Book 1

OF chronic diseases the pain is great, the period of wasting long, and the recovery uncertain; for either they are not dispelled at all, or the diseases relapse upon any slight error; for neither have the patients resolution to persevere to the end; or, if they do persevere, they commit blunders in a prolonged regimen. And if there also be the suffering from a painful system of cure,—of thirst, of hunger, of bitter and harsh medicines, of cutting or burning,—of all which there is sometimes need in protracted diseases, the patients resile as truly preferring even death itself. Hence, indeed, is developed the talent of the medical man, his perseverance, his skill in diversifying the treatment, and conceding such pleasant things as will do no harm, and in giving encouragement. But the patient also ought to be courageous, and co-operate with the physician against the disease. For, taking a firm grasp of the body, the disease not only wastes and corrodes it quickly, but frequently disorders the senses, nay, even deranges the soul by the intemperament of the body. Such we know mania and melancholy to be, of which I will treat afterwards. At the present time I shall give an account of cephalæa.

IF the head be suddenly seized with pain from a temporary cause, even if it should endure for several days, the disease is called Cephalalgia. But if the disease be protracted for a long time, and with long and frequent periods, or if greater and more untractable symptoms supervene, we call it Cephalæa.

There are infinite varieties of it; for, in certain cases, the pain is incessant and slight, but not intermittent; but in others it returns periodically, as in quotidian fevers, or in those which have exacerbations every alternate day: in others it continues from sunset to noon, and then completely ceases; or from noon to evening, or still further into night; this period is not much protracted. And in certain cases the whole head is pained; and the pain is sometimes on the right and sometimes on the left side, or the forehead, or the bregma; and these may all occur the same day in a random manner.

But in certain cases, the parts on the right side, or those on the left solely, so far that a separate temple, or ear, or one eyebrow, or one eye, or the nose which divides the face into two equal parts; and the pain does not pass this limit, but remains in the half of the head. This is called Heterocrania, an illness by no means mild, even though it intermits, and although it appears to be slight. For if at any time it set in acutely, it occasions unseemly and dreadful symptoms; spasm and distortion of the countenance take place; the eyes either fixed intently like horns, or they are rolled inwardly to this side or to that; vertigo, deep-seated pain of the eyes as far as the meninges; irrestrainable sweat; sudden pain of the tendons, as of one striking with a club; nausea; vomiting of bilious matters; collapse of the patient; but, if the affection be protracted, the patient will die; or, if more slight and not deadly, it becomes chronic; there is much torpor, heaviness of the head, anxiety, and ennui. For they flee the light; the darkness soothes their disease: nor can they bear readily to look upon or hear anything agreeable; their sense of smell is vitiated, neither does anything agreeable to smell delight them, and they have also an aversion to fetid things: the patients, moreover, are weary of life, and wish to die.

The cause of these symptoms is coldness with dryness. But if it be protracted and increase, as regards the pains, the affection becomes Vertigo.

IF darkness possess the eyes, and if the head be whirled round with dizziness, and the ears ring as from the sound of rivers rolling along with a great noise, or like the wind when it roars among the sails, or like the clang of pipes or reeds, or like the rattling of a carriage, we call the affection Scotoma (or Vertigo); a bad complaint indeed, if a symptom of the head, but bad likewise if the sequela of cephalæa, or whether it arises of itself as a chronic disease. For, if these symptoms do not pass off, but the vertigo persist, or if, in course of time, from the want of any one to remedy, it is completed in its own peculiar symptoms, the affection vertigo is formed, from a humid and cold cause. But if it turn to an incurable condition, it proves the commencement of other affections—of mania, melancholy, or epilepsy, the symptoms peculiar to each being superadded. But the mode of vertigo is, heaviness of the head, sparkles of light in the eyes along with much darkness, ignorance of themselves and of those around; and, if the disease go on increasing, the limbs sink below them, and they crawl on the ground; there is nausea and vomitings of phlegm, or of yellow or black bilious matter. When connected with yellow bile, mania is formed; when with black, melancholy; when with phlegm, epilepsy; for it is liable to conversion into all these diseases.

EPILEPSY is an illness of various shapes and horrible; in the paroxysms, brutish, very acute, and deadly; for, at times, one paroxysm has proved fatal. Or if from habit the patient can endure it, he lives, indeed, enduring shame, ignominy, and sorrow: and the disease does not readily pass off, but fixes its abode during the better periods and in the lovely season of life. It dwells with boys and young men; and, by good fortune, it is sometimes driven out in another more advanced period of life, when it takes its departure along with the beauty of youth; and then, having rendered them deformed, it destroys certain youths from envy, as it were, of their beauty, either by loss of the faculties of a hand, or by the distortion of the countenance, or by the deprivation of some one sense. But if the mischief lurk there until it strike root, it will not yield either to the physician or the changes of age, so as to take its departure, but lives with the patient until death. And sometimes the disease is rendered painful by its convulsions and distortions of the limbs and of the face; and sometimes it turns the mind distracted. The sight of a paroxysm is disagreeable, and its departure disgusting with spontaneous evacuations of the urine and of the bowels.

But also it is reckoned a disgraceful form of disease; for it is supposed, that it is an infliction on persons who have sinned against the Moon: and hence some have called it the Sacred Disease, and that for more reasons than one, as from the greatness of the evil, for the Greek word ἱερὸς also signifies great; or because the cure of it is not human, but divine; or from the opinion that it proceeded from the entrance of a demon into the man: from some one, or all these causes together, it has been called Sacred.

Such symptoms as accompany this disease in its acute form have been already detailed by me. But if it become inveterate, the patients are not free from harm even in the intervals, but are languid, spiritless, stupid, inhuman, unsociable, and not disposed to hold intercourse, nor to be sociable, at any period of life; sleepless, subject to many horrid dreams, without appetite, and with bad digestion; pale, of a leaden colour; slow to learn, from torpidity of the understanding and of the senses; dull of hearing; have noises and ringing in the head; utterance indistinct and bewildered, either from the nature of the disease, or from the wounds during the attacks; the tongue is rolled about in the mouth convulsively in various ways. The disease also sometimes disturbs the understanding, so that the patient becomes altogether fatuous. The cause of these affections is coldness with humidity.

BLACK bile, if it make its appearance in acute diseases of the upper parts of the body, is very dangerous; or, if it pass downwards, it is not free from danger. But in chronic diseases, if it pass downward, it terminates in dysentery and pain of the liver. But in women it serves as a purgation instead of the menses, provided they are not otherwise in a dangerous condition. But if it be determined upwards to the stomach and diaphragm, it forms melancholy; for it produces flatulence and eructations of a fetid and fishy nature, and it sends rumbling wind downwards, and disturbs the understanding. On this account, in former days, these were called melancholics and flatulent persons. And yet, in certain of these cases, there is neither flatulence nor black bile, but mere anger and grief, and sad dejection of mind; and these were called melancholics, because the terms bile (χολὴ) and anger (ὀργὴ) are synonymous in import, and likewise black (μέλαινα), with much (πολλὴ) and furious (θηριώδης). Homer is authority for this when he says:—

Then straight to speak uprose The Atreidan chief, who `neath his sway a wide-spread empire held: Sore vexed was he; his mighty heart in his dark bosom swelled With rage, and from his eyes the fire like lightning-flashes broke.

The melancholics become such when they are overpowered by this evil.

It is a lowness of spirits from a single phantasy, without fever; and it appears to me that melancholy is the commencement and a part of mania. For in those who are mad, the understanding is turned sometimes to anger and sometimes to joy, but in the melancholics to sorrow and despondency only. But they who are mad are so for the greater part of life, becoming silly, and doing dreadful and disgraceful things; but those affected with melancholy are not every one of them affected according to one particular form; but they are either suspicious of poisoning, or flee to the desert from misanthropy, or turn superstitious, or contract a hatred of life. Or if at any time a relaxation takes place, in most cases hilarity supervenes, but these persons go mad.

But how, and from what parts of the body, the most of these complaints originate, I will now explain. If the cause remain in the hypochondriac regions, it collects about the diaphragm, and the bile passes upwards, or downwards in cases of melancholy. But if it also affects the head from sympathy, and the abnormal irritability of temper change to laughter and joy for the greater part of their life, these become mad rather from the increase of the disease than from change of the affection.

Dryness is the cause of both. Adult men, therefore, are subject to mania and melancholy, or persons of less age than adults. Women are worse affected with mania than men. As to age, towards manhood, and those actually in the prime of life. The seasons of summer and of autumn engender, and spring brings it to a crisis.

The characteristic appearances, then, are not obscure; for the patients are dull or stern, dejected or unreasonably torpid, without any manifest cause: such is the commencement of melancholy. And they also become peevish, dispirited, sleepless, and start up from a disturbed sleep.

Unreasonable fear also seizes them, if the disease tend to increase, when their dreams are true, terrifying, and clear: for whatever, when awake, they have an aversion to, as being an evil, rushes upon their visions in sleep. They are prone to change their mind readily; to become base, mean-spirited, illiberal, and in a little time, perhaps, simple, extravagant, munificent, not from any virtue of the soul, but from the changeableness of the disease. But if the illness become more urgent, hatred, avoidance of the haunts of men, vain lamentations; they complain of life, and desire to die. In many, the understanding so leads to insensibility and fatuousness, that they become ignorant of all things, or forgetful of themselves, and live the life of the inferior animals. The habit of the body also becomes perverted; colour, a darkish-green, unless the bile do not pass downward, but is diffused with the blood over the whole system. They are voracious, indeed, yet emaciated; for in them sleep does not brace their limbs either by what they have eaten or drunk, but watchfulness diffuses and determines them outwardly. Therefore the bowels are dried up, and discharge nothing; or, if they do, the dejections are dried, round, with a black and bilious fluid, in which they float; urine scanty, acrid, tinged with bile. They are flatulent about the hypochondriac region; the eructations fetid, virulent, like brine from salt; and sometimes an acrid fluid, mixed with bile, floats in the stomach. Pulse for the most part small, torpid, feeble, dense, like that from cold.

A story is told, that a certain person, incurably affected, fell in love with a girl; and when the physicians could bring him no relief, love cured him. But I think that he was originally in love, and that he was dejected and spiritless from being unsuccessful with the girl, and appeared to the common people to be melancholic. He then did not know that it was love; but when he imparted the love to the girl, he ceased from his dejection, and dispelled his passion and sorrow; and with joy he awoke from his lowness of spirits, and he became restored to understanding, love being his physician.

THE modes of mania are infinite in species, but one alone in genus. For it is altogether a chronic derangement of the mind, without fever. For if fever at any time should come on, it would not owe its peculiarity to the mania, but to some other incident. Thus wine inflames to delirium in drunkenness; and certain edibles, such as mandragora and hyoscyamus, induce madness: but these affections are never called mania; for, springing from a temporary cause, they quickly subside, but madness has something confirmed in it. To this mania there is no resemblance in the dotage which is the calamity of old age, for it is a torpor of the senses, and a stupefaction of the gnostic and intellectual faculties by coldness of the system. But mania is something hot and dry in cause, and tumultuous in its acts. And, indeed, dotage commencing with old age never intermits, but accompanies the patient until death; while mania intermits, and with care ceases altogether. And there may be an imperfect intermission, if it take place in mania when the evil is not thoroughly cured by medicine, or is connected with the temperature of the season. For in certain persons who seemed to be freed from the complaint, either the season of spring, or some error in diet, or some incidental heat of passion, has brought on a relapse.

Those prone to the disease, are such as are naturally passionate, irritable, of active habits, of an easy disposition, joyous, puerile; likewise those whose disposition inclines to the opposite condition, namely, such as are sluggish, sorrowful, slow to learn, but patient in labour, and who when they learn anything, soon forget it; those likewise are more prone to melancholy, who have formerly been in a mad condition. But in those periods of life with which much heat and blood are associated, persons are most given to mania, namely, those about puberty, young men, and such as possess general vigour. But those in whom the heat is enkindled by black bile, and whose form of constitution is inclined to dryness, most readily pass into a state of melancholy. The diet which disposes to it is associated with voracity, immoderate repletion, drunkenness, lechery, venereal desires. Women also sometimes become affected with mania from want of purgation of the system, when the uterus has attained the development of manhood; but the others do not readily fall into mania, yet, if they do, their cases are difficult to manage. These are the causes; and they stir up the disease also, if from any cause an accustomed evacuation of blood, or of bile, or of sweating be stopped.

And they with whose madness joy is associated, laugh, play, dance night and day, and sometimes go openly to the market crowned, as if victors in some contest of skill; this form is inoffensive to those around. Others have madness attended with anger; and these sometimes rend their clothes and kill their keepers, and lay violent hands upon themselves. This miserable form of disease is not unattended with danger to those around. But the modes are infinite in those who are ingenious and docile,—untaught astronomy, spontaneous philosophy, poetry truly from the muses; for docility has its good advantages even in diseases. In the uneducated, the common employments are the carrying of loads, and working at clay,—they are artificers or masons. They are also given to extraordinary phantasies; for one is afraid of the fall of the oilcruets..... and another will not drink, as fancying himself a brick, and fearing lest he should be dissolved by the liquid.

This story also is told:—A certain joiner was a skilful artisan while in the house, would measure, chop, plane, mortice, and adjust wood, and finish the work of the house correctly; would associate with the workmen, make a bargain with them, and remunerate their work with suitable pay. While on the spot where the work was performed, he thus possessed his understanding. But if at any time he went away to the market, the bath, or on any other engagement, having laid down his tools, he would first groan, then shrug his shoulders as he went out. But when he had got out of sight of the domestics, or of the work and the place where it was performed, he became completely mad; yet if he returned speedily he recovered his reason again; such a bond of connection was there between the locality and his understanding.

The cause of the disease is seated in the head and hypochondriac region, sometimes commencing in both together, and the one imparting it to the other. In mania and melancholy, the main cause is seated in the bowels, as in phrenitis it is mostly seated in the head and the senses. For in these the senses are perverted, so that they see things not present as if they were present, and objects which do not appear to others, manifest themselves to them; whereas persons who are mad see only as others see, but do not form a correct judgment on what they have seen.

If, therefore, the illness be great, they are of a changeable temper, their senses are acute, they are suspicious, irritable without any cause, and unreasonably desponding when the disease tends to gloom; but when to cheerfulness, they are in excellent spirits; yet they are unusually given to insomnolency; both are changeable in countenance, have headache, or else heaviness of the head; they are sharp in hearing, but very slow in judgment; for in certain cases there are noises of the ears, and ringings like those of trumpets and pipes. But if the disease go on to increase, they are flatulent, affected with nausea, voracious and greedy in taking food, for they are watchful, and watchfulness induces gluttony. Yet they are not emaciated like persons in disease (embonpoint is rather the condition of melancholics) and they are somewhat pale. But if any of the viscera get into a state of inflammation, it blunts the appetite and digestion; the eyes are hollow, and do not wink; before the eyes are images of an azure or dark colour in those who are turning to melancholy, but of a redder colour when they are turning to mania, along with purplecoloured phantasmata, in many cases as if of flashing fire; and terror seizes them as if from a thunderbolt. In other cases the eyes are red and blood-shot.

At the height of the disease they have impure dreams, and irresistible desire of venery, without any shame and restraint as to sexual intercourse; and if roused to anger by admonition or restraint, they become wholly mad. Wherefore they are affected with madness in various shapes; some run along unrestrainedly, and, not knowing how, return again to the same spot; some, after a long time, come back to their relatives; others roar aloud, bewailing themselves as if they had experienced robbery or violence. Some flee the haunts of men, and going to the wilderness, live by themselves.

If they should attain any relaxation of the evil, they become torpid, dull, sorrowful; for having come to a knowledge of the disease they are saddened with their own calamity.

ANOTHER SPECIES OF MANIA.

Some cut their limbs in a holy phantasy, as if thereby propitiating peculiar divinities. This is a madness of the apprehension solely; for in other respects they are sane. They are roused by the flute, and mirth, or by drinking, or by the admonition of those around them. This madness is of divine origin, and if they recover from the madness, they are cheerful and free of care, as if initiated to the god; but yet they are pale and attenuated, and long remain weak from the pains of the wounds.

Apoplexy, Paraplegia, Paresis, Paralysis, are all generically the same. For they are all a defect of motion, or of touch, or of both; sometimes also of understanding, and sometimes of other sense. But apoplexy is a paralysis of the whole body, of sensation, of understanding and of motion; wherefore to get rid of a strong attack of apoplexy is impossible, and of a weak, not easy. But paraplegia is a remission of touch and motion, but of a part, either of the hand or of the leg. Paralysis for the most part is the remission (paresis) of motion only, and of energy. But if the touch alone is wanting—(but such a case is rare)—the disease is called Anæsthesia rather than paresis. And when Hippocrates says, the leg on the same side was apoplectic, he means to say that it was in a death-like, useless, and incurable state; for what is strong apoplexy in the whole body, that he calls paraplegia in the limb. Paresis, properly speaking, is applied to suppression or incontinence of urine in the bladder. But distortion of the eye-brows, and of the cheeks, and of the muscles about the jaws and chin to the other side, if attended with spasm, has got the appellation of Cynic spasm. Loss of tone in the knees, and of sensibility for a time, with torpor, fainting, and collapse, we call lipothymia.

Wherefore, the parts are sometimes paralysed singly, as one eye-brow, or a finger, or still larger, a hand, or a leg; and sometimes more together; and sometimes the right or the left only, or each by itself, or all together, either entirely or in a less degree; and the parts only which are distant, homonymous, and in pairs—the eyes, hands, and legs; and also the parts which cohere, as the nose on one side, the tongue to the middle line of separation, and the one tonsil, the isthmus faucium, and the parts concerned in deglutition to one half. I fancy, also, that sometimes the stomach, the bladder, and the rectum, as far as its extremity, suffers in like manner; but the internal parts, when in a paralytic state, are concealed from the sight. Their functions, however, are but half performed; and from this I conclude, that these parts are half affected, as being cut in twain by the disease. And, indeed, this thing teaches us a lesson in respect to the diversity of power and discrimination between the right side and the left. For the inherent cause is equal; and means which occasion the affection are common in both cases, whether cold or indigestion, and yet both do not suffer equally. For Nature is of equal power in that which is equally paired; but it is impossible that the same thing should happen where there is an inequality. If, therefore, the commencement of the affection be below the head, such as the membrane of the spinal marrow, the parts which are homonymous and connected with it are paralysed: the right on the right side, and the left on the left side. But if the head be primarily affected on the right side, the left side of the body will be paralysed; and the right, if on the left side. The cause of this is the interchange in the origins of the nerves, for they do not pass along on the same side, the right on the right side, until their terminations; but each of them passes over to the other side from that of its origin, decussating each other in the form of the letter X. To say all at once, whether all together or separate parts be affected with paralysis..... or of both; sometimes the nerves from the head suffer (these, generally, induce loss of sensibility, but, in a word, they do not readily occasion loss of sensibility; but if they sympathise with the parts which are moved, they may undergo, in a small degree, the loss of motion); and sometimes those which pass from muscle to muscle (from the spinal marrow to the muscles), these have the power of motion, and impart it to those from the head; for the latter possess the greater part of their motory power from them, but yet have it, to a small extent, of themselves: the former, too, principally suffer loss of motion, but rarely of themselves experience anæsthesia; indeed, as appears to me, not at all. And if the ligaments of nerves, which derive their origin from certain of the bones, and terminate in others, be loosened or torn, the parts become powerless, and are impeded in their movements, but do not become insensible.

The varieties of paralysis are these: sometimes the limbs lose their faculties while in a state of extension, nor can they be brought back into the state of flexion, when they appear very much lengthened; and sometimes they are flexed and cannot be extended; or if forcibly extended, like a piece of wood on a rule, they become shorter than natural. The pupil of the eye is subject to both these varieties, for sometimes it is much expanded in magnitude, when we call it Platycoria; but the pupil is also contracted to a small size, when I call it Phthisis and Mydriasis. The bladder, also, is paralysed in respect to its peculiar functions; for either it loses its powers as regards distension, or it loses its retentive powers, or it becomes contracted in itself, when being filled with urine, it cannot expel the same. There are six causes of paralytic disorders; for they arise from a wound, a blow, exposure to cold, indigestion, venery, intoxication. But so likewise the vehement affections of the soul, such as astonishment, fear, dejection of spirits, and, in children, frights. Great and unexpected joy has also occasioned paralysis, as, likewise, unrestrained laughter, even unto death. These, indeed, are the primary causes; but the ultimate and vital cause is refrigeration of the innate heat. It suffers from humidity, or dryness, and is more incurable than the other; but if also in connection with a wound, and complete cutting asunder of a nerve, it is incurable. In respect to age, the old are peculiarly subject, and difficult to cure; in children, the cases are easily restored. As to seasons, the winter; next, the spring; afterwards, the autumn; least of all, the summer. Of habits, those naturally gross, the humid, indolent, brutish.

When the affections are confirmed, they are made manifest by loss of motion, insensibility of heat and cold; and also of plucking the hair, of tickling, and of touching. It is rare indeed when in them the extremities are painful; but insensibility to pain is not worse as regards recovery. Wherefore the disease occurs suddenly; but if at any time it have prolonged onsets, there supervene heaviness, difficulty of motion, torpor, a sensation of cold, sometimes an excess of heat, short sleeps, greater phantasies, when they become suddenly paralytic.

But in the Cynic spasm, it is not usual for all parts of the face to be cramped; but those of the left side are turned to the right, and those of the right to the left, when there is a considerable distortion of the jaw to this side or to that, as if the jawbone were dislocated. And in certain of these cases, also, there is luxation at the joint, when in yawning the jaw is displaced to the opposite side: strabismus of the affected eye, and palpitation in the under eyelid; the upper eyelid also palpitates, sometimes along with the eye, and at other times alone. The lips are distended, each on its own side; but sometimes both being collapsed, they splutter; in others, they are closely compressed, and are suddenly separated so as to expel the common spittle with a noise.

The tongue, also, is drawn aside; for it consists of a muscle and nerves, and at certain times, along its whole extent, it starts up to the palate, and makes an unusual sound. The uvula, also, is drawn aside; and if the mouth is shut, there is an unexpected noise within. And if you separate the mouth, you will perceive the uvula sometimes attached to the palate through its whole surface, and sometimes swiftly palpitating with force, like a bag-fish, when likewise a sound is produced. But there is apt to be deception in cynic spasms; for to the spectator it appears as if the parts unaffected were those possessed by the disease; for owing to the tension and colour of the affected parts, and the enlargement of the eye, they appear as if they were diseased. But in laughter, speaking, or winking, the true state of matters becomes manifest; for the parts affected are all drawn aside with a smack; the lip expresses no smile, and is motionless in talking; the eyelid is immoveable, the eye fixed, and the sense of touch is lost; while the sound parts speak, wink, feel, laugh.

IF an ulcer form in the lungs from an abscess, or from a chronic cough, or from the rejection of blood, and if the patient spit up pus, the disease is called Pye and Phthisis. But if matter form in the chest or side, or be brought up by the lungs, the name is Empyema. But if, in addition to these symptoms, the lungs contract an ulcer, being corroded by the pus passing through it, the disease no longer gets the name of empyema, but takes that of Phthoe instead of it. It is accompanied with febrile heat of a continual character, but latent ceasing, indeed, at no time, but concealed during the day by the sweating and coldness of the body; for the characteristics of phthoe are, that a febrile heat is lighted up, which breaks out at night, but during the day again lies concealed in the viscera, as is manifested by the uneasiness, loss of strength, and colliquative wasting. For had the febrile heat left the body during the day, how should not the patient have acquired flesh, strength, and comfortable feeling? For when it retires inwardly, the bad symptoms are all still further exacerbated, the pulse small and feeble; insomnolency, paleness, and all the other symptoms of persons in fever. The varieties of the sputa are numerous: livid, black, streaked, yellowish-white, or whitish-green; broad, round; hard, or glutinous; rare, or diffluent; devoid of smell, fetid. There are all these varieties of pus. But those who test the fluids, either with fire or water, would appear to me not to be acquainted with phthoe; for the sight is more to be trusted than any other sense, not only with regard to the sputa, but also respecting the form of the disease. For if one of the common people see a man pale, weak, affected with cough, and emaciated, he truly augurs that it is phthoe (consumption). But in those who have no ulcer in the lungs, but are wasted with chronic fevers—with frequent, hard, and ineffectual coughing, and bringing up nothing, these, also, are called consumptive, and not without reason. There is present weight in the chest (for the lungs are insensible of pain),—anxiety, discomfort, loss of appetite; in the evening coldness, and heat towards morning; sweat more intolerable than the heat as far as the chest; expectoration varied, as I have described.

Voice hoarse; neck slightly bent, tender, not flexible, somewhat extended; fingers slender, but joints thick; of the bones alone the figure remains, for the fleshy parts are wasted; the nails of the fingers crooked, their pulps are shrivelled and flat, for, owing to the loss of flesh, they neither retain their tension nor rotundity; and, owing to the same cause, the nails are bent, namely, because it is the compact flesh at their points which is intended as a support to them; and the tension thereof is like that of the solids. Nose sharp, slender; cheeks prominent and red; eyes hollow, brilliant and glittering; swollen, pale, or livid in the countenance; the slender parts of the jaws rest on the teeth, as if smiling; otherwise of a cadaverous aspect. So also in all other respects; slender, without flesh; the muscles of the arms imperceptible; not a vestige of the mammæ, the nipples only to be seen; one may not only count the ribs themselves, but also easily trace them to their terminations; for even the articulations at the vertebræ are quite visible; and their connections with the sternum are also manifest; the intercostal spaces are hollow and rhomboidal, agreeably to the configuration of the bone; hypochondriac region lank and retracted; the abdomen and flanks contiguous to the spine. Joints clearly developed, prominent, devoid of flesh, so also with the tibia, ischium, and humerus; the spine of the vertebræ, formerly hollow, now protrudes, the muscles on either side being wasted; the whole shoulder-blades apparent like the wings of birds. If in these cases disorder of the bowels supervene, they are in a hopeless state. But, if a favourable change take place, symptoms the opposite of those fatal ones occur.

The old seldom suffer from this disease, but very rarely recover from it; the young, until manhood, become phthisical from spitting of blood, and do recover, indeed, but not readily; children continue to cough even until the cough pass into phthoe, and yet readily recover. The habits most prone to the disease are the slender; those in which the scapulæ protrude like folding doors, or like wings; in those which have prominent throats; and those which are pale and have narrow chests. As to situations, those which are cold and humid, as being akin to the nature of the disease.

THOSE persons in whose cavities above, along the region of the chest, or, in those below the diaphragm, abscesses of matter form, if they bring it up, they are said to be affected with Empyema; but if the matter pass downwards, they are said to labour under Apostemes. And in the ulcers in the chest, or in the lungs, if phthoe supervene, or in the pleura, or the sternum, or anywhere below at the junction of the lungs with the spine — in all these cases the passage for the matter upwards is by the lungs. But in the viscera below the diaphragm, the liver, spleen, and kidneys, it is by the bladder; and in women by the womb. And I once made an opening into an abscess in the colon on the right side near the liver, and much pus rushed out, and much also passed by the kidneys and bladder for several days, and the man recovered.

The common causes of all are a blow, indigestion, cold and the like. Of those in the chest also, chronic cough, pleuritis, peripneumony, and protracted defluxion; but also the determination of some acute diseases to any one of them.

The humour is sometimes inert, weak, and rests on something else; sometimes bitingly acrid, and occasioning putrefactions even unto death. And there are many other varieties, as I shall presently declare. It is a wonder how from a thin, slender membrane, having no depth, like that which lines the chest, so much pus should flow; for in many cases there is a great collection. The cause is an inflammation from redundancy of blood, by which the membrane is thickened; but from much blood much pus is formed intermediately. But if it be determined inwards, the ribs being the bones in this region....... I have said above, that another species of phthisis would naturally occur. But if it point outwards, the bones are separated, for the top of the abscess is raised in one of the intercostal spaces, when the ribs are pushed to this side or to that.

There are certain symptoms common to all, and certain ones peculiar to each. A heaviness rather than pain is a common symptom (for the lungs are insensible), weak fevers, rigor towards evening, sweats in the remission, insomnolency, swellings in the extremities of the feet, and fingers of the hands, which at one time abate and at another increase; uncomfortable feeling; loss of appetite; wasting of the whole body; and if the change be prolonged, the phthisical habit is formed; for Nature can no longer perform her office, for the digestion is not as before, nor is there the plump habit of body; the colour dark; respiration in all cases bad, but worse in those affecting the upper cavity; but also cough at first as long as the inflammation is urgent, when the pains also are greater, and rigor, and heat, and watchfulness, and dyspnœa still more; pulse small, sluggish, feeble; they are disordered in the intellect; distension of the thorax.

But if it be already come to the formation of pus, all the the greatest symptoms take place. Expectoration small with greater cough, and from an urgent abscess, at first of pituitous matters, tinged with bile of a darker colour as if from soot, but likewise tinged with blood, and thick; but if about to burst, of fleshy and deep-seated matter. And, if it burst, there is danger of suffocation should much pus be suddenly poured forth; but if gradually, there is no danger. If then the pus is going to pass downwards, the upper part, where the abscess is situated, experiences sharp pain; discharges from the bowels fluid, at first watery with phlegm, afterwards bloody matter; and then again, substances resembling flesh floating in a fluid, if it has already burst. Pus follows them either by the bowels or the urine. Metastasis to the kidneys and bladder peculiarly favourable.

The pus, whether it be carried upwards or downwards, is of various colours—pale, white, ash-coloured, or livid, black and fetid; or devoid of smell and very thick; or intermediate; or smooth and consistent; or rough and unequal, with fleshy substances floating in it, these being round or broad, readily separated or viscid. To say all in a word respecting the pus, such kinds as are white, concocted, devoid of smell, smooth, rounded, and are quickly coughed up, or pass downwards, are of a salutary character; but such as are very pale, bilious, and inconsistent, are bad. Of these by far the worst are the livid and black, for they indicate putrefaction and phagedenic ulcers.

Along with these things, it will be proper to know also the habit and other concomitants of the disease. If at the time of the discharge, he feels comfortable, and gets rid of the fever; has good digestion, good colour, and a good appetite, if he coughs up readily, has a good pulse, and good strength; the patient is free from danger. But if fever supervene, and all the other symptoms turn worse, he is in a hopeless state. One ought also to consider the places in which the abscesses are seated. For where the matter forms in the sternum, it is slowly turned to a suppuration; for the parts are slender, devoid of flesh and cartilaginous; and such parts do not readily receive the superfluities of inflammation, but remain a long time without being formed into pus; for cartilage is of a cold nature, but the inflammations thereof are innocuous. The wasting of the constitution is bad; for the suppuration lasts a long time; the spleen, the liver, the lungs, and diaphragm pass more quickly into suppuration, but they are dangerous and fatal.

WHEN, in cases of peripneumonia, the patients survive, though the inflammation be not discussed, those who escape the acute stage of the affection have suppurations. The symptoms, then, of an incipient and of a formed abscess have been stated by me under Empyema. If formed, then, there is no necessity for the same harsh measures and pains to procure the rupture and discharge of it as in the solid parts of the body, as it is readily brought up; for the distension of its pores is required rather than of the solid texture of its parts; for the lungs being a porous body and full of perforations like a sponge, it is not injured by the humour, but transmits it from pore to pore, until it reach the trachea. Thus the fluid finds a ready outlet, the pus being a flexible and slippery substance, and the respiration blows the breath (pneuma) upwards. For the most part they recover, unless at any time one be suffocated by the copious influx of the fluid, when, owing to the quantity of the pus, the trachea does not admit the air. Others die a protracted death, after the manner of those labouring under phthisis and empyema. The pus is white and frothy, being mixed with saliva, but sometimes ash-coloured or blackish. And sometimes one of the bronchia has been spit up in a case of large ulceration, if the abscess is deep, when portions of the viscus are also brought up. Hoarse, breathing short, voice heavy-toned, their chest becomes broad, and yet they stand in need of its being still broader, owing to the collection of fluid; the dark parts of the eyes glancing, the whites are very white and fatty; cheeks ruddy; veins in the forehead protuberant. There is a marvel in connection with these cases, how the strength is greater than the condition of the body, and the buoyancy of spirits surpasses the strength.

IF from running, gymnastic exercises, or any other work, the breathing become difficult, it is called Asthma (ἆσθμα); and the disease Orthopnœa (ὀρθόπνοια) is also called Asthma, for in the paroxysms the patients also pant for breath. The disease is called Orthopnœa, because it is only when in an erect position (ὀρθίῳ σχήματι) that they breathe freely; for when reclined there is a sense of suffocation. From the confinement in the breathing, the name Orthopnœa is derived. For the patient sits erect on account of the breathing; and, if reclined, there is danger of being suffocated.

The lungs suffer, and the parts which assist in respiration, namely the diaphragm and thorax, sympathise with them. But if the heart be affected, the patient could not stand out long, for in it is the origin of respiration and of life.

The cause is a coldness and humidity of the spirit (pneuma); but the materiel is a thick and viscid humour. Women are more subject to the disease than men, because they are humid and cold. Children recover more readily than these, for nature in the increase is very powerful to heat. Men, if they do not readily suffer from the disease, die of it more speedily. There is a postponement of death to those in whom the lungs are warmed and heated in the exercise of their trade, from being wrapped in wool, such as the workers in gypsum, or braziers, or blacksmiths, or the heaters of baths.

The symptoms of its approach are heaviness of the chest; sluggishness to one’s accustomed work, and to every other exertion; difficulty of breathing in running or on a steep road; they are hoarse and troubled with cough; flatulence and extraordinary evacuations in the hypochondriac region; restlessness; heat at night small and imperceptible; nose sharp and ready for respiration.

But if the evil gradually get worse, the cheeks are ruddy; eyes protuberant, as if from strangulation; a a râle during the waking state, but the evil much worse in sleep; voice liquid and without resonance; a desire of much and of cold air; they eagerly go into the open air, since no house sufficeth for their respiration; they breathe standing, as if desiring to draw in all the air which they possibly can inhale; and, in their want of air, they also open the mouth as if thus to enjoy the more of it; pale in the countenance, except the cheeks, which are ruddy; sweat about the forehead and clavicles; cough incessant and laborious; expectoration small, thin, cold, resembling the efflorescence of foam; neck swells with the inflation of the breath (pneuma); the præcordia retracted; pulse small, dense, compressed; legs slender: and if these symptoms increase, they sometimes produce suffocation, after the form of epilepsy.

But if it takes a favourable turn, cough more protracted and rarer; a more copious expectoration of more fluid matters; discharges from the bowels plentiful and watery; secretion of urine copious, although unattended with sediment; voice louder; sleep sufficient; relaxation of the præcordia; sometimes a pain comes into the back during the remission; panting rare, soft, hoarse. Thus they escape a fatal termination. But, during the remissions, although they may walk about erect, they bear the traces of the affection.

PNEUMODES is a species of asthma; and the affection is connected with the lungs as is the case in asthma. The attendant symptoms are common, and there is but little difference; for dyspnœa, cough, insomnolency, and heat are common symptoms, as also loss of appetite and general emaciation. Moreover, the disease is protracted for a time, yet not longer than one year; for, if the autumn begin it, the patients die in the spring or in the summer; or if the winter, they terminate their life towards the autumn. Old persons also are at certain times readily seized; and being seized with rigors, it requires but a slight inclination of the scale to lay them on the bed of death. All labour in particular under want of breath; pulse small, frequent, feeble. But these symptoms are also common to asthma; they have this as peculiar; they cough as if going to expectorate, but their effort is vain, for they bring up nothing; or if anything is forcibly separated from the lungs, it is a small, white, round substance, resembling a hailstone. The thorax is broader, indeed, than natural, but not altered in shape, and is free from ulceration; yet, though the lungs be free from suppuration, they are filled with humours, which are, as it were, compacted. The intervals of the paroxysms in this affection are greater. Some, indeed, die speedily of suffocation before anything worse is transferred to the general system. In other cases the affection terminates in dropsy about the loins, or in anasarca.

IN the formation of the body, the liver and spleen are equally balanced; for these viscera are equal in number, the one on the right side and the other on the left. They are unequal, however, in power, as regards health and diseases. In health, indeed, inasmuch as the liver has the power of nutrition, for the roots of all the veins unite to form the liver: but in diseases it has much greater power to restore health and occasion death. As far, then, as the liver is superior in health, so much the worse is it in diseases, for it experiences more sudden and violent inflammations, and has more frequent and more fatal abscesses. In scirrhus, too, it proves fatal more quickly and with greater pain than the spleen. Those things which relate to inflammations thereof I have described among the acute affections.

If it be converted into pus, a sharp pain possesses the parts as far as the clavicle and the tops of the shoulders, for the diaphragm from which the liver is suspended is dragged down by the weight, and the diaphragm drags the membrane lining the ribs to which it is attached, and this membrane (the pleura) is stretched up to the clavicle and top of the shoulders, which also are dragged down. Along with the abscess there is acrid heat and rigors; cough dry and very frequent; colour grass-green; and if the patients be intensely jaundiced, it is of the white kind; sleep not quite clear of phantasies; on the main, their understanding settled; or if, from any temporary cause, there be delirium, it quickly passes off; swelling under the nipples or sides, which deceives many, as if it proceeded from the peritoneum. But if there be swelling and pain on pressure below the false ribs, the liver is swelled; for it is filled by a collection of fluid. But if the collection is not below the bone, it is a symptom of the membrane (the peritoneum) being affected, and its boundaries are distinctly circumscribed; for the hand applied in pressure, after passing the circumference of the liver, sinks down into an empty space in the abdomen. But the hardness of the peritoneum is undefined, and no process at its extremity is apparent. If the process incline inwardly, nature is far superior to the physician; for it is either turned upon the bowels or the bladder, and far the least dangerous is the passage by the bladder: but if it incline outwards, it is bad not to make an incision, for otherwise the liver is corroded by the pus, and death is not long deferred. But, if you intend to make an incision, there is danger of hemorrhage, from which the patient may die suddenly; for hemorrhage in the liver cannot be checked. But if you are reduced to the necessity of making an incision, heat a cautery in the fire to a bright heat, and push it down to the pus, for it at the same time cuts and burns: and if the patient survive, there will run out a white, concocted, smooth, not fetid, very thick pus, by which the fever and other bad symptoms are diminished, and altogether the health is restored. But if the pus passes into the intestines, the belly has watery discharges at first, but afterwards they resemble the washings of flesh, and, again, they are like those in dysentery proceeding from ulcerations; but sometimes a bloody ichor, or thrombus is passed. Bile also is discharged, intensely yellow, or leekgreen, and, lastly, before death, black.

But if the abscess do not suppurate, and the discharges from the bowels are fetid like putrefaction, the food passes undigested, owing to the stomach and intestines having lost their tone; for thus the liver, even though now in good condition, does not perform digestion; along with these symptoms there is acrid heat, and altogether there is a turn to the worse; colliquative wasting of the flesh, pulse small, difficulty of breathing, when at no distance of time their life is at an end. In certain cases, the dysentery and the ulceration have healed, but the disease changed to dropsy. But if all these symptoms abate, if pus that is white, smooth, consistent, and inodorous, is discharged, and the stomach digests the food, there may be good hopes of the patient. But the best thing is for it to be discharged by the urine; for the passage by it is safer and less troublesome than the other.

But if, after the inflammation, the liver does not suppurate, the pain does not go off, its swelling, changing to a hard state, settles down into scirrhus; in which case, indeed, the pain is not continued, and when present is dull; and the heat is slight; there is loss of appetite; delight in bitter tastes, and dislike of sweet; they have rigors; are somewhat pale, green, swollen about the loins and feet; forehead wrinkled; belly dried up, or the discharges frequent. The cap of these bad symptoms is dropsy.

In the dropsy, provided there is a copious discharge of thick urine, having much re-crementitious sediment, there is a hope that the dropsical swelling may run off; but if the urine be thin, without sediment, and scanty, it conspires with the dropsy. But if nature change to her pristine state, and burst upon the bowels, along with copious watery discharges, it has also sometimes cured the dropsy. This mode of cure, however, is dangerous; for what from the copious evacuations, and the extreme prostration, the patients have sometimes died of weakness, as from hemorrhage. Sweating, if copious, carries off the disease with less danger, for dropsical persons generally have not a moist skin. Such is the termination of the affections in the liver.

But if the liver suppurate..... children, and those till manhood; women less so. The causes are intemperance, and a protracted disease, especially from dysentery and colliquative wasting; for it is customary to call these persons tabid who die emaciated from ulcers of the liver.

SCIRRHUS, a chronic disease, is habitual to the spleen (suppuration does not readily occur in it, and yet it does occur sometimes), when the pain is not severe, but swelling much greater than the pain; for it has been seen swelled on the right side as far as the liver in the whole common space between them, hence many have been deceived in supposing that it is not an affection of the spleen, but of the membrane, for it appears to them that the peritonæum is inflamed. It is hard and unyielding as stone. Such the spleen generally becomes in scirrhus, when also it is attended with great discomfort.

But if it suppurate, it is soft to the touch, yielding to pressure at its top, when there is a formation of pus; but when it is not suppurated it does not yield. Sometimes it hangs entire in the abdomen, being moved about to this side and to that, whilst it remains a small body, and has space to float in. Nausea, restlessness, especially about the time of breaking.

The symptoms of distension are, fevers, pains, and rigors (for generally they are free of rigors, and of pain when the heat is small, and hence abscess about the spleen is sometimes latent); for the viscus is porous and insensible even in health: they are swollen, dropsical, of a dark-green colour, along with disquietude, dyspnœa as if from weight of the chest, for the evil is well marked. Even to its upper parts the abdomen is filled with a flatus (pneuma), thick, misty, humid in appearance but not in reality; much desire of coughing comes on, and their expectoration is small and dry. If there be watery discharges from the bowels, they at first bring some slight relief; but if they increase, they waste the patient, and yet nevertheless they do good.

But, if it should break, pure concocted pus is never discharged, but whitish and ashy, sometimes feculent, or livid. If the abscess become deeper, the fluid is dark, when likewise some of the juice of the melted spleen is discharged. In certain cases, entire portions of the spleen have been brought up, for the spleen is of a soluble nature. And if the ulcer does not heal, but remains for a long time, they lose appetite, become cachectic, swollen, unseemly to look at, having many ulcers on all parts of the body, especially on the legs, where the sores are round, livid, hollow, foul, and difficult to heal. Wasted thereby, they expire.

In a small tumour, with hardness and resistance, pain is wanting; on this account they live a long time. But if overpowered by the affection, dropsy, phthisis, and wasting of the body necessarily supervene; and this form of death removes them from life.

Children, then, and young persons are most readily affected, and most readily escape from it. Old persons, indeed, do not often suffer, but they cannot escape; but certain elderly persons have been cut off by latent disease of the spleen; for, even with a small swelling, the scale of death has turned with them. A protracted and consumptive disease induces these affections, and in young persons inactivity especially, when, after contention and many exercises, the body has become inactive. As to localities, the marshy; as to waters, the thick, saltish, and fetid. Of the seasons, autumn is pecularly malignant.

If a distribution of bile, either yellow, or like the yolk of an egg, or like saffron, or of a dark-green colour, take place from the viscus, over the whole system, the affection is called Icterus, a dangerous complaint in acute diseases, for not only when it appears before the seventh day does it prove fatal, but even after the seventh day it has proved fatal in innumerable instances. Rarely the affection has proved a crisis to a fever towards the end, but itself is not readily discussed.

It is formed not only from a cause connected with the liver, as certain physicians have supposed, but also from the stomach, the spleen, the kidneys, and the colon. From the liver in this manner: if the liver become inflamed or contract scirrhus, but remain unchanged with regard to its functional office, it produces bile, indeed, in the liver, and the bladder, which is in the liver, secretes it; but if the passages which convey the bile to the intestine, be obstructed from inflammation or scirrhus, the bladder gets over-distended, and the bile regurgitates; it therefore becomes mixed with the blood, and the blood, passing over the whole system, carries the bile to every part of the body, which acquires the appearance of bile. But the hardened fæces are white and clayey, as not being tinged with bile, because the bowels are deprived of this secretion. Hence also the belly is very much dried up; for it is neither moistened nor stimulated by the bile. The colour in this species is whitish-green.

If jaundice make its appearance in connection with the spleen, it is dark-green, for its nutriment is black, because the spleen is the strainer of the black blood, the impurities of which it does not receive nor elaborate when diseased, but they are carried all over the body with the blood. Hence patients are dark-green from icterus in connection with the spleen; but the colour is darker than usual in the customary discharges from the bowels, for the superfluity of the nutriment of the spleen becomes recrement from the bowels.

And icterus also is formed in connection with the colon and stomach, provided their powers of digestion be vitiated; for digestion takes place even in the colon, and from it a supply of nutriment is sent upwards to the liver. Provided, then, the liver receive its other food in a cruder state than usual, it indeed goes through its own work, but leaves that of the other undone; for in distribution it diffuses the blood which carries the marks of the inactivity of the colon to all parts of the body. The indigestion in this case is connected with the formation of the bile in the colon.

Thus icterus may be formed in any viscus, not only of those which send nutriment to the liver, but also of those which receive it from the liver. For nature sends nutriment to all parts, not only by ducts perceptible to the senses, but much more so by vapours, which are readily carried from all parts to all, nature conducting them even through the solid and dense parts. Wherefore these vapours become tinged with bile, and discolour any part of the body in which they get lodged. Moreover, in jaundice connected with the colon, the evacuations are not white; for the liver is not disordered as regards the function of bile, and is not impeded in the transmission of bile to the intestines.

The general system, likewise, is most powerful in producing icterus; for the cause is seated in the whole body. It is of this nature: in every part there is heat for concoction; in every part for the creation and secretion of humours, different in different places, but in each that which is peculiar to it: in flesh, indeed, sweat; in the eyes, tears; in the joints and nose, mucus; in the ears, wax. If the heat, then, fails in the performance of each of its operations, it is itself converted into that which is acrid and fiery; but all the fluids become bile, for the products of heat are bitter, and stained with bile. But if indigestion happens in the blood, the blood assumes the appearance of bile, but is distributed as nourishment to all parts, wherefore bile appears everywhere. For it is a dire affection, the colour being frightful in appearance, and the patients of a golden colour; for the same thing is not becoming in a man which is beautiful in a stone. It is superfluous in me to tell whence the name is derived, further than that it is derived from certain four-footed and terrestrial animals, called ἰκτίδες, whose eyes are of this colour.

There are two species of the affection; for the colour of the whitish-green species either turns to yellow and saffron, or to livid and black. The cause of these is the same as the cause of the two kinds of bile; for, of the latter, one species—namely, the light-coloured—is yellow, thin, and transparent; but this species is also sometimes tinged so as to resemble saffron or the yolk of an egg. The other is of a darker character, like leeks, woad, or wholly black. There are innumerable intermediate varieties of colour, these being connected with the heat and humours. The viscera, also, co-operate in this; for the viscus is either a bright-red, like the liver, or dark-red, like the spleen. When, therefore, the icterus is connected with any viscus, if from the liver, it bears traces of this viscus, and if from the spleen, of it; and so, also, with regard to all the others. But if it possesses no appearance of any, it is an affection of the general habit. These appear manifest in the white of the eyes especially, and in the forehead about the temples; and in those naturally of a white complexion, even from a slight attack, the increased colour is visible.

In cases, therefore, of black icterus, the patients are of a dark-green colour, are subject to rigors, become faintish, inactive, spiritless; emit a fetid smell, have a bitter taste, breathe with difficulty, are pinched in the bowels; alvine evacuations like leeks, darkish, dry, passed with difficulty; urine deeply tinged with black; without digestion, without appetite; restless, spiritless, melancholic.

In the whiter species, the patients are of a light-green colour, and more cheerful in mind; slow in beginning to take food, but eat spiritedly when begun; of freer digestion than those of the former species; alvine discharges, white, dry, clayey; urine bright-yellow, pale, like saffron.

In both cases the whole body is itchy; heat at the nostrils, small, indeed, but pungent; the bilious particles prickly. The taste of bitter things is not bitter; and yet, strange to tell, it is not sweet; but the taste of sweet things is bitter. For in the mouth the bile lodged in the tongue, prevailing over the articles of food, sophisticates the sensation; for the tongue, having imbibed the bile, does not perceive them, while, during the season of abstinence from food, the bile remains torpid, neither is the tongue unpleasantly affected with that to which it is habituated; but the bile, if heated up by the tastes of the articles of food, impresses the tongue. When, therefore, the food is bitter, the sensation is of the bitter things; but when sweet, of the bilious. For the sensation of the bile anticipates the other, and thus deceives those who suppose that bitter things appear sweet; for it is not so, but because it is not exacerbated by the bitter lodged in it from being habituated to the disease, the phantasy of sweet is created; and there is the same condition in sweet and bitter tastes; for the bile is the screen of the fallacious tastes.

When, therefore, it appears without inflammation of any viscus, it is usually not dangerous, though protracted; but if prolonged, and the viscus gets inflamed, it terminates most commonly in dropsy and cachexia. And many have died emaciated, without dropsy. It is familiar to adolescents and young men, and to them it is less dangerous; it is not altogether unusual also with children, but in them it is not entirely free from danger.

CACHEXIA arises as the conversion of nearly all diseases; for almost all diseases are its progenitors. But it likewise is formed by itself, separately from all others, as an original affection of the noxious kind, by deriving its increase from the administration of many and improper medicines. And a bad habit for a season is common to all complaints, with many symptoms; and of this its name is significant. There is emaciation, paleness, swelling, or whatever else happens for the time to be prevalent in the body. But cachexia is the form of one great affection, and gives its name to the same. For the good habit of the patient (Euhexia) in all respects, as regards digestion, the formation of blood for distribution, and every natural operation whence arise good breathing, good strength, and good colour, constitutes the pristine state of good health. But if its nature become changed to the weakness of cacochymy, this constitutes cachexia.

This disease is difficult to cure, and is a very protracted illness; for it is engendered during a protracted space of time, and not from one infirmity of the body, nor in connection with only one viscus; for it is formed by the conversion of all into a vitiated state. Wherefore those diseases which are its offspring are incurable, as dropsy, phthisis, or wasting; for, indeed, the causes of cachexia are akin to those of wasting. The disease is a protracted and continuous dysentery, and the relapses of diseases in certain cases. Generally there is sufficient appetite, and plenty of food is taken; but the distribution thereof takes place in a crude and undigested condition, for the operation of digestion is not performed upon the food.

The cause of it also may be the suppression of the hemorrhoidal discharge, or the omission of customary vomiting, inactivity as regards exercises, and indolence as to great labours. When each of its attendants has ceased to return, there is heaviness of the whole body, now and then paleness, flatulence of the stomach, eyes hollow, sleep heavy, and inactivity. But these symptoms occurring in an erratic form conceal the existence of the disease; but if they remain and strike root, nor readily give way, they are significant of a mighty illness. When in an erect posture, then they become swollen in their feet and legs; but, when reclining, in the parts they lay upon; and if they change their position, the swelling changes accordingly, and the course of the cold humour is determined by its weight. For when the heat evaporates the humidity, if it be not diffused, the humidity again runs in a liquid state. They have an appetite for much food, and are very voracious; the distribution is more expeditious than the digestion, of matters that are crude rather than undigested; but digestion is not at all performed, nor is it digested in the whole body by nature. For the weakness of the heat in the belly and in the system is the same, neither is good and well-coloured blood formed.

And when the whole body is filled with crudities, and the desire as to food is gone, the cachexy having now extended to the stomach, and the affection having now attained its summit, they become swollen, inactive, and spiritless towards every exertion. The belly is dried up, and, for the most part, the alvine discharges are without bile, white, hard, and undigested. They are parched in person, without perspiration, troubled with itchiness; sleep at no time settled, but drowsiness in the reclining position; respiration slow; pulse obscure, feeble, frequent, and very frequent upon any, even a very small, exertion; respiration in these cases asthmatic; veins on the temples elevated, with emaciation of the parts around; but at the wrists the veins much larger and tumid; blood of a dark-green colour. Along with these, phthisis or tabes induces anasarca or ascites, and from their progeny there is no escape.

With regard to the ages which induce this disease, in the first place, old age, in which there is no recovery; children are readily affected, and more readily recover; adults are not very much exposed to the affection, but have by no means easy recoveries. No one season produces this disease, nor does it terminate in any one; but autumn indeed conceives it, winter nurses it, spring brings it to its full growth, and summer despatches it.