On the Causes and Symptoms of Acute Diseases (1.9)

ULCERS occur on the tonsils; some, indeed, of an ordinary nature, mild and innocuous; but others of an unusual kind, pestilential, and fatal. Such as are clean, small, superficial, without inflammation and without pain, are mild; but such as

are broad, hollow, foul, and covered with a white, livid, or black concretion, are pestilential. Aphtha is the name given to these ulcers. But if the concretion has depth, it is an Eschar and is so called: but around the eschar there is formed a great redness, inflammation, and pain of the veins, as in carbuncle; and small pustules form, at first few in number, but others coming out, they coalesce, and a broad ulcer is produced. And if the disease spread outwardly to the mouth, and reach the columella (uvula) and divide it asunder, and if it extend to the tongue, the gums, and the alveoli, the teeth also become loosened and black; and the inflammation seizes the neck; and these die within a few days from the inflammation, fever, fœtid smell, and want of food. But, if it spread to the thorax by the windpipe, it occasions death by suffocation within the space of a day. For the lungs and heart can neither endure such smells, nor ulcerations, nor ichorous discharges, but coughs and dyspnœa supervene.

The cause of the mischief in the tonsils is the swallowing of cold, rough, hot, acid, and astringent substances; for these parts minister to the chest as to the purposes of voice and respiration; and to the belly for the conveyance of food; and to the stomach for deglutition. But if any affection occur in the internal parts, namely, the belly, the stomach, or the chest, an ascent of the mischief by the eructations takes place to the isthmus faucium, the tonsils, and the parts there; wherefore children, until puberty, especially suffer, for children in particular have large and cold respiration; for there is most heat in them; moreover, they are intemperate in regard to food, have a longing for varied food and cold drink; and they bawl loud both in anger and in sport; and these diseases are familiar to girls until they have their menstrual purgation. The land of Egypt especially engenders it, the air thereof being dry for respiration, and the food diversified, consisting of roots, herbs of many kinds, acrid seeds, and thick drink;

namely, the water of the Nile, and the sort of ale prepared from barley. Syria also, and more especially Cœlosyria, engenders these diseases, and hence they have been named Egyptian and Syrian ulcers.

The manner of death is most piteous; pain sharp and hot as from carbuncle;[*] respiration bad, for their breath smells strongly of putrefaction, as they constantly inhale the same again into their chest; they are in so loathsome a state that they cannot endure the smell of themselves; countenance pale or livid; fever acute, thirst is if from fire, and yet they do not desire drink for fear of the pains it would occasion; for they become sick if it compress the tonsils, or if it return by the nostrils; and if they lie down they rise up again as not being able to endure the recumbent position, and, if they rise up, they are forced in their distress to lie down again; they mostly walk about erect, for in their inability to obtain relief they flee from rest, as if wishing to dispel one pain by another. Inspiration large, as desiring cold air for the purpose of refrigeration, but expiration small, for the ulceration, as if produced by burning, is inflamed by the heat of the respiration. Hoarseness, loss of speech supervene; and these symptoms hurry on from bad to worse, until suddenly falling to the ground they expire.