Chapter 32

[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 thejuste milieubetween 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 ofrâlesin 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 theHelleborus niger. SeePaulus Ægineta, Vol. III., p. 108.[547]TheEuphorbia peplus. See Ibid., Vol. III., p. 294.[548]Probably theSeseli tortuosum. See Ibid., Vol. III., p. 330; and Dierbach, Arzn. der Hipp. p. 186.[549]A species of asafœtida, probably theLaserpetium 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, seePaulus 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]Thecyceonwas 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, seePaulus 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 SeePaulus 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, seePaulus 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 thedouche, 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, andwhen 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 causesofardent fever of the ancients was decidedly the same as the bilious remittent fever of modern authors. SeePaulus 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, seePaulus 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 ofdelirium 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 thepinus pinaster. SeePaulus 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 onPaulus 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. (SeePaulus 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 theMylabris cichorii, orM. Fusselini. It continued to be used in ancient times as a diuretic, (seePaulus 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 theReseda mediterranea. SeePaulus 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 namedanabrochismus. SeePaulus 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 onPaulus 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 ofPaulus Ægineta, Syd. Soc. edit.[599]A mineral, consisting principally of sulphate of copper. SeePaulus 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 (seePaulus Ægineta, Vol. III., p. 280); 2d, to theEuphorbia 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, theEuphorbia 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]SeeÆgineta. 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 ThasoorTasso. 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 iscynanche parotidæaorparotitis. 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 themumpsof 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.

[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 ofrâlesin 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 theHelleborus niger. SeePaulus Ægineta, Vol. III., p. 108.

[547]TheEuphorbia peplus. See Ibid., Vol. III., p. 294.

[548]Probably theSeseli tortuosum. See Ibid., Vol. III., p. 330; and Dierbach, Arzn. der Hipp. p. 186.

[549]A species of asafœtida, probably theLaserpetium 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, seePaulus 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]Thecyceonwas 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, seePaulus 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 SeePaulus 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, seePaulus 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 thedouche, 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, andwhen 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 causesofardent fever of the ancients was decidedly the same as the bilious remittent fever of modern authors. SeePaulus 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, seePaulus 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 ofdelirium 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 thepinus pinaster. SeePaulus 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 onPaulus 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. (SeePaulus 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.)

[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 theMylabris cichorii, orM. Fusselini. It continued to be used in ancient times as a diuretic, (seePaulus 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 theReseda mediterranea. SeePaulus 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 namedanabrochismus. SeePaulus 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 onPaulus 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 ofPaulus Ægineta, Syd. Soc. edit.

[599]A mineral, consisting principally of sulphate of copper. SeePaulus 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 (seePaulus Ægineta, Vol. III., p. 280); 2d, to theEuphorbia 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, theEuphorbia 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]SeeÆgineta. 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 ThasoorTasso. 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 iscynanche parotidæaorparotitis. 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 themumpsof 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.

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