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Title: The Genuine Works of Hippocrates, Vol. 1 (of 2) : Translated from the Greek with a Preliminary Discourse and Annotations
Author: Hippocrates
Language: English
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*** Start of this LibraryBlog Digital Book "The Genuine Works of Hippocrates, Vol. 1 (of 2) : Translated from the Greek with a Preliminary Discourse and Annotations" ***
THE
GENUINE WORKS
OF
HIPPOCRATES
TRANSLATED FROM THE GREEK
WITH
A PRELIMINARY DISCOURSE AND ANNOTATIONS
BY
FRANCIS ADAMS, LL.D.
SURGEON
IN TWO VOLUMES
VOL. I
NEW YORK
WILLIAM WOOD AND COMPANY
56 & 58 LAFAYETTE PLACE
1886
THE PUBLISHERS’
BOOK COMPOSITION AND ELECTROTYPING CO.,
157 AND 159 WILLIAM ST.,
NEW YORK.
TRANSLATOR’S PREFACE.
The Council of the Sydenham Society having done me the honor of
consulting me respecting a proposed volume of translations from the
Works of Hippocrates, I ventured to give it as my opinion that such a
selection ought to comprehend the whole of those Treatises which are
now regarded as genuine; and this suggestion having been approved of,
I was appointed to the task of translating and editing them according
to the best of my judgment. The design, then, of the present Work,[1]
is to give a translation of all the genuine remains of the GREAT
HIPPOCRATES, along with such an amount of illustration as may be
sufficient to render them intelligible to any well-educated member
of the profession at the present day. It was understood, indeed,
when I first engaged in this undertaking, that I was merely to give
a faithful translation of the original; but I soon became satisfied,
that a considerable amount of illustration, in the form of Annotations,
Arguments, and so forth, would be indispensable to the general utility
of such a publication. It is well known that many parts of my author’s
works are very obscure, owing to the conciseness of the language,
and the difficulty which now exists of properly apprehending the
views entertained on certain abstruse questions at so very distant
a period; and, consequently, it will readily be understood, that a
simple version, without either comment or illustration, would have
been nearly as unintelligible to most of my readers as the original
itself. And that the works of Hippocrates stand in need of illustration
is rendered apparent from the number of commentaries which have been
written upon them in all ages, commencing almost with his own time.
But whether or not I have been fortunate enough to give just such an
amount of illustration as was necessary, and have taken proper care at
the same time not to load my pages with superfluous matters of this
description, must be left to the judgment of my readers to determine.
However, I may be permitted to say, that whatever value shall be put
upon my performances in this line, I have certainly spared no pains
to make myself well acquainted with the true doctrines of my author,
and that for this purpose I have consulted all the best authorities to
which I could obtain access, from the commentaries of Apollonius and
Galen down to the learned labors of several continental scholars, my
contemporaries, especially Dr. Ermerins, of Holland, and MM. Littré and
Malgaigne, of France. I flatter myself it will also be admitted, that I
have further collected from a variety of sources, a considerable store
of valuable material, for which I am in nowise indebted to any of my
predecessors in the same field of research.
Considering how scanty all the information is which the English
language can supply on many questions connected with the medical
literature of the ancients, I have judged it necessary to enter into a
discussion of several of those subjects, in order to prepare my readers
for understanding the doctrines of my author. These are contained in
the Preliminary Discourse, and will be found to relate principally to
the origin of Grecian Medicine, to the Biography of Hippocrates, and
an analysis of the works which bear his name, and to an exposition
of the principles of the Physical Philosophy which form the basis of
most of the hypotheses which occur in the Hippocratic Collection.
Having bestowed much pains on the illustration of the philosophical
tenets of the ancients, I shall feel anxious to learn how far the
judgment pronounced by me on various controverted points is approved
of by persons possessing the necessary degree of information to enable
them to form a correct estimate of them, along with a proper degree
of candor in judging between the conventional opinions of the present
time, and those which prevailed in so remote an age.
That I have imposed upon myself a very serious additional task, by
engaging not only to give a true version of the language of my author,
but also to expound his opinions, and place them, so to speak, in
juxtaposition with those of the present age, will be readily admitted;
and I have reason perhaps to apprehend, that I have thereby exposed
myself to the strictures of a certain class of critics, who have formed
to themselves a very different ideal of the duties of a translator,
fancying that he ought merely to concern himself with the words of the
original author, and not venture to sit in judgment on the doctrines.
I shall not attempt, however, any formal defense of the method which
I have pursued, but may be allowed to remark, that, if I shall be
found to have failed in satisfying the reasonable expectations of such
readers as are sincerely desirous of becoming familiarly acquainted
with the opinions of an author, whom I verily believe to be the highest
exemplar of professional excellence which the world has ever seen, it
is not from want of zeal in the discharge of the arduous duties which I
had undertaken.
I have little left to say in this place respecting most of the critical
subjects connected with the work, as I have entered at considerable
length into the discussion of these matters in the Preliminary
Discourse. It is proper, however, to acknowledge that I have derived
great assistance from M. Littré’s excellent edition, of which the
parts already published embrace all the treatises here given, with the
exception of the last four. On all occasions I have freely availed
myself of his labors, more especially in amending the text, in which
respect his edition undoubtedly surpasses all those which preceded
it. I have also not neglected to consult all the other standard
editions, especially those of Foës, Van der Linden, and Kühn, and
likewise, as will be seen, many other editions of separate treatises,
so that, altogether, I trust it will be found that I have not often
failed in attaining the true meaning of my author, as far as it can
now be ascertained. I am aware, indeed, that, situated as I am, at a
distance from public libraries, and deprived of personal intercourse
with learned men of congenial pursuits whom I could consult in cases
where I felt myself in doubt, I have labored under disadvantages which
may render my work not so perfect in all respects as could have been
wished; and that, by sending it to the press as soon as completed, it
is not unlikely I may have left it disfigured by certain blemishes
which _multa dies et multa litura_ might have enabled me to remove.
But the urgency of my other professional and private concerns forbade
me to devote much longer time to any one task, however interesting or
important; while the weight of increasing years, and the confirmed
conviction of the endless nature of literary research on such a subject
as this, disposed me, on the present occasion, to keep in mind the
solemn admonition of my Author, that “Life is short, and Art is long.”
F. A.
CONTENTS OF VOL. I.
PAGE
PRELIMINARY DISCOURSE 1
Sect. I.--On the Origin of Grecian Medicine 3
Sketch of the Life of Hippocrates 8
Sect. II.--Disquisition on the Authenticity of the different
Treatises which have been attributed to
Hippocrates 20
Sect. III.--On the Physical Philosophy of the Ancients,
and more especially their Doctrines with
regard to the Elements 107
The Pythagoreans 108
The Platonists 110
The Peripatetics 113
The Stoics 115
The Epicureans 116
ON ANCIENT MEDICINE 127
The Argument 129
The Work 132
ON AIRS, WATERS, AND PLACES 147
The Argument 149
The Work 156
ON THE PROGNOSTICS 185
The Argument 187
The Work 194
Appendix to the Book of Prognostics 214
ON REGIMEN IN ACUTE DISEASES 225
The Argument 227
The Work 234
Appendix to the work on Regimen in Acute Diseases 254
The Argument ib.
The Work 260
FIRST AND THIRD BOOKS OF THE EPIDEMICS 281
Book I.--The Argument 283
The Work 293
Book III.--The Argument 318
The Work 323
ON INJURIES OF THE HEAD 351
The Argument 353
The Work 370
PLATES I., II., III., WITH DESCRIPTION.
PRELIMINARY DISCOURSE.
BY THE EDITOR.
PRELIMINARY DISCOURSE.
SECTION I
ON THE ORIGIN OF GRECIAN MEDICINE, WITH A SKETCH OF THE
LIFE OF HIPPOCRATES.
It is well known that the oldest documents which we possess relative
to the practice of Medicine, are the various treatises contained
in the Collection which bears the name of Hippocrates. Their great
excellence has been acknowledged in all ages, and it has always been a
question which has naturally excited literary curiosity, by what steps
the art had attained to such perfection at so early a period. This
investigation, however, is attended with peculiar difficulties, and
has never been marked by any very satisfactory results. At one time,
indeed, it was usual to solve the question by supposing that Greece
had derived all the arts and sciences, in a state of considerable
advancement, from the oriental nations, who are admitted to have
possessed a considerable degree of civilization before the Hellenic
race became distinguished for intellectual development.[2] The question
with regard to the origin of Medicine was thus supposed to have met
with a satisfactory solution. For, it being generally admitted that the
Hippocratic Medicine had emerged from the schools of philosophy, and it
having been assumed as incontrovertible that the early philosophy of
the Greeks had been derived from the East, the inference appeared to be
quite legitimate that medicine, in a state of considerable advancement,
had been imported from the same quarter. Recent research, however, has
cast great doubts on the supposed descent of Grecian philosophy from
a foreign source, and it is now pretty generally admitted that the
Orientals, in early times, had never made any considerable progress in
mental science.[3] Instead, then, of looking upon philosophy as having
been an exotic production in the land of Hellas, we have every reason
to believe that it was, what its inhabitants, in the noble pride of
political freedom and intellectual superiority, boasted that their
forefathers had been, namely, “the offspring of their own soil.”[4]
Since the philosophy of the Greeks was indigenous, there is every
reason to suppose that their medicine was so in like manner. How long
the union between medicine and philosophy had subsisted before the time
of Hippocrates, has not been determined upon any contemporary evidence,
but the disciples of Pythagoras, in after ages, did not hesitate to
ascribe to him the honor of effecting this alliance.[5] However this
may be, it appears to me very doubtful whether these philosophers ever
practised medicine as a craft. Indeed, it is much more likely that they
merely speculated upon the phenomena of disease. Thus we shall see
afterwards, that Plato himself did not discard speculative medicine
from his system of philosophy, although we are quite sure that he
never practised it as an art. But this connection between medicine and
philosophy was by no means regarded, in after times, as having been
favorable to the advancement of the former, for we find Hippocrates
complimented by Celsus for having brought about a separation between
them.[6]
It is clearly established that, long before the birth of philosophy,
medicine had been zealously and successfully cultivated by the
Asclepiadæ, an order of priest-physicians that traced its origin to
a mythical personage bearing the distinguished name of Æsculapius.
Two of his sons, Podalirius and Machaon, figure in the Homeric poems,
not however as priests, but as warriors possessed of surgical skill
in the treatment of wounds, for which they are highly complimented by
the poet. It was probably some generations after this time (if one may
venture a conjecture on a matter partaking very much of the legendary
character) that Æsculapius was deified, and that Temples of Health,
called _Asclepia_, presided over by the Asclepiadæ, were erected
in various parts of Greece, as receptacles for the sick, to which
invalids resorted in those days for the cure of diseases, under the
same circumstances as they go to hospitals and spas at the present
time. What remedial measures were adopted in these temples we have no
means of ascertaining so fully as could be wished, but the following
facts, collected from a variety of sources, may be pretty confidently
relied upon for their accuracy. In the first place, then, it is well
ascertained that a large proportion of these temples were built in
the vicinity of thermæ, or medicinal springs, the virtues of which
would no doubt contribute greatly to the cure of the sick.[7] At his
entrance into the temple, the devotee was subjected to purifications,
and made to go through a regular course of bathing, accompanied with
methodical frictions, resembling the oriental system now well known
by the name of _shampooing_. Fomentations with decoctions of
odoriferous herbs were also not forgotten. A total abstinence from food
was at first prescribed,[8] but afterwards the patient would no doubt
be permitted to partake of the flesh of the animals which were brought
to the temples as sacrifices. Every means that could be thought of was
used for working upon the imagination of the sick, such as religious
ceremonies of an imposing nature, accompanied by music, and whatever
else could arouse their senses, conciliate their confidence, and in
certain cases, contribute to their amusement.[9] In addition to these
means, it is believed by many intelligent Mesmerists of the present
day, that the aid of Animal magnetism was called in to contribute to
the cure;[10] but on this point the proof is not so complete as could
be wished. Certain it is, however, that as the Mesmerists administer
medicines which are suggested to the imagination of patients during the
state of clairvoyance, the Asclepiadæ prescribed drugs as indicated in
dreams. These, indeed, were generally of a very inert description; but
sometimes medicines of a more dangerous nature, such as hemlock and
gypsum, were used in this way,[11] and regular reports of the effects
which they produced were kept by the priests in the temples. It is
also well known that the Asclepiadæ noted down with great care the
symptoms and issue of every case, and that, from such observations,
they became in time great adepts in the art of prognosis. When we come
to an analysis of the different Hippocratic treatises, it will be seen
that there is strong reason to believe we are still possessed of two
documents composed from the results of observations made in the ancient
Temples of Health. It would also contribute much to the increase of
medical knowledge in this way, that the office of priesthood was
hereditary in certain families, so that information thus acquired
would be transmitted from father to son, and go on accumulating
from one generation to another.[12] Whether the Asclepiadæ availed
themselves of the great opportunities which they must undoubtedly
have had of cultivating human and comparative anatomy, has been much
disputed in modern times; indeed, the contrary is expressly maintained
by some eminent authorities, such as Gruner[13] and Sprengel.[14]
But it will be shown in another place, that there is good reason for
believing that these two scholars have greatly underrated the amount
of anatomical knowledge possessed by Hippocrates, and his predecessors
the priest-physicians in the Temples of Health. Moreover, it is worthy
of remark, that Galen holds Hippocrates to have been a very successful
cultivator of anatomy.[15] Galen further states, upon the authority of
Plato,[16] that the Asclepiadæ paid no attention to dietetics; but this
opinion would require to be received with considerable modification,
for, most assuredly, whoever reflects on the great amount of valuable
information on this subject which is contained in the Hippocratic
treatises, will not readily bring himself to believe that it could have
been all collected by one man, or in the course of one generation. It
is worthy of remark, moreover, that Strabo, whose authority I need
scarcely say stands deservedly high in all literary matters, does not
hesitate to affirm that Hippocrates was trained in the knowledge of
dietetics, from documents preserved in the Asclepion of Cos.[17] That
gymnastics, as stated by Galen,[18] wire not recognized as a regular
branch of the healing art, until the age of Hippocrates, is indeed
not improbable, and this perhaps is what Plato meant when he says
that the Asclepiadæ did not make any use of the pedagogic art until
it was introduced by Herodicus. But at the same time there can be no
doubt, as further stated by Galen,[19] that exercise, and especially
riding on horseback, constituted _one_ of the measures used by
the Asclepiadæ for the recovery of health, having been introduced by
Æsculapius himself.
Of the _Asclepia_ we have mentioned above, it will naturally be
supposed that some were in much higher repute than others, either from
being possessed of peculiar advantages, or from the prevalence of
fashion. In the beginning of the fifth century before the Christian
era, the temples of Rhodes, Cnidos, and Cos were held in especial
favor, and on the extinction of the first of these, another rose up in
Italy in its stead.[20] But the temple of Cos was destined to throw the
reputation of all the others into the background, by producing among
the priests of Æsculapius the individual who, in all after ages, has
been distinguished by the name of the GREAT HIPPOCRATES.[21]
Before proceeding, however, to give a brief sketch of his biography, I
may state, partly by way of recapitulation, and partly in anticipation
of what will be found in a subsequent part of this work, the leading
facts which are known relative to the state of medicine before his time.
1. The origin of Grecian medicine is involved in impenetrable darkness,
being anterior to all authentic history, and nothing being known either
as to its rise or the steps by which it grow up to be a regular art.
2. There is no reason to suppose that the germs of medical science, any
more than those of philosophy, had been originally imported into Greece
from the East.
3. The earliest practitioners of medicine concerning whom we have any
authentic information, were the Asclepiadæ, or priest-physicians, who
endeavored to cure the sick partly by superstitious modes of working
upon the imagination, and partly by more rational means, suggested by
observation and a patient study of the phenomena of disease.
4. Though the men of letters who directed their attention to the
phenomena of disease, as constituting a branch of philosophy, may in
so far have improved the theory of medicine by freeing it from the
trammels of superstition, it is not likely they could have contributed
much to the practice of medicine, which is well known to be founded on
observation and experience.
5. Though there can be little or no doubt that the priest-physicians,
and the philosophers together, were possessed of all the knowledge of
medicine which had been acquired at that time, it is not satisfactorily
ascertained by what means the art had attained that remarkable degree
of perfection which we shall soon see that it exhibited in the hands of
Hippocrates. But I must now proceed with my Sketch of his Life.
* * * * *
That Hippocrates was lineally descended from Æsculapius was generally
admitted by his countrymen, and a genealogical table, professing to
give a list of the names of his forefathers, up to Æsculapius, has
been transmitted to us from remote antiquity. Although I am well aware
that but little reliance can be put on these mythical genealogies, I
will subjoin the list to this section, in order that it may be at hand
for reference, as many allusions will have to be made to it in the
subsequent pages.[22]
Of the circumstances connected with the life of Hippocrates little
is known for certain, the only biographies which we have of him being
all of comparatively recent date, and of little authority. They are
three in number, and bear the names of Soranus Ephesins, Suidas, and
Tzetzes. Of the age in which the first of these authors flourished,
nothing is known for certain; the second is a lexicographer, who lived
in the beginning of the eleventh century; and the third flourished
in the twelfth century. The birth of Hippocrates is generally fixed,
upon the authority of Soranus, as having occurred in the first year
of the 80th Olympiad, that is to say, in the 460th year before the
vulgar era. On this point, however, I must say that I see no good
grounds for the unanimity of opinion which has generally prevailed
among modern scholars. In fact, the counter-evidence of Aulus Gellius
has always appeared to me to be unjustly overlooked, as I cannot
but think that his authority ought to rank much higher than that of
Soranus, of whom nothing is known, not even the century in which he
lived. Aulus Gellius, then, in an elaborate disquisition on Greek and
Roman chronology, states decidedly that Socrates was contemporary with
Hippocrates, but younger than he.[23] Now it is well ascertained, that
the death of Socrates took place about the year 400 A.C., and
as he was then nearly seventy years old, his birth must be dated as
happening about the year 470 A.C. This statement would throw
the birth of Hippocrates back several years beyond the common date,
as given by Soranus. There is also much uncertainty as to the time
of his death: according to one tradition he died at the age of 85,
whereas others raise it to 90, 104, and even 109 years. These dates
of his birth and death, although vague, are sufficient to show that
the period at which we may reasonably suppose he had practised his
profession with the greatest activity and reputation, must have been
the latter part of the fifth century A.C. It will readily
occur to the reader, then, that our author flourished at one of the
most memorable epochs in the intellectual development of the human
race. He had for his contemporaries, Pericles, the famous statesman;
the poets Æschylus, Sophocles, Euripides, Aristophanes, and Pindar;
the philosopher Socrates, with his distinguished disciples Plato
and Xenophon; the venerable father of history, Herodotus, and his
young rival, Thucydides; the unrivalled statuary, Phidias, with his
illustrious pupils, and many other distinguished names, which have
conferred immortal honor on the age in which they lived, and exalted
the dignity of human nature. Nor was Greece the only region of the
earth remarkable at this time for moral and intellectual improvement;
for, if we may believe oriental chronology, Confucius and Zoroaster had
gone off the stage of life only a very few years before the dawn of
this celebrated age of Grecian superiority in the arts and sciences.
Hippocrates, it thus appears, came into the world under circumstances
which must have co-operated with his own remarkable powers of intellect
in raising him to that extraordinary eminence which his name has
attained in all ages. From his forefathers he inherited a distinguished
situation in one of the most eminent hospitals, or Temples of Health,
then in existence, where he must have enjoyed free access to all the
treasures of observations collected during many generations, and at
the same time would have an opportunity of assisting his own father in
the management of the sick.[24] Thus from his youth he must have been
familiar with the principles of medicine, both in the abstract and in
the concrete,--the greatest advantage, I may be permitted to remark,
which any tyro in the healing art can possibly enjoy. In addition to
all this, he had excellent opportunities of estimating the good and
bad effects resulting from the application of gymnastic exercises in
the cure of diseases, under the tuition of Herodicus, the first person
who is known for certain to have cultivated this art as a branch of
medicine.[25] He was further instructed in the polite literature and
philosophy of the age, by two men of classical celebrity, Gorgias
and Democritus; the latter of whom is well known to have devoted
much attention to the study of medicine, and its cognate sciences,
comparative anatomy and physiology.
Initiated in the theory and first principles of medicine, as now
described, Hippocrates no doubt commenced the practice of his art in
the Asclepion of Cos, as his forefathers had done before him. Why he
afterwards left the place of his nativity, and visited distant regions
of the earth, whither the duties of his profession and the calls of
humanity invited him, cannot now be satisfactorily determined. The
respect paid to him in his lifetime by the good and wise in all the
countries which he visited, and the veneration in which his memory
has been held by all subsequent generations, are more than sufficient
to confute the base calumny, invented, no doubt, by some envious
rival, that he was obliged to flee from the land of his nativity in
consequence of his having set fire to the library attached to the
Temple of Health, at Cnidos, in order that he might enjoy a monopoly
of the knowledge which he had extracted from the records which it had
contained.[26] Certain it is, that he afterwards visited Thrace, Delos,
Thessaly, Athens, and many other regions, and that he practised, and
probably taught, his profession in all these places.[27] There are many
traditions of what he did during his long life, but with regard to
the truth of them, the greatest diversity of opinion has prevailed in
modern times. Thus he is said to have cured Perdiccas, the Macedonian
king, of love-sickness; and although there are circumstances connected
with this story which give it an air of improbability, it is by no
means unlikely that he may have devoted his professional services to
the court of Macedonia, since very many of the places mentioned in
his works as having been visited by him, such as Pella and Acanthus,
are situated in that country; and further, in confirmation of the
narrative, it deserves to be mentioned, that there is most satisfactory
evidence of his son Thessalus having been court physician to Archelaus,
king of Macedonia;[28] and it is well ascertained that another of his
descendants, the Fourth Hippocrates, attended Roxane, the queen of
Alexander the Great.[29] Our author’s name is also connected with the
great plague of Athens, the contagion of which he is reported to have
extinguished there and in other places, by kindling fires.[30] The only
serious objection to the truth of this story is the want of proper
contemporary evidence in support of it. It is no sufficient objection,
however, that Thucydides, in his description of the circumstances
attending the outbreak of the pestilence in Attica, makes no mention
of any services having been rendered to the community by Hippocrates;
while, on the contrary, he states decidedly that the skill of the
physicians could do nothing to mitigate the severity of this malady.
It is highly probable, that, if Hippocrates was actually called upon
to administer professional assistance in this way, it must have been
during one of the subsequent attacks or exacerbations of the disease
which occurred some years afterwards. We know that this plague did
not expend its fury in Greece during one season, and then was no more
heard of; but on the contrary, we learn that it continued to lurk
about in Athens and elsewhere, and sometimes broke out anew with all
its original severity. Thucydides briefly mentions a second attack of
the plague at Athens about two years after the first,[31] attended
with a frightful degree of mortality; nor is it at all improbable
that this was not the last visitation of the malady. Though the
name of Hippocrates, then, may not have been heard of at its first
invasion, it is not at all unlikely that, after he had risen to the
head of his profession in Greece, as we know that he subsequently
did, he should have been publicly consulted regarding the treatment
of the most formidable disease which was prevailing at the time.[32]
What adds an appearance of truth to the tale is, that several of the
genuine works of Hippocrates, which were probably published in its
lifetime, relate to the causes and treatment of epidemic and endemic
diseases.[33] That the magistrates of Athens, then, should have applied
to him as the most eminent authority on the subject, to assist them
in their sanitary regulations[34] during the prevalence of this great
pestilence, is so far from being improbable, that I think it would have
been very extraordinary if they had omitted to consult him, seeing that
he was undoubtedly looked up to as the _facile princeps_ among
the physicians of the day. That his services in this way have been
exaggerated by the blind admiration of his worshipers, both at that
time and in after ages, may be readily admitted; but this circumstance
ought not to make us reject the whole story as being fabulous. I
repeat, then, that although this part of the history of Hippocrates
be not vouched by any contemporary evidence, it is by no means devoid
of probability, while the objections which have been started to it by
modern authorities have not so much weight as is generally supposed.
Another circumstance in the life of Hippocrates, for the truth of
which Soranus, Suidas, and a host of ancient authorities concur
in vouching, namely, that he refused a formal invitation to pay a
professional visit to the court of Persia, is rejected with disdain
by almost all the modern scholars who have touched upon this subject.
But was it an uncommon thing for the king of Persia to manœuvre in
this way with Grecian talent in order to attract it to his court? So
far is the contrary known to be the case that, as every person who
is familiar with the early history of Greece must be well aware, the
manner in which “the Great King” rendered himself most formidable to
the Grecian Republics after the humiliating defeats which the military
forces of Persia had sustained at Marathon, Salamis, and Platæa, was
by intriguing with all those distinguished persons in Greece who would
render themselves accessible to his bribes and flatteries, and thus
endeavoring to detach them from the cause of their country. Of this
we have notable examples in the case of two illustrious individuals,
who were nearly contemporary with Hippocrates--I mean Pausanias and
Themistocles. Moreover, it is well known that Grecian physicians at
all times were in high repute at the court of Babylon;[35] witness
Ctesias, the contemporary and kinsman of Hippocrates,[36] who was court
physician to the king of Persia, and was employed in that capacity in
the most serious emergencies.[37] What more natural, then, or more
likely to happen, than that the king of Persia, when he saw his country
overrun by the plague,[38] should seek advice from a neighboring
people, whose superiority to his own subjects in all the arts of war
and peace he and his predecessors had learned from sad experience? I
readily admit that the letters in the Hippocratic Collection which
relate to this story can scarcely be received as genuine; but does this
prove that the event upon which they are made to turn is also devoid
of truth? I can see no probability in this supposition; for whether
we regard these documents as willful forgeries, executed with the
fraudulent intention of palming them on the literary world as genuine
productions, or whether we look upon them as mere exercises made on
given subjects by the Sophists or Scholiasts to display their ability
in sustaining an assumed character, it would have been preposterous
to make them relate to stories of which every person of that age must
have been able to detect the falsehood. Were any person at the present
day, from whatever motive, desirous of palming upon the public certain
letters said to have been written by the celebrated John Hunter, he
would surely not be so imprudent as to endeavor to pass off as genuine
a correspondence purporting to have taken place between him and the
king of France, as every one at all acquainted with professional
biography, would at once perceive that the authenticity of the
documents in question was completely disproved by the falsity of the
narrative upon which they are founded. Seeing, then, that these letters
are admitted on all hands to be very ancient, that is to say, of a date
not much later than the time of Hippocrates, we may rest assured that
the main facts to which they allude were believed at the time to be of
an authentic nature.
For the like reasons I am disposed to think that, although the letters
in the Collection which refer to a pretended correspondence between him
and Democritus are most probably to be regarded as spurious, it is far
from being improbable that the physician may have rendered the services
of his profession to the philosopher. Had there been no grounds
whatever for this story, why so many ancient authors should have agreed
in giving credit to it I cannot imagine.
According to all the accounts which have come down to us of his life,
he spent the latter part of it in Thessaly, and died at Larissa, when
far advanced in years. The corruptions with regard to numbers which,
in the course of transcription, have crept into all works of great
antiquity, sufficiently account for the differences already mentioned
in the statements respecting his age at the time of his death.
These are all the particulars of any importance which can now be
gathered regarding the life of him who has been venerated in all
ages as “The Father of Medicine.” That they are scanty and rather
unsatisfactory, must be admitted; but yet what more, in general, can we
desire to know respecting the biography of a physician than the manner
in which he was educated, how he was esteemed by his contemporaries,
and what he did and wrote to reflect credit on his profession? The
approbation and gratitude of those who have consulted him for the cure
of their maladies are the best testimony to the public character of a
physician, and the estimation in which his writings are held by the
members of his own profession is what constitutes his professional
reputation. I need scarcely say that, as a medical author, the name
of Hippocrates stands pre-eminently illustrious. In this way he has
left monuments of his genius more durable than the marble statues
of Phidias, his contemporary, and as enduring as the tragedies of
Sophocles, or the Olympian odes of Pindar.
In the next section I intend to give a careful analysis of all
the writings which have come down to us from antiquity under
the name of Hippocrates, and to state clearly the grounds upon
which some are to be received as genuine, and others rejected as
supposititious. I shall conclude the present section, although it
may appear that I am anticipating some things which had better have
come after the succeeding one, with a brief account of our author’s
general principles, both as regards the theory and the practice of
medicine; and in doing this I mean not to confine myself strictly
to the treatises which are acknowledged to be genuine, as they are
unfortunately so few in number, that we are often obliged to guess at
the tenets of our author from those held by his immediate successors
and disciples.
The opinions which he held as to the origin of medicine, and the
necessities in human life which gave rise to it, are such as bespeak
the soundness of his views, and the eminently practical bent of his
genius. It was the necessity, he says,[39] which men in the first
stages of society must have felt of ascertaining the properties of
vegetable productions as articles of food that gave rise to the science
of Dietetics; and the discovery having been made that the same system
of regimen does not apply in a disordered as in a healthy condition of
the body, men felt themselves compelled to study what changes of the
aliment are proper in disease; and it was the accumulation of facts
bearing on this subject which gave rise to the art of Medicine. Looking
upon the animal system as one whole, every part of which conspires and
sympathizes with all the other parts, he would appear to have regarded
disease also as one, and to have referred all its modifications to
peculiarities of situation.[40] Whatever may now be thought of his
general views on Pathology, all must admit that his mode of prosecuting
the cultivation of medicine is in the true spirit of the Inductive
Philosophy; all his descriptions of disease are evidently derived from
patient observation of its phenomena, and all his rules of practice are
clearly based on experience. Of the fallaciousness of experience by
itself he was well aware, however, and has embodied this great truth in
a memorable aphorism,[41] and therefore he never exempts the apparent
results of experience from the strict scrutiny of reason. Above all
others, Hippocrates was strictly the physician of experience and common
sense. In short, the basis of his system was a rational experience, and
not a blind empiricism, so that the Empirics in after ages had no good
grounds for claiming him as belonging to their sect.[42]
What he appears to have studied with particular attention is the
natural history of diseases, that is to say, their tendencies to a
favorable or fatal issue; and without this knowledge, what can all
medical practice be but blind empiricism?--a haphazard experiment,
which perchance may turn out either to cure or to kill the patient?
In a word, let me take this opportunity of saying, that the physician
who cannot inform his patient what would be the probable issue of his
complaint, if allowed to follow its natural course, is not qualified to
prescribe any rational plan of treatment for its cure.
One of the most distinguishing characteristics, then, of the
Hippocratic system of medicine, is the importance attached in it to
_prognosis_, under which was comprehended a complete acquaintance
with the previous and present condition of the patient, and the
tendency of the disease. To the overstrained system of Diagnosis
practised in the school of Cnidos, agreeably to which diseases were
divided and subdivided arbitrarily into endless varieties, Hippocrates
was decidedly opposed; his own strong sense and high intellectual
cultivation having, no doubt, led him to the discovery, that to
accidental varieties of diseased action there is no limit, and that
what is indefinite cannot be reduced to science.[43]
Nothing strikes one as a stronger proof of his nobility of soul, when
we take into account the early period in human cultivation at which he
lived, and his descent from a priestly order, than the contempt which
he everywhere expresses for ostentatious charlatanry, and his perfect
freedom from all popular superstition.[44] Of amulets and complicated
machines to impose on the credulity of the ignorant multitude, there
is no mention in any part of his works. All diseases he traces to
natural causes, and counts it impiety to maintain that any one more
than another is an infliction from the Divinity. How strikingly the
Hippocratic system differs from that of all other nations in their
infantine state must be well known to every person who is well
acquainted with the early history of medicine.[45] His theory of
medicine was further based on the physical philosophy of the ancients,
more especially on the doctrines then held regarding the elements of
things, and the belief in the existence of a spiritual essence diffused
through the whole works of creation, which was regarded as the agent
that presides over the acts of generation, and which constantly strives
to preserve all things in their natural state, and to restore them
when they are preternaturally deranged. This is the principle which
he called Nature, and which he held to be a _vis medicatrix_.
“Nature,” says he, or at least one of his immediate followers says, “is
the physician of diseases.”[46] His physical opinions are so important,
that I have resolved to devote an entire section to an exposition of
the ancient doctrines on this head. (See Sect. III.)
Though his belief in this restorative principle would naturally
dispose him to watch its operations carefully, and make him cautious
not to do anything that would interfere with their tendencies to
rectify deranged actions, and though he lays it down as a general
rule by which the physician should regulate his treatment, “to do
good, or at least to do no harm,”[47] there is ample evidence that on
proper occasions his practice was sufficiently bold and decided. In
inflammatory affections of the chest he bled freely, if not, as has
been said, _ad deliquum animi_,[48] and in milder cases he practised
cupping with or without scarification.[49] Though in ordinary cases
of constipation he merely prescribed laxative herbs, such as the
mercury (_mercurialis perennis_),[50] beet,[50] and cabbage,[50] he
had in reserve elaterium,[51] scammony,[52] spurges,[53] and other
drastic cathartics, when more potent medicines of this class were
indicated. And although when it was merely wished to evacuate upwards
in a gentle manner, he was content with giving hyssop,[54] and other
simple means, he did not fail, when it was desirable to make a more
powerful impression, to administer the white hellebore with a degree
of boldness, which his successors in the healing art were afraid
to imitate.[55] A high authority has expressly stated that he was
the discoverer of the principles of derivation and revulsion in the
treatment of diseases.[56] Fevers he treated as a general rule, upon
the diluent system, but did not fail to administer gentle laxatives,
and even to practise venesection in certain cases.[57] When narcotics
were indicated, he had recourse to mandragora, henbane, and perhaps to
poppy-juice.[58]
In the practice of surgery he was a bold operator. He fearlessly,
and as we would now think, in some cases unnecessarily, perforated
the skull with the trepan and the trephine in injuries of the head.
He opened the chest also in empyema and hydrothorax. His extensive
practice, and no doubt his great familiarity with the accidents
occurring at the public games of his country, must have furnished him
with ample opportunities of becoming acquainted with dislocations
and fractures of all kinds; and how well he had profited by the
opportunities which he thus enjoyed, every page of his treatises “On
Fractures,” and “On the Articulations,” abundantly testifies. In fact,
until within a very recent period, the modern plan of treatment in such
cases was not at all to be compared with his skillful mode of adjusting
fractured bones, and of securing them by means of waxed bandages. In
particular, his description of the accidents which occur at the elbow-
and hip-joints will be allowed, even at the present day, to display
a most wonderful acquaintance with the subject. In the treatment of
dislocations, when human strength was not sufficient to restore the
displacement, he skillfully availed himself of all the mechanical
powers which were then known.[59] In his views with regard to the
nature of club-foot, it might have been affirmed of him a few years
ago, that he was twenty-four centuries in advance of his profession
when he stated that in this case there is no dislocation, but merely a
declination of the foot; and that in infancy, by means of methodical
bandaging, a cure may in most cases be effected without any surgical
operation. In a word, until the days of Delpech and Stromeyer, no
one entertained ideas so sound and scientific on the nature of this
deformity as Hippocrates.
But I must not allow my enthusiastic admiration to carry me too
far. I will therefore conclude the present section by making a few
observations on the peculiar style of our author’s writings. According
to Galen, whose extensive acquaintance with Greek literature rendered
him a most competent judge, the characteristics of his style are
extreme conciseness, precision, and, in certain cases, obscurity, as
the natural result of labored brevity.[60] To these traits of character
he adds, elsewhere, that Hippocrates makes it a rule to avoid all
superfluity of discussion and unnecessary repetitions, and never says
more than what is indispensable.[61] Now, it is no proper objection
to this general view of the character of his style, as stated by M.
Littré, that it is not the same in all his works; as, for example,
in his treatise “On Airs, Waters, and Places,” where the style is
certainly not so laconic as in some of his others; although, even with
regard to it, I must be permitted to say that I agree with a most
competent authority, the late Dr. Coray, that its style is remarkable
for conciseness.[62] And, indeed, if brevity of expression, bordering
at times upon obscurity, be not the characteristic of the style of
Hippocrates, we must admit that his mode of composition is not in
accordance with the taste of his age. There can be no doubt that the
style of Hippocrates is nearly akin to that of his contemporary,
the historian Thucydides, which is thus described by a very acute
and original critic: “The most obvious and characteristic of his
peculiarities is an endeavor to express as much matter as possible
in as few words as possible, to combine many thoughts into one, and
always to leave the reader to supply something of his own. Hence his
conciseness often becomes obscure.”[63] I would beg leave to add that
other peculiarities in the style of Thucydides, which are severely
animadverted upon by Dionysius, may be clearly recognized also in the
writings of Hippocrates, especially irregularities of syntax, with a
somewhat rude and inartificial mode of constructing his sentences. I
mention this the rather that the English reader may not expect to find
in my translation any of those well-turned periods and graceful modes
of construction by which elegant composition is now distinguished. I
wish it to be known that in making this translation, I have followed
the example of the modern authority lately referred to, that is to
say, I have been more studious of fidelity than of elegance, and have
endeavored to give not only the matter, but also the manner, of my
author.[64]
* * * * *
As promised above, I here subjoin that Mythical Genealogy of
Hippocrates from Tzetzes.
Æsculapius was the father of Podalirius, who was the father of
Hippolochus, who was the father of Sostratus, who was the father
of Dardanus, who was the father of Crisamis, who was the father of
Cleomyttades, who was the father of Thedorus, who was the father of
Sostratus II., who was the father of Theodorus II., who was the father
of Sostratus III., who was the father of Nebrus, who was the father of
Gnosidicus, who was the father of Hippocrates I., who was the father of
Heraclides, who was the father of HIPPOCRATES II., otherwise
called the GREAT HIPPOCRATES. (Chiliad. vii., 155.)
I may also add a few particulars, deserving to be known, respecting
the family of Hippocrates. As Galen relates, he had two sons, Thessalus
and Draco, each of whom had a son who bore the name of Hippocrates.
(Comment. ii., in Lib. de Nat. Human.) It thus appears that there were
in the family four persons of the name of Hippocrates, closely related
to one another. First, the father of Heraclides, and grandfather
of Hippocrates II.; second, Hippocrates II., our author; third and
fourth, his grandchildren, the sons of Thessalus and Draco. Besides
these, three or four other members of the family bearing the name of
Hippocrates are enumerated by Suidas. Of Thessalus, it is related by
Galen (l.c.) that he adhered strictly to the principles of his father,
and became physician to Archelaus, king of Macedonia. Of Draco little
mention is made, only it is well known that he also followed his
father’s profession. But of all the family of Hippocrates the Great,
Polybus, his son-in-law, is the most celebrated. Galen calls him the
disciple of Hippocrates and successor in his school, and adds, that he
made no innovations on the doctrines of his teacher. (Comment. i., in
Libr. de Nat. Hum.)
SECTION II.
DISQUISITION ON THE AUTHENTICITY OF THE DIFFERENT TREATISES
WHICH HAVE BEEN ATTRIBUTED TO HIPPOCRATES.
There can scarcely be a doubt that Hippocrates followed the practice
which we know to have been adopted by almost all the great writers of
antiquity with regard to the publication of their works, namely, that
of publishing them separately, at the time they were composed. We know,
for example (to begin with a distinguished author, regarding whom our
information is particularly ample), that Horace published his books of
satires, epistles, odes, and epodes separately, and at different times;
and that the collection of them in its present form was not compiled
until after his death.[65] We have every reason for concluding that
the same rule was followed by Martial,[66] Cicero,[67] and other Roman
authors. It is further well ascertained (to come to a period not far
removed from the age of Hippocrates) that Plato[68] and Aristotle[69]
likewise gave their works to the literary world upon the same plan. We
have every reason, therefore, to suppose that Hippocrates published
several of his works separately, in his life time; and indeed Galen
often expresses himself so as to leave little or no ground for doubt
on this point.[70] It would be most interesting and important then to
know, were this possible, in what order the different works of our
author were published. But unfortunately this is a question which we
have no proper data for solving satisfactorily, only as the “Aphorisms”
are evidently made up in a great measure of conclusions drawn from the
results of discussions and observations recorded in other of his works,
we have every reason to infer that this important work was among that
latest of his literary labors.[71] But although we may not be able to
determine the order in which the different pieces were composed and
published, we need have no hesitation in deciding with all the best
authorities, ancient and modern, that all the following treatises
were composed by him, and, from the first, obtained the sanction of
his name, viz.: the “Prognostics;” the “First and Third Epidemics;”
“On Regimen in Acute Diseases;” “On Airs, Waters, and Places;” “On
Wounds of the Head;” the “Aphorisms.” It is in so far satisfactory,
then, to know, that respecting the authorship of these works there has
never been any reasonable question, and that whoever entertains doubts
on this point of literary history, ought, on the same principles of
criticism, to dispute the authenticity of the “Protagoras” and “Phædo”
of Plato; of the “History of Animals” and “Politics” of Aristotle; and
of the “Olynthiacs” and “Philippics” of Demosthenes. In a word, nothing
but the most lawless spirit of scepticism can lead any one to challenge
the genuineness of the works which I have just now enumerated. These,
however, it will be seen, constitute but a very small portion of the
treatises contained in the Hippocratic Collection; and with regard
to a very great number of the others, it is unfortunately not only
impossible to bring any competent evidence of their genuineness, but it
is also quite apparent that they betray marks of an entirely different
authorship; and this is abundantly obvious, whether we look to the
matters which they contain, or the manner in which these are given.
Thus in some of the treatises we discover hypothetical doctrine and
rules of practice utterly at variance with those which are contained in
the works of acknowledged authenticity; and in some of them, instead
of that nervous conciseness which, as we have already stated, has
always been held to be characteristic of the style of Hippocrates, we
find an insipid verbosity and vagueness of expression, which clearly
stamp them as being productions of a very different hand. But, besides
this internal evidence which we have to assist us in forming a correct
judgment on these works, we fortunately still possess a considerable
number of ancient Commentaries, written expressly in illustration of
them, from which, in many instances, modern critics have been enabled
to draw very satisfactory data for forming a correct judgment on
the points at issue. Before proceeding further, it is but fair to
acknowledge that I have freely availed myself of the labors of Vander
Linden, Ackerman, Gruner, Littré, and other learned men, who have
preceded me in this field of investigation, but at the same time I may
venture to assure the reader that there is scarcely a passage in any of
the ancient authorities, bearing on the points in discussion, which I
have not examined carefully for myself.
The oldest commentator of whom we have any mention, is the
celebrated Herophilus, who flourished about the year 300 A.C.[72] But
of his Commentaries we have no remains, nor of those of the other
commentators down to Apollonius Citiensis, a writer of the first
century A.C. His Scholia on the Hippocratic treatise, “De Articulis,”
along with those of Palladius, Stephanus, Theophilus, Meletius, and
Joannes Alexandrinus, all writers of an uncertain date, but certainly
much later than the Christian era, were published by the late Dr.
Dietz, at Konigsburg, in 1834. To these we have to add two others, of
much higher celebrity, namely, Erotian, who lived during the reign
of Nero, and the famous Galen, who, it is well known, flourished in
the latter part of the second century, P.C. It is from the works of
these two writers that the most important facts are to be elicited,
for forming a correct judgment respecting the authenticity of the
Hippocratic treatises. As we shall have occasion to quote their
opinions on the different heads of our inquiry, it would be useless to
occupy room by giving their entire list in this place. Suffice it to
say, that Erotian rarely assigns any reason for admitting the treatises
into his list of genuine works, and that Galen generally rests his
judgment, when he assigns any grounds for it, upon the evidence of
preceding authorities, and upon what he holds to be the characteristics
of the doctrines and style of Hippocrates. These, assuredly, are most
sound and legitimate principles of criticism; but it has been often
supposed, that in applying them the great commentator is at times very
dogmatic, and not always consistent with himself. But, upon the whole,
all must allow that Galen is our best guide on the subject of our
present inquiry. And, moreover, it is from his works especially that we
are enabled to glean whatever information we possess with regard to the
opinions of the earlier commentators, from Herophilus down to his own
times.
I will now proceed to give a brief sketch of the labors of modern
critics in this department.
The earliest modern authority is Lemos, whose work was published in
the end of the sixteenth century. It appears that he follows almost
entirely the opinions of Galen, and seldom or never ventures to
exercise an independent judgment of his own.
The work of Mercuriali is a much more elaborate and important
performance, and his principles of judgment appear to me most
unexceptionable, being founded entirely upon ancient authority and
peculiarity of style; only it may, perhaps, be objected, that he rather
exaggerates the importance of the latter at the expense of the former;
for it must be admitted that very contradictory conclusions have
sometimes been founded on imaginary peculiarities of style. I cannot
agree with M. Littré, however, that the whole system of Mercuriali is
founded on a _petitio principii_; as if, before describing the
style of his author, he ought to have decided which were his genuine
writings.[73] For, as already stated, any one is perfectly warranted in
assuming that certain of the works which bear the name of Hippocrates
are genuine, and from them, and the general voice of antiquity,
Mercuriali was further justified in deciding what are the peculiarities
of the style of Hippocrates, and in applying them as a test of the
genuineness of other works which had been attributed to the same
author. Mercuriali divides the Hippocratic treatises into four classes,
as follows: The first comprehends those which bear the characters of
his doctrine and style. The second comprises those which are composed
of notes taken from memory, and published by Thessalus, Polybus, or
other of his disciples, and contain foreign matter interpolated with
them. The third class consists of those which have not been composed by
Hippocrates, but are the work of his sons or disciples, and represent
his doctrines with greater or less exactness. The fourth includes those
tracts which have nothing to do with the school of Hippocrates. As
the views and principles of Mercuriali accord, in the main, very well
with my own, I think it proper to set down his classification of the
treatises.
CLASSIS I.
1. De Natura Humana.
2. De Aëribus, Aquis, et Locis.
3. Aphorismi.
4. Prognostica.
5. De Morbis popularibus.
6. De Morbis acutis.
4. De Vulneribus Capitis.
8. De Fracturis.
9. De Articulis.
10. De Officina Medici.
11. Mochlicus.
12. De Alimento.
13. De Humoribus.
14. De Ulceribus.
CLASSIS II.
1. De Locis in Homine.
2. De Flatibus.
3. De Septimestri Partu.
4. De Octimestri Partu.
5. De Ossibus.
CLASSIS III.
1. De Carnibus seu Principiis.
2. De Genitura.
3. De Natura Pueri.
4. De Affectionibus.
5. De Affectionibus internis.
6. De Morbis.
7. De Natura Muliebri.
8. De Morbis Muliebribus.
9. De Sterilibus.
10. De Fœtatione et Superfœtatione.
11. De Virginium Morbis.
12. De Sacro Morbo.
13. De Hemorrhoidibus.
14. De Fistulis.
15. De Salubri Diæta.
16. De Diæta, tres Libri.
17. De Usu Liquidorum.
18. De Judicationibus.
19. De Diebus Judicatoriis.
20. Prædictionum Libri.
21. Coacæ Prænotiones.
22. De Insomniis.
CLASSIS IV.
1. Jusjurandum.
2. Præceptiones.
3. De Lege.
4. De Arte.
5. De Arte Veteri.
6. De Medico.
7. De Decenti Ornatu.
8. De Exsectione Fœtus.
9. De Resectione Corporum.
10. De Corde.
11. De Glandulis.
12. De Dentitione.
13. De Visu.
14. Epistolæ.
15. De Medicamentis purgantibus } Latinè tantum.[74]
16. De Hominis Structura }
Perhaps we may venture to affirm, without much risk of challenge, that
the works of no ancient author owe more to the exertions of a single
individual than those of Hippocrates due to the labors of Foës. Of his
excellencies as an editor, and expositor of the meaning of his author,
I will have occasion to speak afterwards; and here I shall merely state
regarding him, that as a critic called upon to decide with regard to
the authenticity and spuriousness of the different works, his merits
are by no means proportionally high. He rarely or never ventures to
differ from Galen, and everywhere evinces so easy a disposition to
recognize the works in question as being the productions of his beloved
author, that his opinion on any point connected with their authenticity
is not deserving of much weight.
Haller arranges the Hippocratic treatises in the following classes:
The first contains those which in all ages have been admitted as being
genuine.[75] The second embraces those which contain doctrines at
variance with those “of the divine old man,” or inventions of a later
date, or vices which Hippocrates disclaims. The third embraces those
which are manifestly spurious, as is obvious from their being mere
compendia of the works of Hippocrates, or which betray a manner totally
at variance with his. The fourth embraces a certain number of pieces
not contained in the preceding classes. Such is Haller’s arrangement,
which, however, is not entitled to much consideration; for the
illustrious author himself seems to admit, candidly, that his critical
knowledge of the language was too slender to warrant him in trusting
his own judgment when it came into collision with any high authority,
such as Foës; and, moreover, it would appear, that his edition of the
works of Hippocrates had been got up in a very slovenly manner, by some
incompetent person, after his death.
Gruner is one the most learned and original of our authorities on the
literature of the Hippocratic works.[76] His decision, with regard to
the authenticity of the different pieces, is made to rest mainly on
internal evidence, that is to say, upon their possessing the proper
characteristics of the language and style of Hippocrates. These he
is at great pains in showing to be, in the first place, brevity,
approaching to the laconic, which he justly holds with Galen[77] to
be one of the most striking peculiarities of the ancient style of
writing. To conciseness and simplicity, he adds gravity of manner,
and an absence of all subtlety of reasoning. This last trait in the
literary character of Hippocrates I hold to be particularly apparent in
the works which are generally admitted to be genuine. Some stress is
also laid by him on the use of the Ionic dialect, but this is a most
fallacious criterion, and had better have been left out of the question
altogether; as there is good reason to believe that great liberties
were used with the language of Hippocrates by the ancient editors and
commentators, more especially by Artemidorus Capito, who lived a short
time before Galen.[78] And besides, as every person who is generally
acquainted with Greek literature knows, although the Ionic dialect in
the age of Hippocrates had been fused into the Attic,[79] for several
centuries afterwards it continued to be arbitrarily used by many
writers, both of prose and verse, owing to the high character which it
possessed, as being the dialect of the Homeric poems. Hence it is used
in later times, not only by the poets such as Quintus Smyrnæus, Nonnus,
and Oppian, but also by at least one great medical author, I mean
Aretæus. It would appear, however, that Gruner himself was sensible
that much stress ought not to be laid on peculiarity of dialect; for,
in resuming his conclusions as to the proper tests of genuineness
in judging of the Hippocratic writings, he determines them to be
conciseness and gravity of language, paucity of reasoning, and accuracy
of observation, along with the authority of the ancient critics, that
is to say, of the commentators. Now, it certainly must be admitted
that, taken together, these principles are most just and reasonable;
only it is apparent, that, like Mercuriali, he has ranked last what he
ought to have laid most stress upon, namely, ancient authority. For,
as remarked above, unless ancient authority had previously determined
certain works in the Collection to be genuine, the modern critic would
have had no premises from which he could have drawn conclusions as to
the characteristics of our author’s style. Starting, then, from the
principles now stated, Gruner arranges the works of Hippocrates in two
divisions, namely, the genuine and the supposititous. We shall only
give the former list, which embraces the following ten treatises:
1. Jusjurandum.
2. Aphorismi.
3. De Aëre, Aquis, et Locis.
4. Prænotiones.
5. Prædictionum, ii.
6. De Officina Medici.
7. Popularium Morborum, i., iii.
8. De Victu Acutorum.
9. De Vulneribus Capitis.
10. De Fracturis.
It will be shown below that in this list he has admitted one work
(Prædict. ii.), which certainly has not sufficient claims to the place
which he has assigned it; and, on the other hand, he has acted most
inconsistently in rejecting the work “De Articulis,” while he admitted
“De Fracturis,” for, as we shall see, there is the strongest reason for
believing that the two originally constituted one work. But the truth
of the matter is, that Gruner having hastily adopted the notion that
Hippocrates was altogether ignorant of human anatomy, the celebrated
passage in this treatise which so strikingly alludes to the dissection
of the human body[80] would decide him to reject it from his list of
genuine works.
Though Le Clerc, in his “History of Medicine” (b. iii.), shows himself
to be well acquainted with the fact that many of the treatises ascribed
to Hippocrates are supposititious, he nowhere lays down any rules for
distinguishing the genuine from the spurious, only he insists strongly
on conciseness as being one of the most striking characteristics of the
style of Hippocrates, and shrewdly remarks that the treatises which
abound most in reasoning are those which are most suspected of being
spurious.
Schulze also, in his “History of Medicine,” with much learning
and excellent judgment, enters cursorily upon the examination of
the question regarding the genuineness of the works ascribed to
Hippocrates, but he scarcely ever deviates from the rules laid down
by Mercuriali and Le Clerc. Indeed, he almost always agrees with the
latter. We shall have occasion to refer pretty frequently to his
opinions when we come to give our own judgment on the authenticity of
the particular treatises contained in the Hippocratic Collection.
Ackerman,[81] in the first place, gives an elaborate and very lucid
exposition of the labors of all preceding critics in the same line,
and then proceeds to deliver his own opinions _seriatim_ on the
different treatises. He rests his judgment generally on the authority
of the ancients, and more especially of Erotian and Galen; and in so
doing, M. Littré thinks he acted so judiciously, that he does not
hesitate to pronounce Ackerman to be the safest guide which we can
follow. Like Gruner, he divides the works into two classes, the genuine
and the spurious. The former list is as follows:--
1. Epidemica, i., iii.
2. Prænotiones.
3. Prædictorum, ii.
4. Aphorismi.
5. De Victu Acutorum.
6. De Aëre, Aquis, Locis.
7. De Vulneribus Capitis.
This, it will be remarked, is the smallest list which we have yet
encountered, and one cannot but feel saddened to find the remains of
the great Hippocrates thus reduced to so small a compass. We shall
have occasion, however, by and by, to show that Ackerman has been
too unsparing in applying the obelisk[82] to treatises of suspected
authenticity.
Grimm, the German translator of Hippocrates, professes also, like
Ackerman, to be guided principally by ancient authority, such as that
of Galen and Erotian, but he only reposes full confidence in it when
confirmed by internal evidence. The style, he says, should be simple,
brief, and expressive, and the language in accordance with the epoch.
He adds, no hypothesis, no subtlety, however ancient, no extraordinary
remedies or modes of treatment, should be found in these books.
Starting from these principles, which, it will be remarked, are rather
fancifully laid down, Grimm reduces the number of genuine works to the
following very meagre list:
1. Popularium Morborum, i., iii.
2. Prognostica.
3. Aphorismi.
4. De Victu Acutorum, p. i.
5. De Aëre, Aquis, Locis.
The reader will not fail to remark, in this result of Grimm’s inquiry,
indications of that bold spirit of scepticism for which the learned
criticism of Germany has been distinguished of late--the spirit of her
Wolfs and Lachmans, of her Asts and Schliermachers, which has deprived
the Iliad and Odyssey of their ancient authorship, and reduced the
bulky tomes of Plato to a very small volume. It is impossible not to
admire the learning, the ingenuity, and the love of truth which these
critics display, but surely the sober judgment of other scholars,
not infected with the same spirit of innovation, will pause before
acquiescing in the justness of a verdict which would deprive so many
immortal performances of the _prestige_ with which they have so
long been regarded. For my own part, I would venture to say, _pace
tantorum virorum_, that these learned critics are deficient in a
practical acquaintance with the laws of evidence, and do not properly
take into account that, in matters of common life, negative evidence is
never allowed to bear down positive, unless the former be remarkably
strong, and the latter particularly weak. When, then, the voice of
antiquity pronounces strongly and consistently in favor of any work, no
negative evidence, unless of a very remarkable character, ought to be
allowed to counterbalance the positive. In short, what I object to in
Grimm is, that he gives an undue preponderance to the internal evidence
over the external, that is to say, over the traditionary evidence of
antiquity, and that in this respect he goes to greater lengths than
even Gruner and Ackerman.
Kurt Sprengel is the author of a separate work on the Hippocratic
writings[83] which I have not seen, but I have reason to believe that
the substance of it is contained in his “History of Medicine,” where
(t. i., p. 295) he enters into a very elaborate disquisition on the
authenticity of the works ascribed to Hippocrates. He insists much, as
a test of authenticity, upon the style, which, in imitation of Galen,
he describes as being concise and laconic to a degree which sometimes
renders it obscure. Hippocrates, he adds, avoids all superfluous
discussion and unseasonable repetitions, and expresses himself as
briefly as possible, without adding conditions or restrictions. He
justly remarks, that what Celsus says of Hippocrates, namely, that he
separated philosophy from medicine, must be received with considerable
limitations, and not in too strict a sense, as if there were no
philosophical tenets in his works. On the other hand, Sprengel uses
these philosophical doctrines as a guide for determining the date of
the different treatises. This is a new, and no doubt a very important,
element in the criticism of these works; but it is one very liable to
be abused, as our information on many occasions, with regard to the
introduction of new doctrines in philosophy, is by no means such as
can be safely trusted to. Sprengel’s opinion on the various works in
question we shall have occasion to state when we come to revise them
separately.
We now proceed to the examination of the labors of two very learned
and ingenious critics, Link and Petersen, who, treading in the
footsteps of Sprengel, have expended much research in endeavoring to
solve the question regarding the date of the Hippocratic treatises, by
considering the philosophical and pathological theories which prevail
in them. I think it right to state that I have not had an opportunity
of consulting the work of Link, and therefore have been obliged to
judge of his opinions, in a great measure, from Petersen’s essay, which
is professedly based on the principles of Link. Of Peterson’s little
tract, I have no hesitation in declaring that I have seldom seen a work
of the kind which displays more critical acumen and deep research; and
although I cannot bring myself to subscribe to many of his general
conclusions, I feel bound in gratitude to acknowledge the benefits
which I have derived from many of his special investigations.[84] On
one important point, which he is at great pains to make out, I have
already stated that I am disposed to agree with him, namely, respecting
the date of our author’s birth, which I certainly think he has proved
by the most unexceptionable authorities to have been considerably
earlier than as generally stated. Petersen divides the Hippocratic
works into nine classes, in the following chronological order:--The
first contains those treatises in which the flow of bile and phlegm
is considered to be the cause of disease;[85] the second recognizes
fire,[86] and the third, air, as the principle of things;[87] in the
fourth, bile and phlegm are spoken of as the primary humors of the
human body;[88] in the fifth, spirit (πνεῦμα) and humidity are held to
be the first principles of generation;[89] in the sixth, the elements
of the body are held to be contrary to one another;[90] in the seventh,
yellow and black bile, phlegm, and blood are set down as being the
primary humors of the human body:[91] in the eighth bile, water,
phlegm, and blood are held to be the primary humors;[92] and in the
ninth, fire and water are held to be the principles of things.[93]
Now, assuredly, no reasonable person will deny to the author of this
distribution the praise of great boldness and originality of thought.
We may well apply to him the words of the poet, that if he has failed
in attaining his object, “magnis tamen excidit ausis.” For my own
part, I cannot but regret to see so much talent and research expended
upon conjectural points of criticism, which, from their nature, can
never be determined with any degree of certainty; for, after all his
labors, few scholars, I venture to predict, will prefer being guided
by his hypothetical reasoning, however ingenious, rather than by the
authority of the ancient commentators. I must also use the liberty to
remark, that M. Petersen appears to me to have no well defined ideas
regarding the doctrines which the ancient philosophers held respecting
the elements of things. For example, when he states, as the basis of
the theory which prevails in the tract “On Ancient Medicine,” that the
elements are the contraries to one another, he evidently confounds the
elements, namely, fire, air, earth, and water, with the powers, or, as
we should now call them, the qualities, hot, cold, moist, and dry. (See
the next Section.) And although, in the treatises “On the Seventh Month
Fœtus,” and “On the Eighth Month Fœtus,” much and deserved importance
is attached to heat as the prime mover of conception, and although, in
the treatise “On Airs,” the importance of air as a cause of disease
be strongly insisted upon, one is not warranted, as he contends, in
concluding that the authors of these treatises recognize respectively
fire and air as the first principle of all things. M. Littré, also, in
his candid reviews of M. Petersen’s work, points out some very striking
oversights which M. Petersen has committed in his arrangement of the
different treatises.[94]
I now come to M. Littré, who, in the Introduction to his edition of
Hippocrates, has certainly surpassed all who went before him, in the
extent of his labors on the general literature of the Hippocratic
Treatises. How highly I estimate his work I need not here stop to
declare; indeed the reputation it has already gained is so established,
that it would be vain to blame and useless to praise it. I have to
express my regret, however, in entering upon my exposition of his
opinions, that they are given in a very expanded form, and with a
degree of diffuseness, _plus quam Galenica_, so that I find it
difficult, within my necessary limits, to convey to the reader a
distinct view of the very important matters which M. Littré has brought
together to bear upon his subject.
He is at great pains to establish the following positions with regard
to the various treatises contained in the Collection which bears the
name of Hippocrates: 1st. That the Collection did not exist in an
authentic form, earlier than the date of Herophilus and his disciples,
that is to say, until nearly 100 years after the death of Hippocrates.
2d. That it contains portions which certainly do not belong to
Hippocrates; and, 3d, also Collections of Notes, etc., which would
never have been published by the author in their present form; and,
4th, Compilations, which are either abridged, or copied word for word
from other works which still form part of the Collection. 5th. As the
different treatises do not belong to the same author, so neither were
they all composed at the same time, some being much more modern than
the others. 6th. We find in the Collection mention made of numerous
treatises written by the followers of Hippocrates, which are now lost,
and which were no longer in existence when the Collection was first
published. 7th. The most ancient writers do not know, for certain,
to whom the several works forming the Collection belonged; 8th, with
the exception of a small number, which all of them, for one reason or
another, agreed in attributing to Hippocrates himself.[95]
I have now a few observations to make upon each of these positions.
The first, which is a most important one in connection with our present
subject, I regret to say, is, I think, by no means satisfactorily made
out by M. Littré. He shows, it is true, that Herophilus is the first
commentator on any of the Hippocratic Treatises of whom there is any
mention, but all we know of his labors in this line merely amounts to
this, that he had commented on certain passages in the “Prognostics,”
and probably also in the “Aphorisms,”[96] but I do not see that this
amounts to any proof either that the Collection was or was not formed
in his time. The proof of the second position is made to rest upon
a fact, which has attracted the attention of all the critics on the
Hippocratic Treatises, namely, that a memorable description of the
veins, which appears in the Hippocratic treatise “On the Nature of
Man,” is published by Aristotle, in the third book of his “History of
Animals,” as the production of his son-in-law, Polybus. Now, M. Littré
argues here, that as the publication of the Aristotelian Collection did
not take place until long after that of the Hippocratic, the persons
who made the latter could not have taken the passage in question from
the other, and the only way in which we can account for the change
of title, is by supposing that the works of Polybus had retained the
name of their true author in the days of Aristotle, but had lost it
at the time the Hippocratic Collection was made. Hence he infers that
the Hippocratic Collection must have been made subsequently to the
time of Aristotle.[97] But I must say that I do not recognize the
force of this argument; for, although the whole of Aristotle’s works
were not published in a collected form, until the time of Apellicon,
we have every reason to believe that many of his works were published
separately, in his own lifetime. The fact, then, would rather tell the
other way, and it might be argued, that the Hippocratic Collection must
have been made before the time of Aristotle, otherwise the persons
who made it would never have fallen into the mistake of attributing
to Hippocrates a passage which so high an authority as Aristotle had
referred to Polybus. But the truth is, that we are not entitled to
draw any positive inference from all this, with regard to the epoch in
question. It is well known that, in all ages, literary publications
have sometimes come abroad into the world in an anonymous shape; and it
need excite no surprise that with regard to the fragment in question,
as in many other cases, there should have been a diversity of opinion
as to its authorship.
The third we shall see fully made out in our analysis of the different
treatises given below.
The fourth will also be clearly proved, when we come to the examination
of certain treatises, as, for example, the “Officina Medici.”
The fifth is not made out to my satisfaction. M. Littré, however,
thinks it is satisfactorily proved that the latest epoch of these
productions does not come lower down than Aristotle and Praxagoras,
and none so low as Erasistratus and Herophilus. Hence he draws the
conclusion that the Collection must have been made between the time of
Aristotle and Herophilus.[98]
The sixth we shall see clearly made out, in our critique on the
separate treatises.
The seventh is abundantly evident from what has been already stated,
and will be made more apparent in the subsequent parts of this Section.
But there is nothing peculiar to the Hippocratic Collection in all
this, for there is as great uncertainty respecting many of the works
ascribed to Plato, and other collections of pieces which have come
down to us from high antiquity. Nay, every person who is conversant
with biblical criticism must be aware how difficult it has proved to
determine the authorship of many of the Psalms which bear the sainted
name of King David.[99]
In support of the eighth position, little need be said in addition
to what has been already stated. I need only repeat briefly that we
have as much certainty that some of the treatises in the Hippocratic
Collection are genuine, as we have that any other ancient works which
have come down to us are the productions of the authors whose names
they bear. But I hasten to give M. Littré’s distribution of the
different works in the Collection. He divides them into the following
classes.
CLASS I.--The Works which truly belong to Hippocrates.
1. On Ancient Medicine.
2. The Prognostics.
3. The Aphorisms.
4. The Epidemics, i., iii.
5. The Regimen in Acute Diseases.
6. On Airs, Waters, and Places.
7. On the Articulations.
8. On Fractures.
9. The Instruments of Reduction (Mochlicus).
10. The Physician’s Establishment, _or_ Surgery.
11. On Injuries of the Head.
12. The Oath.
13. The Law.
CLASS II.--The Writings of Polybus.
1. On the Nature of Man.
2. Regimen of Persons in Health.
CLASS III.--Writings anterior to Hippocrates.
1. The Coan Prænotions.
2. The First Book of Prorrhetics.
CLASS IV.--Writings of the School of Cos,--of the Contemporaries or
Disciples of Hippocrates.
1. Of Ulcers.
2. Of Fistulæ.
3. Of Hemorrhoids.
4. Of the Pneuma.
5. Of the Sacred Disease.
6. Of the Places in Man.
7. Of Art.
8. Of Regimen, and of Dreams.
9. Of Affections.
10. Of Internal Affections.
11. Of Diseases, i., ii., iii.
12. Of the Seventh Month Fœtus.
13. Of the Eighth Month Fœtus.
CLASS V.--Books which are but Extracts and Notes.
1. Epidemics, ii., iv., v., vi., vii.
2. On the Surgery.[100]
CLASS VI.--Treatises which belong to some unknown author, and form
a particular series in the Collection.
1. On Generation.
2. On the Nature of the Infant.
3. On Diseases, iv.
4. On the Diseases of Women.
5. On the Diseases of Young Women.
6. On Unfruitful Women.
CLASS VII.--Writing belonging to Leophanes.
On Superfœtation.
CLASS VIII.--Treatises posterior to Hippocrates, and composed about
the age of Aristotle and Praxagoras.
1. On the Heart.
2. On Aliment.
3. On Fleshes.
4. On the Weeks.
5. Prorrhetic, ii.
6. On the Glands.
7. A fragment of the piece “On the Nature of Bones.”
CLASS IX.--Series of Treatises, of Fragments and of Compilations,
which have not been quoted by any ancient critic.
1. On the Physician.
2. On Honorable Conduct.
3. Precepts.
4. On Anatomy.
5. On the Sight.
6. On Dentition.
7. On the Nature of the Woman.
8. On the Excision of the Fœtus.
9. The eighth Section of the Aphorisms.
10. On the Nature of the Bones.
11. On Crisis.
12. On Critical Days.
13. On Purgative Medicines.
CLASS X.--Writings now lost, which once formed a part of the
Collection:
1. On dangerous Wounds.
2. On Missiles and Wounds.
3. The first Book of Doses--the Small.
CLASS XI.--Apocryphal pieces--Letters and Discourses.
Such is the classification of M. Littré, which he professes to have
founded on the four following rules, or principles: firstly, on the
authority of direct witnesses, that is to say, of authors who preceded
the formation of the Alexandrian Library; secondly, on the consent of
the ancient critics; thirdly, on the application of certain points
in the history of medicine, which appear to him to offer a date, and
consequently a positive determination; fourthly, on the concordance of
the doctrines, the similitude of the writings, and the characters of
the style. Of these rules, the one which he professes to have been most
guided by is the first, all the others being of subordinate importance.
From what has now been stated, the reader will not fail to remark that
the principles upon which the classification of Littré is founded
scarcely differ at all from those of Ackerman. The reasonableness of
these rules, moreover, no one, I presume, will venture to call in
question, whatever may be thought of the judgment with which they
are applied in particular instances. My own opinions on this point I
need not state here, as they will come out more properly in my own
disquisition on the characters of the particular treatises.
But, before concluding this part of my task, I must not neglect to
notice the learned labors of a much esteemed friend and countryman--the
first, the last, the only, scholar (I lament to say) which England
has produced in this department of ancient criticism--Dr. Greenhill,
of Oxford, who, in his excellent article on _Hippocrates_ in
Smith’s “Dictionary of Greek and Roman Biography and Mythology,” enters
into a very elaborate disquisition on the authenticity of the various
works which compose the Collection. His general distribution appears
to me to be very ingenious, and his judgment in particular cases most
correct, but it is proper I should state that I, perhaps, am scarcely
qualified to pronounce an impartial judgment on this point, having had
the honor of being consulted by the author, as he himself candidly
acknowledges, while he was employed on this task. On the following page
is his tabular view of the different divisions and subdivisions of the
Collection.
* * * * *
Having now finished this survey of the labors of preceding inquirers,
I proceed to state the results of my own investigations in the same
department; and in doing so, I shall give _seriatim_ the evidence
for and against the authenticity of the different treatises, along
with my own decision in every instance. And, in order to add to the
value of this disquisition, I mean to give an abstract of the contents
of those works which I look upon as spurious, that the reader may be
enabled to compare the doctrines contained in them with those which are
delivered in the treatises which are recognized as genuine. Moreover,
it is my object that the present volume should contain a summary of all
the valuable matters to be found in the Hippocratic Treatises, whether
genuine or not.
Before proceeding further, I must state the _rules by which I test
the genuineness of the works in the Hippocratic Collection_:
1. All the works which are acknowledged as genuine by the ancient
commentators and lexicographers which have come down to us, and
especially by Erotian and Galen, are to be admitted as such, unless
it can be shown that still older authorities held a different opinion
regarding them, or that they contain doctrines and views decidedly at
variance with those contained in the treatises which all allow to be
genuine, or that the style and mode of handling the subject matter be
altogether different from the well-known method of Hippocrates.
2. The peculiar style and method of Hippocrates are held to
be--conciseness of expression, great condensation of matter, and
disposition to regard all professional subjects in a practical point
of view, to eschew subtle hypotheses, and modes of treatment based on
vague abstractions.
The Hippocratic Collection consists of
|
+-----------------------+------------------------+
| | |
Works certainly written Works certainly not Works _perhaps_ written
by Hippocrates, written by by Hippocrates,
Class I.[101] Hippocrates. Class II.[102]
|
+-----------------------+-----------------------+
| | |
Works earlier than Works later than Works about
Hippocrates, Hippocrates. contemporary with
Class III.[103] | Hippocrates.
| |
| +---------+-----+
| | |
| Works whose Works whose
| author is author is
| conjectured, unknown,
| Class IV.[104] Class V.[105]
|
+-------------------------+
| |
Works authentic, but Works neither genuine
not genuine, i. e. nor authentic, i. e.
not willful willful forgeries,
forgeries. Class VIII.[106]
|
+--+--------------+
| |
Works by the Works by various
same author, authors,
Class VI.[107] Class VII.[108]
3. No treatise is to be received as genuine which is not recognized
as such by any one of the ancient authorities, however strong a case
may be made out in favor of its claims by modern critics from internal
evidence.
I. Περὶ ἀρχαίης ἰητρικῆς--_On Ancient Medicine_.
Of all the treatises which are recognized as the genuine productions
of “The Great Hippocrates,” by M. Littré, this is decidedly the one
which possesses the most questionable title to that honor. The only
ancient authority that admits it as such is Erotian; it is passed
over unnoticed by Galen and Palladius; and Athenæus does not scruple
to affirm, respecting it, that some considered the one half of it
spurious, and others the whole. (Deipn., ii., 16.) Foës, Schulze, and
Zuinger,[109] are almost the only modern names in its favor; and it is
rejected by Mercuriali, Gruner, Conringius, Ackerman, and Kühn.[110]
The grounds, however, upon which Ackerman decides against its
authenticity are of little weight, namely, that as it is stated in it
(§ 1, 2) that medical works were numerous at the time it was composed,
this circumstance implies a date considerably posterior to Hippocrates.
But it is to be borne in mind, that Xenophon, who was almost
contemporary with Hippocrates, puts into the mouth of Socrates, who
was certainly nearly of the same age, the saying, that there were many
medical works then in existence (Memorab., iv.), so that at all events
the argument of Ackerman falls to the ground. M. Littré, moreover,
espouses its claims with remarkable zeal, and persuades himself that
he has settled this point by showing that a passage in the Phædrus
of Plato,[111] which is quoted by Galen, as referring to a sentiment
contained in the Hippocratic treatise “De Natura Pueri,”[112] does, in
fact, have reference to the work now under consideration. This position
he labors hard to establish, and succeeds at last so much to his own
satisfaction, that he does not hesitate to declare, as the result of
his elaborate disquisition, “that he had demonstrated the treatise “On
Ancient Medicine” to be the work of Hippocrates.”[113] Now, I must be
permitted to say, with great deference to M. Littré, that his prolix
process of argumentation, spun out as it is over twenty-six pages, does
not carry the same conviction to my mind as it does to his own.[114]
But still, as this treatise has, at all events, one ancient authority
in its favor, and as the matter contained in it appears to me to be
highly valuable, I have not scrupled to follow the example of M. Littré
in placing it at the head of the Works of Hippocrates. I shall have
occasion to say more on the contents of it in the Argument prefixed to
my translation.
II. Προγνωστικόν--_Prognostics_.
Of the genuineness of this work there has never been any question,
so far as I am aware, from the time of the earliest of the ancient
commentators, Herophilus, down to the present day.[115] That it is an
admirable specimen of the plan upon which the Hippocratic practice was
founded, there can be no doubt. The most important critical question
to be decided with regard to it is the relation it bears to two other
treatises on the same subject, namely, the “Prorrhetica,” and “Coacæ
Prænotiones,” whether the “Prognostics” be founded on them, or whether
they be made up from the “Prognostics.” This question will come more
properly to be discussed in the Argument to the “Prognostics.”
Of this treatise there have been the following translations into
English:
“The Booke of the Presages of the Divine Hippocrates, divided
into three parts, etc. By Peter Low, Arrelian Doctor in the
Faculty of Chirurgery in Paris. Lond., 1597.”
“The Prognostics and Prorrhetics of Hippocrates, translated
from the original Greek, with large annotations, critical and
explanatory; to which is prefixed a short account of the Life
of Hippocrates. By John Moffat. Lond., 1788.”
“Hippocrates on Air, Water, and Situation: or, Prognostics,
etc. By Francis Clifton, M.D. Lond., 1734.”
Of these the last is the only one which possesses the slightest claim
to consideration. It is the work of a scholar, who had evidently
paid the most studious attention to his author with the intention of
publishing a new edition of his works, a design, by the way, which
it is much to be regretted, that he did not live to execute. What
became of his literary labors in this department I have never been
able to ascertain. The greatest fault I find with his translation
is the quaintness of his style; for it cannot be alleged of him, as
of Moffat, that he often mistakes the meaning of his author. The
translations of the latter are utterly worthless, in fact, they are
disgraceful to the translator, who ought to have been ashamed to engage
in a task for which he was so utterly unqualified. The translations
by Low are done in a strangely antiquated style, and otherwise have
nothing to recommend them on the score of fidelity. Moreover, all
these translators introduce confusion into the subject by mixing up
together the contents of the “Prognostica,” “Prorrhetica,” and “Coacæ
Prænotiones.” Even Clifton is guilty of this indiscretion, although
better might have been expected from him; for, considering how well
acquainted he appears to have been with the spirit of his author,
he ought to have been able to appreciate properly the obligations
which Hippocrates had conferred on his profession by methodising
subject-matters which had previously been destitute of scientific
arrangement.
III. Ἀφορισμοί--_Aphorisms_.
That the greater part of the Book of Aphorisms is the work of
Hippocrates himself there can be little or no doubt, but that it
contains interpolations, some of which are of high antiquity, is
equally indisputable. This is distinctly stated by Galen.[116] On this
subject I would beg leave to quote the remarks of Dr. Greenhill: “Some
doubts have arisen in the minds of several eminent critics as to the
origin of the Aphorisms, and, indeed, the discussion of the genuineness
of this work may be said to be an epitome of the questions relating to
the whole Hippocratic Collection. We find here a very celebrated work,
which has, from early times, borne the name of Hippocrates, but of
which some parts have always been condemned as spurious. Upon examining
these portions, which are considered to be genuine, we observe that
the greater part of the first three sections agrees almost word for
word with passages to be found in his acknowledged works; while in the
remaining sections we find sentences taken apparently from spurious or
doubtful treatises, thus adding greatly to our difficulties, inasmuch
as they sometimes contain doctrines and theories opposed to those
which we find in the works acknowledged to be genuine. And these
facts are (in the opinion of the critics alluded to) to be accounted
for in one of two ways; either Hippocrates himself, in his old age
(for the Aphorisms have always been attributed to this period of his
life), put together certain extracts from his own works, to which were
afterwards added other sentences taken from later authors; or else,
the collection was not formed by Hippocrates himself, but by some
person or persons after his death, who made aphoristical extracts from
his works, and from those of other writers, of a later date, and the
whole was attributed to Hippocrates, because he was the author of the
sentences that were most valuable and came first in order. This account
of the formation of the Aphorisms appears extremely plausible, nor does
it seem to be any decisive objection to say, that we find among them
sentences which are not to be met with elsewhere; for when we recollect
how many works of the old medical writers, and perhaps of Hippocrates
himself, are lost, it is easy to conceive that these sentences may have
been extracted from some treatise that is no longer in existence. It
must, however, be confessed, that this conjecture, however plausible
and probable, requires further proof and examination before it can be
received as true.”[117] The fact of the matter is, that interpolation
is a mode of corruption from which few works of antiquity have escaped
altogether free, and it was, no doubt, often practised upon them in
a very innocent manner, and without any fraudulent intention. Thus,
when the subject treated of by any author came afterwards to receive
any notable improvements or alterations, the possessors of such a
work would naturally mark them down on the margins of their MS., and
these annotations in the course of transcription would often come to
be incorporated with the genuine text. Such a work as the Aphorisms,
consisting of detached sentences, was particularly liable to suffer in
the manner now adverted to. Another mode of vitiation, which has been
frequently practised upon ancient works, is the addition of appendices
to them. Every classical reader must be aware that the Odyssey of Homer
is generally admitted by the critics to have come down to us in this
state; nay, many learned divines do not scruple to admit that certain
portions of the Sacred Volume have not been exempt from this casualty.
I may mention that the last chapter of the Pentateuch, the last Psalm
in the Septuagint, and even the last chapter of the Gospel of St. John,
have been suspected, by very able critics, of being appendices. I have
stated in another place (PAULUS ÆGINETA, Vol. III., p. 437),
that an addition in this way has probably been made to the medical
works of Aëtius. On the addition of appendices to works, see further,
Galen (de Placit. Hippocrat. et Plat., vi., 3). Taking all this into
account, it need excite no wonder that an appendix should have been
added, by some unknown hand, to the seven sections of Aphorisms, and,
accordingly, it is generally admitted that the eighth section is
spurious.
I shall reserve my analysis of the contents of the genuine sections to
the Argument prefixed to the translation.
We have the following translations of the Aphorisms into English: “The
Aphorisms of Hippocrates”, translated into English:
“By S. H. Load. 1610.”
“By Conrad Sprengel. Lond. 1708.”
“By T. Coar. Lond. 1822.”
“By J. W. Underwood. Lond. 1828.”
Of these I have only carefully examined the translations by Sprengel
and Coar. That of Sprengel displays considerable pretensions to
erudition, but, upon a careful examination, it will be quite apparent
that the translator was not possessed of a competent acquaintance
either with the Greek or English language. In short, nothing can be
conceived more quaint, inelegant, and inaccurate, than the language of
this translation. Lest I should be suspected of prejudices against my
predecessor, and of exaggerating his faults, I shall subjoin a short
list of passages which I hold to be mistranslated, so that the reader
may judge for himself, whether my opinion of the work be well founded
or not. (See Aph. i., 11,[118] 15,[119] 20,[120] 23;[121] ii., 6,[122]
15,[123] 27, 31, 34, 40; iii., 16, 21.)
The production of Coar is not destitute of some merit, although it is
but too apparent that he was not fully competent for the task which
he had undertaken. He gives, separately, every Aphorism in Greek, to
which he subjoins first a Latin and then an English translation. In
the Preface, he admits that “in executing the English translation
considerable assistance had been derived from the elegant French
translation of M. de Mercy.” From this admission it will readily be
gathered, that the translator felt conscious that he did not possess
a proper acquaintance with the language of the original. I subjoin
references to a few of the passages which, upon examination, appeared
to me to be incorrectly rendered. (See Aph. i., 2,[124] 10,[125]
20;[126] ii., 49;[127] iii., 11,[128] 26, 31; iv., 1; v., 26, 44, 68.)
IV. Ἐπιδημιῶν α’ και γ’--_The First and Third Books of the
Epidemics_.
These are among the most undoubtedly genuine remains of Hippocrates,
and well sustain the high reputation of their great author. In fact, of
all the earlier records of medicine, these are about the most precious
which have come down to us. Although, as I have stated, no one has
questioned their genuineness, Galen complains that, by some mishap
or other, they had not wholly escaped from some derangement of the
subject-matters which they contain, and from additions being made to
them.[129]
The following, I believe, are the only English translations of them
which have ever been published.
“A Comment on forty-two histories described by Hippocrates in
the First, and Third Books of his Epidemics. By J. Floyer.”
“The History of Epidemics, by Hippocrates, in Seven Books.
Translated into English from the Greek, with Notes and
Observations. By Samuel Farr, M.D. Lond. 1780.”
The former of these I have not been able to see. The other, although
it appears to have been got up with considerable care, is manifestly
the work of a man not properly acquainted with the language and
doctrines of his author. In proof of this, I subjoin below a few
examples collected from the first book, near the beginning.[130]
V. Περὶ διαίτης ὸξέων--_On the Regimen in Acute Diseases_.
This work is acknowledged as genuine by Erotian,[131] Palladius,[132]
and Galen,[133] and other ancient authorities, as well as by all the
modern critics, from Mercuriali and Lemos down to Littré and Greenhill.
The authenticity of the latter part, indeed, is questioned by Galen,
who pronounces the style, theories, and language to be different from
those of Hippocrates. Yet even he admits that it is of great antiquity,
being more ancient than the time of Erasistratus, who lived within less
than a century from the death of Hippocrates.[134] Even if not genuine,
then, this part (which is published by M. Littré as an appendix)
possesses great value, not only as containing important matter, but
as furnishing us with the opinions of the Coan school at a very early
period after the time of our author. We shall have occasion to give
a fuller analysis of its contents, in the Argument prefixed to the
translation of it.
VI. Περὶ ἀέρων, ὑδάτων, καὶ τόπων--_On Airs, Waters, and Places_.
Fortunately there are no reasonable grounds for questioning the
authenticity of this highly important work. It is admitted as genuine
by Erotian, Palladius,[135] Athenæus,[136] and Galen,[137] and by
every one of the modern critics, with the exception of Haller, who
pronounces against it upon very insufficient grounds. He argues that
it is obvious, from its contents, that the author of this treatise
was a European, which cannot be said of Hippocrates, seeing that his
native place, Cos, was one of the Asiatic islands.[138] But, if Haller
had possessed any competent acquaintance with classical literature, he
must have been aware that all the inhabitants of the islands adjoining
to Asia Minor were colonists from Greece, and consequently looked upon
themselves as Europeans, and not as Asiatics.[139] Nor is this more
remarkable than that the present inhabitants of America should rank
themselves ethnologically with the Europeans, and not with the native
inhabitants of the country they now occupy.
An edition of this treatise, with a French translation, was published
at Paris by a learned modern Greek, Dr. Coray, in the beginning of this
century; the annotations to which are highly valuable. The only English
translation of it which we possess, as far as I know, is the following:
“Hippocrates upon Air, Water, and Situation. By Francis
Clifton, M.D. Lond. 1734.”
This, I am inclined to think, is the best English translation which we
have of any of the Hippocratic treatises. It is generally accurate,
and the only drawback to it which I am aware of, is the style, which
is often exceedingly quaint and obsolete. The translator, as we stated
above, was well acquainted with all the works of Hippocrates, and of
his painstaking industry the notes in this treatise bear undoubted
evidence. Of these I have availed myself, whenever I could derive any
assistance from them, but from the translation itself I have never
copied literally.
VII. Περὶ ἄρθρων--_On the Articulations_.
This work was received as genuine by all the ancient commentators,
from Bacchius and Philinus, the disciples of Herophilus, down to
Erotian, Galen,[140] and Palladius.[141] It was also admitted by
all the earlier modern critics, down to Gruner, who rejected it on
these grounds: 1. Because it contains a reference to the treatise “On
Glands,” which all acknowledge to be spurious. 2. That in the course
of the work a degree of anatomical knowledge is evinced, far beyond
what its actual state in the time of Hippocrates would warrant. 3. That
the legend of the Amazons, which is received as true history in the
treatise “On Airs, etc.” is rejected as fabulous in this work. Grimm
also agrees with Gruner in condemning it as spurious; but Littré shows
good reasons for admitting it into the list of genuine productions. He
replies in a very satisfactory manner to Gruner’s objections. Thus he
shows, in particular, what we have adverted to previously, that the
knowledge of anatomy which was possessed in the Hippocratic age, had
been much underrated by Gruner and others, and that the two passages in
which the Amazons are supposed to be referred to, are not parallel, and
do not admit of a comparison. He also very properly insists upon it, as
a strong argument in favor of the genuineness of this treatise, that it
had been commented upon by Ctesias.[142] The work, indeed, contains so
much valuable matter, of which subsequent authors (as Celsus and Paulus
Ægineta) have freely availed themselves, in handling the subjects which
are treated of in it, that I have every disposition to receive it as
genuine. We shall see, afterwards, that, taken in connection with the
next work, it is a perfect masterpiece on the subject of Fractures and
Dislocations.
VIII. Περὶ ἀγμῶν--_On Fractures_.
Tried by the tests laid down by us above, this treatise must
undoubtedly be received as genuine. It is decidedly acknowledged as
such by Palladius, Erotian, Galen, and, in short, by all the ancient
authorities, and the only modern critics who venture to question its
claim are Grimm, the German translator of Hippocrates, and Kühn; and,
in fact, the latter does so merely in deference to Grimm, for his
arguments on the question of its authenticity all tell the other way.
That the treatises “On Fractures” and “On Articulations” constituted
originally one work, is shown in a very convincing manner by Galen,
in his introductory comment on the latter.[143] This is an additional
reason for admitting the work “On Articulations” as genuine. Indeed,
I do not hesitate to declare that whoever refuses to admit these two
treatises as genuine, may consistently dispute the claims of any other
work of the same date.
IX. Μοχλικός--_On the Instruments of Reduction_.
This work is quoted by Galen as one of the acknowledged books of
Hippocrates,[144] and is admitted by Erotian into his list of genuine
works; nay, it appears from the latter that it had been commented upon
by Bacchius. Of the modern authorities, Foës and Littré concur with
the ancient in admitting its claims, but it is rejected by Lemos,
Mercuriali, Haller, Gruner, Grimm, and Kühn. No one who reads it
carefully can fail to remark that, as stated by Galen,[145] it is a
compendium of the work “On the Articulations,” so that whoever admits
the latter to be genuine must acknowledge the treatise now under
consideration to be one which embodies the opinions of Hippocrates,
whether it were actually composed by him or not. Taking all this into
account, it appears to me superfluous diligence in modern critics to
search out grounds for questioning its authenticity.
X. Περὶ τῶν ἐν κεφαλῇ τρωμάτων--_On Injuries of the Head_.
This work is acknowledged as genuine by all the authorities, ancient
and modern. The only objection to its genuineness is the appearance of
certain interpolations towards the end of it.[146] This, however, as we
have remarked above (No. III.), is a mode of vitiation from which few
ancient works are altogether exempt.
XI. Ὂρκος--_The Oath_.
This interesting little piece is quoted as genuine by Erotian,[147]
Theodore Priscian,[148] Soranus Ephesius,[149] St. Jerome,[150]
Gregory Nazianzen,[151] Suidas,[152] and Scribonius Largus.[153] It
is also received as such by Foës, Gruner, and Littré, but is rejected
by Mercuriali, Schulze, Haller, Kühn, Ackerman, and other modern
authorities, as quoted by Ackerman. The only reasonable grounds which I
can see for questioning its authenticity is the silence of Galen with
regard to it; but when we take into account that Galen has nowhere
given an entire list of what he considers to be the genuine works of
Hippocrates, this omission on his part may be merely incidental, and
is not of much weight. On the other hand, the argument which M. Littré
seeks to establish in favor of its authenticity on fancied allusions
to it by Aristophanes[154] and Plato,[155] appears to me to have no
weight; indeed, he himself gives up the former in another place.[156]
I have met with the following English translations of this piece, and
no doubt there may be others:
“The Protestation which Hippocrates caused his Scholars to
make, by Peter Low; Lond. 1597.”
“----, by Francis Clifton, M.D.; Lond. 1734.”
The translation by Low is in a quaint and antiquated style; that by
Clifton is carefully done.
XII. Νόμος--_The Law_.
This little piece is noticed by Erotian, and admitted as genuine
by M. Littré, but Mercuriali, Gruner, Ackerman, Kühn, and Greenhill
incline to reject it. It is well written, but the style is rather too
scholastic for the age and taste of the great Father of Medicine. At
the same time, it has so many points of accordance with “The Oath,”
that it seems inconsistent to admit the one as authentic and reject the
other as spurious.
XIII. Κατ' ἰητρεῖον--_On the Surgery_.
All the ancient commentators which have come down to us, such as
Erotian, Galen, and Palladius, admit it to be genuine; but it would
appear from Galen that some of the older commentators were not
satisfied upon this point, some doubting whether it was the production
of the great Hippocrates or of Thessalus, and some referring it to
Hippocrates, the son of Gnosidicus.[157] It is received also by Foës,
Gruner, and, after a good deal of hesitation, by M. Littré. Schulze
expresses himself on this point doubtfully,[158] and the work is
rejected by Grimm, Ackerman, and Kühn. Beyond all doubt, it is a
compendium of the treatises “On Fractures” and “On the Articulations,”
so that, whether the composition of Hippocrates himself or not, there
can be no question that the subject-matter of it is derived from him.
Galen appears to have been remarkably fond of this treatise, and
makes frequent reference to it in his great work “On the Dogmata of
Hippocrates and Plato.” It would appear that Diocles, Philotimus, and
Mantias had written treatises bearing the same title.
There is some difficulty in determining accurately what was the nature
of the ancient _Iatrium_ ιητρεῖον. See an interesting disquisition
on this subject in Littré’s edition of Hippocrates, t. v., p. 25. It
most probably was an establishment kept by the physician, in which
were contained not only all sorts of medicines, but also all kinds of
surgical apparatus. Mention of the _Iatrium_ is made by Plato
(Legg. iv., p. 720, and i., p. 646; ed. Tauch.) Aristotle is said to
have possessed an _Iatrium_, which, if the story be true, he had
no doubt acquired from his father, who was a medical practitioner.[159]
From what is stated by Plato, it would appear that the assistants
were qualified to administer professional assistance in the absence
of their superior, and were also called doctors. (Legg. iv.) So it
appears that the modern abuse of this title was sanctioned by classical
usage! It must be recollected that, in the time of Hippocrates, eminent
physicians were _periodeutæ_, that is to say, wanderers from
place to place, and consequently they would stand in need of such
an establishment as we have described the _Iatrium_ to be. See
further the Argument to this work.
XIV. Περὶ φύσεως ἀνθρώπου--_On the Nature of Man_.
Erotian, Galen, Palladius, and Macrobius[160] do not hesitate to
quote the doctrines contained in this treatise as being those of the
great Hippocrates, but its authenticity has long been considered
very questionable, owing to the circumstance that a passage in it of
considerable length, relative to the anatomy of the venous system, is
quoted by Aristotle[161] as being the production of Polybus, and it
is accordingly received as such by Haller,[162] Gruner, Littré, and
most of our recent authorities on ancient medicine. Galen, however,
contends that the passage quoted by Aristotle is not the work either
of Hippocrates or of Polybus, but an interpolation, and that the rest
of the treatise is genuine.[163] But Galen, at the same time, admits
that Dioscorides, the Commentator (he must not be confounded with
the celebrated author of the Materia Medica), had marked the first
part of this treatise with the sign of the obelisk, as indicating his
suspicion of its being spurious, and that he held it to be the work
of Hippocrates, the son of Thessalus, that is to say, of a grandson
of the great Hippocrates. But, whatever may be decided regarding its
authorship, a careful perusal of the treatise will satisfy any one that
it is a piece of patchwork; made up of several fragments, which do not
cohere properly together. It certainly also appears to me that many of
the philosophical dogmata which are delivered in it do not accord well
with the doctrines contained in those treatises which are universally
admitted to be genuine.
After alluding briefly to the opinions of those philosophers who held
that the human body is formed from the four elements, that is to say,
fire, air, water, and earth, the writer proceeds to state his own
doctrines regarding the four humors, namely, blood, phlegm, yellow and
black bile, and the diseases which are occasioned by the prevalence of
one or other of them, according to the seasons of the year, and other
circumstances. The doctrines, as herein stated, are very hypothetical,
and certainly, as already hinted, not in accordance with those
delivered in the genuine works. It is proper to mention, however,
that Galen, in several parts of his works, makes Hippocrates to be
the author of the theories of the elements and of the humors.[164]
The treatise contains certain general truths and rules of practice
not unworthy of some consideration, such as this, that diseases are
cured by their contraries, that is to say, that diseases arising from
repletion are removed by evacuation, and _vice versa_; and that
diseases in general are occasioned either by the food we eat, or the
air we breathe, those which prevail epidemically being produced by the
latter cause. All sudden changes of diet are held to be attended with
danger, and to be avoided. It is also an important rule of practice
that, in venesection, blood should be abstracted from a part as
distant as possible from the seat of the pain and of the collection
of blood. There can be no doubt, in a word, as we have stated in the
preceding section, on the authority of Galen, that Hippocrates was
well acquainted with the principle of revulsion in the practice of
medicine. The natural heat, or, as it is now called, the animal heat,
is stated to be greater the younger the body is--a physiological
doctrine strenuously advocated by Galen in several parts of his works,
but more especially in the treatise “Against Lycus.”[165] The theory
of the formation of urinary calculi is also discussed. The same occurs
in the treatise “De Aëre,” etc., and in the work “De Morbis” (iv.,
28). Allusion is likewise made to the occurrence of substances in the
urine resembling hairs.[166] The last fragment of which this treatise
is composed relates to fevers, the greater part of which are held to be
occasioned by bile. It is said that there are four varieties of them,
namely, synochus, quotidian, tertian and quartan; that the synochus
is formed from the most intense bile, and comes soonest to a crisis,
and the others in the order we have stated them. This is very unlike
the doctrines of fever laid down in the genuine works, and accordingly
this portion of the treatise was a great stumbling-block to those among
the ancient commentators who contended for the genuineness of the
treatise.[167] Altogether, then, I must say, that a careful perusal
of the work leads me to the conclusion that, notwithstanding the high
authorities in its favor, it does not deserve to be received as a
genuine production of Hippocrates.[168]
XV. Περὶ διαίτης ὑγιεινῆς--_On Diet in Health_.
This work is passed over unnoticed by Palladius and Erotian; and
Galen, although he wrote a commentary on it which still remains,
informs us that some of the elder commentators had assigned it to
Polybus, the son-in-law to Hippocrates.[169] He further mentions
that it had been variously referred to Euryphon, Phaon, Philistion,
and others; ancient authority in its favor is, therefore, very
equivocal. The modern critics are pretty unanimous in rejecting it;
indeed, Littré, improving on the hint cast out by Galen, does not
scruple to refer it and the preceding treatise to Polybus. Though
the subject-matters of it are not, in the main, of much importance,
it contains some directions for the regulation of the diet, which
are by no means injudicious. One of his directions, with regard to
clothing, is very different, however, from what we might have expected,
considering the fondness of the ancients for the use of oil to
counteract the effects of cold.[170] The author of this work directs
oily garments to be used in summer, but clean ones in winter. Emetics
are recommended to be taken by persons of a gross habit of body, but to
be avoided by those who are slender. This rule is expressed by Celsus
in the following terms: “Vomitus inutilis gracilibus et imbecillum
stomachum habentibus, utilis plenis et biliosis omnibus, si vel nimium
se repleverint vel parum concoxerint.”[171] The author of this treatise
recommends hyssop as an emetic, and we find its use in this way not
infrequently noticed in the Hippocratic treatises, but not in the works
of subsequent authorities, as far as I am aware. The work concludes
with a passage on diseases of the brain, which also occurs, “De Morbis”
(ii.), and seems much out of place here. It is said that they are first
manifested by stupor of the head, frequent passing of urine, and other
symptoms of strangury; and it is added, that a discharge of water or of
mucus by the nose or ears relieves these complaints.
Altogether, considering how slender the evidence is, both external and
internal, in favor of the authenticity of this treatise, I can have no
hesitation in rejecting it as spurious.
XVI. Προρῥητικον, α’--_First Book of Prorrhetics_.
XVII. Κωακὰι προγνώσεις--_Coan Prognostics_.
These two works are so evidently allied to one another, that I have
judged it expedient to treat of them together. The greatest difference
of opinion has prevailed among the critics, both ancient and modern,
with regard to them. Erotian declares expressly that the “Prorrhetics,”
both first and second, are not genuine; and Galen, although he writes
a commentary on the first book, complains of the difficulty he
experienced in explaining certain vocables of dubious meaning contained
in it,[172] and elsewhere states that the treatise is composed of
extracts from the “Prognostics,” “Epidemics,” and “Aphorisms.” Foës
is almost the only modern scholar of any note who stands up for the
genuineness of the first book of the “Prorrhetics;” and it is decidedly
rejected by Grimm, Ackerman, Haller, Littré and nearly all the other
modern authorities. The “Coacæ Prænotiones” have very little ancient
authority in their favor, and even Foës rejects the work with greater
disdain than it would seem to merit. Of late years, the opinion has
gained pretty general assent that these two treatises are more ancient
than the days of Hippocrates;[173] that, in fact, they constitute
the materials out of which he composed the “Prognostics,” and are
the results of the observations made by the priest-physicians in the
Asclepion, or Temple of Health, at Cos. This idea is followed out with
great ability by Dr. Ermerius, in his “Specimen Historico-Medicum
Inaugurale de Hippocratis doctrina a Prognostice oriunda,” where, by
a most ingenious and convincing process of comparison, he appears
clearly to make out that the “Coacæ Prænotiones” are formed from
the first book of the “Prorrhetica,” and the “Prognostics” from the
“Coacæ Prænotiones.” These positions, I repeat, he seems to me to have
established most satisfactorily, and I cannot hesitate to declare it
as my opinion that Dr. Ermerius has thereby thrown great light on
this department of the Hippocratic literature. M. Littré has justly
appreciated the labors of Dr. Ermerius, and adopted his views without
reserve. (v. i., p. 351.) As I shall have occasion to compare the
contents of these two treatises now under consideration with the
subject-matters of the “Prognostics” in my Argument to the latter, I
shall confine myself at present to a few observations, selected in a
good measure from M. Littré’s argument to the “Coacæ Prænotiones.”
In the first place, M. Littré makes some interesting remarks on
vomicæ of the chest after pneumonia and pleurisy; but this subject
will come to be treated of in the notes on the “Prognostics.” He next
gives some important observations on the following passage in the
“Coacæ Prænotiones,” § 418: “All sprains are troublesome, and cause
intense pains at the commencement, and in certain cases occasion
after-consequences; the most troublesome are those about the breast,
and the most dangerous are those in which there is vomiting of blood,
much fever, and pain about the mammæ, chest, and back; when all these
occur, the patients quickly die; but in those cases in which they
do not all occur, nor are severe, they are longer protracted; the
inflammation at farthest is protracted to forty days.” He relates,
in illustration of this passage, a case very much in point, from the
“Journal de Médecine,” Juillet, 1843, of a healthy person who, in
lifting a log of wood, strained the parts about the chest so as to
experience a cracking sensation about the breast; it was followed by
intense inflammation, which, in spite of plentiful depletion, ended in
an empyema which opened by the fifth intervertebral space. The patient
recovered. This case is a good illustration of a species of accident
frequently described in the Hippocratic Collection. He then briefly
considers the question whether or not Hippocrates was acquainted with
_the croup_, on which he does not give any decided opinion. In
my opinion, the term _croup_ is now used in a vague sense, being
applied to cases of angina, in which the inflammation spreads down to
the glottis and trachea, and also to cases of bronchitis attended with
a croupy cough. I am confident that pure _cynanche trachealis_,
that is to say, acute disease originating in the trachea, is of very
rare occurrence, at least, it certainly is so in the north of Scotland.
That the ancients were well acquainted with that species of cynanche in
which the disease spreads down to the windpipe there can be no doubt.
See the Commentary on §§ 26, 27, Book III., of PAULUS ÆGINETA.
It may reasonably be doubted whether they were not fully as well
acquainted with diseases of the fauces and windpipe as the moderns are.
M. Littré’s observations on sphacelus of the brain do not at all accord
with the opinions of Dr. Coray,[174] nor with those advanced in the
Commentary on PAULUS ÆGINETA, B. III., § 7. He thinks that
Hippocrates meant by it necrosis of the cranium. Although I still so
far adhere to my former opinion that by sphacelus was generally meant
_ramollissement_ of the brain, I must admit that some of the
passages in the Hippocratic Collection, where it is described, would
bear out M. Littré’s ideas regarding it. On the subject of sphacelus,
see “De Morbis,” near the beginning.
M. Littré draws, from a variety of sources, much interesting matter
in illustration of § 500 of the “Coacæ Prænotiones:” “Amaurosis is
produced by wounds in the eyelash, and a little above it; the more
recent the wound, they see the better; but when the cicatrix becomes
older the amaurosis increases.” Plattner[175] held that in this case
the amaurosis is connected with lesion of the frontal nerve. Beer[176]
shows that the affection of the sight is not connected with injury
of the nerve, but is rather the result of concussion of the ball of
the eye. Walker, and Littré himself, are rather disposed to question
altogether the truth of the statement made by Hippocrates.
M. Littré concludes his argument with some observations on the
lethargus of the ancients, which he holds, and correctly, as I think,
to be a pseudo-continual fever. My own opinion, as delivered in the
Commentary on Book III., § 9, of PAULUS ÆGINETA, will be
found to be very similar. Lethargus is there stated to have been a
species of remittent fever, resembling the causus. M. Littré, further
in illustration of this subject, gives from the works of Mr. R. Clark,
an English physician at Sierra Leone, an interesting account of a
sleepy-dropsy, to which the Negroes there are subject.
The greater part of the contents of these treatises are mixed up by
Clifton with his translation of the “Prognostics;” and Moffat gives a
complete translation of this book of the “Prorrhetics.” The latter,
like all the other translations by the same hand, is utterly worthless.
Clifton is only culpable for having introduced confusion into the
contents of works which had been so admirably arranged by Hippocrates.
XVIII. Προῤῥητικόν, β’--_The Second Book of Prorrhetics_.
The reception which this work has met with from the critics, ancient
and modern, appears rather singular. Erotian and Galen, who, in
general, are too facile in admitting the claims of suspected works,
in the present instance reject a work which many modern authorities
acknowledge as genuine; as, for example, Haller, Gruner, Grimm, and,
with certain qualifications, Ackerman and Kühn. I must say, however,
with Foës, Littré, and Greenhill, that I cannot see how we can
consistently recognize as genuine a work which has so large an amount
of ancient authority against it, and none in its favor. At the same
time, all must admit that the treatise in question contains nothing
unworthy of the name of Hippocrates, and that, if estimated by the
value of its contents, it is one of the most important works in the
whole Collection. I will, therefore, give an abstract of its contents,
along with my translation of the “Prognostics.” It is deserving of much
attention, as being the only work we possess which gives us an insight
into the method taken by the ancient physicians to gain the confidence
of their patients by their mode of conducting the preliminary
examination of every case. In my younger days I knew an old physician,
who was an adept in this art of conciliating the confidence of his
patients by anticipating their histories of their own complaints.
XIX. Περὶ ἑλκῶν--_On Ulcers_.
This treatise is decidedly admitted as genuine by Galen,[177] Erotian,
Celsus, and by Foës, Lemos, Mercuriali, Schulze,[178] and Vidus
Vidius,[179] but is rejected by Haller, Gruner, Ackerman, and Kühn,
on internal evidence, the nature of which we shall presently examine.
M. Littré in so far concurs in the judgment of the authorities who
reject it, although he does not admit the grounds of their decision.
Gruner’s principal, indeed I may say his sole, argument against the
authenticity of this work is founded on the nature of the substances
recommended by the author for the treatment of ulcers; namely, such
acrid and (as Gruner chooses to call them) _absurd_ medicines as
arsenic, black hellebore, and cantharides. But how does it appear that
these are “absurd” applications to ulcers, when even at the present
day the two strongest of them, namely, arsenic and cantharides, are
the means often resorted to for the cure of indolent and malignant
ulcers? The same articles are recommended by Celsus (v.), and by Paulus
Ægineta.[180] It is true that the titles given to certain of the
prescriptions contained in this treatise are not appropriate, such as
_emollient_ (μαλθακώδεα), applied to applications which contain
many acrid ingredients. But in this case, as is remarked by Foës, we
should consider the text to be in so far corrupt, for certainly this
does not constitute a legitimate reason for rejecting the treatise
_in toto_.
Vidus Vidius, in his interesting commentary on this work, mentions,
as a proof of its authenticity, that most of the principles laid down
by Galen for the treatment of ulcers, are taken from this part of the
works of Hippocrates. In a word, agreeably to the rules laid down by me
for testing the authenticity of these treatises, I do not see that I am
warranted in refusing to admit the claims of this work to be considered
genuine. I hold myself bound, therefore, to give a translation of it.
It may be proper in this place to mention that the term ulcer (ἕλκος)
is used in this treatise to signify both a wound inflicted by an
external body, and a solution of continuity from any internal cause.
This usage of the word is sanctioned by the older poets, as, for
example, Homer (Iliad, ii., 723; Ib., xiv., 130); Pindar (Nem., viii.,
50; Pyth., iii., 84); and Bion (Adonis).
XX. Περὶ συρίγγων--_On Fistulæ_.
Though this work be acknowledged as genuine by Erotian, Dioscorides,
Celsus, Paulus Ægineta, and by Foës and Vidus Vidius, it is set down
for spurious by Haller, Gruner, and Ackerman; and even by Littré and
Greenhill its claims are not fully recognized. I can see no good
reason, however, for rejecting it, since, as I have stated, the ancient
authority in favor of it is very strong, and I can detect nothing
in the doctrines and rules of practice delivered in it which are at
variance with those laid down in the treatises which all admit to be
genuine. Ackerman, indeed, pretends that the theory of bile and phlegm,
as being the cause of disease, does not belong to Hippocrates or his
school. But this is evidently begging the question; and, moreover,
Galen, who must be admitted to be a high authority in such a case,
decidedly holds Hippocrates to be the author of the Theory of the
Humors.[181] Galen seems to say that this treatise, and the following
one on hemorrhoids, constituted one work in his time; and he does not
throw out the slightest suspicion against the genuineness of either, as
the words of Ackerman would lead one to suppose.[182]
Vidus Vidius, although he acknowledges Hippocrates as the author of
this work, holds that it had not been published by him, but had been
left in an unfinished state. The argument, however, which he uses in
proof of this opinion, is by no means convincing; he contends that the
part which relates to inflammation of the anus is quite out of place in
a work devoted to the consideration of fistulæ. But few who have much
practical acquaintance with the subject will agree with him on this
point, for it is well known that fistulæ, for the most part, originate
in inflammation and abscess about the verge of the anus.
XXI. Περὶ αἱμοῤῥοιδων--_On Piles_.
This little tract has experienced the same reception from the critics
as the preceding one, that is to say, it is acknowledged as genuine
by ErotianΠερὶ αἱμοῤῥοιδων and Galen, and by Foës and Vidus Vidius,
but is decidedly rejected as such by Mercuriali, Gruner, Grimm, and
Ackerman. I can remark nothing in it, however, which appears to me at
all inconsistent with the doctrines contained in the genuine works,
unless it be that in this tract the author appears to direct that in
operating upon hemorrhoids they should be all extirpated, whereas in
one of his Aphorisms, which is quoted by Paulus Ægineta, in his chapter
on this subject, he recommends that one should be left, as an outlet
to the superfluous blood. (vi., 79.) I do not know how this divergence
of opinion is to be explained, but, at all events, such an apparent
contradiction would not warrant us in rejecting the treatise altogether.
XXII. Περὶ ίερῆς νούσου--_On the Sacred Disease_.
This work is acknowledged as genuine by Erotian, Galen,[183] and
Cælius Aurelianus,[184] but is rejected by Lemos, Mercuriali, Haller,
Gruner, Ackerman, Kühn, and even by M. Littré, although the last of
these admits that the grounds upon which it had been refused a place
among the genuine works are very equivocal. I feel very much at a
loss what to decide with regard to it. It is unquestionably the work
of a man possessed of a highly cultivated mind, free from the popular
superstition of his age, and familiarly acquainted with comparative
anatomy, and having no contemptible knowledge of human physiology.
There is, in fact, no name, whether in ancient or modern times, to
which it might not do honor. That it is not unworthy, then, of the
great Hippocrates, all must allow, but whether or not he be the actual
author of it, there is much difficulty in determining satisfactorily.
That, in certain respects, it is very unlike his other works, must
be admitted; the talent which it displays is more of a reflective
than of a perceptive nature, which is the reverse of the common
character of Hippocrates, who, in his genuine works, evidently evinces
a disposition to trust to accurate observation rather than to acute
ratiocination. The style, too, I must admit, is more diffuse than the
true Hippocratic style generally is. All this might, no doubt, be
accounted for, upon the supposition that the work was addressed to the
general reader, and not to the professional. Other reasons might be
imagined, to account for the diversity of style and matter, but these
I shall not occupy time in discussing, as I have decided upon giving a
translation of it, so that the English reader may be enabled to judge
for himself as to its genuineness. Whether the tract in question be the
work of Hippocrates, or, as some have supposed, of his philosophical
friend Democritus,[185] there can be little or no doubt that it is a
production of that age, for it appears to me that their contemporary,
Plato, has evidently made reference to it. Thus, in that portion
of his “Timæus” which treats of the causes of diseases, he clearly
seems, in accounting for epilepsy, to have had in view the doctrines
contained in this treatise. For although he uses the term “sacred
disease,” and applies “most divine,” as an epithet to the cavities
(_ventricles_?) of the head, he still, in imitation of the author
of this work, accounts for the disease upon natural causes, that is to
say, from derangements of the pneuma and phlegm.[186]
XXIII. Περὶ φυσὠν--_On Airs_.
This treatise deserves, in many respects, to be put in the same
category as the last; that is to say, it is generally admitted by
the ancient authorities, but rejected by the modern. Thus it is
noticed as genuine by Erotian and Galen, and by Gregory Nazianzen and
Stobæus.[187] On the other hand Mercuriali, Le Clerc,[188] Haller,
Gruner, Ackerman, and Kühn reject it. M. Littré, also, in deference
to the opinion of later critics, refuses it a place in his list of
genuine works, but, at the same time, expresses himself doubtfully on
this point. Le Clerc, although, as we have stated, he inclines to the
opinion of those who reject it, does not hesitate to declare, “that
this book, upon reading it, seems to be one of the most rational and
coherent of all Hippocrates’s works.” And I in so far agree with Le
Clerc, that the contents of it are of great importance for the right
understanding of the ancient theory of medicine, whether we refer the
tract in question to Hippocrates or not. I shall now give a summary of
the doctrines contained in it, which I must say appear to me to smack
rather of the school of philosophy, than of the practical good sense
for which the author of the First and Third Epidemics, and of the
Prognostics, is so remarkable.
The author sets out with stating “that there are certain arts
which are of laborious acquisition, but are profitable to those who
practise them; of general utility to the common people, but painful to
those who exercise them. Of such a nature is the art of medicine. The
physician contemplates dreadful things (δεινὰ), comes in contact with
what are unpleasant, and reaps sorrow to himself from the afflictions
of others; but the sick are freed from the greatest evils by the art,
namely, from diseases, pains, sorrow, and death; for medicine has been
found decidedly to be a cure for all these. In the manual parts of
medicine (surgery) practice is necessary. For in all that relates to
manipulation, usage is the best teacher. But with regard to the most
obscure and difficult diseases, a judgment is to be formed rather from
opinion than art; and it is in such cases that experience differs
much from inexperience. And it is a most important consideration to
determine what is the cause of diseases, and what the beginning and
fountain-head, as it were, of the evils in the body; for if one be
acquainted with the cause of the disease, he may be able to apply the
suitable remedies to the affections of the body, judging of diseases
from their contraries: for this mode of cure is that which is most
in accordance with nature. Thus, for example, hunger is a disease;
for whatever afflicts man is called a disease. What, then, is the
cure of hunger? Whatever will allay hunger, that is to say, food,
and by it the other is to be cured. Again, drink cures thirst; and,
moreover, evacuation cures repletion, and repletion evacuation, and
rest labor, and labor rest; and, in a word, _the contraries are
the cure of contraries_. For medicine consists of addition and
subtraction--the subtraction of what is redundant, and the addition
of what is deficient. And he that does these things best, is the best
physician; and he that is most removed from this system, is the most
removed from a knowledge of the art. The manner of all diseases is the
same, but they differ in place; and hence diseases appear to have no
resemblance to one another, owing to the diversity and dissimilarity
of situations. For there is but one form (ἰδίη) of all disease, and
the cause is the same. What that is I will attempt to explain in
the following discourse. The bodies of men and of other animals are
nourished by three kinds of aliment, namely, food, drink, and airs;
and those winds in the body are called spirits, which are named airs
out of it. This it is which exercises the greatest power over the
symptoms, and it is worth while to attend to the power of it; for the
wind is a current and stream of air. When, then, much air makes a
strong current, trees are torn from their roots by the force of the
blast, and the sea is raised in billows, and ships of immense size are
tossed aloft. Such power it possesses, and yet it is invisible to the
sight, and is manifest only to the understanding. And what would there
be without it, and from what thing is it absent? and with what is it
not present? For the whole space between the earth and heaven is full
of air, and it is the cause of winter and of summer; in winter becoming
condensed and cold, and in summer mild and tranquil. The path also of
the sun, moon, and stars is through air--for air is the pabulum of
fire, and fire deprived of air could not live.... And with regard to
the sea, that it contains a portion of air is obvious to everybody.
For water-animals could not exist if they did not participate in the
air; and how could they participate in it otherwise, except by means
of the water, and by drawing in the air along with it. And the moon’s
foundation is upon it, and this it is which supports the earth,[189]
and nothing is void of it. And why the air is possessed of such power
in other things has been now stated; but in men this is the cause of
life, and of disease to those who are in ill health. And all bodies
stand so much in need of air, that whereas if deprived of everything
else, such as food and drink, a man may subsist for two, three, or more
days; if the passage of air into the body be stopped, he will perish in
a short part of a day, so necessary is air to the body. And, besides,
there is some intermission of every other operation which men perform,
for life is full of change; but this operation alone living animals
perform incessantly, sometimes inspiring, and sometimes expiring. That
all living animals, then, are closely connected with air has now been
shown. After this we must forthwith declare what infirmities probably
arise in an especial manner from this source--when it is redundant
or deficient in quantity, or when polluted with morbific miasmata it
enters the body. That diseases are the offspring of air I will show
from the most common of all diseases, I mean, fever; for this disease
accompanies all others, and most especially inflammations. This is well
illustrated by the accidents which befall the feet; for along with the
inflammation a bubo and fever speedily supervene. There are two kinds
of fever (that I may touch upon that subject); the one common to all,
which is called the plague, and the other being connected with vitiated
food in those who use it. The air, then, is the cause of both these.
A common fever (epidemic?) therefore is such, because all draw in the
same breath (pneuma).” The author afterwards attempts an explanation
of the phenomena of rigors, which, however, is not very intelligible,
and then of the febrile heat and sweats which succeed them. The latter
he compares to the condensed steam of boiling-water. He afterwards
proceeds to explain that when the blood is mixed up with vitiated air
(gases?), it occasions diseases in various parts of the body; for
example, pain in the eyes, when it fixes there; when in the ears, the
disease is seated there; when in the nose, coryza is the consequence;
and when in the chest, branchus (bronchitis?), and so forth. To the
same cause he ascribes the origin of dropsy, namely, to the prevalence
of airs, and the melting down of the flesh. He also accounts for the
formation of apoplexy, by supposing that it arises from the flesh of
the parts being filled up with gases; and in the same way he explains
the origin of epilepsy very elaborately, and most ingeniously, but
at too great length to suit my limits in this place. Altogether the
treatise is one of the most interesting pieces of medical philosophy
which has come down to us from antiquity. It shows very decidedly what
a talent for dealing with abstract ideas the ancient Greeks were endued
with.
XXIV. Περὶ τόπων τῶν κατ’ ἄνθρωπον--_On the Places in Man_.
The ancient authority in favor of this treatise is pretty strong. It is
included in Erotian’s list, is quoted by Cælius Aurelianus,[190] and
by Ruffus Ephesius,[191] and is incidentally noticed by Galen in two
places of his Glossary.[192] That it is further quoted by Athenæus, as
stated by Gruner and Ackerman, would appear to me to be a mistake.[193]
It is admitted to be genuine by Le Clerc, Schulze, Haller, Triller,
Sprengel, Zuinger, Petersen, and others. It is rejected, however, by
Lemos, Mercuriali, Duret, Reinsius, Gruner, and Ackerman. M. Littré
does not venture to assign it a place among the genuine treatises,
and yet he evidently inclines to the opinion that later critics
had rejected it on very doubtful grounds, and leaves the question
undecided. The following summary of its contents will show that it is
not destitute of valuable matter.
The author of it commences with announcing this important
physiological principle, which microscopical observations on the
development of the chick have amply confirmed: “It appears to me
that in the body there is no beginning, but that all parts are alike
beginning and end; for in a described circle no beginning is to be
found.” He goes on to remark that, in consequence of this, diseases
affect the whole body; that when seated in the dry parts of it they are
more permanent, but when in the fluid, more changeable: that one part
of the body imparts disease to the other parts, namely, the stomach to
the head, and the head to the stomach; and that if the very smallest
part of the body suffer, it will impart its suffering to the whole
frame. He afterwards enters into a lengthened anatomical description
of the parts of the body which, although quoted by Galen,[194] and
not unfavorably noticed by Gruner,[195] cannot now command much
interest. He then describes seven defluxions from the head, namely, to
the nose; to the ears; to the eyes; to the chest--producing empyema
and phthisis; to the spine--producing another species of phthisis
(_tabes dorsalis_?); to the fleshy parts--inducing dropsy; and to
the joints--occasioning ischias and kedmata (_morbus coxarius_?)
All this seems very hypothetical, and does not appear to savor of the
strict process of induction which we remark in the genuine treatises
of Hippocrates. When the disease is seated in the head, he directs
numerous and deep incisions to be made in the scalp, down to the bone.
He notices pleurisy, and its termination in empyema; the latter, he
further remarks, may originate in ruptures (_sprains_?), and in
this case, on succussion, an undulatory sound may be heard. He also
states decidedly that empyema forms in phthisical persons, and that,
in their case, too, a sound like that of water in a bladder may be
heard on succussion. The symptoms accompanying empyema are given
very graphically. He also describes the _tabes dorsalis_. He
afterwards gives the treatment of pleurisy and pneumonia, in which it
is remarkable that no mention is made of venesection, notwithstanding
that, in the work “On Regimen in Acute Diseases,” Hippocrates
recommends bleeding _ad deliquium_ in these diseases; and Galen
accounts for his silence respecting venesection in his treatment of
fevers on the supposition that he did not notice it, because he took it
for granted, as a general rule, that the operation was performed.[196]
This consideration, as much as any other, inclines me to doubt the
authenticity of this treatise. Ischiatic disease he directs to be
treated by cupping-instruments and heating medicines, administered
internally. Anasarca, in a young person, he treats by scarifications.
In the brief notice of injuries of the head here introduced, much the
same views are advocated as in the work on that subject, of which a
translation is given in this volume. The treatment of callous ulcers,
as here laid down, is deserving of great attention; “remove the
indurated parts by a septic medicine, and then produce reunion of the
parts.” Every practical surgeon must recognize this as a very sound and
important rule of practice.
The treatment of suicidal mania appears singular:--“Give the patient
a draught made from the root of mandrake, in a smaller dose than will
induce mania.” He also, in like manner, recommends mandragora in
convulsions, applied by means of fires lighted around the patient’s
bed. Pains of the head he directs to be treated by opening the veins
of the temples, or by applying the cautery to them. He then insists,
in strong terms, that, under certain circumstances, purgatives will
bind the bowels, and astringents loosen them. And he further makes
the important remark that, although the general rule of treatment be
“contraria contrariis curantur,” the opposite rule also holds good
in some cases, namely, “similia similibus curantur.” It thus appears
that the principles of _Allopathy_ and _Homœopathy_ are recognized by
the author of this treatise. In confirmation of the latter principle,
he remarks that the same substance which occasions strangury will
also sometimes cure it, and so also with cough. And further, he
acutely remarks, that warm water, which, when drunk, generally excites
vomiting, will also sometimes put a stop to it by removing its cause.
He estimates successful and unsuccessful practice according to the
rule whether the treatment was rightly planned or not; for he argues
what is done in ignorance cannot be said to be correctly done, even
if the results are favorable. The work concludes with a short passage
on the diseases of women, all of which are said to be connected with
the uterus. We find here the first mention that is anywhere made of
the globus hystericus; indeed, I do not remember to have met with
the term in any of the ancient medical works, with the exception of
the Hippocratic treatises. He recommends fetid things to be applied
to the nose, and aromatic and soothing things to the genital organs.
The process of fumigating the uterus is fully described; and likewise
suppositories and pessaries are mentioned. In the treatment of
uterine hemorrhage the rules here laid down are most important. All
heating things, diuretics, and purgatives are to be avoided; the foot
of the patient’s bed is to be raised, and astringent pessaries are
to be introduced. My own opinion of the work may now be given in a
few words. It undoubtedly contains much valuable matter which would
be no discredit to Hippocrates, nor to any of the greatest medical
authorities, whether of ancient or modern times. I desiderate in it,
however, a proper unity of design, and think I see too much of a
speculative disposition to suit with the character of the Coan sage.
That it is to be referred to the Cnidian school, as suggested by
Gruner, seems doubtful; for, as we are informed by Hippocrates himself,
the Cnidian physicians only gave the most obvious symptoms, while their
practice was very inert, consisting entirely of drastic purgatives,
whey, and milk, whereas in this work the diagnostic symptoms are more
profoundly stated then they are in most of the Hippocratic treatises,
and the practice, in many instances, is very bold and decided. The
knife, the actual cautery, the use of strong purgatives and narcotics,
are freely recommended in various diseases. Altogether, then, although
I would hesitate to ascribe the present work to Hippocrates himself,
I must admit myself inclined rather to refer it to the Coan than the
Cnidian school. I see no proper data, however, for forming a decided
opinion on this head, more especially as we are but very imperfectly
acquainted with the tenets of the Cnidian school.[197]
XXV. Περὶ τέχνης--_On Art_.
This treatise is sustained as genuine by Erotian, and even by one of
the older commentators, Heraclides of Tarentum, but it is nowhere
noticed by Galen, and Suidas would appear to refer it to Hippocrates,
the son of Gnosidicus.[198] Mercuriali, Gruner, Haller, Ackerman, Kühn,
and most of the modern authorities hold it decidedly to be spurious.
Foës and Zuinger, however, do not object to its authenticity; and
Littré, although he excludes it from his list of the genuine works of
Hippocrates admits that it is very ancient, and formed a portion of the
Collection from the commencement. To me it appears that it is written
in too subtle and abstract a style to admit the supposition of its
being the work of a practical physician like Hippocrates. Although it
contains a good deal of original thought, there is not much in it which
would prove interesting to the medical reader of the present day. It
is an elaborate defense of the art of medicine against the attacks of
those who maintain that it is no art at all, or one of an uncertain
nature. According to the author’s definition, the aim of the physician
should be to remove the pains of the sick, to blunt the intensity
of diseases, and not to interfere with those that are mastered by
disease, as knowing that medicine can be of no avail in such a case. In
conclusion, I shall merely remark that the evidence, both internal and
external, is against the supposition of its being genuine, but still
there appears no good reason for doubting that it emanated from the
school of Cos.
XXVI. Περὶ διαιτης--_On Regimen_.
The evidence in favor of this large and interesting work,
unfortunately, is by no means strong. It is passed by unnoticed by
Erotian, and Galen expresses himself, in general, regarding the work in
very equivocal terms, mentioning that some had referred it to Euryphon,
some to Phaon, others to Philistion, and others, again, to Aristo.[199]
In other places, however, he expresses himself less unfavorably as to
the authenticity of the last two books. Haller, Gruner, Ackerman, Kühn,
and, in fact, nearly all the modern authorities, reject it.[200] M.
Littré, although he agrees with them, remarks justly that the work is
one of great value, and exhibits many evident traces of conformity with
the writings which are truly Hippocratic.
The nature of the work is as follows: The first book is altogether
made up of abstract principles, which savor very much of the dogmata
of Heraclitus. Thus, the author of it holds that there are in men,
and in all other animals, two principles, different in power but
consentaneous in use, namely, fire and water; that these together are
sufficient for all others, and for themselves; that the one contains
the principle of motion, and the other of nutrition; that these give
rise to the separate existence of seeds and animals, of all varieties,
shapes, and characters; that, in reality, none of those things which
exist either perish or are created, but they are altered by being mixed
together and separated from one another, but that men suppose that
the one passes from Hades to light, and the other again from light
to Hades. In a word, the contents of the first book savor more of
philosophy than of practical medicine. For example, it is said, “The
trainers of the athletæ instruct their pupils in this manner--to break
the law according to law, to commit injustice according to justice; to
deceive, to steal, to rob, to commit violence, in the most elegant and
disgraceful manner: he who cannot do these things is bad, he who can
do them is good; which is a proof of the folly of the many who, when
they behold these things decide that the one of these is good and the
others bad. Many wonder, but few are judges. Men going to the market
proceed thus: they deceive one another in buying and selling, he who
deceives most is admired. They execute these things--they drink and
become mad, they run, they wrestle, they fight, they steal, they cheat;
the one is preferred to all the others. Hypocrites and deceivers!
Before the spectators they say one thing. and think another.[201] The
same persons creep out, and they creep in not the same persons; to one
man they say one thing, and do another; the same person not always
the same--sometimes he has one mind, and sometimes another. In this
manner all the arts have communion with human nature.” All this is too
fanciful and recondite for the physician of whom Celsus says “primus ex
omnibus memoria dignis ab studio sapientiæ disciplinam hanc separavit.”
It is clearly the production of a philosopher and not of a practical
physician, such as we know Hippocrates to have been. The latter part of
this book, however, is of a more practical nature, and treats of many
things relating to regimen and dietetics, such as the arrangement of
meals, of exercises, etc.
The second book is a regular work on Dietetics, and exhibits this
branch of medicine in a more advanced state than might have been
expected, considering the time it was written. After some preliminary
observations on climate, which bear a great resemblance to those
contained in the treatise “On Airs,” etc., the author treats, in a
very scientific and methodical manner, of the various animal and
vegetable substances which are used as articles of food. It concludes
with a discussion on certain matters connected with regimen, such
as exercises, baths, sleep, and so forth. Foës remarks that a great
portion of the opinions advanced by Celsus on the head of Dietetics is
borrowed from this book.
The third book treats again of various subjects connected with
Dietetics, such as exercises, the arrangement of meals, the
administration of emetics, the use of venery, and the like. It is full
of important matter, but looks like a distinct treatise from the two
preceding books, for one cannot conceive that the author of one work
would have twice resumed the consideration of the same subject. Le
Clerc, with considerable appearance of reason, ascribes the book to
Herodicus, the master of Hippocrates in the gymnastic art.[202]
Altogether, the work is one of the highest importance in medical
literature, whether we ascribe it to Hippocrates or not. On this point
the evidence, both external and internal, we have seen to be very
inconclusive. The most probable conclusion that can be drawn regarding
it is, that the work is a compilation of important documents from a
variety of sources, but who the compiler was, whether Hippocrates or
one of his successors cannot be determined.[203]
XXVII. Περὶ ἐνυπνίον--_On Dreams_.
This little work is generally admitted to be a continuation of the
preceding one, and consequently stands upon much the same grounds as
regards its authorship.[204] As Le Clerc and Gruner have well remarked,
it is written with much acumen, and evinces great freedom of spirit,
and exemption from popular errors and superstitions. It commences in
the following strain:
“He who forms a correct judgment of those signs which occur in sleep,
will find that they have a great efficacy in all respects; for the mind
is awake when it ministers to the body, being distributed over many
parts; it is not then master of itself, but imparts a certain portion
of its influence to every part of the body, namely, to the senses,
to the hearing, seeing, touch, walking, acting, and to the whole
management of the body, and therefore its cogitations are not then in
its own power. But when the body is at rest, the soul, being in a state
of movement, steals over the organs of the body, manages its own abode,
and itself performs all the actions of the body; for the body, being
asleep, does not perceive, but the soul, being awake, beholds what is
visible, hears what is audible, walks, touches, is grieved, reflects,
and, in a word, whatever the offices of the soul or body are, all these
the soul performs in sleep.[205] Whoever, then, knows how to judge of
these correctly, will find it a great part of wisdom. But with regard
to such dreams as are divine, and prognosticate something, either
good or evil, to cities, or to a particular people, there are persons
who have the art of judging of them accurately, without falling into
mistakes. But such affections of the body as the soul prognosticates,
namely, such as are connected with repletion and evacuation, from
the excess of customary things or the change of unusual things, on
these also persons pronounce judgment, and sometimes they succeed,
and sometimes they err, and understand neither how this happens, that
is to say, how it comes that sometimes they are right, and sometimes
they fall into mistakes; but warning people to be upon their guard
lest some mischief befall them, they do not instruct them how to
guard themselves, but direct them to pray to the gods; and to offer
up prayers is no doubt becoming and good, but while praying to the
gods a man ought also to use his own exertions. With regard to these,
then, the matter stands thus: Such dreams as represent at night a man’s
actions through the day, and exhibit them in the manner in which they
occur, namely, as performed and justly deliberated, these are good to
a man, and prognosticate health, inasmuch as the soul perseveres in
its diurnal cogitations, and is not weighed down by any repletion,
evacuation, or any other external accident. But when the dreams are the
very opposite to the actions of the day, and when there is a conflict
between them--when this happens, I say, it indicates a disorder in the
body; when the contrast is great, the evil is great, and when the one
is small the other is small also.” For the cure of this state, as being
connected with repletion, he recommends evacuation by vomiting, active
exercise, and a restricted diet. The author of the treatise proceeds to
state the signification of dreams which relate to the sun, moon, and
stars, of which the last are said to be connected with the external
parts of the body, the sun with the middle, and the moon with the
cavities. This is the nearest approach to alchemy which I have met with
in the works of any of the ancient physicians. But I must not proceed
much further with my extracts from this work, which there is no reason
to suppose a genuine production of Hippocrates, and the substance of
which would not much interest the general reader nowadays, when the
interpretation of dreams has been entirely abandoned by the profession.
The work concludes as follows:
“He who observes these rules as laid down by us will be healthy through
life.... The regimen, also, as far as it was possible for a man to find
it out with the assistance of the gods, has been expounded by me.” This
looks like the conclusion of a large work, and gives probability to the
supposition that this treatise originally formed a part of the work “On
Diet,” as stated above.[206]
It would appear that this work, although little regarded now, was
highly esteemed two hundred years ago, for we find that the celebrated
Julius Cæsar Scaliger wrote an elaborate commentary on it.[207] On the
“Oneirocritica,” see further Vander Linden, “Manuductio ad Mediciam,”
who refers to this treatise of Hippocrates, and also to the works
of Scaliger, Ferrer, and Cardanus on the same subject. The only
other ancient writers on this subject which have come down to us are
Artemidorus, Achmet, Astrampsychus, and Nicephorus.[208] The work of
Artemidorus is an elaborate production on the interpretation of all
sorts of dreams; and to the sober judgment of the present generation it
cannot but be regarded as a memorable instance of the misapplication of
human intellect and industry. The whole subject of the “Oneirocritica,”
however, may well deserve the serious consideration of the most learned
philosopher as affording a most striking and lamentable proof how
prone men, even of cultivated minds, are to view things exactly in the
light in which they fancy them to exist. This truth is most strikingly
illustrated by the work of Artemidorus, who first gives the theory, as
it were, of dreams, and in the last book relates particular instances
in confirmation of the principles previously laid down by him. No one,
assuredly, can rise from the perusal of such a work without being
strongly impressed with the great truth embodied in our author’s first
aphorism, “Experience is fallacious, and decision is difficult.” The
“Oneirocritica” of Achmet is the work of an Arabian, and is interesting
as containing all the superstitious notions of the Orientals, that
is to say, of the Persians, Egyptians, and Indians, on this subject.
Allusion is also made to the dreams recorded in the Jewish Scripture.
The author sets out with declaring that, from the interpretation of
dreams one may acquire a certain foreknowledge of all the casualties
of life, namely, of life or death, of poverty or riches, of disease or
health, of joy or sorrow, of victory over one’s enemies or defeat, and
this with far greater accuracy than from astronomy (astrology?), for
that astronomers differed much in opinion among themselves, whereas
about the interpretation of dreams there could be no doubt!!
The following list of writers on the “Oneirocritica” previous to
Artemidorus will show the attention which has been paid to this
subject in very early times: Artemon Milesius, Antiphon, Apollodorus
Tellmissensis, Apollonius Atalensis, Aristander Telmissensis,
Aristarchus, Alexander Myndius, Cratippus, Demetrius Phalereus,
Dionysius Rhodius, Epicharmus, Geminus Tyrius, Hermippus, Nicostratus
Ephesius, Phœbus Antiochenus, Philochorus, Panyasis Halicarnessensis,
Serapion, Strabo. Mighty names once on a day! Now they are but “the
dream of a shadow!”[209]
XXVIII. Περὶ παθῶν--_On Affections_.
This treatise being passed over in silence by Erotian, and rejected
as unworthy of Hippocrates by Galen, although he acknowledges that it
contains many fine things,[210] has been generally regarded as spurious
by modern critics, as for example, Foës, Haller, Gruner, Ackerman,
Littré, Greenhill, and others. The work is carefully written, but
seemingly without a plan, or any well-defined object. It touches, in
general terms, on most of the diseases to which the human body is
subject, and concludes with some general observations on regimen. All
diseases are said to be derived from phlegm or bile. This seems very
unlike the etiology of diseases, as laid down in the true Hippocratic
treatises. Pleurisy is to be treated by purgatives and soothing
applications, but without any mention of bleeding. The termination of
the disease in empyema is described. The symptoms of pneumonia are
also given in brief but striking terms. The sputa, at first, are said
to consist of phlegm, and are thick and pure, but on the sixth and
seventh day they become somewhat bilious and sublivid. This disease is
also said to terminate in empyema. Some of the general observations
contained in this work are deserving of attention. Of all the diseases
the acute are the most painful and the most fatal, and they require the
greatest care and the most accurate treatment. No additional mischief
should, at all events, be inflicted by the physician, but he must do
the patient as much good as lies in his power; and if the physician
treats the case properly, and the patient sinks under the weight of
the disease, it will not be the physician’s fault; but if, while the
physician does not treat nor understand the disease properly, the
patient fall a victim to the disease, the physician will then be to
blame. In treating ileus, when a clyster fails to relieve the bowels,
they are to be inflated by means of a bladder attached to a pipe, and
then the pipe is to be removed, and a clyster immediately injected, in
which case, if the bowels admit the clyster, they will be opened, and
the patient will recover, but if otherwise, he will die, especially on
the seventh day. The treatise further contains some very interesting
remarks on the causes and varieties of dropsy. When the water is not
otherwise removed, an incision is to be made either at the navel,
or behind at the loins. It deserves to be mentioned that, in this
treatise, there are frequent references to a work of the author’s “On
Medicines.” Whether it was the same as the treatise bearing that title
which we possess cannot be determined. In the course of the work, the
use of the cautery is freely recommended for the cure of diseases.
From the account which we have given of this treatise, and the paucity
of evidence in favor of its genuineness, it will readily be understood
that we have no hesitation in deciding that it is not one of the
genuine productions of Hippocrates.
XXIX. Περὶ τῶν ἐντὸς παθῶν--_On Internal Affections_.
This treatise has but little ancient authority in support of it.
Erotian has omitted it in his list of the works of Hippocrates;
Palladius does not mention it; and Galen notices it in a confused
manner under a variety of titles.[211] Foës, Schulze, and others, have
referred it to the Cnidian school; and if this point could be made
out satisfactorily, it would give the treatise a remarkable degree of
interest, as furnishing us with a key to the opinions of one of the
oldest sects in medicine. That the reader may be enabled to form his
own opinion in this matter, we will now give a brief outline of its
contents.
The work commences with a short description of hæmoptysis, which is
said to originate either in ulceration or rupture of an artery of the
lungs, the ordinary causes of which are held to be severe exercise,
falls, blows, violent vomiting, or fevers. The symptoms are pretty well
described, and a mild system of treatment recommended. Inflammation
of the lungs is said to be produced principally by drinking wine, and
an immoderate indulgence in eating mullets and eels. The treatment at
first is like what we have described the Cnidian system to have been,
consisting of milk, emetics, and purges; but if these do not answer,
the actual cautery is to be applied to the breast. Erysipelas of the
lungs is described in much the same terms as at “De Morbis,” i., 13;
ii., 53.[212] A correct description is given of empyema as connected
with tubercle of the side, for which draughts are recommended, with
broth made from poppies, etc. When matter forms, it is to be let out
either by the knife or the cautery.[213] Three species of phthisis
are described, the first being derived from phlegm, the second from
violent labor, and the third being the tabes dorsalis. The treatment
in all these affections appears to be very empirical, and unlike the
usual therapeutics of Hippocrates. Four diseases of the kidneys are
described, of which the first is calculus, and the second abscess, in
which case the writer recommends an incision to be made, in order to
furnish an outlet to the pus. Now, it is deserving of remark, that,
of all the ancient authorities which have come down to us, Ruffus
Ephesius would appear to be the only other author who makes mention
of this practice.[214] The author of the treatise states, that if the
matter of the abscess find vent by the intestinum rectum the patient
may recover. The disease altogether, he adds, is troublesome, and in
many cases ends in renal tabes. He most probably here alludes to what
is now called Bright’s disease. From disease of the kidneys is said
to arise an affection of the venæ cavæ, which runs from the head near
the jugulars, along the spine to the malleolus externus. He says it
originates in bile and phlegm which collect in the veins. Varices, I
suppose, are here meant to be described. If not cured by purging with
hellebore and scammony, the actual cautery is to be applied at the
shoulders, below the scapulæ, at the hip-joint, at the middle of the
thigh, above the knee, and at the ankle. Now it is deserving of notice,
that this disease is not mentioned by subsequent authors on medicine,
so that we are warranted in concluding that the treatise was not looked
upon by them as being a production of the Great Hippocrates: for if
it had been so regarded, we are sure that Galen, Aretæus, Celsus, and
all the worthies of the Arabian school, would not have overlooked
this description. And, moreover, the description of the disease from
first to last is vague and prolix, being the very reverse of that
graphic style of delineation which we find in the genuine works of
Hippocrates: and yet the work contains other matters of a different
stamp. For example, treating of dropsy, the author says it is sometimes
connected with tubercles of the lungs, which get filled with water and
burst into the chest. In proof of this, he appeals to observations on
cattle, sheep, and swine, which are said to be very subject to these
tubercles (phymata); and he argues that men are still more liable to
them. And in many cases, he adds, empyema originates in tubercles. In
that case, when the collection protrudes externally, he directs that
an opening should be made in it; but if not, he directs the patient to
be shaken by the shoulders, when the sound of the fluid within will
be heard. When the side in which the greater collection is situated
has been ascertained, he recommends us to cut down to the third rib
from the last, and then make a perforation with a trocar[215] (τρυπάνῳ
τρυγλητηρίῳ), so as to give vent to a small portion of the fluid; the
opening is then to be filled with a tent, and the remainder evacuated
after twelve days. Four species of icterus are described: these would
appear to be febrile affections. Five varieties of typhus are next
noticed in rather vague terms; there can be little doubt that they were
all cases of remittent fever. Several varieties of a disease which
is called morbus crassus are described with much prolixity, and so
vaguely as not convey to us a distinct idea of the disease. He says of
two of the varieties, that they last for six years. Unless these were
varieties of elephantiasis (and we have no evidence of its existence so
early), I am at a loss to comprehend what disease is alluded to. The
treatise concludes with an account of three species of tetanus.
From the analysis now given of its contents, it will be readily seen
that this work abounds in interesting matter, but that, at the same
time, it is clearly of a different stamp from what we find in the
genuine works of Hippocrates, nay, that in all probability it does not
belong to the Coan school. In conclusion, I have, then, to state that I
think the presumption of its being a production of the Cnidian school
is very strong.
XXX. Περὶ νοὐσων--_On Diseases_.
A work with this title is cited by Erotian, Cælius Aurelianus,[216] and
by Galen,[217] but so confusedly that we must come to the conclusion
regarding these Books, that the ancient authority in support of their
genuineness is by no means satisfactory. Galen evidently inclines to
the opinion of Dioscorides the Commentator, that the Second Book is
the work of the younger Hippocrates, this is to say, of a grandson of
our author. Almost all the modern authorities, as, for example, Foës,
Haller, Ackerman, Gruner, and Littré, concur in rejecting the whole
four as spurious. The Fourth Book in particular is separated by M.
Littré from the other three, as being a portion of the work “On the
Diseases of Women,” rather than of the work “On Diseases.” We shall
be better enabled to speak decidedly on this and the other questions
regarding the authenticity of these books, when we have examined the
nature of their contents.
After a very striking exordium, in which it is stated that the first
object of him who turns his attention to the healing art should be to
consider the causes of disease, and the natural tendencies of every one
of them, that is to say, of their dispositions to death, or to loss of
parts, the author proceeds to deliver his doctrine as to the causes
of them, which he assumes to be either internal, namely, bile and
phlegm; or external, such as labor, wounds and excess in heat, cold,
dryness, and humidity. The following accidents are said to be mortal:
a wound of the brain, of the spinal marrow, of the liver, of the
diaphragm, of the bladder, of a large blood-vessel, or of the heart.
He ranks the following as fatal diseases: phthisis, dropsy, and, when
they attack a pregnant woman, pneumonia, causus, pleurisy, phrenitis,
and erysipelas of the womb. The issue of the following is set down
as doubtful in ordinary circumstances: pneumonia, causus, phrenitis,
pleuritis, quinsy, enlargement of the uvula, hepatitis, splenitis,
nephritis, dysentery, menorrhagia. The following are not deadly:
chronic defluxions on the joints (κέδματα), melancholy, gout, ischiatic
disease, tenesmus, quartan and tertian fevers, strangury, ophthalmy,
leprosy, lichen, arthritis; yet even from these patients often become
maimed in particular members, such as in the limbs from arthritis, or
in the eyes from ophthalmy. Diseases also have a tendency to pass into
one another, as, for example, pleurisy into causus, phrenitis into
pneumonia, tenesmus into dysentery, and lientery; and pleurisy and
pneumonia into empyema. He makes the following curious observations
on the awkward mistakes which a physician may commit in the practice
of his profession: not to know when there is matter in an abscess or
tubercle; not to ascertain the existence of fractures or dislocations;
having probed the head in case of injury thereof, not to ascertain
that there is a fracture of the skull; not to be able to introduce an
instrument into the bladder, nor to be able to ascertain whether there
is a stone in it or not; in the case of empyema, not to ascertain the
existence of matter by succussion; and in using the knife or cautery,
to apply either of them to too great or too small an extent. The
treatise also contains many other general observations, which are very
ingeniously stated, as, for example, the following enumeration of the
untoward accidents which may occur to a medical practitioner: Having
administered an emetic for the purpose of evacuating bile or phlegm
upwards, to induce rupture of a vessel by the act of vomiting, although
the patient had previously been sensible of no pain in the region;
having given an emetic to a woman with child, to induce abortion
in consequence; in curing empyema, when looseness of the bowels is
superinduced, and cuts off the patient; in applying an ointment for
a disease of the eyes, when acute pains supervene, which end either
in rupture of the eye or amaurosis, the physician in such a case gets
the blame for having applied the ointment; and when a physician gives
anything to a woman in labor on account of pains in the bowels, and the
woman gets worse or dies, the physician incurs censure. And in diseases
and injuries, when there is a necessary succession of bad symptoms, the
physician gets the blame, as men do not perceive that the aggravation
of the symptoms is a necessary consequence of the nature of the
disease. And if a physician visits a patient in fever, or who has met
with an injury, and if the patient gets worse after the first medicine
that is administered, the physician is blamed; whereas he does not get
the same amount of credit if the patient improves, as the amendment
is attributed to the nature of the case. This book contains what I
believe is the most circumstantial detail of the phenomena of empyema
that is to be met with in any ancient work on medicine. The author
ascribes the disease principally to three causes: to the termination
of pneumonia, to a defluxion from the head, and to the consequences of
a ruptured vessel. Whoever is acquainted with the modern literature of
the subject, or possesses a practical knowledge of the disease, will
not fail, from the accompanying description of the last of these, to
recognize a case of cavity of the lungs produced by the ulceration
of tubercles. True empyema, however, as the result of chronic
inflammation, is also described in distinct terms. The never-failing
test by succussion is constantly adverted to in these cases. Distinct
mention is also made of the _râle_, by which the existence of
matter in the lungs is ascertained. Allusion is probably made here to
the well-known gurgling sound produced by matter in a cavity. There
is a good deal of other important matters in this book, but these my
necessary limits oblige me to pass over unnoticed. I shall merely
allude to the distinct mention which is made of _ruptures_, by
which was meant a severe sprain or other injury ending in suppuration,
or protracted pains in the part. Fever is said to be formed in this
manner: when bile or phlegm is heated, the whole of the body is heated,
and they are heated either by internal things, such as food or drink,
or by external, such as labor, wounds, excess of heat or cold; also
from the sight or hearing, but rarely from these. In the treatment of
pneumonia, venesection in the arm is recommended. Altogether this book
contains much valuable matter, but mixed up with hypothesis in a way
not usually met with in the genuine works of Hippocrates.
The second book, at the very commencement, betrays a strong
disposition to diagnosis. Eight diseases at the head are described, but
in such terms that we fail to recognize the distinguishing features
of each. Besides these, a little way further on the author describes
several other diseases of the head, including hydrocephalus, the
symptoms of which are given with great precision, namely, acute pain
about the bregma and temples, alternate rigor and fever, impairment
of the sight, double vision, vertigo, etc. He recommends errhines,
purgatives, and even trepanning of the skull. Even of this disease
several varieties are described in very striking terms; so that for
once at least we are tempted to question the correctness of the
judgment which Hippocrates pronounced against the rival school of
Cnidos, for cultivating diagnosis to an undue extent.
Several varieties of quinsy are likewise described, including various
diseases of the parts about the fauces, and among them the disease
named _hypoglottis_, by which appears to be meant an abscess below the
tongue, attended with swelling of that organ. Five varieties of polypus
nasi are next described, and suitable plans of treatment recommended,
namely, with the ligature, the knife, and the cautery. Pleurisy and
pneumonia are described, and their termination in empyema, the symptoms
of which are circumstantially described again; and, moreover, three
varieties of it are noticed. Here, again, we find mention made of the
diagnostic method, by succussion, and a recommendation of the operation
of _paracentesis thoracis_, to evacuate the fluid. Next are described
several varieties of phthisis, including the _tabes dorsalis_, of
which a curious description is given. An interesting account is also
given of _spermatorrhœa_. The treatment consists in abstinence from
immoderate drinking, venery, and excessive exercises, except walking,
_for a year_, avoiding cold and the sun, and taking the tepid bath. The
description of the varieties of pulmonic disease is most interesting,
although some of them are not sufficiently well defined. Hydrothorax is
also described, and paracentesis recommended in the treatment of it.
After describing lethargy, which was clearly a species of remittent
fever, he gives descriptions of certain diseases, under the names of
_morbus resiccatorius_ (ἀυαντή), _Febris mortifera_, _Lividus morbus_,
_morbus ructus ciens_, and _morbus pituitosus_. No one can fail to
recognize in these descriptions the spirit of the Cnidian school of
medicine, and one very different from that of Hippocrates. Indeed
we have positive authority for referring this work to the Cnidian
school, for Galen assigns the description of the _morbus lividus_ to
the Cnidian physician Euryphon.[218] The author describes a singular
species of melancholy, which, he says, is sometimes epidemic in spring;
he calls it _cura, morbus gravis_. It appears to have been a variety
of the lycanthropia. See PAULUS ÆGINETA, III., 16. The book concludes
with a description of two species of _melæna_, and of _sphacelotes_,
the latter being a variety of the other. Now what strikes one in going
over this book is, that it cannot be a portion of the same work as the
First Book, for we cannot conceive it probable that an author would
have treated twice of the very same subjects in one work. Moreover, as
we have stated, there are evidently many things in it which are not at
all in accordance with the principles of the Coan school.
In the third book very much the same ground is again gone over as
in the two preceding books. In the first place, diseases of the head
are described under the names of _tumor cerebri_, _plenitudo cerebri
dolorem inferens_, _sydere icti_, _sphacelismus_, _lethargus_ (then
intervenes a brief account of _Febris ardens_, quite out of place),
of _dolor capitis_, and _phrenitis_. Afterwards comes a description
of _cynanche_, and _paracynanche_, next of _icterus_, and afterwards
of _tetanus_, for the cure of which the author recommends the cold
affusion. (On the merits and demerits of this practice, see the English
edition of PAULUS ÆGINETA, III., 20.) For ileus, as in a preceding
book, among other modes of treatment, it is directed to inflate the
bowels by means of a pipe and bladder, and then to evacuate their
contents with a clyster. Afterward, pneumonia and pleurisy are most
circumstantially described, and the treatment of them laid down with
a degree of prolixity very unlike the usual manner of Hippocrates.
Thus, to promote the expectoration in pleurisy, he recommends the flos
æris, asafœtida, trefoil, pepper, etc.[219] I am not aware that any
other ancient authority recommends these medicines for the cure of
this disease. The symptoms and diagnosis of empyema as the consequence
of pleurisy, are given in much the same terms as in the preceding
book. Succussion is particularly alluded to. For empyema, burning and
incision are recommended. In performing paracentesis, he forbids all
the matter to be evacuated at once. Altogether, a perusal of this book
leads me to the positive inference that it is not the production of
the same author as the two preceding books; for what could induce the
author to go over the same ground three different times in one work?
The fourth book is manifestly the production of a different author
from the others, indeed, as appears evident from the conclusion
of the work, it is continuous with the treatise “On the Nature of
Women.” It commences with an elaborate discussion on the four humors,
blood, phlegm, water, and bile, from which all diseases are said to
derive their origin. The whole book is tinged with the exposition
of this doctrine; indeed all the contents of it are for the most
part hypothetical, and very unlike the matter contained in the
genuine compositions of Hippocrates. From first to last there is no
well-defined description of disease in it. The observations on lumbrici
and calculus are the portions of it which command the greatest interest.
I shall now briefly recapitulate the conclusions which I am prepared
to draw from a careful examination of the contents of this work. 1.
As the same diseases, for example, pleurisy, pneumonia, and empyema,
are all circumstantially treated of in each of the first three books,
it is impossible to suppose them all portions of the same work, or
even the productions of the same author. 2. In the fourth a different
hypothesis is advanced from that which is laid down in the first, and
from this circumstance, joined to many other considerations already
enumerated, there can be no doubt that it is the production of an
entirely different author. 3. Although all parts of these books
contain abundance of valuable materials, many of the principles and
rules of practice which are developed in them are not akin to those of
Hippocrates, but rather savor of the Cnidian school, which trusted too
much to a fanciful diagnosis, instead of cultivating prognosis as the
basis of its system, like the school of Hippocrates and his followers.
4. The internal evidence in the present instance against their
genuineness, more than counterbalances the small amount of ancient
authority which there is in support of these books.
XXXI. Περὶ ἑπταμήνου--_On the Seven Months’ Birth_.
XXXII. Περὶ ὀκταμήνου--_On the Eight Months’ Birth_.
Although the genuineness of these two works is admitted by Galen[220]
and by Foës,[221] they are not looked upon as the productions of
Hippocrates by almost any other of the authorities, whether ancient or
modern, and in particular, Palladius, Ackerman, Gruner, Littré, and
Greenhill reject them. Yet all admit them to be of very high antiquity,
so that, in this respect, they are not destitute of considerable
interest. The contents of them are altogether of a philosophical
nature, and such as we might expect the school of Democritus to
produce. The author of them holds that fœtuses born at the seventh
month survive, but not those of the eighth. It is clear that he was
imbued with the Pythagorean notions regarding the mystical power of the
number seven.[222] Altogether, the style and matter of these treatises
do not appear to me to accord well with the spirit which prevails in
the true Hippocratic works, but at the same time it must be admitted
that the preponderance of authority for or against their authenticity
is not decided.[223]
XXXIII. Ἐπιδημών, β’, δ’, ε’, ς’, ζ’--_The 2d, 4th, 5th,
6th, and 7th Books of the Epidemics_.
With the exception of Erotian, who admits the whole of the seven books
of Epidemics into his list of the works of Hippocrates, I am not aware
that any of the authorities, ancient or modern, recognize them as
genuine. Galen says that the seventh is allowed by all to be spurious;
that the fifth is the work of Hippocrates, the son of Draco, that is
to say, of a grandson of the great Hippocrates; and that the second,
fourth, and sixth were held by some to be the productions of a son of
Hippocrates, and by some they were looked upon as having been written,
indeed, by Hippocrates himself, but merely as notes or commentaries.
Galen himself inclines to the opinion that these four books are the
production of Thessalus, the son of Hippocrates.[224]
From what has been stated respecting these books, it will be clearly
seen that, although there is no reason whatever to suppose they were
published by Hippocrates, it is, at the same time, highly probable
that he had something to do with the composition of them, and that,
at all events, they emanated from the school upon which his name has
cast so much splendor. I think myself, therefore, called upon to give a
condensed view of their contents; and in doing so, I shall not scruple
to avail myself of the very important annotations made on them by
M. Littré, in his recent edition of this portion of the Hippocratic
treatises.
With regard to these books, in general, he observes that they are
naturally divided into two groups, the one containing the second,
fourth, and sixth books, the other the fifth and seventh. The
correctness of this division is quite evident from a comparison of
the contents of the different books, and, to a certain extent, it is
recognized by Galen.[225]
As to the locality of these observations, M. Littré shows that the spot
of their greatest activity is Thessaly and Thrace, although mention of
Athens, and of certain cities of the Peloponnesus occasionally occurs.
He traces with much minuteness the connection of these books with the
other works in the Hippocratic Collection. For example, he shows the
connection between those in the first group, with the “Aphorisms,”
in particular, but also with the treatises, “On Airs,” etc., “The
Mochlicus,” “The Surgery,” etc., and of those in the other group, with
the work “On Wounds of the Head” in particular. I will now offer a few
remarks on the contents of each of these books.
M. Littré, in his argument prefixed to the second book, treats of
various matters contained in it, the most interesting of which is his
elaborate disquisition on the nature of the carbuncles (ἄνθρακες)
described in his book, during the course of which he brings into review
various collateral passages from the works of subsequent authors, and
discusses the question at considerable length whether or not they
apply to smallpox. I am free to admit that it would have been to my
advantage if I had seen this part of the writings of M. Littré before
piling my commentary on PAULUS ÆGINETA, B. IV., 25. I must
be permitted to say, however, that I see no reason for changing my
opinions with regard to the anthrax of the Greek writers on medicine.
I certainly cannot agree with M. Theod. Kauser, in setting down the
ancient descriptions of the anthrax and plague (λοιμὸς) as applying
to the smallpox. Having diligently studied the minute descriptions
which the ancient medical authors give of the different varieties of
cutaneous disease, I am confident that if the smallpox had actually
existed in their days, they would not have passed over the disease with
a vague and casual notice, but would have given us such a sketch of its
appearances that no one could have failed to recognize its features.
The carbuncles, then, which are incidentally mentioned by Hippocrates
at the beginning of this book, I am disposed to look upon as one of
those anomalous phases of disease which are every now and then making
their appearance, and I cannot persuade myself that they had anything
to do with smallpox.
Among the important matters contained in this book may be noticed the
remarks on deposits, an interesting subject often alluded to in the
Hippocratic treatises, § 7. At § 22 a case is obscurely noticed, which
M. Littré concludes, but upon very slight grounds, to have been a case
of purulent infection. At § 24 spontaneous luxation of the cervical
vertebræ is described, as M. Littré, in his argument, remarks, with
admirable judgment. It is also alluded to at “Aphoris,” iii., 26, and
“De Articulis,” tom. iv., p. 179, ed. Littré. This affection, which
came afterwards to be overlooked, has been redescribed of late years.
In the third section there is given an interesting account of causus,
the remittent fever of hot climates, so admirably described afterward
by Aretæus. The fourth section is occupied with a description of the
veins of the body, which is certainly confused, and yet we find in it
the distinction between the nature of the arteries and veins clearly
pointed out. It is curious, moreover, that Galen, in one place, stands
up for this part as being genuine and accurate.[226] See also b.v. §
46. The last two sections treat professedly of physiognomy, but contain
other detached and unconnected observations on medical subjects.
Altogether, the impression which a careful perusal of this book conveys
to one is, that it is a compilation of the most incongruous matters,
strung together without any plan; but, at the same time, one cannot
fail to detect in it traces of no contemptible talent for observation
and description.
The fourth book, of the whole number, is the one which is written with
the least unity of design. Yet, as M. Littré remarks, it is interesting
as containing the history of an epidemical causus, complicated with
jaundice and ophthalmia, which would appear to have been very similar
to the febrile epidemic which prevailed in Scotland a few years ago.
With this opinion I entirely acquiesce, after having had a good deal
of experience in the treatment of that epidemic. It was decidedly of
the remittent type, was frequently accompanied with jaundice, and the
patients were very subject to relapses and affections of the eyes.[227]
For Hippocrates’s description of it see tom. v., p. 169, ed. Littré.
M. Littré also makes the important remark that, of late years, proper
attention has not been paid to the state of the urine at the epoch of
a crisis in fevers. He mentions that M. Martin Solon holds that, at
the resolution of diseases, the urine is apt to become albuminous;
but that, in a true crisis, the precipitate is generally composed of
urate of ammonia. M. Zimmerman found the urinary deposit composed of
the urate of ammonia, with the triple phosphates and the crystals of
uric acid. Certain observations on this critical deposit occur in this
book of the Epidemics, but they are met with more frequently and more
distinctly expressed in the genuine books, I mean the first and third.
It appears to me most remarkable that the important observations made
by Hippocrates on the state of the urine in febrile diseases should
have been lost sight of in an age when the chemical characters of the
urine have been so much studied; for I am fully satisfied, from my own
practical acquaintance with fevers, that in most cases the febrile
crisis is marked by a copious sediment in the urine. An interesting
case of empyema, which was treated by the cautery, is related at §
4. A case is related at § 19 of a singular affection of the mouth in
two children, attended with necrosis and exfoliation of the bones. At
§ 39 there is a case of metastasis of purulent matter from the hand
to the lungs. At § 11 a case is related of a child who sustained an
injury in the head from another child, was trepanned, and died on the
twenty-fourth day. We shall see in the work “On Injuries of the Head”
that the ancients were very free in the application of the trepan to
the skull. Cases of nyctalopia are alluded to at § 52, and at § 58 a
case is related of mania supervening on the cure of hemorrhoids. But,
upon the whole, the most interesting part of this book is that which
contains the narratives of febrile cases, and the remarks on relapses,
§ 28.
Though the fifth and seventh books of the Epidemics are pronounced by
Galen to be unworthy of the Great Hippocrates, they contain detached
observations of much interest, insomuch that Haller was almost disposed
to admit the genuineness of the fifth. Lemos and Mercuriali, on
the other hand, hold them to be wholly removed from all connection
with the genuine remains of Hippocrates. It is remarkable, however,
that the fifth is referred to by Celsus,[228] Quintilian,[229] and
Plutarch.[230] This, in fact, is the book which contains the memorable
passage in which the author admits, that in a case of injury of the
head he mistook a fracture for a suture of the skull,[231] and for
this candid admission Hippocrates is highly lauded by the authors we
have just quoted. The Hippocratic treatises also contain many other
instances in which the author admits having committed mistakes. How
much might the medical art not have advanced before this time, if
the example thus set of recording for the benefit of posterity, the
mistakes which one commits had been more generally followed?[232]
The first paragraph contains the case of a woman who had fever and
took medicine which did her no good; a hard swelling, accompanied
with severe pains, seized her below the navel, which were removed
by strongly rubbing in oil with the hands, after which she had a
copious discharge of blood downwards, and recovered. M. Littré, from
a comparison of this passage with Epidem. ii., 6, 26; iv., 45, 56,
draws the conclusion, that reference is here made to the practice
of compressing the bowels with the hands in cases of ileus, for
which Praxagoras, the master or Herophilus, is censured by Cælius
Aurelianus.[233] At § 9 there is the case of a man affected with
prurigo, and a condition of the skin resembling leprosy, which nobody
could remove. He then went to the hot baths in the island of Melos, and
was cured of his cutaneous affection, but soon after became dropsical
and died. In § 10 there is related a case of cholera, treated with
hellebore, which produced great evacuations upwards and downwards,
and the patient recovered. This mode of practice is animadverted upon
by Cælius Aurelianus. (Morb. Acut. iii., 20.) § 12th contains an
instructive history of headache in a woman, which nothing relieved
but free menstruation, and afterwards conception. At § 15, there is a
very interesting case of necrosis or caries at the hip-joint, for the
relief of which a large incision was made down to the bone and the
cautery applied; on the eleventh day tetanus supervened, and proved
fatal on the eighth day afterwards, although treated by embrocations,
fomentations, and strong purgatives. The author remarks in conclusion,
that the patient would have lived longer, if the purgative medicine
had not been administered. At § 16 there is a case of injury of the
head, where the surgeon at first sawed the bone down to the diploe, a
practice alluded to in the treatise “On Injuries of the Head,” § 21.
In this case erysipelas came on, and yet the patient recovered. It
is to be regretted that the text here is in a corrupt state. At § 18
there is a case of pregnancy in which the administration of a strong
purgative was followed by fatal results. At § 20 there is related a
case of hemorrhoids, seemingly _mali moris_, which proved fatal
in consequence of an operation having been performed upon them. § 24th
contains the history of a case of hæmoptysis, which ended in phthisis.
The author makes the shrewd remark that the patient was indisposed
before the vomiting of blood commenced. I may here remark, how well
this accords with the doctrine of Louis, that hæmoptysis is rather
the consequence than the cause of tubercular disease. At § 38 there
is another case of hæmoptysis in which the patient was choked by a
large quantity of blood which he was bringing up; the spleen also, in
this case, was affected, and there were bloody discharges downwards.
This book contains a great variety of serious cases connected with
accidents. At § 50 is a fatal case of concussion of the brain. At §
74 there is a fatal case of tetanus supervening upon a slight injury
of one of the fingers and in the following section there is a case of
tetanus arising from a strain of the thumb and proving fatal. In the
next section there is a case of fatal tetanus from the injudicious
healing of a sore on the leg.
Though Galen refuses to sustain the sixth book as genuine, he
has written an elaborate commentary upon it, and mentions at the
commencement that commentaries had been written upon it before his
time by Zeuxis of Tarentum, the Erythræan Heraclides, and before
them by Bacchius and Glaucis. It is a large work, being divided into
eight different sections, which have little or no connection with one
another. Upon the whole, as M. Littré remarks, the most interesting
portion of it is the part in which are described the phenomena
attending an epidemic cough, or influenza, which reigned in Perinthus.
See § vii. It broke out in winter about the solstice, and was preceded
by great changes of the winds. There was a great tendency to relapses,
and it was further complicated with pulmonic affections, nyctalopia,
angina, paralysis, etc. It was observed, that any member which was
much exposed to fatigue was the part most liable to be attacked. All
these complications occurred in the relapse, and never in the original
attack. Women were less liable to be affected than men, the reason of
which is supposed to have been, that they do not expose themselves
so much to the air as men do. In women, too, all the attacks were
mild; but in the men some were mild and others fatal. When a febrile
rigor supervened, the attack speedily was mortal. The usual remedies
were tried, namely, purging, venesection, bleeding by the renal vein,
and emetics; but none of them did any good. M. Littré remarks, that
in the course of his reading he has never met with an example of an
epidemic exactly resembling the one here described. It is, therefore,
an interesting picture of a disease not otherwise known. The sixth
section begins with the announcement of the physiological doctrine so
frequently quoted with approbation, namely, that “the fleshy parts
attract both from the bowels and from without, and that the whole body
inspires and expires.” This doctrine is fully expanded and illustrated
in an interesting volume by Abraham Kaau.[234] The fifth section
opens with another philosophical tenet, which Sydenham often quotes
with approbation, namely, that “Nature is the physician of diseases.”
“Nature,” the writer adds, “although untaught and uninstructed, does
what is proper.” Galen’s Commentary on this passage contains much
interesting matter, and is a fine specimen of the medical philosophy of
the ancients.[235]
The seventh book, as we have already remarked, is closely allied to
the fifth. Galen pronounces it to be universally condemned as being
spurious, and of more recent origin than the others; but Littré,
although of course he does not stand up for its genuineness, justly
contends that it is replete with valuable matter. Grimm holds, from the
nature of its contents, that it must have derived its origin from the
Cnidian school, whereas the fifth sprung from the Coan. I must say,
however, that I cannot see any good grounds for this opinion. According
to M. Littré, it is a _recueil_ of particular facts superior to
anything of the kind left to us by antiquity, and such that its equal
can scarcely be found in modern times. The cases being for the most
part of an isolated nature and not susceptible of any arrangement, it
is not possible within my narrow limits to give any general idea of
the contents of this book. I shall be content, therefore, with a very
few extracts as a specimen of it. It opens with two very interesting
cases of fever, accompanied with sweats, which were treated mildly by
purgatives and clysters, and terminated favorably. It strikes me as
singular in reading these cases, that the characters of the urine are
not distinctly given, as in the cases related in the first and third
Epid. All that is said on this score is, that “the urine was like that
of chronic diseases.” The tenth is a case of ardent fever proving fatal
by intestinal hemorrhage. Some of the fatal cases of dropsy following
fever are very instructive, as §§ 20, 21. Two cases of empyema (so
they are marked by M. Littré) would appear to have been phthisis with
cavities in the lungs. In both, mention is made of _râles_. See
§§ 26, 27, and also 93, 107. In the 29th and six following sections
there are reports of cases of severe wounds. Apparently they must
have occurred in the time of war. The 36th, 37th, and 38th, are cases
of tetanus supervening upon very slight wounds. A good many cases
of phthisis are reported, as at §§ 49, 50, 51; in the last of those
the pectoral _râles_ are particularly noticed. In the 48th the
disease is ascribed to the woman having been injured by succussion
in order to procure the expulsion of the afterbirth. (On this case
see the interesting remarks of M. Littré, tom. v., p. 359.) At § 52
are the cases of two children who died of disorder of the bowels,
complicated with an affection of the head, as indicated by their
constantly pressing on the part with the hand; and it is remarked,
that after death there was a hollow in the seat of the bregma. Every
experienced physician must have met with such cases. M. Littré refers
in illustration of the disease here treated of to an analysis of a
work by M. Elsæsser, in the “Archives Générales de Médecine,” March,
1845, p. 346; on _ramollissement_ of the occiput. The cases of
phrenitis, here related, are evidently febrile affections, as at §§ 79,
80. At § 102 a case is related in which serious symptoms supervened on
the eating of a raw mushroom. The patient being treated by emetics and
the hot bath, recovered. At § 121 is related the case of a person who
had convulsive laughter, connected, as was supposed, with a wound of
the diaphragm.
And now, having concluded my review of these Books of Epidemics, I will
venture to affirm, without fear of contradiction, that when we look to
the importance and rarity of the matters contained in them, the work,
even at the present day, is perfectly unrivalled. That the books are
the composition of different hands must be admitted, but altogether
the contents of them bear the imprint of the mind and spirit of
Hippocrates, and evince a talent for the cultivation of medicine which
has never been surpassed. What a noble people the Greeks must have been
in the days of Themistocles and Pericles!
XXXIV. Περὶ χυμῶν--_On the Humors_.
It must be admitted that there are few treatises in the Hippocratic
Collection which unite such a concurrence of high authorities, both
ancient and modern, in their favor as this work, and yet there seems
good reason for joining the later critics in refusing its claims to be
received as genuine. In favor of it may be quoted Erotian, Palladius,
and Galen, among the ancient, and Foës, Zuinger, and Haller, among
the modern authorities. Against it are ranged several of the older
authorities, namely, Zeuxis, Heraclides, and Glaucias, some of whom
refer it to a younger Hippocrates, some to Thessalus, others to
Polybus, and others again to Democritus.[236] Accordingly, the highest
modern authorities, as Mercuriali, Gruner, Ackerman, Kühn, and Littré,
refuse to receive it into the list of genuine works; and the last of
these seems to make it out pretty clearly that the treatise is composed
of detached observations extracted from the other Hippocratic works.
After repeated perusals of it, what strikes myself is, that it bears
a close resemblance to the treatise “On the Surgery,” that is to say,
that it is a recapitulation of the conclusions arrived at in certain
of the other works of Hippocrates. Perhaps, then, it must be admitted
that there is some inconsistency in allowing the one a place among the
genuine works of Hippocrates, and refusing the similar claims of the
other. That the work in question contains a most interesting summary
of what were regarded, in ancient times, as great medical truths,
cannot be doubted. From the condensed form in which the subject matters
of it are presented, it will readily be apprehended that they do not
well admit of being given in the form of an abstract, and that any
specimens of its contents will afford but a very imperfect idea of its
value as a whole. I would remark, at the outset, that the title of the
work, “On the Humors,” appears not very applicable, since very few of
the paragraphs relate to the humors; in fact, as already hinted, the
treatise may be said to be a _recueil_ of various observations
gathered out of other works. I also feel at a loss to account for M.
Littré’s disposition to rank it as the eighth book of the Epidemics,
as it bears no resemblance either in form or matter to that work;
the one consisting of isolated observations and of particular facts,
and the other of general principles; and the style of the one being
comparatively full, whereas the other is remarkably succinct, so as
to be nearly unintelligible in many places. Take the following as a
specimen of it: “The earth is to trees what the stomach is to animals;
it nourishes, heats, and cools; cools when emptied, heats when filled,
as the earth when manured is hot in winter, so is it with the stomach.”
This important observation, that the earth, in connection with the
vegetable productions, is analogous to the stomach in animals, is
repeated by Aristotle and other of the ancient philosophers.[237] The
author makes the important remark, (§ 14,) that we ought to study the
condition of the body previous to the season in which the disease broke
out; in confirmation of which M. Littré, in his arguments, gives some
very interesting observations by M. Forster.[238] In the paragraph on
deposits, the author remarks, that in fevers attended with a feeling of
lassitude, the deposits generally take place to the joints and jaws.
It is afterwards stated--and if confirmed by experience, as I think I
have observed it to be in many cases, it is an important remark--that
“when the feet are hot, the depositions point downwards, but when cold,
upwards.” § 7. In § 12 diseases are thus classified: “with regard to
the modes of diseases, some are congenital, as may be learned upon
inquiry; some are connected with the nature of the locality, (for
many are affected, and therefore many are acquainted with them); some
with the condition of the body and the diet, the constitution of the
disease, and the seasons. The localities which are ill situated in
respect to the seasons engender diseases similar to the season; in
like manner, irregularities as to heat and cold in the same day when
it has such effects, produce autumnal diseases in the locality, and
in the other seasons likewise. The diseases which are engendered by
fetid and marshy waters are calculus and splenic diseases, and such are
influenced by good or bad winds.” Altogether, as will be readily seen,
it is a work of great ability, and will amply repay a diligent perusal.
Galen esteemed it very much, and did not hesitate to declare that, not
only Plato, Aristotle, and Theophrastus, but also several of the most
distinguished medical authors had copied freely from it.[239]
XXXV. Περὶ χρήσιος ὑγρῶν--_On the Use of Liquids_.
This would seem to be the work which appears in Erotian’s list under
the title of “On Waters” (περὶ ὑδατῶν); and, contrary to what is stated
by Foës and Gruner, it is quoted by Galen in two places;[240] and it
is further referred to by Athenæus, under the same title as that given
to it by Erotian.[241] Foës pronounces it to be a mutilated work, and
one which is wanting in many of the MSS. of the Hippocratic treatises;
and all the modern critics, from Lemos and Mercuriali down to Littré
and Greenhill, regard it as spurious. Gruner speaks of it as being a
work of little importance, and Ackerman as being a mere compilation
from the Aphorisms.[242] Gruner further remarks, that the title does
not suit well with its contents, and this is in so far correct, for
undoubtedly the title given to it by Erotian is more suitable, as it
treats almost exclusively of the medicinal properties of waters; and
this it certainly does in a fuller and more interesting manner than
they are treated of in any other ancient, and, I may almost venture
to add, any modern work with which I am acquainted. I look upon its
contents, then, as being extremely valuable, even as the work has
come down to us, but it is to be regretted that the text is in a very
unsatisfactory state. Water the author of the treatise recommends as
a fomentation to the eyes, when applied with a sponge; and further,
as a general or local fomentation, for producing relaxation of any
part when contracted. When poured over the head, and other parts,
it is said to induce sleep, is useful in convulsions, and relieves
pains of the eyes and ears. Cold water inflames ulcers, except such
as have a tendency to hemorrhage, and also fractures, luxations, etc.
In applying water to the body, the author recommends the feelings of
the patient to be consulted, unless he be in a state of paralysis or
of stupor, or be suffering from exposure to great cold, or be in great
pain. In these cases, he adds, the patient may be insensible, and
instances have occurred of persons having their feet congealed by cold,
which have dropped off upon the affusion of hot water. The immoderate
use of hot water induces relaxation of the fleshy parts (muscles?),
weakness of the nerves, torpor of the understanding, hemorrhage, and
deliquum animi, so as even to prove fatal; and much cold water will
occasion spasms, tetanus, lividity, and febrile rigors. The parts of
the body which are usually covered endure the cold water worst, and
are most refreshed by hot. Cold water disagrees with the brain and
its processes, the bones, the teeth, and the nerves; and hence, it
is added, convulsions, distentions, and febrile rigors, which are
induced by cold, are relieved by hot water. Hot water occasions delight
and determination (to the skin?); cold, on the other hand, pain and
determination inwardly: wherefore the loins, the breast, the back, and
the hypochondriac region, are injured by cold applications, but delight
in warm. Cold water, thrown on the extremities, relieves lipothymia,
the reason of which he states, but the text is so corrupt that I dare
not undertake to translate the passage. Ulcers, excoriated parts of the
body, and burns, bear cold ill. The extremities, the bladder, and the
organs of generation, delight in warm water. Salt water is proper to
itchy parts, and to parts affected with pungent humors, but disagrees
with burns, and abraded surfaces. Vinegar is said to have much the
same properties as salt water in the cure of these complaints. Warm
water, in which salt has been melted, is beneficial in lichen, leprosy,
alphos, and other complaints of a like nature. The lees of vinegar
(_caustic potass_?) also answer in these cases. The astringency of
cold water is increased by having beet leaves, ivy, bramble, sumach,
sage, etc. boiled in it. Red pustules, like lentils, are benefited by
cold things, but eruptions arising from cold, and resembling millet,
are improved by hot. There are certain cases in which both hot and cold
are applicable, such as gouty affections, and most sprains: in these,
cold applications deaden the pain, and warm soothe it. Indurations and
ankyloses of a joint are to be removed by pouring warm water out of a
vessel upon it. Rheums of the eyes are relieved by rubbing them with
some fatty substance, to obtund the acrimony of the tears. In pains,
suppurations, pungent tears, and deep ulcers of the eyes, hot water is
most expedient; when the eyes are merely red, and free of pain, cold
is to be preferred. Cold does not agree with complaints of the rectum
and uterus, nor with cases of bloody urine. Cold raises pain when it
is applied to ulcers, hardens the skin, renders it painful, suppresses
suppuration, renders parts livid and black, is injurious in febrile
rigors, spasms, and tetanus. But he adds, sometimes in a robust young
man, in the middle of summer, when laboring under tetanus not connected
with a wound, the affusion of cold water brings back the heat. (See
Aphor. v., 21, and PAULUS ÆGINETA, B. III., 20). Hot water
does the same. It promotes ulceration in all cases, softens the skin,
attenuates it, is anodyne, and soothes rigors, spasms, and tetanus,
and removes heaviness of the head. It is most particularly applicable
in fractures, when the bone is laid bare, and especially in injuries
of the head. Hot water agrees with all ulcerations, whether innate or
produced by artificial means, in herpes exedens, in blackened parts,
and in diseases of the ears, anus, and womb. But cold water is inimical
in all these cases, except when hemorrhage is apprehended.
The above is a brief summary of the matters contained in this little
treatise. That they are highly important, and evince an extraordinary
talent for apprehending the true bearing of practical points in
medicine, will hardly be denied by any person who is a competent judge.
Many of the rules and observations contained in it are, no doubt,
the same as those found in the Aphorisms (see Section v.), but there
is also no lack of valuable matter in it, which is not to be found
elsewhere. Though I am disposed, then, to agree with the authorities
who exclude it from the list of genuine works, I do not hesitate to
declare it as my decided opinion, that it is not unworthy of the
reputation of the great Hippocrates, and that, if not written by him,
it must be the production of some person who thoroughly apprehended
his high principles and discriminating views. How much, then, is it
to be regretted, that this treatise should have come down to us in so
mutilated a state that the meaning, in many places, can only be guessed
at with considerable hesitation!
XXXVI. Περὶ γονῆς--_On Semen_.
XXXVII. Περὶ φύσιος παιδίου--_On the Nature of the Infant_.
That these two treatises originally constituted one work, has been
remarked by Foës, Gruner, Ackerman, Littré, and others. Indeed, this
will be made sufficiently obvious, upon comparing the conclusion of
the one with the beginning of the other. Galen, in one place,[243]
quotes the former of these as if he held it to be a genuine work of
Hippocrates, but elsewhere he mentions that it had been referred to
Polybus.[244] Erotian mentions, among the works of Hippocrates, a
treatise bearing the title of the latter, under which he probably
comprehended both treatises. It is also noticed as a Hippocratic
treatise by Palladius,[245] and by Macrobius.[246] Both are rejected
by Haller, Gruner, Ackerman, Kühn, Littré, and Greenhill. Indeed the
story of the female musician, whom the author gravely admits that he
taught the way how to get rid of a conception,[247] is so alien to the
morals of Hippocrates, as declared in “The Oath,” that it is impossible
for a moment to suppose him guilty of such an act of flagitiousness.
Moreover the treatise so abounds in little subtleties and conceits,
especially in reference to the Pythagorean doctrine of numbers, that
no competent judge will hesitate for a moment in pronouncing it not
to be the production of the Great Hippocrates.[248] Without doubt,
however, these treatises are of great antiquity, and are valuable
as containing the hypotheses with regard to the origin of the fœtus
which prevailed in the schools down to the days of Harvey; that is to
say, that the embryo is formed from the male semen, into which the
uterine vessels enter, and form the cotyledones (_or_ placenta).
It contains, moreover, an hypothesis adopted by Aristotle in several
of his physiological works regarding the semen, namely, that it is
collected from all parts of the body; and hence, if any part be
mutilated in the parent, it is so likewise in the fœtus.[249] The
author moreover holds, that the fœtus breathes, and is nourished by
the umbilicus,[250] which may be looked upon as an anticipation of the
modern doctrine, that the placenta performs the function both of a lung
and of an intestine. It contains a statement regarding the incubation
of the egg, which has been often repeated in modern times, but which,
from personal observation, I can affirm not to be true; namely, that
the hen chips the shell to let out the chick.[251] Presentations in
delivery are divided into those by the head, the feet, and crossways. I
would mention, in conclusion, that these works abound in repetitions,
and are written in a diffuse style, very unlike that of Hippocrates.
Altogether, then, I can have no hesitation in pronouncing both
treatises to be spurious. From what has been stated of them above, it
must be obvious, however, that to the student of ancient anatomy and
physiology they are very interesting, and will repay a careful perusal.
Although, probably, later productions than the age of Hippocrates,
there can be no doubt that they are anterior to the memorable epoch of
Herophilus and Erasistratus.
XXXVIII. Περὶ γυναικείων--_On the Diseases of Women_.
We have already stated in our critical remarks on the fourth book,
“On Diseases,” that it and the present treatise are evidently the
productions of the same author. Although Erotian and Galen[252]
make reference to it as if acknowledging it to be the production of
Hippocrates, its claim is rejected by Foës, Schulze, Gruner, and
Ackerman, and all the modern authorities of any note. Its connection
with the treatises “De Genitura” and “De Natura Pueri,” is pointed out
by Foës and Gruner; and Littré does not hesitate to refer to the same
author the whole of the following treatises, “De Genitum,” “De Natura
Pueri,” “De Morbis,” iv., “De Morbis Mulierum,” “De Morbis Virginum,”
“De Sterilibus.” Although not the composition of Hippocrates, all these
treatises are, without doubt, of high antiquity, and were anterior to
the age of Aristotle.
The work now under consideration contains much valuable matter, and
deserves a careful perusal. I feel rather at a loss what selections
to make from it, as a specimen of its contents, but shall be brief
on the present occasion, more especially as I have no difficulty in
establishing the point, that the treatise in question is not one of the
genuine works of Hippocrates.
The observations contained in the first part of it, on menstruation
and the causes of sterility, are ingenious. For the cure of sterility,
fumigation of the uterus is recommended, and a minute description
is given of the mode of performing this process, by means of a tube
introduced into the os uteri, and connected with a vessel which emits
aromatic fumes. When sterility is connected with the shutting up of
the os uteri, the author gives directions for expanding it by means of
a wooden or leaden pipe. We need scarcely remark, that this practice
has been revived of late years. A minute description is given of a
malformation of the vagina, in which the passage is nearly obliterated
by a membrane. Allusion is probably made here to a preternatural
rigidity of the hymen. The author directs the membrane to be fairly
torn, and the part dressed with wine and myrrh. In transverse and
footling presentations of the child it will be best, he says, to bring
it down by the head. Both cases are said to be dangerous, so that
either the mother or child is lost, and sometimes both. Treating of
retention of the placenta, the author remarks, that if it is not cast
off it becomes putrid, and thus comes away on the sixth or seventh
day, or later. To promote its expulsion, he recommends southernwood,
dittany, the flowers of the white violet, and asafœtida. The process
of abortion, and the unpleasant circumstances connected with retention
of the placenta in this case, are given with much accuracy. Hydrops
uteri is described at considerable length. For an account of it, see
PAULUS ÆGINETA, Vol I., p. 573, Syd. Soc. edition, and the
modern authorities there referred to. For ulcers of the womb, he
recommends applications consisting of many stimulating ingredients,
such as the flos argenti, etc. The subject of difficult delivery is
resumed; when the arm or leg of a living child is protruding, it is
directed to be pushed back, and the child turned to the head; and if
the fœtus be dead, either the same thing may be done, or the projecting
part may be cut off, and the head opened with a sharp knife, and the
bones thereof extracted, and the body brought along. The chest also
may be opened, if there be any difficulty in extracting the body.
The author expresses himself strongly in regard to the danger of
abortions. All abortions, he says, are attended with more danger than
deliveries at the full time. Artificial abortion never takes place
without violence, whether produced by medicine, a draught, or food, or
a suppository, or any other means.
The second book commences with a description of fluor albus, an
affection to which the old are stated to be more subject than the
young. It arises from suppression of the menses, from parturition,
or a fever. Among other means which he speaks of for the cure of it,
he mentions the application of cupping-instruments to the mammæ.
Astringents from the vegetable kingdom are to be administered, such
as sumach boiled in vinegar, mulberries, or the like. A full account
of the red fluor, _or_ uterine hemorrhage, is also given. It is
said to be connected principally with parturition. The treatment which
is recommended can scarcely be improved upon, even after the lapse
of two thousand years: a sponge is to be wetted and applied to the
pudenda; soft garments are to be moistened with cold water, and laid
on the belly; and _the foot of the bed is to be raised_. When the
hemorrhage is connected with putridity many women thus perish, indeed
few recover. A long description is given of hysterical convulsions
which is said principally to attack antiquated maids and widows. It is
remarked that hysterical complaints bring on cough, and other pectoral
complaints. A very striking and accurate description is given of
procidentia uteri. Inflation of the womb is also described. On it see
PAULUS ÆGINETA, Vol. I., p. 632, Syd. Soc. edition. There is
also a curious description of the mole. The clitoris is described under
the name of columna.[253]
From the extracts now given, it will be seen that these Books contain
a great variety of most important matter. Indeed, there are few
treatises in the Collection more deserving of an attentive perusal.
They furnish the most indubitable proofs that the obstetrical art had
been cultivated with most extraordinary ability at an early period.
Beyond all doubts the complaints of women, and the accidents attending
parturition, must at that time have come under the jurisdiction of
the male practitioner. But, considering the wandering life which
Hippocrates led, and that during the best part of it he must have been
what is now called a consulting physician, it is not at all likely
that he could have acquired that acquaintance with the minutiæ of
obstetrical practice which this work displays. It is not, then, at all
probable that he can be the author of it.
XXXIX. Περὶ ἀφόρων--_On Sterile Women_.
This treatise is closely connected with the preceding one, both in
matter and style. It relates to a subject which, as we have shown, is
also treated of in the other work, I mean sterility, the most common
cause of which is held to be the state of the os uteri, when it is
oblique to the passages of the vagina, constricted from cicatrices,
or otherwise diseased. Distinct directions are given for opening the
mouth of the womb, after which a cleansing application, composed of
cantharides and myrrh, is to be made to it. The mole, and procidentia
uteri, are described in nearly the same terms as in the preceding
treatise. Though it bears a great resemblance, then, to the work “On
the Diseases of Women,” it is not likely, as suggested by Albertus
Fabricius,[254] that it is an appendix to it, for why should an author
treat twice of the same subject in the same work?
XL. Περὶ παρθενίων--_On the Complaints of Young Women._
Foës looks upon this little tract as being the prelude to the greater
work “On the Diseases of Women.” It is destitute of all claims to
be held as genuine, and accordingly no critic, ancient or modern,
stands up for it. Gruner is inclined to ascribe it to the author of
the treatise “On the Sacred Disease,” but I see no grounds for this
opinion, except it be that, in the two treatises, there is a certain
similarity of views with regard to the nature of the hysterical
convulsion. This, however, is not a sufficient reason for deciding that
they both must have come from the same source, for all the ancient
authorities, from Hippocrates to Actuarius, held pretty much the same
ideas regarding the nature of “Uterine suffocation.” See PAULUS
ÆGINETA, III., 71. The author of this little fragment gives very
naïve advice to virgins who are subject to hysterics; instead of making
costly oblations of garments and the like to Diana, as recommended by
the prophets, he gravely advises them ὡς ταχίστα συνοικῆσαι ἀνδρασι.
XLI. Περὶ ἐπικυήσιος--_On Superfœtation._
This treatise, I believe, is not mentioned by any one of the ancient
authorities, and it is almost universally rejected by the modern.
I need scarcely remark that it relates to a very curious subject, and
that great doubts are now entertained whether or not superfœtation
in women ever actually takes place. I can state, however, that two
trustworthy persons, the one a surgeon and the other a _sage
femme_, informed me, some years ago, that they once attended
together a case in which a woman was first delivered of a fœtus about
four months old, and, about thirty-six hours afterwards, of a fully
grown child. The ancient _savants_ all believed in the occurrence
of superfœtation. See in particular Aristotle (Hist. Anim. vii., 5);
and Pliny, (H. N., vii., 11.)
The following are a few of the most interesting observations which
I have remarked in perusing this treatise. When the secundines are
evacuated before the child, they cause difficult parturition, and the
case is dangerous unless the head present. Presentations of the hand
and foot are directed to be replaced. When the placenta is retained
after the expulsion of the child, the child is to be laid upon wool,
or upon two bladders, filled with water, either of which is to be
pricked, so that the water may run off gradually, and thus draw down
the placenta. When there is a copious discharge of blood before labor,
there is a risk that the child may be dead, or at least not viable.
When women with child long for coals, the appearance of these things
is to be seen on the child’s head. (For the opinions of the ancients
on the effect of imagination on the fœtus in utero, see the commentary
on B. I., § 1, of PAULUS ÆGINETA, Syd. Soc. edition.) Some
ridiculous things are contained in this work, such as the following;
when a man wishes to beget a male child let his left testicle be tied,
and when a female the right.[255] The composition of suppositories
for cleansing the uterus is described at considerable length towards
the end of the treatise. Altogether, the work is by no means devoid
of interest, but, as I have already said, it is certainly not the
composition of Hippocrates. Littré, on the authority of the passage
quoted from Aristotle on this head, refers the treatise to Leophanes.
From the account which we have given of its contents, it will be
remarked that the title and contents of it do not well accord together.
This remark, however, applies to other of the Hippocratic treatises
besides the one we are now treating of.
XLII. Περὶ γυναικείης--_On the Female Nature_.
As Foës remarks, this work is mostly made up of excerpts from the
treatise “De Muliebribus.” I need not, therefore, occupy time in
discussing its claims to be regarded as genuine, nor in giving an
outline of its contents.
XLIII. Περὶ καρδίης--_On the Heart_.
Galen, in one place, appears to cite a passage in this treatise, but
without naming it.[256] It is not found in Erotian’s list, and all the
modern authorities, including even Foës, who is more disposed than
most of the others to deal leniently with the claims of the treatises
which bear the name of Hippocrates, concur in refusing to admit it
as genuine. Still, however, there can be no question as to its being
a work of very high antiquity. It is to be regretted, then, that the
text is in a very unsatisfactory state. It contains, upon the whole, a
wonderfully accurate description of all the parts about the heart--of
its substance, which is said to be a strong muscle; of its pericardium,
which is described as being a smooth tunic, containing a little fluid
resembling urine; of its ventricles (γαστέρες); of its auricles
(ὄυατα); of the origin of the veins from it; of its sigmoid valves; of
its office, to be, as it were, the fountain head, from which all parts
of the body are irrigated, and the seat of the understanding, which
is said to be in the left ventricle. The understanding, it is added,
is not nourished by the blood, but by a pure and luminous (φωτοειδὴς)
superfluity from it. Altogether, this little treatise bespeaks much
practical acquaintance with human anatomy, and, considering the age
in which it was written, must be the production of a very superior
mind. It contains an account of an experiment which has been much
animadverted upon, both by ancient and modern authorities. The writer
says, if a colored fluid be given to an animal, such as a sow, to
drink, and if its throat be cut while it is in the act of swallowing,
it will be found that part of the fluid has passed down by the gullet
to the lungs. See in particular Aulus Gellius (Noctes Atticæ, xvii.,
11); Macrobius (Saturnal. vii., 15); and Plutarch (Sympos. vii., 1.)
Aulus Gellius says decidedly that Plato had adopted this opinion from
Hippocrates. Aulus Gellius and Macrobius also quote Plutarch as having
stated, in his ‘Symposiacon,’ that Hippocrates is the author of this
opinion; but the text of Plutarch (l.c.) is in an unsatisfactory state.
See Schulze (Hist. Med. i., iii., vi., 12.)
XLIV. Περὶ τροφῆς--_On Aliment_.
It must be admitted that this treatise has very high authorities
in favor of its authenticity, such as Erotian, Galen,[257] Aulus
Gellius,[258] Palladius,[259] Stephanus;[260] and, in modern times,
Mercuriali, Foës, Haller, and Le Clerc.[261] It is rejected by Casper
Hoffman,[262] Gruner, Ackerman, Kühn, Littré, and Greenhill, though,
by the last two, not in decided terms. Considering the respectability
of the external evidence in its favor, I should certainly not have
hesitated in admitting it as genuine, had not a careful examination
of its contents led me to form the unbiassed decision that it
must be the production of some metaphysician, rather than of a
medical practitioner, such as we know Hippocrates to have been. The
physiological dogmata with which it abounds are announced in so
antithetical, not to say paradoxical, a manner, that I can conceive
nothing more foreign to the style and character of the true writings of
Hippocrates. I shall give a few specimens:--“The species of aliment is
one and many; all these (kinds of aliment?) are one nature and not one.
Purging is upwards and downwards, and neither upwards nor downwards.
Purging in aliment is excellent, purging in aliment is bad. Aliment
not aliment, unless it conveys nourishment; it is aliment in name but
not in deed; aliment in deed and no longer in name only. Sweet and
not sweet; sweet potentially, as water, sweet to the taste, as honey.
Things not animals are animated; animals are animated, the parts of
animals are animated. It (the embryo) is and is not.” Now, I must say,
that all this appears to me to savour more of the taste of Democritus
than of Hippocrates himself. It may be said, indeed, that the very
circumstance of Galen’s having admitted the work as genuine, and
having composed an elaborate commentary on it, is a most presumptive
proof of its authenticity; for where shall we find so excellent a
judge of the doctrines of Hippocrates as his great commentator? But
then it must be taken into account that Galen himself had a great
_penchant_ towards metaphysical subtleties, and this would lead
him to believe that what was in accordance with his own tastes must
have been in accordance with those of his great professional hero.
But, notwithstanding the doubts which hang over the question of its
authorship, it may be confidently affirmed regarding this treatise
that, illustrated as it is by Galen’s commentary (even although it has
come down to us in a mutilated state), few works in the Collection are
more suggestive than the present one. I shall merely give a few more
specimens of it:--“The root of the veins is the liver, and the root of
the arteries is the heart; and from them blood and spirits are carried
to all parts, and heat passes to the same.” This passage is frequently
quoted and commented upon by ancient authors; as by Galen,[263] and
Aretæus.[264] We have seen it stated in the preceding treatise that
the heart is the place from which both veins and arteries originate.
This seems a presumptive proof that these two treatises must have
had a distinct authorship. “The aliment reaches to the hairs, the
nails, and the outer surfaces from within; and aliment from without
passes from the most external to the most internal parts, there is one
conflux and one conspiration (ξύρροια μία, ξύμπνοια μία). All parts
sympathize throughout the whole frame, but in so far every part has
its own peculiar action.” This passage, also, is very celebrated and
frequently quoted.[265] I need scarcely remark that it embraces a
grand and most important view of the animal economy. “Milk is food to
some with whom it agrees, and to others not. To some wine is food, and
to others not; and so with flesh and many other kinds of aliment. We
must look to situation and habit. Humidity is the vehicle of food. The
natures (instincts?) of all things are untaught. Persons who perspire
freely are weak, more healthy, and have easier recoveries than others.
Those who perspire ill are stronger than others before they become
indisposed, but being indisposed have more difficult recoveries. These
remarks apply to the whole and to the parts.”
From these specimens it will be readily seen that the work abounds
in curious matters, but of a very different stamp from those which
the true Hippocratic treatises contain. Contrary, then, to my general
rule, I certainly feel disposed in the present instance to reject,
upon internal evidence, a treatise which has the most unexceptionable
external evidence in its favor.
XLV. Περὶ σαρκῶν, ἤ ἀρχῶν--_On Fleshes, or Principles_.
This treatise does not appear in Erotian’s list of the Hippocratic
works, and it is rejected by all the modern authorities, from
Mercuriali downwards. Galen is inconsistent in his notice of it.[266]
Some of the philosophical dogmata which it contains are curious, such
as the following specimen: “It appears to me that what we call heat
is immortal, and that it knows all, sees, hears, and perceives all
things that are and will be.[267] When things, then, were thrown into
confusion the greater part of this passed off to the highest circle,
and this it is which the ancients called ether.” The following extract
is held by Gruner, but probably without any good reason, to evince a
degree of anatomical knowledge in advance of the age of Hippocrates:
“There are two hollow veins from the heart, the one called the artery,
and the other the vena cava. The artery has more heat than the vein.”
The other veins are also described with considerable accuracy. It is
stated that the fœtus in utero sucks in fluid (liquor amnii?) by its
lips, and in proof of this the author remarks that the child voids
fæces soon after delivery, which, it is argued, must be derived from
food. The opinion thus stated has been often maintained in modern
times, but does not appear to be well founded. The author mentions
correctly that persons in attempting to commit suicide open the
trachea, in which case, he adds, the patient lives, but loses his voice
until the opening be closed. Conringius and Haller, with considerable
plausibility, but yet without any direct proof, attribute this treatise
to Democritus.
XLVI. Περὶ ἑβδομάδων--_On Hebdomads_.
This treatise exists now only in the Latin translation, which M.
Littré has discovered in the Royal (_National_, it is now called!)
Library in Paris, and will be published in his edition of the works
of Hippocrates. M. Littré gives an elaborate and most interesting
disquisition on it, and seems to make out clearly that it is the
production of the same author as the treatise “On Fleshes,” which we
last noticed. It is cited by Philo Judæus,[268] and several other
writers of antiquity. Galen, however, held it not to be the production
of Hippocrates. A considerable extract from it is contained in the
tract “On Critical Days,” and the eighth section of the Aphorisms,
which has always been looked upon as spurious, is said by M. Littré to
be mostly taken from this treatise.
XLVII. Περὶ ἀδένων--_On the Glands_.
Erotian makes no mention of this treatise, and Galen pronounces it to
be the work of the recent Hippocratists.[269] M. Littré remarks, and
with great truth, that it is difficult to find out the grounds upon
which the ancient critics have rejected this work. Certain it is that
it contains a goodly store of interesting matters, none of which, as
far as I can discover, are inconsistent with the true doctrines of
Hippocrates. In it a pretty correct description is given of the glands,
including those of the mesentery. The brain itself is said to be of
glandular nature, and also the kidneys. An ingenious account is also
given of the origin of scrofula, which is said to be produced by the
lodgment of humors in the glands of the neck, which get into a state
of slow inflammation. Glands, the author says, are seated mostly in
parts of the body which most abound in humidities, such as the armpits
and groins, and hence such parts produce hairs. In the case of the
mesentery, however, no hairs are produced, because the humidities here
are excessive, and choke up, as it were, the seeds of the hairs; in
like manner as seeds sown in marshy grounds perish. A very ingenious
account is given of the origin of phthisis, which is said to spring
from tubercles in the lungs and matter (pus), which corrodes the lungs
when “the patients do not readily recover.” A curious description is
next given of the tabes dorsalis, “in which disease the patient does
not wish to live.” How expressive this language is of the state of mind
in the case of the unfortunates who are subject to spermatorrhœa! The
treatise concludes with some striking remarks on the sympathy between
the mammæ and uterus, and on the influence which both exercise on the
development of the female character. Altogether the contents of this
treatise are most valuable, and may suggest important views to the
medical practitioner and physiologist, even at the present day. We need
have no hesitation in pronouncing, with regard to it, that it reflects
infinite credit on the school from which it emanated, and that it is
not unworthy of Hippocrates, although we have reason to believe that he
was not actually the author of it.
XLVIII. Περὶ φλεβῶν--_On the Veins_.
This is merely an excerpt from the treatise “On the Nature of the
Bones.”
XLIX. Περὶ ἰητροῦ--_On the Physician_.
I may mention in this place, generally, that the treatises which follow
have no ancient authority in support of them, and that, with very few
exceptions, they are also rejected by all the modern critics. Their
contents, moreover, are not of much practical importance, and therefore
I shall be very brief in my analysis of them.
The treatise in question is held to be genuine by no one critic, as
far as I know, with the exception of Foës, who appears, in part, to
sanction its claims. The object of the author is announced to be in
order to instruct the physician how to conduct matters connected
with the iatrium, that is to say, with his establishment or surgery.
Mercuriali, I may mention, is unjustly severe in his animadversions on
the exordium. (See Conringius, Introd. p. 120.) The physician should
have a healthy look himself, for the writer says, people fancy that
a person who does not keep himself in good health is not qualified
to take charge of the health of others. He should be of a prudent
disposition and a gentleman in morals.[270] Minute directions are given
respecting the site and other circumstances connected with the iatrium:
clean and soft towels are to be at hand, linen is to be used for the
eyes, and sponges for the sores. In supplying bandages, attention is
to be paid to utility rather than to display. The surgeon should pay
great attention to all matters connected with this operation: for it is
attended with much disgrace when any manual operation does not succeed.
Minute directions are given about the performance of venesection at
the arm, and mention is made of several untoward accidents connected
with it, such as the blowing up of the vein, whereby the flow of
blood is stopped; and suppuration following as a consequence of the
operation. In order to acquire dexterity in the treatment of accidents,
the author recommends the young physician to attach himself to some
foreign army; and from this Gruner infers, that the work cannot belong
to Hippocrates, as domestic wars were but too common in his time; and
there could have been no necessity for the surgeon’s seeking foreign
service in order to gain experience. It does not occur to me, however,
that there is much force in this argument; for intervals of peace were
just as common during the long life of Hippocrates, as during the
interval between his death and the time when the Collection was made.
But, in fact, there is no necessity to seek recondite reasons for
rejecting a treatise which has no proper authority in support of it.
L. Περὶ εὐσχημοσύνης--_On Decorum_.
This work, like the last, has not the slightest claim to be
looked upon as genuine. Moreover, it has come down to us in a very
unsatisfactory state as regards the text, so that the meaning is often
very dark and uncertain; and I must confess that, as a general rule, I
have little inclination to spend much time in searching out a meaning,
in obscure writings, when, after it is discovered, it is not likely
to repay the exertions made in discovering it. I am always disposed
to remember the advice which Galen repeatedly gives to the student of
medicine, “to concern himself more about things than about words.”[271]
The object of the author seems to be to give general directions with
regard to decorum in the physician’s communication with the sick. It
is evidently the production of some sophist, according to Bernard, of
some one belonging to the Stoical sect. I shall be brief in my abstract
of it. A philosophical physician is equal to a god. In the practice
of medicine all the virtues relating to wisdom are exercised; namely,
contempt of money, decency, modesty, simplicity in dress, character,
judgment, quietness, accessibility, purity of life, sententious maxims,
knowledge of the purifications which are proper and necessary in life,
abstinence from lucre, freedom from superstition, divine excellence.
The physician should keep himself aloof, and not hold much converse
with the common people, unless when necessary. The surgeon should
be well provided with all the means required in the practice of his
profession, such as dressings, medicines, instruments, and so forth,
as any deficiency in these might produce serious results. Minute
directions are given for the regulation of the physician’s address in
entering the chamber of the sick, and his conduct while there.
LI. Παραγγέλιαι--_Precepts_.
This little tract stands altogether in much the same circumstances as
the preceding one, that is to say, it is wholly destitute of all good
authority in its favor, and the nature of its contents is what might
rather be expected from a sophist than a practical physician. The text,
moreover, is in a most unsatisfactory state. I shall dismiss it then
with a very brief notice. It opens with an advice to the physician not
to trust to speculation but to rational experience. He ought to learn
remedies from all quarters, even from the vulgar, and not be avaricious
in his dealings with the sick, more especially if strangers and needy.
The author alludes, as Schulze thinks, to the practice then followed
by the physicians of migrating from one city to another, and of making
a public declaration of their pretensions at their first entry into
any place. These physicians were called _periodeutæ_. The author
of this tract advises the physician, in such a case, not to make any
vainglorious or inflated profession of his abilities. He also enjoins
the medical practitioner to look to the health of those who are free
from disease, as well as those who was indisposed.
LII. Περὶ ἀνατομῆς--_On Dissection_.
This small fragment of ancient anatomical science has no claim to be
regarded as the work of Hippocrates. Neither Erotian nor Galen, nor
any other ancient critic, holds it as such, and the modern authorities
are unanimous in rejecting it. That it may have been the composition
of Democritus, as suggested by Gruner, seems not unlikely. It abounds
in harsh and obsolete terms, which have never been satisfactorily
explained. Some parts of the anatomical description are difficult to
determine, as for example, “the large bronchia which extend from the
heart to the liver;” “the vena scalena, which extends from the liver to
the kidneys.” The latter passage, however, may be supposed to refer to
the emulgent vein.
LIII. Περὶ ὀδοντοφυίης--_On Dentition_.
This little tract is destitute of any competent evidence of its
authenticity. Some of the observations contained in it bespeak a
familiar acquaintance with the diseases of infancy. Thus it is
said, that when the bowels are loose at the term of dentition, if
the digestion be good, the children thrive, and are not subject to
convulsions. When children at the breast vomit up their food, the
bowels are constipated. When there is fever accompanying dentition,
children are seldom attacked with convulsions. But when there is heavy
sleep along with dentition, there is danger of convulsions. All the
children that are seized with convulsions at the time of dentition do
not die. Children that take food during dentition bear vomiting best.
Ulcers on the tonsils are attended with danger.
LIV. Περὶ ἐγκατοτὸμης άμβρύου--_On Excision of the Fœtus_.
No one stands up for the genuineness of this treatise,[272] which,
however, is not wanting in interesting matter relative to the
extraction of the fœtus in cross-presentations. For an abstract of the
practice there recommended, see PAULUS ÆGINETA, Vol. II., p.
389, Syd. Soc. edition. A circumstantial description is also given of
the process of _succussion_, the dangerous effects of which, in
certain cases, are related in the Epidemics.
LV. Περὶ ὄψιος--_On Vision_.
This little fragment is admitted by all the authorities to be
spurious. It contains a description of glaucoma, for which purging of
the head and the application of the actual cautery are recommended, and
also in certain cases venesection. In epidemic ophthalmy, purging both
of the head and bowels is recommended.
LVI. Περὶ ὀστέων φύσιος--_On the Nature of the Bones_.
M. Littré has very ingeniously shown that this work is a compilation
made up of fragments of other works, and thus he has announced his
intention of excluding it altogether from the Hippocratic Collection.
Certain it is, beyond all dispute, that the treatise is not the
production of Hippocrates himself. The following are a few of the most
notable things which I have observed in it. “It appears to me that what
we call heat is immortal, and that it understands, sees, hears, and
perceives all things that are and will be.” The heat, it is further
said, is the origin of all movement in animals. This will be recognized
as the original of the doctrine of the _Calidum innatum_, which
figures in the works of our earlier physiologists in modern times. See
the works of Harvey and the other physiologists of the seventeenth
century; also what is said on this subject in the next section. The
aorta and vena cava are correctly described, the one as an artery, the
other as a vein; and their origin from the ventricles of the heart is
noticed. The author states (p. 440, ed. Kühn), that he had known cases
of attempted suicide in which the windpipe had been opened, and yet
death did not ensue; only while the opening remained the person lost
the power of speaking. See No. XLV.
LVII. Περὶ κρισίων--_On the Crises_.
This tract has no ancient authority whatever in support of it, and
Foës, Gruner, and Littré concur in holding it to be a compilation
from other Hippocratic treatises, more especially the Aphorisms and
Prognostics. This, indeed, must be obvious to every person who reads it
with any attention.
LVIII. Περὶ κρισίμων--_On Critical Days_.
This treatise stands in the same predicament as the preceding one,
that is to say, it has no ancient authority in support of it; indeed
Galen declares against it when he says that Hippocrates had not given
any work on the Critical Days. (Tom. iii., p. 440; ed. Basil.) It is
manifestly a compilation from the other treatises, more especially from
those “On Internal Diseases” and “On Diseases.” Still it appears to
me to be an interesting and well-written compilation. For example, it
would be difficult to point out in any other work, ancient or modern,
a better description of pneumonia than is given towards the conclusion
of it. Tetanus also is accurately described. To be sure, Gruner
infers, from the circumstance that three varieties of this disease
are described, that the work in question must have emanated from the
Cnidian school. But Aretæus, and, indeed, all the ancient authorities
that treat of tetanus, describe three varieties of this disease; and
therefore this is no good reason for excluding it from the Coan school.
LIX. Περὶ φαρμάκων--_On Purgative Medicines_.
Though it must be admitted that this little fragment can boast of no
competent authorities to establish its claim to be placed among the
genuine works of Hippocrates, it bears undoubted marks of having been
written by some person well acquainted with his principles, and having
no ordinary acquaintance with professional matters. Thus the author
states very correctly the effects of idiosyncrasy in modifying the
operation both of purgatives and emetics, and advises the physician to
make inquiry beforehand what effects such medicines, if formerly taken,
had produced on the patient; for, he adds, it would be a disgraceful
casualty to occasion a man’s death by the administration of a purgative
medicine. He also interdicts the administration of purgatives during
the heat of a fever, and during the very hot seasons of the year.
These practical rules appear to me to be highly important, and yet how
frequently do we see them disregarded! At the time we have mentioned,
the author prudently remarks that it is safer to administer a clyster.
LX. Περὶ ἑλλεβορισμοῦ--_On the Administration of Hellebore_.
This little tract is usually published among the _Epistolæ_, and,
as a matter of course, it has no evidence in support of its genuineness
further than they have, which, as we shall presently see, is very
slender. It contains, however, very acute and important observations
on the administration of hellebore, to which it is well known that
the Hippocratists were very partial. But these are mostly extracted
from the Aphorisms, and need not be noticed in this place. The Book of
Prognostics also is quoted, but seemingly by mistake.
LXI. Ἐπιστολαι--_The Epistles_.
No scholar can require to be informed that, since the memorable
controversy in this country between the Honorable C. Boyle and the
celebrated Dr. Bentley, respecting the authenticity of the Epistles
which bear the name of Phalaris, the whole of the “Epistolæ Græcanicæ”
have been generally condemned as spurious. Against this judgment I
have no intention to protest; but I may be allowed to remark that
many ancient works which are usually acknowledged as genuine have not
so much external evidence in their favor as these Epistles possess.
The Epistles ascribed to Plato, for example, are quoted as genuine
by Cicero,[273] and by Diogenes Laertius.[274] Those of Hippocrates,
too, are quoted and recognized by Erotian, Soranus, and other ancient
authorities. Still, however, as I have stated, I have no intention to
stand up against the general opinion of scholars from the Scaligers
down to the present time, by which they have been condemned as
supposititious; only I contend that, as it is admitted on all hands
that they are very ancient,[275] that is to say, that they must have
been composed within less than a hundred years after the death of
Hippocrates, it is utterly incredible that the Sophists who wrote
them, whether for a fraudulent purpose that they might derive profit
from them by passing them off for the productions of the great name
they bear, or whether for the purpose of displaying their own skill
in sustaining an assumed character, should have made them turn upon
alleged occurrences in the life of Hippocrates which every person
at that early period must have been able to judge whether they were
fictitious or not. I see no reason, then, to doubt that the main
facts to which these Epistles relate are real, although the Epistles
themselves be supposititious.[276]
* * * * *
Having thus stated my opinion of these Epistles in general terms, I
shall now dismiss them with a very brief notice.
They are differently arranged by modern authorities; I shall follow M.
Littré in the few remarks which I have to offer upon them.
The first series of these Epistles relates to the services which
Hippocrates is said to have rendered to the people of Athens during
the time of the memorable plague. The spuriousness of these, it is
generally held, is proved beyond all doubt by the silence of Thucydides
with regard to any such professional services rendered by Hippocrates
on the occasion; and no doubt if it were maintained that these took
place at the outbreak of the disease in Greece, that is to say, at the
commencement of the Peloponnesian war, the inference would be most
legitimate. But if we be permitted to suppose that, as the plague
is known to have lurked about in different parts of Greece for a
considerable time, the services of Hippocrates did not take place until
several years afterwards, there is nothing in the story which bears the
slightest air of falsehood, even if we adhere to the common chronology
respecting the birth of our author. Indeed, I repeat, if the Sophist
who composed these letters had founded them on tales which everybody
knew to be false, he could never have hoped to impose upon the learned
men of the next generation, and make his forgeries pass for genuine.
The second series relates to Democritus, and these must be admitted
to be the most interesting of the whole group. Now that Hippocrates
visited Abdera, and that he was familiarly acquainted with Democritus,
are facts which the most sceptical critic will hardly venture to call
in question.[277] But that the Epistles themselves were not written by
the physician and philosopher whose name they bear, I readily admit to
be probable. Most undoubtedly the letter of Hippocrates, in which he
is made to describe his visit to Democritus, however full it may be
of curious matters, is written in a style and manner very unlike the
well-known characters of the true writings of Hippocrates.
Third. The short letter inscribed from Hippocrates to his son
Thessalus, contains nothing from which its authenticity or the contrary
could be legitimately inferred, only it is destitute of all ancient
authority in its favor. In it the father recommends to the son the
study of geometry and arithmetic, as a proper preparation to the study
of medicine.
Fourth. This series, consisting of “The Oration at the Altar,” “The
Decree of the Athenians,” and “The Oration of Thessalus, son of
Hippocrates,” although now generally regarded as spurious, possess
more direct evidence in their favor than any of the others. In fact,
they are decidedly recognized as genuine by Erotian. The documents
in question have all reference to the services of Hippocrates and
his disciples in the pestilence which pervaded Greece during the
Peloponnesian war. These services are alluded to by many ancient
authorities, as we have shown in the Commentary on PAULUS
ÆGINETA, Book II., § 35. In conclusion, I repeat that, supported
as the main facts referred to in these documents are by the highest
testimony which antiquity can furnish, I cannot but regard the facts as
true, although the documents themselves be given up as supposititious.
* * * * *
I will now briefly recapitulate the general results of the
investigations on which I have been occupied in the present section:
1. That all the authorities, ancient and modern, who have investigated
the question regarding the genuineness of the works which have
come down to us under the name of Hippocrates, are agreed that a
considerable portion of them are not the productions of the author
himself.
2. That it is almost universally admitted that the following treatises
are genuine, viz.:
The Prognostics.
On Airs, etc.
On Regimen in Acute Diseases.
Seven of the Books of Aphorisms.
Epidemics I. and III.
On the Articulations.
On Fractures.
On the Instruments of Reduction.
The Oath.
3. That the following treatises may be pretty confidently acknowledged
as genuine, although the evidence in their favor is not so strong as it
is with regard to the preceding list:--
On Ancient Medicine.
On the Surgery.
The Law.
On Ulcers.
On Fistulæ.
On Hemorrhoids.
On the Sacred Disease.
4. That as it certainly appears that the Book of Prognostics is
composed, in a great measure, from the contents of the First
“Prorrhetics” and the “Coacæ Prænotiones,” there can be little or
no doubt that these two treatises are more ancient than the time of
Hippocrates.
5. That although the exact time at which the Collection, as it now
stands, was made out has never been determined in a very satisfactory
manner, an examination of the contents of the different treatises leads
to the conclusion that most of them represent pretty faithfully the
opinions held by the family of Hippocrates and his immediate successors
in the Coan school of medicine.
6. That a few of them, and more especially the two important works “On
Internal Affections,” and “On Diseases,” would appear to bear distinct
traces of having emanated from the contemporary school of Cnidos.
7. That although the Epistles and certain public documents usually
published at the end of the Collection may justly be suspected of being
spurious, there is undoubted evidence that they are of very ancient
date, and were composed, most probably, within less than a hundred
years after the death of Hippocrates, so that there is every reason for
believing that they relate to real events in the life of our author,
and not to fictitious as some have supposed.
SECTION III.
ON THE PHYSICAL PHILOSOPHY OF THE ANCIENTS, AND MORE ESPECIALLY
THEIR DOCTRINES WITH REGARD TO THE ELEMENTS.
As it is impossible to understand properly the medical theories which
occur in the Hippocratic treatises without a competent acquaintance
with the Physical Philosophy of the ancients, I have thought it
necessary to devote an entire chapter to an exposition of the tenets
held by the philosophers regarding the elements of things. I might
have been able to dispense with this labor provided there had been any
modern publication to which I could refer the reader for the necessary
information on the subject in question; but, unfortunately, there is no
work in the English language, as far as I am aware, in which the nature
of the ancient doctrines is properly described. To give an example
in point: Dr. Watson, the bishop of Llandaff, in his essay “On the
Transmutability of Water into Earth,” makes the following remarks on
the ancient doctrine concerning the elements: “If but one particle of
water can, by any means, be changed into a particle of earth, the whole
doctrine of the Peripatetic sect concerning the elements of things
will be utterly subverted: the diversities of bodies subsisting in the
universe will no longer be attributed to the different combinations of
earth, air, fire, and water, _as distinct, immutable principles, but
to the different magnitudes, figures, and arrangements of particles of
matter of the same kind_.”[278]
Now it will at once be perceived by any person who is at all
acquainted with modern science, that if the ancient dogmata be as here
represented, they are altogether destitute of any solid foundation in
truth and nature, and we may well wonder that such a baseless structure
should have endured for so long a period. But before passing this
severe judgment on the tenets of our great forefathers in philosophy,
it will be well to investigate their doctrines more accurately than Dr.
Watson appears to have done in this instance.
In pursuing the present investigation, I shall, in the first place,
give literal translations of extracts from the works of the most
celebrated sects of philosophers; namely, the Pythagoreans, Platonists,
Peripatetics, Stoics, and Epicureans. It will, of course, be readily
perceived, from what I have now stated, that I do not mean to confine
my inquiry to the period of ancient philosophy which preceded
Hippocrates, but that I am to bring it down to a pretty late age. This
course I find it indispensably necessary to follow, as I could not
derive sufficient illustration of the subject were I to restrict myself
to the works of the earlier philosophers, who either preceded our
author or were his contemporaries. I shall first give the extracts by
themselves, and then make some remarks in illustration of the doctrines
which they expound. I think it proper to mention further, that I am
answerable for the correctness of the translations in all cases, unless
where it is otherwise stated.
THE PYTHAGOREANS.
“Fire being compressed produces air, and air water, and water earth:
and from earth the same circuit of changes takes place till we come to
fire.”[279]
“In that part of the universe where Nature and Generation exert their
powers, it is necessary that there should be these three things: In
the first place, that thing which being tangible furnishes a body to
everything which comes into existence. This is the universal recipient
and substance of impression for things generated, bearing the same
relation to things which are generated from them that water does to
juice, and silence to sound, and darkness to light, and materials
to the things fabricated from them. For water is void of taste and
quality, bearing the same relation to sweet and bitter, and to sharp
and salt. The air is unformed as to sound, or speech, or melody. And
darkness is devoid of color and shape, and bears the same relation
towards bright, and yellow, and white. But white bears reference also
both to the statuary art and that which forms figures of wax. But
matter admits of another comparison with the art of statuary. For
all things exist in it _potentially_ before they are made, but
_actually_ after they are made and have received their nature. In
order, therefore, that there should be generation, it is necessary that
there should be some one substance as a substratum. In the second place
there are the _contraries_, in order that they may be changes and
transmutations, the primary matter undergoing passion and affection, in
order that the qualities (_or_ powers, δυναμεις), being mutually
passive, may not destroy, nor be destroyed, by one another. These (the
contraries) are, heat and cold, moisture and dryness. In the third
place are those substances in which these powers reside, namely, fire
and water, air and earth. For these differ from the powers (qualities?)
For the substances are consumed in place by one another, but the powers
are neither consumed nor formed, for they are the incorporeal reasons
of these.[280] Of these four, heat and cold are causes, and active; but
dryness and humidity are as the materials, and passive. In the first
place there is matter, the universal recipient, for it is the common
subject (_or_ substratum) of all things, so that it is the first
sensible body in potentiality, and the original of all things: next are
the contraries, such as heat and cold, moisture and dryness; and in the
third place there are fire, water, earth, and air: _these all change
into one another_, but the contraries do not change.”[281]
The primary matter is afterwards defined to be “the subject body, that
which receives all the changes, the universal recipient, and that which
potentially is the first to the touch.”[282]
“The first principles of all created things are the substratum, matter,
and the reason of shape; namely, form. The bodies are their offspring,
namely, fire, air, earth, water.”[283]
“Pythagoras taught that the original of all things is the monad, that
from the monad sprung the duad, which is the subject matter to the
efficient monad: that from the monad and infinite duad were formed the
numbers: from the numbers the points; from them the lines, from these
figures of superficies; from the superficies the solid figures; from
these the solid bodies, of which are the elements, fire, water, earth,
air:--_that from these, changed and converted into every shape_,
is formed the world, which is animated, intelligent, of a spherical
shape, comprehending in its middle the earth, which also is spherical
and inhabited all round.[284]
“Pythagoras said, that none of the elements is pure, for that earth
contains fire, and fire air, and water air, etc.”[285]
“Nor those which elements we call abide,
Nor to this figure, nor to that are ty’d:
For this eternal world is said of old
But four prolific principles to hold,
Four different bodies: two to heaven ascend,
And other two down to the centre tend:
Fire first with wings expanded mounts on high,
Pure, void of weight, and dwells in upper sky:
Then air, because unclogged, in empty space
Flies after fire, and claims the second place;
But weighty water, as her nature guides,
Lies on the lap of earth; and mother Earth subsides.
All things are mixed of these, which all contain,
And into these are all resolved again:
Earth rarefies to dew; expanding more
The subtile dew in air begins to soar:
Spreads as she flies and weary of the name,
Extenuates still and changes into flame.
Thus having by degrees perfection won,
Restless they soon untwist the web they spun.
And fire begins to lose her radiant hue,
Mix’d with gross air, and air descends in dew:
_And dew condensing does her form forego
And sinks a heavy lump of earth below_,
Thus are their figures never at a stand,
But changed by Nature’s innovating hand.”[286]
THE PLATONISTS.
“Let us therefore say that the mother, _or_ receptacle of every
visible, nay of every sensible production, is neither earth, nor air,
nor fire, nor water, nor any of the things which arise out of these,
nor out of which these arise, but a certain invisible and formless
being, the universal recipient, concerning which being, if we say that
it is in a very dubious way intelligible, and something most hard to be
apprehended, we shall not speak false.”[287]
The primary matter “admits of everything, but partakes of no shape
nor resemblance to anything which enters into it. It is the substance
of impression[288] to everything in nature, being moved and altered
by those things which enter into it (_the forms_?), and by their
means it appears sometimes one thing and sometimes another.”[289]
“In the first place, we see that which we call water, being
compressed, become stones and earth. But being dissolved and expanded,
it becomes breath and air. Air, by combustion, is converted into fire,
which, being compressed and extinguished, assumes its original form.
Fire and air meeting together, and being condensed, become cloud and
vapor; and from the condensation of these, running water is formed.
_And from water again, earth and stones are formed._”[290]
Plato taught “that God, matter, and form, are the originals of all
things:--that matter is increate and incorruptible, neither fire, nor
water, nor any of the principles nor elements, but a substance capable
of form and subject to fabrication: that when rude and deprived of
every quality of configuration, God, the artificer, formed the universe
from it. He taught, that matter is the original of all bodies, that it
was stamped with the impression of forms, and hence were produced the
elements, namely, fire, water, earth, and air.”[291]
“Earth contains water, and water, as some suppose, carries earth: air
is formed from water, and from dense air fire is formed.”[292]
“There being four kinds of bodies, by the mutual changes of them
the nature of the world is preserved. _For water is formed from
earth_, and air from water, and ether from air: and then inversely,
from ether, air; from air, water; and from water, earth, which is
lowest in the scale.”[293]
“Those who have investigated matter, if they have formed any right
conception of it, have agreed in considering it as the subject and
receptacle of forms.”[294]
“Concerning the receptacle of bodies this may be said. In the first
place, that there must be a certain substratum to bodies different from
themselves, _is demonstrated by the transmutation of the elements
into one another_. For that which is changed is not altogether
consumed, or, if it is, a substance is changed into a non-entity. And
neither has that which is born come into existence from nothing, but
it has undergone a change from one form into another. For something
remains which has received the new form and cast off the other. And
this is shown by destruction, for it applies only to a compound body;
and, if this be true, every such body is compounded of matter and
form. Induction bears testimony to the truth of this, by showing, that
whatever is dissolved was compounded; and analysis in the same manner,
as, for example, if a phial be resolved into gold, and gold into water;
and water, in like manner, when it perishes, requires to be something
analogous. But the elements must be either form, or primary matter, or
a compound of form and matter. But they cannot be form, for without
matter, how could they be possessed of bulk and magnitude? But they
are not primary matter, for it is not consumed. It follows, then, that
they must consist of form and the primary matter. But form regards
quality and shape, but it (the primary matter) pertains to the subject
which is indeterminate, (ἀόριστον _or_ ἀόρατον) because it is not
form.”[295]
“Matter of itself is devoid of form, matter is the subject of all
things.”[296]
“The followers of Plato and Aristotle are of opinion, that there is
a difference between the first principles and the elements. For, the
elements are compounded, but the first principles are not compounded
nor formed from any thing. What we call the elements are fire, air,
earth, and water; but we call that a principle which has nothing
from which it is formed, since otherwise it is not a principle, but
that from which it is formed. But there is something antecedent to
water and earth, from which they are formed; namely, the first matter
which is devoid of shape and form; then there is form (which we call
_entelocheia_) and privation.”[297]
“Plato, wishing to prove that the elements have one common matter as a
substratum to all, in his ‘Timæus,’ enters into a discussion regarding
their transmutation into one another. But he being well acquainted with
the art of demonstration, has treated properly of the change of the
first bodies into one another. But Thales, Anaximenes, Anaximander,
and Heraclitus, assuming each that there is some one element, endeavor
to prove this from their changing into one another. Yet all these
seem to me to have had an obscure idea (ὀνειράττειν) of some matter,
which is a common substratum to all the elements, and seeing that it
is single they supposed that there is but one element. But instead of
saying that this is a common element from which the others, I mean air,
fire, water, and earth, are formed, they passed it over altogether and
endeavored to demonstrate the same thing of some one of the elements,
all proceeding upon the same mode of demonstration, although they did
not all make choice of the same element.”[298]
“With regard to the old philosophers, called physical, it will be
obvious to us when we read their writings on Nature, that they held the
existence of a first matter which is increate and eternal, being the
substratum to all created and perceptible things.”[299]
“That the elements change into one another is admitted, even by the
followers of Thales, it being so apparent. Hence it is inferred that
the elements have one common matter for a substratum.”[300]
Philo, the platonic Jew of Alexandria, in his treatise “On the
Creation of the World,” thus expresses his opinions regarding the
original state of matter. “Whoever would wish to discover the cause
why this universe was framed, would not be far from the truth, in my
opinion, if he said with one of the ancients, that the Father and Maker
of it is good, and for that reason he spared not to impart of his most
excellent nature to a substance having nothing beautiful in itself, but
possessing the capacity of becoming all things. Of itself it was devoid
of form, quality, and life; and was full of contrariety, confusion, and
dissonance.”
“Moses, the chief of philosophers, and instructed in many of the most
comprehensive secrets of Nature by oracles, was aware that it was
most necessary that there should be in the universe an active cause
and a passive subject. That the active is the most pure and perfect
soul of the universe, more excellent than virtue, more excellent than
knowledge, more excellent than even goodness and beauty. That the
passive is of itself without life and motion, but being moved and
figured, and enlivened by mind, it was changed into a most perfect
work.”[301]
His opinion regarding the elements may be collected from the following
passages:--“Fire being extinguished is converted into thick air, and
air being compressed subsides into water, and water being still more
compressed is changed into earth, the densest of the elements.”[302]
“Nothing that is pure can be comprehended by the senses.”[303]
“The elements are inanimate matter, of itself devoid of motion, and
subjected to the artificer, by whom it is transformed into all kinds of
shapes and qualities.”[304]
I shall venture to give under this head the opinions of one of the
Arabian medical authors.
“It is to be kept in mind that the elements which are perceived by the
senses, namely, fire, air, earth, and water, are by no means the pure
elements, but such as are comprehended by the mind. These are not to be
perceived by the senses. None of the others is pure, nor without some
admixture.”[305]
THE PERIPATETICS.
Aristotle defines the first matter as follows: “I call matter the first
subject of everything, all things being formed from it existing in them
not accidentally; and when anything is destroyed, it comes to this at
last.”[306]
In his Logical work he thus defines his ideas regarding the first
substances, namely, mind and matter. “The first substances being
the subjects of all other things, and as every other thing may
be predicated by them and exists in them, are called the prime
substances.[307] “We must distinguish the first bodies from matter,
for we must suppose concerning them that they have a first principle
and origin, namely, matter, which is inseparable from them, and is the
subject of the contraries. For heat does not furnish the materials to
cold, nor it to heat, but the subject to both. So that we have first
the sensible body in potentiality, the first principle; then we have
the contraries, I mean cold and heat; and thirdly, fire and water, and
the like. These change into one another, and not as Empedocles and
others say of them.[308]
“The _material_ of all bodies, great and small, is the same.
This is apparent; for when air is formed from water, the same matter,
when it becomes another thing, acquires nothing new, only that which
formerly existed in capacity now exists actually.”[309]
The following extracts will show the opinions of his most celebrated
commentators:
“Air and fire have one common character, namely, heat; therefore they
readily change into one another. Air and water readily change into
one another, for they have a common character, namely, moisture. In
like manner, water and earth, for they have an alliance, namely,
coldness.”[310]
“The physical philosophers analyze any substance, as, for example,
a man into head, hands, and feet; and these into bones, flesh, and
nerves; and these into the four elements; and these again into matter
and form.”[311]
“Water is formed from air, and air from water, and fire from air,
because they all have one common substratum, matter.”[312]
The next two extracts will show the opinions entertained by Aristotle’s
successor in the Peripatetic school of philosophy.
“Of the simple substances, fire has peculiar powers. _For air, water,
and earth, admit only of changes into one another_, but none of them
can produce itself.”[313]
“The nature of those substances called simple is mixed, and existing in
one another.”[314]
“The Peripatetics divided Nature into two things, the one of which is
efficient, and the other that which furnishes it with the materials
from which anything is made. Power exists in the one, and matter is the
essence of the other.”[315]
“The first principles are air, fire, water, and earth, for from them
are formed all living things and the productions of the earth: they are
therefore called elements; of these, air and fire have the power of
moving and forming the others (I mean water and earth), of receiving
or suffering. Besides these, Aristotle thought that there is a fifth
element, from which the stars and the souls of individuals are made;
but that all these had for a substratum a certain matter devoid of
form and quality, from which all things are framed, a substance which
has a capacity for all things, and admits of all changes, that when it
perishes it is not reduced to nothing, but into its parts, which can be
cut and divided infinitely, since there is nothing in Nature that is
not divisible.”[316]
THE STOICS.
“They are of opinion that the first principles of all things are
two--the active and the passive: that the passive is matter, a
being devoid of all qualities; the active, or efficient, is the
reason (λόγος) residing in it, that is, God. That he, being eternal,
fabricates all things from it all (all matter?). That there is a
difference between the first principles and the elements--that the
former are increate and indestructible, whilst the elements are
destructible by burning (ἐκπύρωσιν).--That the first principles are
bodies devoid of form, whereas the elements are possessed of form.
That God and Mind, Fate and Jupiter, are one and the same being under
different appellations; that he formed the four elements, fire, air,
water, earth.”[317]
“Our Stoics say, that there are two principles in Nature from which
all things are formed, namely, cause and matter. That matter lies
inert, a being prepared for all things, but inactive, unless some one
move it.--That cause, that is, reason, forms matter, and changes it at
will. There must be something _by_ which everything is made and
_of_ which it is made: the former is the cause, the latter the
matter.”[318]
“Some of our sect are of opinion that air, being changeable into fire
and water, etc.”[319]
“We are of opinion that earth is changeable. To this we may add that
all things are formed from all things--air from water--water from
air--fire from air--air from fire; _why, then, should not earth be
formed from water, and water from earth?_ Earth is formed from
water--why then not water from earth?”[320]
“The Stoics divided Nature into two things, the one of which is the
efficient, and the other that which furnishes itself as the materials
from which anything is made.”[321]
Suidas says, regarding the first principles: “The first principles of
all things are two, the efficient and the passive. The passive, then,
is a being devoid of qualities--earth, matter. The efficient is the
reason residing in it, namely, God. The principles and elements are
different, inasmuch as the former are increate and indestructible,
while the elements are destructible by burning. Besides, the first
principles are without body and form, but the elements have form.”[322]
“Zeno, the son of Mnaseas, the Citiensian, taught that there are two
principles, God and matter, the one efficient and the other passive;
and that there are four elements.”[323]
“The Stoics maintain that the first principles are two, God and matter;
not that they consider God as an element, but as the active principle,
whilst matter is the passive.”[324]
“Always remember the saying of Heraclitus, _that the dissolution of
earth is to become water, and the dissolution of water to become earth;
and the dissolution of air to become fire, and conversely_.”[325]
“Contemplate the courses of the stars as if carried about with them,
and frequently revolve in your mind the mutual transmutations of the
elements into one another.”[326]
“Acquire the habit of contemplating the transmutation of all things
into one another.”[327]
“Fire, air, water, earth, were so formed by Nature as to furnish
aliment by turns to one another.”[328]
THE EPICUREANS.
“Therefore all those who teach things took their birth
From simple fire, or water, air, or earth,
Lie under palpable mistakes. And those
That teach from doubled elements they rose,
As air and fire, as earth and water joined,
Or all four, earth, air, water, fire combined:
Thus sung Empedocles.
* * * * *
If all things from four elements arose,
And are again by death dissolved to those:
What reason we should rather fondly deem
Them principles of things, than things from them?
_For they alternately are changed and show
Each other’s figure and their nature too._”[329]
The following passage will show the opinions of Democritus, the
contemporary and friend of Hippocrates, from whom Epicurus took his
system of physics.[330] “He taught that the atoms are infinite in
magnitude and number, that they revolve in all space, and that thus
they formed _the compound bodies fire, water, air, earth_; for
that even these are composed from the atoms, which are impassive and
unchangeable owing to their hardness.”[331]
These extracts prove clearly that the great philosophers of
antiquity stand acquitted of having held the erroneous opinions
generally ascribed to them respecting the elements of things, and
that nothing can be farther from the truth than the account of the
Peripatetic doctrines given by Dr. Watson. Instead of maintaining,
as he carelessly represents, that “earth, air, fire, and water are
distinct, uncompounded, immutable principles;” they taught, on the
contrary, as we have shown, that all the elements are modifications
of one common substance called the primary matter, and consequently
they held, like himself, that “the elements are different magnitudes,
figures, and arrangements of particles of matter of the same kind.”
This primary matter they demonstrated to be devoid of all quality and
form, but susceptible of all forms and qualities.[332] In the language
of the Peripatetics, it is everything in capacity, but nothing in
actuality. They held that there are two original principles, both
increate and indestructible; the one matter, the universal passive
principle[333]--the material _from_ which all things are formed;
and the other, the efficient cause _by_ which all things are
made:--that the one is possessed of universal privation, and the other
of universal energy:--that it is the one which _impresses_,
and the other which _receives_ the forms of all things. They
maintained that the original materials out of which all objects in the
universe are composed being the same, bodies owe their characteristic
qualities not to their substance, but to their form. The elements,
then, according to the notions of the ancient philosophers, are
the first matter arranged into certain distinguishing forms by the
efficient cause. That form with which solidity is associated they
call earth, under which they ranged all metals, stones, and the like,
for all these they held to be allied to one another in nature, as
well as in the form under which they are presented to our senses.
The next arrangement of created substances is that which constitutes
fluidity, and is called water, under which term they comprehended not
only the native element, but every other modification of matter which
assumes a similar form, namely, all juices of vegetables and fluids
of animals.[334] Some of their earliest speculators in philosophy
maintained that all the materials which compose the universe existed
at one time in this form; and it is curious to reflect that modern
geology has reproduced nearly the same doctrine. The third form of
matter, as presented to our sense of touch, is air, under which the
ancient philosophers comprehended all matter in an aërial state, such
as water converted into vapor, and what are now called gases. Whether
or not they believed the atmosphere which surrounds this earth to be
a homogeneous substance, in nowise affects the general principles of
their philosophy; for it is the same thing, as far as regards their
classification, whether they held that the atmosphere consists of one
or of several distinct combinations of the primary matter with form.
As they were well aware that several distinct modifications of matter
are comprehended under each of the other elements, it can hardly be
doubted that they inferred the like of air; and, indeed, it is quite
apparent from the works of Galen that he knew very well that some
kinds of air are favorable, and others unfavorable to respiration and
combustion.[335] But those phenomena which we ascribe to oxygen gas,
they, without doubt, would have attributed to the operations of some
modification of the element fire. By fire, they meant matter in its
extreme state of tenuity and refinement. Of this elementary principle,
Plato[336] and Theophrastus[337] have enumerated many varieties,
and have speculated regarding their nature with great precision and
acuteness. The ancient philosophers believed that fire is universally
diffused through the universe, being sometimes in a _sensible_,
and sometimes in a _latent_ state; or, as Aristotle expressed it,
heat exists sometimes in capacity, and sometimes in energy.[338] They
attributed the phenomena of lightning to an unequal distribution of
this elemental fire.[339] This is the element with which they supposed
life to be most intimately connected; and, indeed, some of them would
appear to have considered fire as the very essence of the soul. “I
am of opinion,” says the author of one of the Hippocratic treatises,
“that what we call heat is immortal, and understands, sees, and hears
all things that are or will be.”[340] This doctrine, which, to say the
least of it, is not very judiciously expressed in this passage, is thus
corrected by the great master of logic and philosophy: “Some,” says
Aristotle, “improperly call fire or some such power the soul; but it
would be better to say that the soul subsists in such a body, because
heat is, of all bodies, the one most obedient to the operations of the
soul; for to nourish and move are the operations of the soul, and these
she performs by the instrumentality of this power (_or_ quality?).
To say that the soul is fire, is as if one were to call a saw or a
wimble the artisan or his art, because his work is accomplished in
co-operation with these instruments. From this it appears why animals
stand in need of heat.”[341] And in like manner he says, in another of
his works: “Some are of opinion that the nature of fire is plainly the
cause of nourishment and of growth; for it appears to be the only body
or element which nourishes and increases itself. Wherefore one might
suppose that it is this that operates both in plants and in animals.
Yet it is but the co-cause (συνάιτιον); for _it_ is not, properly
speaking, the cause, but rather the soul. For the increase of fire is
indeterminate in so far as it is supplied with fuel. But of natural
substances there is a certain limit and reason (λόγος) of magnitude and
increase. This belongs to the soul rather than to fire, to the reason
rather than to the matter.”[342]
From these observations, coupled with the information supplied in
the preceding extracts, it will be perceived that, although there be,
at first sight, a great discrepancy among physical doctrines of the
ancient philosophers, they differed, in fact, much less than they
would appear to do, only that some of them expressed themselves more
scientifically than others in handling the subject of the elements.
Thus, although Thales seems to hold _water_, and Anaximander
_air_, and Heraclitus _fire_, to be original principles, we
have every reason to believe that, as Galen says (l. c.), even they had
an idea that these are not simple substances, but merely modifications
of one unformed principle, the first matter, from which they conceived
that all bodies in the universe are constructed. Contrary, then, to
what is very generally supposed, it would appear that there was at
bottom no very great difference of opinion between the philosophers
of the Ionic school and those of the other sects, namely, the
Pythagoreans, Platonists, Peripatetics, Stoics, and Epicureans; and
further, that, from the earliest dawn of philosophy, down to the time
when it fell into neglect and came to be misunderstood, the physical
doctrines of the philosophers underwent but little variation.
From the elements, then, constructed in the manner now explained, out
of the primary matter, the ancient philosophers taught that all the
secondary bodies in the universe are formed, and as they maintained the
transmutability of the elements into one another, so, in like manner,
they did not hesitate to proclaim it as a great general truth “that all
things are convertible into all things.”[343] The possibility, then,
of such permutations will not, I presume, be questioned by any one who
has formed correct ideas of the powers of the Great First Cause, and
the capacities of the first subject, Matter, and that such permutations
do actually take place in the course of Nature may be inferred from
many phenomena of daily occurrence in the vegetable and animal world.
It cannot have escaped the most careless observation what changes the
great pabulum, water, undergoes in the process of vegetation--how it
is converted into various woods, and barks, and leaves, and flowers,
all of which are resolvable, by the process of decay, into air, or
reducible into earth. It is also well known that, although a more
unfrequent occurrence, all the solid parts of a tree may undergo a
mutation into rock, that is to say, may become petrified. But it is in
the higher classes of animals that these changes of simple matter admit
of the greatest variety. Let us contemplate for a moment some of the
most remarkable mutations which any article of food (as, for example,
flour-bread), which has been presented to the stomach, is destined
to undergo in the animal frame. We know that the vital powers of the
stomach will convert the starch, of which it principally consists, into
a fluid state, that is to say, into what is called first chyme, and
afterwards, when it has undergone some further change, is denominated
chyle by the physiologists. Having been thus changed, it passes, by a
process about the nature of which physiologists are still strangely
divided in opinion, into certain vessels; and then, in some manner
still less understood, it is converted into a fluid _sui generis_,
called blood, abounding in globules of a singular construction, all
fabricated, no doubt, from the food, but, by some occult process,
which has hitherto defied the skillful manipulation of the chemist,
and the accurate observation of the microscopist, to explain in any
satisfactory manner.[344] And so complete is the transformation that
scarcely one particle of the original food can be detected in the
new product by all the vaunted tests of modern science. But blood is
soon after converted into many other fluid and solid substances--into
bones, cartilages, muscles, and vessels, and into bile, mucus, and
other recrementitious matters, all differing greatly from one another,
both in their appearances and in their properties.[345] And when all
the component parts of the animal frame are constructed, and each
seems to have acquired a determinate structure, should the vital
actions by which they are formed become deranged, we may see the
fair fabric undergo the most wonderful mutations, so that arteries
are converted into bones, and bones into flesh and jelly.[346] So
many and so extraordinary are the changes which a simple alimentary
substance may undergo in the animal frame! And if we admit, with the
ancient philosophers, that every such substance is resolvable into one
or more of the elements, and that all the elements are but different
modifications of one common matter, how wonderful a thing must Form be,
since it imparts such varied appearances and qualities to one common
substratum?
* * * * *
In detailing these opinions of the ancient philosophers, it is not my
present business to determine whether they be true or not; my task is
fulfilled, if I have given a distinct and faithful exposition of them,
so that their real import and meaning may be readily comprehended by
the medical reader. I may be allowed to remark, however, that, strange
although that Protean being, the primary matter, may appear to be to
such men of science as are not disposed to recognize the existence of
any substance which cannot be subjected to their senses, and who refuse
to admit the legitimacy of every process of analysis, but what is
conducted in the laboratory of the chemist, opinions similar to those
of the ancient philosophers have been held by some of the most profound
thinkers and distinguished experimentalists of modern times. Thus Lord
Bacon, the reputed father of the inductive philosophy, appears to admit
all the tenets of the ancients regarding the first matter, which,
like them, he considers to have been embodied in the Homeric fable of
Proteus.[347] He says, in reference to it, “that under the person of
Proteus is signified _Matter_, the most ancient of all things,
next to the Deity; that the herd of Proteus was nothing else than the
ordinary species of animals, plants, and metals, into which matter
appears to diffuse, and, as it were, to consume itself; so that, after
it has formed and finished those several species, (its task being,
in a manner, complete,) it appears to sleep and be at rest, nor to
labor at, attempt, or prepare any species farther.”[348] That learned
and accomplished scholar, Mr. Harris, in his work on “Philosophical
Arrangements,” writes thus on the subject we are now treating of:
“Here, then, we have an idea (such as it is) of that singular being,
the Primary Matter, a Being which those philosophers who are immerged
in sensible subjects know not well how to admit, though they cannot
well do without it; a Being which flies the perception of every sense,
and which is at best, even to the intellect, but a negative object, no
otherwise comprehensible than either by analogy or abstraction.
“We gain a glimpse of it by abstraction, when we say that the first
matter is not the lineaments and complexion which make the beautiful
face; nor yet the flesh and blood which make these lineaments and that
complexion; nor yet the liquid and solid aliments, which make that
flesh and blood; nor yet the simple bodies of earth and water, which
make those various aliments; but something which, being below all
these, and supporting them all, is yet different from them all, and
essential to their existence.
“We obtain a sight of it by analogy when we say that, as is the brass
to the statue, the marble to the pillar, the timber to the ship, or
any one secondary matter to any secondary form; so is the First and
Original Matter to all forms in general.”[349]
Nay, the illustrious Sir Isaac Newton would seem, in the following
extract, to countenance the profound speculations of the ancient
philosophers with respect to the elements, and the transmutations of
these substances into one another. He says, “Are not gross bodies and
light (_or_ ether) convertible into one another?--and may not
bodies receive much of their activity from the particles of light
which enter into their composition? The changing of bodies into light
and of light into bodies is very agreeable to the course of Nature,
which seems delighted with permutations. Water, which is a very fluid
tasteless salt, she changes by heat into vapor, a sort of air; and
by cold into ice, which is a hard, pellucid, brittle, fusible stone,
and this stone returns into water by heat, and vapor returns into
water by cold. Earth, by heat, becomes fire, and by cold returns into
earth.”[350]
I may further mention that all the late researches of chemical
philosophers have tended to confirm the tenets of the ancients
regarding the Elements. Thus in that very singular performance “The
Elements of Physiophilosophy,” by Dr. Lorenz Oken, the productions of
the mineral kingdom are classified, very much in accordance with the
ancient arrangement, into four classes, namely, into Earth-earths,
Water-earths, Air-earths, and Fire-earths.[351] It is also well
known that chemical experiment has lately established that several
animal and vegetable substances, such as albumen, fibrin, and casein,
which were formerly looked upon as distinct substances, are all but
modifications of one substance, which is now regarded as the original
of all the tissues; and further, that protein, in every respect
identical with that which forms the basis of the three aforesaid animal
principles, may be obtained from similar elements in the vegetable
kingdom.[352] And if every step which we advance in the knowledge
of the intimate structure of things leads us to contract the number
of substances formerly held to be simple, I would not wonder if it
should yet turn out that oxygen, carbon, hydrogen, and nitrogen are,
like what the ancients held the elements to be--all nothing else but
different modifications of one ever-changing matter. But I will not
indulge further in such speculations, especially as I have reason to
apprehend that I may be thought to be wandering from my own proper
sphere in thus prosecuting researches which may be supposed to have
but a distant bearing on the subject now in hand. I must, however,
be allowed again to repeat my declaration that it is impossible to
comprehend the theories contained in the Hippocratic treatises without
a proper acquaintance with the Physical Philosophy of the ancients,
and that these principles have been misapprehended and misrepresented
most unaccountably by modern writers, so as to occasion corresponding
mistakes with regard to ancient medicine. I trust, then, that my
present labors will not be ineffectual in preventing such mistakes
in future; though, at the same time, knowing, as I well do, the
practical bent of British science at the present day, I cannot but be
apprehensive that a certain portion of my readers will lend a deaf ear
to speculative opinions, of which they cannot recognize the importance,
and will be disposed to discard the doctrines of the ancient
philosophers, before they have rightly comprehended their import:
“Nec mea dona tibi studio comporta fideli
Intellecta prius quam sint, contempta relinquas.”[353]
I am sensible, too, that I may have just reason to suspect that I
still retain a too partial fondness for the fascinating studies in
which I indulged at one period, beyond what, perhaps, was prudent in
a physician, and that it would have been better for me if I had taken
a lesson from the mythical hero of the “Odyssey,” and had resisted
the enchanting voice of the ancient Siren when she sought to allure
me from the active duties of a professional life, with the confident
assurance that I should leave her “much delighted, and with an increase
of knowledge.”[354]
* * * * *
Before concluding, I will briefly recapitulate the results to which our
present inquiry has conducted us:--
1st. That many of the medical theories which occur in the Hippocratic
treatises are founded on the physical philosophy of the ancients, and
more particularly on their doctrines, with regard to the elements of
things.
2d. That all the great sects of the ancient philosophers held that the
four elements, namely, fire, air, earth, and water, are transmutable
into one another, being all of a homogeneous nature, and based on one
common substratum, namely, the primary matter.
3d. That, by reasoning from observation and analogy, the ancient
philosophers arrived at the conclusion that this primary matter is a
substance devoid of all qualities and forms, but susceptible of all
forms and qualities.
4th. That although certain of the philosophers, the contemporaries
and predecessors of Hippocrates, appear to hold that some one of the
elements, such as fire and water, was the original of all things, even
these had an idea, although not expressed by them in a definite manner,
of a first matter, which serves as a basis to all the elements.
5th. That these doctrines of the ancient philosophers, whether well
founded or not, are countenanced by many eminent names in modern
literature and philosophy.
6th. That the opinion generally entertained regarding the doctrines
of the ancient philosophers on this subject is altogether erroneous.
THE WORKS OF HIPPOCRATES.
ON ANCIENT MEDICINE.
THE ARGUMENT.
Although, as stated in the second section of the Preliminary
Discourse, the evidence in support of this treatise be unfortunately
not such as clearly to establish its genuineness, all who read it
with attention must admit that it is replete with important matters,
and that if not the production of Hippocrates, it is not unworthy of
his high reputation. Notwithstanding, then, that I am by no means
so well convinced as M. Littré is, that the work is genuine, I have
not hesitated to follow his example in placing it at the head of the
list, as the nature of its contents is such as to form an excellent
introduction to the study of the Hippocratic medicine.
It contains, as M. Littré remarks, a polemic, a method, and a system.
The polemic is directed against those of his predecessors who had
corrupted medicine by introducing hypotheses into it as the causes
of disease, such as heat, cold, moisture, and dryness. These it will
be seen that he combats with great force of argument and clearness
of illustration. The philosophical dogmas to which he is supposed to
refer in this place are those of the section of Pythagoreans, called
the Eleatic, who would appear to have held nearly the same opinions
as Pythagoras himself with regard to the elements.[355] But, in
fact, as I trust I have clearly made out in the third section of the
Preliminary Discourse, all the ancient philosophers held substantially
the same opinion regarding the elements, although they did not all
express themselves in the same terms. It is of little consequence,
then, to attempt to find out what particular class of philosophers our
author directs his attack against, it being sufficient to say that
he decidedly condemns the practice of founding the rules of medical
practice on hypothesis.[356] I may here remark, that the censure thus
bestowed on hypothetical systems applies to modern times as well as to
ancient, to those who proclaim theories by which, like Broussais, they
account for all diseases upon figments which they call inflammations,
and those who, like Cullen, attribute most diseases to spasms. We may
rest assured, from the sensible observations which Hippocrates makes on
this subject in the present work, that the causes of all diseases are
realities, provided we could find them out, and that they are not vague
abstractions, as the authors of these hypotheses suppose.
His method of cultivating medicine is founded on an attentive
examination of all the circumstances connected with real life, and his
system consists in studying the condition of the humors in the body,
their origin, their coction, and their disappearance.
The most prominent feature, however, in the contents of this little
treatise is the practical view which is here given of the origin of
medicine, namely, from the necessities and weaknesses of the human
race. The author clearly makes it out that Medicine is, as it were, a
corollary to Dietetics. Nothing of the kind can well be imagined more
ingenious and original than his observations and reasonings on this
head in the introductory sections to this treatise. See in particular §
5.
The remarks in refutation of the hypothesis of cold, heat, moist, and
dry, are very interesting. (§ 13.)
The reflections on the origin of fevers and inflammations are very just
and original, but would appear not to have been properly appreciated by
his successors; for among all the ancient authors who have treated of
fevers, there is, perhaps, no one but himself who has stated in decided
terms that there is something more in a fever than a mere increase of
the innate (_or_ animal) heat. See the Commentary on PAULUS
ÆGINETA, B. II., 1.
The remarks on the effects of the cold bath at § 16 are much to the
purpose, and deserve attention.
The observations on rheums _or_ defluxions (§ 19) are also very
striking, and even at the present day, after the many vicissitudes of
medical theory which we have gone through, it would be difficult to
deny that the opinions here advanced are well founded. At all events
they must be allowed to be highly interesting, as containing the first
germ of a theory which long flourished in the schools of medicine.
At § 20 the author seems to hold that philosophy is not so necessary
to medicine as medicine is to philosophy. Schulze, with a considerable
show of reason, argues that Celsus had this passage in view when he
pronounced, concerning Hippocrates, that he was the first person
who separated medicine from philosophy. (Hist. Med. I., 3, i., 26.)
Schulze contends that what Celsus meant was, that Hippocrates discarded
_à priori_ arguments in medicine, and drew all his inferences
from actual observation. This would appear to me the most plausible
interpretation which has ever been given to this celebrated passage
in the preface of Celsus. Philosophy, then, it would appear, freed
medicine from the delusions of superstition, by substituting the errors
of hypothesis in their place, and the important office which he who was
called the Father of Medicine conferred upon the art was by discarding
both superstition and hypothesis, and substituting the results of
actual observation in the room of both.
From § 22 to the end of the work the author gives important
observations on the modifications which diseases undergo in connection
with the peculiar organization of the part in which they are situated.
It may well be doubted whether the remarks and reflections herein
contained have ever obtained all the attention which they merit.
The style of this piece is certainly elegant and beautiful; and it is
proper to mention that the text is remarkably improved in M. Littré’s
edition. In all the previous editions it was more corrupt than that of
almost any other of the Hippocratic treatises.
The following remarks of M. Littré on the present work appear to me so
just, and are so elegantly expressed, that I cannot deny myself the
pleasure of introducing them here in the original:
“En résumé, le livre de _l’Ancienne Médecine_ donne une idée
des problèmes agités du temps d’Hippocrate, et de la manière donts
ils étaient débattus. Il s’agissait, dans la plus grande généralité
de la pathologie de déterminer la cause des maladies ou, en d’autres
termes, de poser les bases d’un système de médecine. Certains médecins
disaient que cette cause, étant une, résidait dans une propriété unique
du corps, propriété qu’ils spécifiaient. Hippocrate répétait qu’en
fait, cela était en contradiction avec l’expérience, qu’en principe
une hypothèse était suspecte et stérile, et qu’il n’y avait de sureté
que dans l’études des faits et dans la tradition de la science qui y
ramene. Ainsi, quatre cents ans avant J. C., on essayait de rattacher
toute la médecine à une seule propriété hypothétique, comme on l’a
essayé de nos jours; mais cette propriété était ou le chaud, ou le
froid, ou l’humide, ou le sec. Quatre cents ans avant J. C., un esprit
sévère et éclairé combattait de telles opinions au nom de l’expérience,
montrait que les causes des maladies ne pouvant pas se ramener à
une seule, le champ de la pathologie générale était bien plus vaste
qu’on ne croyait; et formulait ce que l’observation lui avait permis
de conclure; mais sa conclusion n’embrasse guère que la trouble dans
le mélange des humeurs, que leur coction et leurs crises. Depuis
lors, la méthode de ceux qu’Hippocrate avait combattus, et la méthode
d’Hippocrate, l’hypothèse et l’observation se sont perpétuées, ainsi
que le témoigne l’histoire de la médecine, mais ce ne sont plus ni
l’ancienne hypothèse, ni l’ancienne observation.
“Il est certainement instructif d’étudier, dans le cours du temps, les
problèmes tels qu’ils ont été posés, et les discussions qu’ils ont
soulevées. On le voit, la science antique a de grandes ressemblances
avec la science moderne; dès l’époque que nous sommes forcés de
regarder comme l’aurore de la médecine, dès les premiers monuments
que nous possédons, les questions fondamentales sont débattues, et
les limites de l’esprit humain sont touchées. Mais en dedans de
ces limites, la science trouve, dans une immensité inépuisable de
combinaisons, les matériaux qui la font grandir; et il est impossible
de ne pas reconnaître que, sur un sol et avec les aliments que lui
fournissent les choses et l’expérience, elle se développe en vertu d’un
principe interne de vie, qui reside dans l’enchaînement nécessaire de
son développement successif.”[357]
ON ANCIENT MEDICINE.
1. Whoever having undertaken to speak or write on Medicine, have first
laid down for themselves some hypothesis to their argument, such as
hot, or cold, or moist, or dry, or whatever else they choose (thus
reducing their subject within a narrow compass, and supposing only
one or two original causes of diseases or of death among mankind),
are all clearly mistaken in much that they say; and this is the more
reprehensible as relating to an art which all men avail themselves
of on the most important occasions, and the good operators and
practitioners in which they hold in especial honor. For there are
practitioners, some bad and some far otherwise, which, if there had
been no such thing as Medicine, and if nothing had been investigated
or found out in it, would not have been the case, but all would have
been equally unskilled and ignorant of it, and everything concerning
the sick would have been directed by chance. But now it is not so;
for, as in all the other arts, those who practise them differ much
from one another in dexterity and knowledge, so is it in like manner
with Medicine. Wherefore I have not thought that it stood in need of
an empty hypothesis, like those subjects which are occult and dubious,
in attempting to handle which it is necessary to use some hypothesis;
as, for example, with regard to things above us and things below the
earth;[358] if any one should treat of these and undertake to declare
how they are constituted, the reader or hearer could not find out,
whether what is delivered be true or false; for there is nothing which
can be referred to in order to discover the truth.
2. But all these requisites belong of old to Medicine, and an origin
and way have been found out, by which many and elegant discoveries
have been made, during a length of time, and others will yet be found
out, if a person possessed of the proper ability, and knowing those
discoveries which have been made, should proceed from them to prosecute
his investigations. But whoever, rejecting and despising all these,
attempts to pursue another course and form of inquiry, and says he has
discovered anything, is deceived himself and deceives others, for the
thing is impossible. And for what reason it is impossible, I will now
endeavor to explain, by stating and showing what the art really is.
From this it will be manifest that discoveries cannot possibly be made
in any other way. And most especially, it appears to me, that whoever
treats of this art should treat of things which are familiar to the
common people. For of nothing else will such a one have to inquire
or treat, but of the diseases under which the common people have
labored, which diseases and the causes of their origin and departure,
their increase and decline, illiterate persons cannot easily find out
themselves, but still it is easy for them to understand these things
when discovered and expounded by others. For it is nothing more than
that every one is put in mind of what had occurred to himself. But
whoever does not reach the capacity of the illiterate vulgar and fails
to make them listen to him, misses his mark. Wherefore, then, there is
no necessity for any hypothesis.
3. For the art of Medicine would not have been invented at first, nor
would it have been made a subject of investigation (for there would
have been no need of it), if when men are indisposed, the same food and
other articles of regimen which they eat and drink when in good health
were proper for them, and if no others were preferable to these. But
now necessity itself made medicine to be sought out and discovered by
men, since the same things when administered to the sick, which agreed
with them when in good health, neither did nor do agree with them. But
to go still further back, I hold that the diet and food which people in
health now use would not have been discovered, provided it had suited
with man to eat and drink in like manner as the ox, the horse, and all
other animals, except man, do of the productions of the earth, such
as fruits, weeds, and grass; for from such things these animals grow,
live free of disease, and require no other kind of food. And, at first,
I am of opinion that man used the same sort of food, and that the
present articles of diet had been discovered and invented only after a
long lapse of time. For when they suffered much and severely from this
strong and brutish diet, swallowing things which were raw, unmixed,
and possessing great strength, they became exposed to strong pains and
diseases, and to early deaths. It is likely, indeed, that from habit
they would suffer less from these things then than we would now, but
still they would suffer severely even then; and it is likely that the
greater number, and those who had weaker constitutions, would all
perish; whereas the stronger would hold out for a longer time, as even
nowadays some, in consequence of using strong articles of food, get
off with little trouble, but others with much pain and suffering. From
this necessity it appears to me that they would search out the food
befitting their nature, and thus discover that which we now use: and
that from wheat, by macerating it, stripping it of its hull, grinding
it all down, sifting, toasting, and baking it, they formed bread;[359]
and from barley they formed cake (maza),[360] performing many
operations in regard to it; they boiled, they roasted, they mixed, they
diluted those things which are strong and of intense qualities with
weaker things, fashioning them to the nature and powers of man, and
considering that the stronger things Nature would not be able to manage
if administered, and that from such things pains, diseases, and death
would arise, but such as Nature could manage, that from them food,
growth, and health, would arise. To such a discovery and investigation
what more suitable name could one give than that of Medicine? since it
was discovered for the health of man, for his nourishment and safety,
as a substitute for that kind of diet by which pains, diseases, and
deaths were occasioned.
4. And if this is not held to be an art, I do not object. For it is not
suitable to call any one an artist of that which no one is ignorant of,
but which all know from usage and necessity. But still the discovery is
a great one, and requiring much art and investigation. Wherefore those
who devote themselves to gymnastics and training, are always making
some new discovery, by pursuing the same line of inquiry, where, by
eating and drinking certain things, they are improved and grow stronger
than they were.[361]
5. Let us inquire then regarding what is admitted to be Medicine;
namely, that which was invented for the sake of the sick, which
possesses a name and practitioners, whether it also seeks to accomplish
the same objects, and whence it derived its origin. To me, then, it
appears, as I said at the commencement, that nobody would have sought
for medicine at all, provided the same kinds of diet had suited with
men in sickness as in good health. Wherefore, even yet, such races of
men as make no use of medicine, namely, barbarians, and even certain
of the Greeks, live in the same way when sick as when in health; that
it to say, they take what suits their appetite, and neither abstain
from, nor restrict themselves in anything for which they have a desire.
But those who have cultivated and invented medicine, having the same
object in view as those of whom I formerly spoke, in the first place,
I suppose, diminished the quantity of the articles of food which they
used, and this alone would be sufficient for certain of the sick, and
be manifestly beneficial to them, although not to all, for there would
be some so affected as not to be able to manage even small quantities
of their usual food, and as such persons would seem to require
something weaker, they invented soups, by mixing a few strong things
with much water, and thus abstracting that which was strong in them by
dilution and boiling. But such as could not manage even soups, laid
them aside, and had recourse to drinks, and so regulated them as to
mixture and quantity, that they were administered neither stronger nor
weaker than what was required.
6. But this ought to be well known, that soups do not agree with
certain persons in their diseases, but, on the contrary, when
administered both the fevers and the pains are exacerbated, and it
becomes obvious that what was given has proved food and increase to the
disease, but a wasting and weakness to the body. But whatever persons
so affected partook of solid food, or cake, or bread, even in small
quantity, would be ten times and more decidedly injured than those who
had taken soups, for no other reason than from the strength of the food
in reference to the affection: and to whomsoever it is proper to take
soups and not eat solid food, such a one will be much more injured
if he eat much than if he eat little, but even little food will be
injurious to him. But all the causes of the sufferance refer themselves
to this rule, that the strongest things most especially and decidedly
hurt man, whether in health or in disease.
7. What other object, then, had he in view who is called a physician,
and is admitted to be a practitioner of the art, who found out the
regimen and diet befitting the sick, than he who originally found
out and prepared for all mankind that kind of food which we all now
use, in place of the former savage and brutish mode of living? To me
it appears that the mode is the same, and the discovery of a similar
nature. The one sought to abstract those things which the constitution
of man cannot digest, because of their wildness and intemperature, and
the other those things which are beyond the powers of the affection in
which any one may happen to be laid up. Now, how does the one differ
from the other, except that the latter admits of greater variety, and
requires more application, whereas the former was the commencement of
the process?
8. And if one would compare the diet of sick persons with that of
persons in health, he will find it not more injurious than that of
healthy persons in comparison with that of wild beasts and of other
animals. For, suppose a man laboring under one of those diseases which
are neither serious and unsupportable, nor yet altogether mild, but
such as that, upon making any mistake in diet, it will become apparent,
as if he should eat bread and flesh, or any other of those articles
which prove beneficial to healthy persons, and that, too, not in great
quantity, but much less than he could have taken when in good health;
and that another man in good health, having a constitution neither
very feeble, nor yet strong, eats of those things which are wholesome
and strengthening to an ox or a horse, such as vetches, barley, and
the like, and that, too, not in great quantity, but much less than he
could take; the healthy person who did so would be subjected to no
less disturbance and danger than the sick person who took bread or
cake unseasonably. All these things are proofs that Medicine is to be
prosecuted and discovered by the same method as the other.
9. And if it were simply, as is laid down, that such things as are
stronger prove injurious, but such as are weaker prove beneficial and
nourishing, both to sick and healthy persons, it were an easy matter,
for then the safest rule would be to circumscribe the diet to the
lowest point. But then it is no less mistake, nor one that injures
a man less, provided a deficient diet, or one consisting of weaker
things than what are proper, be administered. For, in the constitution
of man, abstinence may enervate, weaken, and kill. And there are many
other ills, different from those of repletion, but no less dreadful,
arising from deficiency of food; wherefore the practice in those cases
is more varied, and requires greater accuracy. For one must aim at
attaining a certain measure, and yet this measure admits neither weight
nor calculation of any kind, by which it may be accurately determined,
unless it be the sensation of the body; wherefore it is a task to
learn this accurately, so as not to commit small blunders either on
the one side or the other, and in fact I would give great praise to
the physician whose mistakes are small, for perfect accuracy is seldom
to be seen, since many physicians seem to me to be in the same plight
as bad pilots, who, if they commit mistakes while conducting the ship
in a calm do not expose themselves, but when a storm and violent
hurricane overtake them, they then, from their ignorance and mistakes,
are discovered to be what they are, by all men, namely, in losing their
ship. And thus bad and commonplace physicians, when they treat men who
have no serious illness, in which case one may commit great mistakes
without producing any formidable mischief, (and such complaints
occur much more frequently to men than dangerous ones); under these
circumstances, when they commit mistakes, they do not expose themselves
to ordinary men; but when they fall in with a great, a strong, and
a dangerous disease, then their mistakes and want of skill are made
apparent to all. Their punishment is not far off, but is swift in
overtaking both the one and the other.[362]
10. And that no less mischief happens to a man from unseasonable
depletion than from repletion, may be clearly seen upon reverting to
the consideration of persons in health. For, to some, with whom it
agrees to take only one meal in the day, and they have arranged it so
accordingly; whilst others, for the same reason, also take dinner, and
this they do because they find it good for them, and not like those
persons who, for pleasure or from any casual circumstance, adopt the
one or the other custom: and to the bulk of mankind it is of little
consequence which of these rules they observe, that is to say, whether
they make it a practice to take one or two meals. But there are certain
persons who cannot readily change their diet with impunity; and if they
make any alteration in it for one day, or even for a part of a day,
are greatly injured thereby. Such persons, provided they take dinner
when it is not their wont, immediately become heavy and inactive,
both in body and mind, and are weighed down with yawning, slumbering,
and thirst; and if they take supper in addition, they are seized with
flatulence, tormina, and diarrhœa, and to many this has been the
commencement of a serious disease, when they have merely taken twice
in a day the same food which they have been in the custom of taking
once. And thus, also, if one who has been accustomed to dine, and
this rule agrees with him, should not dine at the accustomed hour, he
will straightway feel great loss of strength, trembling, and want of
spirits, the eyes of such a person will become more pallid, his urine
thick and hot, his mouth bitter; his bowels will seem, as it were,
to hang loose; he will suffer from vertigo, lowness of spirit, and
inactivity,--such are the effects; and if he should attempt to take
at supper the same food which he was wont to partake of at dinner,
it will appear insipid, and he will not be able to take it off; and
these things, passing downwards with tormina and rumbling, burn up his
bowels; he experiences insomnolency or troubled and disturbed dreams;
and to many of them these symptoms are the commencement of some disease.
11. But let us inquire what are the causes of these things which
happened to them. To him, then, who was accustomed to take only one
meal in the day, they happened because he did not wait the proper time,
until his bowels had completely derived benefit from and had digested
the articles taken at the preceding meal, and until his belly had
become soft, and got into a state of rest, but he gave it a new supply
while in a state of heat and fermentation, for such bellies digest much
more slowly, and require more rest and ease. And as to him who had
been accustomed to dinner, since, as soon as the body required food,
and when the former meal was consumed, and he wanted refreshment, no
new supply was furnished to it, he wastes and is consumed from want of
food. For all the symptoms which I describe as befalling to this man I
refer to want of food. And I also say that all men who, when in a state
of health, remain for two or three days without food, experience the
same unpleasant symptoms as those which I described in the case of him
who had omitted to take dinner.
12. Wherefore, I say, that such constitutions as suffer quickly and
strongly from errors in diet, are weaker than others that do not; and
that a weak person is in a state very nearly approaching to one in
disease; but a person in disease is the weaker, and it is, therefore,
more likely that he should suffer if he encounters anything that is
unseasonable. It is difficult, seeing that there is no such accuracy
in the Art, to hit always upon what is most expedient, and yet many
cases occur in medicine which would require this accuracy, as we shall
explain. But on that account, I say, we ought not to reject the ancient
Art, as if it were not, and had not been properly founded, because it
did not attain accuracy in all things, but rather, since it is capable
of reaching to the greatest exactitude by reasoning, to receive it and
admire its discoveries, made from a state of great ignorance, and as
having been well and properly made, and not from chance.
13. But I wish the discourse to revert to the new method of those
who prosecute their inquiries in the Art by hypothesis. For if hot,
or cold, or moist, or dry, be that which proves injurious to man, and
if the person who would treat him properly must apply cold to the
hot, hot to the cold, moist to the dry, and dry to the moist--let me
be presented with a man, not indeed one of a strong constitution, but
one of the weaker, and let him eat wheat, such as it is supplied from
the thrashing-floor, raw and unprepared, with raw meat, and let him
drink water. By using such a diet I know that he will suffer much and
severely, for he will experience pains, his body will become weak, and
his bowels deranged, and he will not subsist long. What remedy, then,
is to be provided for one so situated? Hot? or cold? or moist? or dry?
For it is clear that it must be one or other of these. For, according
to this principle, if it is one of these which is injuring the patient,
it is to be removed by its contrary. But the surest and most obvious
remedy is to change the diet which the person used, and instead of
wheat to give bread, and instead of raw flesh, boiled, and to drink
wine in addition to these: for by making these changes it is impossible
but that he must get better, unless completely disorganized by time and
diet. What, then, shall we say? whether that, as he suffered from cold,
these hot things being applied were of use to him, or the contrary? I
should think this question must prove a puzzler to whomsoever it is
put. For whether did he who prepared bread out of wheat remove the hot,
the cold, the moist, or the dry principle in it?--for the bread is
consigned both to fire and to water, and is wrought with many things,
each of which has its peculiar property and nature, some of which it
loses, and with others it is diluted and mixed.
14. And this I know, moreover, that to the human body it makes a great
difference whether the bread be fine or coarse;[363] of wheat with or
without the hull, whether mixed with much or little water, strongly
wrought or scarcely at all, baked or raw--and a multitude of similar
differences; and so, in like manner, with the cake (maza); the powers
of each, too, are great, and the one nowise like the other. Whoever
pays no attention to these things, or, paying attention, does not
comprehend them, how can he understand the diseases which befall a
man? For, by every one of these things, a man is affected and changed
this way or that, and the whole of his life is subjected to them,
whether in health, convalescence, or disease. Nothing else, then, can
be more important or more necessary to know than these things. So that
the first inventors, pursuing their investigations properly, and by a
suitable train of reasoning, according to the nature of man, made their
discoveries, and thought the Art worthy of being ascribed to a god, as
is the established belief. For they did not suppose that the dry or
the moist, the hot or the cold, or any of these, are either injurious
to man, or that man stands in need of them; but whatever in each was
strong, and more than a match for a man’s constitution, whatever he
could not manage, that they held to be hurtful, and sought to remove.
Now, of the sweet, the strongest is that which is intensely sweet; of
the bitter, that which is intensely bitter; of the acid, that which
is intensely acid; and of all things that which is extreme, for these
things they saw both existing in man, and proving injurious to him.
For there is in man the bitter and the salt, the sweet and the acid,
the sour and the insipid,[364] and a multitude of other things having
all sorts of powers both as regards quantity and strength. These, when
all mixed and mingled up with one another, are not apparent, neither
do they hurt a man; but when any of them is separate, and stands by
itself, then it becomes perceptible, and hurts a man. And thus, of
articles of food, those which are unsuitable and hurtful to man when
administered, every one is either bitter, or intensely so, or saltish
or acid, or something else intense and strong, and therefore we are
disordered by them in like manner as we are by the secretions in the
body. But all those things of which a man eats and drinks are devoid
of any such intense and well-marked quality, such as bread, cake, and
many other things of a similar nature which man is accustomed to use
for food, with the exception of condiments and confectionaries, which
are made to gratify the palate and for luxury. And from those things,
when received into the body abundantly, there is no disorder nor
dissolution of the powers belonging to the body; but strength, growth,
and nourishment result from them, and this for no other reason than
because they are well mixed, have nothing in them of an immoderate
character, nor anything strong, but the whole forms one simple and not
strong substance.
15. I cannot think in what manner they who advance this doctrine,
and transfer the Art from the cause I have described to hypothesis,
will cure men according to the principle which they have laid down.
For, as far as I know, neither the hot nor the cold, nor the dry, nor
the moist, has ever been found unmixed with any other quality; but I
suppose they use the same articles of meat and drink as all we other
men do. But to this substance they give the attribute of being hot, to
that cold, to that dry, and to that moist. Since it would be absurd to
advise the patient to take something hot, for he would straightway ask
what it is? so that he must either play the fool, or have recourse to
some one of the well-known substances: and if this hot thing happen
to be sour, and that hot thing insipid, and this hot thing has the
power of raising a disturbance in the body (and there are many other
kinds of heat, possessing many opposite powers), he will be obliged
to administer some one of them, either the hot and the sour, or the
hot and the insipid, or that which, at the same time, is cold and sour
(for there is such a substance), or the cold and the insipid. For, as
I think, the very opposite effects will result from either of these,
not only in man, but also in a bladder, a vessel of wood, and in many
other things possessed of far less sensibility than man; for it is not
the heat which is possessed of great efficacy, but the sour and the
insipid, and other qualities as described by me, both in man and out
of man, and that whether eaten or drunk, rubbed in externally, and
otherwise applied.
16. But I think that of all the qualities heat and cold exercise the
least operation in the body, for these reasons: as long time as hot
and cold are mixed up with one another they do not give trouble, for
the cold is attempered and rendered more moderate by the hot, and
the hot by the cold; but when the one is wholly separate from the
other, then it gives pain; and at that season when cold is applied it
creates some pain to a man, but quickly, for that very reason, heat
spontaneously arises in him without requiring any aid or preparation.
And these things operate thus both upon men in health and in disease.
For example, if a person in health wishes to cool his body during
winter, and bathes either in cold water or in any other way, the more
he does this, unless his body be fairly congealed, when he resumes his
clothes and comes into a place of shelter, his body becomes more heated
than before. And thus, too, if a person wish to be warmed thoroughly
either by means of a hot bath or strong fire, and straightway having
the same clothing on, takes up his abode again in the place he was in
when he became congealed, he will appear much colder, and more disposed
to chills than before. And if a person fan himself on account of a
suffocating heat, and having procured refrigeration for himself in this
manner, cease doing so, the heat and suffocation will be ten times
greater in his case than in that of a person who does nothing of the
kind. And, to give a more striking example, persons travelling in the
snow, or otherwise in rigorous weather, and contracting great cold in
their feet, their hands, or their head, what do they not suffer from
inflammation and tingling when they put on warm clothing and get into
a hot place? In some instances, blisters arise as if from burning with
fire, and they do not suffer from any of those unpleasant symptoms
until they become heated. So readily does either of these pass into
the other; and I could mention many other examples. And with regard
to the sick, is it not in those who experience a rigor that the most
acute fever is apt to break out? And yet not so strongly neither,
but that it ceases in a short time, and, for the most part, without
having occasioned much mischief; and while it remains, it is hot,
and passing over the whole body, ends for the most part in the feet,
where the chills and cold were most intense and lasted longest: and,
when sweat supervenes, and the fever passes off, the patient is much
colder than if he had not taken the fever at all. Why then should that
which so quickly passes into the opposite extreme, and loses its own
powers spontaneously, be reckoned a mighty and serious affair? And what
necessity is there for any great remedy for it?
17. One might here say--but persons in ardent fevers, pneumonia, and
other formidable diseases, do not quickly get rid of the heat, nor
experience these rapid alterations of heat and cold. And I reckon this
very circumstance the strongest proof that it is not from heat simply
that men get into the febrile state, neither is it the sole cause of
the mischief, but that this species of heat is bitter, and that acid,
and the other saltish, and many other varieties; and again there is
cold combined with other qualities. These are what proves injurious:
heat, it is true, is present also, possessed of strength as being that
which conducts, is exacerbated and increased along with the other, but
has no power greater than what is peculiar to itself.
18. With regard to these symptoms, in the first place those are most
obvious of which we have all often had experience. Thus, then, in such
of us as have a coryza and defluction from the nostrils, this discharge
is much more acrid than that which formerly was formed in and ran from
them daily; and it occasions swelling of the nose, and it inflames,
being of a hot and extremely ardent nature, as you may know, if you
apply your hand to the place; and, if the disease remains long, the
part becomes ulcerated although destitute of flesh and hard; and the
heat in the nose ceases, not when the defluxion takes place and the
inflammation is present, but when the running becomes thicker and less
acrid, and more mixed with the former secretion, then it is that the
heat ceases. But in all those cases in which this decidedly proceeds
from cold alone, without the concourse of any other quality, there is
a change from cold to hot, and from hot to cold, and these quickly
supervene, and require no coction. But all the others being connected,
as I have said, with acrimony and intemperance of humors, pass off in
this way by being mixed and concocted.
19. But such defluxions as are determined to the eyes being possessed
of strong and varied acrimonies, ulcerate the eyelids, and in some
cases corrode the cheeks and parts below the eyes upon which the flow,
and even occasion rupture and erosion of the tunic which surrounds
the eyeball. But pain, heat, and extreme burning prevail until the
defluxions are concocted and become thicker, and concretions form about
the eyes, and the coction takes place from the fluids being mixed up,
diluted, and digested together. And in defluxions upon the throat,
from which are formed hoarseness, cynanche, erysipelas, and pneumonia,
all these have at first saltish, watery, and acrid discharges, and
with these the diseases gain strength. But when the discharges become
thicker, more concocted, and are freed from all acrimony, then, indeed,
the fevers pass away, and the other symptoms which annoyed the patient;
for we must account those things the cause of each complaint, which,
being present in a certain fashion, the complaint exists, but it ceases
when they change to another combination. But those which originate from
pure heat or cold, and do not participate in any other quality, will
then cease when they undergo a change from cold to hot, and from hot to
cold; and they change in the manner I have described before. Wherefore,
all the other complaints to which man is subject arise from powers
(qualities?). Thus, when there is an overflow of the bitter principle,
which we call yellow bile, what anxiety, burning heat, and loss of
strength prevail! but if relieved from it, either by being purged
spontaneously, or by means of a medicine seasonably administered, the
patient is decidedly relieved of the pains and heat; but while these
things float on the stomach, unconcocted and undigested, no contrivance
could make the pains and fever cease; and when there are acidities of
an acrid and æruginous character, what varieties of frenzy, gnawing
pains in the bowels and chest, and inquietude, prevail! and these
do not cease until the acidities be purged away, or are calmed down
and mixed with other fluids. The coction, change, attenuation, and
thickening into the form of humors, take place through many and
various forms; therefore the crises and calculations of time are of
great importance in such matters; but to all such changes hot and cold
are but little exposed, for these are neither liable to putrefaction
nor thickening. What then shall we say of the change? that it is a
combination (crasis) of these humors having different powers toward one
another. But the hot does not lose its heat when mixed with any other
thing except the cold; nor again, the cold, except when mixed with the
hot. But all other things connected with man become the more mild and
better in proportion as they are mixed with the more things besides.
But a man is in the best possible state when they are concocted and
at rest, exhibiting no one peculiar quality; but I think I have said
enough in explanation of them.
20. Certain sophists and physicians say that it is not possible for
any one to know medicine who does not know what man is [and how he was
made and how constructed], and that whoever would cure men properly,
must learn this in the first place. But this saying rather appertains
to philosophy, as Empedocles and certain others have described what man
in his origin is, and how he first was made and constructed.[365] But
I think whatever such has been said or written by sophist or physician
concerning nature has less connection with the art of medicine than
with the art of painting. And I think that one cannot know anything
certain respecting nature from any other quarter than from medicine;
and that this knowledge is to be attained when one comprehends the
whole subject of medicine properly, but not until then; and I say
that this history shows what man is, by what causes he was made,
and other things accurately. Wherefore it appears to me necessary
to every physician to be skilled in nature, and strive to know, if
he would wish to perform his duties, what man is in relation to the
articles of food and drink, and to his other occupations, and what
are the effects of each of them to every one. And it is not enough
to know simply that cheese is a bad article of food, as disagreeing
with whoever eats of it to satiety, but what sort of disturbance it
creates, and wherefore, and with what principle in man it disagrees;
for there are many other articles of food and drink naturally bad which
affect man in a different manner. Thus, to illustrate my meaning by an
example, undiluted wine drunk in large quantity renders a man feeble;
and everybody seeing this knows that such is the power of wine, and
the cause thereof; and we know, moreover, on what parts of a man’s
body it principally exerts its action; and I wish the same certainty
to appear in other cases. For cheese (since we used it as an example)
does not prove equally injurious to all men, for there are some who can
take it to satiety without being hurt by it in the least, but, on the
contrary, it is wonderful what strength it imparts to those it agrees
with; but there are some who do not bear it well, their constitutions
are different, and they differ in this respect, that what in their body
is incompatible with cheese, is roused and put in commotion by such a
thing; and those in whose bodies such a humor happens to prevail in
greater quantity and intensity, are likely to suffer the more from it.
But if the thing had been pernicious to the whole nature of man, it
would have hurt all. Whoever knows these things will not suffer from it.
21. During convalescence from diseases, and also in protracted
diseases, many disorders occur, some spontaneously, and some from
certain things accidentally administered. I know that the common herd
of physicians, like the vulgar, if there happen to have been any
innovation made about that day, such as the bath being used, a walk
taken, or any unusual food eaten, all which were better done than
otherwise, attribute notwithstanding the cause of these disorders, to
some of these things, being ignorant of the true cause but proscribing
what may have been very proper. Now this ought not to be so; but one
should know the effects of a bath or a walk unseasonably applied; for
thus there will never be any mischief from these things, nor from any
other thing, nor from repletion, nor from such and such an article of
food. Whoever does not know what effect these things produce upon a
man, cannot know the consequences which result from them, nor how to
apply them.
22. And it appears to me that one ought also to know what diseases
arise in man from the powers, and what from the structures. What do
I mean by this? By powers, I mean intense and strong juices; and by
structures, whatever conformations there are in man. For some are
hollow, and from broad contracted into narrow; some expanded, some hard
and round, some broad and suspended,[366] some stretched, some long,
some dense, some rare and succulent,[367] some spongy and of loose
texture.[368] Now, then, which of these figures is the best calculated
to suck to itself and attract humidity from another body? Whether
what is hollow and expanded, or what is solid and round, or what is
hollow, and from broad, gradually turning narrow? I think such as from
hollow and broad are contracted into narrow: this may be ascertained
otherwise from obvious facts: thus, if you gape wide with the mouth
you cannot draw in any liquid; but by protruding, contracting, and
compressing the lips, and still more by using a tube, you can readily
draw in whatever you wish. And thus, too, the instruments which are
used for cupping are broad below and gradually become narrow, and are
so constructed in order to suck and draw in from the fleshy parts.
The nature and construction of the parts within a man are of a like
nature; the bladder, the head, the uterus in woman; these parts clearly
attract, and are always filled with a juice which is foreign to them.
Those parts which are hollow and expanded are most likely to receive
any humidity flowing into them, but cannot attract it in like manner.
Those parts which are solid and round could not attract a humidity, nor
receive it when it flows to them, for it would glide past, and find no
place of rest on them. But spongy and rare parts, such as the spleen,
the lungs, and the breasts, drink up especially the juices around them,
and become hardened and enlarged by the accession of juices. Such
things happen to these organs especially. For it is not with the spleen
as with the stomach, in which there is a liquid, which it contains and
evacuates every day; but when it (the spleen) drinks up and receives a
fluid into itself, the hollow and lax parts of it are filled, even the
small interstices; and, instead of being rare and soft, it becomes hard
and dense, and it can neither digest nor discharge its contents: these
things it suffers, owing to the nature of its structure. Those things
which engender flatulence or tormina in the body, naturally do so in
the hollow and broad parts of the body, such as the stomach and chest,
where they produce rumbling noises; for when they do not fill the
parts so as to be stationary, but have changes of place and movements,
there must necessarily be noise and apparent movements from them. But
such parts as are fleshy and soft, in these there occur torpor and
obstructions, such as happen in apoplexy. But when it (the flatus?)
encounters a broad and resisting structure, and rushes against such a
part, and this happens when it is by nature not strong so as to be able
to withstand it without suffering injury; nor soft and rare, so as to
receive or yield to it, but tender, juicy, full of blood, and dense,
like the liver, owing to its density and broadness, it resists and does
not yield. But flatus, when it obtains admission, increases and becomes
stronger, and rushes toward any resisting object; but owing to its
tenderness, and the quantity of blood which it (the liver) contains,
it cannot be without uneasiness; and for these reasons the most acute
and frequent pains occur in the region of it, along with suppurations
and chronic tumors (phymata). These symptoms also occur in the site of
the diaphragm, but much less frequently; for the diaphragm is a broad,
expanded, and resisting substance, of a nervous (tendinous?) and strong
nature, and therefore less susceptible of pain; and yet pains and
chronic abscesses do occur about it.
23. There are both within and without the body many other kinds of
structure, which differ much from one another as to sufferings both in
health and disease; such as whether the head be small or large; the
neck slender or thick, long or short; the belly long or round; the
chest and ribs broad or narrow; and many others besides, all which you
ought to be acquainted with, and their differences; so that knowing the
causes of each, you may make the more accurate observations.
24. And, as has been formerly stated, one ought to be acquainted
with the powers of juices, and what action each of them has upon
man, and their alliances towards one another. What I say is this: if
a sweet juice change to another kind, net from any admixture, but
because it has undergone a mutation within itself; what does it first
become?--bitter? salt? austere? or acid? I think acid. And hence, an
acid juice is the most improper of all things that can be administered
in cases in which a sweet juice is the most proper. Thus, if one
should succeed in his investigations of external things, he would be
the better able always to select the best; for that is best which is
farthest removed from that which is unwholesome.
ON AIRS, WATERS, AND PLACES.
THE ARGUMENT.
Dr. Coray, in his excellent edition of this treatise, divides it
into six chapters, as follows: first, the Introduction (from § 1–3)
comprehends some general observations on the importance of cultivating
a knowledge of the effects which the different seasons, the winds, the
various kinds of water, the situation of cities, the nature of soils
and the modes of life, exercise upon the health, and the necessity of
a physician’s making himself well acquainted with all these matters,
if he would wish to practise his profession successfully. The author
insists, with particular earnestness, on the utility of studying the
constitution of the year and the nature of the seasons, and refutes the
opinions of those persons, in his days, who held that a knowledge of
all these things belongs to meteorology rather than to medicine. The
second chapter (§ 3–7) treats of climate, and the diseases prevalent in
localities characterized by their exposure to particular winds. Those
winds being peculiar to Greece, their names occasion some trouble in
order to understand them correctly, and we shall give below a summary
of what the modern Greek Coray says in illustration of them. This part
of the present treatise appears to have been highly elaborated, and
contains much important information. The third chapter (§ 7–10) treats
of the various kinds of water, and their effects in different states of
the human constitution. The remarks contained here are of an eminently
practical nature, and evidently must have been the results of patient
observation and experiment, so that, even at the present day, it would
be difficult to detect our author in a single error of judgment. In
this place he has occasion to deliver his opinions on the formation of
urinary calculi, which he does at considerable length; and I may be
permitted to remark, whatever may be thought of his etiology of the
disease, it will be admitted that his theory is plausible, and the best
that could well have been framed in the state of knowledge which then
prevailed on that subject. Indeed, even at the present day, it must
be allowed that this is a dark subject; we have acquired, it is true,
many new and curious facts connected with the minute structure of these
concretions, but it can hardly be affirmed that we have been able to
evolve from them any general principles, or certain rules of practice.
In the fourth chapter (§ 10–12), the nature of the seasons is treated
of, and their influence on the health circumstantially stated. Some
of the observations contained in this part of the work are remarkable
for their acuteness and originality, such as the following, that, in
estimating the effects of a season on the health, we ought to take
into account the seasons which preceded it. This is well expressed by
Celsus, as follows: “neque solum interest quales dies sint sed etiam
quales præcesserint.” (Præfat.) See also Hippocrates (de Humoribus, §
8); and Coray (ad h. 1. § cix.) It will be seen in our annotations that
a considerable number of the Aphorisms are abstracted from this part of
the present treatise. In the fifth chapter (§ 12–17), the effects of
climate and the institutions of society on the inhabitants of Asia are
treated of at considerable length. Our author, in this place, evinces
a great acquaintance with human life, and a most philosophical spirit
in contemplating the subject which he is handling. Indeed few works in
any language display so much accurate observation and originality of
thought. The varieties of disposition, and of intellectual and moral
development among mankind, are set down as being derived, in a great
measure, from differences of climate and modes of government. Thus the
Asiatics are of an effeminate and slavish disposition, because they
live in a soft climate, on a rich soil, where they are little exposed
to hardships or labor, and under a despotic form of government, which
arrests the development of their mental energies.[369] This part also
contains some interesting observations on the Macrocephali and the
inhabitants of Phasis. In the sixth and last chapter (§ 17 to the
end), the peculiar traits of the European character, as connected with
climate and institutions, are described in a very interesting manner.
Here the observations on the Amazons, Sauromatæ, and Scythians are
well deserving of an attentive perusal, and more particularly the
description of the disease induced by continual riding on horseback,
the probable nature of which we shall consider presently. Here, too,
are given our author’s remarks on diseases supposed to be divine,
which, as we have stated in the Preliminary section on his life, evince
a wonderful exemption from the superstitious belief of his age, and
indicate an extraordinary depth of thought.
This is a general outline of the contents of this treatise, which
is one of the most celebrated in the whole Collection. From what we
have stated, it will at once be seen that it relates to a subject
of commanding interest, and deserves to be carefully studied, as
containing the oldest exposition which we possess of the opinions
entertained by an original and enlightened mind on many important
questions connected with Public Hygiene and Political Economy, two
sciences which, of late years, have commanded a large amount of
professional attention. Whether or not modern experience may confirm
our author’s judgment in every particular case, it surely can neither
be unprofitable nor uninteresting to ascertain what his opinions on
these subjects actually were. Let us be thankful, then, that the
destroying hand of time has spared us so valuable a relic of antiquity;
and, instead of undervaluing our ancient instructor because he shows
himself ignorant of many truths which we are now familiar with, let us
be grateful to him for the amount of information which he has supplied
to us, and for setting us an example which it must be both safe and
profitable for us to follow. Surely great praise is due to the man who
first mooted so many important questions, and stated their bearings in
distinct terms, although he did not always succeed in solving them.[370]
I may take the present opportunity of mentioning that M. Littré,
with some appearance of truth, blames Hippocrates for having rather
overrated the influence of climate and institutions, in producing
military valor, which, as he justly remarks, has been proved by
modern examples to be most intimately connected with discipline, and
a knowledge of the arts of war. But if Hippocrates was wrong on this
point, it was because he did not avail himself properly of the lights
of his own age; for he might have learned from his contemporary,
Socrates, the very doctrine which M. Littré here inculcates. “The
question being put to him,” says Xenophon, “whether valor was a thing
that could be taught, or was natural? I am of opinion, he said, that as
one body is born with greater powers than another for enduring labor,
so is one soul produced by nature stronger than another for enduring
dangers. For I see persons brought up under the same institutions and
habits differing much from one another in courage. But I think that
every nature may be improved in valour by learning and discipline.
For it is obvious that the Scythians and Thracians would not dare to
contend with the Lacedemonians with bucklers and spears; and it is
clear that, the Lacedemonians would not be willing to contend with
the Thracians with small targets and javelins, or with the Scythians
with bows and arrows.” (Memorab. iii., 9.) The same doctrine is taught
with remarkable subtlety of argument and originality of thought in the
“Protagoras” of Plato, (see § 97). If, then, Hippocrates was wrong on
this head, (which, however, may be doubted), it is clear that he is
not to be screened by the alleged ignorance of his age, and that he
might have put himself right by attending to the instructions of a
contemporary with whom he, in all probability, was familiar, and who
undoubtedly was the greatest master of human nature that ever existed.
As there are certain matters connected with this treatise which will
require a more lengthened discussion than can well suit with foot
notes, I think it advisable to treat of them in this place:--
1. With regard to the seasons of the year, as indicated try the
risings and settings of the stars. the following observations, taken in
a great measure from Clifton’s Preface will supply, in as brief a space
as possible, all the information that will be required; “As the reader
will find frequent mention of seasons, equinoxes, solstices, risings
and settings of the sun and stars (particularly Arcturus, the Dog-star,
and the Pleiades), it may not be amiss to premise, in the first place,
that a year was divided by the ancients into four parts, every one of
these was distinguished astronomically.
“Thus, for instance, the winter began at the setting of the Pleiades,
and continued to the vernal equinox.
“The spring began at the vernal equinox, and ended at the rising of the
Pleiades.
“The summer began at the rising of the Pleiades, and ended at the
rising of Arcturus.
“The autumn began at the rising of Arcturus, and ended at the setting
of the Pleiades.
“The rising and setting of the stars is always to be understood of what
astronomers call the heliacal rising or setting, i. e. when a star
rises or sets with the sun.
“The rising and setting of the sun in summer or winter (an expression
which often occurs in this treatise), implies those points of the
compass the sun rises and sets at.”[371]
[Illustration]
II. On the winds, of which frequent mention is made by our author,
Coray has treated with a degree of prolixity and earnestness for which
it is difficult to recognize the necessity. The figure given above, if
properly studied and understood, will supply the professional reader
with all the information he will require on this head.
III. One of the most singular diseases noticed in this work is the
effeminacy with which the Scythians are said to have been attacked in
consequence of spending the greater part of their time on horseback.
(See § 22.) As the subject has attracted a good deal of attention
lately, I will give a summary of the information which has been
collected respecting it. See Coray, etc., t. ii., p. 331; Littré, t.
ii., p. 5, 6; and Avert., xxxix., p. 47; t. iv., p. 9.
In the first place, then, it can scarcely admit of doubt that the
disease is the same as that which Herodotus describes in the following
passage: “Venus inflicted upon the Scythians, who pillaged her temple
at Ascalon, and on their descendants, _the feminine disease_;
at least it is to this cause that they attribute their disease; and
travellers that go to the land of Scythia see how these persons are
affected whom the Scythians called _accursed_ (ἐναρεες).”[372]
All the opinions which have been entertained respecting this affection
are referred by M. Littré to the three following categories:
I. A vice, namely (A), Pederasty, which, he says is the most ancient
opinion we have respecting it, as indicated by Longinus[373] (on the
Sublime, 25), and defended by his commentators, Toll and Pearce, and by
Casaubon and Coster.[374] (B), Onanism, the opinion to which Sprengel
inclines in his work on Hippocrates.
2. A bodily disease, to wit: (A), Hemorrhoids, as maintained by
Paul Thomas de Girac,[375] by Valkenäer, by Bayer,[376] and by the
Compilers of the ‘Universal History.’[377] (B), A true menstruation,
as appears to be maintained by Lefevre and Dacier,[378] and by others.
(C), Blenorrhagia, as Guy Patin[379] and others suppose. (D), A true
impotence, as held by Mercuriali and others.
3. A mental disease, as maintained by Sauvages,[380] Heyne,[381]
Coray,[382] and others.
M. Rosenbaum is at great pains to make out that the affection in
question was pederasty, and that the _accursed_ (ἐνάρεες) of
Herodotus were the same as the _pathici_ of the Romans. I must
say, that in my opinion Rosenbaum makes out a strong case in support
of this opinion. In particular it will be remarked, that Herodotus
says, the descendants of these Scythians were also afflicted with this
complaint. Now Celsus Aurelianus says expressly, that the affection of
the pathici was hereditary.[383] Taking everything into account, I must
say that my own opinion has always been that the disease in question
must have been some variety of _spermatorrhœa_. I need scarcely
remark that this affection induces a state, both of body and mind,
analogous to that of the pathici, as described by ancient authors.
Before leaving this subject, however, I should mention that M. Littré,
in the fourth volume of his Hippocrates (p. xi.), brings into view a
thesis by M. Graff, the object of which is to prove that the disease
of the Scythians was a true sort of impotence; and in illustration of
it, he cites a passage from the memoirs of M. Larrey, containing a
description of a species of impotence, attended with wasting of the
testicle, which attacked the French army in Egypt. But, as far as I can
see, this disease described by Larrey had nothing to do with riding on
horseback, and I cannot see any relation between it and the diseases
described by Herodotus and Hippocrates.
IV. Of all the legendary tales of antiquity, there is probably no
one which was so long and so generally credited by the best informed
historians, critics, geographers, poets, and philosophers, as the
story of the Amazons. They are noticed historically by Homer (Iliad,
iii., 186; vi., 152); Apollonius Rhodius (ii., 196); Pindar (Olymp.
xiii., 84); Herodotus (ix., 27); Lysias (Epitaph. 3); Plato (Menex.);
Isocrates (Panyg.); Ctesias (Persic.); Plutarch (Theseus); Strabo
(Geogr. ix.); Pausanias (iv., 31, 6; vii., 2, 4); Arrian (Exped.
Alexand.); Quintus Curtius (vi., 4). Now it is singular that in all
this list of authorities, which, it will be remarked, comprehends
the _élite_ of ancient scholars, no one, with the exception of
Strabo, ventures to express the slightest doubt respecting the actual
existence of the Amazons. Some of them, indeed, admit that the race
had become extinct in their time; but they all seem satisfied that
the Amazons had truly existed in a bygone age, and consequently they
acknowledge them as real historical personages. See, in particular,
Arrian, who, although compelled by his respect for truth to acknowledge
that they did not exist in the days of Alexander the Great, still does
not hesitate to declare that it appeared incredible that this race of
women, celebrated as they were by the most eminent authors, should
never have existed at all. Yet, notwithstanding the mass of evidence
in support of their actual existence, I suppose few scholars nowadays
will hesitate to agree with Heyne (Apollodor. ii., 5, 9), and with
Grote (Hist. of Greece, i., 2), in setting down the whole story as mere
myth. But, considering how generally it had been believed, we need not
wonder that Hippocrates in this treatise should appear to entertain no
doubt of their actual existence. The reader will remark that he makes
the locality of the Amazons to be in Europe, among the Sarmatians,
on the north side of the Euxine. It is generally taken for granted,
however, in the ancient myths, that their place of residence was on
the banks of the Thermodon, in Cappadocia, and they are described as
having afterwards crossed to the opposite side of the Euxine, when
expelled from this locality. But, in fact, they are remarkable so
much for nothing as their ubiquity, being sometimes located in Asia,
sometimes in Africa, and at other times in Athens. I may remark,
before concluding, that Mr. Payne Knight (Symbolical Language, etc.,
Classical Journal, 23), and Creuzer (Symbolik. etc.), give a symbolical
interpretation to the story of the Amazons; but this mode of explaining
the myths of antiquity is altogether fanciful and unsatisfactory. It
seems safer and more judicious to deal with them as Mr. Grote has
done,[384] that is to say, to receive them as tales in which the
ancients believed, without having any rational foundation for their
faith. That there may have been a certain basis of truth in the story
of the Amazons need not be denied; but in this, as in all the ancient
myths, it is a hopeless task to attempt to separate truth from fiction.
ON AIRS, WATERS, AND PLACES.
1. Whoever wishes to investigate medicine properly, should proceed
thus: in the first place to consider the seasons of the year, and what
effects each of them produces (for they are not at all alike, but
differ much from themselves in regard to their changes).[385] Then
the winds, the hot and the cold, especially such as are common to all
countries, and then such as are peculiar to each locality. We must
also consider the qualities of the waters, for as they differ from
one another in taste and weight, so also do they differ much in their
qualities. In the same manner, when one comes into a city to which he
is a stranger, he ought to consider its situation, how it lies as to
the winds and the rising of the sun; for its influence is not the same
whether it lies to the north or the south, to the rising or to the
setting sun. These things one ought to consider most attentively, and
concerning the waters which the inhabitants use, whether they be marshy
and soft, or hard, and running from elevated and rocky situations, and
then if saltish and unfit for cooking; and the ground, whether it be
naked and deficient in water, or wooded and well watered, and whether
it lies in a hollow, confined situation, or is elevated and cold; and
the mode in which the inhabitants live, and what are their pursuits,
whether they are fond of drinking and eating to excess, and given to
indolence, or are fond of exercise and labor, and not given to excess
in eating and drinking.[386]
2. From these things he must proceed to investigate everything else.
For if one knows all these things well, or at least the greater
part of them, he cannot miss knowing, when he comes into a strange
city, either the diseases peculiar to the place, or the particular
nature of common diseases, so that he will not be in doubt as to the
treatment of the diseases, or commit mistakes, as is likely to be the
case provided one had not previously considered these matters. And
in particular, as the season and the year advances, he can tell what
epidemic diseases will attack the city, either in summer or in winter,
and what each individual will be in danger of experiencing from the
change of regimen. For knowing the changes of the seasons, the risings
and settings of the stars, how each of them takes place, he will be
able to know beforehand what sort of a year is going to ensue. Having
made these investigations, and knowing beforehand the seasons, such a
one must be acquainted with each particular, and must succeed in the
preservation of health, and be by no means unsuccessful in the practice
of his art. And if it shall be thought that these things belong rather
to meteorology,[387] it will be admitted, on second thoughts, that
astronomy contributes not a little, but a very great deal, indeed, to
medicine. For with the seasons the digestive organs of men undergo a
change.
3. But how each of the afore-mentioned things should be investigated
and explained, I will now declare in a clear manner. A city that is
exposed to hot winds (these are between the wintry rising, and the
wintry setting of the sun), and to which these are peculiar, but which
is sheltered from the north winds; in such a city the waters will be
plenteous and saltish, and as they run from an elevated source, they
are necessarily hot in summer, and cold in winter;[388] the heads of
the inhabitants are of a humid and pituitous constitution, and their
bellies subject to frequent disorders, owing to the phlegm running down
from the head; the forms of their bodies, for the most part, are rather
flabby; they do not eat nor drink much; drinking wine in particular,
and more especially if carried to intoxication, is oppressive to them;
and the following diseases are peculiar to the district: in the first
place, the women are sickly and subject to excessive menstruation; then
many are unfruitful from disease, and not from nature, and they have
frequent miscarriages; infants are subject to attacks of convulsions
and asthma, which they consider to be connected with infancy,[389]
and hold to be a sacred disease (epilepsy). The men are subject to
attacks of dysentery, diarrhœa, hepialus,[390] chronic fevers in
winter, of epinyctis,[391] frequently, and of hemorrhoids about the
anus. Pleurisies, peripneumonies, ardent fevers, and whatever diseases
are reckoned acute, do not often occur, for such diseases are not apt
to prevail where the bowels are loose. Ophthalmies occur of a humid
character, but not of a serious nature, and of short duration, unless
they attack epidemically from the change of the seasons. And when they
pass their fiftieth year, defluxions supervening from the brain, render
them paralytic when exposed suddenly to strokes of the sun,[392] or
to cold. These diseases are endemic to them, and, moreover, if any
epidemic disease connected with the change of the seasons, prevail,
they are also liable to it.
4. But the following is the condition of cities which have the
opposite exposure, namely, to cold winds, between the summer settings
and the summer risings of the sun, and to which these winds are
peculiar, and which are sheltered from the south and the hot breezes.
In the first place the waters are, for the most part, hard and cold.
The men must necessarily be well braced and slender, and they must have
the discharges downwards of the alimentary canal hard, and of difficult
evacuation, while those upwards are more fluid, and rather bilious
than pituitous. Their heads are sound and hard, and they are liable to
burstings (of vessels?) for the most part. The diseases which prevail
epidemically with them, are pleurisies, and those which are called
acute diseases. This must be the case when the bowels are bound; and
from any causes, many become affected with suppurations in the lungs,
the cause of which is the tension of the body, and hardness of the
bowels; for their dryness and the coldness of the water dispose them
to ruptures (of vessels?). Such constitutions must be given to excess
of eating, but not of drinking; for it is not possible to be gourmands
and drunkards at the same time. Ophthalmies, too, at length supervene;
these being of a hard and violent nature, and soon ending in rupture
of the eyes; persons under thirty years of age are liable to severe
bleedings at the nose in summer; attacks of epilepsy are rare but
severe. Such people are likely to be rather long-lived; their ulcers
are not attended with serous discharges, nor of a malignant character;
in disposition they are rather ferocious than gentle. The diseases I
have mentioned are peculiar to the men, and besides they are liable to
any common complaint which may be prevailing from the changes of the
seasons. But the women, in the first place, are of a hard constitution,
from the waters being hard, indigestible, and cold; and their menstrual
discharges are not regular, but in small quantity, and painful. Then
they have difficult parturition, but are not very subject to abortions.
And when they do bring forth children, they are unable to nurse them;
for the hardness and indigestible nature of the water puts away their
milk. Phthisis frequently supervenes after childbirth, for the efforts
of it frequently bring on ruptures and strains.[393] Children while
still little are subject to dropsies in the testicle, which disappear
as they grow older; in such a town they are late in attaining manhood.
It is, as I have now stated, with regard to hot and cold winds and
cities thus exposed.
5. Cities that are exposed to winds between the summer and the winter
risings of the sun, and those the opposite to them, have the following
characters:--Those which lie to the rising of the sun are all likely
to be more healthy than such as are turned to the North, or those
exposed to the hot winds, even if there should not be a furlong
between them.[394] In the first place, both the heat and cold are more
moderate. Then such waters as flow to the rising sun, must necessarily
be clear, fragrant, soft, and delightful to drink, in such a city. For
the sun in rising and shining upon them purifies them, by dispelling
the vapors which generally prevail in the morning. The persons of
the inhabitants are, for the most part, well colored and blooming,
unless some disease counteract. The inhabitants have clear voices,
and in temper and intellect are superior to those, which are exposed
to the north, and all the productions of the country in like manner
are better. A city so situated resembles the spring as to moderation
between heat and cold, and the diseases are few in number, and of a
feeble kind, and bear a resemblance to the diseases which prevail in
regions exposed to hot winds. The women there are very prolific, and
have easy deliveries. Thus it is with regard to them.
6. But such cities as lie to the west, and which are sheltered from
winds blowing from the east, and which the hot winds and the cold winds
of the north scarcely touch, must necessarily be in a very unhealthy
situation: in the first place the waters are not clear, the cause of
which is, because the mist prevails commonly in the morning, and it is
mixed up with the water and destroys its clearness, for the sun does
not shine upon the water until he be considerably raised above the
horizon. And in summer, cold breezes from the east blow and dews fall;
and in the latter part of the day the setting sun particularly scorches
the inhabitants, and therefore they are pale and enfeebled, and are
partly subject to all the aforesaid diseases, but no one is peculiar to
them. Their voices are rough and hoarse owing to the state of the air,
which in such a situation is generally impure and unwholesome, for they
have not the northern winds to purify it; and these winds they have
are of a very humid character, such being the nature of the evening
breezes. Such a situation of a city bears a great resemblance to autumn
as regards the changes of the day, inasmuch as the difference between
morning and evening is great. So it is with regard to the winds that
are conducive to health, or the contrary.
7. And I wish to give an account of the other kinds of waters,
namely, of such as are wholesome and such as are unwholesome, and
what bad and what good effects may be derived from water; for water
contributes much towards health.[395] Such waters then as are marshy,
stagnant, and belong to lakes, are necessarily hot in summer, thick,
and have a strong smell, since they have no current; but being
constantly supplied by rain-water, and the sun heating them, they
necessarily want their proper color, are unwholesome and form bile; in
winter, they become congealed, cold, and muddy with the snow and ice,
so that they are most apt to engender phlegm, and bring on hoarseness;
those who drink them have large and obstructed spleens, their bellies
are hard, emaciated, and hot; and their shoulders, collar-bones, and
faces are emaciated; for their flesh is melted down and taken up by the
spleen, and hence they are slender; such persons then are voracious and
thirsty; their bellies are very dry both above and below, so that they
require the strongest medicines.[396] This disease is habitual to them
both in summer and in winter, and in addition they are very subject
to dropsies of a most fatal character; and in summer dysenteries.
diarrhœas, and protracted quartan fevers frequently seize them, and
these diseases when prolonged dispose such constitutions to dropsies,
and thus prove fatal. These are the diseases which attack them in
summer; but in winter younger persons are liable to pneumonia, and
maniacal affections; and older persons to ardent fevers, from hardness
of the belly. Women are subject to œdema and leucophlegmasiæ;[397]
when pregand then during nursing they become wasted and sickly, and
the lochial discharge after parturition does not proceed properly
with the women. The children are particularly subject to hernia, and
adults to varices and ulcers on their legs, so that persons with
such constitutions cannot be long-lived, but before the usual period
they fall into a state of premature old age. And further, the women
appear to be with child, and when the time of parturition arrives,
the fulness of the belly disappears, and this happens from dropsy of
the uterus.[398] Such waters then I reckon bad for every purpose.
The next to them in badness are those which have their fountains in
rocks, so that they must necessarily be hard, or come from a soil
which produces thermal waters, such as those having iron, copper,
silver, gold, sulphur, alum, bitumen, or nitre (soda) in them: for
all these are formed by the force of heat.[399] Good waters cannot
proceed from such a soil, but those that are hard and of a heating
nature, difficult to pass by urine, and of difficult evacuation by
the bowels. The best are those which flow from elevated grounds, and
hills of earth; these are sweet, clear, and can bear a little wine;
they are hot in summer and cold in winter, for such necessarily must be
the waters from deep wells. But those are most to be commended which
run to the rising of the sun, and especially to the summer sun; for
such are necessarily more clear, fragrant, and light. But all such as
are saltish, crude, and hard, are not good for drink. But there are
certain constitutions and diseases with which such waters agree when
drunk, as I will explain presently. Their characters are as follows:
the best are such as have their fountains to the east; the next, those
between the summer risings and settings of the sun, and especially
those to the risings; and third, those between the summer and winter
settings; but the worst are those to the south, and the parts between
the winter rising and setting, and those to the south are very bad, but
those to the north are better. They are to be used as follows: whoever
is in good health and strength need not mind, but may always drink
whatever is at hand. But whoever wishes to drink the most suitable for
any disease, may accomplish his purpose by attending to the following
directions: To persons whose bellies are hard and easily burnt up, the
sweetest, the lightest, and the most limpid waters will be proper; but
those persons whose bellies are soft, loose, and pituitous, should
choose the hardest, those kinds that are most crude, and the saltest,
for thus will they be most readily dried up; for such waters as are
adapted for boiling, and are of a very solvent nature, naturally loosen
readily and melt down the bowels; but such as are intractable, hard,
and by no means proper for boiling, these rather bind and dry up the
bowels. People have deceived themselves with regard to salt waters,
from inexperience, for they think these waters purgative, whereas they
are the very reverse; for such waters are crude, and ill adapted for
boiling, so that the belly is more likely to be bound up than loosened
by them.[400] And thus it is with regard to the waters of springs.
8. I will now tell how it is with respect to rain-water, and
water from snow. Rain waters, then, are the lightest, the sweetest,
the thinnest, and the clearest; for originally the sun raises and
attracts the thinnest and lightest part of the water, as is obvious
from the nature of salts; for the saltish part is left behind owing
to its thickness and weight, and forms salts; but the sun attracts
the thinnest part, owing to its lightness, and he abstracts this not
only from the lakes, but also from the sea, and from all things which
contain humidity, and there is humidity in everything; and from man
himself the sun draws off the thinnest and lightest part of the juices.
As a strong proof of this, when a man walks in the sun, or sits down
having a garment on, whatever parts of the body the sun shines upon do
not sweat, for the sun carries off whatever sweat makes its appearance;
but those parts which are covered by the garment, or anything else,
sweat, for the particles of sweat are drawn and forced out by the
sun, and are preserved by the cover so as not to be dissipated by the
sun; but when the person comes into the shade the whole body equally
perspires, because the sun no longer shines upon it.[401] Wherefore,
of all kinds of water, these spoil the soonest; and rain water has
a bad smell, because its particles are collected and mixed together
from most objects, so as to spoil the soonest. And in addition to
this, when attracted and raised up, being carried about and mixed
with the air, whatever part of it is turbid and darkish is separated
and removed from the other, and becomes cloud and mist, but the most
attenuated and lightest part is left, and becomes sweet, being heated
and concocted by the sun, for all other things when concocted become
sweet. While dissipated then and not in a state of consistence it is
carried aloft. But when collected and condensed by contrary winds, it
falls down wherever it happens to be most condensed. For this is likely
to happen when the clouds being carried along and moving with a wind
which does not allow them to rest, suddenly encounters another wind and
other clouds from the opposite direction: there it is first condensed,
and what is behind is carried up to the spot, and thus it thickens,
blackens, and is conglomerated, and by its weight it falls down and
becomes rain. Such, to all appearance, are the best of waters, but they
require to be boiled and strained;[402] for otherwise they have a bad
smell, and occasion hoarseness and thickness of the voice to those who
drink them.[403] Those from snow and ice are all bad, for when once
congealed, they never again recover their former nature; for whatever
is clear, light, and sweet in them, is separated and disappears; but
the most turbid and weightiest part is left behind.[404] You may
ascertain this in the following manner: If in winter you will pour
water by measure into a vessel and expose it to the open air until
it is all frozen, and then on the following day bring it into a warm
situation where the ice will thaw, if you will measure the water
again when dissolved you will find it much less in quantity. This is
a proof that the lightest and thinnest part is dissipated and dried
up by the congelation, and not the heaviest and thickest, for that is
impossible:[405] wherefore I hold that waters from snow and ice, and
those allied to them, are the worst of any for all purposes whatever.
Such are the characters of rain-water, and those from ice and snow.
9.[406] Men become affected with the stone, and are seized with
diseases of the kidneys, strangury, sciatica, and become ruptured,
when they drink all sorts of waters, and those from great rivers into
which other rivulets run, or from a lake into which many streams of
all sorts flow, and such as are brought from a considerable distance.
For it is impossible that such waters can resemble one another, but
one kind is sweet, another saltish and aluminous, and some flow from
thermal springs; and these being all mixed up together disagree, and
the strongest part always prevails; but the same kind is not always
the strongest, but sometimes one and sometimes another, according to
the winds, for the north wind imparts strength to this water, and
the south to that, and so also with regard to the others. There must
be deposits of mud and sand in the vessels from such waters, and the
aforesaid diseases must be engendered by them when drunk, but why not
to all I will now explain. When the bowels are loose and in a healthy
state,[407] and when the bladder is not hot, nor the neck of the
bladder very contracted, all such persons pass water freely, and no
concretion forms in the bladder; but those in whom the belly is hot,
the bladder must be in the same condition; and when preternaturally
heated, its neck becomes inflamed; and when these things happen, the
bladder does not expel the urine, but raises its heat excessively. And
the thinnest part of it is secreted, and the purest part is passed
off in the form of urine, but the thickest and most turbid part is
condensed and concreted, at first in small quantity, but afterwards
in greater; for being rolled about in the urine, whatever is of a
thick consistence it assimilates to itself, and thus it increases and
becomes indurated. And when such persons make water, the stone forced
down by the urine falls into the neck of the bladder and stops the
urine, and occasions intense pain; so that calculous children rub their
privy parts and tear at them, as supposing that the obstruction to
the urine is situated there. As a proof that it is as I say, persons
affected with calculus have very limpid urine, because the thickest
and foulest part remains and is concreted.[408] Thus it generally is
in cases of calculus. It forms also in children from milk, when it is
not wholesome, but very hot and bilious, for it heats the bowels and
bladder, so that the urine being also heated undergoes the same change.
And I hold that it is better to give children only the most diluted
wine, for such will least burn up and dry the veins. Calculi do not
form so readily in women, for in them the urethra is short and wide,
so that in them the urine is easily expelled; neither do they rub the
pudendum with their hands, nor handle the passage like males;[409] for
the urethra in women opens direct into the pudendum, which is not the
case with men, neither in them is the urethra so wide, and they drink
more than children do.[410] Thus, or nearly so, is it with reward to
them.
10. And respecting the seasons, one may judge whether the year will
prove sickly or healthy from the following observations:[411]--If
the appearances connected with the rising and setting stars be as
they should be; if there be rains in autumn; if the winter be mild,
neither very tepid nor unseasonably cold, and if in spring the rains be
seasonable, and so also in summer, the year is likely to prove healthy.
But if the winter be dry and northerly, and the spring showery and
southerly, the summer will necessarily be of a febrile character, and
give rise to ophthalmies and dysenteries.[412] For when suffocating
heat sets in all of a sudden, while the earth is moistened by the
vernal showers, and by the south wind, the heat is necessarily doubled
from the earth, which is thus soaked by rain and heated by a burning
sun, while, at the same time, men’s bellies are not in an orderly
state, nor the brain properly dried; for it is impossible, after such
a spring, but that the body and its flesh must be loaded with humors,
so that very acute fevers will attack all, but especially those of a
phlegmatic constitution. Dysenteries are also likely to occur to women
and those of a very humid temperament. And if at the rising of the
Dog-star rain and wintry storms supervene, and if the etesian winds
blow, there is reason to hope that these diseases will cease, and that
the autumn will be healthy; but if not, it is likely to be a fatal
season to children and women, but least of all to old men; and that
convalescents will pass into quartans, and from quartans into dropsies;
but if the winter be southerly, showery and mild, but the spring
northerly, dry, and of a wintry character, in the first place women
who happen to be with child, and whose accouchement should take place
in spring, are apt to miscarry; and such as bring forth, have feeble
and sickly children, so that they either die presently or are tender,
feeble, and sickly, if they live. Such is the case with the women.
The others are subject to dysenteries[413] and dry ophthalmies, and
some have catarrhs beginning in the head and descending to the lungs.
Men of a phlegmatic temperament are likely to have dysenteries; and
women, also, from the humidity of their nature, the phlegm descending
downwards from the brain; those who are bilious, too, have dry
ophthalmies from the heat and dryness of their flesh; the aged, too,
have catarrhs from their flabbiness and melting of the veins, so that
some of them die suddenly and some become paralytic on the right side
or the left.[414] For when, the winter being southerly and the body
hot, the blood and veins are not properly constringed; a spring that
is northerly, dry, and cold, having come on, the brain when it should
have been expanded and purged, by the coryza and hoarseness is then
constringed and contracted, so that the summer and the heat occurring
suddenly, and a change supervening, these diseases fall out. And such
cities as lie well to the sun and winds, and use good waters, feel
these changes less, but such as use marshy and pooly waters, and lie
well both as regards the winds and the sun, these all feel it more. And
if the summer be dry, those diseases soon cease, but if rainy, they
are protracted; and there is danger of any sore that there is becoming
phagedenic from any cause; and lienteries and dropsies supervene at
the conclusion of diseases; for the bowels are not readily dried up.
And if the summer be rainy and southerly, and next the autumn, the
winter must, of necessity, be sickly, and ardent fevers are likely to
attack those that are phlegmatic, and more elderly than forty years,
and pleurisies and peripneumonies[415] those that are bilious. But
if the summer is parched and northerly, but the autumn rainy and
southerly, headache and sphacelus of the brain[416] are likely to
occur; and in addition hoarseness, coryza, coughs, and in some cases,
consumption.[417] But if the season is northerly and without water,
there being no rain, neither after the Dog-star nor Arcturus; this
state agrees best with those who are naturally phlegmatic, with those
who are of a humid temperament, and with women: but it is most inimical
to the bilious; for they become much parched up, and ophthalmies of a
dry nature supervene, fevers both acute and chronic, and in some cases
melancholy;[418] for the most humid and watery part of the bile being
consumed, the thickest and most acrid portion is left, and of the blood
likewise, whence these diseases come upon them. But all these are
beneficial to the phlegmatic, for they are thereby dried up, and reach
winter not oppressed with humors, but with them dried up.
11. Whoever studies and observes these things may be able to foresee
most of the effects which will result from the changes of the seasons:
and one ought to be particularly guarded during the greatest changes
of the seasons, and neither willingly give medicines, nor apply the
cautery to the belly, nor make incisions there until ten or more days
be past. Now, the greatest and most dangerous are the two solstices,
and especially the summer, and also the two equinoxes, but especially
the autumnal.[419] One ought also to be guarded about the rising of
the stars, especially of the Dog-star, then of Arcturus, and then the
setting of the Pleiades; for diseases are especially apt to prove
critical in those days, and some prove fatal, some pass off, and all
others change to another form and another constitution. So it is with
regard to them.
12. I wish to show, respecting Asia and Europe, how, in all respects,
they differ from one another, and concerning the figure of the
inhabitants, for they are different, and do not at all resemble one
another. To treat of all would be a long story, but I will tell you how
I think it is with regard to the greatest and most marked differences.
I say, then, that Asia differs very much from Europe as to the nature
of all things, both with regard to the productions of the earth and
the inhabitants, for everything is produced much more beautiful and
large in Asia; the country is milder, and the dispositions of the
inhabitants also are more gentle and affectionate.[420] The cause of
this is the temperature of the seasons, because it lies in the middle
of the risings of the sun[421] towards the east, and removed from the
cold (and heat),[422] for nothing tends to growth and mildness so much
as when the climate has no predominant quality, but a general equality
of temperature prevails. It is not everywhere the same with regard
to Asia, but such parts of the country as lie intermediate between
the heat and the cold, are the best supplied with fruits and trees,
and have the most genial climate, and enjoy the purest waters, both
celestial and terrestrial. For neither are they much burnt up by the
heat, nor dried up by the drought and want of rain, nor do they suffer
from the cold; since they are well watered from abundant showers and
snow, and the fruits of the season,[423] as might be supposed, grow
in abundance, both such as are raised from seed that has been sown,
and such plants as the earth produces of its own accord, the fruits
of which the inhabitants make use of, training them from their wild
state and transplanting them to a suitable soil; the cattle also which
are reared there are vigorous, particularly prolific, and bring up
young of the fairest description; the inhabitants too, are well fed,
most beautiful in shape, of large stature, and differ little from one
another either as to figure or size; and the country itself, both as
regards its constitution and mildness of the seasons, may be said to
bear a close resemblance to the spring. Manly courage, endurance of
suffering, laborious enterprise, and high spirit, could not be produced
in such a state of things either among the native inhabitants or those
of a different country, for there pleasure necessarily reigns. For this
reason, also, the forms of wild beasts there are much varied.[424] Thus
it is, as I think, with the Egyptians and Libyans.
13. But concerning those on the right hand of the summer risings of
the sun as far as the Palus Mæotis[425] (for this is the boundary of
Europe and Asia), it is with them as follows: the inhabitants there
differ far more from one another than those I have treated of above,
owing to the differences of the seasons and the nature of the soil. But
with regard to the country itself, matters are the same there as among
all other men; for where the seasons undergo the greatest and most
rapid changes, there the country is the wildest and most unequal; and
you will find the greatest variety of mountains, forests, plains, and
meadows; but where the seasons do not change much there the country is
the most even; and, if one will consider it, so is it also with regard
to the inhabitants; for the nature of some is like to a country covered
with trees and well watered; of some, to a thin soil deficient in
water; of others, to fenny and marshy places; and of some again, to a
plain of bare and parched land.[426] For the seasons which modify their
natural frame of body are varied, and the greater the varieties of them
the greater also will be the differences of their shapes.
14. I will pass over the smaller differences among the nations, but
will now treat of such as are great either from nature, or custom; and,
first, concerning the Macrocephali.[427] There is no other race of
men which have heads in the least resembling theirs. At first, usage
was the principal cause of the length of their head, but now nature
cooperates with usage. They think those the most noble who have the
longest heads. It is thus with regard to the usage: immediately after
the child is born, and while its head is still tender, they fashion
it with their hands, and constrain it to assume a lengthened shape by
applying bandages and other suitable contrivances whereby the spherical
form of the head is destroyed, and it is made to increase in length.
Thus, at first, usage operated, so that this constitution was the
result of force: but, in the course of time, it was formed naturally;
so that usage had nothing to do with it; for the semen comes from all
parts of the body, sound from the sound parts, and unhealthy from the
unhealthy parts. If, then, children with bald heads are born to parents
with bald heads; and children with blue eyes to parents who have blue
eyes; and if the children of parents having distorted eyes squint also
for the most part; and if the same may be said of other forms of the
body, what is to prevent it from happening that a child with a long
head should be produced by a parent having a long head?[428] But now
these things do not happen as they did formerly, for the custom no
longer prevails owing to their intercourse with other men. Thus it
appears to me to be with regard to them.
15. As to the inhabitants of Phasis,[429] their country is fenny,
warm, humid, and wooded; copious and severe rains occur there at all
seasons; and the life of the inhabitants is spent among the fens; for
their dwellings are constructed of wood and reeds, and are erected
amidst the waters; they seldom practise walking either to the city or
the market, but sail about, up and down, in canoes constructed out of
single trees, for there are many canals there.[430] They drink the
hot and stagnant waters, both when rendered putrid by the sun, and
when swollen with rains. The Phasis itself is the most stagnant of
all rivers, and runs the smoothest;[431] all the fruits which spring
there are unwholesome, of feeble and imperfect growth, owing to the
redundance of water, and on this account they do not ripen, for much
vapor from the waters overspreads the country. For these reasons the
Phasians have shapes different from those of all other men; for they
are large in stature, and of a very gross habit of body, so that not
a joint nor vein is visible; in color they are sallow, as if affected
with jaundice. Of all men they have the roughest voices, from their
breathing an atmosphere which is not clear, but misty and humid; they
are naturally rather languid in supporting bodily fatigue. The seasons
undergo but little change either as to heat or cold; their winds for
the most part are southerly, with the exception of one peculiar to
the country, which sometimes blows strong, is violent and hot, and
is called by them the wind _cenchron_. The north wind scarcely
reaches them, and when it does blow it is weak and gentle. Thus it is
with regard to the different nature and shape of the inhabitants of
Asia and Europe.
16. And with regard to the pusillanimity and cowardice of the
inhabitants, the principal reason why the Asiatics are more unwarlike
and of more gentle disposition than the Europeans is, the nature of the
seasons, which do not undergo any great changes either to heat or cold,
or the like; for there is neither excitement of the understanding nor
any strong change of the body by which the temper might be ruffled, and
they be roused to inconsiderate emotion and passion, rather than living
as they do always in the same state. It is changes of all kinds which
arouse the understanding of mankind, and do not allow them to get into
a torpid condition. For these reasons, it appears to me, the Asiatic
race is feeble, and further, owing to their laws; for monarchy prevails
in the greater part of Asia, and where men are not their own masters
nor independent, but are the slaves of others, it is not a matter of
consideration with them how they may acquire military discipline, but
how they may seem not to be warlike, for the dangers are not equally
shared, since they must serve as soldiers, perhaps endure fatigue,
and die for their masters, far from their children, their wives, and
other friends; and whatever noble and manly actions they may perform
lead only to the aggrandizement of their masters, whilst the fruits
which they reap are dangers and death; and, in addition to all this,
the lands of such persons must be laid waste by the enemy and want
of culture.[432] Thus, then, if any one be naturally warlike and
courageous, his disposition will be changed by the institutions. As a
strong proof of all this, such Greeks or barbarians in Asia as are not
under a despotic form of government, but are independent, and enjoy
the fruits of their own labors, are of all others the most warlike;
for these encounter dangers on their own account, bear the prizes of
their own valor, and in like manner endure the punishment of their own
cowardice. And you will find the Asiatics differing from one another,
for some are better and others more dastardly; of these differences, as
I stated before, the changes of the seasons are the cause. Thus it is
with Asia.
17. In Europe there is a Scythian race, called Sauromatæ, which
inhabits the confines of the Palus Mæotis, and is different from all
other races.[433] Their women mount on horseback, use the bow, and
throw the javelin from their horses, and fight with their enemies as
long as they are virgins; and they do not lay aside their virginity
until they kill three of their enemies, nor have any connection with
men until they perform the sacrifices according to law. Whoever takes
to herself a husband, gives up riding on horseback unless the necessity
of a general expedition obliges her. They have no right breast; for
while still of a tender age their mothers heat strongly a copper
instrument constructed for this very purpose, and apply it to the right
breast, which is burnt up, and its development being arrested, all the
strength and fullness are determined to the right shoulder and arm.
18. As the other Scythians have a peculiarity of shape, and do not
resemble any other, the same observation applies to the Egyptians, only
that the latter are oppressed by heat and the former by cold.[434]
What is called the Scythian desert is a prairie, abounding in meadows,
high-lying, and well watered; for the rivers which carry off the water
from the plains are large. There live those Scythians which are called
Nomades, because they have no houses, but live in wagons. The smallest
of these wagons have four wheels, but some have six; they are covered
in with felt, and they are constructed in the manner of houses, some
having but a single apartment, and some three; they are proof against
rain, snow, and winds. The wagons are drawn by yokes of oxen, some of
two and others of three, and all without horns, for they have no horns,
owing to the cold.[435] In these wagons the women live, but the men
are carried about on horses, and the sheep, oxen, and horses accompany
them; and they remain on any spot as long as there is provender for
their cattle, and when that fails they migrate to some other place.
They eat boiled meat, and drink the milk of mares, and also eat
_hippace_, which is cheese prepared from the milk of the mare.
Such is their mode of life and their customs.[436]
19. In respect of the seasons and figure of body, the Scythian race,
like the Egyptian, have a uniformity of resemblance, different from
all other nations; they are by no means prolific, and the wild beasts
which are indigenous there are small in size and few in number, for
the country lies under the Northern Bears, and the Rhiphæan mountains,
whence the north wind blows; the sun comes very near to them only when
in the summer solstice, and warms them but for a short period, and not
strongly; and the winds blowing from the hot regions of the earth do
not reach them, or but seldom, and with little force; but the winds
from the north always blow, congealed, as they are, by the snow, the
ice, and much water, for these never leave the mountains, which are
thereby rendered uninhabitable. A thick fog covers the plains during
the day, and amidst it they live, so that winter may be said to be
always present with them; or, if they have summer, it is only for a
few days, and the heat is not very strong. Their plains are high-lying
and naked, not crowned with mountains, but extending upwards under
the Northern Bears.[437] The wild beasts there are not large, but
such as can be sheltered under-ground; for the cold of winter and the
barrenness of the country prevent their growth, and because they have
no covert nor shelter.[438] The changes of the seasons, too, are not
great nor violent, for, in fact, they change gradually; and therefore
their figures resemble one another, as they all equally use the same
food, and the same clothing summer and winter, respiring a humid and
dense atmosphere, and drinking water from snow and ice; neither do they
make any laborious exertions, for neither body nor mind is capable of
enduring fatigue when the changes of the seasons are not great.[439]
For these reasons their shapes are gross and fleshy, with ill-marked
joints, of a humid temperament, and deficient in tone: the internal
cavities, and especially those of the intestines, are full of humors;
for the belly cannot possibly be dry in such a country, with such a
constitution and in such a climate; but owing to their fat, and the
absence of hairs from their bodies, their shapes resemble one another,
the males being all alike, and so also with the women: for the seasons
being of an uniform temperature, no corruption or deterioration takes
place in the concretion of the semen, unless from some violent cause,
or from disease.[440]
20. I will give you a strong proof of the humidity (laxity?) of their
constitutions.[441] You will find the greater part of the Scythians,
and all the Nomades, with marks of the cautery on their shoulders,
arms, wrists, breasts, hip-joints, and loins, and that for no other
reason but the humidity and flabbiness of their constitution, for they
can neither strain with their bows, nor launch the javelin from their
shoulder owing to their humidity and atony: but when they are burnt,
much of the humidity in their joints is dried up, and they become
better braced, better fed, and their joints get into a more suitable
condition.[442] They are flabby and squat at first, because, as in
Egypt, they are not swathed(?);[443] and then they pay no attention to
horsemanship, so that they may be adepts at it; and because of their
sedentary mode of life; for the males, when they cannot be carried
about on horseback, sit the most of their time in the wagon, and rarely
practise walking, because of their frequent migrations and shiftings of
situation; and as to the women, it is amazing how flabby and sluggish
they are. The Scythian race are tawny from the cold, and not from the
intense heat of the sun, for the whiteness of the skin is parched by
the cold, and becomes tawny.
21. It is impossible that persons of such a constitution could be
prolific, for, with the man, the sexual desires are not strong, owing
to the laxity of his constitution, the softness and coldness of his
belly, from all which causes it is little likely that a man should
be given to venery; and besides, from being jaded by exercise on
horseback, the men become weak in their desires. On the part of the men
these are the causes; but on that of the women, they are embonpoint and
humidity; for the womb cannot take in the semen, nor is the menstrual
discharge such as it should be, but scanty and at too long intervals;
and the mouth of the womb is shut up by fat and does not admit the
semen; and, moreover, they themselves are indolent and fat, and their
bellies cold and soft.[444] From these causes the Scythian race is not
prolific. Their female servants furnish a strong proof of this; for
they no sooner have connection with a man than they prove with child,
owing to their active course of life and the slenderness of body.
22. And, in addition to these, there are many eunuchs among the
Scythians, who perform female work, and speak like women. Such persons
are called effeminates.[445] The inhabitants of the country attribute
the cause of their impotence to a god, and venerate and worship such
persons, every one dreading that the like might befall himself; but
to me it appears that such affections are just as much divine as all
others are, and that no one disease is either more divine or more human
than another, but that all are alike divine, for that each has its own
nature, and that no one arises without a natural cause.[446] But I will
explain how I think that the affection takes its rise. From continued
exercise on horseback they are seized with chronic defluxions in
their joints (_kedmata_[447]) owing to their legs always hanging
down below their horses; they afterwards become lame and stiff at the
hip-joint, such of them, at least, as are severely attacked with it.
They treat themselves in this way: when the disease is commencing,
they open the vein behind either ear, and when the blood flows, sleep,
from feebleness, seizes them, and afterwards they awaken, some in good
health and others not. To me it appears that the semen is altered by
this treatment, for there are veins behind the ears which, if cut,
induce impotence; now, these veins would appear to me to be cut.[448]
Such persons afterwards, when they go in to women and cannot have
connection with them, at first do not think much about it, but remain
quiet; but when, after making the attempt two, three, or more times,
they succeed no better, fancying they have committed some offence
against the god whom they blame for the affection, they put on female
attire, reproach themselves for effeminacy, play the part of women, and
perform the same work as women do. This the rich among the Scythians
endure, not the basest, but the most noble and powerful, owing to
their riding on horseback; for the poor are less affected, as they
do not ride on horses. And yet, if this disease had been more divine
than the others, it ought not to have befallen the most noble and the
richest of the Scythians alone, but all alike, or rather those who have
little, as not being able to pay honors to the gods, if, indeed, they
delight in being thus rewarded by men, and grant favors in return; for
it is likely that the rich sacrifice more to the gods, and dedicate
more votive offerings, inasmuch as they have wealth, and worship the
gods; whereas the poor, from want, do less in this way, and, moreover,
upbraid the gods for not giving them wealth, so that those who have few
possessions were more likely to bear the punishments of these offences
than the rich. But, as I formerly said, these affections are divine
just as much as others, for each springs from a natural cause, and this
disease arises among the Scythians from such a cause as I have stated.
But it attacks other men in like manner, for whenever men ride much
and very frequently on horseback, then many are affected with rheums
in the joints, sciatica, and gout, and they are inept at venery. But
these complaints befall the Scythian, and they are the most impotent of
men for the aforesaid causes, and because they always wear breeches,
and spend the most of their time on horseback,[449] so as not to touch
their privy parts with the hand, and from the cold and fatigue they
forget the sexual desire, and do not make the attempt until after
they have lost their virility.[450] Thus it is with the race of the
Scythians.
23. The other races in Europe differ from one another, both as to
stature and shape, owing to the changes of the seasons, which are very
great and frequent, and because the heat is strong, the winters severe,
and there are frequent rains, and again protracted droughts, and winds,
from which many and diversified changes are induced. These changes are
likely to have an effect upon generation in the coagulation of the
semen, as this process cannot be the same in summer as in winter, nor
in rainy as in dry weather; wherefore, I think, that the figures of
Europeans differ more than those of Asiatics; and they differ very much
from one another as to stature in the same city; for vitiations of the
semen occur in its coagulation more frequently during frequent changes
of the seasons, than where they are alike and equable. And the same may
be said of their dispositions, for the wild, and unsociable, and the
passionate occur in such a constitution; for frequent excitement of
the mind induces wildness, and extinguishes sociableness and mildness
of disposition, and therefore I think the inhabitants of Europe more
courageous than those of Asia; for a climate which is always the same
induces indolence, but a changeable climate, laborious exertions both
of body and mind; and from rest and indolence cowardice is engendered,
and from laborious exertions and pains, courage. On this account the
inhabitants of Europe are more warlike than the Asiatics, and also
owing to their institutions, because they are not governed by kings
like the latter, for where men are governed by kings there they must be
very cowardly, as I have stated before; for their souls are enslaved,
and they will not willingly, or readily undergo dangers in order to
promote the power of another; but those that are free undertake dangers
on their own account, and not for the sake of others; they court hazard
and go out to meet it, for they themselves bear off the rewards of
victory, and thus their institutions contribute not a little to their
courage.[451]
Such is the general character of Europe and Asia.[452]
24. And there are in Europe other tribes, differing from one
another in stature, shape, and courage: the differences are those I
formerly mentioned, and will now explain more clearly. Such as inhabit
a country which is mountainous, rugged, elevated, and well watered,
and where the changes of the seasons are very great, are likely to
have great variety of shapes among them, and to be naturally of an
enterprising and warlike disposition;[453] and such persons are apt
to have no little of the savage and ferocious in their nature; but
such as dwell in places which are low-lying, abounding in meadows
and ill ventilated, and who have a larger proportion of hot than of
cold winds, and who make use of warm waters--these are not likely to
be of large stature nor well proportioned, but are of a broad make,
fleshy, and have black hair; and they are rather of a dark than of a
light complexion, and are less likely to be phlegmatic than bilious;
courage and laborious enterprise are not naturally in them, but may
be engendered in them by means of their institutions. And if there
be rivers in the country which carry off the stagnant and rain water
from it, these may be wholesome and clear; but if there be no rivers,
but the inhabitants drink the waters of fountains, and such as are
stagnant and marshy, they must necessarily have prominent bellies and
enlarged spleens. But such as inhabit a high country, and one that is
level, windy, and well-watered, will be large of stature, and like to
one another; but their minds will be rather unmanly and gentle. Those
who live on thin, ill-watered, and bare soils, and not well attempered
in the changes of the seasons, in such a country they are likely to
be in their persons rather hard and well braced, rather of a blond
than a dark complexion, and in disposition and passions haughty and
self-willed. For, where the changes of the seasons are most frequent,
and where they differ most from one another, there you will find
their forms, dispositions, and nature the most varied. These are the
strongest of the natural causes of difference, and next the country in
which one lives, and the waters; for, in general, you will find the
forms and dispositions of mankind to correspond with the nature of the
country; for where the land is fertile, soft, and well-watered, and
supplied with waters from very elevated situations, so as to be hot
in summer and cold in winter, and where the seasons are fine, there
the men are fleshy, have ill-formed joints,[454] and are of a humid
temperament; they are not disposed to endure labor, and, for the most
part, are base in spirit; indolence and sluggishness are visible in
them, and to the arts they are dull, and not clever nor acute. When
the country is bare, not fenced, and rugged, blasted by the winter and
scorched by the sun, there you may see the men hardy, slender, with
well-shaped joints,[454] well-braced, and shaggy; sharp industry and
vigilance accompany such a constitution; in morals and passions they
are haughty and opinionative, inclining rather to the fierce than to
the mild; and you will find them acute and ingenious as regards the
arts, and excelling in military affairs; and likewise all the other
productions of the earth corresponding to the earth itself.[455] Thus
it is with regard to the most opposite natures and shapes; drawing
conclusions from them, you may judge of the rest without any risk of
error.
ON THE PROGNOSTICS.
THE ARGUMENT.
Of the genuineness of this work I have treated in the Preliminary
Discourse, and have also briefly touched upon its relation to two other
important treatises in the Hippocratic collection, the “Prorrhetics”
and the “Coacæ Prænotiones.” The latter subject I am now to resume,
and in doing so I mean to avail myself of the talented dissertation of
Dr. Ermerins, to which also I have already made allusion. Indeed I am
persuaded that I cannot do a more acceptable service to my profession
in Britain than by laying before them a brief exposition of the
important views brought forward in this “Dissertatio Inauguralis.”[456]
After some preliminary observations on the ancient Temples of Health,
which are mainly derived from Sprengel’s “History of Medicine”[457]
he passes on to consider the opinion stated by this author and others
before his time, that the first book of the “Prorrhetics” and the
“Coacæ Prænotiones” are the results of isolated observations made upon
the sick in the Asclepion of Cos. The probability of this opinion
being well founded he shows to be very great; and he next endeavors
to solve the question whether the first book of the “Prorrhetics”
be derived from the “Coacæ Prænotiones,” or whether the latter be
the more modern work of the two. He comes to the conclusion that the
“Prorrhetics” is the more ancient work, for the following reasons: 1st.
Because in it the names of the patients are frequently given, which
is rarely the case in the “Coacæ Prænotiones.” 2d. Because queries
and doubts are oftener found in this book than in the other, when one
takes into account the number of presages. 3d. Because the number
of observations which this book contains is much smaller than those
which the “Coacæ” embrace. 4th. This is confirmed by the circumstance
that the enunciations of the prognoses are far less extended in the
“Prorrhetics,” whence it is clearly proved that they are not derived
from so great a field of observations as those we meet with in the
other work. He then gives a most lucid view of the parallelism which
subsists between the “Prorrhetica” and the “Coacæ,” and, as the results
of his observations upon them, he draws the following most important
conclusions:
1. “By a most fortunate occurrence certain monuments of the medical
art, as cultivated by the Asclepiadæ, are preserved to us in the first
“Prorrhetics” and the “Prænotiones Coacæ” which books appear to be
fragments and excerpts from the histories of diseases and cures which
were formerly found on the votive tablets of the Coan temple.
2. This sacerdotal medicine was at first a certain medical divination,
which, as it was the offspring of pure observation, so the system of
prognostics of the Coans was altogether aloof from the theories and
systems of the philosophers, and is therefore to be reckoned most
worthy of our attention, both from the great love of observation which
we admire in it, and from the exquisite and beautiful sense of the
simple truth which it evinces.
3. We must keep in view the origin of these presages from individual
observations gradually collected, in order that we may have a knowledge
of this system of prognostic semeiology. Hence we comprehend how we
meet with so many doubtful propositions, and so many uncertain and
vague remarks, and that imperfect etiology which confounded causes with
their effects, and again, the latter with the former.
4. The readers must particularly keep before their eyes this origin,
and the antiquity of those writings, if they would pass a correct
judgment on the merits of the Asclepiadæ towards the art of medicine.
Whatever in their works we have the pleasure of possessing, all attest
the infancy of the art; many things are imperfect, and not unfrequently
do we see them, while in the pursuit of truth, groping, as it were, and
proceeding with uncertain steps, like men wandering about in darkness;
but yet the method which they applied, and to which they would seem to
have betaken themselves of their own accord, was so excellent, that
nothing could surpass it. It was the same method which Hippocrates
himself always adopted, and which, in fine, Lord Bacon, many ages
afterwards, commended as the only instrument by which truth in medicine
can be found out.
5. As this method is founded on true induction, so are its dicta to be
held the more worthy of admiration, the more they possess a universal
signification. To give an example; what assiduous observation, and
what abundance of rational experience, must have been required for
enunciating the following admirable truth, and, as it were, law of
nature: “Those things which bring alleviation with bad signs, and do
not remit with good, are troublesome and difficult.”
6. Many passages bear reference to the condition of the vital powers,
which they took into account at all times, both in making presages and
in exercising the art. For, although they had not our theories of the
vital force, they perceived its effects very well by observation; and
for this very reason, that they did not search for the art in theories,
but in observation alone, we owe so many excellent things to them,
since they did not adapt their observation to theories, but related a
trustworthy and faithful history of the operations of nature.
7. They sought after many things from a comparison of health with
disease, in which also they rightly calculated the manners and customs
of men. Thus they call that, in the first place, the best mode of
reclining, which is adopted by the patient when in good health, and
hence they estimate the other modes as being less good, or altogether
unfavorable. Nor did they only compare health with disease, but
they compared also the symptoms of diseases with one another, and
interpreted the one from the other. Thus they first depict and
pronounce a favorable opinion on the best kind of excretions, and
then they described the other abnormal kinds, and pass an unfavorable
judgment on them.
8. They particularly relate the operations of a _natura medicatrix_,
which, in a region such as Greece is, and in athletic, strong bodies,
on which they appear to have practised the art, and for the most part
in acute diseases, and the few chronic ones derived from them which
they have left described, might especially be looked for. Hence that
doctrine of crises most deserving of attention, the rudiments, indeed,
of which we only have here preserved, but a just notion of which we may
easily draw from these fragments.
9. The Asclepiadæ would appear to have accommodated and directed their
art to this natural Therapia. Hence the advice that convulsions arising
from a great hemorrhage, forcibly stopped, should be cured by the
abstraction of blood. It is to be regretted that but a few monuments
of their practice remain; but these embrace admirable imitations of
nature, and the most prudent caution in administering remedies.
10. Neither did they neglect surgery, but deliver many excellent
remarks on things pertaining to wounds, ulcers, and fractures.
11. Although it cannot be made out for certain that everything which is
preserved in these writings existed before Hippocrates, there can be no
doubt that many of them are more ancient than he. And although we may
attribute some things rather to Hippocrates himself, it is nevertheless
certain that the method of deducing the art from observation and
comparison had existed before him. Some may, perhaps, object that
these books are to be attributed to the youth of Hippocrates, and
that the others, more elaborate and perfect, had proceeded from the
same person in his old age; but this supposition we may refute by a
single argument, namely, that it would be absurd to ascribe so many
observations about so many diseases to one man.
12. From the whole Coan system of cultivating medicine, the best hopes
might justly have been expected; and from what follows it will be seen
that the result did not disappoint this expectation.”
These deductions, I must say, appear to be most legitimately
drawn; and having thus satisfactorily made out that the “Coacæ
Prænotiones” are founded on the “Prorrhetics,” Dr. Ermerins proceeds
to make an interesting comparison between the former and the book
of “Prognostics.” Here again we can only find room for the general
conclusions.
1. “We have compared together two monuments of antiquity embracing
entirely the same doctrine, so that we may hold it as put out of all
doubt that they must have derived their origin from the same school,
only the one yields to the other in antiquity, as its more expanded
mode of expression shows.
2. The more recent work is attributed to Hippocrates by all the critics
and interpreters; the most ancient authors have made mention of it, and
all the characteristic marks by which the genuine works of Hippocrates
are distinguished from the spurious, without doubt, are found in it;
for whether you look to the brevity and gravity of the language, or the
paucity of the reasonings, the correctness of the observations, or the
dialect in which they are expressed, or, in fine, its agreement with
the whole Hippocratic doctrine,--all these attest that “the divine old
man” is the author of this work.
3. From a comparison of the “Coacæ Prænotiones” with the “Prognostics,”
it is as clear as the light of day that Hippocrates composed this work
from them, in such a manner that he circumscribed many of the symptoms,
limited the enunciations, and amplified them all by his own experience
in the medical Art. Hence the Prognostics may not inaptly be called the
Commentary of Hippocrates on the “Coacæ Prænotiones.”
4. With regard to the exquisite and artificial order, in which we see
many things proposed in his book, we agree entirely with Sprengel, who
thinks that they have proceeded from a more recent describer. This is
confirmed by our comparison of both works.
5. This work exhibits the fundamental principles and originals of the
Hippocratic doctrine, and although we hardly know anything as to the
manlier in which Hippocrates composed his writings, and of the form
which he gave them, it does not seem at all out of the way to hold this
book to be the oldest of all the works which “the Father of Medicine”
has left to us.
6. Inasmuch as this work is entitled the Book of Prognostics, so
it turns on the _prescience_ πρόνοια, that is to say, the
foreknowledge of the physician, which Hippocrates recommends to
physicians for three reasons: first, for the confidence of mankind,
which it will conciliate to the physician; then because it will free
the practitioner from all blame, if he has announced beforehand the
fatal result of diseases; and further, as being a very great instrument
in effecting the cure.
7. Like the Coan priests, Hippocrates drew his Prognostics from a
comparison of disease with health. This he held to be of so great
importance, that he first delivers physiological semeiotics, and then
adds pathological.
8. In calculating and judging of signs he neglected neither age nor
sex, and, in the first place, directed his mind to the power of habit
on the human body.
9. Nor did Hippocrates stop here, but directed care to be had of the
attack of epidemics, and the condition of the season.
10. The Prognostics of Hippocrates are not of one time or place, but
extend through every age, and through the whole world; inasmuch as the
prognostic signs have been proved to be true in Libya, in Delos, and
in Scythia, and it should be well known that every year, and at every
season of the year, bad symptoms bode ill, and good symptoms good.
11. But he who would wish to know properly beforehand those who
will recover from a disease, and those who will die, and those in
whom the disease will persevere for many days, and those in whom it
will last for a few, should be able to comprehend and estimate the
doctrine of all the signs, and weigh in his mind and compare together
their strength. The Hippocratic foreknowledge rests not only on the
observation of the signs, but also on the understanding of them.
12. The Book of Prognostics exhibits observations of acute diseases,
and of chronic arising from them, in which Hippocrates has diligently
noted the times and modes of the crises.
13. Such is the authority of critical days and signs, that in those
fevers which cease without the symptoms of resolution, and not upon
critical days, a relapse is to be expected.
14. The series of critical days which Hippocrates delivers, proceeds
solely upon the observation of nature. Yet neither can any of them be
exactly numbered by entire days, since neither the year nor the months
are usually numbered by entire days.”
Dr. Ermerins, in the remaining part of his Essay, shows, in a very
lucid manner, that the rules of Prognosis laid down in this treatise by
Hippocrates, are manifestly those by which he is regulated in his other
works, and more especially in the Epidemics and Aphorisms. We must
not, however, occupy room with any further exposition of the contents
of this important treatise, which does equal credit to the author
himself, and to the medical system of education pursued in the learned
university from which it emanated.
* * * * *
I will now give some remarks and reflections of my own on the treatise
under consideration.
In this work, then, Hippocrates appears to have had for his object, to
give such a general description of the phenomena of disease as would
apply to all the disorders of the animal frame. With this intention
he brings into review the state of the countenance, the position of
the patient in bed, the movements of the hands, the respiration,
the sweats, the state of the hypochondria, dropsies which are the
consequences of acute diseases, the sleep, the urine, the alvine
dejections, the vomitings, and the sputa. In doing this, his uniform
practice is to contrast the healthy with the morbid appearances.
Although M. Littré regards it as a treatise on special Pathology, it
appears to me to be decidedly a general work on Semeiology. Certain it
is that all the best commentators, such as Erotian and Stephanus,[458]
decidedly regard it as a semeiological work. The class of ancient
writings with which it admits of being most closely compared, are
the works on the prognostics of the weather. On this subject Greek
literature contains several works of a very philosophical nature,
such as the Phænomena of Aratus, and several of the minor tracts of
Theophrastus. Now as the object of these authors was to connect the
most striking phenomena in the sky, the earth, and the sea, with
the changes in the weather, of which they are the precursors, so
the intention of the medical writer of Prognostics was to point out
the alterations in the animal frame, which certain preternatural
symptoms usually indicate. And as the utility of an acquaintance with
prognostics of the weather to the husbandman and sailor is sufficiently
obvious, the benefit to be derived from a knowledge of medical
prognostics by the physician is equally so. Our author, it will be seen
in the Preface to this work, enumerates three objects to be attained
by cultivating an acquaintance with prognostics; first, to attract the
confidence of one’s patients; second, to free the physician from blame
by enabling him to announce beforehand the issue of the disorder about
which he is consulted; and, third, to give him a decided advantage in
conducting the treatment by preparing him for remarkable changes in
the diseases before they occur. And, in like manner, I may be allowed
to remark, the master of a ship who shows himself prepared for all
changes of the weather, will naturally attract the confidence of those
intrusted to his charge; and whatever may be the result, he will be
freed from blame if his ship should be damaged in a storm which he had
previously predicted; and surely his knowledge of impending commotions
in the sea and sky, will be of advantage to him by enabling him to make
preparations for them.
Looking then to the importance of general Prognostics, I have often
wondered why this branch of Semeiology is no longer cultivated by the
profession. Did not the ancient physicians follow the best possible
plan when they first described the general phenomena of diseased
action, and then applied them to particular cases? Surely they did
right in first taking a comprehensive view of the whole subject of
disease before attempting to examine the different parts of it in
detail. This, in fact, constitutes the great superiority of the ancient
_savans_ over the modern, that the former possessed a much
greater talent for apprehending general truths than the latter, who
confine their attention to particular facts, and too much neglect the
observation of general appearances. I trust no one will be offended
if I venture to pronounce regarding the present condition of our
professional literature, that (to borrow an illustration from the Logic
of Kant) it is altogether Cyclopic,--that is to say, it wants the eye
of Philosophy, for, although we have learned to examine particular
objects with greater accuracy than our forefathers did, the sphere
of our mental vision, so to speak, is more confined than theirs, and
cannot embrace the same enlarged views of general subjects. Surely then
we might gain a useful lesson by endeavoring to combine their more
comprehensive views with our own more accurate and minute observation.
Some people may be inclined to think that we have greatly detracted
from the credit which Hippocrates has long enjoyed as being the
undoubted author of this work, by showing that in composing it he
was so much indebted to the labors of his predecessors. But I have
long been impressed with the conviction that in compositions even of
the highest order, there is much less originality than is generally
supposed, and that true genius frequently is displayed more in its
own felicitous way of dealing with materials formerly prepared and
collected for its use than in searching out new matter to work
upon,[459] and hence it will be found upon examination that many of the
most distinguished efforts of human intellect have consisted in the
successful performance of tasks which had been frequently attempted by
previous laborers in the same line. Many artists, before the time of
Phidias, had acquired reputation by their attempts at making the statue
of Jupiter;[460] but this did not deter him from undertaking the same
task: and we may well believe that he would avail himself of every
practical lesson which he could draw from the success or failure of his
predecessors, in perfecting that matchless performance which completely
cast all others into the background. The sad misfortunes of Œdipus had
been often represented on the Athenian stage before Sophocles made them
the subject of those inimitable dramas, which still enjoy an unrivalled
reputation, nor will it be often considered how much assistance he may
have derived from the labors of those who had gone before him. It is
well known that of all the literary performances of Aristotle, there
is no one which gained him so enduring a reputation as his Categories,
and yet it is admitted that his division of the subject into the ten
Predicaments, was taken from the Pythagorean philosopher Archytas;[461]
in short, the great merit of Aristotle on this as on many other
occasions, consisted in defining and arranging a subject on which much
had been previously effected by the labors of his predecessors. And, to
give one example more, long before the time of Galen, the temperaments,
and the facts in physiology and pathology bearing upon Hygiene, had
been frequently and successfully investigated, but he, by recasting all
these subject-matters into his _Ars Medica_, composed a work which
posterity regarded as his master-performance, and every word and tittle
of which, for a succession ages, were commented upon and admired in
the Schools of Medicine. And of all our Author’s admired performances,
there is perhaps no one which has exerted so great an influence upon
the literature of the profession as the present work, for all the
Greek, Roman, and Arabian writers on medicine, subsequent to him, make
use of his terms, and copy his descriptions of morbid phenomena.
THE BOOK OF PROGNOSTICS.
1. It appears to me a most excellent thing for the physician to
cultivate Prognosis; for by foreseeing and foretelling, in the presence
of the sick, the present, the past, and the future, and explaining
the omissions which patients have been guilty of,[462] he will be the
more readily believed to be acquainted with the circumstances of the
sick; so that men will have confidence to intrust themselves to such a
physician. And he will manage the cure best who has foreseen what is
to happen from the present state of matters. For it is impossible to
make all the sick well; this, indeed, would have been better than to
be able to foretell what is going to happen; but since men die, some
even before calling the physician, from the violence of the disease,
and some die immediately after calling him, having lived, perhaps,
only one day or a little longer, and before the physician could bring
his art to counteract the disease; it therefore becomes necessary to
know the nature of such affections, how far they are above the powers
of the constitution; and, moreover, if there be anything divine in the
diseases,[463] and to learn a foreknowledge of this also. Thus a man
will be the more esteemed to be a good physician, for he will be the
better able to treat those aright who can be saved, from having long
anticipated everything; and by seeing and announcing beforehand those
who will live and those who will die, he will thus escape censure.[464]
2. He should observe thus in acute diseases: first, the countenance
of the patient, if it be like those of persons in health, and more so,
if like itself, for this is the best of all; whereas the most opposite
to it is the worst, such as the following; _a sharp nose, hollow
eyes, collapsed temples_; _the ears cold, contracted, and their
lobes turned out_: _the skin about the forehead being rough,
distended, and parched_; _the color of the whole face being green,
black, livid, or lead-colored_.[465] If the countenance be such
at the commencement of the disease, and if this cannot be accounted
for from the other symptoms, inquiry must be made whether the patient
has long wanted sleep; whether his bowels have been very loose; and
whether he has suffered from want of food; and if any of these causes
be confessed to, the danger is to be reckoned so far less; and it
becomes obvious, in the course of a day and a night, whether or not the
appearance of the countenance proceeded from these causes.[466] But
if none of these be said to exist, and if the symptoms do not subside
in the aforesaid time, it is to be known for certain that death is at
hand. And, also, if the disease be in a more advanced stage either
on the third or fourth day, and the countenance be such, the same
inquiries as formerly directed are to be made, and the other symptoms
are to be noted, those in the whole countenance, those on the body, and
those in the eyes; for if they shun the light, or weep involuntarily,
or squint, or if the one be less than the other, or if the white of
them be red, livid, or has black veins in it; if there be a gum upon
the eyes, if they are restless, protruding, or are become very hollow;
and if the countenance be squalid and dark, or the color of the whole
face be changed--all these are to be reckoned bad and fatal symptoms.
The physician should also observe the appearance of the eyes from below
the eyelids in sleep; for when a portion of the white appears, owing to
the eyelids not being closed together, and when this is not connected
with diarrhœa or purgation from medicine, or when the patient does not
sleep thus from habit, it is to be reckoned an unfavorable and very
deadly symptom; but if the eyelid be contracted, livid, or pale, or
also the lip, or nose, along with some of the other symptoms, one may
know for certain that death is close at hand. It is a mortal symptom,
also, when the lips are relaxed, pendent, cold, and blanched.
3.[467] It is well when the patient is found by his physician
reclining upon either his right or his left side, having his hands,
neck, and legs slightly bent, and the whole body lying in a relaxed
state, for thus the most of persons in health recline, and these are
the best of postures which most resemble those of healthy persons. But
to lie upon one’s back, with the hands, neck, and the legs extended,
is far less favorable. And if the patient incline forward, and sink
down to the foot of the bed, it is a still more dangerous symptom; but
if he be found with his feet naked and not sufficiently warm, and the
hands, neck, and legs tossed about in a disorderly manner and naked,
it is bad, for it indicates aberration of intellect. It is a deadly
symptom, also, when the patient sleeps constantly with his mouth open,
having his legs strongly bent and plaited together, while he lies upon
his back; and to lie upon one’s belly, when not habitual to the patient
to sleep thus while in good health, indicates delirium, or pain in the
abdominal regions. And for the patient to wish to sit erect at the acme
of a disease is a bad symptom in all acute diseases, but particularly
so in pneumonia.[468] To grind the teeth in fevers, when such has not
been the custom of the patient from childhood, indicates madness and
death, both which dangers are to be announced beforehand as likely
to happen; and if a person in delirium do this it is a very deadly
symptom. And if the patient had an ulcer previously, or if one has
occurred in the course of the disease, it is to be observed; for if the
man be about to die the sore will become livid and dry, or yellow and
dry before death.[469]
4. Respecting the movement of the hands I have these observations to
make: When in acute fevers, pneumonia, phrenitis, or headache, the
hands are waved before the face, hunting through empty space, as if
gathering bits of straw, picking the nap from the coverlet, or tearing
chaff from the wall--all such symptoms are bad and deadly.[470]
5. Respiration, when frequent, indicates pain or inflammation in the
parts above the diaphragm: a large respiration performed at a great
interval announces delirium; but a cold respiration at nose or mouth
is a very fatal symptom. Free respiration is to be looked upon as
contributing much to the safety of the patient in all acute diseases,
such as fevers, and those complaints which come to a crisis in forty
days.[471]
6. Those sweats are the best in all acute diseases which occur on the
critical days, and completely carry off the fever. Those are favorable,
too, which taking place over the whole body, show that the man is
bearing the disease better. But those that do not produce this effect
are not beneficial. The worst are cold sweats, confined to the head,
face, and neck; these in an acute fever prognosticate death, or in a
milder one, a prolongation of the disease; and sweats which occur over
the whole body, with the characters of those confined to the neck, are
in like manner bad. Sweats attended with a miliary eruption, and taking
place about the neck, are bad; sweats in the form of drops and of
vapour are good. One ought to know the entire character of sweats, for
some are connected with prostration of strength in the body, and some
with intensity of the inflammation.[472]
7.[473] That state of the hypochondrium is best when it is free from
pain, soft, and of equal size on the right side and the left. But
if inflamed, or painful, or distended; or when the right and left
sides are of disproportionate sizes;--all these appearances are to
be dreaded. And if there be also pulsation in the hypochondrium, it
indicates perturbation or delirium; and the physician should examine
the eyes of such persons; for if their pupils be in rapid motion, such
persons may be expected to go mad. A swelling in the hypochondrium,
that is hard and painful, is very bad, provided it occupy the whole
hypochondrium; but if it be on either side, it is less dangerous
when on the left. Such swellings at the commencement of the disease
prognosticate speedy death; but if the fever has passed twenty days,
and the swelling has not subsided, it turns to a suppuration.[474] A
discharge of blood from the nose occurs to such in the first period,
and proves very useful; but inquiry should be made if they have
headache or indistinct vision; for if there be such, the disease will
be determined thither. The discharge of blood is rather to be expected
in those who are younger than thirty-five years. Such swellings as
are soft, free from pain, and yield to the finger, occasion more
protracted crises, and are less dangerous than the others. But if
the fever continue beyond sixty days, without any subsidence of the
swelling, it indicates that empyema is about to take place; and a
swelling in any other part of the cavity will terminate in like manner.
Such, then, as are painful, hard, and large, indicate danger of speedy
death; but such as are soft, free of pain, and yield when pressed
with the finger, are more chronic than these. Swellings in the belly
less frequently form abscesses than those in the hypochondrium; and
seldomest of all, those below the navel are converted into suppuration;
but you may rather expect a hemorrhage from the upper parts. But the
suppuration of all protracted swellings about these parts is to be
anticipated. The collections of matter there are to be thus judged of:
such as are determined outwards are the best when they are small, when
they protrude very much, and swell to a point; such as are large and
broad, and which do not swell out to a sharp point, are the worst. Of
such as break internally, the best are those which have no external
communication, but are covered and indolent; and when the whole
place is free from discoloration. That pus is best which is white,
homogeneous, smooth, and not at all fetid; the contrary to this is the
worst.
8.[475] All dropsies arising from acute diseases are bad; for they do
not remove the fever, and are very painful and fatal. The most of them
commence from the flanks and loins, but some from the liver; in those
which derive their origin from the flanks and loins the feet swell,
protracted diarrhœas supervene, which neither remove the pains in the
flanks and loins, nor soften the belly;[476] but in dropsies which are
connected with the liver there is a tickling cough, with scarcely any
perceptible expectoration, and the feet swell; there are no evacuations
from the bowels, unless such as are hard and forced; and there are
swellings about the belly, sometimes on the one side and sometimes on
the other, and these increase and diminish by turns.[477]
9. It is a bad symptom when the head, hands, and feet are cold, while
the belly and sides are hot; but it is a very good symptom when the
whole body is equally hot.[478] The patient ought to be able to turn
round easily, and to be agile when raised up; but if he appear heavy
in the rest of his body as well as in his hands and feet, it is more
dangerous; and if, in addition to the weight, his nails and fingers
become livid, immediate death may be anticipated; and if the hands and
feet be black it is less dangerous than if they be livid, but the other
symptoms must be attended to; for if he appear to bear the illness
well, and if certain of the salutary symptoms appear along with these
there may be hope that the disease will turn to a deposition, so that
the man may recover; but the blackened parts of the body will drop off.
When the testicles and members are retracted upwards, they indicate
strong pains and danger of death.[479]
10. With regard to sleep--as is usual with us in health, the patient
should wake during the day and sleep during the night. If this rule
be anywise altered it is so far worse: but there will be little harm
provided he sleep in the morning for the third part of the day; such
sleep as takes place after this time is more unfavorable; but the worst
of all is to get no sleep either night or day; for it follows from this
symptom that the insomnolency is connected with sorrow and pains, or
that he is about to become delirious.[480]
11. The excrement is best which is soft and consistent, is passed
at the hour which was customary to the patient when in health, in
quantity proportionate to the ingesta; for when the passages are such,
the lower belly is in a healthy state.[481] But if the discharges be
fluid, it is favorable that they are not accompanied with a noise,
nor are frequent, nor in great quantity; for the man being oppressed
by frequently getting up, must be deprived of sleep; and if the
evacuations be both frequent and large, there is danger of his falling
into deliquium animi.[482] But in proportion to the ingesta he should
have evacuations twice or thrice in the day, once at night and more
copiously in the morning, as is customary with a person in health. The
fæces should become thicker when the disease is tending to a crisis;
they ought to be yellowish and not very fetid. It is favorable that
round worms be passed with the discharges when the disease is tending
to a crisis.[483] The belly, too, through the whole disease, should be
soft and moderately distended; but excrements that are very watery, or
white, or green, or very red, or frothy, are all bad. It is also bad
when the discharge is small, and viscid, and white, and greenish, and
smooth; but still more deadly appearances are the black, or fatty, or
livid, or verdigris-green, or fetid. Such as are of varied characters
indicate greater duration of the complaint, but are no less dangerous;
such as those which resemble scrapings,[484] those which are bilious,
those resembling leeks, and the black; these being sometimes passed
together, and sometimes singly.[485] It is best when wind passes
without noise, but it is better that flatulence should pass even
thus than that it should be retained; and when it does pass thus, it
indicates either that the man is in pain or in delirium, unless he
gives vent to the wind spontaneously.[486] Pains in the hypochondria,
and swellings, if recent, and not accompanied with inflammation,
are relieved by borborygmi supervening in the hypochondrium, more
especially if it pass off with fæces, urine, and wind; but even
although not, it will do good by passing along, and it also does good
by descending to the lower part of the belly.[487]
12. The urine is best when the sediment is white, smooth, and
consistent during the whole time, until the disease come to a crisis,
for it indicates freedom from danger, and an illness of short
duration; but if deficient, and if it be sometimes passed clear, and
sometimes with a white and smooth sediment, the disease will be more
protracted, and not so void of danger. But if the urine be reddish,
and the sediment consistent and smooth, the affection, in this case,
will be more protracted than the former, but still not fatal.[488] But
farinaceous sediments in the urine are bad, and still worse are the
leafy;[489] the white and thin are very bad, but the furfuraceous are
still worse than these. Clouds carried about in the urine are good
when white, but bad if black. When the urine is yellow and thin, it
indicates that the disease is unconcocted; and if it (the disease)
should be protracted, there may be danger lest the patient should not
hold out until the urine be concocted.[490] But the most deadly of
all kinds of urine are the fetid, watery, black, and thick; in adult
men and women the black is of all kinds of urine the worst, but in
children, the watery.[491] In those who pass thin and crude urine for
a length of time, if they have otherwise symptoms of convalescence, an
abscess may be expected to form in the parts below the diaphragm.[492]
And fatty substances floating on the surface are to be dreaded, for
they are indications of melting. And one should consider respecting
the kinds of urine, which have clouds, whether they tend upwards or
downwards, and the colors which they have and such as fall downwards,
with the colors as described, are to be reckoned good and commended;
but such as are carried upwards, with the colors as described, are to
be held as bad, and are to be distrusted.[493] But you must not allow
yourself to be deceived if such urine be passed while the bladder is
diseased; for then it is a symptom of the state, not of the general
system, but of a particular viscus.[494]
13. That vomiting is of most service which consists of phlegm and
bile mixed together, and neither very thick nor in great quantity; but
those vomitings which are more unmixed are worse. But if that which is
vomited be of the color of leeks or livid, or black, whatever of these
colors it be, it is to be reckoned bad; but if the same man vomit all
these colors, it is to be reckoned a very fatal symptom. But of all
the vomitings, the livid indicates the most imminent danger of death,
provided it be of a fetid smell. But all the smells which are somewhat
putrid and fetid, are bad in all vomitings.[495]
14. The expectoration in all pains about the lungs and sides, should
be quickly and easily brought up, and a certain degree of yellowness
should appear strongly mixed up with the sputum. But if brought up long
after the commencement of the pain, and of a yellow or ruddy color, or
if it occasions much cough, or be not strongly mixed, it is worse; for
that which is intensely yellow is dangerous, but the white, and viscid,
and round, do no good. But that which is very green and frothy is bad;
but if so intense as to appear black, it is still more dangerous than
these; it is bad if nothing is expectorated, and the lungs discharge
nothing, but are gorged with matters which boil (as it were) in the
air-passages. It is bad when coryza and sneezing either precede or
follow affections of the lungs, but in all other affections, even the
most deadly, sneezing is a salutary symptom.[496] A yellow spittle
mixed up with not much blood in cases of pneumonia, is salutary and
very beneficial if spit up at the commencement of the disease, but if
on the seventh day, or still later, it is less favorable. And all sputa
are bad which do not remove the pain. But the worst is the black, as
has been described. Of all others the sputa which remove the pain are
the best.[497]
15. When the pains in these regions do not cease, either with
the discharge of the sputa, nor with alvine evacuations, nor from
venesection, purging with medicine, nor a suitable regimen, it is to
be held that they will terminate in suppurations.[498] Of empyemata
such as are spit up while the sputum is still bilious, are very fatal,
whether the bilious portion be expectorated separate, or along with
the other; but more especially if the empyema begin to advance after
this sputum on the seventh day of the disease. It is to be expected
that a person with such an expectoration shall die on the fourteenth
day, unless something favorable supervene. The following are favorable
symptoms: to support the disease easily, to have free respiration, to
be free from pain, to have the sputa readily brought up, the whole body
to appear equally warm and soft, to have no thirst, the urine, and
fæces, sleep, and sweats to be all favorable, as described before; when
all these symptoms concur, the patient certainly will not die; but if
some of these be present and some not, he will not survive longer than
the fourteenth day. The bad symptoms are the opposite of these, namely,
to bear the disease with difficulty, respiration large and dense, the
pain not ceasing, the sputum scarcely coughed up, strong thirst, to
have the body unequally affected by the febrile heat, the belly and
sides intensely hot, the forehead, hands, and feet cold; the urine, and
excrements, the sleep, and sweats, all bad, agreeably to the characters
described above; if such a combination of symptoms accompany and either
on the ninth or eleventh. Thus then one may conclude regarding this
expectoration, that it is very deadly, and that the patient will not
survive until the fourteenth day. It is by balancing the concomitant
symptoms whether good or bad, that one is to form a prognosis; for thus
it will most probably prove to be a true one. Most other suppurations
burst, some on the twentieth, some on the thirtieth, some on the
fortieth, and some as late as the sixtieth day.[499]
16. One should estimate when the commencement of the suppuration will
take place, by calculating from the day on which the patient was first
seized with fever, or if he had a rigor, and if he says, that there is
a weight in the place where he had pain formerly, for these symptoms
occur in the commencement of suppurations. One then may expect the
rupture of the abscesses to take place from these times according to
the periods formerly stated. But if the empyema be only on either side,
one should turn him and inquire if he has pain on the other side; and
if the one side be hotter than the other, and when laid upon the sound
side, one should inquire if he has the feeling of a weight hanging from
above, for if so, the empyema will be upon the opposite side to that on
which the weight was felt.[500]
17. Empyema may be recognized in all cases by the following symptoms:
In the first place, the fever does not go off, but is slight during the
day, and increases at night, and copious sweats supervene, there is a
desire to cough, and the patients expectorate nothing worth mentioning,
the eyes become hollow, the cheeks have red spots on them, the nails of
the hands are bent, the fingers are hot especially their extremities,
there are swellings in the feet, they have no desire of food, and
small blisters (phlyctænæ) occur over the body. These symptoms attend
chronic empyemata, and may be much trusted to; and such as are of short
standing are indicated by the same, provided they be accompanied by
those signs which occur at the commencement, and if at the same time
the patient has some difficulty of breathing. Whether they will break
earlier or later may be determined by these symptoms; if there be
pain at the commencement, and if the dyspnœa, cough, and ptyalism be
severe, the rupture may be expected in the course of twenty days or
still earlier; but if the pain be more mild, and all the other symptoms
in proportion, you may expect from these the rupture to be later; but
pain, dyspnœa, and ptyalism, must take place before the rupture of the
abscess. Those patients recover most readily whom the fever leaves the
same day that the abscess bursts,--when they recover their appetite
speedily, and are freed from the thirst,--when the alvine discharges
are small and consistent, the matter white, smooth, uniform in color,
and free of phlegm, and if brought up without pain or strong coughing.
Those die whom the fever does not leave, or when appearing to leave
them it returns with an exacerbation; when they have thirst, but no
desire of food, and there are watery discharges from the bowels; when
the expectoration is green or livid, or pituitous and frothy; if all
these occur they die, but if certain of these symptoms supervene, and
others not, some patients die and some recover, after a long interval.
But from all the symptoms taken together one should form a judgment,
and so in all other cases.
18. When abscesses form about the ears, after peripneumonic
affections, or depositions of matter take place in the inferior
extremities and end in fistula, such persons recover. The following
observations are to be made upon them: if the fever persist, and the
pain do not cease, if the expectoration be not normal, and if the
alvine discharges be neither bilious, nor free and unmixed; and if the
urine be neither copious nor have its proper sediment, but if, on the
other hand, all the other salutary symptoms be present, in such cases
abscesses may be expected to take place. They form in the inferior
parts when there is a collection of phlegm about the hypochondria; and
in the upper when the hypochondria continue soft and free of pain, and
when dyspnœa having been present for a certain time, ceases without any
obvious cause.[501] All deposits which take place in the legs after
severe and dangerous attacks of pneumonia, are salutary, but the best
are those which occur at the time when the sputa undergo a change;
for if the swelling and pain take place while the sputa are changing
from yellow and becoming of a purulent character, and are expectorated
freely, under these circumstances the man will recover most favorably
and the abscess becoming free of pain, will soon cease; but if the
expectoration is not free, and the urine does not appear to have the
proper sediment, there is danger lest the limb should be maimed, or
that the case otherwise should give trouble. But if the abscesses
disappear and go back, while expectoration does not take place, and
fever prevails, it is a bad symptom; for there is danger that the man
may get into a state of delirium and die. Of persons having empyema
after peripneumonic affections, those that are advanced in life run
the greatest risk of dying; but in the other kinds of empyema younger
persons rather die.[502] In cases of empyema treated by the cautery or
incision, when the matter is pure, white, and not fetid, the patient
recovers; but if of a bloody and dirty character, he dies.[503]
19. Pains accompanied with fever which occur about the loins and
lower parts, if they attack the diaphragm, and leave the parts below,
are very fatal. Wherefore one ought to pay attention to the other
symptoms, since if any unfavorable one supervene, the case is hopeless;
but if while the disease is determined to the diaphragm, the other
symptoms are not bad, there is great reason to expect that it will
end in empyema.[504] When the bladder is hard and painful, it is an
extremely bad and mortal symptom, more especially in cases attended
with continued fever; for the pains proceeding from the bladder alone
are enough to kill the patient; and at such a time the bowels are
not moved, or the discharges are hard and forced. But urine of a
purulent character, and having a white and smooth sediment, relieves
the patient. But if no amendment takes place in the characters of the
urine, nor the bladder become soft, and the fever is of the continual
type, it may be expected that the patient will die in the first stages
of the complaint. This form attacks children more especially, from
their seventh to their fifteenth year.[505]
20. Fevers come to a crisis on the same days as to number on which men
recover and die. For the mildest class of fevers, and those originating
with the most favorable symptoms, cease on the fourth day or earlier;
and the most malignant, and those setting in with the most dangerous
symptoms, prove fatal on the fourth day or earlier. The first class of
them as to violence ends thus: the second is protracted to the seventh
day, the third to the eleventh, the fourth to the fourteenth, the
fifth to the seventeenth, and the sixth to the twentieth. Thus these
periods from the most acute disease ascend by fours up to twenty. But
none of these can be truly calculated by whole days, for neither the
year nor the months can be numbered by entire days. After these in the
same manner, according to the same progression, the first period is
of thirty-four days, the second of forty days, and the third of sixty
days. In the commencement of these it is very difficult to determine
those which will come to a crisis after a long interval; for these
beginnings are very similar, but one should pay attention from the
first day, and observe further at every additional tetrad, and then one
cannot miss seeing how the disease will terminate. The constitution
of quartans is agreeable to the same order. Those which will come to
a crisis in the shortest space of time, are the easiest to be judged
of; for the differences of them are greatest from the commencement,
thus those who are going to recover breathe freely, and do not suffer
pain, they sleep during the night, and have the other salutary
symptoms, whereas those that are to die have difficult respiration, are
delirious, troubled with insomnolency, and have other bad symptoms.
Matters being thus, one may conjecture, according to the time, and each
additional period of the diseases, as they proceed to a crisis. And
in women, after parturition, the crises proceed agreeably to the same
ratio.[506]
21. Strong and continued headaches with fever, if any of the deadly
symptoms be joined to them, are very fatal. But if without such
symptoms the pain be prolonged beyond twenty days, a discharge of blood
from the nose or some abscess in the inferior parts may be anticipated;
but while the pain is recent, we may expect in like manner a discharge
of blood from the nose, or a suppuration, especially if the pain be
seated above the temples and forehead; but the hemorrhage is rather to
be looked for in persons younger than thirty years, and the suppuration
in more elderly persons.[507]
22. Acute pain of the ear, with continual and strong fever, is to be
dreaded; for there is danger that the man may become delirious and die.
Since, then, this is a hazardous spot, one ought to pay particular
attention to all these symptoms from the commencement. Younger persons
die of this disease on the seventh day, or still earlier, but old
persons much later; for the fevers and delirium less frequently
supervene upon them, and on that account the ears previously come to
a suppuration, but at these periods of life, relapses of the disease
coming on generally prove fatal. Younger persons die before the ear
suppurates; only if white matter run from the ear, there may be hope
that a younger person will recover, provided any other favorable
symptom be combined.[508]
23. Ulceration of the throat with fever, is a serious affection,
and if any other of the symptoms formerly described as being bad,
be present, the physician ought to announce that his patient is in
danger.[509] Those quinsies are most dangerous, and most quickly prove
fatal, which make no appearance in the fauces, nor in the neck, but
occasion very great pain and difficulty of breathing; these induce
suffocation on the first day, or on the second, the third, or the
fourth.[510] Such as, in like manner, are attended with pain, are
swelled up, and have redness (erythema) in the throat, are indeed very
fatal, but more protracted than the former, provided the redness be
great.[511] Those cases in which both the throat and the neck are red,
are more protracted, and certain persons recover from them, especially
if the neck and breast be affected with erythema, and the erysipelas
be not determined inwardly.[512] If neither the erysipelas disappear
on the critical day, nor any abscess form outwardly, nor any pus be
spit up, and if the patient fancy himself well, and be free from
pain, death, or a relapse of the erythema is to be apprehended. It
is much less hazardous when the swelling and redness are determined
outwardly; but if determined to the lungs, they superinduce delirium,
and frequently some of these cases terminate in empyema.[513] It is
very dangerous to cut off or scarify enlarged uvulæ while they are red
and large, for inflammations and hemorrhages supervene; but one should
try to reduce such swellings by some other means at this season. When
the whole of it is converted into an abscess, which is called Uva, or
when the extremity of the variety called Columella is larger and round,
but the upper part thinner, at this time it will be safe to operate.
But it will be better to open the bowels gently before proceeding to
the operation, if time will permit, and the patient be not in danger of
being suffocated.[514]
24. When the fevers cease without any symptoms of resolution
occurring, and not on the critical days, in such cases a relapse may
be anticipated.[515] When any of the fevers is protracted, although
the man exhibits symptoms of recovery, and there is no longer pain
from any inflammation, nor from any other visible cause, in such a
case a deposit, with swelling and pain, may be expected in some one
of the joints, and not improbably in those below. Such deposits occur
more readily and in less time to persons under thirty years of age;
and one should immediately suspect the formation of such a deposit, if
the fever be protracted beyond twenty days; but to aged persons these
less seldom happen, and not until the fever be much longer protracted.
Such a deposit may be expected, when the fever is of a continual type,
and that it will pass into a quartan, if it become intermittent, and
its paroxysms come on in an irregular manner, and if in this form it
approach autumn. As deposits form most readily in persons below thirty
years of age, so quartans most commonly occur to persons beyond that
age. It is proper to know that deposits occur most readily in winter,
that then they are most protracted, but are less given to return.[516]
Whoever, in a fever that is not of a fatal character, says that he has
pain in his head, and that something dark appears to be before his
eyes, and that he has pain at the stomach, will be seized with vomiting
of bile; but if rigor also attack him, and the inferior parts of the
hypochondrium are cold, vomiting is still nearer at hand; and if he
eat or drink anything at such a season, it will be quickly vomited.
In these cases, when the pain commences on the first day, they are
particularly oppressed on the fourth and the fifth; and they are
relieved on the seventh, but the greater part of them begin to have
pain on the third day, and are most especially tossed on the fifth,
but are relieved on the ninth or eleventh; but in those who begin to
have pains on the fifth day, and other matters proceed properly with
them, the disease comes to a crisis on the fourteenth day. But when in
such a fever persons affected with headache, instead of having a dark
appearance before their eyes, have dimness of vision, or flashes of
light appear before their eyes, and instead of pain at the pit of the
stomach, they have in their hypochondrium a fulness stretching either
to the right or left side, without either pain or inflammation, a
hemorrhage from the nose is to be expected in such a case, rather than
a vomiting. But it is in young persons particularly that the hemorrhage
is to be expected, for in persons beyond the age of thirty-five,
vomitings are rather to be anticipated. Convulsions occur to children
if acute fever be present, and the belly be constipated, if they cannot
sleep, are agitated, and moan, and change color, and become green,
livid, or ruddy. These complaints occur most readily to children which
are very young up to their seventh year; older children and adults are
not equally liable to be seized with convulsions in fevers, unless some
of the strongest and worst symptoms precede, such as those which occur
in frenzy. One must judge of children as of others, which will die
and which recover, from the whole of the symptoms, as they have been
specially described.[517] These things I say respecting acute diseases,
and the affections which spring from them.
25. He who would know correctly beforehand those that will recover,
and those that will die, and in what cases the disease will be
protracted for many days, and in what cases for a shorter time, must
be able to form a judgment from having made himself acquainted with
all the symptoms, and estimating their powers in comparison with one
another, as has been described, with regard to the others, and the
urine and sputa, as when the patient coughs up pus and bile together.
One ought also to consider promptly the influx of epidemical diseases
and the constitution of the season.[518] One should likewise be well
acquainted with the particular signs and the other symptoms, and
not be ignorant how that, in every year, and at every season, bad
symptoms prognosticate ill, and favorable symptoms good, since the
aforesaid symptoms appear to have held true in Libya, in Delos, and in
Scythia;[519] from which it may be known that, in the same regions,
there is no difficulty in attaining a knowledge of many more things
than these; if having learned them, one knows also how to judge and
reason correctly of them. But you should not complain because the name
of any disease may happen not to be described here, for you may know
all such as come to a crisis in the afore-mentioned times, by the same
symptoms.[520]
APPENDIX
TO
THE BOOK OF PROGNOSTICS.
As announced in the Preliminary Discourse (Sect. II., 18), I shall
now proceed to give an abstract of the principal matters contained
in the SECOND BOOK OF PRORRHETICS, which appear to me to be
highly interesting, and as they relate to the subjects treated of in
the Prognostics, they may be more suitably introduced here than in any
other place.
The author commences the treatise with expressing his disapproval of
certain modes of making prognostics which he had seen practiced. He
says he had heard of many and famous predictions having been made by
physicians, such as he himself did not pretend that he could make.
Such, for example, as for a physician to call in upon a patient who was
looked upon as being in a desperate condition by another physician, and
predict that he would not die, but would lose his sight. Or to predict
with regard to another patient supposed to be in a bad way, that he
will recover, but will become lame of a hand. And of a third who, to
all appearance, cannot recover, to predict that he will get well,
but that his toes will blacken and putrefy. Similar predictions are
related under this class. Another mode of prediction is to prophecy to
buyers and traders, to one death, to another madness, and to the rest
diseases, and that from what is now occurring, or has occurred before,
and all the predictions to turn out true. Another kind of predictions
relates to Athletæ, and those who practice gymnastic and laborious
exercises for the cure of diseases, where the practitioner pretends to
so much exactness, that if the patient is guilty of any act of omission
or commission in regard to food, drink, or venery, the physician
will detect it. He himself makes no pretensions to any such skill in
divination, but announces it as his object to describe the symptoms
by which it may be known whether a man will die or live, and whether
his disease will be of short or of long duration. With regard to the
predictions of abscesses, lameness, death, or madness, the author holds
that they can only be made after the morbid conditions leading to them
have fairly set in. He strongly disapproves of all ostentatious modes
of making predictions, and gives it as his advice that in all such
cases the greatest prudence and reserve should be observed, since if a
man become an adept in this art of prognostications, he will gain great
credit with his patient, whereas if he fall into mistakes, he will
incur odium, and will be looked upon as being deranged.
With regard to the prognostics made by those who practice gymnastics,
he recommends them not to be made in a charlatan manner, but with
suitable caution, and directs minute attention to be paid to the
circumstances of the patient, which one has superior advantages in
observing under this system. He says, for example, that a physician who
feels a patient’s belly and pulse, pays attention to the breathing at
the nostrils, and listens to the speech, and sound of the respiration,
will be less likely to be deceived in forming a prognostic on his
patients than he who neglects these things. He expresses himself,
however, as being incredulous as to the possibility of detecting any
little transgressions of orders which a patient may commit, although
greater departures from instructions may be suspected. After some
general observations in respect to diet, and other matters relating to
it, he proceeds to a more circumstantial description of the symptoms
upon which a prognosis is to be founded. And first, with regard to the
alvine dejections, those of persons who live a laborious life, and use
food and drink sparingly, are small and hard, and are passed every day,
every third day, or every fourth day, but if they pass the last period
there is danger of the man’s being seized with fever or diarrhœa. When
the stools are so liquid that they do not assume a shape, they are all
of a worse character in these cases. The dejections of persons who lead
an active life are less copious than those of the indolent, provided
they use the same amount of food. Liquid dejections taking place on the
seventh day, and quickly coming to a crisis, are beneficial, if they
occur all at once, and are not repeated. But if accompanied with fever,
or if the diarrhœa is prolonged, all such dejections are bad, whether
bilious, pituitous, or of indigested matters, and require a particular
regimen and mode of treatment.
With regard to the urine, it should be in proportion to the drink that
is taken, and somewhat thicker than the fluid that is drunk. If it be
more copious than natural, this indicates either that the patient has
disobeyed orders as to the amount of his drink, or that his body is in
a state of atrophy. If the urine is passed in deficient quantity, with
a noise, it indicates either that the man stands in need of purging, or
that the bladder is diseased. A small quantity of blood passed without
fever and pain does not indicate anything bad, but proves a solution to
a state of lassitude. But if in large quantity, with the addition of
any of these symptoms, it is to be dreaded. But if the urine be passed
with pain, and if pus be passed along with the urine in a fever, the
physician should announce that the patient will thus be relieved of his
complaints.[521] Thick urine having a thin sediment indicates some pain
and swelling about the joints. All the other sediments which occur in
the urine of persons who practice exercises are connected with disease
about the bladder; this will be clearly shown by the obstinate pains
with which they are accompanied. The author, although he states that he
had been conversant with the teachers of prognostics from urine, and
their children and disciples, seems to express himself doubtful as to
the possibility of acquiring a great degree of accuracy in regard to
these matters.
Respecting dropsy, consumption, gout, and epilepsy, he states generally
that if they are hereditary they are difficult to remove. A favorable
prognosis is to be formed in dropsy when the patient’s viscera are
sound, when his strength is firm, the digestion and respiration
natural, when he is free of pain, the temperature of the body moderate,
and when there is no wasting of the extremities. It is favorable when
there is no cough, thirst, nor dryness of the tongue, when the bowels
are easily moved by medicine, and when, at other times, the dejections
are consistent. Dropsy, supervening, along with fever, upon a great
discharge of blood, is of a most intractable nature, and the physician
should intimate the danger to some other person beforehand. When great
swellings suddenly subside and rise again, there is more hope in such a
case than in dropsies connected with a discharge of blood. He concludes
his observations on dropsies with the remark, that they are apt to
deceive the patients, so that they desert their physicians and thus
perish.
With regard to consumptive patients, he says, he has the same
observations to make with regard to the sputa and cough as he had
written with regard to empyema.[522] If the patient is to recover,
the sputa should be white, equable, of one color, without phlegm; the
defluxion from the head should be determined to the nose; there should
be no fever, nor anorexia, nor thirst; the alvine discharges firm,
proportionate to the ingesta, and the patient should not get thin.
The best form of the chest is when it is quadrangular and hairy, and
when the cartilage is small, and covered with flesh. Young persons,
who become affected with empyema from determination (metastasis?), or
fistula, or from any other similar cause, or from the retrocession
of an abscess, do not recover unless many of the favorable symptoms
combine in the case. They die, most commonly, in autumn, which proves
peculiarly fatal in protracted diseases. Of all others, virgins, and
women suffering from amenorrhœa, seldomest recover; and in their cases
there is no hope unless menstruation be restored. All sexes, he seems
to say (but the meaning appears to me rather ambiguous), have a better
chance of recovery, when there is a discharge of blood, especially in
those cases in which there are pains in the back and chest, connected
with black bile; and if, after the evacuation, there be a remission
of the pain; if the cough and fever do not set in; and if the thirst
be tolerable. He seems to state (but the text is in an unsatisfactory
condition), that relapses take place unless there be deposits in the
place, the best of which are those which contain most blood; and that
in those cases in which there are pains in the chest, if the patients
get emaciated, and cough, and a dyspnœa supervenes, without fever
or empyema, they should be asked whether, when they cough, and have
difficulty of breathing, the sputa be compact, and attended with little
smell.
With regard to persons affected with the gout, those who are aged,
have tofi in their joints, who have led a hard life, and whose bowels
are constipated, are beyond the power of medicine to cure. But, the
best natural remedy for them is an attack of dysentery, or other
determination to the bowels. Persons, under opposite circumstances, may
be cured by a skilful physician.
The prognosis in epilepsy is unfavorable when the disease is
congenital, and when it endures to manhood, and when it occurs to a
grown person, and without any obvious cause. When connected with the
head it is particularly to be apprehended, but least so when it seems
to be derived from the hands or feet. The cure may be attempted in
young persons, but not in old.
In the case of children, he mentions various complaints, such as
distortion of the eyes, tubercles about the neck, pain in the bowels,
omental hernia, etc., which, upon inquiry, will be found to be the
consequences of an attack of epilepsy.
The judgment to be formed in the case of ulcers is to be founded on the
age of the patient, the situation of the sore, and its appearance.
Strumous tubercles, which end in suppuration, occur most frequently in
young persons. Adults are subject to bad favi, internal cancers, and
herpetic sores, after epinyetis, until they pass sixty. Old persons are
subject to cancers, both deep-seated and superficial, which never leave
them. They are particularly intractable when seated in the armpits, the
loins, and the thighs.
Of affections of the joints, the most dangerous are those seated in the
thumb and great toe. When there is a chronic sore on the side of the
tongue the surgeon should examine whether it be not occasioned by the
sharp edge of a tooth.[523]
The most dangerous wounds are those which implicate the large veins
(blood-vessels), in the neck and groin; then those of the brain and
liver; next, those of the bowels and bladder. These cases are all
dangerous, but not uniformly fatal, as some suppose. Much depends upon
constitution, as to liability to fever and inflammation after a wound.
Sometimes, also, the wounds of smaller vessels prove fatal by inducing
hemorrhage, fever, or delirium. In all recent wounds, however, the
physician should endeavor to afford assistance.
Of spreading ulcers, the most fatal are such mortifications as are
very deep, black, and dry; and those are bad and dangerous which are
accompanied with a black ichorous discharge. Those which are white and
mucous are less dangerous, but are more subject to relapse, and become
inveterate. Herpes is the least dangerous of the spreading sores,
but is most difficult to remove about deep-seated cancers.[524] An
ephemeral fever, with very white and thick pus, is beneficial in such a
case; also, sphacelus of a nerve, of a bone, or of both, in deep-seated
and black mortifications. For a free discharge of pus takes place and
carries off the mortification.
The prognostics in wounds of the head are given in nearly the same
terms as laid down in the treatise on that subject, and therefore I
need not enter minutely into an exposition of what is stated regarding
them here. Those in the upper part of the head, more especially if they
implicate a suture, are said to be particularly dangerous. The author
directs the surgeon to inquire whether, at the time of the accident,
the patient fell down or became comatose, as in this case greater
danger is to be apprehended.
Large wounds of the joints, if they involve the connecting nerves,
necessarily leave the limb maimed. Several other observations connected
with these injuries are added, of which one of the most important
is the direction to practice flexion and extension of the limb,
frequently, with the view, no doubt, of preventing rigidity of the
joint.
Large excisions in the arm becoming inflamed end in suppurations, which
require to be evacuated by the knife or cautery. Injuries of the spinal
marrow, whether from disease or accident, are attended with loss of
motion and sensibility, retention of the alvine and urinary discharges;
but, after a time, involuntary evacuations take place, which are soon
followed by death. When the throat is frequently filled with blood,
and there is no headache or cough, nor any other morbid symptoms, the
physician should examine whether there be not an ulcer or a leech in
the part.
With regard to the eyes, the prognostics are given with so much
prolixity of detail that I must be content with a brief abstract of
them. Much attention is paid to the characters of the discharge from
the eyes in diseases of them, namely, of the glutinous matter and
tears; thus, if the gum be white and soft, the tears mixed with it not
very hot, and the swelling light and loose, under these circumstances
the eyelids are glued up during the night, so that the eye is free of
pain, and thus the disease is without danger, and of short duration.
The other appearances of the eye, and the discharges, are also minutely
given. When the discharge is green or livid, the tears copious and
hot, a burning heat in the head, and pains darting through the head to
the eye, there must necessarily be ulceration in the eye; and there is
much reason to apprehend that it will burst. If, when one can get a
sight of the eye, it should be found burst, and the pupil projecting
above the rupture, it is bad and difficult to restore; and, if there
be sloughing, the eye will be wholly useless. According to the form
and depth of the ulcers must be the subsequent cicatrices. These are
minutely described according to their different varieties. Mention is
also made of the prognostics from the eyes in fevers, as described by
the author in another work. It is most likely that allusion is here
made to the first book of “Prorrhetics.” In conclusion, the surgeon is
directed to pay great attention to the state of the urine in diseases
of the eyes.
Dysenteries, when they set in with fever, alvine discharges of a mixed
character, or with inflammation of the liver, or of the hypochondrium,
or of the stomach, such as are painful, with retention of the food
and thirst, all these are bad; and the more of these symptoms there
are, the greater the danger; and the fewer, the more hope is there of
recovery. Children from five to ten years of age are the most apt to
die of this complaint; the other ages less so. Such dysenteries as
are of a beneficial nature, and are attended with blood and scrapings
of the bowels, cease on the seventh, or fourteenth, or twentieth, or
thirtieth day, or within that period. In such cases even a pregnant
woman may recover and not suffer abortion.
All cases of lientery are said to be of a bad character when they are
continued and protracted, both day and night, and when the dejections
are either very crude, or black, soft, and fetid; for they occasion
thirst and determine the fluids otherwise than to the bladder, give
rise to ulcerations (aphthæ?) in the mouth, redness and ephelis[525] of
all colors, and at the same time the belly is in a state of ferment,
and has a foul, wrinkled appearance externally. This disease is most
to be dreaded by old persons; it is formidable to men of middle age,
but less so in the other ages. The indications of cure, it is acutely
stated, are to determine the fluids to the urine, to relieve the body
from its atrophy, and change the color of the skin.
All the other varieties of diarrhœa without fever are of short
duration and mild; for they will all cease when washed out, or of their
own accord. The discharge may be predicted as about to cease when,
upon touching the belly, there is no movement, and flatulence passes
with the discharge. Eversion of the gut takes place in the case of
middle-aged persons having piles, of children affected with the stone,
and in protracted and intense discharges from the bowels, and of old
persons having mucous concretions (scybalæ?).
Women may be judged of whether they are in a fit state for conception
or not by attending to the following circumstances:--In the first place
to their shapes. Women of smaller stature more readily conceive than
taller persons; the thin than the fat; the white than the ruddy; the
dark than the pale; those who have prominent veins than the contrary.
In oldish women it is bad to have much flesh, but a good thing to
have swelled and large breasts. In addition, inquiry should be made
whether or not the menstruation be regular as to time and quantity.
And it should be ascertained whether the uterus be healthy, of a dry
temperament, and soft; neither in a state of retraction nor prolapsus;
and its mouth neither turned aside, nor too close, nor too open. When
any of these obstructions come in the way, it is impossible that
conception can take place.
Such women as cannot conceive, but appear green, without fever, and the
viscera are not in fault; these will say that the head is pained, and
that the menstrual discharge is vitiated and irregular. But such of
these as have the proper color, are of a fat habit of body, the veins
are inconspicuous, they have no pains, and the menses either never
appear at all, or are scanty and intense, and this is one of the most
difficult states of sterility to remove. In other cases the health is
not to blame, but the fault lies in the position of the womb. The other
contingencies in this place are attended with pains, discoloration, and
wasting.
Ulceration in the womb from parturition, an abscess of a chronic
nature, or from any other cause, is necessarily accompanied with
fevers, buboes, and pains in the place; and if the lochial discharge
be also suppressed, all these evils are more intense and inveterate,
along with pains of the hypochondrium and head. And when the ulcer
heals, the part necessarily is smoother and harder, and the woman is
less adapted for conception. If, however, the ulceration be in the
right side only, the woman may conceive of a female child, or if in
the left, of a male. When a woman cannot conceive, and fever comes on
with a slight cough, inquiry should be made whether she has any ulcer
about the uterus, or any other of the complaints I have described; for
if she has no complaint in that region to account for her loss of flesh
and sterility, it may be expected that she will have vomiting of blood,
and the catamenia will necessarily be suppressed. But if the fever be
carried off by the evacuation of blood, and if the catamenia appear,
she will then prove with child. But if looseness of the bowels having a
bad character take place before there is an evacuation of blood, there
is danger lest the woman perish before a vomiting of blood can take
place.
In cases of false conception, in which women are deceived by the
non-appearance of the menses, and by the increase of the belly and
movement in it, they will be found to have had headache and pains about
the neck and hypochondria, and there is no milk in the breasts except a
little of a watery character. But when the swelling of the womb passes
away they will conceive, unless there be any other impediment. For
this affection is beneficial in so far as it produces a change in the
uterus, so that afterwards the woman may prove with child. Women with
child have not these pains unless the headache be habitual to them,
and in addition they have milk in their breasts. Women affected with
chronic discharges are to be asked whether they have pains in the head
and loins, and in the lower part of the belly, and whether their teeth
be set on edge, and if they have dimness of sight, and noises in their
ears. Such women as vomit bile for several days while in a fasting
state, though they are not with child nor have fever, are to be asked
whether they have vomited up round lumbrici, and if they say not, they
should be warned that this will happen to them. This affection happens
principally to married women, then to virgins, and less seldom to other
people.
Pains without fever are not deadly, but mostly prove protracted, and
have many changes and relapses. Several varieties of headache are
described, and the prognosis in each laid down. The natural cure of
them is a coryza, a discharge of mucus from the nose, or sneezing.
Pains spreading from the head to the neck and back, are relieved by
abscesses, expectoration of pus, hemorrhoids, exanthemata on the body,
or pityriasis on the head.
Heaviness and pruritus in the head, either in a part or through the
whole of it, if, on inquiry, they extend to the tip of the tongue,
indicate a confirmed disease, and one difficult to remove. They are
best removed by the occurrence of an abscess. But those cases which
are accompanied with vertigo are difficult to cure, and are apt to
pass into mania. Other diseases in the head, of a very strong and
protracted character, occur to both men and women, but especially to
young persons, and virgins at the season of manhood, and especially at
the catamenial period. Women, however, are less subject to pruritus and
melancholic affections than the men, unless the menses have disappeared.
Both men and women who have long had a bad color, but not in the form
of jaundice, are subject to headaches, eat stones and earth, and have
piles. Those who have green colors, without decided jaundice, are
affected in like manner, only instead of eating stones and earth, they
are more subject to pains in the hypochondriac region. Persons who are
pale for a length of time, and have the face tumid, will be found to
have headache, or pains about the viscera, or some disease in the anus;
and in most cases, not one, but many, or all these evils make their
appearance.
Nyctalopia is most apt to attack young persons, either males or
females, and to pass off spontaneously on the fortieth day or in seven
months, and in some cases it endures for a whole year. Its duration
may be estimated from the strength of the disease and the age of the
patient. They are relieved by deposits which determine downwards, but
these rarely occur in youth. Married women and virgins that have the
menstrual discharge regular are not subject to the complaint. Persons
having protracted defluxions of tears who are attacked with nyctalopia,
are to be questioned whether they had any previous complaint in the
head.
Such persons as have frequent pains in the vertex and temples, without
fever or loss of color, unless they have some other obvious deposit in
the face, or speak in a rough tone, or have pain in the teeth, may be
expected to have a hemorrhage from the nose. Those who have bleeding at
the nose, although they may appear to be otherwise in good health, will
be found to have enlarged spleen, or pain in the head, or flashes of
light before their eyes. Most of these patients have both headache and
affection of the spleen.
The gums are diseased and the mouth fetid in persons who have enlarged
spleens. But persons who, although they have enlarged spleens, are
exempt from hemorrhages and fœtor of the mouth have malignant ulcers
on the legs and black cicatrices. But if they have any obvious deposit
in the countenance, or if their speech be rough, or if they have
toothache, a hemorrhage from the nose may be expected. Those who have
great swellings below the eyes will be found to have enlarged spleens.
And if there come on swellings in the feet, and if they appear to be
dropsical, the belly and loins must be attended to.
Distortions of the countenance, if not sympathetic with some other
part of the body, quickly pass off either spontaneously or by remedial
means. The others are of an apoplectic nature. In other cases, when
the diseased part wastes from want of motion, there can be no relief
afforded. But when wasting does not take place there may be recovery.
With regard to the time when this may occur, it is to be prognosticated
by attending to the severity of the disease, to its duration, to the
age of the patient, and to the season, it being known that of all
cases the inveterate, and such as are the consequences of repeated
attacks, are the worst, and the most difficult to remove, and those in
aged persons. Autumn and winter are more unfavorable seasons for such
complaints than spring and summer.
Pains in the shoulder, which, passing down the arms, occasion torpor
and pains, do not usually terminate in deposits, but the patients
get better by vomiting black bile. But when the pains remain in the
shoulders, or extend to the back, the patients are relieved by vomiting
pus or black bile. They are to be judged of thus:--If their breathing
be free, and if they be slender, it is rather to be expected that they
will vomit black bile. But if they have more difficulty of breathing,
and if there is any unusual color on the countenance, whether reddish
or black, it is to be expected that they will rather spit blood. It
should also be attended to whether there be swellings on the feet. This
disease attacks men most violently from forty to sixty years of age. At
this period of life ischiatic diseases are most troublesome.
Ischiatic diseases are to be thus judged of:--In the case of old
persons, when the torpor and coldness of the loins and legs are very
strong, and when they lose the power of erections, and the bowels are
not moved, or with difficulty, and the fæces are passed with much
mucus, the disease will be very protracted, and it should be announced
beforehand that the disease will not last shorter time than a year
from its commencement; and amendment is to be looked for in spring
and summer. Ischiatic diseases are no less painful in young men, but
are of shorter duration, for they pass off in forty days; and neither
is the torpor great, nor is there coldness of the legs and loins. In
those cases in which the disease is seated in the loins and leg, but
the patient does not suffer so much as to be confined to bed, examine
whether any concretions have taken place in the hip-joint, and make
inquiry whether the pain extends to the groin; for if both these
symptoms be present, the disease will be of long duration. And the
physician should also inquire whether there be torpor in the thigh, and
if it extend to the ham; and if he says so, he is to be again asked if
it spreads along the leg to the ankle of the foot. Those who confess
to the most of these symptoms are to be told that the limb will be
sometimes hot and sometimes cold; but those persons in whom the pain
leaves the loins, and is turned downwards, are to be encouraged; but
when the disease does not leave the hip and loins, such persons are
to be warned that it is to be dreaded. In those cases in which there
are pains and swellings about the joints, and they do not pass off,
after the manner of gout, you will find the bowels enlarged, and a
white sediment in the urine; and, if you inquire, the patient will
admit that the temples are often pained, and he will say that he has
nightly sweats. If the urine have not this sediment, nor do the sweats
take place, there is danger either that the joints will become lame,
or that the tumor called meliceris will form in it. This disease forms
in those persons who in their youth had epistaxis, and in whom it
had ceased afterwards. They are to be interrogated whether they had
discharges of blood in their youth, and if they have pruritus in the
breast and back. And the same thing happens to those who have severe
pains in the bowels, without disorder of them, or who have hemorrhoids.
This is the origin of these complaints. But if the patients have a
bad color, they are to be interrogated whether their head be pained,
for they will say that it is. In those cases in which the bowels are
pained on the right side, the pains are stronger, and especially when
the pain terminates in the hypochondrium at the liver. Such pains are
immediately relieved if borborygmi take place in the belly. But when
the pain ceases, they pass thick and green urine. The disease is not
deadly, but very protracted. But when the disease is already of long
standing, the patients have dimness of sight in consequence of it.
But they are to be interrogated whether, when young, they had a flow
of blood, and regarding the dimness of vision, the greenness of the
urinary discharge, and regarding the borborygmi, if they took place and
gave relief; for they will confess to all these symptoms.
Lichen, leprosy, and leucè, when they occur in young children and
infants, or when they appear at first small, and gradually increase
in the course of a long time--in these cases the eruption is not to
be regarded as a deposit, but as a disease; but when they set in rank
and suddenly, this case is a deposit. Leucè also arises from the most
fatal diseases, such as the disease called phthisis;[526] but leprosy
and lichen are connected with black bile. These complaints are the more
easily cured the more recent they are, and the younger the patients,
and the more soft and fleshy the parts of the body in which they occur.
ON REGIMEN IN ACUTE DISEASES.
THE ARGUMENT.
In this treatise two very important questions are discussed: first, a
nosological question, regarding the proper distinction of diseases from
one another; and secondly, a therapeutical, respecting the rules by
which the regimen in acute diseases ought to be regulated. The former
of these is of a polemical nature, being an attack directed against
the physicians of the Cnidian school of medicine, who distinguished
diseases from one another in an arbitrary manner, from incidental
varieties in their constitution, and without proper attention to their
true constitution and identity. As will be seen in the annotations, the
Cnidians pretended to recognize several varieties of disease connected
with bile,--several fanciful divisions of diseases of the bladder,
and so forth; to which mode of distinguishing diseases there would
obviously be no end, since of incidental varieties in any case there
can be no limit. The other question discussed in this treatise relates
to what may justly be pronounced to be one of the most important points
connected with the practice of medicine, namely, the proper regimen
in acute diseases; that is to say, in idiopathic fevers and febrile
diseases, comprising most of those diseases now classed under the head
of _Zymotic_, and which constitute by far the highest item in
our bills of mortality at the present day. Our author distinguishes
them by the names of pleurisy, pneumonia, phrenitis, lethargy, causus,
and their cognate diseases, including fever of the continual type.
Now it is to be borne in mind, that the phrenitis,[527] lethargy, and
causus of Hippocrates, were all epidemic fevers, so that, with the
exception of pleurisy and pneumonia, all the diseases here treated of
are fevers of the country in which Hippocrates resided. One, then,
cannot well imagine a question which from the commencement of the
medical Art must have been felt of higher importance than this,--how
so numerous and formidable a class of diseases ought to be treated. In
the attempt to solve it, every imaginable mode of treatment, as might
have been expected beforehand, was tried, and its effects determined
by experience. Herodicus, the master of Hippocrates in gymnastics,
applied his panacea in the treatment of febrile diseases, and, as we
are informed, with the most disastrous results. “Herodicus,” says the
author of the sixth Book of Epidemics, “killed persons in fever by
promenading, much wrestling, and fomentations.” (§ iii., 18.) It may
_now_ appear wonderful that so extraordinary a mode of practice
should have ever been attempted in this case; but while men of all
ranks continue to resort for the cure of all sorts of diseases to any
individual who has got a single hobby with which he constantly works to
his own profit, whether it be _gymnastics_, or _shampooing_,
or the _wet sheet_, we may expect to hear that such rash
experiments have been repeated. Truly mankind pay as dearly for their
tame submission to the insane practices of professional chiefs, as the
Greeks are represented by the poet to have suffered from the follies of
their princes:
“Quicquid delirant Reges, plectuntur Achivi.”[528]
And surely it is much to be desired that men would learn a lesson from
the Past, and not allow every new page in the history of society and of
the profession to furnish a repetition of the oft-told tale of supine
credulity on the one side, and of audacious folly on the other. From
what has been stated, it will readily be understood that it was soon
settled that active exercise is inadmissible in febrile diseases.[529]
It would next come to be determined, what rule was to be followed with
regard to the administration of food in fevers. On this point, as will
be seen below in our annotations, the most diametrically opposite plans
of treatment were essayed. One authority administered the most highly
nutritious articles of food, namely, fleshes, to his patients, while,
on the other hand, some wasted them by enforcing a total abstinence
for several days. Experience, we may be well assured, was not long in
deciding against both the starving and the glutting system: the palled
appetite would soon refuse to accept of solids, and the parched tongue
would speedily crave some allowance of liquids. Even before the days
of Hippocrates, there is every reason to suppose that these extreme
modes of treatment had been abandoned; but still he complains that
in his time many important points in the treatment of acute diseases
were wholly undetermined, such as the following: whether plain drink,
that is to say water, was to be administered;--or, water seasoned
by the admixture of something farinaceous, such as the decoction of
barley;--whether the same should be given so thick as to constitute a
nutritious gruel, or strained so as to form merely a drink;--whether
wine should be given in small quantity, or more copiously;--whether any
of these things should be given from the commencement of the disease,
or not until after an interval of certain days. Hippocrates informs us
that the most discordant opinions prevailed upon these points, and his
professed object, in this treatise, is to reduce the rules of practice
to certain fixed principles. How our author performs this task, the
reader is left to judge for himself; it may be interesting, however,
to know, that Galen with all his devoted admiration of Hippocrates,
is not disposed to admit that his solution of the question at issue
is quite lucid and satisfactory. This opinion Galen pronounces on two
separate occasions; in his commentary on this treatise, and in his
great Work “On the Tenets of Hippocrates and Plato.” As I look upon his
observations contained in the latter Work to be of great importance
toward understanding the bearing of this treatise, I shall not scruple
to introduce a translation of the greater part of them in this place.
The ninth book of the Work we have mentioned opens with an elaborate
disquisition on the logical principles which ought to guide us in
deciding with regard to identity and difference, both in Philosophy and
Medicine: on the former of these subjects he quotes freely from Plato,
and on the other from Hippocrates. Coming, then, to the question in
hand, he says:--“And thus Hippocrates proceeded in the work ‘On the
Regimen of Acute Diseases,’ finding fault with the Cnidian physicians,
as being ignorant of the differences of diseases with regard to genus
and species; and he himself points out the definitions according to
which that which appears to be one, being divided becomes many, not
only in the case of diseases, but also in that of all other things; in
which we find that many of the most celebrated physicians fall into
mistakes, even with regard to the remedies. For some, coming to the
particular use of them, have established a most immethodical method
of instruction; whilst others, stating a very general precept, lay
down a rule which at first sight appears very methodical, but in truth
is very bad, and hence they disagree among themselves; some, as for
example those treating of the remedy for a certain affection, such
as pleurisy, declaring it to be venesection, others purging, some
fomentations by means of sponges, and others of bags, or something
of the like kind. And they differ, in the same manner, with regard
to the use and disuse of the bath, of oxymel, of hydromel, and of
water, of wine, and of ptisan, either giving of the strained juice
only, or of the barley portion only; and some, with regard to food,
giving discordant decisions as to the differences of the sick, and
the indications which a pleuritic affection requires. And that he, as
being the first discoverer, has handled these subjects in rather a
confused manner, I have shown in my Commentary on the treatise which
has been improperly entitled, ‘Against the Cnidian Sentences,’ and ‘On
the Ptisan.’ But in order that those who are desirous of learning,
may have a clear exposition of this question in a brief form, I
shall not scruple to give here a summary of it. In the commencement
of pleuritic attacks, when the side is just beginning to be pained,
inasmuch as the nature of the disease is not yet obvious, he directs
fomentations, otherwise called heating applications, to be tried,
and he explains the materials of which they consist. And then, if
the complaint is not removed, it is to be ascertained whether the
patient took food recently, and whether the bowels have been moved,
and he gives instructions what should be done in these cases. But
if the disease does not yield to these means, he gives definitions
of those cases which require venesection and purging, and those in
which one should use hydromel for drink, or oxymel, or water until
the crisis, without giving any food; and those in which the juice of
ptisan is to be used, or the barley along with it, and when food is to
be administered. In like manner, with regard to the administration of
wine, it is determined in what cases it is to be given, and in what
not, and when, and of what quality. And in like manner respecting
baths, and other matters of the like kind. And as a twofold mistake
is committed with regard to the divisions (of diseases), some doing
it in a deficient manner, and others carrying this process to excess,
Hippocrates, finding fault with both, expresses himself thus, in the
beginning of the book: ‘Some of them, indeed, were not ignorant of the
many varieties of each complaint, and their manifold division, but when
they wish to tell clearly the members (species?) of each disease, they
do not write correctly; for the species would be almost innumerable
if every symptom experienced by the patients were held to constitute
a disease, and receive a different name.’ And again, respecting the
remedies, as being deficient, he writes thus: ‘And not only do I not
give them credit on this account, but also because those they use are
few in number.’ Afterwards, assuming what is of great importance to the
question, he does not give a clear solution of it, and therefore the
whole bearing of the question is misunderstood by many physicians. I
have, therefore, given an exposition of the whole subject, in my first
Commentary ‘On the Regimen of Acute Diseases;’ and it is necessary to
show the import of it briefly. The question is given by Hippocrates
in the following terms: ‘But it appears to me that those things are
more especially deserving of being consigned to writing, which are
undetermined by physicians, notwithstanding that they are of vital
importance, and either do much good or much harm. By undetermined, I
mean such as those: wherefore certain physicians, during their whole
lives, are constantly administering untrained ptisans, and fancy they
thus accomplish the cure properly, whereas others take great pains
that the patient may not swallow a particle of the barley (thinking it
would do much harm), but strain the juice through a cloth before giving
it: others, again, will neither give thick ptisan nor the juice, some
until the seventh day of the disease, and some until after the crisis.
Physicians are not in the practice of mooting such questions, nor
perhaps, if mooted, would a solution of them be readily found, although
the whole Art is thereby exposed to much censure from the vulgar, who
fancy that really there is no such science as Medicine, since, in
acute diseases, practitioners differ so much among themselves, that
those things which one administers, as thinking it the best that can
be given, another holds to be bad.’ And a little afterwards: ‘I say,
then, that this question is a most excellent one, and allied to very
many others, and some of the most vital importance in the Art: for,
that it can contribute much to the recovery of the sick, and to the
preservation of health in the case of those who use it well, and that
it promotes the strength of those who take gymnastic exercises, and is
useful to whatever one may wish to apply it.’ The inquiry regarding
the differences of opinion among practitioners, he says, is of the
greatest consequence, not only to the sick, for the recovery of health,
but also to those in health, for the preservation of it, and to those
who practise it for the recovery and preservation of deportment. And
he afterwards adds, ‘to whatever one may wish;’ as indicating that
the solution of this inquiry is applicable not only to medicine but
to all the other arts to which one may choose to apply it. For it is
wonderful that physicians practising an art, in which the remedies
applied may be determined by experience whether they are beneficial or
hurtful, should yet make the most conflicting statements respecting
those things which are beneficial and those which are prejudicial. For,
in philosophy, it is not to be wondered at that there should be no end
to most disputes, since these things cannot be clearly determined by
experience; and therefore some hold that the world is uncreated, some
that it was created, some that there is nothing beyond its boundary,
some that there is, and some declaring what that which is contained
is, and some pronouncing it to be a vacuum, having no substance in it,
and some holding that worlds in inconceivable numbers, and infinite,
exist. For such discrepancy of opinion cannot be set at rest by any
clear appeal to the senses. But it is not so with respect to the
benefit or injury derived from remedies administered to the body,
since the differences among physicians, in this case, may be decided
by experience, as to which of them are beneficial and which injurious.
Wherefore the solution of this question is not very clearly stated by
Hippocrates, and on that account it has excited the observation of
almost all the commentators on this book. It is this: some of the sick
require abstinence from food, until the disease come to a crisis, and
some require food, and of these some require the unstrained ptisan,
and some the strained, as also some require still more substantial
food, and, moreover, some require oxmyel, or hydromel, and some water,
or wine. Wherefore to those physicians who have cultivated the Art
upon experience alone, that only appears beneficial which perchance
has seemed useful in most cases. Neither do they venture to try the
opposite mode of regimen, for fear of failure. He alone, then, who
knows the constitution of the sick, and the nature of the disease, and
the powers of the remedy which is administered, and the time in which
it ought to be used, will be able rationally to devise the remedy to be
applied, and confirm his expectation of it by experience.”
Galen gives other remarks, not devoid of interest, on the same subject,
but these want of room obliges me to pass by. I may mention, however,
that after giving, in the form of extract, the passage on wine (§ 12),
he makes the remark, that if the question be put whether wine should be
given to persons in fever, the proper answer to it would be, that it is
to be given in some certain cases, and in others not. (See tom. v., p.
773, ed. Kühn.) Thus far Galen.
Before quitting this subject, I would beg leave to make a few remarks
on some points of medical practice which are here treated of, and
which appear to me to be either overlooked, or not satisfactorily
determined at the present day; and also upon some modern innovations on
the practice of the ancients. As far as I have observed, it is quite
a common practice now to administer food, such as farinaceous gruels,
or animal broths, without much reserve, after evacuation of the system
either by purging or bleeding. Now it will be seen that Hippocrates
forbids food to be administered at such a season, as the body, being
weakened by the depletion, is unable to digest it properly, and
consequently what is given as a support to the frame proves a load to
it. To the reason here assigned for this practice, might be added that
the vascular system, having been emptied, greedily absorbs the food
before it is properly digested. I am not sure that this physiological
principle is stated in any of the works of Hippocrates, but it is
frequently to be met with in the works of Galen, and in those of the
toxicologists, from Nicander to Actuarius. See PAULUS ÆGINETA,
Book V., 2, Syd. Soc. edit.
I would beg leave to call the attention of my professional readers
to the guarded and judicious manner in which pleurisy is treated by
our author, beginning with hot fomentations to the side, and gradually
advancing to the more active means, namely, purging and venesection.
It will be remarked that Hippocrates holds depletion to be the only
legitimate mode of removing the pain of the side, and that his
commentator, in illustration of his meaning, pointedly condemns the use
of narcotics in this case. Now this is a most important consideration,
as bearing on a mode of practice which has obtained much favor of
late years; I allude, of course, to the treatment by a combination of
mercurials and opium. The experience of some thirty years would seem to
decide in its favor, but how often have certain methods of treatment
in other cases obtained the sanction of professional favor for a
much longer period, and yet in the end been abandoned as positively
prejudicial? In my younger days I knew old practitioners, of the
highest reputation, who administered these medicines in scrofula,--in
cancer,--in every case! One cannot think of the changes in professional
opinions on the mercurial treatment of syphilis, since the days of John
Hunter, without the most painful feeling of distrust in all modes of
treatment where one cannot recognize some reasonable bond of connection
between the remedy applied and the effects produced, or where long
experience and analogy are in favor of them, and where the judgment
runs no risk of being imposed upon by fallacious appearances and
collateral circumstances. In a word, who does not feel disposed, in the
practice of medicine, constantly to recur to the great truth proclaimed
by our author in his first Aphorism? “Experience is fallacious, and
judgment is difficult.”
I am almost afraid further to put the question to the profession of
the present day, whether or not the administration of antimonials in
pleuro-pneumonia be an improvement on the ancient practice, or the
reverse? Shall we say, then, that experience has decided that this
substance (antimony), which, when applied to the cuticle, or to its
prolongation, the epithelium of the stomach and bowels, occasions pain,
heat, and vascular congestion, produces the very opposite effects
on the lungs, when absorbed into the blood and conveyed to them? I
dare not venture to answer these questions myself, but suggest them
as deserving to be reconsidered, with serious impartiality, by the
profession. I trust, however, it will not be supposed that I incline
to stand up for ancient modes of practice, because they are old, or
to condemn modern methods because they are new; I merely state the
reflections which the comparison of ancient and modern usages, on this
important subject, has suggested to me.
Our author, it will be seen, attaches much importance to the
administration of the ptisan, or decoction of barley, in
pleuro-pneumonia. Our modern Hippocrates, I mean, of course, Sydenham,
was equally partial to this practice,[530] which is still very much
followed on the continent.
It will be remarked, that Hippocrates says nothing of counter-irritants
to the skin, in the treatment of pleurisy, all his external
applications being of the soothing kind. The stimulant treatment,
however, is not altogether modern, having been recommended in certain
cases by the Arabians. (See PAULUS ÆEGINETA, Vol. I., p. 501.)
Celsus also approves of sinapisms to the side. (iv., 6.)
The use of the bath and of the _douche_, or affusion of hot water
in febrile diseases, is an important question, which well deserves to
be reconsidered by the profession. (See the annotations on § 18.)
The reader will no doubt have been struck with the remark of Galen,
in the extract given above, that our author’s plan in the present work
is deficient in method, because he himself was the discoverer of the
subject-matters to which it relates. Galen then seems to have been of
opinion that it was too much to expect from any individual, that he
should produce a work which would be remarkable at the same time for
the originality of its materials, and for the methodical arrangement of
them. In confirmation of Galen’s judgment in this case, I would direct
attention to the difference that there is between this treatise and the
“Prognostics;” for all must admit that the matters of which the latter
work is composed are admirably methodized, and we have shown above that
they were derived in a great measure from the previous labors of the
Asclepiadæ.
ON REGIMEN IN ACUTE DISEASES.
Those who composed what are called “The Cnidian Sentences”[531]
have described accurately what symptoms the sick experience in every
disease, and how certain of them terminate; and in so far a man, even
who is not a physician, might describe them correctly, provided he
put the proper inquiries to the sick themselves what their complaints
are. But those symptoms which the physician ought to know beforehand
without being informed of them by the patient, are, for the most part,
omitted, some in one case and some in others, and certain symptoms of
vital importance for a conjectural judgment.[532] But when, in addition
to the diagnosis, they describe how each complaint should be treated,
in these cases I entertain a still greater difference of opinion with
them respecting the rules they have laid down; and not only do I not
agree with them on this account, but also because the remedies they use
are few in number; for, with the exception of acute diseases, the only
medicines which they give are drastic purgatives, with whey, and milk
at certain times. If, indeed, these remedies had been good and suitable
to the complaints in which they are recommended, they would have been
still more deserving of recommendation, if, while few in number, they
were sufficient; but this is by no means the case. Those, indeed,
who have remodeled these “Sentences” have treated of the remedies
applicable in each complaint more in a medical fashion. But neither
have the ancients written anything worth mentioning respecting regimen,
although this be a great omission. Some of them, indeed, were not
ignorant of the many varieties of each complaint, and their manifold
divisions, but when they wish to tell clearly the numbers (species?) of
each disease they do not write correctly;[533] for their species would
be almost innumerable if every symptom experienced by the patients were
held to constitute a disease, and receive a different name.[534]
2. For my part, I approve of paying attention to everything relating
to the art, and that those things which can be done well or properly
should all be done properly; such as can be quickly done should be
done quickly; such as can be neatly done should be done neatly; such
operations as can be performed without pain should be done with the
least possible pain; and that all other things of the like kind should
be done better than they could be managed by the attendants. But I
would more especially commend the physician who, in acute diseases,
by which the bulk of mankind are cut off, conducts the treatment
better than others. Acute diseases are those which the ancients
named pleurisy, pneumonia, phrenitis, lethargy, causus, and the
other diseases allied to these, including the continual fevers. For,
unless when some general form of pestilential disease is epidemic,
and diseases are sporadic and [not] of a similar character, there
are more deaths from these diseases than from all the others taken
together.[535] The vulgar, indeed, do not recognize the difference
between such physicians and their common attendants, and are rather
disposed to commend and censure extraordinary remedies. This, then,
is a great proof that the common people are most incompetent, of
themselves, to form a judgment how such diseases should be treated:
since persons who are not physicians pass for physicians owing most
especially to these diseases, for it is an easy matter to learn the
names of those things which are applicable to persons laboring under
such complaints. For, if one names the juice of ptisan, and such and
such a wine, and hydromel, the vulgar fancy that he prescribes exactly
the same things as the physicians do, both the good and the bad, but in
these matters there is a great difference between them.
3. But it appears to me that those things are more especially
deserving of being consigned to writing which are undetermined by
physicians, notwithstanding that they are of vital importance, and
either do much good or much harm. By undetermined I mean such as these,
wherefore certain physicians, during their whole lives, are constantly
administering unstrained ptisans, and fancy they thus accomplish the
cure properly, whereas others take great pains that the patient should
not swallow a particle of the barley (thinking it would do much harm),
but strain the juice through a cloth before giving it; others, again,
will neither give thick ptisan nor the juice, some until the seventh
day of the disease, and some until after the crisis.[536] Physicians
are not in the practice of mooting such questions; nor, perhaps, if
mooted, would a solution of them be found; although the whole art is
thereby exposed to much censure from the vulgar, who fancy that there
really is no such science as medicine, since, in acute diseases,
practitioners differ so much among themselves, that those things which
one administers as thinking it the best that can be given, another
holds to be bad; and, in this respect, they might say that the art
of medicine resembles augury, since augurs hold that the same bird
(omen) if seen on the left hand is good, but if on the right bad: and
in divination by the inspection of entrails you will find similar
differences; but certain diviners hold the very opposite of these
opinions.[537] I say, then, that this question is a most excellent one,
and allied to very many others, some of the most vital importance in
the Art, for that it can contribute much to the recovery of the sick,
and to the preservation of health in the case of those who are well;
and that it promotes the strength of those who use gymnastic exercises,
and is useful to whatever one may wish to apply it.
4. Ptisan, then, appears to me to be justly preferred before all
the other preparations from grain in these diseases, and I commend
those who made this choice,[538] for the mucilage of it is smooth,
consistent, pleasant, lubricant, moderately diluent, quenches thirst
if this be required, and has no astringency; gives no trouble nor
swells up in the bowels, for in the boiling it swells up as much as it
naturally can. Those, then, who make use of ptisan in such diseases,
should never for a day allow their vessels to be empty of it, if I may
say so, but should use it and not intermit, unless it be necessary to
stop for a time, in order to administer medicine or a clyster. And
to those who are accustomed to take two meals in the day it is to be
given twice, and to those accustomed to live upon a single meal it is
to be given once at first, and then, if the case permit, it is to be
increased and given twice to them, if they appear to stand in need of
it. At first it will be proper not to give a large quantity nor very
thick, but in proportion to the quantity of food which one has been
accustomed to take, and so as that the veins may not be much emptied.
And, with regard to the augmentation of the dose, if the disease be of
a drier nature than one had supposed,[539] one must not give more of
it, but should give before the draught of ptisan, either hydromel or
wine, in as great quantity as may be proper; and what is proper in each
case will be afterward stated by us. But if the mouth and the passages
from the lungs be in a proper state as to moisture, the quantity of
the draught is to be increased, as a general rule, for an early and
abundant state of moisture indicates an early crisis, but a late and
deficient moisture indicates a slower crisis.[540] And these things are
as I have stated for the most part; but many other things are omitted
which are important to the prognosis, as will be explained afterwards.
And the more that the patient is troubled with purging, in so much
greater quantity is it to be given until the crisis, and moreover until
two days beyond the crisis, in such cases as it appears to take place
on the fifth, seventh, or ninth day, so as to have respect both for the
odd and even day; after this the draught is to be given early in the
day, and the other food in place is to be given in the evening. These
things are proper, for the most part, to be given to those who, from
the first, have used ptisan containing its whole substance; for the
pains in pleuritic affections immediately cease of their own accord
whenever the patients begin to expectorate anything worth mentioning,
and the purgings become much better, and empyema much more seldom takes
place, than if the patients used a different regimen, and the crises
are more simple, occur earlier, and the cases are less subject to
relapses.
5. Ptisans are to be made of the very best barley, and are to be well
boiled, more especially if you do not intend to use them strained. For,
besides the other virtues of ptisan, its lubricant quality prevents
the barley that is swallowed from proving injurious, for it does not
stick nor remain in the region of the breast; for that which is well
boiled is very lubricant, excellent for quenching thirst, of very easy
digestion, and very weak, all which qualities are wanted. If, then, one
do not pay proper attention to the mode of administering the ptisan,
much harm may be done; for when the food is shut up in the bowels,
unless one procure some evacuation speedily, before administering
the draught, the pain, if present, will be exasperated; and, if not
present, it will be immediately created, and the respiration will
become more frequent, which does mischief, for it dries the lungs,
fatigues the hypochondria, the hypogastrium, and diaphragm. And
moreover if, while the pain of the side persists, and does not yield
to warm fomentations, and the sputa are not brought up, but are viscid
and unconcocted, unless one get the pain resolved, either by loosening
the bowels; or opening a vein, whichever of these may be proper;--if
to persons so circumstanced ptisan be administered, their speedy
death will be the result.[541] For these reasons, and for others of a
similar kind still more, those who use unstrained ptisan die on the
seventh day, or still earlier, some being seized with delirium, and
others dying suffocated with orthopnœa and râles.[542] Such persons
the ancients thought _struck_, for this reason more especially,
that when dead the affected side was livid, like that of a person who
had been struck. The cause of this is that they die before the pain is
resolved, being seized with difficulty of respiration, and by large and
rapid breathing, as has been already explained, the spittle becoming
thick, acid, and unconcocted, cannot be brought up, but, being retained
in the bronchi of the lungs, produces râles; and, when it has come to
this, death, for the most part, is inevitable; for the sputa being
retained prevent the breath from being drawn in, and force it speedily
out, and thus the two conspire together to aggravate the mischief;
for the sputa being retained renders the respiration frequent, while
the respiration being frequent thickens the sputa, and prevents them
from being evacuated. These symptoms supervene, not only if ptisan be
administered unseasonably, but still more if any other food or drink
worse than ptisan be given.
6. For the most part, then, the results are the same, whether the
patient have used the unstrained ptisan or have used the juice alone;
or even only drink; and sometimes it is necessary to proceed quite
differently. In general, one should do thus: if fever commences shortly
after taking food, and before the bowels have been evacuated, whether
with or without pain, the physician ought to withhold the draught until
he thinks that the food has descended to the lower part of the belly;
and if any pain be present, the patient should use oxymel, hot if it
is winter, and cold if it is summer; and, if there be much thirst, he
should take hydromel and water.[543] Then, if any pain be present, or
any dangerous symptoms make their appearance, it will be proper to give
the draught neither in large quantity nor thick, but after the seventh
day, if the patient be strong. But if the earlier-taken food has not
descended, in the case of a person who has recently swallowed food, and
if he be strong and in the vigor of life, a clyster should be given, or
if he be weaker, a suppository is to be administered, unless the bowels
open properly of themselves. The time for administering the draught is
to be particularly observed at the commencement and during the whole
illness; when, then, the feet are cold, one should refrain from giving
the ptisan, and more especially abstain from drink; but when the heat
has descended to the feet, one may then give it; and one should look
upon this season as of great consequence in all diseases, and not least
in acute diseases, especially those of a febrile character, and those
of a very dangerous nature. One may first use the juice, and then the
ptisan, attending accurately to the rules formerly laid down.
7. When pain seizes the side, either at the commencement or at a
later stage, it will not be improper to try to dissolve the pain by
hot applications.[544] Of hot applications the most powerful is hot
water in a bottle, or bladder, or in a brazen vessel, or in an earthen
one; but one must first apply something soft to the side, to prevent
pain. A soft large sponge, squeezed out of hot water and applied, forms
a good application; but it should be covered up above, for thus the
heat will remain the longer, and at the same time the vapor will be
prevented from being carried up to the patient’s breath, unless when
this is thought of use, for sometimes it is the case. And further,
barley or tares may be infused and boiled in diluted vinegar, stronger
than that it could be drunk, and may then be sewed into bladders and
applied; and one may use bran in like manner. Salts or toasted millet
in woolen bags are excellent for forming a dry fomentation, for the
millet is light and soothing. A soft fomentation like this soothes
pains, even such as shoot to the clavicle. Venesection, however, does
not alleviate the pain unless when it extends to the clavicle. But
if the pain be not dissolved by the fomentations, one ought not to
foment for a length of time, for this dries the lungs and promotes
suppuration; but if the pain point to the clavicle, or if there be a
heaviness in the arm, or about the breast, or above the diaphragm, one
should open the inner vein at the elbow, and not hesitate to abstract
a large quantity, until it become much redder, or instead of being
pure red, it turns livid,[545] for both these states occur. But if
the pain be below the diaphragm, and do not point to the clavicle, we
must open the belly either with black hellebore[546] or peplium,[547]
mixing the black hellebore with carrot or seseli,[548] or cumin, or
anise, or any other of the fragrant herbs; and with the peplium the
juice of sulphium[549] (asafœtida), for these substances, when mixed up
together, are of a similar nature.[550] The black hellebore acts more
pleasantly and effectually than the peplium, while, on the other hand,
the peplium expels wind much more effectually than the black hellebore,
and both these stop the pain, and many other of the laxatives also
stop it, but these two are the most efficacious that I am acquainted
with. And the laxatives given in draughts are beneficial, when not
very unpalatable owing to bitterness, or any other disagreeable taste,
or from quantity, colour, or any apprehension. When the patient has
drunk the medicine, one ought to give him to swallow but little
less of the ptisan than what he had been accustomed to; but it is
according to rule not to give any draughts while the medicine is under
operation;[551] but when the purging is stopped then he should take a
smaller draught than what he had been accustomed to, and afterwards go
on increasing it progressively, until the pain cease, provided nothing
else contra-indicate. This is my rule, also, if one would use the juice
of ptisan, (for I hold that it is better, on the whole, to begin with
taking the decoction at once, rather than by first emptying the veins
before doing so, or on the third, fourth, fifth, sixth, or seventh day,
provided the disease has not previously come to a crisis in the course
of this time), and similar preparations to those formerly described are
to be made in those cases.
8. Such are the opinions which I entertain respecting the administering
of the ptisan; and, as regards drinks, whichsoever of those about to
be described may be administered, the same directions are generally
applicable. And here I know that physicians are in the practice of
doing the very reverse of what is proper, for they all wish, at the
commencement of diseases, to starve their patients for two, three, or
more days, and then to administer the ptisans and drinks; and perhaps
it appears to them reasonable that, as a great change has taken place
in the body, it should be counteracted by another great change. Now,
indeed, to produce a change is no small matter, but the change must be
effected well and cautiously, and after the change the administration
of food must be conducted still more so. Those persons, then, would be
most injured if the change is not properly managed, who used unstrained
ptisans; they also would suffer who made use of the juice alone; and so
also they would suffer who took merely drink, but these least of all.
9. One may derive information from the regimen of persons in good
health what things are proper; for if it appear that there is a great
difference whether the diet be so and so, in other respects, but more
especially in the changes, how can it be otherwise in diseases, and
more especially in the most acute? But it is well ascertained that even
a faulty diet of food and drink steadily persevered in, is safer in
the main as regards health than if one suddenly change it to another.
Wherefore, in the case of persons who take two meals in the day, or
of those who take a single meal, sudden changes induce suffering and
weakness; and thus persons who have not been accustomed to dine, if
they shall take dinner, immediately become weak, have heaviness over
their whole body, and become feeble and languid, and if, in addition,
they take supper, they will have acid eructations, and some will
have diarrhœa whose bowels were previously dry, and not having been
accustomed to be twice swelled out with food and to digest it twice
a day, have been loaded beyond their wont. It is beneficial, in such
cases, to counterbalance this change, for one should sleep after
dinner, as if passing the night, and guard against cold in winter
and heat in summer; or, if the person cannot sleep, he may stroll
about slowly, but without making stops, for a good while, take no
supper, or, at all events, eat little, and only things that are not
unwholesome, and still more avoid drink, and especially water. Such a
person will suffer still more if he take three full meals in the day,
and more still if he take more meals; and yet there are many persons
who readily bear to take three full meals in the day, provided they
are so accustomed. And, moreover, those who have been in the habit of
eating twice a day, if they omit dinner, become feeble and powerless,
averse to all work, and have heartburn; their bowels seem, as it
were, to hang loose, their urine is hot and green, and the excrement
is parched; in some the mouth is bitter, the eyes are hollow, the
temples throb, and the extremities are cold, and the most of those
who have thus missed their dinner cannot eat supper; or, if they do
sup, they load their stomach, and pass a much worse night than if
they had previously taken dinner. Since, then, an unwonted change of
diet for half a day produces such effects upon persons in health, it
appears not to be a good thing either to add or take from. If, then,
he who was restricted to a single meal, contrary to usage, having his
veins thus left empty during a whole day, when he supped according to
custom felt heavy, it is probable that if, because he was uneasy and
weak from the want of dinner, he took a larger supper than wont, he
would be still more oppressed; or if, wanting food for a still greater
interval, he suddenly took a meal after supper, he will feel still
greater oppression. He, then, who, contrary to usage, has had his veins
kept empty by want of food, will find it beneficial to counteract the
bad effects during that day as follows: let him avoid cold, heat, and
exertion, for he could bear all these ill; let him make his supper
considerably less than usual, and not of dry food, but rather liquid;
and let him take some drink, not of a watery character, nor in smaller
quantity than is proportionate to the food, and on the next day he
should take a small dinner, so that, by degrees, he may return to his
former practice. Persons who are bilious in the stomach bear these
changes worst, while those who are pituitous, upon the whole, bear the
want of food best, so that they suffer the least from being restricted
to one meal in the day, contrary to usage. This, then, is a sufficient
proof that the greatest changes as to those things which regard
our constitutions and habits are most especially concerned in the
production of diseases, for it is impossible to produce unseasonably
a great emptying of the vessels by abstinence, or to administer food
while diseases are at their acme, or when inflammation prevails; nor,
on the whole, to make a great change either one way or another with
impunity.[552]
10. One might mention many things akin to these respecting the stomach
and bowels, to show how people readily bear such food as they are
accustomed to, even if it is not naturally good, and drink in like
manner, and how they bear unpleasantly such food as they are not
accustomed to, even although not bad, and so in like manner with drink;
and as to the effects of eating much flesh, contrary to usage, or
garlic, or asafœtida, or the stem of the plant which produces it, or
things of a similar kind possessed of strong properties, one would be
less surprised if such things produce pains in the bowels, but rather
when one learned what trouble, swelling, flatulence, and tormina
the cake (maza) will raise in the belly when eaten by a person not
accustomed to it; and how much weight and distention of the bowels
bread will create to a person accustomed to live upon the maza; and
what thirst and sudden fullness will be occasioned by eating hot bread,
owing to its desiccant and indigestible properties; and what different
effects are produced by fine and coarse bread when eaten contrary to
usage, or by the cake when unusually dry, moist, or viscid; and what
different effects polenta produces upon those who are accustomed and
those who are unaccustomed to the use of it; or drinking of wine or
drinking of water, when either custom is suddenly exchanged for the
other; or when, contrary to usage, diluted wine or undiluted has been
suddenly drunk, for the one will create water-brash in the upper part
of the intestinal canal and flatulence in the lower, while the other
will give rise to throbbing of the arteries, heaviness of the head, and
thirst; and white and dark-colored wine, although both strong wines,
if exchanged contrary to usage, will produce very different effects
upon the body, so that one need the less wonder that a sweet and strong
wine, if suddenly exchanged, should have by no means the same effect.
11. Let us here briefly advert to what may be said on the opposite
side; namely, that a change of diet has occurred in these cases,
without any change in their body, either as to strength, so as to
require an increase of food, or as to weakness, so as to require
a diminution. But the strength of the patient is to be taken into
consideration, and the manner of the disease, and of the constitution
of the man, and the habitual regimen of the patient, not only as
regards food but also drink. Yet one must much less resort to
augmentation, since it is often beneficial to have recourse to
abstraction, when the patient can bear it, until the disease having
reached its acme and has become concocted. But in what cases this must
be done will be afterwards described. One might write many other things
akin to those which have been now said, but there is a better proof,
for it is not akin to the matter on which my discourse has principally
turned, but the subject-matter itself is a most seasonable proof. For
some at the commencement of acute diseases have taken food on the same
day, some on the next day; some have swallowed whatever has come in
their way, and some have taken _cyceon_.[553] Now all these things
are worse than if one had observed a different regimen; and yet these
mistakes, committed at that time, do much less injury than if one were
to abstain entirely from food for the first two or three days, and on
the fourth or fifth day were to take such food; and it would be still
worse, if one were to observe total abstinence for all these days, and
on the following days were to take such a diet, before the disease
is concocted;[554] for in this way death would be the consequence to
most people, unless the disease were of a very mild nature. But the
mistakes committed at first were not so irremediable as these, but
could be much more easily repaired. This, therefore, I think a strong
proof that such or such a draught need not be prescribed on the first
days to those who will use the same draughts afterwards. At the bottom,
therefore, they do not know, neither those using unstrained ptisans,
that they are hurt by them, when they begin to swallow them, if they
abstain entirely from food for two, three, or more days; nor do those
using the juice know that they are injured in swallowing them, when
they do not commence with the draught seasonably. But this they guard
against, and know that it does much mischief, if, before the disease
be concocted, the patient swallow unstrained ptisan, when accustomed
to use strained. All these things are strong proofs that physicians
do not conduct the regimen of patients properly, but that in those
diseases in which total abstinence from food should not be enforced
on patients that will be put on the use of ptisans, they do enforce
total abstinence; that in those cases in which there should be no
change made from total abstinence to ptisans, they do make the change;
and that, for the most part, they change from abstinence to ptisans,
exactly at the time when it is often beneficial to proceed from ptisans
almost to total abstinence, if the disease happen to be in the state of
exacerbation.[555] And sometimes crude matters are attracted from the
head, and bilious from the region near the chest, and the patients are
attacked with insomnolency, so that the disease is not concocted; they
become sorrowful, peevish, and delirious; there are flashes of light in
their eyes, and noises in their ears; their extremities are cold, their
urine unconcocted; the sputa thin, saltish, tinged with an intense
colour and smell; sweats about the neck, and anxiety; respiration,
interrupted in the expulsion of the air,[556] frequent and very large;
expression of the eyelids dreadful; dangerous _deliquia_; tossing
of the bedclothes from the breast; the hands trembling, and sometimes
the lower lip agitated. These symptoms, appearing at the commencement,
are indicative of strong delirium, and patients so affected generally
die, or if they escape, it is with a deposit, hemorrhage from the nose,
or the expectoration of thick matter, and not otherwise. Neither do I
perceive that physicians are skilled in such things as these; how they
ought to know such diseases as are connected with debility, and which
are further weakened by abstinence from food, and those aggravated by
some other irritation; those by pain, and from the acute nature of the
disease, and what affections and various forms thereof our constitution
and habit engender, although the knowledge or ignorance of such things
brings safety or death to the patient. For it is a great mischief if to
a patient debilitated by pain, and the acute nature of the disease, one
administer drink, or more ptisan, or food, supposing that the debility
proceeds from inanition. It is also disgraceful not to recognize a
patient whose debility is connected with inanition, and to pinch him in
his diet; this mistake, indeed, is attended with some danger, but much
less than the other, and yet it is likely to expose one to much greater
derision, for if another physician, or a private person, coming in and
knowing what has happened, should give to eat or drink those things
which the other had forbidden, the benefit thus done to the patient
would be manifest. Such mistakes of practitioners are particularly
ridiculed by mankind, for the physician or non-professional man thus
coming in, seems as it were to resuscitate the dead. On this subject
I will describe elsewhere the symptoms by which each of them may be
recognized.
12. And the following observations are similar to those now made
respecting the bowels. If the whole body rest long, contrary to
usage, it does not immediately recover its strength; but if, after a
protracted repose, it proceed to labor, it will clearly expose its
weakness. So it is with every one part of the body, for the feet
will make a similar display, and any other of the joints, if, being
unaccustomed to labor, they be suddenly brought into action, after a
time. The teeth and the eyes will suffer in like manner, and also every
other part whatever. A couch, also, that is either softer or harder
than one has been accustomed to will create uneasiness, and sleeping in
the open air, contrary to usage, hardens the body. But it is sufficient
merely to state examples of all these cases. If a person having
received a wound in the leg, neither very serious nor very trifling,
and he being neither in a condition very favorable to its healing nor
the contrary, at first betakes himself to bed, in order to promote the
cure, and never raises his leg, it will thus be much less disposed to
inflammation, and be much sooner well, than it would have been if he
had strolled about during the process of healing; but if upon the fifth
or sixth day, or even earlier, he should get up and attempt to walk,
he will suffer much more then than if he had walked about from the
commencement of the cure, and if he should suddenly make many laborious
exertions, he will suffer much more than if, when the treatment was
conducted otherwise, he had made the same exertions on the same days.
In fine, all these things concur in proving that all great changes,
either one way or another, are hurtful. Wherefore much mischief takes
place in the bowels, if from a state of great inanition more food than
is moderate be administered (and also in the rest of the body, if
from a state of great rest it be hastily brought to greater exertion,
it will be much more injured), or if from the use of much food it be
changed to complete abstinence, and therefore the body in such cases
requires protracted repose, and if, from a state of laborious exertion,
the body suddenly falls into a state of ease and indolence, in these
cases also the bowels would require continued repose from abundance of
food, for otherwise it will induce pain and heaviness in the whole body.
13. The greater part of my discourse has related to changes, this way
or that. For all purposes it is profitable to know these things, and
more especially respecting the subject under consideration,--that in
acute diseases, in which a change is made to ptisans from a state of
inanition, it should be made as I direct; and then that ptisans should
not be used until the disease be concocted, or some other symptom,
whether of evacuation or of irritation, appear in the intestines, or
in the hypochondria, such as will be described. Obstinate isomnolency
impairs the digestion of the food and drink, and in other respects
changes and relaxes the body, and occasions a heated state, and
heaviness of the head.[557]
14. One must determine by such marks as these, when sweet, strong,
and dark wine, hydromel, water and oxymel, should be given in acute
diseases.[558] Wherefore the sweet affects the head less than the
strong, attacks the brain less, evacuates the bowels more than the
other, but induces swelling of the spleen and liver; it does not
agree with bilious persons, for it causes them to thirst; it creates
flatulence in the upper part of the intestinal canal, but does not
disagree with the lower part, as far as regards flatulence; and yet
flatulence engendered by sweet wine is not of a transient nature, but
rests for a long time in the hypochondria. And therefore it in general
is less diuretic than wine which is strong and thin; but sweet wine is
more expectorant than the other. But when it creates thirst, it is less
expectorant in such cases than the other wine, but if it do not create
thirst, it promotes expectoration better than the other. The good and
bad effects of a white, strong wine, have been already frequently and
fully stated in the disquisition on sweet wine; it is determined to
the bladder more than the other, is diuretic and laxative, and should
be very useful in such complaints; for if in other respects it be less
suitable than the other, the clearing out of the bladder effected by
it is beneficial to the patient, if properly administered. There are
excellent examples of the beneficial and injurious effects of wine,
all which were left undetermined by my predecessors. In these diseases
you may use a yellow wine, and a dark austere wine for the following
purposes: if there be no heaviness of the head, nor delirium, nor
stoppage of the expectoration, nor retention of the urine, and if the
alvine discharges be more loose and like scrapings than usual, in such
cases a change from a white wine to such as I have mentioned, might be
very proper. It deserves further to be known, that it will prove less
injurious to all the parts above, and to the bladder, if it be of a
more watery nature, but that the stronger it is, it will be the more
beneficial to the bowels.
15. Hydromel, when drunk in any stage of acute disease, is less
suitable to persons of a bilious temperament, and to those who have
enlarged viscera, than to those of a different character; it increases
thirst less than sweet wine; it softens the lungs, is moderately
expectorant, and alleviates a cough; for it has some detergent
quality in it, whence it lubricates the sputum.[559] Hydromel is also
moderately diuretic, unless prevented by the state of any of the
viscera. And it also occasions bilious discharges downwards, sometimes
of a proper character, and sometimes more intense and frothy than
is suitable; but such rather occurs in persons who are bilious, and
have enlarged viscera. Hydromel rather produces expectoration, and
softening of the lungs, when given diluted with water.[560] But unmixed
hydromel, rather than the diluted, produces frothy evacuations, such
as are unseasonably and intensely bilious, and too hot; but such an
evacuation occasions other great mischiefs, for it neither extinguishes
the heat in the hypochondria, but rouses it, induces inquietude, and
jactitation of the limbs, and ulcerates the intestines and anus. The
remedies for all these will be described afterwards. By using hydromel
without ptisans, instead of any other drink, you will generally succeed
in the treatment of such diseases, and fail in few cases; but in
what instances it is to be given, and in what it is not to be given,
and wherefore it is not to be given,--all this has been explained
already, for the most part. Hydromel is generally condemned, as if
it weakened the powers of those who drink it, and on that account it
is supposed to accelerate death; and this opinion arose from persons
who starve themselves to death, some of whom use hydromel alone for
drink, as fancying that it really has this effect. But this is by no
means always the case. For hydromel, if drunk alone, is much stronger
than water, if it do not disorder the bowels; but in some respects it
is stronger, and in some weaker, than wine that is thin, weak, and
devoid of _bouquet_. There is a great difference between unmixed
wine and unmixed honey, as to their nutritive powers, for if a man
will drink double the quantity of pure wine, to a certain quantity
of honey which is swallowed, he will find himself much stronger from
the honey, provided it do not disagree with his bowels, and that his
alvine evacuations from it will be much more copious. But if he shall
use ptisan for a draught, and drink afterward hydromel, he will feel
full, flatulent, and uncomfortable in the viscera of the hypochondrium;
but if the hydromel be taken before the draught, it will not have
the same injurious effects as if taken after it, but will be rather
beneficial. And boiled hydromel has a much more elegant appearance
than the unboiled, being clear, thin, white, and transparent, but I am
unable to mention any good quality which it possesses that the other
wants. For it is not sweeter than the unboiled, provided the honey be
fine, and it is weaker, and occasions less copious evacuations of the
bowels, neither of which effects is required from the hydromel. But one
should by all means use it boiled, provided the honey be bad, impure,
black, and not fragrant, for the boiling will remove the most of its
bad qualities and appearances.
16. You will find the drink, called oxymel, often very useful in these
complaints, for it promotes expectoration and freedom of breathing.
The following are the proper occasions for administering it. When
strongly acid it has no mean operation in rendering the expectoration
more easy, for by bringing up the sputa, which occasion troublesome
hawking, and rendering them more slippery, and, as it were, clearing
the windpipe with a feather, it relieves the lungs and proves emollient
to them; and when it succeeds in producing these effects it must do
much good. But there are cases in which hydromel, strongly acid,
does not promote expectoration, but renders it more viscid and thus
does harm, and it is most apt to produce these bad effects in cases
which are otherwise of a fatal character, when the patient is unable
to cough or bring up the sputa. On this account, then, one ought to
consider beforehand the strength of the patient, and if there be any
hope, then one may give it, but if given at all in such cases it
should be quite tepid, and in by no means large doses. But if slightly
acrid it moistens the mouth and throat, promotes expectoration, and
quenches thirst; agrees with the viscera seated in the hypochondrium,
and obviates the bad effects of the honey; for the bilious quality of
the honey is thereby corrected. It also promotes flatulent discharges
from the bowels, and is diuretic, but it occasions watery discharges
and those resembling scrapings, from the lower part of the intestine,
which is sometimes a bad thing in acute diseases, more especially when
the flatulence cannot be passed, but rolls backwards; and otherwise it
diminishes the strength and makes the extremities cold, this is the
only bad effect worth mentioning which I have known to arise from the
oxymel. It may suit well to drink a little of this at night before the
draught of ptisan, and when a considerable interval of time has passed
after the draught there will be nothing to prevent its being taken.
But to those who are restricted entirely to drinks without draughts
of ptisan, it will therefore not be proper at all times to give it,
more especially from the fretting and irritation of the intestine
which it occasions, (and these bad effects it will be the more apt to
produce provided there be no fæces in the intestines and the patient
is laboring under inanition,) and then it will weaken the powers of
the hydromel. But if it appears advantageous to use a great deal of
this drink during the whole course of the disease, one should add to
it merely as much vinegar as can just be perceived by the taste, for
thus what is prejudicial in it will do the least possible harm, and
what is beneficial will do the more good. In a word, the acidity of
vinegar agrees rather with those who are troubled with bitter bile,
than with those patients whose bile is black; for the bitter principle
is dissolved in it and turned to phlegm, by being suspended in it;
whereas black bile is fermented, swells up, and is multiplied thereby:
for vinegar is a melanogogue. Vinegar is more prejudicial to women than
to men, for it creates pains in the uterus.
17. I have nothing further to add as to the effects of water when
used as a drink in acute diseases; for it neither soothes the cough in
pneumonia, nor promotes expectoration, but does less than the others
in this respect, if used alone through the whole complaint. But if
taken intermediate between oxymel and hydromel, in small quantity,
it promotes expectoration from the change which it occasions in the
qualities of these drinks, for it produces, as it were, a certain
overflow. Otherwise it does not quench the thirst, for it creates bile
in a bilious temperament, and is injurious to the hypochondrium; and
it does the most harm, engenders most bile, and does the least good
when the bowels are empty; and it increases the swelling of the spleen
and liver when they are in an inflamed state; it produces a gurgling
noise in the intestines and swims on the stomach; for it passes slowly
downwards, as being of a coldish and indigestible nature, and neither
proves laxative nor diuretic; and in this respect, too, it proves
prejudicial, that it does not naturally form fæces in the intestines:
and, if it be drunk while the feet are cold, its injurious effects
will be greatly aggravated, in all those parts to which it may be
determined. When you suspect in these diseases either strong heaviness
of the head, or mental alienation, you must abstain entirely from wine,
and in this case use water, or give weak, straw colored wine, entirely
devoid of _bouquet_, after which a little water is to be given
in addition; for thus the strength of the wine will less affect the
head and the understanding: but in which cases water is mostly to be
given for drink, when in large quantity, when in moderate, when cold,
and when hot; all these things have either been discussed already or
will be treated of at the proper time. In like manner, with respect
to all the others, such as barley-water, the drinks made from green
shoots, those from raisins, and the skins of grapes and wheat, and
bastard saffron, and myrtles, pomegranates, and the others, when the
proper time for using them is come, they will be treated of along
with the disease in question, in like manner as the other compound
medicines.[561]
18. The bath is useful in many diseases, in some of them when used
steadily, and in others when not so. Sometimes it must be less used
than it would be otherwise, from the want of accommodation; for in few
families are all the conveniences prepared, and persons who can manage
them as they ought to be. And if the patient be not bathed properly, he
may be thereby hurt in no inconsiderable degree, for there is required
a place to cover him that is free of smoke, abundance of water,
materials for frequent baths, but not very large, unless this should be
required. It is better that no friction should be applied, but if so, a
hot soap (_smegma_)[562] must be used in greater abundance than is
common, and an affusion of a considerable quantity of water is to made
at the same time and afterwards repeated. There must also be a short
passage to the basin, and it should be of easy ingress and egress. But
the person who takes the bath should be orderly and reserved in his
manner, should do nothing for himself, but others should pour the water
upon him and rub him, and plenty of waters, of various temperatures,
should be in readiness for the _douche_, and the affusions
quickly made;[563] and sponges should be used instead of the comb
(_strigil_), and the body should be anointed when not quite dry.
But the head should be rubbed by the sponge until it is quite dry; the
extremities should be protected from cold, as also the head and the
rest of the body; and a man should not be washed immediately after he
has taken a draught of ptisan or a drink; neither should he take ptisan
as a drink immediately after the bath. Much will depend upon whether
the patient, when in good health, was very fond of the bath, and in the
custom of taking it: for such persons, especially, feel the want of it,
and are benefited if they are bathed, and injured if they are not. In
general it suits better with cases of pneumonia than in ardent fevers;
for the bath soothes the pain in the side, chest, and back; concocts
the sputa, promotes expectoration, improves the respiration, and allays
lassitude; for it soothes the joints and outer skin, and is diuretic,
removes heaviness of the head, and moistens the nose. Such are the
benefits to be derived from the bath, if all the proper requisites be
present; but if one or more of these be wanting, the bath, instead of
doing good, may rather prove injurious; for every one of them may do
harm if not prepared by the attendants in the proper manner. It is by
no means a suitable thing in these diseases to persons whose bowels are
too loose, or when they are unusually confined, and there has been no
previous evacuation; neither must we bathe those who are debilitated,
nor such as have nausea or vomiting, or bilious eructations; nor such
as have hemorrhage from the nose, unless it be less than required at
that stage of the disease, (with those stages you are acquainted:)
but if the discharge be less than proper, one should use the bath,
whether in order to benefit the whole body or the head alone. If then
the proper requisites be at hand, and the patient be well disposed to
the bath, it may be administered once every day, or if the patient be
fond of the bath there will be no harm, though he should take it twice
in the day. The use of the bath is much more appropriate to those who
take unstrained ptisan, than to those who take only the juice of it,
although even in their case it may be proper; but least of all does
it suit with those who use only plain drink, although, in their case
too it may be suitable; but one must form a judgment from the rules
laid down before, in which of these modes of regimen the bath will be
beneficial, and in which not. Such as want some of the requisites for
a proper bath, but have those symptoms which would be benefited by it,
should be bathed; whereas those who want none of the proper requisites,
but have certain symptoms which contra-indicate the bath, are not to be
bathed.
APPENDIX TO THE WORK
ON
REGIMEN IN ACUTE DISEASES.
THE ARGUMENT.
No one can read this piece attentively without coming to the conclusion
that it is not a natural continuation of the subject discussed in the
preceding work, but that it is made up, in a considerable measure, of
materials extracted from it. Expositions of subjects which are there
given methodically are here presented in a disjointed form; and rules
of practice there laid down with precision are here often delivered in
a vague and indefinite shape. Still, however, it must be admitted, that
the reverse is sometimes the case, and that what is presented imperfect
in the former part of the work is here sometimes reproduced very
much improved. It has been therefore a matter of much dispute among
the critics whether this portion be the composition of Hippocrates,
or whether it be altogether the work of a different hand. The most
probable conjecture respecting it seems to be, that as Hippocrates in
the preceding part several times announces his intention of giving
a continuation of the subject, some one of his immediate disciples
undertook the work which he had thus promised, and composed this
treatise from fragments left by the author himself, and from materials
collected from his other works. As stated by Galen in his Commentary,
and as we have explained in our remarks on the “Aphorisms,” in the
second section of the Preliminary Discourse, it was a common practice,
in ancient times, to add appendices to popular works. I can have no
hesitation, then, in following the example of M. Littré, who recognizes
it as an appendix to the preceding work. But I must say that I rather
incline, with Galen, to think that there are many things in it which
cannot have come from Hippocrates, than to hold with M. Littré that it
is nearly or altogether his composition. But however that may be, it
indisputably contains much interesting matter, for which we have every
reason to believe that we are indebted to Hippocrates, either directly
or at second hand. I shall now give a brief abstract of its contents.
He commences with some general observations on the nature and
treatment of causus, the endemial fever of Greece. What is said on this
head is much to the purpose, but incomplete. Then there is given a
general rule for bleeding in diseases which certainly is well deserving
of attention at the present day, when professional opinions on this
point of medical practice are very much unsettled. Nowadays we have
abandoned all general rules of practice, and profess to be guided
solely by experience; but how variable and uncertain are its results
in the present case! I myself--albeit but verging towards the decline
of life--can well remember the time when a physician would have run
the risk of being indicted for culpable homicide if he had ventured
to bleed a patient in common fever; about twenty-five years ago
venesection in fever, and in almost every disease, was the established
order of the day; and now what shall I state as the general practice
that has been sanctioned by the experience of the present generation?
I can scarcely say, so variable has the practice in fever and in many
other diseases become of late years. One thing is remarkable in the
present work with regard to venesection in pneumonia and pleurisy,
namely, that it is directed to be carried the length of inducing
_deliquium animi_, contrary to the practice laid down in the
preceding work, and to the rule which was followed by all the other
ancient authorities. Another of the rules regarding bleeding here
delivered is also deserving of attention, namely, that in inflammatory
diseases it is improper to purge before bleeding, but that venesection
should precede all other means of cure.
The section in which cynanche is treated of appears to me to be highly
interesting and important. I think it may be a question whether the
prognostic spirit of Hippocrates and his followers had not in a great
measure anticipated all the results of modern diagnosis.
After this there follows some additional account of causus, which,
although out of place, contains observations of considerable interest.
To the treatment of pleurisy and pneumonia we have already alluded, but
the subject is so interesting that we cannot dismiss it with so brief a
notice. In the ancient method of treating fevers and febrile affections
three main objects would appear to have been kept in view: 1st, by
depletions, to remove the morbid fluids from the general system, or to
draw them off from a particular spot in which they had fixed; 2d, by
diluents, to supply the waste of fluids occasioned by the preternatural
heat of the body; and, 3d, to support the strength by a suitable supply
of such nutriment as the system is then capable of receiving.
Now with regard to venesection, it will be seen in this and the
preceding work that the practice is regulated by certain well-marked
indications, namely, the seat of the pain, the condition of the
patient, and the characters of the sputa. The purging is regulated by
the state of matters below the chest, it being held as a general rule
that clysters should be administered regularly every day during the
first days of the fever. After purging comes the cooling drinks, such
as oxymel. The administration of farinaceous food in a liquid state,
that is to say, of unstrained ptisan, is to be regulated by the state
of the sputa and urinary sediment, namely, when the sputa have put on a
purulent appearance, and the sediment has become copious and reddish.
Now this certainly seems to be a very intelligible and judicious rule
for the administration of nutritious articles in febrile diseases. I
need scarcely remark that at the present time there is scarcely a rule
of practice in medicine which is worse defined than this respecting
the administration of wine and other alimentary substances in febrile
diseases. In proof of what is now stated, I would beg leave to refer
the reader to what will be admitted to be one of the best authorities
in modern literature on fever, I mean to Dr. Tweedie’s elaborate
article on this subject, in the “Cyclopædia of Medicine.” It will be
seen, at vol. ii., p. 208, that the rules for the administration of
wine and other articles of food are by no means well defined. A cool
skin and a soft pulse, when combined with debility, are the indications
upon which most stress is laid; but the pulse, as long ago it was
pronounced by Celsus to be, is “res fallacissima,” and of this the
excellent author seems to have been sensible; for the injunctions
which he gives to regulate the administration of the wine and other
articles, by the effects they produce, sufficiently show that he was
sensible how deficient in precision our knowledge of the subject is at
present. At the same time he makes it appear that he was well aware
of one important fact in the treatment of febrile diseases, which,
although distinctly recognized by Hippocrates, is still frequently
overlooked by ordinary practitioners, namely, that in convalescence
the stomach partakes of the general debility, and is unable to digest
food in any great quantity at that time.[564] M. Littré further calls
attention to another rule for the administration of wine, lately laid
down by Dr. Stokes, of Dublin, which is certainly a most important
one, provided it is confirmed by time and experience. It is founded on
auscultation, and is to this effect; that when the impulse of the heart
is abnormally weak, and when there is a diminution of the proportion
between the two _bruits_, or when there is a preponderance in the
sound of the second _bruit_, wine may be freely administered.
Now, as I have said, this rule, if sanctioned by ample experience,
is undoubtedly a most excellent one; but I may be allowed to remark,
that my own observations on the heart in fever have led me to the
conclusion that, as I have stated respecting the pulse, its sounds are
very fallacious; and I must say that the rule of Hippocrates appears
more likely to prove a certain guide in this instance. For is it not
a natural view of the subject, that wine and other articles of food
should be withheld while the emunctories are not in a condition to
cast off the recrementitous superfluities of the system; but that when
the secretions are properly established, alimentary substances may be
safely administered?[565]
There is another point connected with the regimen in acute diseases
on which I have a remark or two to make--it is the administration of
animal matters in a fluid state, such as beef-tea, or soups from fowls.
These we see frequently administered in febrile cases by practitioners
of the present day, but by the ancient authorities they would appear
to have been entirely rejected. Which party is the safer guide in this
case? For my own part, I have long thought that animal matters, when
introduced into the system while in a febrile state, have a tendency
to become putrid, and thereby to occasion an increase of the heat and
general disorder.
After some defective observations on dysentery, our author treats of
tetanus; but here Galen objects to the characters which he gives of the
urine, and to his practice as regards the administration of wine. His
views, however, are not very different from those which now prevail.
Having made some general remarks on the administration of hellebore,
to which he was very partial, he proceeds to point out the bad effects
resulting from any change in regimen. His views here are very similar
to the observations contained in the preceding portion of the work, and
in the treatise “On Ancient Medicine.”
The account of dry cholera is confused and vague. By it he would seem
to mean flatulent colic, or _dry belly-ache_. See Opera, ed.
Littré, tom. ii., p. 388.
The paragraph on dropsy is interesting, although the views taken of
the subject are incomplete. Tympanitis is recognized as a variety of
dropsy. Then follow some detached observations on persons whose bowels
are heated, and on the regulation of the diet, with some remarks on
the different states which counter-indicate purging. At § 23 there are
some practical observations on various conditions of the constitution,
which it would no doubt be proper for the physician to make himself
acquainted with. The contents of all the remaining paragraphs would
seem to have nothing to do with the subject of this treatise.
From what is now stated the reader will readily perceive that this
treatise abounds in interesting matters, which, even at the present
day, may prove suggestive of important views in the theory and practice
of medicine. And although the style, in the judgment of Galen, be very
different from Hippocrates, and the mode of thought deficient in that
precision for which he is so remarkable, the treatise is unquestionably
a work of great ability, and contains what we have reason to regard
as the results of his experience and meditations on many important
subjects. I should have thought it quite unwarrantable, therefore, to
have rejected this piece from a volume which professes to give all
the genuine remains of our great author. And moreover, at the risk,
perhaps, of being set down as an antique devotée, I do not hesitate
to declare that in my opinion this and the preceding portion, taken
together, contain more original information on the important subject
to which they relate than is to be found in any medical work which has
been written from the days of our author down to the present time.
I shall conclude the present Argument by giving from Cælius Aurelianus
the criticisms of Soranus on the opinions of our author, as delivered
in these two treatises. It is to be borne in mind that Soranus was
the chief of the ancient sect of physicians called _Methodici_,
which was very inimically disposed towards all the others, and more
especially to Hippocrates. Though most of the strictures are evidently
overstrained, it cannot fail to be interesting to the reader to have an
opportunity of considering them, such as they are.
After giving an elaborate analysis of our author’s views, Cælius
Aurelianus proceeds as follows: “His Soranus respondens ait. In
calefactionibus acres esse sales, ac necessario tumorem provocare,
febremque accendere, poscam etiam constringere et stricturam passionis
augere. Item milium frixum graveolens et nidorosum, atque capiti
grave, maximè acutè fabricitantium esse perspicimus. Spongiis etiam
erat melius quenquam in dimissione patientes partes vaporare, atque
oleo calido perfundere. Est præterea improprium, ac sine ratione, tunc
uti phlebotomo quoties ad superiora dolor tetenderit; prohibere autem
quoties ad inferiora descenderit. Oportet ergo sub hoc argumento neque
difficultate tumorum partibus inferioribus impeditos phlebotomare:
neque etiam podagricos si quidem inferiora tumere videantur, sed
necessariò quoties dolor ad superiora tetenderit, phlebotomiam
adhibendam videmus. Siquidem sæpe pejorante ventris fluore, hoc
adjutorii genus prohibetur. Neque etiam (ut ait) oportet interiorem
venam dividi. Siquidem et exteriori et media divisa corpora releventur.
Quippe quum e contrario interiorem prohibeant, propter magnitudinem,
ne tumor augeatur. Item sanguinis mutatio iners est detractionis
moderationi, sicuti de adjutoriis scribentes demonstrabimus. Sese
denique idem Hippocrates impugnat in consequentibus, dicens usque
ad animi defectum faciendam detractionem, quod magis vehementer est
nocens: siquidem est pericolosa defectio, et neque si sit temporaliter
defectionis causa, sensu carens ægrotans, dolore relevatus, videbitur
(quum resumptus fuerit) rursum non dolere, quum magis atque magis
ejusdem passionis debilia corpora vehementius officiant. Item
purgativa medicamina (quæ Græci καθαρτικὰ vocant) acrimoniæ causa,
stomachum tumentem, atque hypezocota membranum acuunt in tumorem; et
in periculum ventris effusionem provocantia, magnificam passionis
ingerunt vehementiam. Nutrire etiam cibo post medicamen non oportebat.
Pugnat enim purgationi faciundæ illatum cibi nutrimentum. Quippe quum
medicamine corruptum, officii sui careat viribus. Mitto etiam quod ex
initio acescere facile ptisanæ succus perspiciatur, confectus quippe ex
ordei succo, qui sit digestione difficilis. Dehine ægrotantis corpus
non valet tantum sustinere nutrimentum, quantum sanitatis tempore
solitum videbatur. Item mulsum ex aceto (quod oxymeli appellavit)
sine discretione accipimus. Est etiam immodica usque ad septimum
diem cibi abstinentia, quam custodiendam ordinavit.[566] Quippe cum
nullus vehementiam passionis sustinere valet, nisi nutrimento quamvis
parvo toleratus: et neque in declinatione passionis aliquid humanius
cibo largitur, sed in iisdem sorbilibus perseverandum existimat
succis. At cum fuerint sputa segniora, tunc ut existimat, erit primo
æger nutriendus, quomodo necessariò declinante passione occurrunt
intolerato. In cæteris relinquendum temporibus absque nutrimento
ægrotantem apertissimè indicavit, quum semper plurimum utilitatis
adjutorium cibi, quam cætera possunt adjutoria, largiatur. Omne etiam
corpus erit unctione coæquandum, et non ejus particula. Quippe cum
totum cibo nutriatur, ipsa quoque unctio non exerta, anxietatem ingerit
ægrotanti, quæ latentem difficultatem, atque accessione veniente,
corporis provocat incendium.”
APPENDIX TO THE WORK
ON
REGIMEN IN ACUTE DISEASES.
Ardent fever (causus)[567] takes place when the veins, being dried up
in the summer season, attract acrid and bilious humors to themselves;
and strong fever seizes the whole body, which experiences aches of the
bones, and is in a state of lassitude and pain. It takes place most
commonly from a long walk and protracted thirst, when the veins being
dried up attract acrid and hot defluxions to themselves. The tongue
becomes rough, dry, and very black; there are gnawing pains about the
bowels; the alvine discharges are watery and yellow; there is intense
thirst, insomnolency, and sometimes wandering of the mind. To a person
in such a state give to drink water and as much boiled hydromel of a
watery consistence as he will take; and if the mouth be bitter, it
may be advantageous to administer an emetic and clyster; and if these
things do not loosen the bowels, purge with the boiled milk of asses.
Give nothing saltish nor acrid, for they will not be borne; and give
no draughts of ptisan until the crisis be past. And the affection is
resolved if there be an epistaxis, or if true critical sweats supervene
with urine having white, thick, and smooth sediments, or if a deposit
take place anywhere; but if it be resolved without these, there will be
a relapse of the complaint, or pain in the hips and legs will ensue,
with thick sputa, provided the patient be convalescent. Another species
of ardent fever: belly loose, much thirst, tongue rough, dry, and
saltish, retention of urine, insomnolency, extremities cold. In such a
case, unless there be a flow of blood from the nose, or an abscess form
about the neck, or pain in the limbs, or the patient expectorate thick
sputa (these occur when the belly is constipated), or pain of the hips,
or lividity of the genital organs, there is no crisis; tension of the
testicle is also a critical symptom. Give attractive draughts.[568]
2. Bleed in the acute affections, if the disease appear strong, and
the patients be in the vigor of life, and if they have strength.[569]
If it be quinsy or any other of the pleuritic affections, purge with
electuaries; but if the patient be weaker, or if you abstract more
blood, you may administer a clyster every third day, until he be out of
danger, and enjoin total abstinence if necessary.
3. Hypochondria inflamed not from retention of flatus, tension of
the diaphragm, checked respiration, with dry orthopnœa, when no pus
is formed, but when these complaints are connected with obstructed
respiration; but more especially strong pains of the liver, heaviness
of the spleen, and other phlegmasiæ and intense pains above the
diaphragm, diseases connected with collections of humors,--all these
diseases do not admit of resolution, if treated at first by medicine,
but venesection holds the first place in conducting the treatment;
then we may have recourse to a clyster, unless the disease be great
and strong; but if so, purging also may be necessary; but bleeding
and purging together require caution and moderation. Those who
attempt to resolve inflammatory diseases at the commencement by the
administration of purgative medicines, remove none of the morbific
humors which produce the inflammation and tension: for the diseases
while unconcocted could not yield, but they melt down those parts which
are healthy and resist the disease; so when the body is debilitated the
malady obtains the mastery; and when the disease has the upper hand of
the body, it does not admit of a cure.[570]
4. When a person suddenly loses his speech, in connection with
obstruction of the veins,--if this happen without warning or any other
strong cause, one ought to open the internal vein of the right arm,
and abstract blood more or less according to the habit and age of the
patient. Such cases are mostly attended with the following symptoms:
redness of the face, eyes fixed, hands distended, grinding of the
teeth, palpitations, jaws fixed, coldness of the extremities, retention
of airs in the veins.[571]
5. When pains precede, and there are influxes of black bile and
of acrid humors, and when by their pungency the internal parts are
pained, and the veins being pinched and dried become distended, and
getting inflamed attract the humors running into the parts, whence
the blood being vitiated, and the airs collected there not being able
to find their natural passages, coldness comes on in consequence of
this stasis, with vertigo, loss of speech, heaviness of the head, and
convulsion, if the disease fix on the liver, the heart, or the great
vein (vena cava?); whence they are seized with epilepsy or apoplexy,
if the defluxions fall upon the containing parts,[572] and if they are
dried up by airs which cannot make their escape; such persons having
been first fomented are to be immediately bled at the commencement,
while all the peccant vapors and humors are buoyant, for then the cases
more easily admit of a cure; and then supporting the strength and
attending to the crisis, we may give emetics, unless the disease be
alleviated; or if the bowels be not moved, we may administer a clyster
and give the boiled milk of asses, to the amount of not less than
twelve heminæ, or if the strength permit, to more than sixteen.
6. Quinsy takes place when a copious and viscid defluxion from the
head, in the season of winter or spring, flows into the jugular veins,
and when from their large size they attract a greater defluxion; and
when owing to the defluxion being of a cold and viscid nature it
becomes enfarcted, obstructing the passages of the respiration and of
the blood, coagulates the surrounding blood, and renders it motionless
and stationary, it being naturally cold and disposed to obstructions.
Hence they are seized with convulsive suffocation, the tongue turning
livid, assuming a rounded shape, and being bent owing to the veins
which are seated below the tongue (for when an enlarged uvula, which
is called _uva_, is cut, a large vein may be observed on each
side). These veins, then, becoming filled, and their roots extending
into the tongue, which is of a loose and spongy texture, it, owing
to its dryness receiving forcibly the juice from the veins, changes
from broad and becomes round, its natural color turns to livid,
from a soft consistence it grows hard, instead of being flexible it
becomes inflexible, so that the patient would soon be suffocated
unless speedily relieved. Bleeding, then, in the arm, and opening the
sublingual veins, and purging with the electuaries, and giving warm
gargles, and shaving the head, we must apply to it and the neck a
cerate, and wrap them round with wool, and foment with soft sponges
squeezed out of hot water; give to drink water and hydromel, not cold;
and administer the juice of ptisan when, having passed the crisis, the
patient is out of danger. When, in the season of summer or autumn,
there is a hot and nitrous defluxion from the head (it is rendered
hot and acrid by the season), being of such a nature it corrodes and
ulcerates, and fills with air, and orthopnœa attended with great
dryness supervenes; the fauces, when examined, do not seem swollen;
the tendons on the back part of the neck are contracted, and have the
appearance as if it were tetanus; the voice is lost, the breathing
is small, and inspiration becomes frequent and laborious. In such
persons the trachea becomes ulcerated, and the lungs engorged, from the
patient’s not being able to draw in the external air. In such cases,
unless there be a spontaneous determination to the external parts of
the neck, the symptoms become still more dreadful, and the danger more
imminent, partly owing to the season, and the hot and acrid humors
which cause the disease.[573]
7. When fever seizes a person who has lately taken food, and whose
bowels are loaded with fæces which have been long retained, whether it
be attended with pain of the side or not, he ought to lie quiet until
the food descend to the lower region of the bowels, and use oxymel for
drink; but when the load descends to the loins, a clyster should be
administered, or he should be purged by medicine; and when purged, he
should take ptisan for food and hydromel for drink; then he may take
the cerealia, and boiled fishes, and a watery wine in small quantity,
at night, but during the day, a watery hydromel. When the flatus is
offensive, either a suppository or clyster is to be administered; but
otherwise the oxymel is to be discontinued, until the matters descend
to the lower part of the bowels, and then they are to be evacuated
by a clyster. But if the ardent fever (_causus_) supervene when
the bowels are empty, should you still judge it proper to administer
purgative medicine, it ought not be done during the first three
days, nor earlier than the fourth. When you give the medicine, use
the ptisan, observing the paroxysms of the fevers, so as not to give
it when the fever is setting in, but when it is ceasing, or on the
decline, and as far as possible from the commencement. When the feet
are cold, give neither drink nor ptisan, nor anything else of the kind,
but reckon it an important rule to refrain until they become warm,
and then you may administer them with advantage. For the most part,
coldness of the feet is a symptom of a paroxysm of the fever coming on;
and if at such a season you apply those things, you will commit the
greatest possible mistake, for you will augment the disease in no small
degree. But when the fever ceases, the feet, on the contrary, become
hotter than the rest of the body; for when the heat leaves the feet, it
is kindled up in the breast, and sends its flame up to the head. And
when all the heat rushes upwards, and is exhaled at the head, it is not
to be wondered at that the feet become cold, being devoid of flesh, and
tendinous; and besides, they contract cold, owing to their distance
from the hotter parts of the body, an accumulation of heat having
taken place in the chest: and again, in like manner, when the fever is
resolved and dissipated, the heat descends to the feet, and, at the
same time, the head and chest become cold. Wherefore one should attend
to this; that when the feet are cold, the bowels are necessarily hot,
and filled with nauseous matters; the hypochondrium distended: there
is jactitation of the body, owing to the internal disturbance; and
aberration of the intellect, and pains; the patient is agitated, and
wishes to vomit, and if he vomits bad matters he is pained; but when
the heat descends to the feet, and the urine passes freely, he is every
way lightened, even although he does not sweat; at this season, then,
the ptisan ought to be given; it would be death to give it before.[574]
8. When the bowels are loose during the whole course of fevers, in
this case we are most especially to warm the feet, and see that they
are properly treated with cerates, and wrapped in shawls, so that they
may not become colder than the rest of the body; but when they are
hot, no fomentation must be made to them, but care is to be taken that
they do not become cold; and very little drink is to be used, either
cold water or hydromel. In those cases of fever where the bowels are
loose, and the mind is disordered, the greater number of patients pick
the wool from their blankets, scratch their noses, answer briefly when
questions are put to them, but, when left to themselves, utter nothing
that is rational. Such attacks appear to me to be connected with black
bile. When in these cases there is a colliquative diarrhœa, I am of
opinion that we ought to give the colder and thicker ptisans, and
that the drinks ought to be binding, of a vinous nature, and rather
astringent. In cases of fever attended from the first with vertigo,
throbbing of the head, and thin urine, you may expect the fever to be
exacerbated at the crisis; neither need it excite wonder, although
there be delirium. When, at the commencement, the urine is cloudy or
thick, it is proper to purge gently, provided this be otherwise proper;
but when the urine at first is thin, do not purge such patients, but,
if thought necessary, give a clyster: such patients should be thus
treated; they should be kept in a quiet state, have unguents applied
to them, and be covered up properly with clothes, and they should use
for drink a watery hydromel, and the juice of ptisan as a draught in
the evening; clear out the bowels at first with a clyster, but give
no purgative medicines to them, for, if you move the bowels strongly,
the urine is not concocted, but the fever remains long, without sweats
and without a crisis. Do not give draughts when the time of the crisis
is at hand, if there be agitation, but only when the fever abates
and is alleviated. It is proper to be guarded at the crises of other
fevers, and to withhold the draughts at that season. Fevers of this
description are apt to be protracted, and to have determinations, if
the inferior extremities be cold, about the ears and neck, or, if these
parts are not cold, to have other changes; they have epistaxis, and
disorder of the bowels. But in cases of fever attended with nausea, or
distention of the hypochondria, when the patients cannot lie reclined
in the same position, and the extremities are cold, the greatest care
and precaution are necessary; nothing should be given to them, except
oxymel diluted with water; no draught should be administered, until the
fever abate and the urine be concocted; the patient should be laid in
a dark apartment, and recline upon the softest couch, and he should be
kept as long as possible in the same position, so as not to toss about,
for this is particularly beneficial to him. Apply to the hypochondrium
linseed by inunctions, taking care that he do not catch cold when the
application is made; let it be in a tepid state, and boiled in water
and oil. One may judge from the urine what is to take place, for if
the urine be thicker, and more yellowish, so much the better; but if
it be thinner, and blacker, so much the worse;[575] but if it undergo
changes, it indicates a prolongation of the disease, and the patient,
in like manner, must experience a change to the worse and the better.
Irregular fevers should be let alone until they become settled, and,
when they do settle, they are to be treated by a suitable diet and
medicine, attending to the constitution of the patient.
9. The aspects of the sick are various; wherefore the physician should
pay attention, that he may not miss observing the exciting causes,
as far as they can be ascertained by reasoning, nor such symptoms as
should appear on an even or odd day, but he ought to be particularly
guarded in observing the odd days, as it is in them, more especially,
that changes take place in patients. He should mark, particularly,
the first day on which the patient became ill, considering when and
whence the disease commenced, for this is of primary importance to
know. When you examine the patient, inquire into all particulars;
first how the head is, and if there be no headache, nor heaviness in
it; then examine if the hypochondria and sides be free of pain; for
if the hypochondrium be painful, swelled, and unequal, with a sense
of satiety, or if there be pain in the side, and, along with the
pain, either cough, tormina, or belly-ache, if any of these symptoms
be present in the hypochondrium, the bowels should be opened with
clysters, and the patient should drink boiled hydromel in a hot state.
The physician should ascertain whether the patient be apt to faint when
he is raised up, and whether his breathing be free; and examine the
discharges from the bowels, whether they be very black, or of a proper
color, like those of persons in good health, and ascertain whether the
fever has a paroxysm every third day, and look well to such persons
on those days. And should the fourth day prove like the third, the
patient is in a dangerous state.[576] With regard to the symptoms,
black stools prognosticate death; but if they resemble the discharges
of a healthy person, and if such is their appearance every day, it is a
favorable symptom; but when the bowels do not yield to a suppository,
and when, though the respiration be natural, the patient when raised
to the night-table, or even in bed, be seized with deliquium, you may
expect that the patient, man or woman, who experiences these symptoms,
is about to fall into a state of delirium. Attention also should be
paid to the hands, for if they tremble, you may expect epistaxis; and
observe the nostrils, whether the breath be drawn in equally by both;
and if expiration by the nostrils be large, a convulsion is apt to take
place; and should a convulsion occur to such a person, death may be
anticipated, and it is well to announce it beforehand.
10. If, in a winter fever, the tongue be rough, and if there be
swoonings, it is likely to be the remission of the fever. Nevertheless
such a person is to be kept upon a restricted diet, with water for
drink, and hydromel, and the strained juices, not trusting to the
remission of the fevers, as persons having these symptoms are in danger
of dying; when, therefore, you perceive these symptoms, announce this
prognostic, if you shall judge proper, after making the suitable
observations. When, in fevers, any dangerous symptom appears on the
fifth day, when watery discharges suddenly take place from the bowels,
when deliquium animi occurs, or the patient is attacked with loss of
speech, convulsions, or hiccup, under such circumstances he is likely
to be affected with nausea, and sweats break out under the nose and
forehead, or on the back part of the neck and head, and patients with
such symptoms shortly die, from stoppage of the respiration.[577]
When, in fevers, abscesses form about the legs, and, getting into a
chronic state, are not concocted while the fever persists, and if one
is seized with a sense of suffocation in the throat, while the fauces
are not swelled, and if it do not come to maturation, but is repressed,
in such a case there is apt to be a flow of blood from the nose; if
this, then, be copious, it indicates a resolution of the disease, but
if not, a prolongation of the complaint; and the less the discharge,
so much worse the symptoms, and the more protracted the disease; but
if the other symptoms are very favorable, expect in such a case that
pains will fall upon the feet; if then they attack the feet, and if
those continue long in a very painful, and inflamed state, and if
there be no resolution, the pains will extend by degrees to the neck,
to the clavicle, shoulder, breast, or to some articulation, in which
an inflammatory tumour will necessarily form. When these are reduced,
if the hands are contracted, and become trembling, convulsion and
delirium seize such a person; but blisters break out on the eyebrow,
erythema takes place, the one eyelid being tumefied overtops the other,
a hard inflammation sets in, the eye become strongly swelled, and the
delirium increases much, but makes its attacks rather at night than by
day. These symptoms more frequently occur on odd than on even days,
but, whether on the one or the other, they are of a fatal character.
Should you determine to give purgative medicines in such cases, at
the commencement, you should do so before the fifth day, if there be
borborygmi in the bowels, or, if not, you should omit the medicines
altogether. If there be borborygmi, with bilious stools, purge
moderately with scammony; but with regard to the treatment otherwise,
administer as few drinks and draughts as possible, until there be some
amendment, and the disease is past the fourteenth day. When loss of
speech seizes a person, on the fourteenth day of a fever, there is
not usually a speedy resolution, nor any removal of the disease, for
this symptom indicates a protracted disease; and when it appears on
that day, it will be still more prolonged. When, on the fourth day of
a fever, the tongue articulates confusedly, and when there are watery
and bilious discharges from the bowels, such a patient is apt to fall
into a state of delirium; the physician ought, therefore, to watch
him, and attend to whatever symptoms may turn up. In the season of
summer and autumn an epistaxis, suddenly occurring in acute diseases,
indicates vehemence of the attack, and inflammation in the course of
the veins, and on the day following, the discharge of thin urine; and
if the patient be in the prime of life, and if his body be strong from
exercise, and brawny, or of a melancholic temperament, or if from
drinking he has trembling hands, it may be well to announce beforehand
either delirium or convulsion;[578] and if these symptoms occur on even
days, so much the better; but on critical days, they are of a deadly
character. If, then, a copious discharge of blood procure an issue
to the fullness thereof about the nose, or what is collected about
the anus, there will be an abscess, or pains in the hypochondrium, or
testicles, or in the limbs; and when these are resolved, there will
be a discharge of thick sputa, and of smooth, thin urine. In fever
attended with singultus, give asafœtida, oxymel, and carrot, triturated
together, in a draught; or galbanum in honey, and cumin in a linctus,
or the juice of ptisan. Such a person cannot escape, unless critical
sweats and gentle sleep supervene, and thick and acrid urine be passed,
or the disease terminate in an abscess: give pine-fruit[579] and myrrh
in a linctus, and further give a very little oxymel to drink; but if
they are very thirsty, some barley-water.
11. Peripneumonia, and pleuritic affections, are to be thus observed:
If the fever be acute, and if there be pains on either side, or in
both, and if expiration be attended with pain, if cough be present, and
the sputa expectorated be of a blond or livid color, or likewise thin,
frothy, and florid, or having any other character different from the
common, in such a case, the physician should proceed thus: if the pain
pass upward to the clavicle, or the breast, or the arm, the inner vein
in the arm should be opened on the side affected, and blood abstracted
according to the habit, age, and color of the patient, and the season
of the year, and that largely and boldly, if the pain be acute, so as
to bring on deliquium animi,[580] and afterwards a clyster is to be
given. But if the pain be below the chest, and if very intense, purge
the bowels gently in such an attack of pleurisy, and during the act of
purging give nothing; but after the purging give oxymel. The medicine
is to be administered on the fourth day; on the first three days after
the commencement, a clyster should be given, and if it does not relieve
the patient, he should then be gently purged, but he is to be watched
until the fever goes off, and till the seventh day; then if he appear
to be free from danger, give him some unstrained ptisan, in small
quantity, and thin at first, mixing it with honey. If the expectoration
be easy, and the breathing free, if his sides be free of pain, and
if the fever be gone, he may take the ptisan thicker, and in larger
quantity, twice a day. But if he do not progress favorably, he must
get less of the drink, and of the draught, which should be thin, and
only given once a day, at whatever is judged to be the most favorable
hour; this you will ascertain from the urine. The draught is not to be
given to persons after fever, until you see that the urine and sputa
are concocted, (if, indeed, after the administration of the medicine he
be purged frequently, it may be necessary to give it, but it should be
given in smaller quantities and thinner than usual, for from inanition
he will be unable to sleep, or digest properly, or wait the crisis;)
but when the melting down of crude matters has taken place, and his
system has cast off what is offensive, there will then be no objection.
The sputa are concocted when they resemble pus, and the urine when
it has reddish sediments like tares. But there is nothing to prevent
fomentation and cerates being applied for the other pains of the sides;
and the legs and loins may be rubbed with hot oil, or anointed with
fat; linseed, too, in the form of a cataplasm, may be applied to the
hypochondrium and as far up as the breasts. When pneumonia is at its
height, the case is beyond remedy if he is not purged, and it is bad if
he has dyspnœa, and urine that is thin and acrid, and if sweats come
out about the neck and head, for such sweats are bad, as proceeding
from the suffocation, _râles_, and the violence of the disease
which is obtaining the upper hand, unless there be a copious evacuation
of thick urine, and the sputa be concocted; when either of these come
on spontaneously, that will carry off the disease. A linctus for
pneumonia: Galbanum and pine-fruit in Attic honey; and southernwood in
oxymel; make a decoction of pepper and black hellebore, and give it in
cases of pleurisy attended with violent pain at the commencement. It is
also a good thing to boil opoponax in oxymel, and, having strained it,
to give it to drink; it answers well, also, in diseases of the liver,
and in severe pains proceeding from the diaphragm, and in all cases in
which it is beneficial to determine to the bowels or urinary organs,
when given in wine and honey; when given to act upon the bowels, it
should be drunk in larger quantity, along with a watery hydromel.
12. A dysentery, when stopped, will give rise to an aposteme, or
tumour, if it do not terminate in fevers with sweats, or with thick and
white urine, or in a tertian fever, or the pain fix upon a varix, or
the testicles, or on the hip-joints.[581]
13. In a bilious fever, jaundice coming on with rigor before the
seventh day carries off the fever, but if it occur without the fever,
and not at the proper time, it is a fatal symptom.
14. When the loins are in a tetanic state, and the spirits in the
veins are obstructed by melancholic humors, venesection will afford
relief.[582] But when, on the other hand, the anterior tendons are
strongly contracted, and if there be sweats about the neck and face,
extorted by the violent pain of the parched and dried tendons of the
sacral extremity (these are very thick, sustaining the spine, and
giving rise to very great ligaments, which terminate in the feet,) in
such a case, unless fever and sleep come on, followed by concocted
urine and critical sweats, give to drink a strong Cretan wine, and
boiled barley-meal for food; anoint and rub with ointments containing
wax; bathe the legs and feet in hot water, and then cover them up; and
so in like manner the arms, as far as the hands, and the spine, from
the neck to the sacrum, are to be wrapped in a skin smeared with wax;
this must extend to the parts beyond, and intervals are to be left for
applying fomentations, by means of leather bottles filled with hot
water, then, wrapping him up in a linen cloth, lay him down in bed. Do
not open the bowels, unless by means of a suppository, when they have
been long of being moved. If there be any remission of the disease, so
far well, but otherwise, pound of the root of bryonia[583] in fragrant
wine, and that of the carrot, and give to the patient fasting early
in the morning, before using the affusion, and immediately afterwards
let him eat boiled barley-meal in a tepid state, and as much as he can
take, and in addition let him drink, if he will, wine well diluted.
If the disease yield to these means, so much the better, but, if
otherwise, you must prognosticate accordingly.
15. All diseases are resolved either by the mouth, the bowels, the
bladder, or some other such organ. Sweat is a common form of resolution
in all these cases.[584]
16. You should put persons on a course of hellebore who are troubled
with a defluxion from the head. But do not administer hellebore to
such persons as are laboring under empyema connected with abscesses,
hæmoptysis, and intemperament, or any other strong cause, for it will
do no good; and if anything unpleasant occur the hellebore will get
the blame of it. But if the body have suddenly lost its powers, or if
there be pain in the head, or obstruction of the ears and nose, or
ptyalism, or heaviness of the limbs, or an extraordinary swelling of
the body, you may administer the hellebore, provided these symptoms
be not connected with drinking, nor with immoderate venery; nor with
sorrow, vexation, nor insomnolency, for, if any of these causes exist,
the treatment must have respect to it.
17. From walking arise pains of the sides, of the back, of the loins,
and of the hip-joint, and disorder of the respiration has often been
from the same cause, for, after excesses of wine and flatulent food,
pains shoot to the loins and hips, accompanied with dysuria.[585]
Walking is the cause of such complaints, and also of coryza and
hoarseness.
18. Disorders connected with regimen, for the most part, make their
attack accordingly as any one has changed his habitual mode of
diet.[586] For persons who dine contrary to custom experience much
swelling of the stomach, drowsiness, and fullness; and if they take
supper over and above, their belly is disordered; such persons will be
benefited by sleeping after taking the bath, and by walking slowly for
a considerable time after sleep; if, then, the bowels be moved, he may
dine and drink a small quantity of wine not much diluted; but if the
bowels are not opened, he should get his body rubbed with hot oil, and,
if thirsty, drink of some weak and white wine, or a sweet wine, and
take repose; if he does not sleep he should repose the longer. In other
respects he should observe the regimen laid down for those who have
taken a debauch. With regard to the bad effects of drinks, such as are
of a watery nature pass more slowly through the body, they regurgitate,
as it were, and float about the hypochondria, and do not flow readily
by urine; when filled up with such a drink, he should not attempt any
violent exertion, requiring either strength or swiftness, but should
rest as much as possible until the drink has been digested along with
the food; but such drinks as are stronger or more austere, occasion
palpitation in the body and throbbing in the head, and in this case
the person affected will do well to sleep, and take some hot draught
for which he feels disposed; for abstinence is bad in headache and the
effects of a surfeit. Those who, contrary to usage, restrict themselves
to one meal, feel empty and feeble, and pass hot urine in consequence
of the emptiness of their vessels; they have a salt and bitter taste in
the mouth; they tremble at any work they attempt; their temples throb;
and they cannot digest their supper so well as if they had previously
taken their dinner. Such persons should take less supper than they are
wont, and a pudding of barley-meal more moist than usual instead of
bread, and of potherbs the dock, or mallow, and ptisan, or beets, and
along with the food they should take wine in moderation, and diluted
with water; after supper they should take a short walk, until the urine
descend and be passed; and they may use boiled fish.
Articles of food have generally such effects as the following:[587]
Garlic occasions flatulence and heat about the chest, heaviness of the
head, and nausea, and any other habitual pain is apt to be exasperated
by it; it is diuretic, which, in so far, is a good property which it
possesses; but it is best to eat it when one means to drink to excess,
or when intoxicated. Cheese produces flatulence and constipation, and
heats the other articles of food; and it gives rise to crudities and
indigestion, but it is worst of all to eat it along with drink after
a full meal. Pulse of all kinds are flatulent, whether raw, boiled,
or fried; least so when macerated in water, or in a green state; they
should not be used except along with food prepared from the cerealia.
Each of these articles, however, has bad effects peculiar to itself.
The vetch, whether raw or boiled, creates flatulence and pain. The
lentil is astringent, and disorders the stomach if taken with its
hull. The lupine has the fewest bad effects of all these things. The
stalk and the juice of silphium (_asafœtida_), pass through some
people’s bowels very readily, but in others, not accustomed to them,
they engender what is called dry cholera;[588] this complaint is more
especially produced by it if mixed with much cheese, or eaten along
with beef. Melancholic diseases are most particularly exacerbated by
beef, for it is of an unmanageable nature, and requires no ordinary
powers of stomach to digest it; it will agree best with those who use
it well boiled and pretty long kept. Goat’s flesh has all the bad
properties of beef; it is as indigestible, more flatulent and engenders
acid eructations and cholera; such as has a fragrant smell, is firm,
and sweet to the taste, is the best, when well baked and cooled; but
those kinds which are disagreeable to the taste, have a bad smell, and
are hard, such are particularly bad, and especially if very fresh; it
is best in summer and worst in autumn. The flesh of young pigs is bad,
either when it is too raw or when it is over-roasted, for it engenders
bile and disorders the bowels. Of all kinds of flesh, pork is the best;
it is best when neither very fat, nor, on the other hand, very lean,
and the animal had not attained the age of what is reckoned an old
victim; it should be eaten without the skin, and in a coldish state.
19. In dry cholera the belly is distended with wind, there is rumbling
in the bowels, pain in the sides and loins, no dejections, but, on the
contrary, the bowels are constipated. In such a case you should guard
against vomiting, but endeavor to get the bowels opened. As quickly
as possible give a clyster of hot water with plenty of oil in it, and
having rubbed the patient freely with unguents, put him into hot water,
laying him down in the basin, and pouring the hot water upon him by
degrees; and if, when heated in the bath, the bowels be moved, he will
be freed from the complaint. To a person in such a complaint it will
do good if he sleep, and drink a thin, old, and strong wine; and you
should give him oil, so that he may settle, and have his bowels moved,
when he will be relieved. He must abstain from all other kinds of food;
but when the pain remits, give him asses’ milk to drink until he is
purged. But if the bowels are loose, with bilious discharges, tormina,
vomitings, a feeling of suffocation, and gnawing pains, it is best to
enjoin repose, and to drink hydromel, and avoid vomiting.
20. There are two kinds of dropsy, the one anasarca, which, when
formed, is incurable; the other is accompanied with emphysema
(tympanites?) and requires much good fortune to enable one to triumph
over it.[589] Laborious exertion, fomentation, and abstinence (are to
be enjoined). The patient should eat dry and acrid things, for thus
will he pass the more water, and his strength be kept up. If he labors
under difficulty of breathing, if it is the summer season, and if he is
in the prime of life, and is strong, blood should be abstracted from
the arm, and then he should eat hot pieces of bread, dipped in dark
wine and oil, drink very little, and labor much, and live on well-fed
pork, boiled with vinegar, so that he may be able to endure hard
exercises.[590]
21. Those who have the inferior intestines hot, and who pass acrid and
irregular stools of a colliquative nature, if they can bear it, should
procure revulsion by vomiting with hellebore; but if not, should get
a thick decoction of summer wheat in a cold state, lentil soup, bread
cooked with cinders, and fish, which should be taken boiled if they
have fever, but roasted if not feverish; and also dark-colored wine if
free of fever; but otherwise they should take the water from medlars,
myrtles, apples, services, dates, or wild vine. If there be no fever,
and if there be tormina, the patient should drink hot asses’ milk in
small quantity at first, and gradually increase it, and linseed, and
wheaten flour, and having removed the bitter part of Egyptian beans,
and ground them, sprinkle on the milk and drink; and let him eat eggs
half-roasted, and fine flour, and millet, and perl-spelt (chondrus)
boiled in milk;--all these things should be eaten cold, and similar
articles of food and drink should be administered.
22. The most important point of regimen to observe and be guarded about
in protracted diseases, is to pay attention to the exacerbations and
remissions of fevers, so as to avoid the times when food should not be
given, and to know when it may be administered without danger; this
last season is at the greatest possible distance from the exacerbation.
23. One should be able to recognize those who have headache from
gymnastic exercises, or running, or walking or hunting, or any other
unseasonable labour, or from immoderate venery; also those who are of
a pale colour, or troubled with hoarseness; those who have enlarged
spleen, those who are in a state of anæmia, those who are suffering
from tympanites, those having dry cough and thirst, those who are
flatulent, and have the course of the blood in their veins intercepted;
those persons whose hypochondria, sides, and back are distended; those
having torpor; those laboring under amaurosis, or having noises in
their ears; those suffering from incontinence of urine or jaundice, or
whose food is passed undigested; those who have discharges of blood
from the nose or anus, or who have flatulence and intense pain, and who
cannot retain the wind. In these cases you may do mischief, but cannot
possibly do any good by purging, but may interrupt the spontaneous
remissions and crises of the complaints.[591]
24. If you think it expedient to let blood, see that the bowels be
previously settled, and then bleed; enjoin abstinence, and forbid the
use of wine; and complete the cure by means of a suitable regimen, and
wet fomentations.[592] But if the bowels appear to be constipated,
administer a soothing clyster.
25.[593] If you think it necessary to give medicines, you may safely
purge upwards by hellebore, but none of those should be purged
downwards. The most effectual mode of treatment is by the urine,
sweats, and exercise; and use gentle friction so as not to harden the
constitution; and if he be confined to bed let others rub him. When
the pain is seated above the diaphragm, place him erect for the most
part, and let him be as little reclined as possible; and when he is
raised up let him be rubbed for a considerable time with plenty of hot
oil. But if the pains be in the lower belly below the diaphragm, it
will be useful to lie reclined and make no motion, and to such a person
nothing should be administered except the friction. Those pains which
are dissolved by discharges from the bowels, by urine, or moderate
sweats, cease spontaneously, if they are slight, but if strong they
prove troublesome; for persons so affected either die, or at least do
not recover without further mischief, for they terminate in abscesses.
26. _A draught for a dropsical person._ Take three cantharides,[594]
and removing their head, feet, and wings, triturate their bodies in
three cupfuls (cyathi) of water, and when the person who has drunk the
draught complains of pain, let him have hot fomentations applied. The
patient should be first anointed with oil, should take the draught
fasting, and eat hot bread with oil.
27.[595] _A styptic._ Apply the juice of the fig inwardly to
the vein; or having moulded biestings into a tent, introduce up the
nostril, or push up some chalcitis with the finger, and press the
cartilages of the nostrils together; and open the bowels with the
boiled milk of asses: or having shaved the head apply cold things to it
if in the summer season.
28. The sesamoides[596] purges upwards when pounded in oxymel to the
amount of a drachm and a half, and drunk; it is combined with the
hellebores, to the amount of the third part, and thus it is less apt to
produce suffocation.
29. _Trichiasis._ Having introduced a thread into the eye of a
needle push it through the upper part of the distended eyelid, and do
the same at the base of it; having stretched the threads tie a knot on
them, and bind up until they drop out: and, if this be sufficient, so
far well; but if otherwise, you must do the same thing again.[597] And
hemorrhoids, in like manner, you may treat by transfixing them with a
needle and tying them with a very thick and large woolen thread; for
thus the cure will be more certain. When you have secured them, use a
septic application, and do not foment until they drop off, and always
leave one behind; and when the patient recovers, let him be put upon
a course of hellebore. Then let him be exercised and sweated; the
friction of the gymnasium and wrestling in the morning will be proper;
but he must abstain from running, drinking, and all acrid substances,
except marjoram; let him take an emetic every seven days, or three
times in a month; for thus will he enjoy the best bodily health. Let
him take straw-colored, austere, and watery wine, and use little drink.
30. _For persons affected with empyema._ Having cut some bulbs
or squill, boil in water, and when well boiled, throw this away, and
having poured in more water, boil until it appear to the touch soft and
well-boiled; then triturate finely and mix roasted cumin, and white
sesames, and young almonds pounded in honey, form into an electuary
and give; and afterwards sweet wine. In draughts, having pounded about
a small acetabulum of the white poppy, moisten it with water in which
summer wheat has been washed, add honey, and boil. Let him take this
frequently during the day. And then taking into account what are to
happen, give him supper.
31. _For dysentery._ A fourth part of a pound of cleaned beans,
and twelve shoots of madder having been triturated, are to be mixed
together and boiled, and given as a linctus with some fatty substance.
32. _For diseases of the eyes._ Washed spodium (tutty?) mixed
with grease, and not of a thinner consistence than dough, is to be
carefully triturated, and moistened with the juice of unripe raisins;
and having dried in the sun, moisten until it is of the consistence of
an ointment. When it becomes again dry, let it be finely levigated,
anoint the eyes with it, and dust it upon the angles of the eyes.
33. _For watery eyes._ Take one drachm of ebony and nine oboli of
burnt copper, rub them upon a whetstone, add three oboli of saffron;
triturate all these things reduced to a fine powder, pour in an Attic
hemina of sweet wine, and then place in the sun and cover up; when
sufficiently digested, use it.[598]
34. _For violent pains of the eyes._ Take of chalcitis,[599] and
of raisin, of each 1 dr., when digested for two days, strain; and
pounding myrrh and saffron, and having mixed must, with these things,
digest in the sun; and with this anoint the eyes when in a state of
severe pain. Let it be kept in a copper vessel.
35. _Mode of distinguishing persons in an hysterical fit._ Pinch
them with your fingers, and if they feel, it is hysterical; but if not,
it is a convulsion.
36. _To persons in coma_, (dropsy?) give to drink meconium (_euphorbia
peplus?_) to the amount of a round Attic _leciskion_ (small
acetabulum[600]).
37. Of squama æris, as much as three specilla can contain, with the
gluten of summer wheat: levigate, pound, form into pills, and give; it
purges water downwards.
38. _A medicine for opening the bowels._ Pour upon figs the juice
of spurge, in the proportion of seven to one: then put into a new
vessel and lay past when properly mixed. Give before food.
39. Pounding meconium, pouring on it water, and straining, and
mixing flour, and baking into a cake, with the addition of boiled
honey, give in affections of the anus and in dropsy; and after eating
of it, let the patient drink of a sweet watery wine, and diluted
hydromel prepared from wax: or collecting meconium, lay it up for
medicinal purposes.[601]
FIRST AND THIRD BOOKS
OF
THE EPIDEMICS.
THE EPIDEMICS.
BOOK I.
THE ARGUMENT.
The ancient physicians commonly used the term Epidemic in the same
sense as it is understood now, that is to say, as applying to any
disease which attacks a multitude of persons in a locality at any
particular period. This, as will be seen in our annotations below, is
nearly the definition which Galen gives of it; and it is generally
used by Hippocrates, in the first and third books of the “Epidemics,”
in pretty much the same sense as it is used by our great modern
authority on epidemics, Sydenham. But, although this be the strict
sense in which the ancient authorities use the term, it must be borne
in mind that, as applied to the whole seven books of the “Epidemics,”
it must be taken in a much wider signification; for there are many
things treated of in them to which the term epidemic can by no means
be thus applied, such as surgical cases, fragments of anatomical
descriptions, philosophical speculations, empirical remedies, general
reflections on various topics, and so forth. In fact, the work entitled
“The Books of Epidemics” can be viewed in no other light than as an
_Adversaria_, or _Memorandum Book_, in which is collected
a variety of isolated facts and detached observations, to serve as
the materials for more elaborate and finished works on professional
subjects. Indeed, Galen does not hesitate to give it as his opinion,
that some of the most celebrated of our author’s productions, such
as the “Aphorisms” and “Prognostics,” are in a great measure made up
from the materials originally laid up in this capacious repertory of
observations;[602] and, with regard to the former of these works,
there is no person familiarly acquainted with it but must admit the
truth of Galen’s remark. But, respecting the other, although it
must be obvious, upon a comparison of them, that there is a close
connection between it and the “Epidemics,” there can be no doubt that,
in composing the “Prognostics,” Hippocrates availed himself of other
materials ready prepared for his use, in the “Prorrhetics” and “Coan
Prænotions” of his predecessors, the Asclepiadæ;[603] so that, of all
his admired productions, it, perhaps, is the one which has the least
pretension to any originality of matter. If it be thought strange that
the term epidemics should have been applied to a work composed of
such heterogeneous materials, I would remark, in explanation, that,
although the subject-matters of which it consists are not all of this
nature, the most valuable portion of them refers to epidemics, and it
is not to be wondered at that the whole collection should have got its
appellation from the most prominent subject to which it relates.
* * * * *
I shall now proceed to give a succinct analysis of the various subjects
which are contained in the First and Third Books of the “Epidemics.”
The first book opens with a description of the leading phenomena of
a certain season, which is called the First Constitution; it was
southerly, coldish, rainy, clouded and misty, with some intervals of
drought. The most noted diseases of spring in this constitution were
causus and an epidemical parotitis. But the most important subject
which is handled under this head, is an epidemic phthisis, of which a
very interesting description is given.
The Second Constitution is described as being northerly and humid;
humid ophthalmies, dysenteries, and diarrhœas are described among the
prevailing diseases of the season; but the most marked affection which
is said to have occurred in this constitution, is a continual fever
of a serious character, which did not come to a crisis until after it
had run a long course. It is described as passing off by deposits, and
principally by dropsies, and an affection of the urinary organs. One
cannot help being struck with the remark which Hippocrates makes, that
he never knew a case prove fatal in which the strangury supervened.
The directions as to the treatment he condenses into one general rule,
which well deserves to be engraved in letters of gold, that “_the aim
of the physician should be to do good to his patient, or, at least, to
do no harm_.” The description of this constitution concludes with
some general reflections on the prognostics in causus and phrenitis.
The Third Constitution is described as being of a very variable
character; winter stormy, spring rainy, summer hot, autumn cold and
dry. The ardent fevers (_or_ causi) began early in the season, but
did not assume a fatal character until autumn. This disease came to a
crisis in four modes--by an epistaxis, by a copious flow of urine, by a
deposit, or by an alvine discharge. In women, there was also sometimes
a crisis by menstruation.
The Fourth Constitution is one which, by Galen and the other
authorities, has been entitled the pestilential, and has attracted
great attention, as being supposed to have derived its peculiar
characters from the great Plague which prevailed during the
Peloponnesian war, and which is described in so interesting a manner
by Thucydides. Galen, not only in his Commentary, but in various
other parts of his works, advocates this opinion, and it will be seen
from what is stated in our annotations, that there is in reality a
striking resemblance between the features of the plague, as delineated
by Thucydides, and the epidemical diseases which are noticed by
Hippocrates as having prevailed during this constitution. Of all the
diseases here described the most remarkable is the erysipelas, which,
although not of a very fatal character, was still of a formidable
nature, as it frequently terminated in gangrene. Causus, phrenitis, and
anthrax are also described as being common under this constitution. The
last of these being a well-known symptom of the Oriental plague, it has
naturally excited a good deal of speculation to determine whether or
not our author here refers to the glandular plague. See our remarks on
Epidem. III.
* * * * *
In these books it is remarkable that phthisis is treated of as a
febrile disease, and in particular as supervening upon attacks of the
semitertian. There seems reason to suppose that our author means to
describe a hectic fever succeeding to intermittents, which had caused
organic derangement of the internal viscera, more especially of the
liver and spleen. See PAULUS ÆGINETA, Book II., 32.
In the first book, fourteen cases of disease are related, and in the
beginning of the third twelve, and sixteen in the end; thus making
forty-two in all. It is worthy of remark, that in twenty-five of these
the result was fatal. There is every reason, then, to suppose that
they were selected for a purpose, but what that purpose was cannot now
be easily determined. The most natural would, no doubt, have been to
illustrate, by examples, the forms of the different diseases which are
described as occurring during the Constitutions previously described.
But there seems to be little or no reason to suppose that this is the
object for which they are related. In proof of this, I may mention
that there is not in the collection a single case of the epidemical
erysipelas which is described as having been the prevailing disease
during the fourth Constitution. Indeed it must strike everybody, who
reads them carefully, as a singular feature in these cases, that the
lineaments of a particular disease are seldom to be recognized, and
this perhaps may be regarded as a proof of the faithfulness with which
they have been copied from nature. In short, we here recognize the
features of disease in the concrete, and not in the abstract. And is
not this what we should expect in all true copies from Nature? How
often does the candid physician find himself forced honestly to admit
that he is at a loss what name to give to the combination of morbid
actions which he is called upon to treat! The common herd of mankind
would seem to fancy, as in Nature there are certain types of all
animal and vegetable substances, and the botanist has no difficulty in
classing such a plant, for example, as the _conium maculatum_;
and the natural historian can readily pronounce that such a bird is
the _alcedo Ispida_; that the physician, in like manner, upon
examining the characteristic features of any case, should have no
difficulty in pronouncing that it is _pleuritis_, for example,
or _pneumonia_, or the like. But how often does it happen, that
the complaint in question is an aggregate of symptoms, produced by
peculiarities of constitution, and incidental circumstances, which,
taken together, constitute an _ensemble_ which does not well admit
of being referred to any one of the general forms of disease described
in our nosological systems? Now, I say the most wonderful feature in
the cases related by Hippocrates, is that they are descriptive of the
symptoms observed in certain diseased individuals, instead of being,
what most modern cases are, symptoms drawn to correspond with certain
ideal forms of disease. What, in my opinion, likewise adds very much
to the value of these cases is, that (as Galen somewhere remarks in
his Commentary) the author never aimed to make his Books of Epidemics
a work on Therapeutics, and hence, in noting morbid phenomena, his
mind in not warped by any particular hypothesis, nor by any selfish
interest, in order to place some favorite mode of practice, advocated
by himself, in a favorable light. May I be permitted here to remark,
that the reader will be much struck with our author’s admirable
talent for describing the phenomena of disease as they are actually
presented to us, if he will compare the case related by him in these
two books with those of almost any modern authority whatever;--for
example, with those related by the late Dr. James Hamilton, in his
celebrated work on Purgative Medicines. In the latter, you look
in vain for the strongly-marked features which present themselves
in all the cases related by our author,--for a description of the
condition of the hypochondriac region,--of the state of the animal
heat in the extremities,--of the minute characters of the alvine and
urinary discharges,--of the respiration,--of the patients’ position
in bed,--and many other symptoms, which are invariably noticed by
Hippocrates. And what reasonable person will venture to deny, that
the symptoms I have just now mentioned are most important features in
every febrile disease, and that no one can be said to have a sufficient
view of such a case, who does not take these into account? To confine
our attention at present to only one of these symptoms,--can it ever
be a matter of indifference what are the physical characters of so
important an excretion as the urine? that is to say, whether the
grosser particles of it, which usually fall to the bottom, be present
in the urine or not? Yet in all the seventeen cases related in the
modern work just now referred to, the characters of the urine are not
given in a single instance. And although the object of the writer is
to enforce his own peculiar views, as to the utility of purgative
medicines in this disease, he scarcely ever gives the minute characters
of the alvine discharges, as is uniformly the case with Hippocrates;
or if they are noticed at all, it is in so confused a manner that
the reader is at a loss to determine whether they are produced by
the disease, or by the medicines which have been administered. For
the issue of the case no obvious cause is stated, but the reader is
expected to draw the conclusion that, as purgatives were freely given,
and a considerable proportion of the cases did well,--(agreeably to the
hackneyed rule, _post quod, ergo propter quod_,)--the purgatives
brought about the fortunate result. Had the cases been fully and
circumstantially detailed, it might have been found that, as in those
related by Hippocrates, recovery was preceded by a critical discharge
of urine, accompanied with a copious sediment; and then the more
probable inference would have been, that the amendment was referable to
_it_, and not to the purgative medicines which were administered.
It is, I regret to say, a notable example of the want of logical
training in the education of professional men, in the present age, that
inferences regarding a peculiar method of practice were allowed to be
founded upon narratives of observations so defective and one-sided as
those I refer to.
* * * * *
I cannot quit the present subject of discussion, without saying a
few words in reference to what must strike the reader as a singular
feature in the cases related in the books of the Epidemics; I mean the
general omission of any mention of treatment. The reader will find in
our annotations various remarks of Galen on this head, from which he
will learn that the Great Commentator inclines to the opinion, that in
all these cases the usual routine of practice was followed, but that
no mention is made of medicines, unless when there was some deviation
from the established rules. For example, in a certain febrile case,
it is stated that the patient was bled on the eighth day, and Galen
contends that venesection is noticed in this instance, merely because
it was contrary to the established rule of not bleeding after the
fourth day; for that if the practice had been in accordance with the
general rule, it would not have been noticed at all. Now it must be
admitted, that this supposition is by no means improbable, and that
examples of this usage are not wanting, even in the modern literature
of medicine. To give an example, which just occurs to me; in not a
few of the cases of cerebral disease related by Dr. Abercrombie, in
his work “On the Brain,” there is no allusion whatever to remedies,
although no one, who recollects the vigorous system of treatment then
pursued by the profession in “Modern Athens,” will doubt for a moment
that they must have been applied. As this eminent authority, then,
when he believed that the treatment had no perceptible effect on the
course which the disease ran, thought himself warranted in omitting all
mention of it, it might be supposed, in like manner, that Hippocrates
may have passed over the remedies applied, from some such motive or
consideration. But another reason for the absence of remedies in these
Reports may be readily supposed. May not Hippocrates have been at first
quite undecided what was the proper plan of treatment to be adopted
in those cases, and thought it the wisest course to attempt nothing
rashly, but to be for a season the quiet spectator of the course
which the diseases in question were naturally disposed to run, before
attempting to interfere in the struggle between morbific agents with
which he was imperfectly acquainted, and their great physician, as
he held Nature to be?[604] And however much the advocates for a bold
system of treating diseases may be disposed to deride this expectant
method, which Asclepiades contemptuously denominated “the contemplation
of death,”[605] it does not want the sanction of a name which is
second only to Hippocrates in the literature of epidemical fevers.
Sydenham admits, that with all the diligence which he had applied to
the study of these diseases, he was always greatly puzzled what plan
of treatment to adopt at the first breaking out of a new epidemic, and
that it was only “ingenti adhibita cautela intentisque animi nervis,”
that he could make up his mind what course of treatment to adopt in
such an emergency. Need it be wondered at, then, that two thousand
years earlier the modest mind of our great author should have hesitated
for a time, before deciding how to act under similar circumstances? I
must own, therefore, that I have long inclined to the opinion, that,
distracted with the conflicting plans of treatment adopted by his
contemporaries, Hippocrates at first did little or nothing in the
treatment of epidemical fevers, and that it was only after a patient
study of their symptoms, and many cautious trials, that he ventured to
lay down those excellent rules of treatment which he has described so
admirably in his work “On Regimen in Acute Diseases.” This, however, is
merely my individual opinion, and the reader must receive it as such.
M. Littré, in the Argument prefixed to his translation of the
Epidemics, enters very fully into the discussion of the question
regarding the nature of the diseases which are treated of in the course
of this work. This is a task, however, which I deem it superfluous to
undertake at any length, as I have stated my opinions on this subject
in the Commentaries on the Second Book of PAULUS ÆGINETA,
and after maturely weighing what has been elicited by subsequent
inquirers, I find no cause to retract any of the opinions which are
there advanced. That the causus of Hippocrates, and the other ancient
authorities, was not the typhus of the more temperate parts of Europe,
but a bilious fever, of the remittent type, must be quite apparent
to every person at all acquainted with the medical literature of
febrile diseases. M. Littré’s researches lead him to exactly the same
conclusion, and much deference is due to his judgment in this case,
as it must be admitted that a French physician is now very favorably
situated for contrasting the diseases of temperate and hot climates,
owing to the familiar intercourse which at present subsists between
Paris and Algiers. Of all the materials which he has collected from
the observations of French physicians in Algeria, the most interesting
are those which he draws from a work on Fevers, by M. Maillot. The
description which is there given of “la fièvre algide,” is so striking,
and is so much calculated to illustrate the nature of the fevers which
are treated of in this work of Hippocrates, that I shall not scruple to
quote it entire.
“La fièvre algide (dit M. Maillot) n’est pas généralement, comme
on le dit, la prolongation indéfinie du stade de froid; je l’ai vue
rarement débuter de la sorte. Il y a même entre ces deux états une
contraste frappante. Dans le premier stade des fièvres intermittentes,
la sensation du froid est hors de toute proportion avec l’abaissement
réel de la température de la peau, tandis que, dans la fièvre algide,
le froid n’est pas perçu par le malade, alors que la peau est
glacée. C’est ordinairement pendant la réaction que commencent les
symptômes qui la caractérisent; souvent ils surviennent tout à coup
au milieu d’une réaction qui paraissait franche. Au trouble de la
circulation succède en peu d’instants et presque sans transition le
ralentissement du pouls, qui devient bientôt très rare, fuit sous le
doigt et disparaît; l’abaissement de la température du corps va vite
et suit la progression promptement décroissante de la circulation;
les extrémitiés, la face, le torse, se refroidissent successivement;
l’abdomen seul conserve encore quelque temps un peu de chaleur;
le contact de la peau donne la sensation de froid que procure le
marbre. Les lèvres sont décolorées, l’haleine froide, la voix cassée,
les battemens du cœur rares, incomplets, appréciables seulement
par l’auscultation; les facultés intellectuelles sont intactes, et
le malade se complaît dans cet état de repos, surtout lorsqu’il
succède à une fièvre violente, la physionomie est sans mobilité,
l’impassibilité la plus grande est peinte sur son visage; ses traits
sont morts. La marche de cette fièvre est très insidieuse; il n’est
peut-être personne, dont elle n’ait surpris la vigilance, avant
d’être familiarisé avec l’observation des accidens de cette nature,
on prend souvent pour une très grande amélioration due aux déplétions
sanguines, le calme qui succède aux accidents inflammatoires; et plus
d’une fois, dans de semblables circonstances, on n’a été détrompé que
par la mort soudaine du malade. Toutes les fois qu’à une réaction
plus on moins forte, on verra succéder tout à coup un ralentissement
du pouls, avec pâleur de la langue et décoloration des lèvres, on ne
devra hésiter à diagnostiquer une fièvre algide. La temporisation ici
donne la mort, en quelques heures. Dans quelques cas très rares, j’ai
cependant vu cet état algide se prolonger trois ou quatre jours. Le
malade expire en conservant toutes ses facultés intellectuelles,[606]
il s’éteint comme par un arrêt de l’innervation. Lorsque la mort n’est
pas le terme de cet état morbide si grave, le pouls se relève; la peau
reprend sa chaleur naturelle; quelquefois alors la réaction détermine
une irritation de l’encéphale ou des voies digestives; mais rarement
elle est assez intense pour qu’on soit obligé de la combattre par des
déplétions sanguines.”[607] I shall add a remark, which M. Littré
gives on the same authority: “J’ai tenu à mentionner ici l’impression
qu’éprouva M. Maillot au début de sa pratique en Algérie, et qui est si
instructive; car, aller subitement de France exercer la médecine dans
un pays chaud, ou lire les observations d’Hippocrate, c’est tout un:
l’impression est la même, le changement de scène est aussi grand.”[608]
I cannot help remarking in this place, however, that it appears to
me singular, that M. Littré should represent the febris algida as
being confined to southern climates, and should speak of it as being
unknown in Paris; for, at all events, there seems to be no doubt
that it prevails in a more northerly region, namely, in Holland. It
is thus described by the celebrated Franciscus de le Boe (_or_
Sylvius), who was professor of practical medicine at Leyden about the
middle of the 17th century: “Febres algidæ observantur nonnunquam,
non tantum frigore præsertim, sed frigore tantum molestæ: adeo ut
aliquando et frequentius levis, aliquando et rarius nullus sequatur
calor. Tales, etiam semper algidas in Nosocomio academico habuimus
ita manifestas, ut non tantum incipiente, atque augescente, sed etiam
vigente et déclinante, imò cessante paroxysmo, id est, semper tum suo,
tum adstantium, tum medicorum sensu moleste ubique frigerent, nunquam
teperent, minus calerent ullibi ægri. Suntque hæ algidæ graviores
semper forsan quotidianæ.”[609] The febris algida is also named “rigor
without heat,” by the Greek authorities, and “frigus quod non calefit”
by the Arabians, who, like Sylvius, as quoted above, regard it as a
variety of the quotidian intermittent. See PAULUS ÆGINETA,
Book II., 26.
M. Littré[610] quotes the remark of an excellent English authority
on fever, J. Johnson,[611] that it is singular the effects of marsh
effluvia should have escaped the observation of Hippocrates, more
especially as the remittent and intermittent fevers, of which he
treats so fully, are mostly derived from this source. Now I must
say, that I am not aware of there being any passages in the works of
Hippocrates where the effects of marsh effluvia in engendering such
fevers are distinctly noticed; but if Hippocrates was ignorant of this
fact, in the etiology of fevers, it was well known to Galen, as may
be seen on reference to his very interesting work “On the Difference
of Fevers.”[612] The Arabians also were familiar with the fact. See
Avicenna, iv., 1, 2, 1.
In the treatise “On Airs,” which, although not admitted by us into the
list of genuine works, has considerable pretension to be so regarded,
the causes of fever are treated of with great precision, and there the
pestilential fevers are said to derive their origin from miasma, but
whether or not under this term be included marsh effluvia, cannot be
determined. But perhaps a better reason might be assigned for there
being little or no allusion to malaria in the works of Hippocrates,
namely, that after all, this was _not_ the cause of the epidemical
diseases which he describes. The following extract from a work of very
high authority on fever is well deserving of consideration in this
place: “A question has arisen as to whether or not the inflammatory
states of fever, in warm countries, are caused by malaria, or by the
other causes now instanced (excess of heat, etc.). There can be no
doubt that malaria very frequently produces in the plethoric, young,
and robust, who have recently arrived in a hot climate, fever of an
inflammatory and continued kind; but it must also be conceded that this
fever chiefly occurs, even in persons thus constituted, during the dry
season, and at times and in places where the existence of malaria is
doubtful, or, at least, by no means proved. It is notoriously admitted
that the inflammatory states of continued fever, in both the East and
West Indies, appear among those soldiers, sailors, and civilians, who
have not been long in a warm country, and who have not suffered from
disease since their arrival; and that they take place chiefly during
the dry and warm seasons, and in situations where the usual affects of
malaria are never observed. This is the result of the experience of
Jackson, Annesley, Boyle, Twining, Conwell, and the other experienced
practitioners in warm countries. It agrees with my own observations,
and is even admitted by Dr. Fergusson, who has gone much further
than any one else in assigning malaria as the cause of intertropical
fevers.”[613] I may mention, moreover, that Hippocrates and his
contemporaries were evidently not ignorant of the fact, that the
atmosphere in the vicinity of marshes and large rivers is unwholesome
to the inhabitants of warm climates. See De Diæta, ii, 2.
The following are part of the conclusions which M. Littré draws
from his investigations into the nature of the fevers described by
Hippocrates. I quote them as being strongly confirmatory of the
opinions delivered by me in the Commentary on the Second Book of
PAULUS ÆGINETA.
“Les fièvres décrites dans les _Epidémies_ d’Hippocrate différent
de nos fièvres continués.
“Les fièvres décrites dans les _Epidémies_ ont, dans leur
apparence générale, une similitude très grande avec celles des pays
chauds.
“La similitude n’est pas moins grande dans les détails que dans
l’ensemble.
“Dans les unes comme dans les autres les hypochondres sont pour un
tiers des cas, le siége d’une manifestation toute spéciale.
“Dans les unes comme dans les autres, il y a une forte tendence ou
réfroidissement du corps, à la sueur froide et à la lividité des
extrémités.”
On almost all the other diseases treated of in these books, M. Littré’s
opinions, in like manner, exactly coincide with those delivered by
me in the above-mentioned work. Thus he arrives at the conclusion,
that the Phrenitis and Lethargus of Hippocrates were varieties of the
Causus. Compare PAULUS ÆGINETA, Book III., 6, 9. He refers
them to _les fièvres pernicieuses comateuses pseudo-continués et les
fièvres pernicieuses dolorantes pseudo-continués_ of M. Maillot.
It would appear from the extracts which he quotes from a work of M.
Roux, on the Diseases of Morea, that a similar tendency to pass into
phrenitis and lethargy is still observable in the land of Greece. The
fevers of the East Indies also, as described by Dr. Twining,[614]
appear to partake very much of the same character. In a word, the
conclusions to which a patient study of modern authorities on the
subject have brought me amount to this; that the fevers described by
Hippocrates in his “Epidemics,” are exactly the same as those which
are now described as still prevailing in the land of Greece: that they
correspond very well with those described by Cleghorn as occurring in
Majorca; differ but little from those described by Pringle, Monro,
and Sylvius, as happening in the Low Countries, and differ from those
described by Twining, as happening in Bengal, only in a few particulars.
From the analysis of their contents given above it will readily be
understood that the subject-matters of these two books are not arranged
methodically. Indeed it is quite obvious from the nature of the work
that the matters which are treated of in it had never been methodized
by the author. Certainly then, as proposed by Desmair,[615] it would
be a much more natural arrangement to give the four Constitutions of
the season first, and then to give the forty-two cases together. But
the present arrangement being of old standing, no editor has thought
himself warranted to depart from it.
There are two important professional subjects of which it may appear
surprising that there is no mention in the “Books of the Epidemics,”
I mean sphygmology and contagion. Galen repeatedly declares it as his
opinion, that Hippocrates paid no attention to the characters of the
arterial pulse, and that the subject was not at all studied until
after his time; and as far as I can see there is no ground for calling
in question this opinion of Galen. Herophilus, in fact, would appear
to have been the first person that made any progress in this study.
It is more remarkable that Hippocrates should omit all allusion to
the other subject, more especially as the contagiousness of certain
diseases would appear to have been the popular belief of his age. Thus
his contemporary, Thucydides, in describing the plague, expresses
himself in such terms as puts it beyond a doubt that he regarded the
disease as being of a contagious nature. And another contemporary,
Isocrates, makes such observations on a certain case of empyema, by
which he evidently means phthisis pulmonalis, as to show that it also
was regarded as being communicable.[616] How the omission is to be
accounted for I do not know, but certain it is that not the least
reference to contagion, in any shape, is to be found in any of the
Hippocratic treatises.
BOOK I.--OF THE EPIDEMICS.
SEC. I.--CONSTITUTION FIRST.
1. In Thasus,[617] about the autumnal equinox, and under the
Pleiades,[618] the rains were abundant, constant, and soft, with
southerly winds; the winter southerly, the northerly winds faint,
droughts; on the whole, the winter having the character of spring. The
spring was southerly, cool, rains small in quantity. Summer, for the
most part, cloudy, no rain, the Etesian winds, rare and small, blew in
an irregular manner. The whole constitution of the season being thus
inclined to the southerly, and with droughts early in the spring, from
the preceding opposite and northerly state, ardent fevers occurred
in a few instances, and these very mild, being rarely attended with
hemorrhage, and never proving fatal.[619] Swellings appeared about
the ears, in many on either side, and in the greatest number on both
sides, being unaccompanied by fever so as not to confine the patient
to bed; in all cases they disappeared without giving trouble, neither
did any of them come to suppuration, as is common in swellings from
other causes. They were of a lax, large, diffused character, without
inflammation or pain, and they went away without any critical sign.
They seized children, adults, and mostly those who were engaged in
the exercises of the palestra and gymnasium, but seldom attacked
women. Many had dry coughs without expectoration, and accompanied
with hoarseness of voice. In some instances earlier, and in others
later, inflammations with pain seized sometimes one of the testicles,
and sometimes both;[620] some of these cases were accompanied with
fever and some not; the greater part of these were attended with much
suffering. In other respects they were free of disease, so as not to
require medical assistance.[621]
2. Early in the beginning of spring, and through the summer, and
towards winter, many of those who had been long gradually declining,
took to bed with symptoms of phthisis; in many cases formerly of a
doubtful character the disease then became confirmed; in these the
constitution inclined to the phthisical.[622] Many, and, in fact,
the most of them, died; and of those confined to bed, I do not know
if a single individual survived for any considerable time; they died
more suddenly than is common in such cases. But other diseases, of a
protracted character, and attended with fever, were well supported, and
did not prove fatal: of these we will give a description afterwards.
Consumption was the most considerable of the diseases which then
prevailed, and the only one which proved fatal to many persons. Most
of them were affected by these diseases in the following manner:
fevers accompanied with rigors, of the continual type, acute, having
no complete intermissions, but of the form of the semitertians,
being milder the one day, and the next having an exacerbation, and
increasing in violence; constant sweats, but not diffused over the
whole body; extremities very cold, and warmed with difficulty; bowels
disordered, with bilious, scanty, unmixed, thin, pungent, and frequent
dejections. The urine was thin, colourless, unconcocted, or thick, with
a deficient sediment, not settling favorably, but casting down a crude
and unseasonable sediment. Sputa small, dense, concocted, but brought
up rarely and with difficulty; and in those who encountered the most
violent symptoms there was no concoction at all, but they continued
throughout spitting crude matters. Their fauces, in most of them,
were painful from first to last, having redness with inflammation;
defluxions thin, small and acrid; they were soon wasted and became
worse, having no appetite for any kind of food throughout; no thirst;
most persons delirious when near death. So much concerning the
phthisical affections.[623]
3. In the course of the summer and autumn many fevers of the continual
type, but not violent;[624] they attacked persons who had been long
indisposed, but who were otherwise not in an uncomfortable state.
In most cases the bowels were disordered in a very moderate degree,
and they did not suffer thereby in any manner worth mentioning; the
urine was generally well coloured, clear, thin, and after a time
becoming concocted near the crisis. They had not much cough, nor was it
troublesome; they were not deficient in appetite, for it was necessary
to give them food, (on the whole, persons labouring under phthisis were
not affected in the usual manner).[625] They were affected with fevers,
rigors, and deficient sweats, with varied and irregular paroxysms, in
general not intermitting, but having exacerbations in the tertian form.
The earliest crisis which occurred was about the twentieth day, in most
about the fortieth, and in many about the eightieth. But there were
cases in which it did not leave them thus at all, but in an irregular
manner, and without any crisis; in most of these the fevers, after a
brief interval, relapsed again; and from these relapses they came to a
crisis in the same periods; but in many they were prolonged so that the
disease was not gone at the approach of winter. Of all those which are
described under this constitution, the phthisical diseases alone were
of a fatal character; for in all the others the patients bore up well,
and did not die of the other fevers.[626]
SEC. II.--CONSTITUTION SECOND.
1. In Thasus, early in autumn, the winter suddenly set in rainy
before the usual time, with much northerly and southerly winds. These
things all continued so during the season of the Pleiades, and until
their setting.[627] The winter was northerly, the rains frequent, in
torrents, and large, with snow, but with a frequent mixture of fair
weather. These things were all so, but the setting in of the cold
was not much out of season. After the winter solstice, and at the
time when the zephyr usually begins to blow, severe winterly storms
out of season, with much northerly wind, snow, continued and copious
rains; the sky tempestuous and clouded; these things were protracted,
and did not remit until the equinox. The spring was cold, northerly,
rainy, and clouded; the summer was not very sultry, the Etesian winds
blew constant, but quickly afterwards, about the rising of Arcturus,
there were again many rains with north winds. The whole season being
wet, cold, and northerly, people were, for the most part, healthy
during winter; but early in the spring very many, indeed, the greater
part, were valetudinary. At first ophthalmies set in, with rheums,
pains, unconcocted discharges, small concretions, generally breaking
with difficulty, in most instances they relapsed, and they did not
cease until late in autumn.[628] During summer and autumn there were
dysenteric affections, attacks of tenesmus and lientery, bilious
diarrhœa, with thin, copious, undigested, and acrid dejections, and
sometimes with watery stools; many had copious defluxions, with pain,
of a bilious, watery, slimy, purulent nature, attended with strangury,
not connected with disease of the kidneys, but one complaint succeeding
the other; vomitings of bile, phlegm, and undigested food, sweats, in
all cases a redundance of humors. In many instances these complaints
were unattended with fever, and did not prevent the patients from
walking about, but some cases were febrile, as will be described. In
some all those described below occurred with pain. During autumn,
and at the commencement of winter, there were phthisical complaints,
continual fevers; and, in a few cases, ardent; some diurnal, others
nocturnal, semitertians, true tertians, quartans, irregular fevers.
All the fevers which are described attacked great numbers. The ardent
fevers attacked the smallest numbers, and the patients suffered the
least from them, for there were no hemorrhages, except a few and to a
small amount, nor was there delirium; all the other complaints were
slight; in these the crises were regular, in most instances, with the
intermittents, in seventeen days; and I know no instance of a person
dying of causus, nor becoming phrenitic.[629] The tertians were more
numerous than the ardent fevers, and attended with more pain;[630]
but these all had four periods in regular succession from the first
attack, and they had a complete crisis in seven, without a relapse
in any instance. The quartans attacked many at first, in the form of
regular quartans, but in no few cases a transition from other fevers
and diseases into quartans took place; they were protracted, as is
wont with them, indeed, more so than usual. Quotidian, nocturnal, and
wandering fevers attacked many persons, some of whom continued to keep
up, and others were confined to bed. In most instances these fevers
were prolonged under the Pleiades and till winter. Many persons, and
more especially children, had convulsions from the commencement;[631]
and they had fever, and the convulsions supervened upon the fevers;
in most cases they were protracted, but free from danger, unless in
those who were in a deadly state from other complaints. Those fevers
which were continual in the main, and with no intermissions, but having
exacerbations in the tertian form,[632] there being remissions the one
day and exacerbations the next, were the most violent of all those
which occurred at that time, and the most protracted, and occurring
with the greatest pains, beginning mildly, always on the whole
increasing, and being exacerbated, and always turning worse, having
small remissions, and after an abatement having more violent paroxysms,
and growing worse, for the most part, on the critical days. Rigors, in
all cases, took place in an irregular and uncertain manner, very rare
and weak in them, but greater in all other fevers; frequent sweats, but
most seldom in them, bringing no alleviation, but, on the contrary,
doing mischief. Much cold of the extremities in them, and these were
warmed with difficulty. Insomnolency, for the most part, especially
in these fevers, and again a disposition to coma. The bowels, in all
diseases, were disordered, and in a bad state, but worst of all in
these. The urine, in most of them, was either thin and crude, yellow,
and after a time with slight symptoms of concoction in a critical form,
or having the proper thickness, but muddy, and neither settling nor
subsiding; or having small and bad, and crude sediments; these being
the worst of all. Coughs attended these fevers, but I cannot state that
any harm or good ever resulted from the cough. The most of these were
protracted and troublesome, went on in a very disorderly and irregular
form, and, for the most part, did not end in a crisis, either in the
fatal cases or in the others; for if it left some of them for a season
it soon returned again. In a few instances the fever terminated with
a crisis; in the earliest of these about the eightieth day, and some
of these relapsed, so that most of them were not free from the fever
during the winter; but the fever left most of them without a crisis,
and these things happened alike to those who recovered and to those
who did not. There being much want of crisis and much variety as to
these diseases, the greatest and worst symptom attended the most of
them, namely, a loathing of all articles of food, more especially with
those who had otherwise fatal symptoms; but they were not unseasonably
thirsty in such fevers. After a length of time, with much suffering and
great wasting, abscesses were formed in these cases, either unusually
large, so that the patients could not support them, or unusually small,
so that they did no good, but soon relapsed and speedily got worse. The
diseases which attacked them were in the form of dysenteries, tenesmus,
lientery, and fluxes; but, in some cases, there were dropsies, with or
without these complaints. Whatever attacked them violently speedily
cut them off, or again, did them no good. Small rashes, and not
corresponding to the violence of the disease, and quickly disappearing,
or swellings occurred about the ears, which were not resolved, and
brought on no crisis.[633] In some they were determined to the joints,
and especially to the hip-joint, terminating critically with a few,
and quickly again increasing to its original habit. Persons died of
all these diseases, but mostly of these fevers, and especially infants
just weaned, and older children, until eight or ten years of age, and
those before puberty. These things occurred to those affected with the
complaints described above, and to many persons at first without them.
The only favorable symptom, and the greatest of those which occurred,
and what saved most of those who were in the greatest dangers, was
the conversion of it to a strangury, and when, in addition to this,
abscesses were formed.[634] The strangury attacked, most especially,
persons of the ages I have mentioned, but it also occurred in many
others, both of those who were not confined to bed and those who
were. There was a speedy and great change in all these cases. For the
bowels, if they happened previously to have watery discharges of a
bad character, became regular, they got an appetite for food, and the
fevers were mild afterwards. But, with regard to the strangury itself,
the symptoms were protracted and painful. Their urine was copious,
thick, of various characters, red, mixed with pus, and was passed with
pain. These all recovered, and I did not see a single instance of death
among them.
5.[635] With regard to the dangers of these cases, one must always
attend to the seasonable concoction of all the evacuations, and to the
favorable and critical abscesses. The concoctions indicate a speedy
crisis and recovery of health; crude and undigested evacuations, and
those which are converted into bad abscesses, indicate either want
of crisis, or pains, or prolongation of the disease, or death, or
relapses; which of these it is to be must be determined from other
circumstances. _The physician must be able to tell the antecedents,
know the present, and foretell the future--must meditate these things,
and have two special objects in view with regard to diseases, namely,
to do good or to do no harm. The art consists in three things--the
disease, the patient, and the physician. The physician is the servant
of the art, and the patient must combat the disease along with the
physician._[636]
6. Pains about the head and neck, and heaviness of the same along
with pain, occur either without fevers or in fevers. Convulsions
occurring in persons attacked with frenzy, and having vomitings of
verdigris-green bile, in some cases quickly prove fatal. In ardent
fevers, and in those other fevers in which there is pain of the neck,
heaviness of the temples, mistiness about the eyes, and distention
about the hypochondriac region, not unattended with pain, hemorrhage
from the nose takes place,[637] but those who have heaviness of the
whole head, cardialgia and nausea, vomit bilious and pituitous matters;
children, in such affections, are generally attacked with convulsions,
and women have these and also pains of the uterus; whereas, in elder
persons, and those in whom the heat is already more subdued, these
cases end in paralysis, mania, and loss of sight.
THIRD CONSTITUTION.
7. In Thasus, a little before and during the season of Arcturus,[638]
there were frequent and great rains, with northerly winds. About
the equinox, and till the setting of the Pleiades, there were a few
southerly rains: the winter northerly and parched, cold, with great
winds and snow. Great storms about the equinox, the spring northerly,
dryness, rains few and cold. About the summer solstice, scanty rains,
and great cold until near the season of the Dog-star.[639] After the
Dog-days, until the season of Arcturus, the summer hot, great droughts,
not in intervals, but continued and severe: no rain; the Etesian winds
blew; about the season of Arcturus southerly rains until the equinox.
8. In this state of things, during winter, paraplegia set in, and
attacked many, and some died speedily; and otherwise the disease
prevailed much in an epidemical form, but persons remained free from
all other diseases.[640] Early in the spring, ardent fevers commenced
and continued through the summer until the equinox. Those then that
were attacked immediately after the commencement of the spring and
summer, for the most part recovered, and but few of them died. But when
the autumn and the rains had set in, they were of a fatal character,
and the greater part then died.[641] When in these attacks of ardent
fevers there was a proper and copious hemorrhage from the nose, they
were generally saved by it, and I do not know a single person who
had a proper hemorrhage who died in this constitution. Philiscus,
Epaminon, and Silenus, indeed, who had a trifling epistaxis on the
fourth and fifth day, died.[642] The most of those seized with the
disease had a rigor about the time of the crisis, and especially those
who had no hemorrhage; these had also the rigor associated. Some were
attacked with jaundice on the sixth day,[643] but these were benefited
either by an urinary purgation, or a disorder of the bowels, or a
copious hemorrhage, as in the case of Heraclides, who was lodged with
Aristocydes: this person, though he had the hemorrhage from the nose,
the purgation by the bladder, and disorder of the bowels, experienced
a favorable crisis on the twentieth day, not like the servant of
Phanagoras, who had none of these symptoms, and died. The hemorrhages
attacked most persons, but especially young persons and those in the
prime of life, and the greater part of those who had not the hemorrhage
died:[644] elderly persons had jaundice or disorder of the bowels,
such as Bion, who was lodged with Silenus. Dysenteries were epidemical
during the summer, and some of those cases in which the hemorrhage
occurred, terminated in dysentery, as happened to the slave of Eraton,
and to Mullus, who had a copious hemorrhage, which settled down into
dysentery, and they recovered. This humor was redundant in many cases,
since in those who had not the hemorrhage about the crisis, but the
risings about the ears disappeared, after their disappearance there was
a sense of weight in the left flank extending to the extremity of the
hip, and pain setting in after the crisis, with a discharge of thin
urine; they began to have small hemorrhages about the twenty-fourth
day, and the swelling was converted into the hemorrhage. In the case of
Antiphon, the son of Critobulus, the fever ceased and came to a crisis
about the fortieth day. Many women were attacked, but fewer than of
the men, and there were fewer deaths among them. But most of them had
difficult parturition, and after labor they were taken ill, and these
most especially died, as, for example, the daughter of Telebolus died
on the sixth day after delivery.[645] Most females had the menstrual
discharge during the fever, and many girls had it then for the first
time: in certain individuals both the hemorrhage from the nose and the
menses appeared; thus, in the case of the virgin daughter of Dætharses,
the menses then took place for the first time, and she had also a
copious hemorrhage from the nose, and I knew no instance of any one
dying when one or other of these took place properly. But all those
in the pregnant state that were attacked had abortions, as far as I
observed. The urine in most cases was of the proper color, but thin,
and having scanty sediments:[646] in most the bowels were disordered
with thin and bilious dejections; and many, after passing through the
other crises, terminated in dysenteries, as happened to Xenophanes
and Critias. The urine was watery, copious, clear, and thin; and even
after the crises, when the sediment was natural, and all the other
critical symptoms were favorable, as I recollect having happened to
Bion, who was lodged in the house of Silenus, and Critias, who lived
with Xenophanes, the slave of Areton, and the wife of Mnesistratus. But
afterwards all these were attacked with dysentery. It would be worth
while to inquire whether the watery urine was the cause of this.[647]
About the season of Arcturus many had the crisis on the eleventh day,
and in them the regular relapses did not take place, but they became
comatose about this time, especially children; but there were fewest
deaths of all among them.
9. About the equinox, and until the season of the Pleiades, and at
the approach of winter, many ardent fevers set in; but great numbers at
that season were seized with phrenitis, and many died;[648] a few cases
also occurred during the summer. These then made their attack at the
commencement of ardent fevers, which were attended with fatal symptoms;
for immediately upon their setting in, there were acute fever and
small rigors, insomnolency, aberration, thirst, nausea, insignificant
sweats about the forehead and clavicles, but no general perspiration;
they had much delirious talking, fears, despondency, great coldness of
the extremities, in the feet, but more especially in their hands: the
paroxysms were on the even days; and in most cases, on the fourth day,
the most violent pains set in, with sweats, generally coldish, and the
extremities could not be warmed, but were livid and rather cold, and
they had then no thirst; in them the urine was black, scanty, thin,
and the bowels were constipated; there was an hemorrhage from the nose
in no case in which these symptoms occurred, but merely a trifling
epistaxis; and none of them had a relapse, but they died on the sixth
day with sweats.[649] In the phrenitic cases, all the symptoms which
have been described did not occur, but in them the disease mostly came
to a crisis on the eleventh day, and in some on the twentieth. In those
cases in which the phrenitis did not begin immediately, but about the
third or fourth day, the disease was moderate at the commencement,
but assumed a violent character about the seventh day. There was a
great number of diseases, and of those affected, they who died were
principally infants, young persons, adults having smooth bodies, white
skins, straight and black hair, dark eyes, those living recklessly and
luxuriously; persons with shrill, or rough voices, who stammered and
were passionate, and women more especially died from this form. In
this constitution, four symptoms in particular proved salutary; either
a hemorrhage from the nose, or a copious discharge by the bladder of
urine, having an abundant and proper sediment, or a bilious disorder
of the bowels at the proper time, or an attack of dysentery.[650] And
in many cases it happened, that the crisis did not take place by any
one of the symptoms which have been mentioned, but the patient passed
through most of them, and appeared to be in an uncomfortable way,
and yet all who were attacked with these symptoms recovered. All the
symptoms which I have described occurred also to women and girls; and
whoever of them had any of these symptoms in a favorable manner, or
the menses appeared abundantly, were saved thereby, and had a crisis,
so that I do not know a single female who had any of these favorably
that died. But the daughter of Philo, who had a copious hemorrhage from
the nose, and took supper unseasonably on the seventh day, died. In
those cases of acute, and more especially of ardent fevers, in which
there is an involuntary discharge of tears, you may expect a hemorrhage
from the nose, unless the other symptoms be of a fatal character, for
in those of a bad description, they do not indicate a hemorrhage, but
death. Swellings about the ears, with pain in fevers, sometimes when
the fever went off critically, neither subsided nor were converted into
pus; in these cases a bilious diarrhœa, or dysentery, or thick urine
having a sediment, carried off the disease, as happened to Hermippus
of Clazomenæ. The circumstances relating to crises, as far as we can
recognize them, were so far similar and so far dissimilar. Thus two
brothers became ill at the same hour (they were brothers of Epigenes,
and lodged near the theatre), of these the elder had a crisis on the
sixth day, and the younger on the seventh, and both had a relapse at
the same hour; it then left them for five days, and from the return
of the fever both had a crisis together on the seventeenth day. Most
had a crisis on the sixth day; it then left them for six days, and
from the relapse there was a crisis on the fifth day.[651] But those
who had a crisis on the seventh day, had an intermission for seven
days; and the crisis took place on the third day after the relapse.
Those who had a crisis on the sixth day, after an interval of six
days were seized again on the third, and having left them for one
day, the fever attacked them again on the next and came to a crisis,
as happened to Evagon the son of Dætharses. Those in whom the crisis
happened on the sixth day, had an intermission of seven days, and
from the relapse there was a crisis on the fourth, as happened to
the daughter of Aglaïdas. The greater part of those who were taken
ill under this constitution of things, were affected in this manner,
and I did not know a single case of recovery, in which there was not
a relapse agreeably to the stated order of relapses; and all those
recovered in which the relapses took place according to this form:
nor did I know a single instance of those who then passed through the
disease in this manner who had another relapse. In these diseases
death generally happened on the sixth day, as happened to Epaminondas,
Silenus, and Philiscus the son of Antagoras. Those who had parotid
swellings experienced a crisis on the twentieth day, but in all these
cases the disease went off without coming to a suppuration, and was
turned upon the bladder. But in Cratistonax, who lived by the temple
of Hercules, and in the maid servant of Scymnus the fuller, it turned
to a suppuration, and they died. Those who had a crisis on the seventh
day, had an intermission of nine days, and a relapse which came to a
crisis on the fourth day from the return of the fever, as was the case
with Pantacles, who resided close by the temple of Bacchus. Those who
had a crisis on the seventh day, after an interval of six days had a
relapse, from which they had a crisis on the seventh day, as happened
to Phanocritus, who was lodged with Gnathon the painter. During the
winter, about the winter solstices, and until the equinox, the ardent
fevers and frenzies prevailed, and many died. The crisis, however,
changed, and happened to the greater number on the fifth day from the
commencement, left them for four days and relapsed; and after the
return, there was a crisis on the fifth day, making in all fourteen
days. The crisis took place thus in the case of most children, also in
elder persons. Some had a crisis on the eleventh day, a relapse on the
fourteenth, a complete crisis on the twentieth; but certain persons,
who had a rigor about the twentieth, had a crisis on the fortieth. The
greater part had a rigor along with the original crisis, and these had
also a rigor about the crisis in the relapse. There were fewest cases
of rigor in the spring, more in summer, still more in autumn, but by
far the most in winter; then hemorrhages ceased.
SEC. III.
10. With regard to diseases, the circumstances from which we form a
judgment of them are,--by attending to the general nature of all, and
the peculiar nature of each individual,--to the disease, the patient,
and the applications,--to the person who applies them, as that makes a
difference for better or for worse,--to the whole constitution of the
season, and particularly to the state of the heavens, and the nature
of each country;--to the patient’s habits, regimen, and pursuits;--to
his conversation, manners, taciturnity, thoughts, sleep, or absence
of sleep, and sometimes his dreams, what and when they occur;--to his
picking and scratching;[652]--to his tears;--to the alvine discharges,
urine, sputa, and vomitings; and to the changes of diseases from the
one into the other;--to the deposits, whether of a deadly or critical
character;--to the sweat, coldness, rigor, cough, sneezing, hiccup,
respiration, eructation, flatulence, whether passed silently or with
a noise;--to hemorrhages and hemorrhoids;--from these, and their
consequences, we must form our judgment.[653]
11. Fevers are,--the continual, some of which hold during the day and
have a remission at night, and others hold during the night and have
a remission during the day;[654] semitertians, tertians, quartans,
quintans, septans, nonans. The most acute, strongest, most dangerous,
and fatal diseases, occur in the continual fever. The least dangerous
of all, and the mildest and most protracted, is the quartan, for it
is not only such from itself, but it also carries off other great
diseases.[655] In what is called the semitertian, other acute diseases
are apt to occur, and it is the most fatal of all others, and moreover
phthisical persons, and those laboring under other protracted diseases,
are apt to be attacked by it.[656] The nocturnal fever is not very
fatal, but protracted; the diurnal is still more protracted, and in
some cases passes into phthisis. The septan is protracted, but not
fatal; the nonan more protracted, and not fatal. The true tertian comes
quickly to a crisis, and is not fatal; but the quintan is the worst of
all, for it proves fatal when it precedes an attack of phthisis, and
when it supervenes on persons who are already consumptive.[657] There
are peculiar modes, and constitutions, and paroxysms, in every one of
these fevers; for example,--the continual, in some cases at the very
commencement, grows, as it were, and attains its full strength, and
rises to its most dangerous pitch, but is diminished about and at the
crisis; in others it begins gentle and suppressed, but gains ground and
is exacerbated every day, and bursts forth with all its heat about and
at the crisis; while in others, again, it commences mildly, increases,
and is exacerbated until it reaches its acmé, and then remits until at
and about the crisis.[658] These varieties occur in every fever, and in
every disease. From these observations one must regulate the regimen
accordingly. There are many other important symptoms allied to these,
part of which have been already noticed, and part will be described
afterwards, from a consideration of which one may judge, and decide in
each case, whether the disease be acute, and whether it will end in
death or recovery; or whether it will be protracted, and will end in
death or recovery; and in what cases food is to be given, and in what
not; and when and to what amount, and what particular kind of food is
to be administered.
12. Those diseases which have their paroxysms on even days have their
crises on even days; and those which have their paroxysms on uneven
days have their crises on uneven days. The first period of those which
have the crisis on even days, is the 4th, 6th, 8th, 10th, 14th, 20th,
30th, 40th, 60th, 80th, 100th; and the first period of those which have
their crises on uneven days, is the let, 3d, 5th, 7th, 9th, 11th, 17th,
21st, 27th, 31st. It should be known, that if the crisis take place on
any other day than on those described, it indicates that there will
be a relapse, which may prove fatal. But one ought to pay attention,
and know in these seasons what crises will lead to recovery and what
to death, or to changes for the better or the worse. Irregular fevers,
quartans, quintans, septans, and nonans should be studied, in order to
find out in what periods their crises take place.
13. FOURTEEN CASES OF DISEASE.[659]
CASE I.--Philiscus, who lived by the Wall, took to bed on
the first day of acute fever; he sweated; towards night was uneasy. On
the second day all the symptoms were exacerbated; late in the evening
had a proper stool from a small clyster; the night quiet. On the third
day, early in the morning and until noon, he appeared to be free from
fever; towards evening, acute fever, with sweating, thirst, tongue
parched; passed black urine; night uncomfortable, no sleep; he was
delirious on all subjects. On the fourth, all the symptoms exacerbated,
urine black; night more comfortable, urine of a better color. On the
fifth, about mid-day, had a slight trickling of pure blood from the
nose; urine varied in character, having floating in it round bodies,
resembling semen, and scattered, but which did not fall to the bottom;
a suppository having been applied, some scanty flatulent matters were
passed; night uncomfortable, little sleep, talking incoherently;
extremities altogether cold, and could not be warmed; urine black;
slept a little towards day; loss of speech, cold sweats; extremities
livid; about the middle of the sixth day he died. The respiration
throughout, like that of a person recollecting himself, was rare, and
large, and spleen was swelled upon in a round tumor, the sweats cold
throughout, the paroxysms on the even days.[660]
CASE II.--Silenus lived on the Broad-way, near the house
of Evalcidas. From fatigue, drinking, and unseasonable exercises, he
was seized with fever. He began with having pain in the loins; he had
heaviness of the head, and there was stiffness of the neck. On the
first day the alvine discharges were bilious, unmixed, frothy, high
colored, and copious; urine black, having a black sediment; he was
thirsty, tongue dry; no sleep at night. On the second, acute fever,
stools more copious, thinner, frothy; urine black, an uncomfortable
night, slight delirium. On the third, all the symptoms exacerbated;
an oblong distention, of a softish nature, from both sides of the
hypochondrium to the navel; stools thin, and darkish; urine muddy, and
darkish; no sleep at night; much talking, laughter, singing, he could
not restrain himself. On the fourth, in the same state. On the fifth,
stools bilious, unmixed, smooth, greasy; urine thin, and transparent;
slight absence of delirium. On the sixth, slight perspiration about
the head; extremities cold and livid; much tossing about; no passage
from the bowels, urine suppressed, acute fever. On the seventh, loss
of speech; extremities could no longer be kept warm; no discharge of
urine. On the eighth, a cold sweat all over; red rashes with sweat, of
a round figure, small, like _vari_, persistent, not subsiding; by
means of a slight stimulus, a copious discharge from the bowels, of
a thin and undigested character, with pain; urine acrid, and passed
with pain; extremities slightly heated; sleep slight, and comatose;
speechless; urine thin, and transparent. On the ninth, in the same
state. On the tenth, no drink taken; comatose, sleep slight; alvine
discharges the same; urine abundant, and thickish; when allowed to
stand, the sediment farinaceous and white; extremities again cold.
On the eleventh, he died. At the commencement, and throughout, the
respiration was slow and large; there was a constant throbbing in the
hypochondrium; his age was about twenty.[661]
CASE III.--Herophon was seized with an acute fever; alvine discharges
at first were scanty, and attended with tenesmus; but afterwards
they were passed of a thin, bilious character, and frequent; there
was no sleep; urine black, and thin. On the fifth, in the morning,
deafness; all the symptoms exacerbated; spleen swollen; distention
of the hypochondrium; alvine discharges scanty, and black; he became
delirious. On the sixth, delirious; at night, sweating, coldness;
the delirium continued. On the seventh, he became cold, thirsty, was
disordered in mind; at night recovered his senses; slept. On the
eighth, was feverish; the spleen diminished in size; quite collected;
had pain at first about the groin, on the same side as the spleen;
had pains in both legs; night comfortable; urine better colored, had
a scanty sediment. On the ninth, sweated; the crisis took place;
fever remitted. On the fifth day afterwards, fever relapsed, spleen
immediately became swollen; acute fever; deafness again. On the third
day after the relapse, the spleen diminished; deafness less; legs
painful; sweated during the night; crisis took place on the seventeenth
day; had no disorder of the senses during the relapse.[662]
CASE IV.--In Thasus, the wife of Philinus, having been delivered of a
daughter, the lochial discharge being natural, and other matters going
on mildly, on the fourteenth day after delivery was seized with fever,
attended with rigor; was pained at first in the cardiac region of the
stomach and right hypochondrium; pain in the genital organs; lochial
discharge ceased. Upon the application of a pessary all these symptoms
were alleviated; pains of the head, neck, and loins remained; no sleep;
extremities cold; thirst; bowels in a hot state; stools scanty; urine
thin, and colorless at first. On the sixth, towards night, senses much
disordered, but again were restored. On the seventh, thirsty; the
evacuations bilious, and high colored. On the eighth, had a rigor;
acute fever; much spasm, with pain; talked much, incoherently; upon
the application of a suppository, rose to stool, and passed copious
dejections, with a bilious flux; no sleep. On the ninth, spasms. On
the tenth, slightly recollected. On the eleventh, slept; had perfect
recollection, but again immediately wandered; passed a large quantity
of urine with spasms, (the attendants seldom putting her in mind,) it
was thick, white, like urine which has been shaken after it has stood
for a considerable time until it has subsided, but it had no sediment;
in color and consistence, the urine resembled that of cattle, as far as
I observed. About the fourteenth day, startings over the whole body;
talked much; slightly collected, but presently became again delirious.
About the seventeenth day became speechless, on the twentieth died.[663]
CASE V.--The wife of Epicrates, who was lodged at the house
of Archigetes, being near the term of delivery, was seized with a
violent rigor, and, as was said, she did not become heated;[664] next
day the same. On the third, she was delivered of a daughter, and
everything went on properly. On the day following her delivery, she was
seized with acute fever, pain in the cardiac region of the stomach, and
in the genital parts. Having had a suppository, was in so far relieved;
pain in the head, neck, and loins; no sleep; alvine discharges scanty,
bilious, thin, and unmixed; urine thin, and blackish. Towards the night
of the sixth day from the time she was seized with the fever, became
delirious. On the seventh, all the symptoms exacerbated; insomnolency,
delirium, thirst; stools bilious, and high colored. On the eighth, had
a rigor; slept more. On the ninth, the same. On the tenth, her limbs
painfully affected; pain again of the cardiac region of the stomach;
heaviness of the head; no delirium; slept more; bowels constipated. On
the eleventh, passed urine of a better color, and having an abundant
sediment; felt lighter. On the fourteenth had a rigor; acute fever. On
the fifteenth, had a copious vomiting of bilious and yellow matters;
sweated; fever gone; at night acute fever; urine thick, sediment
white.[665] On the seventeenth, an exacerbation; night uncomfortable;
no sleep; delirium. On the eighteenth, thirsty; tongue parched; no
sleep; much delirium; legs painfully affected. About the twentieth,
in the morning, had a slight rigor; was comatose; slept tranquilly;
had slight vomiting of bilious and black matters; towards night
deafness. About the twenty-first, weight generally in the left side,
with pain; slight cough; urine thick, muddy, and reddish; when allowed
to stand, had no sediment; in other respects felt lighter; fever not
gone; fauces painful from the commencement, and red; uvula retracted;
defluxion remained acrid, pungent, and saltish throughout. About the
twenty-seventh, free of fever; sediment in the urine; pain in the side.
About the thirty-first, was attacked with fever, bilious diarrhœa;
slight bilious vomiting on the fortieth. Had a complete crisis, and was
freed from the fever on the eightieth day.[666]
CASE VI.--Cleonactides, who was lodged above the Temple of
Hercules, was seized with a fever in an irregular form; was pained
in the head and left side from the commencement, and had other
pains resembling those produced by fatigue: paroxysms of the fevers
inconstant and irregular; occasional sweats; the paroxysms generally
attacked on the critical days. About the twenty-fourth was cold in the
extremities of the hands, vomitings bilious, yellow, and frequent,
soon turning to a verdigris-green color; general relief. About the
thirtieth, began to have hemorrhage from both nostrils, and this
continued in an irregular manner until near the crisis; did not loathe
food, and had no thirst throughout, nor was troubled with insomnolency;
urine thin, and not devoid of color. When about the thirtieth day,
passed reddish urine, having a copious red sediment; was relieved,
but afterwards the characters of the urine varied, sometimes having
sediment, and sometimes not. On the sixtieth, the sediment in the urine
copious, white, and smooth; all the symptoms ameliorated; intermission
of the fever; urine thin, and well colored. On the seventieth, fever
gone for ten days. On the eightieth had a rigor, was seized with acute
fever, sweated much; a red, smooth sediment in the urine; and a perfect
crisis.[667]
CASE VII.--Meton was seized with fever; there was a painful
weight in the loins. Next day, after drinking water pretty copiously,
had proper evacuations from the bowels. On the third, heaviness of
the head, stools thin, bilious, and reddish. On the fourth, all the
symptoms exacerbated; had twice a scanty trickling of blood from the
right nostril; passed an uncomfortable night; alvine discharges like
those on the third day; urine darkish, had a darkish cloud floating in
it, of a scattered form, which did not subside. On the fifth, a copious
hemorrhage of pure blood from the left nostril; he sweated, and had a
crisis. After the fever restless, and had some delirium; urine thin,
and darkish; had an affusion of warm water on the head; slept and
recovered his senses. In this case there was no relapse, but there were
frequent hemorrhages after the crisis.[668]
CASE VIII.--Erasinus, who lived near the Canal of Bootes,
was seized with fever after supper; passed the night in an agitated
state. During the first day quiet, but in pain at night. On the
second, symptoms all exacerbated; at night delirious. On the third,
was in a painful condition; great incoherence. On the fourth, in a
most uncomfortable state; had no sound sleep at night, but dreaming
and talking; then all the appearances worse, of a formidable and
alarming character; fear, impatience. On the morning of the fifth, was
composed, and quite coherent, but long before noon was furiously mad,
so that he could not constrain himself; extremities cold, and somewhat
livid; urine without sediment; died about sunset. The fever in this
case was accompanied by sweats throughout; the hypochondria were in
a state of meteorism, with distention and pain; the urine was black,
had round substances floating in it, which did not subside; the alvine
evacuations were not stopped; thirst throughout not great; much spasms
with sweats about the time of death.[669]
CASE IX.--Criton, in Thasus, while still on foot, and going
about, was seized with a violent pain in the great toe; he took to bed
the same day, had rigors and nausea, recovered his heat slightly, at
night was delirious. On the second, swelling of the whole foot, and
about the ankle erythema, with distention, and small bullæ (phlyctænæ);
acute fever; he became furiously deranged; alvine discharges bilious,
unmixed, and rather frequent. He died on the second day from the
commencement.[670]
CASE X.--The Clazomenian who was lodged by the Well of Phrynichides
was seized with fever. He had pain in the head, neck, and loins from
the beginning, and immediately afterwards deafness; no sleep, acute
fever, hypochondria elevated with a swelling, but not much distention;
tongue dry. On the fourth, towards night, he became delirious. On the
fifth, in an uneasy state. On the sixth, all the symptoms exacerbated.
About the eleventh a slight remission; from the commencement to the
fourteenth day the alvine discharges thin, copious, and of the color
of water, but were well supported; the bowels then became constipated.
Urine throughout thin, and well colored, and had many substances
scattered through it, but no sediment. About the sixteenth, urine
somewhat thicker, which had a slight sediment; somewhat better, and
more collected. On the seventeenth, urine again thin; swellings about
both his ears, with pain; no sleep, some incoherence; legs painfully
affected. On the twentieth, free of fever, had a crisis, no sweat,
perfectly collected. About the twenty-seventh, violent pain of the
right hip; it speedily went off. The swellings about the ears subsided,
and did not suppurate, but were painful. About the thirty-first, a
diarrhœa, attended with a copious discharge of watery matter, and
symptoms of dysentery; passed thick urine; swellings about the ears
gone. About the fortieth day, had pain in the right eye, sight dull. It
went away.[671]
CASE XI.--The wife of Dromeades having been delivered of a
female child, and all other matters going on properly, on the second
day after was seized with rigor and acute fever. Began to have pain
about the hypochondrium on the first day; had nausea and incoherence,
and for some hours afterwards had no sleep; respiration rare, large,
and suddenly interrupted. On the day following that on which she had
the rigor, alvine discharges proper; urine thick, white, muddy, like
urine which has been shaken after standing for some time, until the
sediment had fallen to the bottom; it had no sediment; she did not
sleep during the night. On the third day, about noon, had a rigor,
acute fever; urine the same; pain of the hypochondria, nausea, an
uncomfortable night, no sleep; a coldish sweat all over, but heat
quickly restored. On the fourth, slight allevation of the symptoms
about the hypochondria; heaviness of the head, with pain; somewhat
comatose; slight epistaxis, tongue dry, thirst, urine thin and oily;
slept a little, upon awaking was somewhat comatose; slight coldness,
slept during the night, was delirious. On the morning of the sixth had
a rigor, but soon recovered her heat, sweated all over; extremities
cold, was delirious, respiration rare and large. Shortly afterwards
spasms from the head began, and she immediately expired.[672]
CASE XII.--A man, in a heated state, took supper, and drank
more than enough; he vomited the whole during the night; acute fever,
pain of the right hypochondrium, a softish inflammation from the inner
part; passed an uncomfortable night; urine at the commencement thick,
red, but when allowed to stand, had no sediment, tongue dry, and not
very thirsty. On the fourth, acute fever, pains all over. On the fifth,
urine smooth, oily, and copious; acute fever. On the sixth, in the
evening, very incoherent, no sleep during the night. On the seventh,
all the symptoms exacerbated; urine of the same characters; much
talking, and he could not contain himself; the bowels being stimulated,
passed a watery discharge with lumbrici: night equally painful. In the
morning had a rigor; acute fever, hot sweat, appeared to be free of
fever; did not sleep long; after the sleep a chill, ptyalism; in the
evening, great incoherence; after a little, vomited a small quantity of
dark bilious matters. On the ninth, coldness, much delirium, did not
sleep. On the tenth, pains in the limbs, all the symptoms exacerbated;
he was delirious. On the eleventh, he died.[673]
CASE XIII.--A woman, who lodged on the Quay, being three
months gone with child, was seized with fever, and immediately began to
have pains in the loins. On the third day, pain of the head and neck,
extending to the clavicle, and right hand; she immediately lost the
power of speech; was paralyzed in the right hand, with spasms, after
the manner of paraplegia; was quite incoherent; passed an uncomfortable
night; did not sleep; disorder of the bowels, attended with bilious,
unmixed, and scanty stools. On the fourth, recovered the use of her
tongue; spasms of the same parts, and general pains remained; swelling
in the hypochondrium, accompanied with pain; did not sleep, was quite
incoherent; bowels disordered, urine thin, and not of a good color. On
the fifth, acute fever; pain of the hypochondrium, quite incoherent;
alvine evacuations bilious; towards night had a sweat, and was freed
from the fever. On the sixth, recovered her reason; was every way
relieved; the pain remained about the left clavicle; was thirsty,
urine thin, had no sleep. On the seventh trembling, slight coma, some
incoherence, pains about the clavicle and left arm remained; in all
other respects was alleviated; quite coherent. For three days remained
free from fever. On the eleventh, had a relapse, with rigor and fever.
About the fourteenth day, vomited pretty abundantly bilious and yellow
matters, had a sweat, the fever went off, by coming to a crisis.[674]
CASE XIV.--Melidia, who lodged near the Temple of Juno, began to
feel a violent pain of the head, neck, and chest. She was straightway
seized with acute fever; a slight appearance of the menses; continued
pains of all these parts. On the sixth, was affected with coma, nausea,
and rigor; redness about the cheeks; slight delirium. On the seventh,
had a sweat; the fever intermitted, the pains remained. A relapse;
little sleep; urine throughout of a good color, but thin; the alvine
evacuations were thin, bilious, acrid, very scanty, black, and fetid;
a white, smooth sediment in the urine; had a sweat, and experienced a
perfect crisis on the eleventh day.[675]
BOOK III.--OF THE EPIDEMICS.
THE ARGUMENT.
Though in the Argument prefixed to the First Book of the Epidemics I
have given a pretty full summary of the contents both of that book and
the third, I have still a few observations to make on some important
points, which were not sufficiently considered on that occasion; and
this I do the more readily, as it will afford me an opportunity of
noticing a subject on which M. Littré has bestowed very extensive
research. I allude to the origin of the Glandular Plague. As I make it
a rule, in giving these my annotations, not to enter into any lengthy
details, I shall now state, in a very succinct manner, the result of
my inquiries. The reader is referred, for a fuller discussion of the
subject, to the more ample disquisitions of M. Littré.[676]
The opinion has been pretty generally maintained by modern
authorities, that the first description which we have of the glandular
plague of the East is that given by the historian Procopius, in the
sixth century; and the inference drawn therefrom is that the disease
was unknown until his time. This opinion is still held, to a certain
extent, by Hecker, Rosenbaum, Pariset, Nauman, and others of the most
distinguished scholars of the day, but it appears to be untenable after
the discovery of the “Fragment” of Ruffus, published by Mai, Rome,
1831. As the passage is very important, I shall give a translation of
it in this place. It is as follows: “The buboes called pestilential are
most fatal and acute, especially those which are seen occurring about
Libya, Egypt, and Syria, and which are mentioned by Dionysius Curtus.
Dioscorides and Posidonius make much mention of them in the plague
which occurred in their time in Libya; they say it was accompanied by
acute fever, pain, and prostration of the whole body, delirium, and the
appearance of large and hard buboes, which did not suppurate, not only
in the accustomed parts, but also in the groins and armpits.” The only
thing which detracts from the value of this paragraph is the difficulty
of determining exactly who the authorities are which are referred to
in it. Of Dionysius Curtus nothing is known; indeed it is more than
probable, that there is some mistake in this name. There are several
medical authors of the name of Dioscorides and Posidonius, and it is
difficult to determine to which of them reference is here made. Still,
however, there seems to be no reason for questioning the authenticity
of the passage. Ruffus, I may add, is generally admitted to have
flourished in the reign of Trajan.[677]
To this important document let me join an interesting extract
from Galen’s work “On Fevers.” Galen, _treating professedly of
Pestilential Fevers_, which he maintains are all connected with a
tendency to putridity, expresses himself as follows: “Moreover, as
Hippocrates says, all fevers from buboes are bad, with the exception
of ephemerals; although the bubo is also of the class of phlegmons.
And I agree in so far with what is said of putrefaction, for this
is the cause of the fever in inflammations, and not as Erasistratus
supposed.[678] But yet there are certain fevers from buboes of the
class of ephemerals, as certain others proclaim them to be; diseases
difficult to cure, which derive their origin from an inflammation,
an ulcer, an abscess, or some other such affection in a viscus. But
the ephemeral fevers from buboes differ from those connected with
putrefactions, either in a certain viscus, or in the hollow and very
large vessels, that in those from buboes, which always impart their
heat to the surrounding parts, the heat is communicated to the heart,
and the putrefactive fume does not reach it, but remains circumscribed
in the seat of the bubo, and the heat reaching the heart solely by a
change in the connecting parts, in like manner as in those exposed
to excessive heat and fatigue, the diffusion of the heat takes
place from the parts first warmed to the source of vitality; but in
a putrefaction about the viscera and large vessels, a fume, as it
were, from the putrefying humors reaches the cavities of the heart,
etc.”[679] From these two passages alone, without taking into account
several others of less importance, which might be gathered from other
medical authorities,[680] it must be quite obvious that the glandular
plague was known, at all events, in the second century of the Christian
era. Moreover it is equally clear, that Galen did not look upon it
as a new disease, but considered that it was noticed in the works
of Hippocrates. To my mind, then, there can be no doubt that the
pestilence which prevailed during the Peloponnesian war partook of the
nature of the glandular plague. What has tended to create doubts on
this subject, in the minds of many learned men, is the omission of any
distinct mention of buboes in the graphic description of it given by
Thucydides. But it should always be taken into account that Thucydides
was not a professional man, and therefore there is a strong presumption
that his acquaintance with the disease, even although, as he states, he
himself had experienced an attack of it, must have been altogether of
a general nature. Indeed Galen, both in the treatise from which I have
quoted above and in many other parts of his works, does not hesitate
to declare, that the historian describes the disease as a common,
that is to say, a non-professional man, whereas Hippocrates gives
its characters as a physician. It is also to be borne in mind, that
the description of it given by Thucydides applies to it only at its
outbreak in the city of Athens, and it is a well-known characteristic
of pestilential epidemics that they change very much during their
progress. This character of them was well illustrated in the Plague
of Aleppo, so admirably described by Dr. Russel; for although the
glandular form of the disease prevailed in a large number of cases, a
considerable proportion of them were unaffected with buboes. Indeed
it appears to me to be too much the practice for the profession, as
well as the public, to imagine to themselves a certain type or ideal
of every disease, and when they do not recognize the exact characters
which they fancy it should present, they immediately set down such
cases as constituting an entirely different disease. This is an error
that is constantly committed, and one which I believe to be at the
bottom of the discordant opinions which prevail among professional
men, on the subject of the glandular plague. It would be well for the
physician to bear in mind how many varieties of symptoms the fever
designated as Typhus puts on,--some with the rash reckoned peculiar
to this fever, and some without it,--some with petechiæ, and miliary
eruptions, and others without them; and many other complications of
symptoms, which are sometimes present and sometimes not.
With regard to the hypothesis lately advanced by Mr. Theod.
Krause,[681] and in so far countenanced by M. Littré, that the plague
of Athens was an epidemical variola, I must say that I can see no
probability in this supposition; for that a disease so strongly
marked as smallpox should have prevailed in ancient times, and yet
not be distinctly noticed by the Greek and Roman writers on medicine,
I cannot conceive, more especially when we call to recollection the
very accurate descriptions which they have left us of other cutaneous
diseases, by no means attended with symptoms of so obvious a nature.
Indeed it appears to me most wonderful, that such an opinion should
have been entertained by any person at all acquainted with the Arabic
writers on medicine, who described most distinctly both the plague and
the smallpox. Not to lose ourselves amidst a host of authorities, I
would refer the reader, in particular, to Avicenna, iv., 1, 4, where
the two diseases are treated of most distinctly, so that I cannot
entertain a doubt that the Arabian physicians considered them to be
essentially different.
In a considerable number of the cases reported in this book, there are
affixed to them in the original certain characters, the interpretation
of which the reader will find given in the translation. It will be
necessary, then, to give the reader some account of the origin of
these characters, regarding which our sole authority is Galen, who,
in his Commentaries on this book, enters on the question in his
usual elegant and attractive style. He admits that he derived his
information principally from Zeuxis, one of his predecessors in the
office of commenting upon the works of Hippocrates. (See § 2, of the
Preliminary Discourse.) It appears that Ptolemy Philadelphus was so
zealous in his search for books to adorn his library, in Alexandria,
that he gave instructions to the masters of ships going on distant
voyages to collect all the books they could procure, and bring them
back with them; that he ordered copies to be taken of books brought
to him in this way, and kept the originals, but returned the copies,
along with large sums of money, in certain cases, to those who had
lent them to him; and that the works so obtained were preserved in a
separate department of the library, with the inscription, “The Books
of the Ships.” Among these was found a copy of the Third Book of the
Epidemics, with the inscription, “One of the Books of the Ships,
according to the _redacteur_ Memnon of Sida.” Others say, that the
term “_redacteur_” was wanting, and that the book bore simply the
inscription of “Memnon;” and that the servants of the king inscribed
the names of all the seamen who had brought these books, when they were
installed on the shelves of the library. This, it would seem, was not
done immediately after their arrival in Alexandria, but that at first
they were collected together in certain houses. Memnon, the librarian,
then, is generally supposed to have surreptitiously introduced the
characters into one of the copies, in order that he might raise himself
into importance by interpreting them. But whether or not this ruse was
actually perpetrated by Memnon, the general belief of the commentators
was, that Hippocrates himself had nothing to do with them. In fact,
Zeno would appear to have been the only commentator who held them to
be genuine, and ascribed the introduction of them to our author. The
opinion thus advanced by Zeno led him into a violent controversy with
the two Apollonii, namely, the Empiric and Biblas, who strenuously
maintained that the characters were an interpolation executed by
Memnon. This came to be the settled opinion of the commentators,
and among others of Galen, who, although he gives a key to the
interpretation of the characters, maintains, on all occasions, that
they are of no authority, and had in fact been forged by Memnon.
The following is the key which Galen gives to the interpretation
of the characters: α, signifies ἀποφθορὰν, _abortion_, or ἀπώλειαν,
_loss_; γ, signifies γονοειδὲς ὁυρον, _urine resembling semen_; δ,
punctuated below, thus, δ, signifies ἱδρῶτα, _sweat_, and διάρροιαν,
_diarrhœa_, and διαφόρησιν, _perspiration_, or in fact any other
_evacuation_ which it is wished to express; ἐ, signifies ἐποχὴν,
_retention_, or ἒδραν, _seat_; ζ, signifies ζήτημα, _the object
of research_; θ, signifies θάνατον, _death_; ι, signifies ἱδρῶτα,
_sweat_; κ, signifies κρίσιν, _crisis_, or κοιλιακὴν διάθεσιν; μ,
signifies μανίαν, _madness_, or μήτραν, _the womb_; ν, signifies
νεότητα, _youth_, or νέκρωσιν, _mortification_; x, signifies ξανθὴν
χολὴν, _yellow bile_, or ξένον τι καὶ σπάνιον, _something strange and
rare_, or ξυσμὸν, _irritation_, or ξηρότητα, _dryness_; ο, signifies
ὀδύνας, _pains_, or οὖρον, _urine_ (but some think that it is only
when it has a ὐ above it that it signifies urine); π signifies πλῆθος,
_abundance_, or πτύελον, _sputum_, or πυρὸν (πυρρὸν?), _yellow_, or
πυρετὸν, _fever_, or πνεύμονος τάθος, _affection of the lungs_; π, with
a character ι in its middle [symbol] or [symbol]), signifies πυθανὸν,
_probable_; ρ, signifies ῥύσιν, _flux_, or ρίγος, _chill_; φ, signifies
φρενῖτιν, _phrensy_; ς, signifies σπασμὸν, _convulsion_, or στομαχοῦ
ἢ στόματός κάκωσιν, _illness of the stomach or mouth_; τ, signifies
τόκον, _accouchement_; υ, signifies ὑγείαν, _health_, or ὑποχόνδριον,
_hypochondrium_; χ, signifies χολὴν, _bile_, or χολῶδες, _bilious_; ψ,
signifies ψύξιν, _congealing_; ω, signifies ὠμότητα, _crudity_. See
Galeni Opera, t. v., p. 412, ed. Basil.; and Littré’s Hippocrates, t.
iii., p. 33.
According to this key, the characters at the end of the first case are
thus explained by Galen: they are [symbol]ΠΟΥΜΥ. Here, then, [symbol]
signifies πιθανὸν, _it is probable_, Π, πλῆθος, _that an abundance_,
ου, οὔρων, _of urine_; Μ, _on the 40th day_; Υ, ὑγείαν, _brought
health_. It is more fully expressed thus by Galen: πιθανὸν ειναιδιὰ τὸ
πλῆθος τῶν ἐκριθέντων όυρων ἀυτὸ λυρθῆναι τό νοσημα καὶ ὑγιῆ γενέσθαι
τὸν ἄνθρωπον ἑν τῂ τεσσαρακοστῇ τῶν ἡμερῶν, that is to say, “_it is
probable that, owing to the copious discharge of urine, the disease was
resolved, and the patient became well on the fortieth day_.”
BOOK III.--OF THE EPIDEMICS.
SEC. I.
CASE I.--Pythion, who lived by the Temple of the Earth, on
the first day, trembling commencing from his hands; acute fever,
delirium. On the second, all the symptoms were exacerbated. On the
third, the same. On the fourth alvine discharges scanty, unmixed, and
bilious. On the fifth, all the symptoms were exacerbated, the tremors
remained; little sleep, the bowels constipated. On the sixth sputa
mixed, reddish. On the seventh, mouth drawn aside. On the eighth, all
the symptoms were exacerbated; the tremblings were again constant;
urine, from the beginning to the eighth day, thin, and devoid of color;
substances floating in it, cloudy. On the tenth he sweated; sputa
somewhat digested, had a crisis; urine thinnish about the crisis; but
after the crisis, on the fortieth day, an abscess about the anus, which
passed off by a strangury.
_Explanation of the characters._ It is probable that the great
discharge of urine brought about the resolution of the disease, and the
cure of the patient on the fortieth day.[682]
CASE II.--Hermocrates, who lived by the New Wall,[683] was seized with
fever. He began to have pain in the head and loins; an empty distention
of the hypochondrium; the tongue at first was parched; deafness at the
commencement; there was no sleep; not very thirsty; urine thick and
red, when allowed to stand it did not subside; alvine discharge very
dry, and not scanty. On the fifth, urine thin, had substances floating
in it which did not fall to the bottom;[684] at night he was delirious.
On the sixth, had jaundice;[685] all the symptoms were exacerbated;
had no recollection. On the seventh, in an uncomfortable state; urine
thin, as formerly; on the following days the same. About the eleventh
day, all the symptoms appeared to be lightened. Coma set in; urine
thicker, reddish, thin substances below, had no sediment; by degrees he
became collected. On the fourteenth, fever gone; had no sweat; slept,
quite collected; urine of the same characters. About the seventeenth,
had a relapse, became hot. On the following days, acute fever, urine
thin, was delirious. Again, on the twentieth, had a crisis; free of
fever; had no sweat; no appetite through the whole time; was perfectly
collected; could not speak, tongue dry, without thirst; deep sleep.
About the twenty-fourth day he became heated; bowels loose, with a
thin, watery discharge; on the following days acute fever, tongue
parched. On the twenty-seventh he died. In this patient deafness
continued throughout;[686] the urine either thick and red, without
sediment, or thin, devoid of color, and having substances floating in
it; he could taste nothing.
_Explanation of the characters._ It is probable that it was the
suppression of the discharges from the bowels which occasioned death on
the twenty-seventh day.
CASE III.--The man who was lodged in the Garden of Dealces:[687] had
heaviness of the head and pain in the right temple for a considerable
time, from some accidental cause, was seized with fever, and took to
bed. On the second, there was a trickling of pure blood from the left
nostril, but the alvine discharges were proper, urine thin, mixed,
having small substances floating in it, like coarse barley meal, or
semen. On the third, acute fever; stools black, thin, frothy, a livid
sediment in the dejections; slight coma; uneasiness at the times he
had to get up; sediment in the urine livid, and somewhat viscid. On
the fourth, slight vomiting of bilious, yellow matters, and, after a
short interval, of the color of verdigris; a few drops of pure blood
ran from the left nostril; stools the same; urine the same; sweated
about the head and clavicles; spleen enlarged, pain of the thigh on
the same side; loose swelling of the right hypochondrium; at night had
no sleep, slight delirium. On the sixth, stools black, fatty, viscid,
fetid; slept, more collected. On the seventh, tongue dry, thirsty,
did not sleep; was somewhat delirious; urine thin, not of a good
color. On the eighth, stools black, scanty, and compact; slept, became
collected; not very thirsty. On the ninth had a rigor, acute fever,
sweated, a chill, was delirious, strabismus of the right eye, tongue
dry, thirsty, without sleep.[688] On the tenth, much the same. On the
eleventh, became quite collected; free from fever, slept, urine thin
about the crisis. The two following days without fever; it returned on
the fourteenth, then immediately insomnolency and complete delirium.
On the fifteenth, urine muddy, like that which has been shaken after
the sediment has fallen to the bottom; acute fever, quite delirious,
did not sleep; knees and legs painful; after a suppository, had
alvine dejection of a black color. On the sixteenth, urine thin, had
a cloudy eneorema, was delirious. On the seventeenth, in the morning,
extremities cold, was covered up with the bedclothes, acute fever,
general sweat, felt relieved, more collected; not free of fever,
thirsty, vomited yellow bile, in small quantities; formed fæces passed
from the bowels, but soon afterwards black, scanty, and thin; urine
thin, not well colored. On the eighteenth, not collected, comatose.
On the nineteenth, in the same state. On the twentieth, slept; quite
collected, sweated, free from fever, not thirsty, but the urine thin.
On the twenty-first, slight delirium; somewhat thirsty, pain of the
hypochondrium, and throbbing about the navel throughout. On the
twenty-fourth, sediment in the urine, quite collected. Twenty-seventh,
pain of the right hip joint; urine thin and bad, a sediment; all the
other symptoms milder. About the twenty-ninth, pain of the right eye;
urine thin. Fortieth, dejections pituitous, white, rather frequent;
sweated abundantly all over; had a complete crisis.[689]
_Explanation of the characters._ It is probable that, by means of
the stools, the urine, and the sweat, this patient was cured in forty
days.
SEC. II.
CASE IV.--In Thasus, Philistes had headache of long continuance,
and sometimes was confined to bed, with a tendency to deep sleep;
having been seized with continual fevers from drinking, the pain was
exacerbated; during the night he, at first, became hot. On the first
day, he vomited some bilious matters, at first yellow, but afterwards
of a verdigris-green color, and in greater quantity; formed fæces
passed from the bowels; passed the night uncomfortably. On the second,
deafness, acute fever; retraction of the right hypochondrium; urine
thin, transparent, had some small substances like semen floating in it;
delirium ferox about mid-day. On the third, in an uncomfortable state.
On the fourth, convulsions; all the symptoms exacerbated. On the fifth,
early in the morning, died.
_Explanation of the characters._ It is probable that the death of
the patient on the fifth day is to be attributed to a phrenitis, with
unfavorable evacuations.[690]
CASE V.--Charion, who was lodged at the house of Demænetus,
contracted a fever from drinking. Immediately he had a painful
heaviness of the head; did not sleep; bowels disordered, with thin
and somewhat bilious discharges. On the third day, acute fever;
trembling of the head, but especially of the lower lip; after a little
time a rigor, convulsions; he was quite delirious; passed the night
uncomfortably. On the fourth, quiet, slept little, talked incoherently.
On the fifth, in pain; all the symptoms exacerbated; delirium; passed
the night uncomfortably; did not sleep. On the sixth, in the same
state. On the seventh had a rigor, acute fever, sweated all over his
body; had a crisis. Throughout the alvine discharges were bilious,
scanty, and unmixed; urine thin, well colored, having cloudy substances
floating in it. About the eighth day, passed urine of a better color,
having a white scanty sediment; was collected, free from fever for a
season. On the ninth it relapsed. About the fourteenth, acute fever. On
the sixteenth, vomited pretty frequently yellow, bilious matters. On
the seventeenth had a rigor, acute fever, sweated, free of fever; had a
crisis; urine, after the relapse and the crisis, well colored, having a
sediment; neither was he delirious in the relapse. On the eighteenth,
became a little heated; some thirst, urine thin, with cloudy substances
floating in it; slight wandering in his mind. About the nineteenth,
free of fever, had a pain in his neck; a sediment in the urine. Had a
complete crisis on the twentieth.
_Explanation of the characters._ It is probable that the patient
was cured in twenty days, by the abundance of bilious stools and
urine.[691]
CASE VI.--The daughter of Euryanax, a maid, was taken ill of
fever. She was free of thirst throughout, but had no relish for food.
Alvine discharges small, urine thin, scanty, not well colored. In the
beginning of the fever, had a pain about the nates. On the sixth day,
was free of fever, did not sweat, had a crisis; the complaint about
the nates came to a small suppuration, and burst at the crisis. After
the crisis, on the seventh day, had a rigor, became slightly heated,
sweated. On the eighth day after the rigor, had an inconsiderable
rigor; the extremities cold ever after. About the tenth day, after
a sweat which came on, she became delirious, and again immediately
afterwards was collected; these symptoms were said to have been brought
on by eating grapes. After an intermission of the twelfth day, she
again talked much incoherently; her bowels disordered with bilious,
scanty, unmixed, thin, acrid discharges; she required to get frequently
up. She died on the seventh day after the return of the delirium. At
the commencement of the disease she had pain in the throat, and it was
red throughout; uvula retracted, defluxions abundant, thin, acrid;
coughed, but had no concocted sputa; during the whole time loathed all
kinds of food, nor had the least desire of anything; had no thirst, nor
drank anything worth mentioning; was silent, and never spoke a word;
despondency; had no hopes of herself. She had a congenital tendency to
phthisis.[692]
CASE VII.--The woman affected with quinsy, who lodged in
the house of Aristion: her complaint began in the tongue; speech
inarticulate; tongue red and parched. On the first day, felt chilly,
and afterwards became heated. On the third day, a rigor, acute fever;
a reddish and hard swelling on both sides of the neck and chest,
extremities cold and livid; respiration elevated; the drink returned
by the nose; she could not swallow; alvine and urinary discharges
suppressed. On the fourth, all the symptoms were exacerbated. On the
sixth she died of the quinsy.
_Explanation of the characters._ It is probable that the cause of
death on the sixth day was the suppression of the discharges.[693]
CASE VIII.--The young man who was lodged by the Liars’ Market
was seized with fever from fatigue, labor, and running out of season.
On the first day, the bowels disordered, with bilious, thin, and
copious dejections; urine thin and blackish; had no sleep; was thirsty.
On the second all the symptoms were exacerbated; dejections more
copious and unseasonable; he had no sleep; disorder of the intellect;
slight sweat. On the third day, restless, thirst, nausea, much tossing
about, bewilderment, delirium; extremities livid and cold; softish
distention of the hypochrondrium on both sides. On the fourth, did not
sleep; still worse. On the seventh he died. He was about twenty years
of age.
_Explanation of the characters._ It is probable that the cause of
his death on the seventh day was the unseasonable practices mentioned
above. An acute affection.[694]
CASE IX.--The woman who lodged at the house of Tisamenas had a
troublesome attack of iliac passion; much vomiting; could not keep her
drink; pains about the hypochondria, and pains also in the lower part
of the belly; constant tormina; not thirsty; became hot; extremities
cold throughout, with nausea and insomnolency; urine scanty and thin;
dejections undigested, thin, scanty. Nothing could do her any good. She
died.[695]
CASE X.--A woman of those who lodged with Pantimides, from
a miscarriage, was taken ill of fever. On the first day, tongue dry,
thirst, nausea, insomnolency, belly disordered, with thin, copious,
undigested dejections. On the second day, had a rigor, acute fever;
alvine discharges copious; had no sleep. On the third, pains greater.
On the fourth, delirious. On the seventh she died. Belly throughout
loose, with copious, thin, undigested evacuations; urine scanty, thin.
An ardent fever.[696]
CASE XI.--Another woman, after a miscarriage about the fifth month,
the wife of Ocetes, was seized with fever. At first had sometimes coma
and sometimes insomnolency; pain of the loins; heaviness of the head.
On the second, the bowels were disordered, with scanty, thin, and at
first unmixed dejections. On the third, more copious, and worse; at
night did not sleep. On the fourth was delirious; frights, despondency;
strabismus of the right eye; a faint cold sweat about the head;
extremities cold. On the fifth day, all the symptoms were exacerbated;
talked much incoherently, and again immediately became collected; had
no thirst; labored under insomnolency; alvine dejections copious, and
unseasonable throughout; urine scanty, thin, darkish; extremities cold,
somewhat livid. On the sixth day, in the same state. On the seventh she
died. Phrenitis.[697]
CASE XII.--A woman who lodged near the Liars’ Market, having
then brought forth a son in a first and difficult labor, was seized
with fever. Immediately on the commencement had thirst, nausea, and
cardialgia; tongue dry; bowels disordered, with thin and scanty
dejections; had no sleep. On the second, had slight rigor, acute fever;
a faint cold sweat about the head. On the third, painfully affected;
evacuations from the bowels undigested, thin, and copious. On the
fourth, had a rigor; all the symptoms exacerbated; insomnolency. On the
fifth, in a painful state. On the sixth, in the same state; discharges
from the bowels liquid and copious. On the seventh, had a rigor, fever
acute; much thirst; much tossing about; towards evening a cold sweat
over all; extremities cold; could no longer be kept warm; and again
at night had a rigor; extremities could not be warmed; she did not
sleep; was slightly delirious, and again speedily collected. On the
eighth, about mid-day, she became warm, was thirsty, comatose, had
nausea; vomited small quantities of yellowish bile; restless at night,
did not sleep; passed frequently large quantities of urine without
consciousness. On the ninth, all the symptoms gave way; comatose,
towards evening slight rigors; small vomitings of bile. On the tenth,
rigor; exacerbation of the fever, did not sleep at all; in the morning
passed much urine having a sediment; extremities recovered their heat.
On the eleventh, vomited bile of a verdigris-green color; not long
after had a rigor, and again the extremities cold; towards evening a
rigor, a cold sweat, much vomiting; passed a painful night. On the
twelfth, had copious black and fetid vomitings; much hiccup, painful
thirst. On the thirteenth, vomitings black, fetid, and copious; rigor
about mid-day, loss of speech. On the fourteenth, some blood ran from
her nose, she died. In this case the bowels were loose throughout; with
rigors; her age about seventeen. An ardent fever.[698]
SECTION III.--CONSTITUTION 2.[699]
The year was southerly, rainy; no winds throughout.[700] Droughts
having prevailed during the previous seasons of the year, the south
winds towards the rising of Arcturus were attended with much rain.
Autumn gloomy and cloudy, with copious rains. Winter southerly, damp,
and soft. But long after the solstice, and near the equinox, much
winterly weather out of season; and when now close to the equinox,
northerly, and winterly weather for no long time. The spring again
southerly, calm, much rain throughout until the dog-days. Summer fine
and hot; great suffocating heats. The Etesian winds blew small and
irregular; again, about the season of Arcturus, much rains with north
winds. The year being southerly, damp, and soft towards winter, all
were healthy, except those affected with phthisis, of whom we shall
write afterwards.
3. Early in spring, along with the prevailing cold, there were many
cases of erysipelas, some from a manifest cause, and some not.[701]
They were of a malignant nature, and proved fatal to many; many had
sore-throat and loss of speech. There were many cases of ardent fever,
phrensy, aphthous affections of the mouth,[702] tumors on the genital
organs; of ophthalmia, anthrax,[703] disorder of the bowels, anorexia,
with thirst and without it; of disordered urine, large in quantity,
and bad in quality; of persons affected with coma for a long time,
and then falling into a state of insomnolency. There were many cases
of failure of crisis, and many of unfavorable crisis; many of dropsy
and of phthisis. Such were the diseases then epidemic.[704] There
were patients affected with every one of the species which have been
mentioned, and many died. The symptoms in each of these cases were as
follows:
4. In many cases erysipelas, from some obvious cause, such as an
accident, and sometimes from even a very small wound, broke out all
over the body, especially, in persons about sixty years of age, about
the head, if such an accident was neglected in the slightest degree;
and this happened in some who were under treatment; great inflammation
took place, and the erysipelas quickly spread all over.[705] In the
most of them the abscesses ended in suppurations, and there were great
fallings off (sloughing) of the flesh, tendons, and bones; and the
defluxion which seated in the part was not like pus, but a sort of
putrefaction, and the running was large and of various characters.
Those cases in which any of these things happened about the head were
accompanied with falling off of the hairs of the head and chin, the
bones were laid bare and separated, and there were excessive runnings;
and these symptoms happened in fevers and without fevers. But these
things were more formidable in appearance than dangerous; for when
the concoction in these cases turned to a suppuration, most of them
recovered; but when the inflammation and erysipelas disappeared, and
when no abscess was formed, a great number of these died.[706] In like
manner, the same things happened to whatever part of the body the
disease wandered, for in many cases both forearm and arm dropped off;
and in those cases in which it fell upon the sides, the parts there,
either before or behind, got into a bad state; and in some cases the
whole femur and bones of the leg and whole foot were laid bare. But of
all such cases, the most formidable were those which took place about
the pubes and genital organs.[707] Such was the nature of these cases
when attended with sores, and proceeding from an external cause; but
the same things occurred in fevers, before fevers, and after fevers.
But those cases in which an abscess was formed, and turned to a
suppuration, or a seasonable diarrhœa or discharge of good urine took
place, were relieved thereby: but those cases in which none of these
symptoms occurred, but they disappeared without a crisis, proved fatal.
The greater number of these erysipelatous cases took place in the
spring, but were prolonged through the summer and during autumn.
5. In certain cases there was much disorder, and tumors about the
fauces, and inflammations of the tongue, and abscesses about the
teeth. And many were attacked with impairment or loss of speech;[708]
at first, those in the commencement of phthisis, but also persons in
ardent fever and in phrenitis.
6. The cases of ardent fever and phrenitis occurred early in spring
after the cold set in, and great numbers were taken ill at that time,
and these cases were attended with acute and fatal symptoms. The
constitution of the ardent fevers which then occurred was as follows:
at the commencement they were affected with coma, nausea, and rigors;
fever not acute, not much thirst, nor delirium, slight epistaxis,[709]
the paroxysms for the most part on even days; and, about the time of
the paroxysms, forgetfulness, loss of strength and of speech, the
extremities, that is to say, the hands and feet, at all times, but more
especially about the time of the paroxysms, were colder than natural;
they slowly and imperfectly became warmed, and again recovered their
recollection and speech.[710] They were constantly affected either with
coma, in which they got no sleep, or with insomnolency, attend with
pains;[711] most had disorders of the bowels, attended with undigested,
thin, and copious evacuations; urine copious, thin, having nothing
critical nor favorable about it; neither was there any other critical
appearance in persons affected thus; for neither was there any proper
hemorrhage, nor any other of the accustomed evacuations, to prove a
crisis. They died, as it happened, in an irregular manner, mostly about
the crisis, but in some instances after having lost their speech for a
long time, and having had copious sweats. These were the symptoms which
marked the fatal cases of ardent fever; similar symptoms occurred in
the phrenitic cases; but these were particularly free from thirst, and
none of these had wild delirium[712] as in other cases, but they died
oppressed by a bad tendency to sleep, and stupor.
7. But there were also other fevers, as will be described. Many had
their mouths affected with aphthous ulcerations. There were also many
defluxions about the genital parts, and ulcerations, boils (phymata),
externally and internally, about the groins.[713] Watery ophthalmies of
a chronic character, with pains; fungous excrescences of the eyelids,
externally and internally, called fici, which destroyed the sight of
many persons.[714] There were fungous growths, in many other instances,
on ulcers, especially on those seated on the genital organs. There
were many attacks of carbuncle (anthrax) through the summer, and other
affections, which are called “the putrefaction” (_seps_); also
large ecthymata,[715] and large tetters (_herpetes_) in many
instances.
8. And many and serious complaints attacked many persons in the
region of the belly. In the first place, tenesmus, accompanied with
pain, attacked many, but more especially children, and all who had
not attained to puberty; and the most of these died. There were many
cases of lientery and of dysentery; but these were not attended with
much pain.[716] The evacuations were bilious, and fatty, and thin, and
watery; in many instances the disease terminated in this way, with and
without fever; there were painful tormina and volvuli of a malignant
kind; copious evacuations of the contents of the guts, and yet much
remained behind; and the passages did not carry off the pains, but
yielded with difficulty to the means administered; for in most cases
purgings were hurtful to those affected in this manner; many died
speedily, but in many others they held out longer. In a word, all
died, both those who had acute attacks and those who had chronic, most
especially from affections of the belly, for it was the belly which
carried them all off.
9. All persons had an aversion to food in all the afore-mentioned
complaints to a degree such as I never met with before,[717] and
persons in these complaints most especially, and those recovering from
them, and in all other diseases of a mortal nature. Some were troubled
with thirst, and some not; and both in febrile complaints and in others
no one drank unseasonably or disobeyed injunctions.
10. The urine in many cases was not in proportion to the drink
administered, but greatly in excess; and the badness of the urine
voided was great, for it had not the proper thickness, nor concoction,
nor purged properly; for in many cases purgings by the bladder indicate
favorably, but in the greatest number they indicated a melting of the
body, disorder of the bowels, pains, and a want of crisis.[718]
11. Persons laboring under phrenitis and causus were particularly
disposed to coma; but also in all other great diseases which occurred
along with fever. In the main, most cases were attended either by heavy
coma, or by short and light sleep.
12. And many other forms of fevers were then epidemic, of tertian,
of quartan, of nocturnal,[719] of continual, of chronic, of erratic,
of fevers attended with nausea, and of irregular fevers. All these
were attended with much disorder, for the bowels in most cases
were disordered, accompanied with rigors, sweats not of a critical
character, and with the state of the urine as described. In most
instances the disease was protracted, for neither did the deposits
which took place prove critical as in other cases; for in all
complaints and in all cases there was difficulty of crisis, want of
crisis, and protraction of the disease, but most especially in these.
A few had the crisis about the eightieth day, but in most instances
it (the disease?) left them irregularly. A few of them died of dropsy
without being confined to bed. And in many other diseases people were
troubled with swelling, but more especially in phthisical cases.
13. The greatest and most dangerous disease, and the one that proved
fatal to the greatest number, was the consumption.[720] With many
persons it commenced during the winter, and of these some were confined
to bed, and others bore up on foot; the most of those died early in
spring who were confined to bed; of the others, the cough left not a
single person, but it became milder through the summer; during the
autumn, all these were confined to bed, and many of them died, but
in the greater number of cases the disease was long protracted. Most
of these were suddenly attacked with these diseases, having frequent
rigors, often continual and acute fevers; unseasonable, copious, and
cold sweats throughout; great coldness, from which they had great
difficulty in being restored to heat; the bowels variously constipated,
and again immediately in a loose state, but towards the termination
in all cases with violent looseness of the bowels; a determination
downwards of all matters collected about the lungs; urine excessive,
and not good; troublesome melting. The coughs throughout were frequent,
and sputa copious, digested, and liquid, but not brought up with much
pain; and even when they had some slight pain, in all cases the purging
of the matters about the lungs went on mildly. The fauces were not
very irritable, nor were they troubled with any saltish humors; but
there were viscid, white, liquid, frothy, and copious defluxions from
the head. But by far the greatest mischief attending these and the
other complaints, was the aversion to food, as has been described.
For neither had they any relish for drink along with their food, but
continued without thirst. There was heaviness of the body, disposition
to coma, in most cases swelling, which ended in dropsy; they had
rigors, and were delirious towards death.
14. The form of body peculiarly subject to phthisical complaints was
the smooth, the whitish, that resembling the lentil; the reddish, the
blue-eyed, the leucophlegmatic,[721] and that with the scapulæ having
the appearance of wings: and women in like manner,[722] with regard to
the melancholic and subsanguineous, phrenitic and dysenteric affections
principally attacked them. Tenesmus troubled young persons of a
phlegmatic temperament. Chronic diarrhœa, acrid and viscid discharges
from the bowels, attacked those who were troubled with bitter bile.
15. To all those which have been described, the season of spring was
most inimical, and proved fatal to the greatest numbers: the summer was
the most favorable to them, and the fewest died then; in autumn, and
under the Pleiades, again there died great numbers. It appears to me,
according to the reason of things, that the coming on of summer should
have done good in these cases; for winter coming on cures the diseases
of summer, and summer coming on removes the diseases of winter. And
yet the summer in question was not of itself well constituted, for it
became suddenly hot, southerly, and calm; but, notwithstanding, it
proved beneficial by producing a change on the other constitution.
16. I look upon it as being a great part of the art to be able to judge
properly of that which has been written. For he that knows and makes a
proper use of these things, would appear to me not likely to commit any
great mistake in the art. He ought to learn accurately the constitution
of every one of the seasons, and of the diseases; whatever that is
common in each constitution and disease is good, and whatever is bad;
whatever disease will be protracted and end in death, and whatever
will be protracted and end in recovery; which disease of an acute
nature will end in death, and which in recovery. From these it is easy
to know the order of the critical days, and prognosticate from them
accordingly. And to a person who is skilled in these things, it is easy
to know to whom, when, and how aliment ought to be administered.[723]
SEC. 17. SIXTEEN CASES.[724]
CASE I.--In Thasus, the Parian who lodged above the Temple
of Diana was seized with an acute fever, at first of a continual and
ardent type; thirsty, inclined to be comatose at first, and afterwards
troubled with insomnolency; bowels disordered at the beginning, urine
thin. On the sixth day, passed oily urine, was delirious. On the
seventh, all the symptoms were exacerbated; had no sleep, but the
urine of the same characters, and the understanding disordered; alvine
dejections bilious and fatty. On the eighth, a slight epistaxis; small
vomiting of verdigris-green matters; slept a little. On the ninth,
in the same state. On the tenth, all the symptoms gave way. On the
eleventh, he sweated, but not over the whole body; he became cold, but
immediately recovered his heat again. On the fourteenth, acute fever;
discharges bilious, thin, and copious; substances floating in the
urine; he became incoherent. On the seventeenth, in a painful state,
for he had no sleep, and the fever was more intense. On the twentieth,
sweated all over; apyrexia, dejections bilious; aversion to food,
comatose. On the twenty-fourth, had a relapse. On the thirty-fourth,
apyrexia; bowels not confined; and he again recovered his heat.
Fortieth, apyrexia, bowels confined for no long time, aversion to
food; had again slight symptoms of fever, and throughout in an
irregular form; apyrexia at times, and at others not; for if the fever
intermitted, and was alleviated for a little, it immediately relapsed
again; he used much and improper food; sleep bad; about the time of
the relapse he was delirious; passed thick urine at that time, but
troubled, and of bad characters; bowels at first confined, and again
loose; slight fevers of a continual type; discharges copious and thin.
On the hundred and twentieth day he died. In this patient the bowels
were constantly from the first either loose, with bilious, liquid, and
copious dejection, or constipated with hot and undigested fæces; the
urine throughout bad; for the most part coma, or insomnolency with
pain; continued aversion to food. Ardent fever.
_Explanation of the characters._ It is probable that the
weakness produced by the fever, the phrenitis, and affection of the
hypochondrium caused death on the hundred and twentieth day.[725]
CASE II.--In Thasus, the woman who lodged near the Cold Water, on
the third day after delivery of a daughter, the lochial discharge not
taking place, was seized with acute fever, accompanied with rigors.
But a considerable time before delivery she was feverish, confined to
bed, and loathed her food. After the rigor which took place, continual
and acute fevers, with rigors. On the eighth and following days, was
very incoherent, and immediately afterwards became collected; bowels
disordered, with copious, thin, watery, and bilious stools; no thirst.
On the eleventh was collected, but disposed to coma; urine copious,
thin, and black; no sleep. On the twentieth, slight chills, and
immediately afterwards was warm; slight incoherence; no sleep; with
regard to the bowels, in the same condition; urine watery, and copious.
On the twenty-seventh, free from fever; bowels constipated; not long
afterwards violent pain of the right hip-joint for a considerable time;
fevers afterwards supervened; urine watery. On the fortieth, complaints
about the hip-joint better; continued coughs, with copious, watery
sputa; bowels constipated; aversion to food; urine the same; fever
not leaving her entirely, but having paroxysms in an irregular form,
sometimes present, sometimes not. On the sixtieth, the coughs left her
without a crisis, for no concoction of the sputa took place, nor any
of the usual abscesses; jaw on the right side convulsively retracted;
comatose, was again incoherent, and immediately became collected; utter
aversion to food; the jaw became relaxed; alvine discharges small,
and bilious; fever more acute, affected with rigors; on the following
days lost her speech, and again became collected, and talked. On the
eightieth she died. In this case the urine throughout was black, thin,
and watery; coma supervened; there was aversion to food, despondency,
and insomnolency; irritability, restlessness; she was of a melancholic
turn of mind.
_Explanation of the characters_. It is probable that the suppression of
the lochial discharge caused death on the eightieth day.[726]
CASE III.--In Thasus, Pythion, who was lodged above the Temple of
Hercules, from labor, fatigue, and neglected diet, was seized with
strong rigor and acute fever; tongue dry, thirsty, and bilious; had
no sleep; urine darkish, eneorema floating on the top of the urine,
did not subside. On the second day, about noon, coldness of the
extremities, especially about the hands and head; loss of speech and
of articulation; breathing short for a considerable time; recovered
his heat; thirst; passed the night quietly; slight sweats about the
head. On the third, passed the day in a composed state; in the evening,
about sunset, slight chills; nausea, agitation; passed the night in
a painful state; had no sleep; small stools of compact fæces passed
from the bowels. On the fourth, in the morning, composed; about noon
all the symptoms became exacerbated; coldness, loss of speech, and of
articulation; became worse; recovered his heat after a time; passed
black urine, having substances floating in it; the night quiet; slept.
On the fifth, seemed to be lightened, but a painful weight about the
belly; thirsty, passed the night in a painful state. On the sixth, in
the morning, in a quiet state; in the evening the pains greater; had a
paroxysm; in the evening the bowels properly opened by a small clyster;
slept at night. On the seventh, during the day, in a state of nausea,
somewhat disturbed; passed urine of the appearance of oil; at night,
much agitation, was incoherent, did not sleep. On the eighth, in the
morning, slept a little; but immediately coldness, loss of speech,
respiration small and weak; but in the evening recovered his heat
again; was delirious, but towards day was somewhat lightened; stools
small, bilious, and unmixed. On the ninth, affected with coma, and with
nausea when roused; not very thirsty; about sunset he became restless
and incoherent; passed a bad night. On the tenth, in the morning, had
become speechless; great coldness; acute fever; much perspiration; he
died. His sufferings were on the even days.
_Explanation of the characters._ It is probable that the excessive
sweats caused death on the tenth day.[727]
CASE IV.--The patient affected with phrenitis, having taken
to bed on the first day, vomited largely of verdigris-green and thin
matters; fever, accompanied with rigors, copious and continued sweats
all over; heaviness of the head and neck, with pain; urine thin,
substances floating in the urine small, scattered, did not subside;
had copious dejections from the bowels; very delirious; no sleep. On
the second, in the morning, loss of speech; acute fever; he sweated,
fever did not leave him; palpitations over the whole body, at night,
convulsions. On the third, all the symptoms exacerbated; he died.
_Explanation of the characters._ It is probable that the sweats
and convulsions caused death.[728]
CASE V.--In Larissa, a man, who was bald, suddenly was seized with
pain in the right thigh; none of the things which were administered
did him any good. On the first day, fever acute, of the ardent type,
not agitated, but the pains persisted. On the second, the pains in the
thigh abated, but the fever increased; somewhat tossed about; did not
sleep; extremities cold; passed a large quantity of urine, not of a
good character. On the third, the pain of the thigh ceased; derangement
of the intellect, confusion, and much tossing about. On the fourth,
about noon, he died. An acute disease.[729]
CASE VI.--In Abdera, Pericles was seized with a fever of the acute,
continual type, with pain; much thirst, nausea, could not retain his
drink; somewhat swelled about the spleen, with heaviness of the head.
On the first day, had hemorrhage from the left nostril, but still the
fever became more violent; passed much muddy, white urine, which when
allowed to stand did not subside. On the second day, all the symptoms
were exacerbated, yet the urine was thick, and more inclined to have a
sediment; the nausea less; he slept. On the third, fever was milder;
abundance of urine, which was concocted, and had a copious sediment;
passed a quiet night. On the fourth, had a copious and warm sweat all
over about noon; was free of fever, had a crisis, no relapse. An acute
affection.[730]
CASE VII.--In Abdera, the young woman who was lodged in the
Sacred Walk was seized with an ardent fever. She was thirsty, and could
not sleep; had menstruation for the first time. On the sixth, much
nausea, flushing, was chilly, and tossed about. On the seventh, in the
same state; urine thin, but of a good color; no disturbance about the
bowels. On the eighth, deafness, acute fever, insomnolency, nausea,
rigors, became collected; urine the same. On the ninth, in the same
state, and also on the following days; thus the deafness persisted. On
the fourteenth, disorder of the intellect; the fever abated. On the
seventeenth, a copious hemorrhage from the nose; the deafness slightly
better; and on the following days, nausea, deafness, and incoherence.
On the twentieth, pain of the feet; deafness and delirium left her; a
small hemorrhage from the nose; sweat, apyrexia. On the twenty-fourth,
the fever returned, deafness again; pain of the feet remained;
incoherence. On the twenty-seventh, had a copious sweat, apyrexia;
the deafness left her; the pain of her feet partly remained; in other
respects had a complete crisis.
_Explanation of the characters._ It is probable that the
restoration of health on the twentieth day was the result of the
evacuation of urine.[731]
CASE VIII.--In Abdera, Anaxion, who was lodged near the Thracian
Gates, was seized with an acute fever; continued pain of the right
side; dry cough, without expectoration during the first days, thirst,
insomnolency; urine well colored, copious, and thin. On the sixth,
delirious; no relief from the warm applications. On the seventh, in
a painful state, for the fever increased, while the pains did not
abate, and the cough was troublesome, and attended with dyspnœa. On
the eighth, I opened a vein at the elbow, and much blood, of a proper
character, flowed; the pains were abated, but the dry coughs continued.
On the eleventh, the fever diminished; slight sweats about the head;
coughs, with more liquid sputa; he was relieved. On the twentieth,
sweat, apyrexia; but after the crisis he was thirsty, and the
expectorations were not good. On the twenty-seventh the fever relapsed;
he coughed, and brought up much concocted sputa: sediment in the urine
copious and white; he became free of thirst, and the respiration was
good. On the thirty-fourth, sweated all over, apyrexia, general crisis.
_Explanation of the characters._ It is probable that the evacuation of
the sputa brought about the recovery on the thirty-fourth day.[732]
CASE IX.--In Abdera, Heropythus, while still on foot, had
pain in the head, and not long afterwards he took to bed; he lived
near the High Street. Was seized with acute fever of the ardent type;
vomitings at first of much bilious matter; thirst; great restlessness;
urine thin, black, substances sometimes floating high in it, and
sometimes not; passed the night in a painful state; paroxysms of
the fever diversified, and for the most part irregular. About the
fourteenth day, deafness; the fever increased; urine the same. On
the twentieth and following days, much delirium. On the thirtieth,
copious hemorrhage from the nose, and became more collected; deafness
continued, but less; the fever diminished; on the following days,
frequent hemorrhages, at short intervals. About the sixtieth, the
hemorrhages ceased, but violent pain of the hip-joint, and increase
of fever. Not long afterwards, pains of all the inferior parts; it
then became a rule, that either the fever and deafness increased, or,
if these abated and were lightened, the pains of the inferior parts
were increased. About the eightieth day, all the complaints gave way,
without leaving any behind; for the urine was of a good color, and had
a copious sediment, while the delirium became less. About the hundredth
day, disorder of the bowels, with copious and bilious evacuations,
and these continued for a considerable time, and again assumed the
dysenteric form with pain; but relief of all the other complaints. On
the whole, the fevers went off, and the deafness ceased. On the hundred
and twentieth day, had a complete crisis. Ardent fever.
_Explanation of the characters._ It is probable that the bilious
discharge brought about the recovery on the hundred and twentieth
day.[733]
CASE X.--In Abdera, Nicodemus was seized with fever from
venery and drinking. At the commencement he was troubled with nausea
and cardialgia; thirsty, tongue was parched; urine thin and dark. On
the second day, the fever exacerbated; he was troubled with rigors
and nausea; had no sleep; vomited yellow bile; urine the same;
passed a quiet night, and slept. On the third, a general remission;
amelioration; but about sunset felt again somewhat uncomfortable;
passed an uneasy night. On the fourth, rigor, much fever, general
pains; urine thin, with substances floating in it; again a quiet night.
On the fifth, all the symptoms remained, but there was an amelioration.
On the sixth, some general pains; substances floating in the urine;
very incoherent. On the seventh, better. On the eighth, all the other
symptoms abated. On the tenth, and following days, there were pains,
but all less; in this case throughout, the paroxysms and pains were
greater on the even days. On the twentieth, the urine white and thick,
but when allowed to stand had no sediment; much sweat; seemed to be
free from fever; but again in the evening he became hot, with the same
pains, rigor, thirst, slightly incoherent. On the twenty-fourth, urine
copious, white, with an abundant sediment; a copious and warm sweat all
over; apyrexia; the fever came to its crisis.
_Explanation of the characters._ It is probable that the cure was
owing to the bilious evacuations and the sweats.[734]
CASE XI.--In Thasus, a woman, of a melancholic turn of mind, from
some accidental cause of sorrow, while still going about, became
affected with loss of sleep, aversion to food, and had thirst and
nausea. She lived near the Pylades, upon the Plain. On the first,
at the commencement of night, frights, much talking; despondency,
slight fever; in the morning, frequent spasms, and when they ceased,
she was incoherent and talked obscurely; pains frequent, great, and
continued. On the second, in the same state; had no sleep; fever more
acute. On the third, the spasms left her; but coma, and disposition
to sleep, and again awake, started up, and could not contain herself;
much incoherence; acute fever; on that night a copious sweat all over;
apyrexia, slept, quite collected; had a crisis. About the third day,
the urine black, thin, substances floating in it generally round, did
not fall to the bottom; about the crisis a copious menstruation.[735]
CASE XII.--In Larissa,[736] a young unmarried woman was seized
with a fever of the acute and ardent type; insomnolency, thirst; tongue
sooty and dry; urine of a good color, but thin. On the second, in an
uneasy state, did not sleep. On the third, alvine discharges copious,
watery, and greenish, and on the following days passed such with
relief. On the fourth, passed a small quantity of thin urine, having
substances floating towards its surface, which did not subside; was
delirious towards night. On the sixth, a great hemorrhage from the
nose; a chill, with a copious and hot sweat all over; apyrexia, had a
crisis. In the fever, and when it had passed the crisis, the menses
took place for the first time, for she was a young woman. Throughout
she was oppressed with nausea, and rigors; redness of the face; pain of
the eyes; heaviness of the head; she had no relapse, but the fever came
to a crisis. The pains were on the even days.[737]
CASE XIII.--Apollonius, in Abdera, bore up (under the fever?) for
some time, without betaking himself to bed. His viscera were enlarged,
and for a considerable time there was a constant pain about the liver,
and then he became affected with jaundice; he was flatulent, and of
a whitish complexion. Having eaten beef, and drunk unseasonably, he
became a little heated at first, and betook himself to bed, and having
used large quantities of milk, that of goats and sheep, and both boiled
and raw, with a bad diet otherwise, great mischief was occasioned by
all these things; for the fever was exacerbated, and of the food taken
scarcely any portion worth mentioning was passed from the bowels;
the urine was thin and scanty; no sleep; troublesome meteorism;
much thirst; disposition to coma; painful swelling of the right
hypochondrium; extremities altogether coldish; slight incoherence,
forgetfulness of everything he said; he was beside himself. About
the fourteenth day after he betook himself to bed, had a rigor,
became heated, and was seized with furious delirium; loud cries, much
talking, again composed, and then coma came on; afterwards the bowels
disordered, with copious, bilious, unmixed, and undigested stools;
urine black, scanty, and thin; much restlessness; alvine evacuations of
varied characters, either black, scanty, and verdigris-green, or fatty,
undigested, and acrid; and at times the dejections resembled milk.
About the twenty-fourth, enjoyed a calm; other matters in the same
state; became somewhat collected; remembered nothing that had happened
since he was confined to bed; immediately afterwards became delirious;
every symptom rapidly getting worse. About the thirtieth, acute fever;
stools copious and thin; was delirious; extremities cold; loss of
speech. On the thirty-fourth he died. In this case, as far as I saw,
the bowels were disordered; urine thin and black; disposition to coma;
insomnolency; extremities cold; delirious throughout. Phrenitis.[738]
CASE XIV.--In Cyzicus,[739] a woman who had brought forth twin
daughters, after a difficult labor, and in whom the lochial discharge
was insufficient, at first was seized with an acute fever, attended
with chills; heaviness of the head and neck, with pain; insomnolency
from the commencement; she was silent, sullen, and disobedient; urine
thin, and devoid of color; thirst, nausea for the most part; bowels
irregularly disordered, and again constipated. On the sixth, towards
night, talked much incoherently; had no sleep. About the eleventh day
was seized with wild delirium, and again became collected; urine black,
thin, and again deficient, and of an oily appearance; copious, thin,
and disordered evacuations from the bowels. On the fourteenth, frequent
convulsions; extremities cold; not in anywise collected; suppression of
urine. On the sixteenth loss of speech. On the seventeenth, she died.
Phrenitis.
_Explanation of the characters._ It is probable that death
was caused, on the seventeenth day, by the affection of the brain
consequent upon her accouchement.[740]
CASE XV.--In Thasus, the wife of Dealces, who was lodged upon
the Plain, from sorrow was seized with an acute fever, attended with
chills. From first to last she wrapped herself up in her bedclothes;
still silent, she fumbled, picked, bored, and gathered hairs (from
them); tears, and again laughter; no sleep; bowels irritable, but
passed nothing; when directed, drank a little; urine thin and scanty;
to the touch of the hand the fever was slight; coldness of the
extremities. On the ninth, talked much incoherently, and again became
composed and silent. On the fourteenth, breathing rare, large, at
intervals; and again hurried respiration. On the sixteenth, looseness
of the bowels from a stimulant clyster; afterwards she passed her
drink, nor could retain anything, for she was completely insensible;
skin parched and tense. On the twentieth, much talk, and again became
composed; loss of speech; respiration hurried. On the twenty-first she
died. Her respiration throughout was rare and large; she was totally
insensible; always wrapped up in her bedclothes; either much talk, or
complete silence throughout. Phrenitis.[741]
CASE XVI.--In Melibœa,[742] a young man having become heated by
drinking and much venery, was confined to bed; he was affected with
rigors and nausea; insomnolency and absence of thirst. On the first
day much fæces passed from the bowels along with a copious flux; and
on the following days he passed many watery. stools of a green color;
urine thin, scanty, and deficient in color; respiration rare, large,
at long intervals; softish distention of the hypochondrium, of an
oblong form, on both sides; continued palpitation in the epigastric
region throughout; passed urine of an oily appearance. On the tenth,
he had calm delirium, for he was naturally of an orderly and quiet
disposition; skin parched and tense; dejections either copious and
thin, or bilious and fatty. On the fourteenth, all the symptoms were
exacerbated; he became delirious, and talked much incoherently. On the
twentieth, wild delirium, jactitation, passed no urine; small drinks
were retained. On the twenty-fourth he died. Phrenitis.[743]
ON INJURIES OF THE HEAD.
THE ARGUMENT.
This treatise opens with a description of the bones of the head,
which, although in most respects pretty accurate, is remarkable for
containing an account of particular configurations of the cranium,
and of certain varieties in the arrangement of the sutures, which it
has puzzled modern authorities in anatomy to explain, otherwise than
upon the supposition that the writer must have been but imperfectly
acquainted with the subject. But as the work otherwise bears evidence
that our author must have examined the bones of the head very
carefully, and moreover, as in all his works he displays a wonderfully
minute acquaintance with osteology, (to say nothing of the historical
tradition, mentioned by Pausanias, that he was possessed of a skeleton,
which at his death he bequeathed to the Temple of Apollo, at Delphi,)
it seems incredible that he should have committed most glaring blunders
in describing the prominent features of a part to which it is clear
that he had paid very great attention. Moreover, the reputation of
Hippocrates for accuracy stood so high, that an eminent authority
does not hesitate to declare of him, that he was a man who knew not
how to deceive or be deceived.[744] An easy way of getting rid of
the difficulty would no doubt be, to adopt the conjecture advanced
by Scaliger,[745] and in part approved of by Riolanus,[746] that the
treatise had suffered much in early times, from the interpolations of
ignorant transcribers; or to hold, with M. Malgaigne, that the whole
work is to be condemned as spurious. But it would be a dangerous
practice in ancient criticism, to reject as spurious a work which has
such unexceptionable evidence in its favor, although it may contain
matter which appears to us derogatory to the reputation of its author,
and it will be admitted, by any competent judge who examines the
arguments by Scaliger, that the proofs which he brings forward of great
interpolations in this treatise, are generally of a very fanciful
nature.
On a point so obscure, and which has puzzled so many eminent
scholars, it is to be feared that I shall not be able to throw much
additional light, but as, consistently with my general plan, I cannot
well avoid stating some opinion on the question I shall endeavor to
elucidate it in so far by giving in the first place a brief sketch
of the information supplied by all the other ancient authorities who
have touched upon this subject. I shall begin, then, with Aristotle,
the contemporary of our author, who, in his work “On the History of
Animals,” gives the following very inaccurate description of the
sutures of the human skull: “The female cranium has one circular
suture, but men generally three, which unite in one point. But a male
skull has been seen not having a suture.”[747] Celsus describes the
sutures in the following terms: “Ex ceteris, quo suturæ pauciores
sunt, eo capitis valetudo commodior est. Neque enim certus eorum
numerus est, sicut ne locus quidem. Ferè tamen duæ, super aures,
tempora a superiori parte discernunt; tertia ad aures, occipitium a
summo capite deducit; quarta, ab eodem vertice per medium caput ad
frontem procedit; eaque modo sub imo capillo desinit, modo frontem
ipsam secans inter supercilia finitur.” (viii., 1.) “Nam neque utique
certa sedes, supra posui, suturarum est.” (viii., 4.) Pliny gives
the following description of the head, which it is impossible not to
recognize as having been borrowed from our author: “Vertices bini
hominum tantum aliquibus. Capitis ossa plana, tenuia, sine medullis,
serratis pectinatim structa compagibus.”[748] Of Ruffus Ephesius I may
just mention, that his descriptions of the human body are in general
remarkable for their correctness, which is not to be wondered at, as he
would appear to have followed, in general, Erasistratus and the other
authorities belonging to the great Alexandrian period in anatomy; and
that he has described very accurately all the sutures of the human
cranium, but says not a word of the different configurations of the
head, as here given by our author.[749] We now come to Galen, who gives
a very lengthy description of the various forms of the head, in nearly
the same terms as our author, and after alluding to the uses of the
sutures, the principal of which he holds to be to permit transpiration
from the brain, he proceeds thus to describe the distribution of the
sutures: “That there is one which runs straight along the middle of the
head, (the sagittal?) and two transverse, (the coronal and lambdoid?)
has been stated previously, and need not require many words in this
place. For, the head being like an oblong sphere, one was justly
made to extend straight through its middle from behind forwards, and
two transverse sutures meet it, and the form of the three sutures is
like the letter H. For the whole head being more elongated in this
case than usual, and, as it were, compressed towards the ears, it
was equitable that the number of the sutures should be unequal as to
length and breadth, otherwise Nature would undeservedly have been
named just, by Hippocrates, in thus giving equal gifts to the unequal.
But it is not the case; for being most just, she formed the strongest
suture which extends along the length of the head single, being thus
proportionate to the width of the parts on both sides of it; namely,
on the right and on the left; but she formed the transverse double in
number, the one behind, as formerly said, called the lambdoid, and
the other before, called the coronal, so that the bone of the head
between these two sutures might be equal to those in the middle, on
each side (the parietal bones?). The sutures of the head, in that
configuration which is acuminated,[750] furnish a very great example of
the justness of Nature. For there are three principal figures of the
head: the one entirely opposed to the natural configuration already
described, when the head loses both its protuberances, that behind and
the other before, and is equal on all hands, and like a true sphere;
and two others, the one form having no protuberance in front, and the
other none in the occiput. The sutures of the spherical head are like
the letter χ, two only in number, and intersecting one another; the
one extending transverse from the one ear to the other, and the other
extending straight through the middle of the vertex to the middle
of the forehead. For, as when one part of the head is excessive,
being longer than the other, it was just that the longer form should
have more sutures, so, when both are alike, Nature bestowed an equal
number on both. But in the head which wants the protuberance at the
occiput, the straight and the coronal sutures remain, but the lambdoid
is wanting (it being near to the protuberance that is wanting), so
that the figure of the two resembles the letter T; as also when the
protuberance of the head in front is wanting, the coronal at the same
time is wanting, but there remains the one running lengthways and
joining the lambdoid, and this form of construction is made to resemble
the letter T. A fourth species of acuminated (sugar-loaf) head might
be imagined, but which does not occur, with the head more prominent at
the two ears than in front and behind.” He goes on to state the reasons
why there is no such construction of the head as this, and concludes as
follows: “Wherefore Hippocrates described four configurations, and the
sutures of each, in the manner we have now said that they exist, being
justly distributed to each configuration by Nature as to position and
number.”[751] The description of the bones and sutures of the head,
given in the Latin work “De Ossibus,” generally attributed to Galen, is
to the same effect. The same number of distinct configurations of the
head, and the same characters as regards the sutures, is also given by
Avicenna, who professedly copies from Galen. (I., i., 5, 3.)
When examined together, these descriptions certainly must be admitted
to have the appearance of being all derived from one original,
namely, from our author, in this place; and taken literally, there
can be no doubt that their meaning amounts to this: that the number
of the sutures varies with the form of the head; that when there are
protuberances both before and behind, the head in its upper part has
two transverse sutures, namely, the coronal and the lambdoid, and one
longitudinal, namely, the sagittal; that if the anterior protuberance
be wanting, the coronal is wanting, and, if the posterior, the
lambdoid. Now I need scarcely remark, that modern anatomists do not
recognize such varieties in the configuration of the head nor in the
numbers of the sutures, and that it is very rare indeed for either the
coronal or the lambdoid suture to be found wanting. To all appearance,
then, Galen was mistaken, and it only appears remarkable that, with all
his knowledge of anatomy, theoretical and practical, and considering
the opportunities which he must have possessed of examining human
skeletons in Alexandria, he should have failed to observe and describe
the bones of the cranium for himself.
Before stating my own conjectures on this question, it may be
interesting to examine the solution of it attempted by authorities
who lived about the period when the original study of human anatomy
was revived in modern times. In the first place, then, I may mention
that Ambrose Paré, who, I need scarcely say, was possessed of no mean
talent for original observation, in treating of fractures of the
head, adopts exactly the description given by Hippocrates; thus he
describes “the bunches of the head” in nearly the same terms as our
author, and adds, that such “bunches change the figure and site of
the sutures,” and that “there be some skulls that want the foremost
suture, and other some the hind, and sometimes none of the true
sutures, but only the false, _or_ spurious, remain.”[752] Nay,
it. cannot but appear remarkable, that Vesalius, the great antagonist
of Galen and of the ancient authorities in general, in the present
instance does not venture to call in question their opinion, but gives
a description of the different forms of the head, and the varieties
of the sutures, which scarcely at all differs from that given by
Hippocrates.[753] It is singular, also, that certain other authorities,
who were much more disposed to show a leaning to antiquity, such as
Columbus, Eustachius, Fallopius, and Riolanus, should, in the present
instance, have manifested a more independent spirit in challenging
the authority of Hippocrates, though, at the same time, they show a
disposition to find out some mode of bringing him clear off. Thus, for
example, Riolanus is compelled to admit that there is no such variety
in the forms and numbers of the sutures as Hippocrates describes;
but he attempts to free him from error, by suggesting that the cases
in which Hippocrates found them wanting must have been those of old
men.[754] He also quotes some very extraordinary instances, in which
something approaching the varieties described by our author had been
remarked.[755] Fallopius does not hesitate, in his great anatomical
work, to express the surprise he felt that all the authorities should
have assented to the descriptions of the protuberances and sutures
of the head given by Hippocrates; for that he, after having examined
large heaps of crania in the Musea of Ferrara and Florence, had not
found that they agreed with the descriptions given by Hippocrates;
that he had seen crania without a suture, and yet not wanting in the
protuberances; and in like manner, that he had seen the coronal suture
obliterated, and yet the skull possessed its anterior prominence,
and the lambdoid wanting, although the posterior protuberance was as
usual. Altogether, then, in this work he modestly ventures to impugn
the authority of Hippocrates.[756] In his work entitled “Expositio in
Librum Galeni de Ossibus,” he adopts the same views, and there declares
that he had never seen the sutures obliterated except from old age.
But, in his work entitled “Expositio in Lib. Hippocrat. de Vulneribus
Capitis,” he gives two suppositions, which he had devised in order to
defend the authority of Hippocrates: first, that Hippocrates did not
give these varieties of form as real, but as hypothetical; and second,
that he merely described them as being the vulgar opinion, without
pledging himself to the correctness of the description. These, as far
as I am aware, are the only defences which have ever been set up for
our author in this matter, and it must be admitted that they are not
very satisfactory. I shall now present the reader with the conjectural
explanation which has occurred to myself. I have imagined that what
Hippocrates meant was to express himself to the following effect:
when the forehead is remarkably prominent, and, at the same time,
there is a great depression behind, the cranium, if looked upon from
above, will show the coronal suture running across the fore part of
the head, and the sagittal through its middle, while the lambdoid will
be inconspicuous, from being below the level of the coronal. The two
together, then, would form some resemblance to the letter T. When, on
the other hand, the forehead is low, that is to say, wants its normal
development, and the occiput is unusually prominent, the lambdoid
suture joins the sagittal, so as to present some appearance of the same
letter reversed. But in a square-built head, where the frontal and
occipital regions have protuberances equally developed, the coronal and
lambdoid sutures run nearly parallel to one another, and are joined
in the middle by the sagittal, in which case the three sutures may be
imagined to present some resemblance to the Greek letter Η. When there
is no protuberance either before or behind, and the sagittal suture
passes through the middle of the bone down to the nasal process, the
coronal suture intersects it, so as to give them something like the
shape of the Greek letter χ.[757] I offer this explanation, however,
merely as a conjecture, and wish the reader to judge of it accordingly.
I now proceed to give an analysis of the contents of this treatise, and
to attempt to form a correct estimate of their value.
Injuries of the cranial bones are divided by our author into five
orders, as follows: 1, simple fractures, _or_ fissures of various kinds
and sizes (§ 4); 2, contusion, without fracture or depression (§ 5);
3, fractures attended with depression (§ 6); 4, the _hedra_, that is
to say, the indentation or cut in the outer table of the bone, and not
necessarily attended either with fracture or contusion (§ 7); 5, the
counter-fissure, or _fracture par contre-coup_ fracture and the severe
contusion, require the operation of trepanning; whereas neither the
_hedra_ (_or_ simple cut) nor the depressed fracture require it, and
the counter-fissure does not admit it, owing to the obscurity of the
symptoms with which it is attended (§ 9).
In the first place, the surgeon is to ascertain the nature and
situation of the wound, by a careful investigation of all the
circumstances of the case, but so as to avoid the use of the sound, if
possible (§§ 9, 10).
Next are described the various kind of injury which the different sorts
of weapons are most likely to inflict, and from the consideration of
them the surgeon is to form an estimate of the probable nature of the
accident (§ 11).
The characters of the _hedra_, or superficial injury of the
cranium, and the difficulty of forming a correct estimate of it, when
complicated by the presence of a suture, are strongly insisted upon (§
12).
The principles upon which the treatment of injuries situated in
different parts of the head should be treated, are carefully defined
and stated. Great, and as now would be thought, superfluous directions
are given, for ascertaining whether or not a fissure exists in the
bone. The treatment, as far as applications go, is to be mild and
desiccant. When a fracture cannot be made to disappear by scraping, the
trepan is to be applied (§§ 13, 14).
The dangers which the bone incurs of becoming affected from the soft
parts, are strongly insisted upon, and applications of a drying nature
are prescribed (§ 15).
The condition of a piece of bone which is going to exfoliate is
correctly and strikingly described (§ 16).
The treatment of depression is laid down, and the danger of applying
the trepan in this case is strongly insisted upon (§ 17).
The peculiarities in the case of children are pointed out. Under
certain circumstances, when there is contusion combined with the
fracture, he admits of perforating the skull with a small trepan (§ 18).
When, after a severe injury, symptoms of irritation and inflammation
appear to be coming on, the surgeon is to lose no time in proceeding to
the operation. Some correct observations are made on the consequences
of injuries of the head on other parts of the body (§ 19).
The treatment of erysipelatous inflammation is distinctly laid down
(§20).
The operation of trepanning the skull is circumstantially described,
and an interesting description is given of a mode of doing the
operation peculiar to our author[758] (§ 21).
This, then, as far as I know, is the first exposition ever made of a
highly important subject in surgery, upon which professional men are
still greatly divided in opinion. I cannot, then, resist the temptation
to offer some remarks on the views of practice here recommended, and to
institute a comparison between them and certain methods of treatment
which have been in vogue of late years.
I can scarcely doubt but it will be generally admitted that the
exposition of the subject here given is remarkably lucid, that
our author’s divisions of it are strongly marked, and his rules
of practice, whether correct or not, distinctly laid down. At all
events, it will not be affirmed that there is any confusion in his
ideas, or that his principles of treatment are not properly defined.
After all that has been written on injuries of the head, it would be
difficult to point to any better arrangement of them than that of our
author, into five orders: 1st, simple fractures without depression;
2d, contusions without fracture or depression; 3d, depression with
fracture; 4th, simple incisions without fracture; 5th, fractures _par
contre-coup_.
As regards the operation of trepanning the skull, then, our author’s
rule of practice is sufficiently well defined: we are to operate in
the first two of these cases, that is to say, in simple fractures and
contusions, but not in the last three, that is to say, in fracture
with depression, in simple incisions in the skull, and in the
counter-fissure. To begin, then, with the examination of those cases in
which the operation is proscribed: it is not to be had recourse to in
the counter-fissure, because, from the nature of it, there is generally
no rule by which its existence can be positively ascertained, and
therefore the case is to be given up as hopeless.
In the simple incision of the bone, that is to say, in the slash or
indentation, when the effects of the injury are not transmitted to the
brain, it must be obvious that all instrumental interference must be
strongly contraindicated.[759]
At first sight it will appear remarkable to a surgeon, who approaches
the subject with views exclusively modern, that our author should have
interdicted the use of instruments in that class of injuries in which
one would be inclined to suppose that they are most clearly indicated,
namely, in a fracture of considerable extent, attended with depression
of part of the bone from its natural level. Several questions present
themselves here to be solved. Is the operation generally required? Has
it been successful when it has been had recourse to? When it is to be
performed, should it be done immediately, or not until the bad effects
of the injury have manifested themselves?
With regard, then, to the necessity of the operation for depressed
fractures, the most discordant opinions have prevailed in modern times,
and even within a very recent period. Not to go farther back than
Pott, it is well known that he established it as the general rule of
practice, that in every case of fracture with depression, the skull
should be perforated, and the depressed portion of the bone either
raised to its level, or entirely removed. But since his time a great
change of opinion has taken place on this subject, and of late it
has become the general rule of practice (if rule can be predicated,
where opinions are so vague and indeterminate) not to interfere, even
in cases of depression, unless urgent symptoms have supervened. The
late Mr. Abernethy took the lead in questioning the propriety of the
rule laid down by Pott; and with the view of demonstrating that the
operation may be often dispensed with in fractures complicated with
depression, and in order, as he says, “to counteract in some degree
the bias which long-accustomed modes of thinking and acting are apt to
impress on the minds of practitioners,” he relates the histories of
five cases of fracture with depression, which, in the space of twelve
months, occurred under his own eyes in St. Bartholomew’s Hospital, and
which all terminated favorably, although no operation was performed.
These cases, supported by the authority of so great a name as Mr.
Abernethy, made a deep impression on the profession, especially in
this country, so that it became the established rule of practice in
British surgery never to interfere in cases of fracture, unless with
the view of removing urgent symptoms. See Cooper’s Surgical Dictionary,
edit. 1825, and the previous edition. The old Hippocratic rule in
regard to the trepan, when it is at all to be applied, namely, that
of applying it as a preventive of bad consequences, was altogether
eschewed, and it was held to be perfectly unwarrantable to perforate
the skull, except with the intention of removing substances which were
creating irritation and pressure of the brain. This practice, I say,
was sanctioned by all the best army and hospital surgeons, from about
the beginning of the present century, down to a very recent period.
What, then, it will be asked, have been the results? Has experience
confirmed the safety of this rule of practice, or has it not? To enable
us to solve these queries, we have most elaborate and trustworthy
statistics, published a few years ago by Dr. Laurie of Glasgow, which
deserve to be seriously studied by every surgeon who may be called
upon to discharge the duties of his profession in such cases. I cannot
find room for long extracts from these valuable papers, but may be
allowed to state a few of the more important results which are to be
deduced from Dr. Laurie’s interesting investigation. Coming then at
once to the point, it deserves to be remarked that Dr. Laurie’s ample
experience has led him to reject decidedly the rule of practice,
which, as I have stated, was established by Mr. Abernethy, about
forty years ago, namely, that, in cases of depression, the symptoms
of compression should be our guide to the employment of the trephine.
He adds, “however well this rule may sound, when delivered _ex
cathedrá_, it will be found of very little practical utility, for
this reason, that if we limit interference to cases exhibiting symptoms
of compression, we had much better not interfere at all, inasmuch as
such cases prove almost invariably fatal. Such, at least, has been
the experience of the Glasgow hospitals; for out of fifty-six cases
operated upon, including, in point of time, a period little short of
fifty years, there does not appear in our records a single unequivocal
instance of profound insensibility, in which the mere operation of
trepanning removed the coma and paralysis, or in any way conduced
to the recovery of the patient. We wish to be clearly understood as
speaking of the trephine used in reference to the state of the bone in
cases of profound insensibility, not employed to remove extravasated
blood. Nor does the cause of our want of success appear at all obscure.
We believe that in practice the cases of urgent compression dependent
on depressed bone alone are very few indeed; we are well aware that
many such are on record, we do not presume to impugn their accuracy, we
merely affirm that the records of the Glasgow Infirmary do not add to
the number.” He thus states his views with regard to the principles by
which the application of the trephine should be regulated. “From what
we have said, it will appear that we coincide with these who, in using
the trephine, in cases of compound fracture of the skull, look more to
the state of the bone than to the general symptoms, and _who employ
it more as a preventive of inflammation and its consequences, than as
a cure for urgent symptoms, the immediate result of the accident_.”
He goes on to state that “the details we have given are by no means
in favor of the trephine. Of fifty-six cases operated upon, eleven
recovered, and forty-five died. We feel assured that this affords too
favorable a view of the actual results.”[760]
* * * * *
From the extracts now given, it will readily be seen that this very
able authority has rejected entirely the rule of practice established
by Mr. Abernethy, and that, in so far, he has reverted to the principle
upon which the use of the instruments in simple fractures of the
skull was regulated by Hippocrates, namely, as a preventive of the
bad consequences of fracture on the brain, rather than with the view
of relieving them when established. It will further be seen that, in
whatever way applied, the use of perforating instruments in the case of
depressed fractures is attended with so unsatisfactory results, that
it may be doubted if any other operation in surgery, recognized as
legitimate, be equally fatal.[761] Less than one fifth of the patients
operated upon recovered. In fact, he very candidly admits “that it
would not have been greatly to the disadvantage of the patients
admitted into the Glasgow Infirmary, if the trephine had never found
its way within its walls.” He further, in conclusion, adverts to the
well-known fact that Desault, in the end, completely abandoned the
operation, and that Mr. Lawrence states, “as far as the experience of
this Hospital (St. Bartholomew’s) goes, he can cite very few instances
in which the life of the patient had been saved by the operation of
trephining.”[762]
Altogether, then, it will be allowed to no very questionable
whether, in general, the Hippocratic treatment, in cases of fracture
with depression, would not be fully as successful as the modern
practice of perforating the skull. Moreover, it is by no means well
ascertained, as generally assumed by superficial observers of facts
in medical practice, that depressed fractures are more dangerous than
other injuries of the skull attended with less formidable appearances.
Indeed, recent experience has shown, in confirmation of the opinion
advanced by our author, that extensive fractures, with great
depression, are frequently not followed by any very dangerous train
of consequences. (See Thomson’s “Observations made in the Military
Hospitals of Belgium,” pp. 59, 60; Hennen’s “Military Surgery,” p. 287;
Cooper’s “Lectures,” xiii.; Mr. Guthrie’s “Lectures on Injuries of the
Head,” p. 56.) All these, in substance, coincide with Mr. Guthrie, who
mentions with approbation that “it has been stated from the earliest
antiquity, that the greater the fracture, the less the concussion
of the brain.” I may mention further, that I myself, in the course
of my own experience, have known many instances in which fractures
with considerable depression were not followed, either immediately
or afterwards, by any bad consequences; while, on the other hand,
I have known cases in which simple contusion of the bone, without
fracture or extravasation, and without even very urgent symptoms of
concussion at first, have proved fatal in the course of a day or two.
Now, in such circumstances, Hippocrates would have operated by either
perforating the skull at once, down to the meninx, and removing a
piece of it, or by sawing it nearly through, and leaving the piece of
bone to exfoliate. It will be asked here, what object can he have had
in view by this procedure? This he has nowhere distinctly defined;
but, judging from the whole tenor of this treatise, and that of his
commentator, Galen, I can have no doubt in my mind that what he wished
to accomplish was to loosen the bones of the head, and give greater
room to the brain, which he conceived to be in a state of congestion
and swelling brought on by the vibration, or _trémoussement_,
communicated directly to the brain by the contusion. It is, in fact, an
opinion which Hippocrates repeatedly inculcates, not only with regard
to the brain, but also respecting injuries of the chest and joints,
that severe contusions are, in general, more dangerous than fractures,
the effects of the vibration in the former case being more violent than
in the latter.[763] Believing, then, that, in contusions, the internal
structure of the brain is extensively injured, and that irritation,
with hypertrophy, are the consequences, he advocated instrumental
interference, in order as I have stated, to give more room to the
brain, and relieve it from its state of compression.[764] This, no
doubt, was the rationale of his practice also in simple fractures, not
attended with depression, that is to say, his object in perforating the
skull was to remove tension, and furnish an outlet to the collection
within, whether of a liquid or a gaseous nature.
There can be no doubt that our author also had it in view, by
perforating the skull, to afford an issue to extravasated blood and
other matters collected within the cranium. This clearly appears
from what is stated in section 18, and the same rule of practice is
distinctly described by Celsus in the following terms: “Raro, sed
aliquando tamen evenit, ut os quidem totum integrum maneat, intus
vero ex ictu vena aliqua in cerebri membrana rupta aliquid sanguinis
mittat; isque ibi concretus magnos dolores moveat, et oculos quibusdam
obcæcet.... Sed ferè contra id dolor est, et, eo loco cute incisa,
pallidum os reperitur: ideoque id os quoque excidendum est.” (viii.,
4.) It is quite certain, then, that one of the objects for which our
author recommended trepanning, was to give issue to extravasated blood
on the surface of the skull. This naturally leads me to compare the
results of modern experience in the treatment of cases of contusion,
with or without extravasation of blood.
All the earlier of our modern authorities on surgery, such as
Theodoric, Pet. c. Largelata, Ambrose Paré, Wiseman, and Fallopius,
distinctly held that contusions of the skull, even when not complicated
with a fracture, are often of so formidable a nature as to require
the use of perforating instruments. The same views are strenuously
advocated by Pott, who has described the effects of contusion in very
elegant and impressive language. See page 42; ed. Lond. 1780. The
upshot is, that one of the consequences of a severe contusion of the
bone frequently is separation of the pericranium, “which is almost
always followed by a separation between the cranium and the dura
mater; a circumstance extremely well worth attending to in fissures
and undepressed fractures of the skull, because it is from this
circumstance principally that the bad symptoms and the hazard in such
cases arise.” (p. 50.)[765] After insisting, in very strong terms, on
the danger attending severe contusions of the, skull, he proceeds to
lay down the rules of treatment, which, in a word, are comprehended
in the two following intentions:--first, to prevent bad consequences
by having recourse, at first, to depletion; and, second, to procure
the discharge of matter collected under the cranium, which can be
answered only by the perforation of it. He agrees with Archigenes that
the operation is generally too long deferred, and that the sooner it
is performed the better. Still, however, it is to be borne in mind
that even Potts does not make it a general rule to operate at first,
_before_ the bad symptoms have come on, that is to say, during the
first three days, and that he rather appears to have followed Celsus,
who alludes to the method of Hippocrates, and describes his rule of
practice in the following terms:
--“In omni vero fisso fractoque osse, protinus antiquiores medici
ad ferramenta veniebant, quibus id exciderent. Sed multo melius est
ante emplastra experiri, etc.... Si vero sub prima curatione febris
intenditur, ... magni dolores sunt, cibique super hæc fastidium
increseit; tum demum ad manum scalprumque veniendum est.” (viii., 4.)
Pott then, it appears, follows the rule of Celsus, and does not operate
until unpleasant effects have developed themselves;[766] but, at the
same time, he candidly admits that, although the course now described
be all that our art is capable of doing in these melancholy cases,
he wishes he could say that it was frequently successful. He then
goes on to relate several cases: first, of simple contusion without
a wound; second, of contusion with a wound; and, third, of contusion
with extravasation. In all these classes of cases he operated with
very equivocal results; but then it is to be borne in mind, that, as
I have said, he operated, like Celsus, after the bad effects had come
on, and not, like Hippocrates, at first, in order to prevent them.
Even with all these discouraging results, he continued to adhere to
this rule of treatment, which, under the sanction of his name, became
the established practice of the profession. The late Mr. Abernethy,
who took the lead in innovating upon Pott’s rules for the application
of the trephine, did not venture to make any material change in this
case when he supposed that there was any considerable extravasation of
blood; and he delivered it as a test whereby we might judge whether
or not a great vessel had been ruptured within the skull, to examine
whether or no the bone bled, having generally found, as, indeed, had
been clearly laid down by Celsus, that in these cases the bone does
not bleed. The rule of practice, then, to operate in order to remove
the coagula of blood and matters which form between the skull and the
dura mater, was sanctioned by Sir Charles Bell and Sir Astley Cooper;
but they, like Mr. Abernethy, generally condemn interference when the
fluids are situated below the membrane. On this subject Mr. Guthrie
remarks:--“The operation of incising the dura mater, to admit of the
discharge of blood or matter from beneath, and even of puncturing
the brain, is much more commonly performed in France than in Great
Britain, where it is very rarely had recourse to, _and which may be
an error_,” etc. (p. 125.)
After thirty years’ further experience, this practice has been
tested by the recent statistics of Dr. Laurie, and the results, as
stated by him, are very discouraging. In the Hospital of Glasgow,
it was found in practice that there was no certain symptom whereby
it could be determined at what part of the head the blood had been
effused, nor, when discovered, could it, in general, be removed by
trephining the skull. The results, in short, were the following: “We
have thus thirty-nine cases in which extravasation existed as the
principal lesion, or as an important complication, in only one of which
extravasation existed as the principal lesion, or as an important
complication; in only one of which could an operation have saved the
patient; and of the seventeen cases operated upon, _not one_
recovered after, or was benefited by, the removal of the coagula.”
Such, then, are the results of modern experience, as far as they
are at present ascertained, in the use of the trephine for the
treatment of contusion, and undepressed fracture, complicated with
the effusion either of blood or of matter, from the days of Pott down
to the present time. The reader, however, should bear in remembrance
that the practice, of which the results have been shown to be so
unsatisfactory, is not that of Hippocrates, but of Celsus; for, in the
present instance, even Dr. Laurie repudiates the idea of operating
“for the purpose of relieving the evil consequences _which may
follow_ concussion of the brain,” and holds distinctly in this case
that one is not warranted in even entertaining the idea of operating,
unless--“first, when the puffy tumor indicates the spot which probably
has sustained the greatest amount of injury; second, such an inflamed
and suppurating condition of the injured soft parts as renders it more
than probable that the corresponding portion of the dura mater is in
a similarly diseased condition; third, inflammatory fever, preceded
or followed by rigors, and symptoms of compression.” From what has
been stated, then, it must appear evident that the recent statistics
furnish no test whatever of the results of the practice laid down by
Hippocrates, which was founded upon an entirely different principle,
namely, the preventive.
But, however anxious I may feel to prosecute further this comparison
of the results of ancient and of modern experience on this highly
interesting subject, my necessary limits compel me to bring this
discussion to a close. Before doing so, however, I shall briefly state
the inferences which I think may be drawn from a careful study of all
the principle authorities who have written on injuries of the head from
Hippocrates down to the present time:
1. All the serious injuries of the skull may be arranged conveniently
under the classes of contusions, simple fractures and fractures with
depressions.
2. Hippocrates recommended the operation of perforating the cranium, in
cases of simple fractures and contusions, whenever he apprehended that
these would be followed by serious consequences, such as inflammation,
extravasation of blood, and the effusion of matter.
3. Hippocrates operated in these cases during the first three days,
before any serious symptoms had come on, but Celsus rejected this
rule, and postponed the operation until after these effects had been
developed.
4. The objects which Hippocrates had in view by perforating the
skull, either entirely through or nearly so, would appear to have been
to slacken the tightness of the skull, and procure the evacuation of
extravasated blood lying within it.
5. The object for which Celsus opened the skull would appear to have
been solely to remove bodies which were creating irritation in the
brain.
6. All the ancient authorities looked upon contusions and simple
fractures as being very formidable injuries, which generally produce
congestion in the brain, with inflammation and effusion.
7. In modern times, at least within the last hundred years, the
trephine has never been applied in cases of contusion and simple
fracture, upon the principle of the operation acting as a preventive
of subsequent mischief, but only with the object of relieving effusion
when it was supposed to have taken place within the cranium, that is to
say, upon the plan recommended by Celsus.
8. The most contradictory accounts are given by modern authorities,
especially by the French surgeons of the eighteenth century, as to the
different results in cases of this description, when let alone, and
when treated upon the Celsian principle; and the recent statistics of
the operation are extremely unfavorable.
9. Hippocrates regarded fractures accompanied with depression and a
considerable separation of the bones as being generally less dangerous
than severe contusions and simple fractures, as in the former case
the brain is usually less hurt by the vibration of the shock which
inflicted the injury, and there is an outlet to any noxious matters
which may get congested in the brain.
10. Hippocrates, as a general rule, did not operate in cases of
depression, not even in cases of comminuted fracture, but in the latter
case left the pieces of bone to separate gradually by suppuration.
11. Celsus, on the other hand, approved of removing spiculæ at once,
of raising the depressed corner of a fractured bone, by sawing off the
superincumbent part, and even of perforating the adjoining bone, and,
in certain instances, of removing the whole of the depressed portion.
12. Pott laid it down as a general rule of practice, to operate with
the trephine in all cases of fracture accompanied with any considerable
degree of depression, and this formed the established practice in
this country, until the late Mr. Abernethy, about forty years ago,
introduced the rule of not interfering in such cases until urgent
symptoms had come on.
13. Of late years a further innovation has taken place in this rule
of practice in cases of depressed fracture, the operation being had
recourse to by Dr. Laurie and others, on the principle of preventing
the bad effects likely to result from the injury.
14. On whatever principle applied, the statistics of large hospitals
exhibit the results of the operation in a most unfavorable light,
insomuch that many of the most able and experienced surgeons of the
day hesitate whether, as a general rule, the operation ought not to be
abandoned altogether.
_Finally, a careful study of the whole literature of the subject,
from Hippocrates down to the present time, leads to the conclusion that
what constitutes the great difficulty in the treatment of injuries
of the head is, that the operation, to be successful, would require
to be performed early, and rather with a view of preventing serious
consequences, than of removing them after they have come on; and that
these can seldom be estimated so correctly as could be wished, since
they frequently bear no proportion to the apparent magnitude of the
mischief which the cranium has sustained._[767]
As the reader may find some difficulty in apprehending correctly the
nature of the instruments and other apparatus used by the ancients
in surgical operations, I have subjoined drawings of them, taken
principally from the works of Vidus Vidius and Andreas à Cruce, who
both lived at a time when these instruments must have been sufficiently
common in the cabinets of learned physicians, so that there is every
presumption that the figures which they give are sufficiently correct.
The manner in which they were used will readily be comprehended
from their shapes, assisted by the following lucid description of
the ancient process of trepanning the skull, given by Mr. Pott. “If
the piece of bone intended to be removed was larger than could be
comprehended within the modiolus (_trephine?_) then in use, and
which was a very defective instrument in many respects, the operation
was thus performed by means of terebræ. The piece intended to be taken
away was surrounded with perforations made at small distances from
each other, and then either the scalper excisorius or the scalper
lenticulatus was introduced, and, by means of repeated strokes with
a heavy mallet, was driven through all the interspaces between each
perforation. By these means the portion of bone so surrounded was
removed, and the dura mater was laid bare.”[768] That the modiolus of
Celsus was a small circular saw with a pivot, exactly like the modern
trephine, seems quite obvious from his own description of it; and that
the instrument called by our author terebra serrata (πρίων χαρακτὸς)
was identical with it, cannot admit of any doubt. See Foës, Œc. Hipp.
in voce πρίων.
Before concluding, I must also say a few words on one important point
connected with the constitutional treatment, which the modern reader
may at first sight be surprised to find no mention made of in this
treatise--I mean the use of venesection in the treatment of injuries of
the head. Now certainly it does not appear that Hippocrates regarded
bleeding as necessarily forming a portion of the system of treatment
in injuries of the bones of the head any more than in those of other
bones. But, although these were his views, it can be as little doubted,
by any one who is acquainted with his general views of practice, that
he bled whenever the abstraction of blood was indicated, either to
produce evacuation or revulsion. We know, for example, that in pains
of the back part of the head he opened the temporal vessels,[769]
and that in all inflammations and febrile diseases he abstracted
blood freely, nay, perhaps, _ad deliquium animi_.[770] And that
Hippocrates enforced the depletory system of treatment in injuries
of the head, when pain and inflammatory fever supervened, is quite
obvious, from its having been the system pursued in such cases by all
subsequent authorities, who looked up to him as their great guide in
practice. See PAULUS ÆGINETA, Book VI., 90, Syd. Soc. Edit.
I may mention further, as a proof that I am not straining a point
in the present instance, in order, as might be supposed, to bring
my author clear off in a case where he would appear to have been in
fault, that Ambrose Paré, who is a great advocate for depletion in
the treatment of fractures of the skull, is at great pains to show
that he has Hippocrates on his side in support of this practice.[771]
But while it is maintained that our author did not omit venesection
when properly indicated, I did not mean to say that he or any of the
ancient authorities carried the abstraction of the blood to the extent
practiced by Pott, or the members of the Royal Academy of Surgery in
France, nor as was done by the army and hospital surgeons of this
country during the late war.[772] Whether or not this was a defect
in ancient practice I shall not take it upon me to offer an opinion.
Suffice it to say, that there is undoubted evidence that in injuries
of the head the ancient surgeon, as is _naively_ recommended by
Avicenna, “bled his patient when he stood in need of being bled;”[773]
that is to say, according to special indications, and not in obedience
to any general rule.[774]
There is another point of practice in injuries of the head to which
it is proper that I should draw attention--I mean cold applications.
Now it is beyond a doubt that the application of cold in diseases of
the brain is pointedly condemned by Hippocrates, and that he used hot
applications instead;[775] and, moreover, that most of the ancient
authorities adhered to his rule on this point. At the same time it
would appear, that in extreme cases certain of them did not scruple to
apply ice to the shaved head.[776] I shall only remark further, that in
this case, as in diseases of the eyes, perhaps the safest rule is, to
be guided very much by the feelings and habits of the patient.
[The Plates referred to will be found at the end of the work.]
ON INJURIES OF THE HEAD
1. Men’s heads are by no means all like to one another, nor are
the sutures of the head of all men constructed in the same form.
Thus, whoever has a prominence in the anterior part of the head (by
prominence is meant the round protuberant part of the bone which
projects beyond the rest of it), in him the sutures of the head take
the form of the Greek letter _tau_, Τ; for the head has the
shorter line running transverse before the prominence, while the other
line runs through the middle of the head, all the way to the neck.[777]
But whoever has the prominence in the back part of the head, in him the
sutures are constructed in quite the opposite form to the former; for
in this case the shorter line runs in front of the prominence, while
the longer runs through the middle all along to the forehead.[778] But
whoever has a prominence of the head both before and behind, in him
the sutures resemble the Greek letter _êta_ Η; for the long lines
of the letter run transverse before each prominence while the short
one runs through the middle and terminates in the long lines.[779] But
whoever has no prominence on either part he has the sutures of the head
resembling the Greek letter χ; for the one line comes transverse to the
temple while the other passes along the middle of the head.[780] The
bone at the middle of the head is double, the hardest and most compact
part being the upper portion, where it is connected with the skin,
and the lowest, where it is connected with the meninx (dura mater);
and from the uppermost and lowermost parts the bone gradually becomes
softer and less compact, till you come to the _diploe_.[781] The
diploe is the most porous, the softest, and most cavernous part. But
the whole bone of the head, with the exception of a small portion of
the uppermost and lowermost portions of it, is like a sponge; and the
bone has in it many juicy substances, like caruncles; and if one will
rub them with the fingers, some blood will issue from them.[782] There
are also in the bone certain very slender and hollow vessels full of
blood. So it is with regard to hardness, softness, and porosity.
2. In respect to thickness and thinness; the thinnest and weakest part
of the whole head is the part about the bregma; and the bone there has
the smallest and thinnest covering of flesh upon it, and the largest
proportion of brain is situated in that region of the head. And hence
it happens that from similar or even smaller wounds and instruments,
when a person is wounded to the same or a less degree, the bone of
the head there is more contused, fractured, and depressed; and that
injuries there are more deadly and more difficult to cure; and it is
more difficult to save one’s life in injuries there than in any other
part of the head; that from having sustained a similar or even a less
wound a man will die, and that, too, in a shorter space of time than
from a wound in any other part of the head. For the brain about the
bregma feels more quickly and strongly any mischief that may occur to
the flesh or the bone; for the brain about the bregma is in largest
quantity, and is covered by the thinnest bone and the least flesh. Of
the other portions, the weakest is that about the temples; for it is
the conjunction of the lower jaw with the cranium, and there is motion
there up and down as at a joint; and the organ of hearing is near it;
and further, a hollow and important vein runs along the temple. But
the whole bone of the head behind the vertex and the ear is stronger
than the whole anterior part, and the bone itself has a larger and
deeper covering of flesh upon it. And hence it follows, that when
exposed to the same or even greater injuries from instruments of the
same or greater size, the bone is less liable to be fractured and
depressed than elsewhere; and that in a fatal accident the patient will
live longer when the wound is in the posterior part of the head than
when elsewhere; and that pus takes longer time to form and penetrate
through the bone to the brain, owing to the thickness of the bone; and
moreover, as there is less brain in that part of the head, more persons
who are wounded in the back part of the head escape than of those who
are wounded in the anterior part.[783] And in fatal cases, a man will
survive longer in winter than in summer, whatever be the part of the
head in which the wound is situated.
3. As to the _hædræ_ (dints _or_ marks?) of sharp and light
weapons, when they take place in the bone without fissure, contusion,
or depression inwards (and these take place equally in the anterior
and posterior part of the head), death, when it does occur, does not
properly result from them. A suture appearing in a wound, when the
bone is laid bare, on whatever part of the head the wound may have
been inflicted, is the weakest point of the head to resist a blow or a
weapon, when the weapon happens to be impinged into the suture itself;
but more especially when this occurs in the bregma at the weakest part
of the head, and the sutures happen to be situated near the wound, and
the weapon has hit the sutures themselves.[784]
4. The bone in the head is liable to be wounded in the following
modes, and there are many varieties in each of these modes of fracture:
When a wounded bone breaks, in the bone comprehending the fissure,
contusion necessarily takes place where the bone is broken; for an
instrument that breaks the bone occasions a contusion thereof more or
less, both at the fracture and in the parts of the bone surrounding
the fracture.[785] This is the first mode. But there are all possible
varieties of fissures; for some of them are fine, and so very fine that
they cannot be discovered, either immediately after the injury, or
during the period in which it would be of use to the patient if this
could be ascertained. And some of these fissures are thicker and wider,
certain of them being very wide. And some of them extend to a greater,
and some to a smaller, distance. And some are more straight, nay,
completely straight; and some are more curved, and that in a remarkable
degree. And some are deep, so as to extend downwards and through the
whole bone; and some are less so, and do not penetrate through the
whole bone.
5. But a bone may be contused, and yet remain in its natural condition
without any fracture in it; this is the second mode. And there are
many varieties of contusion; for they occur to a greater and less
degree, and to a greater depth, so as sometimes to extend through the
whole bone; or to a less depth, so as not to extend through the whole
bone; and to a greater and smaller length and breadth. But it is not
possible to recognize any of these varieties by the sight, so as to
determine their form and extent; neither, indeed, is it visible to the
eyes when any mischief of this kind takes place, and immediately after
the injury, whether or not the bone has been actually bruised, as is
likewise the ease with certain fractures at a distance from the seat of
injury.[786]
6. And the bone being fractured, is sometimes depressed inwards from
its natural level along with the fractures, otherwise there would be
no depression; for the depressed portion being fractured and broken
off, is pushed inwards, while the rest of the bone remains in its
natural position; and in this manner a fracture is combined with the
depression.[787] This is the third mode. There are many varieties
of depression, for it may comprehend a greater and a smaller extent
of bone, and may either be to a greater depth, or less so, and more
superficial.[788]
7. When a _hedra_, or dint of a weapon, takes place in a bone,
there may be a fracture combined with it; and provided there be a
fracture, contusion must necessarily be joined, to a greater or less
extent, in the seat of the dint and fracture, and in the bone which
comprehends them.[789] This is the fourth mode. And there may be a
_hedra_, or indentation of the bone, along with contusion of the
surrounding bone, but without any fracture either in the _hedra_
or in the contusion inflicted by the weapon. But the indentation of
a weapon takes place in a bone, and is called _hedra_, when the
bone remaining in its natural state, the weapon which struck against
the bone leaves its impression on the part which it struck. In each
of these modes there are many varieties, with regard to the contusion
and fracture, if both these be combined with the _hedra_, or if
contusion alone, as it has been already stated that there are many
varieties of contusion and fracture. And the _hedra_, or dint, of
itself may be longer and shorter, crooked, straight, and circular; and
there are many varieties of this mode, according to the shape of the
weapon; and they may be more or less deep, and narrower or broader, and
extremely broad. When a part is cleft, the cleft or notch which occurs
in the bone, to whatever length or breadth, is a _hedra_, if the
other bones comprehending the cleft remain in their natural position,
and be not driven inwards; for in this case it would be a depression,
and no longer a _hedra_.[790]
8. A bone may be injured in a different part of the head from that
on which the person has received the wound, and the bone has been
laid bare. This is the fifth mode. And for this misfortune, when it
occurs, there is no remedy; for when this mischief takes place, there
is no means of ascertaining by any examination whether or not it has
occurred, or on what part of the head.[791]
9. Of these modes of fracture, the following require trepanning: the
contusion, whether the bone be laid bare or not; and the fissure,
whether apparent or not. And if, when an indentation (_hedra_)
by a weapon takes place in a bone it be attended with fracture and
contusion, and even if contusion alone, without fracture, be combined
with the indentation, it requires trepanning. A bone depressed from
its natural position rarely requires trepanning; and those which are
most pressed and broken require trepanning the least; neither does
an indentation (_hedra_) without fracture and contusion require
trepanning; nor does a notch, provided it is large and wide; for a
notch and a _hedra_ are the same.[792]
10. In the first place, one must examine the wounded person, in
what part of the head the wound is situated, whether in the stronger
or weaker parts; and ascertain respecting the hairs about the wound,
whether they have been cut off by the instrument, and have gone into
the wound; and if so, one should declare that the bone runs the risk
of being denuded of flesh, and of having sustained some injury from
the weapon. These things one should say from a distant inspection, and
before laying a hand on the man;[793] but on a close examination one
should endeavor to ascertain clearly whether the bone be denuded of
flesh or not; and if the denuded bone be visible to the eyes, this will
be enough; but otherwise an examination must be made with the sound.
And if you find the bone denuded of the flesh, and not safe from the
wound, you must first ascertain the state of the bone, and the extent
of the mischief, and what assistance it stands in need of. One should
also inquire of the wounded person how and in what way he sustained the
injury; and if it be not apparent whether the bone has sustained an
injury or not, it will be still more necessary, provided the bone be
denuded, to make inquiry how the wound occurred, and in what manner;
for when contusions and fractures exist in the bone, but are not
apparent, we must ascertain, in the first place from the patient’s
answers, whether or not the bone has sustained any such injuries,
and then find out the nature of the case by word and deed, with the
exception of sounding. For sounding does not discover to us whether the
bone has sustained any of these injuries or not; but sounding discovers
to us an indentation inflicted by a weapon, and whether a bone be
depressed from its natural position, and whether the bone be strongly
fractured; all which may also be ascertained visibly with the eyes.[794]
11. And a bone sustains fractures, either so fine as to escape the
sight, or such as are apparent, and contusions which are not apparent,
and depression from its natural position, especially when one person
is intentionally wounded by another, or when, whether intentionally or
not, a blow or stroke is received from an elevated place, and if the
instrument in the hand, whether used in throwing or striking, be of a
powerful nature, and if a stronger person wound a weaker. Of those who
are wounded in the parts about the bone, or in the bone itself, by a
fall, he who falls from a very high place upon a very hard and blunt
object is in most danger of sustaining a fracture and contusion of the
bone, and of having it depressed from its natural position; whereas he
that falls upon more level ground, and upon a softer object, is likely
to suffer less injury in the bone, or it may not be injured at all.
Of those instruments which, falling upon the head, wound the parts
about the bone, or the bone itself, that which falls from a very high
place, and the least on a level with the person struck, and which is
at the same time very hard, very blunt, and very heavy, and which is
the least light, sharp, and soft, such an instrument would occasion a
fracture and contusion of the bone. And there is most danger that the
bone may sustain these injuries, under such circumstances, when the
wound is direct and perpendicular to the bone, whether struck from the
hand or from a throw, or when any object falls upon the person, or
when he is wounded by falling, or in whatever way the bone sustains a
direct wound from this instrument. Those weapons which graze the bone
obliquely are less apt to fracture, contuse, or depress the bone, even
when the bone is denuded of flesh; for in some of those wounds thus
inflicted the bone is not laid bare of the flesh. Those instruments
more especially produce fractures in the bone, whether apparent or not,
and contusions, and inward depression of the bone, which are rounded,
globular, smooth on all sides, blunt, heavy, and hard; and such weapons
bruise, compress, and pound the flesh; and the wounds inflicted by such
instruments, whether obliquely or circularly, are round, and are more
disposed to suppurate, and to have a discharge, and take longer time
to become clean; for the flesh which has been bruised and pounded must
necessarily suppurate and slough away. But weapons of an oblong form,
being, for the most part, slender, sharp, and light, penetrate the
flesh rather than bruise it, and the bone in like manner; and such an
instrument may occasion a _hedra_ and a cut (for a _hedra_
and a cut are same thing); but weapons of this description do not
produce contusions, nor fractures, nor depressions inwardly. And in
addition to the appearances in the bone, which you can detect by the
sight, you should make inquiry as to all these particulars (for they
are symptoms of a greater or less injury), whether the wounded person
was stunned, and whether darkness was diffused over his eyes, and
whether he had vertigo, and fell to the ground.[795]
12. When the bone happens to be denuded of flesh by the weapon, and
when the wound occurs upon the sutures, it is difficult to distinguish
the indentation (_hedra_) of a weapon which is clearly recognized
in other parts of the bone, whether it exist or not, and especially if
the _hedra_ be seated in the sutures themselves. For the suture
being rougher than the rest of the bone occasions confusion, and it
is not clear which is the suture, and which the mark inflicted by the
instrument, unless the latter (_hedra_) be large. Fracture also
for the most part is combined with the indentation when it occurs in
the sutures; and this fracture is more difficult to discern when the
bone is broken, on this account, that if there be a fracture, it is
situated for the most part in the suture. For the bone is liable to be
broken and slackened there, owing to the natural weakness of the bone
there, and to its porosity, and from the suture being readily ruptured
and slackened: but the other bones which surround the suture remain
unbroken, because they are stronger than the suture.[796] For the
fracture which occurs at the suture is also a slackening of the suture,
and it is not easy to detect whether the bone be broken and slackened
by the indentation of a weapon occurring in the suture, or from a
contusion of the bone at the sutures; but it is still more difficult
to detect a fracture connected with contusion. For the sutures, having
the appearance of fissures, elude the discernment and sight of the
physician, as being rougher than the rest of the bone, unless the bone
be strongly cut and slackened, (for a cut and a _hedra_ are the
same thing.)[797] But it is necessary, if the wound has occurred at the
sutures, and the weapon has impinged on the bone or the parts about it,
to pay attention and find out what injury the bone has sustained. For a
person wounded to the same, or a much smaller, extent, and by weapons
of the same size and quality, and even much less, will sustain a much
greater injury, provided he has received the blow at the sutures, than
if it was elsewhere. And many of these require trepanning, but you must
not apply the trepan to the sutures themselves, but on the adjoining
bone.[798]
13. And with regard to the cure of wounds in the head, and the mode
of detecting injuries in the bone which are not apparent, the following
is my opinion:--In a wound of the head, you must not apply anything
liquid, not even wine, but as little as possible, nor a cataplasm, nor
conduct the treatment with tents, nor apply a bandage to an ulcer on
the head, unless it be situated on the forehead, in the part which is
bare of hairs, or about the eyebrow and eye, for wounds occurring there
require cataplasms and bandages more than upon any other part of the
head.[799] For the rest of the head surrounds the whole forehead, and
the wounds wherever situated become inflamed and swelled, owing to an
influx of blood from the surrounding parts.[800] And neither must you
apply cataplasms and bandages to the forehead at all times; but when
the inflammation is stopped and the swelling has subsided, you must
give up the cataplasms and bandages. A wound in any other part of the
head must not be treated with tents, bandages, or cataplasms, unless it
also requires incision. You must perform incision on wounds situated
on the head and forehead, whenever the bone is denuded of flesh, and
appears to have sustained some injury from the blow, but the wound
has not sufficient length and breadth for the inspection of the bone,
so that it may be seen whether it has received any mischief from the
blow, and of what nature the injury is, and to what extent the flesh
has been contused, and whether the bone has sustained any injury, or
whether it be uninjured by the blow, and has suffered no mischief; and
with regard to the treatment, what the wound, and the flesh, and the
injury of the bone stand in need of. Ulcers of this description stand
in need of incision; and, if the bone be denuded of the flesh, and if
it be hollow, and extend far obliquely, we cut up the cavity wherever
the medicine cannot penetrate readily, whatever medicine it may be;
and wounds which are more inclined to be circular and hollow, and for
the most part others of the like shape, are cut up by making a double
incision in the circle lengthways, according to the figure of the man,
so as to make the wound of a long form. Incisions may be practiced with
impunity on other parts of the head, with the exception of the temple
and the parts above it, where there is a vein that runs across the
temple, in which region an incision is not to be made. For convulsions
seize on a person who has been thus treated; and if the incision be on
the left temple, the convulsions seize on the right side; and if the
incision be on the right side, the convulsions take place on the left
side.[801]
14. When, then, you lay open a wound in the head on account of the
bones having been denuded of the flesh, as wishing to ascertain
whether or not the bone has received an injury from the blow, you must
make an incision proportionate to the size of the wound, and as much
as shall be judged necessary. And in making the incision you must
separate the flesh from the bone where it is united to the membrane
(_pericranium?_) and to the bone, and then fill the whole wound
with a tent, which will expand the wound very wide next day with as
little pain as possible; and along with the tents apply a cataplasm,
consisting of a mass (_maza_) of fine flour pounded in vinegar,
or boiled so as to render it as glutinous as possible.[802] On the
next day, when you remove the tent, having examined the bone to see
what injury it has sustained, if the wound in the bone be not right
seen by you, nor can you discover what mischief the bone itself has
sustained, but the instrument seems to have penetrated to the bone
so as to have injured it, you must scrape the bone with a raspatory
to a depth and length proportionate to the suture of the patient,
and again in a transverse direction, for the sake of the fractures
which are not seen, and of the contusions which are not discovered,
as not being accompanied with depression of the bone from its natural
position. For the scraping discovers the mischief, if the injuries in
the bone be not otherwise manifest. And if you perceive an indentation
(_hedra_) left in the bone by the blow, you must scrape the dint
itself and the surrounding bones, lest, as often happens, there should
be a fracture and contusion, or a contusion alone, combined with the
dint, and escape observation. And when you scrape the bone with the
raspatory, and it appears that the wound in the bone requires the
operation, you must not postpone it for three days, but do it during
this period, more especially if the weather be hot, and you have
had the management of the treatment from the commencement. If you
suspect that the bone is broken or contused, or has sustained both
these injuries, having formed your judgment from the severity of the
wound, and from the information of the patient, as that the person
who inflicted the wound, provided it was done by another person, was
remarkably strong, and that the weapon by which he was wounded was of
a dangerous description, and then that the man had been seized with
vertigo, dimness of vision, and stupor, and fell to the ground,--under
these circumstances, if you cannot discover whether the bone be broken,
contused, or both the one and the other, nor can see the truth of the
matter, you must dissolve the jet-black ointment,[803] and fill the
wound with it when thus dissolved, and apply a linen rag smeared with
oil, and then a cataplasm of the maza with a bandage; and on the next
day, having cleaned out the wound, scrape the bone with the raspatory.
And if the bone is not sound, but fractured and contused, the rest of
it which is scraped will be white; but the fracture and contusion,
having imbibed the preparation, will appear black, while the rest of
the bone is white. And you must again scrape more deeply the fracture
where it appears black; and, if you thus remove the fissure, and cause
it to disappear, you may conclude that there has been a contusion of
the bone to a greater or less extent, which has occasioned the fracture
that has disappeared under the raspatory; but it is less dangerous, and
a matter of less consequence, when the fissure has been effaced. But
if the fracture extend deep, and do not seem likely to disappear when
scraped, such an accident requires trepanning. But having performed
this operation, you must apply the other treatment to the wound.
15. You must be upon your guard lest the bone sustain any injury from
the fleshy parts if not properly treated. When the bone has been sawed
and otherwise denuded, whether it be actually sound, or only appears
to be so, but has sustained some injury from the blow, there may be
danger of its suppurating (although it would not otherwise have done
so), if the flesh which surrounds the bone be ill cured, and become
inflamed and strangled; for it gets into a febrile state, and becomes
much inflamed.[804] For the bone acquires heat and inflammation from
the surrounding flesh, along with irritation and throbbing, and the
other mischiefs which are in the flesh itself, and from these it
gets into a state of suppuration. It is a bad thing for the flesh
(_granulations?_) in an ulcer to be moist and mouldy, and to
require a long time to become clean. But the wound should be made to
suppurate as quickly as possible; for, thus the parts surrounding the
wound would be the least disposed to inflammation, and would become
the soonest clean; for the flesh which has been chopped and bruised by
the blow, must necessarily suppurate and slough away. But when cleaned
the wound must be dried, for thus the wound will most speedily become
whole, when flesh devoid of humors grows up, and thus there will be no
fungous flesh in the sore. The same thing applies to the membrane which
surrounds the brain: for when, by sawing the bone, and removing it from
the meninx, you lay the latter bare, you must make it clean and dry as
quickly as possible, lest being in a moist state for a considerable
time, it become soaked therewith and swelled; for when these things
occur, there is danger of its mortifying.[805]
16. A piece of bone that must separate from the rest of the bone,
in consequence of a wound in the head, either from the indentation
(_hedra_) of a blow in the bone, or from the bone being otherwise
denuded for a long time, separates mostly by becoming exsanguous.
For the bone becomes dried up and loses its blood by time and a
multiplicity of medicines which are used; and the separation will take
place most quickly, if one having cleaned the wound as quickly as
possible will next dry it, and the piece of bone, whether larger or
smaller. For a piece of bone which is quickly dried and converted, as
it were, into a shell, is most readily separated from the rest of the
bone which retains its blood and vitality; for, the part having become
exsanguous and dry, more readily drops off from that which retains its
blood and is alive.[806]
17. Such pieces of bone as are depressed from their natural position,
either being broken off or chopped off to a considerable extent, are
attended with less danger, provided the membrane be safe; and bones
which are broken by numerous and broader fractures are still less
dangerous and more easily extracted.[807] And you must not trepan any
of them, nor run any risks in attempting to extract the pieces of
bone, until they rise up of their own accord, upon the subsidence of
the swelling. They rise up when the flesh (_granulations_) grows
below, and it grows from the diploe of the bone, and from the sound
portion, provided the upper table alone be in a state of necrosis.
And the flesh will shoot up and grow below the more quickly, and the
pieces of bone ascend, if one will get the wound to suppurate and make
it clean as quickly as possible. And when both the tables of the bone
are driven in upon the membrane, I mean the upper and lower, the wound,
if treated in the same way, will very soon get well, and the depressed
bones will quickly rise up.[808]
18. The bones of children are thinner and softer, for this reason,
that they contain more blood [than those of adults]; and they are
porous and spongy, and neither dense nor hard. And when wounded to
a similar or inferior degree by weapons of the same or even of an
inferior power, the bone of a young person more readily and quickly
suppurates, and that in less time than the bone of an older person; and
in accidents, which are to prove fatal, the younger person will die
sooner than the elder. But if the bone is laid bare of flesh, one must
attend and try to find out, what even is not obvious to the sight, and
discover whether the bone be broken and contused, or only contused; and
if, when there is an indentation in the bone, whether contusion, or
fracture, or both be joined to it; and if the bone has sustained any of
these injuries, we must give issue to the blood by perforating the bone
with a small trepan, observing the greatest precautions, for the bone
of young persons is thinner and more superficial than that of elder
persons.[809]
19. When a person has sustained a mortal wound on the head, which
cannot be cured, nor his life preserved, you may form an opinion of
his approaching dissolution, and foretell what is to happen from the
following symptoms which such a person experiences.[810] When a bone
is broken, or cleft, or contused, or otherwise injured, and when by
mistake it has not been discovered, and neither the raspatory nor
trepan has been applied as required, but the case has been neglected
as if the bone were sound, fever will generally come on before the
fourteenth day if in winter, and in summer the fever usually seizes
after seven days. And when this happens, the wound loses its color,
and the inflammation dies in it; and it becomes glutinous, and appears
like a pickle, being of a tawny and somewhat livid color; and the
bone then begins to sphacelate, and turns black where it was white
before, and at last becomes pale and blanched. But when suppuration
is fairly established in it, small blisters form on the tongue and he
dies delirious. And, for the most part, convulsions seize the other
side of the body; for, if the wound be situated on the left side, the
convulsions will seize the right side of the body; or if the wound be
on the right side of the head, the convulsion attacks the left side of
the body.[811] And some become apoplectic. And thus they die before the
end of seven days, if in summer; and before fourteen, if in winter.
And these symptoms indicate, in the same manner, whether the wound be
older or more recent. But if you perceive that fever is coming on, and
that any of these symptoms accompany it, you must not put off, but
having sawed the bone to the membrane (_meninx_), or scraped it
with a raspatory, (and it is then easily sawed or scraped,) you must
apply the other treatment as may seem proper, attention being paid to
circumstances.[812]
20. When in any wound of the head, whether the man has been trepanned
or not, but the bone has been laid bare, a red and erysipelatous
swelling supervenes in the face, and in both eyes, or in either of
them, and if the swelling be painful to the touch, and if fever and
rigor come on, and if the wound look well, whether as regards the flesh
or the bone, and if the parts surrounding the wound be well, except the
swelling in the face, and if the swelling be not connected with any
error in the regimen, you must purge the bowels in such a case with a
medicine which will evacuate bile; and when thus purged the fever goes
off, the swelling subsides, and the patient gets well. In giving the
medicine you must pay attention to the strength of the patient.[813]
21. With regard to trepanning, when there is a necessity for it, the
following particulars should be known. If you have had the management
of the case from the first, you must not at once saw the bone down to
the meninx; for it is not proper that the membrane should be laid bare
and exposed to injuries for a length of time, as in the end it may
become fungous. And there is another danger if you saw the bone down to
the meninx and remove it at once, lest in the act of sawing you should
wound the meninx. But in trepanning, when only a very little of the
bone remains to be sawed through, and the bone can be moved, you must
desist from sawing, and leave the bone to fall out of itself.[814] For
to a bone not sawed through, and where a portion is left of the sawing,
no mischief can happen; for the portion now left is sufficiently thin.
In other respects you must conduct the treatment as may appear suitable
to the wound. And in trepanning you must frequently remove the trepan,
on account of the heat in the bone, and plunge it in cold water. For
the trepan being heated by running round, and heating and drying the
bone, burns it and makes a larger piece of bone around the sawing to
drop off, than would otherwise do. And if you wish to saw at once down
to the membrane, and then remove the bone, you must also, in like
manner, frequently take out the trepan and dip it in cold water. But if
you have not charge of the treatment from the first, but undertake it
from another after a time, you must saw the bone at once down to the
meninx with a serrated trepan,[815] and in doing so must frequently
take out the trepan and examine with a sound (specillum), and otherwise
along the tract of the instrument.[816] For the bone is much sooner
sawn through, provided there be matter below it and in it, and it often
happens that the bone is more superficial,[817] especially if the
wound is situated in that part of the head where the bone is rather
thinner than in other parts. But you must take care where you apply the
trepan, and see that you do so only where it appears to be particularly
thick, and having fixed the instrument there, that you frequently make
examinations and endeavor by moving the bone to bring it up. Having
removed it, you must apply the other suitable remedies to the wound.
And if, when you have the management of the treatment from the first,
you wish to saw through the bone at once, and remove it from the
membrane, you must, in like manner, examine the tract of the instrument
frequently with the sound, and see that it is fixed on the thickest
part of the bone, and endeavor to remove the bone by moving it about.
But if you use a perforator (_trepan?_), you must not penetrate to
the membrane, if you operate on a case which you have had the charge of
from the first, but must leave a thin scale of bone, as described in
the process of sawing.
END OF VOL. I.
EXPLANATION OF THE PLATES TO VOL. I.
[Illustration: PLATE I.
FIG. 1. The Saw used by carpenters. (Taken from
_Chirurgia è Græco in Latinum conversa, Vido Vidio interprete
Lutetiæ Parisiorum_, p. 115.)
2. A small Saw. (_Ibid._)
3. The Modiolus, _or_ ancient Trephine. (_Ibid._)
4. The Terebra, _or_ Trepan, called Abaptiston.
(_Ibid._ p. 116.)
5. The Auger used by carpenters. (_Ibid._ p. 116.)
6. The Terebra, _or_ Trepan, which is turned round by a
thong bound tight about its middle. (_Ibid._ p. 117.)
7. The Auger, _or_ Trepan, which is turned round by a bow.
(_Ibid._ p. 118.)
8. A Terebra, _or_ Trepan, which is turned round by a
thong on a cross-beam. (_Ibid._ p. 119.)
9. A Terebra, _or_ Trepan, which has a ball in its upper
end, by which it is turned round. (_Ibid._ p. 120.)
10. A Terebra, _or_ Trepan, which is turned round by
a cross piece of wood, _or_ handle, on its upper end.
(_Ibid._ p. 120.)]
[Illustration: PLATE II.
FIG. 1. A Terebra, _or_ Trepan, turned round by a
handle in its middle. (_Ibid._ p. 122.) It resembles the
centre-bit of modern artisans.
1. A hole into which the iron head is fixed.
2. Upright part, three inches long.
3. Cross part, one inch long.
4. The part which is grasped in turning the instrument.
5. Cross part, an inch long.
6. Upright part.
7. A ball fixed to the top.
A. B. C. Different forms of the iron head fixed in the hole 1.
FIG. 2. Scalper rectus, _or_ straight Raspatory.
(_Ibid._ p. 123.)
3. Scalper in medio recurvatus, _or_ bent Raspatory.
(_Ibid._ p. 123.)
4, 5, 6. Ancient Modioli, as represented by Pott (_Injuries
of the Head_, p. 153).]
[Illustration: PLATE III.
FIGS. 1 and 2. A Scalper, _or_ Raspatory, with
which the moderns scrape the bone. (_Chirurgia è Græco,
&c._, p. 125.)
3. Scalper cavus _or_ scooped Raspatory. (_Ibid._ p.
126.)
4. A Lenticular. (_Ibid._ p. 127.)
5. A Malleolus, _or_ Mallet. (_Ibid._ p. 126.)
6. A Lever, by which modern surgeons protect the dura mater,
and raise a depressed bone. (_Ibid._ p. 128.)
7. The ancient Meningophylax. (_Ibid._ p. 128.)
8. Forfex excisoria, _or_ Cutting Scissors. (_Ibid._
p. 129.)
9. A Forceps, used for extracting bones. (_Ibid._ p. 130.)]
FOOTNOTES:
[1] It is necessary to inform my readers in this place, that, owing to
its bulk, it has been judged expedient by the Council of the Sydenham
Society to divide the work into two separate parts or volumes.
[2] This is the view which is taken regarding the origin of Grecian
medicine by Schulze, in his Historia Medicinæ. He is a most learned and
trustworthy authority on the history of medicine, but in the present
instance his judgment is biassed by the opinion which was generally
held in his age with respect to the origin of Grecian philosophy. At
that time it was customary to follow the later Platonists in tracing
the rise of philosophy to Egypt. Lord Monboddo, in his work on Ancient
Metaphysics, strongly espouses this opinion, which, in fact, was the
established belief of learned men down to a late period. Kant advocated
the views which are here adopted.
[3] See in particular the introductory chapters to Ritter’s History of
Ancient Philosophy; Thirlwall’s History of Greece, c. xii.; Grote’s
History of Greece, P. I., c. xvii. The opinion now generally held on
this subject may be explained in few words. The Homeric poems are
beyond all doubt of Grecian origin, for it cannot be shown that the
ancient Egyptians or Babylonians had anything resembling a regular
epos. Now, as Mr. Grote well observes, “from the poetry of Homer to
the history of Thucydides, and the philosophy of Plato and Aristotle,
was a prodigious step, but it was the native growth of the Hellenic
youth into the Hellenic man, and what is of still greater moment, it
was brought about without breaking the thread either of religious or
poetic tradition--without any coercive innovation or violent change in
the mental feelings. The transition of Grecian mind from its poetical
to its comparatively positive state was self-operated, and accomplished
by its own inherent and expansive force--aided indeed, but by no means
either impressed or provoked, from without.”--L. c.
[4] Plato, Menex.
[5] Celsus mentions Pythagoras, Empedocles, and Democritus, as the most
distinguished of the philosophers who cultivated medicine.--Præfat.
[6] “Hippocrates primus ab studio sapientiæ disciplinam hanc
separavit.”--Præfat.
[7] See the authorities quoted at PAULUS ÆGINETA, Vol. I.,
p. 73, Syd. Soc. edition; also in particular Xenophon’s Memorabilia,
iii., 13; and Pausanias, ii., 2. The most complete list which is
anywhere given of the ancient Asclepia, is that contained in Schulze’s
History of Medicine, i., 24. It is to be regretted, however, that the
references to Pausanias are made according to the pages of an old
edition, instead of books and chapters, so that one experiences some
difficulty in finding the passages referred to. The number of Asclepia
in Greece noticed by him is sixty-four. Plutarch states in positive
terms that all the Temples of Health were erected in high situations,
and where the air was wholesome.--(Quæst. Rom.) On the practice of
medicine in the Ancient Temples of Health, see further Sprengel, Hist.
de la Méd., e. v. Sprengel, however, does not acknowledge so candidly
as he ought to have done his obligations to his predecessor Schulze.
[8] Philostratus, Vita Apollonii, i., 9; Strabo, Geogr., xiv.
[9] Pausanias, vii., 21.
[10] This I have reason to know is the belief of the learned and
estimable author of the Isis Revelata.
[11] Aristides, Orat. in Æsculap., viii. It may be proper to state
that Sprengel, in referring to this passage (Hist. de la Méd., p. 160.
French edition), falls into the mistake of saying that these medicines
were prescribed to Aristides himself.
[12] Galen, de Administ, Anatom., ii.
[13] Censura Operum Hippocrat., p. 184.
[14] Hist. de la Méd., i., 5, p. 175, French edit. Schulze, in like
manner, depreciates the anatomical knowledge of the Asclepiadæ, and
holds that it had been overrated by Galen.--Hist. Med., i., 2, 5.
[15] Comment, in Libr. de Artie, iii., 28; de Decret. Hippocrat. et
Platon., viii., I.
[16] Polit., iii., 399; ed. Tauchnitz.
[17] Geograph., xiv., 2.
[18] De Sanitate tuenda, i.
[19] L. c.
[20] Galen, Opera, tom. iv., ed. Basil, 35.
[21] Aristotle, Polit., vii., 4. Notwithstanding the high compliment
which Aristotle here pays to the professional reputation of
Hippocrates, there can be no doubt that he does not always make proper
acknowledgment for the many obligations which he lies under to the Coan
sage. Galen states repeatedly that the greater part of Aristotle’s
physiology is derived from Hippocrates.
[22] See some ingenious observations on these mythical genealogies
in Grote’s History of Greece., vol. i., p. 593. He holds that they
are altogether unworthy of credit, or at least that there is no test
whereby one can separate the true from the false in them. Clinton,
indeed, in his Fasti Hellenici, attaches more importance to them; but
apparently Mr. Grote’s judgment on them is perfectly just. See further
vol. ii., p. 53, etc.
[23] Noctes Atticæ, xvii., 21.
[24] That Hippocrates drew the rudiments of his medical knowledge from
the reports of cases collected in the Asclepion of Cos, is attested by
good authorities. See Strabo, Geogr., xiv.; Pliny, H. N., xxix., 2.
[25] On the introduction of the gymnastic exercises into the practice
of medicine, see Schulze, Hist. Med., i., 2, 8. The author of the VI.
Epidem. condemns Herodicus for using exercises in the treatment of
acute diseases. Herodicus is frequently mentioned in the Dialogues of
Plato. See Protagoras, § 20; and de Repub., iii. Plato says, that being
in ill health, he wore out first himself and afterwards many others, by
combining gymnastics with medicine.
[26] Somnus alludes to this fiction, and quotes Andreas as an authority
for it. See also Pliny, H. N., xxix., 2. Tzetzes calls it the Temple of
Cos, and not of Cnidos, which was burned.
[27] See Plato, Protagoras.
[28] Galen, Comment. in Libr. de Nat. Human.
[29] Suidas in voce Hippocrates.
[30] It was a common practice in ancient times to kindle great fires
as _disinfectants_ or _deodorizers_. We have entered pretty
fully upon this subject in our Commentary on PAULUS ÆGINETA,
Vol. I., p. 274. There can be no doubt that it was the established
practice of the profession in the days of Hippocrates. The names of
Acron, Empedocles, and Hippocrates are particularly famous as having
successfully adopted the practice. See Aëtius, v., 94; Paulus Ægineta,
l. c.; Pliny, H. N., xxxvi., 69; and Plutarch, De Iside et Osiride.
[31] Hist., iii., 87.
[32] It deserves to be mentioned further, as adding probability to the
present narrative, that it was quite common in ancient times for the
Asclepiadæ to be publicly consulted by cities and States respecting the
general health of the inhabitants, and this both for the prevention and
cure of diseases. See Aristid. Opera, i., p. 81.
[33] Galen, in many parts of his works, alludes to the professional
services of Hippocrates during the great plague described by
Thucydides. He mentions decidedly that Thucydides gives only
those symptoms which would strike a common, that is to say, a
non-professional man; whereas Hippocrates describes the disease
accurately like a professional man, but gives few of those symptoms
which appeared most interesting to Thucydides.--De Difficult. Respir.,
ii., 7.
[34] Thucydides mentions that the mortality of the plague was greatly
aggravated by the influx of the people from the country into the city,
and the crowding of them in ill-ventilated huts. (ii., 52.) Mitford,
in describing the plague of Athens, remarks that the want of sewers
in ancient times must have contributed very much to the severity of
the disease. (Hist. of Greece, vol. ii., p. 195.) He refers (l. c.) to
Strabo (Geogr. v.) for proof that the Romans were the first people who
constructed sewers.
[35] See Xenophon, Cyropæd., i. and viii.
[36] Galen, Comment in libr. de Artic. iii.
[37] Xenophon, Anabasis, i. It has never been clearly determined
whether he was in the suite of Artaxerxes the king, or of his brother
Cyrus, before the battle of Cunaxa, in which the latter was killed,
and the former being severely wounded, was attended professionally by
Ctesias. Diodorus Siculus, indeed, says decidedly that he was taken
prisoner on the occasion. (Bibl. ii., 32.) But we are certain, from the
authentic narrative of Xenophon, that he was not taken prisoner in the
battle, nor is it likely that he was one of those who were kidnapped
afterwards, otherwise the historian would certainly not have omitted
the name of so distinguished a personage. Besides, had he been brought
to Babylon in this way, as a captive, Artaxerxes was not likely to
have intrusted his royal life to a person who had been so lately the
professional attendant on his rebel brother.
[38] See Thucyd., ii., 48.
[39] De Prisca Medicina.
[40] See in the next section, under xxiii. Though I have not admitted
the treatise here referred to into the list of genuine works, it will
be seen below that it possesses considerable evidence in its favor, and
that beyond doubt it is very ancient.
[41] Aphor., I., 1.
[42] See Galen, Opera, tom. v., p. 488; ed. Basil.
[43] This is clearly defined and stated by Aristotle, Phys., i. See
also Boethius in Præd., p. 113; ed. Basil.
[44] This is the more remarkable, as it does not appear to have been
the established creed of the greatest literary men and philosophers
of the age, who still adhered or professed to adhere to the popular
belief in the extraordinary interference of the gods with the works of
Nature and the affairs of mankind. This at least was remarkably the
case with Socrates, whose mind, like that of most men who make a great
impression on the religious feelings of their age, had evidently a deep
tinge of mysticism. See Xenoph. Memor., i., 1, 6–9; Ibid. iv., 7, 7;
also Grote’s History of Greece, vol. i., p. 499. The latter remarks,
“Physical and astronomical phenomena are classified by Socrates among
the divine class, interdicted to human study.” (Mem., i. 1, 13.) He
adds, in reference to Hippocrates, “On the other hand, Hippocrates,
the contemporary of Socrates, denied the discrepancy, and merged into
one the two classes of phenomena--the divine and the scientifically
determinable,--which the latter had put asunder. Hippocrates treated
all phenomena as at once both divine and scientifically determinable.”
(p. 499.) He then quotes the memorable passage in the treatise “On
Airs,” etc. It does not appear, however, that in ancient times the
charge of Atheism was ever brought against him. It has been urged
against him by modern fanatics, but scarcely deserves a serious
refutation. See Schulze (Hist. Med., i., 3, 2), and Ackerman (Hist.
Lit. Hippocr., pp. xii, xiii; ed. Kühn). By such persons, whoever does
not join in their anthropomorphical notions of a first cause is held up
for an Atheist.
[45] For the medicine of the ancient Jews, Egyptians, and Babylonians,
see the introductory chapters of Sprengel’s Hist. de la Méd. The
medicine of the Hindoos, as given in the “Susruta” of D’Hanvantare,
abounds in superstitious practices.
[46] Epidem., vi.
[47] Epidem., i.
[48] De Diæta in Morb. Acut., Prognost., 15. See the argument to the
Appendix to the former work.
[49] See Galen, Oper. tom. v., p. 106; ed. Basil.
[50] See De Morbis, pluries; de Prisca, Med., 22.
[51] De Superfœt. et pluries.
[52] De Ratione Victus in Acut. There is some doubt, however, whether
the σκαμμώνιον of Dioscorides be the _Convolvulus scammonia_. Some
rather take it for the _C. sagittifolius_.
[53] De Superfœt. et alibi.
[54] De Morb. Mulier.
[55] De Fract., Aphor. et alibi.
[56] Galen, Meth. Med., v., 3; Comment. in Libr. de Humor. See further
in illustration, Œconom. Hippocrat. under Παροχετεύειν and 'Αντίσπασις;
and Schulze, Hist. Med., i., 3, 4, 10.
[57] See Epidem., i, and iii.; Aphor., i., 16; and De Diæta Acutor.,
passim.
[58] See de Morbis, ii.; and Le Clerc, Hist. Med., 1, 3, 20.
[59] See the work “On the Articulations,” pluries.
[60] See in particular Venesect. adv. Erasistrat., Comment. in Lib. de
Offic. Medic.
[61] De Dyspn., ii., p. 181; ed. Basil. This brevity of style, Galen,
in another passage of the same work, pronounces to be characteristic
of all the old writings. In fact, when the materials of writing were
scarce and dear, it is not likely that authors would indulge in an
extravagant use of them.
[62] Coray, Traité de Hippocrat. des Airs, etc., Discours préliminaire,
pp. l., lvii.
[63] Dionysius Halicarnassensis de iis quæ Thucyd. propria sunt, et de
Platon. judicium.
[64] Opus supra laudatum, p. clxxiv.
[65] See the editions of Horace by Bentley and Tate, pluries.
[66] See in Bentley’s Horace. The poet himself in several of his
pieces, alludes to the separate publication of the various books, as
i., 97; vi., 1; ii., præfat.; et pluries.
[67] See Middleton’s Life of Cicero, pluries.
[68] See the editions by Ast, Bekker, and Stallbaum, and the ancient
authorities there referred to.
[69] See the preliminary dissertation prefixed to Buhle’s edition; also
Schneider’s edition of the Historia Animalium, Epimetrum iii.
[70] He mentions, in his commentary on the treatises entitled
“On Regimen in Acute Diseases,” that, from the marks of confused
arrangement about it, he was persuaded the author had left it in an
unfinished state, and that it had been published after his death. See
Opera, tom. v., p. 70; ed. Basil.
[71] See Galen, de Crisibus, i., 6.
[72] Galen, Gloss., tom. v., p. 705; ed. Basil. As frequent mention of
the commentators will occur in the course of this work, I will here
subjoin a complete list of them, with a few brief notices of them,
more especially of a chronological nature, derived principally from
the following sources: Ackerman, Bibliotheca Græca; Dietz, Præfatio
in Scholia Apollonii, etc.; Littré, Op. Hippocrat., tom. i., pp.
80–132; Daremberg, Cours sur l’Histoire et la Littérature des Sciences
Médicales.
Herophilus, the famous anatomist of Alexandria; flourished
about from 310–280 A.C.
Xenocrates of Cos, quoted by Erotian as an authority on the
Prognostics; nearly contemporary with Herophilus.
Philinus of Cos, contemporary with Herophilus, and probably a
disciple.
Bacchius, contemporary with Philinus.
Glaucias immediately after Bacchius; flourished probably
between 290–260 A.C.
Zeuxis the Empiric, immediately after Glaucias and before Zeno;
probably from 270–240 A.C. See Daremberg.
Heraclides Tarentinus, somewhat later than Bacchius, probably
between 260–240 A.C.
Zeno the Herophilean, the contemporary and rival of Heraclides;
probably the same as Zeno of Laodicea.
Apollonius Biblas, the contemporary and rival of Zeno.
Callimachus, according to Daremberg, an immediate disciple of
Herophilus.
Epiceleustus of Crete, of uncertain date.
Apollonius Ophis, of uncertain date.
Lysimachus of Cos, uncertain.
Euphorion, uncertain.
Heraclides the Erythrean, rather uncertain; but, according to
Daremberg, a contemporary with Heraclides Tarentinus. The same
as Heraclides the Herophilean. (Strabo, Geogr., xiv.)
Epicles, uncertain.
Eurycles, uncertain.
Philonides of Sicily, uncertain.
Ischomachus, uncertain.
Cydias, uncertain.
Cinesias, uncertain.
Demetrius, the Epicurean.
Diagoras, uncertain.
Nicander the Poet of Colophon, from 150–120 A.C.
Apollonius Citiensis; Daremberg places him between 80–52
A.C. See also Dietz and Littré.
Asclepiades of Bithynia, contemporary with Pompey the Great;
about 60–40 A.C.
Thessalus, the famous Methodist; about 50–70 P.C.
Erotian flourished in the reign of Nero, from 50–70
P.C. His Glossary still preserved.
Sabinus, of uncertain date, but probably not long anterior to
Galen, by whom he is frequently quoted. (Op., tom. v., p. 433.)
Metrodorus, disciple of Sabinus.
Rufus _or_ Ruffus Ephesius, contemporary with Sabinus.
Several of his works remain, but no portion of his Commentaries
on Hippocrates.
Marinus, the celebrated anatomist, about the beginning of the
second century P.C.
Quintus, the Empiric, probably about from 110–130 P.C.
Lycus, the Macedonian, the disciple of Quintus; from 120–140
P.C. See Daremberg.
Lycus, of Naples, date rather uncertain.
Artemidorus, a favorite of the Emperor Hadrian; often blamed
by Galen for his alterations of the text; about 120–140
P.C.
Dioscorides (_not_ the author of the Materia Medica), an
associate of Artemidorus.
Numesianus, somewhat later than Dioscorides.
Dionysius, about the time of the last.
Pelops, the disciple of Numesianus.
Satyrus, the disciple of Quintus.
Phecianus, the disciple of Quintus.
Julian the Alexandrian, the immediate predecessor of Galen, who
frequently animadverts on his writings.
GALEN, flourished between 150–190 P.C.;
wrote Commentaries, still in existence, on the following
works:--On the Nature of Man; on Regimen in Health; on Regimen
in Acute Diseases; on the Prognostics; on the First Book of the
Prorrhetics; on the Aphorisms; on the First, the Third, and the
Sixth Books of the Epidemics; on the Treatise on Fractures; on
the Articulations; on the Physicians’ Establishment or Surgery;
on the Humours; fragments of the Commentaries on Airs, Waters,
Places, and on the Aliment. Besides these, he wrote several
other Commentaries, which are lost.
Domnus, of uncertain date, after Galen.
Attalion, like the last, cited in the Commentary attributed to
Oribasius.
Philagrius, of uncertain date, quoted by Theophilus.
Gesius, of uncertain date.
Asclepius, of uncertain date, quoted by Theophilus. (Dietz,
tom. ii., p. 458.)
Stephanus, the Athenian, supposed by Dietz to have lived in the
reign of Heraclius, that is to say, in the earlier part of the
seventh century. According to Dietz, not the same as Stephanus
Alexandrinus.
Palladius, probably about the seventh century; his Commentary
on the book “On Fractures,” published by Foës, and a
considerable portion of his Commentary “On the Sixth Epidemic,”
by Dietz.
Joannes Alexandrinus, probably near the time of Palladius; part
of his Commentary “On the Nature of the Young Man,” published
by Dietz.
Theophilus, or Philotheus, surnamed Protospatharius, probably
flourished in the seventh century P.C. See the
Annotations of Dr. Greenhill, in his excellent edition of the
work “De Corporis Humani Fabrica;” Oxford, 1842. Several of his
Commentaries on the Aphorisms, published by Dietz.
Meletius, of uncertain date; part of his Commentaries on the
Aphorisms, published by Dietz. See also Anec. Gr., ed. Cramer.
Damascius, of uncertain date; a few of his Commentaries on the
Aphorisms, published by Dietz.
[73] Œuvres d’Hippocrat., tom. i., p. 171.
[74] See Schulze, Hist. Med., i., 3, 1.
[75] It will be proper to give this Class:--
1. De Aëre, Aquis, et Locis.
2. De Natura Hominis.
3. De Locis in Homine.
4. De Humoribus.
5. De Alimento.
6. De Morbis popularibus.
7. Prognosticon.
8. Prædictionum, ii.
9. De Victu Acutorum.
10. De Fracturis.
11. De Articulis.
12. Mochlicus.
13. De Vulneribus Capitis.
14. Officina Medici.
15. Aphorismi.
[76] Censura Librorum Hippocrateorum, Vratislaviæ, 1772.
[77] De Elementis, i., 9.
[78] Tom. v., p. 442; ed. Basil.
[79] Galen, who is a most unexceptionable judge in such a case, says
that the language of Hippocrates inclines to the Attic, and that some
had held it to be Old Attic. (Tom. v., p. 525; ed. Basil.) Dionysius
of Halicarnassus, another admirable critic, says that Herodotus is the
most excellent standard of the Ionic (and so, by the way, Photius also
says, under the head of _Ctesias_) and Thucydides of the Attic.
(De Platon. Judicium.) Now, since we have already made it appear that
there is a most striking similarity between the language of Hippocrates
and Thucydides, the judgment of Dionysius is evidently in accordance
with that of Galen on this point. Indeed, as briefly stated in the
text, the Attic was nothing more than a new development of the Ionic,
and scarcely more different from it than the English language in the
age of Pope is from the same in the age of Milton. It is to be borne
in mind that the name Ionian was originally applied to the Thracians
and the inhabitants of Attica, who were evidently closely allied to
one another in consanguinity. It was in Thrace that learning and
civilization first sprang up under the auspices of Thamyris, Orpheus,
and Musæus, by whom the elegant arts were transplanted to Athens.
(See Hesychius, in voce Iones; Eustathius, ad Iliad., ii.; Diogenes
Laertius, _Prœfat_.; also Hermes Philologus, p. 23, by the author
of this disquisition, whose mind now reverts with great delight, _ad
studia quæ adolescentiam alebant_.) The inhabitants of Asiatic Ionia
and the adjoining islands were colonists from Attica. (Thucyd., i.,
12; Herodotus, viii., 44; Heraclides, de Polit.) From what has been
stated it will readily be understood that the only standard of polite
Greek was the Ionic, with its offspring the Attic. The Æolic and Doric
dialects, although used in certain scientific and popular compositions,
such as Bucolics and certain philosophical treatises, were never looked
upon as being fashionable and learned dialects.
[80] De Artic., i.
[81] See his Historia Literaria Hippocratis, in the Bibliotheca Græca
of Albertus Fabricius, or in vol. i. of Kühn’s edition of Hippocrates.
[82] Galen, tom. v., p. 17; ed. Basil.
[83] Apologie, etc.
[84] Hippocratis nomine quæ circumferuntur scripta ad temporis rationes
disposuit Christianus Petersen, p. prior. Hamburgi, 1839.
[85] Prædict., i.; Coacæ Prænot.; de Loc. in Hom.
[86] De Carne.; de Part. Sept.; de Part. Oct.; de Superf.; de Dent.
[87] De Flat.
[88] De Morb. Popul., i., iii.; de Morb., i.; de Affect.; de Morbo
Sacro; de Insan.; de Veratr. Usu; de Victu Acut.; de Victu Sal.; Præn.;
Prædict., ii.; Aphor.; de Aëre, Locis, et Aq.; de Insom.; de Hæmorrh.;
de Fistul.
[89] De Nat. Puer.
[90] De Prisca Med.
[91] De Nat. Hom.; de Humor.; de Nat. Oss.; de Corde; de Corp. Sect.;
de Gland.; de Visu; de Alim.; de Usu Liquid.; de Affect. Intern.; de
Morb. Popul., ii., iv., etc.; de Morb., ii., iii.; de Morb. Mulier.; de
Nat. Mulieb.; de his quæ ad Virg. Spect.; de Steril.; de Vulner.; de
Judic.; de Dieb. Judic.
[92] De Morb., iv.; de Genitura; de Remed. Purgant.
[93] De Victu Sanor. libri tres.
[94] Tom. ii., pp. 32, 33.
[95] Œuvres d’Hippocrate, tom. i., p. 263.
[96] See Stephanus, Comment. in Prognost. Hippocrat., tom. ii., p. 61,
ed. Dietz.; and Galen, tom. v., p. 328, ed. Basil.
[97] The well known story regarding the concealment of Aristotle’s
library by his heir, Neleus of Scepsis, and its restoration by
Apellicon, is faithfully related by Strabo, Geograph., ix. In this
passage Strabo states, that before the restoration of the library by
Apellicon, there were but few of Aristotle’s works in the hands of the
peripatetic philosophers, and these principally his exoteric works. But
that the treatise “On the History of Animals” was an exoteric work, can
admit of no question. This is confidently maintained by the learned
Schneider in the prolegomena to his edition of this work. Indeed, as
he suggests, there is no good reason for doubting that the treatise
“On the History of Animals” had been published by Aristotle in his
lifetime. (Epimetrum, ii.) See also Buhle’s dissertation prefixed to
his edition of Aristotle’s works. I need scarcely add that, it being
thus shown that all the most learned authorities on the literature of
Aristotle’s works are agreed that the History of Animals, in which is
contained this disputed fragment on the veins, was published before the
time when the Hippocratic Collection is supposed to have been made, M.
Littré’s conclusions on this head must fall to the ground.
[98] The death of Aristotle is referred to A.C. 321. Now
this is just about the date of the foundation of the Royal Library at
Alexandria, and very near the age when Herophilus flourished. These (M.
Littré’s) positions clearly made out, it would follow that the dates of
the treatises in the Collection come down very near to the foundation
of the Alexandrian Library.
[99] See Hengstenberg’s Commentary on the Psalms, pluries.
[100] Although this piece be admitted into the first class, it also
merits a place here.
[101] Prænotiones or Prognostica; Aphorismi; Epidemiorum, i., iii.; de
Diæta Acutorum; de Aëre, Aquis, et Locis; de Capitis Vulneribus.
[102] De Prisca Medicina; de Articulis; de Fracturis; Mochlicus;
Jusjurandum; Lex; de Ulceribus; de Fistulis; de Hæmorrhoidibus; de
Officina Medici; de Morbo Sacro.
[103] Prorrhetica, i.; Coacæ Prænotiones.
[104] De Natura Hominis; de Salubri Victus Ratione; de Natura Muliebri;
de Morbis, ii., iii.; de Superfœtatione.
[105] De Flatibus; de Locis in Homine; de Arte; de Diæta; de Insomniis;
de Affectionibus; de Internis Affectionibus; de Morbis, i.; de
Septimestri Partu; de Octimestri Partu; Epidemiorum, ii., iv., vii.; de
Humoribus; de Usu Liquidorum.
[106] Epistolæ; Thessali Legati Oratio; Oratio ad Aram; Atheniensium
Senatus-Consultum.
[107] De Genitura; de Natura Pueri; de Morbis, iv.; de Mulierum Morbis;
de Virginum Morbis; de Sterilibus.
[108] Epidemiorum, v., vii.; de Corde; de Alimento; de Carnibus; de
Septimanis; de Natura Ossium; de Glandulis; de Medico; de Decenti
habitu; Præceptiones; de Anatomia; de Dentitione; de Exsectione Fœtus;
de Visu; de Crisibus; de Diebus Criticis; de Medicamentis Purgativis.
[109] Hippocrat. Coi Comment. etc., Theod. Zuingeri studio. Basil, 1579.
[110] See his additions to Ackerman’s Dissertation, in his edition of
the Works of Hippocrates.
[111] § 122, tom. i., p. 172 (ed. Bekker), where see the note of
Heindorf.
[112] Galeni Opera, tom. v., pp. 2, 16; ed. Basil.
[113] Œuvres Complètes, etc., tom. i., p. 320.
[114] The argument turns principally on the meaning of the expression,
τι πότε λέγει Ἱπποκράτης τε καὶ ὁ ἀληθὴ λόγος, which M. Littré contends
signifies, “ce qu’Hippocrate et la raison _pourraient dire_.”
Now I must say that, to me, the words of Plato here quoted do not
warrant the interpretation which M. Littré puts upon them; and, not
satisfied with my own judgment on this point, which happens in the
present instance to be an important one, I applied to one of the best
authorities in Britain on the minutiæ of the Greek language for his
opinion, and was happy to find that it entirely corresponded with my
own. Having alluded in the text to the prolixity of the discussion
which M. Littré enters into on this occasion, I trust that eminent
scholar will not be offended (provided these pages ever meet his eyes)
if I introduce here an anecdote of the celebrated Kuster. Having been
shown a work in which the quantity of argumentation and reflection
greatly over-balanced the amount of facts and references, he laid it
aside with the remark, “I find nothing here but reasoning: _non sic
itur ad astra_.”
[115] Galeni Opera, tom. v., p. 119; ed. Basil.
[116] Comment. vii.; et sect. vii., 53 et seq.
[117] See under _Hippocrates_ in Smith’s Greek and Roman
Biographical and Mythological Dictionary.
[118] “In all paroxysms, or sharp fits of intermitting diseases, we
must take away meat, for then to give it is hurtful.”
[119] “The belly is naturally hottest in winter and the spring,
and most addicted to rest. Consequently in these seasons a greater
proportion of food is to be allowed, because the inward heat is
stronger, which is the reason that a more plentiful food is necessary.
This difference may be seen in such as are old, and in such as are
lusty and well-grown bodies.”
[120] “Those things that are or have been justly determined by nature,
ought not to be moved or altered, either by purging or other irritating
medicines; but should be left alone.”
[121] “Things evacuated and purged are not to be estimated by the
multitude and quantity, but by their fitness to be avoided and sent
forth; and must be such as are not too troublesome to the patient to
bear. Though, where it is necessary, we must proceed in evacuating,
even to swooning and fainting, if the patient can bear it.”
[122] “Those who are grieved in any part of the body, and are scarce
sensible of their grief, have a distempered mind.”
[123] “When the upper parts of the throat or gullet are sore, or a
breaking out of small tumours does arise in the body, we ought to look
upon the excrements; for if they are choleric, the body is also sick;
but if they are like the excrements of sound persons, the body may be
nourished without danger.”
[124] “When that which ought to be evacuated is discharged by
spontaneous vomiting and diarrhœa, it is useful and easily endured; but
when otherwise, the contrary. _This is equally true with regard to
every vessel_,” etc.
[125] “They in whom the greatest vigor of the disease is immediately
perceived, are to be immediately sparingly supplied with food; but from
those in whom it occurs later, the food must at that time, or a little
earlier, be abstracted. Previously, however, we must nourish more
freely, that the sick may be supported.”
[126] “Whilst the crisis is forming, and when it is complete, nothing
ought to be moved or to be introduced, whether by purgatives or other
irritants; but all should be left at rest.”
[127] “They who are accustomed to daily labor, although even weak or
old, endure it more easily than the robust or young, who are even
accustomed to it.”
[128] “In regard to the seasons, if the winter has been dry and cold,
and the spring moist and warm, in summer acute fevers, ophthalmias, and
dysenteries must necessarily occur, chiefly, however, among females and
men of pituitous temperament.”
[129] Tom. v., p. 399; ed, Basil.
[130] “The state of the air being, upon the whole, dry, with a south
wind, which was just contrary to what happened the year before, when
the north chiefly prevailed; there were but few inflammatory fevers,
and these were of a mild disposition, very few being attended with
hemorrhages, and much fewer, if any, with death.” (p. 4.)
“They affected children, young persons, and those who were arrived at
years of maturity, and especially those who used much exercise, yet but
few women.” (Ibid.)
“Before the summer, and even during that season, nay, in winter
likewise, there were many who had been disposed to a phthisis who were
now afflicted with that disease,” etc. (Ibid.)
“The extremities were generally very cold, there was seldom any heat in
them.” (p 3.)
[131] Præfat. Gloss.
[132] Comment. in Libr. de Fract.
[133] In Lib. Prognos. Comment.
[134] Tom. v., p. 89; ed. Basil.
[135] Comment. in Lib. de Fract.
[136] Deipnos, ii., 7.
[137] De Propr. Lib., in III. Epid., Comm. ii., Præf.
[138] Bibl. Med., p. 1, 29, 59.
[139] The inhabitants of Asiatic Ionia, and the islands adjoining, were
all colonists from Attica. (See in particular Thucyd., i., 12; and also
Herodot. viii., 44; and Heraclides, de Politiis.) Dr. Coray supposes
that Hippocrates represents himself as being a European, in consequence
of his having composed this treatise in Europe, at a distance from his
native country. But there is no necessity for this supposition, as
Hippocrates, being of Grecian descent, would naturally enough consider
himself a European, since the great body of the Greeks were Europeans.
Coray mentions a striking instance of Haller’s incapacity to form a
correct judgment on the works of Hippocrates, from want of a proper
acquaintance with the Greek language.--Discours Préliminaire, etc., p.
lvi.
[140] De Placit. Hippocr., et Platon. ix.; de Diff. Resp., iii., 7.
[141] Ap. Foës., p. 197.
[142] Galeni Opera, tom. v., p. 652; ed. Basil.
[143] Opera, tom. v., p, 578; ed. Basil.
[144] Ibid., p. 170.
[145] In Prædict. i., Comm. i., 4.
[146] V. Galen, in Exeges. in vocibus ἐκλούσθω, σφάκερος, etc.
[147] Præfat. Gloss. Hippocrat.
[148] Gynæc., tom. i., P. I., p. 13.
[149] In vita Hippocrat.
[150] Ad Nepotian. de vita Cleric., Ep. ii., p. 13, tom. i.; ed. Paris,
1643.
[151] Orat. Funebr., in Cæsarium Fratrem.
[152] Sub voce Hippocrates.
[153] Epist. ad C. Jal. Callistum.
[154] Thesmophor., l. 240.
[155] De Legg. iv., l. vi., p. 134; ed. Tauchnitz.
[156] Tom. ii., p. xlviii.; Add. et Corrig.
[157] Tom. v., p. 526; ed. Basil, etc. Elsewhere he quotes it as being
undoubtedly genuine.--De Placit. Hippoc. etc., ix., 1.
[158] Hist. Med., p. 283.
[159] See Polybius, as quoted by Littré, l., c.; also section iii. of
the Preliminary Discourse.
[160] Saturnal., vii., 6.
[161] Hist. Animal., iii., 3.
[162] In Boerhaav., Meth. Stud. Med.
[163] De Placit. Hippocrat. et Plat., vi., 3; et Opera, tom. v., p. 22;
ed. Basil.
[164] De Nat. Facult., tom. i., p. 87.
[165] Opera, tom. v., p. 329; ed. Basil.
[166] See English translation of PAULUS ÆGINETA, Book I., p.
549.
[167] See Galen, tom. v., p. 2.
[168] See further, under No. 1.
[169] Opera, tom. v., pp. 17, 29.
[170] See PAULUS ÆGINETA, I., 50.
[171] I., 3.
[172] Sect. ii., near the beginning.
[173] Comment. in III. Epidem.
[174] Ad Hippocrat. de Aëre, Aquis, Locis, § 65.
[175] De Vulneribus superciliis allatis. Lips., 1741.
[176] Lehre von den Augen-krankheiten. Wien, 1813.
[177] In VI. Aphor., 3, Comm. vi.; Meth. Med., iv., 6.
[178] Hist. Med., i., 3, 4, 60. His language is particularly strong:
“Maximè genuinus ab omnibus judicatur.”
[179] In his Commentary on this work.
[180] Book iv., 44. See the authorities quoted in the Commentary on
this chapter in the English edition. Schulze properly remarks, that
the composition which he recommends as an application to certain sores
resembles the Ægyptiacum of modern times.--Hist. Med., i., 3, 4, 63.
[181] Comment in Lib. de Nat. Human.
[182] They are as follows: “Continuari cum libello de hæmorrhoidis
manifeste spurio, ideoque ipsum esse spurium, Galenus jam notat in
Gloss., s. v. πήρινα et στρυβλήν.” Now, as stated above, Galen does not
say a word against the authenticity of these works.
[183] Comment i., in Hipp. Prognost. The quotation prefixed to this
work in the editions of Vander-linden and Frobenius, in which Galen is
stated to have held this work not to be genuine, is admitted by Littré
to be of no authority.
[184] Morb. Diuturn., i., 4.
[185] See Menage in Diogen. Laert., p. 241.
[186] See § 66, tom. vii., p. 359: ed. Bekker.
[187] See all these authorities as quoted by Ackerman.
[188] Hist. de la Méd., i., iii., 4.
[189] It may appear a singular idea that the earth is supported on air,
and yet it was very generally held by the learned men of antiquity. The
poet Lucan thus alludes to this doctrine:
“Dum terra fretum terramque levabit
Aer.” Pharsal., i., 89.
And in like manner Ovid:
“Nec circumfuso pendebat in aere tellus
Ponderibus librata suis.” Met., I., 11.
Bentley remarks, in his note on the passage in Lucan, “Omnis poetarum
chorus hoc prædicat ut et philosophorum veterum.”
[190] Morb. Chron., i.
[191] Corp. Human. Appell., ii., 1.
[192] See under θήριον and κρημνόι.
[193] They refer apparently to Deipnos, ii., 7, where Athenæus quotes
a treatise of Hippocrates περὶ τόπων, but he evidently means by it the
work “de Aëre, Aquis, Locis.” It is to be borne in mind that Athenæus
often makes his references in a loose manner.
[194] De Facult. Natur., ii.
[195] Censura Libr. Hippocrat., p. 115.
[196] Comment. in Epidem., ii., 3. See also Le Clerc, Hist. de la
Méd., iii., 17; and Sprengel, Hist. de la Méd., tom. i., p. 325, etc.
A passage, which we shall see below, in the Prognostics (§ 15) puts it
beyond a doubt that venesection was part of the routine of practice
pursued by Hippocrates in cases of pneumonia. See also (and this
passage is very decisive) de Diæta in Morb. Acut., § 5; and Galen’s
Commentary, pluries.
[197] The strongest argument in favor of its being a production of the
Cnidian school is the mode of treating pneumonia here laid down, which
certainly in so far agrees with what Galen says of Cnidian practice
in such cases, namely, that those authorities omitted bleeding and
purging. See Opera, tom. v., p. 87.
[198] See under Ἱππωκράτης. The meaning of the passage, however, is
somewhat doubtful.
[199] Comment, in Lib. Vict. Acut., i., p. 43; ed. Basil.
[200] Zuinger, however, stands up for its genuineness. Hippocratis
Vigenti duo Comment., etc., p. 386. He gives a most elaborate analysis
of it.
[201] These dreamy views of human life look very much like an
anticipation of the Fourierism of the present day. So true is the
hackneyed saying, “there is nothing new under the sun!”
[202] Hist. de la Méd., i., iii., 13.
[203] Hippocrates, in his treatise ‘On Diet in Acute Diseases,’ says
decidedly that the ancients--that is to say, his predecessors--had
written nothing of any value on the subject of Dietetics (§ 1). From
this we may infer that the present work was not known in his days; for
it can scarcely be supposed that he would have spoken so disparagingly
of it.
[204] Galen quotes it as a portion of the work on Diet. See Opera, tom.
v., p. 377; ed. Basil.
[205] This idea is well explained and enlarged upon by Alexander
Aphrodisiensis.--Probl. i., 118. This writer must not be confounded
with the commentator on Aristotle.
[206] Zuinger points out a striking mark of the connection between it
and the work ‘On Diet:’ op. sup. laud. p. 549.
[207] Amstel., 1658.
[208] Oneirocritica, etc. Lutetiæ, 1603.
[209] Σκιᾱς ὄναρ ἄνθρωποι. Pind. Pyth., viii.
[210] Comment. in Libr. de Diæt. Acut., i.
[211] Tom. v., pp. 306, 614, etc.; ed. Basil.
[212] See the Syd. Soc. edition of PAULUS ÆGINETA, Vol. I., p.
264.
[213] Galen, by the way, mentions that Euryphon, the celebrated Cnidian
physician in the days of Hippocrates, was in the practice of treating
empyema with the actual cautery.--Comment. in Aphor., vii., 44. This
is a strong confirmation of the opinion that this treatise must have
emanated from the Cnidian school.
[214] See the Syd. Soc. edition of PAULUS ÆGINETA, Vol. I., p.
354.
[215] I presume it was the rib itself that was perforated, and not
the intercostal space. The term τρύπανον was generally applied to the
trepan. The epithet τρυγλητήριον, or, as Foës proposes to read it,
τρωλοδυτήριων, is probably derived from τρώγλη, a hole, and δύω, to
penetrate; joined together, they would signify a trepan for boring
holes.
[216] Morb. Acut., iii., 17.
[217] De Humor., Comment. in VI. Epidem.
[218] Opera, tom. v., p. 456; ed. Basil.
[219] The silphium, indeed, is mentioned among the remedies for this
case in the treatise “On Regimen in Acute Diseases” (7), but not the
other articles.
[220] Ad Epidem., vi., 6, 27.
[221] Hippocrat. Opera, i., p. 318.
[222] The opinions on this subject are given very fully by Aulus
Gellius. Noctes Atticæ, iii., 10.
[223] I should mention that Zuinger pronounces, without the slightest
hesitation, in favor of their genuineness: op. sup. laud. pp. 188, 199.
[224] De Difficult. Respir., ii., 8; ibid., iii., 1.
[225] Comm. Epid., vi., 2, 15.
[226] Opera, tom. v., p. 24; ed. Basil.
[227] See series of papers in illustration of it, published in the
Medical Gazette for the year 1847, by Dr. Wardel. On one point I
cannot agree with this writer; he says, the fever was of a continued
character, whereas in all the cases which I met with it was decidedly
remittent.
[228] VIII., 4.
[229] Institut., Orat. iii.
[230] De Perfect. in Virt.
[231] § 27.
[232] It cannot but appear singular that so distinguished a person as
Robert Boyle should have found fault with Hippocrates for relating
so many cases of which the issue was fatal. He says, “Revera penes
me non parum Hippocratis auctoritate decedit, quod in scriptis suis
tot ægrotorum epiphonema _ipsos mortuos esse_ legerem.”--Exer.
v., de Utilitate Philosoph. Exper., p. 192. On the other hand, Mart.
Lister justly defends Hippocrates: “A me sane absit illa quorundam
nuperorum scriptorum jactantia, qui nihil exhibent, nisi quod bonum
eventum habuit; errores et infortunia caute abscondunt, aliter autem
nobis profuit magnus Hippocrates, apud quem fere non nisi casus funesti
occurrunt, ac si iidem potioris doctrinæ essent.”--Exercit. de Hydrope.
[233] Acut. Morb., iii., 17.
[234] Perspiratio dicta Hippocrati.
[235] By Nature, the ancient philosophers understood an immaterial
principle diffused through all the works of creation, that is to say,
an internal principle of motion and of rest, which presides over
the growth and nourishment of all substances. It is well defined by
Aristotle in different parts of his works. See De Anima, ii., 4; and
Auscultationes Naturales, pluries. That truly learned and ingenious
author Bishop Berkeley, in his “Siris,” describes nature as being mind
so fuddled with matter as to have lost its consciousness. Probably, the
distinction between a material and immaterial principle as the cause
of the vital phenomena was not so well understood until after Plato
and Aristotle had cultivated mental philosophy with so great success;
for, as we shall see in the next section, Hippocrates seems to identify
mind with heat, that is to say, he confounds the cause of motion and of
change with its first instrument, _or_ co-cause (συνάιτιον).
[236] See the references given by Gruner, Ackerman, and Littré.
[237] See Musonius, Ap. Stobæi Sentent., xviii. It occurs frequently in
Galen.
[238] Des Maladies de la France dans leurs Rapports avec les Saisons,
p. 193. Paris, 1840.
[239] Natural. Facult., ii., 8; de Placit. Plat. et Hippocrat., viii.,
5.
[240] Opera, tom. v., pp. 257, 479; ed. Basil.
[241] Deipnos, ii., 46.
[242] Zuinger considers it in the light of extracts from the Note-book
of Hippocrates (or Hippocratea Adversaria).
[243] Ad Aphor. v., 37.
[244] De Fœtus fabricat.
[245] Comment. in Libr. de Fract. ap. Foës, p. 147.
[246] Somnium Scipionis, i., 6.
[247] Vol. i., p. 386; ed. Kühn.
[248] Even Zuinger admits that, both in style and matter, these
treatises are unlike the genuine works of Hippocrates.
[249] Vol. i., p. 371; ed. Kühn.
[250] Ibid., p. 387.
[251] Ibid., p. 420.
[252] In Gloss. in voce ἄλφιτα, etc.
[253] See Foës, Œconom. Hippocrat. in voce κιών.
[254] Bibl. Græc., ii., 24, p. 801.
[255] Aristotle refers this opinion to Leophanes, De Generatione
Animalium, v., 1.
[256] De Placit. Hippocrat. et Plat., ix.
[257] Comment., tom. xv., p. 224; ed. Kühn.
[258] Noct. Attic., iii., 16.
[259] Ap. Foës; ed. Hippocrat.
[260] Comment. in Galen; ed. Dietz.
[261] Hist. Med., P. i., iii., 2, 257.
[262] In Boerhaav. Meth. Stud. Med., i., 3, p. 594.
[263] De Placit. Hippocrat. et Platon.
[264] De Acut., i., 7; de Chron., i., 13.
[265] See Galen, de Facult. Natural., i.; de Diff. Febr., ii.; de Usu
Pulsuum, i.; and Alexander Trallian, i.
[266] In Epidem. Comm., iii., 29, etc.
[267] See the remarks on this passage in the next section.
[268] De Cosmopœa.
[269] Opera, tom. v., p. 594; ed. Basil.
[270] Καλὸν καὶ αγαθὸν. See the Annotations on Mitchell’s Aristophanes
as to the import of this expression. I quote from memory.
[271] I quote here from memory, not having leisure to search the
passages in Galen’s works where this saying occurs. It is a maxim,
however, which he frequently repeats.
[272] One word (ἰχθύη) which occurs in this work is in the Glossaries
of Galen and Erotian. This is likely to be an interpolation.
[273] Tuscul. Disputat., v., 35.
[274] In vita Platonis.
[275] I have always looked upon the “Epistolæ Græcanicæ” as being a
species of literary composition allied to the _Declamationes_
of the Romans, that is to say, that they were mere exercises in
composition. On the latter, see Quintilian, Instit. Orator., iv.,
2. We possess a volume of these Declamations under the name of
Quintilian, but they are not generally admitted to be genuine. They
are exercises on themes prescribed in the schools of rhetoric. The
subjects were sometimes historical events, connected with the lives of
distinguished personages. The poet Juvenal alludes to Declamations in
several places, as in Satir. i., 16; x., 167; vi., 169; vii., 161. The
Satyricon of Petronius Arbiter opens with a powerful invective against
the declaimers of the day, whom the author holds to have been the
corrupters of all true eloquence.
[276] Scaliger, Menage, Gruner, and Littré, although they regard the
Epistles as spurious, admit that they are “very ancient.”
[277] See Diog. Lært. ix. Ælian. Var. Hist. iv., 20.
[278] Chemical Essays, vol. iv., Essay 7.
[279] Ocellus Lucanus, On the Universe.
[280] Αόγοι γὰρ ἀσώματοι τυγχάνουσι τούτων.
[281] Ocellus Lucanus, On the Universe.
[282] Ibid.
[283] Timæus Locrus, On the Soul of the Universe.
[284] Diogenes Laertius, Life of Pythagoras. That Monad and Duad, in
the symbolical language of Pythagoras, signified Mind and Matter, is
positively stated by Philo Judæus. Ἑπόμενος δ' ἀκολουθίᾳ ύσεως κἀκεῖνο
λέξω ὅτι μουὰς εἴκων αἰτίου πρώτου, δυὰς δε παθητῆς καὶ διαιρετῆς
ὕλης.--De Specialibus Legibus. It may be proper to mention here that it
is not true, as has been often stated in modern works, that Pythagoras
himself taught the same system of the world as Copernicus; the first
person who did so was Philolaus the Pythagorean philosopher. See
Diogenes Laertius.
[285] Jamblichus, Life of Pythagoras, § 27. I have adopted the
emendation of the text proposed by Obrechtus.
[286] Ovid’s Metamorph., translated by Dryden, Book XV.
[287] Plato, in his Timæus.
[288] Ἐκμαγεῖον. Harris, in his Philosophical Arrangements, translates
this word by “impression”; but it does not, strictly speaking, signify
impression, but the substance which receives the impression. Wax, for
example, is not the impression of the seal, but the substance which
receives the impression. Matter, in like manner, is not the impression
of forms, but the substance which receives the impression.
[289] Plato, in his Timæus.
[290] Ibid. These opinions regarding the elements and the first matter
are expressed with much precision and clearness; but, in other parts of
his Timæus, it must be admitted that he betrays some confusion of ideas
on this subject, as is remarked by his illustrious pupil Aristotle (De
Ortu et Interitu, ii., 1). A translation of part of Plato’s Timæus
regarding the elements, may be seen in the Somnium Scipionis of
Macrobius, lib. i.
[291] Apuleius the Platonic Philosopher, On Natural Philosophy.
[292] Idem, On the Universe.
[293] Cicero, On the Nature of the Gods, ii., 33.
[294] Plotinus, Ennead ii., 4.
[295] Plotinus, Ennead ii., 6.
[296] Proclus, Inst. Theol., 72.
[297] Plutarch, On the Opinions of the Philosophers.
[298] Galen, On the Elements, etc., ii.
[299] Galen, Commentary on the Nature of Man.
[300] Idem, On the Elements, etc.
[301] Philo, on the Creation of the World.
[302] On the Indestructibility of the Universe.
[303] On the Creation.
[304] On a Contemplative Life.
[305] Haly Abbas, Theor., i., 5.
[306] Auscult. Natur., i., near the end.
[307] Categor.
[308] On Birth and Death, ii., 1.
[309] Auscult. Phys., iv.
[310] Simplicius, Comment. in Auscult. Nat., iv.
[311] Ammonius, Comment. in Porphyr. Introd.
[312] Ibid.
[313] Theophrastus, On Fire.
[314] Ibid.
[315] Cicero, Quæd. Acad., i., 6.
[316] Cicero, Quæd. Acad., i., 7.
[317] Diogenes Laertius, in the Life of Zeno the Stoic. The reader must
take care not to confound him with Zeno the Eclectic.
[318] Seneca, Ep. 65.
[319] Seneca, Nat. Quæst., ii., 15.
[320] Seneca, Nat. Quæst., iii., 10.
[321] Lactantius, Div. Inst., iii., 3.
[322] See under ἀρχαι.
[323] Plutarch, Concerning the Opinions of the Philosophers.
[324] Simplicius, Comm. in Aristot. Auscult. Nat., p. 7; ed. Ald.
[325] Marcus Antoninus, iv., 46.
[326] Ibid.
[327] Ibid.
[328] Manilius, Astron., iii., 53:--
“Principium rerum et custos natures latentûm
Cum tantas strueret moles per inania mundi:
* * * * *
Aëraque et terras flammamque undamque natantem
Mutua in alternum præbere alimenta juberet.”
[329] Lucretius, Of the Nature of Things, Book i., translated by Creech.
[330] Cicero, Acad. Quæst., i., 2; Galen, de Elementis.
[331] Diogenes Laertius, Life of Democritus.
[332] Ἡ ὔλη ἄποιος. Galen, de Element. ex Hippocrat.
[333] The eternity of matter is a doctrine which was maintained by all
the ancient philosophers and by several of the Christian fathers of
the church, but is generally rejected by our modern divines as being,
in their opinion, contradictory to Revelation. But were it really
so, it would hardly have found an advocate in the learned and pious
author of “Paradise Lost.” That such was truly his opinion can now
admit of no doubt, from what he states on the subject in his treatise
on Christianity, published some years ago by the present Archbishop
of Canterbury; and the same might have been inferred from more than
one passage in his great poem. The Jewish philosopher, Philo, seems to
admit the eternity of matter, although he denies the eternity of the
world. (On the Creation.)
[334] “There are varieties,” says Strabo, “of the watery element; for
this kind is saltish, and that sweet, and fit for drink; and others
again poisonous, salutary, deadly, cold, and hot.”--Geograph., xvii.,
1. See also Aristot., Meteorol.
[335] Aristotle inquires whether the atmosphere be a single substance
or many, and if many, of how many it consists. (Meteorol., i., 3.) I
may be allowed to remark in this place, that Galen’s ideas regarding
respiration are wonderfully accurate, and not very different from
those now entertained by the profession. Thus he compares the process
of respiration to combustion, and says it produces the same change
upon atmospheric air. He further agrees with modern physiologists in
considering it as the vital operation by which the innate (or animal)
heat is preserved. (De Respiratione.) Compare this treatise with Baron
Cuvier’s admirable section on Respiration and observe on how many
points these two great physiologists agree. (Leçons d’Anatom. Compar.,
26.)
[336] Timæus.
[337] De Igne.
[338] De Partibus Animalium, ii., 2. His great commentator, Averrhoes
the Arabian, states this distinction very correctly. See Cantic.
Avicennæ, tr. v.
[339] Lucan’s Pharsalia, i., 157, 606.
[340] De Carnibus. (See the preceding section.) In like manner
Phornutus says, “our souls are fire.” (De Nature Deorum, ap. Gale’s
Opuscula Mythologica, p. 142.) Such is also said to have been the
doctrine of Hippocrates and Democritus. See Macrobius (Somnium
Scipionis, i., 14); and Nemesius (de Nat. Hominis). In the Hippocratic
treatise De Septimadibus, which M. Littré has discovered in Latin, the
essence of the soul is held to be heat. (Ed. Littré, i., p. 391.)
[341] De Partibus Animalium, ii., 7.
[342] De Anima, ii., 4.
[343] Ὄτι πᾶν ἐκ πάντος γινέσθαι πέφυκε.--Aristot. de Ortu et Interitu.
et Auscultationes Naturales, i.
[344] See Simon’s Chemistry, vol. i., p. 118, and the authorities there
referred to.
[345] Baron Cuvier says: “En un mot, toutes les fonctions animales
paroissent en reduire à des transformations de fluides; et c’est dans
la manière dont ces transformations s’opérent, que gît le véritable
secret de cette admirable économie.”--Leçons d’Anatom. Comp. lib. i.
[346] It will be readily understood that allusion is here made to the
diseases ossification and osteosarcoma.
[347] The same application of this myth is made by Eustatheus, the
commentator on Homer (ad Odyss., iv., 417), and by Heraclides Ponticus
(Gale’s Opuscula Mytholog., p. 490). The words of Heraclides are very
striking: “That hence it was with good reason that the formless matter
was called Proteus; and that Providence which modified each being with
its peculiar form and character was called Eidothia.”
[348] De Sapient. Vet., cap. xiii.
[349] Op. cit., iv.
[350] These opinions of Newton bear a strong resemblance to those of
Strabo, as expressed in the following passage: “Since all things are in
motion and undergoing great changes, it is to be supposed that neither
does the earth always remain the same, so as neither to be augmented
nor diminished; nor yet water; nor that either always possesses the
same seat, for that a change of one thing into another seems very much
according to nature. For that much earth is converted into water, and
much water into earth.”--Geograph., xvii., 1.
[351] See p. 120, Ray Society’s edition.
[352] See Simon’s Chemistry, vol. i., p. 5; Sydenham Society’s edition.
The etymology of the term _protein_ is there given from πρωτέυω,
_I am first_; but it may more properly be derived from Proteus, to
which, as we have mentioned above, the first matter was likened.
[353] Lucretius, de R. N., i., 48.
[354] I have always looked upon the story of the Sirens as being one
of the most beautiful fictions in the Homeric poems. By the two Sirens
I cannot but think that the poet meant to represent Philosophy and
Melody, these being, as it were, the handmaids of Poetry. They assail
the virtue of Ulysses with no vulgar temptations, by assuring him that
they were well acquainted with all the martial exploits in which he had
been engaged, and that he would leave them “much delighted, and with an
increase of knowledge.”
Ἀλλ’ ὄγε τερψάμενος νεἰται καὶ πλέιονα ἐιδώς.
Odyss, xii., 188.
[355] Diogenes Laertius, in fact, states that Xenophanes, the founder
of the school, held the doctrine of the four elements. On the Eleatic
philosophy, see further, Aristotle (de Xenophane; and Metaphys.,
i., 5); and, of the modern authorities Ritter (History of Ancient
Philosophy, vol. i.,) and Grote (Hist. of Greece, tom. iv., p. 518,
etc.) Whether or not these modern authors, however, have rightly
apprehended the doctrine of Xenophanes and Anaximander with regard to
the elements, may, I think, be justly doubted. Dr. Thirlwall gives
a very judicious exposition of the ethical opinions of the Eleatic
philosophers, but does not touch on their physical. (Hist. of Greece, §
12.)
[356] M. Littré is inclined to give the Pythagorean philosopher,
Alcmæon, the credit of priority in broaching the philosophical theory
which runs through this treatise. His only authority, however, on this
point is Plutarch (De Placit. Philos., v., 30); whereas Galen, as he
admits, says expressly that Hippocrates himself is the author of this
theory. Now, I must say that, of the two, Galen appears to me to be
the better authority, being profoundly skilled both in medical and
philosophical literature. But further, neither Diogenes Laertius in his
life, nor any other writer who has noticed Alcmæon, says anything of
his having promulgated the theory of the Crasis.
[357] Tom. i., p. 567.
[358] See Note, p. 191.
[359] The invention of bread must have been very ancient, as is obvious
from the circumstance of its being referred to a mythological name,
that is to say, Demeter _or_ Ceres. The ancients would appear to
have paid great attention to the manufacture of bread. See Athenæus
Deipnos, iii., 26; and PAULUS ÆGINETA, B. I., 78, Syd. Soc.
edition.
[360] The maza was a sort of pudding _or_ cake made from
barley-meal mixed up with water, oil, milk, oxymel, hydromel, or the
like. It also was a very ancient invention, for it is mentioned in one
of the works of Hesiod, which is universally allowed to be genuine, I
mean the Opera et Dies, 1., 588.
[361] We have stated in our brief sketch of the Life of Hippocrates,
that he studied the application of gymnastics to medicine under the
great master of the art, Herodicus. He was a native of Selymbra in
Thrace, and is generally represented as the father of medicinal
gymnastics; but, as we have mentioned above, this statement must be
received with considerable allowance, since there is every reason to
believe that the Asclepiadæ applied exercises to the cure of diseases.
[362] He means both the pilot and physician.
[363] Καθαρὸς ἄρτος ἢ συγκομιστός. There has been some difference
of opinion regarding these two kinds of bread; but it appears to me
probable that the former was made of flour from which the bran had been
entirely excluded, and the other from flour containing the whole of the
bran. Later authorities called the one _siligo_, and the other
_autopyrus_. See PAULUS ÆGINETA, Vol. I., p. 121.
[364] He alludes here to the secretions and humors in the body. See the
Commentary of Heurnius.
[365] See Littré, h. 1.
[366] Meaning probably the diaphragm, with its membranes. See the
Commentary of Heurnius, p. 92.
[367] Meaning the mammæ, according to Heurnius.
[368] Such as the spleen and lungs.
[369] Although I shall touch cursorily on this subject in my
annotations, I cannot deny myself the pleasure of setting down here the
following passage from the treatise of Longinus “On the Sublime.” It is
to be borne in mind that it was written by a noble-minded Greek, who
lived at the court of an Oriental despot, and must have been a daily
observer of the effects which he so feelingly depicts. Who does not
lament to think of a generous mind placed under circumstances where
cowardice is honored and courage debased? And what more melancholy
picture of human misery can be imagined than that which is here
exhibited of the bodily and mental powers in a state of arrested
development from the effects of confinement?
Ἥμισυ γάρ τ' ἀρετῆς (κατὰ τὸν Ὅμηρον) ἀποαίνυται δύλιον ἦμαρ· ὥσπερ οὖν
(εἴγε γησὶ, τοῦτο πιστόν ἐστι) ἀκούω τὰ γλωττόκομα, ἐν οἱς οἱ Πυγμαῖοι
καλούμενοι νάνοι τρέφονται, οὐ μόνον κωγύει τῶν εγκεκλεισμένων τὰς
αὐξήσεις, ἀλλὰ καὶ συνάγει διὰ τὸν περικείμενον τοῖς σώμασι δεσμόν· οὒ
τως ἅπασαν δουλείαν, καὶ ἦ δικαιοτάτη, ψυχῆς γλωττόκομον, καὶ κοιόν δή
τις ἀποφήναιτο δεσωπτήριον.--§ 39.
[370] M. Littré thus states the four principal points to which
Hippocrates here directs attention:
“1st. Il cherche quelle est, sur le maintein de la santé et la
production des maladies, l’influence de l’exposition des villes par
rapport au soleil et aux vents.
“2d. Il examine quelles sont les propriétés des eaux, bonnes ou
mauvaises.
“3d. Il s’efforce de signaler les maladies qui prédominent suivant les
saisons, et suivant les alternatives que chacune d’elles épreuve.
“4th. Enfin, il compare l’Europe et l’Asie, et it rattache les
différences physiques et morales qui en séparent les habitants, aux
différences du sol et du climat.”
He goes on, however, to state, that these four questions, although
neatly put, are merely sketched, and half insinuates that it is a
defect in the work, that it merely contains our author’s assertions,
without the corresponding proofs. In a modern work, he remarks, the
mode of procedure would be different; for it would be expected that the
general truths should be supported by detailed and prolonged statistics
on particular facts. It is to be borne in mind, however, that the work
of Hippocrates was probably meant merely as a text-book, on which were
grounded his public prelections, wherein would, no doubt, be given all
the necessary proofs and illustrations. In this respect, it resembles
the esoteric works of Aristotle, of which the author of them said that
when they were published the contents of them, in one sense, were not
communicated to the public, as they would be unintelligible without
the illustrations by which they were accompanied when delivered in his
school. In conclusion, I would beg leave to remark that, if the work
of Hippocrates, in its present form, appear defective when compared
with what a modern work on the same subject would be expected to be,
it has also peculiar traits which would hardly be matched in a modern
composition. In a modern work we might have a greater abundance of
particular facts, and a more copious detail of individual observations,
but would there be such an exuberance of general truths, of grand
results, and of original reflections?
[371] The classical reader is referred to Theophrastus’ treatise De
Signis Aquarum et Ventorum, for much interesting information on this
subject.--See also Galen, Op. tom. v., p. 346, 347, ed. Basil.
[372] I. 105.
[373] It appears to me, however, that the meaning of Longinus in this
place is rather overstrained.
[374] Coster, Défense des (Œvres de Voiture, etc., p. 194.
[375] Réponse à l’Apologie de Voiture, par Coster, p. 54.
[376] Memoria Scythica, in Comm. Petropol. p. 377–78.
[377] P. vi., p. 35.
[378] Notæ in Longinum.
[379] Comment, in vetus Monument, p. 415.
[380] Nosol. Meth. p. 365.
[381] De maribus inter Scythas morbo effeminatis, etc., p. 28.
[382] Hipp. de Aere, etc., t. ii., p. 326.
[383] Morb. Târd. iv., 9.
[384] Hist. of Greece, pluries.
[385] The part in parenthesis is rather obscure. In the old French
translation it is rendered thus: “Elles sont très différentes entre
elles par leur nature, et il arrive d’ailleurs une infinité de
changemens qui sont tous divers.” On these changes, see Aphor. iii.,
2–15.
[386] I have translated this passage agreeably to the reading suggested
by Coray, that is to say, ὀυκ ἐδωδὸς, which appears to be a great
improvement, although it is not adopted by Littré. Without the negation
(ὀυκ) the contrast between the first and the last clause of the
sentence is entirely lost. It will be remarked that I have translated
ἀριστητάι, eating to excess. The ἄριστον, or dinner, was a meal which
persons of regular habits seldom partook of, and hence Suetonius
mentions it as an instance of Domitian’s gormandising propensities,
that he was in the habit of taking dinner.--See Vita Domitiani; also
PAULUS ÆGINETA, B. I., 109.
[387] It will be remarked that our author uses meteorology and
astronomy almost as synonymous terms. In his time meteorology was
looked upon by practical men as a visionary subject of investigation,
which had a tendency to make those who engaged in it atheists, and the
enemies of Socrates took advantage of the prejudices then prevailing
against it to represent him as a meteorologist. See Aristophanes
(Nub. 225.) Aristophanes, who would appear to have been always too
ready to pander to the popular prejudices of the day, also represents
the physicians as being “meteorological impostors,”--μετεωροφένακας.
(Ibid. 330.) The enlightened mind of Aristotle, however, regarded
meteorology in a very different light, and accordingly he wrote a
work on the subject replete with all the astronomical and geological
knowledge of his time. In it he professes to treat of the heavenly
bodies and atmospherical phenomena, including winds, earthquakes and
the like; also of minerals, fossils, etc. See the introduction to his
_Meteorologica_.
[388] Upon reference to the editions of Coray, Clifton, and Littré, it
will be seen that the text here is in a doubtful state. I shall not
weary the reader by stating my reasons for adhering to the meaning
which I have adopted.
[389] In place of the common reading, παιδίον, Coray adopts θεῖον which
certainly, at first sight, appears to be an improvement. But I admit,
with Littré, that the authority of Galen (tom. v., p. 447, ed. Basil),
is quite decisive in favour of παιδίον. It is also to be taken into
account in this place that the author of the treatise on Dentition
brings prominently into view the connection between infancy and
convulsions, which adds probability to the supposition that in those
days convulsions may have been called “the disease of infancy.”
[390] The Hepialus is a species of intermittent fever, very common in
warm climates. It would appear to be a variety of the quotidian. See
PAULUS ÆGINETA, Vol. I., 252, Syd. Soc. edition.
[391] Frequent mention of this disease of the skin occurs in the works
of the ancient writers on medicine. See PAULUS ÆGINETA, Vol.
II., 40. We have there stated that it would appear to have been some
species of Eczema, with which we are now unacquainted. Coray has a
very lengthy note on it, but arrives at no satisfactory conclusions on
the subject. He brings into review three cutaneous diseases, namely,
the _bouton d’Alep._. (described, Mémoir. de la Société Royale
de Médic., année 1777, 1778, t. i., p. 313;) the _pelagre_,
(described, Toaldo, Essai Méteorolog., pp. 19, 20; Comment. de Rebus
in Scient. Nat. et Médec. Gestis., tom. xxxi., p. 553; and Journ. de
Médec. tom. lxxx., p. 272;) and the _lepre des Asturies_ or _mal
de la rosa_, (described by Thieri, Journ. de Médec., tom. ii., p.
337.)
[392] _Coups de soleil_, or strokes of the sun, are often
mentioned incidentally in the works of the ancient authors, but no
one has treated of them in any very systematic manner, as far as I
recollect. On the effects of exposure to cold and heat, see, however,
PAULUS ÆGINETA, Vol. I., 49–51, Syd. Soc. edition.
[393] Ῥηγματα καὶ σπάσματα. There has been much difference of opinion
as to the exact import of these two terms. It would appear to me that
they were intended to apply to a rupture or straining of the fibres,
occasioned by external violence. M. Littré has a very interesting note
on this subject, tom. v., p. 579. On these strainings see further Coacæ
Prænotiones, 376, 418. M. Littré, l. c., relates a case of empyema
brought on by lifting a heavy piece of wood. On these terms see further
the Annotations on Demosthenes, Olynth. ii., 8, ed. Dobson; and Foës,
Œc. Hippocr.
[394] Clifton translates this clause of the sentence thus: “Even if
there be but a small distance between them,” and, I think, correctly,
although Coray is not quite satisfied with this interpretation. The
stadium was _nearly_ the eighth part of a Roman mile, that is to
say, it consisted of 94½ French toises, or 625 English feet.
[395] In another place, I have given a summary of the information
supplied by the ancient authors on this subject, (PAULUS
ÆGINATA, Vol. I., 66.) Upon the whole, none of them gives so
much valuable matter on it as our author. Coray has some elaborate
annotations on this passage.
[396] It can scarcely admit of a doubt that our author here alludes to
scurvy. (See Coray at this place, and Lind on Scurvy, iii., 1.) He also
describes the disease distinctly in the second book of Prorrhetics,
that is to say, if Hippocrates be actually the author of that book.
See also Epidem. ii., 1; de Affection., de inter. affect.; Cælius
Aurelianus, Tard. Pass. iii., 4; Celsus, iv., 9; Aëtius, x., 11; Pliny,
H. N., xxv., 3; Aretæus, Morb. Diuturn, i., 14; and Paulus Ægineta,
iii., 49; Marcellus, de Medic. ii.
[397] The leucophlegmasia is treated of in different parts of the
Hippocratic treatises, as Aphor. vii., 29; de Morb. ii. By it he
evidently meant a species of dropsy, as Galen remarks in his commentary
on the Aphorisms (l. c.). It occurs in Aretæus’s chapter on dropsy.
Morb. Diuturn. ii., 1; Octavius Horatianus, v. Celsus makes it to be
synonymous with anasarca, iii., 21. Our author would seem to notice
these varieties of dropsy as being affections to which pregnant women
are subject.
[398] On hydrops uteri see the authorities quoted in the Commentary on
PAULUS ÆGINATA, B. III., 48, Syd. Soc. edition. It may appear
singular that hydatids of the womb should be particularly prevalent
in the case of women that drink unwholesome water from marshes, and
yet our author’s observation is confirmed by a modern authority as
quoted by Coray: “Il a été également prouvé par les observations des
Modernes, que les fausses grossesses produites par les hydatides; sont
très-communes dans les pays marécageux, ou la plupart des habitans
ont une constitution lâche, propre à l’affection scorbutique, qui
y est presque endémique, qu’elles terminent plus ou moins tard par
l’excrétion de ces hydatides.”--(Notes sur le Traité des Airs, &c., p.
106.) Sydenham, moreover, describes the symptoms of false pregnancy in
much the same terms as our author. (Tract de Hydrop.)
[399] On the Thermal waters of the ancients, see PAULUS ÆGINATA, Vol.
I., 72. I have treated fully of the ancient _alum_ and _nitre_ under
στυπτηρία and λίτρον, in the Third Volume. Coray, in his notes on this
passage, does not throw much light on this subject. The opinion here
delivered by our author, that these metallic substances are produced by
the operation of heat, is adopted and followed out by Aristotle towards
the end of the third book on Meteorologia.
[400] Corny appears to me to be unnecessarily puzzled to account for
our author’s statement, that saltish waters, although held to be
purgative, are, in fact, astringent of the bowels. But, although their
primary effect certainly be cathartic, is it not undeniable that their
secondary effect is to induce or aggravate constipation of the bowels?
Certain it is, moreover, that all the ancient authorities held salts
to be possessed of desiccant and astringent powers. See PAULUS
ÆGINETA, Vol. III., under ἂλες.
[401] Aristotle discusses the subject in his Problems, ii., 9, 36, 37;
ii., 15; i., 53; v., 34, and arrives at nearly the same conclusions as
Hippocrates. See also Theophrastus de Sudoribus.
[402] I cannot hesitate in adopting the emendation suggested by Coray
(ἀποσήθεσθαι) in place of the common reading (ἀποσήπεσθαι), which
evidently has no proper meaning in this place. I am surprised that M.
Littré should have hesitated in admitting it into the text.
[403] Athenæus, in like manner, praises rain water. Deipnos ii., 5.
[404] It appears singular that Athenæus, who is undoubtedly a most
learned and judicious authority on all matters relating to Dietetics,
speaks as favorably of water from ice as he does of rain water. Both
he praises for their lightness, (l. c.) Celsus gives the character
of the different kinds of water with his characteristic terseness
and accuracy: “Aqua levissima pluvialis est; deinde fontana; tum ex
flumine; tum ex puteo: post hæc ex nive, aut glacie; gravior his ex
lacu; gravissima ex palude,” (ii., 19.) Galen treats of the medicinal
and dietetical properties of water in several of his works, and
uniformly agrees with Hippocrates in the judgment he pronounces on
them. See in particular, De Ptisana; De Sanit. tuend. ii.; Comment. ii.
in Libr. de Ratione victus in Morb. acut.
[405] Athenæus, on the other hand, argues from the fact that ice is
lighter than water, that water formed from ice must be light. Pliny
gives a lucid statement of the opinions of those who held that water
from ice is light and wholesome, and those who, like Hippocrates,
held it to be just the reverse. He says in the words of Hippocrates,
literally translated, “nec vero pauci inter ipsos e contrario ex
gelu ac nivibus insaluberrimos potius prædicant, quoniam exactum sit
inde, quod tenuissimum fuerit.” (H.N. xxxi., 21.) See also Seneca,
Quæst. Natural. iv. It would appear that iced _liqueurs_ were
greatly relished at the tables of _gourmands_ in those days. I
need scarcely remark that there has been great difference of opinion
in modern times regarding the qualities of water from melted snow and
ice. It was at one time generally believed that it is the cause of the
goîtres to which the inhabitants of the valleys bordering on the Alps
are subject. This opinion, however, is by no means generally held at
the present time.
[406] This is a most interesting chapter, as containing the most
ancient observations which we possess on the important subject of
urinary calculi. The ancients never improved the theory, nor added much
to the facts which are here stated by our author. We have given the
summary of their opinions in the Commentary on PAULUS ÆGINETA,
B. III., 45. I would beg leave to remark that, notwithstanding the
number of curious facts which modern chemistry has evolved regarding
the composition of urinary calculi, the etiology of the disease is
nearly as obscure now as it was in the days of Hippocrates.
[407] Coray remarks that Prosper Martian, in his commentary on this
passage, confirms the truth of the observation here made, that persons
affected with calculus have the bowels constipated.
[408] Theophilus, in his treatise De Urinis, would seem to contradict
this observation of Hippocrates, when he states that the urine of
calculous persons is thick and milky (8.) But, according to Prosper
Martian, when the calculus is in the state of formation, its characters
are as described by the latter, whereas, when the calculus is already
formed, the urine is limpid, as described by Hippocrates.
[409] It is worthy of remark that Celsus states just the reverse with
regard to the practice of women laboring under the stone; he says:
“Feminæ vero oras naturalium suorum manibus admotis scabere crebro
coguntur.” (ii., 7.) Are we to suppose that he followed a different
reading? Considering how well he shows himself acquainted with the
works of Hippocrates, it cannot be thought that he had overlooked this
passage.
[410] Our author, it will be remarked, ascribes the comparative
immunity from calculus which females enjoy to their freer use of
liquids. Celsus, in laying down directions for the regimen of a
calculous person, as preparatory for the operation, among other things,
directs, “ut aquam bibat,” (vii., 26–2.) Coray collects the opinions of
several modern authorities in favor of drinking water as a preventive
of calculus. Thus Tissot states that the Chinese, who drink so much
water with their tea, enjoy almost an immunity from the disease. (De la
Santé des Gens de Lettres, p. 196,) Campfer, in like manner, affirms
that calculus has become less common in Europe since the introduction
of tea, which he justly attributes to the amount of water drunk with
it, rather than to any virtues of the plant itself. (Comment de Reb. in
scient. nat. et medic. gestis, vol. xvi., p. 594.) Metzger attributes
the diminution of the number of calculous cases in Königsberg to the
use of draughts of tepid water. (Journal de Médec., vol. lxvii., 348.)
The Turks, according to Thevenot, owing to their free use of water, are
almost exempt from the disease. (Voyage au Lévant, c. xxvii., p. 70.)
[411] Coray makes the following remarks on the natural characters of
the seasons in Greece. The natural temperature of the winter in Greece
was cold and humid; thus a dry and northerly winter was reckoned an
unnatural season. Spring was reckoned unnatural when the heat and rain
were excessive. See further Theophrast. de Caus. Plant. ii., 1.
[412] See Aphorism iii., 11.
[413] The celebrated Haller charges Hippocrates with inaccurate
observation in stating that dysenteries are epidemic in spring, which,
he contends, is contrary to modern experience. (Bibl. Med. Pract., vol.
i., p. 61.) Hippocrates, however, is defended by Gruner (Cens. libr.
Hippocrat. ii., 5, p. 51), and by Coray. (Notes, etc., p. 159.) The
latter justly argues, that although dysentery may not prevail at that
season in Germany, that is no reason for holding why it may not be
so in Greece. He also refers to the works of Birnstiel and Stoll for
descriptions of epidemical dysentery, occurring in the season of spring.
[414] See Aphorism iii., 12; also Aristot. Probl. i., 9; Celsus, ii., 1.
[415] Coray, in this place, refers to an epidemic of the same
description related by Caillar, which prevailed in the winter of 1751,
and was treated by emetics more successfully than by bleeding.
[416] By sphacelus of the brain Clifton understands “paralytic
diseases,” which is not far removed from the conclusion which we have
arrived at respecting it in the Commentary on PAULUS ÆGINETA,
Vol. I., p. 365. See Coray’s lengthened note on this passage.
[417] Aphorism, iii., 13.
[418] Aphorism, iii., 14.
[419] I have stated in my analysis of the short treatise “On Purgative
Medicines,” that the author of it forbids the administration of these
medicines, that is to say, of drastic purgatives, during excessive heat
or cold.
[420] One may see, upon consulting the editions of Clifton, Coray, and
Littré, that there are great varieties of readings in regard to the
word which I have translated “affectionate.” It will be remarked that I
have followed Coray and Littré in reading εύοργητότερα. Clifton adopts
ἀεργότερα, and translates it “unactive.”
[421] This expression of our author is ambiguous. Coray explains it
thus: “il entend le lever d’été, qu’il place à 45 degrés de l’Est au
Nord, dans l’horizon de la Grece, et particulièrement celui de l’île de
Cos; et le lever d’hiver qu’il place à 45 degrés de l’Est au Sud.”
[422] The sense undoubtedly requires this addition, and therefore I
have not scrupled to follow the reading of Cornarius, καὶ τοῡ θερμοῡ.
[423] The term here used meant particularly the fructus horæi, or
summer fruits; namely, cucumbers, gourds, and the like. (See PAULUS
ÆGINETA, B. I., § 80.) Surely Coray forgot himself, when he wrote
thus regarding the distinction between the summer and autumnal fruits
of his country: “les Grecs entendoient particulièrement par ὡρᾱια les
fruits de la fin de l’été, c’est-à-dire, de cette partie de l’année
qu’ils appelloient ὀπώραν, etc.”
[424] It is but too apparent that there is a lacuna in the text here. A
chapter devoted to an examination of the peculiarities of the Egyptians
and Libyans is evidently lost. As M. Littré has remarked, Galen appears
to refer to the contents of the lost chapter. (Opera, tom. xvi., p.
392; ed. Kühn.)
[425] That is to say, the Sea of Azoff. See Herodotus, iv., 86, who
calls it Μαιῆτις. This was generally held to be the division between
Europe and Asia, as stated by our author. As Coray remarks, its borders
on the north-west are occupied by the inhabitants of Little Tartary:
it has the Crimea on the south-west; the Tartars of Cuban and the
Circassians on the south-east.
[426] That the inhabitants of a country bear a resemblance to the
country itself, is no doubt a profound and most philosophical remark,
although it must be admitted that the comparisons which our author
makes are somewhat quaintly expressed, and hence a German physician
wished the passage expunged, as being unworthy of Hippocrates. (Comment
de Reb. in Scient. Natur. et Med. gestis, vol. xx., p. 131.) There
can be no question, however, that it embodies a grand general truth,
although the particular application of it may not always be apparent.
[427] On the Macrocephali, see Pliny, H. N. vi., 4; Stephanus, de
Urbibus; Suidas and Harpocration in Μακροκέφαλοι; Pomponius Mela, i.,
19; Strabo, xii.; Scholiast Apollon. Rhod., i.; Dionysius Periegetes.
The exact situation of the savage nation of the Macrocephali cannot
be precisely determined, but it was evidently not far from the Palus
Mæotis, and most probably in the vicinity of the Caucasus. Little is
known of them, except what our author says respecting the practice
which they had of disfiguring their heads by squeezing them, in early
infancy, into an elongated shape. It is well known that the same absurd
usage prevailed among the early inhabitants of MEXICO. I need
scarcely say that much important information respecting them has been
obtained of late years. M. Littré, in the fourth vol. of his edition of
Hippocrates, supplies some very important information in illustration
of this subject, from a recent publication of Dr. H. Rathke. Certain
tumuli having been excavated at Kertch, in the Crimea, there were found
in them, besides different utensils and statues, several skeletons,
and it was most remarkable that the form of the head was greatly
elongated, in the manner described by Hippocrates with regard to the
Macrocephali. The author’s words are: “On y remarquait, en effet, un
hauteur extraordinaire par rapport au diamètre de la base, et par là
ils frappaient même les personnes qui n’avaient aucune connaissance de
la structure du corps humain.”
[428] The same theory respecting the secretion of the semen is given
in the treatises “De Genitura” and “De Morbo Sacro.” It is espoused by
Galen, in his little work. “Quod animal sit quod utero continetur.”
Coray remarks that Hippocrates’s theory on the origin of the fœtus does
not differ much from that of Buffon.
[429] I need scarcely remark that both the river and city of this name
are very celebrated in ancient mythology and history. See in particular
Apollonius Rhodius, with his learned Scholiast, Arg. II.; Strabo, xi.;
Pliny, H. N., vi., 4; Procopius, Pers., ii., 29; Mela, i., 85; Arrian,
periplus. The river takes its rise in the Caucasus, and terminates in
the Black Sea. It is called _Rion_ by the inhabitants, and the
river and a city situated upon it are called _Fache_ by the Turks.
See Coray at this place, and Mannert., Geograph., iv., 394.
[430] Coray quotes from Lamberti, a modern traveller, a description
of the Colchide and its inhabitants, which agrees wonderfully with
the account of both given by our author. The following is part of his
description: “Il sito della Colchide porta seco un’ aria tanto humida
che forse in altro luogo non si è veduta la simile. E la ragione si è
perchè venendo dall’ occidente bagnata, dall’ Eusino, et dall’ oriente
cinta dal Caucaso, dal quale sorgano gran quantità di fiumi rende
da per tutto l’aria humidissima affatto. A questo s’ aggiungono la
frequenza de’ boschi, fra quali non viene agitata l’aria da’ venti, et
li spessi venti marini apportatoi di pioggie et de’ vapori del mare.
Questa humidità si grande genera poi gran quantità de’ vapori, che
sollevati in alto si dissolvono in frequentissime pioggie.”--Relatione
della Colchide, c. 27. He goes on to state that a great part of the
inhabitants are fishers.
[431] It is singular that Procopius, on the other hand, states that
the Phasis is a very rapid river, and Chardin confirms his statement.
(Voyage en Perse, vol. i., p. 105.) Lamberti reconciles these
discrepant accounts by explaining that the river is rapid in its course
near where it rises among the mountains, but quite smooth and stagnant
when it arrives at the plain.--Relat. dell Colchid., 29.
[432] The best practical proof of the justness of our author’s
reflections in this place is the result of the battle of Salamis; and
the noblest intellectual monument which ever the wit of man has raised
to the triumph of freedom is the Persæ of Æschylus, in celebration of
that event. A single line, descriptive of the Greeks, is sufficient to
account for their superiority to the Asiatics:
Οὔ τινος δοῦλοι κέκληνται φωτὸς, οὐδ' ὑπήκοοι.--1., 240.
None seem to have felt the force of this great truth so much as the
Persian despots themselves, or to have estimated the effects of
civil liberty higher than they did. The younger Cyrus, before the
battle of Cynaxa, addresses his Grecian soldiers in the following
memorable words: Ὦ ἄνδρες Ἕλληνες, οὐκ ἀνθρώπων ἀπορῶν βαρβάρων
συμμάχους ἡμᾶς ἄγω, ἀλλὰ νομίζων ἀμείνονας καὶ κρείττους πολλπῶν
βαρβάρων ὑμᾶς εἶναι διὰ τοῦτο προσέλαβον ὅπως οὖν ἔσεσθε ἄνδρες ἄξιοι
τῆς ἐλευθερίας, ἧς κέκτησθε, καὶ ὑπὲρ ἧς ὑμᾶς ἐγὼ εὐδαιμονίζω· εὖ
γὰρ ἴστε, ὅτι τὴν ἐλευθερίαν ἑλοίμην ἂν ἀντὶ ὧν ἔχω πάντων καὶ ἄλλων
πολλαπλασίων.--Anab., i., 7. Such being the established opinions of
the intelligent portion of mankind in the days of Hippocrates, the
sentiment here expressed would then be regarded as a self-evident
truth. Plato, indeed, modifies this opinion in so far when he holds
despotism to be the consequence and not the cause of servility.--De
Repub., viii.
[433] The name Sauromatæ or Sarmatæ was applied by the ancient
geographers to certain inhabitants of that vast and, to them, nearly
unexplored country, extending from the Sinus Codanus _or_ Baltic
Sea, to the Euxine _or_ Black Sea. It comprehends, then, a large
portion of Russia, Poland, and perhaps Prussia. (See Pomponius Mela,
iii., 4; Ptolemy, Geograph.; and Maltebrun, Geograph., vol. i., p.
126.) That the Sarmatians and Scythians were the same race of men,
although some of the authorities make a distinction between them, can
scarcely admit of a doubt. Our author, it will be remarked, seems to
restrict the name to a peculiar race of Scythians, who lived near the
Palus Mæotis (_or_ Sea of Asaph). From the account which he gives
of them it is impossible to doubt that he alludes to the Amazonians, so
celebrated in ancient legends. The opinion which I entertain of them is
pretty fully stated in the Argument to this treatise. That our author
should not have doubted the real existence of the Amazonians need
excite no wonder, considering the very positive and very circumstantial
account of them given by his contemporary Herodotus (iv., 110–18).
[434] It may at first sight appear singular that our author should have
mixed up his account of the Scythians with allusions to the Egyptians;
but he probably had in view Herodotus (ii., 103–6), who connects the
Egyptians with the Scythians, and more especially with the tribe of
them called Colchians. He states in particular that the Colchians and
Egyptians resembled one another in the fashion of their linen, their
whole course of life, and in their language.
[435] Herodotus (iv., 28, 29) and Strabo (Geogr., vii.), assign the
same reason for the Scythian cattle not having horns.
[436] This description evidently applies to the wandering tribes
which roam over the steppes of Tartary. The passage is of classical
celebrity, for I cannot but fancy that certainly Virgil (Georg.,
iii., 349–83), and perhaps Horace (Od. iii., 24), had it in view
when they drew their pictures of the nomadic life of the Scythians.
The extraordinary cold of that region, notwithstanding its southern
latitude, has not been exaggerated by ancient authors; but to account
for it, as the modern traveller, Clark, remarks, is still a problem
which no one has solved. Strabo mentions that carts were driven
across the Palus Mæotis (Geogr., vii., 3). The chariots covered in
from the inclemency of the weather with a roof of felt, are described
also by Strabo (Geogr., l. c.); and, according to Dr. Coray, similar
contrivances are still to be found among the Kalmucs and other savage
nations. (Notes sur le Traité des Airs, etc., h. 1.) A preparation from
milk resembling the hippace is still used by the inhabitants of that
region. On the people who lived upon this composition from milk, see in
particular Strabo, vii., 3.
[437] The following lines of Virgil, referred to above, may be almost
said to be a translation of this passage:
“Semper hiems, semper spirantes frigora Cauri.
Tum sol pallentes haud unquam discutit umbras;
* * * * *
Talis Hyperboreo septem subjecta trioni
Gens effrena virûm Rhiphæo tunditur Euro.”
It was in this region of mist and cold that the celebrated race of the
Cimmerians resided. See Herodot., i., 6, etc.; Homer, Odyss. x., 14.
The montes Rhiphæi would appear to have been the Ural mountains which
separate Russia from Siberia.
[438] It is well known now that excessive cold has a tendency to retard
the growth of animals. This opinion is confirmed in several instances
by Pallas (Voy. en Russie, i., 197; iii., 431.) Strabo mentions, as the
consequences of the cold which prevails in the country of the Getæ,
that there are no asses in it, the cattle want horns, and the horses
are small. (Geogr., vii., 3.)
[439] Buffon, on the other hand, maintains that the Nomadic race
are men of active habits. (Hist., Nat., tom. iii., p. 384.) Pallas,
however, confirms the judgment of Hippocrates. (Voyag. en Russie, tom.
i., p. 499.) See also Coray, ad. h. l.
[440] It is to be borne in mind that Hippocrates, and after him most of
the ancient authorities, held that the fœtus is formed from the male
semen. This doctrine prevailed generally down to the days of Harvey.
Some of the ancient physiologists, however, maintained that “omne
animal est ab ovo.” See Plutarch, de Placit. Philos.
[441] Ὑγρότης, when applied to the body, may signify both humidity and
relaxation, in like manner as the adjective (ὑγρὸς) signifies humid and
relaxed. We shall see an example of the latter signification in the
Prognostics.
[442] This practice came to be one of the regular operations of
surgery, being performed with the view of correcting the tendency of
a joint to dislocation. It is minutely described by Hippocrates (De
Artic., xi.), Paulus Ægineta, (VI., 42), Albucasis (Chirurg., i., 27),
Haly Abbas (Pract., ix., 78). See the Sydenham Society’s edition of
PAULUS ÆGINETA, 1. c.
[443] The meaning of this passage is ambiguous. I have followed Coray,
who gives some very interesting annotations on it. He translates these
words, “Ils sont naturellement d’une complexion lâche et trapus;
premièrement, parceque dans leur enfance ils ne sont point emmaillotés,
non plus que les Ægyptiens.” Clifton has given nearly the same meaning
of the passage: “Their fluidness and breadth proceed first from their
neglect of bandages, as in Egypt.” Littré, on the other hand, appears
to give a different interpretation of the passage: “D’abord parceque on
ne les emmaillotte pas, comme en Egypte.”
[444] A fat condition of the body was also supposed adverse to
conception in the case of cattle. Virgil alludes to this opinion, and
the means used to counteract the effects of an excessively fat state
of the body in the following verses, which have been always admired as
an example how delicately a great genius can touch upon an indelicate
subject:
“Ispa autem macie tenuant armenta volentes,
Atque, ubi concubitus primos jam nota voluptas
Sollicitat, frondesque negant, et fontibus arcent.
Sæpe etiam cursu quatiunt et sole fatigunt;
Hoc faciunt nimio ne luxu obtusior usus
Sit genitali arvo, et sulcos oblimet inertes;
Sed rapiat sitiens venerem, interiusque recondat.”
Georg., iii., 136.
[445] On the nature of this affection see the Argument. There is a
variety in the reading, most of the MSS. having ἀνανδριείς, but the one
usually marked 2146, which is followed in the Aldine edition, reading
ἀνδριεῖς. See a long discussion in Coray’s edition on this point. There
seems to be no good reason for at all interfering with the text as it
now stands.
[446] Our author in this place, as in the treatise on the Sacred
Disease, holds the philosophical opinion in opposition to the
superstitious, that all diseases have natural causes, and that no one
more than another is to be ascribed to the extraordinary interference
of supernatural beings. Plato, his contemporary, would appear to have
endeavored to steer a sort of middle course between the scientific and
the popular belief. Thus he ascribes epilepsy, like all other diseases,
to a natural cause, namely, in this instance, to a redundancy of black
bile; but he qualifies this opinion by calling the passages of the
brain (the ventricles?) most divine, and adds that the disease had been
most appropriately denominated sacred. (Timæus, § 66.)
[447] The origin and signification of this term are by no means well
defined. See Galen (Exeges, etc.), Foës (Œcon. Hippocr.), and Coray
(ad h. l.). It has been applied first, to certain varieties of morbus
coxarius; secondly, to chronic buboes, superinduced by disease of the
hip-joint; thirdly, to paralysis of the muscles about the genital
organs; fourthly, aneurismal varix. (See Aretæus, Morb. Acut., ii.,
8; and the note in Boerhaave’s edition.) I must own that I find some
difficulty in deciding to which of these significations I should give
the preference; I rather incline, however, to the first, from what our
author says towards the end of this section, namely, that all men who
ride much “are afflicted with rheums in the joints, sciatica and gout,
and are inept at venery.”
[448] This opinion of our author was no doubt founded on the erroneous
notion regarding the distribution of the veins which prevailed in his
time, and which we find advocated in the tract “on the Nature of Man,”
and elsewhere. (See Aristot., H. N., iii., 3.) Coray strives hard, in
his annotations on this passage, to make out that the fact may be as
stated by his ancient countryman, although the hypothesis by which
he explained it be false. It is singular, however, that, after the
lapse of more than two thousand years, Phrenology should have come to
the assistance of Hippocrates in this case. I need scarcely remark
that Gall and his followers hold that the cerebellum is the seat of
the animal appetites, so that, if this be really the fact, a close
sympathy between the back of the head and the genital organs may be
very legitimately inferred. At all events, this coincidence between
ancient observation and modern hypothesis must be admitted to be very
remarkable.
[449] Aristotle, on the other hand, holds that the effects of
equitation are aphrodisiac. (Probl. iv., 12.) Coray attempts to
reconcile the discordant opinions of the physician and philosopher, by
supposing that moderate exercises may excite the venereal appetite,
whereas excessive extinguish them. Van Swieten agrees with Hippocrates
that inordinate exercise in riding may induce impotence. (Comment. in
Boerh. Aphor., § 1063.)
[450] It is a singular idea of our author that the wearing of breeches
by confining the development of the genital organs impairs the sexual
desires. It is curious, as remarked by Coray, that the same opinion is
advocated by Hunter in his treatise on the Venereal Disease. Coray also
quotes the following passage from Lalement: “Sæpe audivimus pistores et
cæteros quorum partes pudendæ subligaculis non obteguntur sed liberius
pendent crassos et bene nutritos habere testiculos.”--Comment. in
Hippocrat. de Aer., etc.
[451] I trust I shall be excused in quoting entire Dr. Coray’s note
on this section: “Trente mille Macédoniens (dit Pauw) ont conquis la
Perse; quarante mille Mogols ont conquis les Indes; cinquante mille
Tartares ont conquis la Chine, où l’on comptait alors plus de quarante
millions d’habitans, qui abandonnèrent leurs souverains. On a vu de nos
jours l’armée du grand Visir déserter presque complètement dans les
environs de Varna; et jamais les Turcs n’eurent plus de bon sens qu’en
cette occasion là; car leurs tyrans ne méritent pas qu’on verse une
seule goutte de sang pour les maintenir sur le trône de ces contrées
qu’ils ont dévastées en voleurs et en brigands. (Recherch. philosoph.
sur les Grecs.)--Par ce dernier exemple on voit encore combien les
causes politiques ou morales, et les causes naturelles, peuvent se
modifier réciproquement. Les Russes, quoique soumis à un gouvernement
despotique, ont cependant été la terreur des Turcs, à cause, sans doute
de la différence du climat, de la discipline militaire, et des progrès
dans la civilisation. Ces circonstances ont concouru à mitiger le
despotisme Russe, et à le rendre si différent du despotisme brutal des
Turcs. Il en est de même des autres peuples Septentrionaux de l’Europe.
Quoique gouvernés par des loix qui ne sont point leur ouvrage, ils sont
très belliqueux, et par la nature de leur climat, et par les lumières
que les sciences et les arts ont répandues parmi eux.”
[452] Aristotle, in drawing the traits of the European and Asiatic
character, would appear to have borrowed freely from our author. He
says the inhabitants of cold countries and of Europe are full of
spirit, but deficient in intellect and skill; they therefore remain
in a state of freedom, but without regular government, and they are
incapable of governing their neighbors. The inhabitants of Asia are
described by him as being intellectual and skilled in the arts, but
deficient in courage, and therefore they are in constant subjection and
slavery. The Greeks, he maintains, held an intermediate place between
these two, have both courage and intellect, and therefore enjoy freedom
and good government. (Polit., iii., 7.)
[453] We have lately had a notable example of the warlike and
independent spirit of mountaineers in the determined resistance which
the Circassians have made to the colossal power of Russia. Great
Britain, too, I may be permitted to remark, experienced disasters in
contending with the mountaineers of Affganistan, such as she had never
met with in the rich plains of India. And, by the way, the conqueror of
Greece and of Persia was very nearly cut off by the same people. See
Arrian, Exped. Alexandr., iv., 22, etc.
[454] Ἄναρθροι. The meaning of this term seems to be, persons whose
joints are indistinct owing to fatness.
[455] Coray supposes, and apparently with justice, that our author
in this passage tacitly refers to the inhabitants of Attica. It is
worthy of remark that Thucydides ascribes the early civilization of the
Athenians to the infertility of the soil. (Ἀττίκην λεπτόγεων, i., 2.)
See Arnold’s Note, h., 1.; also the quotation from Aristotle at § 23;
and Plato’s Timæus, tom. iii., p. 247; ed. Bekker. According to Coray
(but perhaps he was partially disposed towards his adopted country),
the characters of Provence and Marseilles are analogous to those of
Attica and Athens, and the effects on the inhabitants similar. That
Marseilles was at one time a flourishing seat of learning is undoubted;
see Tacitus (Agricola) and Strabo (Geogr., iii.); but in literary
celebrity it cannot surely aspire to be put on a level with the region
which produced an Æschylus, a Thucydides, a Plato, and a Demosthenes!
And it may be doubted whether even the Marseillais Hymn equals in
masculine energy the war songs of Tyrtæus!
[456] Its title is, Specimen Historico-Medicum Inaugurale de
Hippocratis Doctrina a Prognostice Oriunda. Lugduni Batavorum, 1832.
[457] Cap. v.
[458] Comment. in Prognos. ap. Dietz.
[459] The opinion here advanced is expressed with great precision
by a French writer who has been making some figure in the political
world of late. “Great men,” says Louis Blanc, “only govern society
by means of a force which they themselves borrow. They enlighten the
world only by a burning focus of all the scattered rays emanating from
itself.”--Organization of Labor, p. 98, English edition.
[460] Ascarus, a Theban statuary for one. See Pausanias, v., 24, 1.
[461] See the Commentary of Simplicius. As I quote from memory I cannot
refer to the page.
[462] Galen, in his Commentary on this clause of the sentence, acutely
remarks that patients are justly disposed to form a high opinion of a
physician who points out to them symptoms of their complaint which they
themselves had omitted to mention to him. And Stephanus further remarks
that the patient naturally estimates highly the acumen of the physician
who detects any errors in regimen which he has been guilty of, such as
drinking water, or eating fruit when forbidden; (Ed. Dietz, p. 54;) or
when he has some disease about him, such as bubo or inflammation, which
he wishes to conceal. (Ibid., p. 63.)
[463] It has puzzled all the commentators, ancient and modern, to
explain satisfactorily why Hippocrates, in this place, seems to adopt
the popular creed, and acknowledge that a certain class of diseases are
of divine origin; whilst in his treatises “On Airs,” etc., and “On the
Sacred Disease” he combats this doctrine as being utterly unfounded.
Galen attempts to get over the difficulty by supposing that, in this
place, by divine our author means diseases connected with the state of
the atmosphere; this, however, would merely imply that, on the present
occasion, he expressed himself in accordance with the popular belief.
And, by the way, I would beg leave to remark that the plague which is
described by Homer in the exordium to the Iliad, and is referred to the
wrath of a god, that is to say, of Apollo, was at the same time held
by Eustathius and other commentators to be connected with the state
of the atmosphere; that is to say, agreeably to the vulgar belief,
epidemical diseases were looked upon as divine. See also Stephanus,
the commentator, t. i., p. 77; ed. Dietz. M. Littré has given, from a
MS. in the Royal (National?) Library at Paris, a gloss never before
published, which contains an interesting extract from one of the
early Hippocratic commentators, Xenophon of Cos, bearing upon this
passage. It is to this effect, that Bacchius, Callimachus, Philinus,
and Heraclides Terentinus, supposed that by divine, in this place, was
meant pestilential, because the pestilence was held to be from god; but
that Xenophon, the acquaintance of Praxagoras, reckoned the nature of
the critical days divine; for, as to persons in a storm, the appearance
of the gods Dioscuri brings safety, so do the critical days bring life
to men in disease. (Opera, tom. i., p. 76.) See some remarks on this
scholium by Grote, Hist. of Greece, vol. i., p. 488. On the θεῖον of
Hippocrates see further Berends, Lect. in Aphor., p. 349.
[464] It will be remarked that, in his sketch of Prognosis (πρόνοια),
in this place our author uses the term with considerable latitude; in
fact, it comprehends the past, the present, and the future condition
of the patient. Hippocrates, in a word, appears to have desired
that the physician should be in his line what his contemporary,
Thucydides, describes Themistocles to have been as a statesman: “Quod
de instantibus (ut ait Thucydides), verissime judicabat, et de futuris
callidissime conjiciebat.”--Cornelius Nepos, in vita Themistocles. See
also Thucydides, i., 138. Probably both these writers had in his mind
the character of the prophet as drawn by Homer: Ὃς ᾔδη τά τ' ἕοντα τά
τ' ἐσσόμενα πρό τ' ἔοντα.. (Iliad i.)
[465] The groundwork of the matters contained in this section is to be
found in the Coacæ Prænotiones, 212; but it is greatly expanded and
improved by our author. I need scarcely remark that the description of
the features of a dying man is of classical celebrity. It is given in
elegant prose by Celsus, ii., 6; and by Lucretius it is thus put into a
poetical form:
“Item ad supremum denique tempus
Compressæ nares, nasi primoris acumen
Tenue, cavati oculi, cava tempora, frigida pellis
Duraque, inhorrebat rictum, frons tenta minebat.”
De Rerum Natura, vi., 1190.
Shakespeare’s description of the death of Falstaff, by the way,
contains images which have always appeared to me to be borrowed (at
second-hand, no doubt) from this and other passages of the present
work: “For after I saw him fumble with the sheets, and play with
flowers, and smile upon his fingers’-ends, I knew there was but one
way: for his nose was as sharp as a pin, and he babbled of green
fields.--So he bade me lay more clothes on his feet: I put my hand into
the bed and felt them, and they were as cold as any stone,” etc.--Henry
V., ii., 3. Although perhaps it may be thought rather hypercritical,
I cannot omit the present opportunity of making the remark, that it
appears to me rather out of character to make the wandering mind of a
London debauchee dwell upon images “of green fields.” One would have
thought that “the ruling passion strong in death” would have rather
suggested stews and pot-houses to the imagination of such a person.
[466] It will be remarked that our author modifies his judgment on
the result of the _ensemble_ of dangerous symptoms which he has
just described, provided they be connected with want of food and of
rest, or with looseness of the bowels. See Galen’s Commentary on this
passage. Celsus renders this clause of the sentence as follows: “Si ita
hæc sunt, ut neque vigilia præcesserit, neque ventris resolutio, neque
inedia.”--ii., 6. I may briefly mention that both Galen and Stephanus
seem to have understood this passage as I have translated it. Littré it
will be seen has rendered it somewhat differently.
[467] The prognostics, drawn from the position in which the patient is
found reclining, are mostly taken from the Coacæ Prænotiones, 497. As
usual, however, Hippocrates has improved very much the materials which
he avails himself of.
I would here point out a mistake which most of the modern translators
have committed respecting the meaning of an expression contained in
this paragraph. It is καὶ τὸ ξύμπαν σῶμα ὑγρον κείμενον, which Clifton,
Moffat, and even Littré understand as descriptive of the body’s being
in a moist state with sweat. Littré’s translation is, “Le corps entier
en moiteur.” The translators forget that the word ὑγρὸν is used by the
best classical authors to signify “relaxed” or “soft.” Thus Pindar,
in his celebrated description of the eagle perched upon the sceptre
of Jupiter, and lulled asleep by the power of music (every English
scholar will remember Gray’s version of it in his Ode on the Progress
of Poesy), has the expression ὑγρὸν νῶτον, which Heyne interprets
by _flexile_ and _lubricum_. (Ad Pyth., 1.) See also the
Scholiast, in h. 1. Galen apprehends the meaning of the term as I have
stated it: thus he defines it as applying to the position intermediate
between complete extension and complete flexion, that is to say,
half-bent or relaxed. Foës also renders the expression correctly by
“corpus molliter positum.” (Œconom. Hippocrat.) See also Stephanus
(p. 96, ed. Dietz), who decidedly states that the epithet (ὑγρὸς), in
this place, means slightly bent or relaxed. Heurnius explains ὑγρὸν as
signifying “molliter decumbens,” p. 189. Celsus renders the words in
question by “cruribus paulum reductis,” ii., 3.
[468] This is taken pretty closely from the Coacæ Prænotiones, 235.
[469] This sentence is thus translated by Celsus: “Ubi ulcus, quod aut
ante, aut in ipso morbo natum est, aridum, et aut pallidum, aut lividum
factum est.” (ii., 6.) It is imitated from the Coacæ Prænotiones, 496.
[470] This graphic description of the movement of the hands in delirium
is nearly original, being but slightly touched upon in the Coacæ
Prænotiones, 76. The terms are copied by most of the ancient authors
subsequent to Hippocrates, in their descriptions of phrenitis and
febrile delirium. See in particular PAULUS ÆGINETA, Book III.,
6. Stephanus, in his Commentary, has several very philosophical remarks
on this passage, namely, upon the rationale of the ocular deception
which leads to these extraordinary movements of the hands. (Ed. Dietz,
t. i., pp. 103, 104.)
[471] This is imitated pretty closely from the Coacæ Prænotiones, 260.
Dr. Ermerins remarks that there is a greater number of symptoms in the
Prænotiones than in the Prognostics. He therefore suggests the question
whether there may not be a lacuna in the text. The description of the
respiration preceding dissolution in the Prænotiones is certainly
most graphic, and it appears wonderful that it should be omitted by
Hippocrates in the Prognostics.
[472] The paragraph on sweats is founded on the Coacæ Prænotiones, 572,
573; but the Prognostics is much fuller than the other. The cold sweats
described in this paragraph were called syncoptic by the ancients, and
were supposed to be connected with atony of the pores of the skin. See
Galen, h. 1., and De Causis Sympt. iii., 9. Stephanus, with rather too
much logical parade, gives a good many acute and interesting remarks on
this passage. He says that cold sweats are connected with a complete
prostration of the innate heat (calidum innatum). (p. 114.)
[473] The characters of the hypochondriac region are copied in part
from the Coacæ Prænotiones, 279, 280, 282; but they are much improved
in the Prognostics. It will be remarked that in the Epidemics great
attention is paid to the state of the hypochondria. Stephanus remarks
that pulsation _or_ palpitation in the hypochondria is caused by
violent throbbing of the aorta as it passes through this region, which
is occasioned by the effervescence and inflammation of the important
parts which are situated in it, and with which the brain is apt to
sympathize. (p. 118.) Meteorism of the hypochondriac region is often
mentioned in the reports of the cases described in the Epidemics.
[474] The author evidently alluded to hepatitis ending in abscess. This
would seem to have been a very common termination of inflammation of
the liver in Greece, as it is often described in the ancient medical
works. See PAULUS ÆGINETA, B. III., 46, and the authorities
quoted there in the Sydenham Society’s edition.
[475] The paragraph on the prognostics relating to dropsies is founded
in a great measure on the Coacæ Prænotiones, 454. The ancient writers
who treat systematically of dropsy generally describe four varieties
of it, namely, dropsy from disease of the liver, from disease of the
spleen, from fever, and from a sudden draught of cold water. See De
Morbis, and PAULUS ÆGINETA, B. III., 48, Sydenham Society’s
edition.
[476] On this variety I have remarked in the Comment. on Paulus
Ægineta: “Hippocrates refers one species of dropsy to disease of the
parts situated in the loins, by which Galen and Stephanus agree that
he means the jejunum, mesaraic veins, and kidneys.” (Paulus Ægineta,
l. c.) M. Littré accordingly holds it probable that allusion is made
to granular degeneration of the kidneys, that is to say, to Bright’s
disease. (Opera, etc., tom. ii., 388.)
[477] Dr. Ermerins remarks that the species of dropsy here described
was most probably connected with organic disease of the parts situated
in the abdominal region, arising from inflammation with which they had
been previously attacked.
[478] This paragraph is pretty closely taken from the Coacæ
Prænotiones, 492. A good deal of stress is laid upon the state of the
temperature of the extremities in the reports of the febrile cases
contained in the Epidemics. He announces it as a general truth that
coldness of the extremities in acute diseases is bad. (Aphor. vii., 1.)
Sprengel considers that he has stated this fact in too general terms,
as there are many exceptions to it. (Hist. de la Méd., tom. i., 317.)
[479] This is taken in part from the Coacæ Prænotiones, 493. Sprengel
finds great fault with Hippocrates for laying it down as a rule, that
in cases of gangrene a black color of the part is less dangerous than
a livid. Dr. Ermerins, however, espouses the side of Hippocrates,
and maintains that our author has acutely pointed out the difference
between gangrene proving critical, and gangrene connected with weakness
of the vital actions in the part. In the former case the part becomes
perfectly black, whereas in the other it is livid. He mentions that
he observed in an hospital at the same time a case of mortification
from cold, and another of the same from want and congelation; that in
the former the part was black, and the patient recovered; whilst in
the other the arms were livid, and the patient soon died. (Specimen
Hist. Med., p. 68.) Stephanus, by the way, gives nearly the same
explanation of this remark. (p. 142.) Perhaps our author had in view
the plague of Athens, in which the disease often terminated favorably
in mortification of the fingers or toes. (Thucyd., ii., 49.)
[480] A considerable portion of the Prognostics from Sleep are taken
from the Coacæ Prænotiones, 497. This part is elegantly rendered
by Celsus: “Ubi nocturna vigilia premitur, etiamsi interdiu somnus
accedit; ex quo tamen pejor est, qui inter quartam horum et noctem
est, quam qui matutino tempore ad quartam. Pessimum tamen est, si
somnus neque noctu, neque interdiu accedit; id enim fere sine continuo
dolore esse non potest.” (ii., 4.) Stephanus gives a philosophical
disquisition on the nature and causes of sleep. (pp. 142–8.)
[481] This is pretty closely taken from the Coacæ Prænotiones, 601.
[482] A small part of this is to be found in the Coacæ Prænotiones, 609.
[483] Part of this is borrowed from the Coacæ Prænotiones, 601.
[484] Strigmentosa: that is to say, resembling the scrapings _or_
strippings of the bowels.
[485] This in part is borrowed from the Coacæ Prænotiones, 604, 631.
[486] This is pretty closely copied from the Coacæ Prænotiones, 495.
[487] This is taken from the Coacæ Prænotiones, 281. Several of the
other ancient writers on medicine, both Greek and Arabian, have
treated fully on the characters of the alvine discharges; but, upon
the whole, have not added much to the information contained in the
Coacæ Prænotiones and Prognostics. See the Commentary on PAULUS
ÆGINETA, B. II., 13. Stephanus has many interesting observations
on the prognostics from the urine. He remarks that the urine is a good
index of the condition which the digestive process is in, and more
especially the process of sanguification. (p. 162.)
[488] This is closely copied from the Coacæ Prænotiones, 575.
[489] According to Stephanus, both the farinaceous and leafy sediments
are the products of a melting of the solid parts, as a consequence of
inflammatory heat. (p. 165.)
[490] A small portion of the above occurs in the Coacæ Prænotiones, 578.
[491] For part of this our author is indebted to the Coacæ Prænotiones,
580.
[492] See Coacæ Prænotiones, 582.
[493] This is partly taken from the Coacæ Prænotiones, 577.
[494] Galen, in his Commentary, justly praises Hippocrates for the
acuteness of the remark contained in this sentence, since both with
regard to the urinary and fecal discharges, it must be highly important
to determine whether their characters be indicative of the condition
of the general system, or of the viscus by which they are secreted.
(Opera, v., p. 142; ed. Basil.) The ancients paid great attention
to the characters of the urine in disease, and their knowledge of
the subject will be admitted, even at the present day, to have been
remarkable. The works of some of the later authorities, particularly of
Theophilus and Actuarius, are well deserving of an attentive perusal.
See PAULUS ÆGINETA, Vol. I., p. 225.
[495] This is partly taken from the Coacæ Prænotiones, 556.
[496] These characters of the sputa are partly borrowed from the Coacæ
Prænotiones, 390, 399.
[497] They are founded on the Coacæ Prænotiones, 390, 391.
[498] This is taken in part from the Coacæ Prænotiones, 302, 304.
The succeeding paragraphs on empyema are also partly derived from
the Coacæ Prænotiones, 393, 402, 428. I may be allowed to remark
in this place that modern pathologists are agreed that abscesses
after pneumonia are of rare occurrence; at the same time, however,
purulent infiltration and its natural consequence, expectoration of
pus, are not so very uncommon results of the disease. True pulmonary
abscess or empyema is commonly occasioned by chronic inflammation. I
am inclined to think that the ancients applied the term also to the
cavities in the lungs produced by the softening of tubercles. It is
difficult otherwise to account for the frequent mention of empyemata
in the works of the ancient authorities on medicine, especially
in the Hippocratic treatises. See De Locis in Homine, p. 415, ed.
Foës; and tom. i., p. 306, ed. Kühn, et alibi. M. Littré makes the
following remarks on the descriptions of empyema which occur in the
Hippocratic treatises: “On remarquera dans le _Pronostic_, et
cette remarque s’étend à plusieurs autres des écrits Hippocratiques,
qu’une très-large place est faite aux affections de la poitrine,
péripneumonies et pleurésies. Il paraîtrait que, sous le climat de
la Grèce, ces affections ont une grande fréquence, plus peut-être
qu’elles n’en ont même dans notre climat. La description, fort abrégée
il est vraie, qu’en donne Hippocrate, me porte à penser que, si cette
description est exacte, elles ne suivent pas la même marche que parmi
nous. En effet, que sont ces empyèmes que, suivant Hippocrate, se font
jour an dehors sous forme d’expectoration purulente? On peut croire,
que dans les dénominations d’empyèmes sont compris les épanchements
pleurétiques; mais les épanchements pleurétiques ne se font pas jour au
dehors, ils se guérissent par résorption; alors, que sont ces empyèmes
signalés par Hippocrate, comme terminaison des péripneumonies, et ces
expectorations qui en procurent l’evacuation? Il m’est impossible de
répondre à ces questions: peut-être des observations faites dans la
Grèce même, permettraient de résoudre la difficulté.” (Œuvres Complets
d’Hippocrate, tom. ii., p. 97.) Perhaps, as I have hinted above, the
most probable answer that could be returned to the questions put by M.
Littré would be, that many of the cases of pneumonia terminating in
empyema, which occur in the Hippocratic treatises, were what are now
described as cases of acute phthisis. See Louis on Phthisis, ii., 2.
In confirmation of my supposition that many of the cases of empyema
described by the ancients were, in fact, cases of phthisis, I would
refer to PAULUS ÆGINETA, B. III., 32, where it will be seen
that the two diseases, phthisis and empyema, are treated of under the
same head. See also the second book of the Prorrhetics, tom. i., pp.
198–201; ed. Kühn.
M. Littré reverts to this subject in the Argument to the Coacæ
Prænotiones, tom. v., p. 576, where he relates, from two recent
authorities, a case of empyema after pleurisy, and another after
pneumonia, in both of which the pus was evacuated by the mouth. He also
quotes the remark of an English writer, Dr. Twining, that, in and about
Bengal, abscess of the lungs after pneumonia is by no means very rare.
Still M. Littré admits that the paucity of such cases in modern works
must lead to the conclusion either that Hippocrates had not observed
correctly, or that this termination is more rare now than formerly. I
leave the reader to judge whether my suggestion stated above does not
remove this difficulty.
[499] The observations of Andral have in some measure confirmed the
opinion of Hippocrates and other authors, ancient and modern, that
there are certain days in the duration of the disease in which there
is a greater tendency to amelioration. Of ninety-three cases, he found
twenty-three give way on the seventh, thirteen on the eleventh, eleven
on the fourteenth, and nine on the twentieth days. The recoveries in
the remaining cases commenced on twelve out of forty-two non-critical
days, as many as eleven being ascribed to the tenth day. Thus the
recoveries on critical days averaged as high as fourteen, while those
on non-critical scarcely exceeded three. (Dr. C. J. B. Williams on
Pneumonia, Cyclop. of Pract. Med., vol. iii., p. 405.) See also Andral,
Clin. Med., c. ii., p. 365.
[500] Stephanus has a lengthened and most important commentary on this
passage, containing an elaborate disquisition on empyema. (pp. 184–91.)
[501] This is taken pretty closely from the Coacæ Prænotiones, 395.
[502] A part of this is copied from the Coacæ Prænotiones, 396.
[503] It will be seen in our analysis of several of the Hippocratic
treatises, such as De Affect. Intern., De Morbis, etc., that it was
the common practice in such cases to evacuate the matter either by the
cautery or the knife. See also Aphorism, vii., 44.
[504] Part of this is borrowed from the Coacæ Prænotiones, 108.
[505] This is in part derived from the Coacæ Prænotiones, 471. Galen,
in his commentary, is at pains to explain that by a hard bladder
Hippocrates means a bladder in a state of inflammation.
[506] The subject of the critical days is not touched upon in the Coacæ
Prænotiones, so that the contents of this section are either original
or taken from some source with which we are totally unacquainted.
Galen, indeed, does not hesitate to declare that Hippocrates himself
was the first who treated of the critical days; but whether he had
any competent authority for pronouncing this opinion cannot be
satisfactorily determined. The critical days are incidentally treated
of in the Epidemics and Aphorisms; but, as we have stated in our
critique on the Hippocratic treatises in the Preliminary Discourse,
the work “On Critical Days” is in all probability spurious. The system
of the critical days taught by Hippocrates was adopted by almost all
the ancient authorities, with the exception of Archigenes and his
followers, who, however, were not numerous nor of any great name, with
the exception of Celsus. See the Commentary on PAULUS ÆGINETA,
B. II., 7, Syd. Soc. edition.
[507] The contents of this section are borrowed in a great measure from
the Coacæ Prænotiones, 160. Dr. Ermerins remarks that the headache here
described is probably of a catarrhal or rheumatic nature. (Specimen
Hist. Med. Inaug., etc., p. 84.)
[508] This is taken in great measure from the Coacæ Prænotiones, 189.
Galen in his commentary, remarks that patients die of violent pains of
the ear, owing to the brain sympathizing, which brings on delirium, and
sometimes occasions sudden death. I may be allowed to remark that every
experienced physician must have met with such cases.
[509] A considerable part of this section on ulcerated sore-throat is
extracted from the Coacæ Prænotiones. The present sentence is from
§ 276. The medical reader will not fail to remark that Hippocrates
displays a wonderfully accurate acquaintance with these affections.
[510] This is founded on the contents of the Coacæ Prænotiones, 363.
The disease here described is evidently angina laryngæa.
[511] This is taken in part from the Coacæ Prænotiones, 364. As Dr.
Ermerins remarks in his note on it, the disease here described is
evidently angina pharyngæa.
[512] This is closely copied from the Coacæ Prænotiones, 365. The
danger of erythematous swelling being determined inwards, is well
understood nowadays.
[513] This is taken, with slight alterations, from the Coacæ
Prænotiones, 365, 367. The latter clause is more fully expressed in
the Coacæ Prænotiones than in the Prognostics. “In those cases in
which cynanche is determined to the lungs, some die in seven days, and
some escaping these get into a state of empyema, unless they have a
pituitous expectoration.” This is evidently a correct description of
the disease spreading to the lungs.
[514] No part of this last clause is to be found in the Coacæ
Prænotiones. The operations of excising and burning the diseased uvula
are minutely described by Paulus Ægineta and other of the ancient
authorities. See PAULUS ÆGINETA, B. VI., 31. I need scarcely
remark that both these operations have been revived of late years.
[515] This is taken with little variation from the Coacæ Prænotiones,
146.
[516] A part of what precedes is taken from the Coacæ Prænotiones, 143;
all that follows, with the exception of a short sentence, is original.
[517] Our author here and elsewhere impresses it upon his readers that
it is from the _tout ensemble_ of the symptoms that a judgment
is to be formed in every case. This is evidently a remark of the most
vital importance in forming a prognosis. Galen’s observations in the
succeeding commentary are very interesting, and deserve an attentive
perusal.
[518] That is to say, the physician ought to get speedily acquainted
with the nature of the epidemics which prevail at every particular
season. I need scarcely remark that this is a subject which is
largely treated of in the works of our English Hippocrates, Sydenham.
Hippocrates himself is very full on this head, more especially in his
Epidemics and Aphorisms, as we shall see below.
[519] It has excited a great deal of discussion and difference of
opinion to determine what our author means by specifying these three
places; but the explanation given by Galen in his Commentary seems to
me quite satisfactory. According to him, the meaning of our author is
that good and bad symptoms tell the same in all places, in the hot
regions of Libya, the cold of Scythia, and the temperate of Delos. It
is further to be borne in mind that Odessus in Scythia, and Cyrene in
Libya, were the extremities of the Grecian world, whilst Delos may be
regarded as its centre. It is proper to remark, however, that by the
three places mentioned, Erotian understands the three quarters of the
earth--Africa, Asia, and Europe. See under Λιβύη.
[520] The meaning of this last sentence has been supposed to be
somewhat ambiguous; but to me it appears evidently to be this, that
the rules of prognosis, as laid down above, apply to all diseases of
an acute character, whether their names happen to be mentioned in the
course of this work or not, so that it should not be considered a
defect in the work that any one is omitted.
[521] See Epidem., i., and iii.
[522] Empyema is treated of in the Prognostics, the first book of
Prorrhetics, the Coacæ Prænotiones, and the work De Morbis. Which of
these is here alluded to cannot be determined for certain; it seems
probable, however, that it is to the preceding book of Prorrhetics.
[523] This important observation is thus rendered by Celsus: “Quæ in
latere linguæ ulcera nascuntur diutissimè durant. Videndumque est, num
contra dens aliquis acutior sit, qui sanescere sæpe ulcus eo loco non
sinit, ideoque limandus est.” (vi., 12.)
[524] Allusion seems to be made to herpes exedens.
[525] See PAULUS ÆGINETA, B. III., 25.
[526] Foës inclines to think that the proper reading in this place
is νοὔσος φοινικίη, and not φθινικὴ, and that Galen alludes to this
passage in his Exegesis under the former of these terms, where he
says that by φοινικίη νοῡσος was probably meant elephantiasis. The
other reading, however, would seem quite applicable, for I have known
phthisis and leprosy combined in the same case.
[527] The phrenitis of Sydenham in like manner was an epidemical fever,
and not an idiopathic inflammation of the brain. See Opera, p. 56; ed.
Syd. Soc. That Hippocrates regarded phrenitis as a variety of causus,
attended with determination to the brain, is obvious from Epidem. i.
See Op. Galen., tom. v., p. 371; ed. Basil.
[528] Horace, Serm. i., 2.
[529] One mode of exercise, namely, gestation, is to be excepted,
which had at least one distinguished advocate in ancient times. Celsus
writing of it says, “Asclepiades etiam in recenti vehementique,
præcipueque ardente febre, ad discutiendam eam, gestatione dixit
utendum: sed id pericolose fit; meliusque quiete ejusmodi impetus
sustinetur.” (ii., 15.) A great modern authority on fever, Dr. R.
Jackson, speaks favorably of this practice, although, as we see, it is
so pointedly condemned by Celsus. Celsus, however, admits of gestation
in that species of remittent fever which was called lethargus. (iii.,
20.)
[530] Observ. Med., vi., 3, 4.
[531] The Cnidian Sentences in all probability were the results of the
observations and theories made in the Temple of Health at Cnidos. We
may reasonably conclude from what we know of them, that, like the Coacæ
Prænotiones at Cos, the Cnidian Sentences at Cnidos were looked up to
in the time of Hippocrates as the great guides to medical practice.
How much, then, it is to be regretted that they have not come down
to us like the other! It is clear, however, from Galen’s Commentary,
that the work was extant in his time, and from it, as will be seen,
we are enabled to draw a few particulars respecting the theoretical
and practical views of the Cnidians. Le Clerc considers it likely that
Euryphon was the author of the Cnidian Sentences (Hist. Phys., i., 3,
30); but it is evident, from the terms in which Hippocrates refers
to them, that they were not the work of a single author. He makes
mention, it will be remarked, of more than one person being concerned
in remodelling them.
[532] By this our author means that the Cnidians neglected Prorrhetics
and Prognostics. This must be obvious to every person who had entered
properly into the spirit of the Hippocratic system of medicine.
[533] The text of this sentence is in a very unsatisfactory state, and
much difference of opinion has prevailed respecting the meaning. See
the annotations of Littré, and the remarks of Galen, as quoted in the
Argument.
[534] Galen, in his Commentary, mentions that the Cnidians described
seven species of diseased bile, and twelve diseases of the bladder;
and, again, four diseases of the kidneys; and, moreover, four species
of strangury, four species of tetanus, and four of jaundice; and,
again, three species of phthisis. Galen, having made this statement,
remarks that they looked to the peculiarities of the body, instead of
regarding the identity of the diatheses, as was done by Hippocrates.
In other words, they split diseases into endless varieties, instead
of attending to the essence or general nature of each. The system
of Hippocrates, then, was founded on a rational prognosis, whereas
that of the Cnidians was founded on mistaken principles of diagnosis.
The principles of the Hippocratic system are admirably explained and
developed in Galen’s great work On the Method of Cure, _or_
Therapeutics.
[535] Galen, in his Commentary on this passage, states that when a
disease of a mild character prevailed generally, it was called an
epidemic; and when of a malignant nature, it was called the plague.
(See further PAULUS ÆGINETA, Book II., 36, Syd. Soc. edition.)
It will be remarked that I have included the word (_not_) in
brackets. This I have done because not only the reading, as given in
the common editions of Galen, is in its favor, but because the sense
appears to me to require it. Surely when diseases are of an epidemic
character they are similar; but when they are sporadic, they are not
similar. M. Littré, however, rejects it altogether.
[536] The question here mooted is certainly one of the most important
that can well be entertained, namely, whether or not a certain portion
of nutriment ought to be given to persons laboring under fever. It
would appear, from what is stated by Galen upon the authority of
Erasistratus, that the most diametrically opposite modes of practice
had been followed by different individuals--that some had starved
their patients altogether for a considerable time; whereas, on the
other hand, a physician of the name of Petronas allowed his patients
flesh and wine. Our author, it will be remarked, does not allude to
these extreme modes of practice in this place, but enters at great
length into the question whether or not unstrained ptisan (_or_
barley gruel) should be administered in fevers, and, if so, under what
circumstances.
[537] Galen, in his Commentary, has some very interesting remarks on
the differences of opinion among the diviners. This, in fact, may well
be supposed, since, as will now be pretty generally acknowledged, the
whole art was founded upon conjecture and deception. The comparison of
medicine to divination is therefore very discreditable to the former.
[538] Our author now enters upon the consideration of one of his
principal objects in the present work, namely, to describe the modes of
preparing ptisan (_or_ the decoction of barley), and its uses in
acute diseases. He is so full on this subject that the present treatise
is quoted by Athenæus (Deipnos. ii., 16), by the name of the work On
the Ptisan. Galen states that, on the principle that diseases are to
be cured by their contraries, as the essence of a febrile disease is
combined of heat and dryness, the indication of cure is to use means
of a cooling and moistening nature, and that the ptisan fulfils both
these objects. I may be allowed to remark in this place, that probably
there is not a more important rule in the whole practice of medicine
than this, that fevers are to be treated by things of a cooling and
diluent nature. I may mention further regarding the ptisan of the
ancients, that it would appear to have been very little different from
the decoction of barley, as now in use; that is to say, it was prepared
from pearl-barley roughly pounded and boiled for a time in water. As
will be seen by the text, it was given to the sick either strained or
entire, according to circumstances. A similar decoction was prepared
from wheat, and was called πτιαάνη πυρίνη. See Galen (De Aliment., i.)
The simple term ptisan, however, is always to be understood as applying
to the decoction of barley.
[539] Galen gives the following illustration of what is meant by a
disease of a peculiarly dry nature. In pneumonia, pleurisy, and in all
the affections about the lungs and trachea, the disease is held to be
of a dry nature when there is no expectoration from the parts affected;
and in any complaints about the liver, the mesentery, the stomach, the
small or great intestines, or spleen, when the belly is either entirely
constipated, or when the discharges brought away by artificial means
are dry and scybalous; and diseases of the arteries and veins are known
to be dry by the dryness of the tongue, and the parched appearance of
the whole body. In the same manner external ulcers are accounted dry
when there is no discharge from them. And ophthalmies are held to be
dry when there is no discharge from the eyes or nose. And, in short,
all diseases are recognized as being dry which are not attended with
any discharge.
[540] It is curious to remark that a double charge was founded against
our author on the ground of his treatment of febrile cases, as here
laid down. The followers of Thessalus held that he gorged his patients
with too much food, whereas Erasistratus and his followers held that
he starved them. Galen, on the other hand, contends that the practice
of Hippocrates is the _juste milieu_ between these two extremes.
(Opera, tom. v., p. 47; ed. Basil.)
[541] This sentence shows that Hippocrates understood thoroughly
the proper treatment of pleurisy. When the disease did not yield to
fomentations, but the pain continued, either a vein was opened or the
bowels moved; for without first using these means, it was reckoned
fatal practice to administer ptisan. Galen relates that it was also
considered an unsafe practice to give opium, mandragora, or hyoscyamus
for the purpose of alleviating the pain, instead of having recourse
to venesection or purging for the removal of it. This is a practical
remark well deserving of the most serious consideration.
[542] How briefly, and yet how graphically, our author has described
the termination of pleurisy! It is singular that no succeeding author
has written so learnedly of _râles_ in affections of the breast
as Hippocrates, down at least to the time of Laennec, who repeatedly
acknowledges his obligations to our author.
[543] I need scarcely remark that the seasonable administration of
drink, and especially of water, is one of the most important points
connected with the treatment of febrile diseases. This is so much the
case that, as Galen remarks in his Commentary on this passage, fevers
may often be extinguished at once by a large quantity of water given
in due season. This subject is fully treated of by him in his Methodus
Medendi.
[544] The professional reader will not fail to remark, what is pointed
out in strong language by Galen, how judiciously our author commences
with the most gentle means, and gradually rises to the most powerful
and dangerous; namely, bleeding and the administration of drastic
purgatives. One cannot help being further struck with the rich supply
of information which he has on the simple subject of fomentations.
[545] By livid (πέλιον) is here meant the colour intermediate between
red and black. See Galen, h. 1.
[546] Probably the _Helleborus niger_. See PAULUS ÆGINETA, Vol. III.,
p. 108.
[547] The _Euphorbia peplus_. See Ibid., Vol. III., p. 294.
[548] Probably the _Seseli tortuosum_. See Ibid., Vol. III., p. 330;
and Dierbach, Arzn. der Hipp. p. 186.
[549] A species of asafœtida, probably the _Laserpetium derias_. PAULUS
ÆGINETA, Vol. III., p. 339.
[550] It is worthy of remark, that our author directs aromatics to be
mixed with the purgatives. The reason for prescribing them, as Galen
states, was to counteract the bad effects of the purgatives upon the
stomach. The ancients, in my opinion, acted much more wisely in this
respect than the moderns generally do, for the latter are constantly
administering the most nauseous cathartics to their patients without
taking any pains to obviate their bad effects upon the stomach. On the
ancient modes of administering purgatives, see PAULUS ÆGINETA,
B. VII., 4.
[551] Galen, in his Commentary, remarks that the common herd of
physicians followed the very opposite rule to that here laid down
by Hippocrates, that is to say, they administered food copiously
after evacuations. According to Galen, the object of Hippocrates in
proscribing food of all descriptions at that season is, because the
powers of the system, being then weakened, are unable either to bear
food or to digest it.
[552] See Celsus, I., 3.
[553] The _cyceon_ was a mixture of various articles of food, but
generally contained cheese, honey, and wine. See Athenæus (Deipnos,
ii.). It is described by Homer as the potion which Circe administered
to the followers of Ulysses. (Odyss. x., 235). There is frequent
mention of it in the Hippocratic treatises, as at De Diæta, ii.; de
Muliebribus, ii.; and in the works of the other medical authors.
[554] The meaning here is somewhat obscure, but appears to be this:
that if a patient fast for the first two or three days, and take food
of a heavy nature on the fourth or fifth, he will be much injured, but
that the mistake will be still more fatal if the fast be continued for
the first four or five days, and if he then indulge freely in food at
the end of these.
[555] There is considerable difficulty as to the text at this place.
See Foës in his Annotations and Œconomica, and a very lengthy note by
Littré.
[556] The preternatural mode of respiration here described is several
times adverted to by Galen, as at De Dyspnœa, iii.; Comment. in Aphor.,
iv., 68; and Comment. in h. 1. Galen seems to understand the meaning to
be, that the breathing is intercepted in the inspiration. I should have
rather been disposed to think that it is the expiration which is said
to be interrupted. But I suppose we must bow to so great an authority
as Galen! I may mention, by the way, that his Commentary on this and
the collateral passages of our author is most interesting; but, as
usual, too diffuse for my narrow limits. It relates to a most important
point in medical practice, on which great ignorance and uncertainty
prevail among us, even at the present day.
[557] Galen finds the language in this last sentence so confused, that
he does not hesitate to declare that he is convinced the work must have
been left by Hippocrates in an unfinished state, and not published
until after his death. He decides that ἐφθότης signifies a heated
state connected with humors, and not with dryness; that is to say, a
condition analogous to boiling, and not to roasting.
[558] Galen, in his elaborate Commentary on this section, complains
that our author’s account of wines is imperfect, inasmuch as several
varieties are omitted; at the same time it must be admitted that his
observations on this head are very much to the purpose, and highly
judicious. For the other ancient authorities on this subject, see
PAULUS ÆGINETA, Book I., 95, Syd. Soc. edit.
[559] I need scarcely mention that hydromel was a drink prepared by
boiling honey in a large proportion of water. It was of different
degrees of strength; sometimes there were only two parts of water to
one of honey, and at other times from seven to eight parts were used
See PAULUS ÆGINETA, Book I., 96, Syd. Soc. edit.
[560] Galen, in explanation, mentions that hydromel is of a detergent
nature; and hence it clears out the air-passages, and thus promotes
expectoration. When the sputa are thick and viscid, it cuts and
attenuates them. (Opera, tom. v., pp. 75, 76; ed. Basil.)
[561] Although, as we have shown in our analysis of the treatise on
the Use of Liquids, Hippocrates and his followers were sufficiently
liberal in the administration of water on proper occasions, it will be
seen from the contents of this section that our author was by no means
disposed to give water freely in febrile diseases, nor in affections
of the chest. Whatever may now be thought of his observations on this
point of practice, all must admit that they are deserving of high
attention. Galen’s Commentary is also very interesting. It appears
from it that he disapproved of giving water alone, but always added a
small proportion of wine to it in order to give it a flavour. That the
quantity of wine which was added to the water must have been small, is
obvious from an anecdote which he relates in this place. He says that a
certain physician, who saw the insignificant amount of the wine which
was put into the water, said, bantering him, “Your patient will have
the pleasure of seeing the wine indeed, but will not be able to taste
it.” Galen, however, contends that, although the quantity thus added be
small, it is sufficient to act as a stomachic, and to obviate the bad
effects which the water would otherwise produce. (Opera, tom. v., p.
83; ed. Basil.) It will be perceived from the context, that Hippocrates
intended to give a separate treatise on each particular disease, not
considering the present work on general therapeutics sufficiently
explicit, as Galen remarks.
[562] The smegma was an abstergent composition used by the ancients in
bathing for the purpose of cleansing the skin. For a full account of
the smegmata, see PAULUS ÆGINETA, Vol. III., pp. 536–41.
[563] Galen, in his Commentary, remarks that the physicians usually
did not put their patients into the baths, but made use of the
_douche_, or affusion of hot water. He adds, that persons in good
health may leave the hot bath and plunge into the cold, but that this
practice is not safe in the case of invalids. He recommends, then, that
there should be at hand a good supply of baths of various temperatures,
so that the patient may gradually pass from one of a high to others
of a low temperature. By the way, I have often wondered that Dr.
Currie, who certainly had no inconsiderable pretensions to classical
scholarship, should have been so profoundly ignorant as he appears to
have been of the use of the warm affusion by Hippocrates and Galen in
the treatment of febrile diseases. His rival, Dr. Jackson, had a much
more respectable acquaintance with the ancient authorities on medicine;
and I have often thought it was to be regretted that the profession at
that period, in giving a trial to the affusion of cold and hot water in
fever, put itself under the leadership of Currie instead of Jackson.
[564] Dr. Tweedie’s observations agree so well with those of
Hippocrates, that I will give the reader an opportunity of comparing
them together. “This organ (the stomach), in convalescence, partakes
of the external or muscular debility, and the convalescent may as well
expect to be able to carry a heavy load on his shoulders as to digest
an undue quantity of food, even of a suitable kind.” (p. 215.)
[565] The directions given by that excellent authority Alexander
Trallian, for the regulation of the regimen in phrenitis, are to the
same effect. Wine is to be given when there is much insomnolency, when
the strength is reduced, when the fever is no longer strong and ardent,
and _when concoction appears already in the urine_. The author
makes the acute remark, that the remedy is attended with certain evil
consequences, but that it is the part of a prudent physician to balance
the good and bad effects, and administer the article in question when
the good preponderate. (i., 13.)
[566] This can scarcely be supposed anything else than a wilful
misrepresentation of our author’s rule of practice in this case. See
the fourth section of the preceding part.
[567] The causes _of_ ardent fever of the ancients was decidedly
the same as the bilious remittent fever of modern authors. See
PAULUS ÆGINETA, Vol. I., p. 262. We shall find many cases
of it related in the Epidemics. In fact the causus is the ordinary
fever of Greece and other countries bordering upon the Mediterranean.
Galen, in his Commentary on this section, mentions that he had known it
generally superinduced by drinking wine after great fatigue in summer.
There can be no doubt that this was the fever of which Alexander the
Great died. The description of the disease in his case, as given by
Arrian from the Royal Journals (βασίλειοι ἑφημερίδες), has so much the
air of truth, and withal appears to me so interesting, that I shall be
excused introducing it in this place. “And the Royal Journals ran thus:
that he drank at a jollification in the house of Medius; then rising
up and being bathed, slept, and again supped with Medius, and again
drank until the night was far advanced; that giving over drinking he
bathed; and having bathed, ate a little, and slept there, because he
was already feverish; that being carried on a little to the sacrifices,
he performed them according to his daily practice; that the sacrifices
being performed, he reclined in the dining-room (ἀνδρὼν) until the
dusk of evening, and there gave orders to the commander respecting
the march and voyage, that those who had to proceed on foot should be
prepared for marching on the fourth day, and those who were to sail
on the fifth; that he was carried hence upon a couch to the river,
and being placed in a boat was taken across the river to the garden,
and then being again bathed, that he rested. Next day, that he again
was bathed and performed the appointed sacrifices; and going into a
chamber, that he reclined and conversed with Medius, and gave orders
to the commanders to meet him in the morning. That having done these
things, he took a little supper; and having been carried back to the
chamber, that he was in a continued state of fever during the whole
night; that next day he bathed, and after the bath performed the
sacrifices; that he gave orders to Nearchus and the other commanders
respecting the voyage, that it should take place on the third day;
that next day he bathed again, and performed the appointed sacrifices;
that the religious rites being over, he did not cease to be feverish,
but that calling the commanders he gave orders for having every thing
in readiness for the voyage; that he was bathed next day, and being
bathed was already in a bad state. That next day being carried to
the house adjoining the bath, he performed the appointed sacrifices;
that he was in a bad state, but yet that he called to him the chiefs
of his commanders, and again gave orders respecting the voyage; that
the following day he was carried with difficulty to the religious
rites and sacrificed, and that notwithstanding he gave orders to the
commanders respecting the voyage. That next day, although already in a
bad state, he performed the appointed sacrifices; that he gave orders
that the commanders should watch in the saloon, and the chiliarchs and
pentacosiarchs before the doors; and that being altogether now in a
bad state, he was carried from the garden to the palace. That when the
commanders came in he recognized them, but did not speak, being now
speechless; that he was in a bad state of fever during that night and
day, and during another night and day. Thus it is written in the Royal
Journals.” Thus far the report is no doubt to be strictly depended
upon; the historical embellishments added to it from other sources can
have no interest to the professional reader. (Appiani Exped. Alexandr.,
vii., 37.) It deserves to be remarked, as a remarkable feature in this
case, that the mind appears to have been pretty entire during the whole
course of the fever. Now, this is one of the characteristics of causus
as described by Aretæus (Morb. Acut., ii., 4). It is further one of the
most marked features of the yellow fever, which, from all I can learn
of it, would appear decidedly to be an aggravated form of causus.
[568] Galen admits that he did not understand the exact import of this
term.
[569] This is a general rule of such importance that Galen wonders our
author did not embody it in one of his Aphorisms. Galen’s observations
on venesection in this commentary, and in his two treatises on
this subject, are highly important. It will be remarked that three
circumstances are held to form indications of the necessity for
bleeding: first, if the disease be of a strong nature; second, if the
patient be in the vigor of life; and, third, if his strength be entire.
[570] This section, as Galen remarks, contains a list of the principal
cases in which venesection is to be had recourse to.
[571] I need scarcely point out to the professional reader that these
symptoms are very descriptive of congestion in the brain, threatening
an attack either of apoplexy or epilepsy. See the treatise on the
Sacred Disease.
[572] Meaning apparently the great vessels. See Galen’s Commentary.
[573] The description here given of cynanche, more especially of
the variety in which the ulceration spreads down to the trachea and
produces engorgement of the lungs, is most characteristic, and bespeaks
a great practical acquaintance with the disease. Judged of in a
becoming spirit of candor, it must be admitted that even at the present
day we have scarcely made any advancement in our knowledge of this
subject. What are our descriptions of ulcerous sore-throat, diptherite,
œdema glottidis, croup, and laryngismus stridulus, but reproductions
in a divided and (may I be allowed to suggest?) a less accurate form,
of the general views here presented by our author? For an abstract of
the views of the other ancient authorities in medicine, see PAULUS
ÆGINETA, Book III., 27. Aretæus deserves particularly to be
consulted (Morb. Acut., i., 7). It will be remarked that our author
speaks of a spontaneous determination to the skin, as being calculated
to remove the urgent symptoms within. Galen, in commenting upon this
clause, states that some physicians were in the practice of applying to
the skin certain medicines possessed of ulcerative powers, in order to
determine to the surface, and thus imitate Nature’s mode of cure.
[574] Though the contents of this section are by no means devoid of
interest, it must be obvious to the reader that the observations on
causus are out of place here. See the Commentary of Galen.
[575] I would beg leave to direct the attention of the medical reader
to the observations of our author in this and many other places on
the characters of the urine in fevers. That in febrile diseases the
sediment is wanting previous to the crisis, and that at and after
the crisis, when favorable, the sediment becomes remarkably copious,
I believe to be certain facts; and yet I question if, with all our
boasted improvements in urology, they be generally known and attended
to. I have called attention in the Argument to the important rule of
practice which our author founds on the state of the urine at the
crisis.
[576] He means by this, that the disease is not of an intermittent type.
[577] This seems the most appropriate meaning in this place, but the
passage may also signify “a state of great emphysema or meteorism.” See
Galen.
[578] It is impossible not to recognize here a brief sketch of
_delirium tremens_. The trembling hands from drinking, with the
subsequent delirium, can leave no doubts on the subject. See further
Littré, tom. ii., p. 382.
[579] The fruit of the _pinus pinaster_. See PAULUS ÆGINETA, Vol. III.,
p. 301.
[580] It will be remarked, that in this place the author directs that
the bleeding should be carried to a greater extent than in the former
part of this treatise. In general, the ancient authorities forbade the
abstraction of blood until it induced lipothymia. This is decidedly the
rule of practice laid down by Aretæus (De Curat. Morb. Acut., ii., 1).
[581] Galen, in his Commentary, remarks that this account of dysentery
is vague, the species of dysentery here alluded to not being properly
defined.
[582] This case is vague and undefined. I suppose the author alludes to
opisthotonos in this sentence, and to emprosthotonos in the succeeding
part of this section.
[583] _Bryonia dioica._ See Dierbach, etc., p. 131.
[584] Galen, in his Commentary, remarks that the modes of solution in
fevers are not completely given in this place; for example, our author
omits those by the uterus and the nose.
[585] The text is in a very unsettled state.
[586] The substance of this section occurs in the preceding part of
this work, which certainly amounts to a strong presumption that the
present treatise is not genuine. Very similar views are also laid down
in the treatise On Ancient Medicine.
[587] On the Dietetics of the ancients, see the Commentary on
PAULUS ÆGINATA, Vol. I., pp. 106–86.
[588] By dry cholera would seem to be meant flatulent colic. See
Galen’s Commentary. It is also described below, and further with great
accuracy by Alexander Trallian (vii., 16).
[589] Galen, in his Commentary on this section, finds many things
imperfectly stated, and therefore unworthy of his great author. For
example, he remarks, only two varieties of dropsy are mentioned,
namely, anasarca and tympanites; whereas there are three at least,
and some even describe four varieties. By the three kinds of dropsy,
Galen and the other ancient authorities meant anasarca, ascites,
and tympanitis. (See PAULUS ÆGINETA, Book III., 48). That
tympanites should have been ranked with dropsy need excite no wonder,
when we consider the resemblance of this affection to ascites. In fact
I have known cases of tympanites in which paracentesis was performed
by inexperienced surgeons under the impression that they were cases
of ascites. See some elaborate annotations on this head by Ermerins
(Specimen Hist. Med., p. 125), and by Littré (Op. Hippocrat., tom.
iv., p. 415). With regard to venesection in dropsy, Galen remarks that
the rule of practice is not laid down here with sufficient precision;
it is only when the dropsy is connected with the suppression of the
hemorrhoidal or menstrual discharge, or when the patient is in a
plethoric state, that blood can be abstracted with advantage. He also
finds fault with the directions for the subsequent treatment, as not
being accurately given. He justly remarks, that none but persons in the
vigor of life and in good health would be able to digest dark-colored
wine and pork after venesection. I may mention further that the text
is faulty, that the words ἐγχειρέων γίνεσθαι ἄφυκτος should have been
written ἀποκτέινει δ’ ἐυθὺς ὁ ὔδερος ἐφὴν γένηται. He attributes the
mistake to the first amanuensis who wrote the words in question.
[590] In reference to this practice Horace says:
“Si noles sanus curres hydropicus.” (Serm. I., 1.)
[591] Galen finds many things in this section also carelessly and
confusedly written, and therefore unworthy of Hippocrates. For example,
the list of cases in which purging is inapplicable, Galen holds to be
incomplete; and even in some of the cases specified by Hippocrates he
demurs to admit his views to be correct; for example, in diseases of
the spleen he contends that melanogogues are strongly indicated. Many
more of the rules he considers to be vaguely and inaccurately stated.
Altogether, then, he holds that it is a loss of time to devote much
attention to writings of such a stamp; but, he shrewdly remarks, there
is no persuading many people to study only such writings as are clear,
and to leave such as are not so to the writers themselves; for it is
just that, as they have paid no regard that we should understand what
they have written, we should not be very anxious to find out and learn
what they say.
[592] Galen correctly remarks that this rule is applicable in certain
cases, but not in all.
[593] As Galen remarks in his Commentary, something appears to be
wanting here in order to indicate the disease to which these directions
apply. Perhaps, as he suggests afterwards, they are meant to apply to
general pains.
[594] The Cantharis of the ancients was indisputably the _Mylabris
cichorii_, or _M. Fusselini_. It continued to be used in
ancient times as a diuretic, (see PAULUS ÆGINETA, Vol. III.,
p. 153;) and is well known in the East at the present day.
[595] All the remaining part of this work evidently consists of
fragments put together, without any method or arrangement. Though
not devoid of interest, they decidedly have no connection with the
treatise On Regimen in Acute Diseases. Indeed an impartial examination
of the whole Appendix must satisfy any one that there are but too good
grounds for holding with Galen, that the whole work is a disorderly
compilation, which, although it may have been made up of notes written
or dictated by Hippocrates, had certainly not been published by him.
[596] It most probably is the _Reseda mediterranea_. See
PAULUS ÆGINETA, Vol. III., p. 331.
[597] This description has always been regarded as very obscure.
According to Galen it is the operation which was afterwards named
_anabrochismus_. See PAULUS ÆGINETA, Vol. III., pp. 262, 269. M. Littré
gives the following interesting observations on this passage by M.
Malgaigne: “Quoiqu’il semble que l’auteur emploie deux fils, cependant
il n’est fait mention que d’une aiguille. Il paraît bien indiqué que
l’aiguille traverse deux plis transverseaux en marchant de haut en bas.
Voici comment je traduirais le passage en question: pour le trichiasis,
avec une aiguille armée d’un fil, traversé de haut en bas le point le
plus élevé (ou la base); de la paupière supérieure, après lui avoir
fait former un pli, et repasser l’aiguille de la même manière un peu
plus bas (ou près du bord libre); rapprochez les extrémités du fil, et
fixez-les par un nœud: puis laissez-les tomber d’eux-mêmes. Si cela
réussit, c’est bien: si non, it faudra recommencer.” (Op. Hippocrat.,
tom. iii., p. xliv). In my Commentary on PAULUS ÆGINETA, (Vol. II.,
p. 163.) I have in so far fallen into the mistake of supposing this
description to apply to the lower eyelid, and M. Ermerins would appear
to have done the same. See Littré, l. c. The operation by the ligature
on hemorrhoids will be found more circumstantially described in the
treatise on that subject, of which a translation is given in this
volume.
[598] For the weights and measures mentioned here, and in other
parts of our author’s works, see the Comment. on the last section of
PAULUS ÆGINETA, Syd. Soc. edit.
[599] A mineral, consisting principally of sulphate of copper. See
PAULUS ÆGINETA, Vol. III., pp. 400–2.
[600] The μηκώνιον was applied to three totally distinct substances;
1st, To a sort of opium, that is to say, the expressed juice of the
poppy (see PAULUS ÆGINETA, Vol. III., p. 280); 2d, to the _Euphorbia
peplus_, L., (see Appendix to Dunbar’s Greek Lexicon, under the
name): and, 3d, to the excrement of new-born children. It is singular
that the learned Foës, in his Œconomia Hippocratica, should apply
it in this place to the last of these; for if Hippocrates had used
such a substance medicinally, we may be well assured that it would
not have been overlooked by Dioscorides and Galen. There is every
reason, however, to suppose that it is the same as the πέπλος of
Dioscorides and Galen, that is to say, the _Euphorbia peplus_, which
was recommended as a drastic purgative by all the ancient authorities
on the Materia Medica, and consequently would be a medicine very
applicable either in coma or dropsy.
[601] All the commentators admit that the last section is obscure. It
would appear to me that Galen understands the expression τὸ ἀπὸ τῶν
κοπρἰων as applying ἑδρικοῖς, that is to say, to affections of the
anus. I have followed Littré in giving the passage a very different
interpretation, but I am by no means sure that Galen may not be right.
[602] De Diebus Decretoriis, i.
[603] See the Argument of the Prognostics.
[604] Μηδὲν εἰκῆ, μηδὲν ὑπερορῇν. (Epid. vi., 2, 12). Νούσων φύσιες
ἰητροί· ἀνεθρίσκει ἡ φύσις αὐτὴ ἐωυτῇ τὰς ἐφόδους· ἀπαίδευτος ἡ φύσις
ἐοῦσα καὶ οὐ μαθοῦσα τὰ δέοντα ποίει. (Ibid. vi., 5, 1.)
[605] Galen, De Venesect. adv. Erasist., c. iii.
[606] One cannot help being struck with the resemblance between this
description and a passage in Aretæus’s chapter on Causus: Ψυχῆς
κατάστασις, ἄισθησις σύμπασα καθαρὴ, διάνοια λεπτὴ, γνώμη μαντικὴ, κ.
τ. λ. In the yellow fever of the West Indies, which would certainly
appear to me to be a variety of the causus, the mind is said to be
wonderfully entire to the last. Dr. Fergusson gives a very striking
instance of this in describing the case of Sir James Leith, the British
Governor of Guadaloupe.
[607] Traité des Fièvres ou Irritations Cérébro-spinales
intermittentes, d’après des Observations recueillies en France, en
Corse et en Afrique. Paris, 1836.
[608] Œuvres d’Hippocrate, etc., tom. ii., p. 565.
[609] Prax. Med. nova Idea, i., 31.
[610] Tom. ii., p. 565.
[611] On the Influence of Tropical Climates.
[612] Tom. vii., p. 290; ed. Kühn.
[613] Copland’s Dictionary of Practical Medicine, P. iv., p. 974.
[614] Clinical Observations on the more important Diseases of Bengal.
Calcutta, 1835.
[615] Epidém. d’Hippocrate.
[616] See _Ægineta_. The narrative contains the most distinct and
unequivocal traces of the belief in the contagiousness of consumption.
[617] Thasus is an island in the Ægean sea, off the coast of Thrace,
which bears the modern name of Thaso _or_ Tasso. It was in a
flourishing condition in the time of Hippocrates, and a tributary to
Athens, but revolted from that power after its disasters in Sicily
during the Peloponnesian war. See Herodot., vi., 47; Thucydid., i.,
101; viii., 66. Galen states that it is cold, with a northerly exposure.
[618] According to Galen, in his Commentary on this passage, the
setting of the Pleiades takes place fifty days after the autumnal
equinox. See the Argument to the treatise On Airs, etc.
[619] We have already stated that the ardent fevers or causi, of which
repeated mention is made in the Hippocratic treatises, were fevers of
the remittent type, in short that they were the same as the bilious
remittent fevers of Pringle and Monro.
[620] I need scarcely say that the disease here described is _cynanche
parotidæa_ or _parotitis_. It is a remarkable proof of our author’s
talent for observation, that he has pointed out the tendency of the
disease to be complicated with swelling and inflammation of the
testicles. Altogether the description of the disease here given is
quite applicable to the _mumps_ of modern times. As stated by him, the
swelling of the testicles is generally painful. See the Commentary of
Galen.
[621] On reference to Galen’s Commentary it will be seen that anciently
the reading of this passage was reckoned equivocal. According to one of
the readings, the meaning is that those who were sick did not require
to come to the Iatrium for advice. See also Littré’s annotations on
this passage.
[622] Galen thinks our author expresses himself confusedly in this
place, but Littré justly defends him from this charge. According to
Littré, Hippocrates means that those who had been long affected with
consumption (the term used, ὑποφθειρομένων, rather signifies had
obscure symptoms of consumption), then betook themselves to bed; but
those who were in a doubtful state, then first manifested signs of
confirmed phthisis; and, finally, that there were some who then for the
first time felt the attack of phthisis, and that these were persons who
were predisposed to it. According to Galen, the phthisical constitution
is marked by a narrow and shallow chest, with the scapulæ protuberant
behind like wings; and hence he says chests of this construction
have been named alar. He further states that there are two forms of
consumption, the one originating in a defluxion from the head, and the
other being connected with the rupture of a vessel in the lungs. I may
be allowed to mention in this place, in confirmation of our author’s
accuracy of observation with regard to the connection of hemoptysis
with phthisis, that Louis found hemoptysis to a greater or less extent
in two thirds of his cases. (Researches on Phthisis, p. 166, Sydenham
Society edition.) The same author relates several cases in which death
occurred suddenly and unexpectedly, as Hippocrates states to have
happened to some of his patients. (Ibid.)
[623] I am of opinion that the species of phthisis noticed in the
latter part of this section was the acute form of phthisis described
by Louis (p. 351). Our author, it will be remarked, states that his
patients were mostly delirious when near death. Louis, in like manner,
mentions delirium in, I believe, every one of the cases of acute
phthisis which he relates. Galen justly remarks, that, in the ordinary
forms of phthisis, delirium is not a common symptom. I would also call
attention to our author’s observation regarding the inflamed state of
the fauces, which is also amply confirmed by the observation of Louis
in this form of phthisis.
[624] The nature of the continual fevers of the ancients is fully
explained in the Commentary on the twenty-seventh section of the
Second Book of PAULUS ÆGINETA. Galen, in his Commentary on
this passage, marks their nature very distinctly in few words. He says
that such fevers as have an exacerbation of fever ending in complete
apyrexia are called intermittents, whereas such as do not end in a
complete remission of the fever are called continual. See further De
Diff. Febr., ii., 2. In a word, the continual fevers were decidedly of
the remittent type. See further Donald Monro’s work on Army Diseases,
in the beginning of the chapter on the Bilious Remittent Fever.
[625] The introduction of phthisis in this place has created some
difficulty in the interpretation, as may be seen on reference to Galen
and Littré. Galen gives a very interesting account of the way in which
interpolations often took place. (Opera, tom. v., p. 356.)
[626] The text of this last sentence is in an unsettled state. The
following would be a translation of it as it stands in the Basle
edition of Galen’s Works: “Of all the cases described under this
constitution, those alone which were of a phthisical character proved
fatal. But they (the phthisical affections?) did not supervene upon the
other fevers.” Provided this be the true meaning of the passage, it
would merit great attention, as seeming to contain a declaration that
intermittent fevers superinduced an immunity to phthisis. I need not
say that this supposed fact has been exciting a great deal of interest
lately in the profession, more especially in France.
[627] It is to be borne in mind that the autumn began with the rising
of Arcturus, and ended with the setting of the Pleiades. The setting
of the Pleiades then indicated the commencement of winter. The
classical reader will find the different seasons, strikingly defined
by the rising and setting of the stars, in Virgil’s Georgics. See in
particular Georg. i., 221.
[628] Galen thus explains the origin of the ophthalmies. He says, the
constitution of the air being not only cold and humid, but attended
also with hurricanes. The eyes were thus injured, and consequently were
the first part of the body to show symptoms of disease. The dysenteric
and other alvine complaints which followed, he ascribes to the
constriction of the skin induced by the cold, and to the humoursæ of
the system aggravated and increased by the humid state of the season.
These humours being thus shut up by the occlusion of the pores of the
skin, part of them were determined to the intestines, occasioning
diarrhœa, tenesmus, dysentery, etc.; some to the bladder, inducing
strangury; and some to the mouth of the stomach, occasioning vomiting.
[629] Galen states in his Commentary that the phrenitis is connected
with inflammation of the parts about the brain. We have mentioned
before that the phrenitis of the ancients was a febrile affection, and
not idiopathic inflammation of the brain, as is generally supposed.
[630] According to Galen, the causi _or_ ardent fevers are occasioned
by yellow bile collected about the vessels of the liver and stomach,
and the tertians by the same diffused over the whole body.
[631] Galen states in his Commentary that children are peculiarly
subject to convulsions owing to the weakness of their nervous system.
He adds, that in their case convulsions are not attended with so much
danger as in other cases. See the Hippocratic treatise On Dentition.
[632] The fever here described is evidently the semitertian. See
PAULUS ÆGINETA, Book II., 34. “The true semitertian,” says M. Bartels,
as quoted by M. Littré, “is a real complication of an intermittent
fever with another fever of a continual type. It does not show itself
but rarely in our countries; but it is more frequent in the hotter
countries of Europe, although the false semitertian has oftener than
once been confounded with the true. In the true, the intermittent fever
is tertian; the non-intermittent is quotidian.” See also Galen, Opera,
tom. v., p. 362; ed. Basil.
[633] The text here is in an unsatisfactory state, and, as usual in
such cases, no ingenuity nor pains can do much to mend it. See Foës
and Littré. I have translated the disputed words “not resolved,” which
seems to me to agree best with the sense. Every practical physician
knows that swellings of the glands, which continue long and do not
suppurate, are unfavorable in fevers.
[634] The modern physician will not fail to be struck with this
observation as to the termination of certain cases of fever in
determination to the kidneys. Galen remarks in his Commentary on this
passage, that as the general system is often purged by the bowels, so
is it also sometimes by the kidneys and bladder. This, he adds, is a
protracted and painful mode of resolution in fevers. The reader will
remark the characters of the urine as stated below by our author. One
cannot help being struck with his statement, that all these cases
recovered. I am not aware of any modern observations bearing on this
point.
[635] There is considerable difficulty here in determining the reading.
See Littré, whom I have followed.
[636] I need scarcely remark that this passage is of classical
celebrity. Galen, in his Commentary, remarks that the first time he
read it he thought it unworthy of Hippocrates to lay it down as a rule
of practice, that “the physician should do good to his patient, or at
least no harm;” but that, after having seen a good deal of the practice
of other physicians, and observed how often they were justly exposed to
censure for having bled, or applied the bath, or given medicines, or
wine unseasonably, he came to recognize the propriety and importance of
the rule laid down by Hippocrates. The practice of certain physicians,
Galen remarks, is like playing at the dice, when what turns up may
occasion the greatest mischief to their patients. The last clause of
this passage is very forcibly put. Galen, however, informs us that in
some of the MSS. instead of “art” he found “nature;” that is to say,
that the physician is “the minister (_or_ servant) of nature.”
Either of the readings, he remarks, will agree very well with the
meaning of the passage.
[637] The reader will find it interesting to refer here to the
Prognostics. See also the Commentary of Galen. Let me here impress
upon the reader the necessity of making frequent comparisons of the
Prognostics with this work, if he would wish rightly to apprehend the
bearing and meaning of the latter. That the Epidemics are entirely
founded upon the principles of prognosis there can be no doubt.
[638] It is to be recollected that the rising of Arcturus marked the
beginning of autumn, and the setting of the Pleiades the end of it. See
above.
[639] The season of the Dog-star was immediately after the summer
solstice, namely, when the sun enters the constellation Leo. The
classical reader will readily bring to his recollection the lines of
Horace, which are descriptive of this season:
“Jam Procyon furit;
Et stella vesani Leonis,
Sole dies referente siccos.”
[640] Galen, in his Commentary, remarks that the attacks of paraplegia
(that is to say, of apoplexy) were brought on by the cold winds of the
winter succeeding to a humid autumn.
[641] The causi _or_ ardent fevers, it is worthy of remark, began
this season in spring, but were not of a fatal character until autumn.
In modern times the bilious remittent fever has uniformly been found
to be most aggravated in autumn, and hence it has been named by some
authorities the autumnal remittent fever. See the works of Sydenham,
Pringle, Monro, and Cleghorn. Monro mentions that he seldom saw it in
spring, but that it is common in the neighborhood of London towards the
end of summer and beginning of autumn. All these authorities are agreed
that it is of a highly bilious nature.
[642] Monro mentions epistaxis as occurring in the autumnal remittent
fever; he says it did not prove a crisis in any case.
[643] The complication of the autumnal remittent fever with jaundice
is noticed by Sir John Pringle (Obs. iii., 4), and by Monro (On
Army Diseases, p. 161). Galen, in his Commentary, remarks that when
nature is unable to evacuate the bile, it is collected in the skin,
and occasions jaundice. He adds, that the occurrence of the jaundice
in this case was unfavorable, owing to its taking place before the
seventh day. When occurring on the seventh day, jaundice was reckoned a
favorable symptom. See On Crises, 3; Aphorism, iv., 62, 64.
[644] The reader may feel interested to learn Galen’s hypothesis by
which he accounts for the hemorrhage in this case. He says it is
produced by the redundancy of yellow bile, which, being mixed up with
the blood and heating it, is carried up to the head, where it produces
rupture of the vessels and hemorrhage.
[645] Modern observations have confirmed this account of the generally
fatal issue of febrile diseases after parturition. In the Hippocratic
work On Diseases, fever after delivery in a woman is reckoned among the
cases which generally prove fatal.
[646] I would again request the attention of my contemporaries to the
characters of the urine before a crisis, as given by Hippocrates; and,
in confirmation of them I will venture to introduce here an extract
from Donald Monro’s admirable account of the autumnal remittent fever:
“The urine in the beginning was commonly of a high color, though
sometimes it was pale and limpid; but when the fever came to remit,
there was often a small sediment after each paroxysm; and as the fever
was going off, _it let fall a sediment in all_.” (Army Diseases,
etc., p. 159.) The absence of the sediment in the urine before the
crisis is an important fact in the history of febrile diseases, which I
have reason to think is not now sufficiently adverted to.
[647] Galen does not hesitate to give it as his opinion that the
dysentery was owing to the bile not being properly purged off by the
urine.
[648] The reader will find it interesting here to mark the alliance
between the causus and phrenitis, to which we formerly adverted. Galen
remarks that both arise from the same humour, that is to say, bile,
which when it collects in the veins of the lower part of the body
gives rise to causus; but from the beginning of autumn to the equinox,
produces phrenitis by being determined to the brain.
[649] This is perhaps the most striking account of an aggravated form
of causus which is anywhere to be found. Although less finished than
the celebrated picture of the disease given by Aretæus, it is evidently
more original. In fact, any human production which is very original
cannot well be finished, and consequently a very finished work can
scarcely be expected to be very original.
[650] It is impossible to overrate the importance of these observations
on crises in fevers, provided they be correct and confirmed by general
experience. Monro, without appearing to have our author in view, seems
to give an ample confirmation of his doctrines on crises as here laid
down.
[651] From Galen’s Commentary it appears that the text here is in a
doubtful state. See also Littré.
[652] Allusion is here made to the symptoms of delirium as described in
the fourth paragraph of the Prognostics. See Galen’s Commentary on this
passage.
[653] What an admirable and comprehensive enumeration of all the
circumstances upon which the prognosis and diagnosis of diseases are
to be founded! Here we find nothing either wanting or redundant; and
with what conciseness and precision the whole is stated! Galen gives an
elaborate and, upon the whole, a very interesting Commentary on this
section, but does not supply any new views, and there are few terms in
it requiring explanation.
[654] Having already stated in this work, as well as in the Commentary
on PAULUS ÆGINETA, Book II., 27, my opinion respecting the
nature of the continual fevers, I need not enlarge on the subject
in this place. Whoever wishes for more information may find much to
interest him in the Commentary of Galen. Respecting the septans and
nonans, he remarks, that, although conversant with fevers from his
youth, he had never met with any cases of these.
[655] Galen, in illustration, states that epilepsy is sometimes carried
off by an attack of quartan fever.
[656] The semitertian was always looked upon as a very formidable form
of fever. See PAULUS ÆGINETA, Book II., 34. Galen gives a
prolix, but not a very distinct account of it.
[657] Galen, in his Commentary, states that he had often seen persons
in consumption attacked with tertian and quotidian intermittents,
but admits that he had no more experience of quintans than he had of
septans and nonans. Avicenna. however, is not so sceptical as to the
occurrence of these rare forms of intermittents. Indeed he says, he
had often met with quintans, and that a trustworthy physician of great
experience had assured him that he had met with nonans. (iii., 1, 3,
67.) Rhazes also would appear to acknowledge the occurrence of all
these varieties of intermittent fever. (Contin., xxx., 10, 1, 409.)
[658] The text is much improved in Littré’s edition, so that the
meaning is pretty intelligible without any commentary. Galen states
in explanation, that the three varieties of fever are thus marked and
distinguished from one another: in the first, the fever attains its
height at the commencement, and gradually diminishes until the crisis;
in the second, it begins mild, and gradually reaches its height at the
crisis; in the third, the fever begins mild, gradually attains its
height, and then gradually subsides until the crisis.
[659] These are all febrile diseases, and for the most part of the
ardent type. In order to enter properly into the spirit of them, the
reader will find it necessary to revert frequently to the Prognostics,
and compare the parallel passages. See also the Argument.
[660] Galen, in his Commentary, remarks that the fatal issue of this
case might have been anticipated after the return of the fever on the
third day, with a complication of bad symptoms, such as great thirst,
dry tongue, black urine, delirium, coldness of the extremities, and
so forth. The modern reader will be struck with the description of
the respiration, namely, that the patient seemed like a person who
forgot for a time the _besoin de respirer_, and then, as it were,
suddenly recollected himself. Such is the meaning of the expression as
explained by Galen in his Commentary, and in his work On Difficulty
of Breathing. By “rare” is always meant “few in number.” The reader
will remark that this is a striking case of a fever having regular
exacerbations on the even days, and slight remissions on the uneven.
[661] This, it will be remarked, is a case of fever induced from
obvious causes, namely, excessive fatigue and dissipation. We must
take into account, however, the febrile constitution of the season.
According to Galen, the fatal result could have been confidently
foreseen from the seventh day. The distention in the hypochondriac
region here described would appear to have been meteorism. The
throbbing in this region was no doubt owing no the same cause. The rash
was most probable miliary. It is described as resembling _vari_
(ἴονθοι), by which was probably meant _acne_. See PAULUS
ÆGINETA, Vol. I., p. 454. Upon reference to the Prognostics, it
will be remarked that the characters of the urine are all bad, that is
to say, it was either suppressed, or the sediment was either wanting or
black and farinaceous. See Prognost. 12. By “black,” as applied to the
urine, is to be understood “a dark-red color,” like that of wine.
[662] There is nothing in this case very remarkable, or which stands in
need of elucidation; but yet the reader may feel interested in Galen’s
reflections upon it. The recovery he holds to have been unexpected,
as a different result might have been anticipated from the characters
of the alvine discharge, and of the urine at the commencement. The
favorable change he attributes to the swelling of the spleen, whereby
the peccant humors were attracted to it; and he further remarks, that
as the swelling of the spleen diminished, the humors are described as
having passed down to the extremities, after having first affected the
groin of the side on which the spleen is situated. He further calls
attention to the improved characters of the urine when the swelling of
the spleen and pains of the limbs supervened. Still, however, he adds,
there was a remnant of the cacochymy in the system which gave rise to
the relapse on the fourteenth day, so that the complete crisis did not
take place until the seventeenth day.
[663] This is evidently a well-marked case of puerperal fever, or
of fever complicated with the puerperal state. There is nothing
particularly interesting in Galen’s commentary on it. He states that
the application made in order to remove the suppression of the lochial
discharge may either have been a pessary or a suppository. It seems
most likely to have been the former. On the composition of the ancient
pessaries, see PAULUS ÆGINETA, Book VII., 24. He remarks that
the symptoms first stated are unfavorable, but not necessarily fatal,
until we come to the coldness of the extremities, which is an extremely
mortal symptom in the beginning of a disease when combined with a very
violent fever. The modern reader will be struck with the expression
that “the attendants seldom put her in mind” to make water; it is very
descriptive, however, of the state of stupor the patient was in when
she was so insensible that she did not attend to the calls of nature.
[664] Galen remarks that it was reckoned very extraordinary for a rigor
not to be followed by febrile heat. See Comment. et de Rigore; de Diff.
Febr., ii.; and Foës’s long annotations on this passage.
[665] It will be remarked that the characters of the urine throughout
are favorable. Though darkish at first, this was reckoned not
unfavorable, as being connected with the lochial discharge. (See Galen.
Comment. 2, Epid. iii.) The sediments afterwards are all of good omen;
but, as Galen remarks, its first characters indicated a prolonged fever.
[666] On the Critical Days, see PAULUS ÆGINETA Book II., 7.
[667] On comparing the symptoms here enumerated with the Prognostics,
it will be remarked that none of them are of fatal omen. But the white
sediment, and afterwards the reddish color of the urine, while they
indicated recovery, at the same time prognosticated a protracted attack
of fever. See Prognost., 12. The reader will further remark that there
is an absence of all the decidedly fatal symptoms, such as delirium,
coldness of the extremities at the commencement, and so forth.
[668] The rapid recovery in this case would seem to be partly
attributable to the decided plan of treatment, namely, the copious
affusion of hot water on the head. Hippocrates probably had it in view
when he wrote the forty-second Aphorism of the Seventh Book: “In fever
not connected with bile, if a large quantity of hot water be poured
over the head, it proves a resolution of the fever.” Galen points it
out as a remarkable circumstance, that in this case the crisis took
place without concoction of the urine, in consequence of the hemorrhage
from the nose, and the sweating.
[669] In this case, as Galen remarks, the continued sweats, unfavorable
condition of the hypochondriac region, and the black urine, precluded
all hopes of recovery. He thinks our author related the case as an
instance of sudden death in fever, this patient having died on the
fourth day after the attack (the first not being counted). See his
Commentary. He also makes reflections upon this case in his work On
Difficulty of Breathing, where he points out the danger of meteorism of
the hypochondriac region as being necessarily accompanied with dyspnœa,
and connected with inflammation (2).
[670] This case, as Galen remarks, is interesting from the suddenness
of the fatal result. We should not hesitate nowadays to set it down
as a case of malignant erysipelas; the pain, swelling, and bullæ of
the foot and ankle must have been of this nature. By the way, these
bullæ, when not followed by suppuration, are represented in the Coacæ
Prænotiones, as a fatal symptom. Galen thinks it strange that this
patient was not bled, but accounts for it by supposing that Hippocrates
had been called in too late. He remarks on this case in the Second Book
of his work On Difficulty of Breathing.
[671] Galen looks upon this patient as an example _or_ paradigm of
general principles in Prognostics. Thus, with regard to the characters
of the urine, it is stated that on the eleventh day the urine was thin,
of a good color, and having many substances floating about in it, but
without sediment. Thus matters remained until the sixteenth, when the
urine became somewhat thicker, and had a slight sediment. Now Galen
remarks (as the reader will find on turning to the Book of Prognostics)
that these characters of the urine are indicative of recovery after a
protracted disease. Galen further points out that no one of the fatal
symptoms are mentioned, and that swellings of the parotid glands and
the dysenteric affections of the bowels indicated that the crisis
would be distant. He also calls attention to the case as confirmatory
of the doctrines of Critical Days. In the Second Book of his work On
Difficulty of Breathing, he makes some remarks, of no great importance
however, on the meteorism of the hypochondriac region, as noticed in
this case.
[672] In this case, as Galen remarks, the characters of the urine
from the first were such as to indicate a fatal and speedy result. On
the second day the urine was turbid, and without any sediment; on the
third day the same, and consequently confirming the anticipation of the
disease proving mortal; on the fourth, oily urine, with epistaxis, so
that it was not to be wondered at that the patient died on the sixth.
Indeed, when we further take into account the state of the breathing,
the coldness of the extremities, the meteorism of the hypochondriac
region, and the subsultus tendinum, it is difficult to imagine a
more hopeless case of fever. Having mentioned “oily urine,” it may
be well to state its characters, as fully given by one of the later
authorities on urology, namely Theophilus. He says, when the urine
in fevers assumes the color of oil, it indicates that the fat of the
body is melting down; when the appearance of the urine still more
resembles oil, it shows a still greater melting; and when the urine
in consistence and color exactly resembles oil of a dark color, it
prognosticates a fatal collapse. (De Urinis, 17; ed. Ideler.) On this
subject, see further some very interesting observations by Foës, in his
annotations on this passage (p. 988). With regard to the respiration in
this case, see also the remarks of Galen in the Third Book of his work
On Difficulty of Breathing (tom. vii., p. 932; ed. Kühn). As Galen here
remarks, Hippocrates explains the meaning of this passage in one of
his Aphorisms, where he writes thus: “In fevers, when the respiration
stops, it is a bad symptom, for it prognosticates convulsion.”
[673] According to Galen, this case is an instructive example of the
danger of neglecting the diet at the commencement of complaints which
appear unimportant. This man, having taken supper at the beginning
of a fever which appeared slight, suffered therefrom as the result
showed; that is to say, vomiting ensued, followed by serious symptoms,
among which Galen particularizes, as indicating a fatal result, urine
at first thick and without sediment, and afterwards oily. So much
importance did the ancient physicians attach to observations on the
urine in fevers! Galen further calls attention to the fact, that the
patient died on a critical day, that is to say, on the eleventh.
[674] Galen, in the commentary, makes a remark regarding this report,
which appears more important to him than it will do to most modern
readers, namely, that he wonders Hippocrates did not state the age of
this patient. He adds, that it is very rare for a pregnant woman to
have such a serious fever without parting with her child. He thinks the
patient, in the present instance, owed her recovery to the strength
of her constitution, as “urine white, and not of a good color,” in
combination with the other bad symptoms, indicated an unfavorable
result. By the way, upon reference to the Basle edition of Galen, and
to Foës’s annotations on this case, it will be seen that there is a
difference of reading in the words descriptive of the urine, that is to
say, some read ἀχρόων, some εὑχρόων. Certainly it appears to me that
Foës is right in preferring the latter. The decided crisis, it will be
remarked, took place on a critical day, that is to say, the fourteenth,
by a sweat.
[675] Here again Galen calls attention principally to the characters
of the urine, which is first described as being “of a good color, but
thin.” Now, by a good color of the urine, Galen observes, was meant of
a slightly yellow color. In this case, as usual, the crisis was marked
by a sediment in the urine.
[676] Œuvres d’Hippocrate, tom. iii., Arg., pp. xxxvi.-xlii. tom. v.,
pp. 57–70.
[677] There is some doubt, however, even on this head; indeed Riolanus
does not scruple to affirm, with a considerable degree of plausibility,
that Ruffus must have lived after Galen, since he is nowhere mentioned
by the latter. (Anthropographia, i., 5.)
[678] In illustration, consult Plutarch (Placit. Philosoph., v., 29).
[679] De Differ. Feb., i., 7; tom. vii., p. 296, ed. Kühn.
[680] Commentary on PAULUS ÆGINETA, Book II., 16, 36; IV., 25,
Syd. Soc. edition.
[681] Disquisitio Historico-Medica de Natura Morbi Atheniensium.
Stuttgart, 1831.
[682] On this case Galen has left very lengthy and elaborate
commentaries, containing much important and amusing matter, but not
a little verbose trifling, to say the least. Our limits, as well as
our tastes, dispose us to be very sparing in our extracts from them.
Passing over his remarks on the solecism in syntax, with which the
Report commences, and his observations on the absence of all mention
of the exciting causes, as is the usual practice of our author, I
shall proceed to state what Galen says on the apparent neglect of
venesection in a case where it would certainly appear to have been
clearly indicated. In this case, as Galen remarks, one or other of
these suppositions may be made: either that bleeding was not practiced,
or that the author did not think of mentioning the practice here, as
supposing that it would be taken for granted that it was applied. Now,
he adds, the former supposition is very improbable, considering how
partial our author shows himself to this practice in his works which
are unquestionably genuine, such as On the Regimen in Acute Diseases,
the Aphorisms, the work On the Articulations, and even in this very
book, where in one place he mentions that he abstracted blood copiously
on the eighth day. If, then, he bled so late in febrile diseases, Galen
contends that he was not likely to neglect the operation in an earlier
stage, when so much more demanded. He argues further, that in many
of the other reports of cases he neglects to mention that the usual
routine of practice was followed: and therefore he inclines to the
opinion that it is omitted to be mentioned here, because the author
supposed there could be no question on this point, more especially as
it was his universal rule to bleed in all great complaints, when not
prevented by the age or powers of the patient. He afterwards insists
strongly on venesection having been indicated in this case, in order
to procure revulsion from the brain. As usual with the commentator,
he calls attention to the characters of the urine, and explains the
meaning of the term “cloudy,” as applied to the _eneorema_,
or substances floating in the urine, by which he contends is to be
understood a color intermediate between white and black. What follows
in this very lengthy Commentary is very interesting in a general point
of view as regards the views of some of the older commentators, but
is not directly applicable to the present case. His observations on
the characters affixed to this and many of the subsequent cases have
been noticed in the Argument. The reader will further remark of this
case that it is an instance of fever passing into a deposit (_or_
abscess), and the latter into strangury, of which our author had made
mention in the First Book of the Epidemics. I may further mention
that the reader will find much interesting matter in Galen’s work On
Trembling, in illustration of the nature of the attack under which the
patient labored.
[683] Galen, in his Commentary, communicates a singular notion which
one of the earlier commentators maintained respecting the name of the
place where this patient was laid, that is to say, that this new wall,
having been recently washed with quicklime, had been the cause of this
patient’s illness. Galen, however, rejects this paltry conceit. He says
on his own authority, that there being three distinct classes of fever,
namely, the ephemeral, the hectic, and those connected with putrid
humors, the present case belongs to the last of these.
[684] Galen compares the characters of the urine with their indications
as given in the Prognostics. None of them are favorable, although not
decidedly fatal.
[685] This complication cannot fail to attract attention, from its
resemblance to an epidemic which prevailed in Scotland in the year
1843. In this epidemic, as in the present case, the fever was very
subject to relapses and to jaundice at an early stage. Hippocrates,
in one of his Aphorisms, pronounces jaundice in fevers before the
seventh day to be a fatal symptom. (iv., 62, 64.) Galen justly thinks
it somewhat singular that no further mention of the jaundice is made
in the course of the report; but he inclines from this to draw the
conclusion that it remained in the same state throughout. As there
was no crisis by the stomach, the bowels, the urine, or sweat, he
concludes that the jaundice could not have been carried off. From all
that has been said, he adds, it is clear that the organ primarily
affected was the liver. Galen, then, decidedly opposes the view taken
in the Explanation of the Characters respecting the cause of this man’s
death, which he contends was not connected with any suppression of the
alvine discharges, but with the affection of the liver. On the Scotch
Epidemic, see Ed. and Lond. Med. Journal, March, 1844.
[686] Most of the ancient authorities regarded deafness as an
unfavorable symptom in fevers. See PAULUS ÆGINETA, Book II.,
4. The modern are divided in opinion on this point. Pringle and Huxham
regard it as a favorable symptom, but Home looks upon it as unfavorable.
[687] Here again Galen mentions the absurd notion of Sabinus the
commentator, that this man’s disease was occasioned by the locality in
which he was laid. Galen, on the other hand, thinks it likely that the
patient was conveyed to the garden as being a favorable situation for a
person ill of fever. He further alludes to this case in the Second Book
of his work On Critical Days.
[688] Galen remarks, that as there is no mention of a single favorable
symptom up to this date, the patient would certainly have died if he
had not been of a vigorous constitution.
[689] Thus, as Galen remarks, after two ineffectual attempts, Nature
accomplished a cure on the fortieth day.
[690] There is not much to remark in this case. A modern reader will
suspect that there had been cerebral disease before the attack of the
fever, and that matters had been brought to a crisis by the drinking
of wine. Indeed Galen, in his Commentary, remarks that the precursory
symptoms indicate a congestion of humors in the brain, which of course
would be much aggravated by the wine, the brain then being, as he says,
in a bad state; and the patient having inflicted an additional injury
to the organ, by means of the drink, brought on the acute attack,
which proved fatal in five days. The deafness, delirium, spasms, and
bilious vomitings all indicate a cerebral affection. The state of
the hypochondria, as described in the report, Galen would seem to
attribute to a spasmodic affection of the diaphragm, from sympathy with
the brain. Retraction of the hypochondrium is pronounced to be a bad
symptom in the First Book of the Prorrhetics. Galen justly contends
that there is no reason in this case to suspect any inflammation in
that region.
[691] Galen’s remarks on this case are unusually brief; he attributes
the fever to a bilious plethora, and states that the result was such
as might have been anticipated from a knowledge of the critical days,
and of the characters of the urine. Indeed the latter appear to me well
deserving of attention.
[692] This is in many respects an interesting case, and more
especially, from its being stated that the disease was complicated
with hereditary consumption. Galen, in his Commentary, remarks that
some authorities denied that any disease is congenital, but this
opinion he decidedly rejects. The phthisical affection, however, as
he justly remarks, would not have occasioned so sudden an issue if it
had not been complicated with a complete prostration of the natural
powers. He insists strongly on the striking description here given of
the total loss of the natural appetite, both in regard to food and
drink. Of course, no worse state of the system can be imagined than
that in which it is totally insensible to its own wants, nay, that
it loathes the very articles which it stands most in need of. Galen
properly remarks in another place (Comment. I., in Epid. i.), that
it is an extremely unfavorable symptom when in an ardent fever there
is no thirst. The small abscess about the nates would seem to have
been an incidental complication. It would appear to be now settled by
the best pathological authorities that there is no natural alliance
between _phthisis_ and _fistula in ano_, as was at one time
suspected. See Andral (Cliniq. Médicale, tom. iv., p. 308), and Louis
(On Phthisis, p. 89, Sydenham Society’s edition). The affection of the
fauces and throat, which is described as having attacked the patient at
“the commencement of the disease,” would appear to have been a common
complication of that epidemic. It is noticed in the First Book of the
Epidemics. Foës remarks, however, that some had referred it to that
redness of the fauces to which persons laboring under consumption are
liable. Compare Louis, l. c. p. ii., § 12. Galen makes mention of a
difference of reading in the MSS. he used in reference to the Critical
Days.
[693] On this brief case Galen has left a lengthy and elaborate
Commentary, abounding in most interesting matters on a variety of
subjects; as, for example, the different readings and opinions of the
more ancient commentators on the characters at the end of this and
the other reports; on the formation of the Hippocratic Collection,
and the extraordinary zeal of the Ptolemies in procuring books for
their great Library at Alexandria, and so forth. There is not much in
it, however, which bears directly on the present case, and therefore
we shall give but a very brief abstract of it. It appears from Galen
that there was a considerable diversity of readings in the latter part
of it, more especially in regard to the number of days the patient
lived; some of the old authorities having placed the death on the
fifth, some on the seventh, and others on the eighth. Galen inclines
to hold by the text as we now have it, and maintains, apparently with
good reason, that under such a combination of fatal symptoms it was
not likely that the patient’s strength should have stood out longer
than the fourth day. Another curious subject connected with this case
which Galen slightly touches upon, but without throwing any light
upon it, is the omission of the treatment. He justly remarks, that if
Hippocrates treated the patient himself, or superintended the treatment
as managed by another, it is singular that there is no mention of
a clyster having been administered, nor of a cataplasm having been
applied, nor of venesection having been practiced. I shall not attempt
to solve the question here propounded by Galen. See the Argument. His
Commentary also contains an interesting discussion on the meaning of
the expression “respiration elevated.” To give the sum of what has
been advanced on this subject in a few words, it may signify laborious
breathing so as to move the labia of the nose; or it may mean simply
orthopnœa, or it may signify laborious respiration, attended with
elevation of the chest. By the way, this is evidently the “sublimis
anhelitus” of Horace, in his famous ode entitled “Nireus.” I have often
wondered that such a learned physician as Julius Cæsar Scaliger, in
his celebrated critique on Horace in his Poetics, should have remarked
on this expression: “Ex toto Galeno non intelligo quid sit sublimis
anhelitus.” Galen, in fact, treats fully of the “sublimis anhelitus”
in various parts of his works. See in particular On Difficulty of
Breathing.
[694] Galen has given us a lengthy Commentary on this case, but a great
part of it relates to the characters and to other matters not of any
very great importance in this place. As he remarks, it is a striking
example of an acute fever induced by immoderate fatigue. It appears
from his Commentary, moreover, that some of the older authorities had
added “drinking” to the excesses which induced his affection; that is
to say, they proposed to read πότων instead of πόνων. The symptoms,
upon reference to the Prognostics, are all such as indicated a fatal
result, namely, the blackish and thin urine, “the fumbling with
the bedclothes,” the coldness and lividity of the extremities, the
meteorism, and so forth.
[695] In Galen’s Commentary on this case there is not much of any great
interest to the professional reader of the present day. He animadverts
again on the omission of all mention of the treatment, although, as he
states, venesection and the other usual means had no doubt been tried;
indeed the report implies as much. Hippocrates, he repeats, never
thinks of mentioning the usual routine of practice, as he takes it for
granted that the reader will understand that it was not neglected.
It is only on special occasions, then, that he thinks of making any
particular reference to the treatment. Galen remarks, that ileus being
an inflammation of the upper intestines, is a particularly dangerous
affection.
[696] As remarked by Galen in his Commentary, this was no doubt a
case of ardent fever _or_ caucus, complicated with an incidental
miscarriage. There is no reason for looking upon it as being a case
of puerperal fever. Galen thinks that the last word (caucus) is an
addition made by the copyists, having been transferred from the
Glossarium to the text in the course of transcription. Galen, as usual,
directs attention to the characters of the urine, which in this case
are particularly unfavorable, being defective both in quantity and
quality.
[697] Galen’s remarks on the circumstances of this case are
sufficiently to the purpose, but there is nothing very striking in
them. He states that the abortion may have been occasioned either
by external causes--such as the application of pessaries for this
purpose, and the like--or internal, such as hemorrhage from the neck
of the uterus. and so forth. As in the former case, he pronounces the
last word (phrenitis) to be an addition to the text, as Hippocrates
never enters upon the diagnosis of diseases, as is done in the work
On Diseases. I suppose he means that our author’s real works are all
founded on Prognosis; whereas the other, being derived from the Cnidian
school, is founded on Diagnosis. See our observations on this subject
in the Preliminary Discourse, and the Argument to the Prognostics.
[698] Galen remarks, that with such a combination of fatal symptoms,
namely, coldness of the extremities, fetid vomiting, etc., it is
wonderful that this patient stood out until the fourteenth day.
He thinks, however, that this is to be explained from her age and
constitution. He justly remarks that the occurrence of the epistaxis
could not be supposed sufficient to carry of such a combination of
unfavorable symptoms. He once more protests against the last word of
the report (causus) being admitted as genuine. He confesses himself
unable to determine whether “The Liars’ Market” was in Athens or
elsewhere.
[699] This is entitled the pestilential constitution by Galen. By
constitution, he explains, is meant not only the preternatural state of
the atmosphere, but also of everything else which influences the state
of the general health.
[700] Galen remarks, that in the First Book of the Epidemics three
constitutions of the year are described and also that others are
described in the Second Book; but that these are not carefully drawn
out for publication like those of the First and Third. He further
remarks on this head, that the constitution of the season might prepare
us for the putrid diseases, which are described below, as heat is the
active, and humidity the material, cause of all putrefaction.
[701] Galen remarks that erysipelas is occasioned by a bilious
defluxion, but that it is not always of a malignant and putrid nature;
on the contrary, when the defluxion is mild, and the bile which
produces it is natural, it is not attended with any considerable injury
to the body, if properly managed; but that the humor which produced
the erysipelas about to be described was not such, but of a malignant,
corrosive, and septic nature, being engendered by the humid and calm
state of the weather in such persons as were of a choleric constitution.
[702] According to Galen, aphthæ in general are superficial ulcerations
in the mouth, produced by the acrimony of the nurse’s milk, and which
are easily removed by an astringent application. But in the present
instance the aphthæ were of a malignant nature.
[703] The carbuncle (anthrax), Galen says, is always dangerous, and the
product of bad humors. See PAULUS ÆGINETA, Vol. II., pp. 78,
79. Galen, in his excellent work On the Difference of Fevers, writes
thus: “In constitutions of the year, similar to those which Hippocrates
describes as taking place in Cranon (See Ep. ii.). I have known cases
of anthrax prevailing epidemically in no few numbers, the formation and
other symptoms of which were exactly as described by him.” (Tom. vii.,
p. 293; ed. Kühn.)
[704] Galen explains under this head that the term _epidemic_ is
not applied to any one disease, but that when many cases of any disease
occur at the same time in a place, the disease is called an epidemic;
and that when it is remarkably fatal it is called a plague.
[705] The history of the epidemical erysipelas here described cannot
fail to prove interesting to the modern reader. I need scarcely remark
that epidemics of a similar nature are occasionally met with in
Great Britain at the present day. I myself have encountered two such
epidemics in the locality where I am now writing, the one in 1823, and
the other in 1846. As described by Hippocrates, the disease sometimes
supervened upon a slight injury, and generally terminated in gangrene.
On epidemical erysipelas, see De Haen (Ratio Medendi), Bartholinus
(Hist. Anatom. Rat. Hist., 56), Wells (Transactions of a Society
for the Improvement of Medical and Chirurgical Knowledge), Cooper’s
Surgical Dictionary; and Cyclopædia of Practical Medicine, under
_Erysipelas_.
[706] Galen amply confirms this statement, that when erysipelas fixes
on a particular part of the body it is more formidable in appearance
than in reality, and that the disease is attended with most danger when
it leaves an external member, and is determined inwardly.
[707] The classical reader will here call to his recollection a
striking passage in the celebrated description of the Plague of Athens,
as given by Thucydides: “For the mischief, being at first seated in
the head, spread over the whole body, and if one survived the most
formidable symptoms, an attack on the extremities manifested itself;
for it was determined to the genital organs and to the hands and feet,
and many escaped with losing them, and some with the loss of their
eyes.” (ii., 49.) The passage is thus rendered by Lucretius:
“tamen in nervos huic morbus et artus
Ibat et in partes genitales corporis ipsas;
Et graviter partim metuentes limina lethi
Vivebant ferro privati parte virili:
Et manibus sine nonnulli pedibusque manebant
In vita tamen et perdebant lumina partim.”
(vi., 1203.)
Lucretius, it will be remarked, understands the historian to mean
that the mortified parts were amputated; and this opinion, although
rejected by most of our non-professional editors of Thucydides, is
confirmed by what Galen says in his Commentary on this passage, namely,
that in erysipelas of the genital organs “we (meaning the physicians
of his own time) are often obliged to excise the putrid parts, and
apply the cautery to them.” I would here further point out a singular
mistake into which Dr. Bloomfield falls in his note on this passage of
Thucydides; he says that the words of the original (ἄκρας χεῑρας καὶ
πόδας) “can only signify the ends of or lower joints of the fingers and
toes.” No one who is acquainted with the language of our author will
require to be told that this is an entire misconception. In the works
of Hippocrates χεῖρες is often put for the arms, and χεῖρες ἄκραι are
always applied to the hands.
[708] Upon reference to the Glossary of Erotian, the Commentary of
Galen, and the Annotations of Foës and Littré, the reader will see that
there is great difficulty in determining the text in this place. After
examining all that has been written on the subject, one cannot come to
any satisfactory conclusion as to the true reading. I have adopted the
meaning which seems to suit best with the passage. The professional
reader will scarcely require to be reminded that in cases of phthisis
there is often a notable impairment of the voice.
[709] Galen makes the important remark on this word, that, in febrile
diseases, epistaxis is always a bad symptom.
[710] This obliviousness is a feature of the plague, as described by
Thucydides: “And some, when they first left their beds, were seized
with an utter forgetfulness of all things, and knew not themselves nor
their relatives.” (l. c.)
[711] Our author alludes to the affection called coma vigil by the
later authorities. In this affection, as Galen remarks, the patient
lies with his eyes shut, but can get no sound sleep. This, of course,
is so much more the case provided pain be present, as it necessarily
will prevent the occurrence of sleep. See Galen’s tract On Coma.
[712] The low muttering delirium of typhoid fevers is here evidently
alluded to. Galen, in his Commentary, guards the reader against
supposing that the fever passed into lethargus.
[713] This description apparently can refer to nothing but pestilential
buboes.
[714] It is impossible not to recognize this as a description of
_purulent ophthalmia_. Celsus thus describes the ficus: “Est
etiam ulcus quod a fici similitudine σύκωσις Græcis nominatur,
ubi caro excrescit; et id quidem generale est. Sub eo vero duæ
species aunt. Alterum ulcus durum et rotundum est: alterum humidum
et inæquale. Ex duro exiguum quoddam et glutinosum exit: ex humido
plus, et mali odoris.” See the Lexicons of Hesychius and Phavorinus,
and also PAULUS ÆGINETA, Book III., 3. It will be remarked
that Hippocrates also makes mention of fungous excrescences about
the pudenda. Were they syphilitic? In other words, did they derive
their origin from elephantiasis? See the Annotations on PAULUS
ÆGINETA, Book IV., 1, Sydenham Society’s edition.
[715] The meaning of this term is not precisely determined. Galen’s
account of it may apply both to exanthemata, and pustulæ. The
description of the eruption in the Plague of Athens is likewise vague
and indeterminate. (Thucyd, ii., 49.)
[716] These intestinal complaints are all mentioned in the description
of the Plague at Athens. (l. c.) Upon reference to the Commentary of
Galen, the reader will remark that there is a question here respecting
the reading.
[717] Galen, in his Commentary, makes the remark that he observed the
same symptom in the plague which raged in his time.
[718] It will readily be understood that a colliquative diabetes would
prove a very unfavorable complication of these complaints.
[719] By nocturnal fevers, according to Galen, was meant quotidians,
which had their paroxysms during the night. Foës inclines to think that
diurnal should also be inserted in this place. These nocturnal fevers
are thus described by D. Monro: “The sick were restless and uneasy _at
night_; but commonly felt themselves cooler and lighter in the daytime:
and although they had no cold fit, as the fever came on _at nights_,
and many of them no breathing sweat, as they became cooler and freer
from the fever in the morning; yet the fits were so remarkable, that
many of the patients used to say that they had a regular fit of an
ague _every night_, and some few that they had the fit every second
_night_.” (Army Diseases, etc., p. 158.)
[720] The account of the origin and progress of consumption here given
is, upon the whole, wonderfully correct. Common experience seems
to have decided that spring and autumn are the most fatal seasons
to phthisical patients. Avicenna makes the remark, which is very
important, and deserves to be kept in mind, that by phthisis, in this
place, Hippocrates most probably meant hectic fever, connected with
disease of the internal viscera, which had been in an inflamed state
during the acute attack of the fever. (iii., 1, 3, 67.)
[721] I shall not enter into a discussion of the different readings of
this interesting passage. I may mention that our great pathological
authority on phthisis, Dr. Louis, agrees with Hippocrates in deciding
that the lymphatic temperament constitutes a more or less marked
predisposition to the development of phthisis. (p. 483.) Galen
describes the phlegmatic temperament as being attended with a soft
and slightly tumid skin. He attributes the disease in their case to a
cacochymy, that is to say, to cachexia. I need scarcely remark that
this opinion is strongly advocated by one of the highest authorities
of the day, I mean Sir James Clark. See his treatise on Tubercular
Phthisis. Galen gives a discussion on the color of the eyes, about
which there is some difficulty, as the ancient terms which relate to
colors are not very well defined. The term here used (χαροπὸς) may
signify either blue or gray. Galen considers this color of the eyes as
a symptom of a cold and humid temperament.
[722] There is an ambiguity in the part of the sentence which relates
to women, as Galen states in his Commentary. Galen does not hesitate to
declare that women are more subject to phthisis than men, an opinion
upon which modern authorities are not at all agreed. See the recent
publications of Louis and Clark on Phthisis.
[723] The last paragraph, and the latter clause of the preceding one,
were at first attached to the end of the subsequent cases, and were
transferred to their present position by Dioscorides the commentator
a short time before Galen. They evidently embody a most distinct and
admirable enumeration of the general facts with which the practical
physician ought to make himself acquainted.
[724] We learn from the Commentary of Galen that some of the older
critics supposed that the sixteen cases about to be related had been
selected by Hippocrates in illustration of his doctrines, as laid
down in the preceding description of what is generally entitled the
Pestilential Season. Galen, however, does not incline to this opinion.
[725] This is an example of one of those protracted fevers of an
intermittent type, which, as I have been informed by an intelligent
physician who practiced for several years in the Ionian Islands, are so
common in the climate of Greece. There is not much of any particular
value in Galen’s Commentary on this case. He informs us that one
of the older commentators absurdly maintained the opinion that the
country of this patient was given because, according to Asclepiades,
the inhabitants of Paros were most especially benefited by bleeding.
But, as Galen says, this remark is particularly out of place here,
since no mention of venesection occurs in the report. Galen, and after
him Foës, have given very lengthy and elaborate disquisitions on the
nature of oily urine. The result is, that it is an unfavorable, but not
necessarily a fatal, character. It is minutely described by the later
authorities on urology, namely, Theophilus and Actuarius. See also the
Commentary on PAULUS ÆGINETA, Book II., 14, Sydenham Society’s
edition.
[726] This appears clearly to be a case of fever, complicated with, but
not produced by parturition. Galen, however, seems to ascribe the fever
and its fatal results to the retention of the lochial discharge. The
characters of the urine, he properly remarks, are unfavorable, being
copious, thin, and black. He also calls attention to the want of proper
concoction in the sputa, to which he attributes the fatal relapse.
[727] Galen’s Commentary on this case is written in his usual light
and diffuse style, but contains very little which is calculated to
throw light on the text, or on the nature of the disease which is here
described. If any one find difficulty in comprehending the characters
of the respiration, as given in this narrative, he can turn to Galen’s
work, On Difficulty of Breathing, where they are explained very
fully. I may just mention that by shortness of breath (βραχύπνοος)
was understood, by Hippocrates and Galen, frequency of the act of
respiration.
[728] This case, as Galen remarks, is an instance of the most acute
form of phrenitis. He states that he himself had met with cases of
phrenitis in which the patients had died on the fourth and fifth day,
but that he had never seen a case which proved so suddenly fatal as the
present one. He further makes some very interesting reflections on the
suddenness of the attack in such cases, which is the more wonderful, as
the exciting cause of them must be gradually collecting in the system,
and acquiring strength and intensity, and it is singular that it should
then be developed all at once, and cut off the patient in a very short
time, as if he had swallowed poison, or had been stung by a venomous
animal. He compares the latency of the febrile humor in the system to
that of the mad dog, which will remain for a long time in the body of
a person who had been bitten, and then all at once will manifest its
effects, by inducing the rage. For the ancient views on the subject
of Hydrophobia, see PAULUS ÆGINETA, Book V., 4, Sydenham
Society’s edition.
[729] Galen, in his Commentary on this case, enters into a train
of reflections how a physician ought to proceed when called in to
a patient so circumstanced. He ought, in the first place, as the
Commentator properly remarks, to make careful inquiry, in order to
find out whether the pain in the limb be occasioned by any external
cause, as persons often meet with local injuries by sudden twisting
and movements of their limbs, or even by laying a limb uncomfortably
in bed, without being aware of it. When no such cause of the complaint
can be discovered, Galen says the physician should try to ascertain
whether or not it be connected with the regimen or temperament of the
patient. If it shall turn out that the body is in a plethoric state,
general bleeding must be had recourse to, before any local applications
are made to the part. It is then to be fomented, and liquid and heating
medicines applied to it. Whether or not this was the mode of treatment
which Hippocrates adopted in this case, Galen cannot take upon himself
to affirm, as no mention is made in the report of venesection, nor of
the particular remedies which were used. I am of opinion that this
is one of the most interesting cases in the whole Collection, for I
believe it to be a faithful report of a disease which on three several
occasions I have met with during an active professional practice of
thirty years, and which I have not seen described elsewhere. In all
my cases, indeed, the patients were from twelve to sixteen years old,
but in other respects the symptoms were the same as here described by
Hippocrates. In every one of the cases the patient was seized with pain
and swelling of the thigh, attended with high fever, great jactitation,
and partial delirium. They all proved fatal in the course of three or
four days. Whether the disease be connected with diffuse inflammation
of the areolar substance, or with inflammation of the veins, or whether
it be a general fever complicated with a local affection of the limb,
or what may be the exact nature of the affection, I have not been able
to determine. From what is stated above, it will be clearly seen how
justly Hippocrates deserves the compliment paid to him by Galen, of
having been, of all medical authorities, the most careful in observing
the phenomena of disease. (Opera Galeni, tom. vii., p. 829, ed. Kühn.)
[730] Galen remarks, that this is one of those cases which appear
formidable to the inexperienced, but which those who are practiced in
the art judge of as being likely to come to a speedy crisis. He adverts
to the slight swelling of the spleen and the characters of the urine,
which soon showed a proper sediment, as being particularly favorable
symptoms. The more that we study Hippocratic medicine, we shall be the
more convinced that too little attention has been paid of late years to
the physical characters of the urine in all febrile complaints.
[731] Galen’s Commentary on this case is unusually brief. He holds it
to be a case connected with general plethora, as indicated by the good
color of the urine. He once more makes the remark that a favorable
issue of the case might have been anticipated, from the characters of
the urine.
[732] Galen remarks in his Commentary, that of all the cases related
in the First and Third Books of the Epidemics, this is the only one
in which Hippocrates says that the patient was bled, not, he adds,
that this was the only case in which venesection was adopted, but
because, although the general rule was not to bleed after the fourth
day, the patient, in the present instance, was bled on the eighth. Many
others, he says, were no doubt bled on the second, third, and fourth
days, but of these bleedings, and the other means used, Hippocrates in
general takes no notice, except that he sometimes states, in order to
render the malignity of the disease more apparent, that it was nowise
benefited by the remedies applied. In other cases he adds, he would
appear, from the words he uses (such as “as far as I am aware”), not to
have attended the patient at the commencement. Galen further directs
attention to the characters of the expectoration, the concoction of
which he looks upon as having proved the means of carrying off this
fever. Galen has reviewed the symptoms of this case very fully, and
in a most interesting manner, in the Second Book of his work, On
Difficulty of Breathing, see ed. Kühn, tom. vii., p. 854, etc. That it
was a case of fever complicated with pleurisy seems clear, as Galen
remarks. Galen further treats of the characters of the sputa in this
case, in the First Book of his work, On Crises. Upon reference to
the edition of Littré, it will be seen that unfortunately there is
considerable variation in the readings of this passage.
[733] On this case Galen makes the remark that this patient must have
had a strong constitution, otherwise it could not have withstood such
an affection. He adds that, moreover, his pulse must have possessed
strength, but that, as formerly said by him, this department of
prognostics is altogether omitted by Hippocrates, in his reports of
febrile cases. He further remarks that the respiration and appetite
were not to complain of, and the only bad symptom was the thinness and
blackness of the urine, which therefore required a long time for nature
to overcome, by occasioning hemorrhage, pain of the hip-joint, and
determination downwards. He adds, that great diseases require decided
crises, and that even with those now mentioned, the disease was not
entirely removed in this case, until concoction in the urine took place.
[734] Galen passes over this case without any remark worth mentioning.
I cannot but think that the abundant sediment in the urine, which
preceded the favorable crisis, is a fact in the case well deserving to
be noticed. Galen, however, in the present instance, omits all notice
of it, and ascribes the recovery to the profuse sweat.
[735] The only thing of importance in Galen’s Commentary on this case
is the remark that this woman’s melancholy was most probably connected
with suppression of the menses, and that to this cause the dark color
of the urine in the present instance is most probably to be ascribed.
To the critical evacuations by the sweat and menstruation he attributes
the recovery.
[736] There were several ancient cities of this name, but there can
be no doubt that the one here referred to is the celebrated city of
Thessaly. See Strabo, Geograph. ix.
[737] Galen considers it a remarkable feature in this case that
although the crisis occurred on the sixth day, there was no relapse.
The recovery he ascribes to the copious menstruation which then took
place for the first time. He also calls attention to the characters of
the urine, which, he says, are those which usually accompany delirium,
although this is omitted in the Prognostics.
[738] Galen, in his Commentary, merely remarks that Hippocrates, at
the conclusion of the report, briefly enumerates the more prominent
symptoms from which a fatal result might have been confidently
prognosticated. By enlarged viscera, in this case, we are informed by
Galen in another place, that our author meant inflammation and swelling
(Comment. in Rat. Vict. in Acut. c. iii.) There can be no doubt that
by viscera Hippocrates meant the liver and spleen (see the work just
referred to). Galen briefly remarks on this case towards the end of the
Second Book of his work, On Difficulty of Breathing.
[739] Cyzicus was a flourishing city on the Propontis. See Strabo,
Geogr. xii.; and Pliny, H. N. v. 32.
[740] Galen, in his Commentary, accounts for this fatal disease upon
the supposition that the uterus was inflamed, and affected the brain by
sympathy, hence maniacal delirium and convulsions were the consequence.
Galen, both in his Commentary, and in his work On Crises, refers to
this case, in confirmation of his doctrine of critical days.
[741] I will venture to affirm, without much fear of contradiction,
that in all the works on medicine, both ancient and modern, there
is not to be found so vivid a delineation of the symptoms of fever,
complicated with effusion on the brain. Those who have added new
features to the picture, have thereby detracted from the general
effect. Galen, in his Commentary, insists more especially on the
character of the respiration, but there does not appear to me to be any
particular obscurity about it. He also touches on this case towards the
end of the Second Book, On Difficulty of Breathing. After reading all
his prolix disquisition on the subject, one does not feel much better
instructed on the subject. Galen, at times, nay, very frequently, seems
to forget a favorite saying of his own, namely. that he who would wish
to lay in a copious store of knowledge during life, should trouble
himself little about words, and attend principally to things.
[742] There were two Thessalian cities of this name, the one in
Estiæotis, and the other in Magnesia. This would appear to be the
latter. See Pliny, H. N. iv., 9; and Livy, xliv., 13.
[743] Galen’s Commentary contains few observations of much interest,
and which are not sufficiently obvious. Excesses in drinking and
debauchery, he remarks, hurt the nerves and the origin of them, that
is to say, the brain. Thus he accounts for the delirium with which
this case of fever was attended. All the other prominent symptoms,
such as the palpitation in the epigastric region, the swelling of
the hypochondrium, and the like, were noticed previously. Galen
also reviews the symptoms of this case in his work On Difficulty of
Breathing, II.
[744] “Hippocrates qui tam fallere quam falli nescit.” (Macrobius in
Somn. Scipionis, i., 6.)
[745] Hippocratis Coi de Cap. Vuln., etc., a Francisco Vertuniano.
Ejusdem textus Græcus a J. Scalig. Castigatus, etc.
[746] Comment. de Ossibus.
[747] Hist. Animal., i., 7. In reference to this description, it is
stated by Vesalius, who in the course of his life had examined a great
number of crania, that it is very rare indeed to meet with a skull in
which the sutures are wanting. He accounts for the statement made by
Herodotus (Hist. ix.) and Aristotle (1. c.), respecting skulls without
sutures, upon the supposition that the observations of these authors
must have been made upon those of old persons, in whom the sutures are
often very indistinct. (Chirurg. Magn., i., 17.)
[748] H. N., xi., 48; ed. Hardouin.
[749] De Partib. Animal., p. 34; ed. Londin.
[750] Φοεός. The exact meaning of this term is well defined by
Eustathius in his Commentary on Homer (ad Iliad., ii., 219), ό ἐις
ὀξὺ λήγονσαν ἔχων τὴν κεφαλήν. It is excellently expressed by Damm as
follows: “One whose head diminishes towards the top like a sugar-loaf.”
(Lexicon Homericum in voce Φοεός.)
[751] De Usu Partium, ix., 17.
[752] Surgery, v., 4.
[753] Chirurg. Mag., i., 17.
[754] It is well known that in very advanced age the sutures get nearly
effaced. See the Cyclopædia of Anatomy, vol. i., p. 745.
[755] Comment. de Ossibus.
[756] Obs. Anatom.
[757] This letter was very varied in form. See Galen and Foës.
[758] The operation consisted in sawing the bone nearly through, and
leaving it in this state until it exfoliated, or until the bone could
be separated from the dura mater without violence. See below.
[759] It is no doubt true that a simple cut in the outer table of the
bone, when accompanied with concussion or contusion, may produce fatal
effects within, and this, in fact, is stated by our author; but, of
itself, as he says, the simple incision or _hedra_ cannot be of a
dangerous nature, nor require any recourse to instruments. The cases
related by M. Littré in the Argument were all evidently complicated
with contusion, and are thus referable to the second class of these
injuries. It is most worthy of remark, that in the very interesting
account of “slicing cuts,” given in Mr. Guthrie’s excellent work, On
Injuries of the Head, the result, without any operation, by the most
simple system of treatment, was in general very favorable. (pp. 95,
96.) On these cuts and superficial injuries of the skull, see further
Hennen (pp. 283, 284), Thomson (pp. 51, 52), and Chelius (vol. i., p.
388).
[760] London and Edinburgh Medical Journal, 1844.
[761] Although, as we have stated, Dr. Laurie’s rule of practice now
be to use the trephine on the preventive principle, it is probable
that most of his cases occurred at a period when the practice of Mr.
Abernethy was universally followed. His statistics therefore are no
test of the results of the operation, when performed on the preventive
principle.
[762] See Lawrence’s Clinical Lecture in the Medical Gazette, vol.
xxi., p. 345; and Guthrie’s work, On Injuries of the Head, p. 113.
[763] See De Articulis, § 50; and Mochlicus, § 36.
[764] On hypertrophy and swelling of the brain after injuries, see
the very interesting observations made by Mr. Guthrie, in his work on
Injuries of the Head, p. 125.
[765] It is proper to mention in this place that Quesnay, with great
good sense, discusses the question, whether or nor the separation of
the pericrunium in this case be a sure indication of matter being
collected within the cranium. He decides in the negative. (p. 17, Syd.
Soc. edition of Selected Mem. of the Acad. of Surgery.)
[766] I ought to mention, however, in this place, that in simple
undepressed fractures, Pott allows of the operation as a preventive;
that, at least, is one of his objects in having recourse to the
operation. (p. 130.)
[767] Ambrose Paré expresses very strongly the difficulty of forming a
correct prognosis in injuries of the head: “Ex quo intelligere licet,
multos ab exiguis vulneribus mortem oppetere, alios ex ingentibus et
penitus magnis desperatisque convalescere.” (Opera, ix., 9.)
[768] Injuries of the Head, p. 148.
[769] Aphor. v., 68.
[770] See the Argument to the treatise, On Regimen in Acute Diseases.
[771] Opera, ix., 10.
[772] Sir Astley Cooper mentions an instance in which 208 ounces of
blood were abstracted from a patient!! In Quesnay’s Memoir there is
nothing more common than to find it reported that he had bled a patient
three or four times in the course of a day. In one case 160 ounces were
taken in nine days; “but,” it is gravely added, “two years elapsed
before she was quite well again.”
[773] IV., 5, 3, 1.
[774] The principles upon which depletion by bleeding and purging
should be regulated are fully stated and discussed by Galen, in the
Fourth Book of his great work on Therapeutics. The rule is briefly
given by Hippocrates in his Second Aphorism: “respect being paid to
place, season, age, and the disease in which it is proper or not.”
[775] See Aphor. v., 18, 22; and § 12 of this treatise. The
professional authorities of the present day are not agreed as to the
expediency of using poultices or cold lotions in injuries of the scalp.
Guthrie and Hennen recommend the latter; but South, in the edition of
Chelius, prefers the former.
[776] This is related of Philagrius in a very interesting scholium on
the Aphorism just quoted. See Scholia in Hippocrat. et Galen., tom.
ii., p. 457; ed. Dietz.
[777] Perhaps the meaning here is, that when the forehead is much
elevated, and the occiput much depressed, if one looks down upon the
skull from above, the sagittal and coronal sutures will present the
appearance of the letter Τ.
[778] The meaning, I suppose, may be, that when the forehead is very
low, and when the occiput is protuberant, if one looks down upon the
skull from above, the sagittal and lambdoidal sutures will present the
appearance of the letter Τ reversed.
[779] The meaning would appear to be, that in a square-built head, that
is to say, when it is prominent both before and behind, the coronal and
sagittal sutures run nearly parallel to one another, and the sagittal
connects them together in the middle. In this case they would present
the appearance of the letter Η reversed.
[780] Perhaps this alludes to the form of the head in which the
sagittal suture passes through the middle of the os frontis down to the
nose, in which case we may imagine that the coronal suture intersects
the lambdoidal in such a manner as to have some resemblance to the
letter χ. It is to be borne in mind, that the character of this letter
was very variable in ancient writing. Ruffus Ephesius describes the
sagittal suture as sometimes passing down the middle of the frontal
bone.
[781] This passage was considered by Scaliger as a gloss, but as
interpreted by M. Littré, whom I have followed, the meaning is quite
suitable. See his note, h. 1.
[782] It is difficult to say what can be meant by caruncles in this
place, but still I agree with M. Littré that Scaliger was not warranted
in proposing to eject the passage from the text as an interpolation.
Unless the _glandulæ Pacchioni_ are meant (and the description
must be admitted not to be quite applicable to them), I cannot pretend
to explain or account for the description.
[783] I need scarcely remark, that if by this is strictly meant that
wounds in the posterior part of the head are less dangerous than those
in the anterior, the statement is at variance with the experience of
certain modern authorities. See, in particular, Pott and Liston, p.
46. At the same time, it is, no doubt, anatomically correct, that
the occipital bone can bear more violence, without being seriously
fractured, than the frontal or parietal bones, and it is worthy of
remark, that the views and experience of Mr. Guthrie are very consonant
with those of Hippocrates. He says: “The result of my experience on
this point is, that brain is more rarely lost from the fore part of
the head with impunity, than from the middle part; and that a fracture
of the skull, with even a lodgment of a foreign body, and a portion
of the bone in the brain, may be sometimes borne without any great
inconvenience in the back part.... I have never seen a person live with
a foreign body lodged in the anterior lobe of the brain, although I
have seen several recover with the loss of a portion of the brain at
this part. My experience, then, leads me to believe, that an injury of
apparently equal extent is more dangerous on the forehead than on the
side or middle of the head, and much less so on the back part than on
the side. A fracture of the vertex is of infinitely less importance
than one of the base of the cranium, which, although not necessarily
fatal, is always attended with the utmost danger.” (On Injuries of the
Head, p. 3.) I feel difficulty in reconciling these discordant results
of modern experience. Perhaps the fact of the matter is, that injuries
on the upper part of the occipital region are the least dangerous of
any, whereas those in the lower part of it, are particularly fatal.
[784] Vidus Vidius thus explains the _hedra_ or _sedes_:
“Inciditur os ita ut teli vestigium remaneat, quod genus fracturæ
appellatur a Hippocrate ἒδρα, id est sedes, quum (ut ipse inquit)
appareat in osse qua telum insederit; fit autem ab acuto telo, quod
et ipse in sequentibus, et Galenus, in Commentario, in librum memoriæ
prodidit, quum sub telo acuto incidi os dixit. Requirit autem sedes
ut incisum os nullo modo ad cerebri membranam inclinatur.” (Chirurg.
Græc., p. 71.) Andreas à Cruce defines it thus: “Potissimum vero sedes
vocatur ubi osse in suo statu remanente qua parte telum insederit
apparet.” (De Vulneribus, 1. 2.) By _hedra_ would appear to have
been understood a dint, or impression, left in a bone by a blow which
has not produced fracture or depression. It was also applied to a cut
or slash affecting only the outer plate of the skull. Hippocrates, it
will be remarked, pronounces this sort of injury not to be dangerous
of itself, but M. Littré relates a case taken from the “Journal de
Médecine,” in which a sabre-cut, which only penetrated through the
external plate of the cranium, and did not touch the internal, proved
fatal. (Op. Hippocrat. iii., p. 170.) Our author, in the latter
part of this paragraph, mentions cursorily injury of the skull at
a suture, and more circumstantially in the twelfth paragraph. This
accident is very correctly described by the later writers, under the
name of _diastasis_. See Heliodorus (ap. Chirurg. Veteres, p.
100), and Archigenes (ibid., p. 117). Pott declares that he did not
remember having ever seen a single instance of recovery when there
was separation of the bones at a suture. Morgagni, in like manner,
represents the case as being of a particularly serious character.
(De Caus. et Sed. Morb.) I once saw a strongly marked case in which
there was a considerable separation of the bones at the upper part
of the temporal suture, along with an extensive wound, unguardedly
inflicted by the scalpel of a juvenile surgeon, in order to explore
the nature of the accident. As might have been expected, under these
circumstances, the case had a fatal issue. Mr. Guthrie writes thus of
_diastasis_: “It is well known, that when a violent shock has been
received on the head, particularly by a fall on the vertex, the sutures
are often separated to a considerable extent; _these cases usually
terminate fatally_.” (p. 135.)
[785] The meaning here is somewhat obscure, but as Arantius states in
his commentary on this tract, our author probably means that a fissure
is necessarily complicated with a contusion, or, in other words, that
there can be no fissure without contusion.
[786] Arantius and Porralius, in their conjoined commentary on this
treatise, mention that in contusion sometimes only the outer plate of
the skull is contused, but the inner is depressed upon the dura mater.
This is a case of which we have examples in modern surgery; but it
does not appear clearly to be alluded to in this place by our author.
Mr. Guthrie, indeed, understands the ἀπήχημα of the Greek authors, and
_resonitus_ of the Latin, to apply to this variety of fracture;
but he appears to me to be mistaken, for these terms unquestionable
refer to the _contre-coup_, of which we will treat presently.
Quesnay, indeed, uses the term _contre-coup_ in this double sense,
but, as I think, very injudiciously, as it tends to introduce confusion
of ideas; for assuredly the case of a fracture on a different part of
the head from that which received the blow, and a fracture on the inner
plate of the skull from an injury on the outer, are quite different
cases. See Quesnay, etc., p. 20, Syd. Soc. edit.
[787] The expressions in this place are somewhat confused, but the
meaning evidently is, that without fracture there can be no depression.
[788] This third mode of fracture is thus defined by Celsus: “At ubi
medium desedit, eandem cerebri membranam os urget; interdum etiam ex
fractura quibusdam velut aculeis pungentibus,” (viii., 4.) Hippocrates,
it will be remarked, makes no mention of spiculæ in his description of
depression. Galen describes two varieties of depression; in the one
the depressed portion retains its situation, and in the other it rises
again to its former level. (De Caus. Morb.) Hippocrates does not appear
to have been acquainted with the latter. Modern experience has shown
that it sometimes occurs in children.
[789] It is almost impossible to know what to make of this passage,
owing to the corrupt state of the text.
[790] The nature of this mode of injury is explained in the annotations
on the third paragraph. It does not appear clear why our author has
given two separate descriptions of this injury. He describes, it will
be remarked, several varieties of it, according as it is complicated
or not with contusion and fracture. Galen uses _hedra_ in one
place. (Meth. Med. vi.) The term _hedra_ is rendered _teli
sedes_ by the Latin translators of the Greek medical authors. (See
Asellii Comment. in Hippocrat. de Vuln. Capit.) It is used also by
Ambrose Paré, Wiseman, and all our earlier writers on surgery. Wiseman
thinks the term most appropriate when applied to wounds inflicted by a
pole-axe, halberd, or the like. (v. 9.) Paré applies it to a kind of
injury, in which the bone is not broken through, but the print of the
weapon is left on the skull. (xx., 7.) Fallopius gives an interesting
discussion on it. (In librum Hippocrat. de Vuln. Capit.) The term
incision, borrowed from Paulus Ægineta, has been since used in its
stead. See Quesnay, on the Use of the Trepan, p. 29, Syd. Soc. edition;
and on simple incisions or sabre-cuts, see, in particular, Mr. Guthrie,
Injuries of the Head, p. 86.
[791] This, it will readily be perceived, is the _fractura per
resonitum_, that is to say, the _fracture par contre-coup_, or
counter-fissure of modern authorities. Except Paulus Ægineta, I am not
aware that any of the ancient authorities question the occurrence of
this species of the accident, and with the exception of Vidus Vidius,
Guido, Fallopius, and Dinus de Garbo, it is generally recognized by the
best modern authorities, from Bertaphalia and Andreas à Cruce, down
to Sir Astley Cooper and Mr. Liston. Mr. Guthrie, indeed, remarks,
that in recent times there has been no well-authenticated instance of
fracture on the one side of the head from a blow on the other. Such
cases, however, are not wanting in the works of the earlier modern
authorities. Quesnay writes thus: “We find in authors, also, many
cases of fracture by _contre-coup_, from one part of the head
to the part opposite: and in honor of the ancients we may cite the
case related by Amatus, who applied the trepan to the part of the
head opposite to the wound, when he found that the symptoms were not
relieved by applying it on the side wounded, and that the patient
suffered from severe pain on the other side. This second trepan
proved very apropos, for it allowed the escape of pus, which had
collected under the skull.” (On the use of the Trepan.) All our modern
authorities, including Mr. Guthrie, admit the reality of the case in
which fracture of the base of the skull is produced by a blow on the
upper part of the head. In imitation of our author, this case was
denominated “infortunium” by the earlier authorities, such as Asellius
and Porralius, being accounted an irremediable misfortune, because its
seat could not be detected; and it is noticed in the following terms by
Sir Astley Cooper, who did not trouble himself much about the writings
of his predecessors, but formed his opinions from actual observation:
“When the basis of the skull is fractured from a high fall, from the
whole pressure of the body resting upon that part, on opening the brain
and tearing up the dura mater, extravasated blood is commonly observed;
_this kind of fracture must inevitably prove fatal, nor can it be
discovered till after death_.” (Lectures, xiii.)
[792] Whatever opinion may now be formed of the rule of practice here
laid down, all must admit that it is clearly stated and distinctly
defined. We have seen above that our author describes five modes of
injury in the skull, namely, the incision or indentation, confined
to its outer table; the contusion; the direct fracture; the fracture
_par contre-coup_; and the depression. He now states decidedly
that it is only in the case of contusion and simple fracture, that the
trepan can be applied with advantage. I have entered so fully into the
_rationale_ of this practice in the Argument, that I do not think
it necessary to say more on the subject in this place.
[793] This passage indicates strongly our author’s partiality for
prognostics, or rather, I should say, for prorrhetics. It would appear
to have been a primary consideration with him, in all cases, to secure
the physician from blame, and to teach him how to gain the confidence
of the patient and his attendants. Few who have practiced medicine
for a great many years, will question the propriety of these rules
of conduct, or doubt the importance of taking all honorable steps to
ensure the confidence and good-will of patients and their friends.
[794] There is a remark made by Arantius and Porralius on the latter
part of this paragraph, which, although it appears to be scarcely
warranted by anything in the text of our author, I quote for its
importance, as showing that the earlier authorities were well aware of
the danger and impropriety of treating injuries of the head in children
by instruments: “Sed præ ceteris illud notandum quod dixerit (_nudato
osse_) quasi dicat, eo non denudato quamvis calliso aut fisso, quod
raro accidit, non esse tamen sectione denudandam calvariam: nam in
pueris, ubi decidunt non raro accidit ut eorum collidatur calvaria,
frangaturque, cute integra, quod etsi accidat, et tactu hoc probe
precipiatur, sanguisque e venis effusus sub cute fluctua, abstinendum
tamen a sectione est, neminem enim servatum vidi, cui sectio adhibita
sit, propterea quod eorum calor facile dissipetur, eoque magis, quum
gemitu et clamore caput valdè incelescat, et ad fluxiones suscipiendas
proclive reddatur,” (Comm. in Hip. de Vuln. Cap.) It will be seen at
§ 18, that our author allowed the application of a small trepan in
children when strongly indicated.
[795] This passage is rendered as follows by Celsus: “Igitur, ubi
ea percussa, protinus requirendum est, num bilem is homo vomuerit;
num oculi ejus obcæcati sint; num obmutuerit; num per nores auresque
sanguis ei effiuxerit: num conciderit, num sine sensu quasi dormiens
jacuerit. Hæc enim non nisi osse fracto eveniunt; atque, ubi
inciderunt, scire licet, necessariam, sed difficilem curationem
esse.” (viii., 4.) Now, although it is no doubt true, as remarked by
Pott (Injuries of the Head, § 4), that these symptoms sometimes take
place, without there being any fracture of the skull, and that, on the
other hand, as had been previously pointed out by Paré and Le Dran,
fractures do sometimes take place without being accompanied by all
these symptoms, still there can be no doubt that as a general rule
the doctrine of Celsus is correct, and that, at all events, a case is
to be treated as serious in which these symptoms occur. With regard
to one of the characteristics of a fracture, thus noticed by Celsus,
a modern authority of great experience, but little acquaintance with
ancient learning, observes, “Blood flowing from the nose and ears is a
symptom attending fracture of the skull. It may be consequent on mere
concussion, a vibration which ruptures the membranes; but oftener it is
a consequence of fissure across the bone.” (Institutes of Surgery, by
Sir Charles Bell, vol., i, p. 173.)
[796] The separation of the bones at a suture, usually called
_diastasis_, is noticed in the annotations on § 8. I have also
alluded, in my analysis of the Fifth Book of the Epidemics, to the case
in which the author, generally supposed by ancient authorities to be
Hippocrates, mistook a suture for a fracture of the skull. See Epidem.
v., 14; and Celsus, viii., 4.
[797] On the terms which occur parenthetically, the philological reader
may consult the note of Stephanus, contained in the edition of Erotian
by Franzius, under ἑδράιως. I may here remark, that it is difficult to
account for the frequent repetition of these words in parentheses.
[798] It will be remarked that, as a general rule, Hippocrates forbids
us to apply the trepan at the sutures, but, notwithstanding this
prohibition, it would appear to have been departed from in two cases
related in the Sixth Book of the Epidemics. (See § 27 and 28.) The
rule, however, to avoid the application of the trepan at the sutures,
was generally observed by nearly all the modern authorities down to
Pott, and even he admits that the sutures should be avoided when the
trephine may with equal utility be set on any other part. Louis, in
a paper lately reprinted from the Memoirs of the Royal Academy of
Surgery, by the Sydenham Society, gives an interesting examination
of the doctrine of the ancient and modern authors on this rule of
practice. Most of the authorities quoted by him are averse to the
application of the trepan over sutures, except when very urgently
required. C. Porralius, in his marginal notes on Arantius’s Commentary
on this work of Hippocrates, assigns three reasons for avoiding the
sutures in this operation: 1st, because the bone is weak at that place;
2dly, because the membrane there being in close connection with the
bone, is in danger of being injured; 3dly, because, by the contraction
of the callus, the transpiration there will be stopped. The last of
these reasons is based on the physiological doctrine of the ancient
authorities respecting the uses of the sutures, one of which was, to
permit transpiration from the brain. See Galen, de Usu Partium, ix., 1,
2.
[799] Our author, it will be remarked, forbids liquid applications,
tents, cataplasms, and bandages, in wounds of the head. He seems to
have approved most of things of a drying nature. The other authorities
would appear to differ considerably in their views regarding the proper
principles upon which wounds on the head are to be treated. Celsus
directs us, after laying bare the dura mater by trepanning, to apply
strong vinegar to it, and when the membrane is inflamed, he approves of
tepid rose-water. (viii., 4.) Paulus Ægineta, after the operation of
trepanning, directs a piece of cloth, or small ball of wool dipped in
oil, to be applied to the part. I believe they all agreed in rejecting
sutures. See Galen, de Med. sec. Genera III.
[800] Hippocrates would seem to hold the fanciful idea, that the
forehead is environed by the rest of the head, and that afflux of blood
takes place from the parts around to it. Scaliger rejects this passage
as containing a doctrine wholly unworthy of our author.
[801] The danger of incisions, in the temporal region, is adverted to
in several parts of the Hippocratic Collection, as in the work On the
Articulations, in the Prorrhetics, and the Coan Prænotions. Even at the
present day, when the treatment of hemorrhage is better understood than
in the days of the great Fathers of Grecian medicine, a large incision
in that quarter is regarded with considerable apprehension. Convulsion,
that is to say, tetanus, was supposed to be the frequent, if not the
invariable, result of a wound in the temporal muscle. Pott, indeed,
contends that lock-jaw is not necessarily produced by a wound there; he
admits, however, that the application of the trepan to the temple is
not often successful, but the reason of this he contends is, that in
these fractures the breach generally extends to the base of the skull
(§ 5). Quesnay, however, inclines to support the views of Hippocrates.
(On the Use of the Trepan, p. 15, Syd. Soc. edit.) Scultet, in like
manner, pronounces decidedly that a wound in the temple is a very
dangerous affair. (Armam. Chirurg. Tabl. xxxi.)
[802] The _maza_ was evidently a poultice prepared with barley-meal
and vinegar, or water. See the Annotations on the treatise On Ancient
Medicine.
[803] Celsus translates this passage as follows: “At si ne tum quidem
rima manifesta est, inducendum supra os atramentum scriptorium est,
deinde scalpro id deradendum; nigritiem enim continet, si quid fissum
est.” (viii., 4.) Arantius properly remarks, that the ancient ink must
not be confounded with the modern, which is composed principally of
copperas and galls. It was, no doubt, the milder kind prepared from the
soot of pines with gum which was used in this case. On the writing-ink
of the ancients, see Dioscorides (M. M., v., 182) and Pliny (H. N.,
xxxv., 6).
[804] The text in the beginning of this paragraph is in a very
unsatisfactory state. It seems pretty clear, however, that in this
place our author describes caries of the bone brought on by an
unhealthy state of the integuments. The description--allowance being
made for the corruption of the text--is sufficiently distinct, and
most probably has reference to that condition of the parts which is
so graphically described by Pott as forming “a puffy, circumscribed,
indolent tumour of the scalp, and a spontaneous separation of the
pericranium from the skull under such tumour.”
[805] Our author in this place would appear to treat of incipient
hernia cerebri, as immediately before he treats of fungous ulcers on
the pericranium. Galen in like manner, praises powerfully dessicant
medicines upon the authority of Meges the Sidonian, who, he says, had
great experience in these cases. He speaks of the plaster called Isis
as being a most efficacious application to the dura mater, when laid
bare. Its principal ingredients are of an escharotic and detergent
nature, such as squama æris, burnt copper, ammoniac salts, myrrh,
aloes, and the like. See PAULUS ÆGINETA, Vol. III., p. 564.
Galen concludes his remarks on this subject with stating that, before
getting into an inflamed state, the dura mater, as being of a dry
nature, endures the most powerful medicines. (Meth. Med., vi., at the
end.)
[806] This description of a piece of bone which is going to exfoliate,
is remarkably correct. Compare it with the following narrative: “A
girl of ten or twelve years of age was struck on the head by an iron
rod falling on her; the blow caused no wound, and the young woman was
soon well, with the exception of a fixed pain of no great extent, which
remained over one of the parietal bones. The pain continued for several
years. M. Mareschal, who was at last consulted, considered it necessary
to trepan. He exposed the bone at the painful part, and applied one
crown of a trepan; he observed, _that the bone, when sawed, appeared
dry, like a skull that had been buried_.” (Quesnay, on the Use of
the Trepan.) This agrees excellently with the description given by
Hippocrates. It is to be regretted, however, that the text here; as
far as regards one word ἀποστρακὸς, is in a very unsatisfactory state.
The conjectural emendation of Schneider (ἀπεσκληκὸς) seems to be a
plausible emendation, but it is not adopted by Littré.
[807] Our author delivers the same doctrine in the work On the
Articulations, and states that extensive fractures of the bones are
often less dangerous than others which appear not so formidable. I
need scarcely remark that modern experience has confirmed the truth
of this position. How often has it been seen that one patient died
from a slight injury to the skull, while another recovered from an
extensive fracture of it? Mr. Guthrie appears in so far to agree in
opinion with our author, that extensive fractures are less dangerous
than they appear; he says, “Mr. Keate, who has had great opportunities
for observation in St. George’s Hospital, has invariably remarked that
the symptoms dependent on extravasation have been less severe in the
first instance, in proportion as the separation of the edges of the
fracture have been greater one from the other, or when the sutures have
yielded to the shock and have been separated. It has been stated from
the earliest antiquity, that the greater the fracture, the less the
concussion of the brain.” (p. 56.) See the Argument.
[808] It will be remarked as a striking feature in our author’s views
of practice in injuries of the head, not to interfere with fractures
attended with depression. See the Argument, where the rationale of this
practice is fully discussed.
[809] Although these directions of our author regarding the treatment
of children be most important, I am not aware that any other of the
ancient authorities has shown his sense of their value of them by
repeating them. It is well known that in children there is but one
table, and that it is very thin. Our author, as remarked above, does
not entirely omit the operation in the case of children, but uses a
small trepan.
[810] The reader will again remark an instance of our author’s fondness
for prognosis, and his observance of the rule at all times to prevent
the surgeon from committing himself by attempting hopeless cases.
Celsus, writing in the same spirit, says, “Ante omnia scire medicum
oportere, quæ vulnera insanabilia sint, quæ difficilem curationem
habeant; ... non attingere, _nec subire speciem ejus, ut occisi, quem
sors ipsius intermit_.” (v., 26.)
[811] This is an opinion held by all the ancient authorities. Some
interesting cases in point are related in the First Book of the
Continens of Rhazes. It was explained on the principle that the
cerebral nerves decussate. (See Aretæus, on the Causes of Disease, i.,
7.) Modern experience, in the main, is in accordance with the ancient
on this point. Paralysis has generally been found on the opposite side
to that which has received the injury. See Thomson’s Observations,
etc., p. 52; Larrey’s Mem. de Chirurg., iv., p. 180; Hennen’s
Principles, p. 301.
[812] This passage is thus translated by Celsus: “Si sub prima
curatione febris intenditur, brevesque somni, et iidem per summa
tumultuosi sunt, ulcus madet, neque alitur, et in cervicibus glandulæ
oriuntur, magni dolores sunt, cibique super hoc fastidium increscit,
tum demum ad manum scalprumque veniendum est.” (vii., 4.)
[813] The practice advocated in this paragraph is alluded to by Paulus
Ægineta, in his chapter on Fractures of the Skull. (vi., 90.)
[814] The operation here described by our author is the more deserving
of attention, as it appears to have been peculiar to him. It is not
described by Celsus, Paulus Ægineta, Albucasis, nor any one of the
ancient authorities, as far as I can find; neither am I aware of its
having been attempted in modern times. The object of it, however, seems
to be very rational, namely, to avoid doing serious injury to the dura
mater by tearing the bone forcibly from it at once.
[815] The instrument here used is named πρίων χαρακτὸς; and, as far as
I can see, was the same as the modiolus of Celsus, and the χοινικὶς
of the later authorities. It would certainly appear to have been a
circular saw, and consequently not unlike our modern trephine. See the
figures and the Argument.
[816] The following sentence, taken from Sir Charles Bell’s description
of the operation, looks like a translation of this passage of
Hippocrates; but it is well known that our English surgeon was not
guilty of reading Greek! “Withdraw your trephine from time to time,
brush it, and run the flat probe round the circular cut.” The specillum
of the ancient surgeons was, in most respects, not unlike our modern
probe.
[817] The meaning here would seem to be, that the bone does not
extend so deep as might be supposed. See Foës, Œcon. Hippoc., under
ἐπιπολαιότερον ὀστέου.
Transcriber’s Notes:
1. Obvious printers’, punctuation and spelling errors have been
corrected silently.
2. Where hyphenation is in doubt, it has been retained as in the
original.
3. Some hyphenated and non-hyphenated versions of the same words have
been retained as in the original.
4. Possible errors in Greek words or phrases have been retained as in
original.
5. Italics are shown as _xxx_.
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