Kitap 2
12
Arthritis fixes itself sometimes in one joint and sometimes in another; sometimes in the hip-joints; and for the most part in these cases the patient remains lame in it; and the other joints it affects little, and sometimes does not go to the small joints, as the feet and hands. If it seizes the greater members which are able to contain the disease, it does not go beyond these organs; but if it begin from a small one, the attack is mild and unexpected. The commencement of ischiatic disease is from the thigh behind, the ham, or the leg. Sometimes the pain appears in the cotyloid cavity, and again extends to the nates or loins, and has the appearance of anything rather than an affection of the hip-joint. But the joints begin to be affected in this way: pain seizes the great toe; then the forepart of the heel on which we lean; next it comes into the hollow of the foot, but the ankle swells last; and they blame a wrong cause; some, the friction of a new shoe; others, a long walk; another again, a stroke or being trod upon; but no one will of his own accord tell the true one; and the true one appears incredible to the patients when they hear of it. On this account the disease gets to an incurable state, because at the commencement, when it is feeble, the physician is not at hand to contend with it; but if it has acquired strength from time, all treatment is useless. In some, then, it remains in the joints of the feet until death, but in others it spreads over the compass of the whole body. For the most part, it passes from the feet to the hands. For to the disease there is no great interval between the hands and the feet, both being of a similar nature, slender, devoid of flesh, and very near the external cold, but very far from the internal heat; next the elbow and the knee, and after these the hip-joint; which is the transition to the muscles of the back and chest. It is incredible how far the mischief spreads. The vertebræ of the spine and neck are affected with the pain, and it extends to the extremity of the os sacrum: there is a general pain of all the parts of the groin, and a pain peculiar to each part thereof. But likewise the tendons and muscles are intensely pained; the muscles of the jaws and temples; the kidneys, and the bladder next in succession. And, what a wonder! at last the nose, the ears, and the lips, suffer; for every where there are nerves and muscles. A certain person had pains in the sutures of the head, and not knowing why he was pained there, he pointed out the shapes of the sutures—the oblique, the straight, the transverse—both behind and before, and stated that the pain was narrow and fixed in the bones; for the disease spreads over every commissure of the bones, in the same manner as in the joints of a foot or of a hand. Callosities also form in the joints; at first they resemble abscesses, but afterwards they get more condensed, and the humour being condensed is difficult to dissolve; at last they are converted into hard, white tophi, and over the whole there are small tumours, like vari and larger; but the humour is thick, white, and like hailstones. For it is a cold disease of the whole (body), like hail; and there appears to be a difference in regard to heat and cold; for in certain cases there is delight in things otherwise disagreeable. But, I fancy, that the cause is a refrigeration of the innate heat, and that the disease is single; but if it speedily give way, and the heat re-appears, there is need of refrigeration and it delights in such things; this is called the hot species. But if the pain remain internally in the nerves, and the part not becoming heated subside, nor get swollen, I would call this variety cold, for which there is need of hot medicines to restore the heat, of which those very acrid are most necessary. For heat excites the collapsed parts to swelling, and calls forth the internal heat, when there is need of refrigerants. In proof of this, the same things are not always expedient in the same cases, for what is beneficial at one time proves prejudicial in another; in a word, heat is required in the beginning, and cold at the conclusion. Wherefore Gout does not often become unremitting; but sometimes it intermits a long time, for it is slight; hence a person subject to Gout has won the race in the Olympiac games during the interval of the disease.
