DROPSY is indeed an affection unseemly to behold and difficult to endure; for very few escape from it, and they more by fortune and the gods, than by art; for all the greater ills the gods only can remedy. For either the disease lurking in a vital organ has changed the whole system to cachexy, or the general system from some plague that has gone before has changed the viscera to a Cacochymy, when both co-operate with one another to increase the illness, and no part is uninjured from which even a slight assistance might be rendered to Nature. It is a cold and dense vapour converted into humidity, resembling a mist in the universe; or, it is the conversion of a humid and cold cause which changes the patient to such a habit. For a fluid rolling about in the lower belly we do not call Dropsy, since neither is the affection situated in that place; but when the tumour, swelling, colour, and the habit melting down to water, conspire in the disease, it both is, and is called Dropsy. For, even should the water at any time burst outwardly, or should one give vent to it, by making an incision in the hypochondrium, the dropsical affection will still remain confirmed; wherefore the primary cause of it is cachexia.

There are many varieties, each having different names. For if the watery suffusion float in the flanks, and, owing to its fulness, when tapped it sound like a drum, the disease is called Tympanites. But if the water be confined in large quantity in the peritonæum, and the intestines float in the liquid, it gets the appellation of Ascites. But if the lower belly contain none of these, but the whole body swell, if in connexion with a white, thick, and cold phlegm, the disease is called Phlegmatias; but if the fleshy parts are melted down into a sanguineous, watery, or thin humour, then the species of dropsy called Anasarca is formed. The constitution of each of them is bad; but the combination of them is much worse. For sometimes the variety which forms in the lower belly ( Ascites), is associated with that variety in which the fluid is diffused all over the body. But the most dangerous is that form in which Tympanites is mixed with Anasarca. For of the dropsies that form in the lower belly, Tympanites is particularly worse than Ascites. But of those affecting the whole body, Leucophlegmatia is less than Anasarca. It is mild then, so to speak of such hopeless diseases, when a smaller affection is combined with another smaller one. But it is much worse if one of the smaller enters into combination with one of the greater. But if a complete mixture of two great affections take place, the product thereof is a greater evil.

The symptoms are very great and very easy to see, to touch, and to hear; in Ascites, for example, to see the tumidity of the abdomen, and the swelling about the feet; the face, the arms, and other parts are slender, but the scrotum and and prepuce swell, and the whole member becomes crooked, from the inequality of the swelling:—To touch—by strongly applying the hand and compressing the lower belly; for the fluid will pass to other parts. But when the patient turns to this side or that, the fluid, in the change of posture, occasions swelling and fluctuation, the sound of which may be heard. But if you press the finger firmly on any part, it becomes hollow, and remains so for a considerable time. These are the appearances of Ascites.

Tympanites may be recognised, not only from the sight of the swelling, but also by the sound which is heard on percussion. For if you tap with the hand, the abdomen sounds; neither does the flatus ( pneuma) shift its place with the changes of posture; for the flatus, even although that which contains it should be turned upwards and downwards, remains always equally the same; but should the flatus ( pneuma) be converted into vapour and water (for Ascites may supervene on Tympanites), it shifts its form, indeed, the one half running in a fluid state, if the conversion be incomplete.

In Anasarca and Leucophlegmatia the lower belly is empty, the patients are swelled in the face and arms; and likewise, in these cases, whatever parts are empty in the others, in them become full. For in Leucophlegmatia there is collected a white, cold, and thick phlegm; with it the whole body is filled, and the face is swollen, and also the neck and arms; but the abdomen is full from the swelling; but the mammæ are raised up into a swelling in the case of such youths as are still in the happy period of life. But, in Anasarca, there is wasting of the flesh to a fleshy humour, and a bloody ichor, such as runs from ulcerations of the bowels, and such as flows from bruises produced by the fall of weights, if the outer skin be scarified. But the combination of the two has the symptoms of both.

In all the species there are present paleness, difficulty of breathing, occasional cough; they are torpid, with much languor and loss of appetite; but if they take any food, however small in quantity and free from flatulence, they become flatulent, and have distension as if from repletion; skin dry, so that it does not become moist even after the bath; they are white and effeminate; but in Anasarca they are of a dark-green colour, and have dark veins; in Ascites and Tympanites these are prominent, both in the face, and in the wrists, and the abdomen. But in Anasarca and Leucophlegmatia all the parts are concealed by the swelling; sleep heavy; they are torpid, with slight dejection of spirit; concern about trifles; fondness of life; endurance not from good spirits and good hopes like those in prosperity, but from the nature of the affection. It is not possible exactly to state the cause; but this is a mighty wonder, how in certain diseases, not altogether dangerous, the patients are spiritless, dejected, and wish to die, but in others they have good hopes and are fond of life. Diseases produce both these contraries.

Dropsy sometimes is occasioned suddenly by a copious cold draught, when, on account of thirst, much cold water is swallowed, and the fluid is transferred to the peritonæum; by which means the innate heat in the cavities is congealed, and then the drops which formerly were converted into air and dissipated, flow into the cavities. If this, therefore, happen, the cure of these cases is easier before any of the viscera or the whole person is affected. Moreover flatulent food, indigestion, and the Buprestis ¹ have sometimes occasioned dropsies.

It is an illness common to all, men and women, in every period of life, only that certain ages are more exposed to certain species of the disease; children to Anasarca and Leucophlegmatia; young men until manhood are subject to swelling about the lower belly ( Ascites?) Old persons are prone to suffer all kinds, as being deficient in heat, for old age is cold; but they are not exposed to collections of humours, and to them, therefore, Tympanites is the familiar form.

All the species, indeed, are unfavourable; for dropsy, in all its forms of disease, is bad. But of these, leucophlegmatia is the more mild; for in it there are many and various chances of good fortune, such as an evacuation of sweat, of urine, or from the bowels, by which the dropsical habit is carried off. But tympanites is of a difficult nature, and still more so anasarca; for in this affection the physician would require to change the whole person, a thing not easy for the gods themselves to accomplish.

Sometimes the dropsy forms in a small space, such as the head in hydrocephalus; or in the lungs alone; or in the liver, or the spleen; or the womb in women; and this last is easier to cure than any of the others, for provided its mouth relax from its former constriction, if it contains a fluid, it discharges the same outwardly, and if a flatus, it is dissipated. But if the uterus suffer at all in anasarca, for the most part the whole woman becomes dropsical.

This other form of dropsy is known: small and numerous bladders, full of fluid, are contained in the place where ascites is found; but they also float in a copious fluid, of which this is a proof; for if you perforate the abdomen so as to evacuate the fluid, after a small discharge of the fluid, a bladder within will block up the passage; but if you push the instrument farther in, the discharge will be renewed. This species, then, is not of a mild character; for there is no ready passage by which the bladders might escape. It is said, however, that in certain cases such bladders have come out by the bowels. I have never seen such a case, and therefore write nothing of them; for I am unable to tell whether the discharge be from the colon, or the stomach. What is the mode of their formation? For the passage whereby all matters may be discharged by the anus is patent; but the discharge of the water collected about the loins by the bowels is incredible. For a wounded intestine is not free from trouble and danger.

DIABETES is a wonderful affection, not very frequent among men, being a melting down of the flesh and limbs into urine. Its cause is of a cold and humid nature, as in dropsy. The course is the common one, namely, the kidneys and bladder; for the patients never stop making water, but the flow is incessant, as if from the opening of aqueducts. The nature of the disease, then, is chronic, and it takes a long period to form; but the patient is short-lived, if the constitution of the disease be completely established; for the melting is rapid, the death speedy. Moreover, life is disgusting and painful; thirst, unquenchable; excessive drinking, which, however, is disproportionate to the large quantity of urine, for more urine is passed; and one cannot stop them either from drinking or making water. Or if for a time they abstain from drinking, their mouth becomes parched and their body dry; the viscera seem as if scorched up; they are affected with nausea, restlessness, and a burning thirst; and at no distant term they expire. Thirst, as if scorched up with fire. But by what method could they be restrained from making water? Or how can shame become more potent than pain? And even if they were to restrain themselves for a short time, they become swelled in the loins, scrotum, and hips; and when they give vent, they discharge the collected urine, and the swellings subside, for the overflow passes to the bladder.

If the disease be fully established, it is strongly marked; but if it be merely coming on, the patients have the mouth parched, saliva white, frothy, as if from thirst (for the thirst is not yet confirmed), weight in the hypochondriac region. A sensation of heat or of cold from the stomach to the bladder is, as it were, the advent of the approaching disease; they now make a little more water than usual, and there is thirst, but not yet great.

But if it increase still more, the heat is small indeed, but pungent, and seated in the intestines; the abdomen shrivelled, veins protuberant, general emaciation, when the quantity of urine and the thirst have already increased; and when, at the same time, the sensation appears at the extremity of the member, the patients immediately make water. Hence, the disease appears to me to have got the name of diabetes, as if from the Greek word διαβήτης ( which signifies a siphon), because the fluid does not remain in the body, but uses the man’s body as a ladder ( διαβάθρη), whereby to leave it. ² They stand out for a certain time, though not very long, for they pass urine with pain, and the emaciation is dreadful; nor does any great portion of the drink get into the system, and many parts of the flesh pass out along with the urine.

The cause of it may be, that some one of the acute diseases may have terminated in this; and during the crisis the diseases may have left some malignity lurking in the part. It is not improbable, also, that something pernicious, derived from the other diseases which attack the bladder and kidneys, may sometimes prove the cause of this affection. But if any one is bitten by the dipsas, ³ the affection induced by the wound is of this nature; for the reptile, the dipsas, if it bite one, kindles up an unquenchable thirst. For they drink copiously, not as a remedy for the thirst, but so as to produce repletion of the bowels by the insatiable desire of drink. But if one be pained by the distension of the bowels and feel uncomfortable, and abstain from drink for a little, he again drinks copiously from thirst, and thus the evils alternate; for the thirst and the drink conspire together. Others do not pass urine, nor is there any relief from what is drank. Wherefore, what from insatiable thirst, an overflow of liquids, and distension of the belly, the patients have suddenly burst.

THE kidneys are of a glandular nature, but redder in colour, like the liver, rather than like the mammæ and testicles; for they, too, are glands, but of a whiter colour. In shape they resemble the testicles, but are broader, and, at the same time, curved. Their cavities are small and like sieves, for the percolation of the urine; and these have attached to each of them nervous canals, like reeds, which are inserted into the shoulders of the bladder on each side; and the passage of the urine from each of the kidneys to the bladder is equal.

About it, the kidneys, and those passages, many and complicated diseases are formed, partly acute, proving fatal by hemorrhage, fevers, and inflammation, as has been described by me; but partly chronic, others wearing out the patient by wasting, and although not of a fatal character, incurable, and persisting until death. Wherefore, the chronic are—abscesses, ulcers, the formation of stones, and hemorrhoids. The ulcerations from abscess in man are all very protracted, and difficult to cure.

The formation of stones is a long process, the stoppage of them painful, for the passage of them is not easily accomplished; and in addition to these, the retention of urine is formidable. But if several small ones stop together in the passage, or a large one be impacted; and if these occur to both kidneys, so as to occasion retention of urine and distension of the parts, the patients die in a few days. Nature, therefore, did well in forming the cavity of the kidneys oblong, and of equal size with the ureters, and even a little larger, so that if a stone formed above, it might have a ready passage to the bladder. On this account, also, the stones have an oblong form, because, for the most part, they are consolidated in the ureters; and such in that place as are of unequal thickness are slender before, owing to the ureters being narrow, but thick behind, because the kidneys verge downwards. They are formed in the kidneys only, but when in a heated state; for the stones have no fixed place in the ureters, but the gravel floats downwards with the urine, and thus is both indicative of the affection, and furnishes the materiel of it. But if an unusually large one at any time be detained in the pelvis of the kidney, pains of the loins, about the regions of the psoœ, as far as the middle of the ribs, take place, and hence, in many cases, the pain leads to mistake, as if it proceeded from pleurisy; heaviness of the hips; painful flexion about the spine, so that they stoop forward with difficulty; very painful tormina; at the same time, the pains are heavy with a sense of twisting, for the intestine is convoluted. But if the urine be retained in large quantity, and with distension, the desire of making water resembles the pains of labour; they are troubled with flatulence, which cannot find vent; the fevers are pungent, and of a dry nature. Tongue parched; the belly, also, dried up; they are emaciated, and lose appetite; or if they take anything, they cannot readily swallow or digest it. But if the stone fall down into the ureters, there is shivering, as if from rigor, the sensation as if from the passing of a stone with violent exertion. And if it fall down into the bladder, there is an abundant evacuation of watery urine, flatulent discharges from the bowels, the stomach settled, eructations, rest from former illnesses; and sometimes blood is poured out along with the urine, from excoriation of the passage. Another painful operation is the passage through the member; for if the stone be larger than the urethra, it is detained for a long time, the bladder is filled behind, and the ischuria is very painful, for along with the bladder the ureters, also, are filled. The passage of crooked stones is most difficult, for I have seen hooked protuberances on certain of these concretions. But, for the most part, they are oblong, being formed according to the shape of the passages. In colour, some are white, clayey, as is mostly the case with children; others are yellow, and saffron-coloured in old persons, in whom the stones usually form in the kidneys, whereas in children it is rather in the bladder. The causes of the concretion are two-fold: in old persons, a cold body and thick blood. For cold concretes thick fluids more readily than heat, the proof of which is seen in the Thermal springs; for when congealed, the water gets concreted into a sort of chalk-stones. But in children, the copious recrement of the blood, being overheated, gives origin to their formation, like fire.

Such are the affections connected with the formation of stones. Certain persons pass bloody urine periodically: this affection resembles that from hemorrhoids, and the constitution of the body is alike; they are very pale, inert, sluggish, without appetite, without digestion; and if the discharge has taken place, they are languid and relaxed in their limbs, but light and agile in their head. But if the periodical evacuation do not take place, they are afflicted with headache; their eyes become dull, dim, and rolling: hence many become epileptic; others are swollen, misty, dropsical; and others again are affected with melancholy and paralysis. These complaints are the offspring of the stoppage of a customary discharge of blood. If, then, the blood flow pure and unmixed with urine, for the most part the blood of the urine flows from the bladder. Sometimes it is discharged in great quantity from rupture of the kidneys; sometimes it is coagulated, and a thrombus is formed of extravasated blood; sometimes it is coagulated in the bladder, when dreadful ischuria comes on.

After the rupture there succeed ulcers, which are slow and difficult to heal; the indication of which is a scab, or red film, like a spider’s web, or white pus passed in the urine, sometimes pure and unmixed, and sometimes mixed up with the urine. And by these symptoms we may also diagnose abcesses, if, in addition, fevers and rigors supervene towards evening; pains about the loins, pruritus; but if it burst, clots of a purulent and fleshy nature, and now a discharge of white pus. But the ulcers are pungent, sometimes clear, and sometimes foul. This is indicated by the pus and the urine, whether fetid or free of smell.

Spring, then, induces hemorrhages and abscesses; winter and autumn, stones. But if along with the stones ulcers be formed, the diseases indeed are incurable, there is speedy emaciation and death.

OF the diseases in the bladder no one is mild: the acute proving fatal by inflammation, wounds, spasm, and acute fevers; while an ulcer, abcess, paralysis, or a large stone, are chronic and incurable. For it ( a large stone?) can neither be broken by a draught, nor by medicine, nor scraped outwardly, nor cut without danger. For the small ones of the bladder are to be cut out, but the other proves fatal the same day, or in a few days, the patients dying from spasms and fevers; or, if you do not cut him, retention of the urine takes place, and the patient is consumed slowly with pains, fevers, and wasting. But if the stone is not very large, there is frequent suppression of urine; for by falling readily into the neck of the bladder, it prevents the escape of the urine. Although it be safer to cut in these cases than for the large stones, still the bladder is cut; and although one should escape the risk of death, still there is a constant drain of water; and although this may not be dangerous, to a freeman the incessant flow of urine is intolerable, whether he walk or whether he sleep; but is particularly disagreeable when he walks. The very small ones are commonly cut without danger. If the stone adhere to the bladder, it may be detected with care; and, moreover, such cases prove troublesome from the pain and weight, even when there is no dysuria, but yet the patient may have difficulty of making water. You may diagnose all cases of stone by the sediments of sand in the urine, and, moreover, they have the genital parts enlarged by handling them; for when they make water, and there is a stone behind, they are pained, and grasp and drag the genital parts, as if with the intention of tearing out the stone along with the bladder. The fundament sympathises by becoming itchy, and the anus is protruded with the forcing and straining, from the sensation, as it were, of the passage of the stone. For the bladder and anus lie close to one another, and when either suffers, the other suffers likewise. Wherefore, in inflammations of the rectum, the bladder is affected with ischuria; and in acute pains of the bladder, the anus passes nothing, even when the bowels are not much dried up. Such are the sufferings connected with calculi.

Hemorrhage, although it may not prove fatal very speedily, yet in the course of time has wasted many patients. But the clots of blood produced by it are quickly fatal by inducing ischuria, like as in stones; for even if the blood be thin, of a bright colour, and not very coagulable, yet the bladder accumulates it for a length of time, and its heating and boiling (as it were) coagulates the blood, and thus a thrombus is formed. Ischuria, then, is most peculiarly fatal. But on these symptoms there supervene acute pain, acrid heat, a dry tongue, and from these they die delirious.

If pain come on from a wound, the wound itself is dangerous; but the sore, even if not fatal at first, becomes incurable from fever or inflammation; for the bladder is thin, and of a nervous nature, and such parts do not readily incarnate nor cicatrise. Moreover, the urine is bilious, acrid, and corrosive. The ordinary condition of the ulcer is this:—when the bladder is filled, it is stretched; but when emptied, it contracts: it is in the condition, then, of a joint in extension and flexion, and no ulcer in a joint is easy of cure.

The bladder also suppurates from an abscess. The symptoms of an abscess of the bladder are the same as in other cases; for the abscess in forming is attended with inflammation, fevers, and rigors. The dangers are the same. But if it discharges urine which is thick, white, and not fetid, the ulcers from them are mild; but if it spread, they pass urine which is feculent, mixed with pus, and of a bad smell: of such persons the death is not distant. The urine, indeed, is pungent, and the evacuation thereof painful, and the pain darts to the extremity of the member. All things, even those which are opposed to one another, prove injurious to them; repletion and inanition, inactivity and exercise, baths and abstinence from baths, food and abstinence from food, sweet things and acid things; certain articles being serviceable in certain cases, but proving injurious in others, not being able to agree in any one.

GONORRHŒA is not, indeed, a deadly affection, but one that is disagreeable and disgusting even to hear of. For if impotence and paralysis possess both the fluids and genital organs, the semen runs as if through dead parts, nor can it be stopped even in sleep; for whether asleep or awake the discharge is irrestrainable, and there is an unconscious flow of semen. Women also have this disease, but their semen is discharged with titillation of the parts, and with pleasure, and from immodest desires of connection with men. But men have not the same prurient feelings; the fluid which runs off being thin, cold, colourless, and unfruitful. For how could nature, when congealed, evacuate vivifying semen? And even young persons, when they suffer from this affection, necessarily become old in constitution, torpid, relaxed, spiritless, timid, stupid, enfeebled, shrivelled, inactive, pale, whitish, effeminate, loathe their food, and become frigid; they have heaviness of the members, torpidity of the legs, are powerless, and incapable of all exertion. In many cases, this disease is the way to paralysis; for how could the nervous power not suffer when nature has become frigid in regard to the generation of life? For it is the semen, when possessed of vitality, which makes us to be men, hot, well braced in limbs, hairy, well voiced, spirited, strong to think and to act, as the characteristics of men prove. For when the semen is not possessed of its vitality, persons become shrivelled, have a sharp tone of voice, lose their hair and their beard, and become effeminate, as the characteristics of eunuchs prove. But if any man be continent in the emission of semen, he is bold, daring, and strong as wild beasts, as is proved from such of the athletæ as are continent. For such as are naturally superior in strength to certain persons, by incontinency become inferior to their inferiors; while those by nature much their inferiors by continency become superior to their superiors: but an animal becomes strong from nothing else than from semen. Vital semen, then, contributes much to health, strength, courage, and generation. From satyriasis a transition takes place to an attack of gonorrhœa.

THE stomach is the president of pleasure and disgust, being an important neighbour to the heart for imparting tone, good or bad spirits, from the sympathy of the soul. This is the primary power of the stomach. These things have been described by me in another place. The offspring of pleasure are, good digestion, good condition, and good colour of the body; of disgust, their contraries, and also sometimes depression of spirits, when proper nutrition is wanting; and in melancholic patients, loathing of food. If, then, this organ be diseased, there is dislike and abomination of articles of food, not only if administered, but even if the food is not seen; nay, the very remembrance of them is attended with nausea, distress, water-brash, and heart-ache; and in certain cases there is salivation and vomiting. Even when the body wastes, provided their stomach remain empty, they bear this pain more easily than that produced by the administration of food. But if at any time they are compelled by necessity to take food, the pain is worse than hunger; the act of masticating in the mouth occasions sufferance, and to drink is a still greater pain. And it is not that they suffer thus from suitable food, and bear more unusual food well; owing to a change from that which is natural to the opposite, there is a painful sensation as to everything, an aversion to, and dislike of, all kinds of food. Along with these there is pain between the scapulæ, much greater after the administration of food or drink; loathing, distress, sight dull, noises of the ears, heaviness of the head, torpidity of the limbs, their joints sink under them; palpitation in the hypochondriac region; phantasy, as of the spine being moved towards the lower limbs; they seem as if carried about, now this way and now that, whether they stand, or lie down, like reeds or trees shaken by a gale of wind; they belch out a cold and watery phlegm. But if there be bile in bilious persons, they have dimness of sight, and no thirst, even when owing to the food they appear thirsty; are sleepless, torpid, drowsy, not from true sleep, but like those in comatose affections; emaciated, very pale, feeble, relaxed, imbecile, dispirited, timid, inactive, quick to passion, very moody; for such persons at times have fallen into a state of melancholy.

These mental emotions necessarily attend the affection when in connection with the stomach; but certain people, recognising the parts which sympathise, and from which the most dreadful symptoms arise, reckon the stomach as the cause. But the contiguity of the heart, which is of all organs the first, is a strong confirmation of the truth of what I say; for the heart is placed in the middle of the lungs, and this intermediate space comprehends the stomach; and, moreover, both are connected with the spine; and from this vicinity to the heart arise the heart-ache, prostration of strength, and symptoms of melancholy.

There are other, and, indeed, innumerable causes of this disease; but the principal is, much pus poured forth by the belly through the stomach. It is familiar to such persons as from their necessities live on a slender and hard diet; and to those who, for the sake of education, are laborious and persevering; whose portion is the love of divine science, along with scanty food, want of sleep, and the meditation on wise sayings and doings—whose is the contempt of a full and multifarious diet; to whom hunger is for food, water for drink, and watchfulness in place of rest; to whom in place of a soft couch, is a hammock on the ground without bed-clothes, a mean coverlet, a porous mantle, and the only cover to whose head is the common air; whose wealth consists in the abundant possession and use of divine thought (for all these things they account good from love of learning); and, if they take any food, it is of the most frugal description, and not to gratify the palate, but solely to preserve life; no quaffing of wine to intoxication; no recreation; no roving or jaunting about; no bodily exercise nor plumpness of flesh; for what is there from which the love of learning will not allure one?—from country, parents, brothers, oneself, even unto death. Hence, to them, emaciation of the frame; they are ill-complexioned; even in youth they appear old, and dotards in understanding; in mind cheerless and inflexible; depraved appetite, speedy satiety of the accustomed slender and ordinary food, and from want of familiarity with a varied diet, a loathing of all savoury viands; for if they take any unusual article of food, they are injured thereby, and straightway abominate food of all kinds. It is a chronic disease of the stomach. But inflammations, defluxions, heart-burn, or pain thereof, are not called the Stomachic affection.

Summer brings on this disease, whence springs the complete loss of digestion, of appetite, and of all the faculties. With regard to the period of life, old age; for in old men, even without any disease, owing to their being near the close of life, the appetite is nearly gone.

THE stomach being the digestive organ, labours in digestion, when diarrhœa seizes the patient. Diarrhœa consists in the discharge of undigested food in a fluid state; and if this does not proceed from a slight cause of only one or two days’ duration; and if, in addition, the patient’s general system be debilitated by atrophy of the body, the Cœliac disease of a chronic nature is formed, from atony of the heat which digests, and refrigeration of the stomach, when the food, indeed, is dissolved in the heat, but the heat does not digest it, nor convert it into its proper chyme, but leaves its work half finished, from inability to complete it; the food then being deprived of this operation, is changed to a state which is bad in colour, smell, and consistence. For its colour is white and without bile; it has an offensive smell, and is flatulent; it is liquid, and wants consistence from not being completely elaborated, and from no part of the digestive process having been properly done except the commencement.

Wherefore they have flatulence of the stomach, continued eructations, of a bad smell; but if these pass downwards, the bowels rumble, evacuations are flatulent, thick, fluid, or clayey, along with the phantasy, as if a fluid were passing through them; heavy pain of the stomach now and then, as if from a puncture; the patient emaciated and atrophied, pale, feeble, incapable of performing any of his accustomed works. But if he attempt to walk, the limbs fail; the veins in the temples are prominent, for owing to wasting, the temples are hollow; but also over all the body the veins are enlarged, for not only does the disease not digest properly, but it does not even distribute that portion in which the digestion had commenced for the support of the body; it appears to me, therefore, to be an affection, not only of the digestion, but also of the distribution.

But if the disease be on the increase, it carries back the matters from the general system to the belly, when there is wasting of the constitution; the patients are parched in the mouth, surface dry and devoid of sweat, stomach sometimes as if burnt up with a coal, and sometimes as if congealed with ice. Sometimes also, along with the last scybala, there flows bright, pure, unmixed blood, so as to make it appear that the mouth of a vein has been opened; for the acrid discharge corrodes the veins. It is a very protracted and intractable illness; for, even when it would seem to have ceased, it relapses again without any obvious cause, and comes back upon even a slight mistake. Now, therefore, it returns periodically.

This illness is familiar to old persons, and to women rather than to men. Children are subject to continued diarrhœa, from an ephemeral intemperance of food; but in their case the disease is not seated in the cavity of the stomach. Summer engenders the disease more than any other of the seasons; autumn next; and the coldest season, winter, also, if the heat be almost extinguished. This affection, dysentery and lientery, sometimes are engendered by a chronic disease. But, likewise, a copious draught of cold water has sometimes given rise to this disease.

PERSONS in colic are cut off speedily by volvulus and tormina. There are very many causes of this affection. The symptoms are, heaviness during abstinence from food, particularly in the part most affected; much torpor; they are inactive, lose appetite, become emaciated, sleepless, swollen in countenance. And if the colon be affected in connection with the spleen, they are of a dark-green colour; but of a light-green when in connection with the liver, from the sympathy of the nearest viscera. And if they take food, even in small quantity, and such as is not flatulent, they become very flatulent, and have a desire to pass wind, which, however, does not find vent: forced eructations upwards, but without effect; or, if any should be forcibly expelled, the flatus is fetid and acid which escapes upwards. The kidneys and bladder sympathise, with pain and ischuria; but in such cases the symptoms interchange with one another. But a greater wonder than these, —an unexpected pain has passed down to the testicles and cremasters; and this sympathetic affection has escaped the observation of many physicians, who have made an incision into the cremasters, as if they were the particular cause of the disease. But in these cases also the symptoms interchange with one another.

From this disease are produced other diseases; abscesses and ulcers, of no mild character; dropsies and phthisis, which are incurable. For the disease is formed from cold and thick humours, and a copious and glutinous phlegm; but, also, it comes on with a frigid period of life, a cold season, and a cold locality, and during a hard winter.

OF the intestines, the upper being thin and bilious ( χολώδεα) as far as the cœcum, have got the Greek name χολώδες. From these proceed the lower, which are thick and fleshy, as far as the commencement of the Rectum.

Wherefore ulcers form in all of them; and the varieties of these ulcers constitute Dysentery: on this account, these diseases are complex. For some of them erode the intestines superficially, producing only excoriation; and these are innocuous; but they are far more innocent if the affections be low down. Or if the ulcers be yet a little deeper, they are no longer of a mild character. But ulcers which are deep and have not stopped spreading, but are of a phagedænic, painful, spreading, and gangrenous character, are of a fatal nature; for the small veins get corroded in the course of their spreading, and there is an oozing of blood in the ulcers. Another larger species of ulcers: thick edges, rough, unequal, callous, as we would call a knot in wood: these are difficult to cure, for they do not readily cicatrise, and the cicatrices are easily dissolved.

The causes of dysentery are manifold; but the principal are, indigestion, continued cold, the administration of acrid things, such as myttôtos, ⁴ onions by themselves, garlic, food of old and acrid flesh, by which dyspepsia is produced; also unaccustomed liquids, cyceon, ⁵ or zythus ⁶ (ale), or any similar beverage produced in any country as a substitute for wine to quench thirst. But also a blow, exposure to cold, and cold drink, create ulcerations.

The dejections and the circumstances attendant on the ulcers are different in different cases; for, if superficial, when from above, the discharges are thin, bilious, devoid of odour except that which they derive from the intestines; those from the jejunum are rather more coloured, saffron-like, and fetid. Those dejections which contain the food in a dissolved state but rough, are sometimes fetid in smell when the ulcers are gangrenous, and sometimes have the smell as if from scybala. But in the ulcerations from the parts below, the discharges are watery, thin, and devoid of smell. But if deeper they are like ichor, reddish, of the colour of dark wine, or like the washings of flesh; and these are sometimes by themselves and sometimes with the fæces, these being dissolved in the surrounding fluid, devoid of bile and of smell; or they are evacuated in a consistent and dry state, lubricated with the surrounding fluid. But if the ulcers be larger and smoother, in those above they are bilious, and pinch the parts from which they come and through which they pass (they even pinch the anus), for the bile is acrid, more especially if from an ulcer; and the bile is fatty, like grease. In the deeper ulcers below, a thick clot of blood with phlegm, like flesh not very fat, or like the scrapings of the bowels: nay, even entire portions are mixed up with them; they are discharged white, thick, mucous, like chopped tallow, along with the humour in which they float: these proceed from the rectum: but sometimes they are merely mucous, prurient, small, round, pungent, causing frequent dejections and a desire not without a pleasurable sensation, but with very scanty evacuations: this complaint gets the appellation of tenesmus. But from the colon there are discharged pieces of flesh, which are red, large, and have a much larger circumference. If the ulcers become deep, and the blood thick and feculent, these are more fetid than the former; but if the ulcers spread and are phagedænic, and if nothing will stop them, above, in addition to being intensely bilious, the dejections become saffron-like, frothy, feculent, blackish, like woad or like leeks, thicker than the former, fetid like a mortification; food now undigested, as if only masticated by voracious teeth. But if the under parts are also corroded, black clots of blood, thick, fleshy, very red, clotted, sometimes, indeed, black, but at other times of all various colours, fetid, intolerable; involuntary discharges of fluids. And sometimes a substance of considerable length, in many respects not to be distinguished from a sound piece of intestine, has been discharged, and, to those ignorant of the matter, has caused apprehension about the intestine: but the fact is this,—the intestines, like the stomach, consist of two coats, which lie close to one another in an oblique manner; when, therefore, the connection between them is dissolved, the inner coat, being separated to some length, protrudes externally, while the outer one remains alone, incarnates, and gets cicatrised, and the patients recover and live unharmed. It is the lower gut alone which suffers thus, owing to its fleshy nature. And, if blood be discharged from any vessel, it runs of a bright red or black colour, pure, and unmixed with food or scybala; and if a concretion is spread over it like broad spiders’ webs, it coagulates when cold, and no longer would be taken for a secretion of blood; but being discharged with much flatulence and noise, it has the appearance of being much larger than its actual amount. Sometimes, also, a purulent abscess forms in the colon, nowise different from the other internal ulcers; for the symptoms, the pus, and the mode of recovery are the same. But if there be hard secretions of matters resembling flesh, as if pounded, and like rough bodies, the abscess is not of a mild nature. Sometimes a copious discharge of water takes place from the colon in the form of dysentery, which has freed many patients from dropsy. In a word, such are the ulcers in the intestines; and their forms and the secretions from them as I have described.

I will now describe the symptoms accompanying each of these states of disease, whether the ulcers be mild or malignant. To speak in general terms, then, if the excoriation is superficial, whether it be above or below, the patients are free from pain and from fever, and get better without being confined to bed, in various ways, by merely some slight changes of diet. But if ulceration supervene, in the upper bowels there are tormina, which are pungent, acrid, as if from the presence of a small amount of hot bile; and occasionally there is suppuration: indeed, for the most part, there is suppuration, or digestions imperfectly performed, though there is no want of appetite. But if the ulcers form in the lower part of the bowels, they are much less dangerous than in those above, for the bowels there are of a much more fleshy nature than those above. But if those above become hollow and phagedænic, there are acute fevers, of a latent kind, which smoulder in the intestines; general coldness, loss of appetite, insomnolency, acid eructations, nausea, vomiting of bile, vertigo: but if the discharge become copious, and consist of more bilious matters, the tormina become permanent, and the other pains increase; sometimes there is prostration of strength, feebleness of the knees; they have ardent fever, are thirsty, and anxious; black vomiting, tongue dry, pulse small and feeble. Akin to these are the fatal symptoms I have stated among those of malignant ulcers; cardiac affections even to deliquium animi, from which some never recover, but thus expire. These dangerous symptoms are common also to erosions of the lower intestines if the ulcers spread, and the discharge be not checked, only that the tormina and pains are below the umbilicus where the ulcers are situated. The forms of the secretions are such as I have said; but if they be small at first, and there be a postponement of their spreading for a long time, various changes take place in the ulcers, some subsiding, and others swelling up, like waves in the sea. Such is the course of these ulcers. But if nature stand out, and the physician co-operate, the spreading may, indeed, be stopped, and a fatal termination is not apprehended, but the intestines remain hard and callous, and the recovery of such cases is protracted.

In hemorrhage from the bowels, if it proceed from a large vein or artery, it is sudden death; for neither is it possible to introduce the hand so as to reach the ailment, nor to apply any medicine to the sore. And even if the hemorrhage were restrained by the medicine, the escape from death would not be certain; for, in some cases, the falling off of a large eschar widens the mouth of the vein, and when clots form within, and remain there, the disease is incurable. It is necessary, then, to cure hemorrhages in their commencement. Its approach, also, for the most part is obvious, although not in all cases quite apparent: anxiety attends, with restlessness, heaviness in the part where the rupture is to take place, ruddiness of the countenance if the blood has not yet burst forth. And if the vein has burst lately, for the most part the symptoms are alleviated; but if it has been a longer time ago, this takes place more slowly, and with more difficulty. Such are the ulcers in the intestines.

They occur in the season of summer; next in autumn; less in spring; least of all in winter. Diarrhœa attacks children and adolescents, but dysentery adults and young persons. In old age convalescence is difficult, and cicatrization protracted. Corroding sores are unusual in old persons, but yet hemorrhage is in accordance with old age.

IF many thick and hard cicatrices form after dysenteries, and broad and very deep ulcerations of the upper intestines, the food passes from them to those below in a fluid state, without separation of the nutritious part; for the cicatrix shuts up the pores by which the nutriment is carried upwards. The patient, therefore, is seized with atrophy, loss of colour and of strength. The affection gets the appellation of Lientery, this name being applied to a cicatrix of the intestines. And here the affection is from ulcers. But sometimes the intestines do not acquire cicatrization, but yet usage and habit reconcile the intestines to the discharge. For, the heat in these parts, if congealed, neither at times performs digestion, nor is the nutriment distributed upwards; but being unchanged, owing to weakness, it fails to undergo any part of the process. But if the purging, though of vitiated matters, be temporary, and not confirmed, a simple vomit after food will sometimes remove the disease. But if the exciting cause be prolonged, and get confirmed, it does no good.

A chronic disease, and cachexia so mild as not to confine the patient to bed, will engender this disease. But dropsies sometimes have terminated favourably in this disease; a change from one evil to another, but still a better change.

THE uterus in women is beneficial for purgation and parturition, but it is the common source of innumerable and bad diseases; for not only is it subject to ulcers, inflammation, and the fluor, but, if the whole organ be suddenly carried upwards, it quickly causes death. The fatal diseases of an acute nature connected therewith have been described elsewhere: but the chronic affections are, the two species of fluor; hardness; ulcers, part mild, but part malignant; prolapsus of the whole, or of part.

The fluor, then, is either of a red or white colour; its appearance indicates this. It is the red if it consist of bright red blood, and the varieties thereof; or livid, or black and thin, or thick and coagulated, like a thrombus; or white, like water; or a bright ochre colour, like bile: in thickness like a thinnish or thin and fetid ichor. The white flux (or fluor albus) is like pus, and the true form like white whey; but a clot of blood frequently runs off with the pus. But there is an infinite variety of forms of it, as regards more or less quantity. Its periods sometimes agree with those of the menstrual purgation, but it does not continue the regular time as before; there is not much blood, but it flows during many days; the interval is for a few days, but is quite free from discharge. Another variety as to the period: the first purgation is at the regular time, but it occurs two or three times during each month. Another variety: a continual flux; small, indeed, every day, but by no means small during the whole month; for the uterus never closes its mouth, labouring under relaxation, so as to permit the flow of the fluid: but if it neither intermits nor diminishes, they die of hemorrhage. The symptoms are, the woman’s colour in accordance with those of the discharge; sleepless, loathes food, anxious, relaxed, especially in the red flux, and subject to pains; the discharge fetid in both varieties, but to a greater and less extent at different times; for the white is worse if the putrefaction be unusually great; and sometimes the red, if the erosion be exacerbated. In a word, the black is the worst of all; the livid next; the pale, the white, and the purulent, are more protracted, indeed, but less dangerous. Of these the pale is worse indeed, but much better when mixed with the customary discharge. Now the customary discharge is red in all its varieties. But, indeed, the red are worse in old women; but the white are not at all so to the young; but even to them that which is customary is less troublesome. Another white fluor: the menstrual discharge white, acrid, and attended with an agreeable pruritus; along with which the discharge of a white thick fluid, like semen, is provoked. This species we call female gonorrhœa. It is a refrigeration of the womb, which therefore becomes incapable of retaining its fluids; hence, also, the blood changes to a white colour, for it has not the purple colour of fire. The stomach, also, is subject to the affection, and vomits phlegm; and also the bowels are similarly affected in diarrhœa.

Ulcers, too, are formed in the womb; some broad and attended with tingling, which, being close together, are, as it were, a superficial excoriation; pus thick, without smell, scanty. These ulcers are mild. But there are others deeper and worse than these, in which the pains are slight, pus somewhat more abundant, much more fetid, and yet, notwithstanding, these also are mild. But if they become deeper, and the lips of the sores hard or rough, if there is a fetid ichor, and pain stronger than in the former case, the ulcer corrodes the uterus; but sometimes a small piece of flesh is cast off and discharged, and this sore not coming to cicatrization, either proves fatal after a long time, or becomes very chronic. This sore gets the appellation of phagedæna. The sores also are dangerous if in these cases the pain gets exacerbated, and the woman becomes uneasy. From the sore there is discharged a putrid matter, intolerable even to themselves; it is exasperated by touching and by medicines, and irritated by almost any mode of treatment. The veins in the uterus are swelled up with distension of the surrounding parts. To the skilled, it is not difficult to recognise by the touch, for it is not otherwise obvious. Febrile heat, general restlessness, and hardness is present, as in malignant diseases; the ulcers, being of a fatal nature, obtain also the appellation of cancers. Another cancer: no ulceration anywhere, swelling hard and untractable, which distends the whole uterus; but there are pains also in the other parts which it drags to it. Both these carcinomatous sores are chronic and deadly; but the ulcerated is worse than the unulcerated, both in smell and pains, in life and in death.

Sometimes the whole uterus has protruded from its seat, and lodged on the woman’s thighs; an incredible affliction! yet neither has the uterus not been thus seen, nor are the causes which produce it such as do not occur. For the membranes which are inserted into the flanks, being the nervous ( ligamentous?) supporters of the uterus, are relaxed; those at the fundus, which are inserted into the loins, are narrow; but those at its neck, on each side to the flanks, are particularly nervous and broad, like the sails of a ship. All these, then, give way if the uterus protrude outwardly, wherefore this procidentia generally proves fatal; for it takes place from abortion, great concussions, and laborious parturition. Or if it do not prove fatal, the women live for a long time, seeing parts which ought not to be seen, and nursing externally and fondling the womb. It would appear that, of the double membrane of the womb, the internal lining coat is sometimes torn from the contiguous one, for there are two transverse plates of the coat; this, then, is thrown off with the flux, and in abortion and laborious parturition, when it adheres to the placenta. For if it be forcibly pulled, the coat of the uterus being stretched, ..... But if the woman do not die, it is either restored to its seat, or but a small part appears externally, for the woman conceals it with her thighs. Sometimes the mouth of the womb only, as far as the neck, protrudes, and retreats inwardly if the uterus be made to smell to a fetid fumigation; and the woman also attracts it if she smells to fragrant odours. But by the hands of the midwife it readily returns inwards when gently pressed, and if anointed beforehand with the emollient plasters for the womb.

ARTHRITIS is a general pain of all the joints; that of the feet we call Podagra; that of the hip-joint, Schiatica; that of the hand, Chiragra. The pain then is either sudden, arising from some temporary cause; or the disease lies concealed for a long time, when the pain and the disease are kindled up by any slight cause. It is, in short, an affection of all the nerves, if the ailment being increased extend to all; the first affected are the nerves which are the ligaments of the joints, and such as have their origin and insertion in the bones. There is a great wonder in regard to them; there is not the slightest pain in them, although you should cut or squeeze them; but if pained of themselves, no other pain is stronger than this, not iron screws, nor cords, not the wound of a sword, nor burning fire, for these are often had recourse to as cures for still greater pains; and if one cut them when they are pained, the smaller pain of the incision is obscured by the greater; and, if it prevail, they experience pleasure in forgetting their former sufferings. The teeth and bones are affected thus.

The true reason of this none but the gods indeed can truly understand, but men may know the probable cause. In a word, it is such as this; any part which is very compact is insensible to the touch or to a wound, and hence it is not painful to the touch or to a wound. For pain consists in an exasperated sense, but what is compact cannot be exasperated, and hence is not susceptible of pain. But a spongy part is very sensible, and is exasperated by an injury. But since dense parts also live by their innate heat, and possess sensibility by this heat, if then the exciting cause be material, such as either a sword, or a stone, the material part of the patient is not pained, for it is dense by nature. But if an intemperament of the innate heat seize it, there arises a change of the sense; the heat therefore is pained by itself, being roused within by the impression on the sense. The pains then are from nature’s being increased, or a redundance thereof.

Arthritis fixes itself sometimes in one joint and sometimes in another; sometimes in the hip-joints; and for the most part in these cases the patient remains lame in it; and the other joints it affects little, and sometimes does not go to the small joints, as the feet and hands. If it seizes the greater members which are able to contain the disease, it does not go beyond these organs; but if it begin from a small one, the attack is mild and unexpected. The commencement of ischiatic disease is from the thigh behind, the ham, or the leg. Sometimes the pain appears in the cotyloid cavity, and again extends to the nates or loins, and has the appearance of anything rather than an affection of the hip-joint. But the joints begin to be affected in this way: pain seizes the great toe; then the forepart of the heel on which we lean; next it comes into the hollow of the foot, but the ankle swells last; and they blame a wrong cause; some, the friction of a new shoe; others, a long walk; another again, a stroke or being trod upon; but no one will of his own accord tell the true one; and the true one appears incredible to the patients when they hear of it. On this account the disease gets to an incurable state, because at the commencement, when it is feeble, the physician is not at hand to contend with it; but if it has acquired strength from time, all treatment is useless. In some, then, it remains in the joints of the feet until death, but in others it spreads over the compass of the whole body. For the most part, it passes from the feet to the hands. For to the disease there is no great interval between the hands and the feet, both being of a similar nature, slender, devoid of flesh, and very near the external cold, but very far from the internal heat; next the elbow and the knee, and after these the hip-joint; which is the transition to the muscles of the back and chest. It is incredible how far the mischief spreads. The vertebræ of the spine and neck are affected with the pain, and it extends to the extremity of the os sacrum: there is a general pain of all the parts of the groin, and a pain peculiar to each part thereof. But likewise the tendons and muscles are intensely pained; the muscles of the jaws and temples; the kidneys, and the bladder next in succession. And, what a wonder! at last the nose, the ears, and the lips, suffer; for every where there are nerves and muscles. A certain person had pains in the sutures of the head, and not knowing why he was pained there, he pointed out the shapes of the sutures—the oblique, the straight, the transverse—both behind and before, and stated that the pain was narrow and fixed in the bones; for the disease spreads over every commissure of the bones, in the same manner as in the joints of a foot or of a hand. Callosities also form in the joints; at first they resemble abscesses, but afterwards they get more condensed, and the humour being condensed is difficult to dissolve; at last they are converted into hard, white tophi, and over the whole there are small tumours, like vari and larger; but the humour is thick, white, and like hailstones. For it is a cold disease of the whole (body), like hail; and there appears to be a difference in regard to heat and cold; for in certain cases there is delight in things otherwise disagreeable. But, I fancy, that the cause is a refrigeration of the innate heat, and that the disease is single; but if it speedily give way, and the heat re-appears, there is need of refrigeration and it delights in such things; this is called the hot species. But if the pain remain internally in the nerves, and the part not becoming heated subside, nor get swollen, I would call this variety cold, for which there is need of hot medicines to restore the heat, of which those very acrid are most necessary. For heat excites the collapsed parts to swelling, and calls forth the internal heat, when there is need of refrigerants. In proof of this, the same things are not always expedient in the same cases, for what is beneficial at one time proves prejudicial in another; in a word, heat is required in the beginning, and cold at the conclusion. Wherefore Gout does not often become unremitting; but sometimes it intermits a long time, for it is slight; hence a person subject to Gout has won the race in the Olympiac games during the interval of the disease.

Men then are more readily affected, but more slightly the women; women more rarely than men, but more severely. For what is not usual nor cognate, if from necessity it gets the better engenders a more violent ailment. The most common age is after thirty-five; but sooner or slower according to the temperament and regimen of every one. The pains then are dreadful, and the concomitants worse than the pains; fainting even upon touch, inability of motion, loss of appetite, thirst, restlessness. But, if they recover partly, as if escaped from death, they live dissolutely, are incontinent, open-handed, cheerful, munificent, and luxurious in diet; but partly, as if they would (not?) again escape from death, they enjoy the present life abundantly. In many cases the gout has passed into dropsy, and sometimes into asthma; and from this succession there is no escape.

THERE are many things in common as to form, colour, size, and mode of life between the affection Elephas and the wild beast the elephant; but neither does the affection resemble any other affection, nor the animal any other animal. The wild beast, the elephant, indeed, is very different from all others; in the first place then, he is the greatest and the thickest of animals; in size, he is as great as if you were to put one animal on another, like a tower; in bulk, he is as large as if you should place several other very large animals side by side. But neither in shape is he much like unto any other. Then, as to colour, they are all intensely black, and that over their whole body. One horse, indeed, is very white, like the Thracian steeds of Rhesus; others white-footed, like the white-footed horse of Menelaus; and bay, like one hundred and fifty; others are tawny, as assuming the shape of a horse having a tawny mane, he lay down with her. And so it is with oxen, and dogs, and all other reptiles and animals which live on the earth. But elephants are only of a lurid colour, like to night and death. With regard to shape, they have a very black head, and unseemly face of no marked form, upon a small neck, so that the head appears to rest upon the shoulders, and even then it is not very conspicuous. For the ears are large, broad, resembling wings, extending to the collar-bone and breast-bone, so as to conceal the neck with the ears, like ships with their sails. The elephant has wonderfully white horns on a very dark body—others call them teeth—these alone are most white, such as is nothing else of even any other white animal; and these are not above the forehead and temples, as is the nature of other horned animals, but in the mouth and upper jaw, not indeed quite straight forwards but a little bent upwards, so that it might swallow in a straight direction, and lift a load in its flat teeth. Moreover the horns are large, the medium length being as much as a fathom, and some much larger; that is to say, as long as two fathoms. And the upper jaw from its lip has a long, ex-osseous, crooked, and serpent-like protuberance; and there are two perforations at the extremity of this protuberance; and these by nature are perforated all the way to the lungs, so as to form a double tube, so that the animal uses this pipe as a nostril for respiration, and likewise as a hand; for it could take a cup if it please with this protuberance, and can grasp it round and hold it firmly, and none could it take by force from the animal, except another stronger elephant. And with this also it seeks herbage for food; for neither does it live by eating flesh with its mouth and small teeth. For, its feet being long, raise the animal considerably above the ground; but its neck also, as I have said, is small, and therefore it cannot browse on the earth with its mouth; and moreover the excrescence of the horns in front of the mouth prevents the mouth from touching the herbage. Wherefore it raises a great load with its protuberance; then as if with a binder having bound the same with it, he can convey it to his mouth; whence the ancients properly call it proboscis, for it collects food in front of the animal. But neither is it able to drink from a lake or river with its mouth, for the same reason. But, if it is thirsty, it introduces into the water the extreme nostril of the proboscis, and then, as if inhaling, it draws in much water, instead of air; and when it has filled its nose, as it were a cup, it pours the same as a stream of water into its mouth, and then it draws anew and discharges again, until it fills its belly, as it were a vessel of burden. It has a rough and very thick skin, containing fissures with prominent edges, long channels, and other hollow clefts, some transverse, others oblique, very deep, like in all respects to a furrowed field. Other animals have naturally hairs for a mane, but in the elephant this is merely down. There are also innumerable other differences between it and other animals; for, like man, it bends its leg backward at the knee; and like woman, it has its dugs at the arm-pits. But there is no necessity for me now to write concerning the animal, except in so far as there is any discrepancy between the animal and the disease, and in so far as the symptoms of the patient resemble the nature of the animal. The disease is also called Leo, on account of the resemblance of the eyebrows, as I shall afterwards explain; and Satyriasis, from the redness of the cheeks, and the irresistible and shameless impulse ad coitum. Moreover it is also called the Heracleian affection, insomuch as there is none greater and stronger than it.

Wherefore the affection is mighty in power, for it is the most powerful of all in taking life; and also it is filthy and dreadful to behold, in all respects like the wild animal, the elephant. And from the disease there is no escape, for it originates in a deadly cause; it is a refrigeration of the innate heat, or rather a congelation like a great winter, when the water is converted into snow, or hail, or ice, or frost. This is the common cause of death, and of the affection.

But the commencement of the disease gives no great indication of it; neither does it appear as if any unusual ailment had come upon the man; nor does it display itself upon the surface of the body, so that it might be immediately seen, and remedies applied at the commencement; but lurking among the bowels, like a concealed fire it smolders there, and having prevailed over the internal parts, it afterwards blazes forth on the surface, for the most part beginning, like a bad signal-fire, on the face, as it were its watch-tower; but in certain cases from the joint of the elbow, the knee, and knuckles of the hands and feet. In this way the patient’s condition is hopeless, because the physician, from inattention and ignorance of the patient’s ailment, does not apply his art to the commencement when the disease is very feeble. For, indeed, they are merely torpid, as if from some light cause, drowsy, inactive, dry in the bowels, and these symptoms are not very unusual even in healthy persons. But upon the increase of the affection, the respiration is fetid from the corruption within of the breath ( pneuma). The air, or something external, would seem to be the cause of this. Urine thick, muddy, like that of cattle; the distribution of crude undigested food; and yet of these things there is no perception nor regard; for neither are they aware whether or not they digest, thus digestion or indigestion is all one to them, since, for anything useful and proper to them, digestion is not usual with them. The distribution, however, is easy, the disease, as it were, greedily attracting the food for its own nourishment; for this reason the lower belly is very dry. Tumours prominent, not continuous with one another anywhere, but thick and rough, and the intermediate space cracked, like the skin of the elephant. Veins enlarged, not from abundance of blood, but from thickness of the skin; and for no long time is the situation of them manifest, the whole surface being elevated equally in the swelling. The hairs on the whole body die prematurely, on the hands, the thighs, the legs, and again on the pubes; scanty on the chin, and also the hairs on the head are scarce. And still more frequently premature hoariness, and sudden baldness; in a very short time the pubes and chin naked of hair, or if a few hairs should remain, they are more unseemly than where they are gone. The skin of the head deeply cracked; wrinkles frequent, deep, rough; tumours on the face hard, sharp; sometimes white at the top, but more green at the base. Pulse small, dull, languid, as if moved with difficulty through the mud; veins on the temples elevated, and also those under the tongue; bowels bilious; tongue roughened with vari, resembling hailstones; not unusual for the whole frame to be full of such (and thus also in unsound victims, the flesh is full of these tubercles resembling hail). But if the affection be much raised up from the parts within, and appear upon the extremities, lichens occur on the extremities of the fingers; there is pruritus on the knees, and the patients rub the itchy parts with pleasure. ⁷ And the lichen sometimes embraces the chin all round; it reddens the cheeks, but is attended with no great swelling; eyes misty, resembling bronze; eye-brows prominent, thick, bald, inclining downwards, tumid from contraction of the intermediate space; colour livid or black; eye-lid, therefore, much retracted to cover the eyes, as in enraged lions; on this account it is named leontium. Wherefore it is not like to the lions and elephants only, but also in the eye-lids resembles swift night. Nose, with black protuberances, rugged; prominence of the lips thickened, but lower part livid; nose elongated; teeth not white indeed, but appearing to be so under a dark body; ears red, black, contracted, resembling the elephant, so that they appear to have a greater size than usual; ulcers upon the base of the ears, discharge of ichor, with pruritus; shrivelled all over the body with rough wrinkles; but likewise deep fissures, like black furrows on the skin; and for this reason the disease has got the name of elephas. Cracks on the feet and heels, as far as the middle of the toes; but if the ailment still further increase, the tumours become ulcerated, so that on the cheeks, chin, fingers, and knees, there are fetid and incurable ulcers, some of which are springing up on one part, while others are subsiding on another. Sometimes, too, certain of the members of the patient will die, so as to drop off, such as the nose, the fingers, the feet, the privy parts, and the whole hands; for the ailment does not prove fatal, so as to relieve the patient from a foul life and dreadful sufferings, until he has been divided limb from limb. For it is long-lived, like the animal, the elephant. But if there be a sudden pain of the limbs, it attacks much more grievously, spreading sometimes to this part, and sometimes to that. Appetite for food not amiss; taste indiscriminate, neither food nor drink affords pleasure; aversion to all things from a painful feeling; atrophy; libidinous desires of a rabid nature; spontaneous lassitude; the figure of each of the limbs heavy, and even the small limbs are oppressive to the patient. Moreover, the body is offended with everything, takes delight neither in baths nor abstinence from them, neither in food nor in abstinence from it, neither in motion nor in rest, for the disease has established itself in all the parts. Sleep slight, worse than insomnolency, from its fantasies; strong dyspnœa, suffocation as if from strangling. In this way certain patients have passed from life, sleeping the sleep which knows no waking, even until death.

When in such a state, who would not flee;—who would not turn from them, even if a father, a son, or a brother? There is danger, also, from the communication of the ailment. Many, therefore, have exposed their most beloved relatives in the wilderness, and on the mountains, some with the intention of administering to their hunger, but others not so, as wishing them to die. There is a story that one of those who had come to the wilderness, having seen a viper creep out of the earth, compelled by hunger, or wearied out with the affection, as if to exchange one evil for another, ate the viper alive, and did not die until all his members had become putrid and dropped off: and that another person saw a viper creep into a cask of new wine, and after drinking of the same to satiety, vomit it up, and discharge a great deal of its venom along with the new wine; but when the viper was smothered in the new wine, that the man drank of it largely and greedily, seeking thus to obtain a rescue from life and the disease; but when he had carried the drinking to satiety and intoxication, he lay down on the ground, at first as if about to die; but when he awoke from his sleep and intoxication, first of all his hair fell off, next the fingers and nails, and all the parts melted away in succession. But as the power was still in the semen, nature formed the man again, as if from the act of generation: it made other hairs to grow, and made new nails and clean flesh, and put off the old skin, like the slough of a reptile; and he was called back, like another new man, to a growth of life. Thus goes the fable; not very probable, indeed, nor yet entirely incredible; for that one ill should be overcome by another is credible. And that from the existing spark nature should renew the man, is not so incredible as to be held to be a prodigy.