Chapter 31

[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 tempusCompressæ nares, nasi primoris acumenTenue, cavati oculi, cava tempora, frigida pellisDuraque, 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 theensembleof 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 byflexileandlubricum. (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 particularPaulus 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 pulsationorpalpitation 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. SeePaulus 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, andPaulus 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 scrapingsorstrippings 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 onPaulus 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. SeePaulus 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 lePronostic, 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 toPaulus 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 onPaulus 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. SeePaulus 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 thetout ensembleof 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]SeePaulus 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,orTherapeutics.[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 furtherPaulus 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 (orbarley 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 (orthe 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.

[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 tempusCompressæ nares, nasi primoris acumenTenue, cavati oculi, cava tempora, frigida pellisDuraque, 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.

“Item ad supremum denique tempusCompressæ nares, nasi primoris acumenTenue, cavati oculi, cava tempora, frigida pellisDuraque, inhorrebat rictum, frons tenta minebat.”De Rerum Natura, vi., 1190.

“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 theensembleof 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 byflexileandlubricum. (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.

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 byflexileandlubricum. (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 particularPaulus 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 pulsationorpalpitation 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. SeePaulus 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, andPaulus 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 scrapingsorstrippings 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 onPaulus 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. SeePaulus 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 lePronostic, 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 toPaulus 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.

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 onPaulus 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. SeePaulus 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 thetout ensembleof 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]SeePaulus 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,orTherapeutics.

[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 furtherPaulus 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 (orbarley 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 (orthe 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.

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