On the Causes and Symptoms of Acute Diseases (2.8)

FROM the portæ of the liver, there passes a wide vein through the space intermediate between its extremities, which, being always divided into slender and more numerous branches, is distributed at last all over the liver in vessels imperceptible to the sight; and with their extremities anastomose the extremities of other veins, which, at first, are slender and numerous, grow larger and fewer in number, and, at last, they are collected into one large vein; hence, having become two by division, these pass through the liver. The upper one, then, having passed through the first lobe, appears on its convex side; then, having passed the diaphragm, it is inserted into the heart: this is called the vena cava. The other, having passed through the lower lobe, the fifth, to its concave side, makes its

exit near the spine, and is extended along it as far as the ischiatic region; and it, also, is called vena cava. It obtains the same name, as being one and the same vein, which derives its origin from the liver. For if one choose, one may pass a plate of metal from the vena cava connected with the heart to that by the spine, and from the spine through the liver to the heart; for it is the same passage leading upwards.

This vein, then, as I think, is all diseased in acute and strong affections; for it is altogether one vein. But other physicians fancy that only the part along the spine is affected, because there are no manifest symptoms in regard to the portion about the heart; for it is extended through the chest, having no adhesions, but floating in the chest, until, from the diaphragm, it adheres to the heart. If, then, any of the great ailments seize this vein, they are concealed by the thorax surrounding it.

Wherefore kedmata[*] also form about this vein when a hemorrhage, bursting forth quickly proves fatal, the blood being discharged by the lungs and the arteria aspera, if it burst in the chest; but if, at its origin, the blood is poured into the lower belly, so that the bowels float in it, when the patients die before the blood makes its appearance, the belly being filled with blood.

Inflammation likewise forms about the vein, and it, also, proves fatal, if it be great; for there is an acrid and pungent heat enclosed in the cavities of both, but little surpassing what is natural, so that to the touch the heat appears to be slight; but the patient fancies himself burning hot; pulse small, very frequent, so as to appear compressed and forcibly accelerated;

coldness of the extremities; intense thirst; dryness of the mouth; redness of countenance, along with paleness; he is reddish over the whole body; hypochondriac region hard, and retracted upwards; pain principally on the right side, and palpitation therein, extending to the flanks; and in certain cases, also, of the artery along the spine, provided the pulsation displays itself in the other hypochondriac region; for lying, as it does, on the left side, it sympathises with the other; the exhalation in the general system affording no relief, and not even making the skin soft, for it is dry, shrivelled, and rough; and more especially in the regions of the body where the bones are prominent, such as the back part of the elbow, the knees, or the knuckles. Sleep disturbed; the bowels, in certain cases, discharging nothing, and in others, the discharges small, acrid, bilious; urine, a bright yellow and pungent; not disordered, indeed, in mind, but they are torpid and wasted. Hence, those who have seen this constitution of disease have called it Causus, for the present symptoms are those of a species of Causus; and in autumn there is a tendency to malignity, both in adults and the young, in whom the habit of body is slender, from bad diet and hard labour. These, for the most part, die on the fourteenth day; but when the disease is protracted, they die in double that period. But those who either originally have a slight inflammation, or when a great inflammation is gradually resolved, escape the disease indeed, but never get rid of the mischief; for they labour under causus a long time. But the dangerous symptoms cease, namely, the pains, distension of the hypochondria, the bad pulse, and torpor of the intellect; but still they have nausea, are ill at ease, with distress of mind; and, moreover, these are attended with an accession of causus and thirst, dryness of the tongue and mouth; they inspire largely, drawing in a long and copious breath, as if wishing to draw in the whole atmosphere, for the purpose of refrigeration. And if they drink a large draught of cold water, they are relieved, indeed, for a short time; but then again the thirst is kindled up, and again they drink copiously. And this is the successive course of the malady. And a good physician would give with impunity a copious cold draught, as in other species of causus, and even with less risk, in the case of those labouring under causus from disease of the vena cava. And if either the bowels or the bladder carry off the drink, there is no necessity for inducing vomiting; but if not, after much cold drink much vomiting must be induced. For the patient would burst, if, after drinking so much, he should have no discharges by sweating, by urine, or by the bowels.