OF ACUTE DISEASES.
CHAPTER V. — ON THE PAROXYSM OF EPILEPTICS.
* * * * sluggishness, vertigo, heaviness of the tendons, plethora and distension of the veins in the neck ; and much nausea indeed after food, but also, not unfrequently, with abstinence, there is a feint nausea ; and phlegm is often vomited ; want of appetite and indigestion after little food : they have flatulence and meteorism in the hypochondria. These symptoms, indeed, are constant.
But, if it be near the accession of the paroxysm, there are before the sight circuler flashes of purple or black colours, or of all mixed together, so as to exhibit the appearance of the rainbow expanded in the heavens ; noises in the ears ; a heavy smell ; they are passionate, and unreasonably peevish. They fall down then, some from any such cause as lowness of spirits, but others from gazing intently on a running stream, a rolling wheel, or a turning top. But sometimes the smell of heavy odours, such as of the gagate stone (jet), makes them fall down. In these cases, the aliment is fixed in the head, and from it the disorder springs ; but, in others, it arises also from the nerves remote from the head, which sympathise with the primary organ. Wherefore the great fingers of the hands, and the great toes of the feet are contracted ; pain, torpor, and trembling succeed, and a rush of them to the head takes place. If the mischief spread until it reach the head, a crash takes place, in these cases, as if from the stroke of a piece of wood, or of atone ; and, when they rise up, they tell how they have been maliciously struck by some person. This deception occurs to those who are attacked with the ailment for the first time. But those to whom the affection has become habitual, when ever the disease recurs, and has already seized the finger, or is commencing in any part, having from experience a foreknowledge of what is about to happen, call, from among those who are present, upon their customary assistants, and entreat them to bind, pull aside, and stretch the affected members ; and they themselves tear at their own members, as if pulling out the disease ; and such assistance has sometimes put off the attack for a day. But, in many cases, there is the dread as of a wild beast rushing upon them, or the phantasy of a shadow ; and thus they have fallen down.
In the attack, the person lies insensible ; the hands are clasped together by the spasm ; the legs not only plaited together, but also dashed about hither and thither by the tendons. The calamity bears a resemblance to slaughtered bulls ; the neck bent, the head variously distorted, for some times it is arched, as it were, forwards, so that the chin rests upon the breast ; and sometimes it is retracted to the back, as if forcibly drawn thither by the hair, when it rests on this shoulder or on that. They gape wide, the mouth is dry ; the tongue protrudes, so as to incur the risk of a great wound, or of a piece of it being cut off, should the teeth corne forcibly together with the spasm ; the eyes rolled inwards, the eyelids for the most part are separated, and affected with palpitation ; but should they wish to shut the lids they cannot bring them together, insomuch that the white of the eyes can be seen from below. The eyebrows sometimes relaxed towards the mesal space, as in those who are frowning, and sometimes retracted to the temples abnormally, so that the skin about the forehead is greatly stretched, and the wrinkles in the intersuperciliary space disappear : the checks are ruddy and quivering ; the lips sometimes compressed together to a sharp point, and sometimes separated towards the sides, when they are stretched over the teeth, like as in persons smiling.
As the illness increases lividity of countenance also supervenes, distension of the vessels in the neck, inability of speech as in suffocation ; insensibility even if you call loudly. The utterance a moaning and lamentation ; and the respiration a sense of suffocation, as in a person who is throttled ; the pulse strong, and quick, and small in the beginning, — great, slow, and feeble in the end, and irregular throughout ; tentigo of the genital organs. Such sufferings do they endure towards the end of the attack.
But when they come to the termination of the illness, there are unconscious discharges of the urine, and watery discharges from the bowels, and in some cases an evacuation also of the semen, from the constriction and compression of the vessels, or from the pruriency of the pain, and titillation of the humours ; for in these cases the pains are seated in the nerves. The mouth watery ; phlegm copious, thick, cold, and, if you should draw it forth, you might drag out a quantity of it in the form of a thread. But, if with length of time and much pain, the matters within the chest ferment, but the restrained spirit (pneuma) agitates all things, and there is a convulsion and disorder of the same, a flood, as it were, of humours swells up to the organs of respiration, the mouth, and the nose ; and if along with the humours the spirit be mixed, it appears like the relief of all the former feelings of suffocation. They accordingly spit out foam, as the sea ejects froth in mighty tempests ; and then at length they rise up, the affinent now being at an end. At the termination, they are torpid in their members at first, experience heaviness of the head, and loss of strength, and are languid, pale, spiritless, and dejected, from the suffering and shame of the dreadful malady.
CHAPTER III. — ON VERTIGO, OR SCOTOMA.
If darkness possess the eyes, and if the head be whirled round with dizziness, and the ears ring as from the sound of rivers rolling along with a great noise, or like the wind when it roars among the sails, or like the clang of pipes or reeds, or like the rattling of a carriage, we call the affection Scotoma (or Vertigo); a bad complaint indeed, if a symptom of the head, but bad likewise if the sequela of cephalæa, or whether it arises of itself as a chronic disease. For, if these symptoms do not pass off ; but the vertigo persist, or if, in course of time, from the want of any one to remedy, it is completed in its own peculiar symptoms, the affection vertigo is formed, from a humid and cold cause. But if it turn to an incurable condition, it proves the commencement of other affections — of mania, melancholy, or epilepsy, the symptoms peculiar to each being superadded. But the mode of vertigo is, heaviness of the head, sparkles of light in the eyes along with much darkness, ignorance of themselves and of those around ; and, if the disease go on increasing, the limbs sink below them, and they crawl on the ground ; there is nausea and vomitings of phlegm, or of yellow or black bilious matter. When connected with yellow bile, mania is formed ; when with black, melancholy ; when with phlegm, epilepsy ; for it is liable to conversion into all these diseases.
CHAPTER IV. — ON EPILEPSY.
Epilepsy is an illness of varions shapes and horrible ; in the paroxysms, brutish, very acute, and deadly ; for, at times, one paroxysm has proved fatal. Or if from habit the patient can endure it, he lives, indeed, enduring shame, ignominy, and sorrow : and the disease does not readily pass off, but fixes its abode during the better periods and in the lovely season of life. It dwells with boys and young men ; and, by good fortune, it is sometimes driven out in another more advanced period of life, when it takes its departure along with the beauty of youth ; and then, having rendered them deformed, it destroys certain youths from envy, as it were, of their beauty, either by loss of the faculties of a band, or by the distortion of the countenance, or by the deprivation of some one sense. But if the mischief lurk there until it strike root, it will not yield either to the physician or the changes of age, so as to take its departure, but lives with the patient until death. And sometimes the disease is rendered painful by its convulsions and distortions of the limbs and of the face ; and sometimes it turns the mind distracted. The sight of a paroxysm is disagreeable, and its departure disgusting with ,spontaneous evacuations of the urine and of the bowels.
But also it is reckoned a disgraceful form of disease ; for it is supposed, that it is an infliction on persons who have sinned against the Moon : and hence some have called it the Sacred Disease, and that for more reasons than one, as from the greatness of the evil, for the Greek word ἱερὸς also signifies great ; or because the cure of it is not human, but divine ; or from the opinion that it proceeded from the entrance of a demon into the man : from some one, or all these causes together, it has been called Sacred.
Such symptoms as accompany this disease in its acute form have been already detailed by me. But if it become inveterate, the patients are not free from harm even in the intervals, but are languid, spiritless, stupid, inhuman, unsociable, and not disposed to hold intercourse, nor to be sociable, at any period of life ; sleepless, subject to many horrid dreams, without appetite, and with bad digestion ; pale, of a leaden colour ; slow to learn, from torpidity of the understanding and of the senses ; dull of hearing ; have noises and ringing in the head ; utterance indistinct and bewildered, either from the nature of the disease, or from the wounds during the attacks ; the tongue is rolled about in the mouth convulsively in various ways. The disease also sometimes disturbs the understanding, so that the patient becomes altogether fatuous. The cause of these affections is coldness with humidity.
Black bile, if it make its appearance in acute diseases of the upper parts of the body, is very dangerous ; or, if it pass downwards, it is not free from danger. But in chronic diseases, if it pass downward, it terminates in dysentery and pain of the liver. But in women it serves as a purgation instead of the menses, provided they are not otherwise in a dangerous condition. But if it be determined upwards to the stomach and diaphragm, it forms melancholy ; for it produces flatulence and eructations of a fetid and fishy nature, and it sends rumbling wind downwards, and disturbs the understanding. On this account, in former days, these were called melancholics and flatulent persons. And yet, in certain of these cases, there is neither flatulence nor black bile, but mere anger and grief, and sad dejection of mind ; and these were called melancholics, beeause the terms bile (χολὴ) and anger (ὀργὴ) are synonymous in import, and likewise black (μέλαινα), with much (πολλὴ) and furious (θηριώδης). Homer is authority for this when he says :—
" Then straight to speak uprose
The melancholics become such when they are overpowered by this evil.
It is a lowness of spirits from a single phantasy, without fever ; and it appears to me that melancholy is the commencement and a part of mania. For in those who are mad, the understanding is turned sometimes to anger and sometimes to joy, but in the melancholics to sorrow and despondency only. But they who are mad are so for the greater part of life, becoming and doing dreadful and disgraceful things ; but those affected with melancholy are not every one of them affected according to one particular form ; but they are either suspicious of poisoning, or flee to the desert from misanthropy, or turn superstitious, or contract a hatred of life. Or if at any time a relaxation takes place, in most cases hilarity supervenes, but these persons go mad.
But how, and from what parts of the body, the most of these complaints originate, I will now explain. If the cause remain in the hypochondriac regions, it collects about the diaphragm, and the bile passes upwards, or downwards in cases of melancholy. But if it also affects the head from sympathy, and the abnormal irritability of temper change to laughter and joy for the greater part of their life, these become mad rather from the increase of the disease than from change of the affection.
Dryness is the cause of both. Adult men, therefore, are subject to mania and melancholy, or persons of less age than adults. Women are worse affected with mania than men. As to age, towards manhood, and those actually in the prime of life. The seasons of summer and of autumn engender, and spring brings it to a crisis.
The characteristic appearances, then, are not obscure ; for the patients are dull or stern, dejected or unreasonably torpid, without any manifest cause : such is the commencement of melancholy. And they also become peevish, dispirited, sleepless, and start up from a disturbed sleep.
Unreasonable fear also seizes them, if the disease tend to increase, when their dreams are true, terrifying, and clear for whatever, when awake, they have an aversion to, as being an evil, rushes upon their visions in sleep. They are prone to change their mind readily ; to become base, mean-spirited, illiberal, and in a little time, perhaps, simple, extravagant, munificent, not from any virtue of the soul, but from the changeableness of the disease. But if the illness become more urgent, hatred, avoidance of the haunts of men, vain lamentations ; they complain of life, and desire to die. In many, the understanding so leads to insensibility and fatuousness, that they become ignorant of all things, or forgetful of themselves, and live the life of the inferior animals. The habit of the body also becomes perverted ; colour, a darkish-green, unless the bile do not pass downward, but is diffused with the blood over the whole system. They are voracious, indeed, yet emaciated ; for in them sleep does not brace their limbs either by what they have eaten or drunk, but watchfulness diffuses and determines them outwardly. Therefore the bowels are dried up, and discharge nothing ; or, if they do, the dejections are dried, round, with a black and bilious fluid, in which they float ; urine scanty, acrid, tinged with bile. They are flatulent about the hypochondriac region ; the eructations fetid, virulent, like brine from salt ; and sometimes an acrid fluid, mixed with bile, floats in the stomach. Pulse for the most part small, torpid, feeble, dense, like that from cold.
A story is told, that a certain person, incurably affected, fell in love with a girl ; and when the physicians could bring him no relief, love cured him. But I think that he was originally in love, and that he was dejected and spiritless from being unsuccessful with the girl, and appeared to the common people to be melancholic. He then did not know that it was love ; but when he, imparted the love to the girl, he ceased from his dejection, and dispelled his passion and sorrow ; and with joy he awoke from his lowness of spirits, and he became restored to understanding, love being his physician.
The modes of mania are infinite in species, but one alone in genus. For it is altogether a chronic derangement of the mind, without fever. For if fever at any time should come on, it would not owe its peculiarity to the mania, but to some other incident. Thus wine inflames to delirium in drunkenness ; and certain edibles, such as mandragora and hyoscyamus, induce madness : but these affections are never called mania ; for, springing from a temporary cause, they quickly subside, but madness has something confirmed in it. To this mania there is no resemblance in the dotage which is the calamity of old age, for it is a torpor of the senses, and a stupefaction of the gnostic and intellectual faculties by coldness of the system. But mania is something hot and dry in cause, and tumultuous in its acts. And, indeed, dotage commencing with old age never intermits, but accompanies the patient until death ; while mania intermits, and with care ceases altogether. And there may be an imperfect intermission, if it take place in mania when the evil is not thoroughly cured by medicine, or is connected with the temperature of the season. For in certain persons who seemed to be freed from the complaint, either the season of spring, or some error in diet, or some incidental heat of passion, has brought on a relapse.
Those prone to the disease, are such as are naturally passionate, irritable, of active habits, of an easy disposition, joyous, puerile ; likewise those whose disposition inclines to the opposite condition, namely, such as are sluggish, sorrowful, slow to learn, but patient in labour, and who when they learn anything, soon forget it ; those likewise are more prone to melancholy, who have formerly been in a mad condition. But in those periods of life with which muchh heat and blood are associated, persons are most given to mania, namely, those about puberty, young men, and such as possess general vigour. But those in whom the heat is enkindled by black bile, and whose form of constitution is inclined to dryness, most readily pass into a state of melancholy. The diet which disposes to it is associated with voracity, immoderate repletion, drunkenness, lechery, venereal desires. Women also sometimes become affected with mania from want of purgation of the system, when the uterus has attained the development of manhood ; but the others do not readily fall into mania, yet, if they do, their cases are difficult to manage. These are the causes ; and they stir up the disease also, if from any cause an accustomed evacuation of blood, or of bile, or of sweating be stopped.
And they with whose madness joy is associated, laugh, play, dance night and day, and sometimes go openly to the market crowned, as if victors in some contest of skill ; this form is inoffensive to those around. Others have madness attended with anger ; and those sometimes rend their clothes and kill their keepers, and lay violent hands upon themselves. This miserable form of disease is not unattended with danger to those around. But the modes are infinite in those who are ingenious and docile, — untaught astronomy, spontaneous philosophy, poetry truly from the muses ; for docility has its good advantages even in diseases. In the uneducated, the common employments are the carrying of loads, and working at clay,— they are artificers or masons. They are also given to extraordinary phantasies ; for one is afraid of the fall of the oil-cruets [. . . . . .] and another will not drink, as fancying himself a brick, and fearing lest he should be dissolved by the liquid.
This story also is told : —A certain joiner was a skilful artisan while in the house, would measure, chop, plane, mortice, and adjust wood, and finish the work of the house correctly ; would associate with the workmen, make a bargain with them, and remunerate their work with suitable pay. While on the spot where the work was performed, he thus possessed his understanding. But if at any time he vent away to the market, the bath, or on any other engagement, having laid down his tools, he would first groan, then shrug his shoulders as he went out. But when he had got out of sight of the domestics, or of the work and the place where it was performed, he became completely mad ; yet if he returned speedily he recovered his reason again ; such a bond of connection was there between the locality and his understanding.
The cause of the disease is seated in the head and hypochondriac region, sometimes commencing in both together, and the one imparting h to the other. In mania and melancholy, the main cause is seated in the bowels, as in phrenitis it is mostly seated in the head and the senses. For in these the senses are perverted, so that they see things not present as if they were present, and objects which do not appear to others, manifest themselves to them ; whereas persons who are mad see only as others see, but do not form a correct judgment on what they have seen.
If, therefore, the illness be great, they are of a changeable temper, their senses are acute, they are suspicions, irritable without any cause, and unreasonably desponding when the disease tends to gloom ; but when to cheerfulness, they are in excellent spirite ; yet they are unusually given to insomnolency ; both are changeable in countenance, have headache, or else heaviness of the head ; they are sharp in hearing, but very slow in judgment ; for in certain cases there are noises of the ears, and ringings like those of trumpets and pipes. But if the disease go on to increase, they are flatulent, affected with nausea, voracious and greedy in taking food, for they are watchful, and watchfulness induces gluttony. Yet they are not emaciated like persons in disease ( embonpoint is rather the condition of melancholics) and they are sotnewhat pale.
But if any of the viscera get into a state of inflammation, it blunts the appetite and digestion ; the eyes are hollow, and do not wink ; before the eyes are images of an azure or dark colour in those who are turning to melancholy, but of a redder colour when they are turning to mania, along with purple coloured phantasmata, in many cases as if of flashing fire ; and terror seizes them as if from a thunderbolt. In other cases the eyes are red and blood-shot.
At the height of the disease they have impure dreams, and irresistible desire of venery, without any shame and restraint as to sexual intercourse ; and if roused to anger by admonition or restraint, they become wholly mad. Wherefore they are affected with madness in various shapes ; some run along unrestrainedly, and, not knowing how, return again to the same spot ; some, after a long time, come back to their relatives ; others roar aloud, bewailing themselves as if they had experienced robbery or violence. Some flee the haunts of men, and going to the wilderness, live by themselves.
If they should attain any relaxation of the evil, they become torpid, dull, sorrowful ; for having come to a knowledge of the disease they are saddened with their own calamity.
ANOTHER SPECIES OF MANIA.
Some cut their limbs in a holy phantasy, as if thereby propitiating peculiar divinities. This is a madness of the apprehension solely ; for in other respects they are sane. They are roused by the flute, and mirth, or by drinking, or by the admonition of those around them. This madness is of divine origin, and if they recover from the madness, they are cheerful and free of care, as if initiated to the god ; but yet they are pale and attenuated, and long remain weak from the pains of the wounds.