Greater and altogether essential differences between this affection and the English Sweating Sickness appear in another respect. There is every reason to suppose that the cardiac disease first appeared in the time of _Alexander_ the Great, that is to say, at the end of the fourth century before Christ; for the Hippocratic physicians were unacquainted with it, _Erasistratus_, who was body physician to Seleucus Nicator, and was a universally celebrated professor at Alexandria under the first Ptolemy, being the first to mention it. If that age be compared even superficially with that of Henry the VIIth and Henry the VIIIth; and Africa, Asia Minor, and the South of Europe with England, we shall easily be convinced that the two diseases, notwithstanding the agreement in their main symptoms, could not be the same; moreover, much was comprehended by the ancients under the name of morbus cardiacus, which, on a nearer examination, proves not to be one and the same definite form of morbid action: for sometimes this affection is spoken of as an independent disease; sometimes it is mentioned only as a symptom superadded to others—as a kind of transition from other very various diseases, such as has occurred in modern times. _Soranus_ mentions, as such diseases, continued fevers, accompanied by much heat[827]; and reckons among them the “Causus,” that is, an inflammatory bilious fever, to which _Aretæus_ also saw the cardiac disease superadded. These fevers passed, on the fifth or sixth day, into the cardiac disease, and such a transition occurred chiefly on the critical days[828]. In a similar sense _Celsus_ speaks even of _Phrenitis_, under which name we are here to understand all inflammatory fevers accompanied by violent delirium, with the exception of actual inflammation of the brain. Thus we see that the cardiac disease arose and increased on a very different soil from other diseases, and was, to furnish an ancient example, as far from being independent under these circumstances as _lethargy_ was in similar cases.
But there was doubtless an independent idiopathic form of the cardiac disease. Whether this was febrile or not, the most celebrated physicians of ancient times were not agreed. Now, how could they ever have differed upon the subject, if the cardiac disease had always appeared only as a sequela on the fifth or sixth day of inflammatory fevers? _Apollophanes_, a disciple of Erasistratus, and physician to _Antiochus the First_, considered it, with his master, as constantly febrile, and his opinion prevailed for a long time: perhaps he was in the right, for it is probable that in the first half of the third century, the disorder was much more violent than at a subsequent period. His celebrated contemporary, _Demetrius_ of Apamea, disciple of Herophilus, affirmed, that he had recognised fever only in the beginning of the disease, and that it disappeared in its further progress. Very soon, most physicians decided that it was not febrile, but _Asclepiades_ distinguished a febrile and a non-febrile form of the cardiac disease, and it is certain that this physician was a very accurate observer. _Themison_ and _Thessalus_ also agreed with him. _Aretæus_ described, in a cursory manner, the febrile form only, and perhaps was not acquainted with any other. _Soranus_ followed, in the essential points, _Asclepiades_, the founder of his school; and later writers generally regarded the inward heat, the hot breath, and the burning thirst—symptoms which were occasionally less marked, as proofs of the febrile nature of the disease. Numerous theoretical views, belonging to particular schools, of which we do not here treat, were intermingled with these, and upon the whole, that form seems to have been esteemed as non-febrile, in which the signs of feverish excitement appeared less marked. In all cases the cardiac disease set in with external coldness, and with a small contracted quick pulse, symptoms which with certainty indicate fever[829].