On the Causes and Symptoms of Acute Diseases (1.7)

ANGINA is indeed a very acute affection, for it is a compression of the respiration. But there are two species of it; for it is either an inflammation of the organs of respiration, or an affection of the spirit (pneuma) alone, which contains the cause of the disease in itself.

The organs affected are, the tonsils, epiglottis, pharynx, uvula, top of the trachea; and, if the inflammation spread, the tongue also, and internal part of the fauces, when they protrude the tongue outside the teeth, owing to its abnormal size; for it fills the whole of the mouth, and the protuberance thereof extends beyond the teeth. This species is called Cynanche, either from its being a common affection of those animals, or from its being a customary practice for dogs to protrude the tongue even in health.

The opposite symptoms attend the other species; namely, collapse of the organs, and diminution of the natural size, with intense feeling of suffocation, insomuch that it appears to themselves as if the inflammation had disappeared to the internal parts of the thorax, and had seized upon the heart and lungs. This we call Synanche, as if from the disease inclining inwardly and producing suffocation. It appears to me that this is an illness of the spirit (pneuma) itself, which has under-gone a morbid conversion to a hotter and drier state, without any inflammation of the organ itself. Nor is this any great wonder. For in the Charonæan caves the most sudden suffocations occur from no affection of any organ,[*] but the persons die from one inspiration, before the body can sustain any injury. But likewise a man will be seized with rabies, from respiring the effluvia of the tongue of a dog, without having been bitten. It is not impossible then, that such a change of the respiration should occur within, since many other phenomena which occur in a man bear a resemblance to external causes, such as juices which become spoiled both within and without. And diseases resemble deleterious substances, and men have similar vomitings from medicines and from fevers. Hence, also, it was not a wonderful thing, that in the plague of Athens, certain persons fancied that poisonous substances had been thrown into the wells in the Piræus by the Peloponnesians; for these persons did not perceive the affinity between a pestilential disease and deleterious substances.

Cases of Cynanche are attended with inflammation of the tonsils, of the fauces, and of the whole mouth; the tongue protrudes beyond the teeth and lips; they have salivation, the

phlegm running out very thick and cold; they have their faces ruddy and swollen; their eyes protuberant, wide open, and red; the drink regurgitates by the nostrils. The pains violent, but obscured by the urgency of the suffocation; the chest and heart are in a state of inflammation; there is a longing for cold air, yet they inspire but little, until they are suffocated from the obstruction of the passage to the chest. In certain cases, there is a ready transference of the disease to the chest, and these die from the metastasis; the fevers feeble, slight, bringing no relief. But if, in any case, there is a turn to the better, abscesses form on either side, near the ears externally, or internally about the tonsils; and if these occur with torpor, and are not very protracted, the patients recover, indeed, but with pain and danger. But, if a particularly large swelling should occur, in such cases as are converted to an abscess, and the abscess is raised to a point, they are quickly suffocated. Such are the peculiar symptoms of cynanche.

Those of Synanche are, collapse, tenuity, and paleness; the eyes hollow, sunk inwardly; the fauces and uvula retracted upwards, the tonsils approaching one another still more; loss of speech: the feeling of suffocation is much stronger in this species than in the former, the mischief being seated in the chest whence the source of respiration. In the most acute cases, the patients die the same day, in some instances, even before calling in the physician; and in others, although called in, he could afford them no relief, for they died before the physician could apply the resources of his art. In those in which the disease takes a favourable turn, all the parts become inflamed, the inflammation being determined outwardly, so that the disease becomes cynanche in place of synanche. It is also a good thing when a strong swelling, or erysipelas, appears externally on the chest. And the skilful physician diverts the mischief to the chest by means of the cupping-instrument, or

by applying mustard to the breast and the parts near the jaws he determines outwardly and discusses the disease. In certain cases, indeed, the evil by these means has been for a time driven outwards, but when so driven out it speedily reverts, and produces suffocation.

The causes are infinite, more especially exposure to cold, and, less frequently, to heat; blows; fish-bones fixed in the tonsils, cold draughts, intoxication, repletion, and the ills from respiration.