ANIMALS live by two principal things, food and breath ( spirit, pneuma); of these by far the most important is the respiration, for if it be stopped, the man will not endure long, but immediately dies. The organs of it are many, the commencement being the nostrils; the passage, the trachea; the containing vessel, the lungs; the protection and receptacle of the lungs, the thorax. But the other parts, indeed, minister only as instruments to the animal; but the lungs also contain the cause of attraction, for in the midst of them is seated a hot organ, the heart, which is the origin of life and respiration. It imparts to the lungs the desire of drawing in cold air, for it raises a heat in them; but it is the heart which attracts. If, therefore, the heart suffer primarily, death is not far off.

But if the lungs be affected, from a slight cause there is difficulty of breathing; the patient lives miserably, and death is the issue, unless some one effects a cure. But in a great affection, such as inflammation, there is a sense of suffocation, loss of speech and of breathing, and a speedy death. This is what we call Peripneumonia, being an inflammation of the lungs, with acute fever, when they are attended with heaviness of the chest, freedom from pain, provided the lungs alone are inflamed; for they are naturally insensible, being of loose texture, like wool. But branches of the aspera arteria are spread through them, of a cartilaginous nature, and these, also, are insensible; muscles there are nowhere, and the nerves are small, slender, and minister to motion. This is the cause of the insensibility to pain. But if any of the membranes, by which it is connected with the chest, be inflamed, pain also is present; respiration bad, and hot; they wish to get up into an erect posture, as being the easiest of all postures for the respiration. Ruddy in countenance, but especially the cheeks; the white of the eyes very bright and fatty; the point of the nose flat; the veins in the temples and neck distended; loss of appetite; pulse, at first, large, empty, very frequent, as if forcibly accelerated; heat indeed, externally, feeble, and more humid than natural, but, internally, dry, and very hot, by means of which the breath is hot; there is thirst, dryness of the tongue, desire of cold air, aberration of mind; cough mostly dry, but if anything be brought up it is a frothy phlegm, or slightly tinged with bile, or with a very florid tinge of blood. The blood-stained is of all others the worst.

But if the disease tend to a fatal termination, there is insomnolency; sleep brief, heavy, of a comatose nature; vain fancies; they are in a doting state of mind, but not violently delirious; they have no knowledge of their present sufferings. If you interrogate them respecting the disease, they will not acknowledge any formidable symptom; the extremities cold; the nails livid, and curved; the pulse small, very frequent, and failing, in which case death is near at hand, for they die mostly on the seventh day.

But if the disease abate and take a favourable turn, there is a copious hemorrhage from the nose, a discharge from the bowels of much bilious and frothy matters, such as might seem to be expelled from the lungs to the lower belly, provided it readily brings off much in a liquid state. Sometimes there is a determination to the urine. But they recover the most speedily in whose cases all these occur together.

In certain cases much pus is formed in the lungs, or there is a metastasis from the side, if a greater symptom of convalescence be at hand. But if, indeed, the matter be translated from the side to the intestine or bladder, the patients immediately recover from the peripneumony; but they have a chronic abscess in the side, which, however, gets better. But if the matter burst upon the lungs, some have thereby been suffocated, from the copious effusion and inability to bring it up. But such as escape suffocation from the bursting of the abscess, have a large ulceration in the lungs, and pass into phthisis; and from the abscess and phthisis old persons do not readily recover; but from the peripneumony, youths and adults.

THERE are two species of the discharge of blood by the mouth. The one that by the mouth from the head and the vessels there; the passage is by the palate and fauces, where are situated the commencement of the œsophagus and trachea; and with hawking, and small and more urgent cough, they eructate the blood into the mouth; whereas, in that from the mouth, neither does hawking accompany, and it is called Emptysis [ or spitting of blood]. But when the discharge is more scanty, and by drops, or when it comes more copiously from the head, or from the mouth, it is no longer called a bringing up, but either the same, or a spitting, or a hemorrhage. But if it ascend from the chest, and the viscera there, the lungs, aspera arteria, the parts about the spine, the discharge from these is not called a spitting, but a bringing up (in Greek, ἀναγωγή, the name being expressive of its coming upwards). ¹

The symptoms of both are partly common, small and few in number, such as the seat of them, in which there is a coincidence between the bringing up and the spitting. But the peculiarities of each are great, many, and of vital importance, by which it is easy to distinguish either of them from the other. If, therefore, it came from the head, with a large discharge of blood, greater and more numerous symptoms will arise, but scanty from a slight and small spitting; in these cases, there is heaviness of the head, pain, noises of the ears, redness of countenance, distension of the veins, vertigo; and these are preceded by some obvious cause, such as a blow, exposure to cold, or heat, or intoxication; for drinking of wine speedily fills the head, and speedily empties it, by the bursting of a vessel; but from a slight intoxication there may be spitting, proceeding from rarefaction. Occasionally an habitual hemorrhage from the nostrils is stopped, and being diverted to the palate, produces the semblance of a bringing up of blood. If, therefore, it be from the head, there is titillation of the palate, frequent hawking, and with it a copious spitting takes place; a desire supervenes, and they readily cough. But if it flow into the aspera arteria from the palate, they then bring it up by coughing, and this it is which deceives them into the supposition that it comes from the viscera below. It runs, also, from the head into the stomach, when it is vomited up with nausea, and thus proves a source of deception, as appearing to come from the stomach. The blood brought up by spitting is not very thick, but dark in colour, smooth, consistent, unmixed with other substances; for, being hawked up, it comes immediately upon the tongue in a round shape, being readily separated; and if you examine the roof of the palate, you will find it thickened and ulcerated, and, for the most part, bloody; and a slight and simple plan of treatment will suffice, namely, astringents applied to the palate in a cold state; for by hot, relaxing, and dilating applications the flow is increased, and this is an indication that the spitting is from the head, in which case evacuations are to be made from the head by the veins, the nostrils, or by any other channel of discharge. And these things must be done speedily; for if the blood is discharged a considerable time, the flow will become permanent, and the parts there will contract the habit of receiving the blood. The trachea, also, becomes ulcerated, and the patients cough instead of hawking; and this proves the commencement of a consumption.

The flow of blood from the chest and viscera below is called a bringing up (in Greek, ἀναγωγή). It is truly of a fatal nature, if it proceed from any of the vital parts which are ruptured—either the vena cava in the heart, which conveys the blood from the liver, or from the large vein which lies along the spine. For from hemorrhage, as from slaughtering or impeded respiration, death is very speedy. But in those cases in which the blood comes from the lungs, the side, or the trachea, they do not die so speedily; but, nevertheless, they become affected with Empyema and Phthisis. Of these the least formidable is that from the trachea. But if the vomiting come from the stomach or bowels, the cases are not of a very fatal nature, even though the hemorrhage be large; neither is the recovery slow and changeable. But if it proceed from the liver and spleen, it is neither readily nor constantly discharged upwards, but the defluxion is more easy into the stomach and intestines. Yet neither is the discharge upwards by the lungs impossible or incredible, for in fevers there occur hemorrhages of blood from the liver and spleen by the nostrils, the blood flowing from the nostril on the same side as the viscus from which it comes. These, then, are the places from which the blood comes in the bringing up, and such the differences as to danger or mortality.

But the modes are three; for it is brought up either from rupture of a vessel, or from erosion, or from rarefaction. Rupture, then, takes place suddenly, either from a blow, straining at a load, or lifting a weight upward, or a leap from a height, or from bawling aloud, from violent passion, or some other similar cause, when blood is instantly poured forth from the vessel in great quantity.

But if it proceed from erosion, the patient is to be interrogated if he ever had a cough before, or was affected with dyspnœa, and whether nausea or vomiting ever afflicted him previously. For from such chronic affections the vessels are corroded by a continued, copious, and acrid defluxion. When, therefore, the containing vessels, having been long wasted and attenuated, at length give way, they pour forth blood.

But the mode by rarefaction is, indeed, unattended by rupture, and on that account the discharge is neither copious nor sudden, nor does it consist of thick blood; for by the rarefaction of the vessels, the thin portion is excreted. But if much collect in a cavity, and be again brought up, it becomes thicker than natural, but yet not very thick, neither black, like a clot; but it is quickly brought up in greater quantity, as being from a collection. This mode of bringing up blood is common with women who have not their monthly purgation, and appears at the periods of the purgation, and stops during the intervals between them; and if the woman is not cured, the discharge upwards of blood will revert for many periods, and also, in certain cases, the vessels burst from fulness.

And there is a difference of the discharge, whether it be brought up from an artery or a vein. For it is black, thick, and readily coagulates, if from a vein; it is less dangerous, and is more speedily stopped; but if from an artery, it is of a bright yellow colour and thin, does not readily coagulate, the danger is more imminent, and to stop it is not so easy; for the pulsations of the artery provoke the hemorrhage, and the lips of the wound do not coalesce from the frequent movements of the vessel.

Recovery, if from erosion, is protracted, difficult, and doubtful; for, owing to loss of substance, the parts of the ulcer do not come together, for it is an ulcer, and not a wound; and adhesion takes place more readily in ruptures, for the lips of the wound touch one another. This, then, is another difference as to danger. The mode attended with least danger is that from rarefaction; and in it the styptic and refrigerant method of treatment is sufficient.

The places are to be indicated from which the blood is brought up; for many of the symptoms are common, deception is easy, and the cure different. Blood, then, from erosion is not readily brought up from the stomach, for the coldness and stypticity of the articles of food and drink bring the parts to a state of condensation. Neither, also, are cases from erosion common, although more so than the former; for acrid defluxions do not adhere for any length of time, but are either brought up or are passed downwards. Rupture is more common in the stomach. If, then, any rupture take place, the hemorrhage is not very great, such as that from the thorax; for the veins there are slender, and the arteries also are small. But in appearance the blood is not very black, not intensely yellowish, smooth, or mixed with saliva, being brought up with nausea and vomiting, slight cough, sometimes with some discharge, and sometimes alone, without any expectoration; for the trachea sympathises with the gullet, being extended along and connected with it. There is pinching or constriction of the ulcer from the things swallowed, more especially if they are very cold, hot, or austere; and in certain cases pain is produced in the stomach, extending as far as the back; vomitings of phlegm, and sometimes, when the disease is long protracted, and there has been long abstinence from food, they bring up a great quantity of them; fevers, not of a continual type, but of an irregular kind.

But, from the stomach, what is brought up may be black and coagulated, even if it proceed from an artery; but if it proceed from a vein, it is much blacker and much more compact; much nausea and vomiting of pituitous and bilious matter; blood mixed up with the food, provided the man had eaten previously, for both the food and the blood are collected together in the same place; eructations frequent and fœtid, and, if much collect together, there is anxiety of mind and vertigo; but if these be vomited they are relieved. They are prostrate in strength, generally affected with a burning heat, and constant pain of the stomach.

But from the aspera arteria they bring up scanty and very fluid blood, with a cough; or, if they do not bring it up, they cough incessantly. There is a painful feeling in the throat, either a little below or above; voice hoarse and indistinct.

But if it be from the lungs, the discharge is copious, especially if from erosion, with much cough, of an intense yellow colour, frothy, rounded; so that what is brought up from one part may be distinguished from what is brought up from another. But the defluxion, though contained in a common vessel, from the chest, is diversified after mixture, and you may distinguish parts of them as being portions of the thorax, and parts which have a fleshy appearance as being portions of the lungs. There is heaviness of the chest, freedom from pain, and much redness of the face, particularly in these cases.

But if brought up from the thorax, pain stretching to the anterior part of the breast is indicative of the ruptured part; cough intense, expectoration difficult, the blood not very fluid, moderately thick, without froth. But if, in passing, the lung be affected by consent, a certain amount of froth is imparted to it, for the passage from the chest to the trachea is by the lungs.

But if, indeed, from the side there be discharged with cough blood which is black, smooth, fœtid, stinking, as from putrefaction, with acute pain of the side, many die after the manner of pleuritics with fever.

A season that is humid and hot engenders these affections. Spring is thus humid and hot. Next the summer; autumn less, but winter least of all. They die in summer mostly from hemorrhage, for great inflammations do not readily occur then; secondly, in spring, from inflammation and ardent fevers; but in autumn, attacks of phthisis readily occur.

In a word, every discharge of blood upwards, even if small, and although the ruptured vessels may have already united, is attended with lowness of spirits, dejection, and despair of life. For who is so firm in mind as to see himself enduring a state resembling that of a slaughtered animal, and yet have no fear of death? For the largest and most powerful animals, such as bulls, die very quickly from loss of blood. That, however, is no great wonder. But this is a mighty wonder: in the discharge from the lungs alone, which is particularly dangerous, the patients do not despair of themselves, even although near the last. The insensibility of the lungs to pain appears to me to be the cause of this; for pain, even although slight, makes one to fear death, and yet, in most cases, it is more dreadful than pernicious; whereas the absence of pain, even in the great illnesses, is attended with absence of the fear of death, and is more dangerous than dreadful.

WELL by all means has the physician, and well have the common people succeeded in the appellation of this affection! It is, indeed, the name of a very acute malady; for what is there greater or more acute than the power of Syncope ? and what other name more appropriate for the designation of this matter? what other organ more important than the heart for life or for death? Neither is it to be doubted that syncope is a disease of the heart, or that it is an injury of the vital powers thereof—such is the rapidity and such the mode of the destruction. For the affection is the solution of the bonds of the vital power, being antagonistic to the constitution of the man; for having seized fast thereon, it does not let go its hold, but brings him to dissolution. Nor is it any great wonder; for other diseases are peculiar to, and prove fatal to, certain organs, in which they are engendered, and to which they attach themselves. Thus pestilential and very malignant buboes derive their origin from the liver, but from no other part; tetanus, in like manner, from the nerves, and epilepsy from the head. Thus, therefore, syncope is a disease of the heart and of life. But such persons as regard it to be an affection of the stomach, because by means of food and wine, and in certain cases by cold substances, the powers have been restored and the mischief expelled—these, it would seem to me, ought to hold phrenitis to be a disease of the hair and skin of the head, since the phrenitics are relieved by the shaving and wetting thereof. But to the heart the vicinity of the stomach is most important, for from it the heart draws both what is suitable and what is unsuitable to itself. And by the lungs the heart draws spirit ( pneuma) for respiration, but yet the lungs do not hold a primary place in respiration; for the powers are not in the organs, but there where is the original of life and strength: But the stomach is neither the original nor seat of life; and yet one would be injured by atony thereof: for food which proves injurious to the heart does not hurt the stomach itself, but by it the heart; since those dying in such cases have symptoms of heart-affections, namely, pulse small and feeble, bruit of the heart, with violent palpitation, vertigo, fainting, torpor, loss of tone in their limbs, sweating copious and unrestrainable, coldness of the whole body, insensibility, loss of utterance. How should the stomach endure such symptoms? For those peculiar to it are nausea, vomiting, loss of appetite, hiccup, eructation, acidity; whereas in cardiac affections the patients are more acute in their senses, so that they see and hear better than formerly; they are also in understanding more sound, and in mind more pure, not only regarding present things, but also with regard to futurity they are true prophets. These, then, are the powers, not of the stomach, but of the heart, where is the soul and the nature thereof, and to it is to be referred this affection of its powers.

But this form of disease is a solution of the natural tone from a cold cause and humidity, and therefore they are not affected with heat, either internally or externally, neither do they suffer from thirst, and their breath is cold even when the disease proceeds from strong and ardent fevers, by which syncope is usually kindled up. For when nature is strong, and of the proper temperament, it rules all and commands all, whether humour, spirit ( pneuma), or solid, and, by their good order and symmetry, regulates the man in life; but if the bond of nature—that is to say, its tone—be dissolved, then this affection is produced. The original of it is causus, which is in this form.

HEAT, indeed, everywhere, both acrid and subtil, but especially in the internal parts; respiration hot, as if from fire; inhalation of air large; desire of cold; dryness of tongue; parchedness of lips and skin; extremities cold; urine intensely tinged with bile; insomnolency; pulse frequent, small, and feeble; eyes clear, glancing, reddish; healthy colour of the countenance.

But if the affection increase, all appearances become greater and worse; the pulse very small and very frequent; heat very dry and very acrid; intellect wavering; ignorance of all things; they are thirsty; a desire to touch anything cold, whether a wall, a garment, the floor, or a fluid; hands cold, palms thereof very hot, nails livid; breathing thick; perspiration like dew about the forehead and clavicles.

But if nature attain the extremity of dryness and of heat, the hot is converted into cold, and the parched into humidity; for extreme intensities of things change to the opposite state. When, therefore, the bonds of life are dissolved, this is syncope. Then is there an irrestrainable sweat over all the body; respiration cold, much vapour about the nostrils; they have no thirst, and yet the other parts are parched except the organs of thirst, namely, the mouth and stomach; the urine thin and watery; belly for the most part dry, yet in certain cases the discharges are scanty and bilious; a redundancy of humours; even the bones, being dissolved, run off; and from all parts, as in a river, there is a current outwards.

As to the state of the soul, every sense is pure, the intellect acute, the gnostic powers prophetic; for they prognosticate to themselves, in the first place, their own departure from life; then they foretell what will afterwards take place to those present, who fancy sometimes that they are delirious; but these persons wonder at the result of what has been said. Others, also, talk to certain of the dead, perchance they alone perceiving them to be present, in virtue of their acute and pure sense, or perchance from their soul seeing beforehand, and announcing the men with whom they are about to associate. For formerly they were immersed in humours, as if in mud and darkness; but when the disease has drained these off, and taken away the mist from their eyes, they perceive those things which are in the air, and with the naked soul become true prophets. But those who have attained such a degree of refinement in their humours and understanding will scarcely recover, the vital power having been already evaporated into air.

CHOLERA is a retrograde movement of the materiel in the whole body on the stomach, the belly, and the intestines; a most acute illness. Those matters, then, which collect in the stomach, rush upwards by vomiting; but those humours in the belly, and intestines, by the passages downwards. With regard to appearance, then, those things which are first discharged by vomiting, are watery; but those by the anus, liquid and fetid excrement, (for continued indigestion is the cause of this disease); but if these are washed out, the discharges are pituitous, and then bilious. At first, indeed, they are borne easily, and without pain; but afterwards the stomach is affected with retchings, and the belly with tormina.

But, if the disease become worse, the tormina get greater; there is fainting, prostration of strength in the limbs, anxiety, loss of appetite; or, if they take anything, with much rumbling and nausea, there is discharged by vomiting bile intensely yellow, and the downward discharges are of like kind; spasm, contractions of the muscles in the legs and arms; the fingers are bent; vertigo, hiccup, livid nails, frigidity, extremities cold, and altogether they are affected with rigors.

But if the disease tend to death, the patient falls into a sweat; black bile, upwards and downwards; urine retained in the bladder by the spasm; but, in fact, sometimes neither is there any urine collected in the bladder, owing to the metastasis of the fluids to the intestine; loss of utterance; pulse very small, and very frequent in the cases affected with syncope; continual and unavailing strainings to vomit; the bowels troubled with tenesmus, dry, and without juices; a painful and most piteous death from spasm, suffocation, and empty vomiting.

The season of summer, then, engenders this affection; next autumn; spring, less frequently; winter, least of all. With regard to the ages, then, those of young persons and adults; old age least of all; children more frequently than these, but their complaints are not of a deadly nature.

AN inflammation takes place in the intestines, creating a deadly pain, for many die of intense tormina; but there is also formed a cold dull flatus ( pneuma), which cannot readily pass either upwards or downwards, but remains, for the most part rolled up in the small convolutions of the upper intestines, and hence the disease has got the appellation of Ileus ( or Volvulus). But if in addition to the tormina, there be compression and softening of the intestines, and the abdomen protrude greatly, it is called Chordapsus, from the Greek word ἕψησις, which signifies softening, and χορδὴ, which is a name for the intestines; and hence the Mesentery, which contains all the nerves, vessels, and membranes that support the intestines, was called ἐπιχορδὶς by the ancients. ²

The cause of Ileus is a continued corruption of much multifarious and unaccustomed food, and repeated acts of indigestion, especially of articles which are apt to excite Ileus, as the ink of the cuttle-fish. And the same effects may be expected from a blow, or cold, or the drinking of cold water largely and greedily in a state of sweating; and in those cases, in which the gut has descended into the scrotum with fæces, and has not been replaced into the belly, or has been restored to its place with violence, in such cases it is customary for the lower intestines to get inflamed. ³ This affection is customary with children, who are subject to indigestion, and they more readily escape from the mischief, owing to their habits and the humidity of their intestines, for they are loose. Old persons do not readily suffer from the complaint, but rarely recover. The season of summer engenders the disease rather than that of spring; autumn, than winter; but the summer more than both.

Many therefore die speedily of these tormina. But in other cases pus is formed; and then again, the intestine having become black and putrified, has separated, and thus the patients have died. In these cases, provided the Ileus is mild, there is a twisting pain, copious humours in the stomach, loss of tone, languor, vacant eructations bringing no relief, borborygmi in the bowels, the flatus passing down to the anus, but not making its escape.

But if the attack of Ileus acquire intensity, there is a determination upwards of everything, flatus, phlegm, and bile; for they vomit all these; they are pale, cold over the whole body; much pain; respiration bad, they are affected with thirst.

If they are about to die, there is cold sweat, dysuria, anus constricted, so that you could not pass a slender metal plate by it; ⁴ vomiting of fæces; the patients are speechless; pulse, at last rare and small, but before death very small, very dense, and failing. These symptoms attend the disease in the small intestines.

But the same affections occur also in the colon, and the symptoms are similar, as also the issue; some of these escape if pus form in the colon, the reason of which is the fleshy thickness of this intestine. The pain is slender and sharp in the small intestines, but broad and heavy in the colon; the pain also sometimes darts up to the ribs, when the disease puts on the appearance of pleurisy; and these, moreover, are affected with fever; but sometimes it extends to the false ribs, on this side or on that, so that the pain appears to be seated in the liver and spleen; again it affects the loins, for the colon has many convolutions in all directions; but in other cases it fixes on the sacrum, the thighs, and the cremasters of the testicles. But in colic affections, they have rather retchings; and what is vomited is then bilious and oily. And the danger therefrom is so much the less, as the colon is more fleshy, and thicker than the small intestines, and consequently more tolerant of injury.

IN the affections of the liver, the patients do not die, indeed, more quickly than in those of the heart; but yet they suffer more pain; for the liver is, in a great measure, a concretion of blood. But if the cause of death happen to be situated in its Portæ, they die no less speedily than from the heart; for these parts are tissues formed of membranes, of important and slender nerves, and of large veins. Hence certain of the philosophers have held that the desires of the soul are seated there. In hemorrhage it greatly surpasses all the others; for the liver is made up from the roots of veins. Wherefore a great inflammation does form in it, but not very frequently, nor in its vital parts, for the patient would die previously. But a smaller inflammation often takes place, whence it happens that they escape death, indeed, but experience a more protracted state of disease. For of its office, as regards sanguification, there is no stop nor procrastination, as from it a supply of blood is sent to the heart, and to the parts below the diaphragm.

If from a greater cause—a stroke, or continued indigestion of much and bad food, and intoxication, or great cold—an inflammation forms in the portal system, a very speedy death is the result. For there is a latent, smothered, and acrid heat; pulse languid; the kind of pain varied, and every way diversified, sometimes darting to the right side, so as to resemble a sharp weapon fixed in the place, and sometimes resembling tormina; again, at other times the pain is deep—nay, very deep; and, intermediate between the pain, atony and loss of utterance. The diaphragm and succingens ( pleura) are dragged downwards; for from them the liver is suspended as a weight. For this reason, a strong pain extends to the clavicle on the same side; an ineffectual cough, or only a desire thereof, and when it comes to a conclusion, dry; respiration bad, for the diaphragm does not co-operate with the lungs, by assisting them in contraction and dilatation. They draw in a small breath, but expire a larger; colour, a dark-green, leaden; they loathe food, or if they force themselves to take any, they become flatulent in the epigastrium; eructations bilious, acid, fetid; nausea, retchings, belly mostly loose, discharges bilious, viscid, small in quantity. The affections always go on increasing; mind not very much deranged, but torpid, unsettled, stupid; much timidity; coldness of the extremities, tremblings, rigors, hiccup of a spasmodic nature, jaundice, bile intense, the whole body tinged with bile. But if it appear before the seventh day, it proves fatal in many cases.

But those who have escaped a fatal termination, either by a hemorrhage, or a rapid discharge from the bowels of bilious matters, or from frequent discharges of intense urine, in these cases, after three weeks, the liver is converted into a purulent abscess. But if it pass considerably this period without an abscess, it ends inevitably in dropsy; the patients are thirsty, drink little, are dried in body, lose fat; there is a desire for acids, and an insensibility to taste.

Autumn engenders this affection, along with the indigestion produced by much summer-fruit and multifarious food. Of all ages, the adult is most subject to it.

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 kedmata ⁵ 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.

THE kidneys, as far as regards the peculiar structure of the organ, are not productive of any great danger, even if they should suffer acutely; for, being of a glandular nature, they are mild and do not experience deadly diseases. But their office is important, namely, the secretion of the urine from the blood, and its expulsion.

It is stopped either by a stone, or an inflammation arising there, or a clot of blood, or something such; when no mischief arises from sympathy, owing to the peculiar nature of the organ affected, but the retention of the urine produces all sorts of dreadful symptoms. Heat, which is acrid, and induces nausea; a heavy pain along the spine at the loins; distention of the parts, especially of those about the hypochondrium; suppression of urine, not entirely, but they pass urine in drops, and have a desire to pass more, for there is the sensation of an overflow. But if the urine become acrid and pungent, coldness, tremblings, spasms, distention and fulness of the hypochondria supervene. This miserable state and the conjoined feeling become similar to that of tympanites produced by indigestion, from the taking of too much food. Pulse, at first, indeed, slow and languid; but, if the evil press harder, small, frequent, tumultuous, and irregular: sleep slight, painful, not continued; and suddenly starting up as if from the stroke of a sharp instrument, they fall over again into a deep sleep as if from fatigue: they are not much deranged in intellect, but talk incoherently; the countenance livid. But if the desire of making water return again, the patients pass a small quantity in drops, along with spasms and great pains, when, for a short time, they are relieved from their sufferings, and again they experience a relapse. Of those that die, they sink most quickly who pass no urine; but the greater part recover, either from the stone dropping down into the bladder along with the urine, or from the inflammation being converted into pus, or from being gradually dispelled. For, if the urine pass easily even in small quantity, they escape death; but for a length of time they waste in constitution; the patients undergo these sufferings while still able to keep up, but gradually fall into a state of consumption. The same seasons, places, and ages induce these affections as induce those in connection with the venæ cavæ.

Sometimes blood bursts from the kidneys suddenly in large quantity, and flows continuously for many days. None, however, die from the hemorrhage itself, but from the inflammation accompanying the hemorrhage, if the bleeding is stopped; but most frequently they die of strong inflammation induced by the stoppage.

THE bladder is a dangerous part to suffer in acute diseases, even when it merely sympathizes with other parts; but more dangerous and fatal if the affection begin with itself; for it is very potent to make the other parts sympathise with it, as the nerves and the understanding: for the bladder is a cold and white nerve, at a very great distance from the innate heat, but very near the external cold: for it is situated in the lowest part of the belly, at the greatest distance from the chest. But, also, its office is of vital importance, namely, the passage of the urine.

Even, then, when the passage is only stopped by stones, or clots, or from any native or foreign mischief, it is of a deadly nature. In women, the phlegmonous tumour of the uterus may compress it; and in men, the straight intestine at the end bowels, called the Rectum. In many cases, too, owing to involuntary restraint from modesty in assemblies and at banquets, being filled it becomes distended; and, from the loss of its contractile power, it no longer evacuates the urine. When, then, the urine is stopped, there is fulness of the parts above, namely, the kidneys; distension of the ureters, grievous pain of the loins, spasms, tremblings, rigors, alienation of mind. But if it suffer from an ulcer or inflammation, there are, indeed, many bad symptoms; but death from the ulcers is by far the most speedy. With regard, however, to the ulceration and purulent abscess, and those other affections which are not very acute, they will be treated of among the chronic diseases; but such as are acute, and prove fatal in fourteen days, or a little earlier or later, such as inflammation, thrombus, or a stone falling down to the neck of the bladder, of these I will now treat. If, therefore, any of these occur, there is retention of urine; swelling in the hypogastric region; acute pain all over the abdomen; distension of the bladder; a sallow sweat on the tenth day; vomitings of phlegm, then of bile; coldness of the whole body, but especially of the feet: but, if the mischief spread farther, there come on fevers attended with hiccup, pulse irregularly frequent and small, redness of the countenance, thirst, distress of mind, delirium, spasms. From deleterious substances, such as cantharides and buprestis, both the bladder is distended with flatus, and the whole belly suffers violence; and all things get worse, and death cannot be long delayed.

The bladder also sometimes suffers from hemorrhage; the blood there is bright and thin, but the patients never die from it, although it may not be easy to stop. But from the clots and the inflammation there is danger; for the coldness, mortification, gangrene, and the other evils consequent upon it readily prove fatal.

Winter and autumn bring on these diseases. As to age, manhood, but still more old age. The other seasons and periods of life do not generally produce the diseases, and they very rarely prove fatal. Of all others, infants are most free from danger.

IN the middle of the flanks of women lies the womb, a female viscus, closely resembling an animal; for it is moved of itself hither and thither in the flanks, also upwards in a direct line to below the cartilage of the thorax, and also obliquely to the right or to the left, either to the liver or spleen; and it likewise is subject to prolapsus downwards, and, in a word, it is altogether erratic. It delights, also, in fragrant smells, and advances towards them; and it has an aversion to fetid smells, and flees from them; and, on the whole, the womb is like an animal within an animal.

When, therefore, it is suddenly carried upwards, and remains above for a considerable time, and violently compresses the intestines, the woman experiences a choking, after the form of epilepsy, but without convulsions. For the liver, diaphragm, lungs and heart, are quickly squeezed within a narrow space; and therefore loss of breathing and of speech seems to be present. And, moreover, the carotids are compressed from sympathy with the heart, and hence there is heaviness of head, loss of sensibility, and deep sleep.

And in women there also arises another affection resembling this form, with sense of choking and loss of speech, but not proceeding from the womb; for it also happens to men, in the manner of catochus. But those from the uterus are remedied by fetid smells, and the application of fragrant things to the female parts; but in the others these things do no good; and the limbs are moved about in the affection from the womb, but in the other affection not at all. Moreover, voluntary and involuntary tremblings . . . . . . . . . . . but from the application of a pessary to induce abortion, powerful congelation of the womb, the stoppage of a copious hemorrhage, and such like.

If, therefore, upon the womb’s being moved upwards, she begin to suffer, there is sluggishness in the performance of her offices, prostration of strength, atony, loss of the faculties of her knees, vertigo, and the limbs sink under her; headache, heaviness of the head, and the woman is pained in the veins on each side of the nose.

But if they fall down they have heartburn . . . . . in the hypochondriac regions; flanks empty, where is the seat of the womb; pulse intermittent, irregular, and failing; strong sense of choking; loss of speech and of sensibility; respiration imperceptible and indistinct; a very sudden and incredible death, for they have nothing deadly in their appearance; in colour like that of life, and for a considerable time after death they are more ruddy than usual; eyes somewhat prominent, bright, not entirely fixed, but yet not very much turned aside.

But if the uterus be removed back to its seat before the affection come to a conclusion, they escape the suffocation. When the belly rumbles there is moisture about the female parts, respiration thicker and more distinct, a very speedy rousing up from the affection, in like manner as death is very sudden; for as it readily ascends to the higher regions, so it readily recedes. For the uterus is buoyant, but the membranes, its supporters, are humid, and the place is humid in which the uterus lies; and, moreover, it flees from fetid things, and seeks after sweet: wherefore it readily inclines to this side and to that, like a log of wood, and floats upwards and downwards. For this reason the affection occurs in young women, but not in old. For in those in whom the age, mode of life, and understanding is more mobile, the uterus also is of a wandering nature; but in those more advanced in life, the age, mode of living, understanding, and the uterus are of a steady character. Wherefore this suffocation from the womb accompanies females alone.

But the affections common to men happen also to the uterus, such as inflammation and hemorrhage, and they have the common symptoms; namely, fever, asphexy, coldness, loss of speech. But in hemorrhage the death is even more sudden, being like that of a slaughtered animal.

THE Satyrs, sacred to Bacchus, in the paintings and statues, have the member erect, as the symbol of the divine performance. It is also a form of disease, in which the patient has erection of the genital organ, the appellation of Satyriasis being derived from its resemblance to the figure of the god.

It is an unrestrainable impulse to connection; but neither are they at all relieved by these embraces, nor is the tentigo soothed by many and repeated acts of sexual intercourse. Spasms of all the nerves, and tension of all the tendons, groins, and perineum, inflammation and pain of the genital parts, redness of countenance, and a dewy moisture. Wrapped up in silent sorrow, they are stupid, as if grievously afflicted with their calamity. But if the affection overcome the patient’s sense of shame, he will lose all restraint of tongue as regards obscenity, and likewise all restraint in regard to the open performance of the act, being deranged in understanding as to indecency; for they cannot restrain themselves, are thirsty, and vomit much phlegm. Afterwards, froth settles on their lips, as is the case with goats in the season of rutting, and the smell likewise is similar. The urine, after long retention, is white, thick, and like semen; bowels constipated; spontaneous titillations of the sides and arm-pits; they have convulsions, loathe food, or, if presented to them, they snatch it confusedly.

But if the illness tend to death, they become flatulent, belly protuberant, tension of the tendons and of all the muscles, difficulty of movement, contraction of the limbs, pulse small, weak, and irregular.

All these symptoms have been sometimes removed by copious discharges from the bowels of phlegm and bile, and by vomiting in like manner, not without danger. The proper cure is deep and very protracted sleep; for much sleep induces coldness, paralysis, and torpor of the nerves; and torpidity and refrigeration cure Satyriasis.

The affection, for the most part, is formed in spring and summer. Of the periods of life, it occurs principally in boys and striplings, more especially in such as are naturally prone to sexual intercourse. It is a most acute, disgusting, and unseemly ailment. For the most part, the patients die on the seventh day. It is said, that women also suffer from this affection; that they have the same impulse to venery, and the other symptoms the same. I believe, indeed, that lust is engendered in women of a humid temperament, so as to induce a copious discharge of the superfluous humours; but I do not at all believe that they are affected with Satyriasis, for their nature, being cold, is not adapted to it. But neither, also, has woman the parts necessary for erection, like those of a Satyr, whence the affection derives its name; and neither also are men subject to suffocation from the womb, because men have not an uterus.