CHAPTER VIII. ON THE ACUTE DISEASE OF THE VENA CAVA
FROM the portæ of the liver, there passes a wide vein
through
the space intermediate between its extremities, which, being
always divided into slender and more numerous branches, is
distributed at last all over the liver in vessels imperceptible to
the sight; and with their extremities anastomose the extremities
of other veins, which, at first, are slender and numerous,
grow larger and fewer in number, and, at last, they are collected
into one large vein; hence, having become two by
division, these pass through the liver. The upper one, then,
having passed through the first lobe, appears on its convex
side; then, having passed the diaphragm, it is inserted into the
heart: this is called the
vena cava. The other, having passed
through the lower lobe, the fifth, to its concave side, makes its
exit near the spine, and is extended along it as far as the ischiatic
region; and it, also, is called
vena cava. It obtains the same
name, as being one and the same vein, which derives its origin
from the liver. For if one choose, one may pass a plate of
metal from the vena cava connected with the heart to that by
the spine, and from the spine through the liver to the heart;
for it is the same passage leading upwards.
This vein, then, as I think, is all diseased in acute and
strong affections; for it is altogether one vein. But other
physicians fancy that only the part along the spine is affected,
because there are no manifest symptoms in regard to the
portion about the heart; for it is extended through the chest,
having no adhesions, but floating in the chest, until, from the
diaphragm, it adheres to the heart. If, then, any of the
great ailments seize this vein, they are concealed by the thorax
surrounding it.
Wherefore
kedmata1 also form about this vein when a
hemorrhage,
bursting forth quickly proves fatal, the blood being
discharged by the lungs and the arteria aspera, if it burst in
the chest; but if, at its origin, the blood is poured into the
lower belly, so that the bowels float in it, when the patients
die before the blood makes its appearance, the belly being
filled with blood.
Inflammation likewise forms about the vein, and it, also,
proves fatal, if it be great; for there is an acrid and pungent
heat enclosed in the cavities of both, but little surpassing what
is natural, so that to the touch the heat appears to be slight;
but the patient fancies himself burning hot; pulse small, very
frequent, so as to appear compressed and forcibly accelerated;
coldness of the extremities; intense thirst; dryness of the mouth;
redness of countenance, along with paleness; he is reddish
over the whole body; hypochondriac region hard, and retracted
upwards; pain principally on the right side, and palpitation
therein, extending to the flanks; and in certain cases, also, of
the artery along the spine, provided the pulsation displays
itself in the other hypochondriac region; for lying, as it does,
on the left side, it sympathises with the other; the exhalation
in the general system affording no relief, and not even making
the skin soft, for it is dry, shrivelled, and rough; and more
especially in the regions of the body where the bones are
prominent, such as the back part of the elbow, the knees, or
the knuckles. Sleep disturbed; the bowels, in certain cases,
discharging nothing, and in others, the discharges small, acrid,
bilious; urine, a bright yellow and pungent; not disordered, indeed,
in mind, but they are torpid and wasted. Hence, those
who have seen this constitution of disease have called it Causus,
for the present symptoms are those of a species of Causus; and
in autumn there is a tendency to malignity, both in adults and
the young, in whom the habit of body is slender, from bad
diet and hard labour. These, for the most part, die on the
fourteenth day; but when the disease is protracted, they die
in double that period. But those who either originally have a
slight inflammation, or when a great inflammation is gradually
resolved, escape the disease indeed, but never get rid of the
mischief; for they labour under causus a long time. But the
dangerous symptoms cease, namely, the pains, distension of
the hypochondria, the bad pulse, and torpor of the intellect;
but still they have nausea, are ill at ease, with distress of mind;
and, moreover, these are attended with an accession of causus
and thirst, dryness of the tongue and mouth; they inspire
largely, drawing in a long and copious breath, as if wishing to
draw in the whole atmosphere, for the purpose of refrigeration.
And if they drink a large draught of cold water, they are
relieved, indeed, for a short time; but then again the thirst is
kindled up, and again they drink copiously. And this is the
successive course of the malady. And a good physician would
give with impunity a copious cold draught, as in other
species of causus, and even with less risk, in the case of those
labouring under causus from disease of the
vena cava. And
if either the bowels or the bladder carry off the drink, there
is no necessity for inducing vomiting; but if not, after much
cold drink much vomiting must be induced. For the patient
would burst, if, after drinking so much, he should have no
discharges by sweating, by urine, or by the bowels.
