of the muscles and tendons
about the jaws; but the illness is communicated to the whole
frame, for all parts are affected sympathetically with the primary
organs. There are three forms of the convulsion, namely,
in a straight line, backwards, and forwards. Tetanus is in a
direct line, when the person labouring under the distention is
stretched out straight and inflexible. The contractions forwards
and backwards have their appellation from the tension
and the place; for that backwards we call Opisthotonos; and
that variety we call Emprosthotonos in which the patient is
bent forwards by the anterior nerves. For the Greek word
τόνος is applied both to a nerve, and to signify tension.
The causes of these complaints are many; for some are apt
to supervene on the wound of a membrane, or of muscles, or of
punctured nerves, when, for the most part, the patients die; for,
"spasm from a wound is fatal." And women also suffer from
this spasm after abortion; and, in this case, they seldom recover.
Others are attacked with the spasm owing to a severe
blow in the neck. Severe cold also sometimes proves a cause; for
this reason, winter of all the seasons most especially engenders
these affections; next to it, spring and autumn, but least of all
summer, unless when preceded by a wound, or when any strange
diseases prevail epidemically. Women are more disposed to tetanus
than men, because they are of a cold temperament; but
they more readily recover, because they are of a humid. With
respect to the different ages, children are frequently affected,
but do not often die, because the affection is familiar and akin
to them; striplings are less liable to suffer, but more readily
die; adults least of all, whereas old men are most subject
to the disease, and most apt to die; the cause of this is
the frigidity and dryness of old age, and the nature of the
death. But if the cold be along with humidity, these
spasmodic diseases are more innocent, and attended with less
danger.
In all these varieties, then, to speak generally, there is a
pain and tension of the tendons and spine, and of the muscles
connected with the jaws and cheek; for they fasten the lower
jaw to the upper, so that it could not easily be separated even
with levers or a wedge. But if one, by forcibly separating
the teeth, pour in some liquid, the patients do not drink it but
squirt it out, or retain it in the mouth, or it regurgitates by
the nostrils; for the isthmus faucium is strongly compressed,
and the tonsils being hard and tense, do not coalesce so as to
propel that which is swallowed. The face is ruddy, and of
mixed colours, the eyes almost immoveable, or are rolled about
with difficulty; strong feeling of suffocation; respiration bad,
distension of the arms and legs; subsultus of the muscles;
the countenance variously distorted; the cheeks and lips tremulous;
the jaw quivering, and the teeth rattling, and in certain
rare cases even the ears are thus affected. I myself have beheld
this and wondered! The urine is retained, so as to induce
strong dysuria, or passes spontaneously from contraction of
the bladder. These symptoms occur in each variety of the
spasms.
But there are peculiarities in each; in Tetanus there is tension
in a straight line of the whole body, which is unbent and
inflexible; the legs and arms are straight.
Opisthotonos bends the patient backward, like a bow, so
that the reflected head is lodged between the shoulder-blades;
the throat protrudes; the jaw sometimes gapes, but in some
rare cases it is fixed in the upper one; respiration stertorous;
the belly and chest prominent, and in these there is usually
incontinence of urine; the abdomen stretched, and resonant if
tapped; the arms strongly bent back in a state of extension;
the legs and thighs are bent together, for the legs are bent in
the opposite direction to the hams.
But if they are bent forwards, they are protuberant at the
back, the loins being extruded in a line with the back, the
whole of the spine being straight; the vertex prone, the head
inclining towards the chest; the lower jaw fixed upon the
breast bone; the hands clasped together, the lower extremities
extended; pains intense; the voice altogether dolorous; they
groan, making deep moaning. Should the mischief then seize
the chest and the respiratory organs, it readily frees the patient
from life; a blessing this, to himself, as being a deliverance
from pains, distortion, and deformity; and a contingency less
than usual to be lamented by the spectators, were he a son
or a father. But should the powers of life still stand
out, the respiration, although bad, being still prolonged, the
patient is not only bent up into an arch but rolled together
like a ball, so that the head rests upon the knees,
while the legs and back are bent forwards, so as to convey
the impression of the articulation of the knee being dislocated
backwards.
An inhuman calamity! an unseemly sight! a spectacle painful
even to the beholder! an incurable malady! owing to the
distortion, not to be recognised by the dearest friends; and
hence the prayer of the spectators, which formerly would have
been reckoned not pious, now becomes good, that the patient
may depart from life, as being a deliverance from the pains
and unseemly evils attendant on it. But neither can the
physician, though present and looking on, furnish any assistance,
as regards life, relief from pain or from deformity. For
if he should wish to straighten the limbs, he can only do so
by cutting and breaking those of a living man. With them,
then, who are overpowered by the disease, he can merely sympathise.
This is the great misfortune of the physician.
CHAPTER VII. ON ANGINA, OR QUINSEY
ANGINA is indeed a very acute affection, for it is a compression
of the respiration. But there are two species of it; for it is
either an inflammation of the organs of respiration, or an
affection of the spirit (
pneuma) alone, which contains the cause
of the disease in itself.
The organs affected are, the tonsils, epiglottis, pharynx,
uvula, top of the trachea; and, if the inflammation spread, the
tongue also, and internal part of the fauces, when they protrude
the tongue outside the teeth, owing to its abnormal size;
for it fills the whole of the mouth, and the protuberance
thereof extends beyond the teeth. This species is called
Cynanche, either from its being a common affection of those
animals, or from its being a customary practice for dogs to
protrude the tongue even in health.
The opposite symptoms attend the other species; namely,
collapse of the organs, and diminution of the natural size,
with intense feeling of suffocation, insomuch that it appears to
themselves as if the inflammation had disappeared to the internal
parts of the thorax, and had seized upon the heart and
lungs. This we call Synanche, as if from the disease inclining
inwardly and producing suffocation. It appears to me that
this is an illness of the spirit (
pneuma) itself, which has under-gone
a morbid conversion to a hotter and drier state, without
any inflammation of the organ itself. Nor is this any great
wonder. For in the Charonæan caves the most sudden suffocations
occur from no affection of any organ,
1 but the persons
die from one inspiration, before the body can sustain any
injury. But likewise a man will be seized with
rabies, from
respiring the effluvia of the tongue of a dog, without having
been bitten. It is not impossible then, that such a change of
the respiration should occur within, since many other phenomena
which occur in a man bear a resemblance to external
causes, such as juices which become spoiled both within and
without. And diseases resemble deleterious substances, and
men have similar vomitings from medicines and from fevers.
Hence, also, it was not a wonderful thing, that in the
plague of Athens, certain persons fancied that poisonous
substances had been thrown into the wells in the Piræus
by the Peloponnesians; for these persons did not perceive
the affinity between a pestilential disease and deleterious
substances.
Cases of Cynanche are attended with inflammation of the
tonsils, of the fauces, and of the whole mouth; the tongue
protrudes beyond the teeth and lips; they have salivation, the
phlegm running out very thick and cold; they have their faces
ruddy and swollen; their eyes protuberant, wide open, and
red; the drink regurgitates by the nostrils. The pains
violent, but obscured by the urgency of the suffocation; the
chest and heart are in a state of inflammation; there is a longing
for cold air, yet they inspire but little, until they are
suffocated from the obstruction of the passage to the chest.
In certain cases, there is a ready transference of the disease to
the chest, and these die from the metastasis; the fevers feeble,
slight, bringing no relief. But if, in any case, there is a turn
to the better, abscesses form on either side, near the ears externally,
or internally about the tonsils; and if these occur
with torpor, and are not very protracted, the patients recover,
indeed, but with pain and danger. But, if a particularly
large swelling should occur, in such cases as are converted
to an abscess, and the abscess is raised to a point, they
are quickly suffocated. Such are the peculiar symptoms of
cynanche.
Those of Synanche are, collapse, tenuity, and paleness; the
eyes hollow, sunk inwardly; the fauces and uvula retracted
upwards, the tonsils approaching one another still more; loss
of speech: the feeling of suffocation is much stronger in this
species than in the former, the mischief being seated in the
chest whence the source of respiration. In the most acute
cases, the patients die the same day, in some instances, even
before calling in the physician; and in others, although called
in, he could afford them no relief, for they died before the
physician could apply the resources of his art. In those in
which the disease takes a favourable turn, all the parts become
inflamed, the inflammation being determined outwardly, so
that the disease becomes cynanche in place of synanche. It is
also a good thing when a strong swelling, or erysipelas, appears
externally on the chest. And the skilful physician diverts the
mischief to the chest by means of the cupping-instrument, or
by applying mustard to the breast and the parts near the jaws
he determines outwardly and discusses the disease. In certain
cases, indeed, the evil by these means has been for a time driven
outwards, but when so driven out it speedily reverts, and produces
suffocation.
The causes are infinite, more especially exposure to cold,
and, less frequently, to heat; blows; fish-bones fixed in the
tonsils, cold draughts, intoxication, repletion, and the ills from
respiration.
CHAPTER VIII. ON THE AFFECTIONS ABOUT THE UVULA
THE solid body suspended from the roof of the mouth
between the two tonsils is called columella and gurgulio. Uva
is the name of the affection. The columella (
uvula) is of a
nervous nature, but humid, for it is situated in a humid
region. Wherefore this body, the columella, suffers from
various affections, for it becomes thickened from inflammation,
being elongated and of equal thickness from the base to
the extremity, and is attended with redness. Columna is the
appellation of this affection. If it be rounded towards the
extremity alone, and with its enlargement become livid and
darkish, the name of the affection is Uva; for it altogether
resembles a grape in figure, colour, and size. A third affection
is that of the membranes when they have the appearance
of broad sails, or the wings of bats, on this side and on that.
This is called Lorum, for the lengthened folds of the membranes
resemble thongs. But if the columella terminates in a
slender and elongated membrane, having at its extremity a
resemblance to the butt-end of a spear, it gets the name of
Fimbria. This affection arises spontaneously from a defluxion,
like the others, but also from an oblique incision when the
surgeon leaves the membrane at one side.
2 But if the organ
(uvula) become bifid with two membranes hanging on this
side and on that, it has no distinct appellation, but it is an
easy matter for any one who sees it to recognise the nature of
the disease.
A sense of suffocation accompanies all these affections, and
they can by no means swallow with freedom. There is cough
in all the varieties, but especially in those named lorum and
fimbria. For a titillation of the trachea is produced by the
membrane, and in some cases it secretly instils some liquid
into the windpipe, whence they cough. But in uva and
columella there is still more dyspnœa and very difficult
deglutition; for, in these cases, the fluid is squeezed up to the
nostrils, from sympathy of the tonsils. The columella is
common in old persons, the uva in the young and in adults;
for they abound in blood, and are of a more inflammatory
nature. The affections of the membranes are common in
puberty and infancy. It is safe to apply the knife in all
these varieties; but in the uva, while still red, hemorrhage,
pains, and increase of inflammation supervene.
CHAPTER IX. ON ULCERATIONS ABOUT THE TONSILS
ULCERS occur on the tonsils; some, indeed, of an ordinary
nature, mild and innocuous; but others of an unusual kind,
pestilential, and fatal. Such as are clean, small, superficial,
without inflammation and without pain, are mild; but such as
are broad, hollow, foul, and covered with a white, livid,
or black concretion, are pestilential. Aphtha is the name
given to these ulcers. But if the concretion has depth, it
is an Eschar and is so called: but around the eschar there is
formed a great redness, inflammation, and pain of the veins, as
in carbuncle; and small pustules form, at first few in number,
but others coming out, they coalesce, and a broad ulcer is
produced. And if the disease spread outwardly to the mouth,
and reach the columella (
uvula) and divide it asunder, and if
it extend to the tongue, the gums, and the alveoli, the teeth
also become loosened and black; and the inflammation seizes
the neck; and these die within a few days from the inflammation,
fever, fœtid smell, and want of food. But, if it spread
to the thorax by the windpipe, it occasions death by suffocation
within the space of a day. For the lungs and heart can
neither endure such smells, nor ulcerations, nor ichorous discharges,
but coughs and dyspnœa supervene.
The cause of the mischief in the tonsils is the swallowing of
cold, rough, hot, acid, and astringent substances; for these parts
minister to the chest as to the purposes of voice and respiration;
and to the belly for the conveyance of food; and to the
stomach for deglutition. But if any affection occur in the
internal parts, namely, the belly, the stomach, or the chest, an
ascent of the mischief by the eructations takes place to the
isthmus faucium, the tonsils, and the parts there; wherefore
children, until puberty, especially suffer, for children in particular
have large and cold respiration; for there is most heat
in them; moreover, they are intemperate in regard to food,
have a longing for varied food and cold drink; and they bawl
loud both in anger and in sport; and these diseases are
familiar to girls until they have their menstrual purgation.
The land of Egypt especially engenders it, the air thereof
being dry for respiration, and the food diversified, consisting
of roots, herbs of many kinds, acrid seeds, and thick drink;
namely, the water of the Nile, and the sort of ale prepared
from barley. Syria also, and more especially Cœlosyria, engenders
these diseases, and hence they have been named
Egyptian and Syrian ulcers.
The manner of death is most piteous; pain sharp and hot
as from carbuncle;
3 respiration bad, for their breath smells
strongly of putrefaction, as they constantly inhale the same
again into their chest; they are in so loathsome a state that
they cannot endure the smell of themselves; countenance pale
or livid; fever acute, thirst is if from fire, and yet they do not
desire drink for fear of the pains it would occasion; for they
become sick if it compress the tonsils, or if it return by the
nostrils; and if they lie down they rise up again as not being
able to endure the recumbent position, and, if they rise up,
they are forced in their distress to lie down again; they mostly
walk about erect, for in their inability to obtain relief they
flee from rest, as if wishing to dispel one pain by another.
Inspiration large, as desiring cold air for the purpose of refrigeration,
but expiration small, for the ulceration, as if produced
by burning, is inflamed by the heat of the respiration.
Hoarseness, loss of speech supervene; and these symptoms
hurry on from bad to worse, until suddenly falling to the
ground they expire.
CHAPTER X. ON PLEURISY
UNDER the ribs, the spine, and the internal part of the thorax
as far as the clavicles, there is stretched a thin strong membrane,
adhering to the bones, which is named
succingens.
When inflammation occurs in it, and there is heat with cough
and parti-coloured sputa, the affection is named Pleurisy. But
all these symptoms must harmonise and conspire together as
all springing from one cause; for such of them as occur separately
from different causes, even if they all occur together,
are not called pleurisy. It is accompanied by acute pain of
the clavicles; heat acrid;
decubitus on the inflamed side easy,
for thus the membrane (
pleura) remains in its proper seat,
but on the opposite side painful; for by its weight, the inflammation
and suspension of the membrane, the pain stretches to
all its adhesions at the shoulders and clavicles; and in certain
cases even to the back and shoulder blade; the ancients called
this affection Dorsal pleurisy. It is attended with dyspnœa, insomnolency,
anorexia, florid redness of the cheeks, dry cough,
difficult expectoration of phlegm, or bilious, or deeply tinged
with blood, or yellowish; and these symptoms observe no
order, but come and go irregularly; but, worst of all, if the
bloody sputa cease, and the patients become delirious; and
sometimes they become comatose, and in their somnolency
the mind wavers.
But if the disease take a bad turn, all the symptoms getting
worse, they die within the seventh day by falling into syncope;
or, if the commencement of the expectoration, and the
more intense symptoms occurred with the second hebdomad,
they die on the fourteenth day. It sometimes happens that
in the intermediate period there is a transference of all the
symptoms to the lungs; for the lung attracts to itself, being
both porous and hot, and being moved for the attraction of
the substances around, when the patient is suddenly suffocated
by metastasis of the affection. But if the patient pass this
period, and do not die within the twentieth day, he becomes
affected with empyema. These, then, are the symptoms if
the disease get into a bad state.
But if it take a favourable turn, there is a profuse hemorrhage
by the nostrils, when the disease is suddenly resolved;
then follow sleep and expectoration of phlegm, and afterwards
of thin, bilious matters; then of still thinner, and again of
bloody, thick, and flesh-like; and if, with the bloody, the bile
return, and with it the phlegm, the patient's convalescence is
secure; and these symptoms, if they should commence on the
third day, with an easy expectoration of smooth, consistent,
liquid, and (not) rounded sputa, the resolution takes place on
the seventh day, when, after bilious discharges from the
bowels, there is freedom of respiration, the mind settled, fever
diminishing, and return of appetite. But if these symptoms
commence with the second week, the resolution occurs on the
fourteenth day.
But if not so, it is converted into Empyema, as indicated
by rigors, pungent pains, the desire of sitting erect, and the
respiration becoming worse. It is then to be dreaded, lest,
the lungs suddenly attracting the pus, the patient should be
thereby suffocated, after having escaped the first and greater
evils. But if the abscess creep in between the ribs and separate
them, and point outwardly; or, if it burst into an intestine,
for the most part the patient recovers.
Among the seasons of the year winter most especially engenders
the disease; next, autumn; spring, less frequently;
but summer most rarely. With regard to age, old men are
most apt to suffer, and most readily escape from an attack;
for neither is there apt to be a great inflammation in an arid
frame; nor is there a metastasis to the lungs, for old age is
more frigid than any other age, and the respiration small, and
the attraction of all things deficient. Young men and adults
are not, indeed, very apt to suffer attacks; but neither, also, do
they readily recover, for from a slight cause they would not
experience even a slight attack of inflammation, and from
great attacks there is greater danger. Children are least of all
liable to pleurisy, and in their case it is less frequently fatal;
for their bodies are rare, secretions copious, perspiration and
exhalation abundant; hence neither is a great inflammation
formed. This is the felicity of their period of life in the
present affection.
