Aretaeus, Causes and Symptoms of Chronic Diseases (English) (XML Header) [genre: prose; science; medicine] [word count] [Aret. SC].
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1.11CHAPTER XI. ON ASTHMA.

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

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

The cause is a coldness and humidity of the spirit (pneuma); but the materiel is a thick and viscid humour. Women are more subject to the disease than men, because they are humid and cold. Children recover more readily than these, for nature in

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the increase is very powerful to heat. Men, if they do not readily suffer from the disease, die of it more speedily. There is a postponement of death to those in whom the lungs are warmed and heated in the exercise of their trade, from being wrapped in wool, such as the workers in gypsum, or braziers, or blacksmiths, or the heaters of baths.

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

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

But if it takes a favourable turn, cough more protracted and rarer; a more copious expectoration of more fluid matters; discharges from the bowels plentiful and watery; secretion of urine copious, although unattended with sediment; voice louder; sleep sufficient; relaxation of the præcordia; sometimes

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a pain comes into the back during the remission; panting rare, soft, hoarse. Thus they escape a fatal termination. But, during the remissions, although they may walk about erect, they bear the traces of the affection.

1.12CHAPTER XII. ON PNEUMODES.

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

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are greater. Some, indeed, die speedily of suffocation before anything worse is transferred to the general system. In other cases the affection terminates in dropsy about the loins, or in anasarca.

1.13CHAPTER XIII. ON THE LIVER.

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

If it be converted into pus, a sharp pain possesses the parts as far as the clavicle and the tops of the shoulders, for the diaphragm from which the liver is suspended is dragged down by the weight, and the diaphragm drags the membrane lining the ribs to which it is attached, and this membrane (the pleura) is stretched up to the clavicle and top of the shoulders, which also are dragged down. Along with the abscess there is acrid heat and rigors; cough dry and very frequent; colour grass-green; and if the patients be intensely jaundiced, it is of

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

But if the abscess do not suppurate, and the discharges from

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

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

In the dropsy, provided there is a copious discharge of thick urine, having much re-crementitious sediment, there is a hope that the dropsical swelling may run off; but if the urine be thin, without sediment, and scanty, it conspires with the dropsy. But if nature change to her pristine state, and burst upon the bowels, along with copious watery discharges, it has also sometimes cured the dropsy. This mode of cure, however, is dangerous; for what from the copious evacuations, and the extreme prostration, the patients have sometimes died of weakness, as from hemorrhage. Sweating, if copious, carries off the disease with less danger, for dropsical persons

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generally have not a moist skin. Such is the termination of the affections in the liver.

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



Aretaeus, Causes and Symptoms of Chronic Diseases (English) (XML Header) [genre: prose; science; medicine] [word count] [Aret. SC].
<<Aret. SC 1.10 Aret. SC 1.12 (Greek) >>Aret. SC 1.15

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