But should the defluxion make its way to the heart, the person is seized with palpitation and asthma, the chest becomes diseased, and some also have curvature of the spine. For when a defluxion of cold phlegm takes place on the lungs and heart, the blood is chilled, and the veins, being violently chilled, palpitate in the lungs and heart, and the heart palpitates, so that from this necessity asthma and orthopnoea supervene. For it does not receive the spirits ( pneuma ) as much breath as he needs until the defluxion of phlegm be mastered, and being heated is distributed to the veins, then it ceases from its palpitation and difficulty of breathing, and this takes place as soon as it obtains an abundant supply; and this will be more slowly, provided the defluxion be more abundant, or if it be less, more quickly. And if the defluxions be more condensed, the epileptic attacks will be more frequent, but otherwise if it be rarer. Such are the symptoms when the defluxion is upon the lungs and heart; but if it be upon the bowels, the person is attacked with diarrhoea. And if, being shut out from all these outlets, its defluxion be determined to the veins I have formerly mentioned, the patient loses his speech, and chokes, and foam issues by the mouth, the teeth are fixed, the hands are contracted, the eyes distorted, he becomes insensible, and in some cases the bowels are evacuated. And these symptoms occur sometimes on the left side, sometimes on the right, and sometimes in both. The cause of everyone of these symptoms I will now explain. The man becomes speechless when the phlegm, suddenly descending into the veins, shuts out the air, and does not admit it either to the brain or to the vena cava, or to the ventricles, but interrupts the inspiration. For when a person draws in air by the mouth and nostrils, the breath ( pneuma ) goes first to the brain, then the greater part of it to the internal cavity, and part to the lungs, and part to the veins, and from them it is distributed to the other parts of the body along the veins; and whatever passes to the stomach cools, and does nothing more; and so also with regard to the lungs. But the air which enters the veins is of use (to the body) by entering the brain and its ventricles, and thus it imparts sensibility and motion to all the members, so that when the veins are excluded from the air by the phlegm and do not receive it, the man loses his speech and intellect, and the hands become powerless, and are contracted, the blood stopping and not being diffused, as it was wont; and the eyes are distorted owing to the veins being excluded from the air; and they palpitate; and froth from the lungs issues by the mouth. For when the breath ( pneuma ) does not find entrance to him, he foams and sputters like a dying person. And the bowels are evacuated in consequence of the violent suffocation; and the suffocation is produced when the liver and stomach ascend to the diaphragm, and the mouth of the stomach is shut up; this takes place when the breath ( pneuma ) does not enter by the mouth, as it is wont. The patient kicks with his feet when the air is shut up in the lungs and cannot find an outlet, owing to the phlegm; and rushing by the blood upward and downward, it occasions convulsions and pain, and therefore he kicks with his feet. All these symptoms he endures when the cold phlegm passes into the warm blood, for it congeals and stops the blood. And if the deflexion be copious and thick, it immediately proves fatal to him, for by its cold it prevails over the blood and congeals it; or, if it be less, it in the first place obtains the mastery, and stops the respiration; and then in the course of time, when it is diffused along the veins and mixed with much warm blood, it is thus overpowered, the veins receive the air, and the patient recovers his senses. Of little children who are seized with this disease, the greater part die, provided the defluxion be copious and humid, for the veins being slender cannot admit the phlegm, owing to its thickness and abundance; but the blood is cooled and congealed, and the child immediately dies. But if the phlegm be in small quantity, and make a defluxion into both the veins, or to those on either side, the children survive, but exhibit notable marks of the disorder; for either the mouth is drawn aside, or an eye, the neck, or a hand, wherever a vein being filled with phlegm loses its tone, and is attenuated, and the part of the body connected with this vein is necessarily rendered weaker and defective. But for the most it affords relief for a longer interval; for the child is no longer seized with these attacks, if once it has contracted this impress of the disease, in consequence of which the other veins are necessarily affected, and to a certain degree attenuated, so as just to admit the air, but no longer to permit the influx of phlegm. However, the parts are proportionally enfeebled whenever the veins are in an unhealthy state. When in striplings the defluxion is small and to the right side, they recover without leaving any marks of the disease, but there is danger of its becoming habitual, and even increasing if not treated by suitable remedies. Thus, or very nearly so, is the case when it attacks children. To persons of a more advanced age, it neither proves fatal, nor produces distortions. For their veins are ( large? ) and filled with hot blood; and therefore the phlegm can neither prevail nor cool the blood, so as to coagulate it, but it is quickly overpowered and mixed with the blood, and thus the veins receive the air, and sensibility remains; and, owing to their strength, the aforesaid symptoms are less likely to seize them. But when this disease attacks very old people, it therefore proves fatal, or induces paraplegia, because the veins are empty, and the blood scanty, thin, and watery. When, therefore, the defluxion is copious, and the season winter, it proves fatal; for it chokes up the exhalents, and coagulates the blood if the defluxion be to both sides; but if to either, it merely induces paraplegia. For the blood being thin, cold, and scanty, cannot prevail over the but being itself overpowered, it is coagulated, so that those parts in which the blood is corrupted, lose their strength. The flux is to the right rather than to the left because the veins there are more capacious and numerous than on the left side, for on the one side they spring from the liver, and on the other from the spleen. The defluxion and melting down take place most especially in the case of children in whom the head is heated either by the sun or by fire, or if the brain suddenly contract a rigor, and then the phlegm is excreted. For it is melted down by the heat and diffusion of the but it is excreted by the congealing and contracting of it, and thus a defluxion takes place. And in some this is the cause of the disease, and in others, when the south wind quickly succeeds to northern breezes, it suddenly unbinds and relaxes the brain, which is contracted and weak, so that there is an inundation of phlegm, and thus the defluxion takes place. The defluxion also takes place in consequence of fear, from any hidden cause, if we are the at any person’s calling aloud, or while crying, when one cannot quickly recover one’s breath, such as often happens to children. When any of these things occur, the body immediately shivers, the person becoming speechless cannot draw his breath, but the breath ( pneuma ) stops, the brain is contracted, the blood stands still, and thus the excretion and defluxion of the phlegm take place. In children, these are the causes of the attack at first. But to old persons winter is most inimical. For when the head and brain have been heated at a great fire, and then the person is brought into cold and has a rigor, or when from cold he comes into warmth, and sits at the fire, he is apt to suffer in the same way, and thus he is seized in the manner described above. And there is much danger of the same thing occurring, if his head be exposed to the sun, but less so in summer, as the changes are not sudden. When a person has passed the twentieth year of his life, this disease is not apt to seize him, unless it has become habitual from childhood, or at least this is rarely or never the case. For the veins are filled with blood, and the brain consistent and firm, so that it does not run down into the veins, or if it do, it does not master the blood, which is copious and hot.