Kitap 2
13
But the commencement of the disease gives no great indication of it; neither does it appear as if any unusual ailment had come upon the man; nor does it display itself upon the surface of the body, so that it might be immediately seen, and remedies applied at the commencement; but lurking among the bowels, like a concealed fire it smolders there, and having prevailed over the internal parts, it afterwards blazes forth on the surface, for the most part beginning, like a bad signal-fire, on the face, as it were its watch-tower; but in certain cases from the joint of the elbow, the knee, and knuckles of the hands and feet. In this way the patient’s condition is hopeless, because the physician, from inattention and ignorance of the patient’s ailment, does not apply his art to the commencement when the disease is very feeble. For, indeed, they are merely torpid, as if from some light cause, drowsy, inactive, dry in the bowels, and these symptoms are not very unusual even in healthy persons. But upon the increase of the affection, the respiration is fetid from the corruption within of the breath (pneuma). The air, or something external, would seem to be the cause of this. Urine thick, muddy, like that of cattle; the distribution of crude undigested food; and yet of these things there is no perception nor regard; for neither are they aware whether or not they digest, thus digestion or indigestion is all one to them, since, for anything useful and proper to them, digestion is not usual with them. The distribution, however, is easy, the disease, as it were, greedily attracting the food for its own nourishment; for this reason the lower belly is very dry. Tumours prominent, not continuous with one another anywhere, but thick and rough, and the intermediate space cracked, like the skin of the elephant. Veins enlarged, not from abundance of blood, but from thickness of the skin; and for no long time is the situation of them manifest, the whole surface being elevated equally in the swelling. The hairs on the whole body die prematurely, on the hands, the thighs, the legs, and again on the pubes; scanty on the chin, and also the hairs on the head are scarce. And still more frequently premature hoariness, and sudden baldness; in a very short time the pubes and chin naked of hair, or if a few hairs should remain, they are more unseemly than where they are gone. The skin of the head deeply cracked; wrinkles frequent, deep, rough; tumours on the face hard, sharp; sometimes white at the top, but more green at the base. Pulse small, dull, languid, as if moved with difficulty through the mud; veins on the temples elevated, and also those under the tongue; bowels bilious; tongue roughened with vari, resembling hailstones; not unusual for the whole frame to be full of such (and thus also in unsound victims, the flesh is full of these tubercles resembling hail). But if the affection be much raised up from the parts within, and appear upon the extremities, lichens occur on the extremities of the fingers; there is pruritus on the knees, and the patients rub the itchy parts with pleasure. Our author in this place evidently alludes to mentagra, a malignant disease of the face, very prevalent in Rome in his time, that is to say, towards the end of the first and the beginning of the second century. The first description of it which we possess, is contained in Pliny’s Nat. Hist. xxvi., at the beginning, and is to the following effect: That it was one of the new diseases of the face, which at one time had spread over most parts of Europe, but was then mostly confined to Rome: That it had been called by the Greeks, lichen, but that latterly the Latin term mentagra had been applied to it. He further asserts, that it was unknown in former times, and made its first appearance in Italy during the reign of Tiberius: that the men of the middle and lower classes, and more especially women, were exempt from it, the ravages of the disease being confined principally to the nobility, among whom it was propagated by kissing. He adds respecting it, that it was cured by caustics, the effects of which often left unseemly scars on the face. That the disease had come originally from Egypt, the mother of all such distempers. Another very interesting account of the disease, under the names of lichen and mentagra, is given by Marcellus, the Empiric, in chap. cxix., wherein elephantiasis, lepra, and other inveterate diseases of the skin are described. He says that the distemper (vitium) when neglected is apt to spread all over the face, and to contaminate many persons. He prescribes various caustic and stimulant applications for it. Along with it, he gives a very good account of elephantiasis, which, he remarks, also generally begins in the face with vari and other appearances, similar to those described by our author. He states decidedly that the disease is endemical in Egypt, attacking not only the lower ranks, but even kings themselves. Now it is worthy of remark, that beyond all question this is the disease to which frequent allusion is made by the poet Martial as prevailing extensively in Rome, and as being propagated by the fashionable practice of persons saluting one another, by kissing, in the streets. The following passages evidently allude to it—Epigr. xi.,8; xii. 59. From all these descriptions, we cannot entertain a doubt, that the disease, then so prevalent in Rome, was of a malignant and contagious nature, which attacked principally the face, and was propagated by kissing ; and, further, that it was a disease of the same class as elephantiasis. Taking all these circumstances into account, one may venture to decide pretty confidently, that it was a disease akin to the Sivvens of Scotland, which it strikingly resembles in all its characters as described above. Sivvens, in short, is a species or variety of syphilis, which is readily communicated both by the mouth, as in kissing, and per coitum. Further, that Syphilis, and its congener Sivvens, are the brood of the ancient elephantiasis, no one at all acquainted with the history of the latter in ancient, mediæval, and modern times, will entertain a doubt. See the note to Paulus Ægineta, t. ii., 14, 15, 16, and the authorities there referred to: also, the History of Syphilis, as given in Sprengel’s and in Renouard’s History of Medicine. The importance of this subject, which has never been satisfactorily illustrated elsewhere, will be my apology for embracing the present opportunity of endeavouring to throw some additional light on it. And the lichen sometimes embraces the chin all round; it reddens the cheeks, but is attended with no great swelling; eyes misty, resembling bronze; eye-brows prominent, thick, bald, inclining downwards, tumid from contraction of the intermediate space; colour livid or black; eye-lid, therefore, much retracted to cover the eyes, as in enraged lions; on this account it is named leontium. Wherefore it is not like to the lions and elephants only, but also in the eye-lids resembles swift night. Nose, with black protuberances, rugged; prominence of the lips thickened, but lower part livid; nose elongated; teeth not white indeed, but appearing to be so under a dark body; ears red, black, contracted, resembling the elephant, so that they appear to have a greater size than usual; ulcers upon the base of the ears, discharge of ichor, with pruritus; shrivelled all over the body with rough wrinkles; but likewise deep fissures, like black furrows on the skin; and for this reason the disease has got the name of elephas. Cracks on the feet and heels, as far as the middle of the toes; but if the ailment still further increase, the tumours become ulcerated, so that on the cheeks, chin, fingers, and knees, there are fetid and incurable ulcers, some of which are springing up on one part, while others are subsiding on another. Sometimes, too, certain of the members of the patient will die, so as to drop off, such as the nose, the fingers, the feet, the privy parts, and the whole hands; for the ailment does not prove fatal, so as to relieve the patient from a foul life and dreadful sufferings, until he has been divided limb from limb. For it is long-lived, like the animal, the elephant. But if there be a sudden pain of the limbs, it attacks much more grievously, spreading sometimes to this part, and sometimes to that. Appetite for food not amiss; taste indiscriminate, neither food nor drink affords pleasure; aversion to all things from a painful feeling; atrophy; libidinous desires of a rabid nature; spontaneous lassitude; the figure of each of the limbs heavy, and even the small limbs are oppressive to the patient. Moreover, the body is offended with everything, takes delight neither in baths nor abstinence from them, neither in food nor in abstinence from it, neither in motion nor in rest, for the disease has established itself in all the parts. Sleep slight, worse than insomnolency, from its fantasies; strong dyspnœa, suffocation as if from strangling. In this way certain patients have passed from life, sleeping the sleep which knows no waking, even until death.
