On the Causes and Symptoms of Acute Diseases (2.1)

ANIMALS live by two principal things, food and breath (spirit, pneuma); of these by far the most important is the respiration, for if it be stopped, the man will not endure long, but immediately dies. The organs of it are many, the commencement being the nostrils; the passage, the trachea; the containing vessel, the lungs; the protection and receptacle of the lungs, the thorax. But the other parts, indeed, minister only as instruments to the animal; but the lungs also contain the cause of attraction, for in the midst of them is seated a hot organ, the heart, which is the origin of life and respiration. It imparts to the lungs the desire of drawing in cold air, for it raises a heat in them; but it is the heart which attracts. If, therefore, the heart suffer primarily, death is not far off.

But if the lungs be affected, from a slight cause there is difficulty of breathing; the patient lives miserably, and death is the issue, unless some one effects a cure. But in a great affection, such as inflammation, there is a sense of suffocation,

loss of speech and of breathing, and a speedy death. This is what we call Peripneumonia, being an inflammation of the lungs, with acute fever, when they are attended with heaviness of the chest, freedom from pain, provided the lungs alone are inflamed; for they are naturally insensible, being of loose texture, like wool. But branches of the aspera arteria are spread through them, of a cartilaginous nature, and these, also, are insensible; muscles there are nowhere, and the nerves are small, slender, and minister to motion. This is the cause of the insensibility to pain. But if any of the membranes, by which it is connected with the chest, be inflamed, pain also is present; respiration bad, and hot; they wish to get up into an erect posture, as being the easiest of all postures for the respiration. Ruddy in countenance, but especially the cheeks; the white of the eyes very bright and fatty; the point of the nose flat; the veins in the temples and neck distended; loss of appetite; pulse, at first, large, empty, very frequent, as if forcibly accelerated; heat indeed, externally, feeble, and more humid than natural, but, internally, dry, and very hot, by means of which the breath is hot; there is thirst, dryness of the tongue, desire of cold air, aberration of mind; cough mostly dry, but if anything be brought up it is a frothy phlegm, or slightly tinged with bile, or with a very florid tinge of blood. The blood-stained is of all others the worst.

But if the disease tend to a fatal termination, there is insomnolency; sleep brief, heavy, of a comatose nature; vain fancies; they are in a doting state of mind, but not violently delirious; they have no knowledge of their present sufferings. If you interrogate them respecting the disease, they will not acknowledge any formidable symptom; the extremities cold; the nails livid, and curved; the pulse small, very frequent, and failing, in which case death is near at hand, for they die mostly on the seventh day.

But if the disease abate and take a favourable turn, there is

a copious hemorrhage from the nose, a discharge from the bowels of much bilious and frothy matters, such as might seem to be expelled from the lungs to the lower belly, provided it readily brings off much in a liquid state. Sometimes there is a determination to the urine. But they recover the most speedily in whose cases all these occur together.

In certain cases much pus is formed in the lungs, or there is a metastasis from the side, if a greater symptom of convalescence be at hand. But if, indeed, the matter be translated from the side to the intestine or bladder, the patients immediately recover from the peripneumony; but they have a chronic abscess in the side, which, however, gets better. But if the matter burst upon the lungs, some have thereby been suffocated, from the copious effusion and inability to bring it up. But such as escape suffocation from the bursting of the abscess, have a large ulceration in the lungs, and pass into phthisis; and from the abscess and phthisis old persons do not readily recover; but from the peripneumony, youths and adults.