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Full text of "The genuine works of Hippocrates;"



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THE 



SYDENHAM SOCIETY 



INSTITUTED 



MDCCCXLIII 




LONDON 



MDCCCXLIX. 



THE 



GENUINE WORKS 



OF 



HIPPOCRATES 



TRANSLATED FROM THE GREEK 



A PRELIMINARY DISCOURSE AND ANNOTATIONS 



PRANCIS ADAMS, LL.I). 

SURGEON. 



IN TWO VOLUMES 

VOL. I. 



LONDON 

PRINTED FOR THE SYDENHAM SOCIETY 

MDCCCXLIX. 




12 

H'SU 
v,/ 



C. AND J. ADI.AKU, rHINlKllS. 

nAltlHIMUSIKW CI.IISK. 



ADVERTISEMENT. 



The Council of the Sj^denham Society liaving done me the 
honour of consulting me respecting a proposed volume of 
translations from the Works of Hippocrates, I ventured to 
give it as ray opinion that such a selection ought to compre- 
hend the whole of those Treatises which arc now regarded 
as genuine ; and this suggestion having been approved of, 
I was appointed to the task of translating and editing them 
according to the best of my judgment. The design, then, 
of the present Work,^ is to give a translation of all the 
genuine remains of the Great Hippocrates, along with 
such an amount of illustration as may be sufficient to render 
them intelligible to any well-educated member of the profession 
at the present day. It was understood, indeed^ when I first 
engaged in this undertaking, that I was merely to give a faithful 
translation of the original ; but I soon became satisfied, that a 
considerable amount of illustration, in the form of Annotations, 
Arguments, and so forth, would be indispensable to the general 
utility of such a publication. It is well known that many 
parts of my author's works are very obscure, owing to the 
conciseness of the hmguage, and the difficulty which now exists 
of properly apprehending the views entertained on certain 
.abstruse questions at so very distant a period ; and, conse- 
quently, it will readily be understood, that a simple version, 
without either comment or illustration, would have been nearlv 

' It is necessary to inform my readers in tliis place, tliat, owing to its bulk, it has 
been judged expedient by tlie Council of the Sydenhaui Society to divide the work 
into two separate jiarts or volumes. 



vi ADVERTISEMENT. 

as unintelligible to most of my readers as the original itself. 
And that the works of Hippocrates stand in need of illustration 
is rendered apparent from the number of commentaries which 
have been written upon them in all ages, commencing almost 
with his own time. But whether or not I have been fortunate 
enough to give just such an amount of illustration as was 
necessary, and have taken proper care at the same time not to 
load my pages with superfluous matters of this description, must 
be left to the judgment of my readers to determine. However, 
I may be permitted to say, that whatever value shall be put 
upon my performances in this line, I have certainly spared no 
pains to make myself well acquainted with the true doctrines 
of my author, and that for this purpose I have consulted all 
the best authorities to which I could obtain access, from the 
commentaries of Apollonius and Galen down to the learned 
labours of several continental scholars, my contemporaries, 
especially Dr. Ermerins, of Holland, and MM. Littre and 
Malgaigne, of France. I flatter myself it will also be ad- 
mitted, that I have further collected from a variety of sources, 
a considerable store of valuable materials, for which T am in 
nowise indebted to any of my predecessors in the same field of 
research. 

Considering how scanty all the information is which the 
English language can supply on many questions connected with 
the medical literature of the ancients, I have judged it necessary 
to enter into a discussion of several of these subjects, in order 
to prepare ray readers for understanding the doctrines of my 
author. These are contained in the Preliminary Discourse, and 
will be found to relate principally to the origin of Grecian 
INIedicine, to the Biography of Hippocrates, and an analysis of 
the works which bear his name, and to an exposition of the 
principles of the Physical Philosophy which form the basis of 
most of the hypotheses which occur in the Hippocratic Col- 
lection. Having bestoAved much pains on the illustration of the 



ADVERTISEMENT. vii 

philosophical tenets of the ancients, I shall feel anxious to 
learn how far the judgment pronounced by me on various 
controverted points is approved of by persons possessing the 
necessary degree of information to enable them to form a 
correct estimate of them, along with a proper degree of candour 
in judging between the conventional opinions of the present 
time, and those which prevailed in so remote an age. 

That I have imposed upon myself a very serious additional 
task, by engaging not only to give a true version of the 
language of my author, but also to expound his opinions, and 
place them, so to speak, in juxtaposition with those of the pre- 
sent age, will be readily admitted'; and I have reason perhaps to 
apprehend, that I have thereby exposed myself to the strictures 
of a certain class of critics, who have formed to themselves a 
very different ideal of the duties of a translator, fancying that 
he ought merely to concern himself with the words of the 
original author, and not venture to sit in judgment on the doc- 
trines. I shall not attempt, however, any formal defence of the 
method which I have pursued, but ma}'^ be allowed to remark, 
that, if I shall be found to have failed in satisfying the 
reasonable expectations of such readers as are sincerely desirous 
of becoming familiarly acquainted with the opinions of an 
author, whom I verily believe to be the highest exemplar of 
professional excellence which the world has ever seen, it is not 
from want of zeal in the discharge of the arduous duties which 
I had undertaken. 

I have little left to say in this place respecting most of the 
critical subjects connected with the work, as I have entered at 
considerable length into the discussion of these matters in the 
Preliminary Discourse. It is proper, however, to acknowledge 
that I have derived great assistance from M. Littre's excellent 
edition, of which the parts already published embrace all the 
treatises here given, with the exception of the last four. On 
all occasions I have freclv availed mvself of Jus labours. 



viii ADVERTISEMENT. 

more especially in amending the text, in which respect his 
edition undoubtedly surpasses all those which preceded it. I 
have also not neglected to consult all the other standard 
editions, especially those of Foes, Van der Linden, and Kiihn, 
and likewise, as will be seen, many other editions of separate 
treatises, so that, altogether, I trust it will be found that I 
have not often failed in attaining the true meaning of my 
author, as far as it can now be ascertained. I am aware, in- 
deed, that, situated as I am, at a distance from public libraries, 
and deprived of personal intercourse with learned men of con- 
genial pursuits whom I could consult in cases where I felt myself 
in doubt, I have laboured under disadvantages which may 
render my work not so perfect in all respects as could have 
been wished ; and that, by sending it to the press as soon as 
completed, it is not unlikely I may have left it disfigured by 
certain blemishes which mult a dies et multa litura might have 
enabled me to remove. But the urgency of my other pro- 
fessional and private concerns forbade me to devote much 
longer time to any one task, however interesting or important ; 
while the weight of increasing years, and the confirmed con- 
viction of the endless nature of literary research on such a 
subject as this, disposed me, on the present occasion, to keep 
in mind the solemn admonition of my Author, that " Life is 
short, and Art is long." 

F. A. 

Banchouy ; Jan. 1849. 



CONTENTS OF VOL. I. 



I'AGE 

Preliminary Discourse . . . . . . 1 

Sect. I. — Oil the Origin of Grecian Medicine . . .3 

Sketch of the Life of Hippocrates . . . . 9 

Sect. II. — Disquisition on the Authenticity of the different Treatises whicli 

have been attributed to Hippocrates . . .24 

Sect. Ill, — On the Physical Philosophy of the Ancients, and more especially 

their Doctrines witJi regard to the Elements . . 131 



The Pythagoreans 
The Platonists 
The Peripatetics . 
The Stoics . 
The Epicureans . 



132 
135 
139 
141 
143 



On Ancient Medicine 



The Argument 



The Work . 

On Airs, Waters, and Places 
The Argument 
The Work 

On the Prognostics 
The Argument . 
The ^^^ork . 
Appendix to the Book of Prognostics 



155 
157 
IGl 

179 
181 
190 

223 
225 
234 
257 



CONTENTS. 



On Regimen in Acute Diseases . 

The Argument .... 
The Work . . . . . 

Appendix to the work on Regimen in Acute Diseases 

The Argument . . . . 

The Work .... 



PAGE 
. 271 

. 273 
. 282 
. 306 
. ib. 
. 313 



First and Third Books of the Epidemics . 

Book I. — The Argument 

The Work . 
Book III. — The Argument 
The Work 



337 
339 
352 

382 
388 



On Injuries of the Head 
The Argument 
The Work 



421 
423 

445 



Plates I, II, III, with Description. 



errata. 



Page. 

26, /or Philenus, read Philinus. 

b6,for Bacchus, read Bacchius. 

74, for l)roiichus, read branchus. 
I2'.i, for Prpecepta, read Precepts. 
152, /or coinporta, read composta. 
183, for Kci ?), read icai t). 
194, /or Re, read ffic. 



Page. 

206, /o»' wpaia, read wpaia. 

221, for uvap(^oi, read c'ivapOoi, 

237, Hne 10fr.foot,/o/- aMfia, read vwtov. 

290, /or 77fX(6)', read TreXtov. 

42b, for TiiQ, read riiv. 

453, /or Asellius, read Arantius. 



PRELIMINARY DISCOURSE, 



BY THE EDITOR. 



PRELIMINARY DISCOURSE. 



SECTION I. 



ON THE ORIGIN OF GRECIAN MEDICINE, WITH A SKETCH OP 
THE LIFE OF HIPPOCRATES. 

It is well known that tlie oldest documents which we possess 
relative to the practice of Medicine, are the various treatises 
contained in the Collection which bears the name of Hippocrates. 
Their great excellence has been acknowledged in all ages, and 
it has always been a question which has naturally excited lite- 
rary curiosity, by what steps the art had attained to such per- 
fection at so early a period. This investigation, however, 
is attended with peculiar difficulties, and has never been 
marked by any very satisfactory results. At one time, indeed, 
it was usual to solve the question by supposing that Greece had 
derived all the arts and sciences, in a state of considerable ad- 
vancement, from the oriental nations, who are admitted to have 
possessed a considerable degree of civilization before the Hellenic 
race became distinguished for intellectual development.^ The 
question with regard to the origin of Medicine was thus supposed 
to have met with a satisfactory solution. For, it being generally 
admitted that the Hippocratic Medicine had emerged from the 
schools of philosophy, and it having been assumed as incontro- 

' This is the view which is taken regarding the origin of Grecian medicine by 
Sehulze, in his Historia Medicinse. He is a most learned and trustworthy autliority 
on the history of medicine, but in the present instance his judgment is biassed by 
the opinion which was generally held in his age with respect to the origin of 
Grecian philosophy. At that time it was customary to follow the later Platonists in 
tracing the rise of philosophy to Egypt. Lord Monboddo, in his work on Ancient 
Metaphysics, strongly espouses this opinion, which, in fact, was the established 
belief of learned men down to a late period. Kant advocated the views which ai-e here 
adopted. 



4 PRELIMINARY DISCOURSE. [sect. i. 

vertible that tlie early philosophy of the Greeks had been derived 
from the East, the inference appeared to be quite legitimate that 
medicine, in a state of considerable advancement, had been im- 
ported fr om the sa me quarter. Recent research, however, has 
cast great doubts on the supposed descent of Grecian philosophy 
from a foreign source, and it is now pretty generallj^ admitted 
that the Orientals, in early times, had never made any con- 
siderable progress in mental science.^ Instead, then, of looking 
upon philosophy as having been an exotic production in the 
land of Hellas, we have every reason to believe that it was, what 
its inhabitants, in the noble pride of political freedom and in- 
tellectual superiority, boasted that their forefathers had been, 
namely, " the offspring of their own soil.^'" Since the philosophy 
of the Greeks was indigenous, there is every reason to suppose 
that their medicine was so in like manner. How long the union 
between medicine and philosophy had subsisted before the time 
of Hippocrates, has not been determined upon any contem- 
porary evidence, but the disciples of Pythagoras, in after ages, 
did not hesitate to ascribe to him the honour of effecting tliis 
alliance.'^ However this may be, it appears to me very doubtful 
whether these philosophers ever practised medicine as a craft. 
Indeed, it is much more likely that they merely speculated 
upon the phenomena of disease. Thus we shall see afterwards, 
that Plato himself did not discard speculative medicine from 
his system of philosophy, although we are quite sure that he 

' See in particular the introductory chapters to Ritter's History of Ancient Philo- 
sophy ; Thirlwall's History of Greece, c. xii; Grate's History of Greece, P. I, c. xvii. 
The opinion now generally held on this subject may be explained in few words. 
The Homeric poems are beyond all doubt of Grecian origin, for it cannot be shown 
that the ancient Egyptians or Babylonians had anything resembling a regular epos. 
Now, as Mr. Grote well observes, "from the poetry of Homer to the history of 
Thucydides, and the philosophy of Plato and Aristotle, was a prodigious step, but 
it was the native growth of the Hellenic youth into the Hellenic man, and what is 
of still greater moment, it was brought about without breaking the thread either 
of religious or poetic tradition — without any coercive innovation or violent change 
in the mental feelings. The transition of Grecian mind from its poetical to its com- 
paratively positive state was self-operated, and accomplished by its own inherent and 
expansive force — aided indeed, but by no means either impressed or provoked, from 
without." — L. c. 

2 Plato, Menex. 

^ Celsus mentions Pythagoras, Empedocles, and Democritus, as the most distin- 
guished of the philosophers who cultivated medicine — Prafat. 



SECT. I.] GRECIAN MEDICINE. 5 

never i:)ractised it as an art. But tliis connexion between 
medicine and philosophy was by no means regarded, in after 
times, as having been favorable to the advancement of the 
former, for we find Hippocrates complimented by Celsus for 
ha\dng brought about a separation between them.^ 

It is clearly established that, long before the birth of phi- 
losophy, medicine had been zealously and successfully cultivated 
By the Asclepiadne, an order of priest-physicians that traced its 
origin to a mythical personage bearing the distinguished name 
of iEsculapius. Two of his sons, Podalirius and Machaon, figure 
in the Homeric poems, not however as priests, but as Avarriors 
possessed of surgical skill in the treatment of wounds, for which 
they are highly complimented by the poet. It was probably 
some generations after this time (if one may venture a conjec- 
ture on a matter partaking very much of the legendary 
character) that iEsculapius was deified, and that Temples of 
Health, called Asclepia, presided over by the Asclepiadoe, were 
erected in various parts of Greece, as receptacles for the sick, 
to which invalids resorted in those days for the cure of diseases, 
under the same circumstances as they go to hospitals and spas 
at the present time. What remedial measures were adopted in 
these temples we have no means of ascertaining so fully as could, 
be Avished, but the following facts, collected from a variety of 
sources, may be pretty confidently relied upon for their accuracy. 
In the first place, then, it is well ascertained that a large 
proportion ' of these temples were built in the vicinity of 
thermge, or medicinal springs, the virtues of which would no 
doubt contribute greatly to the cure of the sick.~ At his 

* ." Hippocrates primus ab studio sapientise disciplinam banc separavit." — Prrefat. 

- Seethe authorities quoted at Paulus jEgineta, Vol. I, p. 73, Syd. Soc. edition ; 
also in particular Xenoplion's Memorabilia, iii, 13 ; and Pausanias, ii, 2. The most 
complete list which is anywhere given of the ancient Asclepia, is that contained in 
Schulze's History of Medicine, i, 24. It is to be regretted, liowever, that the refer- 
ences to Pausanias are made according to the pages of an old edition, instead of 
books and chapters, so that one experiences some ditRculty in finding the passages 
referred to. The number of Asclepia in Greece noticed by him is sixty-four. Plutarch 
states in positive terms that all the Temples of Health were erected in high situations, 
and where the air was wholesome. — (Qusest. Rom.) On the practice of medicine in 
the ancient Temples of Health, see further Sprengel, Hist, de la Med., c. v. Sprengel, 
however, does not acknowledge so candidly as he ought to have done his obligations 
to his predecessor Schulzc. 



6 PRELIMINARY DISCOURSE. [sect. i. 

entrance into the temple, the devotee was subjected to purifi- 
cations, and made to go through a regular course of bathing, 
accompanied with methodical frictions, resembling the oriental 
system now well known by the name of shampooing. Fomen- 
tations with decoctions of odoriferous herbs were also not for- 
gotten. A total abstinence from food was at first prescribed,' 
but afterwards the patient would no doubt be permitted to par- 
take of the flesh of the animals which were brought to the 
temples as sacrifices. Every means that could be thought of 
was used for working upon the imagination of the sick, such 
as religious ceremonies of an imposing nature, accompanied by 
music, and whatever else could arouse their senses, conciliate 
their confidence, and, in certain cases, contribute to their amuse- 
ment." In addition to these means, it is believed by many in- 
telligent Mesmerists of the present day, that the aid of Animal 
magnetism was called in to contribute to the cure -^ but on 
this point the proof is not so complete as could be wished. 
Certain it is, however, that as the Mesmerists administer medi- 
cines which are suggested to the imagination of patients during 
the state of clairvoyance, the Asclepiadse prescribed drugs as in- 
dicated in dreams. These, indeed, were generally of a very 
inert description; but sometimes medicines of a more dangerous 
nature, such as hemlock and gypsum, were used in this way,^ 
and regular reports of the efi'ects which they produced were 
kept by the priests in the temples. It is also well known that 
the Asclepiadse noted down with great care the symptoms and 
issue of every case, and that, from such obsei'vations, they be- 
came in time great adepts in the art of prognosis. When we 
come to an analysis of the diff'erent Hippocratic treatises, it will 
be seen that there is strong reason to believe we are still 
possessed of two documents composed from the results of obser- 
vations made in the ancient Temples of Health. It would also 
contribute much to the increase of medical knowledge in this 

' Philostratus,'-Vita ApoUouii, i, 9 ; Strabo, Geogr., xiv. 

^ Pausanias, vii, 21. 

^ This I have reason to know is the belief of the learned and estimable author of 
the Isis Kevelata. 

■• Aristides, Orat. in iEsculap., viii. It may be proper to state that Sprengel, in 
referring to this passage (Hist, de la Med., p. 160, French edition), falls into the 
mistake of saying that these medicines were prescribed to Aristides himself. 



SECT. I.] GRECIAN MEDICINE. 7 

way, that the office of priesthood was hereditary in certain 
families^ so that information thus acquired would be transmitted 
from father to son, and go on accumulating from one generation 
to another.^ Whether the Asclepiadte availed themselves of the 
great opportunities which they must undoubtedly have had of 
cultivating human and comparative anatomy, has been much 
disputed in modern times ; indeed, the contrary is expressly 
maintained bv some eminent authorities, such as Gruner^ and 
Sprengel.^ But it will be shown in another place, that 
there is good reason for believing that these two scholars have 
greatly underrated the amount of anatomical knowledge pos- 
sessed by Hippocrates, and his predecessors the priest-physicians 
in the Temples of Health. Moreover, it is worthy of remark, 
that Galen holds Hippocrates to have been a very successful 
cultivator of anatomy.''' Galen further states, upon the authority 
of Plato/ that the Asclepiadse paid no attention to dietetics ; but 
this opinion would require to be received with considerable 
modification, for, most assuredly, whoever reflects on the great 
amount of valuable information on this subject which is con- 
tained in the Hippocratic treatises, will not readily bring him- 
self to believe that it could have been all collected by one man, 
or in the course of one generation. It is worthy of remark, 
moreover, that Strabo, whose authority I need scarcely say 
stands deservedly high in all literary matters, does not hesitate 
to affirm that Hippocrates was trained in the knowledge of 
dietetics, from documents preserved in the Asclepion of Cos.^ 
That gymnastics, as stated by Galen,^ were not recognised as 
a regular branch of the healing art, until the age of Hippocrates, 
is indeed not improbable, and this perhaps is what Plato meant 
when he says that the Asclepiadte did not make any use of the 
pedagogic art until it was introduced by Herodicus. But at the 
same time there can be no doubt, as further stated by Galen,^ 
that exercise, and especially riding on horseback, constituted 

' Galeu, de Administ. Anatom., ii. 

^ Censura Operum Hippocrat., p. 184. 

•' Hist, de la Med., i, 5, p. 175, French edit. Schulze, in like manner, depreciates 
the anatomical knowledge of the Asclepiada;, and holds that it had been overrated 
by Galen. — Hist. Med., i, 2, 5. 

■* Comment, in Libr. de Artie, iii, 28 ; do Decret. Hippocrat. et Platon., viii, 1. 

* Polit., iii, 399 ; ed. Tauchnitz. ^ Geograph., xiv, 2. 

^ De Sanitate tuenda, i. '' 1. c. 



8 PRELIMINARY DISCOURSE. [sect. i. 

one of the measures used by the Asclepiadse for the recovery of 
health, having been introduced by ^sculapius himself. 

Of the Asclepia we have mentioned above, it will naturally 
be supposed that some were in much higher repute than others, 
either from being possessed of peculiar advantages, or from the 
prevalence of fashion. In the beginning of the fifth century 
before the Christian era, the temples of Rhodes, Cnidos, and 
Cos were held in especial favour, aud on the extinction of the 
first of these, another rose up in Italy in its stead.' But the 
temple of Cos was destined to throw the reputation of all the 
others into the background, by producing among the priests 
of ^sculapius the individual who, in all after ages, has been 
distinguished by the name of the Great Hippocrates." 

Before proceeding, however, to give a brief sketch of his 
biography, I may state, partly by way of recapitulation, and 
partly in anticipation of what will be found in a subsequent 
part of this work, the leading facts which are known relative 
to the state of medicine before his time. 

1. The origin of Grecian medicine is involved in impenetrable 
darkness, being anterior to all authentic history, and nothing 
being known either as to its rise or the steps by which it grew 
up to be a regular art. 

2. There is no reason to suppose that the germs of medical 
science, any more than those of philosophy, had been originally 
imported into Greece from the East. 

3. The earliest practitioners of medicine concerning whom we 
have any authentic information, were the Asclepiadae, or priest- 
physicians, who endeavoured to cure the sick partly by super- 
stitious modes of working upon the imagination, and partly by 
more rational means, suggested by observation and a patient 
study of the phenomena of disease. 

4. Though the men of letters Avho directed their attention to 
the phenomena of disease, as constituting a branch of philosophj^, 
may in so far have improved the theory of medicine by freeing 

' Galen, Opera, torn, iv, ed. Basil, 35. 

2 Aristotle, Polit., vii, 4. Notwithstanding the high compliment which Aristotle 
here pays to the professional reputation of Hippocrates, there can be no doubt that 
he does not always make proper acknowledgment for the many obligations which he 
lies under to the Coan sage. Galen states repeatedly that the greater part of 
Aristotle's physiology is derived from Hippocrates. 



SECT. I.] LIFE OF HIPPOCRATES. 9 

it from the trammels of superstition, it is not likely they could 
have contributed much to the practice of medicine, which is 
well known to be founded on observation and experience. 

5. Though there can be little or no doubt that the priest- 
physicians, and the philosophers together, were possessed of all 
the knowledge of medicine which had been acquired at that 
time, it is not satisfactorily ascertained by what means the art 
had attained that remai-kable degree of perfection which we shall 
soon see that it exhibited in the hands of Hippocrates. But I 
must now proceed with my Sketch of his Life. 

That Hippocrates was lineally descended from ^Esculapius 
was generally admitted by his countrymen, and a genealogical 
table, professing to give a list of the names of his forefathers, 
up to ^Esculapius, has been transmitted to us from remote 
antiquity. Although I am well aware that but little reliance can 
be put on these mythical genealogies, I will subjoin the list to this 
section, in order that it may be at hand for reference, as many 
allusions will have to be made to it in the subsequent pages.^ 

Of the circumstances connected with the life of Hippocrates 
little is known for certain, the only biographies which we have 
of him being all of comparatively recent date, and of little au- 
thority. They .are three in number, and bear the names of 
Soranus Ephesius, Suidas, and Tzetzes. Of the age in which the 
first of these authors flourished, nothing is known for certain; the 
second is a lexicographer, who lived in the beginning of the 
eleventh century; and the third flourished in the twelfth century. 
The birth of Hippocrates is generally fixed, upon the authority 
of Soranus, as having occurred in the first year of the 80th 
Olympiad, that is to say, in the 460th year before the vulgar era. 
On this point, however, I must say that I see no good grounds 
for the unanimity of opinion which has generally prevailed 
among modern scholars. In fact, the coimter-evidence of 
Aulus Gellius has always appeared to me to be unjustly over- 

' See some ingenious observations on tliese mythical genealogies in Grote's His- 
tory of Greece, vol. i, p. 593. He holds that they are altogether unworthy of credit, 
or at least that there is no test whereby one can separate the true from the false in 
them. Clinton, indeed, in his Fasti Hellenici, attaches more importance to them ; 
hut apparently Mr. Grote's judgment on them is perfectly just. See further vol. ii, 
p. 53, &c. 



10 PRELIMINARY DISCOURSE. [sect. i. 

looked, as I cannot but think that his authority ought to rank 
mucli higher than that of Soranus, of whom nothing is known^ 
not even the century in which he Uved. Aulus Gellius, 
then, in an eLihorate disquisition on Greek and Roman chro- 
nolog}^, states decidedly that Socrates was contemporary Avith 
Hippocrates, but younger than he.^ Now it is well ascer- 
tained, that the death of Socrates took place about the year 
400 A.C., and as he was then nearly seventy years old, his 
birth must be dated as happening about the year 470 a.c. 
This statement would throw the birth of Hippocrates back 
several years beyond the common date, as given by Soranus. 
There is also much uncertainty as to the time of his death : 
according to one tradition he died at the age of 85, whereas 
others raise it to 90, 104, and even 109 years. These dates 
of his birth and death, although vague, are sufficient to show 
that the period at which we may reasonably suppose fie had 
practised his profession with the greatest activity and repu- 
tation, must have been the latter part of the fifth century a.c. 
It will readily occur to the reader, then, that our author flourished 
at one of the most memorable epochs in the intellectual deve- 
lopment of the human race. He had for his contemporaries, 
Pericles, the famous statesman ; the poets ^schylus, Sophocles, 
Euripides, Aristophanes, and Pindar ; the philosopher Socrates, 
with his distinguished disciples Plato and Xenophon ; the 
venerable father of history, Herodotus, and his young rival, 
Thucydidesj the unrivalled statuary, Phidias, with his illus- 
trious pupils, and many other distinguished names, which have 
conferred immortal honour on the age in which they lived, and 
exalted the dignity of human nature. Nor was Greece the 
only region of the earth remarkable at this time for moral and 
intellectual improvement ; for, if we may believe oriental chro- 
nology, Confucius and Zoroaster had gone off the stage of life onh^ 
a very few years before the dawn of this celebrated age of Grecian 
superiority in the arts and sciences. Hippocrates, it thus ap- 
pears, came into the world under circumstances which must 
have co-operated with his own remarkable powers of intellect in 
raising him to that extraordinary eminence which his name has 
attained in all ages. From his forefathers he inherited a distin- 
guished situation in one of the most eminent hospitals, or Temples 

' Noctes Atticte, xvii. 21. 



SECT. I.] LIFE OF HIPPOCRATES. 11 

of Health, then in existence, where he must have enjoyed free 
access to all the treasures of observations collected during many 
generations, and at the same time would have an opportunity 
of assisting his own father in the management of the sick.^ 
Thus from his youth he must have been familiar with the prin- 
ciples of medicine, both in the abstract and in the concrete, — 
the greatest advantage, I may be permitted to remark, which 
any tyro in the healing art can possibly enjoy. In addition to 
all this, he had excellent opportunities of estimating the good 
and bad effects resulting from the application of gymnastic 
exercises in the cure of diseases, under the tuition of Herodicus, 
the first person Avho is known for certain to have cultivated this 
J art as a branch of medicine." He was further instructed in the 
polite literature and philosophy of the age, by two men of clas- 
sical celebrity, Gorgias and Democritus ; the latter of whom is 
well known to have devoted much attention to the study of 
medicine, and its cognate sciences, comparative anatomy and 
physiology. 

Initiated in the theory and first principles of medicine, as now 
described, Hippocrates no doubt commenced the practice of his 
art in the Asclepion of Cos, as his forefathers had done before 
him. Why he afterwards left the place of his nativity, and 
visited distant regions of the earth, whither the duties of his 
profession and the calls of humanity invited him, cannot now 
be satisfactorily determined. The respect paid to him in his 
lifetime by the good and wise in all the countries which he 
visited, and the veneration in which his memory has been held 
by all subsequent generations, are more than sufficient to con- 
fute the base calumny, invented, no doubt, by some envious 
rival, that he was obliged to flee from the land of his nativity 
in consequence of his having set fire to the library attached to 
the Temple of Health, at Cnidos, in order that he might enjoy 

' That Hippocrates drew the rudiments of his medical knowledge from the reports 
of cases collected in the Asclepion of Cos, is attested by good authorities. See 
Strabo, Geogr., xiv; Pliny, H. N., xxix, 2. 

^ On the introduction of the gymnastic exercises into the practice of medicine, 
see Schuize, Hist. Med., i, 2, 8. The author of the VI Epidem. condemns Hero- 
dicus for using exercises in the treatment of acute diseases. Herodicus is frequently 
mentioned in the Dialogues of Plato. See Protagoras, § 20 ; and de Repub., 
iii. Plato says, that being in ill health, be wore out first himself and afterwards 
many others, by combining gymnastics with medicine. 



12 PRELIMINARY DISCOURSE. [sect. i. 

a monopoly of the knowledge wliicli he had extracted from the 
records which it had contained.^ Certain it is, that he after- 
wards visited Thrace, Delos, Thessaly, Athens, and many other 
regions, and that he practised, and probably taught, his profes- 
sion in all these places.^ There are many traditions of what he 
did during his long life, but with regard to the truth of them, 
the greatest diversity of opinion has prevailed in modern times. 
Thus he is said to have cured Perdiccas, the Macedonian king, 
of love-sickness; and although there are circumstances con- 
nected with this story which give it an air of improbability, it is 
by no means unlikely that he may have devoted his professional 
services to the court of Macedonia, since very many of the 
places mentioned in his works as having been visited by him, 
such as Pella and Acanthus, are situated in that country; and 
further, in confirmation of the narrative, it deserves to be men- 
tioned, that there is most satisfactory evidence of his son 
Thessalus having been court physician to Archelaus, king of 
Macedonia;^ and it is well ascertained that another of his 
descendants, the Fourth Hippocrates, attended Roxane, the 
queen of Alexander the Great.^ 

Our author's name is also connected with the great plague of 
Athens, the contagion of which he is reported to have extin- 
guished there and in other places, by kindling fires."'' The only 
serious objection to the truth of this story is the want of proper 
contemporary evidence in support of it. It is no sufiicient objec- 
tion, however, that Thucydides, in his description of the circum- 
stances attending the outbreak of the pestilence in Attica, makes 
no mention of any services having been rendered to the commu- 

' Soranus alludes to this fiction, and quotes Andreas as an authority for it. See 
also Pliny, H. N., xxix, 2. Tzetzes calls it the Temple of Cos, and not of Cnidos, 
which was burned. 

' See Plato, Protagoras. 

3 Galen, Comment, in Libr. de Nat. Human. 

* Suidas in voce Hippocrates. 

* It was a common practice in ancient times to kindle great fires as disinfectants 
or deodorizers. "We have entered pretty fully upon this subject in our Commentai'y 
on Paulus JiIgineta, Vol. I, p. 274. There can be no doubt that it was the esta- 
blished practice of the profession in the days of Hippocrates. The names of Acron, 
Empedocles, and Hippocrates are particularly famous as having successfully adopted 
the practice. See Aetius, v, 94 ; Paulus ^Egineta, 1. c. ; Phny, H. N., xxxvi, 69 ; and 
Plutarch, De Iside et Osiridc. 



SECT. I.] LIFE OF HIPPOCRATES. 13 

nity by Hippocrates; wliile, on the contrary^ lie states decidedly 
that the skill of the physicians could do nothing to mitigate the 
seventy of this malady. It is highly probable, that, if Hippocrates 
was actually called upon to administer professional assistance in 
this way, it must have been during one of the subsequent attacks 
or exacerbations of the disease Avliich occurred some years after- 
wards We know that this plague did not expend its fury in 
Greece during one season, and then was no more heard of; but 
on the contrary, we learn that it continued to lurk about in 
Athens and elsewhere, and sometimes broke out anew with all 
its original severity. Thucydides briefly mentions a second 
attack of the plague at Athens about two years after the 
first/ attended with a frightful degree of mortality ; nor is 
it at all improbable that this was not the last visitation of the 
malady. Though the name of Hippocrates, then, may not 
have been heard of at its first invasion, it is not at all 
unlikely that, after he had risen to the head of his pro- 
fession in Greece, as we know that he subsequently did, he 
should have been publicly consulted regarding the treatment of 
the most formidable disease which was prevailing at the time." 
What adds an appearance of truth to the tale is, that several of 
the genuine works of Hippocrates, which were probably pub- 
lished in his lifet'ime, relate to the causes and treatment of epi- 
demic and endemic diseases.^ That the magistrates of Athens, 
then, should have applied to him as the most eminent autho- 
rity on the subject J to assist them in their sanitary regulations*^ 

' Hist., iii, 87. 

■^ It deserves to be mentioned further, as adding probability to the present narra- 
tive, that it was quite common in ancient times for the Asclepiadas to be publicly 
consnlted by cities and states respecting the general health of the inhabitants, and 
this both for the prevention and cure of diseases. See Aristid. Opera, i, p. 81. 

^ Galen, in many parts of his vcorks, alludes to the professional services of Hip- 
pocrates during the great plague described by Thucydides. He mentions decidedly 
that Thucydides gives only those symptoms which would strike a common, that is 
to say, a non-professional man ; whereas Hippocrates describes the disease accurately 
like a professional man, but gives few of those symptoms which appeared most 
interesting to Thucydides. — De Difficult. Respir., ii, 7. 

'' Thucydides mentions that the mortality of the plague was greatly aggravated by 
the influx of the people from the country into the city, and the crowding of them in 
ill-ventilated huts, (ii, 52.) Mitford, in describing the plague of Athens, remarks 
that the want of sewers in ancient times must have contributed very much to the 
severity of the disease. (Hist, of Greece, vol. ii, p. 195.) He refers (1. c.) to Strabo 
(Geogr. v) for proof that the Romans were the first people who constructed sewers. 



14 PRELIMINARY DISCOURSE. [sect. i. 

during the prevalence of this great pestilence, is so far from 
being improbable, that I think it would have been very extra- 
ordinary if they had omitted to consult him, seeing that he 
was undoubtedly looked up to as the facile princeps among the 
physicians of the day. That his services in this way have been 
exaggerated by the blind admii'ation of his worshippers, both 
at that time and in after ages, may be readily admitted ; but 
this circumstance ought not to make us reject the whole story 
as being fabulous. I repeat, then, that although this part of 
the history of Hippocrates be not vouched by any contemporary 
evidence, it is by no means devoid of probability, while the 
objections which have been started to it by modern authorities 
have not so much weight as is generally supposed. 

Another circumstance in the life of Hippocrates, for the 
truth of which Soranus, Suidas, and a host of ancient autho- 
rities concur in vouching, namely, that he refused a formal 
in^dtation to pay a professional visit to the court of Persia, is 
I'ejected with disdain by almost all the modern scholars who 
have touched upon this subject. But was it an uncommon 
thing for the king of Persia to manoeuvre in this way with 
Grecian talent in order to attract it to his court? So far is the 
contrary known to be the case, that, as every person who is 
familiar with the early history of Greece must be well aware, 
the manner in which " the Great King" rendered himself most 
formidable to the Grecian Republics after the humiliating 
defeats which the military forces of Persia had sustained at 
Marathon, Salamis, and Platsea, was by intriguing with all 
those distinguished persons in Greece who would render them- 
selves accessible to his bribes and flatteries, and thus endea- 
vouring to detach them from the cause of their country. Of 
this we have notable examples in the case of two illustrious 
individuals, who were nearly contemporarj'^ with Hippocrates — I 
mean Pausanias and Themistocles. Moreover, it is well known 
that Grecian physicians at all times were in high repute at the 
court of Babjdon -^ witness Ctesias, the contemporary and 
kinsman of Hippocrates," who Avas court physician to the king 
of Persia, and was employed in that capacity in the most 



' See Xenophon, Cyropaed., i and viii. 
^ Galen, Comment, in libr. de Artie, iii. 



SECT. I.] LIFE OF HIPPOCRATES. 15 

serious emergencies.^ What more natural, then, or more likely 
to happen, than that the king of Persia, when he saw his 
country overrun by the plague/ should seek advice from a 
neighbouring people, whose superiority to his own subjects in 
all the arts of war and peace he and his predecessors had 
learned from sad experience ? I readily admit that the 
letters in the Hippocratic Collection which relate to this story 
can scarcely be received as genuine ; but does this prove that 
the event upon which they are made to turn is also devoid of 
truth ? I can see no probability in this supposition ; for 
whether we regard these documents as willful forgeries, executed 
with the fraudulent intention of palming them on the literary 
world as genuine productions, or whether we look upon them 
as mere exercises made on given subjects by the Sophists or 
Scholiasts to displa,y their ability in sustaining an assumed 
character, it would have been preposterous to make them 
relate to stories of which every person of that age must have 
been able to detect the falsehood. Were any person at the 
present day, from whatever motive, desirous of palming upon 
the public certain letters said to have been written by the cele- 
brated John Hunter, he would surely not be so imprudent 
as to endeavour to pass off as genuine a correspondence pur- 
porting to have taken place between him and the king of 
France, as every one at all acquainted with professional biography, 
would at once perceive that the authenticity of the documents 
in question was completely disproved by the falsity of the 
narrative upon which they are founded. Seeing, then, that 
these letters are admitted on all hands to be very ancient, 
that is to say, of a date not much later than the time of 

' Xenoplion, Anabasis, i. It has never been clearly determined whether he was 
in the suite of Artaxerxes the king, or of his brother Cyrus, before the battle of 
Cunaxa, in which the latter was killed, and the former being severely wounded, was 
attended professionally by Ctesias. Diodorus Siculus, indeed, says decidedly that 
he was taken prisoner on the occasion. (Bibl. ii, 32.) But we are certain, from the 
authentic narrative of Xenophon, that he was not taken prisoner in the battle, nor is 
it likely that he was one of those who were kidnapped afterwards, otherwise the 
historian would certainly not have omitted the name of so distinguished a personage. 
Besides, had he been brought to Babylon in this way, as a captive, Artaxerxes was 
not hkely to have intrusted his royal life to a person who had been so lately the 
professional attendant on his rebel brother. 

•^ See Thucyd., ii, 48. 



16 PRELIMINARY DISCOURSE. [sect. i. 

Hippocrates, we may rest assured that the main facts to which they 
allude were believed at the time to be of an authentic nature. 

For the like reasons I am disposed to think that, although 
the letters in the Collection which refer to a pretended corre- 
spondence between him and Democritus are most probably to 
be regarded as spurious, it is far from being improbable that 
the physician may have rendered the services of his profession 
to the philosopher. Had there been no grounds whatever for 
this story, why so many ancient authors should have agreed in 
giving credit to it I cannot imagine. 

According to all the accounts which have come down to us of 
his life, he spent the latter part of it in Thessaly, and died at 
Larissa, when far advanced in years. The corruptions with 
regard to numbers which, in the course of transcription, have 
crept into all works of great antiquity, sufficiently account for 
the differences already mentioned in the statements respecting 
his age at the time of his death. 

These are all the particulars of any importance which can 
now be gathered regarding the life of him who has been 
venerated in all ages as " The Father of Medicine." That they 
are scanty and rather unsatisfactory, must be admitted ; but yet 
what more, in general, can we desire to know respecting 
the biography of a physician than the manner in which he 
was educated, how he was esteemed by his contemporaries, 
and what he did and wrote to reflect credit on his profession ? 
The approbation and gratitude of those who have consulted 
him for the cure of their maladies are the best testimony to 
the public character of a physician, and the estimation in which 
his Avritings are held by the members of his own profession 
is what constitutes his professional reputation. I need scarcely 
say that, as a medical author, the name of Hippocrates stands 
pre-eminently illustrious. In this way he has left monuments 
of his genius more durable than the marble statues of Phidias, 
his contemporary, and as enduring as the tragedies of 
Sophocles, or the Olympiac odes of Pindar. 

In the next section I intend to give a careful analysis of all 
the writings which have come down to us from antiquity under 
the name of Hippocrates, and to state clearly the grounds upon 
which some are to be received as genuine, and others rejected 
as supposititious. I shall conclude the present section, 



SECT. I.] LIFE OF HIPPOCRATES. 17 

altliougli it may appear that I am anticipating some things 
which had better have come after the succeeding one, with a 
brief account of our author's general principles, both as regards 
the theory and the practice of medicine ; and in doing this I 
mean not to confine myself strictly to the treatises whicli are 
acknowledged to be genuine, as they are unfortunately so few 
in number, that we are often obliged to guess at the tenets of 
our author from those held by his immediate successors and 
disciples. 

The opinions whicli he held as to the origin of medicine, and 
the necessities in human life which gave rise to it, are such as 
bespeak the soundness of his views, and the eminently practical 
bent of his genius. It was the necessity, he says,^ which men 
in the first stages of society must have felt of ascertaining 
the properties of vegetable productions as articles of food that 
gave rise to the science of Dietetics ; and the discovery having 
been made that the same system of regimen does not apply in 
a disordered as in a healthy condition of the body, men felt 
themselves compelled to study what changes of the aliment are 
proper in disease ; and it was the accumulation of facts bearing 
on this subject which gave rise to the art of Medicine. Looking 
upon the animal system as one whole, every part of which con- 
spires and sympathises with all the other parts, he would 
appear to have regarded disease also as one, and to have referred 
all its modifications to peculiarities of situation.^ Whatever 
may now be thought of his general views on Pathology, all 
must admit that his mode of prosecuting the cultivation of 
medicine is in the true spirit of the Inductive Philosophy ; all 
his descriptions of disease are evidently derived from patient 
observation of its phenomena, and all his rules of practice are 
clearly based on experience. Of the fallaciousness of expe- 
rience by itself he was well aware, however, and has embodied 
this great truth in a memorable aphorism,'^ and therefore he 
never exempts the apparent results of experience from the strict 
scrutiny of reason. Above all others, Hippocrates was strictly 

' De Prisca Medicina. 

- See in the next section, under xxiii. Though I have not admitted the treatise 
here referred to into the list of genuine w orks, it will be seen below that it possesses 
considerable evidence in its favour, and that beyond doubt it is very ancient. 

^ Aphor. I, 1. 



18 PRELIMINARY DISCOURSE. [sect. r. 

the pln'sician of experience and common sense. In short, the 
basis of his system was a rational experience^ and not a blind 
empiricism, so that the Empirics in after ages had no good 
grounds for claiming him as belonging to their sect.^ 

What he appears to have studied with particular attention 
is the natural history of diseases, that is to say, their tendencies 
to a favorable or fatal issue ; and without this knowledge, what 
can all medical practice be but blind empiricism? — a hap- 
hazard experiment, which perchance may turn out either to 
cure or to kill the patient ? In a word, let me take this oppor- 
tunity of saying, that the physician who cannot inform his 
patient what would be the probable issue of his complaint, if 
allowed to follow its natural course, is not qualified to prescribe 
any rational plan of treatment for its cure. 

One of the most distinguishing characteristics, then, of the 
Hippocratic system of medicine, is the importance attached in 
it to prognosis, under which was comprehended a complete 
acquaintance with the previous and present condition of the 
patient, and the tendency of the disease. To the overstrained 
system of Diagnosis practised in the school of Cnidos, agree- 
ably to which diseases were divided and subdivided arbitrarily 
into endless varieties, Hippocrates was decidedly opposed ; his 
own strong sense and high intellectual cultivation having, no 
doubt, led him to the discovery, that to accidental varieties of 
diseased action there is no limit, and that what is indefinite 
cannot be reduced to science." 

Nothing strikes one as a stronger proof of his nobility of soul, 
when we take into account the early period in human cultivation 
at which he lived, and his descent from a priestly order, than the 
contempt which he everywhere expresses for ostentatious charla- 
tanry, and his perfect freedom from all popular superstition.^ Of 
amulets and complicated machines to impose on the credulity 

' See Galen, Opera, torn, v, p. 488 ; ed. Basil. 

^ This is clearly defined and stated by Aristotle, Phys., i. See also Boethius in 
Praed., p. 113; ed. Basil. 

3 This is the more remarkable, as it does not appear to have been the established 
creed of the greatest literary men and philosophers of the age, who still adhered or 
professed to adhere to the popular belief in the extraordinary interference of the 
gods with the works of Nature and the affairs of mankind. This at least was re- 
markably the case with Socrates, whose mind, hke that of most men who make a 
great impression on the religious feelings of their age, had evidently a deep tinge of 



SECT. I.] LIFE OF HIPPOCRATES. 19 

of the ignorant multitude, there is uo mention in any part of 
his AYorks. All diseases he traces to natural causes, and counts 
it impiety to maintain that any one more than another is an 
infliction from the Divinity. How strikingly the Hippocratic 
system difi'ers from that of all other nations in their infantine 
state must be well known to every person who is well acquainted 
with the early history of medicine.^ His theory of medicine 
was further based on the physical philosophy of the ancients, 
more especially on the doctrines then held regarding the 
elements of things^ and the belief in the existence of a spiritual 
essence diff'used through the whole works of creation, which 
was regarded as the agent that presides over the acts of genera- 
tion, and which constantly strives to preserve all things in their 
natural state, and to restore them when they are preternaturally 
deranged. This is the principle which he called Nature, and 
which he held to be a vis medicah'ix . " Nature," says he, or 
at least one of his immediate followers says, " is the physician 
of diseases."^ His physical opinions are so important, that I 
have resolved to devote an entire section to an exposition of the 
ancient doctrines on this head. (See Sect. III.) 

Though his belief in this restorative principle would naturally 
dispose him to watch its operations carefully, and make him 
cautious not to do anything that would interfere with their 
tendencies to rectify deranged actions, and though he lays it 

mysticism. See Xenoph. Memor., i, 1, 6-9; Ibid, iv, 7, 7; also Grote's History of 
Greece, vol. i, p. 499. The latter remarks, " Physical and astronomical phenomena 
are classified by Socrates among the divine class, interdicted to human study." 
(Mem., i, 1, 13.) He adds, in reference to Hippocrates, " On the other hand, Hippo- 
crates, the contemporary of Socrates, denied the discrepancy, and merged into one 
the two classes of phenomena — the divine and the scientifically determinable, — 
which the latter had put asunder. Hippocrates treated all phenomena as at once 
both divine and scientifically determinable." (p. 499.) He then quotes the me- 
morable passage in the treatise ' On Airs,' &c. It does not appear, however, that 
in ancient times the charge of Atheism was ever brought against him. It has been 
urged against him by modern fanatics, but scarcely deserves a serious refutation. 
See Schulze (Hist. Med., i, 3, 2), and Ackerman (Hist. Lit. Hippocr., pp. xii, xiii ; 
ed. Kiihn). By such persons, whoever does not join in their anthropomorphical 
notions of a first cause is held up for an Atheist. 

' For the medicine of the ancient Jews, Egyptians, and Babylonians, see the intro- 
ductory chapters of Sprengel's Hist, de la Med. The medicine of the Hindoos, as 
given in the ' Susruta' of D'Hanvantare, abounds in superstitious practices. 

'■^ Epidem., vi. 



20 PRELIMINARY DISCOURSE. [sect. i. 

down as a general rule by which the physician should regulate 
his treatment^ ^'to do good, or at least to do no harm/" there 
is ample evidence that on proper occasions his practice Avas 
sufficiently bold and decided. In inflammatory afi'ections of 
the chest he bled freely^ if not, as has been said, ad deliquum 
animi,^ and in milder cases he practised cupping with or without 
scarifications.^ Though in ordinary cases of constipation he 
merely pi-escribed laxative herbs, such as the mercury {mer- 
curialis pereniiis),* beet/ and cabbage/ he had in reserve elate- 
rium/ scammony/ sj)urges/ and other drastic cathartics, wlien 
more potent medicines of this class were indicated. And 
although, when it was merely wished to evacuate upwards in a 
gentle manner, he was content with giving hyssop,^ and other 
simple means, he did not fail, when it was desirable to make 
a more powerful impression, to administer the white hellebore 
with a degree of boldness, which his successors in the healing art 
were afraid to imitate.^ A high authority has expressly stated 
that he was the discoverer of the principles of derivation and 
revulsion in the treatment of diseases.^'^ Fevers he treated as 
a general rule, upon the diluent system, but did not fail to 
administer gentle laxatives, and even to practise venesection in 
certain cases. ^^ When narcotics were indicated, he had recourse 
to mandragora, henbane, and perhaps to poppy-juice.^" 

In the practice of surgery he was a bold operator. He 
fearlessly, and as we would now think, in some cases unneces- 

' Epidem., i. 

^ De Diaeta in Morb. Acut., Prognost., 15. See the argument to the Appendix 
to the former work. 

^ See Galen, Oper. torn, v, p. 106; ed. Basil. 

* See De Morbis, pluries; de Prisca Med., 22. 

^ De Superfoet. et pluries. 

^ De Ratione Victus in Acut. There is some doubt, however, whether the aKOfi- 
fiwvioi' of Dioscorides be the Convolvulus scammonia. Some rather take it for the 
C. sagittifoliun. 

'' De Superfcet. et alibi. 

^ De Morb. Mulier. 

^ De Fract., Aphor. et alibi. 

'" Galen, Meth. Med., v, 3 ; Comment, in Libr. de Humor. See further in illus- 
tration, fficonom. Ilippocrat. imder IlnpoxiTsveiv and ' AvriairaaiQ ; and Schulze, 
Hist. Med., i, 3, 4, 10. 

" See Epidem., i and iii; Aphor., i, 16 ; and De Diaeta Acutor., passim. 

'2 See De Morbis, ii; and Le Clerc, Hist. Med., 1, 3, 20, 



SECT. 1.] LIFE OF HIPPOCRATES. 21 

sarily, perforated the skull with the trepan and the trephine in 
injuries of the head. He opened the chest also in empyema and 
hydrothorax. His extensive practice, and no douht his great 
familiarity with the accidents occurring at the public games of 
his country, must have furnished him with ample opportunities 
of becoming acquainted with dislocations and fractures of all 
kinds ; and how well he had profited by the opportunities which 
he thus enjoyed, every page of his treatises ' On Fractures,' 
and ' On the Articulations,^ abundantly testifies. In fact, 
until within a very recent period_, the modern plan of treat- 
ment in such cases was not at all to be compared with his 
skillful mode of adjusting fractured bones, and of securing them 
by means of waxed bandages. In particular, his description 
of the accidents which occur at the elbow- and hip-joints will 
be allowed, even at the present day, to display a most Avon- 
derful acquaintance with the subject. In the treatment of 
dislocations, when human strength was not sufficient to restore 
the displacement, he skillfully availed himself of all the mecha- 
nical powers which were then known.' In his views with 
regard to the nature of club-foot, it might have been affirmed 
of him a few years ago, that he was twenty-four centuries in 
advance of his profession when he stated that in this case there 
is no dislocation, but merely a declination of the foot ; and 
that in infancy, by means of methodical bandaging, a cure 
may in most cases be eff'ected without any surgical operation. 
In a word, until the days of Delpech and Stroraeyer, no one 
entertained ideas so sound and scientific on the nature of this 
deformity as Hippocrates. 

But I must not allow my enthusiastic admiration to carry 
me too far. I will therefore conclude the present section by 
making a few observations on the peculiar style of our author's 
writings. According to Galen, whose extensive acquaintance 
with Greek literature rendered him a most competent judge, 
the characteristics of his style are extreme conciseness, pre- 
cision, and, in certain cases, obscurity, as the natural result of 
laboured brevity." To these traits of character he adds, else- 
where, that Hippocrates makes it a rule to avoid all superfiuity 
of discussion and unnecessary repetitions, and never says more 

• See the work ' On the Articulations,' pluries. 

- See in particular Venesect, adv. Erasistrat., Comment, in Lib. de Offic. Medic. 



22 PRELIMINARY DISCOURSE. [sect. i. 

than what is indispensable.^ Now, it is no proper objection to 
this general view of the character of his style, as stated by M. 
Littre, that it is not the same in all his works ; as, for example, 
in his treatise ' On Airs, Waters, and Places,' where the style 
is certainly not so laconic as in some of his others ; although, 
even with regard to it, I must be permitted to say that I agree 
with a most competent authority, the late Dr. Coray, that its 
style is remarkable for conciseness." And, indeed, if brevity 
of expression, bordering at times upon obscurity, be not the 
characteristic of the style of Hippocrates, we must admit that 
his mode of composition is not in accordance with the taste of 
his age. There can be no doubt that the style of Hippocrates 
is nearly akin to that of his contemporary, the historian 
Thucydides, which is thus described by a very acute and 
original critic : " The most obvious and characteristic of his 
peculiarities is an endeavour to express as much matter as 
possible in as few words as possible, to combine many thoughts 
into one, and always to leave the reader to supply something 
of his own. Hence his conciseness often becomes obscure.""' 
I would beg leave to add that other peculiarities in the style 
of Thucydides, which are severely animadverted upon by 
Dionysius, may be clearly recognised also in the writings of 
Hippocrates, especially irregularities of syntax, with a some- 
what rude and inartificial mode of constructing his sentences. 
I mention this the rather that the English reader may not ex- 
pect to find in my translation any of those well-turned periods 
and graceful modes of construction by which elegant com- 
position is now distinguished. I wish it to be known that in 
making this translation, I have followed the example of the 
modern authority lately referred to, that is to say, I have 
been more studious of fidelity than of elegance, and have 
endeavoured to give not only the matter, but also the manner, 
of my author.* 

' De Dyspii., ii, p. 181 ; ed. Basil. This brevity of style, Galen, in another pas- 
sage of the same work, pronounces to be characteristic of all the old writings. In 
fact, when the materials of writing were scarce and dear, it is not likely that authors 
M'Ould indulge in an extravagant use of them. 

'^ Coi'ay, Traite de Hippocrat. des Airs, &c., Discours preliminaire, pp. 1, Ivii. 

^ Dionysius Halicarnassensis de iis quae Thucyd. propria sunt, et de Platon. judi- 
cium. 

•• Opus supra laudatum, p. clxxiv. 



SECT. I.] GENEALOGY OF HIPPOCRATES. 23 

As promised above, I here subjoin the Mythical Genealogy 
of Hippocrates from Tzetzes. 

j$lsculapius was the father of Podalirius, who was the father 
of Hippolochus, who was the father of Sostratus, who was the 
father of Dardanus, who was the father of Crisamis, who was 
the father of Cleomyttades, who was the father of Theodoras, 
who was the father of Sostratus II, who was the father of 
Theodoras II, who was the father of Sostratus III, who was 
the father of Nebrus, who was the father of Gnosidicus, who 
was the father of Hippocrates I, who was the father of Hera- 
chdes, who was the father of Hippocrates II, otherwise called 
the Great Hippocrates. (Chiliad., vii, 155.) 

I may also add a few particulars, deserving to be known, 
respecting the family of Hippocrates. As Galen relates, he 
had two sons, Thessalus and Draco, each of whom had a son 
who bore the name of Hippocrates. (Comment, ii, in Lib. de 
Nat. Human.) It thus appears that there were in the family 
four persons of the name of Hippocrates, closely related to one 
another. First, the father of Heraclides, and grandfather of 
Hippocrates II ; second, Hippocrates II, our author ; third and 
fourth, his grandchildren, the sons of Thessalus and Draco. 
Besides these, three or four other members of the family bear- 
ing the name of Hippocrates are enumerated by Suidas. Of 
Thessalus, it is related by Galen (1. c.) that he adhered strictly 
to the principles of his father, and became physician to 
Archelaus, king of Macedonia. Of Draco little mention is 
made, only it is well known that he also followed his father's 
profession. But of all the family of Hippocrates the Great, 
Polybus, his son-in-law, is the most celebrated. Galen calls 
him the disciple of Hippocrates and successor in his school, 
and adds, that he made no innovations on the doctrines of his 
teacher. (Comment, i, in Libr. de Nat. Hum.) 



24 PRELIMINARY DISCOURSE. [sect. ii. 



SECTION II. 

DISQUISITION ON THE AUTHENTICITY OF THE DIFFERENT TREA- 
TISES WHICH HAVE BEEN ATTRIBUTED TO HIPPOCRATES. 

There can scarcely be a doubt that Hippocrates followed 
the practice wbicli we know to bave been adopted by almost 
all the great writers of antiquity with regard to the publication 
of their works, namely, that of publishing them separately, at 
the time they were composed. We know, for example (to begin 
with a distinguished author, regarding whom our information 
is particularly ample), that Horace published his books of 
satires, epistles, odes, and epodes separately, and at different 
times; and that the collection of them in its present form 
was not compiled until after his death.' We have every reason 
for concluding that the same rule was followed by Martial," 
Cicero,'^ and other Roman authors. It is further well ascer- 
tained (to come to a period not far removed from the age of 
Hippocrates) that Plato^ and Aristotle^ likewise gave their works 
to the bterary world upon the same plan. We have every 
reason, therefore, to suppose that Hippocrates published several 
of his works separately, in his lifetime; and indeed Galen 
often expresses himself so as to leave little or no ground for 
doubt on this point.*^ It would be most interesting and im- 
portant then to know, were this possible, in what order the dif- 
ferent works of our author were pubHshed. But unfortunately 

» See the editions of Horace by Bentley and Tate, pluries. 

2 See in Bentley's Horace. Tlie poet himself, in several of his pieces, alludes to 
the separate pul)lication of the various hooks, as i, 97 ; vi, 1 ; ii, prajfat. ; et pluries. 

3 See Middleton's Life of Cicero, pluries. 

* See the editions by Ast, Bekker, and Stallbaum, and the ancient authorities 
there referred to. 

* See the prehminary dissertation prefixed to Buhle's edition ; also Schneider's 
edition of the Historia Auimalium, Epimetrum iii. 

6 He mentions, in his commentary on the treatises entitled ' On Regimen in Acute 
Diseases,' that, from the marks of confused arrangement about it, he was persuaded 
the author had left it in an unfinished state, and that it had been published after 
his death. See Opera, torn, v, p. 70 ; ed. Basil, 



SECT. II.] HIPPOCRATIC TREATISES. 2.> 

this is a question which we have no proper data for solving 
satisfactorily^ ouly f^s the ' Aphorisms^ are evidently made iij) 
in a great measure of conclusions drawn from the results of 
discussions and observations recorded in other of his works^ we 
have every reason to infer that this important work was among 
the latest of his literary labours.^ But although we may not 
be able to determine the order in which the different pieces 
were composed and published, Ave need have no hesitation in 
deciding with all the best authorities, ancient and modern, that 
all the following treatises were composed by him, and, from the 
first, obtained the sanction of his name, viz. : the ' Prognostics ;' 
the ' First and Third Epidemics ;' ' On Regimen in Acute 
Diseases;' ' On Airs, Waters, and Places / 'On Wounds of the 
Head / the ' Aphorisms.' It is in so far satisfactory, then, to 
know, that respecting the authorship of these works there has 
never been any reasonable question, and that whoever enter- 
tains doubts on this point of literary history, ought, on the same 
principles of criticism, to dispute the authenticity of the 
'Protagoras' and "'Phsedo' of Plato; of the 'History of Animals' 
and 'Politics' of Aristotle; and of the 'Olynthiacs' and 
' Philippics' of Demosthenes. In a word, nothing but the 
most lawless spirit of scepticism can lead any one to challenge 
the genuineness of the works Avhicli I have just now enumerated. 
These, however, it will be seen, constitute but a very small por- 
tion of the treatises contained in the Hippocratic Collection ; 
and with regard to a very great number of the others, it is un- 
fortunately not only impossible to bring any competent evidence 
of their genuineness, but it is also quite apparent that they 
betray marks of an entirely different authorship ; and this is 
abundantly obvious, whether w^e look to the matters which they 
contain, or the manner in which these are given. Thus in some 
of the treatises we discover hypothetical doctrines and rules of 
practice utterly at variance with those Avliich are contained in 
the works of acknowledged authenticity ; and in some of them, 
instead of that nervous conciseness which, as we have already 
stated, has always been held to be characteristic of the style 
of Hippocrates, we find an insipid verbosity and vagueness of 
expression, which clearly stamp them as being productions of 
a verv different hand. But, besides this internal evidence 

' See Galen, de Crisibus, i, 6. 



26 PRELIMINARY DISCOURSE. [sect. ii. 

Avliich we have to assist us in forming a correct judgment on 
tliese works, we fortunately still possess a considerable number 
of ancient Commentaries, Avritten expressly in illustration of 
them, from which, in many instances, modern critics have been 
enabled to draw very satisfactory data for forming a correct 
judgment on the points at issue. Before proceeding further, 
it is but fair to acknowledge that I have freely availed myself 
of the labours of Vander Linden, Ackerman, Gruner, Littre, 
and other learned men, who have preceded me in this field of 
investigation, but at the same time I may ventui'e to assure the 
reader that there is scarcely a passage in any of the ancient 
authorities, bearing on the points in discussion, which I have 
not examined carefully for myself. 

The oldest commentator of whom we have any mention, is 
the celebrated Herophilus, who flourished about the year 
300 A.c.^ But of his Commentaries we have no remains, nor 
of those of the other commentators down to Apollonius Citiensis, 
a writer of the first century a.c. His Scholia on the Hippo- 
cratic treatise, ' De Articulis,' along with those of Palladius, 

' Galen, Gloss., torn, v, p. 705 ; ed. Basil. As frequent mention of the com- 
mentators will occur in the course of this work, I will here suhjoin a complete list 
of them, with a few brief notices of them, more especially of a chronological nature, 
derived principally from the following sources : Ackerman, Bibliotheca Graeca ; Dietz, 
Praefatio in Scholia Apollonii, &c. ; Littre, Op. Hippocrat., torn, i, pp. 80-132 ; 
Daremberg, Cours sur I'Histoire et la Litterature des Sciences Medicales. 

Herophilus, the famous anatomist of Alexandria ; flourished about from 310-280 a.c. 
Xenocrates of Cos, quoted by Krotian as an authority on the Prognostics ; nearly 

contemporary with Herophilus. 
Philinus of Cos, contemporary with Herophilus, and probably a disciple. 
Bacchius, contemporary with Philenus. 

Glaucias immediately after Bacchius ; flourished probably between 290-260 a.c. 
Zeuxis the Empiric, immediately after Glaucias and before Zeno ; probably from 

270-240 A.c. See Dareml)erg. 
Heraclides Tarentinus, somewhat later than Bacchius, probably about 260-240 a.c. 
Zeno the Herophilean, the contemporary and rival of Heraclides ; probably the same 

as Zeno of Laodicea. 
Apollonius Biblas, the contemporary and lival of Zeno. 
CaUimachus, according to Daremberg, an immediate disciple of Herophilus. 
Epiceleustus of Crete, of uncertain date. 
Apollonius Ophis, of uncertain date. 
Lysimachus of Cos, uncertain. 
Euphorion, nncertain. 
Heraclides the Erjthrean, rather uncertain : but, according to Daremberg, a con- 



SECT. II.] HIPPOCRATIC TREATISES. 27 

Steplianus, Theopliilus, Meletius^ and Joannes Alexandrinns, 
all writers of an uncertain date, but certainly much later than 
the Christian era, were published by the late Dr. Dietz, at 
Konigsburg, in 1831. To these we have to add two others, 
of much higher celebrity, namely, Erotian, who lived during 

temporary with Heraclides Tarentinus. The same as Heraclides the Herophilean. 
(Strabo, Geogr., xiv.) 

Epicles, uncertain. 

Eurycles, uncertain. 

Pliilonides of Sicily, uncertain. 

Ischomachus, uncertain. 

Cydias, uncertain. 

Cinesias, uncertain. 

Demetrius, the Epicurean. 

Diagoras, uncertain. 

Nicander the Poet of Colopliou, from 150-120 a.c. 

Apollonius Citiensis ; Daremberg places him between 80-52 a.c. See also Dietz 
and Littre. 

Asclepiades of Bithynia, contemporary with Pompey the Great ; about 60-40 a.c. 

Thessalus, the famous Methodist ; about 50-70 p.c. 

Erotian flourished in the reign of Nero, from 50-70 r.c. His Glossary still pre- 
served. 

Sabinus, of uncertain date, but probal)ly not long anterior to Galen, by whom he is 
frequently quoted. (Op.^ torn, v, p. 433.) 

Metrodorus, disciple of Sabinus. 

Rnfns or Ruffus Ephesius, contemporary with Sabinus. Several of his works remain, 
but no portion of his Commentaries on Hippocrates. 

Marinus, the celebrated anatomist, about the beginning of the second century p.c. 

Quintus, the Empiric, probably about from 110-130 p.c. 

Lycus, the Macedonian, the disciple of Quintus; from 120-140 p.c. See Daremberg. 

Lycus, of Naples, date rather uncertain. 

Artemidorus, a favorite of the Emperor Hadrian; often blamed by Galen for his 
alterations of the text; about 120-140 p.c. 

Dioscorides {not the author of the Materia Medica), an associate of Artemidorus. 

Numesianus, somewhat later than Dioscorides. 

Dionysius, about the time of the last. 

Pelops, the disciple of Numesianus. 

Satyrus, the disciple of Quintus. 

Phecianus, the disciple of Quintus. 

Julian the Alexandrian, the immediate predecessor of Galen, who frequently animad- 
verts on his WTitings. 

Galen, flourished between 150-190 p.c; wrote Commentaries, still in existence, on 
the following works:— On the Nature of Man; on Regimen in Health; on 
Regimen in Acute Diseases ; on the Prognostics ; on tlie First Book of the 
Prorrhetics; on the Aphorisms; on the First, the Third, and the Sixth Books 
of the Epidemics ; on tlie Treatise on Fractures ; on the Articulations ; on the 



28 PRELIMINARY DISCOURSE. [sect. ii. 

the reign of Nero, and the famous Galen, who, it is well known, 
flourished in the latter part of the second century, p.c. It is 
from the works of these two writers that the most important 
facts are to be eHcited, for forming a correct judgment respecting 
the authenticity of the Hippocratic treatises. As we shall have 
occasion to quote their opinions on the different heads of our 
inquiry, it Avould be useless to occupy room by giving their 
entire lists in this place. Suffice it to say, that Erotian rarely 
assigns any reason for admitting the treatises into his list of 
genuine works, and that Galen generally rests his judgment, 
when he assigns any grounds for it, upon the evidence of pre- 
ceding authorities, and upon what he holds to be the charac- 
teristics of the doctrines and style of Hippocrates. These, 
assuredly, are most sound and legitimate principles of criticism ; 
but it has been often supposed, that in applying them the 
great commentator is at times very dogmatic, and not always 
consistent with himself. But, upon the whole, all must allow 
that Galen is our best guide on the subject of our present 
inquiry. And, moreover, it is from his works especially that we 
are enabled to glean whatever information we possess with re- 
Physicians' Establishment or Surgery ; on the Humours ; fragments of the Com- 
mentaries on Airs, Waters, Places, and on the Aliment. Besides these, he wrote 
several other Commentaries, which are lost. 
Domnus, of uncertain date, after Galen. 

Attalion, like the last, cited in the Commentary attributed to Oribasius. 
Philagrius, of uncertain date, quoted by Theophilus. 
Gesius, of uncertain date. 

Asclepius, of uncertain date, quoted by Theophilus. (Dietz, torn, ii, p. 458.) 
Stephanas, the Athenian, supposed by Dietz to have lived in the reign of Heraclius, 
that is to say, in the earlier part of the seventh century. According to Dietz, 
not the same as Stephanus Alexandrinus. 
Palladius, probably about the seventh century ; his Commentary on the book ' On 
Fractures,' published by Foes, and a considerable portion of his Commentary 
' On the Sixth Epidemic,' by Dietz. 
Joannes Alexandrinus, probably near the time of Palladius ; part of his Commentary 

' On the Nature of the Young Man,' published by Dietz. 
Theophilus, or Philotheus, surnamed Protospatharius, probably flourished in the 
seventh century p.c. See the Annotations of Dr. Greenhill, in his excellent 
edition of the work 'De Corporis Humani Fabrica;' Oxford, 1842. Several of 
his Commentaries on the Aphorisms, published by Dietz. 
Meletius, of uncertain date ; part of his Commentaries on the Aphorisms, published 

by Dietz. See also Anec. Gr., ed. Cramer. 
Damascius, of uncertain date ; a few of his Commentaries on the Aphorisms, pub- 
lished bv Dietz. 



SECT. IT.] HIPPOCRATIC TREATISES. 29 

gard to tlie opinions of the earlier commentators, from Herophilus 
down to his own times. 

I will now proceed to give a brief sketch of the labours of 
modern critics in this department. 

The earliest modern authority is Lemos, whose w^ork was pub- 
lished in the end of the sixteenth century. It appears that he 
follows almost entii'ely the opinions of Galen, and seldom or 
never ventures to exercise an independent judgment of his own. 

The work of Mercuriali is a much more elaborate and im- 
portant performance, and his principles of judgment appear to 
me most unexceptionable, l)eing founded entirely upon ancient 
authority and peculiarity of style ; only it may, perhaps, be ob- 
jected, that he rather exaggerates the importance of the latter 
at the expense of the former; for it must be admitted that very 
conti'adictory conclusions have sometimes been founded on 
imaginary peculiarities of style. I cannot agree with M. Littre, 
however, that the whole svstem of ]Mercuriali is founded on a 
petitio p7'incipii; as if, before describing the style of his author, 
he ought to have decided which were his genuine writings.^ For, 
as already stated, any one is perfectly warranted in assuming 
that certain of the works which bear the name of Hippocrates 
are genuine, and from them, and the general voice of antiquity, 
Mercuriali was further justified in deciding what are the pecu- 
liarities of the style of Hippocrates, and in applying them as a 
test of the genuineness of other works which had been attributed 
to the same author. Mercuriali divides the Hippocratic treatises 
into four classes, as follows : The first comprehends those which 
bear the characters of his doctrine and style. The second com- 
prises those which are composed of notes taken from memorj', 
and published by Thessalus, Polybus, or other of his disciples, 
and contain foreign matter interpolated with them. The third 
class consists of those which have not been composed by 
Hippocrates, but are the work of his sons or disciples, and 
represent his doctrines with greater or less exactness. The fourth 
includes those tracts which have nothing to do with the school 
of Hippocrates. As the views and principles of Mercuriali 
accord, in the main, very well with my own, I think it proper 
to set down his classification of the treatises. 

' (Eiivres rt'Ilippocrat., torn, i, p. 171. 



30 PRELIMINARY DISCOURSE. [sect. ii. 





CLASSIS I. 


1. 


De Natura Humana. 


2. 


De Aeriljus, Aquis^ et Locis. 


3. 


Aphorismi. 


4. 


Prognostica. 


5. 


De Morbis popularibus. 


6. 


De Morbis acutis. 


7. 


De Vubieribus Capitis. 


8. 


De Fracturis. 


9. 


De Articulis. 


10. 


De Officina Medici. 


11. 


Mochlicus. 


12. 


De Alimeuto. 


13. 


De Humoribus. 


14. 


De Ulceribus. 




CLASSIS II. 


1. 


De Locis in Homine. 


2. 


De riatibus. 


3. 


De Septimestri Partu. 


4. 


De Octimestri Partu. 


o. 


De Ossibus. 




CLASSIS III. 


1. 


De Carnibus sen Principiis. 


2. 


De Genitura. 


3. 


De Natura Pueri. 


4. 


De Affectionibus. 


5. 


De Affectionibus internis. 


6. 


De Morbis, 


7. 


De Natura Muliebri. 


8. 


De Morbis Muliebribus. 


9. 


De Sterilibus. 


10. 


De Foetatione et Superfoetatione 


11. 


De Yii'ginum IMorbis. 


12. 


De Sacro Morbo. 


13. 


De Hemorrhoidibus. 


14. 


De Fistulis. 


15. 


De Salubri Diseta. 



SECT. II.] HIPPOCRATIC TREATISES. 31 

16. De Diseta, tres Libri. 

17. De Usu Liquidorum. 

18. De Judicationibus. 

19. De Diebus Judicatoriis. 

20. PrPedictionum Libri. 

21. Coacse Prseiiotiones. 
.22. De Insomniis. 

CLASSIS IV. 

1 . Jnsj urandum . 

2. Prieceptioues. 

3. De Lege. 

4. De Arte. 

5. De Arte Veteri. 

6. De Medico. 

7. De Decenti Ornatu. 

8. De Exsectione Foetus. 

9. De Pi,esectione Corporum. 

10. De Corde. 

11. De Glandulis. 

12. De Dentitione. 

13. De A'isu. 

14. Epistolse. 



15. De Medicamentis purgantibus "^ 



Latine tautum 



] 



16. De Hominis Structura y 

Perhaps we may venture to affirm^ without much risk of 
challenge, that the works of no ancient author owe more to 
the exertions of a single individual than those of Hippocrates 
do to the labours of Foes. Of his excellencies as an editor, 
and expositor of the meaning of his author, I will have occa- 
sion to speak afterwards ; and here I shall merely state regard- 
ing him, that as a critic called upon to decide with regard to 
the authenticity and spuriousness of the different works, his 
merits are by no means proportionally high. He rarely or 
never ventures to differ from Galen, and everywhere evinces 
so easy a disposition to recognise the works in question as 
being the productions of his beloved author, that his opinion 
on any point connected with their authenticity is not deserving 



of much weight. 



See Schulze, Hist. Med., i, 3, 1. 



32 PREIJMINARY DISCOURSE. [sect. ir. 

Haller arranges the Hippocratic treatises in the following 
classes : The first contains those which in all ages have been 
admitted as being genuine.^ The second embraces those 
which contain doctrines at variance with those " of the divine 
old man/^ or inventions of a later date, or vices which Hippo- 
crates disclaims. The third embraces those which are mani- 
festly spurious, as is obvious from their being mere compendia 
of the works of Hippocrates, or which betray a manner 
totally at variance with his. The fourth embraces a certain 
number of pieces not contained in the preceding classes. Such 
is Haller^s arrangement, Avhich, however, is not entitled to 
much consideration ; for the illustrious author himself seems 
to admit, candidly, that his critical knowledge of the language 
was too slender to warrant him in trusting his own judgment 
when it came into collision with any high authority, such as 
Foes ; and, moreover, it would appear, that his edition of the 
works of Hippocrates had been got up in a very slovenly 
manner, by some incompetent person, after his death. 

Gruner is one of the most learned and original of our 
authorities on the literature of the Hippocratic works. ^ His 
decision, with regard to the authenticity of the different pieces, 
is made to rest mainly on internal evidence, that is to say, 
upon their possessing the proper characteristics of the lan- 
guage and style of Hippocrates. These he is at great pains 
in shoAving to be, in the first place, brevity, approaching to 
the laconic, which he justly holds with Galen'^ to be one of the 
most striking peculiarities of the ancient style of writing. To 
conciseness and simplicity, he adds gravity of manner, and an 
absence of all subtlety of reasoning. This last trait in the 
literary character of Hippocrates I hold to be particularly 

' It will be proper to give this Class : — 

1. De Aere, Aquis, et Locis. 9. De Victu Acutonam. 

2. De Natura Hominis. 10. De Fracturis. 

3. De Locis in Homine. 11. De Articulis. 

4. De Hunioribus. 12. Mochlicus. 

5. De Alimento. 13. De Vulneribus Capitis. 

6. De Morbis popularibus. 14. Officina Medici. 

7. Profinosticon. 15. Aphorismi. 

8. Prsedictionum, ii. 

'■^ Censura Librorum Hippocrateorum, Vratislaviae, 1772. 
3 De Elementis, i, 9. 



SECT. IT.] HIPPOCRATIC TREATISES. 33 

apparent in the works which are generally admitted to be 
genuine. Some stress is also laid by him on the use of the 
Ionic dialect, but this is a most fallacious criterion, and had 
better have been left out of the question altogether ; as there is 
good reason to believe that great liberties were used with the lan- 
guage of Hippocrates by the ancient editors and commentators, 
more especially by Artemidorus Capito, who lived a short time 
before Galen.^ And besides, as every person who is generally 
acquainted with Greek literature knows, although the Ionic 
dialect in the age of Hippocrates had been fused into the 
Attic,^ for several centuries afterwards it continued to be arbi- 
trarily used by many writers, both of prose and verse, owing 
to the high character which it possessed, as being the dialect 
of the Homeric poems. Hence it is used in later times, not 
only by the poets, such as Quintus Smyrnseus, Nonnus, and 
Oppian, but also by at least one great medical author, I mean 
Aretseus. It would appear, however, that Gruner himself was 
sensible that much sti'ess ought not to be laid on peculiarity 

' Tom. V, p. 442 ; ed. Basil. 

* Galen, who is a most unexceptionable judge in such a case, says that the 
language of Hippocrates inclines to the Attic, and that some had held it to be Old 
Attic. (Torn. V, p. 525 ; ed. Basil.) Dionysius of Halicarnassus, another admirable 
critic, says that Herodotus 'is the most excellent standard of the Ionic (and so, by 
the way, Photius also says, under the head of Ctesias), and Thucydides of the Attic. 
(De Platon. Judicium.) Now, since we have already made it appear that there is 
a most striking similarity between the language of Hippocrates and Thucydides, the 
judgment of Dionysius is evidently in accordance with that of Galen on this point. 
Indeed, as briefly stated in the text, the Attic was nothing more than a new deve- 
lopment of the Ionic, and scarcely more different from it than the English language 
ill the age of Pope is from the same in the age of Milton. It is to be borne in mind 
that the name Ionian was originally appUed to the Thracians and the inhabitants 
of Attica, who were evidently closely allied to one another in consanguinity. It was 
in Thrace that learning and civilization first sprang up under the auspices of 
Thamyris, Orpheus, and Musaeus, by whom the elegant arts were transplanted to 
Athens. (See Hesychius, in voce Tones; Eustathius, ad Iliad., ii; Diogenes Laertius, 
PrcefaL; also Hermes Philologus, p. 23, by the author of this disquisition, whose 
mind now reverts with great delight, ad sfudia qiuB adolescent iam alebant.) The 
inhabitants of Asiatic Ionia and the adjoining islands were colonists from Attica. 
(Thucyd., i, 12; Herodotus, viii, 44 ; Heraclides, de Poht.) From what has been 
stated it will readily be understood that the only standard of polite Greek was the 
Ionic, with its offspring the Attic. The jEoHc and Doric dialects, although used in 
certain scientific and popular compositions, such as Bucolics and certain philosophical 
treatises, were never looked upon as being fashionable and learneil dialects. 

3 



34 PRELIMINARY DISCOURSE. [sect. ii. 

of dialect; for, in resuming his conclusions as to the proper 
tests of genuineness in judging of the Hippocratic writings, he 
determines them to be conciseness and gravity of language, 
paucity of reasoning, and accuracy of observation, along with 
the authority of the ancient critics, that is to say, of the com- 
mentators. Now, it certainly must be admitted that, taken 
together, these principles are most just and reasonable ; only 
it is apparent, that, like Mercuriali, he has ranked last what 
he ought to have laid most stress upon, namely, ancient autho- 
rity. For, as remarked above, unless ancient authority had 
previously determined certain works in the Collection to be 
genuine, the modern critic would have had no premises from 
which he could have drawn conclusions as to the characteristics of 
our author's style. Starting, then, from the principles now stated, 
Gruner arranges the works of Hippocrates in two divisions, 
namely, the genuine and the supposititious. We shall only give 
the former list, which embraces the following ten treatises : 

1. Jusjurandum. 

2. Aphorism! . 

3. De Aere, Aquis, et Locis. 

4. Prsenotiones. 

5. Prsedictionum, ii. 

6. De Officina Medici. 

7. Popularium Morborum, i, iii. 

8. De Victu Acutorum. 

9. De Vulneribus Capitis. 
10. De Fracturis. 

It will be shown below that in this list he has admitted one 
work (Predict, ii), which certainly has not sufficient claims 
to the place which he has assigned it; and, on the other 
hand, he has acted most inconsistently in rejecting the work 
' De Articulis,' while he admitted that ' De Fracturis,' for, as 
we shall see, there is the strongest reason for believing that 
the two originally constituted one work. But the truth of 
the matter is, that Gruner having hastily adopted the notion 
that Hippocrates was altogether ignorant of human anatomy, 
the celebrated passage in this treatise which so strikingly 
alludes to the dissection of the human body^ would decide him 
to reject it from his list of genuine works. 

' De Artie, i. 



SECT. II.] HIPPOCRATIC TREATISES. 35 

Though Le Clerc, in his ' History of Medicine' (h. iii), 
shows himself to be well acquainted with the fact that many of 
the treatises ascribed to Hippocrates are supposititious, he 
nowhere lays down any rules for distinguisliing the genuine 
from the spurious, only he insists strongly on conciseness as 
beingr one of the most strikinsr characteristics of the style of 
Hippocrates, and shrewdly remarks that the treatises which 
abound most in reasoning are those which are most suspected 
of l)eing spurious. 

Schulze also, in his '^History of Medicine,' with much learning 
and excellent judgment, enters cursorily upon the examination of 
the question regarding the genuineness of the works ascribed to 
Hippocrates, but he scarcely ever deviates from the rules laid 
down by Mercuriali and Le Clerc. Indeed, he almost always 
agrees with the latter. We shall have occasion to refer pretty 
frequently to his opinions when we come to give our own judg- 
ment on the authenticity of the particular treatises contained in 
the Hippocratic Collection. 

Ackerman,^ in the first place, gives an elaborate and very 
lucid exposition of the labours of all preceding critics in the 
same line, and then proceeds to deliver his own opinions 
seriatim on the different treatises. He rests his judgment 
generally on the authority of the ancients, and more especially 
of Erotian and Galen; and in so doing, M. Littre thinks he acted 
so judiciously, that he does not hesitate to pronounce Ackerman 
to 1)6 the safest guide which we can follow. Like Gruner, he 
divides the works into two classes, the genuine and the 
spurious. The former list is as follows : — 

1. Epidemica, i, iii. 

2. Preenotiones. 

3. Prsedictorum, ii. 

4. Aphorismi. 

5. De Victu Acutorum. 

6. De Aere, Aquis, Locis. 

7. De Vulneribus Capitis. 

This, it will be remarked, is the smallest list which we have 
yet encountered, and one cannot but feel saddened to find the 
remains of the great Hippocrates thus reduced to so small a 

' See his Historia Literaria Hippocratis, in the Bibliotheca Gra;ca of Albevtus 
Fabricius, or in vol. i of Kiihn's edition of Hippocrates. 



36 PRELIMINARY DISCOURSE. [sect. ii. 

comjiass. We shall have occasion, however, by and by, to 
shovr that Ackerman has been too unsparing in applying the 
obelisk^ to treatises of suspected authenticity. 

Grimm, the German translator of Hippocrates, professes 
also, like Ackerman, to be guided principally by ancient 
authority, such as that of Galen and Erotian, but he only 
reposes full confidence in it when confirmed by internal evi- 
dence. The style, he says, should be simple, brief, and expressive, 
and the language in accordance with the epoch. He adds, no 
hypothesis, no subtlety, however ancient, no extraordinary 
remedies or modes of treatment, should be found in these 
books. Starting from these principles, which, it will be 
remarked, are rather fancifully laid down, Grimm reduces the 
number of genuine works to the following very meagre list : 

1. Popularium Morborum, i, iii. 

2. Prognostica. 

3. Aphorismi. 

4. De Victu Acutorum, p. i. 

5. De Aere, Aquis, Locis. 

The reader will not fail to remark, in this result of Grimm's 
inquiry, indications of that bold spirit of scepticism for which 
the learned criticism of Germany has been distinguished of late 
— the spirit of her Wolfs and Lachmans, of her Asts and 
Schliermachers, which has deprived the Iliad and Odyssey of 
their ancient authorship, and reduced the bulky tomes of Plato 
to a very small volume. It is impossible not to admire the 
learning, the ingenuity, and the love of truth Avhich these 
critics display, but surely the sober judgment of other scholars, 
not infected with the same spirit of innovation, will pause before 
acquiescing in the justness of a verdict which would deprive so 
many immortal performances of the prestige with which they 
have so long been regarded. For my own part, I would venture 
to say, j^ace tantorum virorum, that these learned critics are 
deficient in a practical acquaintance with the laws of evidence, 
and do not properly take into account that, in matters of 
common life, negative evidence is never allowed to bear down 
positive, unless the former be remarkably strong, and the latter 
particularly weak. When, then, the voice of antiquity pro- 
nounces strongly and consistently in favour of any work, no 

' Galen, torn, v, p. 17 ; ed. Basil. 



SECT. II.] HIPPOCR/^TIC TREATISES. 37 

negative evidence, unless of a very remarkable character, ought 
to be allowed to counterbalance the positive. In short, what 
I object to in Grimm is, that he gives an undue preponderance 
to the internal evidence over the external, that is to say, over 
the traditionary evidence of antiquity, and that in this respect 
he goes greater lengths than even Gruner and Ackerman. 

Kurt Sprengel is the author of a separate work on the 
Hijipocratic writings^ Avhich I have not seen, but I have reason 
to believe that the substance of it is contained in his ' History 
of Medicine,^ where (t. i, p. 295) he enters into a very elabo- 
rate disquisition on the authenticity of the works ascribed to 
Hippocrates. He insists much, as a test of authenticity, upon 
the style, which, in imitation of Galen, he describes as being 
concise and laconic to a degree which sometimes renders it 
obscure, Hippocrates, he adds, avoids all superfluous discus- 
sion and unseasonable repetitions, and expresses himself as 
briefly as possible, Avithout adding conditions or restrictions. 
He justly remarks, that what Celsus says of Hippocrates, namely, 
that he separated philosophy from medicine, must be received 
with considerable limitations, and not in too strict a sense, as if 
there were no philosophical tenets in his works. On the other 
hand, Sprengel uses these philosophical doctrines as a guide 
for determining the date of the different treatises. This is a 
new, and no doubt a very important, element in the criticism 
on these works ; but it is one very hable to be abused, as our 
information on many occasions, with regard to the introduction 
of new doctrines in philosophy, is by no means such as can be 
safely trusted to. Sprengel's opinion on the various works in 
question we shall have occasion to state when we come to 
revise them separately. 

We now proceed to the examination of the labours of two 
very learned and ingenious critics. Link and Petersen, who, 
treading in the footsteps of Sprengel, have expended much re- 
search in endeavouring to solve the question regarding the date 
of the Hippocratic treatises, by considering the philosophical and 
pathological theories which prevail in them. I think it right to 
state that I have not had an opportunity of consulting the work 
of Link, and therefore have been obliged to judge of his opinions, 

' Apologie, &c. 



38 PRELIMINARY DISCOURSE. [sect. ii. 

in a great measure, from Petersen's essay, which is professedly 
based on the principles of Link. Of Petersen's little tract, 
I have no hesitation in declaring that I have seldom seen 
a work of the kind which displays more critical acumen and 
deep research; and although I cannot bring myself to sub- 
scribe to many of his general conclusions, I feel bound in 
gratitude to acknoAvledge the benefit which I have derived from 
many of his special investigations.^ On one important point, 
which he is at great pains to make out, I have already stated 
that I am disposed to agree with him, namely, respecting the 
date of our author's birth, which I certainly think he has 
proved by the most unexceptionable authorities to have been 
considerably earlier than as generally stated. Petersen divides 
the Hippocratic works into nine classes, in the following 
chronological order : — The first contains those treatises in 
which the flow of bile and phlegm is considered to be the cause 
of disease ;^ the second recognises fire,^ and the third, air, as the 
principle of things ;* in the fourth, bile and phlegm are spoken 
of as the primary humours of the human body -^ in the fifth, 
spirit {irvtvixa) and humidity are held to be the first principles 
of generation f in the sixth, the elements of the body are held 
to be contrary to one another;^ in the seventh, yellow and black 
bile, phlegm, and blood are set down as being the primary 
humours of the human body;^ in the eighth, bile, water, 
phlegm, and blood are held to be the primary humours ;^ and 
in the ninth, fire and water are held to be the principles of 
things. 



10 



' Hippocratis nomine quse circumfenintur scripta ad temporis rationes disposuit 
Christianus Petersen, p. prior. Hamburgi, 1839. 

- Prsedict., i ; Coacae Pra;not. ; de Loc. in Horn. 

^ De Came. ; de Part. Sept. ; de Part. Oct. ; de Superf. ; de Dent. 

" De Flat. 

^ De Morb. Popul., i, iii ; de Morb., i ; de Affect. ; de Morbo Sacro ; de Insan. ; 
de Veratr. Usu; de Victu Acut. ; de Victu Sal. ; Prsen. ; Prsedict., ii; Aphor. ; de 
Aere, Locis, et Aq. ; de Insom. ; de Hsemorrh. ; de Fistul. 

6 De Nat. Puer. '' De Prisca Med. 

* De Nat. Horn.; de Humor.; de Nat. Oss.; de Corde; de Corp. Sect.; de Gland.; 
de Visu; de Alim. ; de Usu Liquid.; de Affect. Intern.; de Morb. Popid.,ii, iv, &c. ; 
de Morb., ii, iii ; de Morb. Mulier. ; de Nat. Mulieb. ; de his quae ad Virg. Spect. ; 
de Steril. ; de Vulner. ; de Judic; de Dieb. Judic. 

9 De Morb., iv; de Genitura; de Remed, Piirgaut. 

'" De Victu Sanor. libri tres. 



SECT. 11.] IIIPPOCRATIC TREATISES. 39 

'Now, assuredly, no reasonable jjerson will deny to the author 
of this distribution the praise of great boldness and originality 
of thought. We may well apply to him the words of the poet, 
that if he has failed in attaining his object, " magnis tarn en 
excidit ausis." For my own part, I cannot but regret to see 
so much talent and research expended upon conjectural points 
of criticism, which, from their nature, can never be determined 
with any degree of certainty ; for, after all his labours, few 
scholars, I venture to predict, will prefer being guided by his 
hypathetical reasoning, however ingenious, rather than by the 
authority of the ancient commentators. I must also use the 
liberty to remark, that M. Petersen appears to me to have no well 
defined ideas regarding the doctrines which the ancient philoso- 
phers held respecting the elements of things. For example, when 
he states, as the basis of the theory which prevails in the tract 
' On Ancient Medicine,' that the elements are the contraries 
to one another, he evidently confounds the elements, namely, 
fire, air, earth, and water, with the powers, or, as we should 
now call them, the qualities, hot, cold, moist, and dry. (See 
the next Section.) And although, in the treatises ' On the 
Seventh Month Fcetus,' and ' On the Eighth Month Foetus,' 
much and deserved importance is attached to heat as the prime 
mover of conception, and although, in the treatise ' On Airs,' 
the importance of air as a cause of disease be strongly insisted 
upon, one is not warranted, as he contends, in concluding that 
the authors of these treatises recognise respectively fire and air 
as the first principle of all things. M. Littre, also, in his candid 
review of M. Petersen's work, points out some very striking over- 
sights which M. Petersen has committed in his arrangement 
of the different treatises.^ 

I now come to M. Littre, who, in the Introduction to his 
edition of Hippocrates, has certainly surpassed all who went 
before him, in the extent of his labours on the general literature 
of the Hippocratic Treatises. How highly I estimate his work 
I need not here stop to declare ; indeed the reputation it has 
already gained is so established, that it would be vain to blame 
and useless to praise it. I have to express my regret, however, 
in entering upon my exposition of his opinions, that they are 
given in a very expanded form, and with a degree of diffuse- 

' Tom. ii, pp. 32, 33. 



40 PRELIMINARY DISCOURSE. [sect. ii. 

uess, plus quam Galenica, so that I find it difficulty within my 
necessary limits^ to convey to the reader a distinct view of the 
very important matters which M. Littre has brought together 
to bear upon his subject. 

He is at great pains to establish the following positions with 
regard to the various treatises contained in the Collection which 
bears the name of Hippocrates : 1st. That the Collection did not 
exist, in an authentic form, earlier than the date of Herophilus 
and his disciples, that is to say, until nearly 100 years after 
the death of Hippocrates. 2d. That it contains portions which 
certainly do not belong to Hippocrates ; and, 3d, also Collec- 
tions of Notes, &c., which would never have been published by 
the author in their present form ; and, 4th, Compilations, 
which are either abridged, or copied word for word from other 
works which still form part of the Collection. 5th. As the 
different treatises do not all belong to the same author, so 
neither were they all composed at the same time, some being 
much more modern than the others. 6th. We find in the 
Collection mention made of numerous treatises written by the 
followers of Hippocrates, which are now lost, and which were 
no longer in existence when the Collection was first published. 
7th. The most ancient writers do not know, for certain, to whom 
the several works forming the Collection belonged; 8th, with the 
exception of a small number, which all of them, for one reason 
or another, agreed in attributing to Hippocrates himself.^ 

I have now a few observations to make upon each of these 
positions. The first, which is a most important one in con- 
nexion with our present subject, I regret to say, is, I think, 
by no means satisfactorily made out by M. Littre. He shows, 
it is true, that Herophilus is the first commentator on any of 
the Hippocratic Treatises of whom there is any mention, but 
all we know of his labours in this line merely amounts to this, 
that he had commented on certain passages in the 'Prognostics,' 
and probably also in the 'Aphorisms,'" but I do not see that 
this amounts to any proof either that the Collection was or was 
not formed in his time. The proof of the second position 
is made to rest uj)ou a fact, which has attracted the attention 

' CEuvres d'Hippocrate, toin. i, p. 263. 

" See Stephanus, Comment, in Proguost. llippocrat., torn, ii, p. 61, ed. Dietz. ; 
and Galen, torn, v, p. 328, ed. Basil. 



SECT. II.] HIPPOCRATIC TREATISES. 4 1 

of all tlic critics on tlic Hippocratic Treatises, namely, that 
a memorable description of the veins, which appears in the 
Hippocratic treatise ' On the Nature of Man,' is published by 
Aristotle, in the third book of his ' History of Animals,' as the 
production of his son-in-law, Polybus. Now, M. Littre argues 
here, that as the publication of the Aristotelian Collection did 
not take place until long after that of the Hippocratic^ the 
persons Avho made the latter could not have taken the passage 
in question from the other, and the only way in which we can 
account for the change of title, is by supposing that the works 
of Polybus had retained the name of their true author in the 
days of Aristotle, but had lost it at the time the Hippocratic 
Collection was made. Hence he infers that the Hippocratic 
Collection must have been made subsequently to the time of 
Aristotle,^ But I must say that I do not recognise the force 
of this argument ; for, although the whole of Aristotle's 
works were not published in a collected form, until the 
time of Apellicon, we have every reason to believe that many 
of his works were published separately, in his own lifetime. 
The fact, then, would rather tell the other way, and it might 
be argued, that the Hippocratic Collection must have been made 
before the time of Aristotle, otherwise the persons who made it 
would never have fallen into the mistake of attributing to 
Hippocrates a passage which so high an authority as Aristotle 
had referred to Polybus. But the truth is, that we are 
not entitled to draw any positive inference from all this, 
with regard to the epoch in question. It is well known that, 

' The-well known story regarding the concealment of Aristotle's library by his 
heir, Neleus of Scepsis, and its restoration by Apellicon, is faithfully related by 
Strabo, Geograph., ix. In this passage Strabo states, that before the restoration of 
the library by Apellicon, there were but few of Aristotle's works in the hands of the 
peripatetic philosophers, and these principally his exoteric works. But that the 
treatise ' On the History of Animals' was an exoteric work, can admit of no question. 
This is confidently maintained by the learned Schneider in the prolegomena to his 
edition of this work. Indeed, as he suggests, there is no good reason for doubting 
that the treatise 'On the History of Animals' had been published by Aristotle in his 
lifetime. (Epimetrum, ii.) See also Buhle's dissertation prefixed to his edition of 
Aristotle's works. I need scarcely add that, it being thus shown that all the most 
learned authorities on the literature of Aristotle's works are agreed that the History 
of Animals, in which is contained this disputed fragment on the veins, was published 
before the time when the Hijipocratic Collection is supposed to have been made, 
M. Littre's conclusions on this head must fall to the ground. 



42 PRELIMINARY DISCOURSE. [sect. ii. 

in all ageSj literary publications have sometimes come abroad 
into the world in an anonymous shape ; and it need excite no 
surprise that, with regard to the fragment in question, as in 
many other cases, there should have been a diversity of opinion 
as to its authorship. 

The third we shall see fully made out in our analysis of 
the different treatises given below. 

The fourth will also be clearly proved^ when we come to the 
examination of certain treatises, as, for example, the ' Officina 
Medici.' 

The fifth is not made out to my satisfaction. M. Littre, 
however, thinks it is satisfactorily proved that the latest 
epoch of these productions does not come lower down than 
Aristotle and Praxagoras, and none so low as Erasistratus and 
Herophilus. Hence he draws the conclusion that the Collec- 
tion must have been made between the time of Aristotle and 
Herophilus. 1 

The sixth we shall see clearly made out, in our critique on 
the separate treatises. 

The seventh is abundantly e^ident from what has been 
already stated, and will be made more apparent in the subse- 
quent parts of this Section. But there is nothing peculiar to 
the Hippocratic Collection in all this, for there is as great un- 
certainty respecting many of the works ascribed to Plato, and 
other collections of pieces which have come down to us from 
high antiquity. Nay, every person who is conversant with 
biblical criticism must be aware how difficult it has proved to 
determine the authorship of many of the Psalms Avhich bear the 
sainted name of King David. ^ 

In support of the eighth position, little need be said in ad- 
dition to what has been already stated. I need only repeat 
briefly that we have as much certainty that some of the treatises 
in the Hippocratic Collection are genuine, as we have that any 
other ancient works which have come down to us are the pro- 

' The death of Aristotle is refeiTed to a.c. 321. Now this is just about the date 
of the foundation of the Royal Libran- at Alexandria, and very near the age when 
Herophilus flourished. These (M. Littre's) positions clearly made out, it would 
follow that the dates of the treatises in the Collection come down very near to the 
foundation of the Alexandrian Library. 

^ See Hengstenberg's Commentary on the Psalms, pluries. 



SECT. II.] HIPPOCRATIC TREATISES. 43 

ductions of the authors whose names they bear. But I hasten 
to give M. Littre's distribution of the different works in the 
Collection. He divides them into the following classes : 

] Class I. — The Works which truly belong to Hippocrates. 

1. On Ancient Medicine. 

2. The Prognostics. 

3. The Aphorisms. 

4. The Epidemics, i, iii. 

' 5. The Regimen in Acute Diseases. 

6. On Airs, Waters, and Places. 

7. On the Articulations. 
v^8. On Fractures. 

V/9. The Instruments of Reduction (Mochlicus). 

\K3. The Physician's Establishment, or Surgery. ^ 

11. On Injuries of the Head. 

12. The Oath. 

13. The Law. 

Class II. — The Writings of Polybus. 

1. On the Nature of Man. 

2. Regimen of Persons in Health. 

Class III. — Writings anterior to Hippocrates. 

1. The Coan Pra^notions. 

2. The First Book of Prorrhetics. 

Class IV. — Writings of the School of Cos, — of the Contem- 
poraries or Disciples of Hippocrates. 

1. Of Ulcers. 

2. OfFistulte. 

3. Of Hemorrhoids. 

4. Of the Pneuma. 

5. Of the Sacred Disease. 
C). Of the Places in Man. 

7. Of Art. 

8. Of Regimen, and of Dreams. 
. 9. Of Affections. 

i 10. Of Internal Affections. 

1 11. Of Diseases, i, ii, iii. 

\ 12. Of the Seventh Month Foetus. 

\ 13. Of the Eighth Month Fcctius. 



44 PRELIMINARY DISCOURSE. [sect. ii. 

Class V. — Books which are but Extracts and Notes. 

1. Epidemics^ ii^ iv, v, vi, vii. 

2. On the Surgery. * 

Class VI. — Treatises which belong to some unknown 
author, and form a particular series in the Collection. 

1. On Generation. 

2. On the Nature of the Infant. 

3. On Diseases^ iv. 

4. On the Diseases of Women. 

5. On the Diseases of Young Women. 

6. On Unfruitful Women. 

Class VII. — Writing belonging to Leophanes. 
On Superfoetation. 

Class VIII. — Treatises posterior to Hippocrates, and com- 
posed about the age of Aristotle and Praxagoras. 

1. On the Heart. 

2. On Aliment, 

3. On Fleshes. 

4. On the Weeks. 

5. Prorrhetic, ii. 

6. On the Glands. 

7. A fragment of the piece ' On the Nature of 

Bones.' 

Class IX. — Series of Treatises, of Fragments, and of Com- 
pilations which have not been quoted by any ancient 
critic. 

1. On the Physician. 

2. On Honorable Conduct. 

3. Precepts. 

4. On Anatomy. 

5. On the Sight. 

6. On Dentition. 

7. On the Nature of the Woman. 

8. On the Excision of the Foetus, 

9. The eighth Section of the Aphorisms. 

10. On the Nature of the Bones. 

11. On Crisis. 

12. On Critical Days. 

13. On Purgative Medicines. 

' Although this piece be admitted into the first class, it also merits a place here. 



SECT. ii.J HIPPOCRATIC TREATISES. 45 

Class X. — Writings now lost^ which once formed a part of 
the Collection : 

1. On dangerous Wounds. 

2. On Missiles and Wounds. 

3. The first Book of Doses — the Small. 

Class XI. — Apocryphal pieces — Letters and Discourses. 

Such is the classification of M. Littre, which he professes to 
have founded on the four following rules, or principles : firstly, 
on the authority of direct witnesses, that is to say, of authors 
who preceded the formation of the Alexandrian Library ; 
secondly, on the consent of the ancient critics ; thirdly, on 
the application of certain points in the history of medicine, 
which appear to him to offer a date, and consequently a posi- 
tive determination ; fourthly, on the concordance of the doc- 
trines, the similitude of the writings, and the characters of the 
style. Of these rules, the one which he professes to have been 
most guided by is the first, all the others being of subordinate 
importance. From what has now been stated, the reader will 
not fail to remark that the principles upon which the classifi- 
cation of Littre is founded scarcely differ at all from those of 
Ackerman. The reasonableness of these rules, moreover, no 
one, I presume, will venture to call in question, whatever may 
be thought of the judgment with w'hich they are applied in 
particular instances. My own opinions on this point I need 
not state here, as they will come out more properly in my own 
disquisition on the characters of the particular treatises. 

But, before concluding this part of my task, I must not neglect 
to notice the learned labours of a much esteemed friend and 
countryman — the first, the last, the only, scholar (I lament to 
say) which England has produced in this department of ancient 
criticism — Dr. Greenhill, of Oxford, wdio, in his excellent article 
on Hippocrates in Smithes ' Dictionary of Greek and Roman 
Biography and Mythology,' enters into a very elaborate disqui- 
sition on the authenticity of the various works which compose 
the Collection. His general distribution appears to me to be 
very ingenious, and his judgment in particular cases most 
correct, but it is proper I should state that I, perhaps, am 
scarcely qualified to pronounce an impartial judgment on this 
point, having had the honour of being consulted by the autlior, 
as he himself candidly acknowledges, while he Avas employed 



46 



PRELIMINARY DISCOURSE. 



[sect. II. 



on this task. The following is his tabular view of the different 
divisions and subdivisions of the Collection : 

The Hippocratic Collection consists of 



Works certainly written 

by Hippocrates, 

Class I.' 



I 
Works earlier than 

Hippocrates, 

Class III.^ 



Works authentic, but 
not genuine, i. e. 
not willful 
forgeries. 



Works certainly not 

written by 

Hippocrates. 



Works perhaps written 
by Hippocrates, 
Class II.- 



Works later than 
Hippocrates. 



Works about con- 
temporary with 
Hippocrates. 



Works whose 

author is 

conjectured, 

Class IV.* 



I 



Works neither genuine 
nor authentic, i. e. 
willful forgeries, 
Class VlII.s 



Works whose 
author is 
unknown, 
Class V.s 



Works by the 

same author. 

Class VI.'' 



Works by various 

authors. 

Class VII.^ 



' Prsenotiones or Prognostica; Aphorismi; Epidemiorum, i, iii; de Diseta Acutorum ; 
de Acre, Aquis, et Locis ; de Capitis Vulneribus. 

" De Prisca Medicina; de ArticuUs; de Fracturis; Mochlicus; Jusjurandum; Lex; 
de Ulceribus ; de Fistulis ; de Hsemorrhoidibus ; de Officina Medici ; de Morbo Sacro. 

' Prorrhetica, i ; Coacae Praenotiones. 

■* De Natura Hominis ; de Salubri Victus Ratione ; de Natura MuHebri ; de Morbis, 
ii, iii ; de Superfcetatione. 

* De Flatibus ; de Locis in Homine ; de Arte ; de Diaeta ; de Insomniis ; de 
Affectionibus ; de Internis Affectionibus ; de Morbis, i ; de Septimestri Partu ; de 
Octimestri Partu; Epidemiorum, ii, iv, vii; de Humoribus; de Usu Liquidorum. 

® Epistolse ; Thessali Legati Oratio ; Oratio ad Aram ; Atheniensium Senatus-Con- 
sultum. 

^ De Genitura ; de Natura Pueri ; de Morbis, iv ; de Mulierum Morbis ; de Vir- 
ginum Morbis ; de Sterihbus. 

^ Epidemiorum, v, vii; de Corde; de Alimento; de Carnibus; de Septimanis; de 
Natura Ossium ; de Glandulis ; de IMecUco ; de Decenti habitu ; Prsceptiones ; de 
Anatomia ; de Dentitione ; de Exsectione Foetus ; de Visu ; de Crisibus ; de Diebus 
Criticis ; de Medicamentis Purgativis. 



SECT. II.] HIPPOCRATIC TREATISES. 47 

Having now finished this survey of the labours of preceding 
inquirers, I proceed to state the results of my own investi- 
gations in the same department ; and in doing so, I shall give 
seriatim the evidence for and against the authenticity of the 
different treatises, along with my own decision in every instance. 
And, in order to add to the vahie of this disquisition, I mean 
to give an abstract of the contents of those works which I look 
upon as spurious, that the reader may be enabled to compare 
the doctrines contained in them with those which are delivered 
in the treatises which are recognised as genuine. Moreover, 
it is my object that the present volume should contain a sum- 
mary of all the valuable matters to be found in the Hippocratic 
Treatises, whether genuine or not. 

Before proceeding further, I must state the rules by ivhich I 
test the genuineness of the works in the Hipjjocratic Collection : 

1. All the works which are acknowledged as genuine by 
the ancient commentators and lexicographers which have come 
down to us, and especially by Erotian and Galen, are to be 
admitted as such, unless it can be shown that still older 
authorities held a different opinion regarding them, or that 
they contain doctrines- and views decidedly at variance with 
those contained in the treatises which all allow to be genuine, 
or that the style and mode of handling the subject-matter be 
altogether different from the well-known method of Hippo- 
crates. 

2. The peculiar style and method of Hippocrates are held to 
be — conciseness of expression, great condensation of matter, 
and disposition to regard all professional subjects in a prac- 
tical point of view, to eschew subtle hypotheses, and modes of 
treatment based on vague abstractions. 

3. No treatise is to be received as genuine which is not 
recognised as such by any one of the ancient authorities, how- 
ever strong a case may be made out in favour of its claims by 
modern critics from internal evidence. 



48 PRELIMINARY DISCOURSE. [sect. ii. 

I. rTept aoj(^aiT]g lr]TpiKrig — On Ancient Medicine. I 

Of all the treatises which are recognised as the genuine 
productions of " The Great Hippocrates/' by M. Littre, this 
is decidedly the one which possesses the most questionable 
title to that honour. The only ancient authority that admits 
it as such is Erotian ; it is passed over unnoticed by Galen and 
Palladius ; and Athenseus does not scruple to affirm, respecting 
it, that some considered the one half of it spurious, and others 
the whole. (Deipn., ii, 16.) Foes, Schulze, and Zuinger,' are 
almost the only modern names in its favour; and it is rejected 
by Mercuriali, Gruner, Conringius, Ackerman, and Kiihn." The 
grounds, however, upon which Ackerman decides against its 
authenticity are of little weight, namely, that as it is stated in 
it (§ 1, 2) that medical works were numerous at the time it 
was composed, this circumstance implies a date considerably 
posterior to Hippocrates. But it is to be borne in mind, that 
Xenophon, who was almost contemporary with Hippocrates, 
puts into the mouth of Socrates, who was certainly nearly of 
the same age, the saying, that there were many medical works 
then in existence (Memorab., iv), so that at all events the 
argument of Ackerman falls to the ground. M. Littre, more- 
over, espouses its claims with remarkable zeal, and persuades 
himself that he has settled this point by showing that a passage 
in the Phaedrus of Plato,^ which is quoted by Galen, as referring 
to a sentiment contained in the Hippocratic treatise ' De Natura 
Pueri,'^ does, in fact, have reference to the work now under 
consideration. This position he labours hard to establish, and 
succeeds at last so much to his own satisfaction, that he does 
not hesitate to declare, as the result of his elaborate disqui- 
sition, " that he had demonstrated the treatise ' On Ancient 
Medicine' to be the work of Hippocrates."^ Now, I must be 
permitted to say, with great deference to M. Littre, that 
his prolix process of argumentation, spun out as it is over 
twenty-six pages, does not carry the same conviction to my 

' Hippocrat. Coi Comment. &c., Theod. Zuingeri studio. Basil, 1579. 
^ See his additions to Ackerman's Dissertation, in his edition of the Works of 
Hippocrates. 

* § 122, torn, i, p. 172 (ed. Bekker), where see the note of Heindorf. 
■* Galeni Opera, torn, v, pp. 2, 16 ; ed. Basil. 
^ ffiuvres Completes, &c., tom. i, p. 320. 



SECT. Ti.] HIPPOCRATIC TREATISES. 49 

mind as it does to his own.^ But still, as this treatise has, at all 
events, one ancient authority in its favour, and as the matter 
contained in it appears to me to he highly valuahlc, I have 
not scrupled to follow the example of M. Littre in placing it 
at the head of the Works of Hippocrates. I shall have occasion 
to say more on the contents of it in the Argument prefixed to 
my translation. 

II. TIpoyv(i)CTTiKoi> — Progtiostics. ^ 

Of the genuineness of this work there has never been any 
question, so far as I am aware, from the time of the earliest of 
the ancient commentators, Herophilus, down to the present 
day.^ That it is an admirable specimen of the plan upon 
which the Hippocratic pi*kctice was founded, there can be no 
doubt. The most important critical question to be decided 
with regard to it is the relation it bears to two other treatises 
on the same subject, namely, the ' Prorrhetica,' and ' Coacre 
Prsenotiones,^ whether the ' Prognostics^ be founded on them, 
or whether they be made up from the ' Prognostics.' This 
question will come more properly to be discussed in the 
Argument to the 'Prognostics.' 

Of this treatise there have been the following translations 
into English : 

' The Booke of the Presages of the Divine Hippocrates, 
divided into three parts, &c. By Peter Low, Arrelian 
Doctor in the Faculty of Chirurgery in Paris. Lond., 
1597.' 

' The argument turns principally on the meaning of the expression, n ttote Xsyt t 
'iTTTTo/cparjjc Tf. KM 6 d\j]&))g Xoyog, which M. Littre contends signifies, " ce 
qu' Hippocrate et la raison pourraient dire." Now I must say that, to me, the words 
of Plato here quoted do not warrant the interpretation which M. Littre puts upon 
them; and, not satisfied with my own judgment on this point, which happens in the 
present instance to be an important one, I applied to one of the best authorities in 
Britain on the minutiae of the Greek language for his opinion, and was happy to find 
that it entirely corresponded with my own. Having alluded in the text to the prolixity 
of the discussion which j\L Littre enters into on this occasion, I trust that eminent 
scholar will not be offended (provided these pages ever meet his eyes) if I introduce 
here an anecdote of the celebrated Kuster. Having been shown a work in which 
the quantity of argumentation and reflection greatly overbalanced the amount of facts 
and references, he laid it aside with the remark, " I find nothing here but reasoning ; 
non sic itur ad astral 

* Galeni Opera, torn, v, p. 119; ed. Basil. 

4 



50 PRELIMINARY DISCOURSE. [sect. ii. 

' The Prognostics and Prorrhetics of Hippocrates, translated 
from the original Greek, with large annotations, critical 
and explanatory; to which is prefixed a short account of 
the Life of Hippocrates. By John Moffat. Lond., 1788.* 
' Hippocrates on Air, Water, and Situation ; or, Prog- 
nostics, &c. By Francis Clifton, m.d. Lond., 1734.' 
Of these the last is the only one Avhich possesses the slightest 
claim to consideration. It is the work of a scholar, who had 
evidently paid the most studious attention to his author with 
the intention of publishing a new edition of his works, a de- 
sign, by the way, which it is much to be regretted, that he did 
not live to execute. What became of his literary labours in 
this department I have never been able to ascertain. The 
greatest fault I find with his translation is the quaintness of 
his style ; for it cannot be alleged of him, as of jNIoffat, that 
he often mistakes the meaning of his author. The trans- 
lations of the latter are utterly worthless, in fact, they are 
disgraceful to the translator, who ought to have been ashamed 
to engage in a task for which he Avas so utterly unqualified. 
The translations by Low are done in a strangely antiquated 
style, and otherwise have nothing to recommend them on the 
score of fidelity. Moreover, all these translators introduce 
confusion into the subject by mixing uj) together the contents 
of the ' Prognostica,* ' Prorrhetica,' and ' Coacse Prsenotiones.* 
Even Clifton is guilty of this indiscretion, although better 
might have been expected from him ; for, considering how 
well acquainted he appears to have been with the spirit of his 
author, he ought to have been able to appreciate properly the 
obligations which Hippocrates had conferred on his profession 
by methodising subject-matters which had previously been 
destitute of scientific arrangement. 

III. ' A^o^Kjfxo'i — jipJiorisms. 

That the greater part of the Book of Aphorisms is the 
work of Hippocrates himself there can be little or no doubt, 
but that it contains interpolations, some of which are of high 
antiquity, is equally indisputable. This is distinctly stated by 
Galen. ^ On this subject I would beg leave to quote the remarks 

' Comment, vii ; et sect, vii, 53 et seq. 



SECT. IT.] HIPPOCRATIC TREATISES. 51 

of Dr. Greenhill : " Some doubts have arisen in the minds of 
several eminent critics as to the origin of the Aphorisms, and, 
indeed, the discussion of the genuineness of this work may be 
said to be an epitome of the questions relating to the whole 
Hippocratic Collection. We find here a very celebrated work, 
which has, from early times, borne the name of Hippocrates, 
but of which some parts have always been condemned as spu- 
rious. Upon examining these portions, which are considered 
to be genuine, we observe that the greater part of the first 
three sections agrees almost word for word with passages to be 
found in his acknowledged works; while in the remaining 
sections we find sentences taken apparently from spurious or 
doubtful treatises, thus adding greatly to our difficulties, in- 
asmuch as they sometimes contain doctrines and theories 
opposed to those which we find in the works acknowledged to 
be genuine. And these facts are (in the opinion of the critics 
alluded to) to be accounted for in one of two ways : either 
Hippocrates himself, in his old age (for the Aphorisms have 
always been attributed to this period of his life), put together 
certain extracts from his own works, to which were afterwards 
added other sentences taken from later authors ; or else, the 
collection was not formed by Hippocrates himself, but by some 
person or persons after his death, who made aphoristical ex- 
tracts from his works, and from those of other writers of a 
later date, and the whole was attributed to Hippocrates, be- 
cause he was the author of the sentences that were most 
valuable and came first in order. This account of the for- 
mation of the x^phorisms appears extremely plausible, nor does 
it seem to be any decisive objection to say, that we find among 
them sentences which are not to be met with elsewhere ; for 
when we recollect how many w^orks of the old medical writers, 
and perhaps of Hippocrates himself, are lost, it is easy to con- 
ceive that these sentences may have been extracted from some 
treatise that is no longer in existence. It must, however, 
be confessed, that this conjecture, however plausible and pro- 
bable, requires further proof and examination before it can be 
received as true."' The fact of the matter is, that interpolation 

' See under Hippocrates, in Smith's Greek and Roman Biographical and Mytho- 
logical Dictionary. 



52 PRELIMINARY DISCOURSE. [sect. ii. 

is a mode of corruption from which few works of antiquity have 
escaped altogether free, and it was, no doubt, often practised 
upon them in a very innocent manner, and without any frau- 
dvdent intention. Thus, when the subject treated of by any 
author came afterwards to receive any notable improvements or 
alterations, the possessors of such a work would naturally mark 
them down on the margins of their MS., and these annotations 
in the course of transcription would often come to be incor- 
porated with the genuine text. Such a work as the Aphorisms, 
consisting of detached sentences, was particularly liable to 
suffer in the manner now adverted to. Another mode of 
vitiation, which has been frequently practised upon ancient 
works, is the addition of appendices to them. Every classical 
reader must be aware that the Odyssey of Homer is generally 
admitted by the critics to have come down to us in this state ; 
nay, many learned divines do not scruj)le to admit that certain 
portions of the Sacred Volume have not been exempt from this 
casualty. I may mention that the last chapter of the Pen- 
tateuch, the last Psalm in the Septuagint, and even the last 
chapter of the Gospel of St. John, have been suspected, by 
very able critics, of being appendices. I have stated in 
another place (Paulus ^gineta. Vol. Ill, p. 437), that an 
addition in this w^ay has probably been made to the medical 
works of Aetius. On the addition of appendices to works, see 
further, Galen (de Placit. Hippocrat. et Plat., vi, 3). Taking 
all this into account, it need excite no wonder that an appendix 
should have been added, by some unknown hand, to the seven 
sections of Aphorisms, and, accordingly, it is generally admitted 
that the eighth section is spurious. 

I shall reserve my analysis of the contents of the genuine 
sections to the Argument prefixed to the translation. 

We have the following translations of the Aphorisms into 
English. 

' The Aphorisms of Hippocrates, translated into English : 
' By S. H. Lond. 1610.' 
' By Conrad Sprengel. Lond. 1708.' 
' By T. Coar. Lond. 1822.' 
' By J. W. Underwood. Lond. 1828.' 

Of these 1 have only carefully examined the translations by 



SECT. II.] HIPPOCRATIC TREATISES. r>3 

Sprengel and Coar. That of Sprengel displays considerable 
pretensions to erudition, but, upon a careful examination, it 
will be quite apparent that the translator was not possessed of 
a competent acquaintance either with the Greek or English 
language. In short, nothing can be conceived more quaint, 
inelegant, and inaccurate, than the language of this translation. 
Lest I should be suspected of prejudices against ray predecessor, 
and of exaggerating his faults, I shall subjoin a short list of 
passages which I hold to be mistranslated, so that the reader 
may judge for himself, whether my opinion of the work be well 
founded or not. (See Aph. i, ll,i 15," 20,^ 23 ;^ ii, 6,^ 15,« 27, 
31, 34, 40; iii, 16, 21.) 

The production of Coar is not destitute of some merit, 
although it is but too apparent that he was not fully competent 
for the task which he had undertaken. He gives, separately, 
every Aphorism in Greek, to which he subjoins first a Latin 
and then an English translation. In the Preface, he admits 
that " in executing the English translation considerable assist- 
ance had been derived from the elegant French translation of 
M. de Mercy.^' From this admission it will readily be gathered, 
that the translator felt conscious that he did not possess a proper 
acquaintance with the language of the original. I subjoin 
references to a few of the passages which, upon examination, 

' " 111 all paroxysms, or sharp fits of intermitting diseases, we must take away 
meat, for then to give it is hurtful." 

^ " The belly is naturally hottest in winter and the spring, and most addicted to 
rest. Consequently in these seasons a greater proportion of food is to he allowed, 
because the inward heat is stronger, which is the reason that a more plentiful food 
is necessary. This difference may be seen in such as are old, and in such as are 
lusty and well-grown bodies." 

3 "Those things that are or have been justly determined by nature, ought not to 
be moved or altered, either by purging or other irritating medicines ; but should be 
left alone." 

^ " Things evacuated and purged are not to be estimated by the multitude and 
quantity, but by their fitness to be avoided and sent forth ; and must be such as are 
not too troublesome to the patient to bear. Though, where it is necessary, we must 
proceed in evacuating, even to swooning and fainting, if the patient can bear it." 

^ " Those who are grieved in any part of the body, and are scarce sensible of their 
grief, have a distempered mind," 

^ " When the upper parts of the throat or gullet are sore, or a breaking out of 
small tumours does arise in the body, we ought to look upon the excrements ; for 
if they are choleric, the body is also sick ; but if they are like the excrements of 
sound persons, the body may l)e nourished without danger." 



54 PRELIMINARY DISCOURSE. [sect. ii. 

appeared to me to be incorrectly rendered, (See Aph. i, 2/ 
10/ 20/ ii, 49/ iii, 11/ 26, 31 ; iv, 1; v, 26, 44, 68.) 

IV. 'E7ri^r]iJ,iu)v a Kal y' — The First and TJiird Books of the J 

Epidemics. "^ 

These are among the most undoubtedly genuine remains of 
Hippocrates, and well sustain the high reputation of their great 
author. In fact, of all the earlier records of medicine, these 
are about the most precious which have come down to us. 
Although, as I have stated, no one has questioned their genuine- 
ness, Galen complains that, by some mishap or other, they had 
not wholly escaped from some derangement of the subject- 
matters which they contain, and from additions being made to 
them.^ 

The following, I believe, are the only English translations 
of them which have ever been published. 

' A Comment on forty-two histories described by Hippocrates 
in the First and Third Books of his Epidemics. By 
J. Eloyer.' 

' The History of Epidemics, by Hippocrates, in Seven Books. 
Translated into English from the Greek, with Notes and 
Observations. By Samuel Farr, m.d. Lond. 1780.^ 

The former of these I have not been able to see. The other, 
although it appears to have been got up with considerable care, 
is manifestly the work of a man not properly acquainted with 
the language and doctrines of his author. In proof of this, I 

' " When that which ought to be evacuated is discharged by spontaneous vomiting 
and diarrhoea, it is useful and easily endured ; but when otherwise, the contrary. 
This is equally true with regard to every vessel," &c. 

^ " They in whom the greatest vigour of the disease is immediately perceived, are 
to be immediately sparingly supplied with food ; but from those in whom it occurs 
later, the food must at that time, or a little earlier, be abstracted. Previously, how- 
ever, we must nourish more freely, that the sick may be supported." 

^ " Whilst the crisis is forming, and when it is complete, nothing ought to be 
moved or to be introduced, whether by purgatives or other irritants ; but all should 
be left at rest." 

■• " They who are accustomed to daily labour, although even weak or old, endure 
it more easily than the robust or young, who are even accustomed to it." 

^ " In regard to the seasons, if the winter have been dry and cold, and the spring 
moist and warm, in summer acute fevers, ophthalmias, and dysenteries must neces- 
sarily occur, chiefly, however, among females and men of pituitous temperament." 

« Tom. v, p. 399 ; ed. Basil. 



SECT. II.] HIPPOCRATIC TREATISES. 55 

subjoin below a few examples collected from the fir^st book, 
near the beginning.^ 

V. Ylepl 8iaiTi]g ot,e(i)v — On the Reghnen in Acute Diseases. 

This work is acknowledged as genuine by Erotian/ Palladius;"^ 
and Galen/ and other ancient authorities, as well as Ijy all the 
modern critics, from IMercuriali and Lemos down to Littre and 
Greenhill. The authenticity of the latter part, indeed, is ques- 
tioned by Galen, who pronounces the style, theories, and language 
to be different from those of Hippocrates. Yet even he admits 
that it is of great antiquity, being more ancient than the time 
of Erasistratus, who lived Avithin less than a century from the 
death of Hippocrates.^ Even if not genuine, then, this part 
(which is published by M. Littre as an appendix) possesses great 
value, not only as containing important matter, but as furnishing 
us with the opinions of the Coan school at a very early period 
after the time of our author. We shall have occasion to give 
a fuller analysis of its contents, in the Argument prefixed to 
the translation of it. 

VI. Uepi aiOMv, vdarwv, Kai tottwi' — On Airs, Waters, and . 

Places. 

Fortunately there 'are no reasonable grounds for questioning 
the authenticity of this highly important work. It is admitted 
as genuine by Erotian, Palladius,^ Athenceus,'^ and Galen,*^ and 
by every one of the modern critics, with the exception of 
Haller, who pronounces against it upon very insufficient grounds. 
He argues that it is obvious, from its contents, that the author 

' " The state of the air being, upon the whole, dry, with a south wind, wliicli was 
just contrary to wliat happened the year before, when tlie north chiefly prevailed; 
there were but few inflammatory fevers, and these were of a mild disposition, very 
few being attended with hemorrhages, and much fewer, if any, with death." (p. 4.) 

" They aflfected children, young persons, and those who were arrived at years of 
maturity, and especially those who used much exercise, yet but few women." (Ibid.) 

" Before the summer, and even during that season, nay, in winter likewise, there 
were many who had been disposed to a phthisis who were now afflicted with that 
disease," &c. (Ibid.) 

" The extremities were generally very cold, there w-as seldom any heat in them." 
(p. 3.) 

- Praefat. Gloss. '' Comment, in Libr. de Fract. 

** In Lib. Prognos. Comment. * Tom. v, p. 89 ; ed. Basil. 

® Comment, in Lib. de Fract. ' Deipnos, ii, 7. 

* De Propr. Lib., in III Epid., Comni. ii, Praef. 



56 PRELIMINARY DISCOURSE. [sect. ii. 

of tliis treatise was a European, wliicli cannot be said of Hip- 
pocrates, seeing that liis native place, Cos, was one of the Asiatic 
islands.^ But, if Haller had possessed any competent acquaint- 
ance with classical literature, he must have been aware that all 
the inhabitants of the islands adjoining to Asia Minor were 
colonists from Greece, and consequently looked upon themselves 
as Europeans, and not as Asiatics.^ Nor is this more remarkable 
than that the present inhabitants of America should rank them- 
selves ethnologically with the Europeans, and not with the na- 
tive inhabitants of the country they now occupy. 

An edition of this treatise, with a French translation, was 
published at Paris by a learned modern Greek, Dr. Coray, in 
the beginning of this century ; the annotations to which are 
highly valuable. The only English translation of it which we 
possess, as far as I know, is the following : 

' Hippocrates upon Air, Water, and Situation. By Francis 
Clifton, M.D. Lond. 1734.' 

This, I am inclined to think, is the best English translation 
wliich we have of any of the Hippocratic treatises. It is 
generally accurate, and the oidy drawback to it which I am 
aware of, is the style, which is often exceedingly quaint and 
obsolete. The translator, as we stated above, was well acquainted 
with all the works of Hippocrates, and of his painstaking in- 
dustry the notes in this treatise bear undoubted evidence. Of 
these I have availed myself, whenever I could derive any assist- 
ance from them, but from the translation itself I have never 
copied literally. 

VII. Y\t^\ ap6p(jt)i> — On the Articulations. 

This work was received as genuine by all the ancient 
commentators, from Bacchus and Philinus, the disciples of 

' Bibl. Med., p. 1, 29, 59. 

* The inhabitants of Asiatic Ionia, and the islands adjoining, were all colonists 
from Attica. (See in particular Thucyd., i, 12; and also Herodot., viii, 44; and 
Heraclides, de Politiis.) Dr. Coray supposes that Hippocrates represents himself as 
being a European, in consequence of his having composed this treatise in Europe, at 
a distance from his native country. But there is no necessity for this supposition, 
as Hippocrates, being of Grecian descent, would naturally enough consider himself a 
European, since the great body of the Greeks were Europeans. Coray mentions a 
striking instance of Haller's incapacity to form a correct judgment on the works of 
Hippocrates, from want of a proper acquaintance with the Greek language. — Dis- 
com-s Preliminaire, &c., p. Ivi. 



SECT. II.] HIPPOCRATIC TREATISES. 57 

Herophilus, down to Erotiau, Galeii,^ and Palladius.^ It was 
also admitted by all the earlier modern critics^ down to Gruner, 
who rejected it on these grounds : 1. Because it contains a 
reference to the treatise ' On Glands/ which all acknowledge 
to .be spurious. 2. That in the course of the Avork a degree of 
anatomical knowledge is evinced, far beyond what its actual 
state in the time of Hippocrates would warrant. 3. That the 
legend of the Amazons, which is received as true history in the 
treatise ' On Airs, &c./ is rejected as fabulous in this work. 
Grimm also agrees with Gruner in condemning it as spurious ; 
but Littre shows good reasons for admitting it into the list of 
genuine productions. He replies in a very satisfactory manner 
to Gruner's objections. Thus he shoAvs, in particular, what Ave 
have adverted to previously, that the knowledge of anatomy 
Avliich was possessed in the Hippocratic age, had been much 
underrated by Gruner and others, and that the two passages in 
Avhicli the Amazons are supposed to be referred to, are not 
parallel, and do not admit of a comparison. He also very pro- 
perly insists upon it, as a strong argument in favour of the 
genuineness of this treatise, that it had been commented upon 
by Ctesias.^ The work, indeed, contains so much valuable 
matter, of which subsequent authors (as Celsus and Paulus 
yEgineta) have freely 'availed themselves, in handling the sub- 
jects which are treated of in it, that I have every disposition to 
receive it as genuine. We shall see, afterAvards, that, taken in 
connexion Avitli the next Avork, it is a perfect masterpiece on the 
subject of Fractures and Dislocations. 

VIII. rif^i ayiLiuJi' — On Fractures. 

Tried by the tests laid down by us above, this treatise must 
undoubtedly be received as genuine. It is decidedly acknoAV- 
ledged as such by Palladius, Erotian, Galen, and, in short, by 
all the ancient authorities, and the only modern critics Avho 
venture to question its claim, are Grimm, the German translator 
of Hippocrates, and Kiihn ; and, in fact, the latter does so 
merely in deference to Grimm, for his arguments on the 
question of its authenticity all tell the other Avay. That the 
treatises ' On Fractures' and ' On Articulations' constituted 

• De Placit. Ilippocr., et Platon. ix; de Diff. llesp., iii, 7. 

- Ap. Foiis., p. 197. ^ Galeni Opera, torn, v, p. 052; cd. Basil. 



58 PRELIMINARY DISCOURSE. [sect. ii. 

originally one work, is shown in a very convincing manner 
by Galen, in liis introductory comment on the latter.^ This 
is an additional reason for admitting the work ' On Articu- 
lations' as genuine. Indeed, I do not hesitate to declare that 
whoever refuses to admit these two treatises as genuine, may 
consistently dispute the claims of any other work of the same 
date. 

IX. Mo^XiK'o'c — On the Instruments of Reduction. 

This work is quoted by Galen as one of the acknowledged 
books of Hippocrates,^ and is admitted by Erotian into his list of 
genuine works ; nay, it appears from the latter that it had been 
commented upon by Bacchius. Of the modern authorities. Foes 
and Littre concur with the ancient in admitting its claims, but 
it is rejected by Lemos, Mercuriali, Haller, Gruner, Grimm, 
and Kiihn. No one who reads it carefully can fail to remark 
that, as stated by Galen,^ it is a compendium of the work 
' On the Articulations,' so that whoever admits the latter to be 
genuine must acknowledge the treatise now under consideration 
to be one which embodies the opinions of Hippocrates, whether 
it were actually composed by him or not. Taking all this into 
account, it appears to me superfluous diligence in modern critics 
to search out grounds for questioning its authenticity. 

X. Iltpi T(j)v kv Kt(paXy T^(x)/.iaT(i)v — On Injuries of the Head. 

This work is acknowledged as genuine by all the authorities, 
ancient and modern. The only objection to its genuineness is 
the appearance of certain interpolations towards the end of it.^ 
This, however, as Ave have remarked above (No. Ill), is a mode of 
vitiation from which few ancient works are altogether exempt. 

XI. "OpKog — The Oath. '/ 

This interesting little piece is quoted as genuine by Erotian,^ 
Theodore Priscian,^ Soranus Ephesius,^ St. Jerome,^ Gregory 

' Opera, torn, v, p. 578 ; ed. Basil. ^ Ibid., p. 170. 

^ In Prsedict. i, Comm. i, 4. 

■* V. Galen, in Exeges. in vocibus iKXovuBu, a^uKipog, &c. 

* Prfefat. Gloss. Hippocrat. 

^ Gynffic., torn, i, P. I, p. 13. 
' In vita Hippocrat. 

* Ad Nepotian. de vita Cleric, Ep. ii, p. 13, torn, i ; cd. Paris, 1643. 



SECT. II.] HIPPOCRATIC TREATISES. 59 

Nazianzen/ Suidas/" and Scribonius Largus.^ It is also 
received as such by Foes, Gruner, and Littre, but is rejected 
by Mercui'iali, Scliulze, Haller, Kiihn^ Ackerman, and other 
modern autliorities, as quoted by Ackerman. The only reason- 
able gi'ounds Avhicli I can see for questioning its authenticity is 
the silence of Galen with regard to it : but when -vre take into 
account that Galen has nowhere given an eutu'e list of what he 
considers to be the genuine works of Hippocrates, this omission 
on his part may be merely incidental, and is not of much 
weight. On the other hand, the argument which M. Littre 
seeks to establish in favour of its authenticity on fancied allu- 
sions to it by Aristophanes^ and Plato/ appears to me to have 
no weight ; indeed, he himself gives up the former in another 
place.*' 

I have met with the following English translations of this 
piece, and no doubt there may be others : 

' The Protestation which Hippocrates caused his Scholars to 
make, by Peter Low; Lond. 1597.' 

' , by Francis Clifton, m.d. ; Loud. 1734.' 

The translation by Low is in a quaint and antiquated style; 
that bv CKfton is carefullv done. 

XII. Noaoc — TJie LaiL'. 

This little piece is noticed by Erotian, and admitted as 
genuine by INI. Littre, but Mercuriali, Gruner, Ackerman, 
Kiihu, and Greenhill incline to reject it It is well written, but 
the style is rather too scholastic for the age and taste of the 
great Father of Medicine. At the same time, it has so manv 
points of accordance with ' The Oath,' that it seems inconsistent 
to admit the one as authentic and reject the other as 
spurious. 

XIII. Kar' i?;70cMJi' — Oil the Surgery, ^y' 

AU the ancient commentators which have come down to us, 

such as Erotian, Galen, and Palladius, admit it to be genuine ; 

' Orat. Fuuebr. iu Cssarium Fratrem. - Sub voce Hippocrates. 

3 Epist. ad C. Jal. Callistum. ■• Tliesmophor., 1. 240. 

* De Legg. iv, 1. vi, p. 134 ; cd. Tauchuitz. ° Tom. ii, p. xlviii ; Add. et Corrig. 



CO PRELIMINARY DISCOURSE. [sect. ii. 

but it would appear from Galen that some of the older com- 
mentators were not satisfied upon this point, some doubting 
whether it was the production of the great Hippocrates or of 
Thessalus, and some referring it to Hippocrates^ the son of 
Gnosidicus.^ It is received also by Foes, Gruner, and, after 
a good deal of hesitation, by M. Littre. Schulze expresses 
himself on this point doubtfully," and the work is rejected 
by Grimm, Ackerman, and Kiihn. Beyond all doubt, it is a 
compendium of the treatises ' On Fractures^ and ' On the 
Articulations,' so that, whether the composition of Hippocrates 
himself or not, there can be no question that the subject- 
matter of it is derived from him. Galen appears to have been 
remarkably fond of this treatise, and makes frequent reference 
to it in his great work ' Ou the Dogmata of Hippocrates and 
Plato.' It would appear that Diodes, Philotimus, and Mantias 
had written treatises bearing the same title. 

There is some difficulty in determining accurately what was 
the nature of the ancient Tatrium (ir^Tpeiov). See an interest- 
ing disquisition on this subject in Littre's edition of Hippo- 
crates, t. V, p. 25. It most probably was an establishment 
kept by the physician, in which were contained not only all 
sorts of medicines, but also all kinds of surgical apparatus. 
Mention of the latriwn is made by Plato (Legg. iv, p. 720, and 
i, p. 646 ; ed. Tauch.) Aristotle is said to have possessed an 
latrium, which, if the story be true, he had no doubt acquired 
from his father, who was a medical practitioner.^ From what 
is stated by Plato, it would appear that the assistants were 
qualified to administer professional assistance in the absence 
of their superior, and were also called doctors. (Legg. iv.) So 
it appears that the modern abuse of this title was sanctioned 
by classical usage ! It must be recollected that, in the time of 
Hippocrates, eminent physicians were periodeuta, that is to say, 
wanderers from place to place, and consequently they would 
stand in need of such an establishment as we have described 
the latrium to be. See further the Argument to this work. 

1 Tom. V, p. 526 ; ed. Basil, &c. Elsewhere he quotes it as being undoubtedly 
genuine. — De Placit. Hippoc. &e., ix, 1. 

2 Hist. Med., p. 283. 

^ See Polybius, as quoted by Littre, 1. c. ; also section iii of the Preliminary Dis- 
course. 



SECT. II.] HIPPOCRATIC TREATISES. 61 

XIV. Tlepi (pvaewQ dvOoMTrov — On the Nature of Man. 

Erotian, Galen, Palladius, and Macrobius^ do not hesitate 
to quote the doctrines contained in this treatise as being those 
of the great Hippocrates, but its authenticity has long been 
considered very questionable, owing to the circumstance that a 
passage in it of considerable length, relative to the anatomy of 
the venous system, is quoted by Aristotle" as being the pro- 
duction of Polybus, and it is accordingly received as such by 
Haller,^ Gruner, Littre, and most of our recent authorities on 
ancient medicine. Galen, however, contends that the passage 
quoted by Aristotle is not the work either of Hippocrates or of 
Polybus, but an interpolation, and that the rest of the treatise 
is genuine.^ But Galen, at the same time, admits that 
Dioscorides, the Commentator (he must not be confounded 
with the celebrated author of the Materia Medica), had marked 
the first part of this treatise with the sign of the obelisk, as 
indicating his suspicion of its being spurious, and that he held 
it to be the work of Hippocrates, the son of Thessalus, that is 
to say, of a grandson of the great Hippocrates. But, whatever 
may be decided regarding its authorship, a careful perusal of 
the treatise will satisfy any one that it is a piece of patchwork, 
made up of several fragments, which do not cohere properly 
together. It certainly also appears to me that many of the 
philosophical dogmata which are delivered in it do not accord 
well with the doctrines contained in those treatises which are 
universally admitted to be genuine. 

After alluding briefly to the opinions of those philosophers 
who held that the human body is formed from the four 
elements, that is to say, fire, air, water, and earth, the writer 
proceeds to state his own doctrines regarding the four humours, 
namely, blood, phlegm, yellow and black bile, and the diseases 
which are occasioned by the prevalence of one or other of 
them, according to the seasons of the year, and other circum- 
stances. The doctrines, as herein stated, are very hypothetical, 
and certainly, as already hinted, not in accordance with those 
delivered in the genuine works. It is proper to mention, 

' Saturiial., vii, 6. ^ Hist. Animal., iii, 3. 

3 In Boevhaav. Meth. Stud. Med. 

■* De Placit. Hippocrat. et Plat., vi, 3 ; et Opera, torn, v, p. 22 ; ed. Basil. 



62 PRELIMINARY DISCOURSE. [sect. ii. 

however, that Galen_, in several parts of his works, makes 
Hippocrates to be the author of the theories of the elements and 
of the humours.^ The treatise contains certain general truths 
and rules of practice not unworthy of some consideration, such 
as this, that diseases are cured by their contraries, that is to 
say, that diseases arising from repletion are removed by 
evacuation, and vice versa ; and that diseases in general 
are occasioned either by the food we eat, or the air we 
breathe, those which prevail epidemically being produced by 
the latter cause. All sudden changes of diet are held to be 
attended with danger, and to be avoided. It is also an 
important rule of practice that, in venesection, blood should be 
abstracted from a part as distant as possible from the seat of 
the pain and of the collection of blood. There can be no 
doubt, in a word, as we have stated in the preceding section, 
on the authority of Galen, that Hippocrates was well acquainted 
with the principle of revulsion in the practice of medicine. The 
natural heat, or, as it is now called, the animal heat, is stated 
to be greater the younger the body is — a physiological doctrine 
strenuously advocated by Galen in several parts of his works, 
but more especially in the treatise ' Against Lycus.^" The 
theory of the formation of urinary calculi is also discussed. 
The same occurs in the treatise ' De Aere,' &c., and in the 
work 'De Morbis' (iv, .28). Allusion is likewise made to the 
occurrence of substances in the urine resembling hairs.^ The 
last fragment of which this treatise is composed relates to fevers, 
the greater part of which are held to be occasioned by bile. 
It is said that there are four varieties of them, namely, 
synochus, quotidian, tertian, and quartan ; that the synochus 
is formed from the most intense bile, and comes soonest to a 
crisis, and the others in the order we have stated them. This 
is very unlike the doctrines of fever laid down in the genuine 
works, and accordingly this portion of the treatise was a great 
stumbling-block to those among the ancient commentators who 
contended for the genuineness of the treatise.^ Altogether, 
then, I must say, that a careful perusal of the work leads me 
to the conclusion that, notwithstanding the high authorities in 

' De Nat. Facult., torn, i, p. 87. ' Opera, torn, v, p. 329 ; ed. Basil. 

' See English translation of Paulus jEgineta, Book I, p. 549. 
■• See Galen, torn, v, p. 2. 



SECT. II.] HIPPOCRATIC TREATISES. G3 

its favour, it does not deserve to be received as a genuine pro- 
duction of Hippocrates.^ 

XV. rTtpt Siatrrjc vyiHvtjg — On Diet in Health. 

This work is passed over unnoticed by Palladius and Erotian ; 
and Galen, although he wrote a commentary on it which still 
remains, informs us that some of the elder commentators had 
assigned it to Polybus, the son-in-law to Hippocrates.^ He 
further mentions that it had been variously referred to Eury- 
phon, Phaon, Philistion, and others ; ancient authority in its 
favour is, therefore, very equivocal. The modern critics are 
pretty unanimous in rejecting it ; indeed, Littre, improving 
on the hint cast out by Galen, does not scruple to refer it and 
the preceding treatise to Polybus. Though the subject-matters 
of it are not, in the main, of much importance, it contains 
some directions for the regulation of the diet, which are by no 
means injudicious. One of his directions, with regard to 
clothing, is very different, however, from what we might have 
expected, considering the fondness of the ancients for the use 
of oil to counteract the effects of cold.'^ The author of this 
work directs oily garments to be used in summer, but clean ones 
in winter. Emetics are recommended to be taken by persons 
of a gross habit of body, but to be avoided by those who are 
slender. This rule is expressed by Celsus in the following 
terms : " Vomitus inutilis gracilibus et imbecillum stomachum 
habentibus, utilis plenis et biliosis omnibus, si vel nimium se 
repleverint vel parum coucoxerint."^ The author of this 
treatise recommends hyssop as an emetic, and we find its use 
in this way not unfrequently noticed in the Hippocratic 
treatises, but not in the works of subsequent authorities, as far 
as I am aware. The work concludes with a passage on diseases 
of the brain, which also occurs, ' De Morbis^ (ii), and seems 
much out of place here. It is said that they are first mani- 
fested by stupor of the head, frequent passing of urine, and 
other symptoms of strangury ; and it is added, that a discharge 
of water or of mucus by the nose or ears relieves these com- 
plaints. 

Altogether, considering how slender the evidence is, both 

' See further, under No. I. '^ Opera, toni. v, pp. 1 7, 29. 

^ See Paulus jEgineta, I, 50. '* I, 3. 



64 PRELIMINARY DISCOURSE. [sect. ii. 

external and internal, in favour of tlie authenticity of this 
treatise, I can have no hesitation in rejecting it as spurious. 

XVI. TlpoppnriKov, a — First Book of Prorrhetics. 

XVII. KdjuKai TrpoyvuxTHQ — Coan Prognostics. 

These two works are so evidently allied to one another, that 
I have judged it expedient to treat of them together. The 
greatest difference of opinion has prevailed among the critics, 
both ancient and modern, with regard to them. Erotian 
declares expressly that the ' Prorrhetics,' both first and second, 
are not genuine ; and Galen, although he writes a commentary 
on the first book, complains of the difficulty he experienced in 
explaining certain vocables of dubious meaning contained in 
it,' and elsewhere states that the treatise is composed of extracts 
from the ' Prognostics,' ' Epidemics,' and 'Aphorisms.' Foes 
is almost the only modern scholar of any note wlio stands up 
for the genuineness of the first book of the ' Prorrhetics ;' and 
it is decidedly rejected by Grimm, Ackerman, Haller, Littre, 
and nearly all the other modern authorities. The ' Coacae 
Praenotiones' have very little ancient authority in their favour, 
and even Foes rejects the work with greater disdain than it 
would seem to merit. Of late years, the opinion has gained 
pretty general assent that these two treatises are more ancient 
than the days of Hippocrates ;' that, in fact, they constitute 
the materials out of which he composed the ' Prognostics,' and 
are the results of the observations made by the priest-physicians 
in the Asclepion, or Temple of Health, at Cos. This idea is 
followed out with great ability by Dr. Ermerins, in his 'Specimen 
Historico-Medicum Inaugurale de Hippocratis doctrina a Prog- 
nostice oriunda,' where, by a most ingenious and convincing 
process of comparison, he appears clearly to make out that the 
' Coacse Prsenotiones' are formed from the first book of the 
f Prorrhetica,' and the ' Prognostics' from the ' Coacse Praeno- 
tiones.' These positions, I repeat, he seems to me to have 
established most satisfactorilv, and I cannot hesitate to declare 
it as my opinion that Dr. Ermerius has thereby thrown 
great light on this department of the Hippocratic literature. 

' Sect, ii, near the beginning. ' Comment, in III Epidem. 



SECT. II.] HIPPOCRATIC TREATISES. G5 

M. Littre has justly appreciated the labours of Dr. Ermerius, 
and adopted his views without reserve, (v. i^ p. 351.) As I 
shall have occasion to compare the contents of these two trea- 
tises now under consideration with the subject-matters of th(; 
' Prognostics^ in my Argument to the latter^ I shall confine 
m^^self at present to a few observations^ selected in a good 
measure from M. Littre^s argument to the ' Coacae Prseno- 
tiones.^ 

In the first place, M. Littre makes some interesting remarks 
on vomicae of the chest after pneumonia and pleurisy; but this 
subject will come to be treated of in the notes on the ' Pro- 
gnostics.^ He next gives some important observations on the 
following passage in the ' Coacai Prajnotiones/ § 418 : " All 
sprains are troublesome, and cause intense pains at the com- 
mencement, and in certain cases occasion after-consequences ; 
the most troublesome are those about the breast, and the most 
dangerous are those in which there is vomiting of blood, much 
fever, and pain about the mammae, chest, and back; when all these 
occur, the patients quickly die ; but in those cases in which they 
do not all occur, nor are severe, they are longer protracted ; the 
inflammation at farthest is protracted to forty days." He relates, 
in illustration of this passage, a case very much in point, from 
the 'Journal de Medecine,^ Juillet, 1813, of a healthy person 
who, in lifting a log of wood, strained the parts about the chest so 
as to experience a cracking sensation about the brenst ; it was 
followed by intense inflammation, which, in spite of plentiful 
depletion, ended in an empyema which opened by the fifth inter- 
vertebral space. The patient recovered. This case is a good 
illustration of a species of accident frequently described in the 
Hippocratic Collection. He then briefly considers the question 
whether or not Hippocrates was acquainted with the croup, on 
which he does not give any decided opinion. In my opinion, the 
term croup is now used in a vague sense, being applied to cases 
of angina, in which the inflammation spreads down to the 
glottis and trachea, and also to cases of bronchitis attended with 
a croupy cough. I am confident that pure cynanche trachealis, 
that is to say, acute disease originating in the trachea, is of 
very rare occurrence, at least, it certainlj^ is so in the north of 
Scotland. That the ancients were well acquainted with that 
species of cynanche in which the disease spreads down to the 

5 



66 PRELIMINARY DISCOURSE. [sect. n. 

wiudpipe there can be no donbt. See the Commentary on 
§§ 26, 27, Book III, of Paulus tEgineta. It may reasonably 
be doubted whether they were not fully as well acquainted with 
diseases of the fauces and windpipe as the moderns are. 

M. Littre's observations on sphacelus of the brain do not 
at all accord with the opinions of Dr. Coray/ nor with those 
advanced in the Commentary on Paulus ^gineta, B. Ill, § 7. 
He thinks that Hippocrates meant by it necrosis of the cranium. 
Although I still so far adhere to my former opinion that by 
sphacelus was generally meant ramollissement of the brain, I 
must admit that some of the passages in the Hippocratic 
Collection, where it is described, would bear out M. Littre^s 
ideas regarding it. On the subject of sphacelus, see 'De Morbis,'' 
near the beginning. 

M. Littre draws, from a variety of sources, much interesting 
matter in illustration of § 500 of the ' Coacse Prainotiones :' 
" Amaurosis is produced by wounds in the eyelash, and a 
little above it -, the more recent the wound, they see the 
better ; but when the cicatrix becomes older the amaurosis in- 
creases.^^ Plattner" held that in this case the amaurosis is 
connected with lesion of the frontal nerve. Beer^ shows that 
the aflectiou of the sight is not connected with injury of the 
nerve, but is rather the result of concussion of the ball of 
the eye. Walker, and Littre himself, are rather disposed to 
question altogether the truth of the statement made by 
Hippocrates. 

M. Littre concludes his argument with some observations 
on the lethargus of the ancients, which he holds, and correctly, 
as I think, to be a pseudo-continual fever. My own opinion, 
as delivered in the Commentary on Book III, § 9, of Paulus 
^GiNETA, will be found to be very similar. Lethargus is there 
stated to have been a species of remittent fever, resembling 
the causus. M. Littre, further in illustration of this subject, 
gives from the works of Mr. U. Clark, an English physician at 
Sierra Leone, an interesting account of a sleepy-diopsy, to 
which the Negroes there are subject. 

The greater part of the contents of these treatises are mixed 

' Ad Hippocrat. de Acre, Aquis, Locis, § 65. 
* De Vulneribus superciliis allatis. Lips., 1741. 
" Lehre von den Augcn-kiankheiten. Wien, 1813. 



SECT. II.] HIPPOCRATIC TREATISES. &7 

up by Clifton with his translation of the ' Prognostics / and 
Moffat gives a complete translation of this book of the ' Prorrhe- 
tics.' The latter, like all the other translations by the same 
hand, is utterly worthless, Clifton is only culpable for having 
introduced confusion into the contents of works which had 
been so admirably arranged by Hippocrates. 

XVIII. Yl^opp-qTiKov, )3' — The Second Book of Prorrhetics. 

The reception which this work has met with from the critics, 
ancient and modern, appears rather singular. Erotian and 
Galen, who, in general, are too facile in admitting the claims 
of suspected works, in the present instance reject a work which 
many modern authorities acknowledge as genuine ; as, for 
example, Haller, Gruner, Grimm, and, with certain qualifi- 
cations, Ackerman and Kiihn. I must say, however, with Foes, 
Littre, and Greenhill, that I cannot see how Ave can con- 
sistently recognise as genuine a work which has so large an 
amount of ancient authority against it, and none in its favour. 
At the same time, all must admit that the treatise in question 
contains nothing unworthy of the name of Hippocrates, and 
that, if estimated by the value of its contents, it is one of the 
most important works in the whole Collection. I will, there- 
fore, give an abstract of its contents, along with my translation 
of the ' Prognostics.^ It is deserving of much attention, as being 
the only work we possess which gives us an insight into the 
method taken by the ancient physicians to gain the confidence 
of their patients by their mode of conducting the preliminary 
examination of every case. In my younger days I knew an 
old physician, who was an adept in this art of conciliating the 
confidence of his patients by anticipating their histories of their 
own complaints. 

XIX. He^i eXKMi'—On Ulcers. 

This treatise is decidedly admitted as genuine by Galen,^ 
Erotian, Celsus, and by Foes, Lemos, Mercuriali, Schulze," and 
Vidus Vidius,^ but is rejected by Haller, Gruner, Ackerman, 

' In VI Aplior., 3, Comm. vi ; Meth. Med., iv, 6. 

- Hist. Med., i, 3, 4, GO. His language is particularly strong: " Maximo genuinus 
ab omnibus judicatur." 

^ In his Commentary on this work. 



68 PRELIMINARY DISCOURSE. [sect. ii. 

and Kulm, on internal evidence, the nature of which we shall 
presently examine. M. Littre in so far concurs in the judg- 
ment of the authorities who reject it, although he does not admit 
the grounds of their decision. Gruner^s principal, indeed I may 
say his sole, argument against the authenticity of this work is 
founded on the nature of the substances recommended by the 
author for the treatment of ulcers ; namely, such acrid and 
(as Gruner chooses to call them) absurd medicines as arsenic, 
black hellebore, and cantharides. But how does it appear 
that these are "absurd" applications to ulcers, when even at 
the present day the two strongest of them, namely, arsenic 
and cantharides, are the means often resorted to for the cure 
of indolent and malignant ulcers? The same articles are 
recommended by Celsus (v), and by Paulus iEgineta.^ It is 
true that the titles given to certain of the prescriptions con- 
tained in this treatise are not appropriate, such as emollient 
(imaXOaKwcea), applied to applications which contain many acrid 
ingredients. But in this case, as is remarked by Foes, we 
should consider the text to be in so far corrupt, for certainly this 
does not constitute a legitimate reason for rejecting the treatise 
in toto. 

Vidus Vidius, in his interesting commentary on this work, 
mentions, as a proof of its authenticity, that most of the 
principles laid down by Galen for the treatment of ulcers, are 
taken from this part of the works of Hippocrates. In a 
word, agreeably to the rules laid down by me for testing the 
authenticity of these treatises, I do not see that I am warranted 
in refusing to admit the claims of this work to be con- 
sidered as genuine. I hold myself bound, therefore, to give a 
translation of it. 

It may be proper in this place to mention that the term 
ulcer (eAkoc) is used in this treatise to signify both a wound 
inflicted by an external body, and a solution of continuity from 
any internal cause. This usage of the word is sanctioned by 
the older poets, as, for example. Homer (Iliad., ii, 723 ; lb., xiv, 
130); Pindar (Nem., viii, 50; Pyth., iii, 84); andBion (Adonis). 

' Book iv, 44. See the authorities quoted in the Commentary on this chapter 
in the English edition. Schulze properly remarks, that the composition which he 
recommends as an application to certain sores resembles the iEgyptiacum of modern 
times. — Hist. Med., i, 3, 4, 63. 



SECT. II.] HIPPOCRATIC TREATISES. 69 

XX. Hepi av^iyyiov — On Fistula. 

Though this work be acknowledged as genuine by Erotian, 
Dioscorides, Celsus, Paulus iEgineta, and by Foes and Vidus 
Vidius, it is set down for spurious by Haller, Gruner, and 
Ackerman; and even by Littre and Greenhill its claims are not 
fully recognised. I can see no good reason, however, for reject- 
ing it, since, as I have stated, the ancient authority in favour of 
it is very strong, and I can detect nothing in the doctrines and 
rules of practice delivered in it which are at variance with 
those laid down in the treatises which all admit to be genuine. 
Ackerman, indeed, pretends that the theory of bile and phlegm, 
as being the cause of disease, does not belong to Hippocrates 
or his school. But this is evidently begging the question ; 
and, moreover, Galen, who must be admitted to be a high 
authority in such a case, decidedly holds Hippocrates to be 
the author of the Theory of the Humours.^ Galen seems to 
say that this treatise, and the following one on hemorrhoids, 
constituted one work in his time ; and he does not throw out 
the slightest suspicion against the genuineness of either, as the 
words of Ackerman would lead one to suppose." 

Vidus Vidius, although he acknowledges Hippocrates as the 
author of this work, holds that it had not been published by 
him, but had been left in an unfinished state. The argument, 
however, which he uses in proof of this opinion, is by no means 
convincing ; he contends that the part which relates to inflam- 
mation of the anus is quite out of place in a work devoted to 
the consideration of fistuloe. But few who have much prac- 
tical acquaintance with the subject will agree with him on 
this point, for it is well known that fistulae, for the most part, 
originate in inflammation and abscess about the verge of the 
anus. 

XXI. rifot a'iiiiopf)oiS(oi' — On Piles. 

This little tract has experienced the same reception from the 
critics as the preceding one, that is to say, it is acknowledged 

' Comment, in Lib. de Nat. Human. 

^ Tliey are as follows : " Continuari cum libello de hamorrhoidis manifeste spiirio, 
ideoque ipsum esse spurium, Galenus jam notat in Gloss., s. v. irijpiva et (TrpvjSXiiv." 
Now, as stated above, Galen does not say a word against the a>.ithenticity of these 
works. 



70 PRELIMINARY DISCOURSE. [sect. ii. 

as genuine by Erotian and Galen, and by Foes and Vidus Vidius, 
but is decidedly rejected as such by Mercuriali, Gruner, Grimm, 
and Ackerman. I can remark nothing in it, however, which 
appears to me at all inconsistent with the doctrines contained 
in the genuine works, unless it be that in this tract the author 
appears to direct that in operating upon hemorrhoids they should 
be all extirpated, whereas in one of his Aphorisms, which is 
quoted by Paulus ^gineta, in his chapter on this subject, he 
recommends that one should be left, as an outlet to the super- 
fluous blood, (vi, 79.) I do not know how this divergence of 
opinion is to be explained, but, at all events, such an apparent 
contradiction would not warrant us in rejecting the treatise 
altogether. 

XXII. Hepl t£^)7c i^ouffou — On the Sacred Disease. 

This work is acknowledged as genuine by Erotian, Galen,^ 
and Cffilius Aurelianus,^ but is rejected by Lemos, Mercuriali, 
Haller, Gruner, Ackerman, Klihn, and even by M. Littre, 
althoagh the last of these admits that the grounds upon which 
it had been refused a place among the genuine works are very 
equivocal. I feel very much at a loss what to decide with regard 
to it. It is unquestionably the work of a man possessed of a 
highly cultivated mind, free from the popular superstition of his 
age, and familiarly acquainted with comparative anatomy, and 
having no contemptible knowledge of human physiology. There 
is, in fact, no name, whether in ancient or modern times, to 
which it might not do houour. That it is not unworthy, then, 
of the great Hippocrates, all must allow, but whether or not he 
be the actual author of it, there is much difficulty in determining 
satisfactorily. That, in certain respects, it is very unlike his 
other works, must be admitted ; the talent which it displays is 
more of a reflective than of a perceptive nature, which is the 
reverse of the common character of Hippocrates, who, in his 
genuine works, evidently evinces a disposition to trust to accu- 
rate observation rather than to acute ratiocination. The style, 
too, I must admit, is more diff'use than the true Hippocratic style 

' Comment, i, in Hipp. Prognost. The quotation prefixed to this work in the 
editions of Vander-linden and Frobenius, in which Galen is stated to have held this 
work not to be genuine, is admitted by Littre to be of no authority. 

^ Morb. Diuturn., i, 4. 



SECT, ri.] HIPPOCRATIC TREATISES. 71 

j^enerally is. All this might, no doubt, be accounted for, upon 
the supposition that the work was addressed to the general 
reader, and not to the professional. Other reasons might be 
imagined, to account for the diversity of style and matter, but 
these I shall not occupy time in discussing, as I have decided 
upon giving a translation of it, so that the English reader may 
be enabled to judge for himself as to its genuineness. Whether 
the tract in question be the work of Hippocrates, or, as some 
have supposed, of his philosophical friend Democritus,'^ there 
can be little or no doubt that it is a production of that age, for 
it appears to me that their contemporary, Plato, has evidently 
made reference to it. Thus, in that portion of his ' Timajus' 
which treats of the causes of diseases, he clearly seems, in ac- 
counting for epilepsy, to have had in view the doctrines con- 
tained in this treatise. For although he uses the term " sacred 
disease,^' and applies "most divine," as an epithet to the cavities 
{ventricles?) of the head, he still, in imitation of the author of 
this work, accounts for the disease upon natural causes, that is 
to say, from derangements of the pneuma and phlegm.^ 

XXIII. Ilfpt (^vdMv — On Airs. 

This treatise deserves, in many respects, to be put in the 
same category as the last ; that is to say, it is generally admitted 
by the ancient authorities, but rejected by the modern. Thus 
it is noticed as genuine by Erotian and Galen, and by Gregory 
Nazianzeu and Stobseus.^ On the other hand, Mercuriali, 
Le Clerc,^ Haller, Gruucr, Ackerman, and Kiihn reject it. 
M. Littre, also, in deference to the opinion of later critics, re- 
fuses it a place in his list of genuine works, but, at the same 
time, expresses himself dovd)tfully on this point. Le Clerc, 
although, as we have stated, he inclines to the opinion of those 
who reject it, does not hesitate to declare, " that this book, upon 
reading it, seems to be one of the most rational and coherent 
of all Hippocrates's works." And I in so far agree with Le 
Clerc, that the contents of it are of great importance for the 
right understanding of the ancient theory of medicine, whether 

' See Menage in Diogen. Laert,, p. 241. 

- See § G6, torn, vii, p. 359 ; ed. Bekker. 

^ See all these authorities as quoted by Ackerman. 

' Hist, de la Mod., i, iii, 4. 



72 PRELIMINARY DISCOURSE. [sect. it. 

we refer the tract in question to Hippocrates or not. I shall 
now give a summary of the doctrines contained in it, which I 
must say appear to me to smack rather of the school of philo- 
sophy, than of the practical good sense for which the author 
of the First and Third Epidemics, and of the Prognostics, is so 
remarkable. 

The author sets out with stating "that there are certain 
arts which are of laborious acquisition, but are profitable to 
those who practise them ; of general utility to the common 
people, but painful to those who exercise them. Of such a 
nature is the art of medicine. The physician contemplates 
dreadful things (Sftva), comes in contact with what are un- 
pleasant, and reaps sorrow to himself from the afflictions of 
others ; but the sick are freed from the greatest e\als by the 
art, namely, from diseases, pains, sorrow, and death ; for medi- 
cine has been found decidedly to be a cure for all these. In 
the manual parts of medicine (surgery) practice is necessary. 
For in all that relates to manipulation, usage is the best teacher. 
But with regard to the most obscure and difficult diseases, a 
judgment is to be formed rather from opinion than art; and it 
is in such cases that experience differs much from inexperience. 
And it is a most impoi'tant consideration to determine what is 
the cause of diseases, and what the beginning and fountain- 
head, as it were, of the evils in the body ; for if one be ac- 
quainted with the cause of the disease, he may be able to apply 
the suitable remedies to the aftections of the body, judging of 
diseases from their contraries : for this mode of cure is that 
which is most in accordance with nature. Thus, for example, 
hunger is a disease ; for whatever afflicts man is called a dis- 
ease. What, then, is the cure of hunger ? Whatever will allay 
hunger, that is to say, food, and by it the other is to be cured. 
Again, drink cures thirst ; and, moreover, evacuation cures re- 
pletion, and repletion evacuation, and rest labour, and labour 
rest ; and, in a word, the contraries are the cure of contraries. 
For medicine consists of addition and subtraction — the sub- 
traction of what is redundant, and the addition of what is 
deficient. And he that does these things best, is the best 
physician; and he that is most removed from this system, is the 
most removed from a knowledge of the art. The manner of 
all diseases is the same, but they differ in place; and hence 



SECT. IT.] IIIPPOCRATIC TREATISES. 73 



diseases appear to have no resemblance to one another, owino- 
to the diversity and dissimilarity of situations. For there is 
but one form (tS/r;) of all disease, and the cause is the same. 
What that is I will attempt to explain in the following dis- 
course. The bodies of men and of other animals are nourished 
by three kinds of aliment, namely, food, drink, and airs ; and 
those winds in the body are called spirits, which are named 
airs out of it. This it is which exercises the greatest power 
over the symptoms, and it is worth while to attend to the 
power of it ; for the wind is a current and stream of air. 
When, then, much air makes a strong current, trees are torn 
from their roots by the force of the blast, and the sea is raised 
in billows, and ships of immense size are tossed aloft. Such 
power it possesses, and yet it is invisible to the sight, and is 
manifest only to the understanding. And what would there 
be without it, and from what thing is it absent ? and with 
what is it not present? For the whole space between the 
earth and heaven is full of air, and it is the cause of winter 
and of summer; in winter becoming condensed and cold, and 
in summer mild and tranquil. The path also of the sun, moon, 
and stars is through air — for air is the pabulum of fire, and 

fire deprived of air could not live And with regard to 

the sea, that it contains a portion of air is ol3vious to everybody. 
For water-animals could not exist if they did not participate in 
the air ; and how could they participate in it otherwise, except 
by means of the water, and by drawing in the air along with 
it. And the moon's foundation is upon it, and this it is which 
supports the earth,^ and nothing is void of it. And why the 
air is possessed of such power in other things has been now 
stated ; but in men this is the cause of life, and of disease to 

' It may appear a singular idea that tlie earth is supported on air, and yet it was 
very generally held hy the learned men of antiquity. The poet Lucan thus alludes 
to this doctrine : 

" Dum terra fretum terramque levabit 
Aer." Pharsal., 1, 89. 

And in like manner Ovid: 

" Nee circumfuso pendebat in aere tellus 
Ponderibus librata suis." Met., I, 11. 

Bentley remarks, in his note on the passage in Lucan, " Omnis poetarum chorus 
hoc praedicat ut et philoSophorum veterum." 



74 PRELIMINARY DISCOURSE. [sect. ii. 

those who are in ill health. And all bodies stand so much in 
need of air^ that whereas if deprived of everything else, such 
as food and drink, a man may subsist for two, three, or more 
days ; if the passage of air into the body be stopped, he will 
perish in a short part of a day, so necessary is air to the body. 
And, besides, there is some intermission of every other opera- 
tion which men perform, for life is full of change; but this 
operation alone li\dng animals perform incessantly, sometimes 
inspiring, and sometimes expiring. That all living animals, 
then, are closely connected with air has now been shown. 
After this we must forthwith declare what infirmities probably 
arise in an especial manner from this source — when it is re- 
dundant or deficient in quantity, or when polluted with morbific 
miasmata it enters the body. That diseases are the offspring 
of air I will show from the most common of all diseases, I 
mean, fever ; for this disease accompanies all others, and most 
especially inflammations. This is well illustrated by the acci- 
dents which befall the feet ; for along with the inflammation 
a bubo and fever speedily supervene. There are two kinds of 
fever (that I may touch upon that subject) ; the one common to 
all, which is called the plague, and the other being connected 
with vitiated food in those who use it. The air, then, is the 
cause of both these. A common fever (epidemic ?) therefore is 
such, because all draw in the same breath (pneuma)." The 
author afterwards attempts an explanation of the phenomena 
of rigors, which, however, is not very intelligible, and then of 
the febrile heat and sweats which succeed them. The latter 
he compares to the condensed steam of boiling-water. He 
afterwards proceeds to explain that Avhen the blood is mixed 
up with vitiated air (gases?), it occasions diseases in various 
parts of the body ; for example, pain in the eyes, when it fixes 
there; when in the ears, the disease is seated there; when in 
the nose, coryza is the consequence ; and when in the chest, 
bronchus (bronchitis ?), and so forth. To the same cause he 
ascribes the origin of dropsy, namely, to the prevalence of airs, 
and the melting down of the flesh. He also accounts for the 
formation of apoplexy, by supposing that it arises from the 
flesh of the parts being filled up with gases ; and in the same 
way he explains the origin of epilepsy very elaborately, and 
most ingeniously, but at too great length to suit my limits in 



SECT. 11.] HIPP0CR.4TIC TREATISES. 75 

this place. Altogether the treatise is one of the most inter- 
esting pieces of medical philosophy which has come down to 
us from antiquity. It shows very decidedly what a talent for 
dealing with abstract ideas the ancient Greeks were endued 
with. 

XXIV. Ilepl roTTotj' T(j)i' KciT avd^ioTTov — On the Places in Man. 

The ancient authority in favour of this treatise is pretty 
strong. It is included in Erotian^s list^ is quoted by Cielius 
Aurelianus/ and by HuflFus Ephesius/ and is incidentally 
noticed by Galen in two places of his Glossary.^ That it is 
further quoted by Athenoeus^as stated by Gruuer and Ackerman, 
would appear to me to be a mistake.*' It is admitted to be 
genuine by Le Clerc, Schulze, Haller, Triller, Sprengel, Zuinger, 
Petersen, and others. It is rejected, however, by Lemos, 
Mercurialij Duret, Reinsius, Gruner, and Ackerman. M. 
Littre does not venture to assign it a place among the genuine 
treatises, and yet he evidently inclines to the opinion that later 
critics had rejected it on very doubtful grounds, and leaves the 
question undecided. The following summary of its contents 
will show that it is not destitute of valuable matter. 

The author of it commences with announcing this important 
physiological principle, which microscopical observations on the 
development of the chick have amply confirmed : '' It appears 
to me that in the body there is no beirinuing, but that all 
parts are alike beginning and end; for in a described circle 
no beginning is to be found. ^^ He goes on to remark that, in 
consequence of this, diseases affect the whole body ; that when 
seated in the dry parts of it they are more permanent, but 
when in the fluid, more changeable j that one part of 
the body imparts disease to the other parts, namely, the 
stomach to the head, and the head to the stomach ', and that if 
the very smallest part of the body suffer, it Avill impart its 
sufferino; to the whole frame. He afterwards enters into a 



*» 



' Morb. Clirou., i. - Corp. Human. Appell., ii, 1. 

^ See under Siqpiov and icpr]p,v6i. 

* They refer apparently to Deipnos, ii, 7, where Athenjeus quotes a treatise of 
Hippocrates Trepl totvmv, but he evidently means by it the work ' de Aere, Aquis, 
Locis.' It is to be borne in mind that Athenfeus often makes his references in a 
loose manner. 



76 PRELIMINARY DISCOURSE. [sect. ii. 

lengthened anatomical description of the parts of the body 
which, although quoted by Galen, i and not unfavorably noticed 
by Gruner,^ cannot now command much interest. He then 
describes seven defluxions from the head, namely, to the nose ; 
to the ears ; to the eyes ; to the chest — producing empyema 
and phthisis ; to the spine — producing another species of 
phthisis [tabes dorsalis?); to the fleshy parts — inducing dropsy; 
and to the joints — occasioning ischias and kedmata [morbus 
coxarius?). All this seems very hypothetical, and does not 
appear to savour of the strict process of induction which we 
remark in the genuine treatises of Hippocrates. When the 
disease is seated in the head, he directs numerous and deep 
incisions to be made in the scalp, down to the bone. He 
notices pleurisy, and its termination in empyema; the latter, 
he further remarks, may originate in ruptures [sprains?), and 
in this case, on succussion, an undulatory sound may be heard. 
He also states decidedly that empyema forms in phthisical 
persons, and that, in their case, too, a sound like that of water 
in a bladder may be heard on succussion. The symptoms 
accompanying empyema are given \erj graphically. He also 
describes the tabes dorsalis. He afterwards gives the treatment 
of j)leurisy and pneumonia, in which it is remarkable that no 
mention is made of venesection, notwithstanding that, in the 
work ' On Regimen in Acute Diseases,^ Hippocrates recom- 
mends bleeding ad deliquium in these diseases ; and Galen 
accounts for his silence respecting venesection in his treatment 
of fevers on the supposition that he did not notice it, because 
he took it for granted, as a general rule, that the operation was 
performed.^ This consideration, as much as any other, inclines 
me to doubt the authenticity of this treatise. Ischiatic disease 
he directs to be treated by cupping-instruments and heating 
medicines, administered internally. Anasarca, in a young 
person, he treats by scarifications. In the brief notice of 

• De Facult. Natur., ii. - Censura Libr. Hippocrat., p. 115. 

3 Comment, in Epidem., ii, 3. See also Le Clerc, Hist, rle la Mert., iii, 17; and 
Sprengel, Hist, de la Med., torn, i, p. 325, &c. A passage, which we shall see below, 
in the Prognostics {§ 15) puts it beyond a doubt that venesection was part of the 
routine of pi-actice pursued by Hippocrates in cases of pneumonia. See also (and 
this passage is very decisive) de Diaeta in Morb. Acut., § 5 ; and Galen's Commentary, 
pluries. 



SECT. II.] HIPPOCRATIC TREATISES. 77 

injuries of the head here introduced, much tlie same views are 
advocated as in the work on that subject, of which a trans- 
lation is given in this volume. The treatment of callous ulcers, 
as here laid down, is deserving of great attention, " remove the 
indurated parts by a septic medicine, and then produce reunion 
of the parts." Every practical surgeon must recognise this as 
a very sound and important rule of practice. 

The treatment of suicidal mania appears singular : — " Give 
the patient a draught made from the root of mandrake, in a 
smaller dose than will induce mania." He also, in like manner, 
recommends mandragora in convulsions, applied by means of 
fires lighted around the patient^s bed. Pains of the head he 
directs to be treated by opening the veins of the temples, or by 
applying the cautery to them. He then insists, in strong 
terms, that, under certain circumstances, purgatives will bind 
the bowels, and astringents loosen them. And he further 
makes the important remark that, although the general rule of 
treatment be '^ contraria contrainis curantur," the opposite rule 
also holds good in some cases, namely, " similia similibus 
curantur " It thus appears that the principles both of Allo- 
patliy and Homoeojicithy are recognised by the author of this 
treatise. In confirmation of the latter principle, he remarks 
that the same substance which occasions strangury will also 
sometimes cure it, and so also with cough. And further, he 
acutely remarks, that warm water, which, when drunk, gene- 
rally excites vomiting, will also sometimes put a stop to it by 
removing its cause. He estimates successful and unsuccessful 
practice according to the rule whether the treatment was rightly 
planned or not ; for he argues what is done in ignorance cannot 
be said to be correctly done, even if the results are favorable. 
The work concludes with a short passage on the diseases of 
women, all of which are said to be connected with the uterus. 
We find here the first mention that is anywhere made of the 
globus hystericus ; indeed, I do not remember to have met with 
the term in any of the ancient medical works, Avith the excep- 
tion of the Hippocratic treatises. He recommends fetid tilings 
to be applied to the nose, and aromatic and soothing things to 
the genital organs. The process of fumigating the uterus is 
fully described ; and likewise suppositories and pessaries are 
mentioned. In the treatment of uterine hemorrhage the rules 



78 PRELIMINARY DISCOURSE. [sect. ii. 

here laid down are most important. All heating things, 
diuretics, and purgatives are to be avoided; the foot of the 
patient's bed is to be raised, and astringent pessaries are to be 
introduced. 

My own opinion of the work may now be given in a few 
words. It undoubtedly contains much valuable matter, which 
would be no discredit to Hippocrates, nor to any of the greatest 
medical authorities, whether of ancient or modern times. I 
desiderate in it, however, a proper unity of design, and think I 
see too much of a speculative disposition to suit with the 
character of the Coan sage. That it is to be referred to the 
Cnidian school, as suggested by Gruner, seems doubtful; for, 
as we are informed by Hippocrates himself, the Cnidian phy- 
sicians only gave the most obvious symptoms, while their practice 
was very inert, consisting entirely of drastic purgatives, whey, 
and milk, whereas in this work the diagnostic symptoms are 
more profoundly stated than they are in most of the Hippo- 
cratic treatises, and the practice, in many instances, is very 
bold and decided. The knife, the actual cautery, the use of 
strong purgatives and narcotics, are freely recommended in 
various diseases. Altogether, then, although I would hesitate 
to ascribe the present work to Hippocrates himself, I must 
admit myself inclined rather to refer it to the Coan than the 
Cnidian school. I see no proper data, however, for forming a 
decided opinion on this head, more especially as we are but \erj 
imperfectly acquainted with the tenets of the Cnidian school.^ 

XXV. Ylepl Ti-^vTjQ — On Ai't. 

This treatise is sustained as genuine by Erotian, and even by 
one of the older commentators, Heraclides of Tarentum, but it 
is nowhere noticed by Galen, and Suidas would appear to refer 
it to Hippocrates, the son of Gnosidicus.^ Mercuriali, Gruner, 
Haller, Ackerman, Kiilin, and most of the modern authorities 
hold it decidedly to be spurious. Foes and Zuinger, however, do 

' The strongest argument in favour of its being a production of the Cnidian 
school is the mode of treating pneumonia here laid down, which certainly in so far 
agrees with what Galen says of Cnidian practice in such cases, namely, that those 
authorities omitted bleeding and purging. See Opera, torn, v, p. 87. 

- See under 'iTnroKpuTTjg. The meaning of the passage, however, is somewhat 
doubtful. 



SECT. II.] HIPPOCRATIC TREATISES. 79 

not object to its authenticity; and Littre, although he exckides 
it from his Hst of the genuine works of Hippocrates, admits that 
it is very ancient, and formed a portion of the Collection from 
the commencement. To me it appears that it is written in too 
subtle and abstract a style to admit the supposition of its being 
the work of a practical physician like Hippocrates. Although 
it contains a good deal of original thought, there is not much 
in it which would prove interesting to the medical reader of 
the present day. It is an elaborate defence of the art of 
medicine against the attacks of those who maintain that it is 
no art at all, or one of an uncertain nature. According to the 
author's definition, the aim of the physician should be to 
remove the pains of the sick, to blunt the intensity of diseases, 
and not to interfere with those that are mastered by disease, as 
knoM'ing that medicine can be of no avail in such a case. In 
conclusion, I shall merely remark that the evidence, both internal 
and external, is against the supposition of its being genuine; 
but still there appears no good reason for doubting that it 
emanated from the school of Cos. 

XXVI. m^l StfuVr/c — 0?i Rerjimen. 

The evidence in favour of this large and interesting work, 
unfortunately, is by no means strong. It is passed by unno- 
ticed by Erotian, and Galen expresses himself, in general, 
regarding the work in very equivocal terms, mentioniug that 
some had referred it to Euryphon, some to Phaon, others to 
Philistion, and others, again, to Aristo.^ In other places, how- 
ever, he expresses himself less unfavorably as to the authenticity 
of the last two books, Haller, Gruner, Ackerman, Kiihn, and, 
in fact, nearly all the modern authorities, reject it." M. Littre, 
although he agrees with them, remarks justly that the work is 
one of great value, and exhibits many evident traces of confor- 
mity with the writings which are truly Hippocratic. 

The nature of the work is as follows : The first book is 
altogether made up of abstract principles, which savour ^ery 
much, of the dogmata, of. Heraclitus. Thus, the author of it 
holds that there are in men, and in all other animals, two 

' Comment, in Lib. Vict. Acut., i, p. 43 ; ed. Basil. 

^ Zuinger, however, stands up for its genuineness. nipj)ocratis Vigenli duo 
Comment., &(!., p. SSG. lie gives a most elaborate analysis of it. 



80 PRELIMINARY DISCOURSE. [sect. ii. 

priucipleSj different in power but consentaneous in use, namely, 
fire and water ; that these together are sufficient for all others, 
and for themselves ; that the one contains the principle of 
motion, and the other of nutrition ; that these give rise to the 
separate existence of seeds and animals, of all varieties, shapes, 
and characters ; that, in reality, none of those things which 
exist either perish or are created, but they are altered by being 
mixed together and separated from one another, but that men 
suppose that the one passes from Hades to light, and the other 
again from light to Hades. In a word, the contents of the 
first book savour more of philosophy than of practical medicine. 
For example, it is said, " The trainers of the athletse instruct 
their pupils in this manner — to break the law according to law, 
to commit injustice according to justice ; to deceive, to steal, to 
rob, to commit violence, in the most elegant and disgraceful 
manner : he who cannot do these things is bad, he who can do 
them is good ; which is a proof of the folly of the many who, 
when they behold these things, decide that the one of these is 
good and the others bad. Many wonder, but few are judges. 
Men going to the market proceed thus : they deceive one 
another in buying and selling, he who deceives most is admired. 
They execute these things — they drink and become mad, they 
run, they wrestle, they fight, they steal, they cheat ; the one is 
preferred to all the others. Hypocrites and deceivers ! Before 
the spectators they sa}^ one thing, and think another.' The 
same persons creep out, and they creep in not the same per- 
sons ; to one man they say one thing, and do another; the same 
person not always the same — sometimes he has one mind, and 
sometimes another. In this manner all the arts have commu- 
nion with human nature.^' All this is too fanciful and recondite 
for the physician of whom Celsus says, " primus ex omnibus 
memoria dignis ab studio sapientiee disciplinam banc separavdt.^^ 
It is clearly the production of a philosopher and not of a practical 
physician, such as we know Hippocrates to have been. The latter 
part of this book, however, is of a more practical nature, and 
treats of many things relating to regimen and dietetics, such as 
the arrangement of meals, of exercises, &c. 

' These dreamy views of human life look very much like an anticipation of the 
Fourierism of the present day. So true is the hackneyed saying, " there is nothing 
new under the sun ! " 



SECT. II.] IlIPPOCRATIC TREATISES. 81 



The second book is a regular work on Dietetics, and exhibits 
this branch of medicine iu a more advanced state than might 
have been expected, considering the time it was written. 
After some prehminary observations on climate, which bear 
a great resemblance to those contained in the treatise ' On 
Airs,' &c., the anthor treats, in a very scientific and methodical 
manner, of the various animal and vegetable substances which 
are used as articles of food. It concludes with a discussion on 
certain matters connected with regimen, such as exercises, 
baths, sleep, and so forth. Foes remarks that a great portion 
of the opinions advanced by Celsus on the head of Dietetics is 
borrowed from this book. 

The third book treats again of various subjects connected 
with Dietetics, such as exercises, the arrangement of meals, the 
administration of emetics, the use of venery, and the like. It 
is full of important matter, but looks like a distinct trea- 
tise from the two preceding books, for one cannot conceive 
that the author of one work would have twice resumed the 
consideration of the same subjects. Le Clerc, with consider- 
able appearance of reason; ascribes the book to Herodicus, the 
master of Hippocrates in the gymnastic art.^ 

Altogether, the work is one of the highest importance in medi- 
cal literature, whether -we ascribe it to Hippocrates or not. On 
this point the evidence, both external and internal, we have seen 
to be very inconclusive. The most probable conclusion that can 
be drawn regarding it is, that the work is a compilation of 
important documents from a variety of sources, but who the 
compiler was, whether Hippocrates or one of his successors 
cannot be determined.^ 

XXVII. Hf^t kwrrviiuv — On Dreams. 

This little work is generally admitted to be a continuation of 
the preceding one, and consequently stands upon much the 

' Hist, de la Med., i, iii, 13. 

^ Hippocrates, in his treatise ' On Diet in Acute Diseases,' says decidedly that the 
ancients — that is to say, his predecessors — had written nothing of any value on the 
subject of Dietetics (§ 1). From this we may infer that the present work was not 
known in his days ; for it can scarcely be supposed that he would have spoken so 
disparagingly of it. 

G 



82 PRELIMINARY DISCOURSE. [sect. ii. 

same grounds as regards its authorship.^ As Le Clerc and 
Gruner have well remarked, it is written with much acumen, 
and evinces great freedom of spirit, and exemption from popular 
errors and superstitions. It commences in the following strain : 
" He who forms a correct judgment of those signs which occur in 
sleep, will find that they have a great efficacy in all respects ; 
for the mind is awake when it ministers to the body, being 
distributed over many parts ; it is not then master of itself, 
but imparts a certain portion of its influence to every part of 
the body, namely, to the senses, to the hearing, seeing, touch, 
walking, acting, and to the whole management of the body, 
and therefore its cogitations are not then in its own power. 
But when the body is at rest, the soul, being in a state of 
movement, steals over the organs of the body , manages its own 
abode, and itself performs all the actions of the body ; for the 
body, being asleep, does not perceive, but the soul, being 
awake, beholds what is visible, hears what is audible, walks, 
touches, is grieved, reflects, and, in a word, whatever the ofiices 
of the soul or body are, all these the soul performs in sleep.^ 
Whoever, then, knows how to judge of these correctly, will 
find it a great part of wisdom. But with regard to such dreams 
as are divine, and prognosticate something, either good or evil, 
to cities, or to a particular people, there are persons who have 
the art of judging of them accurately, without falling into mis- 
takes. But such affections of the body as the soul prognosti- 
cates, namely, such as are connected with repletion and 
evacuation, from the excess of customary things or the change of 
unusual things, on these also persons pronounce judgment, and 
sometimes they succeed, and sometimes they err, and under- 
stand neither how this happens, that is to say, how it comes 
that sometimes they are right, and sometimes they fall into 
mistakes ; but warning people to be upon their guard lest some 
mischief befall them, they do not instruct them how to guard 
themselves, but direct them to pray to the gods ; and to offer 
up prayers is no doubt becoming and good, but while praying 

' Galen quotes it as a portion of the work on Diet. See Opera, torn, v, p. 377 ; 
ed. Basil. 

- This idea is well explained and enlarged upon by Alexander Aphrodisiensis. — Probl. 
i, 118. This writer must not be confounded with the commentator on Aristotle. 



SECT. II.] HIPPOCRATIC TREATISES. 83 

to the gods a man ouglit also to use his own exertions. Witli 
regard to these, tlien, the matter stands thus : Such dreams as 
represent at night a man's actions through the day, and exhibit 
them in the manner in which they occurred, namely, as per- 
formed and justly deliberated, these are good to a man, and 
prognosticate health, inasmuch as the soul perseveres in its 
diurnal cogitations, and is not weighed down by any repletion, 
evacuation, or any other external accident. But when the 
dreams are the very opposite to the actions of the day, and 
when there is a conflict between them — when this happens, I 
say, it indicates a disorder in the body ; when the contrast is 
great, the evil is great, and when the one is small, the other is 
small also.'' For the cure of this state, as being connected 
with repletion, he recommends evacuation by vomiting, active 
exercise, and a restricted diet. The author of the treatise pro- 
ceeds to state the signification of dreams which relate to the 
sun, moon, and stars, of which the last are said to be connected 
with the external parts of the body, the sun with the middle, 
and the moon with the cavities. This is the nearest approach 
to alchemy which I have met with in the works of any of the 
ancient physicians. But I must not proceed much fiu'ther 
with my extracts from. this work, which there is no reason to 
suppose a genuine production of Hippocrates, and the substance 
of which would not much interest the general reader nowa- 
days, when the interpretation of dreams has been entirely 
abandoned by the profession. The work concludes as follows: 
" He who observes these rules as laid down by us will be 
healthy through life. . . . The regimen, also, as far as it was 
possible for a man to find it out with the assistance of the gods, 
has been expounded by me.'' This looks like the conclusion of 
a large work, and gives probability to the supposition that this 
treatise originally formed a part of the work ' On Diet,' as 
stated above. ^ 

It would appear that this work, although little regarded 
now, was highly esteemed two hundred years ago, for we find 
that the celebrated Julius Csesar Scaliger wrote an elaborate 
commentary on it.^ On the ' Oneirocritica,' see further Vaiider 

' Zuinger points out a striking mark of the connexion between it and llie work 
On Diet:' op. sup. laud. p. ,549. 
2 Amstcl., IG.'iS. 



84 PRELIMINARY DISCOURSE, [sect. ii. 

Linden, ' Manucluctio ad Medicinam/ who refers to this treatise 
of Hippocrates, and also to the works of Scaliger, Ferrer, and 
Cardanus on the same subject. The only other ancient writers 
on this svibject which have come down to us are Artemidorus, 
Achmet, Astrampsychus, and Nicephorus.^ The work of 
Artemidorus is an elaborate production on the interpretation of 
all sorts of dreams ; and to the sober judgment of the present 
generation it cannot but be regarded as a memorable instance 
of the misapplication of human intellect and industry. The 
whole subject of the ' Oneirocritica/ however, may well deserve 
the serious consideration of the most learned philosopher, as 
affording a most striking and lamentable proof how prone men, 
even of cultivated minds, are to view things exactly in the light 
in which they fancy them to exist. This truth is most strik- 
ingly illustrated by the work of Artemidorus, who first gives 
the theory, as it were, of dreams, and in the last book relates 
particular instances in confirmation of the principles pre\iously 
laid down by him. No one, assuredly, can rise from the perusal 
of such a work without being strongly impressed with the great 
truth embodied in our author's first aphorism, " Experience is 
fallacious, and decision is difficult." The ' Oneirocritica' of 
Achmet is the work of an Arabian, and is interesting as con- 
taining all the superstitious notions of the Orientals, that is to 
say, of the Persians, Egyptians, and Indians, on this subject. 
Allusion is also made to the dreams recorded in the Jewish 
Scripture. The author sets out with declaring that, from the 
interpretation of dreams, one may acquire a certain foreknow- 
ledge of all the casualties of life, namely, of life or death, of 
poverty or riches, of disease or health, of joy or sorrow, of 
victory over one's enemies or defeat, and this with far greater 
accuracy than from astronomy (astrology ?), for that astrono- 
mers differed much in opinion among themselves, whereas about 
the interpretation of dreams there could be no doubt ! ! 

The following list of writers on the ' Oneirocritica' previous 
to Artemidorus will show the attention which had been paid to 
this subject in verv early times : Artemon jNIilesius, Antiphon, 
Apollodorus Tellmissensis, Apollonius Atalensis, Aristander 
Telmissensis, Ai'istarchus, Alexander jM^Tidius, Cratippus, 
Demetrius Phalereus, Dionysius Rhodius, Epicharmus, 

' Oneirocritica, &c. Lutetiae, 1G03. 



SECT. II.] HIPPOCRATIC TREATISES. 85 

Geminus Tjrius, Hermippus, Nicostratus Eplicsius, Phoebus 
Antiocbenus, Pbilocborus, Panyasis Halicarnessensis, Serapioii^ 
Strabo. Mighty names once on a day ! Now they arc but 
'' the dream of a shadow !"i 

XXVIIL n^pl TiaQiLv —On Affections. 

This treatise being passed over in silence hy Erotian, and 
rejected as unworthy of Hippocrates by Galen, althougli he 
acknowledges that it contains many fine things,^ has been 
generally regarded as spurious by modern critics, as for 
example, Poes, Haller, Gruner, Ackerman, Littre, Greenhill, 
and others. The w^ork is carefully Avritten, but seemingly 
without a plan, or any well-defined object. It touches, in 
general terms, on most of the diseases to which the human 
body is subject, and concludes with some general observations 
on regimen. All diseases are said to be derived from phlegm 
or bile. This seems very unlike the etiology of diseases as laid 
down in the true Hippocratic treatises. Pleurisy is to be 
treated by purgatives and soothing applications, but without 
any mention of bleeding. The termination of the disease in 
empyema is described. The symptoms of pneumonia are also 
given in brief but striking terms. The sputa, at first, are said 
to consist of phlegm, and are thick and pure, but on the sixth 
and seventh day they become somewhat bilious and sublivid. 
This disease is also said to terminate in empyema. Some of 
the general observations contained in this Avork are deserving of 
attention. Of all diseases the acute are the most painful and 
the most fatal, and they require the greatest care and the most 
accurate treatment. No additional mischief should, at all 
events, be inflicted by the physician, but he must do the patient 
as much good as lies in his power ; and if the physician treats 
the case properly, and the patient sinks under the weight of 
the disease, it will not be the physician^s fault ; but if, Avliilc 
the physician does not treat nor understand the disease properly, 
the patient fall a victim to the disease, the physician will then 
be to blame. In treating ileus, Avhen a clyster fails to relieve 
the bowels, they are to be inflated by means of a bladder 
attached to a pipe, and then the pipe is to be removed, and 

' S/ciac ovap dvOpoiiroi. Find. Pyth., viii. 
^ Comment, in Libr. dc Diact. Acut., i. 



86 PRELIMINARY DISCOURSE. [sect. ii. 

a clyster immediately injected, in wliich case, if the bowels 
admit the clyster, tliey will be opened, and the patient will 
recover, but if otherwise, he will die, especially on the seventh 
day. The treatise further contains some very interesting 
remarks on the causes and varieties of dropsy. When the water 
is not otherwise removed, an incision is to be made either at 
the navel, or behind at the loins. It deserves to be mentioned 
that, in this treatise, there are frequent references to a work of 
the author's ' On Medicines.' Whether it wSs the same as the 
treatise bearing that title which we possess cannot be deter- 
mined. In the course of the work, the use of the cautery is 
freely recommended for the cure of diseases. 

From the account which we have given of this treatise, and 
the paucity of evidence in favour of its genuineness, it will 
readily be understood that we have no hesitation in deciding 
that it is not one of the genuine productions of Hippocrates. 

XXIX. Uepl Ttov evTuq Tra^wi/ — On Internal Affections. 

This treatise has but little ancient authority in support of it. 
Erotian has omitted it in his list of the works of Hippocrates ; 
Palladius does not mention it ; and Galen notices it in a con- 
fused manner under a variety of titles.^ Foes, Schvilze, and 
others, have referred it to the Cnidian school ; and if this point 
could be made out satisfactorily, it would give the treatise a 
remarkable degree of interest, as fiu'nishing us with a key to 
the opinions of one of the oldest sects in medicine. That the 
reader may be enabled to form his own opinion in this matter, 
we will now give a brief outline of its contents. 

The work commences with a short description of hseraoptysis, 
which is said to originate either in ulceration or rupture of an 
artery of the lungs, the ordinary causes of which are held to 
be severe exercise, falls, blows, violent vomiting, or fevers. 
The symptoms are pretty well described, and a mild system of 
treatment recommended. Inflammation of the lungs is said 
to be produced principally by drinking wine, and an immoderate 
indulgence in eating mullets and eels. The treatment at first 
is like what we have described the Cnidian system to have 
been, consisting of milk, emetics, and purges ; but if these 

' Tom. V, pp. 306, 614, &c. ; cd. Basil. 



SECT. II.] HIPPOCRATIC TREATISES. 87 

do not answer, the actual cautery is to be applied to the breast. 
Erj^sipelas of the lungs is described in much the same terms as 
at ' De Morbis/ i, 13 ; ii, 53.^ A correct description is given 
of empyema as connected with tubercle of the side, for which 
draughts are recommended, with broth made from poppies^ &c. 
When matter forms, it is to be let out either by the kuife or 
the cautery.^ Three species of phthisis are described, the first 
being derived from phlegm, the second from violent labour, 
and the third being the tabes dorsalis. The treatment in all 
these affections appears to be very empirical, and unlike the 
usual therapeutics of Hippocrates. Four diseases of the kidneys 
are described, of which the first is calculus, and the second 
abscess, in which case the writer recommends an incision to 
be made, in order to furnish an outlet to the pus. Now, it is 
deserving of remark, that, of all the ancient authorities which 
have come down to us, Ruffus Ephesius would appear to be the 
only other author who makes mention of this practice.^ The 
author of the treatise states, that if the matter of the abscess 
find vent by the intestinum rectum the patient may recover. 
The disease altogether, he adds, is troublesome, and in many 
cases ends in renal tabes. He most probably here alludes to 
what is now called Bright^s disease. From disease of the 
kidneys is said to arise an affection of the vense cavpe, which 
run from the head near the jugulars, along the spine to the 
malleolus externus. He says it originates in bile and phlegm 
which collect in the veins. Varices, I suppose, are here meant 
to be described. If not cured by purging with hellebore and 
scammony, the actual cautery is to be applied at the shoulders, 
below the scapulse, at the hip- joint, at the middle of the thigh, 
above the knee, and at the ankle. Now it is deserving of 
notice, that this disease is not mentioned by subsequent authors 
on medicine, so that we are warranted in concluding that the 
treatise vias not looked upon by them as being a production of 
the Great Hippocrates ; for if it had been so regarded, we are 

' See the Syd. Soc. edition of Paulus ^'Egineta, Vol. I, p. 264. 

2 Galen, by the way, mentions that Euryphon, the celebrated Cnidiau physician 
in the days of 'Hippocrates, was in the practice of treating empyema with the actual 
cautery.— Comment, in Aphor., vii, 44. This is a strong confirmation of the opinion 
that this treatise must have emanated from the Cnidiau school. 

^ See the Svd. Soc. edition of Paulus /Egineta, Vol. I, p. 354. 



88 PRELIMINARY DISCOURSE. [sect. it. 

sure that Galen, Aretseus, Celsus, and all the worthies of the 
Arabian school, ■would not have overlooked this description. 
And, moreover, the description of the disease from first to last 
is vague and prolix, being the very reverse of that graphic style 
of delineation which we find in the genuine works of Hippo- 
crates : and yet the work contains other matters of a difi'erent 
stamp. For example, treating of dropsy, the author says it is 
sometimes connected with tubercles of the lungs, which get 
filled with water, and burst into the chest. In proof of this, he 
appeals to observations on cattle, sheep, and swine, which are 
said to be very subject to these tubercles (phymata) ; and he 
argues that men are still more Hable to them. And in many 
cases, he adds, empyema originates in tubercles. In that case, 
when the collection protrudes externally, he directs that an 
opening should be made in it; but if not, he directs the patient 
to be shaken by the shoulders, when the sound of the fluid 
within will be heard. When the side in which the greater 
collection is situated has been ascertained, he recommends us 
to cut down to the third rib from the last, and then make a 
perforation with a trocar^ {rpv-rravM TpvyXr^Tvpiw), so as to give 
vent to a small portion of the fluid ; the opening is then to be 
filled with a tent, and the remainder evacuated after twelve 
days. Four species of icterus are described : these would ap- 
pear to be febrile aflections. Five varieties of typhus are next 
noticed in rather vague terms ; there can be little doubt that 
they were all cases of remittent fever. Several varieties of a 
disease which is called morbus crassus are described with much 
prolixity, and so vaguely, as not to convey to us a distinct idea 
of the disease. He says of two of the varieties, that they last 
for six years. Unless these were varieties of elephantiasis (and 
we have no evidence of its existence so early), I am at a loss 
to comprehend what disease is alluded to. The treatise con- 
cludes with an account of three sj)ecies of tetanus. 

From the analysis now given of its contents, it will be 
readily seen that this work abounds in interesting matter, but 

' I presume it was the rib itself that was perforated, and not the intercostal 
space. The term rpvwavov was generally applied to the trepan.. The epithet 
rpvy\7]TT}piov, or, as Foes proposes to read it, TpoAocvTi'jpwv, is probably derived 
from TpioyXi], a hole, and oi'^w, to penetrate ; joined together, they would signify a 
trepan for boring holes. 



SECT. II.] HIPPOCRATIC TREATISES. 89 

that, at the same time, it is clearly of a different stamp from 
what we find in the genuine works of Hippocrates, nay, that 
in all probability it does not belong to the Coan school. In 
conclusion, I have, then, to state that I think the presumption 
of its being a production of the Cnidian school is very strong. 

XXX. Hepl vovacov — On Diseases. 

A work with this title is cited by Erotian, Caelius Aurelianus,^ 
and by Galen,^ but so confusedly that we must come to the 
conclusion regarding these Books, that the ancient authority 
in support of their genuineness is by no means satisfactory. 
Galen evidently inclines to the opinion of Dioscorides the 
Commentator, that the Second Book is the work of the younger 
Hippocrates, that is to say, of a grandson of our author. 
Almost all the modern authorities, as, for example. Foes, Haller, 
Ackerman, Gruner, and Littre, concur in rejecting the whole 
four as spurious. The Fourth Book in particular is separated 
by M. Littre from the other three, as being a portion of the 
work ' On the Diseases of Women,^ rather than of the work 
' On Diseases.^ We shall be better enabled to speak decidedly 
on this and the other questions regarding the authenticity of 
these books, when we have examined the nature of their con- 
tents. 

After a very striking exordium, in which it is stated that 
the first object of him who turns his attention to the healing 
art should be to consider the causes of disease, and the natural 
tendencies of every one of them, that is to say, of their dis- 
positions to death, or to loss of parts, the author proceeds to 
deliver his doctrine as to the causes of them, which he assumes 
to be either internal, namely, bile and phlegm ; or external, 
such as labour, wounds, and excess in heat, cold, dryness, and 
humidity. The following accidents are said to be mortal : a 
wound of the brain, of the spinal marrow, of the liver, of the 
diaphragm, of the l)]adder, of a large blood-vessel, or of the 
heart. He ranks the following as fatal diseases : phthisis, 
dropsy, and, Avhen they attack a pregnant woman, pneumonia, 
causus, pleurisy, phrenitis, and erysipelas of the womb. The 
issue of the following is set down as doubtful in ordinary cir- 
cumstances : pneumonia, causus, phrenitis, pleuritis, quinsy, 

' Morb. Acut., iii, 17. ^ De Humor., Comment, in VI Epidem. 



90 PRELIMINARY DISCOURSE. [sect. ii. 

enlargemeut of the uvula^ hepatitis, splenitis, nephritis, dysen- 
tery, menorrhagia. The following are not deadly : chronic 
defluxions on the joints (/ctS^iiaTa), melancholy, gout, ischiatic 
disease, tenesmus, quartan and tertian fevers, strangury, oph- 
thalmy, leprosy, lichen, arthritis; yet even from these patients 
often become maimed in particular members, such as in the 
limbs from arthritis, or in the eyes from ophthalmy. Diseases 
also have a tendency to pass into one another, as, for example, 
pleurisy into causus, phrenitis into pneumonia, tenesmus into 
dysentery, and lientery ; and pleurisy, and pneumonia into em- 
pyema. He makes the following curious observations on the 
awkward mistakes which a physician may commit in the prac- 
tice of his profession : not to know when there is matter in an 
abscess or tubercle ; not to ascertain the existence of fractures 
or dislocations ; having probed the head in case of injury 
thereof, not to ascertain that there is a fracture of the skull ; 
not to be able to introduce an instrument into the bladder, nor 
to be able to ascertain whether there is a stone in it or not ; 
in the case of empyema, not to ascertain the existence of matter 
])y succussion ; and in using the knife or cautery, to apply 
either of them to too great or too small an extent. The 
treatise also contains many other general observations, which 
are very ingeniously stated, as, for example, the following 
enumeration of the untoward accidents w^hich may occur to a 
medical practitioner : Having administered an emetic for the 
purpose of evacuating bile or pldegm upwards, to induce rup- 
ture of a vessel by the act of vomiting, although the patient 
had previously been sensible of no pain in the region ; having 
given an emetic to a woman with child, to induce abortion in 
consequence ;, in curing empyema, wdien looseness of the bowels 
is superinduced, and cuts off the patient; in applying an oint- 
ment for a disease of the eyes, when acute pains supervene, 
which end either in rupture of the eye or amaurosis, the phy- 
sician in such a case gets the blame for having ajjplied the 
ointment ; and when a physician gives anything to a woman 
in labour on account of pains in the bowels, and the woman 
gets worse or dies, the physician incurs censure. And in 
diseases and injuries, when there is a necessary succession of 
bad symptoms, the physician gets the blame, as men do not 
perceive that the aggravation of the symptoms is a necessary 



SECT. 11.] HIPPOCRATIC TREATISES. 91 

consequence of the nature of the disease. And if a physician 
visits a patient in fever, or who has met witli an injury, and 
if the patient gets worse after the first medicine that is ad- 
ministered, the physician is blamed ; whereas he does not get 
the same amount of credit if the patient improves, as the 
amendment is attributed to the nature of the case. This book 
contains what I beheve is the most circumstantial detail of the 
phenomena of empyema that is to be met with in any ancient 
work on medicine. The author ascribes the disease principally 
to three causes : to the termination of pneumonia, to a de- 
fluxion from the head, and to the consequences of a ruptured 
vessel. Whoever is acquainted with the modern literature of 
the subject, or possesses a practical knowledge of the disease, 
will not fail, from the accompanying description of the last of 
these, to recognise a case of cavity of the lungs produced by 
the ulceration of tubercles. True empyema, however, as the 
result of chronic inflammation, is also described in distinct 
terms. The never-failing test by succussion is constantly ad- 
verted to in these cases. Distinct mention is also made of the 
7-dIe, by which the existence of matter in the lungs is ascer- 
tained. Allusion is probably made here to the well-known 
gurgling sound produced by matter in a cavity. There is a 
good deal of other important matters in this book, but these 
my necessary limits oblige me to pass over unnoticed. I shall 
merely allude to the distinct mention which is made of ruptures, 
by which was meant a severe sprain or other injury ending in 
suppiu'atiou, or protracted pains in the part. Fever is said to 
be formed in this manner : when bile or phlegm is heated, the 
whole of the body is heated, and they are heated either by 
internal things, such as food or drink, or by external, such 
as labour, wounds, excess of heat or cold ; also from the sight 
or hearing, but rarely from these. In the treatment of pneu- 
monia, venesection in the arm is recommended. Altogether 
this book contains much valuable matter, but mixed up with 
hypothesis in a way not usually met with in the genuine works 
of Hippocrates. 

The second book, at the verv commencement, betravs a 
strong disposition to diagnosis^ Eight diseases at the head are 
described, but in such terms that we fail to recognise the dis- 
tinguishing features of each. Besides these, a little way further 



92 PRELIMINARY DISCOURSE. [sect. ii. 

on the author describes several other diseases of the liead, in- 
cluding In'drocephalus, the symptoms of which are given Avith 
great precision, namely, acute pain about the bregma and 
temples, alternate rigor and fever, impairment of the sight, 
double vision, vertigo, &c. He recommends errhines, purga- 
tives, and even trepanning of the skull. Even of this disease 
several varieties are described in very striking terms -, so that 
for once at least we are tempted to question the correctness 
of the judgment which Hippocrates pronounced against the 
rival school of Cnidos, for cultivating diagnosis to an undue 
extent. 

Several varieties of quinsy are likewise described, including 
various diseases of the parts about the fauces, and among them 
the disease named hypojjlottis, by which appears to be meant 
an abscess below the tongue, attended with swelling of that 
organ. Five varieties of polj^pus nasi are next described, and 
suitable plans of treatment recommended, namely, with the 
ligature, the knife, and the cautery. Pleurisy and pneumonia 
are described, and their termination in empyema, the symptoms 
of which are circumstantially described again ; and, moreover, 
three varieties of it are noticed. Here, again, we find mention 
made of the diagnostic method, by succussion, and a recom- 
mendation of the operation of juiracentesis tho7-acis, to evacuate 
the fluid. Next are described several varieties of phthisis, in- 
cluding the tabes dorsalis, of which a curious description is 
given. An interesting account is also given of spermatorrhoea. 
The treatment consists in abstinence from immoderate drinking, 
venery, and excessive exercises, except walking, for a year, 
avoiding cold and the sun, and taking the tepid bath. The 
description of the varieties of pulmonic disease is most interest- 
ing, although some of them are not sufficiently well defined. 
Hydrothorax is also described, and paracentesis recommended 
in the treatment of it. After describing lethargy, which was 
clearly a species of remittent fever, he gives descriptions of cer- 
tain diseases, under the names of morbus resiccatorius [avav-r']), 
Febris mortifera, Lividus morbus, morbus ructus ciens, and 
morbus pituitosus. No one can fail to recognise in these de- 
scriptions the spirit of the Cnidian school of medicine, and one 
very different from that of Hippocrates. Indeed we have 
positive authority for referring this work to the Cnidian school, 



SECT. II.] HIPPOCRATIC TREATISES. 93 

for Galen assigns the description of tlie morbus Iwidiis to the 
Cnidian physician Euryphon.^ The author describes a singular 
species of melancholy, which, he says, is sometimes epidemic 
in spring ; he calls it cura, morbus gravis. It appears to have 
beeu a variety of the lycanthropia. See Paulus 7Egineta,III,16. 
The hook concludes with a description of two species of niehena, 
and of spli.acelotes, the latter being a variety of the other. Now 
what strikes one in going over this book is, that it cannot be 
a portion of the same work as the First Book, for we cannot 
conceive it probable that an author would have treated twice 
of the very same subjects in one work. Moreover, as we have 
stated, there are evidently many things in it which are not at 
all in accordance with the principles of the Coan school. 

In the third book very much the same ground is again gone 
over as in the two preceding books. In the first place, diseases 
of the head are described under the names of tumor cerebri, 
plenituclo cerebri dolorem inferens, sydere icti, sphacelismus, le- 
thargus (then intervenes a brief account of Febris ardens, quite 
out of place), of dolor capitis, nnd phrenitis. Afterwards comes 
a description of cynanche, and paracynanche, next of icterus, 
and afterwards of tetanus, for the cure of which the author 
recommends the cold affusion. (On the merits and demerits 
of this practice, see the English edition of Paulus ^Egineta, 
III, 20.) For ileus, as in a preceding book, among other modes 
of treatment, it is directed to inflate the bowels by means of a 
pipe and bladder, and then to evacuate their contents with a 
clyster. Afterwards, pneumonia and pleurisy are most circum- 
stantially described, and the treatment of them laid down with 
a degree of prolixity very unlike the usual manner of Hippocrates. 
Thus, to promote the expectoration in pleurisy, he recommends 
the flos seris, assafoetida, trefoil, pepper, &c.^ I am not aware 
that any other ancient authority recommends these medicines 
for the cure of this disease. The symptoms and diagnosis of 
empyema as the consequence of pleurisy, are given in much the 
same terms as in the preceding book. Succussion is particularly 
alluded to. For empyema, burning and incision are recom- 

' Opera, torn, v, p. 456 ; ed. Basil. 

- The silphiuni, indeed, is mentioned among the remedies for this case in tlie 
treatise ' On Regimen in Acute Diseases' (7), but not tlie other articles. 



94 PRELIMINARY DISCOURSE. [sect. ii. 

mended. In performing paracentesis, he forbids all the matter 
to be evacuated at once. Altogether, a perusal of this book 
leads me to the positive inference that it is not the production 
of the same author as the two preceding books ; for what could 
induce the author to go over the same ground three different 
times in one work ? 

The fourth book is manifestly the production of a different 
author from the others, indeed, as appears evident from the 
conclusion of the work, it is continuous with the treatise ' On 
the Nature of Women. ^ It commences with an elaborate dis- 
cussion on the four humours, blood, phlegm, water, and bile, 
from which all diseases are said to derive their origin. The 
whole book is tinged with the exposition of this doctrine ; indeed 
all the contents of it are for the most part hypothetical, and 
very unlike the matter contained in the genuine compositions 
of Hippocrates. From first to last there is no well-defined 
description of disease in it. The observations on lumbrici and 
calculus are the portions of it which command the greatest 
interest, 

I shall now briefly recapitulate the conclusions which I am 
prepared to draw from a careful examination of the contents of 
this work. 1. As the same diseases, for example, pleurisy, 
pneumonia, and empyema, are all circumstantially treated of in 
each of the first three books, it is impossible to suppose them all 
portions of the same work, or even the productions of the same 
author. 2. In the fourth a different hypothesis is advanced 
from that which is laid down in the first, and from this cir- 
cumstance, joined to many other considerations already enume- 
rated, there can be no doubt that it is the production of an 
entirely different author. 3. Although all parts of these books 
contain abundance of valuable materials, many of the principles 
and rules of practice which are developed in them are not akin to 
those of Hippocrates, but rather savour of the Cnidian school, 
which trusted too much to a fanciful diagnosis, instead of culti- 
vating prognosis as the basis of its system, like the school of 
Hippocrates and his followers. 4. The internal evidence in the 
present instance against their genuineness, more than counter- 
balances the small amount of ancient authority which there is in 
support of these books. 



SECT. 11.] HIPPOCRATIC TREATISES. 95 

XXXI. Ilspl ETTTa/zr/'vou — On the Seven Months' Birth. 

XXXII. Iltpi oKTainrivov — On the Eighth Months' Birth. 

Although the genuineness of these two works is admitted hy 
Galen^ and by Foes," they are not looked upon as the produc- 
tions of Hippoci'ates by almost any other of the autliorities, 
whether ancient or modern, and in particular, Palladius, Acker- 
man, Gruner, Littre, and Greenhill reject them. Yet all admit 
them to be of very high antiquity, so that, in this respect, they 
are not destitute of considerable interest. The contents of 
them are altogether of a philosophical nature, and such as we 
might expect the school of Democritus to produce. The author 
of them holds that foetuses born at the seventh month survive, 
but not those of the eighth. It is clear that he was imbued 
with the Pythagorean notions regarding the mystical power of 
the number seven .^ Altogether, the style and matter of these 
treatises do not appear to me to accord well with the spirit 
which prevails in the true Hippocratic works, but at the saine 
time it must be admitted that the preponderance of authority 
for or against their authenticity is not decided.^ 

XXXIII. 'Emdnniov, |3', g', e, Q, t—The 2d, Uh, Wi, 6th, and 
7th Books of the Epidemics. 

With the exception of Erotian, who admits the whole of the 
seven books of Epidemics into his list of the works of Hippo- 
crates, I am not aware that any of the authorities, ancient or 
modern, recognise them as genuine. Galen says that the 
seventh is allowed by all to be spurious ; that the fifth is the 
work of Hippocrates, the son of Draco, that is to say, of a 
grandson of the great Hippocrates ; and that the second, fourth, 
and sixth were held by some to be the productions of a sou of 
Hippocrates, and by some they Avere looked upon as having 
been written, indeed, by Hippocrates himself, but merely as 
notes or commentaries. Galen himself inclines to the opinion 
that these four books are the production of Thessalus, the son 
of Hippocrates.^ 

' Ad Epiclem., vi, 6, 27. * Hippocrat. Opera, i, p. 318. 

^ The opinions on this subject are given very fully by Aulus Gellius. Noctes 
Attiese, iii, 10. 

'' I should mention that Zuinger pronounces, without the slightest hesitation, in 
favour of their genuineness: op. sup. laud. pp. 188, l!)i). 

'■ De Difficult. Rospir., ii, 8 ; ibid., iii, 1. 



96 PRELIMINARY DISCOURSE. [sect. ii. 

From what has been stated respecting these books, it will be 
clearly seen that, although there is no reason whatever to sup- 
pose they were published by Hippocrates, it is, at the same 
time, highly probable that he had something to do with the 
composition of them, and that, at all events, they emanated 
from the school upon which his name has cast so much 
splendour. I think myself, therefore, called upon to give a 
condensed view of their contents; and in doing so, I shall not 
scruple to avail myself of the very important annotations made 
on them by M. Littre, in his recent edition of this portion of 
the Hippocratic treatises. 

With regard to these books, in general, he observes that 
they are naturally divided into two groups, the one containing 
the second, fourth, and sixth books, and the other the fifth and 
seventh. The correctness of this division is quite evident from 
a comparison of the contents of the different books, and, to a 
certain extent, it is recognised by Galen.^ 

As to the locality of these observations, M. Littre shows that 
the spot of their greatest activity is Thessaly and Thrace, 
although mention of Athens, and of certain cities of the 
Peloponnesus occasionally occurs. He traces with much 
minuteness the connexion of these books with the other works 
in the Hippocratic Collection. For example, he shows the 
connexion between those in the first group, with the 'Aphorisms,' 
in particular, but also with the treatises, ' On Airs,' &c., 
'The Mochlicus,' 'The Surgery,' &c., and of those in the 
other group, with the work ' On Wounds of the Head' in 
particular. I will now offer a few remarks on the contents of 
each of these books. 

M. Littre, in his argument prefixed to the second book, 
treats of various matters contained in it, the most interesting 
of Avhich is his elaborate disquisition on the nature of the 
carbuncles (ai'0po/c£c) described in his book, during the course 
of which he brings into review various collateral passages from 
the works of subsequent authors, and discusses the question at 
considerable length whether or not they apply to smallpox. 
I am free to admit that it would have been to my advantage 
if I had seen this part of the writings of M. Littre before 

' Comm. Epid., vi, 2, 15. 



SECT. II.] HIPPOCRATIC TREATISES. 97 

piling my commentary on Paulus ^gineta, B. IV, 25. I 
must he permitted to snj, liowevei', that I see no reason for 
changing my opinions with regard to the anthrax of the Greek 
writers on medicine. I certainly cannot agree with M. Theod. 
Kauser, in setting down the ancient descriptions of the anthrax 
and plague (\oifiog) as applying to the smallpox. Having 
diligently studied the minute descriptions which the ancient 
medical authors give of the different varieties of cutaneous 
disease, I am confident that if the smallpox had actually 
existed in their days, they would not have passed over the 
disease with a vague and casual notice, but would have given 
us such a sketch of its appearances that no one could have 
failed to recognise its features. The carbuncles, then, which 
are incidentally mentioned by Hippocrates at the beginning of 
this book, I am disposed to look upon as one of those anoma- 
lous phases of disease which are every now and then making 
their appearance, and I cannot persuade myself that they had 
anything to do with smallpox. 

Among the important matters contained in this book may be 
noticed the remarks on deposits, an interesting subject, often 
alluded to in the Hippocratic treatises, § 7. At § 2.2 a case is 
obscurety noticed, which M. Littre concludes, but upon very 
slight grounds, to have- been a case of purulent infection. At 
§ 24 spontaneous hixation of the cervical vertebrae is described, as 
M. Littre, in his argument, remarks, with admirable judgment. 
It is also alluded to at ' Aphoris.^ iii, 26, and ' De Articulis,^ 
torn, iv, p. 179, ed. Littre. This aifection, which came afterwards 
to be overlooked, has been redescribed of late years. In the 
third section there is given an interesting account of causus, 
the remittent fever of hot climates, so admirably described 
afterwards by Aretaeus. The fourth section is occupied with a 
description of the veins of the body, which is certainly con- 
fused, and yet we find in it the distinction between the nature 
of the arteries and veins clearly pointed out. It is curious, 
moreover, that Galen, in one place, stands up for this part as 
being genuine and accurate.^ See also b. v, § 46. The last 
two sections treat professedly of physiognomy, but contain 
other detached and unconnected observations on medical sub- 

' Opera, loin, v, p. 21 ; ed. Basil. 



98 PRELIMINARY DISCOURSE. [sect. ii. 

jects. Altogether, the impression which a careful perusal of 
this book conveys to one is, that it is a compilation of the most 
incongruous matters, strung together without any plan ; hut, 
at the same time, one cannot fail to detect in it traces of no 
contemptible talent for observation and description. 

The fourth book, of the whole number, is the one which is 
written with the least unity of design. Yet, as M. Littre 
remarks, it is interesting as containing the history of an epide- 
mical causus, complicated with jaundice and ophthalmia, which 
would appear to have been very similar to the febrile epidemic 
which prevailed in Scotland a few years ago. With this 
opinion I entirely acquiesce, after having had a good deal of 
experience in the treatment of that epidemic. It was decidedly 
of the remittent type, was frequently accompanied with jaun- 
dice, and the patients were very subject to relapses aud affections 
of the eyes.^ For Hippocrates's description of it see tom. v, 
p. 169, ed. Littre. M. Littre also makes the important remark 
that, of late years, proper attention has not been paid to the 
state of the urine at the epoch of a crisis in fevers. He mentions 
that M. Martin Solon holds that, at the resolution of diseases, 
the urine is apt to become albuminous ; but that, in a true 
crisis, the precipitate is generally composed of urate of ammonia, 
M. Zimmerman found the urinary deposit composed of the urate 
of ammonia, with the triple phosphates and the crystals of uric 
acid. Certain observations on this critical deposit occur in this 
book of the Epidemics, but they are met with more frequently 
and more distinctly expressed in the genuine books, I mean 
the first and third. It appears to me most remarkable that the 
important observations made l)y Hippocrates on the state of the 
urine in febrile diseases should have been lost sight of in an age 
when the chemical characters of the urine have been so much 
studied ; for I am fully satisfied, from m}^ own practical acquaint- 
ance with fevers, that in most cases the febrile crisis is marked by 
a copious sediment in the urine. An interesting case of empyema, 
which was treated by the cautery, is related at § 4. A case is 
related at §19 of a singular aff'ection of the mouth in two children, 

' See a series of papers in illustration of it, published in the Medical Gazette for 
the year 1847, by Dr. Wardel. On one point I cannot agree with this writer; he 
says, the fever was of a continued character, whereas in all the cases which I met 
with it was decidedly remittent. 



SECT. II.] HIPPOCRATIC TREATISES. 99 

attended with necrosis and exfoliation of the bones. At § 39 
there is a case of metastasis of purulent matter from the hand 
to the lungs. At § 11 a case is related of a child who sus- 
tained an injury in the head from another child^ was tre- 
panned, and died on the twenty-fourth day. We shall see in 
the work ' On Injuries of the Head' that the ancients were very 
free in the application of the trepan to the skull. Cases of 
nyctalopia are alluded to at § 52, and at § 58 a case is related 
of mania supervening on the cure of hemorrhoids. But, upon 
the Avhole, the most interesting part of this book is that which 
contains the narratives of febrile cases, and the remarks on 
relapses, § 28. 

Though the fifth and seventh books of the Epidemics are 
pronounced by Galen to be unworthy of the Great Hippocrates, 
they contain detached observations of much interest, insomuch 
that Haller was almost disposed to admit the genuineness of 
the fifth. Lemos and Mercuriali, on the other hand, hold 
them to be wholly removed from all connexion with the genuine 
remains of Hippocrates. It is remarkable, however, that the 
fifth is referred to by Celsus,^ Quintilian," and Plutarch.'' 
This, in fact, is the book which contains the memorable passage 
in which the author admits, that in a case of injury of the 
head he mistook a fracture for a suture of the skull,* and for 
this candid admission Hippocrates is highly lauded by the authors 
we have just quoted.' The Hippocratic treatises also contain 
many other instances in which the author admits having com- 
mitted mistakes. How much might the medical art not have 
advanced before this time, if the example thus set of recording 
for the benefit of posterity, the mistakes which one conmiits 
had been more generally followed ?'' The first paragraph con- 

' VIII, 4. 2 institut., Orat. iii. 

=* De Perfect, in Virt. M 27. 

"^ It cannot but appear singular that so distinguished a person as Robert Boyle 
should have found fault with Hippocrates for relating so many cases of which the 
issue was fatal. He says, " Revera penes me non parum Ilippocratis auctoritate de- 
cedit, quod in scriptis suis tot a;grotorum epiphonema ipsos mortuos esse legerem.'" — 
Exer. V, de Utilitate Philosoph. Exper., p. 192. On the other hand. Mart. Lister 
justly defends Hippocrates: "A me sane absit ilia quorundam uuperoruni seriptorum 
jactantia, qui nihil exhibent, nisi quod bonum eventuni habuit ; errorcs et infortuuia 
caute abscondunt, aliter autem nobis profuit magnus Hippocrates, apud (|ucm fere 
non nisi casus funesti occurrunt, ac si iidcm potioris doctrin;c cssent.'" — Excrcit. de 
Ilydrope. 



100 PRELIMINARY DISCOURSE. [sect. ii. 

tains the case of a woman who had fever and took medicine 
which did her no good; a hard swelUng, accompanied with 
severe pains, seized her below the navel, which were removed 
by strongly rubbing in oil with the hands, after which she 
had a copious disch;;rge of blood downwards, and recovered. 
M. Littre, from a comparison of this passage with Epidem. ii, 
6, 26; iv, 45, 56, draws the conclusion, that reference is 
here made to the practice of compressing the bowels Avith the 
hands in cases of ileus, for which Praxagoras, the master of 
Herophilus, is censured by Cselius Aurelianus.^ At § 9 
there is the case of a man affected with prurigo^ and a 
condition of the skin resembling leprosy, which nobody 
could remove. He then went to the hot baths in the island 
of Melos, and was cured of his cutaneous affection, but soon 
after became dropsical and died. In § 10 there is related a 
case of cholera, treated with hellebore, which produced great 
evacuations upwards and downwards, and the patient recovered. 
This mode of practice is animadverted upon byCfelius Aurelianus. 
(Morb. Acut. iii, 20.) § 12th contains an instructive history of 
headache in a woman, which nothing relieved but free men- 
struation, and afterwards conception. At § 15, there is a 
very interesting case of necrosis or caries at the hip-joint, for 
the relief of which a large incision was made down to the 
bone and the cautery applied ; on the eleventh day tetanus 
supervened, and proved fatal on the eighth day afterwards, 
although treated by embrocations, fomentations, and strong 
purgatives. The author remarks in conclusion, that the patient 
would have lived longer, if the purgative medicine had not been 
administered. At § 16 there is a case of injury of the head, 
where the surgeon at first sawed the bone down to the diploe, 
a practice alluded to in the treatise ' On Injuries of the Head,^ 
§ 21. In this case erysipelas came on, and yet the patient 
recovered. It is to be regretted that the text here is in a 
corrupt state. At § 18 there is a case of pregnancy in Avhich 
the administration of a strong purgative was followed by fatal 
results. At § 20 there is related a case of hemorrhoids, 
seemingly mali moris, which proved fatal in consequence of 
an operation having been performed upon them. § 24th 
contains the history of a case of hsemoptysis, which ended in 
phthisis. The author makes the shrewd remark that the 

' Acut. Morb., iii, 17. 



SECT. II.] HIPPOCRATIC TREATISES. 101 

patient was indisposed before the vomiting of blood commenced. 
I may here remark, how well this accords with the doctrine of 
Louis, that hemoptysis is rather the consequence than the 
cause of tubercular disease. At § 38 there is another case of 
haemoptysis in which the patient was choked by a large quantity 
of blood which he was bringing up ; the spleen also, in this 
case, was aifected, and there were bloody discharges down- 
wards. This book contains a great A^ariety of serious cases 
connected with accidents. At § 50 is a fatal case of concus- 
sion of the brain. At § 74 there is a fatal case of tetanus 
supervening upon a slight injury of one of the fingers; and in 
the following section there is a case of tetanus arising from a 
strain of the thumb and proving fatal. In the next section 
there is a case of fatal tetanus from the injudicious healing of 
a sore on the leg. 

Though Galen refuses to sustain the sixth book as genuine, 
he has written an elaborate comraeutary upon it, and mentions 
at the commencement that commentaries had been written 
upon it before his time by Zeuxis of Tarentum, the Erythraean 
Heraclides, and before them by Bacchius and Glaucias. It 
is a large work, being divided into eight different sections, 
which have little or no connexion with one another. Upon 
the whole, as M. Littre remarks, the most interesting portion 
of it is the part in which are described the phenomena 
attending an epidemic cough, or influenza, which reigned in 
Perinthus. See § vii. It broke out in winter about the 
solstice, and was preceded by great changes of the winds. 
There was a great tendency to relapses, and it was further 
complicated with pulmonic afl*ections, nyctalopia, angina, 
paralysis, &c. It was observed, that any member which was 
much exposed to fatigue was the part most liable to be attacked. 
Ail these complications occurred in the relapse, raid never in 
the original attack. Women were less liable to be affected 
than men, the reason of w^hicli is supposed to have been, that 
they do not expose themselves so much to the air as men do. 
In women, too, all the attacks were mild; but in the men some 
were mild and others fatal. When a febrile rigor supervened, 
the attack speedily Avas mortal. The usual remedies were 
tried, namely, purging, venesection, bleeding by the ranal 
vein, and emetics ; but none of them did any good, M. Littre 



102 PRELIMINARY DISCOURSE. [sect. ii. 

remarks, that in the course of his reading he has never met 
"with an example of an epidemic exactly resembling the one 
here described. It is, therefore, an interesting picture of a 
disease not otherwise known. The sixth section begins with 
the announcement of the physiological doctrine so frequently 
quoted with approbation, namely, that " the fleshy parts 
attract both from the bowels and from without, and that the 
whole body inspires and expires." This doctrine is fully ex- 
panded and illustrated in an interesting volume by Abraham 
Kaau.^ The fifth section opens with another philosophical 
tenet, which Sydenham often quotes with approbation, naraety, 
that " Nature is the physician of diseases." " Nature," the 
w^riter adds, " although untaught and uninstructed, does what 
is proper." Galenas Commentary on this passage contains 
much interesting matter, and is a fine specimen of the medical 
philosophy of the ancients." 

The seventh book, as we have already remarked, is closely 
allied to the fifth. Galen pronounces it to be universally 
condemned as being spurious, and of more recent origin than 
the others; but Littre, although of course he does not stand 
up for its genuineness, justly contends that it is replete with 
valuable matter. Grimm holds, from the nature of its con- 
tents, that it must have derived its origin from the C nidi an 
school, whereas the fifth sprung from the Coan. I must say, 
however, that I cannot see any good grounds for this opinion. 
According to M. Littre, it is a recueil of particular facts 
superior to anything of the kind left to us by antiquity, and 
such that its equal can scarcely be found in modern times. 

' Perspiratio dicta Hippocrati. 

^ By Nature, the ancient philosophers understood an immaterial principle diffused 
through all the works of creation, that is to say, an internal principle of motion and 
of rest, which presides over the growth and nourishment of all substances. It is 
well defined by Aristotle in different parts of his works. See De Anima, ii, 4 ; and 
Auscultationes Naturales, pluries. That truly learned and ingenious author Bishop 
Berkeley, in his ' Siris,' describes nature as being mind so fuddled with matter as to 
have lost its consciousness. Probably, the distinction between a material and im- 
material principle as the cause of the vital phenomena was not so well understood 
until after Plato and Aristotle had cultivated mental philosophy with so great suc- 
cess ; for, as we shall see in the next section, Hippocrates seems to identify mind 
with heat, that is to say, he confounds the cause of motion and of change with its 
first instrument, or co-cause {(rvvdiTiov). 



SECT. II.] HIPPOCRATIC TREATISES. 103 

Tlie cases being for the most part of an isolated nature and 
not susceptible of any arrangement, it is not possible within my 
narrow limits to give any general idea of the contents of this 
book. I shall be content, therefore, with a very few extracts 
as a specimen of it. It opens with two very interesting cases 
of fever, accompanied with sweats, which were treated mildly 
by purgatives and clysters, and terminated favorably. It 
strikes me as singular in reading these cases, that the cha- 
racters of the urine are not distinctly given, as in the cases 
related in the first and third Epid. All that is said on this 
score is, that "the urine was like that of chronic diseases.^^ 
The tenth is a case of ardent fever proving fatal by intestinal 
hemorrhage. Some of the fatal cases of dropsy following 
fever are very instructive, as §^ 20, 21. Two cases of empyema 
(so they are marked by M. Littre) would appear to have 
been phthisis with cavities in the lungs. In both, mention is 
made oi rales. See §§ 26, 27, and also 93, 107. In the 
29tli and six following sections there are reports of cases of 
severe Avounds. Apparently they must have occurred in the 
time of war. The 3Gth, 37th, and 38th, are cases of tetanus 
supervening upon very slight wounds. A good many cases 
of phthisis are reported, as at §§ 49, 50, 51 ; in the last of these 
the pectoral rales are particularly noticed. In the 49tli the 
disease is ascribed to the woman having been injured by 
succussion in order to procure the expulsion of the after- 
birth. (On this case see the interesting remarks of M. Littre, 
torn. V, p. 359.) At § 52 are the cases of two children who died 
of disorder of the bowels, complicated with an affection of the 
head, as indicated by their constantly pressing on the part with 
the hand ; and it is remarked, that after death there was a 
hollow in the seat of the bregma. Every experienced phj'sician 
must have met with such cases. M. Littre refers an illus- 
tration of the disease here treated of to an analysis of a 
work by M. Elssesser, in the ' Archives Generales de JNIedecine,^ 
March, 1815, p. 31G ; on ramollissement of the occiput. The 
cases of phrenitis, here related, are eAddently febrile afl'ections, 
as at §§ 79, 80. At § 102 a case is related in which serious 
symptoms supervened on the eating of a raw mushroom. The 
patient being treated by emetics and the hot bath, recovered. 
At § 121 is related the case of a person who had convulsive 



104 PRELIMINARY DISCOURSE. [sect. ii. 

laughter couuected, as was supposed, with a wound of the 
diaphragm. 

And now, ha\dng concluded my review of these Books of 
Epidemics, I will venture to affirm, without fear of contra- 
diction, that when we look to the importance and rarity of the 
matters contained in them, the work, even at the present day, 
is perfectly unrivalled. That the books are the composition 
of different hands must be admitted, but altogether the con- 
tents of them bear the imprint of the mind and spirit of 
Hippocrates, and e^dnce a talent for the cultivation of medicine 
which has never been surpassed. What a noble people the 
Greeks must have been in the days of Themistocles and 
Pericles ! 

XXXIV. He^i ^v^iwv — On the Humours. 

It must be admitted that there are few treatises in the 
Hippocratic Collection which unite such a concurrence of high 
authorities,both ancient and modern, in their favour as this work, 
and yet there seems good reason for joining the later critics 
in refusing its claims to be received as genuine. In favour 
of it may be quoted Erotian, Palladius, and Galen, among the 
ancient, and Foes, Zuinger, and Haller, among the modern 
authorities. Against it are ranged several of the older autho- 
rities, namely, Zeuxis, Heraclides, and Glaucias, some of whom 
refer it to a younger Hippocrates, some to Thessalus, others 
to Polybus, and others again to Democritus.^ Accordingly, the 
highest modern authorities, as INIercuriali, Gruner, Ackerman, 
Kiihn, and Littre, refuse to receive it into the list of genuine 
works ; and the last of these seems to make it out pretty 
clearly that the treatise is composed of detached observations 
extracted from the other Hippocratic works. After repeated 
perusals of it, what strikes myself is, that it bears a close re- 
semblance to the treatise ' On the Surgery,^ that is to say, 
that it is a recapitulation of the conclusions arrived at in certain 
of the other works of Hippocrates. Perhaps, then, it must be 
admitted that there is some inconsistency in allowing the one 
a place among the genuine works of Hippocrates, and refus- 
ina; the similar claims of the other. That the work in 



*o 



' Sec the references given by Gruner, Ackerman, and Littre. 



SECT. II.] HIPPOCRATIC TREATISES. 10.5 

question contains a most interesting summary of what M^erc 
regarded, in ancient times^ as great medical truths, cannot be 
doubted. From the condensed form in which the subject 
matters of it are presented, it will readily be apprehended that 
they do not well admit of being given in the form of an 
abstract, and that any specimens of its contents will afford but 
a very imperfect idea of its value as a whole. I would remark, 
at the outset, that the title of the work, ' On the Humours,^ 
appears not very applicable, since very few of the paragraphs 
relate to the humours ; in fact, as already hinted, the treatise 
may be said to be a recueil of various observations gathered 
out of other works. I also feel at a loss to account for 
M. Littre^s disposition to rank it as the eighth book of the 
Epidemics, as it bears no resemblance either in form or matter 
to that Avork : the one consisting of isolated observations and 
of particular facts, and the other of general principles ; and 
the style of the one being comparatively full, whereas the 
other is remarkably succinct, so as to be nearly unintelligible 
in many places. Take the following as a specimen of it : 
" The earth is to trees Avhat the stomach is to animals ; it 
nourishes, heats, and cools ; cools when emptied, heats when 
filled, as the earth when manured is hot in winter, so is it with 
the stomach. ^^ This important observation, that the earth, in 
connexion with the vegetable productions, is analogous to the 
stomach in animals, is repeated by Aristotle and other of the 
ancient philosophers.^ The author makes the important remark, 
(§ 14,) that we ought to study the condition of the body pre- 
vious to the season in which the disease broke out ; in con- 
firmation of which INI. Littre, in his argument, gives some 
very interesting observations by M. Forster.^ In the paragraph 
on deposits, the author remarks, that in fevers attended with a 
feeling of lassitude, the deposits generally take place to the 
joints and jaws. It is afterwards stated — and if confirmed by 
experience, as I think I have observed it to be in many cases, 
it is an important remark — that " when the feet are hot, the 
depositions point downwards, but when cold, upwards." § 7. 
In § 1.2 diseases are thus classified : " with regard to the 
modes of diseases, some are congenital, as may be learned 

' See Musonius, Ap. Stobaei Sentent., xviii. It occurs frequently in Galen. 
^ Des Maladies de la France dans leurs Rapports avec les Saisons, p. I'.)3. Paris, 
1840. 



106 PRELIMINARY DISCOURSE. [sect. ii. 

upon inquiry ; some are connected with the nature of tlie 
locahty, (for many are affected^ and therefore many are ac- 
quainted with them) ; some Avith the condition of the body 
and the diet, the constitution of the disease, and the seasons. 
The localities which are ill situated in respect to the seasons 
engender diseases similar to the season ; in like manner, irre- 
gularities as to heat and cold in the same day when it has 
such eflects, produce autumnal diseases in the locality, and in 
the other seasons likewise. The diseases "which are engendered 
hy fetid and marshy w^aters are calculus and splenic diseases, 
and such are influenced by good or bad winds.^^ Altogether, 
as will be readily seen, it is a work of great ability, and will 
amply repay a diligent perusal. Galen esteemed it very much, 
and did not hesitate to declare that, not only Plato, Aristotle, 
and Theophrastus, but also several of the most distinguished 
medical authors had copied freely from it.^ 

XXXV. Tlepi )^pr/(7ioc uypwi' — On the Use of Liquids. 

This would seem to be the work which appears in Erotian^s 
list under the title of ' On Waters^ (tte^i v^ut(i)v) ; and, con- 
trary to what is stated by Foes and Gruner, it is quoted by 
Galen in two places -^ and it is further referred to by Athenseus, 
under the same title as that given to it by Erotian.® Foes pro- 
nounces it to be a mutilated work, and one which is wanting 
in many of the MSS. of the Hippocratic treatises ; and all the 
modern critics, from Lemos and Mercurial! down to Littre and 
Greenhill, regard it as spurious. Gruner speaks of it as being 
a ATork of little importance, and Ackerman as being a mere 
compilation from the Aphorisms.* Gruner further remarks, 1 
that the title does not suit w-ell with its contents, and this is \ 
in so far correct, for undoubtedly the title given to it by Erotian 
is more suitable, as it treats almost exclusively of the medicinal 
properties of waters; and this it certainly does in a fuller and 
more interesting manner than they are treated of in any other 
ancient, and, I may almost venture to add, any modern work 
with which I am acquainted. I look upon its contents, then, 

' Natural. Facult., ii, 8 ; de Placit. Plat, et Hippocvat., viii, 5. 
2 Opera, torn, v, pp. 257, 479 ; ed. Basil. 
' Deipnos, ii, 46. 

" Zuinger considers it in the light of extracts from the Note-book of Hippocrates 
(or Ilippocratea Adversaria). 



SECT. II.] HIPPOCRATIC TREATISES. 107 

as being extremely valuable, even as the work has come down 
to us, but it is to be regretted that the text is in a very un- 
satisfactory state. Water the author of the treatise recommends 
as a fomentation to the eyes, when applied with a sponge ; and 
further, as a general or local fomentation, for producing relaxa- 
tion of any part when contracted. When poured over the head, 
and other parts, it is said to induce sleep, is useful in convul- 
sions, and relieves pains of the eyes and ears. Cold water in- 
flames ulcers, except such as have a tendency to hemorrhage, 
and also fractures, luxations, &c. In applying water to the 
body, the author recommends the feelings of the patient to be 
consulted, unless he be in a state of paralysis or of stupor, or 
be suffering from exposure to great cold, or be in great pain. 
In these cases, he adds, the patient may be insensible, and in- 
stances have occurred of persons having their feet congealed 
by cold, which have dropped off upon the affusion of hot water. 
The immoderate use of hot water induces relaxation of the 
flesh}'- parts (muscles ?), weakness of the nerves, torpor of the 
understanding, hemorrhage, and deliquum animi, so as even to 
prove fatal ; and much cold water will occasion spasms, tetanus, 
lividity, and febrile rigors. The parts of the body which are 
usually covered endure the cold water worst, and are most re- 
freshed by hot. Cold water disagrees with the brain and its 
processes, the bones, the teeth, and the nerves ; and hence, it 
is added, con\Tilsions, distensions, and febrile rigors, which are 
induced by cold, are relieved by hot water. Hot water occa- 
sions delight and determination (to the skin ?) ; cold, on the 
other hand, pain and determination inwardly : wherefore the 
loins, the breast, the back, and the hypochondriac region, are 
injured by cold applications, but delight in warm. Cold water, 
thrown on the extremities, relieves lipothymia, the reason of 
which he states, but the text is so corrupt that I dare not 
undertake to translate the passage. Ulcers, excoriated parts 
of the body, and burns, bear cold ill. The extremities, the 
bladder, and the organs of generation, delight in warm water. 
Salt water is proper to itchy parts, and to parts aftected with 
pungent humours, but disagrees with burns, and abraded sur- 
faces. Vinegar is said to have much the same properties as salt 
water in the cure of these complaints. Warm water, in which 
salt has been melted, is beneficial in lichen, leprosy, alplios. 



108 PRELIMINARY DISCOURSE. [sect. ii. 

and other complaints of a like nature. The lees of vinegar 
[caustic potass ?) also answer in these cases. The astringency 
of cold water is increased by having beet leaves^ ivy^ bramble, 
sumach, sage, &c. boiled in it. Red pustules, like lentils, are 
benefited by cold things, but eruptions arising from cold, and 
resembling millet, are improved by hot. There are certain 
cases in which both hot and cold are applicable, such as gouty 
affections, and most sprains : in these, cold applications deaden 
the pain, axid warm soothe it. Indurations and ancyloses of a 
joint are to be removed by pouring warm water out of a vessel 
vipon it. Rheums of the eyes are relieved by rubbing them 
with some fatty substance, to obtund the acrimony of the tears. 
In pains, suppurations, pungent tears, and deep idcers of the 
eyes, hot water is most expedient ; when the eyes are merely 
red, and free of pain, cold is to be preferred. Cold does not 
agree with complaints of the rectum and uterus, nor with cases 
of bloody urine. Cold raises pain when it is applied to ulcers, 
hardens the skin, renders it painful, suppresses suppuration, 
renders parts livid and black, is injurious in febrile rigors, 
spasms, and tetanus. But, he adds, sometimes in a robust 
young man, in the middle of summer, when labouring under 
tetanus not connected with a wound, the affusion of cold water 
brings back the heat. (See Aphor. v, 21, and Paulus 
^GiNETA, B. Ill, 20.) Hot water does the same. It promotes 
ulceration in all cases, softens the skin, attenuates it, is anodyne, 
and soothes rigors, spasms, and tetanus, and removes heaviness 
of the head. It is most particularly applicable in fractures, 
when the bone is laid bare, and especially in injuries of the 
head. Hot water agrees with all ulcerations, whether innate 
or produced by artificial means, in herpes exedens, in blackened 
parts, and in diseases of the ears, anus, and womb. But cold 
water is inimical in all these cases, except when hemorrhage 
is apprehended. 

The above is a brief summary of the matters contained in 
this little treatise. That they are highly important, and evince 
an extraordinary talent for apprehending the true bearing of 
practical points in medicine, will hardly be denied by any 
person who is a competent judge. Many of the rules and 
observations contained in it are, no doubt, the same as those 
found in the Aphorisms (see Section v), but there is also no 



SECT. II.] HIPPOCRATIC TREATISES. 109 

lack of valuable matter iu it, which is not to be found elsewhere. 
Though I am disposed, then, to agree with the authorities who 
exclude it from the list of genuine works, I do not hesitate to 
declare it as my decided opinion, that it is not unworthy of the 
reputation of the great Hippocrates, and that, if not written by 
him, it must be the production of some person who thoroughly 
apprehended his high principles and discriminating views. How 
much, then, is it to be regretted, that this treatise should have 
come down to us in so mutilated a state that the meaning, in 
many places, can only be guessed at with considerable hesi- 
tation ! 

XXXVI. Uepl yovijg — On Semen. 

XXXVII. rif^ol (pvaioQ TToiS/ou — On the Nature of the Infant. 

That these two treatises originally constituted one work, has 
been remarked by Foes, Gruner, Ackerman, Littre, and others. 
Indeed, this will be made sufficiently obvious, upon comparing 
the conclusion of the one with the beginning of the other. 
Galen, in one place,^ quotes the former of these as if he held 
it to be a genuine work of Hippocrates, but elsewhere he men- 
tions that it had been referred to Polybus." Erotian mentions, 
among the works of Hippocrates, a treatise bearing the title of 
the latter, under which he probably comprehended both treatises. 
It is also noticed as a Hippocratic treatise by Palladius," and 
by Macrobius.^ Both are rejected by Haller, Gruner, Ackerman, 
Kiihu, Littre, and Greenhill. Indeed the story of the female 
musician, whom the author gravely admits that he taught the 
way how to get rid of a conception,^ is so alien to the morals 
of Hippocrates, as declared in ' The Oath,^ that it is impossible 
for a moment to suppose him gnilty of such an act of flagitious- 
ness. Moreover the treatise so abounds in little subtleties and 
conceits, especially in reference to the Pythagorean doctrine of 
numbers, that no competent judge will hesitate for a moment 
in pronouncing it not to be the production of the Great 
Hippocrates. *" Without doubt, however, these treatises are of 

' Ad Aphor. v, 37. - De Foetus fabricat. 

•■' Comment, in Libr. de Fract. ap. Foes, p. 147. 
'' Somnium Scipionis, i, 6. * Vol. i, p. 380: ed. Kilhn. 

^ Even Zuinger admits tliat, botli in style and matter, these treatises arc unlike 
the genuine works of llippoerates. 



110 PRELIMINARY DISCOURSE. [sect. ii. 

great antiquity^ and are valuable as containing the liypotlieses 
with regard to the origin of the foetus which prevailed in the 
schools down to the days of Harvey ; that is to say^ that the 
embryo is formed from the male semen, into which the uterine 
vessels enter, and form the cotyledones (or placenta). It con- 
tains, moreover, an hypothesis adopted by Aristotle in several 
of his physiological works regarding the semen, namely, that it 
is collected from all parts of the body ; and hence, if any part 
be mutilated in the parent, it is so likewise in the foetus.^ The 
author moreover holds, that the foetus breathes, and is nourished 
by the umbilicus/ which may be looked upon as an anticipation 
of the modern doctrine, that the placenta performs the function 
both of a lung and of an intestine. It contains a statement re- 
garding the incubation of the egg, which has been often repeated 
in modern times, but which, from personal observation, I can 
affirm not to be true ; namely, that the hen chips the shell to 
let out the chick.^ Presentations in delivery are divided into 
those by the head, the feet, and crossways. I would mention, 
in conclusion, that these works abound in repetitions, and are 
written in a diffuse style, very unlike that of Hippocrates. 
Altogether, then, I can have no hesitation in pronouncing both 
treatises to be spurious. From what has been stated of them 
above, it must be obvious, however, that to the student of 
ancient anatomy and physiology they are very interesting, and 
will repay a careful perusal. Although, probably, later pro- 
ductions than the age of Hippocrates, there can be no doubt 
that they are anterior to the memorable epoch of Herophilus 
and Erasistratus. 

XXXVIII. Ilfpi yvvaiKeiojv — On the Diseases of Women. 

We have already stated in our critical remarks on the 
fourth book, ' On Diseases,^ that it and the present treatise 
are evidently the productions of the same author. Although 
Erotian and Galen^ make references to it, as if acknowledging 
it to be the production of Hippocrates, its claim is rejected by 
Foes, Schulze, Gruner, and Ackerman, and all the modern 
autliorities of any note. Its connexion with the treatises ' De 
Genitura^ and ' De Natura Pueri,' is pointed out by Foes and 

' Vol. i, p. 371 ; ed. Kuhn. - Ibid., p. 387. 

" Ibid., p. 420. ■* In Gloss, in voce aX^ira, &c. 



SECT. II.] HIPPOCRATIC TREATISES. 1 1 1 

Gruncr ; and Littre docs not hesitate to refer to the same 
author the whole of the following treatises, ' De Grenitura/ 
' De Natura Pueri/ ' De Morbis/ iv, ' De Morbis Mulierum/ 
' De Morbis Virginum/ ' De Sterilibus.' Although not the 
composition of Hippocrates, all these treatises are, without dou1)t, 
of high antiquity, and were anterior to the age of Aristotle. 

The work now under consideration contains much valuable 
matter, and deserves a careful perusal. I feel rather at a loss 
what selections to make from it, as a specimen of its contents, 
but shall be brief on the present occasion, more especially 
as I have no difficulty in establishing the point, that the treatise 
in question is not one of the genuine works of Hippocrates. 

The observations contained in the first part of it, on menstru- 
ation and the causes of sterility, are ingenious. For the cure 
of sterility, fumigation of the uterus is recommended, and a 
minute description is given of the mode of performing this 
process, by means of a tube introduced into the os uteri, and 
connected with a vessel which emits aromatic fumes. When 
sterility is connected with the shutting up of the os uteri, the 
author gives directions for expanding it by means of a w^ooden 
or leaden pipe. We need scarcely remark, that this practice 
has been revived of late years. A minute description is given 
of a malformation of the -vagina, in which the passage is nearly 
obliterated by a membrane. Allusion is probably made here 
to a preternatural rigidity of the hymen. The author directs 
the membrane to be fairly torn, and the part dressed with wine 
and myrrh. In transverse and footling presentations of the 
child it will be best, he says, to bring it down by the head. 
Both cases are said to be dangerous, so that either the mother 
or child is lost, and sometimes both. Treating of retention of 
the placenta, the author remarks, that if it is not cast ofi' it 
becomes putrid, and thus comes away on the sixth or seventh 
day, or later. To promote its expulsion, he recommends 
southernwood, dittany, the flowers of the Avhite violet, and 
assafoetida. The process of abortion, and the unpleasant cir- 
cumstances connected with retention of the placenta in this 
case, are given with much accuracy. Hydrops uteri is de- 
scribed at considerable length. For an account of it, see 
Paulus tEgineta, Yol. I, p. 573, Syd. Soc. edition, and the 
modern authorities there referred to. For ulcers of the w oinb. 



112 PRELIMINARY DISCOURSE. [sect. ii. 

he recommends applications consisting of many stimulating in- 
gredients, such as the flos argenti, &c. The subject of difficult 
delivery is resumed ; when the arm or leg of a living child 
is protruding, it is directed to be pushed back_, and the child 
turned to the head ; and if the foetus be dead, either the same 
thing may be done, or the projecting part may be cut off, and 
the head opened with a sharp knife, and the bones thereof ex- 
tracted, and the body brought along. The chest also may be 
opened^ if there be any difficulty in extracting the body. The 
author expresses himself strongly in regard to the danger of 
abortions. All abortions, he says, are attended with more 
danger than deliveries at the full time. Artificial abortion never 
takes place without violence, whether produced by medicine, a 
draught, or food, or a suppository, or any other means. 

The second book commences with a description of fluor albus, 
an affection to which the old are stated to be more subject than 
the young. It arises from suppression of the menses, from par- 
turition, or a fever. Among other means which he speaks of 
for the cure of it, he mentions the application of cupping- 
instruments to the mammte. Astringents from the vegetable 
kingdom are to be administered, such as sumach boiled in 
vinegar, mulberries, or the like. A full accomit of the red fluor, 
or uterine hemorrhage, is also given. It is said to be connected 
principally with parturition. The treatment which is recom- 
meuded can scarcely be improved upon, even after the lapse of 
two thousand years : a sponge is to be wetted and applied to 
the pudenda ; soft garments are to be moistened with cold water, 
and laid on the belly ; and the foot of the bed is to be raised. 
When the hemorrhage is connected with putridity many women 
thus perish, indeed few recover. A long description is given 
of the hysterical convulsion which is said principally to attack 
antiquated maids and widows. It is remarked that hysterical 
complaints bring on cough, and other pectoral complaints. A 
very striking and accurate description is given of procidentia 
uteri. Inflation of the womb is also described. On it see 
Paulus ^gineta, Vol. I, p. 632, Syd. Soc. edition. There is 
also a curious description of the mole. The clitoris is described 
under the name of columna.^ 

' See Foes, OEconora. Ilippocrat. in voce Knof. 



SECT. II.] HIPPOCRATIC TREATISES. 113 

From the extracts now given, it will be seen that these Books 
contain a great variety of most important matter. Indeed, there 
are few treatises in the Collection more deserving of an attentive 
pernsal. They furnish the most indubitable proofs that the 
obstetrical art had been cultivated Avith most extraordinary 
ability at an early period. Beyond all doubt the complaints of 
women, and the accidents attending parturition, must at that 
time have come under the jurisdiction of the male practitioner. 
But, considering the wandering life which Hippocrates led, and 
that during the best part of it he must have been what is now 
called a consulting physician, it is not at all likely that he could 
have acquired that acquaintance with the minutia? of obstetrical 
practice which this work displays. It is not, then, at all pro- 
bable that he can be the author of it. 

XXXIX. rifpl a(j>6pMv — On Sterile Women. 

This treatise is closely connected with the preceding one, 
both in matter and style. It relates to a subject which, as we 
have shown, is also treated of in the other work, I mean 
sterility, the most common cause of which is held to be the 
state of the os uteri, when it is oblique to the passage of the 
vagina, constricted from cicatrices, or otherwise diseased. Dis- 
tinct directions are given for opening the mouth of the womb, 
after which a cleansing application, composed of cantharides and 
myrrh, is to be made to it. The mole, and procidentia uteri, 
are described in nearlv the same terms as in the precedino; 
treatise. Though it bears a great resemblance, then, to the 
work 'On the Diseases of Women,^ it is not likely, as suggested 
by Albertus Fabricius,^ that it is an appendix to it, for why 
should an author treat twice of the same subject in the same 
work ? 

XL. Iltpi ira^Qiv'nov — On the Complaints of Young Women. 

Foes looks upon this little tract as being the prelude to the 
greater work ' On the Diseases of Womeu.^ It is destitute of 
all claims to be held as genuine, and accordingly no critic, 
ancient or modern, stands up for it. Gruner is inclined to 
ascribe it to the author of the treatise ' On the Sacred 

< Bibl. Grac, ii, 24, p. 801. 

8 



114 PRELIMINARY DISCOURSE. [sect. ii. 

Disease/ but I see no grounds for this opinion^ except it be that, 
in the two treatises, there is a certain similarity of views with 
regard to the nature of the hysterical convulsion. This, how- 
ever, is not a sufficient reason for deciding that they both must 
have come from the same source, for all the ancient authorities, 
from Hippocrates to Actuarius, held pretty much the same 
ideas regarding the nature of " Uterine suffocation.^^ See 
Paulus Jj^GiNETA, III, 71. The author of this little fragment 
gives a very naive advice to virgins who are subject to hysterics; 
instead of making costly oblations of garments and the like to 
Diana, as recommended by the prophets, he gravely advises 
them WQ Ta'^i(JTa avvoLKrjaai avS^aai ! ! 

XLI. Ylepl sTTiKvriaioQ — On Superfoetation. 

This treatise, I believe, is not mentioned by any one of the 
ancient authorities, and it is almost universally rejected by the 
modern. 

I need scarcely remark that it relates to a very curious 
subject, and that great doubts are now entertained whether or 
not superfoetation in women ever actually takes place. I can 
state, however, that two trustworthy persons, the one a surgeon 
and the other a sage femme, informed me, some years ago, 
that they once attended together a case in which a woman 
was first delivered of a foetus about four months old, and, about 
thirty-six hours afterwards, of a full grown child. The ancient 
savans all believed in the occurrence of superfoetation. See 
in particular Aristotle (Hist. Anim. vii, 5) ; and Plinv, (H. N., 
vii, 11.) 

The following are a few of the most interesting observations 
which I have remarked in perusing this treatise. When the 
secundines are evacuated before the child, they cause difficult 
parturition, and the case is dangerous unless the head present. 
Presentations of the hand and foot are directed to be replaced. 
When the placenta is retained after the expulsion of the child, 
the child is to be laid upon avooI, or upon two bladders filled 
with water, either of which is to be pricked, so that the water 
may run oflF gradually, and thus draw down the placenta. 
When there is a copious discharge of blood before labour, there 
is a risk that the child may be dead, or at least not viable. 
When women with child long for coals, the appearance of 



SECT. II.] HIPPOCRATIC TREATISES. 115 

these things is to be seen on the child's head. (For the 
opinions of the ancients on the effect of imagination on the 
foetus in utero, see the commentary on B. I, § 1, of Paulus 
tEgineta, Syd. Soc. edition.) Some ridiculous things are con- 
tained in this work, such as the following ; when a man wishes 
to beget a male child let his left testicle be tied, and when a 
female the right. ^ The composition of suppositories for 
cleansing the uterus is described at considerable length towards 
the end of the treatise. Altogether, the work is by no means 
devoid of interest, but, as I have already said, it is certainly 
not the composition of Hippocrates. Littre, on the authority 
of the passage quoted from Aristotle on this head, refers the 
treatise to Leophanes. From the account which we have given 
of its contents, it will be remarked that the title and contents 
of it do not well accord together. This remark, however, 
applies to other of the Hippocratic treatises besides the one we 
are now treating of. 

XLII. YIb^I yvuaiKtir]g (pvaiog — On the Female -Nature. 

As Foes remarks, this work is mostly made up of excerpts 
from the treatise ' De Mulicbribus.' I need not, therefore, 
occupy time in discussing its claims to be regarded as genuine, 
nor in giving an outline of its contents. 

XLIII. Tlepl /capS/?7c — On the Heart. 

Galen, in one place, appears to cite a passage in this treatise, 
but without naming it.^ It is not found in Erotian's list, and 
all the modern authorities, including even Foes, who is more 
disposed than most of the others to deal leniently with the claims 
of the treatises which bear the name of Hippocrates, concur in 
refusing to admit it as genuine. Still, however, there can be 
no question as to its being a work of very high antiquity. It 
is to be regretted, then, that the text is in a very unsatisfactory 
state. It contains, upon the whole, a wonderfully accurate 
description of all the parts about the heart — of its substance, 
which is said to be a strong muscle ; of its pericardium, which 
is described as being a smooth tunic, containing a little fluid 

' Aristotle refers this opinion to Leophanes, De Generatione Aniniahuni, v, 1. 
- De Placit. Hippocrat. et Plat., ix. 



116 PRELIMINARY DISCOURSE. [sect. ii. 

resembling urine ; of its ventricles (yatrrEpfg) ; of its auricles 
{ovaTo) ; of the origin of the veins from it ; of its sigmoid 
valves ; of its office^ to be^ as it were, the fountain head^ from 
which all parts of the body are irrigated, and the seat of the 
understanding, which is said to be in the left ventricle. The 
understanding, it is added, is not nourished by the blood, but 
by a pure and luminous [(pwTOii^rtc) superfluity from it. Alto- 
gether, this little treatise bespeaks much practical acquaintance 
with human anatomy, and, considering the age in which it was 
written, must be the production of a very superior mind. It 
contains an account of an experiment which has been much 
animadverted upon, both by ancient and modern authorities. 
The writer says, if a coloured fluid be given to an animal, such 
as a sow, to drink, and if its throat be cut while it is in the act of 
swallowing, it will be found that part of the fluid has passed down 
by the gullet to the lungs. See in particular Aulus Gellius 
(Noctes Atticse, xvii, 11); Macrobius (Saturnal. vii, 15); and 
Plutarch (S37mpos. vii, 1.) Aulus Gellius says decidedly that 
Plato had adopted this opinion from Hippocrates. Aulus Gellius 
and Macrobius also quote Plutarch as having stated, in his 
' Symposiacon,^ that Hippocrates is the author of this opinion ; 
but the text of Plutarch (1. c.) is in an unsatisfactory state. 
See Schulze (Hist. Med. i, iii, vi, 12.) 

XLIV. rifpi rpocprig — On Aliment. 

It must be admitted that this treatise has very high autho- 
rities in favour of its axithenticity, such as Erotian, Galen,^ 
Aulus Gellius,^ Palladius,^ Stephanus / and, in modern times. 
Mercurial], Foes, Haller, and Le Clerc.^ It is rejected by 
Casper Hoff'man,^ Gruner, Ackerman, Klilin, Littre, and Green- 
hill, though, by the last two, not in decided terras. Considering 
the respectability of the external evidence in its favour, I should 
certainly not have hesitated in admitting it as genuine, had 
not a careful examination of its contents led me to form the 

' Comment., torn, xv, p. 224 ; ed. Kiihn. 

^ Noct. Attic, iii, 16. 

^ Ap. Foes; ed. Hippocrat. 

■* Comment, in Galen ; ed. Dietz. 

s Hist. Med., P. i, iii, 2, 257. 

^' In Boerhaav. Meth. Stud. Med., i, 3, p. .'394. 



SECT. II.] HIPPOCRATIC TREATISES. 117 

unbiassed decision that it must be the production of some 
metaphysician^ rather than of a medical practitioner, such as 
we know Hippocrates to have been. The physiological dogmata 
with which it abounds are announced in so antithetical, not to 
say paradoxical, a manner, that I can conceive nothing more 
foreign to the style and character of the true writings of Hippo- 
crates. I shall give a few specimens : — " The species of aliment 
is one and many ; all these (kinds of aliment ?) arc one nature 
and not one. Purging is upwards and downwards, and neither 
upvrards nor downwards. Purging in aliment is excellent, 
purging in aliment is bad. Aliment not aliment, unless it 
conveys nourishment ; it is aliment in name but not in deed : 
aliment in deed and no longer in name only. Sweet and not 
sweet ; sweet potentially, as water, sweet to the taste, as honey. 
Things not animals are animated ; animals are animated, the 
parts of animals are animated. It (the embryo) is and is not.'^ 
Now, I must say, that all this appears to me to savour more of 
the tastes of Deraocritus than of Hippocrates himself. It may 
be said, indeed, that the very circumstance of Galen's having 
admitted the work as genuine, and having composed an elabo- 
rate commentaiy on it, is a most presumptive proof of its 
authenticity; for Avhere shall we find so excellent a judge of the 
doctrines of Hippocrates as his great commentator ? But then 
it must be taken into account that Galen liimself had a great 
•penchant towards metaphysical subtleties, and this would lead 
him to believe that what was in accordance with his own 
tastes must have been in accordance with those of his great 
professional hero. But, notwithstanding the doubts which 
hang over the question of its authorship, it may be confidently 
affirmed regarding this treatise that, illustrated as it is by 
Galen's commentary (even although it has come down to us 
in a mutilated state), few works in the Collection are more 
suggestive than the present one. I shall merely give a few 
more specimens of it : — " The root of the veins is the liver, 
and the root of the arteries is the heart ; and from them blood 
and spirits are carried to all parts, and heat passes to the same." 
This passage is frequently quoted and commented upon by 
ancient authors ; as by Galen, ^ and Aretseus." We have seen 

' De Placit. Hippocrat. et Platoii. 
''■ De Acut., i, 7 ; de Cliron., i, 13. 



118 PRELIMINARY DISCOURSE. [sect. ii. 

it stated in the preceding treatise that the heart is the place 
from which both veins and arteries originate. This seems a 
presumptive proof that these two treatises must have had a 
distinct authorship. " The aliment reaches to the hairs, the 
nails, and the outer surface from within ; and aliment from 
without passes from the most external to the most internal 
parts, there is one conflux and one conspiration {^vp^oia /I'la, 
^v/uiirvoia fiia). All parts sympathise throughout the Avhole 
frame, but in so far every part has its own peculiar action.^' 
This passage, also, is very celebrated and frequently quoted.^ 
I need scarcely remark that it embraces a grand and most im- 
portant view of the animal economy. " Milk is food to some with 
whom it agrees, and to others not. To some wine is food, and 
to others not ; and so with flesh and many other kinds of ali- 
ment. We must look to situation and habit. Humidity is 
the vehicle of food. The natures (instincts ?) of all things are 
untaught. Persons who perspire freely are weak, more healthy, 
and have easier recoveries than others. Those who perspire ill 
are stronger than others before they become indisposed, but 
being indisposed have more difficult recoveries. These remarks 
apply to the whole and to the parts." 

From these specimens it will be readily seen that the work 
abounds in curious matters, but of a very difi'erent stamp from 
those which the true Hippocratic treatises contain. Contrary, 
then, to my general rule, I certainly feel disposed in the present 
instance to reject, upon internal evidence, a treatise which has 
the most unexceptionable external evidence in its favour. 

XLV, riEpt aapicwv, rj ap^iov — On Fleshes, or Principles. 

This treatise does not appear in Erotian^s list of the Hippo- 
cratic works, and it is rejected by all the modern authorities, 
from Mercuriali downwards. Galen is inconsistent in his 
notice of it.~ Some of the philosophical dogmata which it con- 
tains are curious, such as the following specimen : " It appears 
to me that what we call heat is immortal, and that it knows 
all, sees, hears, and perceives all things that are and will be.^ 

' See Galen, de Facult. Natural., i; de Diff. Febr., ii; de Usu Pulsuum, i; and 
Alexander Trallian, i. 

- In Ei)idem. Comm., iii, 29, &c. 

^ See the remarks on this passage in the next section. 



SECT. II.] HIPPOCRATIC TREATISES. 119 

When things, then, were thrown into confusion the greater 
part of this passed off to the highest circle, and this it is which 
the ancients called ether/^ The following extract is held by 
Gruner, but probably without any good reason, to evince a 
degree of anatomical knowledge in advance of the age of 
Hippocrates : " There are two hollow veins from the heart, the 
one called the artery, and the other the vena cava. The artery 
has more heat than the vein." The other veins are also 
described with considerable accuracy. It is stated that the 
foetus in utero sucks in fluid (liquor amnii ?) by its lips, and in 
proof of this the author remarks that the child voids fseces soon 
after delivery, which, it is argued, must be derived from food. 
The opinion thus stated has been often maintained in modern 
times, but does not appear to be well founded. The author 
mentions correctly that persons in attempting to commit suicide 
open the trachea, in which case, he adds, the patient lives, but 
loses his voice until the opening be closed. Conringius and 
Haller, with considerable plausibility but yet without any direct 
proof, attribute this treatise to Democritus. 

XLVI. Ylipl ejdSo/naSwv — On Hebdomads. 

This treatise exists now only in the Latin translation, which 
M. Littre has discovered in the Royal [National, it is now 
called !) Library in Paris, and will be published in his edition 
of the works of Hippocrates. ]\I. Littre gives an elaborate 
and most interesting disquisition on it, and seems to make out 
clearly that it is the production of the same author as the 
treatise ' On Fleshes,^ which we last noticed. It is cited by 
Philo Judffius,^ and several other writers of antiquity. Galen, 
however, held it not to be the production of Hippocrates. A 
considerable extract from it is contained in the tract ' On 
Critical Days,' and the eighth section of the Aphorisms, 
which has always been looked upon as spurious, is said by 
M. Littre to be mostly taken from this treatise. 

XLVIL Hffjt iUv(^v—On the Glands. 

Erotian makes no mention of this treatise, and Galen pro- 
nounces it to be the work of the recent Hippocratists.^ M. Littre 

' De Cosmopoea. • Opera, torn, v, p. 594 ; ed. Basil. 



120 PRELIMINARY DISCOURSE. [sect. ii. 

remarks, and with great truth, that it is difficult to find out 
the grounds upon which the ancient critics have rejected this 
work. Certain it is that it contains a goodly store of inter- 
esting matters, none of which^ as far as I can discover, are 
inconsistent with the true doctrines of Hippocrates. In «it a 
pretty correct description is given of the glands, including 
those of the mesentery. The brain itself is said to be of a 
glandular nature, and also the kidneys. An ingenious account 
is also given of the origin of scrofula^ which is said to be pro- 
duced by the lodgement of humours in the glands of the neck, 
which get into a state of slow inflammation. Glands, the 
author says, are seated mostly in parts of the body which most 
abound in humidities, such as the armpits and groins, and 
hence such parts produce hairs. In the case of the mesentery, 
however, no hairs are produced, because the humidities there 
are excessive, and choke up, as it were, the seeds of the hairs ; 
in like manner as seeds sown in marshy grounds perish. A 
very ingenious account is given of the origin of phthisis, which 
is said to spring from tubercles in the lungs and matter (pus), 
which corrodes the lungs when " the patients do not readily 
recover.^^ A curious description is next given of the tabes 
dorsalis, "in which disease the patient does not wish to live.^' 
How expressive this language is of the state of mind in the 
case of the unfortunates who are subject to spermatorrhoea ! 
The treatise concludes with some striking remarks on the 
sympathy between the mammae and uterus, and on the influence 
which both exercise on the development of the female cha- 
racter. Altogether the contents of this -treatise are most valu- 
able, and may suggest important views to the medical practi- 
tioner and physiologist, even at the present day. We need have 
no hesitation in pronouncing, with regard to it, that it reflects 
infinite credit on the school from which it emanated, and that 
it is not unworthy of Hippocrates, although -we have reason to 
believe that he was not actually the author of it. 

XLVIII. Ilf^i (j)\i(5wv — On the Veins. 

This is merely an excerpt from the treatise ' On the 
Nature of the Bones.^ 



SECT. II.] HIPPOCRATIC TREATISES. 121 

XLIX. Ilt^l njrpou — On the Physician. 

I may mention in this place, generally, that the treatises 
which follow have no ancient authority in support of them, 
and that, with very few exceptions, they are also rejected by 
all the modern critics. Their contents, moreover, are not of 
much practical importance, and therefore I shall be very brief 
in my analysis of them. 

The treatise in question is held to be genuine by no one 
critic, as far as I know, with the exception of Foes, who appears, 
in part, to sanction its claims. The object of the author is 
announced to be in order to instruct the physician how to 
conduct matters connected with the iatriura, that is to say, 
with his establishment or surgery. Mercuriali, I may men- 
tion, is unjustly severe in his animadversions on the exordium. 
(See Conringius, Introd. p. 120.) The physician should have 
a healthy look himself, for the writer says, people fancy that a 
person who does not keep himself in good health is not qualified 
to take charge of the health of others. He should be of a 
prudent disposition and a gentleman in morals.^ Minute 
directions are given respecting the site and other circumstances 
connected with the iatrium ; clean and soft towels are to be at 
hand, linen is to be us'ed for the eyes, and sponges for the 
sores. In applying bandages, attention is to be paid to utility 
rather than to display. The surgeon should pay great attention 
to all matters connected with his operations ; for it is attended 
with much disgrace when any manual operation does not suc- 
ceed. Minute directions are given about the performance of 
venesection at the arm, and mention is made of several 
untoward accidents connected with it, such as the blowing up 
of the vein, whereby the flow of blood is stopped ; and sup- 
puration following as a consequence of the operation. In 
order to acquu-e dexterity in the treatment of accidents, the 
author recommends the young physician to attach himself to 
some foreign army; and from this Gruner infers, that the work 
cannot belong to Hippocrates, as domestic wars were but too 
common in his time ; and there could have been no necessity 

' KaXdv Kai ayaQbv. See the Annotations on Mitchell's Aristophanes as to the 
import of this expression. I quote from memory. 



122 PRELIMINARY DISCOURSE. [sect. ii. 

for the surgeon's seeking foreign service in order to gain expe- 
rience. It does not occur to me, however, that there is much 
force in this argument ; for intervals of peace were just as 
common during the long life of Hippocrates, as during the 
interval between his death and the time when the Collection 
was made. But, in fact, there is no necessity to seek recondite 
reasons for rejecting a treatise which has no proper authority 
in support of it. 

L. IlEpi eva-^r]fxoavvr]g — On Decorum. 

This work, like the last, has not the slightest claim to be 
looked upon as genuine. Moreover, it has come down to us 
in a very unsatisfactory state as regards the text, so that the 
meaning is often very dark and uncertain ; and I must confess 
that, as a general rule, I have little inclination to spend much 
time in searching out a meaning, in obscure writings, when, 
after it is discovered, it is not likely to repay the exertions 
made in discovering it. I am ahvays disposed to remember the 
advice which Galen repeatedly gives to the student of medicine, 
" to concern himself more about things than about words." ^ 
The object of the author seems to be to give general directions 
with regard to decorum in the physician's communication with 
the sick. It is evidently the production of some sophist, 
according to Bernard, of some one belonging to the Stoical 
sect. I shall be brief in my abstract of it. A philosophical 
physician is equal to a god. In the practice of medicine all 
the virtues relating to wisdom are exercised ; namely, contempt 
of money, decency, modesty, simplicity in dress, character, 
judgment, quietness, accessibility, purity of life, sententious 
maxims, knowledge of the purifications which are proper and 
necessary in life, abstinence from lucre, freedom from super- 
stition, divine excellence. The physician should keep himself 
aloof, and not hold much converse with the common people, 
unless when necessary The surgeon should be well provided 
with all the means required in the practice of his profession, 
such as dressings, medicines, instruments, and so forth, as any 
deficiency in these might produce serious results. Minute 

' I quote here from memory, not ha\4ng leisure to search the passages in Galen's 
works where this saying occurs. It is a maxim, however, which he frequently re- 
peats. 



SECT. II.] HIPPOCRATIC TREATISES. 123 

directions are given for the regulation of the physician's address 
in entering the chamber of the sick, and his conduct while 
there. 

LI. UapayytXiai P/'cecepta. 

This little tract stands altogether in much the same circum- 
stances as the preceding one, that is to say, it is wholly des- 
titute of all good authority in its favoui", and the nature of its 
contents is what might rather be expected from a sophist than 
a practical physician. The text, moreover, is in a most unsa- 
tisfactory state. I shall dismiss it then with a very brief notice. 
It opens with an advice to the physician not to trust to specu- 
lation but to rational experience. He ought to learn remedies 
from all quarters, even from the vulgar, and not be avaricious 
in his dealings with the sick, more especially if strangers and 
needy. The author alludes, as Schulze thinks, to the practice 
then followed by the physicians of migrating from one city to 
another, and of making a public declaration of their pretensions 
at their first entry into any place. These physicians were 
called 23€riodeut(e. The author of this tract advises the phy- 
sician, in such a case, not to make any vainglorious or inflated 
profession of his abilities. He also enjoins the medical prac- 
titioner to look to the health of those who are free from 
disease, as well as those who are indisposed. 

LII. Ilfpt avaToiiU}Q — On Dissection. 

This small fragment of ancient anatomical science has no 
claim to be regarded as the work of Hippocrates. Neither 
Erotian nor Galen, nor any other ancient critic holds it as 
such, and the modern authorities are unanimous in rejecting 
it. That it may have been the composition of Democritus, as 
suggested by Gruner, seems not unlikely. It abounds in 
harsh and obsolete terms, which have never been satisfactorily 
explained. Some parts of the anatomical description are diffi- 
cult to determine, as for example, " the large bronchia which 
extend from the heart to the liver ;" " the vena scalena, which 
extends from the liver to the kidneys," The latter passage, 
however, may be supposed to refer to the emulgent vein. 



124 PRELIMINARY DISCOURSE. [sect. ii. 

LIII. Ueol oEovTO(}>viriQ — On Dentition. 

This little tract is destitute of any competent evidence of 
its authenticity. Some of the observations contained in it 
bespeak a familiar acquaintance with the diseases of infancy. 
Thus it is said, that when the bowels are loose at the term of 
dentition, if the digestion be good^ the children thrive and are 
not subject to convulsions. When children at the breast vomit 
up their food, the bowels are constipated. When there is 
fever accompanying dentition, children are seldom attacked 
with convulsions. But when there is heavy sleep along with 
dentition, there is danger of comT:ilsions. All the children 
that are seized with convulsions at the time of dentition do 
not die. Children that take food during dentition bear vomiting 
best. Ulcers on the tonsils are attended with danger. 

LIV. Tlepi k-yKaroTonnq e/i(3pvov — On Excision of the Foetus. 

No one stands up for the genuineness of this treatise/ 
which, however, is not wanting in interesting matter relative 
to the extraction of the foetus in cross-presentations. For an 
abstract of the practice there recommended, see Paulus 
^GiNETA, Vol. II, p. 389, Syd. Soc. edition. A circumstantial 
description is also given of the process of succussion, the dan- 
gerous eJBFects of which, in certain cases, are related in the 
Epidemics. 

LV. Hipl oT^toc — On Vision. 

This little fragment is admitted by all the authorities to be 
spurious. It contains a description of glaucoma, for which 
purging of the head and the application of the actual cautery 
are recommended, and also in certain cases venesection. In 
epidemic ophthalmy, purging both of the head and bowels is 
recommended. 

LVI. YLepi 6<jT£(i)v ^uatof,- — On the Nature of the Bones. 

INI. Littre has very ingeniously shown that this work is a 
compilation made up of fragments of other works, and thus he 
has announced his intention of excluding it altogether from 

' One word {Ix^vri) which occurs in this work is in the Glossaries of Galen and 
Erotian. This is likely to be an interpolation. 



SECT. II.] IIIPPOCRATIC TREATISES. 12') 

the Hippocratic Collection. Certain it is, beyond all dispute, 
that the treatise is not the production of Hippocrates himself. 
The following are a few of the most notable things which I 
have observed in it. "It appears to me that what we call 
heat is immortal, and that it understands, sees, hears, and 
perceives all things that are and will be." The heat, it is 
further said, is the origin of all movement in animals. This 
will be recognised as the original of the doctrine of the Calidum 
innatum, which figures in the works of our earlier physiologists 
in modern times. See the works of Harvey and the other 
physiologists of the seventeenth century ; also what is said on 
this subject in the next section. The aorta and vena cava are 
correctly described, the one as an artery, the other as a vein ; 
and their origin from the ventricles of the heart is noticed. 
The author states, (p. 140, ed. Kiihn,) that he had known cases 
of attempted suicide in which the windpipe had been opened, 
and yet death did not ensue ; only while the opening remained 
the person lost the power of speaking. See No. XLV. 

LVII. Ofot K^iaiMv — On the Crises. 

This tract has no ancient authority whatever in support of 
it, and FoeSj Gruner, and Littre concur in holding it to be 
a compilation from other Hippocratic treatises, more especially 
the Aphorisms and Prognostics. This, indeed, must be obvious 
to every person who reads it with any attention. 

LVIII. Ilfpi K^iai/iiaw — 0?i Critical Days. 

This treatise stands in the same predicament as the preceding 
one, that is to say, it has no ancient authority in support of it ; 
indeed Galen declares against it when he says that Hippocrates 
had not given any work on the Critical Days. (Tom. iii, p. 4 10; 
ed. Basil.) It is manifestly a compilation from the other trea- 
tises, more especially from those 'On Internal Diseases^ and 
' On Diseases.' Still it appears to me to be an interesting and 
well-written compilation. For example, it would be difficult to 
point out in any other work, ancient or modern, a better de- 
scription of pneumonia than is given towards the conclusion 
of it. Tetanus also is accurately described. To be sure, Gruner 
infers, from the circumstance that three varieties of this disease 
are described, that the work in question must have emanated 



126 PRELIMINARY DISCOURSE. [sect. ii. 

from the Cnidian school. But Aretseus, and, indeed, all the 
ancient authorities that treat of tetanus, describe three varieties 
of this disease; and therefore this is no good reason for exclud- 
ing it from the Coan school. 

LIX. He^l (pa^fxaKiDv — On Purgative Medicines. 

Though it must be admitted that this little fragment can 
boast of no competent authorities to establish its claim to be 
placed among the genuine Avorks of Hippocrates, it bears un- 
doubted marks of having been written by some person well 
acquainted with his principles, and ha\ing no ordinary ac- 
quaintance with professional matters. Thus the author states 
very correctly the effects of idiosyncrasy in modifying the 
operation both of purgatives and emetics, and advises the 
physician to make inquiry beforehand what effects such medi- 
cines, if formerly taken, had produced on the patient; for, he 
adds, it would be a disgraceful casualty to occasion a man^s 
death by the administration of a purgative medicine. He also 
interdicts the administration of purgatives during the heat of 
a fever, and during the very hot seasons of the year. These 
practical rules appear to me to be highly important, and yet 
how frequently do we see them disregarded ! At the time we 
have mentioned, the author prudently remarks that it is safer 
to administer a clyster. 

LX. rTtpl £AXfj3of>to-^toD — On the Administration of Hellebore. 

This little tract is usually published among the Epistolce, 
and, as a matter of course, it has no evidence in support of its 
genuineness further than they have, which, as we shall pre- 
sently see, is very slender. It contains, however, very acute 
and important observations on the administration of hellebore, 
to which it is well known that the Hippocratists were very 
partial. But these are mostly extracted from the Aphorisms, 
and need not be noticed in this place. The Book of Prognostics 
also is quoted, but seemingly by mistake. 

LXI. 'EviaToXai — The Epistles. 

No scholar can require to be informed that, since the me- 
morable controversy in this country between the Honorable 
C. Boyle and the celebrated Dr. Bentley, respecting the authen- 



SECT. Ti.] HIPPOCRATIC TREATISES. 127 

ticitj^ of the Epistles which bear the name of Phalaris, the 
whole of the 'Epistolse Grajcanica^^ have been generally con- 
demned as spurious. Against this judgment I have no intention 
to protest; but I may be allowed to remark that many aucient 
works which are usually acknowledged as genuiue have not so 
much external evidence in their favour as these Epistles possess. 
The Epistles ascribed to Plato, for example, are quoted as genuine 
by Cicero,^ and by Diogenes Laertius.~ Those of Hippocrates, 
too, are quoted and recognised by Erotian, Soranus, and other 
ancient authorities. Still, however, as I have stated, I have no 
intention to stand up against the general opinion of scholars 
from the Scaligcrs down to the present time, by which they 
have been condemned as supposititious ; only I contend that, as 
it is admitted on all hands that they are very ancient,'^ that is 
to say, that they must have been composed within less than 
a hundred years after the death of Hippocrates, it is utterly 
incredible that the Sophists who wrote them, whether for a 
fraudulent purpose that they might derive profit from them by 
passing them off for the productions of the great name they 
bear, or whether for the purpose of displaying their own skill 
in sustaining an assumed character, should have made them 
turn upon alleged occurrences in the life of Hippocrates which 
every person at that early period must have been able to judge 
whether they were fictitious or not. I see no reason, then, to 
doubt that the main facts to which these Epistles relate are 
real, although the Epistles themselves be supposititious.^ 

Having thus stated my opinion of these Epistles in general 
terms, I shall now dismiss them w'ith a very brief notice. 

' Tuscul. Disputat., v, 35. ^ In vita Platonis. 

^ I have always looked upon the 'Epistoloc Grrecanicaj' as Iteing a species of literary 
composition allied to the Declamaliones of the Romans, that is to say, that they 
were mere exercises in composition. On the latter, see Quintilian, Instit. Orator., 
iv, 2. We possess a volume of these Declamations under the name of Quintilian, but 
they are not generally admitted to he genuine. They are exercises on themes pre- 
scribed in the schools of rhetoric. The sul)jects were sometimes historical events, 
connected with the lives of distinguished personages. The poet Juvenal alludes to 
Declamations in several places, as in Satir. i, 16; x, 167; vi, 169; vii, 161. The 
Satyricon of Petronius Arbiter opens with a powerful invective against the declaimers 
of the day, whom the author holds to have been the corrupters of all true eloquence. 

^ Scaliger, Menage, Gruner, aud Littre, although they regard the Epistles as spu- 
rious, admit that they are " very ancient." 



128 PRELIMINARY DISCOURSE. [sect. ii. 

They are differently arranged by modern authorities ; I shall 
follow M. Littre in the few remarks which I have to offer upon 
them. 

The first series of these Epistles relates to the services which 
Hippocrates is said to have rendered to the people of Athens 
during the time of the memorable plague. The spuriousness 
of these, it is generally held, is proved beyond all doubt by the 
silence of Thucydides with regard to any such professional ser- 
vices rendered by Hippocrates on the occasion ; and no doubt 
if it were maintained that these took place at the outbreak of 
the disease in Greece, that is to say, at the commencement of 
the Peloponnesian war, the inference would be most legitimate. 
But if Ave be permitted to suppose that, as the plague is known 
to have lurked about in different parts of Greece for a con- 
siderable time, the services of Hippocrates did not take place 
until several years afterwards, there is nothing in the story 
which bears the slightest air of falsehood, even if we adhere to 
the common chronology respecting the birth of our author. 
Indeed, I repeat, if the Sophist who composed these letters 
had founded them on tales which everybody knew to be false, 
he could never have hoped to impose upon the learned men of 
the next generation, and make his forgeries pass for genuine. 

The second series relates to Democritus, and these must be 
admitted to be the most interesting of the whole group. Now 
that Hippocrates visited Abdera, and that he was familiarly 
acquainted with Democritus, are facts which the most sceptical 
critic will hardly venture to call in question.^ But that the 
Epistles themselves were not written by the physician and 
philosopher whose name they bear, I readily admit to be probable. 
Most undoubtedly the letter of Hippocrates, in which he is 
made to describe his visit to Democritus, however full it may 
be of curious matters, is written in a style and manner very 
unlike the well-known characters of the true writings of 
Hippocrates. 

Third. The short letter inscribed from Hippocrates to his son 
Thessalus, contains nothing from which its authenticity or the 
contrary could be legitimately inferred, only it is destitute of 
all ancient authority in its favour. In it the father recom- 

' See Diog. Laert. ix. .Elian. Var. Hist, iv, 20. 



SECT. II.] HIPPOCRATIC TREATISES. 129 

mends to the son the study of geometry and arithmetic, as a 
proper preparation to the study of medicine. 

Fourth. This series, consisting of 'The Oration at the Altar/ 
^ The Deci-ee of the Athenians/ and ' The Oration of Thessalus, 
son of Hippocrates/ although now genei'ally regarded as spu- 
riouSj possess more direct evidence in their favour than any of 
the others. In fact, they are decidedly recognised as genuine by 
Erotiau. The documents in question have all reference to the 
services of Hippocrates and his disciples in the pestilence which 
pervaded Greece during the Peloponnesian war. These services 
are alluded to by many ancient authorities, as we have shown 
in the Commentary on Paulus iEaiNETA, Book II, § 35. In 
conclusion, I repeat that, supported as the main facts referred 
to in these documents are by the highest testimony which 
antiquity can furnish, I cannot but regard the facts as true, 
although the documents themselves be given up as suppositi- 
tious. 

I will now briefly recapitulate the general results of the in- 
vestigations on which I have been occupied in the present 
section : 

1. That all the authorities, ancient and modern, Avho have in- 
vestigated the question regarding the genuineness of the works 
which have come down to us under the name of Hippocrates, 
are agreed that a considerable portion of them are not the pro- 
ductions of the author himself. 

2. That it is almost universally admitted that the following 
treatises are genuine, viz. : 

The Prognostics. 

On Airs, &c. 

On Regimen in Acute Diseases. 

Seven of the Books of Ax^horisms. 

Epidemics I and III. 

On the Articulations. 

On Fractures. 

On the Instruments of Reduction. 

The Oath. 

3. That the following treatises may be pretty confidently 
acknowledged as genuine, although the evidence in their favour 
is not so strong as it is with regard to the preceding list: — 

9 



130 PRELIMINARY DISCOURSE. [sect. it. 

On Ancient Medicine. 

On the Surgery. 

The Law. 

On Ulcers. 

On Fistulse. 

On Hemorrhoids. 

On the Sacred Disease. 

4. That as it certainly appears that the Book of Prognostics 
is composed; in a great measure, from the contents of the First 
' Prorrhetics^ and the ' Coacce Prsenotiones/ there can be little 
or no doubt that these two treatises are more ancient than tlie 
time of Hippocrates. 

5. That although the exact time at which the Collection, as 
it now stands, was made out has never been determined in a 
very satisfactory manner, an examination of the contents of 
the different treatises leads to the conclusion that most of 
them represent pretty faithfully the opinions held by the family 
of Hippocrates and his immediate successors in the Coan school 
of medicine. 

6. That a few of them, and more especially the two im- 
portant works ' On Internal Affections^ and ' On Diseases/ 
would appear to bear distinct traces of having emanated from 
the contemporaiy school of Cnidos. 

7. That although the Epistles and certain public documents 
usually published at the end of the Collection may justly be 
suspected of being spurious, there is undoubted evidence that 
they are of very ancient date, and were composed, most 
probably, within less than a hundred years after the death of 
Hippocrates, so that there is every reason for believing that they 
relate to real events in the life of our author, and not to fictitious 
as some have supposed. 



SECT. III.] PHYSICAL PHILOSOPHY. 1.31 



SECTION III. 

ON THE PHYSICAL PHILOSOPHY OF THE ANCIENTS, AND MORE 
ESPECIALLY THEIR DOCTRINES WITH REGARD TO THE 
ELEMENTS. 

As it is impossible to understand properly tlie medical theories 
wliicli occur in the Hippocratic treatises without a competent 
acquaintance with the Physical Philosophy of the ancients, I 
have thought it necessary to devote an entire chapter to an exposi- 
tion of the tenets held by the philosophers regarding the ele- 
ments of things. I might have been able to dispense with this 
labour provided there had been any modern publication to which 
I could refer the reader for the necessary information on the sub- 
ject in question ; but, unfortunately, there is no work in the 
English language, as far as I am aware, in which the nature of the 
ancient doctrines is properly described. To give an example 
in point : Dr. Watson, the bishop of Llandaff, in his essay 
' On the Trausmutability of Water into Earth,^ makes the 
following remarks on the ancient doctrine concerning the 
elements : '' If but one particle of water can, by any means, 
be changed into a particle of earth, the whole doctrine of the 
Peripatetic sect concerning the elements of things will be 
utterly subverted : the diversities of bodies subsisting in the 
universe will no longer be attributed to the diflPerent com- 
binations of earth, air, fire, and water, as distinct, imnmtable 
principles, but to the different magnitudes, figures, and arrange- 
ments of 23 articles of matter of the same kind." ^ 

Now it will at once be perceived by any person who is at 
all acquainted with modern science, that if the ancient dogmata 
be as here represented, they are altogether destitute of any 
solid foundation in truth and nature, and we may well wonder 
that such a baseless structure should have endured for so long 
' Chemical Essays, vol. iv, Essay 7. 



132 PRELIMINARY DISCOURSE. [sect. iti. 

a period. But before passing this severe judgment on the 
tenets of onr great forefathers in philosophy, it will be well to 
investigate their doctrines more accurately than Dr. Watson 
appears to have done in this instance. 

In pursuing the present investigation, I shall, in the first 
place, give literal translations of extracts from the works 
of the most celebrated sects of philosophers ; namely, the 
Pythagoreans, Platonists, Peripatetics, Stoics, and Epicureans. 
It will, of course, be readily perceived, from what I have now 
stated, that I do not mean to confine my inquiry to the period 
of ancient philosophy which preceded Hippocrates, but that 
I am to bring it down to a pretty late age. This course I 
find it indispensably necessary to follow, as I could not derive 
sufficient illustration of the subject were I to restrict myself 
to the works of the earlier philosophers, who either preceded 
our author or were his contemporaries. I shall first give the 
extracts by themselves, and then make some remarks in illus- 
tration of the doctrines which they expound. I tbink it proper 
to mention further, that I am answerable for the correctness 
of the translations in all cases, unless where it is otherwise 
stated. 

THE PYTHAGOREANS. 

" Fire being compressed produces air, and air water, and 
water earth : and from earth the same circuit of changes takes 
place till we come to fire.'" 

" In that part of the universe where Nature and Generation 
exert their powers, it is necessary that there should be these 
three things ; In the first place, that thing Avhich being tangible 
furnishes a body to everything which comes into existence. 
This is the universal recipient and substance of impression for 
things generated, bearing the same relation to things which 
are generated from them that water does to juice, and silence 
to sound, and darkness to light, and materials to the things 
fabricated from them. For water is void of taste and quality, 
bearing the same relation to sweet and bitter, and to sharp 
and salt. The air is unformed as to sound, or speech, or 
melod3\ And darkness is devoid of colour and shape, and 
bears the same relation towards bright, and yellow, and white. 

' Ocellus Lucanus, On the Universe. 



SECT. III.] PHYSICAL PHILOSOPHY. 133 

But white bears reference also botli to the statuary art and 
that which forms figures of wax. But matter admits of another 
comparison with the art of statuary. For all things exist iu 
it potentially before they are made, but actually after they are 
made and have received their nature. In order, therefore, 
that there should be generation, it is necessary that there 
should be some one substance as a substratum. In the second 
place there are the conti-aries, in order that there may be 
changes and transmutations, the primary matter undergoing 
})assion and affection, in order that the qualities {or powers, 
SvvauHQ), being mutually passive, may not destroy, nor be 
destroyed, by one another. These (the contraries) are, heat 
and cold, moisture and dryness. In the third place are those 
substances in which these powers reside, namely, fire and 
water, air and earth. For these differ from the powers 
(qualities?). For the substances are consumed in place by 
one another, but the powers are neither consumed nor formed, 
for they are the incorporeal reasons of these. ^ Of these four, 
heat and cold are causes, and active ; but dryness and humidity 
are as the materials, and passive. In the first place there is 
matter, the universal recipient, for it is the common subject 
{or substratum) of all things, so that it is the first sensible body 
in potentiality, and the original of all things : next are the 
contraries, such as heat and cold, moisture and dryness ; and 
in the third place there are fire, water, earth, and air : these 
all change into one another, but the contraries do not change.^^ ^ 

The primary matter is afterwards defined to be " the subject 
body, that which receives all the changes, the universal reci- 
pient, and that which potentially is the first to the touch.^^ ^ 

" The first principles of all created things are the sub- 
stratum, matter, and the reason of shape ; namely, form. The 
bodies are their offspring, namel}', fire, air, earth, water.^^ * 

'' Pythagoras taught that the original of all things is the 
monad, that from the monad sprung the duad, which is the 
subject matter to the efficient monad : that from the monad 
and infinite duad were formed the numbers ; from the numbers 

' Aoyot yap uffiofiaToi Tvy\avovai Toimov. 

* Ocellus Lucanus, On the Universe. 

^ Ibid. 

^ TiuiKus Locnis, On the Soul of the Universe. 



134 PRELIMINARY DISCOURSE. [sect. hi. 

tlie points; from them the lines^ from these the figures of 
superficies; from the superficies the solid figures; from these 
the solid bodies, of which are the elements, fire, water, earth, 
air : — that from these, changed and converted into every shape, 
is formed the world, which is animated, intelligent, of a 
spherical shape, comprehending in its middle the earth, which 
also is spherical and inhabited all around.^ 

" Pythagoras said, that none of the elements is pure, for 
that earth contains fire, and fire air, and water air, &c.^^ " 

" Nor those which elements we call abide, 
Nor to this figure, nor to that are ty'd : 
For this eternal world is said of old 
But four prolific principles to hold, 
Four different bodies : two to heaven ascend, 
And other two down to the centre tend ; 
Fire first with wings expanded mounts on high. 
Pure, void of weight, and dwells in upper sky: 
Then air, because unclogged, in empty space 
Flies after fire, and claims the second place ; 
But weighty water, as her nature guides, 
Lies on the lap of earth ; and mother Earth subsides. 
All things are mixed of these, which all contain, 
And into these are all resolved again : 
Earth rarifies to dew ; expanding more 
The subtile dew in aii' begins to soar : 
Spreads as she flies and weary of the name, 
Extenuates still and changes into flame. 
Thus having by degrees perfection won. 
Restless they soon untwist the web they spun, 
And fire begins to lose her radiant hue, 
Mix'd with gross air, and air descends in dew : 
^nd deiv condensing does her form forego 
And sinks a heavy lump of earth below. 
Thus are their figures never at a stand. 

But changed by Nature's innovating hand."^ 

«. 

' Diogenes Laertius, Life of Pythagoras. That Monad and Duad, in the symbolical 
language of Pythagoras, signified Mind and Matter, is positively stated by Philo Judacus. 
'ETTOnivoQ 5' aKoKovSiia ^vffeojg KaKtivo Xk^u on fiovag ^ev tcriv s'Ikwv aniov 
TrpwTov, Svag de Tra^jjr^f Kai SiaipeTfjg vXrjQ. — De Specialibus Legibus. It may be 
proper to mention here that it is not true, as has been often stated in modern works, 
that Pythagoras himself taught the same system of the world as Copernicus ; the first 
person who did so was Philolaus the Pythagorean philosopher. See Diogenes Laertius. 

2 Jamblichus, Life of Pythogaras, § 27. I have adopted the emendation of the 
text proposed by Obrechtus. 

3 Ovid's Metamorph., translated by Dryden, Book xv. 



SECT. III.] PHYSICAL PHILOSOPHY. 135 

THE PLATONISTS. 

" Let us therefore say that the mother^ or receptacle of every 
visible, nay of every sensible production, is neither earth, nor 
air, nor fire, nor water, nor any of the things which arise out 
of these, nor out of which these arise, but a certain invisible and 
formless being, the universal recipient, concerning which being, 
if we say that it is in a very dubious way intelligible, and 
something most hard to be apprehended, we shall not speak 
ftilse." 1 

The primary matter '^ admits of everything, but partakes of 
no shape nor resemblance to anything which enters into it. 
It is the substance of impression^ to everything in nature, 
being moved and altered by those things which enter into it, 
[the forms ?), and by their means it appears sometimes one 
thing and sometimes another.^^ ^ 

" In the first place, we see that which we call water, being 
compressed, become stones and earth. But being dissolved 
and expanded, it becomes breath and air. Air, by combustion, 
is converted into fire, which, being compressed and extinguished, 
assumes its original form. Fire and air meeting together, and 
being condensed, become cloud and vapour ; and from the 
condensation of these, running water is formed. And from 
water again, earth and stones are formed." * 

Plato taught " that God, matter, and form, are the originals 
of all things : — that matter is increate and incorruptible, 
neither fire, nor water, nor any of the principles nor elements, 
but a substance capable of form and subject to fabrication : 

' Plato, iu his Timaeus. 

^ 'EKfiny€iov. Harris, in his Philosophical Arrangements, translates this word 
by "impression ;" but it does not, strictly speaking, signify impression, but the sub- 
stance which receives the impression. Wax, for example, is not the impression of 
the seal, but the substance which receives the impression. Matter, in like manner, 
is not the impression of forms, but the substance which receives the impression. 

^ Plato, in his Timaeus. 

* Ibid. These opinions regarding the elements and the first matter are expressed 
with much precision and clearness ; but, in other parts of his Timaeus, it must be 
admitted that he betrays some confusion of ideas on this subject, as is remarked by 
his illustrious pupil Aristotle (De Ortu et Interitu, ii, 1). A translation of part of 
Plato's Timxus regarding the elements, may be seen in the Somnium Scipionis of 
Macrobius, lib. i. 



13G PRELIMINARY DISCOURSE. [sect. m. 

that when rude and deprived of every quality of configuration, 
God, the artificer, formed the universe from it. He taught, 
that matter is the original of all bodies, that it was stamped 
with the impression of forms, and hence were produced the 
elements, namely, fire, water, earth, and air." ^ 

"^ Earth contains water, and water, as some suppose, carries 
earth : air is formed from water, and from dense air fire is 
formed. '^~ 

" There being four kinds of bodies, by the mutual changes 
of them the nature of the world is preserved. For water is 
formed from earth, and air from water, and ether from air : 
and then inversely, from ether, air ; from air, water ; and from 
water, earth, which is lowest in the scale. '^ ^ 

" Those who have investigated matter, if they have formed 
any right conception of it, have agreed in considering it as the 
subject and receptacle of forms." * 

" Concerning the receptacle of bodies this may be said. In 
the first place, that there must be a certain substratum to bodies 
difl^erent from themselves, is demonstrated by tlte transmutation 
of the elements into one another. For that which is changed 
is not altogether consumed, or, if it is, a substance is changed 
into a non-entity. And neither has that which is born come 
into existence from nothing, but it has undergone a change 
from one form into another. For something remains which 
has received the new form and cast off the other. And this 
is shown by destruction, for it applies only to a compound body; 
and, if this be true, every such body is compounded of matter 
and form. Induction bears testimony to the truth of this, 
by showing, that whatever is dissolved was compounded; and 
analysis in the same manner, as, for example, if a phial be 
resolved into gold, and gold into water ; and water, in like man- 
ner, when it perishes, requires to be something analogous. But 
the elements must be either form, or primary matter, or a 
compound of form and matter. But they cannot be form, for 
without matter, how could they be possessed of bulk and mag- 
nitude ? But they are not primary matter, for it is not con- 

' Apuleius the Platonic Philosopher, On Natural Philosophy. 

■^ Idem, On the Universe. 

^ Cicero, On the Nature of the Gods, ii, 33. 

' Plotiniis, Ennead ii, 4. 



SECT. III.] PHYSICAL PHILOSOPHY. 137 

suraed. It follows, then, that they must consist of form and 
the primary matter. But form regards quality and shape, but 
it (the primary matter) pertains to the subject which is inde- 
terminate, {aopicTTov or aoporoi') because it is not form."^ 

" Matter of itself is devoid of form, matter is the subject of 
all things.^^ - 

" The followers of Plato and Aristotle are of opinion, that 
there is a difference between the first principles and the ele- 
ments. For, the elements are compounded, but the first 
principles are not compounded nor formed from any thing. 
What we call the elements are fire, air, earth, and water; but 
we call that a principle which has nothing from which it is 
formed, since otherwise it is not a principle, but that from 
which it is formed. But there is something antecedent to 
water and earth, from which they are formed ; nam el 3% the 
first matter which is devoid of shape and form ; then there is 
form (which we call eatelocheiu) and privation." ^ 

" Plato, wishing to prove that the elements have one common 
matter as a substratum to all, in his ' Timseus,' enters into a 
discussion regarding their transmutation into one another. 
But he being well acquainted \Yith tlie art of demonstration, has 
treated properly of the change of the first bodies into one an- 
other. But Thales, Anaximenes, Anaximander, and Heraclitus, 
assuming each that there is some one element, endeavour to 
prove this from their changing into one another. Yet all 
these seem to me to have had an obscure idea [ovH^aTTm>) of some 
matter, which is a common substratum to all the elements, and 
seeing that it is single they supposed that there is but one 
element. But instead of saying that this is a common element 
from Avhich the others, I mean air, fire, water, and earth, are 
formed, they passed it over altogether and endeavoured to de- 
monstrate the same thing of some one of the elements, all 
proceeding upon the same mode of demonstration, although 
they did not all make choice of the same element." * 

" With regard to the old philosophers, called physical, it 
will be obvious to us when we read their writings on Nature, 

' Plotinus, Enneacl ii, 6. 

^ Proclus, Inst. TheoL, 72. 

^ Plutarch, On the Opinions of the Philosophers. 

' Galen, On the Elements, &c., ii. 



138 PRELIMINARY DISCOURSE. [sect. hi. 

that they held the existence of a tirst matter which is increate 
and eternal^ being the substratum to all created and perceptible 
things.''^ ^ 

" That the elements change into one another is admitted, 
even by the followers of Thales, it being so apparent. Hence 
it is inferred that the elements have one common matter for a 
substratum."" 

Philoj the platonic Jew of Alexandria, in his treatise ' On 
the Creation of the World/ thus expresses his opinions regarding 
the original state of matter. ^' Whoever would wish to discover 
the cause why this universe was framed, would not be far from 
the truth, in my opinion, if he said with one of the ancients, 
that the Father and Maker of it is good, and for that reason 
he spared not to impart of his most excellent nature to a sub- 
stance having nothing beautiful in itself, but possessing the 
capacity of becoming all things. Of itself it was devoid of 
form, quality, and life ; and was full of contrariety, confusion, 
and dissonance." 

" Moses, the chief of philosophers, and instructed in many 
of the most comprehensive secrets of Nature by oracles, was 
aware that it was most necessary that there should be in the 
universe an active cause and a passive subject. That the 
active is the most pure and perfect soul of the universe, more 
excellent than virtue, more excellent than knowledge, more 
excellent than even goodness and beauty. That the passive 
is of itself without life and motion, but being moved and 
figured, and enlivened by mind, it was changed into a most 
perfect work." ^ 

His opinion regarding the elements may be collected from 
the following passages : — " Fire being extinguished is con- 
verted into thick air, and air being compressed subsides into 
water, and water being still more compressed is changed into 
earth, the densest of the elements."* 

" Nothing that is pure can be comprehended by the senses."^ 

^' The elements are inanimate matter, of itself devoid of 

' Galen, Commentary on the Nature of Man. 

^ Idem, On the Elements, &c. 

^ Philo, on the Creation of the World. 

'' On the IndestructihiUty of the Universe. 

* On the Creation. 



SECT. III.] PHYSICAL PHILOSOPHY. 139 

motion^ and subjected to the artificer, by wliom it is trans- 
formed into all kinds of shapes and qualities.'^ ^ 

I shall venture to give under this head the opinions of one 
of the Arabian medical authors . 

" It is to be kept in mind that the elements which are per- 
ceived by tlie senses, namely, fire, air, earth, and water, are by 
no means the pure elements, but such as are comprehended by 
the mind. These are not to be perceived by the senses. None 
of the others is pure, nor without some admixture."^ 

THE PERIPATETICS. 

Aristotle defines the first matter as follows : '' I call matter 
the fii'st subject of everything, all things being formed from it 
existing in them not accidentally ; and when anything is de- 
stroyed, it comes to this at last.^ 

In his Logical work he thus defines his ideas regarding the first 
substances, namely, mind and matter. " The first substances 
being the subjects of all other things, and as every other thing 
may be predicated by them and exists in them, are called the 
prime substances.^ 

" We must distinguish the first bodies from matter, for we 
must suppose concerning them that they have a first principle 
and origin, namely, matter, Avhich is inseparable from them, 
and is the subject of the contraries. For heat does not furnish 
the materials to cold, nor it to heat, but the subject to both. 
So that we have first the sensible body in potentiality, the first 
principle ; then we have the contraries, I mean cold and heat ; 
and thirdly, fii'e and water, and the like. These change into 
one another, and not as Empedocles and others say of them." 

" The 'material of all bodies, great and small, is the same. 
This is apparent ; for when air is formed from water, the same 
matter, Avhen it becomes another thing, acquires nothing 
new, only that which formerly existed in capacity now exists 
actually.''''^ 

The following extracts will show the opinions of his most 
celebrated commentators : 

' On a Contemplative Life. ^ Haly Abbas, Theor., i, 5. 

^ Auscult. Natur., i, near the end. '' Categor. 

^ On Birth and Death, ii, 1. ^ Auscult. Phys., iv. 



140 PRELIMINARY DISCOURSE. [sect. hi. 

" Air and fire have one common character^ namely, heat ; 
therefore they readily change into one another. Air and water 
readily change into one another, for they have a common 
character, namely, moisture. In like manner, water and earth, 
for they have an alliance, namely, coldness."' 

" The physical philosophers analj^se any substance, as, for 
example, a man into head, hands, and feet; and these into 
bones, flesh, and nerves ; and these into the four elements ; 
and these again into matter and form.^ 

" Water is formed from air, and air from water, and fire from 
air, because they all have one common substratum, matter." ^ 

The next two extracts will show the opinions entertained by 
Aristotle's successor in the Peripatetic school of philosophy. 

" Of the simple substances, fire has peculiar powers. For ah', 
water, and earth, admit only of chanyes into one another, but 
none of them can produce itself."* 

'^ The nature of those substances called simple is mixed, and 
existing in one another."^ 

" The Peripatetics divided Nature into two things, the one 
of which is efficient, and the other that which furnishes it with 
the materials from which anything is made. Power exists in 
the one, and matter is the essence of the other."'' 

" The first principles are air, fire, water, and earth, for from 
them are formed all living things and the productions of the 
earth : they are therefore called elements ; of these, air and fire 
have the power of moving and forming the others (I mean water 
and earth), of receiving or suffering. Besides these, Aristotle 
thought that there is a fifth element, from which the stars and the 
souls of individuals are made ; but that all these had for a sub- 
stratum a certain matter devoid of form and quality, from which 
all things are framed, a substance which has a capacity for all 
things, and admits of all changes, that when it perishes it is 
not reduced to nothing, but into its parts, which can be cut 
and divided infinitely, since there is nothing in Nature that is 
not divisible."^ 

' Simplicius, Comment, in Ausciilt. Nat., iv. 

- Ammonius, Comment, in Porphyr. Introd. ^ Ibid. 

'' Theophrastus, On Fire. ' Ibid. 

•^ Ciceio, Quaed. Acad., i, 6. " Ibid., 7. 



SECT. III.] PHYSICAL PHILOSOPHY. 141 

THE STOICS. 

" They are of opinion that the first principles of all things 
are tAvo — the active and the passive : that the passive is matter, 
a being devoid of all qualities ; the active, or efficient, is the 
reason (Aoyoc) residing in it, that is, God. That he, being 
eternal, fabricates all things from it all (all matter?). That 
there is a difference between the first principles and the 
elements — that the former are increate and indestructible, 
whilst the elements are destructible by burning (t'/cTrupwa-ti'). — 
That the first principles are bodies devoid of form, whereas 
the elements are possessed of form. That God and Mind, 
Fate and Jupiter, are one and the same being under different 
appellations; that he formed the four elements, fire, air, water, 
earth.^'^ 

" Our Stoics say, that there are two principles in Nature from 
which all things are formed, namely, cause and matter. That 
matter lies inert, a being prepared for all things, but inactive, 
unless some one move it. — That cause, that is, reason, forms 
matter, and changes it at will. There must be something by 
which everything is made and 0/ which it is made : the former 
is the cause, the latter the matter.^'" 

" Some of our sect are of opinion that air, being changeable 
into fire and water, &c."^ 

" We are of opinion that earth is changeable. To this we 
may add that all things are formed from all things — air from 
water — water from air — fire from air — air from fire; why, 
then, should not earth be formed from water, and ivater from 
earth ? Earth is formed from water — why then not water from 
earth ?"^ 

" The Stoics divided Nature into two things, the one of which 
is the efficient, and the other that which furnishes itself as the 
materials from which anything is made.^'^ 

Suidas says, regarding the first principles : " The first prin- 
ciples of all things are two, the efficient and the passive. The 
passive, then, is a being devoid of qualities — earth, matter. 

' Diogenes Laertius, in the Life of Zeno the Stoic. The reader must take care 
not to confound him with Zeno the Eclectic. 

^ Seneca, Ep. 65. ^ Seneca, Nat. Quaest., ii, 15. 

^ Seneca, Nat. Qurest., iii, 10. ■'' Lactantius, Div. Inst., iii, 3. 



142 PRELIMINARY DISCOURSE. [sect. hi. 

The efficient is the reason residing in it, namely, God. The 
principles and elements are different, inasmuch as the former 
are increate and indestructible, while the elements are destruc- 
tible by burning. Besides, the first principles are without 
body and form, but the elements have form."^ 

" Zeno, the son of Mnaseas, the Citiensian, taught that there 
are two principles, God and matter, the one efficient and the 
other passive ; and that there are four elements. ^^^ 

" The Stoics maintain that the first principles are two, God 
and matter ; not that they consider God as an element, but as 
the active principle, whilst matter is the passive.^'^ 

" Always remember the saying of Heraclitus, that the dis- 
solution of earth is to become ivater, and the dissolution of water 
to become earth; and the dissolution of air to become fire, and 
conversely."^ 

"^ Contemplate the courses of the stars as if carried about 
with them, and frequently revolve in your mind the mutual 
transmutations of the elements into one another,"'' 

" Acquire the habit of contemplating the transmutation of 
all things into one another."^ 

" Fire, air, water, earth, were so formed by Nature as to 
furnish aliment by turns to one another."^ 

' See under cipxai. 

^ Plutarch, Concerning the Opinions of the Philosophers. 

* Simplicius, Comm. in Aristot. Auscult. Nat., p. 7 ; ed. Aid. 

* Marcus Antoninus, iv, 46. 

5 Ibid. « Tbid. 

' Manilius, Astron., iii, 53 : — 

" Principium rerum et custos natura latentura 
Cum tantas strueret moles per iuania mundi : 

* * * * 

Aeraque et terras flamraamque undamqne natantem 
Mutua in alternum praebere alimenta juberet." 



SECT. III.] PHYSICAL PHILOSOPHY. 143 



THE EPICUREANS. 

" Therefore all those who teach things took their 1)irth 
From simple fire, or water, air, or earth, 
Lie under palpable mistakes. Aud those 
That teach from doubled elements they rose, 
As air and fire, as earth and water joined, 
Or all four, earth, air, water, fire combined : 
Thus sung Empedocles. 

■jf * * * 

If all things from four elements arose. 
And are again by death dissolved to those : 
What reason we should rather fondly deem 
Them principles of things, than things from them ? 
For they alternately are changed and shotv 
Each other's figure and their nature too." ' 

The following passage will show the opinions of Democritus, 
the contemporary and friend of Hippocrates, from whom 
Epicurus took his system of physics.' " He taught that the 
atoms are infinite in magnitude and number, that they re- 
volve in all space, and that thus they formed the compound 
bodies fire, water, air, earth ; for that even these are composed 
from the atoms, which are impassive and unchangeable owing 
to their hardness."" 

These extracts prove clearly that the great philosophers of 
antiquity stand acquitted of having held the erroneous opinions 
generally ascribed to them respecting the elements of things, 
and that nothing can be farther from the truth than the ac- 
count of the Peripatetic doctrines given by Dr. Watson. In- 
stead of maintaining, as he carelessly represents, that " earth, 
air, fire, and water are distinct, uucompounded, immutable 
principles ;" they taught, on the contrary, as we have shown, that 
all the elements are modifications of one common substance 
called the primary matter, and consequently they held, like 
himself, that " the elements are diff'erent magnitudes, figures, 
and arrangements of particles of matter of the same kind." 
This primary matter they demonstrated to be devoid of all 
quality and form, but susceptible of all forms and qualities.^ 

' Lucretius, Of the Nature of Things, Book i, translated by Creech. 

' Cicero, Acad. Qurest., i, 2 ; Galen, de Elementis. 

^ Diogenes Laertius, Life of Democritus. 

* 'H ji\>/ «7roioc. Galen, de Element, ex Hippocrat. 



144 PRELIMINARY DISCOURSE. [sect. hi. 

In the language of the Peripatetics^ it is everything in capa- 
city, but nothing in actuahty. They held that there are two 
original principles, both increate and indestructible ; the one 
matter, the universal passive principle^ — the material from 
which all things are formed ; and the other, the efficient cause 
by which all things are made : — that the one is possessed of 
universal privation, and the other of universal energy : — that 
it is the one which impresses, and the other which receives the 
forms of all things. They maintained that the original mate- 
rials out of which all objects in the universe are composed 
being the same, bodies owe their characteristic qualities not to 
their substance, but to their form. The elements, then, ac- 
cording to the notions of the ancient philosophers, are the first 
matter arranged into certain distinguishing forms by the 
efficient cause. That form with which solidity is associated 
they call earth, under which they ranged all metals, stones, 
and the like, for all these they held to be allied to one another 
in nature, as well as in the form under which they are pre- 
sented to our senses. The next arrangement of created sub- 
stances is that Avhich constitutes fluidity, and is called water, 
under which term they comprehended not only the nati^'e 
element, but every other modification of matter which assumes 
a similar form, namely, all juices of vegetables and fluids of 
animals.^ Some of their earliest speculators in philosophy 
maintained that all the materials which compose the universe 
existed at one time in this form ; and it is curious to reflect 
that modern geology has reproduced nearly the same doctrine. 
The third form of matter, as presented to our sense of touch, 
is air, under which the ancient philosophers comprehended all 

• The eternity of matter is a doctrine which was maintained by all the ancient 
philosophers and by several of the Christian fathers of the church, but is gene- 
rally rejected by our modern divines as being, in their opinion, contradictory to 
Revelation. But were it really so, it would hardly have found an advocate in the 
learned and pious author of ' Paradise Lost.' That such was truly his opinion can 
now admit of no doubt, from what he states on the subject in his treatise on 
Christianity, published some years ago by the present Archbishop of Canterbury ; 
and the same might have been inferred from more than one passage in his great 
poem. The Jewish philosopher, Philo, seems to admit the eternity of matter, al- 
though he denies the eternity of the world. (On the Creation.) 

- " There are varieties," says Strabo, " of the watery element ; for this kind is 
saltish, and that sweet, and fit for drink; and others again poisonous, salutary, deadly, 
cold, and hot." — Geograph., xvii, 1. See also Aristot., Meteorol. 



SECT. III.] PHYSICAL PHILOSOPHY. 143 

matter in an aerial state, such as water converted into vapour, 
and what are now called gases. Whether or not they believed 
the atmosphere which surrounds this earth to be a homo- 
geneous substance, in nowise affects the general principles of 
their philosophy ; for it is the same thing, as far as regards 
their classification, whether they held that the atmosphere con- 
sists of one or of several distinct combinations of the primary 
matter with form. As they were well aware that several dis- 
tinct modifications of matter are comprehended under each of 
the other elements, it can hardly be doubted that they inferred 
the like of air; and, indeed, it is quite apparent from the works 
of Galen that he knew very well that some kinds of air are 
favorable, and others unfavorable to respiration and combustion.^ 
But those phenomena which we ascribe to oxygen gas, they, 
without doubt, would have attributed to the operations of some 
modification of the element fire. By fire, they meant matter in 
its extreme state of tenuity and refinement. Of this elementary 
principle, Plato^ and Theoplirastus'^ have enumerated many 
varieties, and have speculated regarding their nature with great 
precision and acuteness. The ancient philosophers believed 
that fire is universally diffused through the universe, being 
sometimes in a sensible, and sometimes in latent state ; or, as 
Aristotle expressed it, heat exists sometimes in capacity, and 
sometimes in energy.* They attributed the phenomena of 
lightning to an unequal distribution of this elemental fire.' 
This is the element with which they supposed life to be most 
intimately connected ; and, indeed, some of them would appear 
to have considered fire as the very essence of the soul. '' I am 

' Aristotle inquires whether the atmosphere be a single substance or many, and 
if many, of how many it consists. (]\Ieteorol., i, 3.) I may be allowed to remark in 
this place, that Galen's ideas regarding respiration are wondex'fidly accurate, and not 
very different from those now entertained by the profession. Thus he compares the 
process of respiration to combustion, and says it produces the same change upon 
atmospheric aii\ He further agrees with modern physiologists in considering it as the 
vital operation by which the innate {or animal) heat is preserved. (De Respiratione.) 
Compare this treatise with Baron Cuvier's admirable section on Respiration, and 
observe on how many points these two great physiologists agree. (Lecons d'Anatom. 
Compar., 26.) 

^ Timajus. ^ De Igne. 

■* De Partibus Animalium, ii, 2. His great commentator, Averrhoes the Aral)ian, 
states this distinction very correctly. See Cantic, Avicennsc, tr. v. 

5 Lucan's Pharsalia, i, 1."j7, GOG. 

10 



146 PRELIMINARY DISCOURSE. [sect. hi. 

of opinion," says the aiitlior of one of the Hippocratic treatises, 
"that what we call heat is immortal, and understands, sees, 
and hears all things that are or will he."^ This doctrine, 
which, to say the least of it, is not A'ery judiciously expressed 
in this passage, is thus corrected by the great master of logic 
and philosophy : " Some," says Aristotle, " improperly call fire 
or some such power the soul ; but it would be better to say 
that the soul subsists in such a body, because heat is, of all 
bodies, the one most obedient to the operations of the soul ; for 
to nourish and move are the operations of the soul, and these 
she performs by the instrumentality of this power [or quality?). 
To say that the soul is fire, is as if one were to call a saw or 
a wimble the artisan or his art, because his work is accom- 
plished in co-operation with these instruments. From this it 
appears why animals stand in need of heat,"^ And in like 
manner he says, in another of his works : " Some are of 
opinion that the nature of fire is plainly the cause of nourish- 
ment and of growth ; for it appears to be the only body or 
element which nourishes and increases itself. Wherefore one 
might suppose that it is this that operates both in plants and 
in animals. Yet it is but the co-cause [ovvaiTiov); for it is 
not, properly speaking, the cause, but rather the soul. For the 
increase of fire is indeterminate in so far as it is supplied with 
fuel. But of natural substances there is a certain limit and 
reason (Xo^yot;) of magnitude and increase. This belongs to 
the soul rather than to fire, to the reason rather than to the 
matter."^ 

From these observations, coupled with the information 
supplied in the preceding extracts, it will be perceived that, 
although there be, at first sight, a great discrepancy among 
physical doctrines of the ancient philosophers, they differed, in 
fact, much less than they would appear to do, only that some 
of them expressed themselves more scientifically than others in 

' De Caniibus. (See the preceding section.) In lilic manner Pliornutus says, 
" our souls are fire." (De Natura Deorum, ap. Gale's Opuscula Mythologica, p. 142.) 
Such is also said to have been the doctrine of Hippocrates and Democritus. See 
Macrobius (Somnium Scipionis, i, 14) ; and Nemesius (de Nat. Hominis). In the 
Hippocratic treatise De Septimadibus, ■«hich M. Littre has discovered in Latin, the 
essence of the soul is held to be heat. (Ed. Littre, i, p. 391.) 

' De Partibus Animalium, ii, 7. ' De Aniina, ii, 4. 



SECT. III.] PHYSICAL PHILOSOPHY. 147 

handling tlie subject of the elements. Thus, although Tliales 
seems to hold water, and Anaximander air, and Heraclitus^^re, 
to he original principles, we have every reason to believe that, 
as Galen says (1. c), even they had an idea that these are not 
simple substances, but merel}^ modifications of one unformed 
principle, the first matter, from which they conceived that all 
bodies in the universe are constructed. Contrary, then, to 
what is very generally supposed, it would appear that there 
was at bottom no very great difference of opinion between the 
philosophers of the Ionic school and those of the other sects, 
namely, the Pythagoreans, Platouists, Peripatetics, Stoics, and 
Epicureans ; and further, that, from tlie earliest dawn of 
philosophy, down to the time when it fell into neglect nnd 
came to be misunderstood, the physical doctrines of the philo- 
sophers underwent but little variation. 

From the elements, then, constructed in the manner now 
explained, out of the primary matter, the ancient philosophers 
taught that all the secondary bodies in the universe are formed, 
and as they maintained the transmutability of the elements 
into one another, so, in like manner, they did not hesitate to 
proclaim it as a great general truth "that all things are con- 
vertible into all things."^ The possibility, then, of such per- 
mutations will not, I presume, be questioned by any one who 
has formed correct ideas of the powers of the Great Fn-st 
Cause, and the capacities of the first subject, Matter, and that 
such permutations do actually take place in the course of 
Nature may be inferred from many phenomena of daily occur- 
rence in the vegetable and animal world. It cannot have 
escaped the most careless observation what changes the great 
pabulum, water, undergoes in the process of vegetation — how 
it is converted into various woods, and barks, and leaves, and 
flowers, all of which are resolvable, by the process of decay, into 
air, or reducible into earth. It is also well known that, 
although a more unfrequent occurrence, all the solid parts of 
a tree may undergo a mutation into rock, that is to sa}^, may 
become petrified. But it is in the higher classes of animals 
that these changes of simple matter admit of the greatest variety. 

' "On Trav ek iravTOQ yiv'ta^ai nsfpvKt. — Aristot., de Ortu et Interitu, et Auscul- 
tationes Naturales, i. 



148 PRELIMINARY DISCOURSE. [sect. hi. 

Let us contemplate for a moment some of the most remarkable 
mutations which any article of food, (as, for example, flour- 
bread), which has been presented to the stomach, is destined to 
undergo in the animal frame. We know that the vital powers 
of the stomach will convert the starch, of which it principally 
consists, into a fluid state, that is to say, into what is called 
first chyme, and afterwards, when it has underofone some further 
change, is denominated chyle by the physiologists. Ha\ing 
been thus changed, it passes, by a process about the nature of 
which physiologists are still strangely divided in opinion, into 
certain vessels ; and then, in some manner still less understood, 
it is converted into a fluid sui generis, called blood, abounding 
in globules of a singular construction, all fabricated, no doubt, 
from the food, but, by some occult process, which has hitherto 
defied the skilful manipulation of the chemist, and the accurate 
observation of the microscopist, to explain in any satisfactory 
manner.^ And so complete is the transformation that scarcely 
one particle of the original food can be detected in the new 
product by all the vaunted tests of modern science. But blood 
is soon after converted into many other fluid and solid sub- 
stances — into bones, cartilages, muscles, and vessels, and into 
bile, mucus, and other recrementitious matters, all difl'ering 
greatly from one another, Ijotli in their appearances and in 
their properties." And when all the component parts of the 
animal frame are constructed, and each seems to have acquired 
a determinate structure, should the vital actions by which they 
are formed become deranged, we may see the fair fabric undergo 
the most wonderful mutations, so that arteries are converted 
into bones, and bones into flesh and jelly .^ So many and so 
extraordinary are the changes which a simple alimentary sub- 
stance may undergo in the animal frame ! And if we admit, 
with the ancient philosophers, that every such substance is 
resolvable into one or more of the elements, and that all the 

' See Simon's Chemistry, vol. i, p. 118, and the authorities there referred to. 

^ Baron Cuvier says : " En un mot, toutes les fonctions animales paroissent en 
reduire a des transformations de fluides ; et c'est dans la maniere dont ces trans- 
formations s'operent, que git le veritahle secret de cette admirable economie." — 
Lefons d'Anatom. Comp., lib. i. 

3 It will be readily understood that allusion is here made to the diseases ossifica- 
tion and osteosarcoma. 



SECT. III.] PHYSICAL PHILOSOPHY. 149 

elements are but different modifications of one common matter^ 
how wonderful a thing must Form be^ since it imparts such 
varied appearances and qualities to one common substratum ? 

In detailing these opinions of the ancient philosophers^ it is 
not my present business to determine Avhether they be true or 
not ; my task is fulfilled, if I have given a distinct and faithful 
exposition of them, so that their real import and meaning may 
be readily comprehended by the medical reader. I may be 
allowed to remark, however, that, strange although that Protean 
being, the primary matter, may appear to be to such men 
of science as are not disposed to recognise the existence of any 
substance which cannot be sulijected to their senses, and who 
refuse to admit the legitimacy of every process of analysis, but 
what is conducted in the laboratory of the chemist, opinions 
similar to those of the ancient philosophers have been held by 
some of the most profound thinkers and distinguished experi- 
mentalists of modern times. Thus Lord Bacon, the reputed 
father of the inductive philosophy, appears to admit all the 
tenets of the ancients regarding the first matter, which, like 
them, he considers to have been embodied in the Homeric 
fable of Proteus.^ He says, in reference to it, " that under 
the person of Proteus is signified Matter, the most ancient of 
all things, next to the Deity ; that the herd of Proteus was 
nothing else than the ordinary species of animals, plants, and 
metals, into which matter appears to diffuse, and, as it were, to 
consume itself; so that, after it has formed and finished those 
several species, (its task being, in a manner, complete,) it 
appears to sleep and be at rest, nor to labour at, attempt, or 
prepare any species farther."" That learned and accomplished 
scholar, Mr. Harris, in his Avork on ' Philosophical Arrange- 
ments/ writes thus on the subject we are now treating of: 
" Here, then, we have an idea (such as it is) of that singular 
being, the Primary Matter, a Being which those philosophers who 

' The same application of this myth is made by Eustatheus, the commentator on 
Homer (ad Odyss., iv, 417), and hy Heraclides Ponticus (Gale's Opuscula Mytholog., 
p. 490). The words of Heraclides are very striking: " That hence it was with good 
reason that the formless matter was called Proteus ; and that Providence which 
modified each being with its peculiar form and character was called Eidothia." 

^ De Sapient. Vet., cap. xiii. 



150 PRELIMINARY DISCOURSE. [sect, ii 

are immerged in sensible subjects know not well how to admi 
though they cannot well do without it ; a Being which flies tl 
perception of every sense, and which is at best, even to tl 
intellect, but a negative object, no otherwise comprehensib 
than either by analogy or abstraction. 

" We gain a glimpse of it by abstraction, when we say th: 
the first matter is not the lineaments and complexion whi{ 
make the beautiful face ; nor yet the flesh and blood whi( 
make these lineaments and that complexion ; nor yet the liqu 
and solid aliments, which make that flesh and blood ; nor y 
the simple bodies of earth and water, which make those varioi 
aliments ; but something which, being below all these, ar 
supporting them all, is yet difi'erent from them all, and esse: 
tial to their existence. 

" We obtain a sight of it by analogy when we say that, i 
is the brass to the statue, the marble to the pillar, the timbi 
to the ship, or any one secondary matter to any secondary forn 
so is the First and Original Matter to all forms in general."^ 

Nay, the illustrious Sir Isaac Newton would seem, in tl 
following extract, to countenance the profound speculations 
the ancient philosophers Avitli respect to the elements, and tl 
transmutations of these substauces into one another. He say 
" Are not gross bodies and light {or ether) convertible into oi 
another? — and may not bodies receive much of their activii 
from the particles of light which enter into their composition 
The changing of bodies into light and of light into bodies 
very agreeable to the course of Nature, which seems delight( 
with permutations. Water, which is a very fluid tasteless sa 
she changes by heat into vapour, a sort of air ; and by cold in 
ice, which is a hard, pellucid, brittle, fusible stone, and tl 
stone returns into water by heat, and vapour returns into wa1 
by cold. Earth, by heat, becomes fire, and by cold retui 
into earth."^ 

> Op. cit., iv. 

* These opinions of Newton bear a strong resemblance to those of Strabo, as « 
pressed iu the following passage : " Since all things are in motion and undergo 
great changes, it is to be supposed that neither does the earth alw-ays remain 
same, so as neither to be augmented nor diminished ; nor yet water ; nor that ei 
always possesses the same seat, for that a change of one thing into another seems n, 
much according to nature. For that much earth is converted into water, and rich 
water into earth."— Geograph., xvii, 1. | 



SECT. III.] PHYSICAL PHILOSOPHY. 151 

I may further mention that all the late researches of chemical 
philosophers have tended to confirm the tenets of the ancients 
regarding the Elements. Thus in that very singular perform- 
ance ' The Elements of Physiophilosophy/ by Dr. Lorenz Oken^ 
the productions of the mineral kingdom are classified, very 
much in accordance with the ancient arrangement, into four 
classes, namely, into Earth-earths, Water-earths, Air-earths, 
and Fire-earths.^ It is also well known that chemical experi- 
ment has lately established that several animal and vegetable 
substances, such as albumen, fibrin, and casein, which were 
formerly looked upon as distinct substances, are all but modi- 
fications of one substance, which is now regarded as the original 
of all the tissues ; and further, that protein, in every respect 
identical with that which forms the basis of the three aforesaid 
animal principles, may be obtained from similar elements in 
the vegetable kingdom.^ And if every step which we advance in 
the knowledge of the intimate structure of things leads us to con- 
tract the number of substances formerly held to be simple, I would 
not wonder if it should yet turn out that oxygen, carbon, hydro- 
gen, and nitrogen are, like what the ancients held the elements 
to be — all nothing else but different modifications of one ever- 
changing matter. But I Avill not indulge further in such 
speculations, especially as I have reason to apprehend that I 
may be thought to be wandering from my own proper sphere 
in thus prosecuting researches which may be supposed to have 
but a distant bearing on the subject now in hand. I must, 
however, be allowed again to repeat my declaration, that it is 
impossible to comprehend the theories contained in the Hippo- 
cratic treatises without a proper acquaintance with the Physical 
Philosophy of the ancients, and that these principles have been 
misapprehended and misrepresented most unaccountably by 
modern writers, so as to occasion corresponding mistakes with 
regard to ancient medicine. I trust, then, that my present 
labours will not be inefi'ectual in preventing such mistakes in 
future ; though, at the same time, knowing, as I Avell do, the 

' See p. 120, Kay Society's edition. 

2 See Simon's Chemistry, vol. i, p. 5 ; Sydenham Society's edition. The etymology 
of the term prolein is there given from Trpiorivto, I am first ; hut it may more pro- 
perly be derived from Proteus, to which, as we have mentioned above, the first matter 
was likened. 



152 PRELIMINARY DISCOURSE. [sect. hi. 

practical bent of British science at the present day^ I cannot 
but be apprehensive that a certain portion of my readers -oill 
lend a deaf ear to speculative opinions, of which they cannot 
recognise the importance, and will be disposed to discard the 
doctrines of the ancient philosophers before they have rightly 
comprehended their import : 

" Nee mea dona tibi studio comporta fideli 
Iiitelleeta prius quam sint, contempta relinquas." ' 

I am sensible, too, that I may have just reason to suspect 
that I still retain a too partial fondness for the fascinating 
studies in which I indulged at one period, beyond what, 
perhaps, was prudent in a physician, and that it would have 
been better for me if I had taken a lesson from the mythical 
hero of the ' Odyssey,' and had resisted the enchanting voice of 
the ancient Siren when she sought to allure me from the active 
duties of a professional life, with the confident assurance that 
I should leave her " much delighted, and with an increase of 
knowledge. "2 

Before concluding, I will l^riefly recapitulate the results to 
which our present inquiry has conducted us : — 

1st. That many of the medical theories which occur in the 
Hippocratic treatises are founded on the physical philosophy of 
the ancients, and more particularly on their doctrines with 
regard to the elements of things. 

2d. That all the great sects of the ancient philosophers held 
that the four elements, namely, fire, air, earth, and water, are 
transmutable into one another, being all of a homogeneous 
nature, and based upon one common substratum, namely, the 
primary matter. 

' Lucretius, de K. N., i, 48. 

^ I have always looked upon the story of the Sirens as being one of the most 
beautiful fictions in the Homeric poems. By the two Sii^ens I cannot but think 
that the poet meant to represent Philosophy and Melody, these being, as it were, the 
handmaids of Poetry. They assail the virtue of Ulysses with no vulgar temptations, 
by assuring him that they were well acquainted with all the martial exploits in which 
he had been engaged, and that he would leave them " much delighted, and with an 
increase of knowledge." 

'A\X' oyi rtp-^djxtvoc vdrai KCii wXtiova tihoc. 

Odyss. xii, 188. 



SECT. III.] PHYSICAL PHILOSOPHY. 153 

3d. That, by reasoning from observation and analogy, tlie 
ancient philosophers arrived at the conclusion that this primary 
matter is a substance devoid of all qualities and forms, but 
susceptible of all forms and qualities. 

4th. That although certain of the philosophers, the contem- 
poraries and predecessors of Hippocrates_, appear to hold that 
some one of the elements, such as fire or water, was the original 
of all things, even these had an idea, although not expressed by 
them in a definite manner^ of a first matter, which serves as a 
basis to all the elements. 

5tli. That these doctrines of the ancient philosophers, 
whether well founded or not, are countenanced by many eminent 
names in modern literature and philosophy. 

6th. That the opinion generally entertained regarding the 
doctrines of the ancient philosophers on this subject is altogether 
erroneous. 



THE 



WORKS OF HIPPOCRATES. 



ON ANCIENT MEDICINE. 



ON ANCIENT MEDICINE. 



THE ARGUMENT. 

Although, as stated in tlie second section of the Preliminary 
Disconrse, the evidence in support of this treatise be unfortu- 
nately not such as clearly to establish its genuineness, all who 
read it with attention must admit that it is i-eplete with im- 
portant matters, and that if not the production of Hippocrates, it 
is not unworthy of his high reputation. Notwithstanding, then, 
that I am by no means so well convinced as M. Littre is, that 
the Mork is genuine, I have not hesitated to follow his example 
in placing it at the head of the list, as the nature of its contents 
is such as to form an excellent introduction to the study of the 
Hippocratic medicine. 

It contains, as M. Littre remarks, a polemic, a method, and a 
system. The polemic is directed against those of his predecessors 
who had corrupted medicine by introducing hypotheses into it as 
the causes of diseases, such as heat, cold, moisture, and dryness. 
These it will be seen that he combats with great force of argu- 
ment and clearness of illustration. The philosophical dogma 
to which he is supposed to refer in this place are those of the 
section of the Pythagoreans, called the Eleatic, who would 
appear to have held neai'ly the same opinions as Pythagoras 
himself with regard to the elements.' But, in fact, as I trust 
I have clearly made out in the third section of the Preliminary 

' Diogenes Laertius, in fact, states that Xenophanes, tlie fouiuler of the school, 
held the doctrine of the four elements. On the Eleatic philosophy, see further, 
Aristotle (de Xenophane ; and jMetaphys., i, 5) ; and, of the modern authorities, Ritter 
(History of Ancient Philosophy, vol. i) and Grote (Hist, of Greece, torn, iv, p. 518, &c.) 
Whether or not these modern authors, however, have rightly apprehended the doc- 
trine of Xenophanes and Anaximander with regard to the elements, may, I think, be 
justly doubted. Dr. Thirlwall gives a very judicious exposition of the etliical opinions of 
tlie Eleatic philosophers, but does not touch on their physical. (Hist, of Greece, § 12.) 



158 ANCIENT MEDICINE. 

Discourse, all the ancient philosophers held substantially the 
same opinion regarding tlie elements, although they did not 
all express themselves in the same terms. It is of little con- 
sequence, then, to attempt to find out what particular class of 
philosophers our author directs his attack against, it being 
sufficient to say that he decidedly condemns the practice of 
founding the rides of medical practice on hypothesis.^ I may 
here remark, that the censure thus bestowed on hypothetical 
systems applies to modern tiines as well as to ancient, to those 
who proclaim theories by which, like Broussais, they account 
for all diseases upon figments which they call inflammations, 
and those who, like Cullen, attribute most diseases to spasms. 
We may rest assured, from the sensible observations which 
Hippocrates makes on this subject in the present work, that 
the causes of all diseases are realities, provided we could find 
them out, and that they are not vague abstractions, as the 
authors of these hypotheses suppose. 

His method of cultivating medicine is founded on an atten- 
tive examination of all the circumstances connected with real 
life, and his sj'stem consists in studying the condition of the 
humours in the body, their origin, their coction, and their dis- 
appearance. 

The most prominent feature, however, in the contents of 
this little treatise is the practical view which is here given of the 
origin of medicine, namely, from the necessities and weaknesses 
of the human race. The author clearly makes it out that 
Medicine is, as it were, a corollary to Dietetics. Nothing of the 
kind can well be imagined more ingenious and original than 
his observations and reasonings on this head in the intro- 
ductory sections of this treatise. See in particular § 5. 

The remarks in refutation of the hypothesis of cold, heat, 
moist, and dry, are very interesting. (§ 13.) 

The reflections on the origin of fevers and inflammations are 

1 M. Littre is inclined to give the Pytliagorean philosopher, Alcmaeon, the credit 
of priority in broaching the philosophical theory which runs through this treatise. 
His only authority, however, on this point is Plutarch (De Placit. Philos., v, 30) ; 
whereas Galen, as he admits, says expressly that Hippocrates himself is the author 
of this theory. Now, I must say that, of the two, Galen appears to me to be the 
better authority, being profoundly skilled both in medical and philosophical literature. 
But further, neither Diogenes Laertius in his life, nor any other writer who has noticed 
Alcmaeon, says anything of his having promulgated the theory of the Crasis. 



ARGUMENT. 159 

very just and original, but would appear not to have been 
properly appreciated l)y his successors ; for among all the 
ancient authors who have treated of fever, there is, perhaps, no 
one but himself who has stated in decided terms that there is 
something more in a fever than a mere increase of the innate [or 
animal) heat. See the Commentary on Paulus Jj^gineta, 
B. II, 1. 

The remarks on the effects of the cold bath at § 16 are much 
to the purpose, and deserve attention. 

The observations on rheums or defluxions (§19) are also very 
striking, and even at the present day, after the many vicissi- 
tudes of medical theory which we have gone through, it would 
be difficult to deny that the opinions here advanced are well 
founded. At all events they must be allowed to be highly 
interesting, as containing the first germ of a theory which long 
flourished in the schools of medicine. 

At § 20 the author seems to hold that philosophy is not 
so necessary to medicine as medicine is to philosophy. Schulze, 
with a considerable show of reason, argues that Celsus had this 
passage in view when he pronounced, concerning Hippocrates, 
that he was the first person who separated medicine from phi- 
losophy. (Hist. Med, I, 3, i, 26.) Schulze contends that what 
Celsus meant was, that Hippocrates discarded a jjriori argu- 
ments in medicine, and drew all his inferences from actual 
observation. This would appear to me the most plausible 
interpretation which has ever been given to this celebrated 
passage in the preface of Celsus. Philosophy, then, it would 
appear, freed medicine from the delusions of superstition, by 
substituting the errors of hypothesis in their place, and the 
important office which he who was called the Father of Medicine 
conferred upon the art was by discarding both superstition and 
hypothesis, and substituting the results of actual observation 
in the room of both. 

From § 22 to the end of the work the author gives important 
observations on the modifications which diseases undergo in 
connexion with the peculiar organization of the part in which 
they are situated. It may well be doubted whether the re- 
marks and reflections herein contained have ever obtained all 
the attention which they merit. 

The style of this piece is certainly elegant and beautiful ; 



IGO ANCIENT MEDICINE. 

and it is proper to mention that tlie text is remarkably im- 
proved in INI. Littre's edition. In all tlie previous editions it 
was more corrupt than that of almost any other of the Hippo- 
cratic treatises. 

The following remarks of M. Littre on the present work 
appear to me so just^ and are so elegantly expressed, that I 
cannot deny myself the pleasure of introducing them here in 
the original : 

" En resume, le livre de VAncienne Medecine donne une 
idee des problemes agites du temps d'Hippocrate, et de la 
maniere donts ils etaient debattus. II s'agissait, dans la i)lus 
grande generalite de la pathologie de determiner la cause des 
maladies on, en d'autres termes, de poser les bases d'un systeme 
de medecine. Certains medecius disaient que cette cause, 
etant une, residait dans une propriete unique du corps, propriete 
qu'ils specifiaient. Hippocrate repetait qu'en fait, cela etait 
en contradiction avec Texperience, qu'en principe une hypothese 
etait suspecte et sterile, et qu'il n'y avait de surete que dans 
I'etudes des faits et dans la tradition de la science qui y ramene. 
Ainsi, quatre cents ans avant J. C, on essayait de rattacher 
toute la medecine a une seule propriete hypothetique, comme 
on I'a essaye de nos jours ; mais cette propriete etait ou le 
chaud, ou le froid, ou Fhumide, ou le sec. Quatre cents ans 
avant J. C, un esprit severe et eclaire combattait de telles 
opinions au nom de 1' experience, montrait que les causes des 
maladies ne pouvant pas se ramener a une seule, le champ de 
la pathologie generale etait bien plus vaste qu'on ne croyait ; et 
formulait ce que 1' observation lui avait permis de conclure ; 
mais sa conclusion n'embrasse guere que la trouble dans le 
melange des humeurs, que leur coction et leurs crises. Depuis 
lors, la metliode de ceux qu'Hippocrate avait combattus, et la 
methode d'Hippocrate, I'hypothese et ^observation se sont 
perpetuees, ainsi que le temoigne I'histoire de la medecine, 
mais ce ne sont plus ni I'ancienne hypothese, ni I'ancienne 
observation, 

" II est certainement instructif d'etudier, dans le cours du 
temps, les problemes tels qu'ils out ete poses, et les discussions 
qu'ils ont soulevees. On le voit, la science antique a de grandes 
ressemblances avec la science moderne ; des Tepoque que nous 
sommes forces de regarder comme Faurore de la medecine, des 



ANCIENT MEDICINE. 161 

les premiers monuments que nous possedons^ les questions 
fondamentales sont debattues, et les liraites de Fesprit humain 
sont toucliees. Mais en dedans de ces limites^ la science 
trouve, dans unc imraensite inepuisable de combinaisons, les 
materiaux qui la font grandir ; et il est impossible de ne pas 
reconnaitre que^ sur uu sol et avec les aliments que lui four- 
nissent les choses et Texperience, elle se developpe en vertu 
d'un principe interne de vie, qui reside dans Fencliainement 
necessaire de son developpement successif."^ 



',c 



ON ANCIENT MEDICINE. 

1. Whoever having undertaken to speak or write on Medi- ^ 
cine, have first laid down for themselves some hypothesis to their I 
argument, such as hot, or cold, or moist, or dry, or whatever j 
else they choose, (thus reducing their subject Avithin a narrow 
compass, and supposing only one or two original causes of 
diseases or of death among mankind,) are all clearly mistaken 
in much that they say; and this is the more reprehensible as 
relatiug to an art which all men avail themselves of on the 
most important occasions, and the good operators and prac- 
titioners in which they hold in especial honour. For there 
are practitioners, some bad and some far otherwise, which, if 
there had been no such thing as Medicine, and if nothing haji 
been investigated or found out in it, would not have been the* 
case, but all would have been equally unskilled and ignorant 
of it, and everything concerning the sick would have been 
directed by chance. But now it is not so ; for, as in all the 
other arts, those who practise them differ much from one another 
in dexterity and knowledge, so is it in like manner with Me- 
dicine. Wherefore I have not thought that it stood in need 
of an empty hypothesis, like those subjects which are occult 
and dubious, in attempting to handle which it is necessary to 
use some hypothesis ; as, for example. Math regard to things 
above us and things below the earth ;^ if any one should treat 
of these and undertake to declare how they are constituted, ^ 



' Tom. i, p. M7. - See Note, p. 101. 

11 



162 ANCIENT MEDICINE. 

tlie reader or hearer could not find out, whether what is delivered 
be true or false ; for there is nothing which can be referred to 
in order to discover the truth. 

2. But all these requisites belong of old to Medicine, and an 
origin and way have been found out, by whicl/^nany and elegant 
discoveries have been made, during a length of time, and others 
will yet be found out, if a person possessed of the proper ability, 
and knowing those discoveries which have been made, should 
proceed from them to prosecute his investigations. But who- 
ever, rejecting and despising all these, attempts to pursue 
another course and form of inquiry, and says he has discovered 
anything, is deceived himself and deceives others, for the thing 
is impossible^ And for what reasons it is impossible, I will 
now endeavour to explain, by stating and showing what the art 
really is. From this it will be manifest that discoveries cannot 
possibly be made in any other way. And most especially, it 
appears to me, that whoever treats of this art should treat of 
things which are familiar to the common people. For of 
nothing else will such a one have to inquire or treat, but of 
the diseases under which the common people have laboured, 
which diseases and the causes of their origin and departure, 
their increase and decline, illiterate persons cannot easily find 
out themselves, but still it is easy for them to understand these 
things when discovered and expounded by others. For it is 
nothing more than that every one is put in mind of what had 
occurred to himself. But whoever does not reach the capacity 
of the illiterate vulgar, and fails to make them listen to him, 
misses his mark. Wherefore, then, there is no necessity for 
any hypothesis. 

3. For the art of Medicine would not have been invented 
at first, nor would it have been made a subject of investigation 
(for there would have been no need of it,) if Avhen men are 
indisposed, the same food and other articles of regimen which 
they eat and drink when in good health were proper for them, 
and if no others were preferable to these. But now necessity 
itself made medicine to be sought out and discovered by men, 
since the same things when administered to the sick, which 
agreed with them when in good health, neither did nor do 
agree with them. But to go still further back, I hold that 
the diet and food which people in health now use would not 



ANCIENT MEDICINE. 163 

have been discovered, provided it had suited with man to eat 
and drink in like manner as the ox, the horse, and all other 
animals, except man, do of the productions of the earth, such 
as fruits, weeds, and grass ; for from such things these animals 
grow, live free of disease, and require no other kind of food. 
And, at first, I am of opinion that man used the same sort of 
food, and that the present articles of diet had been discovered 
and invented only after a long lapse of time. For when they 
suffered much and severely from this strong and brutish 
dietj swallowing things which were raw, unmixed, and pos- 
sessing great strength, they became exposed to strong pains 
and diseases, and to early deaths. It is likely, indeed, that 
from habit they would suffer less from these things then than 
we would now, but still they would suffer severely even then ; 
and it is likely that the greater number, and those who had 
weaker constitutions, would all perish ; whereas the stronger 
would hold out for a longer time, as even nowadays some, in 
consequence of using strong articles of food, get off with little 
trouble, but others with much pain and suffering. From this 
necessity it appears to me that they would search out the food 
befitting their nature, and thus discover that which we now use : 
and that from wheat, by macerating it, stripping it of its hull, 
grinding it all down, sifting, toasting, and baking it, they formed 
bread; ^ and from barley they formed cake (maza),^ performing 
many operations in regard to it ; they boiled, they roasted, they 
mixed, they diluted those things which are strong and of in- 
tense qualities with weaker things, fashioning them to the nature 
and powers of man, and considering that the stronger things 
Nature would not be able to manage if administered, and 
that from such things pains, diseases, and death would arise, 
but such as Nature could manage, that from them food, growth, 
and health, would arise. To such a discovery and investigation 

' The invention of bread must have been very ancient, as is obvious from the 
circumstance of its being referred to a mythological name, that is to say. Demeter 
or Ceres. The ancients would appear to have paid great attention to the manufacture 
of bread. See Athenieus Deipnos, iii, 26 ; andPAULUS /Egineta, B. I, 78, Syd. Soc. 
edition. 

* The maza was a sort of pudding or cake made from barleymeal mixed up with 
water, oil, milk, oxyniel, hydromcl,or the like. It also was a very ancient invention, 
for it is mentioned in one of the works of Hesiod, which is luuvei'sally allowed to be 
genuine, I mean the Opera et Dies, 1. 5SS. 



164 ANCIENT MEDICINE. 

wliat more suitable name could one give than that of Medicine ? 
since it was discovered for tlie health of man, for his nourish- 
ment and safety, as a substitute for that kind of diet by which 
pains, diseases, and deaths were occasioned. 

4. And if this is not held to be an art, I do not object. 
For it is not suitable to call any one an artist of that which no 
one is ignorant of, but which all know from usage and necessity. 
But still the discovery is a great one, and requiring much art 
and investigation. Wherefore those who devote themselves to 
gymnastics and training, are always making some new discovery, 
by pursuing the same line of inquiry, where, by eating and drink- 
ing certain things, they are improved and grow stronger than 
thev were. ^ 

5. Let us inquire then regarding what is admitted to be 
Medicine ; namely, that which was invented for the sake of the 
sick, which possesses a name and practitioners, whether it also 
seeks to accomplish the same objects, and whence it derived its 
origin. To me, then, it appears, as I said at the commence- 
ment, that nobody would have sought for medicine at all, 
provided the same kinds of diet had suited with men in sickness 
as in good health. Wherefore, even yet, such races of men 
as make no use of medicine, namely, barbarians, and even 
certain of the Greeks, live in the same way when sick as when 
in health ; that is to say, they take what suits their appetite, 
and neither abstain from, nor restrict themselves in anything 
for which they have a desire. But those who have cultivated 
and invented medicine, having the same object in view as 
those of whom I formerly spoke, in the first place, I suppose, 
diminished the quantity of the articles of food which they used, 
and this alone would be sufficient for certain of the sick, and 
be manifestly beneficial to them, although not to all, for there 
would be some so afi'ected as not to be able to manage even 
small quantities of their usual food, and as such persons would 
seem to require something weaker, they invented soups, by 

> We have stated in our brief sketch of the Life of Hippocrates, that he studied 
the application of gymnastics to medicine under the great master of the art, 
Herodicus. He was a native of Selymbra in Thrace, and is generally represented as 
the father of medicinal gymnastics ; but, as we have mentioned above, this statement 
must be received with considerable allowance, since there is every reason to believe 
that the Asclepiadre applied exercises to the cure of diseases. 



ANCIENT MEDICINE. 16*) 

mixing a few strong things with raucli water, and thus ab- 
stracting that which was strong in them by dihition and boihng. 
But such as could not manage even soups, laid them aside, 
and had recourse to drinks^ and so regulated them as to mixture 
and quantity, that they were administered neither stronger nor 
weaker than what was required. 

6. But this ought to be Avell known, that soups do not 
agree with certain persons in their diseases, but, on the con- 
trary, when administered both the fevers and the pains are 
exacerbated, and it becomes obvious that Avliat was given has 
proved food and increase to the disease, but a wasting and 
Aveakness to the body. But whatever persons so aftected par- 
took of solid food, or cake_, or bread, even in small quantity, 
would be ten times and more decidedly injured than those who 
liad taken soups, for no other reason than from the strength of 
the food in reference to the affection ; and to whomsoever it is 
proper to take soups and not eat solid food, such a one will be 
much more injured if he eat much than if he eat little, but 
even little food will be injurious to him. But all the causes of 
the sufferance refer themselves to this rule, that the strongest 
things most especially and decidedly hurt man, whether in 
health or in disease. 

7. What other object, then, had he in vicAV who is called a 
physician, and is admitted to be a practitioner of the art, who 
found out the regimen and diet befitting the sick, than he who 
originally found out and prepared for all mankind that kind of 
food which we all now use, in place of the former savage and 
brutish mode of living ? To me it appears that the mode is the 
same, and the discovery of a similar natui*e. The one sought to 
abstract those things which the constitution of man cannot 
digest, because of their wildness and intemperature, and the 
other those things which are beyond the powers of the affection 
in which any one may happen to be laid up. Now, how does 
the one differ from the other, except that the latter admits of 
greater variety, and requires more application, whereas the 
former was the commencement of the process ? 

8. And if one would compare the diet of sick persons with 
that of persons in health, he will find it not more injurious 
than that of healthy persons in comparison with that of wild 
beasts and of other animals. For, suppose a man labouring 



166 ANCIENT MEDICINE. 

under one of those diseases which are neither serious and 
unsupportable, nor yet altogether mild,, but such as that, upon 
making any mistake in diet, it will become apparent, as if he 
should eat bread and flesh, or any other of those articles which 
prove beneficial to healthy persons, and that, too, not in great 
quantity, but much less than he could have taken when in good 
health ; and that another man in good health, having a consti- 
tution neither very feeble, nor yet strong, eats of those things 
which are wholesome and strengthening to an ox or a horse, 
such as vetches, barley, and the like, and that, too, not in great 
quantity, but much less than he could take ; the healthy person 
Avho did so would be subjected to no less disturbance and 
danger than the sick person who took bread or cake un- 
seasonably. All these things are proofs that Medicine is to be 
prosecuted and discovered by the same method as the other. 

9. And if it were simply, as is laid down, that such things 
as are stronger prove injurious, but such as are weaker prove 
beneficial and nourishing, both to sick and healthy persons, it 
were an easy matter, for then the safest rule would be to cir- 
cumscribe the diet to the lowest point. But then it is no less 
mistake, nor one that injures a man less, provided a deficient 
diet, or one consisting of weaker things than what are proper, 
be administered. For, in the constitution of man, abstinence 
may enervate, weaken, and kill. And there are many other 
ills, different from those of repletion, but no less dreadful, 
arising from deficiency of food ; wherefore the practice in those 
cases is more varied, and requires greater accuracy. For one 
must aim at attaining a certain measure, and yet this measure 
admits neither weight nor calculation of any kind, by which it 
may be accurately determined, unless it be the sensation of the 
body ; wherefore it is a task to learn this accurately, so as not 
to commit small blunders either on the one side or the other, 
and in fact I would give great praise to the physician whose 
mistakes are small, for perfect accuracy is seldom to be seen, 
since many physicians seem to me to be in the same plight as 
bad pilots, who, if they commit mistakes while conducting the 
ship in a calm do not expose themselves, but when a storm and 
violent hurricane overtake them, they then, from their ignorance 
and mistakes, are discovered to be what they are, by all men, 
namely, in losing their ship. And thus bad and commonplace 



ANCIENT MEDICINE. 167 

pliysicians, when they treat men who have no serious illness, 
in which case one may commit great mistakes without producing 
any formidable mischief, (and such complaints occur much 
more frequently to men than dangerous ones) : under these cir- 
cumstances, when they commit mistakes, they do not expose 
themselves to ordinary men ; but when they fall in with a great, 
a strong, and a dangerous disease, then their mistakes and want 
of skill are made apparent to all. Their punishment is not far 
off, but is swift in overtaking both the one and the other. ^ 

10. And that no less mischief happens to a man from 
unseasonable depletion than from repletion, may be clearh^ seen 
upon reverting to the consideration of persons in health. For, 
to some, with whom it agrees to take only one meal in the day, 
and they have arranged it so accordingly ; whilst others, for 
the same reason, also take dinner, and this they do because they 
find it good for them, and not like those persons who, for 
pleasure or from any casual circumstance, adopt the one or the 
other custom : and to the bulk of mankind it is of little conse- 
quence which of these rules they observe, that is to say, whether 
they make it a practice to take one or two meals. But there 
are certain persons who cannot readily change their diet with 
impunity ; and if they make any alteration in it for one day, or 
even for a part of a day, "are greatly injured thereby. Such 
persons, provided they take dinner when it is not their wont, 
immediately liecome heavy and inactive, both in body and mind, 
and are weighed down with yawning, slumbering, and thirst ; 
and if they take supper in addition, they are seized with flatu- 
lence, tormina, and diarrhcea, and to many this has been the 
commencement of a serious disease, when they have merely 
taken twice in a dnj the same food vv^hich they have been in 
the custom of taking once. And thus, also, if one who has 
been accustomed to dine, and this rule agrees with him, should 
not dine at the accustomed hour, he will straightway feel great 
loss of strength, trembling, and want of spirits, the eyes of 
such a person will become more pallid, his urine thick and hot, 
his mouth bitter ; his bowels will seem, as it were, to hang 
loose ; he will suffer from vertigo, lowness of spirit, and 
inactivity, — such are the effects ; and if he should attempt to 
take at supper the same food which he was wont to partake of 

' lie means both tlie pilot and pliysician. 



168 ANCIENT MEDICINE. 

at dinner, it will appear insipid, and he will not be able to take 
it off; and these things, passing downwards with tormina and 
rumbling, burn up his bowels ; he experiences insomnolency 
or troubled and disturbed dreams : and to many of them these 
symptoms are the commencement of some disease. 

11. But let us inquire Avhat are the causes of these things 
which happened to them. To him, then, who was accustomed 
to take only one meal in the day, they happened because he did 
not wait the proper time, until his bowels had completely 
derived benefit from and had digested the articles taken at the 
preceding meal, and until his belly had become soft, and got 
into a state of rest, but he gave it a new supply while in a 
state of heat and fermentation, for such bellies digest much 
more slowly, and require more rest and ease. And as to him 
who had been accustomed to dinner, since, as soon as the body 
required food, and when the former meal was consumed, and 
he Avanted refreshment, no new supply was furnished to it, 
he wastes and is consumed from want of food. For all the 
symptoms which I describe as befalling to this man I refer to 
Avant of food. And I also say that all men who, when in a state 
of health, remain for two or three days without food, experience 
the same unpleasant symj)toms as those which I described in 
the case of him who had omitted to take dinner. 

12. Wherefore, I say, that such constitutions as suffer 
quickly and strongly from errors in diet, are Aveaker than 
others that do not ; and that a weak person is in a state very 
nearly approaching to one in disease ; but a person in disease 
is the weaker, and it is, therefore, more likely that he should 
suffer if he encounters anything that is unseasonable. It is 
difficult, seeing that there is no such accuracy in the Art, to 
hit always upon wliat is most expedient, and yet many cases 
occur in medicine Avliich would require this accuracy, as Ave 
shall explain. But on that account, I say, we ought not to 

•reject the ancient Art, as if it were not, and had not been 
properly founded, because it did not attain accuracy in all 
things, but rather, since it is capa])le of reaching to the greatest 
exactitude by reasoning, to receive it and admire its discoveries, 
made from a state of great ignorance, and as having been well 
and properly made, and not from chance. 

13. But I Avisli the discourse to revert to the new method 



ANCIENT MEDICINE. 169 

of those who prosecute their inquiries in the Art by hypothesis. 
For if hot^ or cohl^ or moist^ or dry, be that which proves in- 
jui'ious to man, and if the person who would treat him properly 
must apply cold to the hot, hot to the cold, moist to the dry, 
and dry to the moist — let me be presented with a man, not 
indeed one of a strong constitution, but one of the weaker, 
and let him eat wheat, such as it is supplied from the thrashing- 
floor^ raw and unprepared, with raw meat, and let him drink 
water. By using such a diet I know that he will suffer much 
and severely, for he will experience pains, his body will become 
weak, and his bowels deranged, and he will not subsist long. 
What remedy, then, is to be provided for one so situated ? 
Hot ? or cold ? or moist ? or dry ? For it is clear that it 
must be one or other of these. For, according to this prin- 
ciple, if it is one of these which is injuring the patient, it 
is to be removed by its contrary. But the surest and most 
obvious remedy is to change the diet Avhich the person used, 
and instead of wheat to give bread, and instead of raw flesh, 
boiled, and to drink Avine in addition to tliese : for b}^ making 
these changes it is impossible but that he must get better, 
unless completely disorganised by time and diet. What, then, 
shall we say ? whether that^ as he sufii'ered from cold, these 
hot things being applied were of use to him, or the contrary? 
I should think this question must prove a puzzler to whomso- 
ever it is put. For whether did he who prepared bread out of 
wheat remove the hot, the cold, the moist, or the dry principle 
in it ? — for the bread is consigned both to fire and to water, 
and is wrought with many things, each of which has its peculiar 
property and nature, some of which it loses, and with others 
it is diluted and mixed. 

14. And this I know, moreover, that to the human body it 
makes a great difference whether the bread be fine or coarse •} 
of wheat with or without the hull, whether mixed with much 
or little water, strongly wrought or scarcely at all, baked or 
raw — and a multitude of similar differences ; and so, in like 

' Ka9«poe apTOQ T; ffvyKOiiiTToc. There has been some difference of opinion 
regarding these two kinds of Ijread ; but it appears to nie probable that the former 
was made of flom- from which the bran had been entirely excluded, and the other 
from flour containing the whole of the bran. Later authorites called the one siligo, 
and the other autopyrus. See Paulus .Egixeta, Vol. I, p. 121. 



170 ANCIENT MEDICINE. 

manner^ Avith the cake (maza) ; tlie powers of each, too_, are 
great_, and the one nowise like the other. Whoever pays 
no attention to these things, or, paying attention, does not 
comprehend them, how can he understand the diseases which 
befall a man ? For, by every one of these things, a man is 
affected and changed this way or that, and the whole of his 
life is subjected to them, whether in health, convalescence, or 
disease. Nothing else, then, can be more important or more 
necessary to know than these things. So that the first inventors, 
pursuing their investigations properly, and by a suitable train 
of reasoning, according to the nature of man, made their dis- 
coveries, and thought the Art worthy of being ascribed to a 
god, as is the established belief. For they did not suppose 
that the dry or the moist, the hot or the cold, or any of these, 
are either injurious to man, or that man stands in need of 
them ; but whatever in each was strong, and more than a 
match for a man's constitution, whatever he could not manage, 
that they held to be hurtful, and sought to remove. Now, of 
the SAveet, the strongest is that which is intensely sweet ; of 
the bitter, that which is intensely bitter; of the acid, that 
which is intensely acid; and of all things that which is extreme, 
for these things they saw both existing in man, and proving 
injurious to him. For there is in man the bitter and the salt, 
the sweet and the acid, the sour and the insipid,^ and a multi- 
tude of other things having all sorts of powers, both as regards 
quantity and strength. These, when all mixed and mingled 
up with one another, are uot apparent, neither do they hurt a 
man ; but when any of them is separate, and stands by itself, 
then it becomes perceptiljle, and hurts a man. And thus, of 
articles of food, those which are unsuitable and hurtful to man 
when administered, every one is either bitter, or intensely so, or 
saltish or acid, or something else intense and strong, and there- 
fore we are disordered by them in like manner as we are by the 
secretions in the body. But all those things of which a man 
eats and drinks are devoid of any such intense and well-marked 
quality, such as bread, cake, and many other things of a similar 
nature which man is accustomed to use for food, with the 
exception of condiments and confectionaries, which are made 

' He alludes here to the secretions and luiuiours in the l)ody. See the Commen- 
tary of Henrnius. 



ANCIENT MEDICINE. I7I 

to gratify tlie palate and for luxury. And from those things^ 
when received into the body abundantly, there is no disorder 
nor dissolution of the powers belonging to the body ; but 
strength, growth, and nourishment result from them, and this 
for no other reason than because they are well mixed, have no- 
thing in them of an immoderate character, nor anything strong, 
but the whole forms one simple and not strong substance. 

15. I cannot think in what manner they who advance this 
doctrine, and transfer the Art from the cause I have described 
to hypothesis, will ciu"e men according to the principle which 
they have laid down. For, as far as I know, neither the 
hot nor the cold, nor the dry, nor the moist, has ever been 
found unmixed with any other quality ; but I suppose thej^ use 
the same articles of meat and drink as all we other men do. 
But to this substance they give the attribute of being hot, to 
that cold; to that dry, and to that moist. Since it would be 
absurd to advise the patient to take something hot, for he 
would straightway ask what it is ? so that he must either play 
the fool, or have recourse to some one of the well-known sub- 
stances : and if this hot thing happen to be sour, and that hot 
thing insipid, and this hot thing has the power of raising a 
disturbance in the body (and there are many other kinds of 
heat, possessing many opposite powers), he will be obliged to 
administer some one of them, either the hot and the sour, or 
the hot and the insipid, or that which, at the same time, is 
cold and sour (for there is such a substance), or the cold and the 
insipid. For, as I think, the very opposite effects will result 
from either of these, not only in man, but also in a bladdei*, a 
vessel of wood, and in many other things possessed of far less 
sensibility than man ; for it is not the heat which is possessed 
of great efficac}^, but the soin- and the insipid, and other qualities 
as described by me, both in man and out of man, and that 
whether eaten or drunk, rubbed in externally, and otherwise 
applied. 

16. But I think that of all the qualities heat and cold 
exercise the least operation in the body, for these reasons : as 
long time as hot and cold are mixed up with one another they do 
not give trouble, for the cold is attempered and rendered more 
moderate by the hot, and the hot by the cold ; but when the 
one is wholly separate from tbc other, then it gives pain ; and 



172 ANCIENT MEDICINE. 

at that season wlien cold is applied it creates some pain to a 
man, but quickh^, for that very reason, heat spontaneously 
arises in him without requiring any aid or preparation. And 
these things operate thus both upon men in health and in 
disease. For example, if a person in health wishes to cool 
his body during winter, and bathes either in cold water or in 
any other way, the more he does this, unless his body be fairly 
congealed, when he resumes his clothes and comes into a place 
of shelter, his body becomes more heated than before. And 
thus, too, if a person wish to be warmed thoroughly either by 
means of a hot bath or strong fire, and straightway having the 
same clothing on, takes up his abode again in the place he was 
in when he became congealed, he will appear much colder, and 
more disposed to chills than before. And if a person fan him- 
self on account of a suffocating heat, and having procured 
refrigeration for himself in this manner, cease doing so, the 
heat and suffocation will be ten times greater in his case than 
in that of a person who does nothing of the kind. And, to 
give a more striking example, persons travelling in the snow, 
or otherwise in rigorous weather, and contracting great cold in 
their feet, their hands, or their head, what do tliev not suffer 
from inflammation and tingling when they put on warm 
clothing and get into a hot place ? In some instances, blisters 
arise as if from burning Avith fire, and they do not suffer from 
any of those unpleasant symptoms until they become heated. 
So readily does either of these pass into the other; and I 
could mention many other examples. And with regard to the 
sick, is it not in those who experience a rigor that the most 
acute fever is apt to break out? And yet not so strongly 
neither, but that it ceases in a short time, and, for the most 
part, without having occasioned much mischief; and while it 
remains, it is hot, and passing over the whole body, ends for 
the most part in the feet, where the chills and cold were most 
intense and lasted longest ; and, when sweat supervenes, and 
the fever passes off, the patient is much colder than if he had 
not taken the fever at all. "Why then should that which so 
quickly passes into the opposite extreme, and loses its own 
powers spontaneously, be reckoned a mighty and serious affair? 
And what necessity is there for any great remedy for it ? 
17. One might here say — but persons in ardent fevers, 



ANCIENT MEDICINE. 173 

pneumonia;, and other formidable diseases, do not quickly get 
rid of the heat, nor experience these rapid alterations of heat and 
cold. And I reckon this veiy circumstance the strongest proof 
that it is not from heat simply that men get into the febrile 
state, neither is it the sole cause of the mischief, but that this 
species of heat is bitter, and that acid, and the other saltish, 
and many other varieties ; and again there is cold combined 
with other qualities. These are what proves injurious ; heat, 
it is true, is present also, possessed of strength, as being that 
which conducts, is exacerbated and increased along with the 
other, but has no power greater than what is peculiar to itself. 

18. With regard to these symptoms, in the first place those 
are most obvious of which we have all often had experience. 
Thus, then, in such of us as have a coryza and defluxion from 
the nostrils, this discharge is much more acrid than that which 
formerly was formed in and ran from them daily ; and it occa- 
sions swelling of the nose, and it inflames, being of a hot and 
extremely ardent nature, as you may know, if you apply your 
hand to the place ; and, if the disease remains long, the part 
becomes ulcerated although destitute of flesh, and hard ; 
and the heat in the nose ceases, not when the defluxion takes 
place and the inflammation is present, but when the running 
becomes thicker and less acrid, and more mixed with the 
former secretion, then it is that the heat ceases. But in all 
those cases in which this decidedly proceeds from cold alone, 
without the concourse of any other qualit}^, there is a change 
from cold to hot, and from hot to cold, and these quickly 
supervene, and require no coctiou. But all the others being 
connected, as I have said, w^ith acrimony and intemperance 
of humours, pass oS in this way by being mixed and concocted. 

19. But such defluxions as are determined to the eyes being 
possessed of strong and varied acrimonies, ulcerate the eyelids, 
and in some cases corrode the cheeks and parts below the eyes 
iipon which they flow, and even occasion rupture and erosion 
of the tunic which surrounds the eyeball. But pain, heat, 
and extreme burning prevail until the defluxions are concocted 
and become thicker, and concretions form about the eyes, and 
the coction takes place from the fluids being mixed up, diluted, 
and digested together. And in defluxions upon the throat, 
from which are formed hoarseness, cynanche, erysipelas, and 



174 ANCIENT MEDICINE. 

pneumonia, all these have at first saltish, watery, and acrid dis- 
charges, and with these the diseases gain strength. But when 
the discharges become thicker, more concocted, and are freed 
from all acrimony, then, indeed, the fevers pass away, and the 
other symptoms which annoyed the patient; for we must account 
those things the cause of each complaint, which, being present in 
a certain fashion, the complaint exists, but it ceases when they 
change to another comliination. But those which originate from 
pure heat or cold, and do not participate in any other quality, 
will then cease when they undergo a change from cold to hot, 
and from hot to cold ; and they change in the manner I have 
described before. Wherefore, all the other complaints to which 
man is subject arise from powers (qualities?). Thus, when 
there is an overflow of the bitter principle, which we call yellow 
bile, what anxiety, burning heat, and loss of strength prevail ! 
but if relieved from it, either by being purged spontaneously, 
or by means of a medicine seasonably administered, the patient 
is decidedly relieved of the pains and heat ; but while these 
things float on the stomach, unconcocted and undigested, no 
contrivance could make the pains and fever cease ; and when 
there are acidities of an acrid and seruginous character, what 
varieties of frenzy, gnawing pains in the bowels and chest, 
and inquietude, prevail ! and these do not cease until the 
acidities be purged awa}', or are calmed down and mixed with 
other fluids. The coction, change, attenuation, and thickening 
into the form of humours, take place through many and va- 
rious forms; therefore the crises and calculations of times are 
of great importance in such matters ; but to all such changes 
hot and cold are but little exposed, for these are neither liable 
to putrefaction nor thickening. What then shall we say of 
the change ? that it is a combination (crasis) of these humours 
having different powers towards one another. But the hot 
does not lose its heat when mixed with any other thing except 
the cold ; nor again, the cold, except when mixed with the hot. 
But all other things connected with man become the more 
mild and better in proportion as they are mixed with the more 
things besides. But a man is in the best possible state when 
they are concocted and at rest, exhibiting no one peculiar 
quality ; but 1 think I have said enough in explanation of them. 
20. Certain sophists and physicians say that it is not possible 



ANCIENT MEDICINE. Ijo 

for any one to know medicine avIio does not know what man 
is [and how he was made and how constructed], and that who- 
ever would cure men properly, must learn this in the first place. 
But this saying rather appertains to philosophy, as Empedocles 
and certain others have described what man in his origin is, 
and how he first was made and constructed.^ But I think 
whatever such has been said or written by sophist or phy- 
sician concerning nature has less connexion with the art of 
medicine than with the art of painting. And I think that one 
cannot know anything certain respecting nature fiom any 
other quarter than from medicine ; and that this knovrledge is 
to be attained when one comprehends the whole snljject of 
medicine properly, but not until then; and I say that this 
history shows what man is, by what causes he was made, and 
other things accurately. Wherefore it appears to me necessary 
to every physician to be skilled in nature, and strive to know, 
if he would wisli to perform his duties, what man is in relation 
to the articles of food and drink, and to his other occupations, 
and what are the eff"ects of each of them to everv one. And 
it is not enough to know simply that cheese is a bad article of 
food, as disagreeing with whoever eats of it to satiety, but what 
sort of disturbance it creates, and wherefore, and with what 
principle in man it disagrees; for there are many other articles 
of food and drink naturally bad which affect man in a different 
manner. Thus, to illustrate my meaning by an example, un- 
diluted wine drunk in large quantity renders a man feeble ; 
and everybody seeing this knows that such is the power of 
wine, and the cause thereof; and we know, moreover, on what 
parts of a man^s body it principally exerts its action ; and I 
wish the same certainty to appear in other cases. For cheese 
(since we used it as an example) does not prove equally in- 
jurious to all men, for there are some who can take it to satiety 
without being hurt by it in the least, but, on the contrary, it 
is wonderful what strength it imparts to those it agrees with ; 
but there are some who do not bear it well, their constitutions 
are different, and they differ in this respect, that Avhat in their 
body is incompatible with cheese, is roused and put in commotion 
by such a thing; and those in whose bodies such a humour 

' See Littiv, h. 1. 



176 ANCIENT MEDICINE. 

happens to prevail in greater quantity and intensity, are likely 
to suffer the more from it. But if the thing had been per- 
nicious to the whole nature of man, it would have hurt all. 
Whoever knows these things will not suffer from it. 

21. During convalescence from diseases, and also in pro- 
tracted diseases, many disorders occur, some spontaneously, and 
some from certain things accidentally administered. I know 
that the common herd of physicians, like the vulgar, if there 
happen to have been any innovation made about that day, such 
as the bath being used, a walk taken, or any unusual food eaten, 
all which were better done than otherwise, attribute notwith- 
standing the cause of these disorders, to some of these things, 
being ignorant of the true cause, but proscribing what may 
have been very proper. Now this ought not to be so ; but 
one should know the effects of a bath or a walk unseason- 
ably applied ; for thus there will never be any mischief from 
these things, nor from any other thing, nor from repletion, nor 
from such and such an article of food. Whoever does not 
know what effect these things produce upon a man, cannot 
know the consequences which result from them, nor how to 
apply them. 

22. And it appears to me that one ought also to know what 
diseases arise in man from the powers, and what from the 
structures. What do I mean by this? By powers, I mean 
intense and strong juices ; and by structures, whatever con- 
formations there are in man. For some are hollow, and from 
broad contracted into narrow ; some expanded, some hard and 
round, some broad and suspended,' some stretched, some long, 
some dense, some rare and succulent," some spongy and of loose 
texture." Now, then, which of these figures is the best calcu- 
lated to suck to itself and attract humidity from another body ? 
Whether what is hollow and expanded, or what is solid and 
round, or what is hollow, and from broad, gradually turning 
narrow ? I think such as from hollow and broad are contracted 
into narrow : this may be ascertained otherwise from obvious 
facts : thus, if you gape wide with the mouth you cannot 

' Meaning probably the diaphragm, with its membranes. See tlie Commentary 
of Heurnius, p. 92. 

2 Meaning the mammae, according to Heurnius. 
" Such as the spleen and kings. 



ANCIENT MEDICINE. 177 

draw in any liquid ; but by protruding, contracting, and com- 
pressing the lips, and still more by using a tube, you can readily 
draw in whatever you wish. And thus, too, the instruments 
which are used for cupping are broad below and gradually be- 
come narrow, and are so constructed in order to suck and draw 
in from the fleshy parts. The nature and construction of the 
parts within a man are of a like nature ; the bladder, the head, 
the uterus in women ; these parts clearly attract, and are 
always filled with a juice which is foreign to them. Those parts 
which are hollow and expanded are most likely to receive any 
humidity flowing into them, but cannot attract it in like manner. 
Those parts which are solid and round could not attract a humi- 
dity, nor receive it when it flows to them, for it would glide past, 
and find no place of rest on them. But spongy and rare parts, 
such as the spleen, the lungs, and the breasts, drink up espe- 
cially the juices around them, and become hardened and enlarged 
by the accession of juices. Such things happen to these organs 
especially. For it is not with the spleen as with the stomach, 
in which there is a liquid, which it contains and evacuates 
every day; but when it (the spleen) drinks up and receives a 
fluid into itself, the hollow and lax parts of it are filled, even 
the small interstices ; and,, instead of being rare and soft, it 
becomes hard and dense, and it can neither digest nor discharge 
its contents : these things it suff'ers, owing to the nature of its 
structure. Those things which engender flatulence or tormina 
in the body, naturally do so in the hollow and broad parts of 
the body, such as the stomach and chest, where they produce 
rumbling noises ; for when they do not fill the parts so as to 
be stationary, but have changes of place and movements, there 
must necessarily be noise and apparent movements from them. 
But such parts as are fleshy and soft, in these there occur 
torpor and obstructions, such as happen in apoplexy. But 
when it (the flatus ?) encounters a broad and resisting structure, 
and rushes against such a part, and this happens when it is by 
nature not strong so as to be able to withstand it without suf- 
fering inj ury ; nor soft and rare, so as to receive or yield to it, 
but tender, juicy, full of blood, and dense, like the liver, owing 
to its density and broadness, it resists and does not yield. 
But flatus, when it obtains admission, increases and becomes 

J-lW 



178 ANCIENT MEDICINE. 

stronger^ and rushes towards any resisting object ; but owing 
to its tenderness, and tlie quantity of blood which it (the liver) 
contains, it cannot be without uneasiness ; and for these reasons 
the most acute and frequent pains occur in the region of it, 
along with suppurations and chronic tumours (phyraata). 
These symptoms also occur in the site of the diaphragm, but 
much less frequently ; for the diaphragm is a broad, expanded, 
and resisting substance, of a nervous (tendinous ?) and strong 
nature, and therefore less susceptible of pain; and yet pains 
and chronic abscesses do occur about it. 

23. Tliere are both within and without the body many 
other kinds of structure, which differ much from one another 
as to sufferings both in health and disease ; such as whether 
the head be small or large ; the neck slender or thick, long or 
short ; the belly long or round ; the chest and ribs broad or 
narrow ; and many others besides, all which you ought to be 
acquainted with, and their differences; so that knowing the 
causes of each, you may make the more accurate observations. 

24'. And, as has been formerly stated, one ought to be 
acquainted with the powers of juices, and what action each of 
them has upon man, and their alliances towards one another. 
What I say is this : if a sweet juice change to another kind, 
not from any admixture, but because it has undergone a mu- 
tation within itself; what does it first become? — bitter? salt? 
austei^e ? or acid ? I think acid. And hence, an acid juice is 
the most improper of all things that can be administered in 
cases in which a sweet juice is the most proper. Thus, if one 
should succeed in his investigations of external things, he would 
be the better able always to select the best ; for that is best 
which is farthest removed from that which is unwholesome. 



ON AIRS, WATERS, AND PLACES. 



ON AIRS, WATERS, AND PLACES. 



THE ARGUMENT. 

Uk. Cokay, in liis excellent edition of this treatise, divides 
it into six cliapters, as follows : first, the Introduction (from 
§ 1 — 3) comprehends some general observations on the 
importance of cultivating a knowledge of the effects which the 
different seasons, the winds, the various kinds of water, the 
situation of cities, the nature of soils, and the modes of life, 
exercise upon the health, and the necessity of a physician's 
making himself Avell acquainted with all these matters, if he 
would wish to practise his profession successfully. The author 
insists, with particular earnestness, on the ntility of studying 
the constitution of the year and the nature of the seasons, and 
refutes the opinions of those persons, in his days, who held 
that a knowledge of all these things belongs to meteorology 
rather than to medicine. The second chapter (from § 3 — 7) 
treats of climate, and the diseases prevalent in localities charac- 
terised by their exposure to particular winds. Those winds 
being peculiar to Greece, their names occasion some trouble in 
order to understand them correctly, and we shall give below a 
summary of what the modern Greek Coray says in illustration of 
them. This part of the present treatise appears to have been 
highly elaborated, and contains much important information. 
The third chapter {^ 7 — 10) treats of the various kinds of water, 
and their effects in different states of the human constitution. 
The remarks contained here are of an eminently practical 
nature, and evidently must have been the results of patient 
observation and experiment, so that, even at the present day, 
it would be difficult to detect our author in a single error of 
judgment. In this place he has occasion to deliver his opinions 
on the formation of urinary calculi, which he does at consider- 



182 AIRS, WATERS, AND PLACES. 

able length ; and I may be permitted to remark, whatever may 
be thought of his etiology of the disease, it Avill be admitted 
that his theory is plausible, and the best that could well have 
been framed in the state of knowledge which then pi^evailed on 
that subject. Indeed, even at the present day, it must be 
allowed that this is a dark subject; we have acquired, it is true, 
many new and curious facts connected with the minute struc- 
ture of these concretions, but it can hardlv be affirmed that we 
have been able to evolve from them any general principles, 
or certain rules of practice. In the fourth chapter (§ 10 — 12), 
the nature of the seasons is treated of, and their influence on 
the health circumstantially stated. Some of the observations 
contained in this part of the work are remarkable for their 
acuteness and originality, such as the following, that, in esti- 
mating the eff'ects of a season on the health, we ought to take 
into account the seasons which preceded it. This is well 
expressed by Celsus, as follows : " neque solum interest quales 
dies sint sed etiam quales prsecesserint.^' (Pr?efat.) See 
also Hippocrates (de Humoribus, § 8) ; and Coray (ad h. 1. 
§ cix.) It will be seen in our annotations that a considerable 
number of the Aphorisms are abstracted from this part of 
the present treatise. In the fifth chapter (§ 12 — 17), the 
effects of climate and the institutions of society on the inhabi- 
tants of Asia are treated of at considerable length. Our author, 
in this place, evinces a great acquaintance with human life, and a 
most philosophical spirit in contemplating the subjects which he 
is handling. Indeed few works in any language display so much 
accurate observation and originality of thought. The varieties 
of disposition, and of intellectual and moral development among 
mankind, are set down as being derived, in a great measure, 
from differences of climate and modes of government. Thus 
the Asiatics are of an effeminate and slavish disposition, because 
they live in a soft climate, on a rich soil, where they are little 
exposed to hardships or labour, and under a despotic form of 
government, which arrests the development of their mental 
energies.^ This part also contains some interesting observations 

' Although I shall touch cursorily on this suhject in my annotations, I cannot deny 
myself the pleasure of setting down here the following passage from the treatise of 
Longinus ' On the Sublime.' It is to be bonie in mind that it was written by a 
noble-minded Greek, who lived at the court of an Oriental despot, and must have 



I 



ARGUMENT. 183 

on the Macrocepliali and the inhabitants of Phasis. In the 
sixth and last chapter (§ 17 to the end), the pecnliar traits of 
the European character, as connected Avith climate and insti- 
tutions, are described in a veiy interesting manner. Here the 
observations on the Amazons, Sauromatffi, and Scythians are 
well deserving of an attentive perusal, and more particularly 
the description of the disease induced by continual riding on 
horseback, the probable nature of which we shall consider pre- 
sently. Here, too, are given our author's remarks on diseases 
supposed to be divine, which, as we have stated in the Prelimi- 
nary section on his life, evince a wonderful exemption from the 
superstitioixs belief of his age, and indicate an extraordinary 
depth of thought. 

This is a general outline of the contents of this treatise, 
which is one of the most celebrated in the whole Collection. 
From what mo have stated, it will at once be seen that it relates 
to a subject of commanding interest, and deserves to be care- 
fully studied, as containing the oldest exposition Avhich we 
possess of the opinions entertained b}' an original and enlight- 
ened mind on many important questions connected with Public 
Hygiene and Political Economy, two sciences which, of late 
years, have commanded a large amount of professional attention. 
Whether or not modern experience may confirm our author's 
judgment in every particular case, it surely can neither be 
unprofitable nor uninteresting to ascertain what his opinions on 
these subjects actually were. Let us be thankful, then, that 
the destroying hand of time h:is spared us so valuable a relic 
of antiquity; and, instead of undervaluing our ancient instructor 
because he shows himself ignorant of many truths which we are 
now familiar with, let us be grateful to him for the amount of 

been a daily observer of the effects which he so feelingly depicts. Who does not 
lament to think of a generous mind placed under circumstances where cowardice is 
honoured and courage del)ased ? And what more melancholy picture of human 
misery can be imagined than that which is here exhibited of the bodily and mental 
powers in a state of arrested development from the effects of confinement ? 

"H/(t(7u yap T apiTr'iQ (KaTci rdv"Of^ir]pot') aTroaivvrai SovXiov t'lfiap' o'xjTrtp ovv 
(tiyf (piiffl, ToiiTO TTiuTov s<TTi) ciKovio TCI yXwrTUKOfxa, ii> o'tg ol Uvyficiioi kciXov- 
fisifoi vdroi Tpf'poi'TCd, ov fiovov KwXvei twv tyKtK\ei(Tnei'0Ji' tciq avKr/fftig, dWd 
Kcti avvdyii did tvv TripiKt'ijiivov toIq (nofiaai Itajiov' o'vtwq uiraaav SovXUav, 

KLl ij dlKCIlOTUTI], 4'VXIJC yXitJTTOKUlXOl', KCH KOIVOV dt) TIQ diro(pi)vaiTo Sia/iw- 

Tt'ipiuv. — § 39. 



184 AIRS, WATERS, AND PLACES. 

information which he has supplied to us, and for setting us an 
example which it must be hoth safe and profitable for us to 
follow. Surely great praise is due to the man who first mooted so 
many important questions, and stated their bearings in distinct 
terms, although he did uot always succeed in solving them.^ 

I may take the present opportunity of mentioning that 
M. Littre, with some appearance of truth, blames Hippocrates 
for having rather overrated the influence of climate and insti- 
tutions in producing military valour, which, as he justly remarks, 
has been proved by modern examples to be most intimately 
connected Avith discipline, and a knowledge of the arts of war. 
But if Hippocrates was wrong on this point, it was because he 
did not avail himself properly of the lights of his own age; for 
he might have learned from his contemporary, Socrates, the 
very doctrine which M. Littre here inculcates. " The question 
being put to him,^' says Xenophon, " whether valour was a 
thing that could be taught, or was natural ? I am of opinion, 

' M. Littre thus states the four principal points to which Hippocrates here directs 
attention : 

" 1st. II cherche quelle est, sur le maintien de la sante et la production des maladies, 
I'influence de I'exposition des villes par rapport au soleil et aux vents. 

" 2d. II examine quelles sont les proprietes des eaux, bonnes ou mauvaises. 

" 3d. II s'efforce de signaler les maladies qui predominent suivant les saisons, et 
suivant les alternatives que chacune d'elles epreuve. 

" 4th. Enfin, il compare I'Europe et I'Asie, et il rattache les differences physiques et 
morales qui en separent les habitants, aux differences du sol et du climat." 

He goes on, however, to state, that these four questions, although neatly put, are 
merely sketched, and half insinuates that it is a defect in the work, that it merely con- 
tains our author's assertions, without the corresponding proofs. In a modern work, he 
remarks, the mode of procedure would be different ; for it would be expected that 
the general truths should be supported by detailed and prolonged statistics on par- 
ticular facts. It is to be borne in mind, however, that the work of Hippocrates was 
probably meant merely as a text-book, on which were grounded his pubUc prelec- 
tions, wherein would, no doubt, be given all the necessary proofs and illustrations. 
In this respect, it resembles the esoteric works of Aristotle, of which the author of 
them said that when they were published the contents of them, in one sense, were 
not communicated to the public, as they would be unintelligible without the illustra- 
tions by which they were accompanied when delivered in bis school. In conclusion, 
I woidd beg leave to remark that, if the work of Hippocrates, in its present form, 
appear defective when compared with what a modern work on the same subject 
would be expected to be, it has also peculiar traits which would hardly be matched 
in a modern composition. In a modern work we might have a greater abundance of 
particular facts, and a more copious detail of individual observations, but would there 
be such an exuberance of general truths, of grand results, and of original reflections .' 



ARGUMENT. 185 

lie said, that as one body is born with greater powers than 
another for enduring hibour, so is one soul produced by nature 
stronger than another for enduring dangers. For I see persons 
brought up under the same institutions and habits differing 
much from one another in courage. But I think that every 
nature may be improved in valour by learning and discipline. 
For it is obvious that the Scythians and Thracians would not 
dare to contend with the Lacedemonians with bucklers and 
spears ; and it is clear that the Lacedemonians would not be 
willing to contend with the Thracians with small targets and 
javelins, or with the Scythians with bows and arrows." 
(Memorab. iii, 9.) The same doctrine is taught with remarkable 
subtlety of argument and originality of thought in the 
'' Protagoras' of Plato, (see § 97). If, then, Hippocrates was 
wrong on this head, (which, however, may be doubted), it is 
clear that he is not to be screened by the alleged ignorance of 
his age, and that he might have put himself right by attending 
to the instructions of a contemporary with whom he, in all 
probability, was familiar, and who undoubtedly was the greatest 
master of human nature that ever existed. 

As there are certain matters connected with this treatise 
AAhich will require a more lengthened discussion than can well 
suit with foot notes, I thinlv it advisable to treat of them in 
this place : — 

I. With regard to the seasons of the year, as indicated by 
the risings and settings of the stars, the following observations, 
taken in a great measure from Clifton's Preface, will supply, 
in as brief a space as possible, all the information that will be 
required : " As the reader will find frequent mention of seasons, 
equinoxes, solstices, risings and settings of the sun and stars 
(particularly Arcturus, the Dog-star, and the Pleiades), it may 
not be amiss to premise, in the first place, that as the year was 
divided by the ancients into four parts, every one of these was 
distinguished astronomically. 

" Thus, for instance, the winter began at the setting of the 
Pleiades, and continued to the vernal equinox. 

" The spring began at the vernal equinox, and ended at the 
rising of the Pleiades. 

" The summer began at the rising of the Pleiades, and ended 
at the rising of Arcturus. 



186 



AIRS, WATERS, AND PLACES. 



" The autumn began at the rising of Arcturus, and ended 
at the setting of the Pleiades. 

" The rising and setting of the stars is always to be under- 
stood of what astronomers call the heliacal rising or setting, 
i. e. when a star rises or sets with the sun. 

*' The rising and setting of the sun in summer or Avinter 
(an expression which often occurs in this treatise), implies those 
points of the compass the sun rises and sets at.^^^ 

II. On the winds, of which frequent mention is made by 
our author, Coray has treated with a degree of prolixity and 
earnestness for which it is difficult to recognise the necessity. 
The figure given below, if properly studied and understood, 
will supply the professional reader Avith all the information he 
will require on this head. 






EiN-E 




AHHAinTHS 
EST 



' The classical reader is referred to Theophrastus' treatise De Signis Aquarum et 
Ventorum, for much interesting information on this subject. — See also Galen, Op. 
torn. V, p. 346, 347, ed. Basil. 



ARGUMENT. 187 

III One of tlie most singular diseases noticed in this work 
is the effeminacy with which the Scythians are said to have 
been attacked in consequence of spending the greater part of 
their time on horseback. (See § 22.) As the subject has at- 
tracted a good deal of attention lately, I will give a summary 
of the information which has been collected respecting it. See 
Coray, &c., t. ii, p. 331 ; Littre^ t. ii, p. 5, 6; and Avert., xxxix, 
p. 47; t. iv, p. 9. 

In the first place, then, it can scarcely admit of doubt that 
the disease is the same as that which Herodotus describes in 
the following passage : " Venus inflicted upon the Scythians, 
who pillaged her temple at Ascalou, and on their descendants, 
the feminine disease ; at least it is to this cause that they attribute 
their disease ; and travellers that go to the land of Scythia see 
how those persons are affected whom the Scythians call ac- 
cursed [ivdpieg)." '■ 

All the opinions which have been entertained respecting this 
affection are referred by M. Littre to the three following 
categories : 

1 . A vice, namely (a). Pederasty, which, he says is the most 
ancient opinion we have respecting it, as indicated by Longinus^ 
(on the Sublime, 25), and defended by his commentators. Toll 
and Pearce, and by Casaubon and Coster.'^ (b), Onanism, the 
opinion to which Sprengel inclines in his work on Hippocrates. 

2. A bodily disease, to wit : (a), Hemorrhoids, as main- 
tained by Paul Thomas de Girac,^ by Yalkenaer, by Bayer,^ and 
by the Compilers of the ' Universal History .^^ (b), A true men- 
struation, as appears to be maintained by Lefevre and Dacier,^ 
and by others, (c), Blenorrhagia, as Guy Patin^ and others sup- 
pose, (d), a true impotence as held by Mercuriali and others. 

3. A mental disease, as maintained by Sauvages,^ Heyne,^° 
Coray,^^ and others. 

' I. 105. 

- It appears to me, however, that tlie meaning of Longinus in this place is rather 
overstrained. 

■* Coster, Defense des ffiuvres de Voiture, &c., p. 104. 

'' Keponse a I'Apologie de Voiture, par Coster, p. 54. 

' Memoria Scythica, in Comm. Petropol. p. 377-78. 

•^ P. vi, p. 35. ' Notae in Louginum. 

* Comment, in vetus Monument, p. 415. ^ Nosol. Meth. p. 3(J5. 

'" Ue maribus inter Scythas morbo effeminatis, &c., p. 28. 
'' Hipp, de Acre, &c., t. ii, p. 320. 



188 AIRS, WATERS, AND PLACES. 

M. Rosenbaivm is at great pains to make out that the affec- 
tion in question was pederasty, and that the accursed (e'vhoeec) 
of Herodotus were the same as the pathici of the Romans. I 
must say^ that in ray opinion E-osenbaum makes out a strong 
case in support of this opinion. In particular it will be re- 
marked, that Herodotus says, the descendants of these Scythians 
were also inflicted with this complaint. Now Celsus Aurelianus 
says expressly, that the affection of the pathici was hereditary.' 
Taking everything into account, I must say that my own 
opinion has always been that the disease in question must have 
been some variety of spermatorrhma. I need scarcely remark 
that this affection induces a state, both of body and mind, 
analogous to that of the pathici, as described by ancient authors. 

Before leaving this subject, however, I should mention that 
M. Littre, in the fourth volvime of his Hippocrates (p. xi), 
brings into view a thesis by M. GraflF, the object of which is to 
prove that the disease of the Scythians was a true sort of im- 
potence ; and in illustration of it, he cites a passage from the 
memoirs of M. Larrey, containing a description of a species of 
impotence, attended with wasting of the testicle, which attacked 
the French army in Egypt, But, as far as I can see, this dis- 
ease described by Larrey had nothing to do with riding on 
horseback, and I cannot see any relation between it and the 
diseases described by Herodotus and Hippocrates. 

IV. Of all the legendary tales of antiquity, there is probably 
no one which was so long and so generally credited by the 
best informed historians, critics, geographers, poets, and phi- 
losophers, as the story of the Amazons. The}^ are noticed 
historically by Homer (Iliad, iii, 186; vi, 152); Apollonius 
Ilhodius (ii, 196) ; Pindar (Olymp. xiii, 84) ; Herodotus (ix, 27); 
Lysias (Epitaph. 3) ; Plato (Menex.) ; Isocrates (Panyg.) ; 
Ctesias (Persic.) ; Plutarch (Theseus) ; Strabo (Geogr. ix) ; 
Pausanias (iv, 31, 6; vii, 2, 4); Arrian (Exped. Alexand.) ; 
Quintus Curtius (vi, 4). Now it is singular that in all this list of 
authorities, which, it will be remarked, comprehends the elite of 
ancient scholars, no one, with the exception of Strabo, ventures 
to express the slightest doubt respecting the actual existence of 
the Amazons. Some of them, indeed, admit that the race had 

' Morb. Tard. iv, 9. 



ARGUMENT. 189 

become extinct in their time ; but they all seem satisfied that 
the Amazons had truly existed in a bygone nge, and consequently 
they acknowledge them as real historical personages. See, in 
particular, Arrian, who, although compelled by his respect for 
truth to acknowledge that they did not exist in the days of 
Alexander the Great, still does not hesitate to declare that it 
apj)eared incredible that this race of women, celebrated as they 
were by the most eminent authors, should never have existed 
at all. Yet, notwithstanding the mass of evidence in support 
of their actual existence, I suppose few scholars now-a-days 
will hesitate to agree with Heyne (Apollodor. ii, 5, 9), and with 
Grote (Hist, of Greece, i, 2), in setting down the whole story 
as a mere myth. But, considering how generally it had been 
believed, we need not wonder that Hippocrates in this treatise 
should appear to entertain no doubt of their actual existence. 
The reader will remark that he makes the locality of the 
Amazons to be in Europe, among the Sarmatians, on the north 
side of the Euxine. It is generally taken for granted, however, 
in the ancient myths, that their place of residence was on the 
banks of the Thermodon, in Cappadocia, and they are described 
as having afterwards crossed to the opposite side of the Euxine, 
when expelled from this locality. But, in fact, they are re- 
markable so much for nothing as their ubiquity, being some- 
times located in Asia, sometimes in Africa, and at other times 
in Athens. I may remark, before concluding, that Mr. Payne 
Knight (Symbolical Language, &c.. Classical Journal, 23), and 
Creuzer (Symbolik. &c.), give a symbolical interpretation to 
the story of the Amazons ; but this mode of explaining the 
myths of antiquity is altogether fanciful and unsatisfactory. 
It seems safer and more judicious to deal with them as Mr. Grote 
has done^, that is to say, to receive them as tales in which the 
ancients believed, without having any rational foundation for 
their faith. That there may have been a certain basis of truth 
in the story of the Amazons need not be denied ; but in this, as 
in all the ancient myths, it is a hopeless task to attempt to sepa- 
rate truth from fiction. 

' Hist, of Greece, pluries. 



190 AIRS, WATERS, 



ON AIRS, WATERS, AND PLACES. 

1. Whoever wishes to investigate medicine properly, should 
proceed thus : in the first place to consider the seasons of the 
year, and what effects each of them produces (for they are not 
at all alike, but differ much from themselves in regard to 
their changes).' Then the winds, the hot and the cold, es- 
pecially such as are common to all countries, and then such as 
are peculiar to each locality. We must also consider the 
qualities of the waters, for as they differ from one another in 
taste and weight, so also do they differ much in their qualities. 
In the same manner, when one comes into a city to which he 
is a stranger, he ought to consider its situation, how it lies as 
to the winds and the rising of the sun ; for its influence is not 
the same whether it lies to the north or the south, to the rising 
or to the setting sun. These things one ought to consider 
most attentively, and concerning the waters which the in- 
habitants use, whether they be marshy and soft, or hard, and 
running from elevated and rocky situations, and then if saltish 
and unfit for cooking ; and the ground, whether it be naked 
and deficient in water, or Avooded and well watered, and 
whether it lies in a hollow, confined situation, or is elevated 
and cold ; and the mode in which the inhabitants live, and 
what are their pursuits, whether they are fond of drinking and 
eating to excess, and given to indolence, or are fond of exercise 
and labour, and not given to excess in eating and drinking.^ 

2. From these things he must proceed to investigate every- 

' The part in parenthesis is rather obscure. In the old French translation it is 
rendered thus : " Elles sont tres difFerentes entre elles par leur nature, et il arrive 
d'ailleurs une infinite de changemens qui sont tous divers." On these changes, see 
Aphor. iii, 2 — 15. 

^ I have translated this passage agreeably to the reading suggested by Coray, that 
is to say, 6vk tSw^bg, which appears to be a great improvement, although it is not 
adopted by Littre. Without the negation (6vk) the contrast between the first and 
the last clause of the sentence is entirely lost. It will be remarked that I have 
translated apttrrjjrat, eating to excess. The apicfTov, or dinner, was a meal which 
persons of regular habits seldom partook of, and hence Suetonius mentions it as an 
instance of the Domitiau's gormandising propensities, that he was in the habit of 
taking dinner. — See Vita Domitiani ; also Paui.us jEgineta, B. I, 109. 



AND PLACES. 191 

thing else. For if one knows all these things well, or at least 
the greater part of them, he cannot miss knowing, when he 
comes into a strange city, cither the diseases peculiar to the 
place, or the particular nature of common diseases, so that he 
will not be in doubt as to the treatment of the diseases, or 
commit mistakes, as is likely to be the case provided one had 
not previously considered these matters. And in particular, as 
the season and the year advances, he can tell what epidemic 
diseases will attack the city, either in summer or in Avinter, 
and what each individual will be in danger of experiencing 
from the change of regimen. For knowing the changes of the 
seasons, the risings and settings of the stars, how each of them 
takes place, he will be able to know beforehand what sort of a 
year is going to ensue. Having made these investigations, 
and knowing beforehand the seasons, such a one must be ac- 
quainted with each particular, and must succeed in the preser- 
vation of health, and be by no means unsuccessful in the 
practice of his art. And if it shall be thought that these 
things belong rather to meteorology,^ it will be admitted, on 
second thoughts, that astronomy contributes not a little, but a 
very great deal, indeed, to medicine. For with the seasons 
the digestive organs of men undergo a change. 

3. But how each of the aforementioned things should be 
investigated and explained, I will now declare in a clear 
manner. A city that is exposed to hot winds (these are ; 
between the wintry rising, and the wintry setting of the j 
sun), and to which these are peculiar, but which is sheltered (/ 
from the north winds ; in such a city the waters will be 
plenteous and saltish, and as they run from an elevated source, 

' It will be remarked that our author uses meteorology and astronomy almost as 
synonymous terms. In his time meteorology was looked upon by practical men as a 
visionaiy subject of investigation, which had a tendency to make those who engaged 
in it atheists, and the enemies of Socrates took advantage of the prejudices then pre- 
vailing against it to represent him as a meteorologist. See Aristophanes (Nub. 225.) 
Aristophanes, who would appear to have been always too ready to pander to the 
popular prejudices of the day, also represents the physicians as being " meteorolo- 
gical impostors," — j^iiTtiogotpevaKaQ. (Ibid. 330.) The enlightened mind of Aristotle, 
however, regarded meteorology in a very different light, and accordingly he wrote a 
work on the subject replete with all the astronomical and geological knowledge of 
his time. In it he professes to treat of the heavenly bodies and atmospherical pheno- 
mena, including winds, earthquakes, and the like ; also of minerals, fossils, &c. Sec 
the introduction to his Meieoroloyica. 



192 AIRS, WATERS, 

they are necessarily hot in snmmer, and cold in winter -^ the 
heads of the inhabitants are of a humid and pituitous constitu- 
tion, and their bellies suljject to frequent disorders, owing to 
the phlegm running down from the head; the forms of their 
y/^bodies, for the most part, are rather flabby ; they do not eat 
nor drink much ; drinking wine in particular, and more es- 
pecially if carried to intoxication, is oppressive to them ; and 
the following diseases are peculiar to the district : in the first 
place, the women are sickly and subject to excessive menstrua- 
tion; then many are unfruitful from disease, and not from nature, 
and they have frequent miscarriages ; infants are subject to 
attacks of convulsions and asthma, which they consider to be con- 
nected with infaucy,2 and hold to be a sacred disease (epilepsy). 
The men are subject to attacks of dysentery, diarrhoea, hepialus,'^ 
chronic fevers in winter, of epinyctis,^ frequently, and of hemor- 
rhoids about the anus. Pleurisies, peripneumonies, ardent 
fevers, and whatever diseases are reckoned acute, do not often 
occui', for such diseases are not apt to prevail where the bowels 
are loose. Ophthalmies occur of a humid character, but not 
of a serious nature, and of short duration, unless they attack 

' Upon reference to the editions of Coray, Clifton, and Littre, it will be seen that 
the text here is in a doubtful state. I shall not weary the reader by stating my 
reasons for adhering to the meaning which I have adopted. 

^ In place of the common reading, ivaiciov, Coray adopts Qtiov, which certainly, 
at first sight, appears to be an improvement. But I admit, with Littre, that the 
authority of Galen (tom. v, p. 447, ed. Basil), is quite decisive in favour of TrcaSiov. 
It is also to be taken into account in this place that the author of the treatise on 
Dentition brings prominently into \-iew the connexion between infancy and con- 
vulsions, which adds probability to the supposition that in those days convulsions 
may have been called "the disease of infancy." 

^ The Hepialus is a species of intermittent fever, very common in warm climates. 
It would appear to be a variety of the quotidian. See Paulus /Egineta, Vol. I, 
252, Syd. Soc. edition. 

■• Frequent mention of this disease of the skin occurs in the works of the ancient 
writers on medicine. See Paulus /Egineta, Vol. II, 40. We have there stated 
that it would appear to have been some species of Eczema, with which we are now 
unacquainted. Coray has a very lengthy note on it, but arrives at no satisfactory 
conclusions on the subject. He brings into review three cutaneous diseases , namely, 
the louton cVAlep., (described. Memoir, de la Societe Royale de Modic, annee 1777, 
1778, t. i, p. 313;) the pelagre, (described, Toaldo, Essai Meteorolog., pp. 19, 20; 
Comment, de Rebus in Scient. Nat. et Medec. Gestis., tom. xxxi, p. 553 ; and Journ. 
de Medec, tom. Ixxx, p. 272 ;) and the Icpre ties Asturies, or nial de la rosa, (de- 
scribed by Thieri, Journ. de Medec, tom. ii, p. 337.) 



AND PLACES. 193 

epidemically from the change of the seasons. And when they 
pass their fiftieth year^ defluxions s\xpervening from the brain, 
render them paralytic when exposed suddenly to strokes of the 
sun/ or to cold. These diseases are endemic to them, and, 
moreover, if any epidemic disease connected with the change 
of ;the seasons, prevail, they are also liable to it. 

i' 4. /But the following is the condition of cities which have 
the opposite exposure, namely, to cold winds, between the 
summer settings and the summer risings of the sun, and to 
which these winds are peculiar, and which are sheltered from 
the south and the hot breezes. In the first j)lace the waters 
are, for the most part, hard and cold. The men must neces- 
sarily be well braced and slender, and they must have the 
discharges downwards of the alimentary canal hard, and of 
difficult evacuation, while those upwards are more fluid, and 
rather bilious than pituitous. Their heads are sound and hard, 
and they are liable to burstings (of vessels ?) for the most part. 
The diseases which prevail epidemically with them, are pleurisies, 
and tliose which are called acute diseases. This must be the 
case when the bowels are bound ; and from any causes, many 
become affected with suppurations in the lungs, the cause of 
which is the tension of the body, and hardness of the bowels ; 
for their dryness and the coldness of the water dispose them to 
ruptures (of vessels?). Such constitutions must be given to 
excess of eating, but not of drinking ; for it is not possible to 
be gourmands and drunkards at the same time. Ophthalmies, 
too, at length supervene ; these being of a hard and violent 
nature, and soon ending in rupture of the eyes ; persons under 
thirty years of age are liable to severe bleedings at the nose in 
summer ; attacks of epilepsy are rare but severe. Such people 
are likely to be rather long-lived ; their ulcers are not attended 
with serous discharges, nor of a malignant character ; in dis- 
position they are rather ferocious than gentle. The diseases I 
have mentioned are peculiar to the men, and besides they are 
liable to any common complaint which may be prevailing from 
the changes of the seasons. But the women, in the first place, 

' Coups de soleil, or strokes of the sun, are often mentioned incidentally in the 
works of thf! ancient authors, but no one has treated of them in any very systematic 
manner, as far as I recollect. On the effects of exposure to cold and heat, see, 
however, Paulus /Egineta, Vol. I, 49-51, Svd. Soc. edition. 

13 



194 AIRS, WATERS, 

are of a hard constitution, from the waters being hard, in- 
digestible, and cold ; and their menstrual discharges are not 
regular, but in small quantity, and painful. Then they have 
difficult parturition, but are not very subject to abortions. And 
when they do bring forth children, they are unable to nurse 
them; for the hardness and indigestible nature of the water 
puts away their milk. Phthisis frequently supervenes after 
childbirth, for the efforts of it frequently bring on ruptures and 
strains.^ Children while still little are subject to dropsies in the 
testicle, which disappear as they grow older ; in such a toAvn they 
are late in attaining manhood. It is, as I have now stated, 
with regard to hot and cold winds and cities thus exposed. 

5. Cities that are exposed to winds between the summer 
and the winter risings of the sun, and those the opposite to 
them, have the following characters : — Those which lie to the 
rising of the sun are all likely to be more healthy than such 
as are turned to the North, or those exposed to the hot winds, 
even if there should not be a furlong betAveen them.^ In the 
first place, both the heat and the cold are more moderate. 
Then such waters as flow to the rising sun, must necessarily 
be clear, fragrant, soft, and delightful to drink, in such a city. 
For the sun in rising and shining upon them purifies them, by 
dispelling the vapours which generally prevail in the morning. 
The persons of the inhabitants are, for the most part, well 
coloured and blooming, unless some disease counteract. The 
inhabitants have clear voices, and in temper and intellect are 
superior to those which are exposed to the north, and all the 
productions of the country in like manner are better. A city 
so situated resembles the spring as to moderation between heat 
and cold, and the diseases are few in number, and of a feeble 

' 'Pi'jyixara kciI ffTracrixaTa. There has been much diflference of opinion as to the 
exact import of tliese two terms. It would appear to me that they were intended to 
apply to a rupture or straining of the fibres, occasioned by external violence, 
M. Littre has a very interesting note on this subject, torn, v, p. 579. On these 
strainings see further Coacaj Prrenotiones, 376, 418. M. Littre, 1. c, relates a case of 
empyema brought on by lifting a heavy piece of wood. On these terms see further 
the Annotations on Demosthenes, Olynth. ii, 8, ed. Dobson ; and Foes, Re. Hippocr. 

2 Clifton translates this clause of the sentence thus : " Even if there be but a small 
distance beween them," and, I think, correctly, although Coray is not quite satisfied 
with this interpretation. The stadium was nearly the eighth part of a Roman mile, 
that is to say, it consisted of 94^ French toises, or 625 English feet. 



xVND PLACES. 19') 

kind, and bear a i*eseml)lancc to tlie diseases which prevail in 
regions exposed to hot winds. The women there are very 
proUfiCj and have easy deliveries. Thus it is with regard to 
them. 

/6. /But such cities as he to the west, and which are sheltered 
froiri winds blowing from the east, and which the hot winds 
and the cold winds of the north scarcely touch, must neces- 
sarily be in a very unhealthy situation : in the first place the 
waters are not clear, the cause of which is, because the mist 
prevails commonly in the morning, and it is mixed up Avith 
the water and destroys its clearness, for the sun does not shine 
upon the water until he l)e considera1)ly raised above the 
horizon. And in summer, cold breezes from the east blow and 
dews fall ; and in the latter part of the day the setting sun 
particularly scorches the inhal)itants, and therefore they are 
pale and enfeebled, and are partly subject to all the aforesaid 
diseases, but no one is peculiar to them. Their voices are 
rough and hoarse owing to the state of the air, which in such 
a situation is generally impure and unwholesome, for they have 
not the northern winds to purify it ; and these winds they have 
are of a very humid character, such being the nature of the 
evening breezes. Such a situation of a city bears a great 
resemblance to autumn as regards the changes of the day, 
inasmuch as the difference between morning and evening is 
great. So it is with regard to the winds that are conducive 
to health, or the contrary. 

7. And I wish to give an account of the other kinds of 
waters, namely, of such as are wholesome and such as are 
unwholesome, and what bad and what good effects may be 
derived from water ; for water contributes much towards 
health.^ Such waters then as are marshy, stagnant, and 
belong to lakes, are necessarily hot in summer, thick, and 
have a strong smell, since they have no current ; but being 
constantly supplied by rain-water, and the sun heating them, 
they necessarily want their proper colour, are unwholesome 
and form bile; in winter, they become congealed, cold, and 

' In another place, I have given a summary of the information supplieil 1iy the 
ancient authors on this suhject, (Paulus /Egineta, VoL I, G6.) Upon the whole, none 
of them gives so much valuahle matter on it as our author. Coray has some elaho- 
rate annotations on this passage. 



196 AIRS, WATERS, 

muddy witli the snow and ice, so tliat tliey are most apt to 
engender phlegm, and bring on hoarseness ; those who drink 
them have large and obstructed spleens, their bellies are 
hard, emaciated, and hot ; and their shoulders, collar-bones, 
and faces' are emaciated ; for their flesh is melted down 
and taken up by the spleen, and hence they are slender ; 
such persons then are voracious and thirsty ; their bellies are 
very dry both above and below, so that they require the 
strongest medicines.^ This disease is habitual to them both 
in summer and in winter, and in addition they are very sub- 
ject to dropsies of a most fatal character; and in summer 
dysenteries, diarrhoeas, and protracted quartan fevers frequently 
sieze them, and these diseases when prolonged dispose such 
constitutions to dropsies, and thus prove fatal. These are the 
diseases which attack them in summer ; but in winter younger 
persons are liable to pneumonia, and maniacal afl'ections ; and 
older persons to ardent fevers, from hardness of the belly. 
Women are subject to oedema and leueophlegmasiee f when 
pregnant they have difficult deliveries ; their infants are large 
and swelled, and then during nursing they become Avasted and 
sickly, and the lochial discharge after parturition does not 
proceed properly with the women. The children are particu- 
larly subject to hernia, and adults to varices and ulcers on 
their legs, so that persons with such constitutions cannot be 
long-lived, but before the usual period they fall into a state 
of premature old age. And further, the women appear to be 
with child, and when the time of parturition arrives, the fulness 
of the belly disappears, and this happens from dropsy of the 

' It can scarcely admit of a doubt that our author here alludes to scurvy. (See 
Coray at this place, and Lind on Scurvy, iii, 1.) He also describes the disease dis- 
tinctly in the second book of Prorrhetics, that is to say, if Hippocrates be actually 
the author of that book. See also Epidem. ii, 1 ; de Affection., de inter, affect. ; 
Cajlius Aurelianus, Tard. Pass, iii, 4; Celsus, iv, 9; Aetius, x, 11; Pliny, H. N., 
XXV, 3 ; Aretffius, IMorb. Diuturn, i, 14 ; and Paulus ^Egineta, iii, 49 ; Marcellus, de 
Medic, ii. 

^ The leucophlegmasia is treated of in different parts of the Hippocratic treatises, 
as Aphor. vii, 29 ; de Morb. ii. By it he evidently meant a species of dropsy, as 
Galen remarks in his commentary on the Aphorisms (1. c). It occurs in Aretieus's 
chapter on di'opsy, Morb. Diuturn, ii, 1 ; Octavius Horatianus, v. Celsus makes it to 
be synonymous with anasarca, iii, 21. Our author would seem to notice these varieties 
of dropsy as being affections to which pregnant women are subject. 



AND PLACES. 197 

uterus/ Such waters then I reckon bad for every purpose. 
The next to them in badness are those which have their 
fountains in rocks^ so that they must necessarily be hard, or 
come from a soil which produces thermal waters^ such as those 
having iron, copper, silver, gold, sulphur, alum, bitumen, or 
nitre (soda) in them ; for all these are formed by the force of 
heat." Good waters cannot proceed from such a soil, but 
those that are hard and of a heating nature, difficult to pass by 
ui'ine, and of difficult evacuation bv the bowels. The best are 
those which flow from elevated grounds, and hills of earth ; 
these are sweet, clear, and can bear a little wine ; they are hot 
in summer and cold in winter, for such necessarily must be 
the waters from deep wells. But those are most to be com- 
mended which run to the rising of the sun, and especially 
to the summer sun; for such are necessarily more clear, 
fragrant, and light. But all such as are saltish, crude, 
and hard, are not good for drink. But there are certain 
constitutions and diseases with which such waters agree when 
drunk, as 1 will explain presently. TLeir characters ai'e 
as follows : the best are such as have their fountains to the 
east ; the next, those between the summer risings and settings 
of the sun, and especially those to the risings ; and third, those 
between the summer and' winter settings ; but the worst are 
those to the south, and the parts between the winter rising 
and setting, and those to the south are very bad, but those to 

' On hydrops uteri see the authorities quoted in the Commentary on Paulus 
^GixETA, B. Ill, 48, Syd. Soc. edition. It may appear singulai- that hydatids of the 
womb should be particularly prevalent in the case of women that drink unwholesome 
water from marshes, and yet our author's observation is confirmed by a modern 
authority, as quoted by Coray : " II a ete egalement prouve par les observations des 
Modernes, que les fausses grossesses produites par les hydatides ; ' sont tres-com- 
munes dans les pays marecageux, ou la plupart des habitans out une constitution 
lacbe, propre a I'atfection scorbutique, qui y est presque endemique, qu'elles se ter- 
minent plus ou moins tard par I'excretion de ces hydatides." — (Notes sur le Traite des 
Airs, &c., p. 106.) Sydenham, moreover, describes the symptoms of false pregnancy 
in much tlie same terms as our author. (Tract de Hydrop.) 

2 On the Thermal waters of the ancients, see Paulus ^-Egixeta, Vol. I, 72. I 
have treated fully of the ancient alum and nitre under arv-nipia and Xirpov, in the 
Third Volume. Coray, in his notes on this passage, does not throw much light on 
this subject. The opinion here delivered by our author, that these metaUic substances 
are produced by the operation of heat, is adopted and followed out by Aristotle 
towards the end of the third book on Meteorologia. 



198 AIRS, WATERS, 

the uorth are better. They are to he used as follows : who- 
ever is in good health and strength need not mindj but may 
always drink whatever is at hand. But whoever wishes to 
drink the most suitable for any disease, may accomplish his 
purpose by attending to the following directions : To persons 
whose bellies are hard and easily burnt up, the sweetest, the 
lightest, and the most limpid waters will be proper ; but those 
persons whose bellies are soft, loose, and pituitous, should 
choose the hardest, those kinds that are most crude, and the 
saltest, for thus will they be most readily dried up ; for such 
waters as are adapted for boiling, and are of a very solvent 
nature, naturally loosen readily and melt down the bowels: 
but such as are intractable, hard, and by no means proper for 
boiling, these rather bind and dry up the bowels. People 
iiave deceived themselves with regard to salt Avaters, from inex- 
perience, for they think these waters purgative, whereas they 
are the very reverse ; for such waters are crude, and ill adapted 
for boiling, so that the belly is more likely to be bound up 
than loosened by them.^ And thus it is with regard to the 
waters of springs. 

8. I will now tell how it is Avith respect to rain-water, and 
water from snow. Rain waters, then, are the lightest, the 
SAveetest, the thinnest, and the clearest ; for originally the sun 
raises and attracts the thinnest and lightest part of the Avater, 
us is obAdous from the nature of salts ; for the saltish part is 
left behind owing to its thickness and weight, and forms 
salts ; but the sun attracts the thinnest part, OAving to its 
lightness, and he abstracts this not only from the lakes, but 
also from the sea, and from all things which contain humidity, 
and there is humidity in everything ; and from man himself 
the sun draAvs off the thinnest and lightest part of the juices. 
As a strong proof of this, Avlien a man Avalks in the sun, or 
sits doAvn having a garment on, whatCA'er parts of the body 

' Coray appears to ine to Ije unnecessarily puzzled to account for our author's 
statement, that saltish waters, although held to be piu'gative, are, in fact, astringent 
of the bowels. But, although their primary effect certainly be cathartic, is it not 
undeniable that their secondary effect is to induce or aggravate constipation of the 
bowels ? Certain it is, moreover, that all the ancient authorities held salts to be 
possessed of desiccant and astringent powers. See Paulus iEciMiTA, Vol. Ill, 
under dXic 



AND PLACES. 199 

the sun sliines upon do not sweat, for the sun cavries off what- 
ever sweat makes its appearance ; but those parts wliich are 
covered by the garment, or anything else, swxat, for the par- 
ticles of sweat are drawn and forced out by the sun, and are 
preserved by the cover so as not to be dissipated by tlie sun ; 
but Avhen the person comes into the shade tlie whole body 
equally perspires, because the sun no longer shines upon it.'^ 
Wherefore, of all kinds of water, these spoil the soonest ; and 
rain w^ater has a bad smell, because its particles are collected 
and mixed together from most objects, so as to spoil the soonest. 
And in addition to this, when attracted and raised up, being 
carried about and mixed with the air, wdiatever part of it is 
turbid and darkish is separated and removed from the other, 
and becomes cloud and mist, but the most attenuated and 
lightest part is left, and becomes sweet, being heated and con- 
cocted by the sun, for all other things when concocted become 
sweet. While dissipated then and not in a state of consistence 
it is carried aloft. But when collected and condensed by con- 
trary winds, it falls down wherever it happens to be most 
condensed. For this is likely to happen when the clouds 
being carried along and moving with a wind which does not 
allow them to rest, suddenly encounters another Avind and other 
clouds from the opposite clirection : there it is first condensed, 
and what is behind is carried up to the spot, aud thus it 
thickens, blackens, and is conglomerated, and by its weight it 
falls down and becomes rain. Such, to all appearance, are 
the best of waters, but they require to be boiled and strained ;" 
for otherwise they have a bad smell, and occasion hoarseness 
and thickness of the voice to those who drink them.^ Those 
from snow and ice are all bad, for when once congealed, they 
never again recover their former nature ; for whatever is clear, 
light, and sweet in them, is separated and disappears ; but the 

' Aristotle discusses the subject in his Problems, ii, 9, 3G, 37 ; ii, 15 ; i, 53 ; v, 34, 
and arrives at nearly the same conclusions as Hippocrates. See also Theophrastus de 
Sudoribus. 

^ I cannot hesitate in adopting the emendation suggested by Coray {aTroalidtaOai) 
in place of the common reading {aTroaiiTreaOai), which evidently has no proper 
meaning in this place. I am surprised that M. Littre should have hesitated in 
admitting it into the text. 

^ Athenseus, in like manner, praises raiu water. Dcipnos ii, 5. 



200 AIRS, WATERS, 

most turbid and weightiest part is left behind.^ You may 
ascertain this in tlie following manner : If in Avinter you will 
pour water by measure into a vessel and expose it to the open 
air until it is all frozen, and then on the following day bring 
it into a warm situation where the ice will thaw, if you will 
_ measure the water again when dissolved you will find it much 
i less in quantity. This is a proof that the lightest and thinnest 
part is dissipated and dried up by the congelation, and not the 
heaviest and thickest, for that is impossible :^ wherefore I hold 
that waters from snow and ice, and those allied to them, are 
the worst of any for all purposes whatever. Such are the 
characters of rain-water, and those from ice and snow. 

9.^ Men become affected with the stone, and are seized with 
diseases of the kidneys, strangury, sciatica, and become ruptured, 

' It appears singular that Atlienaeus, who is undoubtedly a most learned and judi- 
cious authority on all matters relating to Dietetics, speaks as favorably of water 
from ice as he does of rain water. Both he praises for their lightness, (1. c.) Celsus 
gives the character of the different kinds of water with his characteristic terseness and 
accuracy: " Aqua levissima pluvialis est; deinde fontana; tumexflumine; turn ex 
puteo ; post haec ex nive, aut glacie ; gravior his ex lacu ; gravissima ex palude," (ii, 19.) 
Galen treats of the medicinal and dietetical properties of water in several of his works, 
and uniformly agrees with Hippocrates in the judgment he pronounces on them. 
See in particular, De Ptisana ; De Sanit. tuend. ii ; Comment, ii. in Libr. de Ratione 
\ictus in Morb. acut. 

^ Athenaeus, on the other hand, argues from the fact that ice is lighter than water, 
that water formed from ice must be light. Pliny gives a lucid statement of the opinions 
of those who held that water from ice is light and wholesome, and those who, Uke 
Hippocrates, held it to be just the reverse. He says in the words of Hippocrates, literally 
translated, " nee vero pauci inter ipsos e contrario ex gelu ac nivibus insaluberrimos 
potius prsedicant, quoniam exactum sit inde, quod tenuissimum fuerit." (H.N. xxxi, 21.) 
See also Seneca, Qu»st. Natural, iv. It would appear that iced liqueurs were greatly 
relished at the tables of gourmands in those days. I need scarcely remark that there 
has been great difference of opinion in modern times regarding the qualities of water 
from melted snow and ice. It was at one time generally believed that it is the cause 
of the goitres to which the inhabitants of the valleys bordering on the Alps are sub- 
ject. This opinion, however, is by no means generally held at the present time. 

^ This is a most interesting chapter, as containing the most ancient observations 
which we possess on the important subject of urinary calcuU. The ancients never 
improved the theory, nor added much to the facts which are here stated by our 
author. "We have given the summary of their opinions in the Commentary on 
Paulus ^Egineta, B. Ill, 45. I would beg leave to remark that, notwithstanding the 
number of curious facts which modern chemistry has evolved regarding the compo- 
sition of urinary calcuU, the etiology of the disease is nearly as obscure now as it was 
in the days of Hijipocrates. 



AND PLACES. 201 

when they drink all sorts of waters^ and those from great 
rivers into ^vhich other rivnlets run, or from a lake into Avhich 
many streams of all sorts flow, and such as are brought from 
a considerable distance. For it is impossible that such waters 
can resemble one another, but one kind is sweet, another saltish 
and aluminous, and some flow from thermal springs ; and these 
being all mixed up together disagree, and the strongest part 
always prevails ; but the same kind is not always the strongest, 
but sometimes one and sometimes another, according to the 
winds, for the north wind imparts strength to this water, and 
the south to that, and so also with regard to the others. There 
must be deposits of mud and sand in the vessels from such 
waters, and the aforesaid diseases must be engendered by them 
when drunk, but why not to all I will now explain. When 
the bowels are loose and in a healthy state, ^ and when the 
bladder is not hot, nor the neck of the bladder very contracted, 
all such persons pass Avater freely, and no concretion forms in 
the bladder ; but those in whom the belly is hot, the bladder 
must be in the same condition ; and when preternuturally 
heated, its neck becomes inflamed ; and when these things 
happen, the bladder does not expel the urine, but raises its 
heat excessively. And the thinnest part of it is secreted, and 
the purest part is passed off" in the form of urine, but the 
thickest and most turbid part is condensed and concreted, at 
first in small quantity, but afterwards in greater; for being 
rolled about in the urine, whatever is of a thick consistence it 
assimilates to itself, and thus it increases and becomes in- 
durated. And when such persons make water, the stone forced 
down by the urine falls into the neck of the bladder and stops 
the urine, and occasions intense pain ; so that calculous children 
rub their privy parts and tear at them, as supposing that the 
obstruction to the urine is situated there. As a proof that it 
is as I say, persons affected with calculus have very limpid 
urine, because the thickest and foulest part remains and is 
concreted.^ Thus it generally is in cases of calculus. It 

' Coray remarks that Prosper Martian, in his commentary on this passage, con- 
firms tlie truth of the ohservation here made, that persons aftected with calcuhishave 
the bowels constipated. 

^ Tlieophihis, in his treatise De Urinis, would seem to contradict this observation 
of Hippocrates, when he states that the urine of calculous persons is thick and 



202 AIRS, WATERS, 

forms also in cliildren from milk, Allien it is not wliolesomCj 
but very hot and bilious, for it heats the bowels and bladder, 
so that the urine being also heated undergoes the same change. 
And I hold that it is better to give children only the most 
diluted Avine, for such will least burn up and dry the veins. 
Calculi do not form so readily in women, for in them the urethra 
is short and wide, so that in them the urine is easily expelled ; 
neither do they rub the pudendum with their hands, nor handle 
the passage like males ; ^ for the urethra in women opens direct 
into the pudendum, which is not the case with men, neither 
in them is the urethra so wide, and they drink more than 
children do." Thus, or nearly so, is it with regard to them. 

10. And respecting the seasons, one may judge whether the 
year will prove sickly or healthy from the following observa- 
tions:^ — If the appearances connected Avith the rising and 
setting stars be as they should be ; if there be rains in autumn ; 

milky (8). But, according to Prosper Martian, when tlie calculus is in the state of 
formation, its characters are as described by the latter, whereas, when the calculus is 
already formed, the urine is linnjid, as described by Hippocrates. 

' It is worthy of remark that Celsus states just the reverse with regard to the 
practice of women labouring under the stone ; he says : " Feminjc vero oras naturalium 
suorum manibus admotis scabere crebro coguntur." (ii, 7.) Are we to suppose that he 
followed a different reading ? Considering how well he shows himself acquainted 
with the works of Hippocrates, it cannot be thouglit that he had overlooked this 
passage. 

2 Our author, it will be remarked, ascribes the comparative immunity from calculus 
which females enjoy to their freer use of liquids. Celsus, in laying down directions 
for the regimen of a calculous person, as preparatory for the operation, among other 
things, directs, " ut aqnam bibat," (vii, 26-2.) Coray collects the opinions of several 
modern authorities in favour of drinking water as a preventive of calculus. Thus 
Tissot states that the Chinese, who drink so much water with their tea, enjoy almost 
an immunity from the disease. (De la Sante des Gens de Lettres, p. 190.) Campfer, 
in like manner, affirms that calculus has become less common in Europe since the 
introduction of tea, which he justly attributes to the amount of water drunk with it, 
rather than to any virtues of the plant itself. (Comment de Reb. in sclent, nat. et 
medic, gestis, vol. xvi, p. 594.) Metzger attributes the diminution of the number of 
calculous cases in Konigsberg to the use of draughts of tepid water. (Journal de 
Medec, vol. Ixvii, 348.) The Turks, according to Thevenot, owing to their free use 
of water, are almost exempt from the disease. (Voyage au Levant, c. xxvii, p. 70.) 

^ Coray makes the following remarks on the natural characters of the seasons in 
Greece. The natural temperature of the winter in Greece was cold and humid ; thus 
a dry and northerly winter was reckoned an unnatural season. Spring was reckoned 
unnatural when the heat and rain were excessive. See further Theophrast. de Caus. 
Plant, ii, 1. 



AND PLACES. 203 

if the winter be mild_, neither very tepid nor unseasonably 
cold, and if in spring the rains be seasonable, and so also 
in summer, the year is likely to prove healthy. But if the 
winter be dry and northerly, and the spring showery and 
southerly, the summer will necessarily be of a febrile character, 
and give rise to ophthalmies and dysenteries.^ For when 
suffocating heat sets in all of a sudden, while the earth is 
moistened by the vernal showers, and by the south vrind, the 
heat is necessarily doubled from the earth, which is thus soaked 
by rain and heated by a burning sun, while, at the same time, 
men's bellies are not in an orderly state, nor the brain properly 
dried ; for it is impossible, after such a spring, but that the 
body and its flesh must be loaded with humours, so that very 
acute fevers will attack all, but especially those of a phlegmatic 
constitution. Dysenteries are also likely to occur to women 
and those of a very humid temperament. And if at the rising 
of the Dogstar rain and wintry storms supervene, and if the 
ctesian winds hlow, there is reason to hope that these diseases 
will cease, and that the autumn wall be healthy ; but if not, it 
is likely to be a fatal season to children and women, but least 
of all to old men ; and that convalescents will pass into quartans, 
and from quartans into dropsies ; but if the winter be southerly, 
showery, and mild, but the spring northerly, dry, and of a 
wintry character, in the first place women who happen to 
be with child, and whose accouchement should take place 
in springs are apt to miscarry; and such as bring forth, have 
feeble and sickly children, so that they either die presently or 
are tender, feeble, and sickly, if they live. Such is the case 
with the Avomen. The others are subject to dysenteries^ and 
dry ophthalmies, and some have catarrhs beginning in the head 
and descending to the lungs. Men of a phlegmatic temperament 
are likely to have dysenteries ; and women, also, from the 

' See Aphorism iii, 11. 

^ The celebrated Haller charges Hip2J0crates with inaccurate observation in stating 
that dj'senteries are epidemic in spring, which, he contends, is contrary to modern 
experience. (Bibl. Med. Pract., vol. i, p. 61.) Hippocrates, however, is defended l)y 
Gruner (Cens. libr. Hippocrat. ii, 5, p. 51), and by Coray. (Notes, &c., p. 159.) The 
latter justly argues, that although dysentery may not prevail at that season in 
Germany, that is no reason for holding why it may not be so in Greece. He also refers 
to the works of Birnsticl and Stoll for descriptions of epidemical dysentery, occurring 
in the season of spring. 



204 AIRS, WATERS, 

humidity of their nature, the phlegm descending downwards 
from the brain ; those who are bilious, too, have dry ophthalmies 
from the heat and dryness of their flesh ; the aged, too, have 
catarrhs from their flalibiness and melting of the veins, so that 
some of them die suddenly and some become paralytic on the 
right side or the left.' For when, the winter being southerly 
and the l)ody hot, the blood and veins are not properly con- 
stringed; a spring that is northerly, dry, and cold, having come 
on, the brain when it should have been expanded and purged, 
by the coryza and hoarseness is then constringed and con- 
tracted, so that the summer and the heat occurring suddenly, 
and a change supervening, these diseases fall out. And such 
cities as lie well to the sun and winds, and use good Avaters, 
feel these changes less, but such as use marshy and pooly 
waters, and lie well both as regards the winds and the sun, 
these all feel it more. And if the summer be dry, those dis- 
eases soon cease, but if rainy, they are protracted ; and there 
is danger of any sore that there is becoming phagedenic 
from any cause ; and lienteries and dropsies supervene at the 
conclusion of diseases ; for the bowels are not readily dried up. 
And if the summer be rainy and southerly, and next the 
autumn, the winter must, of necessity, be sickly, and ardent 
fevers are likely to attack those that are phlegmatic, and more 
elderly than forty years, and pleurisies and peripneumonies ^ 
those that are bilious. But if the summer is parched and 
northerly, but the autumn rainj'^ and southerly, headache and 
sphacelus of the brain '^ are likely to occur; and in addition 
hoarseness, coryza, coughs, and in some cases, consumption.* 
But if the season is northerly and without water, there being 
no rain, neither after the Dogstar nor Arcturus ; this state 
agrees best with those who are naturally phlegmatic, with those 
who are of a humid temperament, and with women ; but it is 
most inimical to the bilious ; for they become much parched 

' See Aphorism iii, 12 ; also Aristot. Probl. i, 9 ; Celsus, ii, 1. 

- Coray, in this place, refers to an epidemic of the same description related by 
Caillar, which prevailed in the winter of 1751, and was treated by emetics more 
successfully than by bleeding. 

^ By sphacelus of the brain Clifton understands "paralytic diseases," which is not 
far removed from the conclusion which we have arrived at respecting it in the Com- 
mentary on Paulus ^gineta, Vol. I, p. 365. See Coray's lengthened note on this 
passage. ■• Aphorism, iii, 13. 



AND PLACES. 205 

up, and ophtlialmies of a clr}^ nature supervene, fevers both 
acute and cln'onic, and in some cases melanclioly ; ^ for tlie 
most humid and watery part of the bile being consumed, the 
thickest and most acrid portion is left, and of the blood 
likewise, whence these diseases come upon them. But all 
these are beneficial to the phlegmatic, for they are thereby 
dried up, and reach winter not oppressed with humours, but 
with tliem dried up. 

11. Whoever studies and observes these things' may be 
able to foresee most of the effects which will result from the 
changes of the seasons ; and one ought to be particularly 
guarded during the greatest changes of the seasons, and neither 
Avillingly give medicines, nor apply the cautery to the belly, 
nor make incisions thereuntil ten or more days be past. Now, 
the greatest and most dangerous are the two solstices, and 
especially the summer, and also the two equinoxes, but espe- 
cially the autumnal.^ One ought also to be guarded about the 
rising of the stars, especially of the Dogstar, then of Arcturus, 
and then the setting of the Pleiades ; for diseases are especially 
apt to prove critical in those days, and some prove fatal, some 
pass off, and all others change to another form and another 
constitution. So it is with regard to them. 

12. I wish to show, respecting Asia and Europe, how, in 
all respects, they differ from one another, and concerning 
the figure of the inhabitants, for they are different, and do 
not at all resemble one another. To treat of all would be a 
long story, but I will tell you how I think it is with regard to '' 
the greatest and most marked differences. I say, then, that 

(Asia differs very much from Europe as to the nature of all 
things, both with regard to the productions of the earth and 
the inhabitants, for everything is produced much more l)eau- 
tiful and large in Asia; the country is milder, and the dispo- 
sitions of the inhabitants also are more gentle and affectionate.® 

' Aphorism iii, 14. 

- I have stated in my analysis of the short treatise ' On Purgative Medicines,' tliat 
the aiitlior of it forbids the administration of these medicines, that is to say, of drastic 
purgatives, during excessive heat or cold. 

^ One may see, upon consulting the editions of Clifton, Coray, and Littre, that 
there are great varieties of readings in regard to the word which I have translated 
" affectionate." It will be reniaiked that I have followed Coray and Littre, in I'cading 
evopyiiTonpa. Clifton adopts aepyoTepa, and translates it " unactive." 



/ 



20G AIRS, WATERS, 

The cause of this is the temperature of the seasons, because it 
lies in the micklle of the risings of the sun^ towards the east, 
and removed from the cold (and heat)/ for nothing tends to 
growth and mildness so much as when the climate has no 
predominant qualit}^, but a general equality of temperature 
prevails. It is not everywhere the same with regard to Asia, 
but such parts of the country as lie intermediate betw^een the 
heat and the cold, are the best supplied with fruits and trees, 
and have the most genial climate, and enjoy the purest waters, 
both celestial and terrestrialTl For neither are they much 
burnt up by the heat, nor dried up by the drought and w^ant 
of rain, nor do they suffer from the cold ; since they are Avell 
"watered from abundant showers and snow, and the fruits of 
the season,^ as might be supposed, grow in abundance, both 
such as are raised from seed that has been sown, and such plants 
as the earth produces of its own accord, the fruits of which 
the inhabitants make use of, training them from their wild 
state and transplanting them to a suitable soil; the cattle also 
which are reared there are vigorous, particularly prolific, and 
bring up young of the fairest description ; the inhabitants, too, 
are well fed, most beautiful in shape, of large stature, and 
differ little from one another either as to figure or size ; and 
the country itself, both as regards its constitution and mildness 
of the seasons, may be said to bear a close resemblance to the 
spi'ing. jjManly courage, endurance of suffering, laborious en- 
terprise, and high spirit, could not be produced in such a state 
of things either among the native inhabitants or those of a 
different country, for there pleasure necessarily reigns,/ For 
this reason, also, the forms of wild beasts there are much 

' This expression of our author is ambiguous. Coray explains it tlms : " il entend 
le lever d'ete, qu'il place a 45 degres de I'Est an Nord, dans I'horizon de la Grace, et 
particulierement celui de I'ile de Cos ; et le lever d'hiver qu'il place a 45 degres de 
I'Est au Sud." 

- The sense undoubtedly requires this addition, and therefore I have not scrapled 
to follow the reading of Cornarius, Kal tov Oipjiov. 

^ The term here used meant particularly the fructus horcei, or summer fruits ; 
namely, cucumbers, gourds, and the like. (See Paulus jEgineta, B. I, § 80.) 
Surely Coray forgot himself, when he wrote thus regarding the distinction between 
the summer and autumnal fruits of his country : " les Grecs entendoient particuliere- 
ment par wpala les fruits de la fin de I'ete, c'est-a-dire, de cette partie de I'annee 
qu'ils appelloient o-rrojpav, &c." 



AND PLACES. 207 

varied.' Thus it is, as I think, with the Egyptians and 
Libyans. 

13. But concerning those on the right hand of the summer 
risings of the sun as far as the Pakis Mteotis" (for this is the 
bonudary of Europe and Asia), it is with thera as follows : the 
inhabitants there differ far more from one anotlier than those 
I have treated of above, owing to the differences of the seasons 
and the nature of the soil. But with regard to the country 
itself, matters are the same there as among all other men ; for 
where the seasons undergo the greatest and most rapid changes, 
there the countiy is the wildest and most uuequal; and you 
Avill find the greatest variety of mountains, forests, plains, and 
meadows ; but where the seasons do not change much there 
the country is the most even ; and, if one will consider it, so 
is it also with regard to the inhabitants ; for the nature of 
some is like to a country covered with trees and well watered ; 
of some, to a thin soil deficient in water ; of others, to fenny 
and marshy places ; and of some again, to a plain of bare and 
parched land.'^ For the seasons which modify their natural 
frame of body are varied, and the greater the varieties of them 
the greater also wall be the differences of their shapes. 

14. I will pass over the smaller differences among the nations, 
but will now treat of such as are great either from nature or 
custom ; and, first, concerning the Macrocephali.^ There is 
no other race of men which have heads in the least resembling 

' It is but too apparent that there is a lacuna in the text here. A chapter de- 
voted to an examination of the pecuharities of the Egyptians and Libyans is evidently 
lost. As M. Littre has remarked, Galen appears to refer to the contents of the lost 
chapter. (Opera, torn, xvi, p. 392 ; ed. Kiihn.) 

2 That is to say, the Sea of Azoflf. See Herodotus, iv, 86, who calls it Maiiirti;. 
This was generally held to be the division between Europe and Asia, as stated by 
our author. As Coray remarks, its borders on the north-west are occupied by the 
inhabitants of Little Tartary : it has the Crimea on the south-west ; the Tartars of 
Cuban and the Circassians on the south-east. 

3 That the inhabitants of a country bear a resemblance to the country itself, is no 
doubt a profound and most philosophical remark, although it must be admitted that 
the comparisons which our author makes are somewhat quaintly expressed, and hence 
a German physician wished the passage expunged, as being unworthy of Hippocrates. 
(Comment, de Reb. in Scient. Natur. et Med. gestis, vol. xx, p. 131.) There can be 
no question, however, that it embodies a grand general truth, although the particular 
application of it may not always be apparent. 

* On the Macrocephali, see Pliny, H. N. vi, 4 ; Stephanus, de Urbibus ; Suidas and 



208 AIRS, WATERS, 

theirs. At first, usage was tlie principal cause of the length 
of their head, but now nature cooperates with usage. They 
think those the most noble who have the longest heads. It is 
thus with regard to the usage : immediately after the child is 
born, and while its head is still tender, they fashion it with 
their hands, and constrain it to assume a lengthened shape by 
applying bandages and other suitable contrivances whereby the 
spherical form of the head is destroyed, and it is made to in- 
crease in length. Thus, at first, usage operated, so that this 
constitution was the result of force ; but, in tlie course of time, 
it was formed naturally, so that usage had nothing to do with 
it ; for the semen comes from all parts of the body, sound from 
the sound parts, and unhealthy from the uuhealtiiy parts. If, 
then, children with bald heads are born to parents with bald 
heads ; and children with blue eyes to parents who have blue 
eyes ; aud if the children of parents having distorted eyes squint 
also for the most part ; and if the same may be said of other 
forms of the body, what is to prevent it from happening that 
a child with a long head should be produced by a parent having 
a long head ?^ But now these things do not happen as thej'- 
did formerly, for the custom no longer prevails owing to their 

Harpocration in MuKpoKs^aXoi; Pomponius Mela, i, 19; Strabo, xii; Scholiast 
Apollon. Rbod., i ; Dionysius Periegetes. 

The exact situation of the savage nation of the Macrocephali cannot be precisely 
determined, l)ut it was evidently not far from the Palus Maeotis, aud most probably 
in the vicinity of the Caucasus. Little is knovpn of them, except what our author says 
respecting the practice which they had of disfiguring their heads by squeezing them, 
in early infancy, into an elongated shape. It is well known that the same absurd 
usage prevailed among the early inhabitants of Mexico. I need scai'cely say that 
much important information respecting them has been obtained of late years. M. 
Littre, in the fourth vol. of his edition of Hippocrates, supplies some very important 
information in illustration of this subject, from a recent publication of Dr. H. Ratlike. 
Certain tumuli having been excavated at Kertch, in the Crimea, there were found in 
them, besides different utensils and statues, several skeletons, and it was most re- 
markable that the form of the head was greatly elongated, in the manner described 
by Hippocrates with regard to the Macrocephali. The author's words are : " Ou y 
remarquait, en effet, un hauteur extraordinaire par rapport au diametre de la base, 
et par la ils frappaient meme les personnes qui n'avaient aucune connaissance de la 
structure du corps humaiu." 

' The same theory respecting the secretion of the semen is given in the treatises 
' De Genitura' and ' De Morbo Sacro.' It is espoused by Galen, in his little work, 
* Quod animal sit quod utero continetur.' Coray remarks that Hippocrates's theory 
on the origin of the fcetus does not differ much from that of Buffon. 



AND PLACES. 209 

intercourse with other men. Thus it appears to me to be with 
regard to them. 

15. As to the inhabitants of Phasis/ their country is 
fennVj warm, humid, and wooded; copious and severe rains 
occur there at all seasons ; and the life of the inhabitants is 
spent among the fens; for their dwellings are constructed of 
wood and reeds, and are erected amidst the waters ; they seldom 
practise walking either to the city or the market, but sail about, 
up and down, in canoes constructed out of single trees, for there 
are many canals there." They drink the hot and stagnant 
waters, both when rendered putrid by the sun, and when swollen 
with the rains. The Phasis itself is the most stagnant of all 
rivers, and runs the smoothest ;'^ all the fruits which spring 
there are unwholesome, of feeble and imperfect growth, owing 
to the redundance of water, and on this account they do not 
ripen, for much vapour from the w^aters overspreads the country. 
For these reasons the Phasians have shapes different from 
those of all other men ; for they are large in stature, and of a 
very gross habit of bodj% so that not a joint nor vein is visible; 
in colour they are sallow, as if affected with jaundice' Of all 

' I need scarcely remark that both the river and city of this name are very cele- 
brated in ancient mythology and histoiy. See in particular Apollonius Rhodius, with 
his learned Scholiast, Arg. II ; Strabo, xi ; Pliny, H. N., vi, 4 ; Procopius, Pers., ii, 29 ; 
Mela, i, 85 ; Arrian, periplus. The river takes its rise in the Caucasus, and termi- 
nates in the Black Sea. It is called Rion by the inhabitants, and the river and a city 
situated upon it are called Faclie by the Turks. See Coray at this place, and 
Mannert., Geograph., iv, 394. 

^ Coray quotes from Lamberti, a modern traveller, a description of the Colchide 
and its inhabitants, which agrees wonderfully with the account of both given by our 
author. The following is part of his description : " II sito della Colchide porta seco 
un' aria tanto humida che forse in altro luogo non si e veduta la simile. E la ragione 
si e perche venendo dall' occidente bagnata dall Eusino, et dall' oriente cinta dal 
Caucaso, dal quale sorgano gran quantita di fiumi rende da per tutto I'aria humi- 
dissima affatto. A questo s' aggiungono la frequenza de' boschi, fra quali non viene 
agitata I'aria da' venti, et li spessi venti marini apportatoi di pioggie et de' vapori del 
mare. Questa humidita si grande genera poi gran quantita de' vapori, che sollevati 
in alto si dissolvono in frequentissime pioggie." — Relatione della Colchide, c. 27. 
He goes on to state that a great part of the inhabitants are fishers. 

^ It is singular that Procopius, on the other hand, states that the Phasis is a very 
rapid river, and Chardin confirms his statement. (Voyage en Perse, vol. i, p. 105.) 
Lamberti reconciles these discrepant accounts by explaining that the river is rapid 
in its course near where it rises among the mountains, but quite smooth and stagnant 
when it arrives at the plain. — Relat. dell Colchid., 29. 

14 



/ 



210 AIRS, WATERS, 

men they have the roughest voices, from their breathing an 
atmospliere which is not clear, but misty and humid ; they arc 
naturally rather languid in supporting bodily fatigue. The 
seasons undergo but little change either as to heat or cold ; 
their winds for the most part are southerly, with the exception 
of one peculiar to the country, which sometimes blows strong, 
is violent and hot, and is called by them the wind cenchron. 
The north wind scarcely reaches them, and when it does blow 
it is weak and gentle. Thus it is with regard to the different 
nature and shape of the inhabitants of Asia and Europe. 

- 16. ( And with regard to the pusillanimity and cowardice of 
the inhabitants, the principal reason why the Asiatics are raoi'c 
unwarlike, and of a more gentle disposition than the Europeans 
1 is, the nature of the seasons, which do not undergo any great 
changes either to heat or cold, or the like ; for there is neither 
excitement of the understanding nor any strong change of the 
body by which the temper might be ruffled, and they be roused 
to inconsiderate emotion and passion, rather than living as they 
do always in the same stateT\ It is changes of all kinds which 
arouse the understanding ofmankind, and do not allow them 
to get into a torpid condition. For these reasons, it appears 
to me, the Asiatic race is feeble, and further, owing to their 
laws ; I for monarchy prevails in the greater part of Asia, and 
where Snen are not their own masters nor independent, but are 
the slaves of others, it is not a matter of consideration with 
them how they may acquire military discipline, but how they 
may seem not to be warlike, for the dangers are not equally 
shared, since they must serve as soldiers, perhaps endure 
fatigue, and die for their masters, far from their children, 
their wives, and other friends ; and whatever noble and manly 
actions they may perform lead only to the aggrandisement of 
their masters, whilst the fruits which they reap are dangers 
and deathTjand, in addition to all this, the lands of such per- 
sons must be laid waste by the enemy and want of culture.^ 

' The best practical proof of the justness of our author's refJections in this place 
is the result of the battle of Salamis ; and the noblest intellectual monument which 
ever the wit of man has raised to the triumph of freedom is the Persae of jEschylus, 
in celebration of that event. A single line, descriptive of the Greeks, is sufficient to 
account for their superiority to the Asiatics : 

01) Tivoq lovKoL KtKkriVTai (puTog, ovd' vTtijKooi. — 1. 240. 
None seem to have felt the force of this great truth so much as the Persian despots 



AND PLACES. 211 

Thus, then, if any one be naturally warlike and courageous, 
his disposition will be changed by the institutions. As a strong 
proof of all this, such Greeks or barbarians in Asia as are not 
under a despotic form of government, but are independent, 
and enjoy the fruits of their own labours, are of all others the 
most warlike; for these encounter dangers on their own account, 
bear the prizes of their own valour, and in like manner endure 
the punishment of their own cowardice. And you will find 
the Asiatics differing from one another, for some are better and 
others more dastardly ; of these differences, as I stated before, 
the changes of the seasons are the cause. Thus it is with Asia. 
17. In Europe there is a Scythian race, called Sauromatse, 
which inhabits the confines of the Palus Mseotis, and is different 
from all other races.^ Their women mount on horseback, use 
the bow, and throw the javelin from their horses, and fight with 
their enemies as long as they are virgins ; and they do not 
lay aside their virginity until they kill three of their enemies, 
nor have any connexion with men until they perform the sacri- 

themselves, or to have estimated the effects of civil liberty higher than they did. 
The younger Cyrus, before the battle of Cynaxa, addresses his Grecian soldiers 
in the following memorable words : 'Q avdpeg "EWijvsg, ovk ai^Bpwirojv cnropibv 
/3ap€apwv avfuiaxovg vfiag dyoj, ciXXd vofii^tiiv a^uivovag kciI icpeiTTOVQ ttoXKHv 
fiapSdpiov viidg iivai Sid Tovro TrpoaiKa€ov ottioq ovv cffiaOe dvSptg d^ioi T)}g 
tXevOepiag, rjg KSKTijaOe, icai virkp t'jg vfidg kyoj ivocuiiovi^(.o' ev yap lart, on rrjv 
iXtvdepiav iXoifirjv av avri (Lv £%w TrdvTojv Kai dWwv TToXXanXacriioi'. — Anab., 
i, 7. Such being the established opinions of the intelligent portion of mankind in the 
days of Hippocrates, the sentiment here expressed would then be regarded as a self- 
evident truth, Plato, indeed, modifies this opinion in so far when he holds despotism 
to be the consequence and not the cause of servihty. — De Repub., viii. 

' The name Sauromatse or Sarmataj was applied by the ancient geographers to 
certain inhabitants of that vast and, to them, nearly unexplored countiy, extending 
from the Sinus Codanus or Baltic Sea, to the Euxiue or Black Sea. It comprehends, 
then, a large portion of Russia, Poland, and perhaps Prussia. (See Pomponius 
Mela, iii, 4 ; Ptolemy, Geograph. ; and Maltebrun, Geograph., vol. i, p. 126.) That 
the Sarmatians and Scythians were the same race of jnen, although some of the 
authorities make a distinction between them, can scarcely admit of a doubt. Our 
author, it will be remarked, seems to restrict the name to a peculiar race of Scythians, 
who lived near the Palus Majotis (or Sea of Asaph). From the account which he 
gives of them it is impossible to doubt that he alludes to the Amazonians, so cele- 
brated in ancient legends. The opinion which I entertain of them is pretty fully 
stated in the Argument to this treatise. That our author should not have doubted 
the real existence of the Amazonians need excite no wonder, considering the very 
positive and very circumstantial account of them given by his contemporary Hero- 
dotus (iv, 110-18;. 



212 AIRS, WATERS, 

fices according to law. Whoever takes to herself a husband, 
gives up riding on horseback, unless the necessity of a general 
expedition obliges her. They have no right breast ; for while 
still of a tender age their mothers heat strongly a copper in- 
strument, constructed for this very purpose, and apply it to 
the right breast, which is burnt up, and its development being 
arrested, all the strengtli and fulness are determined to the 
right shoulder and arm. 

18. As the other Scythians have a peculiarity of shape, 
and do not resemble any other, the same observation applies to 
the Egyptians, only that the latter are oppressed by heat 
and the former by cold.^ What is called the Scythian desert 
is a prairie, abounding in meadows, high-lying, and well 
watered ; for the rivers which carry off the water from the 
plains are large. There live those Scythians which are called 
Nomades, because they have no houses, but live in waggons. 
The smallest of these waggons have four wheels, but some have 
six j they are covered in with felt, and they are constructed in 
the manner of houses, some having but a single apartment, and 
some three; they are proof against rain, snow, and winds. 
The waggons are drawn by yokes of oxen, some of two and 
others of three, and all without horns, for they have no horns, 
owing to the cold." In these waggons the women live, but the 
men are carried about on horses, and the sheep, oxen, and 
horses accompany them ; and they remain on any spot as long 
as there is provender for their cattle, and when that fails they 
migrate to some other place. They eat boiled meat, and drink 
the milk of mares, and also eat Idppace, which is cheese pre- 
pared from the milk of the mare. Such is their mode of life 
and their customs.^ 

' It may at first sight appear singular that our author should have mixed up his 
account of the Scythians with allusions to the Egyptians ; but he proljably had in 
view Herodotus (ii, 103-6), who connects the Egyptians with the Scythians, and 
more especially with the tribe of them called Colchians. He states in particular that 
the Colchians and Egyptians resembled one another in the fashion of their linen, 
their whole course of life, and in their language. 

2 Herodotus (iv, 28, 29) and Strabo (Geogr., vii) assign the same reason for the 
Scythian cattle not having horns. 

^ This description evidently applies to the wandering tribes which roam over the 
steppes of Tartary. The passage is of classical celebrity, for I cannot but fancy that 
certaiidy Virgil (Georg., iii, 349-83), and perhaps Horace (Od. iii, 24), had it in view 



AND PLACES. 213 

19. In respect of the seasons and figure of body, the Scythian 
race, like the Egyptian, have a uniformity of resemblance, 
diflerent from all other nations ; they are by no means prolific, 
and the wild beasts Avhich are indigenous there are small in 
size and few in number, for the country lies under the Northern 
Bears, and the Rhiphtean mountains, whence the north wind 
blows ; tlie sun comes very near to them only when in the 
summer solstice, and warms them but for a short period, and 
not strongly; and the winds blowing from the hot regions of 
the earth do not reach them, or but seldom, and with little 
force ; but the winds from the north always bloAV, congealed, 
as they are, by the snow, the ice, and much water, for these 
never leave the mountains, which are thereby rendered unin- 
habitable. A thick fog covers the plains during the day, and 
amidst it they live, so that winter may be said to be always 
present with them ; or, if they have summer, it is only for a 
few days, and the heat is not very strong. Their plains are 
high- lying and naked, not crowned with mountains, but ex- 
tending upwards under the Northern Bears.^ The wild beasts 
there are not large, but such as can be sheltered under-ground; 
for the cold of winter and the barrenness of the country prevent 

when they drew their pictures of the nomadic life of the Scythians. The extra- 
ordinary cold of that region, notwithstanding its southern latitude, has not been 
exaggerated hy ancient authors ; but to account for it, as the modern traveller, 
Clark, remarks, is still a problem which no one has solved. Strabo mentions that 
carts were driven across the Palus Maotis (Geogr., vii, 3). The chariots covered in 
from the inclemency of the weather with a roof of felt, are described also by 
Strabo (Geogr., 1. c.) ; and, according to Dr. Coray, similar contrivances are still to 
be found among the Kalmucs and other savage nations. (Notes sur le Traite des 
Airs, &c., h. 1.) A preparation from milk resembling the hippace is still used hy the 
inhabitants of that region. On the people who lived upon this composition from 
milk, see in particular Strabo, vii, 3. 

' The following lines of Virgil, referred to above, may be almost said to be a 
translation of this passage : 

" Semper hiems, semper spirantes frigora Cauri. 
Turn sol pallentes baud unquam discutit umbras ; 

* * * * 

Talis Hyperboreo septem subjecta trioni 
Gens effrena viriira Rhiphseo tunditur Euro." 

It was in this region of mist and cold that the celebrated race of the Cimmerians 
resided. See Ilerodot., i, 6, &c. ; Homer, Odyss. x, 11. Tlie montes Rhiphaii would 
appear to have been the Ural mountains which separate Russia from Siberia. 



214 AIRS, WATERS, 

their growth, and because they have no covert nor shelter.^ The 
changes of the seasons, too, are not great nor violent, for, in 
fact, they change gradually; and therefore their figures resemble 
one another, as they all equally use the same food, and the 
same clothing summer and winter, respiring a humid and 
dense atmosphere, and drinking water from snow and ice ; 
neither do they make any laborious exertions, for neither body 
nor mind is capable of enduring fatigue when the changes of 
the seasons are not great." For these reasons their shapes are 
gross and fleshy, with ill-marked joints, of a humid tempera- 
ment, and deficient in tone : the internal cavities, and especi- 
ally those of the intestines, are full of humours ; for the belly 
cannot possibly be dry in such a country, with such a constitu- 
tion and in such a climate ; but owing to their fat, and the 
absence of hairs from their bodies, their shapes resemble one 
another, the males being all alike, and so also with the women; 
for the seasons being of an uniform temperature, no corruption 
or deterioration takes place in the concretion of the semen, 
unless from some violent cause, or from disease.^ 

20. I will give you a strong proof of the humidity (laxity?) of 
their constitutions.^ You will find the greater part of the Scy- 
thians, and all the Nomades, with marks of the cautery on their 
shoulders, arms, wrists, breasts, hip-joint, and loins, and that 
for no other reason but the humiditv and flabbiness of their 
constitution, for they can neither strain with their bows, nor 
launch the javelin from their shoulder owing to their humidity 
and atony; but when they are burnt, much of the humidity 

' It is well known now that excessive cold has a tendency to retard the growj:h 
of animals. This opinion is confirmed in several instances by Pallas (Voy. en Kussie, 
i, 197; iii, 431). Strabo mentions, as the consequences of the cold which prevails in 
the country of the Getae, that there are no asses in it, the cattle want horns, and the 
horses are small. (Geogr., vii, 3.) 

- Buffon, on the other hand, maintains that the Nomadic race are men of active 
habits. (Hist. Nat., tom. iii, p, 384.) Pallas, however, confirms the judgment of 
Hippocrates. (Voyag. en Russie, torn, i, p. 499.) See also Coray, ad h. 1. 

3 It is to be borne in mind that Hippocrates, and after him most of the ancient 
authorities, held that the foetus is formed from the male semen. This doctrine pre- 
vailed generally down to the days of Ilarvey. Some of the ancient physiologists, 
however, maintained that " omne animal est ab ovo." See Plutarch, de Placit. Philos. 

■* 'YypoTtjg, when applied to the body, may signify both humidity and relaxation, 
in like manner as the adjective (vypoc) signifies humid and relaxed. We shall see 
an example of the latter signification in the Prognostics. 



AND PLACES. 215 

in their joints is dried up, and they become better braced, 
better fed, and their joints get into a more suitable condition.^ 
They are flabby and squat at first, because, as in Egypt, they are 
not swathed (?) ;" and then they pay no attention to horsemanship, 
so that they may be adepts at it ; and because of their sedentary 
mode of life ; for the males, when thc}^ cannot be carried about 
on horseback, sit the most of their time in the waggon, and 
rarely practise walking, because of their frequent migrations and 
shiftiugs of situation ; and as to the women, it is amazing how 
flabby and sluggish they are. The Scythian race are tawny 
from the cold, and not from the intense heat of the sun, for the 
whiteness of the skin is parched by the cold, and becomes 
tawny. 

21. It is impossible that persons of such a constitution 
could be prolific, for, with the man, the sexual desires are not 
strong, owing to the laxity of his constitution, the softness and 
coldness of his belly, from all which causes it is little likely 
that a man should be given to venery ; and besides, from being 
jaded by exercise on horseback, the men become weak in their 
desires. On the part of the men these are the causes ; but on 
that of the AYomen, thej^ are embonpoint and humidity ; for 
the womb cannot take in the semen, nor is the menstrual dis- 
charge such as it should be, but scanty and at too long intervals ; 
and the mouth of the womb is shut up by fat, and does not 
admit the semen ; and, moreover, they themselves are indolent 
and fat, and their bellies cold and soft.^ From these causes 

' This practice came to be one of the regular operations of surgery, being per- 
formed with the view of con-ecting the tendency of a joint to dislocation. It is 
minutely described by Hippocrates (De Artie., xi), Paulus yEgineta (VI, 42), Albu- 
casis (Chirurg., i, 27), Haly Abbas (Pract., ix, 73). Sec the Sydenham Society's 
edition of Paulus /Egineta, 1. c. 

- The meaning of this passage is aml)iguons. I have followed Coray, who gives 
some very interesting annotations on it. lie translates these words, "lis sont 
naturellement d'une complexion lache et trapus ; premierement, parceque dans leur 
enfance ils ne sont point emniaillotes, non plus cpie les ^Egyptiens." Clifton has 
given nearly the same meaning of the passage : " Their fluidness and breadth proceed 
first from their neglect of bandages, as in Egypt." Littre, on the other hand, appears 
to give a different interpretation of the passage : " D'abord parceque on ne les em- 
maillotte pas, comme en Egypte." 

^ A fat condition of the body was also supposed adverse to conception in the case 
of cattle. Virgil alludes to this opinion, and the means used to counteract the effects 
of an excessively fat state of the body in the following verses, which have been 



21 G AIRS, WATERS, 

the Scythian race is not prolific. Their female servants furnish 
a strong proof of this ; for they no sooner have connection with 
a man than they prove with child, owing to their active course 
of life and the slenderness of hody. 

22. And, in addition to these, there are many eunuchs 
among the Scythians, who perform female work, and speak like 
women. Such persons are called effeminates.^ The inhabi- 
tants of the country attribute the cause of their impotence to 
a god, and venerate and worship such persons, every one dread- 
ing that the like might befall himself; but to me it appears 
that such affections are just as much divine as all others are, 
and tliat no one disease is either more divine or more human 
than another, but that all are alike divine, for that each 
has its own nature, and that no one arises without a natural 
cause." But I will explain how I think that the affection takes 
its rise. From continued exercise on horseback they are seized 
with chronic defluxions in their joints [kedmata^) owing to 

alwaj's admired as an example how delicately a great genius can touch upon an 
indeUcate subject : 

" Ipsa autem macie tenuant arraenta volentes : 

Atque, ubi concubitus primes jam nota voluptas 

Sollicitat, frondesque negant, et fontibus arcent. 

Ssepe etlam cursu quatiunt et sole fatigunt ; 

Hoc faciunt nimio ne luxu obtusior usus 

Sit geuitali arvo, et sulcos oblimet iuertes ; 

Sed rapiat sitiens venerem, interiusque recondat." 

Georg., iii, 136. 

' On the nature of this atfection see the Argument. There is a variety in the 
reading, most of the MSS. having avav^pitlQ, but the one usually marked 2146, 
which is followed in the Aldine edition, reading avlpiiiq. See a long discussion in 
Coray's edition on this point. There seems to be no good reason for at all inter- 
fering with the text as it now stands. 

2 Our author in this place, as in the treatise on the Sacred Disease, holds the 
philosophical opinion in opposition to the superstitious, that all diseases have natural 
causes, and that no one more than another is to be ascribed to the extraordinary 
interference of supernatural beings. Plato, his contemporary, would appear to have 
endeavoured to steer a sort of middle course between the scientific and the popular 
belief. Thus he ascribes epilepsy, like all other diseases, to a natural cause, namely, 
in this instance, to a redundancy of black bile ; but he qualifies this opinion by calling 
the passages of the brain (the ventricles?) most divine, and adds that the disease had 
been most appropriately denominated sacred. (Timaeus, § 66.) 

^ The origin and signification of this terra are by no means well defined. See 
Galen (Exeges. &c.). Foes ((Econ. Hippocr.), and Coray (ad h. 1.). It has been applied 
lirst, to certain varieties of morbus coxarius; secondly, to chronic buboes, super- 



AND PLACES. 217 

their legs always hanging down below their horses j they after- 
wards become lame and stiff at the hip-joint, such of them, at 
least; as are severely attacked with it. They treat themselves 
in this Avay : when the disease is commencing, they open the 
vein behind either ear, and when the blood flows, sleep, from 
feebleness, seizes them, and afterwards they awaken, some in 
good health and others not. To me it appears that the semen 
is altered by this treatment, for there are veins behind the ears 
which, if cut, induce impotence ; now, these veins Avoukl 
appear to me to be cut.^ Such persons afterwards, when they 
go in to women and cannot have connection with them, at 
first do not think much about it, but remain quiet ; but when, 
after making the attempt two, three, or more times, they 
succeed no better, fancying they have committed some off'ence 
against the god Avhom they blame for the affection, they put 
on female attire, reproach themselves for effeminacy, play the 
part of women, and perform the same work as women do. This 
the rich among the Scythians endure, not the basest, but the 
most noble and powerful, owing to their riding on horseback j 
for the poor are less afl'ected, as they do not ride on horses. 
And yet, if this disease had been more divine than the others, 
it ought not to have befallen, the most noble and the richest of 
tlie Scythians alone, but all alike, or rather those who have 

induced by disease of the hip-joint ; thirdly, to paralysis of the muscles about the 
genital organs ; fourthly, aneurismal varix. (See Aretaeus, Morb. Acut., ii, 8 ; and the 
note in Boerhaave's edition.) I must own that I find some difficulty in deciding to 
which of these significations I should give tlie preference ; I rather incline, however, 
to the first, from what our author says towards the end of this section, namely, that 
all men who ride much " are afflicted with rheums in the joints, sciatica and gout, 
and are inept at venery." 

' This opinion of our author was no doubt founded on the erroneous notion re- 
garding the distribution of the veins which prevailed in his time, and which we find 
advocated in the tract ' on the Nature of Man,' and elsewhere. (See Aristot., H. N., 
iii, 3.) Coray strives hard, in his annotations on this passage, to make out that the 
fact may be as stated by his ancient countryman, although the hypothesis by which 
he explained it be false. It is singular, however, that, after the lapse of more than 
two thousand years. Phrenology should have come to the assistance of Hippocrates in 
this case. I need scarcely remark that Gall and his followers hold that the cere- 
bellum is the seat of the animal appetites, so that, if this be really the fact, a close 
sympathy between the back of the head and the genital organs may be very legiti- 
mately inferred. At all events, this coincidence between ancient observation and 
modern hypothesis must be admitted to be very remarkable. 



is 



218 AIRS, WATERS, 

little, as not being able to pay honours to the gods, if, indeed, 
they delight in being thus rewarded by men, and grant favours 
in return ; for it is likely that the rich sacrifice more to the 
gods, and dedicate more votive offerings, inasmuch as they 
have wealth, and Avorship the gods ; whereas the poor, from want, 
do less in this way, and, moreover, upbraid the gods for not 
giving them wealth; so that those who have few possessions 
were more likely to bear the punishments of these offences 
than the rich. But, as I formerly said, these affections are 
di^dne just as much as others, for each springs from a natural 
cause, and this disease arises among the Scythians from such a 
cause as I have stated. But it attacks other men in like 
manner, for whenever men ride much and very frequently on 
horseback, then many are affected with rheums in the joints, 
sciatica, and gout, and they are inept at venery. But these 
complaints befall the Scythians, and they are the most impotent 
of men for the aforesaid causes, and because thev alwavs wear 
breeches, and spend the most of their time on horseback,^ so 
as not to touch their privy parts with the hand, and from the 
cold and fatigue they forget the sexual desire, and do not make 
the attempt until after they have lost their virility.^ Thus it 
is with the race of the Scythians. 

23. The other races in Europe differ from one another^oth 
as to stature and shape, owing to the changes of the seasons, 
Avliich are very great and frequent, and because the heat is 
strong, the Avinters severe, and there are frequent rains, and 
again protracted droughts, and winds, from which many and 
diversified changes are induced?! These changes are likely to 

' Aristotle, on the other hand, holds that the effects of equitation are aphrochsiac. 
(Prohl. iv, 12.) Coray attempts to reconcile the discordant opinions of the physician 
and philosopher, by supposing that moderate exercises may excite the venereal appe- 
tite, whereas excessive extinguish them. Van Swieten agrees with Hippocrates that 
inordinate exercise in riding may induce impotence. (Comment, in Boerh. .Vphor., 
§ 1063.) 

2 It is a singular idea of our author that the wearing of breeches by confining the 
development of the genital organs impairs the sexual desires. It is curious, as re- 
marked by Coray, that the same opinion is advocated by Hunter in his treatise on 
the Venereal Disease. Coray also quotes the following passage from Lalement : 
" Ssepe audivimus pistores et caeteros quorum partes pudendje subligacuUs nou 
obteguntm- sed liberius pendent crassos et bene nutritos habere testiculos." — Com- 
ment, in Hippocrat. de Aer., &c. 



AND PLACES. 219 

have an effect upon generation in the coagulation of the semeu^ \. 
as this process cannot be the same in summer as in winter, nor ' 
in rainy as in dry weather ; wherefore^ I think, that the figures •, 
of Europeans differ more than tliose of Asiatics : and they differ 
very much from one another as to stature in the same city; 
for vitiations of the semen occur in its coagulation more fre- 
quently during frequent changes of the seasons, than where 
they are alike and equable. And the same may be said of 
their dispositions, for the wild, the unsociable, and the passionate 
occur in such a constitution ; for frequent excitement of the 
mind induces wildness, and extinguishes sociableness and mild- 
ness of disposition, and therefore I think the inhabitants of 
Europe more courageous than those of Asia; for fa climate 
which is always the same induces indolence, but a changeable 
climate, laborious exertions both of body and mind ; and from 
rest and indolence cowardice is engendered, and from laborious 
exertions and pains, courage. lOn this account the inhabitants 
of Europe are more warlike than the Asiatics, and also owing 
to their institutions, because they are not governed by kings 
like the latter, for where men are governed by kings there 
they must be very cowardly, as I have stated before ; for their 
souls are enslaved, and they -^111 not willingly or readily midergo 
dangers in order to promote the power of another ; but those 
that are free undertake dangers on their own account, and not 
for the sake of others ; they court hazard and go out to meet 
it, for they themselves bear off the rewards of \'ictory, and thus 
their institutions contribute not a little to their courage.^ 

' I trust I shall be excused in quoting entire Dr. Coray's note on this section: 
" Trente mille Macedoniens (dit Pauw) ont conquis la Perse ; quarante mille Mogols 
ont conquis les Indes ; cinquante mille Tartares ont conquis la Chine, ou Ton compt- 
ait alors plus de quarante millions d'habitans, qui abandonncrent leurs souverains. 
On a vu de nos jours I'armee du grand Visir deseiier presque completement dans les 
environs de Varna ; et jamais les Turcs n'eurent plus de bou sens qu'en cette occa- 
sion la ; car leurs tyrans ue meritent pas qu'on verse une seule gontte de sang pour 
les maintenir sur le trone de ces contrees qu'ils ont devastees en voleurs et en brigands. 
(Rechercli. philosoph. sur les Grecs.) — Par ce dernier exeniple on voit encore com- 
l)ien les causes politiques ou morales, et les causes naturelles, peuvent se modifier 
reciproquement. Les Russes, quoique soumis il uu gouvernement despolique, ont 
ccpendant ete la terreur des Turcs, a cause, sans doute, de la difference du climat, de 
la discipline militaire, et des progres dans la civilisation. Ces circonstances ont con- 



220 AIRS, WATERS, 

Such is the general character of Europe and Asia.i 
24. And there are in Europe other tribes, differing from one 
another in stature, shape, and courage : the differences are 
those I formerly mentioned, and will now explain more clearly. 
Such as inhabit a country which is mountainous, rugged, 
elevated, and well watered, and where the changes of the 
seasons are very great, are likely to have great variety of shapes 
among them, and to be naturally of an enterprising and warlike 
disposition ;" and such persons are apt to have no little of the 
savage and ferocious in their nature ; but such as dwell in 
places which are low-lying, abounding in meadows and ill 
ventilated, and who have a larger proportion of hot than of 
cold Avinds, and who make use of warm waters — these are not 
likely to be of large stature nor well proportioned, but are of 
a broad make, fleshy, and have black hair ; and they are rather 
of a dark than of a light complexion, and are less likely to be 
phlegmatic than bilious ; courage and laborious enterprise are 
not naturally in them, but may be engendered in them by 
means of their institutions. And if there be rivers in the 
country which carry off the stagnant and rain water from it, 
these may be wholesome and clear ; but if there be no rivers, 

couru a mitiger le despotisme Kusse, et a le rendre si different du despotisme brutal 
des Turcs. II en est de meme des autres peuples Septentrionaux de I'Europe. 
Quoique gouvernes par des loix qui ne sont point leur ouvrage, ils sont tres belli- 
queux, et par la nature de leur climat, et par les lumieres que les sciences et les arts 
ont repandues parmi eux." 

' Aristotle, in drawing the traits of the European and Asiatic character, -would 
appear to have borrowed freely from our author. He says the inhabitants of cold 
countries and of Europe are full of spirit, but deficient in intellect and skill; they 
therefore remain in a state of freedom, but without regular government, and they 
are incapable of governing their neighbours. The inhabitants of Asia are described 
by him as being intellectual and skilled in the arts, but deficient in courage, and 
therefore they are in constant subjection and slavery. The Greeks, he maintains, 
held an intermediate place between these two, have both courage and intellect, and 
therefore enjoy freedoin and good government. (Polit., iii, 7.) 

2 We have lately had a notable example of the warlike and independent spirit of 
mountaineers in the determined resistance which the Circassians have made to the 
colossal power of Russia. Great Britain, too, I may be permitted to remark, ex- 
perienced disasters in contending with the mountaineers of Afl^ganistan, such as she 
had never met with in the rich plains of India. And, by the way, the conqueror of 
Greece and of Persia was very nearly cut off by the same people. See Arrian, Exped. 
Alexandr., iv, 22, &c. 



AND PLACES. 221 

but the inhabitants drink the waters of fountains, and such as 
are stagnant and marshy, they must necessarily have prominent 
belHes and enlarged spleens. But such as inhabit a hi^-h 
country, and one that is level, windj^, and well-watered, will be 
large of stature, and like to one another ; but their minds will 
be rather unmanly and gentle. Those who live on thin, ill- 
watered, and bare soils, and not well attempered in the changes 
of the seasons, in such a country they are likely to be in their 
persons rather hard and well braced, rather of a blond than a 
dark complexion, and in disposition and passions haughty and 
self-willed. For, where the changes of the seasons are most 
frequent, and where they differ most from one another, there 
you will find their forms, dispositions, and nature the most 
varied. These are the strongest of the natural causes of difference, 
and next the country in which one lives, and the waters ; for, 
in general, you will find the forms and dispositions of mankind 
to correspond with the nature of the country ; for where the land 
is fertile, soft, and well- watered, and supplied with waters from 
very elevated situations, so as to be hot in summer and cold in 
winter, and where the seasons are fine, there the men are fleshy, 
have ill-formed joints,^ and are of a humid temperament ; they 
are not disposed to endure labour, and, for the most part, are 
base in spirit ; indolence and sluggishness are visible in them, 
and to the arts they are dull, and not clever nor acute. When 
the country is bare, not fenced, and rugged, blasted by the 
winter and scorched by the sun, there you may see the men 
hardy, slender, with well-shaped joints,^ Avell-braced, and shaggy; 
sharp industry and vigilance accompany such a constitution ; 
(in morals and passions they are haughty and opiniative, inclining 
rather to the fierce than to the mild ; and you will find them 
acute and ingenious as regards the arts, and excelling in military 
aff'airs; and likewise all the other productions of the earth 
corresponding to the earth itself.^ Jj Thus it is with regard to 

' 'AvapSoi. The meaning of this term seems to be, persons whose joints are indis- 
tinct owing to fatness. 

^ Coray supposes, and apparently with justice, that our author in this passage 
tacitly refers to the inhabitants of Attica. It is worthy of remark that Thucydidcs 
ascribes the early civilization of the Athenians to the infertility of the soil. ('ArriKjyi/ 
XeTTToynov, i, 2.) See Arnold's Note, h. 1. ; also the quotation from Aristotle at 
§ 23; and Plato's Timaeus, torn, iii, p. 247; ed. Bekker. According to Coray (but 



222 AIRS, WATERS, ETC. 

the most opposite natures and shapes ; drawing conclusions 
from thcra^ you may judge of the rest without any risk of 
error. 

perViaps he was partially disposed towards his adopted country), the characters of 
Provence and Marseilles are analogous to those of Attica and Athens, and the effects 
on the inhabitants similar. That Marseilles was at one time a flourishing seat of 
learning is undoubted ; see Tacitus (Agricola) and Stral)o (Geogr., iii) ; but in literary 
celebrity it cannot surely aspire to be put on a level with the region which produced 
an .Eschylus, a Thucydides, a Plato, and a Demosthenes ! And it may be doubted 
whether even the Marseillais Hymn equals in masculine energy the war songs of 
Tyrtaeus ! 



i 



ON THE PROGNOSTICS. 



I 



ON THE PROGNOSTICS. 



THE ARGUMENT. 

Of the genuineness of this work I have treated in the Pre- 
liminary Discourse, and have also briefly touched upon its 
relation to two other important treatises in the Hippocratic 
collection, the ' Prorrhetics' and the ' Coacpe Pmcnotiones/ 
The latter subject I am now to resume, and in doing so I 
mean to avail myself of the talented dissertation of Dr. Ermerins, 
to which also I have already made allusion. Indeed, I am 
persuaded that I cannot do a more acceptable service to my 
profession in Britain than by laying before them a brief 
exposition of the important views brought forward in this 
' Dissertatio Inauguralis/i 

After some preliminary observations on the ancient Temples 
of Health, which are mainly derived from SprengePs ' History 
of Medicine,^2 \^q passes on to consider the opinion stai-ted by 
this author and others before his time, that the first book of 
the ' Prorrhetics/ and the ' Coacse Prsenotiones^ are the results 
of isolated observations made upon the sick in the Asclepion 
of Cos. The probability of this opinion being well founded he 
shows to be very great ; and he next endeavours to solve the 
question whether the first book of the ' Prorrhetics' be derived 
from the ' Coaca3 Praenotiones,' or whether the latter be tlie 
more modern work of the two. He comes to the conclusion 
that the ' Prorrhetics' is the more ancient work, for the follow- 
ing reasons : 1st. Because in it the names of the patients are 
frequently given, which is rarely the case in the ' Coacre Prse- 

' Its title is, Specimen Ilistorico-Medicuin Inaugurale de Ilippocratis Do('tiiiia 
a Prognostice Orimula. Lugduni Batavorura, 1832. 
=* Cap. V. 

15 



226 PROGNOSTICS. 

notiones/ 2d. Because queries and doubts are oftener found in 
this book tlian in the other, when one takes into account the 
number of presages. 3d. Because the number of observations 
which this book contains is much smaller than those which 
the ' Coacse' embrace. 4th. This is confirmed by the circum- 
stance that the enunciations of the prognoses are far less ex- 
tended in the ' Prorrhetics/ whence it is clearly proved that 
they are not derived from so great a field of observations as 
those we meet with in the other work. He then gives a most 
lucid view of the parallelism which subsists between the 
' Prorrhetica' and the ' Coacse/ and, as the results of his ob- 
servations upon them, he draws the following most important 
conclusions : 

1. " Bv a most fortunate occurrence certain monuments of 
the medical art, as cultivated by the Asclepiadae, are preserved 
to us in the first ^ Prorrhetics,^ and the ' Prsenotiones Coacse,^ 
which books appear to be fragments and excerpts from the 
histories of diseases and cures which Avere formerly found on 
the votive tablets of the Coan temple. 

2. This sacerdotal medicine was at first a certain medical 
divination, which, as it was the offspring of pure observation, so 
the system of prognostics of the Coans was altogether aloof from 
the theories and systems of the philosophers, and is therefore to 
be reckoned most worthy of our attention, both from the great 
love of observation which we admire in it, and from the exquisite 
and beautiful sense of the simple truth which it evinces. 

3. We must keep in view the origin of these presages from 
individual observations gradually collected, in order that we 
may have a knowledge of this system of prognostic semeiology. 
Hence we comprehend how we meet with so many doubtful 
propositions, and so many uncertain and vague remarks, and 
that imperfect etiology Avhich confounded causes with their 
effects, and again, the latter with the former. 

4. The readers must particularly keep before their eyes this 
origin, and the antiquity of those writings, if they would pass 
a correct judgment on the merits of the Asclepiadse towards 
the art of medicine. Whatever in their works we have the 
pleasure of pos^essing, all attest the infancy of the art ; many 
things are imperfect, and not unfrequently do Ave see them, 
while in the pursuit of truth, groping, as it were, and pro- 



ARGUMENT. 227 

ceeding with uncertain steps, like men wandering about in 
darkness ; but yet the method which they appUed, and to which 
they woukl seem to have betaken themselves of their own 
accord, was so excellent, that nothing could surpass it. It 
Avas the same method which Hippocrates himself always 
adopted, and which, in fine. Lord Bacon, many ages after- 
wards, commended as the only instrument by which truth in 
medicine can be found out. 

5. As this method is founded on true induction, so are its 
dicta to be held the more worthy of admiration, the more they 
possess a universal signification. To give an example; what 
assiduous observation, and what abundance of rational ex- 
perience, must have been required for enunciating the follow- 
ing admirable truth, and, as it were, law of nature : '^ Those 
things which bring alleviation with bad signs, and do not remit 
with good, are troublesome and difficult." 

6. Many passages bear reference to the condition of the 
vital powers, which they took into account at all times, l^otli 
in making presages and in exercising the art. For, although 
they had not our theories of the vital force, they perceived its 
effects very well by observation; and for this very reason, that 
they did not search for the art in theories, but in observation 
alone, we owe so many excellent things to them, since they 
did not adapt their observation to theories, but related a trust- 
worthy and faithful history of the operations of nature. 

7. They sought after many things from a comparison of 
health with disease, in which also they rightly calculated the 
manners and customs of men. Thus they call that, in the 
first place, the best mode of reclining, which is adopted by the 
patient when in good health ; and hence they estimate the 
other modes as being less good, or altogether unfavorable. 
Nor did they only compare health with disease, but they com- 
pared also the symptoms of diseases with one another, and 
interpreted the one from the other. Thus they first depict 
and pronounce a favorable opinion on the best kind of excre- 
tions, and then they describe the other abnormal kinds, and 
pass an unfavorable judgment on them. 

8. They particularly relate the operations of a natura medi- 
catrix, which, in a region such as Greece is, and in athletic, 
strong bodies, on Mliich they appear to have practised the art, 



228 PROGNOSTICS. 

and for tlie most part in acute diseases, and the few clu'onic 
ones derived from tliem wliich. they have left described, might 
especiallv be looked for. Hence that doctrine of crises most 
deserving of attention, the rudiments, indeed, of which we 
only have here preserved, but a just notion of which we may 
easilv draw from these fragments. 

9. The Asclepiadre Avould appear to have accommodated and 
directed their art to this natural Therapia. Hence the advice 
that con-^Tilsions arising from a great hemorrhage, forcibly 
stopped, should be cured by the abstraction of blood. It is to be 
regretted that but a few monuments of their practice remain ; 
but these embrace admu^able imitations of nature, and the most 
prudent caution in administering remedies. 

10. Neither did thev neglect surj^jerv, but deliver manv 
excellent remarks on things pertaining to wounds, ulcers, and 
fractures. 

11. Although it cannot be made out for certain that every- 
thing which is preserved in these writings existed before 
Hippocrates, there can be no doubt that many of them are 
more ancient than he. And although we mav attribute some 
things rather to Hippocrates himself, it is nevertheless certain 
that the method of deducing the art from observation and com- 
parison had existed before him. Some may, perhaps, object 
that these books are to be attributed to the youth of Hippo- 
crates, and that the others, more elaborate and perfect, had 
proceeded from the same person in his old age ; but this sup- 
position we may refute by a single argument, namely, that it 
would be absurd to ascribe so many observations about so many 
diseases to one man. 

12. From the whole Coan system of cultivating medicine, 
the best hopes might justly have been expected ; and from what 
follows it will be seen that the result did not disappoint this 
expectation.^^ 

These deductions, I must say, appear to be most legitimately 
drawn ; and having thus satisfactorily made out that the ^Coacse 
Prsenotiones^ are founded on the ' Prorrhetics,^ Dr. Ermerins 
proceeds to make an interesting comparison between the former 
and the book of ' Prognostics.' Here again we can only find 
room for the general conclusions. 



ARGUMI5NT. 229 

1. " We have compared together two monuments of antiquity 
embracing entirely the same doctrine, so that we may hokl it 
as put out of all doubt that they must have derived their origin 
from the same school, onlv the one yields to the other in 
antiquity, as its more expanded mode of expression shows. 

2. The more recent work is attributed to Hippocrates by 
all the critics and interpreters ; the most ancient authors have 
made mention of it, and all the characteristic marks by which 
the genuine works of Hippocrates are distinguished from the 
spurious, without doubt, are found in it ; for whether you look 
to the brevity and gravity of the language, or the paucity of 
the reasonings, the correctness of the observations, or the 
dialect in which they are expressed, or, in fine, its agreement 
with the whole Hippocratic doctrine, — all these attest that "the 
divine old man" is the author of this work. 

3. From a comparison of the 'Coac^ie Pra^notiones' with the 
'Prognostics,^ it is as clear as the light of day that Hippocrates 
composed this work from them, in such a manner that he cir- 
cumscribed many of the symptoms, limited the enunciations, 
and amplified them all by his own experience in the medical 
Art. Hence the Prognostics may not inaptly be called the 
Commentary of Hippocrates on the 'Coacse Prsenotiones.^ 

4. With regard to the exquisite and artificial order, in which 
we see many things proposed in this book, we agree entirely 
with Sprengel, who thinks that they have proceeded from a 
more recent describer. This is confirmed by our comparison 
of both works. 

5. This work exhibits the fundamental principles and ori- 
ginals of the Hippocratic doctrine, and although we hardly 
know anything as to the manner in which Hippocrates com- 
posed his writings, and of the form which he gave them, it 
does not seem at all out of the way to hold this book to be the 
oldest of all the works which "the Father of Medicine" has 
left to us. 

6. Inasmuch as this work is entitled the 13ouk of Pro- 
gnostics, so it turns on \\\q, prescience (ttooi'ojo), that is to say, 
the foreknowledge of the physician, which Hippocrates recom- 
mends to physicians for three reasons : first, for the con- 
fidence of mankind, which it will conciliate to the physician ; 
then because it will free the practitioner from all blame, if he 



230 PROGNOSTICS. 

has announced beforehand the fatal result of diseases ; and 
further, as being a very great instrument in effecting the cure. 

7. Like the Coan priests, Hippocrates drew his Prognostics 
from a comparison of disease with health. This he held to be 
of so great importance, that he first delivers physiological 
semeioticSj and then adds pathological. 

8. In calculating and judging of signs he neglected neither 
age nor sex, and, in the first place, directed his mind to the 
power of habit on the human body. 

9. Nor did Hippocrates stop here, but directed care to be 
had of the attack of epidemics, and the condition of the season. 

10. The Prognostics of Hippocrates are not of one time or 
place, but extend through every age, and through the whole 
world ; inasmuch as the prognostic signs have been proved to 
be true in Libj'a, in Delos, and in Sc3^thia, and it should be 
well known that every year, and at every season of the year, 
bad symptoms bode ill, and good symptoms good. 

11. But he who would wish to know properly beforehand 
those who will recover from a disease, and those who will die, 
and those in whom the disease will persevere for many days, 
and those in whom it will last for a few, should be able to 
comprehend and estimate the doctrine of all the signs, and 
weigh in his mind and compare together their strength. The 
Hippocratic foreknowledge rests not only on the observation 
of the signs, but also on the understanding of them. 

12. The Book of Prognostics exhibits observations of 
acute diseases, and of chronic arising from them, in which 
Hippocrates has diligently noted the times and modes of the 
crises. 

13. Such is the authority of critical days and signs, that in 
those fevers which cease Avithout the symptoms of resolution, 
and not upon critical days, a relapse is to be expected. 

14. The series of critical days which Hippocrates delivers, 
proceeds solely upon the observation of nature. Yet neither 
can any of them be exactly numbered by entire days, since 
neither the year nor the months are usually numbered by 
entire days.^^ 

Dr. Ermerins, in the remaining part of his Essay, shows, in 
a very lucid manner, that the rules of Prognosis laid down in 
this treatise by Hippocrates, are manifestly those by which he 



ARGUMENT. 231 

is regulated in his other works, find more especially in the 
Epidemics and Aphorisms. We mnst not, however, occupy room 
with any further exposition of the contents of this important 
treatise, which does equal credit to the author himself, and to 
the m.edical system of education pursued in the learned uni- 
versity from which it emanated. 

I will now give some remarks and reflections of my own 
on the treatise under consideration. 

In this work, then, Hippocrates appears to have had for his 
object, to give such a general description of the phenomena of 
dfsease as would apply to all the disorders of the animal frame. 
With this intention he brings into review the state of the 
countenance, the position of the patient in bed, the movements 
of the hands, the respiration, the sweats, the state of the hypo- 
chondria, dropsies which are the consequences of acute diseases^ 
the sleep, the urine, the alvine dejections, the vomitings, and 
the sputa. In doing this, his unifoi'm practice is to contrast 
the healthy with the morbid appearances. Although ]\I. Littre 
regards it as a treatise on special Pathology, it appears to me 
to be decidedly a general work on Semeiology. Certain it is 
that all the best commentators, such as Erotian and Stephanus/ 
decidedly regard it as a semeiological work. The class of ancient 
writings with which it admits of being most closely compared, 
are the works on the prognostics of the weather. On this 
subject Greek literature contains several works of a very philo- 
sophical nature, such as the Phenomena of Aratus, and several 
of the minor tracts of Theophrastus. Now as the object of 
these authors was to connect the most striking phenomena in 
the sky, the earth, and the sea, with the changes in the weather, 
of which thej^ are the precursors, so the intention of the medical 
writer of Prognostics was, to point out the alterations in the 
animal frame, which certain preternatural symptoms usually 
indicate. And as the utility of an acquaintance with pro- 
gnostics of the weather to the husbandman and sailor is suf- 
ficiently obvious, the benefit to be derived from a knowledge 
of medical prognostics by the physician is equally so. Our 
author, it will be seen in the Preface to this work, enumerates 

' Comment, in Prognos. ap. Dietz. 



232 PROGNOSTICS. 

three objects to be attained by cultivating an acquaintance 
■with prognostics ; firsts to attract the confidence of one's 
patients ; second^ to free the physician from blame by enabling 
him to announce beforehand the issue of the disorder about 
which he is consulted ; aud^ third, to give him a decided 
advantage in conducting the treatment by preparing him for 
remarkable clianges in the diseases before they occur. And, 
in like manner, I may be allowed to remark, the master of a 
ship who shows himself prepared for all changes of the weather, 
Avill naturally attract the confidence of those intrusted to his 
charge ; and whatever may be the result, he will be freed from 
blame if his ship should be damaged in a storm which he had 
previously predicted; and surely his knowledge of impending 
commotions in the sea and sky, will be of advantage to him by 
enabling him to make preparations for them. 

Looking then to the importance of general Prognostics, I 
have often wondered why this branch of Semeiology is no longer 
cultivated by the profession. Did not the ancient physicians 
follow the best possible plan when they first described the general 
phenomena of diseased action, and then applied them to parti- 
cular cases ? Surely they did right in first taking a comprehen- 
sive view of the whole subject of disease before attempting to 
examine the diff'erent parts of it in detail. This, in fact, con- 
stitutes the great superiority of the ancient savans over the 
modern, that the former possessed a much greater talent for 
apprehending general truths than the latter, who confine their 
attention to particular facts, and too much neglect the observa- 
tion of general appearances. I trust no one will be ofi'ended 
if I venture to pronounce regarding the present condition of 
our professional literature, that (to borrow an illustration 
from the Logic of Kant) it is altogether Cyclopic, — that is to 
say, it wants the eye of Philosophy, for, although we have 
learned to examine particular objects with greater accuracy 
than our forefathers did, the sphere of our mental vision, so to 
speak, is more confined than theirs, and cannot embrace the 
same enlarged views of general subjects. Surely then we might 
gain a useful lesson by endeavouring to combine their more 
comprehensive views with our own more accurate and minute 
observation. 

Some people may be inclined to think that we have greatly 



ARGUMENT. 233 

detracted from the credit which Hippocrates has long enjoyed 
as being the undoubted author of this work, by sliowing that 
in composing it he was so much indebted to the labours of 
his predecessors. But I have long been impressed with the 
conviction that in compositions even of the highest order, there 
is much less originality than is generally supposed, and that 
true genius frequently is displayed more in its own felicitous 
way of dealing wdth materials formerly prepared and collected 
for its use than in searching out new matter to work upon/ 
and hence it will be found upon examination that many of the 
most distinguished efforts of human intellect have consisted in 
the successful performance of tasks which had been frequently 
attempted by previous labourers in the same line. Many 
artists, before the time of Phidias, had acquired reputation by 
their attempts at making the statue of Jupiter;^ but this did 
not deter him from undertaking the same task : and we may 
well believe that he would avail himself of every practical 
lesson which he could draw from the success or failure of his 
predecessors, in perfecting that matchless performance w^hich 
completely cast all others into the background. The sad 
misfortunes of CEdipus had been often represented on the 
Athenian stage before Sophocles made them the subject of those 
inimitable dramas, which still enjoy an unrivalled reputation, 
nor W'ill it be often considered how much assistance he may 
have derived from the labours of those who had gone before 
him. It is well known that of all the literary performances 
of Aristotle, there is no one which gained him so enduring 
a reputation as his Categories, and yet it is admitted that 
his division of the subject into the ten Predicaments, was 
taken from the Pythagorean philosopher Archytas f in short, 
the great merit of Aristotle on this as on many other occa- 
sions, consisted in defining and arranging a subject on which 
much had been previously eflected by the labours of his 

' The opinion here advanced is expressed with great precision by a Fi'ench writer 
who has been making some figure in the political world of late. " Great men," 
says Louis Blanc, " only govern society by means of a force which they themselves 
borrow. They enhghten the world only by a burning focus of all the scattered rays 
emanating from itself." — Organization of Labour, p. 98, English edition. 

* Ascarus, a Theban statuary for one. See Pausanias, v, 24, 1. 

^ See the Commentary of Simplicius. As I quote from memory I cannot refer to 
the page. 



234 PROGNOSTICS. 

predecessors. Andj to give one example more, long before the 
time of Galen, the temperaments, and the facts in physiology 
and pathology bearing upon Hygiene, had been frequently and 
successfully investigated, but he, by recasting all these subject- 
matters into his Ars Medica, composed a work which posterity 
regarded as his master-performance, and every word and tittle 
of which, for a succession of ages, were commented upon and 
admired in the Schools of Medicine. And of all our Author^s 
admired performances, there is perhaps no one which has 
exerted so great an influence upon the literature of the pro- 
fession as the present work, for all the Greek, Roman, and 
Arabian writers on medicine, subsequent to him, make use of 
his terms, and copy his descriptions of morbid phenomena. 



THE BOOK OF PROGNOSTICS. 

A.. It appears to me a most excellent thing for the physician 
to cultivate Prognosis ; for by foreseeing and foretelling, in the 
presence of the sick, the present, the past, and tbe future, and 
explaining the omissions which patients have been guilty of,^ 
he will be the more readily believed to be acquainted with 
the circumstances of the sick; so that men will have confi- 
dence to intrust themselves to such a physician. And he will 
manage the cure best who has foreseen what is to happen from 
the present state of matters. For it is impossible to make all 
the sick well ; this, indeed, would have been better than to be 
able to foretel what is going to happen ; but since men die, 
some even before calling the physician, from the violence of 
the disease, and some die immediatelv after callinsr him, havins; 
lived, perhaps, only one day or a little longer, and before the 
physician could bring his art to counteract the disease; it 

' Galen, in his Commentary on this clanse of the sentence, acutely remarks that 
patients are justly disposed to form a high opinion of a physician who points out to 
them symptoms of their complaint which they themselves had omitted to mention to 
him. And Stephanos further remarks that the patient naturally estimates highly 
the acumen of the physician who detects any errors in regimen which he has been 
guilty of, such as drinking water, or eating fruit when forbidden ; (Ed. Dietz, p. 54 ;) 
or when he has some disease about him, such as bubo or inflammation, which he 
wishes to conceal. (Ibid., p. 63.) 



PROGNOSTICS. 235 

therefore becomes necessary to know the nature of such affec- 
tions^ how far they are above the powers of the constitution ; 
ancl^ moreover, if there be anything divine in the diseases/ and 
to learn a foreknowk^dge of this also. Thus a man will be the 
more esteemed to be a good physician, for he will be the better 
able to treat those aright who can be saved, from having long 
anticipated everything ; and by seeing and announcing before- 
hand those who will live and those who will die, he will thus 
escape censure." \ 

2. He should observe thus in acute diseases : first, the 
countenance of the patient, if it be like those of persons in 
health, and more so, if like itself, for this is the best of all; 
Avliereas the most opposite to it is the Avorst, such as the fol- 

' 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,' 
&c., and 'On the Sacred Disease' he combats this doctrine as being utterly un- 
founded. 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 him- 
self 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. Littre 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, Callimacluis, Philinus, and Heraclides Terentinus, sup- 
posed 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 Bt loi' of Hippociates see further Berends, Lect. in Aphor. p. 349. 

^ It will be remarked that, in his sketch of Prognosis (-poroia), 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 instan- 
tibus (ut ait Thucydides), verissime judicabat, et de futuris callidissime conjiciebat." 
— Cornelius Nepos, in vita Themistoclis. See also Thucydides, i, 138. Probably 
both these writers had in his mind the character of the prophet as drawn by Homer : 
"Og i}dy TU T tovra rd r' itraviitfa irpo r iovTU. (Iliad i.) 



236 PROGNOSTICS. 

lowing : a sharp nose, JioUoiv eyes, collapsed temples ; the ears 
cold, contracted, and their lobes turned out ; the skin about the 
forehead being rough, distended, and p) arched ; the colour of the 
ivhole face being green, black, livid, or lead-coloured} If the 
countenance be such at the commencement of the disease, and 
if this cannot be accounted for from the other symptoms, inquiry 
must be made -whether the patient has long wanted sleep ; 
whether his bowels have been very loose ; and whether he has 
suffered from want of food ; and if any of these causes be con- 
fessed to, the danger is to be reckoned so far less ; and it be- 
comes obvious, in the course of a day and a night, whether or 
not the appearance of the countenance proceed from these 
causes." But if none of these be said to exist, and if the 
symptoms do not subside in the aforesaid time, it is to be known 
for certain that death is at hand. And, also, if the disease be 

' The groundwork of the matters contamed in this section is to be found in the 
Coacas Praenotiones, 212; hut it is greatly expanded and improved by our author. 
I need scarcely remark that the description of the features of a dying man is of 
classical celebrity. It is given in elegant prose by Celsus, ii, 6 ; and by Lucretius it 
is thus put into a poetical form : 

" Item ad supremum denique tempus 
Compressse nares, nasi primoris acumen 
Tenue, cavati ocuU, cava tempora, frigida pellis 
Duraque, inhoiTebat rictum, frons tenta minebat." 

De Rerum Xatura, vi, 1190. 
Shakespeare's description of the death of Falstaff, by the way, contains images 
Mhich have always appeared to me to be bon-owed (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 pen, and he babljled of green fields. — So he 
bade me lay more clothes on his feet : I put my liand into the bed and felt them, and 
they were as cold as any stone," &c. — Henrj- 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 ruhng passion strong in death" would have rather suggested stews 
and pot-houses to the imagination of such a person. 

- It will be remarked that our author modifies his judgment on the result of the 
ensemble of dangerous symptoms which he has just described, pro\'ided they be con- 
nected with want of food and of rest, or with looseness of the bowels. See Galen's 
CommentarA' on this passage. Celsus renders this clause of the sentence as follows : 
" Si ita haec sunt, ut neque vigiha praecesserit, neque ventris resolutio, neque inedia." 
— ii, 6. I may briefly mention that both Galen and Stephanus seem to have under- 
stood this passage as I have translated it. Littre it will be seen has rendered it 
somewhat differentlv. 



PROGNOSTICS. 237 

in a more advanced stage either on the third or fourth day, 
and the countenance be such, the same inquiries as formerly 
directed are to be made, and the other symptoms are to be 
noted, those in the whole countenance, those on the body, and 
those in the eyes ; for if they shun the light, or weep involun- 
tarily, or squint, or if the one be less than the other, or if the 
white of them be red, livid, or has black veins in it ; if there 
be a gum upon the eyes, if they are restless, protruding, or 
are become very hollow; and if the countenance be squalid 
and dark, or the colour of the whole face be changed — all these 
are to be reckoned bad and fatal symptoms. The physician 
should also observe the appearance of the eyes from below the 
eyelids in sleep ; for when a portion of the white appears, 
owing to the eyelids not being closed together, and when this 
is not connected with diarrhcea or purgation from medicine, or 
when the patient does not sleep thus from habit, it is to be 
reckoned an unfavorable and very deadly symptom ; but if the 
eyelid be contracted, livid, or pale, or also the lip, or nose, 
along with some of the other symptoms, one may know for 
certain that death is close at hand. It is a mortal symptom, 
also, when the lips are relaxed, pendent, cold, and blanched. 
3.^ It is well when the patient is found by his physician 

' The prognostics, drawn from the position in which the patient is found recHning, 
are mostly taken from the Coacae Praenotiones, 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 com- 
mitted respecting the meaning of an expression contained in this paragraph. It is 
Kai TO ^vfiirav awfia vypuv /csijUfj'oi', which Clifton, Moffat, and even Littre under- 
stand as descriptive of the hody's being in a moist state with sweat. Littre's trans- 
lation is, " Le corps entier en moiteur." The translators forget that the word vypog 
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 vypbv crojfia, 
which Heyne interprets by flexile and luhricum. (Ad Pyth., i.) 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 intei-mediate between complete exten- 
sion and complete flexion, that is to say, half- bent or relaxed. Foes also renders the 
expression correctly by " corpus molliter positum." (CEconom. Hippocrat.) See also 
Stephanus (p. 96, ed. Dietz), who decidedly states that the epithet (vypog), in this 
place, means shghtly bent or relaxed. Heurnius explains vypbv as signifying 
" molliter decumbens," p. 189. Celsus renders the words in question by " cruribus 
paulum reductis," ii. 3. 



238 PROGNOSTICS. 

reclining upon either his right or his left side, having his hands^ 
neck, and legs slightly bent, and the whole body lying in a 
relaxed state, for thus the most of persons in health recline, and 
these are the best of postures which most resemble those of 
healthy persons. But to lie upon one's back, with the hands, 
neck, and the legs extended, is far less favoral)le. And if the 
patient incline forward, and sink down to the foot of the bed, 
it is a still more dangerous symptom ; but if he be found with 
his feet naked and not sufficiently warm, and the hands, neck, 
and legs tossed about in a disorderly manner and naked, it is 
bad, for it indicates aberration of intellect. It is a deadly 
symptom, also, when the patient sleeps constantly with his 
mouth open, having his legs strongly bent and plaited together, 
while he lies upon his back ; and to lie upon one^s belly, 
when not habitual to the patient to sleep thus Avliile in 
good health, indicates delirium, or pain in the abdominal 
regions. And for the patient to wish to sit erect at the acme 
of a disease is a bad symptom in all acute diseases, but particu- 
larly so in pneumonia.^ To grind the teeth in fevers, when 
such has not been the custom of the patients from childhood, 
indicates madness and death, both which dangers are to be 
announced beforehand as likely to happen ; and if a person in 
delirium do this it is a very deadly symptom. And if the 
patient had an ulcer previously, or if one has occurred in the 
course of the disease, it is to be observed ; for if the man be 
about to die the sore will become livid and drv, or vellow and 
dry before deatli.^ 

4. Respecting the movement of the haiids I have these ob- 
servations to make: When in acute fevers, pneumonia, phrenitis, 
or headache, the hands are waved before the face, hunting 
through empty space, as if gathering bits of straw, picking the 
nap from the coverlet, or tearing chaff from the wall — all such 
symptoms are bad and deadly.^ 



' This is takea pretty closely from the Coacas Praenotiones, 235. 

2 This sentence is thus translated by Celsus : "Ubi tilcus, quod aiit ante, aut in 
ipso morbo natum est, aridum, et aut pallidum, aut lividum factum est." (ii, 6.) It 
is imitated from the Coacae Prtenotiones, 496. 

^ This graphic description of the movement of the hands in deliruini is nearly 
original, being but slightly touched upon in the Coacai Prasnotiones, 76. The terms are 
copied by most of the ancient authors subsequent to Hippocrates, in their descriptions 



PROGNOSTICS. 239 

5. Respiration, when frequent, indicates pain or inflammation 
in the parts above the diaphragm: a large respiration performed 
at a great interval announces delirium ; but a cold respiration at 
nose and mouth is a very fatal symptom. Free respiration is 
to be looked upon as contributing much to the safety of the 
patient in all acute diseases, such as fevers, and those complaints 
which come to a crisis in forty days.^ 

6. Those sweats are the best in all acute diseases which 
occur on the criHcal days, and completely carry off the fever. 
Those are favorable, too, which taking place over the whole body, 
show that the man is bearing the disease better. But those 
that do not produce this effect are not beneficial. The worst 
are cold sweats, confined to the head, face, and neck ; these 
in an acute fever prognosticate death, or in a milder one, a 
prolongation of the disease ; and sweats which occur over the 
whole body, Avith the characters of those confined to the neck, 
are in like manner bad. Sweats attended with a miliary erup- 
tion, and taking place about the neck, are Ijad ; sweats in the 
form of drops aud of vapour are good. One ought to- know 
the entire character of sweats, for some are connected with 
prostration of strength in the body, and some with intensity of 
the inflammation.^ 

7.^ That state of the hypochondrium is best when it is free 

of phrenitis and febrile delirium. See in particulai- Paulus ^Egineta, Book III, 6. 
Stephanus, in his Commentary, lias 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.) 

' This is imitated pretty closely from the Coaca; Prrenotiones, 260. Dr. Ermerins 
remarks that there is a greater number of symptoms in the Praenotiones 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 Pra3- 
notiones is certainly most graphic, and it ajipears wonderful that it should be omitted 
by Hippocrates in the Prognostics. 

^ The paragraph on sweats is founded on the Coacae Prasnotiones, 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 inter- 
esting remarks on this passage. He says that cold sweats are connected with a 
complete prostration of the innate heat (calidum innatum). (p. 114.) 

* The characters of the hypochondriac region are copied in part from the Coacae 
Praenotiones, 279, 280, 282; but they are much improved in the Proguostics. It 
will be remarked that in the Epidemics great attention is paid to the state of the 



240 PROGNOSTICS. 

from pain, soft, and of equal size on tlie right side and the 
left. But if inflamed, or painful, or distended ; or when the 
right and left sides are of disproportionate sizes ; — all these 
appearances are to be dreaded. And if there be also pulsation 
in the hypochondrium, it indicates perturbation or delirium ; 
and the physician should examine the eyes of such persons ; 
for if their pupils be in rapid motion, such persons may be 
expected to go mad. A swelling in the hypochondrium, that 
is hard and painful, is very bad, provided it occupy the whole 
hypochondrium ; but if it be on either side, it is less dangerous 
when on the left. Such swellings at the commencement of 
the disease prognosticate speedy death ; but if the fever has 
passed twenty days, and the swelling has not subsided, it turns 
to a suppuration.^ A discharge of blood from the nose occurs 
to such in the first period, and proves very useful ; but inquiry 
should be made if they have headache or indistinct vision ; for 
if there be such, the disease will be determined thither. The 
discharge of blood is rather to be expected in those who are 
younger than thirty-five years. Such swellings as are soft, 
free from pain, and yield to the finger, occasion more pro- 
tracted crises, and are less dangerous than the others. But 
if the fever continue beyond sixty days, without any subsidence 
of the swelling, it indicates that empyema is about to take 
place ; and a swelling in any other part of the cavity will 
terminate in like manner. Such, then, as are painful, hard, 
and large, indicate danger of speedy death ; but such as are 
soft, free of pain, and yield when pressed with the finger, are 
more chronic than these. Swellings in the belly less frequently 
form abscesses than those in the hypochondrium ; and seldomest 
of all, those below the navel are converted into suppuration ; 
but you may rather expect a hemorrhage from the upper parts. 

hypochondria. Stephanus remarks that pulsation or palpitation in the hypochondria 
is caused by violent throbbing of the aorta as it passes through this region, which is 
occasioned by the effervescence and inflammation of the important parts which are 
situated in it, and with which the brain is apt to sympathise, (p. 118.) Meteorism 
of the hypochondriac region is often mentioned in the reports of the cases described 
in the Epidemics. 

' The author evidently alludes to hepatitis ending in abscess. This would seem to 
have been a very common termination of inflammation of the liver in Greece, as it 
is often described in the ancient medical works. See Paulus jEgineta, B. HI, 46, 
and the authorities quoted there in the Sydenham Society's edition. 



PROGNOSTICS. 241 

But tlie suppuration of all protracted swellings about these parts 
is to be anticipated. The collections of matter there are to be 
thus judged of: such as are determined outwards are the best 
when they are small, when they protrude very much, and swell to 
a point; such as are large and broad, and which do not swell out 
to a sharp point, are the worst. Of such as break internally, 
the best are those which have no external communication, but 
are covered and indolent ; and when the whole place is free 
from discoloration. That pus is best which is white, homo- 
geneous, smootli, and not at all fetid ; the contrary to this is 
the worst. 

8.^ All dropsies arising from acute diseases are bad ; for 
they do not remove the fever, and are very painful and fatal. 
The most of them commence from the flanks and loins, but 
some from the liver; in those which derive their origin from 
the flanks and loins the feet swell, protracted diarrhoeas super- 
vene, which neither remove the pains in the flanks and loins, 
nor soften the belly f but in dropsies wdiich are connected 
with the liver there is a tickling cough, Avith scarcely any 
perceptible expectoration, and the feet swell ; there are no 
evacuations from the bowels, unless such as are hard and forced; 
and there are swellings about the belly, sometimes on the one 
side and sometimes on the other, and these increase and 
diminish by turns. ^ / 

9. It is a bad symptom when the head, hands, and feet are 

' Tlie paragraph on the prognostics relating to dropsies is founded in a great 
measure on the Coacse Pra;notiones, 454. The ancient writers wlio treat systema- 
tically of dropsy generally descrihe four varieties of it, namely, dropsy from disease 
of the liver, from disease of the spleen, from fever, and from a su(hlen draught of 
cold water. See De Morbis, andPAULUs /Egineta, B. Ill, 48, Sydenham Society's 
edition. 

* On this variety I have remarked in the Comment, on Paulus yEgineta-: " Hippo- 
crates 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 iEgineta, 1. c.) M. Littre accordingly holds it proljable that allusion 
is made to granular degeneration of the kidneys, that is to say, to Bright's disease. 
(Opera, &c., tom. ii, 388.) 

^ Dr. Ermerins remarks that the species of dropsy here described was most pro- 
bably connected with organic disease of the parts situated in the abdominal region, 
arising from inflammation with which they had been previously attacked. 

IG 



242 PROGNOSTICS. 

cold, while tlie belly and sides are hot ; but it is a very good 
symptom when the whole body is equally hot.' The patient 
ought to be able to turn round easily, and to be agile Avhen 
raised up ; but if he appear heavy in the rest of his body as 
well as in his hands and feet, it is more dangerous ; and if, in 
addition to the weight, his nails and fingers become livid, im- 
mediate death may be anticipated ; and if the hands and feet 
be black it is less dangerous than if they be livid, but the other 
symptoms must be attended to ; for if he appear to bear the 
illness well, and if certain of the salutary symptoms appear 
along with these, there may be hope that the disease will turn 
to a deposition, so that the man may recover ; but the blackened 
parts of the body Avill drop o&. When the testicles and 
member are retracted upwards, they indicate strong pains, and 
danger of death." 

10. With regard to sleep — as is usual with us in health, 
the patient should wake dru'ing the day and sleep during night. 
If this rule be anywise altered it is so far worse : but there will 
be little harm provided he sleep in the morning for the third 
part of the day ; such sleep as takes place after this time is more 
unfavorable ; but the worst of all is to get no sleep either night 
or day ; for it follows from this symptom that the insomnolency 

' This paragraph is pretty closely taken from the Coacaj Praenotiones, 492. A 
good deal of stress is laid upon the state of the temperature of the extremities in 
the reports of the fehrile cases contained in the Epidemics. lie 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 Med., tom. i, 317.) 

* This is taken in part from the Coacae Praenotiones, 493. Sprengel finds great 
fault witli Hippocrates for laying it down as a rule, that in cases of gangrene a black 
colour 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 tbe 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 wliich the cbsease 
often terminated favorably in mortification of the fingers or toes. (Thucyd., ii, 49.) 



PROGNOSTICS. 243 

is connected witli sorrow and pains^ or that he is about to be- 
come delirious.^ 

11. The excrement is best which is soft and consistent, is 
passed at the hour which was customary to the patient when 
in health, in quantity proportionate to the ingesta ; for when 
the passages are such, tlie lower belly is in a healthy state. ^ 
But if the discharges be fluid, it is favorable that they are not 
accompanied with a noise, nor are frequent, nor in great 
quantity; for the man being oppressed by frequently getting 
up, must be deprived of sleep ; and if the evacuations be both 
frequent and large, there is danger of his falling into deliquium 
auimi." But in proportion to the ingesta he should have 
evacuations twice or thrice in the day, once at night and more 
copiously in the morning, as is customary with a person in 
health. The faeces shovild become thicker when the disease is 
tending to a crisis ; they ought to be yellowish and not very 
fetid. It is favorable that round worms be passed with the 
discharges when the disease is tending to a crisis.^ The belly, 
too, through the whole disease, should be soft and moderately 
distended ; but excrements that are very watery, or white, or 
green, or very red, or frothy, are all bad. It is also bad v/hen 
the discharge is small, and viscid, and white, and greenish, and 
smooth ; but still more deadly appearances are the black, or 
fatty, or livid, or verdigris-green, or fetid. Such as are of 
varied characters indicate greater duration of the complaint, 
but are no less dangerous ; such as those which resemble 
scrapings,^ those which are bilious, those resembling leeks, and 
the black ; these being sometimes passed together, and some- 
times singly.^ It is best when wind passes without noise, but 
it is better that flatulence should pass even thus than that it 

' A considerable portion of the Prognostics from Sleep are taken from the Coacaj 
Prsnotiones, 497. This part is elegantly rendered by Celsus : " Ubi nocturna vigilia 
premitur, etiamsi iuterdiu somnus accedit ; ex quo tamen pejor est, qui inter quartam 
lioram 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.) 

^ This is pretty closely taken from the Coacae Praenotiones, 601. 

^ A small part of this is to be found in the Coacse Praenotiones, G09. 

■• Part of this is borrowed from the Coacai Praenotiones, 601. 

* Strigmcntosa : that is to say, resembling the scrapings or stripi)ings of the bowels. 

"* This in part is borrowed from the Coaca; Pranotiones, 004, 031. 



244 PROGNOSTICS. 

should be retained ; and when it does pass thus, it indicates 
either that the man is in pain or in delirium, unless he gives 
vent to the wind spontaneously.' Pains in the h^qiochondria, 
and swellings, if recent, and not accompanied with inflammation, 
are relieved by borborygrai supervening in the hypochondrium, 
more especially if it pass off with fteces, urine, and Avind ; but 
even although not, it will do good by passing along, and it also 
does good by descending to the lower part of the belly .^ 

12, The urine is best when the sediment is white, smooth, 
and consistent during the Avhole time, until the disease come to 
a crisis, for it indicates freedom from danger, and an illness of 
short duration ; but if deficient, and if it be sometimes passed 
clear, and sometimes with a white and smooth sediment, the 
disease will be more protracted, and not so void of danger. 
But if the urine be reddish, and the sediment consistent and 
smooth, the affection, in this case, will be more protracted than 
the former, but still not fatal.^ But farinaceous sediments in 
the urine are bad, and still worse are the leafy j^ the white and 
thin are very bad, but the furfuraceous are still worse than 
these. Clouds carried about in the urine are good when white, 
but bad if black. When the urine is yellow and thin, it in- 
dicates that the disease is unconcocted ; and if it (the disease) 
should be protracted, there may be danger lest the patient 
should not hold out until the urine be concocted.^ But the 
most deadly of all kinds of urine are the fetid, watery, 
black, and thick ; in adult men and women the black is of all 
kinds of urine the worst, but in children, the watery.*^ In 
those who pass thin and crude urine for a length of time, if 

' This is pretty closely copied from the Coacse Praenotiones, 495. 

^ This is taken from the Coacas Praenotiones, 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 Coacse Praenotiones and Prognostics. See the Commentary on 
Paulus tEgineta, B. II, 13. Stephanus has many interesting observations on the 
prognostics from the urine. He remarks that the lu-ine is a good index of the con- 
dition which the digestive process is in, and more especially the process of sanguifica- 
tion, (p. 162.) 

^ This is closely copied from the Coacae Prffinotiones, 575. 

■• According to Stephanus, both the farinaceous and leafy sediments are the pro- 
ducts of a melting of the solid parts, as a consequence of inflammatoiy heat. ( p. 165.) 

* A small portion of the above occurs in the Coacaj Prasnotiones, 578. 

^ For part of this our author is indebted to the Coacae Praenotiones, 580. 



PROGNOSTICS. 245 

they have otherwise symptoms of convalescence, an abscess may 
be expected to form in the parts below tlie diaphragm.' And 
fatty substances floating on the surface are to be dreaded, for 
they are indications of melting. And oae should consider re- 
specting the kinds of urine, which have clouds, whether they 
tend upwards or downwards, and the colours which they have ; 
and such as fall downwards, with the colours as described, are 
to be reckoned good and commended ; but such as are carried 
upwards, with the colours as described, are to be held as bad, 
and are to be distrusted." But you must not allow yourself to 
be deceived if such urine be passed Avhile the bladder is diseased; 
for then it is a symptom of the state, not of the general system, 
but of a particular viscus.^ 

13. That A^omiting is of most service which consists of 
phlegm and bile mixed together, and neither very thick nor 
in great quantity ; but those vomitings which are more unmixed 
are worse. But if that which is vomited be of the colour of 
leeks, or livid, or black, whatever of these colours it be, it is 
to be reckoned bad ; but if the same man vomit all these 
colours, it is to be reckoned a very fatal symptom. But of all 
the vomitings, the livid indicates the most imminent danger 
of death, provided it be of a fetid smell. But all the smells 
which are somewhat putrid and fetid, are bad in all vomitings.* 

14. The expectoration in all pains about the lungs and 
sides, should be quickly and easily brought up,* and a certain 
degree of yellowness should appear strongly mixed up Avitli the 
sputum. But if brought up long after the commencement of 
the pain, and o^ a yellow or ruddy colour, or if it occasions 
much cough, or be not strongly mixed, it is worse ; for that 

' See Coacae Prsenotiones, 582. 

^ This is partly taken from the Coacae Prsenotiones, 577. 

" 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 dis- 
charges, it must be highly important to determine whether their characters be indi- 
cative 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, ])articularly of Theophilus and Actuarius, are well deserving of an at- 
tentive perusal. See Paulus /Egineta, Vol. I, p. 225. 

■* This is partly taken from the Coacai PrtCiiotioncs, 550. 



246 PROGNOSTICS. 

which is intensely yellow is dangerous^ but the white^ and 
viscid, and round, do no good. But that which is very green 
and frothy is bad ; but if so intense as to appear black, it is 
still more dangerous than these; it is bad if nothing is ex- 
pectorated, and the lungs discharge nothing, but are gorged 
with matters which boil (as it were) in the air-passages. It is 
bad when coryza and sneezing either precede or follow affec- 
tions of the lungs, but in all other affections, even the most 
deadly, sneezing is a salutary symptom.^ A yellow spittle 
mixed up with not much blood in cases of pneumonia, is 
salutary and very beneficial if spit up at the commencement of 
the disease, but if on the seventh day, or still later, it is less 
favorable. And all sputa are bad which do not remove the 
pain. But the worst is the black, as has been described. Of 
all others the sputa which remove the pain are the best." 

15. When the pains in these regions do not cease, either 
with the discharge of the sputa, nor with alvine evacuations, 
nor from venesection, purging with medicine, nor a suitable 
regimen, it is to be held that they will terminate in suppura- 
tions.^ Of empyemata such as are spit up while the sputum is 

1 These characters of the sputa are partly borrowed from the Coacae Prsenotiones, 
390, 399. 

^ They are founded on the Coaese Prsenotiones, 390, 391. 

^ This is taken in part from the Coaese Prasnotiones, 392, 394. The succeeding 
paragraphs on empyema are also partly derived from the Coacas Prsenotiones, 393, 
402, 428. I may he allowed to remark in tliis place that modern pathologists are 
agreed that abscesses after pneumonia are of rai-e 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 em- 
pyemata in the works of the ancient authorities on medicine, especially in the Hippo- 
cratic treatises. See De Locis in Homine, p. 415, ed. Foes ; and tom. i, p, 306, ed. 
Kiihn, et alibi. M. Littre makes the following remarks on the descriptions of em- 
pyema which occur in the Hippocratic treatises : " On remarquera dans le Pronostic, 
et cette remarque s'etend a plusieurs autres des ecrits Hippocratiques, qu'une tres- 
large place est faite aux affections de la poitrine, peripneumonies et pleuresies. II 
paraitrait que, sous le climat de la Grece, ces affections ont uue grande frequence, 
plus peut-etre qu'elles n'en ont meme dans notre cUmat. La description, fort abregee 
11 est vraie, qu'en donne Hippocrate, me porte a penser que, si cette description est 
exacte, eUes ne suivent pas la meme marche que parmi nous. En effet, que sont ces 
empyemes que, suivant Hippocrate, se font jour au dehors sous forme d'expectoration 



PROGNOSTICS. 217 

still bilious, are very fatal, whether the bilious portion be 
expectorated separate, or along with the other ; but more 
especially if the empyema begin to advance after this sputum 
on the seventh day of the disease. It is to be expected that 
a person with such an expectoration shall die on the fourteentji 
day, unless something favorable supervene. The following are 
favorable symptoms : to support the disease easily, to have free 
respiration, to be free from pain, to have the sputa readily 
brought up, the whole body to appear equally warm and soft, 
to have no thirst, the urine, and fajces, sleep, and sweats to he 
all favorable, as described before ; when all these symptoms 
concur, the patient certainly will not die ; but if some of these 
be present and some not, he will not survive longer than the 
fourteenth day. The bad symptoms are the opposite of these, 
namely, to bear the disease with difficulty, respiration large 
and dense, the pain not ceasing, the sputum scarcely coughed 
up, strong thirst, to have the body unequally affected by the 
febrile heat, the belly and sides intensely hot, the forehead, 
hands, and feet cold ; the urine, and excrements, the sleep, 

purulente ? On pent croire, que daus les denominations d'empyemes sont compris les 
epanchements pleurutiques ; mais les epanchements pleuretiques ne se font pas jour 
an dehors, ils se guerissent par resorption ; alors, que sont ces erapyemes siguales par 
Ilippocrate, comme terminaison des peripneumonies, et ces expectorations qui en 
procurent I'evacuation ? II m'est impossible de repondre a ces questions : peut-etre 
des observations faites dans la Grece menie, permettraient de resoudre la ditficulte." 
(CEuvres Complets d'Hippocrate, torn, ii, p. 97.) Perhaps, as I have hinted above, the 
most probable answer that could be returned to the questions put by M. Littre would 
be, that many of the cases of pneumonia terminating in empyema, which occur in the 
Hippocratic treatises, were what are now described as cases of acute phthisis. See 
Louis on Phthisis, ii, 2. In confirmation of my supposition that many of the cases 
of empyema described by the ancients were, in fact, cases of phthisis, I would refer to 
Paulus jEgineta, B. Ill, 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, torn, i, pp. 198-201 ; ed. Kiihn. 

M. Littre reverts to this subject in the Argument to the Coacae Prjenotiones, 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, 
lie 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. 
Littre admits that the paucity of such cases in modern works must lead to tlie con- 
clusion either that Hippocrates had not observed coirectly, or tliat this termination 
is more rare now than formerly. I leave the reader to judge whether my suggestion 
stated above does not remove this difficulty. 



248 PROGNOSTICS. 

and sweats, all bad, agreeably to the characters described above ; 
if such a corabiuation of symptoms accompany the expectora- 
tion, the man will certainly die before the fourteenth day, and 
either on the ninth or eleventh. Thus then one may conclude 
regarding this expectoration, that it is very deadly, and that 
the patient will not survive until the fourteenth day. It is by 
balancing the concomitant symptoms whether good or bad, 
that one is to form a prognosis ; for thus it will most probably 
prove to be a true one. Most other suppurations burst, some 
on the twentieth, some on the thirtieth, some on the fortieth, 
and some as late as the sixtieth day.^ 

16. One should estimate when the commencement of the 
suppuration will take place, by calculating from the day on 
which the patient was first seized with fever, or if he had a 
rigor, and if he says that there is a weight in the place where 
he had pain formerly, for these symptoms occur in the com- 
mencement of suppurations. One then may expect the rupture 
of the abscesses to take place from these times according to the 
periods formerly stated. But if the empyema be only on either 
side, one should turn him and inquire if he has pain on the 
other side ; and if the one side be hotter than the other, and 
when laid upon the sound side, one should inquire if he has 
the feeling of a weight hanging from above, for if so, the 
empyema will be upon the opposite side to that on which the 
weight was felt." 

17. Empyema may be recognised in all cases by the follow- 
ing symptoms : In the first place, the fever does not go off, 
but is slight during the day, and increases at night, and copious 
sweats supervene, there is a desire to cough, and the patients 

' " 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 amehoration. 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 ascriljed 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 
iilso Andral, Clin. Med., c. ii, p. 365. 

- Stephanus has a lengthened and most important commentary on this passage, 
containing an elaborate disquisition on empyema, (jip. 184-91.) 



PROGNOSTICS. 249 

expectorate nothing worth mentioning, the eyes become liollow, 
the cheeks have red spots on them, the nails of the hands are 
bent_, the fingers are hot especially their extremities, there ai'e 
swellings in the feet, they have no desire of food, and small 
blisters (phlyctsenae) occur over the body. These symptoms 
attend chronic empyemata, and may be much trusted to; and 
such as are of short standing are indicated by the same, pro- 
vided they be accompanied by those signs which occur at the 
commencement, and if at the same time the patient has some 
difficult}^ of breathing. Whether they will break earlier or later 
may be determined by these symptoms ; if there be pain at the 
commencement, and if the dyspncea, cough, and ptyalism be 
severe, the rupture may be expected in the course of twenty 
days or still earlier ; but if the pain be more mild, and all the 
other symptoms in proportion, you may expect from these the 
rupture to be later ; but pain, dyspnoea, and ptyalism, must 
take place before the rupture of the abscess. Those patients 
recover most readily Avhom the fever leaves the same day that 
the abscess bursts, — when they recover their appetite speedily, 
and are freed from the thirst, — when the alvine discharges are 
small and consistent, the matter white, smooth, uniform in 
colour, and free of phlegm, and if brought up without pain or 
strong coughing. Those die whom the fever does not leave, or 
when appearing to leave them it returns with an exacerbation ; 
when they have thirst, but no desire of food, and there are 
watery discharges from the bowels ; when the expectoration is 
green or livid, or pituitous and frothy ; if all those occur they 
die, but if certain of these symptoms supervene, and others 
not, some patients die and some recover, after a long interval. 
But from all the symptoms taken together one should form a 
judgment, and so in all other cases. 

18. When abscesses form about the ears, after perij)neumonic 
affections, or depositions of matter take place in the inferior 
extremities and end in fistula, such persons recover. The 
following observations are to be made upon them : if the fever 
persist, and the pain do not cease, if the expectoration be not 
normal, and if the alvine discharges be neither bilious, nor 
free and unmixed ; and if the uriue be neither copious nor 
have its proper sediment, but if, on the other hand, all the 
other salutary symptoms be present, in such cases abscesses 



250 PROGNOSTICS. 

may be expected to take place. They form in the inferior 
parts when there is a collection of phlegm about the hypo- 
chondria ; and in the upper when the hypochondria continue 
soft and free of pain, and when dyspnoea having been present 
for a certain time, ceases without any obvious cause.^ All 
deposits Avliich take place in the legs after severe and 
dangerous attacks of pneumonia, are salutary, but the best 
are those which occur at the time when the sputa undergo 
a change ; for if the swelling and pain take place while the 
sputa are changing from yellow and becoming of a purulent 
character, and are expectorated freely, under these circum- 
stances the man will recover most favorably, and the abscess 
becoming free of pain, will soon cease ; but if the expectoration 
is not free, and the urine does not appear to have the proper 
sediment, there is danger lest the limb should be maimed, 
or that the case otherwise should give trouble. But if the 
abscesses disappear and go back, while expectoration does 
not take place, and fever prevails, it is a bad symptom ; for 
there is danger that the man may get into a state of delirium 
and die. Of persons having empyema after peripneumonic 
affections, those that are advanced in life run the greatest risk 
of dying ; but in the other kinds of empyema younger persons 
rather die.^ In cases of empyema treated by the cautery or 
incision, v/lien the matter is pure, Avhite, and not fetid, the 
patient recovers ; but if of a bloody and dirty character, lie dies.'* 
19. Pains accompanied with fever which occur about the 
loins and lower parts, if they attack the diaphragm, and leave 
the parts below, are very fatal. Wherefore one ought to pay 
attention to the other symptoms, since if any unfavorable 
one supervene, the case is hopeless : but if while the disease 
is determined to the diaphragm, the other sjanptoms are 
not bad, there is great reason to expect that it -will end in 
empyema.* When the bladder is hard and painful, it is an 
extremely bad and mortal symptom, more especially in cases 

• This is taken pretty closely from tlie Coacfc Prffiuotiones, 395. 

- A part of this is copied from the CoacBC Prsenotiones, 396. 

^ It will be seen in our analysis of several of the Hippocratic treatises, such as 
De Affect. Intern., De Morbis, &c., 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. 

^ Part of this is borrowed from the Coacai Pracnotioues, 108. 



PROGNOSTICS. 251 

attended with continued fever ; for the pains proceeding 
from the bladder alone are enongh to kill the patient ; and at 
such a time the bowels are not moved, or the discharges are 
liard and forced. But urine of a purulent character, aud 
having a white and smooth sediment, relieves the patient. 
But if no amendment takes place in the characters of the 
urine, nor the bladder become soft, and the fever is of the 
continual type, it may be expected that the patient will die in 
the first stages of the complaint. This form attacks children 
more especialh^, from their seventh to their fifteenth year.^ 

20. I'evers come to a crisis on the same days as to number 
on which men recover and die. For the mildest class of fevers, 
and those originating with the most favorable symptoms, cease 
on the fourth day or earlier ; and the most malignant, and those 
setting in with the most dangerous symptoms, prove fatal on 
the fourth day or earlier. The first class of them as to violence 
ends thus : the second is protracted to the seventh day, the third 
to the eleventh, the fourth to the fourteenth, the fifth to the 
seventeenth, and the sixth to the twentieth. Thus these periods 
from the most acute disease ascend by fours up to twenty. 
But none of these can be truly calculated by whole days, for 
neither the year nor the months can be numbered by entire days. 
After these in the same manner, according to the same pro- 
gression, the first period is of thirty-four days, the second of 
forty days, and the third of sixty days. In the commencement 
of these it is very difficult to determine those which will come 
to a crisis after a long interval; for these beginnings are very 
similar, but one should pay attention from the first day, and 
observe further at every additional tetrad, and then one cannot 
miss seeing how the disease will terminate. The constitution 
of quartans is agreeable to the same order. Those which will 
come to a crisis in the shortest space of time, are the easiest 
to be judged of ; for the differences of them are greatest from 
the commencement, thus those who are going to recover 
breathe freely, and do not suffer pain, they sleep during the 
night, and have the other salutary symptoms, whereas those 
that are to die have difficult respiration^ are delirious, troubled 

' This is in part derived from the Coaca; PraEiiotiones, 471. Galen, in his com- 
mentary, is at pains to explain thathy a hard bladder Hippocrates means a bladder in 
a state of inflammation. 



252 PROGNOSTICS. 

with insomnolency, and have the other bad symptoms. Matters 
being thus^ one may conjecture, according to the time, and 
each additional period of the diseases, as they proceed to a 
crisis. And in women, after parturition, the crises proceed 
agreeably to the same ratio. ^ 

21. Strong and continued headaches with fever, if any of 
the deadly symptoms be joined to them, are very fatal. But if 
without such symptoms the pain be prolonged beyond twenty 
days, a discharge of blood from the nose or some abscess in the 
inferior parts may be anticipated ; but while the pain is recent, 
we may expect in like manner a discharge of blood from the 
nose, or a suppuration, especially if the pain be seated above 
the temples and forehead ; but the hemorrhage is rather to be 
looked for in persons younger than thirty years, and the sup- 
puration in more elderly persons.^ 

22. Acute pain of the ear, with continual and strong fever, 
is to be dreaded ; for there is danger that the man may become 
delirious and die. Since, then, this is a hazardous spot, one 
ought to pay particular attention to all these symptoms from 
the commencement. Younger persons die of this disease on 
the seventh day, or still earlier, but old persons much later ; for 
the fevers and delirium less frequently supervene upon them, 
and on that account the ears previously come to a suppuration, 
but at these periods of life, relapses of the disease coming on, 
generally prove fatal. Younger persons die before the ear 
suppurates ; only if white matter run from the ear, there may 

' The subject of the critical days is not touched upou in the Coacse Prasnotiones, 
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 Ilippocratic treatises in 
the Preliminary Discourse, the work 'On Critical Days' is in all probability spurious. 
The system of tlie critical days taught by Hippocrates was adopted by almost all the 
ancient authorities, with the exception of Archigenes and his followers, who, how- 
ever, were not numerous nor of any great name, with the exception of Celsus. See 
the Commentary on Paulus /Egineta, B. H, 7, Syd. Soc. edition. 

^ The contents of this section ai'e borrowed in a great measure from the CoacEe 
Prsenotiones, 160. Dr. Ermerins remarks that the headache here described is 
probably of a catarrhal or rheumatic nature. (Specimen Hist. Med. Inaug., &c., 
p. 84.) 



PROGNOSTICS. 253 

be hopes that a younger person will recover, provided any other 
favorable symptom be combined.^ 

23. Ulceration of the throat with fever, is a serions aifection, 
and if any other of the symptoms formerly descril^ed as being 
bad, be present, the physician ought to announce that his 
patient is in danger.^ Those quinsies are most dangerous, and 
most quickly prove fatal, which make no appearance in the 
fauces, nor in the neck, but occasion very great pain and dif- 
ficulty of breathing ; these induce suffocation on the first day, 
or on the second, the third, or the fourth.'^ Such as, in like 
manner, are attended with pain, are swelled up, and have 
redness (erythema) in the throat, are indeed very fatal, but 
more protracted than the former, provided the redness be great.'^ 
Those cases in which both the throat and the neck are red, are 
more protracted, and certain persons recover from them, es- 
pecially if the neck and breast be affected with erythema, and 
the erysipelas be not determined inwardly.'' If neither the 
erysipelas disappear on the critical day, nor any abscess form 
outwardly, nor any pus be spit up, and if the patient fancy 
himself well, and be free from pain, death or a relapse of the 
erythema is to be apprehended. It is much less hazardous 
when the swelling and redness are determined outwardly ; but 
if determined to the lungs, they superinduce delirium, and fre- 
quently some of these cases terminate in empyema.^ It is 

' This is taken in great measure from the Coaese Praenotiones, 189. Galen, in his 
commentary, remarks that patients die of violent pains of the ear, owing to the l)rain 
sympathising, wliich brings on delirium, and sometimes occasions sudden death. I may 
be allowed to remark that every experienced pliysiciau must have met with such cases. 

- A considerable part of this section on ulcerated sore-throat is extracted from 
the Coacse Praenotiones. The present sentence is from § 276. The medical reader will 
not fail to remark that Hippocrates displays a wonderfully accurate acquaintance 
with these afliections. 

2 This is founded on the contents of the Coacae Praenotiones, 363. The disease 
here described is evidently angina laryngaja. 

■* This is taken in part from the Coacaj Praenotiones, 364. As Di-. Ermerins re- 
marks in his note on it, the disease here described is evidently angina pharynga:a. 

5 This is closely copied from the Coacas Praenotiones, 365. The danger of ery- 
thematous swelling being determined inwards, is well understood now-a-days. 

^ This is taken, with slight alterations, from the Coacae Praenotiones, 365, 367. 
The latter clause is more fully expressed in the Coacae Praenotiones 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. 



254 PROGNOSTICS. 

very dangerous to cut off or scarify enlarged uvulae while they 
are red and large, for inflammations and hemorrhages super- 
vene ; but one should try to reduce such swellings by some 
other means at this season. When the whole of it is converted 
into an abscess, Avhich is called Uva, or when the extremity 
of the variety called Columella is larger and round, but the 
upper part thinner, at this time it will be safe to operate. 
But it will be better to open the bowels gently before proceeding 
to the operation, if time will permit, and the patient be not in 
danger of being suffocated.' 

24. When the fevers cease without any symptoms of resolu- 
tion occurring, and not on the critical days, in such cases a 
relapse may be anticipated." When any of the fevers is pro- 
tracted, although the man exhibits symptoms of recovery, and 
there is no longer pain from any inflammation, nor from 
any other visible cause, in such a case a deposit, with swelling 
and pain, may be expected in some one of the joints, and not 
improbably in those below. Such deposits occur more readily 
and in less time to persons under thirty years of age ; and one 
should immediately suspect the formation of such a deposit, if 
the fever be protracted beyond twenty days ; but to aged 
persons these less seldom happen, and not until the fever be 
much longer protracted. Such a deposit may be expected, 
when the fever is of a continual type, and that it will pass into 
a quartan, if it become intermittent, and its paroxysms come 
on in an irregular manner, and if in this form it approach 
autumn. As deposits form most readily in persons below 
thirty years of age, so quartans most commonly occur to persons 
beyond that age. It is proper to know that deposits occur 
most readily in winter, that then they are most protracted, but 
are less given to return.^ Whoever, in a fever that is not of a 
fatal character, says that he has pain in his head, and that 
something dark appears to be before his eyes, and that he has 
pain at the stomach, will be seized with vomiting of bile ; but 

' No part of tliis last clause is to be found in the Coacae Prsenotiones. The ope- 
rations of excising and burning the diseased uvula are minutely described by Paulus 
iEgineta and other of the ancient authorities. See Paulus yEgineta, B. VI, 31. 
I need scarcely remark that both these operations have been revived of late yeai-s. 

- This is taken with little variation from the Coacae Prsenotiones, 146. 

^ A iiart of M'hat precedes is taken from the Coacaj Prsenotiones, 143 ; all that 
follows, with the exception of a short sentence, is original. 



I 



PROGNOSTICS. 255 

if a rigor also attack liim, and the inferior parts of tlic liypo- 
cliondrium are cold, vomiting is still nearer at hand ; and if 
he eat or drink anything at such a season, it will be quickly 
vomited. In tliese cases, when the pain commences on the 
first day, they are particularly oppressed on the fourth and the 
fifth ; and they are relieved on the seventh, but the greater 
part of them begin to have pain on the tliird day, and are 
most especially tossed on the fifth, but are relieved on the ninth 
or eleventh ; but in those who begin to have pains on the fifth 
day, and other matters proceed properly with them, the disease 
comes to a crisis on the fourteenth day. But when in such a 
fever persons affected with headache, instead of having a dark 
appearance before their eyes, have dimness of vision, or flashes 
of light appear before their eyes, and instead of pain at the pit 
of the stomach, they have in their hypochondrium a fulness 
stretching either to the right or left side, without either pain 
or inflammation, a hemorrhage from the nose is to be expected 
in such a case, rather thau a vomiting. But it is in young 
persons particularly that the hemorrhage is to be expected, for 
in persons beyond the age of thirty-five, vomitings are rather 
to be anticipated. Convulsions occur to children if acute fever 
be present, and the belly be c.onstipated, if they cannot sleep, 
are agitated, and moan, and change colour, and become green, 
livid, or ruddy. These complaints occur most readily to 
childi'en which are very young up to their seventh year ; older 
children and adults are not equally liable to be seized with con- 
vulsions in fevers, unless some of the strongest and worst 
symptoms precede, such as those which occur in frenzy. One 
must judge of children as of others, which will die and which 
recover, from the whole of the symptoms, as they have been 
specially described.^ These things I say respecting acute dis- 
eases, and the affections which spring from them, 

25. He who would know correctly beforehand those that 
will recover, and those that will die, and in what cases the 
disease will be protracted for many days, and in what cases 

' Our author here and elsewhere impresses it upon his readers that it is from the 
tout ensemble of the symptoms that a judgment is to be formed in every case. This 
is evidently a remark of the most vital importance in forming a prognosis. Galen's 
observations in the succeeding commentary are veiy interesting, and deserve an at- 
tentivc perusal. 



256 PROGNOSTICS. 

for a shorter time, must be able to form a judgment from 
having made himself acquainted with all the symptoms, and 
estimating their powers in comparison with one another, as has 
been described, with regard to the others, and the urine and 
sputa, as when the patient coughs up pus and bile together. 
One ought also to consider promptly the influx of epidemical 
diseases and the constitution of the season.^ One should like- 
wise be well acquainted with the particular signs and the other 
symjitoms, and not be ignorant how that, in every year, and 
at every season, bad symptoms prognosticate ill, and favorable 
symptoms good, since the aforesaid symptoms appear to have 
held true in Libya, in Delos, and in Scythia -^ from which it 
may be known that, in the same regions, there is no difficulty 
in attaining a knowledge of many more things than these ; if 
having learned them, one knows also how to judge and reason 
correctly of them. But you should not complain because the 
name of any disease may happen not to be described here, for 
you may know all such as come to a crisis in the afore-men- 
tioned times, by the same symptoms.^ 

' 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 suhject 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. 

^ 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 Aijivr], 

^ 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. 



APPENDIX 



TO 



THE BOOK OF PROGNOSTICS. 

As announced in the Preliminary Discourse (Sect. II, 18), 
I shall now proceed to give an abstract of the principal matters 
contained in the Second Book of Prorrhetics, which appear 
to me to be highly interesting, and as they relate to the sub- 
jects treated of in the Prognostics, they may be more suitably 
introduced here than in any other place. 

The author commences the treatise with expressing his dis- 
approval of certain modes of making prognostics which he had 
seen practised. He says he had heard of many and famous 
predictions having been made by physicians, such as he himself 
did not pretend that he could make. Such, for example, as 
for a physician to call in upon a patient who was looked upon 
as being in a desperate condition by another physician, and 
predict that he would not die, but would lose his sight. Or 
to predict with regard to another patient supposed to be in a 
bad Avay, that he will recover, but will become lame of a hand. 
And of a third who, to all appearance, cannot recover, to 
predict that he will get Avell, but that his toes will blacken 
and putrefy. Similar predictions are related under this class. 
Another mode of prediction is to prophecy to buyers and traders, 
to one death, to another madness, and to the rest diseases, and 
that from what is now occurring, or has occurred before, and all 
the predictions to turn out true. Another kind of predictions 
relates to Athletse, and those who practise gymnastic and 
laborious exercises for the cure of diseases, where the prac- 
titioner pretends to so much exactness, that if the patient is 
guilty of any act of omission or commission in regard to food, 
drink, or venery, the physician will detect it. He himself 
makes no pretensions to any such skill in divination, but 
announces it as his object to describe the symptoms by which 

17 



258 APPENDIX. 

it may be known whether a man will die or live, and whether 
his disease will be of short or of long duration. With regard 
to the predictions of abscesses, lameness, death, or madness, 
the author holds that they can only be made after the morbid 
conditions leading to them have fairly set in. He strongly 
disapproves of all ostentatious modes of making predictions, 
and gives it as his advice that in all such cases the greatest 
prudence and reserve should be observed, since if a man 
becomes an adept in this art of prognostications, he will gain 
great credit with his patient, wdiereas if he fall into mistakes, he 
will incur odium, and will be looked upon as being deranged. 
With regard to the prognostics made by those who practise 
gymnastics, he recommends them not to be made in a charlatan 
manner, but with suitable caution, and directs minute atten- 
tion to be paid to the circumstances of the patient, which one 
has superior advantages in observing under this system. He 
says, for example, that a physician who feels a patient's belly 
and pulse, pays attention to the breathing at the nostrils, and 
listens to the speech, and sound of the respiration, will be less 
likely to be deceived in forming a prognostic on his patients 
than he who neglects these things. He expresses himself, 
however, as being incredulous as to the possibility of detecting 
any little transgressions of orders which a patient may commit, 
although greater departures from instructions may be suspected. 
After some general observations in respect to diet, and other 
matters relating to it, he proceeds to a more circumstantial 
description of the symptoms upon which a prognosis is to be 
founded. And first, with regard to the alvine dejections, those 
of persons who live a laborious life, and use food and drink 
sparingly, are small and hard, and are passed every day, every 
third day, or ever}' fourth day, but if they pass the last period 
there is danger of the man's being seized Avith fever or diarrhoea. 
When the stools are so liquid that they do not assume a shape, 
they are all of a worse character in these cases. The dejec- 
tions of persons who lead an active life are less copious than 
those of the indolent, provided they use the same amount 
of food. Liquid dejections taking place on the seventh day, 
and quickly coming to a crisis, are beneficial, if they occur all 
at once, and are not repeated. But if accompanied with fever, 
or if the diarrhoea is prolonged, all such dejections are bad. 



PROREHETICS. 259 

whether bilious^ pituitous, or of indigested matters, and require 
a particular regimen and mode of treatment. 

Witli regard to the urine, it shouhl be in proportion to the 
drink that is taken, and somewhat thicker than the fluid that 
is drunk. If it be more copious than natural, this indicates 
either that the patient has disobeyed orders as to the amount 
of his drink, or that his body is in a state of atrophy. If the 
urine is passed in deficient quantity, with a noise, it indicates 
either that the man stands in need of purging, or that the 
bladder is diseased. A small quantity of blood passed without 
fever and pain does not indicate anything Ijad, but proves a solu- 
tion to a state of lassitude. But if in large quantity, with the 
addition of any of these symptoms, it is to be dreaded. But if 
the urine be passed with pain, and if pus be passed along with the 
urine in a fever, the physician should announce that the patient 
will thus be relieved of his complaints.^ Thick urine having a 
thin sediment indicates some pain and swelling about the 
joints. All the other sediments which occur in the urine of 
persons v.ho practise exercises are connected with disease about 
the bladder ; this will be clearly shown by the obstinate pains 
with which they are accompanied. The author, although he 
states that he had been conversant with the teachers of pro- 
gnostics from urine, and their children and disciples, seems to 
express himself doubtful as to the possibility of acquiring a 
great degree of accuracy in regard to these matters. 

Respecting dropsy, consumption, gout, and epilepsy, he states 
generally that if they are hereditary they are difficult to 
remove. A favorable prognosis is to be formed in dropsy 
when the patient's viscera are sound, when his strength is 
firm, the digestion and respiration natural, when he is free of 
pain, the temperature of the body moderate, and when there 
is no wasting of the extremities. It is favorable Avhen there 
is no cough, thirst, nor dryness of the tongue, when the bowels 
are easily moved by medicine, and when, at other times, the 
dejections are consistent. Dropsy, supervening along with 
fever, upon a great discharge of blood, is of a most intractable 
nature, and the physician should intimate the danger to some 
other person beforehand. When great swellings suddenly 

' See Epidem., i and iii. 



260 APPENDIX. 

subside and rise again^ there is more hope in such a case than 
in dropsies connected Avith a discharge of blood. He concludes 
his observations on dropsies with the remark, that they are apt 
to deceive the patients, so that they desert their physicians and 
thus perish. 

With regard to consumptive patients, he says, he has the 
same observations to make with regard to the sputa and cough 
as he had written with regard to empyema.^ If the patient is 
to recover, the sputa should be white, equable, of one colour, 
without phlegm ; the defluxion from the head should be deter- 
mined to the nose ; there should be no fever, nor anorexia, 
nor thirst ; the alvine discharges firm, proportionate to the 
ingesta, and the patient should not get thin. The best form 
of the chest is when it is quadrangular and hairy, and when 
the cartilage is small, and covered with flesh. Young persons, 
who become affected with empyema from determination (metas- 
tasis?), or fistula, or from any other similar cause, or from the re- 
trocession of an abscess, do not recover unless manv of the favor- 
able symptoms combine in the case. They die, most commonly, 
in autumn, which proves peculiarly fatal in protracted diseases. 
Of all others, virgins, and women suffering from amenorrhoea, 
seldoraest recover ; and in their cases there is no hope unless 
menstruation be restored. All sexes, he seems to say (but 
the meaning appears to me rather ambiguous), have a better 
chance of recovery, when there is a discharge of blood, espe- 
cially in those cases in which there are pains in the back and 
chest, connected with black bile ; and if, after the evacuation, 
there be a remission of the pain ; if the cough and fever do 
not set in ; and if the thirst be tolerable. He seems to state 
(but the text is in an unsatisfactory condition), that relapses 
take place unless there be deposits in the place, the best of 
which are those which contain most blood ; and that in those 
cases in which there are pains in the chest, if the patients get 
emaciated, and cough, and a dj^spncea supervenes, without 
fever or empyema, they should be asked whether, when they 

' Empyema is treated of in the Prognostics, the first book of Prorrhetics, the 
Coacae Prjenotiones, and the work De Morbis. Which of these is here alUided to 
cannot be determined for certain ; it seems probable, however, that it is to the pre- 
ceding book of Prorrhetics. 



niOllRHETICS. 2G1 

coiigli, and have difficulty of breatliing, the sputa be compact, 
and attended with little smell. 

With regard to persons affected with the gout, those who 
are aged, have tofi in their joints, who have led a hard life, and 
V, hose bowels are constipated, are beyond the power of medicine 
to cure. But, the best natural remedy for them is, an attack 
of dysentery, or other determination to the bowels. Persons, 
under opposite circumstances, may be cured by a skilful 
physician. 

The prognosis in epilepsy is unfavorable when the disease 
is congenital, and when it endures to manhood, and when it 
occurs to a grown person, and without any obvious cause. 
When connected with the head it is particularly to be appre- 
liended, but least so when it seems to be derived from the 
hands or feet. The cure may be attempted in young persons, 
but not in old. 

In the case of children, he mentions various complaints, such 
as distortion of the eyes, tubercles about the neck, pain in the 
bowels, omental hernia, &c., which, upon inquir}-, will be found 
to be the consequences of an attack of epilepsy. 

The judgment to be formed in the case of ulcers is to be 
founded on the age of the patient, the situation of the sore, 
and its appearance. 

Strumous tubercles, which end in suppuration, occur most 
frequently in young persons. Adults are subject to bad favi, 
internal cancers, and herpetic sores, after epinyctis, until they 
pass sixty. Old persons are subject to cancers, both deep- 
seated and superficial, which never leave them. They are 
particularly intractable when seated in the armpits, the loins, 
and the thighs. 

Of affections of the joints, the most dangerous are those 
seated in the thumb and great toe. When there is a chronic 
sore on the side of the tongue the surgeon should examine 
whether it be not occasioned by the sharp edge of a tooth. ^ 

The most dangerous wounds are those which implicate the 
large veins (blood-vessels), in the neck and groins ; then those 

' This impoitiuit observation is thus rendered by Celsus : " Qux in latere lingnre 
tilcera nascuntur diutissime duraiit. Videndumque est, num contra dens ahquis 
acutior sit, qui sauescere SEepe ulcus co loco nou sinit, ideoque liniaudus est." (vi, 12.) 



262 APPENDIX. 

of the brain and liver ; next; those of the bowels and bladder. 
These cases are all dangerous, but not uniformly fatal, as some 
suppose. Much depends upon constitution, as to liability to fever 
and inflammation after a wound. Sometimes, also, the wounds 
of smaller vessels prove fatal by indacing hemorrhage, fever, or 
delirium. In all recent wounds, however, the physician should 
endeavour to aflbrd assistance. 

Of spreading ulcers, the most fatal are such mortifications as 
are very deep, black, and dry; and those are bad and dangerous 
which are accompanied with a black ichorous discharge. Those 
which are white and mucous are less dangerous, but are more 
subject to relapse, and become inveterate. Herpes is the least 
dangerous of the spreading sores, but is most difficult to remove 
about deep-seated cancers.^ An ephemeral fever, with very white 
and thick pus, is beneficial in such a case ; also, sphacelus of a 
nerve, of a bone, or of both, in deep-seated and black mor- 
tifications. For a free discharge of pus takes place and carries 
ofi" the mortification. 

The prognostics in wounds of the head are given in nearly 
the same terms as laid down in the treaties on that subject, 
and therefore I need not enter minutely into an exposition of 
what is stated regarding them here. Those in the upper part 
of the head, more especially if they implicate a suture, are said 
to be particularly dangerous. The author directs the surgeon 
to inquire whether, at the time of the accident, the patient fell 
down or became comatose, as in this case greater danger is to 
be apprehended. 

Large wounds of the joints, if they involve the connecting 
nerves, necessarily leave the limb maimed. Several other 
observations connected with these injuries are added, of which 
one of the most important is the direction to practise flexion 
and extension of the limb, frequently, with the view, no doul)t, 
of preventing rigidity of the joint. 

Large excisions in the arm becoming inflamed end in sup- 
purations, which require to be evacuated by the knife or 
cautery. Injuries of the spinal marrow, whether from disease 
or accident, are attended with loss of motion and sensibility, 
retention of the alviue and urinary discharges ; but, after 

' Allusion seems to be made to herpes exedens. 



PRORRIIETICS. 263 

a time, involuntary evacuations take place, which are soon fol- 
lowed by death. When the throat is frequently filled with 
blood, and there is no headache or cough, nor any other 
morbid symptoms, the physician should examine whether there 
be not an ulcer or a leech in the part. 

With regard to the eyes, the prognostics are given with so 
much prolixity of detail that I must be content with a brief 
abstract of them. Much attention is paid to the characters 
of the discharge from the eyes in diseases of them, namely, of 
the glutinous matter and tears ; thus, if the gum be white and 
soft, the tears mixed with it not very hot, and the swelling 
light and loose, under these circumstances the ej^elids are glued 
up during the night, so that the eye is free of pain, and thus 
the disease is without danger, and of short duration. The other 
appearances of the eye, and the discharges, are also minutely 
given. When the discharge is green or livid, the tears cojiious 
and hot, a burning heat in the head, and pains darting through 
the head to the eye, there must necessarily be ulceration in 
the eye; and there is much reason to apprehend that it will 
burst. If, when one can get a sight of the eye, it should be 
found burst, and the pupil projecting above the rupture, it is 
bad and difficult to restore ; and, if there be sloughing, the eye 
will be wholly useless. According to the form and depth of the 
ulcers must be the subsequent cicatrices. These are minutely 
described according to their different varieties. Mention is 
also made of the prognostics from the eyes in fevers, as de- 
scribed by the author in another work. It is most likely that 
allusion is here made to the first book of ' Prorrhetics.^ In 
conclusion, the sui'geon is directed to pay great attention to 
the state of the urine in diseases of the eyes. 

Dysenteries, when they set in with fever, alvine discharges 
of a mixed character, or with inflammation of the liver, or of 
the hypochondrium, or of the stomach, such as are painful, with 
retention of the food and thirst, all these are bad ; and the 
more of these symptoms there are, the greater the danger; and 
the fewer, the more hope is there of recovery. Children from 
five to ten years of age are the most apt to die of this com- 
plaint ; the other ages less so. Such dysenteries as are of a 
beneficial nature, and are attended with blood and scrapings of 
the bowels, cease on the seventh, or fourteenth, or twentieth, or 



261 APPENDIX. 

thirtieth day, or within that period. In such cases even a 
pregnant woman may recover and not suffer abortion. 

All cases of lientery are said to be of a bad character when 
they are continued and protracted, both day and night, and 
when the dejections are either very crude, or black, soft, and 
fetid ; for they occasion thirst and determine the fluids other- 
wise than to the bladder, give rise to ulcerations (aphthae?) in 
the mouth, redness and ephelis^ of all colours, and at the same 
time the belly is in a state of ferment, and has a foul, wrinkled 
appearance externally. This disease is most to be dreaded by 
old persons ; it is formidable to men of middle age, but less so 
in the other ages. The indications of cure, it is acutely stated, 
are to determine the fluids to the urine, to relieve the body 
from its atrophy, and change the colour of the skin. 

All the other varieties of diarrhoea without fever are of short 
duration and mild ; for they will all cease when washed out, or 
of their own accord. The discharge may be predicted as about 
to cease when, upon touching the belly, there is no movement, 
and flatulence passes with the discharge. Eversion of the gut 
takes place in the case of middle-aged persons having piles, of 
children affected with the stone, and in protracted and intense 
discharges from the bowels, and of old persons having mucous 
concretions (scybalse?). 

Women may be judged of whether they are in a fit state 
for conception or not by attending to the following circum- 
stances : — In the first place to their shapes. Women of smaller 
statiu^e more readily conceive than taller persons ; the thin 
than the fat; the white than the ruddy; the dark than the 
pale ; those who have proininent veins than the contrary. In 
oldish women it is bad to have much flesh, but a good thing to 
have swelled and large breasts. In addition, inquiry should be 
made whether or not the menstruation be regular as to time 
and quantity. And it should be ascertained whether the uterus 
be healthy, of a dry temperament, and soft; neither in a state 
of retraction nor prolapsus; and its mouth neither turned aside, 
nor too close, nor too open. When any of these obstructions 
come in the way, it is impossible that conception can take 
place. 

Such women as cannot conceive, but appear green, without 

' See Paulus ^gineta, B. Ill, 25. 



PRORRHETICS. 2fi5 

fever, and the viscera are not in fault ; these will say that the 
head is pained, and that the menstrual discharge is vitiated Jind 
irregular. But such of these as have the proper colour, are of 
a fat habit of body, the veins are inconspicuous, they have no 
pains, and the menses either never appear at all, or are scanty 
and intense, and this is one of the most difficult states of ste- 
rility to remove. In other cases the health is not to blame, 
but the fault lies in the position of the womb. The other 
contingencies in this place are attended with pains, discolora- 
tion, and wasting. 

Ulceration in the womb from parturition, an abscess of a 
chronic nature, or from any other cause, is necessarily accom- 
panied with fevers, buboe^5, and pains in the place ; and if the 
lochial discharge be also suppressed, all these e\als are more 
intense and inveterate, along with pains of the hypochondrium 
and head. And when the nicer heals, the part necessarily is 
smoother and harder, and the woman is less adapted for 
conception. If, howcA'cr, the ulceration be in the right side 
onlv, the woman mav conceive of a female child, or if in the 
left, of a male. When a woman cannot conceive, and fever 
comes on with a slight cough, inquiry should be made whether 
she has any ulcer about the uterus, or any other of the com- 
plaints I have described ; for if she has no complaint in that 
region to account for her loss of flesh and sterility, it may be 
expected that she will have vomiting of blood, and the catamenia 
will necessarily be suppressed. But if the fever be carried off 
by the evacuation of blood, and if the catamenia appear, she 
will then prove with child. But if looseness of the bowels 
having a bad character take place before there is an evacuation 
of blood, there is danger lest the woman perish before a vomit- 
ing of blood can take place. 

In cases of false conception, in which women are deceived 
bv the non-appearance of the menses, and by the increase of 
the belly and movement in it, they Avill be found to have had 
headache and pains about the neck and hypochondria, and 
there is no milk in the breasts except a little of a watery 
character. But when the swelling of the womb passes away 
they will conceive, unless there be any other impediment. 
For this affection is beneficial in so far as it produces a change 
in the uterus, so that afterw^ards the woman may prove with 



266 APPENDIX. 

child. Women with child have not these pains unless the 
headache be habitual to them^ and in addition they have milk 
in their breasts. Women affected with chronic discharges are 
to be asked whether they liave pains in the head and loins, 
and in the lower part of the belly, and whether their teeth be 
set on edge, and if they have dimness of sight, and noises in 
their ears. Such women as vomit bile for several days while 
in a fasting state, though they are not with child nor have 
fever, are to be asked whether they have vomited up round 
lumbrici, and if they say not, they should be warned that this 
will happen to them. This aifection happens principally to 
married women, then to virgins, and less seldom to other 
people. 

Pains without fever are not deadly, but mostly prove pro- 
tracted, and have many changes and relapses. Several varieties 
of headache are described, and the prognosis in each laid down. 
The natural cure of them is a coryza, a discharge of mucus 
from the nose, or sneezing. Pains spreading from the head to 
the neck and back, are relieved by abscesses, expectoration of 
pus, hemorrhoids, exanthemata on the body, or ptyriasis on 
the head. 

Heaviness and pruritus in the head, either in a part or 
through the whole of it, if, on inquiry, they extend to the tip 
of the tongue, indicate a confirmed disease, and one difficult 
to remove. They are best removed by the occurrence of an 
abscess. But those cases which are accompanied with vertigo 
are difficult to cure, and are apt to pass into mania. Other 
diseases in the head, of a very strong and protracted character, 
occur to both men and women, but especially to young persons, 
and virgins at the season of manhood, and especially at the 
catamenial period. Women, however, are less subject to 
pruritus and melancholic affections than the men, unless the 
menses have disappeared. 

Both men and women who have long had a bad colour, but 
not in the form of jaundice, are subject to headaches, eat stones 
and earth, and have piles. Those who have green colours, without 
decided jaundice, are affected in like manner, only instead of 
eating stones and earth, they are more subject to pains in the 
hypochoiidriac region. Persons who are pale for a length of 
time, and have the face tumid, will be fovuid to have headache. 



PRORUHETICS. 267 

or pains about the viscera^ or some disease in the anus ; and 
in most cases, not one, but many, or all these evils make their 
appearance. 

Nyctalopia is most apt to attack young persons, either males 
or females, and to pass off spontaneously on the fortieth day 
or in seven months, and in some cases it endures for a whole 
year. Its duration may be estimated from the strength of the 
disease and the age of the patient. They are relieved by 
deposits which determine downwards, but these rarely occur in 
youth. Married women and virgins that have the menstrual 
discharge regular are not subject to the complaint. Persons 
having protracted defluxions of tears who arc attacked with 
nyctalopia, are to be questioned whether they had any previous 
complaint in the head. 

Such persons as have frequent pains in the vertex and 
temples, without fever or loss of colour, unless they have some 
other obvious deposit in the face, or speak in a rough tone, or 
liave pain in the teeth, may be expected to have a hemorrhage 
from the nose. Those who have bleeding at the nose, although 
they may appear to be otherwise in good health, will be found 
to have enlarged spleen, or pain in the head, or flashes of 
light before their eyes. Most of these patients have both 
headache and aflPection of the spleen. 

The gums are diseased and the mouth fetid in persons who 
have enlarged spleens. But persons who, although they have 
enlarged spleens are exempt from hemorrhages and fsetor of the 
mouth, have malignant ulcers on the legs and black cicatrices. 
But if they have any obvious deposit in the countenance, or if 
their speech be rough, or if they have toothache, a hemorrhage 
from the nose may be expected. Those who have great 
swellings below the eyes will be found to have enlarged spleens. 
And if there come on swellings in the feet, and if they appear 
to be dropsical, the belly and loins must be attended to. 

Distortions of the countenance, if not sympathetic with 
some other part of the body, quickly pass ofl:' either spon- 
taneously or by remedial means. The others are of an apo- 
plectic nature. In other cases, when the diseased part wastes 
from want of motion, there can be no relief afforded. But 
when wasting does not take place there may be recovery. 
With regard to the time when this may occur, it is to be 



268 APPENDIX. 

prognosticated by attending to tlie severity of the disease^ to 
its duration^ to the age of the patient, and to the season, it 
being known that of all cases the inveterate, and such as are 
the consequences of repeated attacks, are the worst, and the 
most difficult to remove, and those in aged persons. Autumn 
and winter are more unfavorable seasons for such complaints 
than spring and summer. 

Pains in the shoulder, which, passing down the arms, oc- 
casion torpor and pains, do not usually terminate in deposits, 
but the patients get better by vomiting black bile. But when 
the pains remain in the shoulders, or extend to the back, the 
patients are relieved by vomiting pus or black bile. They are 
to be judged of thus : — If their breathing be free, and if they 
be slender, it is rather to be expected that they will Vomit 
black bile. But if they have more difficulty of breathing, and 
if there is any unusual colour on the countenance, whether 
reddish or black, it is to be expected that they will rather spit 
blood. It should also be attended to whether there be swellings 
on the feet. This disease attacks men most violently from 
forty to sixty years of age. At this period of life ischiatic 
diseases are most troublesome. 

Ischiatic diseases are to be thus judged of: — In the case of 
old persons, when the torpor and coldness of the loins and legs 
are very strong, and when they lose the power of ei^ections, 
and the bowels are not moved, or with difficulty, and the faeces 
are passed with much mucus, the disease will be very protracted, 
and it should be announced beforehand that the disease will 
not last shorter time than a year from its commencement ; and 
amendment is to be looked for in spring and summer. Ischiatic 
diseases are no less painful in young men, but . are of shorter 
duration, for they pass off in forty days ; and neither is the 
torpor great, nor is there coldness of the legs and loins. In 
those cases in which the disease is seated in the loins and leg, 
but the patient does not suffer so much as to be confined to 
bed, examine whether any concretions have taken place in the 
hip-joint, and make inquiry whether the' pain extends to the 
groin ; for if both these symptoms be present, the disease will 
be of long duration. And the physician should also inquire 
whether there be torpor in the thigh, and if it extend to the 
ham ; and if he says so, he is to be again asked if it spreads 



PRORRHETICS. 269 

along the leg to the ankle of the foot. Those who confess to 
the most of these symptoms are to be told that the limb will 
be sometimes hot and sometimes cold ; but those persons in 
whom the pain leaves the loins, and is turned downwards, are 
to be encouraged ; but when the disease does not leave the hip 
and loins, such persons are to be warned that it is to be dreaded. 
In those cases in which there are pains and swellings about 
the joints, and they do not pass off, after the manner of gout, 
von will find the bow^els enlarged, and a wdiite sediment in the 
urine ; and, if you inquire, the patient will admit that the 
temples are often pained, and he will say that he has nightly 
sweats. If the urine have not this sediment, nor do the 
sweats take place, there is danger either that the joint will be- 
come lame, or that the tumour called meliceris v/ill form in it. 
This disease forms in those person who in their youth had 
epistaxis, and in whom it had ceased afterwards. They are 
to be interrogated whether they had discharges of blood in 
their youth, and if they have pruritus in the breast and back. 
And the same thing happens to those Avho have severe pains in 
the bowels, without disorder of them, or who have hemorrhoids. 
This is the origin of these complaints. But if the patients 
have a bad colour, they are .to be interrogated whether their 
head be pained, for they will say that it is. In those cases 
in which the bowels are pained on the right side, the pains are 
stronger, and especially when the pain terminates in the hypo- 
chondrium at the liver. Such pains are immediately relieved 
if borborygmi take place in the belly. But when the pain 
ceases, they pass thick and green urine. The disease is not 
deadly, but very protracted. But when the disease is already 
of long standing, the patients haA^e dimness of sight in conse- 
quence of it. But they are to be interrogated whether, when 
young, they had a flow of blood, and regarding the dimness of 
vision, the greenness of the urinary discharge, and regarding 
the borborygmi, if they took place and gave rehef ; for they will 
confess to all these symptoms. 

Lichen, leprosy, and leuce, w hen they occur in young children 
and infants, or when they appear at first small, and gradually 
increase in the course of a long time — in these cases the erup- 
tion is not to be regarded as a deposit, but as a disease ; but 
when they set in rank and suddenly, this case is a deposit. 



270 APPENDIX. 

Leuce also arises from the most fatal diseases^ such as the 
disease called phthisis / but leprosy and lichen are connected 
with black bile. These complaints are the more easil}^ cured 
the more recent they are, and the younger the patients, and 
the more soft and fleshy the parts of the body in which they 
occur. 

' Foes inclines to think that the proper reading in this place is vovtsoq (jioiviKit), 
and not ^OiviKt), and that Galen alludes to this passage in his Exegesis under the 
former of these terms, where he says that hy <pounKii] vovaoQ was probably meant 
elephantiasis. The other reading, however, would seem quite applicable, for I have 
known phthisis and leprosy combined in the same case. 



ON REGIMEN IN ACUTE DISEASES. 



ON REGIMEN IN ACUTE DISEASES. 



THE ARGUMENT. 

In this treatise two very important questions are discussed : 
firstj a nosological question, regarding the proper distinction 
of diseases from one another ; aud secondly, a therapeutical, 
respecting the rules by which the regimen in acute diseases 
ought to be regulated. The former of these is of a polemical 
nature, being an attack directed against the physicians of the 
Cnidian school of medicine, who distinguished diseases from 
one another in an arbitrary manner, from incidental varieties 
in their constitution, and without a proper attention to their 
true constitution and identity. As will be seen in the anno- 
tations, the Cnidians pretended to recoguise several varieties of 
disease connected with bile, — several fanciful divisions of diseases 
of the bladder, and so forth ; to which mode of distinguishing 
diseases there would obviously be no end, since of incidental va- 
rieties in any case there can be no limit. The other question dis- 
cussed in this treatise relates to what may justly be pronounced 
to be one of the most important points connected with the prac- 
tice of medicine, namely, the proper regimen in acute diseases ; 
that is to saj'", in idiopathic fevers and febrile diseases, comprising 
most of those diseases now classed under the head of Zymotic, 
and which constitute by far the highest item in our bills of 
mortality at the present day. Our author distinguishes them 
by the names of pleurisy, pneumonia, phrenitis, lethargy, 
causus, and their cognate diseases, including fever of the con- 
tinual type. Now it is to be borne in mind, that the phrenitis,^ 
lethargy, and causus of Hippocrates, were all epidemic fevers, 
so that, with the exception of pleurisy and pneumonia, all the 

' The phrenitis of Sydenham in like manner was an epidemical fever, and not aa 
idiopathic inflammation of the brain. See Opera, p. 56 ; ed. Syd. Soc. That Hip- 
pocrates regarded phrenitis as a variety of cansns, attended with determination to 
the brain, is obvious from Epidcm. i. See Op. Galen., torn, v, p. 371 ; ed. Basil. 

18 



274 REGIMEN IN ACUTE DISEASES. 

diseases here treated of are fevers of tlie country in which 
Hippocrates resided. One, then, cannot well imagine a ques- 
tion which from the commencement of the medical Art must 
have been felt of higher importance than this, — how so numerous 
and formidable a class of diseases ought to be treated. In the 
attempt to solve it, every imaginable mode of treatment, as 
might have been expected beforehand, was tried, and its effects 
determined by experience. Herodicus, the master of Hippocrates 
in gymnastics, applied his panacea in the treatment of febrile 
diseases, and, as we are informed, with the most disastrous 
results. " Herodicus,'' says the author of the sixth Book of 
Epidemics, " killed persons in fever by promenading, much 
wrestling, and fomentations.''^ (§ iii, 18.) It may noiv appear 
wonderful that so extraordinary a mode of practice should have 
ever been attempted in this case ; but while men of all ranks 
continue to resort for the cure of all sorts of diseases to any 
individual who has got a single hobby with which he constantly 
works to his own profit, whether it be gymnastics, or shampooing, 
or the ivet sheet, we may expect to hear that such rash experi- 
ments have been repeated. Truly mankind pay as dearly for 
their tame submission to the insane practices of professional 
chiefs, as the Greeks are represented by the poet to have suf- 
fered from the follies of their princes : 

" Quicquid delirant Keges, plectuntur Achivi."' 

And surely it is much to be desired that men would learn a 
lesson from the Past, and not allow every new j)age in the 
history of society and of the profession to furnish a repetition 
of the oft-told tale of supine credulity on the one side, and of 
audacious folly on the other. From what has been stated, it 
will readily be understood that it was soon settled that active 
exercise is inadmissible in febrile diseases." It would next come 
to be determined, what rule was to be followed with regard to 

' Horace, Serm. i, 2. 

* 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, praecipueque ardente febre, ad discutiendam earn, 
gestatione dixit utendum : sed id pericolose tit ; meliusque quiete ejusmodi impetus 
sustiuetur.'" (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.) 



ARGUMENT. 275 

the administration of food in fevers. On this point, as Avill be 
seen below in our annotations, the most diametrically opposite 
plans of treatment were essayed. One authority administered 
the most highly nutritious articles of food, namely, fleshes, to 
his patients, while, on the other hand, some Avasted them by 
enforcing a total abstinence for several days. Experience, we 
may be well assured, was not long in deciding against both the 
starving and the glutting system : the palled appetite would 
soon refuse to accept of solids, and the parched tongue would 
speedily crave some allowance of liquids. Even before the days 
of Hippocrates, there is every reason to suppose that these ex- 
treme modes of treatment had been abandoned ; but still he 
complains that in his time many important points in the treat- 
ment of acute diseases were wholly undetermined, such as the 
following : whether plain drink, that is to say water, was to be 
administered; — or, water seasoned by the admixture of some- 
thing fiirinaceous, such as the decoction of barley; — whether 
the same should be given so thick as to constitute a nutritious 
gruel, or strained so as to form merely a drink ; — whether Avine 
should be given in small quantity, or more copiously ; — whether 
any of these things should be given from the commencement 
of the disease, or not until after an interval of certain davs. 
Hippocrates informs us that the most discordant opinions pre- 
vailed upon tbese points, and his professed object, in this 
treatise, is to reduce the rules of practice to certain fixed prin- 
ciples. How our author performs this task, the reader is left 
to judge for himself; it may be interesting, however, to know, 
that Galen with all his devoted admiration of Hippocrates, is 
not disposed to admit that his solution of the question at issue 
is quite lucid and satisfactory. This opinion Galen pronounces 
on two separate occasions ; in his commentary on this treatise, 
and in his great Work ' On the Tenets of Hippocrates and 
Plato.' As I look upon his observations contained in the latter 
AYork to be of great importance towards understanding the bear- 
ing of this treatise, I shall not scruple to introduce a translation 
of the greater part of them in this place. 

The ninth ]:)ook of the Work we have mentioned opens with 
an elaborate disquisition on the logical principles which ought 
to guide us in deciding Avith regard to identity and difference, 
both in Philosophy and Medicine : on the former of these 



276 REGIMEN IN ACUTE DISEASES. 

subjects he quotes freely from Plato, and on tlie other from 
IIil)pocrates. Coming, then, to the question in hand, he 
says : — "And thus Hippocrates proceeded in the work ' On 
the Regimen of Acute Diseases,^ finding fault with the Cnidian 
physicians, as being ignoraut of the difierences of diseases with 
regard to genus and species ; and he himself points out the 
definitions according to which that which appears to be one, 
being divided becomes many, not only in the case of diseases, 
but also in that of all other things ; in which we find that many 
of the most celebrated physicians fall into mistakes, even with 
regard to the remedies. For some, coming to the particular 
use of them, have established a most immethodical method of 
instruction ; whilst others, stating a very general precept, lay 
down a rule which at first sight appears very methodical, but 
in truth is very bad, and hence they disagree among themselves ; 
some, as for example those treating of the remedy for a certain 
affection, such as pleurisy, declaring it to be venesection, others 
purging, some fomentations by means of sponges, and others of 
bags, or something of the like kind. And they differ, in the 
same manner, with regard to the use and disuse of the bath, of 
oxymel, of hydromel, and of water, of wine, and of ptisan, either 
giving of the strained juice only, or of the barley portion only; 
and some, with regard to food, giving discordant decisions as 
to the differences of the sick, and the indications which a pleu- 
ritic affection requires. And that he, as being the first dis- 
coverer, has handled these subjects in rather a confused manner, 
I have shown in my Commentary on the treatise which has 
been improperly entitled, ' Against the Cnidian Sentences,' 
and ' On the Ptisan.'' But in order that those who are desirous 
of learning, may have a clear exposition of this question in a 
brief form, I shall not scruple to give here a summary of it. 
In the commencement of pleuritic attacks, when the side is just 
beginning to be pained, inasmuch as the nature of the disease 
is not yet obvious, he directs fomentations, otherwise called 
heating applications, to be tried, and he explains the materials 
of which they consist. And then, if the complaint is not re- 
moved, it is to be ascertained whether the patient took food 
recently, and whether the bowels have been moved, and he 
gives instructions what should be done in these cases. But if 
the disease does not yield to these means, he gives definitions 



ARGUMENT. 2/7 

of those cases wliicli require venesection and purging, and those 
in which one shonld use hj^dromcl for drink, or oxymel, or water 
until the crisis, without giving any food ; and those in which 
the juice of ptisan is to be used, or the barley along with it, 
and when food is to be administered. In like manner, with 
regard to the administration of wine, it is determined in wliat 
cases it is to be given, and in what not, and when, and of what 
quality. And in like manner respecting baths, and other 
matters of the like kind. And as a twofold mistake is com- 
mitted with regard to the divisions (of diseases), some doing it 
in a deficient manner, and others carrying this process to excess, 
Hippocrates, finding fault Avitli both, expresses himself thus, in 
the beginning of the book : ' Some of them, indeed, were not 
ignorant of the many varieties of each complaint, and their 
manifold division, but when they wish to tell clearly the members 
(species ?) of each disease, they do not write correctly ; for the 
species would be almost innumerable if every symptom expe- 
rienced by the patients were held to constitute a disease, and 
receive a different name.'' And again, respecting the remedies, 
as being deficient, he writes thus : ' And not only do I not 
give them credit on this account, but also because those they 
use are few in number.'' Afterwards, assuming what is of great 
importance to the question, he does not give a clear solution of 
it, and therefore the whole bearing of the question is mis- 
understood by many physicians. I have, therefore, given an 
exposition of the whole subject, in my first Commentary ' On 
the Regimen of Acute Diseases ;' and it is necessary to show 
the import of it briefly. The question is given by Hippocrates 
in the following terms : ' But it appears to me that those 
things are more especially deserving of being consigned to 
writing, which are undetermined by physicians, notwithstanding 
that they are of vital importance, and either do much good or 
much harm. By undetermined, I mean such as these : where- 
fore certain physicians, during their whole lives, are constantly 
administering unstrained ptisans, and fancy they thus accom- 
plish the cure properly, whereas others take great pains that 
the patient may not s-\vallow a particle of the barley (thinking 
it would do much harm), but strain the juice through a cloth 
before giving it : others, again, will neither give thick ptisan 
nor the juice, some until the seventh day of the disease, and 



278 REGIMEN IN ACUTE DISEASES. 

some until after the crisis. Physicians are not in the practice 
of mooting such questions, nor perhaps, if mooted, v/ould a so- 
lution of them be readily found, although the whole Art is 
thereby exposed to much censure from the vulgar, who fancy 
that really there is no such science as Medicine, since, in acute 
diseases, practitioners differ so much among themselves, that 
those things which one administers, as thinking it the best 
that can be given, another holds to be bad.' And a little 
afterwards : ' I say, then, that this question is a most excellent 
one, and allied to very many others, and some of the most vital 
importance in the Art : for, that it can contribute much to the 
recovery of the sick, and to the preservation of health in the 
case of those who use it well, and that it promotes the strength 
of those who take gymnastic exercises, and is useful to whatever 
one may wish to apply it.^ The inquiry regarding the differences 
of opinion among practitioners, he says, is of the greatest con- 
sequence, not only to the sick, for the recovery of health, but 
also to those in health, for the preservation of it, and to those 
who practise it for the recover}- and preservation of deportment. 
And he afterwards adds, ' to whatever one may wish ;' as indi- 
cating that the solution of this inquiry is applicable not only to 
medicine but to all the other arts to which one may choose to 
apply it. For it is wonderful that physicians practising an art, in 
Avhich the remedies applied may be determined by experience 
whether they are beneficial or hurtful, should yet make the most 
conflicting statements respecting those things which are beneficial 
and those which are prejudicial. For, in philosophy, it is not to be 
Avondered at that there should be no end to most disputes, since 
these things cannot be clearly determined by experience; and 
therefore some hold that the world is uncreated, some that it was 
created, some that there is nothing beyond its boundary, some 
that there is, and some declaring what that which is contained is, 
and some pronouncing it to be a vacuum, having no substance 
in it, and some holding that worlds in inconceivable numbers, 
and infinite, exist. For such discrepancy of opinion cannot be 
set at rest by any clear appeal to the senses. Eut it is not so with 
respect to the benefit or injury derived from remedies adminis- 
tered to the body, since the differences among physicians, in this 
case, may be decided by experience, as to which of them are 
beneficial and which injurious. Wherefore the solution of this 



ARGUMENT. 279 

question is not very clearly stated by Hippocrates, and on that 
account it has excited the observation of almost all the commen- 
tators on this book. It is this : some of the sick require absti- 
nence from food, until the disease come to a crisis, and some re- 
quire food, and of these some require the unstrained ptisan, and 
some the strained, as also some require still more substantial food, 
and, moreover, some require oxymel, or hydromel, and some 
water, or wine. Wherefore to those physicians who have culti- 
vated the Art upon experience alone, that only appears beneficial 
which perchance has seemed useful in most cases. Neither do 
they venture to try the opposite mode of regimen, for fear of 
failure. He alone, then, who knows the constitution of the 
sick, and the nature of the disease, and the powers of the remedy 
which is administered, and the time in which it ought to be used, 
will be able rationally to devise the remedy to be applied, and 
confirm his expectation of it by experience.^' 

Galen gives other remarks, not devoid of interest, on the same 
subject, but these want of room obliges me to pass by. I may 
jnention, however, that after giving, in the form of extract, the 
passage on wine (§ 13), he makes the remark, that if the question 
be put whether wine should be given to persons in fever, the 
proper answer to it would be,. that it is to be given in some cer- 
tain cases, and in others not. (See tom. v, p. 773, cd. Kiilin.) 
Thus far Galen. 

Before quitting this subject, I would beg leave to make a 
few remarks on some points of medical practice which are here 
treated of, and which appear to me to be either overlooked, or 
not satisfactorily determined at the present day; and also upon 
some modern innovations on the practice of the ancients. As 
far as I have observed, it is quite a common practice now to 
administer food, such as farinaceous gruels, or animal broths, 
without much reserve, after evacuation of the system either by 
purging or bleeding. Now it will be seen that Hippocrates 
forbids food to be administered at such a season, as the body, 
being weakened by the depletion, is unable to digest it properly, 
and consequently what is given as a support to the frame proves 
a load to it. To the reason here assigned for this practice, 
might be added that the vascular system, having been emptied, 
greedily absorbs the food before it is properly digested. I am 
not sure that this physiological principle is stated in any of the 
works of Hippocrates, but it is frequently to be met with in the 



280 REGIMEN IN ACUTE DISEASES. 

works of Galen, and in those of the toxicblogists, from Nicander 
to Actuarius. SeePAULUs ^gixeta, Book V, 2, Syd. Soc. edit. 

I woukl beg leave to call the attention of my professional 
readers to the guarded and judicious manner in which pleurisy 
is treated by our author, beginning with hot fomentations to 
the side, and gradually advancing to the more active means, 
namely, purging and venesection. It will be remarked that 
Hippocrates holds depletion to be the only legitimate mode of 
removing the pain of the side, and that his commentator, in 
illustration of his meaning, pointedly condemns the use of 
narcotics in this case. Now this is a most important consi- 
deration, as bearing on a mode of practice which has obtained 
much favour of late years ; T allude, of course, to the treatment 
by a combination of mercurials and opium. The experience of 
some thirty years would seem to decide in its favour, but how 
often have certain methods of treatment in other cases obtained 
the sanction of professional favour for a much longer period, 
and yet in the end been abandoned as positively prejudicial? 
In my younger days I knew old practitioners, of the highest 
reputation, who administered these medicines in scrofula, — in 
cancer, — in every case ! One cannot think of the change in 
professional opinions on the mercurial treatment of syphilis, 
since the days of John Hunter, without the most painful feeling 
of distrust in all modes of treatment where one cannot recognise 
some reasonable bond of connexion between the remedy ap- 
plied and the effects produced, or where long experience and 
analogy are in favour of them, and^where the judgment runs 
no risk of being imposed upon by fallacious appearances and 
collateral circumstances. In a word, who does not feel disposed, 
in the practice of medicine, constantly to recur to the great 
truth proclaimed by our author in his first Aphorism? " Expe- 
rience is fallacious, and judgment is difficult." 

I am almost afraid further to put the question to the pro- 
fession of the present day, whether or not the administration 
of antimonials in pleuro-pneumonia be an improvement on the 
ancient practice, or the reverse ? Shall we say, then, that ex- 
perience has decided that this substance (antimony), which, 
when applied to the cuticle, or to its prolongation, the epithe- 
lium of the stomach and bowels, occasions pain, heat, and vas- 
cular congestion, produces the very opposite effects on the lungs, 
when absorbed into the blood and conveyed to them ? I dare 



ARGUMENT. 281 

not venture to answer these questions myself, but suggest them 
as deserving to be reconsidered, with serious impartiality, by 
the profession. I trust, however, it will not be supposed that 
I incline to stand up for ancient modes of practice, because 
they are old, or to condemn modern methods because they are 
new ; I merely state the reflections which the comparison of 
ancient and modern usages, on this important subject, has 
suggested to me. 

Our author, it will be seen, attaches much importance to 
the administration of the ptisan, or decoction of barley, in 
pleuro-pneumonia, Our modern Hippocrates, I mean, of course, 
Sydenham, was equally partial to this practice,^ which is still 
very much followed on the continent. 

It will be remarked, that Hippocrates says nothing of 
counter-irritants to the skin, in the treatment of pleurisy, all 
his external applications being of the soothing kind. The 
stimulant treatment, however, is not altogether modern, having 
been recommended in certain cases by the Arabians. (See 
Paulus iEoiNETA, Vol. I, p. 501.) Celsus also approves of 
sinapisms to the side, (iv, 6.) 

The use of the bath and of the douche, or aff'usion of hot 
water in febrile diseases, is an, important question, which well 
deserves to be reconsidered by the profession. (See the anno- 
tations on § 18.) 

The reader will no doubt have been struck with the remark 
of Galen, in the extract given above, that our author^s plan in 
the present work is deficient in method, because he himself 
was the discoverer of the subject-matters to which it relates. 
Galen then seems to have been of opinion that it was too much 
to expect from any individual, that he should produce a work 
which would be remarkable at the same time for the originality 
of its materials, and for the methodical arrangement of them. 
In confirmation of Galen's judgment in this case, I would 
direct attention to the difi'erence that there is between this 
treatise and the ' Prognostics / for all must admit that the 
matters of which the latter work is composed are admirably 
methodised, and we have shown above that they were deri^ed 
in a great measure from the previous labours of the Asclepiadne. 

' Observ. Med, vi, 3, 4. 



282 



ON REGIMEN IN ACUTE DISEASES. 

Those who composed what are called ' The Cnidian Sen- 
tences'^ have described accurately what symptoms the sick 
experience in every disease^ and how certain of them terminate ; 
and in so far a man^ even who is not a physician^ might 
describe them correctly, provided he put the proper inquiries 
to the sick themselv^es what their complaints are. But those 
symptoms which the physician ought to know beforehand, 
without being informed of them by the patient, are, for the 
most part, omitted, some in one case and some in others, and 
certain symptoms of vital importance for a conjectural judg- 
ment." But when, in addition to the diagnosis, they describe 
how each complaint should be treated, in these cases I enter- 
tain a still greater difference of opinion with them respecting 
the rules they have laid down ; and not only do I not agree 
with them on this account, but also because the remedies they 
use are few in number ; foi', with the exception of acute 
diseases, the only medicines which they give are drastic purga- 
tives, with whey, and milk at certain times. If, indeed, these 
remedies had been good and suitable to the complaints in 
which they are recommended, they would have been still more 
deserving of recommendation, if, while few in number, they 

' 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, hke the Coaca; Prjcnotioues 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. 

- By this our author means that the Cnidians neglected Prorrhetics and Pro- 
gnostics. This must be obvious to every person who has entered properly into the 
spirit of the Hippocratic system of medicine. 



REGIMEN IN ACUTE DISEASES. 283 

were sufficient ; but this is by no means the case. Those, 
indeed, avIio have remodelled these ' Sentences' have treated 
of the remedies applicable in each complaint more in a medical 
fashion. But neither have the ancients written anj^thing worth 
mentioning respecting regimen, although this be a great omis- 
sion. Some of them, indeed, were not ignorant of the many 
varieties of each complaint, and their manifold divisions, but 
when they wish to tell clearly the numbers (species?) of each 
disease they do not write correctly ;^ for their species Avould be 
almost innumerable if every symptom experienced by the 
patients were held to constitute a disease, and receive a differ- 
ent name.2 

2. For my part, I approve of paying attention to everything 
relating to the art, and that those things which can be done 
well or properly should all be done properly ; such as can be 
quickly done should be done quickly ; such as can be neatly 
done should be done neatly; such operations as can be per- 
formed without pain should be done with the least possible 
pain; and that all other things of the like kind should be done 
better than they could be managed by the attendants. But I 
would more especially commend the physician who, in acute 
diseases, by which the bulk of mankind are cut off, conducts 
the treatment better than others. Acute diseases are those 
which the ancients named pleurisy, pneumonia, phreuitis, 
lethargy, causus, and the other diseases allied to these, includ- 
ing the continual fevers. For, unless when some general form 
of pestilential disease is epidemic, and diseases are sporadic and 
[not] of a similar character, there are more deaths from these 

' 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 Littre, and 
the remarks of Galen, as quoted in the Argument. 

2 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 state- 
ment, remarks tliat 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 Ilippocratic system are admirably explained and 
developed in Galen's great work On the Method of Cure, or Therapeutics. 



284 REGIMEN IN ACUTE DISEASES. 

diseases tlian from all the others taken together.^ The vulgar, 
indeed^ do not recognise the difference between such physicians 
and their common attendants, and are rather disposed to com- 
mend and censure extraordinary remedies. This, then, is a 
great proof that the common people are most incompetent, of 
themselves, to form a judgment how such diseases should he 
treated : since persons who are not physicians pass for physi- 
cians owing most especially to these diseases, for it is an easy 
matter to learn the names of those things which are applicable 
to persons labouring under such complaints. For, if one names 
the juice of ptisan, and such and such a wine, and hj^dromel, 
the vulgar fancy that he prescribes exactly the same things as the 
physicians do, both the good and the bad, but in these matters 
there is a great difference between them. 

3. But it appears to me that those things are more especially 
deserving of being consigned to writing which are undetermined 
by physicians, notwithstanding that they are of vital impor- 
tance, and either do much good or much harm. By undeter- 
mined I mean such as these, wherefore certain physicians, 
during their wliole lives, are constantly administering unstrained 
ptisans, and fancy they thus accomplish the cure properly, 
whereas others take great pains that the patient should not 
swallow a particle of the barley (thinking it would do much 
harm), but strain the juice through a cloth before giving it; 
others, again, will neither give thick ptisan nor the juice, some 
until the seventh day of the disease, and some until after the 
crisis. 2 Physicians are not in the practice of mooting such 
questions ; nor, perhaps, if mooted, would a solution of them 

' Galen, in his Commentary on tliis passage, states tliat when a disease of a mild 
character prevailed generally, it was called an epidemic; and when of a malignant 
nature, it was called the plague. (See further Paulus /Egineta, Book II, 36, Syd. 
Soc. edition.) It will be remarked that I have included the word (wo/) in brackets. 
This I have done because not only the reading, as given in the common editions of 
Galen, is in its favour, 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. Littre, however, rejects it altogether. 

^ 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 labouring 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 ditierent individuals — that some had starved their 



REGIMEN IN ACUTE DISEASES. 285 

be fouud ; although the whole art is thereby exposed to much 
censure from the vulgar, who fancy that there really is no such 
science as medicine, since, in acute diseases, practitioners differ 
so much among themselves, that those things which one 
administers as thinking it the best that can be given^ another 
holds to be bad ; and, in this respect, they might say that the 
art of medicine resembles augury, since augurs hold that the 
same bird (omen) if seen on the left hand is good, but if on 
the right bad : and in divination by the inspection of entrails 
you will find similar differences ; but certain diviners hold the 
very opposite of these opinions.^ I say, then, that this question is 
a most excellent one, and allied to very many others, some of 
the most vital importance in the Art, for that it can contribute 
much to the recovery of the sick, and to the preservation of 
health in the case of those who are well ; and that it promotes 
the strength of those who use gymnastic exercises, and is useful 
to whatever one may wish to apply it. 

4. Ptisan, then, appears to me to be justly preferred before 
all the other preparations from grain in these diseases, and I 
commend those who made this choice," for the mucilage of it 

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 he 
remarked, does not allude to these extreme modes of practice in this place, but enters 
at great length into the question whether or not unstrained ptisan {or barley gruel) 
should be administered in fevers, and, if so, under what circumstances. 

' Galen, in his Commentary, has some very interesting remarks on the differences 
of opinion among the diviners. Tliis, 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 discre- 
ditable to the former. 

^ Our author now enters upon the consideration of one of his principal objects in 
the present work, namely, to describe the modes of preparing ptisan {or the decoction 
of barley), and its uses in acute diseases. He is so full on this subject that the pre- 
sent treatise is quoted by Athenseus (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 woidd appear to have 
been very little different from the decoction of barley, as now in use ; that is to say, 



286 REGIMEN IN ACUTE DISEASES. 

is smooth, consistent, pleasant, lubricant, moderately diluent, 
quenches thirst if this be required, and has no astringency ; 
gives no trouble nor swells up in the bowels, for in the boiling 
it swells up as much as it naturally can. Those, then, who 
make use of ptisan in such diseases, should never for a day 
allow their vessels to be empty of it, if I may say so, but should 
use it and not intermit, unless it be necessary to stop for a 
time, in order to administer medicine or a clyster. And to 
those who are accustomed to take two meals in the day it is to 
be given twice, and to those accustomed to live upon a single 
meal it is to be given once at first, and then, if the case permit, 
it is to be increased and given twice to them, if they appear to 
stand in need of it. At first it will be proper not to give a 
large quantity nor very thick, but in proportion to the quantity 
of food which one has been accustomed to take, and so as that 
the veins may not be much emptied. And, with regard to the 
augmentation of the dose, if the disease be of a drier nature 
than one had supposed,^ one must not give more of it, but 
should give before the draught of ptisan, either hydromel or Avine, 
in as great quantity as may be proper; and what is proper in 
each case will be afterwards stated by us. But if the mouth 
and the passages from the lungs be in a proper state as to 
moisture, the quantity of the draught is to be increased, as a 
general rule, for an early and abundant state of moisture indi- 
cates an early crisis, but a late and deficient moisture indicates 

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, accord- 
ing to circumstances. A similar decoction was prepared from wheat, and was called 
TTTiffavt] TTvpivi]. See Galen (De Aliment., i.) The simple term ptisan, however, is 
always to be understood as applying to the decoction of barley. 

' Galen gives the following illustration of what is meant by a disease of a pecu- 
liarly 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 recognised as being dry which are not attended with 
any discharge. 



REGIMEN IN ACUTE DISEASES. 287 

a slower crisis.^ And these tilings are as I have stated for the 
most part ; but many other things are omitted ■which are im- 
portant to the prognosis, as will be explained afterwards. And 
the more that the patient is troubled with purging, in so much 
greater quantity is it to be given until the crisis, and moreover 
until two days beyond the crisis, in such cases as it appears to 
take place on the fifth, seventh, or ninth day, so as to have 
respect both for the odd and even day : after this the draught 
is to be given early in the day, and the other food in place is to 
be given in the evening. These things are proper, for the most 
part, to be given to those who, from the first, have used ptisan 
containing its whole substance; for the pains in pleuritic affec- 
tions immediately cease of their own accord whenever the 
patients begin to expectorate anything worth mentioning, and 
the purgings become much better, and empyema much more 
seldom takes place, than if the patients used a diff'erent regimen, 
and the crises are more simple, occur earlier, and the cases are 
less subject to relapses. 

5. Ptisans are to be made of the very best barley, and are 
to be well boiled, more especially if j^ou do not intend to use 
them strained. For, besides the other virtues of ptisan, its lubri- 
cant quality prevents the barley that is swallowed from proving 
injurious, for it does not stick nor remains in the region of the 
breast ; for that which is well boiled is very lubricant, excellent 
for quenching thirst, of very easy digestion, and very weak, all 
which qualities are wanted. If, then, one do not pay proper 
attention to the mode of administering the ptisan, much harm 
may be done ; for when the food is shut up in the bowels, 
unless one procure some evacuation speedily, before administer- 
ing the draught, the pain, if present, will be exasperated ; and, 
if not present, it will be immediately created, and the respira- 
tion will become more frequent, which does mischief, for it dries 
the lungs, fatigues the hypochondria, the hypogastrium, and 
diaphragm. And moreover if, while the pain of the side persists, 

' It is curious to remark that a double charge was founded against our author on 
the ground of his treatment of febrile cases, as here laid down. The followers of 
Thessalus held that he gorged his patients with too much food, whereas Erasistratus 
and his followers held that he starved them. Galen, on the other hand, contends 
that the practice of Hippocrates is the juste milieu between these two extremes, 
(Opera, torn, v, p. 47 ; cd. Basil.) 



288 REGIMEN IN ACUTE DISEASES. 

and does not yield to warm fomentationSj and the sputa are 
not brought up^ but are viscid and unconcocted, unless one 
get the pain resolved, either by loosening the bowels, or opening 
a vein, whichever of these may be proper ; — if to persons so cir- 
cumstanced ptisan be administered, their speedy death Avill be 
the result.^ For these reasons, and for others of a similar 
kind still more, those who use unstrained ptisan die on the 
seventh day, or still earlier, some being seized with delirium, 
and others dying siifFocated with orthopnoea and rales. ^ Such 
persons the ancients thought struck, for this reason more espe- 
cially, that when dead the affected side was livid, like that of a 
person who had been struck. The cause of this is that they 
die before the pain is resolved, being seized with difficulty of 
respiration, and by large and rapid breathing, as has been 
already explained, the spittle becoming thick, acid, and uncon- 
cocted, cannot be brought up, but, being retained in the bronchi 
of the lungs, produces rfdes ; and, when it has come to this, 
death, for the most part, is inevitable ; for the sputa being 
retained prevent the breath from being drawn in, and force it 
speedily out, and thus the two conspire together to aggravate 
the mischief; for the sputa being retained renders the respira- 
tion frequent, while the respiration iDcing frequent thickens the 
sputa, and prevents them from being evacuated. These 
symptoms supervene, not only if ptisan be administered un- 
seasonably, but still more if any other food or drink worse than 
ptisan be given. 

6. For the most part, then, the results are the same, whether 
the patient have used the unstrained ptisan or have used the juice 
alone ; or even only drink ; and sometimes it is necessary to 

' This sentence shows that Hippocrates understood thoroughly the proper treat- 
ment 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. 

2 How briefly, and yet how graphically, our author has described the termination 
of pleurisy ! It is singular that no succeeding author has written so learnedly of 
rales in affections of the breast as Hippocrates, down at least to the time of Laennec, 
who repeatedly acknowledges his obligations to our author. 



REGIMEN IN ACUTE DISEASES. 289 

proceed quite differently. In general, one sliould do thus : 
if fever commences shortly after taking food, and before the 
bowels have been evacuated, whether with or without pain, the 
physician ought to withhold the draught until he thinks that 
the food has descended to the lower part of the belly ; and if 
any pain be present, the patient should use oxymel, hot if it is 
winter, and cold if it is summer; and, if there be much thirst, 
he should take hydromel and water.^ Tlien, if any pain be 
present, or any dangerous symptoms make their appearance, it 
will be proper to give the draught neither in large quantity 
nor thick, but after the seventh day, if the patient be strong. 
But if the earlier-taken food has not descended, in the case of 
a person who has recently swallowed food, and if he be strong 
and in the vigour of life, a clyster should be given, or if he be 
weaker, a suppository is to be administered, unless the bowels 
open properly of themselves. The time for administering the 
draught is to be particularly observed at the commencement 
and during the whole illness ; when, then, the feet are cold, 
one should refrain from giving the ptisan, and more especially 
abstain from drink ; but when the heat has descended to the feet, 
one may then give it ; and one should look upon this season as of 
great consequence in all diseases, and not least in acute diseases, 
especially those of a febrile character, and those of a very dan- 
gerous nature. One may first use the juice, and then the ptisan, 
attending accurately to the rules formerly laid down. 

7. When pain seizes the side, either at the commencement 
or at a later stage, it will not be improper to try to dissolve the 
pain by hot applications." Of hot applications the most powerful 
is hot water in a bottle, or bladder, or in a brazen vessel, or in 
an earthen one ,• but one must first apply something soft to 
the side, to prevent pain. A soft large sponge, squeezed out 

' I need scarcely remark that the seasonahle 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 tliat, as Galen remarks in his Commentary on this 
passage, fevers may often be extinguished at once by a large quantity of wafer given 
in due season. This subject is fully treated of by him in his Methodus Medendi. 

'^ The professional reader will not fail to remark, what is pointed out in strong lan- 
guage 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. 

19 



290 REGIMEN IN ACUTE DISEASES. 

of hot water and applied^ forms a good application ; but it 
sliovdd be covered up above^ for thus the heat will remain the 
longer^ and at the same time the vapour will be prevented from 
being carried up to the patient's breath, unless when this is 
thought of use, for sometimes it is the case. And further, 
barley or tares may be infused and boiled in diluted vinegar, 
stronger than that it could be drunk, and may then be sewed 
into bladders and applied; and one may use bran in like manner. 
Salts or toasted millet in woollen bags are excellent for forming 
a dry fomentation, for the millet is light and soothing. A soft 
fomentation like this soothes pains, even such as shoot to the cla- 
vicle. Venesection, however, does not alleviate the pain unless 
when it extends to the clavicle. But if the pain be not dis- 
solved by the fomentations, one ought not to foment for a length 
of time, for this dries the lungs and promotes suppuration; 
but if the pain point to the clavicle, or if there be a heaviness 
in the arm, or about the breast, or above the diaphragm, one 
should open the inner vein at the elbow, and not hesitate to 
abstract a large quantity, until it become much redder, or 
instead of being pure red, it turns livid, ^ for both these states 
occur. But if the pain be below the diaphragm, and do not 
point to the clavicle, we must open the belly either with black 
hellebore" or peplium,^ mixing the black hellebore with carrot 
or seseli,^ or cumin, or anise, or any other of the fragrant 
herbs ; and with the peplium the juice of sulphium'^ (assafffitida), 
for these substances, when mixed up together, are of a similar 
nature.*" The black hellebore acts more pleasantly and effectu- 

' By li\-id {irtXibi') is here meant the colour intermediate between red and black. 
See Galen, h. 1. 

^ Probably the Helleborus niger. See Paulus ^gineta, Vol. Ill, p. 108. 

' The Euphorbia peplus. See Ibid., Vol. Ill, p. 294. 

■* Probably the Seseli tortuosum. See Ibid., Vol. Ill, p. 330 ; and Dierbach, Arzn. 
der Hipp. p. 186. 

* A species of assafoetida, probably the Laserpetium derias. Paulus ^Egineta, 
Vol. Ill, p. 339. 

® It is worthy of remark, that our author directs aromatics to be mL'ied with the 
purgatives. The reason for prescribing them, as Galen states, was to counteract 
the bad effects of the purgatives upon the stomach. The ancients, in my opinion, 
acted much more wisely in this respect than the moderns generally do, for the latter 
are constantly administering the most nauseous cathartics to their patients without 
taking any pains to obviate their bad effects upon the stomach. On the ancient 
modes of administering purgatives, see Paulus /Egineta, B. VII, 4. 



UEGIMEN IN ACUTE DISEASES. 291 

ally than the peplium, while, on the other hand, the peplium 
expels wind much more effectually than the hlack hellebore, 
and both these stop the pain, and many other of the laxatives 
also stop it, but these two are the most eflicacious that I am 
acquainted with. And the laxatives given in draughts are 
beneficial, when not very unpalatable owing to bitterness, or 
any other disagreeable taste, or from quantity, colour, or 
any apprehension. When the patient has drunk the medi- 
cine, one ought to give him to swallow but little less of 
the ptisan than what he had been accustomed to ; but it is 
according to rule not to give any draughts while the medicine 
is under operation -^ but Avhen the purging is stopped then he 
.should take a smaller draught than what he had been accus- 
tomed to, and afterwards go on increasing it progressively, until 
the pain cease, provided nothing else contra-indicate. This is 
my rule, also, if one would use the juice of ptisan, (for I hold 
that it is better, on the whole, to begin with taking the decoc- 
tion at once, rather than by first emptying the veins before 
doing so, or on the third, fourth, fifth, sixth, or seventh day, 
provided the disease has not previously come to a crisis in the 
course of this time), and similar preparations to those formerly 
described are to be made in those cases. 

8. Such are the opinions which I entertain respecting the 
administering of the ptisan ; and, as regards drinks, whichsoever 
of those about to be described may be administered, the same 
directions are general^ applicable. And here I know that 
physicians are in the practice of doing the very reverse of what 
is proper, for they all wish, at the commencement of diseases, 
to starve their patients for two, three, or more days, and then 
to administer the ptisans and drinks ; and perhaps it appears 
to them reasonable that, as a great change has taken place in 
the body, it should be counteracted by another great change. 
Now, indeed, to produce a change is no small matter, but the 
change must be efiected well and cautiously, and after the 
change the administration of food must be conducted still more 

' Galen, in his Commentary, remarks that the common herd of phj'sicians folloVed 
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. 



292 REGIMEN IN ACUTE DISEASES. 

so. Those persons, then, would be most injured if the change 
is not properl}'- managed, who used unstrained ptisans ; they 
also would suffer who made use of the juice alone ; and so also 
they would suffer who took merely drink, but these least of all. 
9. One may derive information from the regimen of persons 
in good health what things are proper ; for if it appear that 
there is a great difference whether the diet be so and so, in 
other respects, but more especially in the changes, how can it 
be otherwise in diseases, and more especially in the most 
acute? But it is well ascertained that even a faulty diet of 
food and drink steadily persevered in, is safer in the main as 
regards health than if one suddenly change it to another. 
Wherefore, in the case of persons who take two meals in the 
day, or of those who take a single meal, sudden changes induce 
suffering and weakness ; and thus persons who have not been 
accustomed to dine, if they shall take dinner, immediately 
become weak, have heaviness over their whole body, and become 
feeble and languid, and if, in addition, they take supper, they 
will have acid eructations, and some will have diarrhoea whose 
boAvels were previously dry, and not having been accustomed to 
be twice swelled out with food and to digest it twice a day, 
have been loaded beyond their wont. It is beneficial, in such 
cases, to counterbalance this change, for one should sleep after 
dinner, as if passing the night, and guard against cold in winter 
and heat in summer; or, if the person cannot sleep, he may 
stroll about slowly, but without making stops, for a good while, 
take no supper, or, at all events, eat little, and only things 
that are not unwholesome, and still more avoid drink, and 
especially water. Such a person will suffer still more if he 
take three full meals in the day, and more still if he take more 
meals ; and yet there are many persons who readily bear to 
take three full meals in the day, provided they are so accus- 
tomed. And, moreover, those who have been in the habit of 
eating twice a day, if they omit dinner, become feeble and 
powerless, averse to all work, and have heartbm'n ; their bowels 
seem, as it were, to hang loose, their urine is hot and green, 
and the excrement is parched ; in some the mouth is bitter, 
the eyes are hollow, the temples throb, and the extremities are 
cold, and the most of those who have thus missed their dinner 
cannot eat supper ; or, if they do sup, they load their stomach. 



REGIMEN IN ACUTE DISEASES. 293 

and pass a much worse night than if they had previously 
taken dinner. Since, then, an unwonted change of diet for 
half a day produces such effects upon persons in health, it 
appears not to be a good thing either to add or take from. If, 
then, he Avho was restricted to a single meal, contrary to usage, 
having his veins thus left empty during a whole day, when he 
supped according to custom felt heavy, it is probable that if, 
because he was uneasy and weak from the want of dinner, he 
took a larger supper than wont, he would be still more 
oppressed ; or if, wanting food for a still greater interval, he 
suddenly took a meal after supper, he will feel still greater 
oppression. He, then, who, contrary to usage, has had his 
veins kept empty by want of food, will find it beneficial to 
counteract the bad effects during that day as follows : let 
him avoid cold, heat, and exertion, for he could bear all these 
ill ; let him make his supper considerably less than usual, and 
not of dry food, but rather liquid ; and let him take some drink, 
not of a watery character, nor in smaller quantity than is pro- 
portionate to the food, and on the next day he should take a 
small dinner, so that, hj degrees, he may retui'n to his former 
practice. Persons who are bilious in the stomach bear these 
changes worst, while those who are pituitous, upon the whole, 
bear the want of food best, so that theysuffer the least from being- 
restricted to one meal in the day, contrary to usage. This, 
then_, is a sufficient proof that the greatest changes as to those 
things which regard our constitutions and habits are most espe- 
cially concerned in the production of diseases, for it is impossible 
to produce unseasonably a great emptying of the vessels by 
abstinence, or to administer food while diseases are at their 
acme, or when inflammation prevails; nor, on the whole, to make 
a great change either one way or another with impunity.^ 

10. One might mention man}^ things akin to these respecting 
the stomach and bowels, to show how people readily bear such 
food as they are accustomed to, even if it is not naturally good, 
and drink in like manner, and how they bear unpleasantly such 
food as they are not accustomed to, even although not bad, and 
so in like manner with drink ; and as to the effects of eating 
much flesh, contrary to usage, or garlic, or assafoetida, or the 
stem of the plant which produces it, or things of a similar kind 

' See Celsus, I, 3. 



294 REGIMEN IN ACUTE DISEASES. 

possessed of strong properties, one would be less surprised if 
such tilings produce pains in the bowels, but rather when one 
learned what trouble, swelling, flatulence, and tormina the cake 
(maza) will raise in the belly when eaten by a person not 
accustomed to it ; and how much weight and distension of the 
bowels bread will create to a person accustomed to live upon 
the maza; and what thirst and sudden fuhiess will be occa- 
sioned by eating hot bread, owing to its desiccant and indiges- 
tible properties ; and what different effects are produced by 
fine and coarse bread when eaten contrary to usage, or by the 
cake when unusually dry, moist, or viscid ; and what different 
effects polenta produces upon those who are accustomed and 
those who are unaccustomed to the use of it ; or drinking of 
wine or drinking of water, when either custom is suddenly 
exchanged for the other ; or when, contrary to usage, diluted 
wine or undiluted has been suddenly drunk, for the one will 
create water-brash in the upper part of the intestinal canal and 
flatulence in the lower, while the other will give rise to throb- 
bing of the arteries, heaviness of the head, and thirst ; and 
white and dark-coloured wine, although both strong wines, if 
exchanged contrary to usage, will produce very difierent eflects 
upon the body, so that the one need the less wonder that a 
sweet and strong wine, if suddenly exchanged, should have by 
no means the same effect. 

11. Let us here briefly advert to what may be said on the 
opposite side ; namely, that a change of diet has occurred in these 
cases, without any change in their body, either as to strength, 
so as to require an increase of food, or as to weakness, so as to 
require a diminution. But the strength of the patient is to be 
taken into consideration, and the manner of the disease, and of 
the constitution of the man, and the habitual regimen of the pa- 
tient, not only as regards food but also drink. Yet one must 
much less resort to augmentation, since it is often beneficial to 
have recourse to abstraction, when the patient can bear it, until 
the disease having reached its acme and has become concocted. 
But in what cases this must be done will be afterwards described. 
One might Avrite many other things akin to those which have 
been nov/ said, but there is a better proof, for it is not akin to 
the matter on which my discourse has principally turned, but 
the subject-matter itself is a most seasonable proof. For some 



REGIMEN IN ACUTE DISEASES. 295 

at the commencement of acute diseases have taken food on the 
same day, some on the next day ; some have swallowed what- 
ever has come in their way, and some have taken cyceon} 
Now all these things are worse than if one had observed a dif- 
ferent regimen ; and yet these mistakes, committed at that 
time, do much less injury than if one Avere to abstain entirely 
from food for the first two or three daj^s, and on the fourth or 
fifth day were to take such food ; and it would be still worse, 
if one were to observe total abstinence for all these days, and 
on the following days were to take such a diet, before the dis- 
ease is concocted :" for in this way death would be the conse- 
quence to most people, unless the disease Avere of a very mild 
nature. But the mistakes committed at first were not so irre- 
mediable as these, but could be much more easily repaired. 
This, therefore, I think a strong proof that such or such a 
draught need not be proscribed on the first days to those who 
will use the same draughts afterwards. At the bottom, there- 
fore, they do not know, neither those using unstrained ptisans, 
that they are hurt by them, when they begin to swallow them, 
if they abstain entirely from food for two, three, or more days ; 
nor do those using the juice know that they are injured in 
swallowing them, when they do not commence with the draught 
seasonably. But this they "guard against, and know that it 
does much mischief, if, before the disease be concocted, the 
patient swallow unstrained ptisan, when accustomed to use 
strained. All these things are strong proofs that physicians 
do not conduct the regimen of patients properly, but that in 
those diseases in which total abstinence from food should not 
be enforced on patients that will be put on the use of ptisans, 
they do enforce total abstinence ; that in those cases in which 
there should be no change made from total abstinence to 

' The cyceon was a mixture of various articles of food, Init generally contained 
cheese, honey, and wine. See Athenaius (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 Ilippocratic treatises, as at De Diaita, ii ; de 
Muliebribus, ii ; and in the works of the other medical authors. 

^ 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. 



296 REGIMEN IN ACUTE DISEASES. 

ptisans, they do make tlie cliange ; and tliat, for the most part, 
they change from abstinence to ptisans, exactly at the time 
when it is often beneficial to proceed from ptisans almost to 
total abstinence, if the disease happen to be in the state of 
exacerbation.^ And sometimes crude matters are attracted 
from the head, and bilious from the region near the chest, and 
the patients are attacked with insomnolency, so that the dis- 
ease is not concocted ; they become sorrowful, peevish, and 
delirious ; there are flashes of light in their eyes, and noises in 
their ears ; their extremities are cold, their urine unconcocted ; 
the sputa thin, saltish, tinged with an intense colour and smell; 
sweats about the neck, and anxiety ; respiration, interrupted in 
the expulsion of the air,^ frequent and very large ; expression 
of the eyelids dreadful ; dangerous deliquia; tossing of the bed- 
clothes from the breast ; the hands trembling, and sometimes 
the lower lip agitated. These symptoms, appearing at the 
commencement, are indicative of strong delirium, and patients 
so affected generally die, or if they escape, it is with a deposit, 
hemorrhage from the nose, or the expectoration of thick matter, 
and not otherwise. Neither do I perceive that physicians are 
skilled in such things as these ; how they ought to know such 
diseases as are connected with debility, and which are further 
weakened by abstinence from food, and those aggravated hy 
some other irritation ; those by pain, and from the acute nature 
of the disease, and what affections and various forms thereof our 
constitution and habit engender, although the knowledge or igno- 
rance of such things brings safety or death to the patient. For 
it is a great mischief if to a patient debilitated by pain, and the 
acute nature of the disease, one administer drink, or more ptisan, 
or food, supposing that the debility proceeds from inanition. 

• There is considerable difficulty as to the text at this place. See Foes in his 
Annotations and fficonomica, and a very lengthy note by Littre. 

" The preternatural mode of respiration here described is several times adverted 
toby Galen, as at De Dyspnoea, 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 col- 
lateral 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 
gi'eat ignorance and uncertainty prevail among us, even at the present day. 



REGIMEN IN ACUTE DISEASES. 297 

It is also disgraceful not to recognise a patient whose debility- 
is connected with inanition^ and to pinch him in his diet ; this 
mistake, indeed, is attended with some danger, but much less 
than the other, and yet it is likely to expose one to much 
greater derision, for if another physician, or a private person, 
coming in and knowing what has happened, should give to eat 
or drink those things which the other had forbidden, the benefit 
thus done to the patient Avould be manifest. Such mistakes of 
practitioners are particularly ridiculed by mankind, for the 
physician or non -professional man thus coming in, seems as it 
Avere to resuscitate the dead. On this subject I will describe 
elsewhere the symptoms by which each of them may be re- 
cognised. 

12. And the following observations are similar to those now 
made respecting the bowels. If the whole body rest long, con- 
trary to usage, it does not immediately recover its strength ; 
but if, after a protracted repose, it proceed to labour, it will 
clearly expose its weakness. So it is with every one part of 
the body, for the feet will make a similar display, and any other 
of the joints, if, being unaccustomed to labour, they be sud- 
denly brought into action, after a time. The teeth and the 
eyes will sufier in like manner, and also every other part 
whatever. A couch, also, that is either softer or harder than 
one has been accustomed to will create uneasiness, and sleeping 
in the open air, contrary to usage, hardens the body. But it 
is sufficient merely to state examples of all these cases. If a 
person having received a wound in the leg, neither very serious 
nor very trifling, and he being neither in a condition very fa- 
vorable to its healing nor the contrar}^, at first betakes himself 
to bed, in order to promote the cure, and never raises his leg, 
it will thus be much less disposed to inflammation, and be much 
sooner well, than it Avould have been if he had strolled about 
during the process of healing ; but if upon the fifth or sixth day, 
or even earlier, he should get up and attempt to walk, he will 
suffer much more then than if he had walked about from the 
commencement of the cure, and if he should suddenly make 
many laborious exertions, he will sufi'er much more than if, 
when the treatment was conducted otherwise, he had made the 
same exertions on the same days. In fine, all these things 
concur in proving that all great changes, either one way or 



298 REGIMEN IN ACUTE DISEASES. 

another, are hurtful. ^Vlierefore much mischief takes place in 
the bowels, if from a state of great inanition more food than is 
moderate be administered (and also in the rest of the body, if 
from a state of great rest it be hastily brought to greater exer- 
tion, it will be much more injured), or if from the use of much 
food it be changed to complete abstinence, and therefore the 
body in such cases requires protracted repose, and if, from a 
state of laborious exertion, the body suddenly falls into a state 
of ease and indolence, in these cases also the bowels would re- 
quire continued repose from abundance of food, for otherwise 
it Avill induce pain and heaviness in the whole body. 

13. The greater part of my discourse has related to changes, 
this way or that. For all purposes it is profitable to know these 
things, and more especially respecting the subjegt under con- 
sideriition, — that in acute diseases, in which a change is made 
to ptisans from a state of inanition, it should be made as I 
direct ; and then that ptisans should not be iised until the dis- 
ease be concocted, or some other symptom, whether of evacua- 
tion or of irritation, appear in the intestines, or in the hypo- 
chondria, such as will be described. Obstinate insomnolency 
impairs the digestion of the food and drink, and in other re- 
spects changes and relaxes the body, and occasions a heated 
state, and heaviness of the head.^ 

14. One must determine by such marks as these, when 
sweet, strong, and dark wine, hydromel, water, and oxymel, 
should be given in acute diseases. 2 Wherefore the sweet affects 
the head less than the strong, attacks the brain less, evacuates 
the bowels more than the other, but induces swelling of the 
spleen and liver; it does not agree with bilious persons, for it 
causes them to thirst ; it creates flatulence in the upper part 
of the intestinal canal, but does not disagree with the lower 

' Galen finds the language in tliis 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 pubhshed until after his death. He decides that 
k<p(j6Ti)Q signifies a heated state connected with humours, and not with dryness ; 
that is to say, a condition analogous to boiling, and not to i-oasting. 

^ 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 veiy much to the 
purpose, and highly judicious. For the other ancient authorities on this subject, 
see Paulits ^Egineta, Book I, 95, Syd. Soc. edit. 



REGIMEN IN ACUTE DISEASES. 2[)!) 

part; as far as regards flatulence ; and yet flatulence engendered 
by sweet wine is not of a transient nature, but rests for a long 
time in the hypochondria. And therefore it in general is less 
diuretic than wine which is strong and thin ; but sweet wine is 
more expectorant than the other. But v/hen it creates thirst, 
it is less expectorant in such cases than the other wine, but if 
it do not create thirst, it promotes expectoration better than 
the other. The good and bad effects of a white, strong wine, 
have been already frequently and fulh^ stated in the disquisition 
on sweet wine; it is determined to tlie bladder more than the 
other, is diuretic and laxative, and should be very useful in such 
complaints ; for if in other respects it be less suitable than the 
other, the clearing out of the bladder effected by it is beneficial 
to the patient, if properly administered. There are excellent 
examples of the beneficial and injurious effects of wine, all which 
were left undetermined by my predecessors. In these diseases 
you may use a yellow wine, and a dark austere wine for the 
following purposes : if there be no heaviness of the head, nor 
delirium, nor stoppage of the expectoration, nor retention of 
the urine, and if the alvine discharges be more loose and like 
scrapings than usual, in such cases a change from a white wine 
to such as I have mentioned, might be very proper. It deserves 
further to be known, that it will prove less injurious to all the 
parts above, and to the bladder, if it be of a more watery nature, 
but that the stronger it is, it will be the more beneficial to the 
bowels. 

15. Hydromel, when drunk in any stage of acute disease, 
is less suitable to persons of a bilious temperament, and to 
those who have enlarged viscera, than to those of a different 
character ; it increases thirst less than sweet wine ; it softens 
the lungs, is moderately expectorant, and alleviates a cough ; 
for it has some detergent quality in it, whence it lubricates the 
sputum.^ Hydromel is also moderately diuretic, unless pre- 
vented by the state of any of the viscera. And it also occasions 
bilious discharges downwards, sometimes of a proper character, 
and sometimes more intense and frothy than is suitable ; but 

' I need scarcely mention that hydromel was a drink prepared l)y boiling honey 
in a large proportion of water. It was of different degrees of strength ; sometimes 
there were only two parts of water to one of honey, and at other times from seven 
to eight parts were used. See Paulus /EgimetAj Book I, 90, Syd. Soc. edit. 



300 REGIMEN IN ACUTE DISEASES. 

such rather occurs in persons who are bilious, and have enlarged 
viscera. Hj'dromel rather produces expectoration, and softening 
of the lungs, when given diluted with Avater.^ But unmixed 
hydromel, rather than the diluted, produces frothy evacuations, 
such as are unseasonably and intensely bilious, and too hot ; 
but such an evacuation occasions other great mischiefs, for it 
neither extinguishes the heat in the hypochondria, but rouses 
it, induces inquietude, and jactitation of the limbs, and ulcerates 
the intestines and anus. The remedies for all these will be 
described afterwards. By using hydromel without ptisans, in- 
stead of any other drink, you will generally succeed in the 
treatment of such diseases, and fail in few cases ; but in what 
instances it is to be given, and in what it is not to be given, 
and wherefore it is not to be given, — all this has been explained 
already, for the most part. Hydromel is generally condemned, 
as if it weakened the powers of those who drink it, and on that 
account it is supposed to accelerate death; and this opinion 
arose from persons who starve themselves to death, some of 
whom use hj'dromel alone for drink, as fancying that it really 
has this effect. But this is by no means always the case. For 
hydromel, if drunk alone, is much stronger than water, if it do 
not disorder the bowels ; but in some respects it is stronger, 
and in some weaker, than wine that is thin, weak, and devoid 
of bouquet. There is a great difference between unmixed wine 
and unmixed honey, as to their nutritive powers, for if a man 
will drink double the quantity of pure wine, to a certain quan- 
tity of honey which is swallowed, he will find himself much 
stronger from the honey, provided it do not disagree with his 
bowels, and that his alvine evacuations from it will be much 
more copious. But if he shall use ptisan for a draught, and 
drink afterwards hydromel, he will feel full, flatulent, and un- 
comfortable in the viscera of the hypochondrium ; but if the 
hydromel be taken before the draught, it will not have the same 
injurious effects as if taken after it, but will be rather beneficial. 
And boiled hydromel has a much more elegant appearance than 
the unboiled, being clear, thin, white, and transparent, but I 

' 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, toiu. v, pp. 75, 70 ; 
ed. Basil.) 



REGIMEN IN ACUTE DISEASES. 301 

am unable to mention any good quality which it possesses that 
the other wants. For it is not sweeter than the unboiled, pro- 
vided the honey be fine, and it is weaker, and occasions less 
copious evacuations of the bowels, neither of which effects is 
required from the hydromel. But one should by all means 
use it boiled, provided the honey be bad, impure, black, and 
not fragrant, for the boiling will remove the most of its bad 
qualities and appearances. 

16. You will find the drink, called oxymel, often very useful 
in these complaints, for it promotes expectoration and freedom of 
breathing. The following are the proper occasions for admi- 
nistering it. When strongly acid it has no mean operation in 
rendering the expectoration more easy, for by bringing up the 
sputa, which occasion troublesome hawking, and rendering 
them more slippery, and, as it were, clearing the windpipe with 
a feather, it relieves the lungs and proves emollient to them ; 
and when it succeeds in producing these effects it must do 
much good. But there are cases in which hydromel, strongly 
acid, does not promote expectoration, but renders it more viscid 
and thus does harm, and it is most apt to produce these bad 
effects in cases which are otherwise of a fatal character, when 
the patient is unable to cough or bring up the sputa. On this 
account, then, one ought to consider beforehand the strength of 
the patient, and if there be any hope, then one may give it, 
but if given at all in such cases it should be quite tepid, and 
in by no means large doses. But if slightly acrid it moistens 
the mouth and throat, promotes expectoration, and quenches 
thirst ; agrees with the viscera seated in the hypochoudrium, 
and obviates the bad effects of the honey ; for the bilious quality 
of the honey is thereby corrected. It also promotes flatulent 
discharges from the bowels, and is diuretic, but it occasions 
watery discharges and those resembling scrapings, from the 
lower part of the intestine, which is sometimes a bad thing in 
acute diseases, more especially when the flatulence cannot be 
passed, but rolls backwards ; and otherwise it diminishes the 
strength and makes the extremities cold; this is the only bad 
effect Avorth mentioning which I have known to arise from the 
oxymel. It may suit well to drink a little of this at night 
before the draught of ptisan, and when a considerable interval 
of time has passed after the draught there will be nothing to 



302 REGIMEN IN ACUTE DISEASES. 

prevent its being taken. But to tliose who are restricted entirely 
to drinks without draughts of ptisan, it will therefore not be 
proper at all times to give it, more especially from the fretting 
and irritation of the intestine which it occasions, (and these 
bad effects it will be the more apt to produce provided there 
be no faeces in the intestines and the patient is labouring under 
inanition,) and then it will weaken the powers of the hydromel. 
But if it appears advantageous to use a great deal of this drink 
during the whole course of the disease, one should add to it 
merely as much vinegar as can just be perceived by the taste, 
for thus what is prejudicial in it will do the least possible harm, 
and what is beneficial will do the mt)re good. In a word, the 
acidity of vinegar agrees rather with those who are troubled 
with bitter bile, than with those patients whose bile is black ; 
for the bitter principle is dissolved in it and turned to phlegm, 
by being suspended in it ; whereas black bile is fermented, 
swells up, and is multiplied thereby : for vinegar is a melano- 
gogue. Vinegar is more prejudicial to Avomen than to men, for 
it creates pains in the uterus. 

17. I have nothing further to add as to the effects of water 
when used as a drink in acute diseases ; for it neither soothes 
the cough in pneumonia, nor promotes expectoration, but does 
less than the others in this respect, if used alone through the 
whole complaint. But if taken intermediate between oxymel 
and hydromel, in small quantity, it promotes expectoration from 
the change which it occasions in the qualities of these drinks, 
for it produces, as it were, a certain overflow. Otherwise it 
does not quench the thirst, for it creates bile in a bilious tem- 
perament, and is injurious to the hypochondrium ; and it does 
the most harm, engenders most bile, and does the least good 
when the bowels are empty ; and it increases the swelling of 
the spleen and liver when they are in an inflamed state ; it 
produces a gurgling noise in the intestines and swims on the 
stomach ; for it passes slowly downwards, as being of a coldish 
and indigestible nature, and neither proves laxative nor diuretic ; 
and in this respect, too, it proves prejudicial, that it does not 
naturally form fseces in the intestines : and, if it be drunk while 
the feet are cold, its injurious effects will be greatly aggravated, 
in all those parts to which it may be determined. When you 
suspect in these diseases either strong heaviness of the head, or 



REGIMEN IN ACUTE DISEASES. 303 

mental alienation, you must abstain entirely from wine, and in 
this case use water, or give a weak, straw-coloured wine, entirely 
devoid of bouquet, after wliicli a little water is to be given in 
addition ; for thus tlie strength of the wine will less affect the 
head and the understanding : but in which cases water is 
mostly to be given for drink, when in large quantity, when in 
moderate, when cold, and w^hcn hot ; all these things have 
either been discussed already or will be treated of at the proper 
time. In like manner, with respect to all the others, such as 
barley-water, the drinks made from green shoots, those from 
raisins, and the skins of grapes and wheat, and bastard saffron, 
and myrtles, pomegranates, and the others, when the proper 
time for using them is come, they will be treated of along with 
the disease in question, in like manner as the other compound 
medicines.^ 

18. The bath is useful in many diseases, in some of them 
when used steadily, and in others when not so. Sometimes it 
must be less used than it would be otherwise, from the want 
of accommodation ; for in few families are all the conveniences 
prepared, and persons who can manage them as they ought to 
be. And if the patient be not bathed properly, he may be 
thereby hurt in no inconsiderable degree, for there is required 
a place to cover him that is fre"e of smoke, abundance of water, 
materials for frequent baths, but not very large, unless this 
should be required. It is better that no friction should be 

' 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 he seen from the contents of this section that 
our author was by no means disposed to give water freely in febrile diseases, nor in 
aflfections 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, torn, v, 
p. 82 ; ed. Basil.) It will be perceived from tlie 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. 



304 REGIMEN IN ACUTE DISEASES. 

applied, but if so, a hot soap [smegma) ^ must be used in greater 
abundance than is common, and an affusion of a considerable 
quantity of Avater is to be made at the same time and after- 
wards repeated. There must also be a short passage to the 
basin, and it should be of easy ingress and egress. But the 
person who takes the bath should be orderly and reserved in 
his manner, should do nothing for himself, but others should 
pour the water upon him and rub him, and plenty of waters, 
of various temperatures, should be in readiness for the douche, 
and the affusions quickly made;^ and sponges should be used 
instead of the comb [strigil,) and the body should be anointed 
when not quite dry. But the head should be rubbed by the 
sponge until it is quite dry; the extremities should be protected 
from cold, as also the head and the rest of the body ; and a 
man should not be washed immediatelv after he has taken a 
draught of ptisan or a drink ; neither should he take ptisan as 
a drink immediately after the bath. Much will depend upon 
whether the patient, when in good health, Avas very fond of 
the bath, and in the custom of taking it : for such persons, 
especially, feel the want of it, and are benefited if they are 
bathed, and injured if they are not. In general it suits better 
with cases of pneumonia than in ardent fevers ; for the bath 
soothes the pain in the side, chest, and back ; concocts the 
sputa, promotes expectoration, improves the respiration, and 
allays lassitude; for it soothes the joints and outer skin, and 

1 The smegma was an abstergent composition used by the ancients in bathing for 
the purpose of cleansing the skin. For a full account of the smegmata, see Paulus 
jEgineta, Vol. Ill, pp. 536-41. 

* Galen, in his Commentary, remarks that the physicians usually did not put their 
patients into the bath, but made use of the douche, or affusion of hot water. He 
adds, that persons in good health may leave the hot bath and plunge into the cold, 
but that this practice is not safe in the case of invalids. He recommends, then, 
that there should be at hand a good supply of baths of various temperatures, so that 
the patient may gradually pass from one of a high to others of a low temperature. 
By the way, I have often wondered that Dr. Currie, who certainly had no incon- 
siderable 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 re- 
spectable 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, 



REGIMEN IN ACUTE DISEASES. 305 

is diuretic, removes heaviness of the head, and moistens the 
nose. Such are the benefits to be derived from the bath, if 
all the proper requisites be present ; Imt if one or more of these 
be wanting, the bath, instead of doing good, may rather prove 
injurious; for every one of them may do harm if not prepared 
by the attendants in the proper manner. It is by no means a 
suitable thing in these diseases to persons whose bowels are 
too loose, or when they are unusually confined, and there has 
been no previous evacuation ; neither must we bathe those who 
are debilitated, nor such as have nausea or vomiting, or bilious 
eructations ; nor such as have hemorrhage from the nose, 
unless it be less than required at that stage of the disease, 
(with those stages you are acquainted :) but if the discharge 
be less than proper, one should use the bath, whether in order 
to benefit the whole body or the head alone. If then the 
proper requisites be at hand, and the patient be well disposed 
to the bath, it may be administered once every day, or if the 
patient be fond of the bath there will be no harm, though he 
should take it twice in the day. The use of the bath is much 
more appropriate to those who take unstrained ptisan, than to 
those who take only the juice of it, although even in their case 
it may be proper; but least of all does it suit with those who 
use only plain drink, although, in their case too it may be 
suitable : but one must form a judgment from the rules laid 
down before, in which of these modes of regimen the bath will 
be beneficial, and in which not. Such as want some of the 
requisites for a proper bath, but have those symptoms which 
would be benefited by it, should be bathed ; whereas those who 
want none of the proper requisites, but have certain symptoms 
which contraindicate the bath, are not to be bathed. 



20 



APPENDIX 



TO 



THE WOKK ON REGIMEN IN ACUTE DISEASES. 



THE ARGUMENT. 

No one can read this piece attentively without coming to 
the conclusion that it is not a natural continuation of the sub- 
ject discussed in the preceding work, but that it is made up, 
in a considerable measure, of materials extracted from it. Ex- 
positions of subjects Avliich are there given methodically are 
here presented in a disjointed form ; and rules of practice there 
laid down with precision are here often delivered in a vague 
and indefinite shape. Still, however, it must be admitted, 
that the reverse is sometimes the case, and that what is pre- 
sented imperfect in the former part of the work is here some- 
times reproduced very much improved. It has been therefore 
a matter of much dispute among the critics whether this portion 
be the composition of Hippocrates, or whether it be altogether 
the work of a difierent hand. The most probable conjecture 
respecting it seems to be, that as Hippocrates in the preceding 
part several times announces his intention of giving a continua- 
tion of the subject, some one of his immediate disciples undertook 
the work which he had thus promised, and composed this 
treatise from fragments left by the author himself, and from 
materials collected from his other works. As stated bv Galen 
in his Commentary, and as we have explained in our remarks 
on the ' Aphorisms,' in the second section of the Preliminary 
Discourse, it was a common practice, in ancient times, to add 
appendices to popular works. I can have no hesitation, then, 
in following the example of M. Littre, who recognises it as an 
appendix to the preceding work. But I must say that I rather 
incline, with Galen, to think that there are many things in it 
which cannot have come from Hippocrates, than to hold with 



REGIMEN IN ACUTE DISEASES— APPENDIX. 307 

M. Littre that it is nearly or altogether his composition. But 
however that may be, it indisputably contains much interesting 
matter, for which we have every reason to believe that we are 
indebted to Hippocrates, either directly or at second hand. I 
shall now give a brief abstract of its contents. 

He commences with some general observations on the nature 
and treatment of causus, the endemial fever of Greece. AVhat 
is said on this head is much to the purpose, but incomplete. 
Then there is given a general rule for bleeding in diseases 
which cei-tainly is well deserving of attention at the present 
day, when professional opinions on this point of medical practice 
are very much unsettled. Now-adays we have abandoned 
all general rules of practice, and profess to be guided solely by 
experience ; but how variable and uncertain are its results in 
the present case ! I myself — albeit but verging towards the 
decline of life — can well remember the time when a physician 
would have run the risk of being indicted for culpable homicide 
if he had ventured to bleed a patient in common fever ; about 
twenty-five years ago venesection in fever, and in almost every 
disease, v/as the established order of the day; and now what 
shall I state as the general practice that has been sanctioned by 
the experience of the present generation ? I can scarcely say, — 
so variable has the practice in fever and in many other diseases 
become of late years. One thing is remarkable in the present 
work with regard to venesection in pneumonia and pleurisy, 
namely, that it is directed to be carried the length of inducing 
deliquium animi, contrary to the practice laid down in the pre- 
ceding work, and to the rule which was followed by all the other 
ancient authorities. Another of the rules regarding bleeding 
here delivered is also deserving of attention, namely, that in 
inflammatory diseases it is improper to purge before bleeding, 
but that venesection should precede all other means of cure. 

The section in which cynanche is treated of appears to me 
to be highly interesting and important. I think it may be a 
question whether the prognostic spirit of Hippocrates and his 
followers had not in a great measure anticipated all the results 
of modern diagnosis. 

After this there follows some additional account of causus, 
Avhich, although out of place, contains observations of consider- 
able interest. 



308 ARGUMENT. 

To the treatment of pleurisy and pneumonia we have already 
alluded, but the subject is so interesting that we cannot dismiss 
it with so brief a notice. In the ancient method of treating 
fevers and febrile affections three main objects would appear 
to have been kept in view : 1st, by depiction, to remove the 
morbid fluids from the general system, or to draw them ofl" 
from a particular spot in which they had fixed ; 2d, by diluents, 
to supply the waste of fluids occasioned by the preternatural 
heat of the body ; and, 3d, to support the strength by a suit- 
able supply of such nutriment as the system is then capable 
of receiving. 

Now with regard to venesection, it will be seen in this and 
the preceding work that the practice is regulated by certain 
well-marked indications, namely, the seat of the pain, the con- 
dition of the patient, and the characters of the sputa. The 
purging is regulated by the state of matters below the chest, 
it being held as a general rule that ctysters should be admi- 
nistered regularly every day during the first days of the fever. 
After purging comes the cooling drinks, such as oxymel. The 
administration of fai^inaceous food in a liquid state, that is to 
say, of unstrained ptisan, is to be regulated by the state of 
the sputa and urinary sediment, namely, when the sputa have 
put ou a purulent appearance, and the sediment has become 
copious and reddish. Now this certainly seems to be a very in- 
telligible and judicious rule for the administration of nutritious 
articles in febrile diseases. I need scarcely remark that at the 
present time there is scarcely a rule of practice in medicine 
which is worse defined than this respecting the administration 
of Avine and other alimentary substances in febrile diseases. 
In proof of what is now stated, I would beg leave to refer the 
reader to what will be admitted to be one of the best autho- 
rities in modern literature on fever, I mean to Dr. Tweedie's 
elaborate article on this subject, in the ' Cyclopaedia of Medi- 
cine.' It will be seen, at vol. ii, p. 208, that the rules for 
the administration of wine and other articles of food are by 
no means well defined. A cool skin and a soft pulse, when 
combined with debility, are the indications upon which most 
stress is laid; but the pulse, as long ago it was pronounced by 
Celsus to be, is "res fallacissima," and of this the excellent 
author seems to have been sensible ; for the injunctions which 



REGIMEN IN ACUTE DISEASES— x\PPENDIX. 309 

he gives to regulate the administration of the wine and other 
articles^ by the eflects thej^ produce, sufficiently show that he 
was sensible how deficient in precision our knowledge of the 
subject is at present. At the same time he makes it appear 
that he was well aware of one important fact in the treatment 
of febrile diseases, which, although distinctly recognised by 
Hippocrates, is still frequently overlooked by ordinary prac- 
titioners, namely, that in convalescence the stomach partakes 
of the general debility, and is unable to digest food in any 
great quantity at that time.' M. Littre further calls attention 
to another rule for the administration of wine, lately laid down 
by Dr. Stokes, of Dublin, which is certainly a most important 
one, provided it is confirmed by time and experience. It is 
founded on auscultation, and is to this effect ; that when the 
impulse of the heart is abnormally weak, and when there is a 
diminution of the proportion between the two bruits, or when 
there is a preponderance in the sound of the second dndt, wine 
may be freely administered. Now, as I have said, this rule, if 
sanctioned by ample experience, is undoubtedly a most excellent 
one ; but T may be allowed to remark, that my own observa- 
tions on the heart in fever have led me to the conclusion that, 
as I have stated respecting the pulse, its sounds are very 
fallacious ; and I must say that the rule of Hippocrates appears 
more likely to prove a certain guide in this instance. For is it 
not a natural view of the subject, that wine and other articles 
of food should be withheld while the emunctories arc not in 
a condition to cast off the recrementitious superfluities of the 
system ; but that when the secretions are jjroperly established, 
alimentary substances may be safely administered?" 

' 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 sto- 
mach), in convalescence, partakes of the external or muscular debdify, and the con- 
valescent 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 Icind." (p. 215.) 

'^ The directions given by that excellent authority Alexander Trallian, for the re- 
gulation of the regimen in phrenitis, are to the same effect. Wine is to be given 
when there is much insomnolency, when the strength is reduced, when the fever is 
no longer strong and ardent, and tvhen concoction ap]iears already in the urine. The 
author makes the acute remark, that the remedy is attended with certain evil con- 
se(iuences, 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.) 



310 ARGUMENT. 

There is another point connected with the regimen in acute 
diseases on which I have a remark or two to make — it is the 
administration of animal matters in a fluid state^ such as beef- 
tea^ or soups from fowls. These we see frequently administered 
in febrile cases by practitioners of the present day, but by the 
ancient authorities they would appear to have been entirely 
rejected. Which party is the safer guide in this case ? For 
my own part, I have long thought that animal matters, when 
introduced into the system while in a febrile state, have a 
tendency to become putrid, and thereby to occasion an increase 
of the heat and general disorder. 

After some defective observations on dysentery, our author 
treats of tetanus ; but here Galen objects to the characters 
which he gives of the urine, and to his practice as regards the 
administration of wine. His views, however, are not very 
different from those which now prevail. 

Having made some general remarks on the administration 
of hellebore, to which he was very partial, he proceeds to point 
out the bad effects resulting from any change in regimen. His 
views here are very similar to the observations contained in the 
preceding portion of the work, and in the treatise ' On Ancient 
Medicine.' 

The account of dry cholera is confused and vague. By it 
he would seem to mean flatulent colic, or dry bellyache. See 
Opera, ed. Littre, torn, ii, p. 388. 

The paragraph on dropsy is interesting, although the views 
taken of the subject are incomplete. Tympanitis is recognised 
as a variety of dropsy. Then follow some detached observations 
on persons whose boAvels are heated, and on the regulation of the 
diet, Avith some remarks on the different states which counter- 
indicate purging. At § 23 there are some practical observations 
on various conditions of the constitution, which it would no 
doubt be proper for the physician to make himself acquainted 
Avith. The contents of all the remaining paragraphs would seem 
to have nothing to do with the subject of this treatise. 

From what is now stated the reader will readily perceive 
that this treatise abounds in interesting matters, which, even 
at the present day, may prove suggestive of important views in 
the theory and practice of medicine. And although the style, 
in the judgment of Galen, be very different from that of 



REGIMEN IN ACUTE DISEASES— APPENDIX. 311 

Hippocrates, and the mode of thought deficient in that precision 
for which he is so remarkal)le, the treatise is unquestionably 
a work of great abilitj% and contains what we have reason to 
regard as the results of his experience and meditations on 
many important subjects. I should have thought it quite un- 
warrantable, therefore, to have rejected this piece from a 
volume which professes to give all the genuine remains of our 
great author. And moreover, at the risk, perhaps, of being set 
down as an antique devotee, I do not hesitate to declare that 
in my opinion this and the preceding portion, taken together, 
contain more original information on the important subject to 
which they relate than is to be found in any medical work 
which has been written from the days of our author down to 
the present time. 

I shall conclude the present Argument by giving from Cselius 
Aurelianus the criticisms of Soranus on the opinions of our 
author, as delivered in these two treatises. It is to be borne 
in mind that Soranus was the chief of the ancient sect of 
physicians called Methodici, which was very inimically disposed 
towards all the others, and more especially to Hippocrates, 
Though most of the strictures are evidently overstrained, it 
cannot fail to be interesting to the reader to have an oppor- 
tunity of considering them, siich as they are. 

After giving an elaborate analysis of onr author's views, 
Cselius Aurelianus proceeds as follows : "■ His Soranus re- 
spondcns ait. In calefactionibus acres esse sales, ac nccessario 
tumorem provocare, febremque accendere, poscam etiani con- 
stringere et stricturam passionis augere. Item milium frixum 
graveolens et nidorosum, atque capiti grave, maxime acute 
fabricitantium esse perspicimus. Spongiis etiam erat melius 
quenquam in dimissione patientes partes vaporare, atque oleo 
calido pcrfundere. Est praiterea improprium, ac sine ratione, 
tunc uti phlebotomo quoties ad superiora dolor tetenderit; 
prohibere autcm quoties ad infcriora descenderit. Oportet 
ergo sub hoc argumento neque difficultate tumorum partibus 
inferioribus impeditos phlebotomare : neque etiam podagricos 
si qnidem inferiora tumere videantur, scd nccessario quoties 
dolor ad superiora tetenderit, phlebotomiam adhibendam 
videmus. Siquidem sa?pe pejorante ventris fluore, hoc adjutorii 
genus prohibetur. Neque etiam (ut ait) oportet iuteriorem 



■ 312 ARGUMENT. 

venam dividi. Siquidem et exterior! et media divisa corpora 
releventur. Quippe quum e contrario interiorem prohibeant, 
propter magnitudinem, ne tumor augeatur. Item sanguinis 
mutatio iners est detractionis raoderationi^ sicuti de adjutoriis 
scribentes domonstrabimus, Sese denique idem Hippocrates 
impugnat in consequentibus, dicens usque ad animi defectum 
faciendam detractionem, quod magis vehementer est nocens : 
siquidem est pericolosa defectio, et neque si sit temporaliter 
defectionis causa, sensu carens segrotans, dolore relevatus, vide- 
bitur (quum resumptus fuerit) rursum non dolere, quum magis 
atque magis ejusdem passionis debilia corpora vehementius 
officiant. Item purgativa medicamina (quae Grseci KadapriKa 
vocant) acrimonije causa, stomachum tumentem, atque hype- 
zocota membranam acuunt in tumorem; et in periculum ventris 
effusionem provocantia, magnificam passionis ingerunt vehe- 
mentiam. Nutrire etiam cibo post medicamen non oportebat. 
Pugnat enim purgationi faciundfe illatum cibi nutrimentum. 
Quippe quum raedicamine corruptum, officii sui careat viribus. 
Mitto etiam quod ex initio acescere facile ptisanss succus per- 
spiciatur, confectus quippe ex ordei succo, qui sit digestione 
difficilis. Deliine eegrotantis corpus non valet tantum sustinere 
nutrimentum, quantum sanitatis tempore solitum videbatur. 
Item mulsum ex aceto (quod oxymeli appellavit) sine discretione 
accipimus. Est etiam immodica usque ad septimum diem cibi 
abstinentia, quam custodiendam ordinavit.^ Quippe cum nullus 
veliementiam passionis sustinere valet, nisi nutrimento quamvis 
parvo toleratus : et neque in declinatione passionis aliquid 
humanius cibo largitur, sed in iisdem sorbilibus perseverandum 
existimat succis. At cum fuerint sputa seguiora, tunc ut 
existimat, erit primo seger nutriendus, quomodo necessario 
declinante passione occurrunt iutolerato. In cseteris relin- 
quendum temporibus absque nutrimento segrotantem aper- 
tissime indicavit, quum semper plurimum utilitatis adjutorium 
cibi, quam csetera possunt'adjutoria, largiatur. Omne etiam 
corpus erit unctione cosequandum, et non ejus particula. 
Quippe cum totum cibo nutriatur, ipsa quoque unctio non 
exerta, anxietatem ingerit segrotauti, quee latentem difficultatem, 
atque accessione veniente, corporis provocat incendium.'^ 

' 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. 



APPENDIX TO THE WORK 



ON 



REGIMEN IN ACUTE DISEASES. 

Ardent fever (causus]^ takes place when the veins^ being 
dried up in the summer season, attract acrid and bilious 
humours to themselves; and strong fever seizes the whole body, 
which experiences aches of the bones, and is in a state of lassi- 
tude and pain. It takes place most commonly from a long 
walk and protracted thirst, when the veins being dried up at- 
tract acrid and hot defluxions to themselves. The tongue be- 
comes rough, dry, and very black ; there are gnawing pains 
about the bowels; the alvine discharges are watery and yellow; 
there is intense thirst, insomnolency, and sometimes v.^andering 
of the mind. To a person in such a state give to drink water 

■ The causus or ardent fever of the ancients was decidedly the same as the bilious 
remittent fever of modem authors. See Paulus jEgineta, Vol. I, p. 262. We 
shall find many cases of it related in the Epidemics. In fact the causus is the ordi- 
nary fever of Greece and other countries bordering upon the Mediterranean. Galen, 
in his Commentary on this section, mentions that he had known it generally super- 
induced 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 (/SatriXf toi t^tjfiepiSig), 
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 ad- 
vanced ; 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 litter to the 
sacrifices, he performed them according to his daily practice ; that the sacrifices being 
performed, he reclined in the dining-room {di^Spior) 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 foiu'th 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 per- 
formed 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 



314 REGIMEN IN ACUTE DISEASES. 

and as much boiled hydromel of a watery consistence as he 
will take ; and if the mouth be bitter, it may be ad\:antageous 
to administer an emetic and clyster ; and if these things do 
not loosen the bowels, purge with the boiled milk of asses. 
Give nothing saltish nor acrid, for they will not be borne ; and 
give no draughts of ptisan until the crisis be past. And the 
affection is resolved if there be an epistaxis, or if true critical 
sweats supervene with urine having white, thick, and smooth 
sediments, or if a deposit take place anywhere ; but if it be 
resolved without these, there will be a relapse of the complaint, 
or pain in the hips and legs will ensue, Avith thick sputa, pro- 
vided the patient be convalescent. Another species of ardent 
fever : belly loose, much thirst, tongue rough, dry, and saltish, 
retention of urine, insomnolency, extremities cold. In such a 
case, unless there be a flow of blood from the nose, or an ab- 
scess form about the neck, or pain in the limbs, or the patient 
expectorate thick sputa (these occur when the belly is consti- 
pated), or pain of the hips, or lividity of the genital organs, 

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 per- 
formed 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 vras 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 lie gave orders to the commanders re- 
specting 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 recognised them, but did not speak, being now 
speechless ; that he was in a l)ad 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 wliole course 
of the fever. Now, this is one of tlie characteristics of causus as described by Aretajus 
(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. 



APPENDIX. 315 

there is no crisis ; tension of the testicle is also a critical 
symptom. Give attractive draughts.^ 

2. Bleed in the acute affections, if the disease appear strong, 
and the patients be in the vigour of life, and if they have 
strength." If it be quinsy or any other of the pleuritic 
affections, purge with electuaries ; but if the patient be weaker, 
or if 3^ou abstract more blood, you may administer a clyster 
every third day, until he be out of danger, and enjoin total 
abstinence if necessary. 

3. Hypochondria inflamed not from retention of flatus, ten- 
sion of the diaphragm, checked respiration, with dry orthopnoea, 
when no pus is formed, but when these complaints are con- 
nected with obstructed respiration ; but more especially strong 
pains of the liver, heaviness of the spleen, and other phlegmasise 
and intense pains above the diaphragm, diseases connected 
with collections of humours, — all these diseases do not admit 
of resolution, if treated at first by medicine, but venesection 
holds the first place in conducting the treatment ; theu we may 
have recourse to a cl3^ster, unless the disease be great and 
strong; but if so, purging also may be necessary; but bleeding 
and purging together require caution and moderation. Those 
who attempt to resolve inflammatoiy diseases at the commence- 
ment by the administration of purgative medicines, remove 
none of the morbific humours which produce the inflammation 
and tension : for the diseases while unconcocted could not yield, 
but they melt down those parts which are healthy and resist 
the disease ; so when the body is debilitated, the malady ob- 
tains the mastery; and when the disease has the upper hand 
of the body, it does not admit of a cure.^ 

4. When a person suddenly loses his speech, in connexion 
with obstruction of the veins, — if this happen without warning 
or any other strong cause, one ought to open the internal vein 

' Galen admits that lie did not understand the exact import of this term. 

' This is a general rule of such importance that Galen M'ouders 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 higlily 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 vigour of life ; and, third, if his strength be entire. 

^ This section, as Galen remarks, contains a list of the principal cases in which 
venesection is to be had recourse to. 



316 REGIMEN IN ACUTE DISEASES. 

of tlie right arm, and abstract blood more or less according to 
tlie habit and age of the patient. Such cases are mostly at- 
tended with the following symptoms : redness of the face, eyes 
fixed, hands distended, grinding of the teeth, palpitations, 
jaws fixed, coldness of the extremities^ retention of airs in the 
veins.^ 

5. When pains precede, and there are influxes of black bile 
and of acrid humours, and when by their pungency the internal 
parts are pained, and the veins being pinched and dried be- 
come distended, and getting inflamed atti^act the humours 
running into the parts, whence the blood being vitiated, and 
the airs collected there not being able to find their natural 
passages, coldness comes on in consequence of this stasis, Avith 
vertigo, loss of speech, heaviness of the head, and convulsion, 
if the disease fix on the liver, the heart, or the great vein 
(vena cava?) ; whence they are seized with epilepsy or apoplexy, 
if the defluxions fall upon the containing parts," and if they are 
dried up by airs which cannot make their escape ; such per- 
sons having been first fomented are to be immediately bled at 
the commencement, while all the peccant vapours and humours 
are buoyant, for then the cases more easily admit of a cure ; 
and then supporting the strength and attending to the crises, 
we may give emetics, unless the disease be alleviated ; or if the 
bowels be not moved, we may administer a clyster and give the 
boiled milk of asses, to the amount of not less than twelve 
heminse, or if the strength permit, to more than sixteen. 

6. Quinsy takes place when a copious and viscid defluxion 
from the head, in the season of Avinter or spring, flows into the 
jugular veins, and when from their large size they attract a 
greater defluxion ; and when owing to the defluxion being of a 
cold and viscid nature it becomes enfarcted, obstructing the 
passages of the respiration and of the blood, coagulates the 
surrounding blood, and renders it motionless and stationary, it 
being naturally cold and disposed to obstructions. Hence they 
are seized with convulsive sufil'ocation, the tongue turning livid, 
assuming a rounded shape, and being bent owing to the veins 

' I need scarcely point out to the professional reader that these symptoms are very 
descriptive of congestion in the hrain, threatening an attack eitlier of apoplexy or 
epilepsy. See the treatise on the Sacred Disease. 

■^ Meaning apparently the great vessels. See Galen's Commentary. 



APPENDIX. 317 

wliicli arc seated below the tongue (for when an enlarged 
uvula, which is called uva, is cut^ a large vein may be ob- 
served on each side). These veins, then, becoming filled, and 
their roots extending into the tongue, which is of a loose and 
spongy texture, it, owing to its dryness receiving forcibly the 
juice from the veins, changes from broad and becomes round, 
its natural colour turns to livid, from a soft consistence it grows 
hard, instead of being flexible it becomes inflexible, so that 
the patient would soon be sufi^ocated unless speedily relieved. 
Bleeding, then, in the arm, and opening the sublingual veins, 
and purging with the electuaries, and giving warm gargles, 
and shaving the head, we must apply to it and the neck a 
cerate, and wrap them round with wool, and foment with soft 
sponges squeezed out of hot water ; give to drink water and 
hydromel, not cold; and administer the juice of ptisan when, 
having passed the crisis, the patient is out of danger. When, 
in the season of summer or autumn, there is a hot and nitrous 
defluxion from the head (it is rendered hot and acrid by the 
season), being of such a nature it corrodes and ulcerates, and 
fills with air, and orthopncea attended with great dryness super- 
venes ; the fauces, when examined, do not seem swollen ; the 
tendons on the back part of the neck are contracted, and have 
the appearance as if it were tetanus ; the voice is lost, the 
breathing is small, and inspiration becomes frequent and 
laborious. In such persons the trachea becomes ulcerated, and 
the lungs engorged, from the patient's not being able to draw 
in the external air. In such cases, unless there be a spon- 
taneous determination to the external parts of the neck, the 
symptoms become still more dreadful, and the danger more 
imminent, partly owing to the season, and the hot and acrid 
humours which cause the disease.^ 

7. When fever seizes a person who has lately taken food, 

' 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 candour, it must be admitted that even at the pre- 
sent day we have scarcely made any advancement in our knowledge of this subject. 
What are our descriptions of ulcerous sore-throat, diptherite, oedema glottidis, croup, 
and laryngismus stridulus, but reproductions in a divided and (may I be allowed to 
suggest?) a less accurate form, of the general views here presented by our author? 
For an abstract of the views of the other ancient authorities in medicine, see Paulus 



318 REGIMEN IN ACUTE DISEASES. 

and whose bowels are loaded with fseces which have been long 
retained, whether it be attended with pain of the side or not, 
he ought to lie quiet until the food descend to the lower region 
of the bowels^ and use oxymel for drink ; but when the load 
descends to the loins, a clyster should be administered, or he 
should be purged by medicine ; and when purged, he should 
take ptisan for food and In'dromel for drink ; then he may take 
the cerealia, and boiled fishes, and a Avatery Avine in small 
quantity, at night, but during the day, a watery hydromel. 
When the flatus is offensive, either a suppository or clyster is 
to be administered; but otherwise the oxymel is to be discon* 
tinned, until the matters descend to the lower part of the 
bowels, and then they are to be evacuated by a clyster. But 
if the ardent fever [causus) supervene when the bowels are 
empty, should jow. still judge it proper to administer purgative 
medicine, it ought not be done during the first three days, 
nor earlier than the fourth. When you give the medicine, use 
the ptisan, observing the paroxysms of the fevers, so as not to 
give it when the fever is setting in, but when it is ceasing, or 
on the decline, and as far as possible from the commencement. 
When the feet are cold, give neither drink nor ptisan, nor 
anything else of the kind, but reckon it an important rule to 
refrain until they become warm, and then you may administer 
them with advantage. For the most part, coldness of the feet 
is a symptom of a paroxysm of the fever coming on ; and if at 
such a season you apply those things, you will commit the 
greatest possible mistake, for you will augment the disease in 
no small degree. But when the fever ceases, the feet, on the 
contrarv, become hotter than the rest of the bodv ; for when 
the heat leaves the feet, it is kindled up in the breast, and 
sends its flame up to the head. And Avhen all the heat rushes 
upwards, and is exhaled at the head, it is not to be wondered 
at that the feet become cold, being devoid of flesh, and tendi- 
nous; and besides, they contract cold, owing to their distance 

iEGiNETA, Book III, 27. Aretffius deserves particularly to be consulted (Morb. Acut., 
i, 7). It will be remarked that our author speaks of a spontaneous determinatiou to 
the skin, as being calculated to remove the urgent symptoms within. Galen, in com- 
menting upon this clause, states that some physicians were in the practice of apjilying 
to the skin certain medicines possessed of ulcerative powers, in order to determine to 
the surface, and thus imitate Nature's mode of cure. 



APPENDIX. 319 

from the liottcv parts of the body, an accumulation of heat 
liaving taken place in the chest : and again, in like manner, 
when the fever is resolved and dissipated, the heat descends to 
the feet, and, at the same time, the head and chest become 
cold. Wherefore one should attend to this; that when the 
feet are cold, the bowels are necessarily hot, and filled with 
nauseous matters; the hypochondrium distended : there is jac- 
titation of the body, owing to the internal disturbance ; and. 
aberration of the intellect, and pains ; the patient is agitated, 
and wishes to vomit, and if he vomits bad matters he is pained ; 
but when the heat descends to the feet, and the urine passes 
freely, he is every way lightened, even although he does not 
sweat ; at this season, then, the ptisan ought to be given ; it 
would be death to give it before.^ 

8. When the bowels are loose during the whole course of 
fevers, in this case Ave are most especially to warm the feet, and 
see that they are properly treated with cerates, and wrapped in 
shawls, so that they may not become colder than the rest of 
the body; but when they are hot, no fomentation must be 
made to them, but care is to be taken that they do not become 
cold; and very little drink is to be used, either cold water or 
hydromel. In those cases of fever where the bowels are loose, 
and the mind is disordered, the greater number of patients pick 
the wool from their blankets, scratch their noses, answer briefly 
when questions are put to them, but, when left to themselves, 
utter nothing that is rational. Such attacks appear to me to 
be connected with black bile. When in these cases there is a 
colliquative diarrhoea, I am of opinion that we ought to give 
the colder and thicker ptisans, and that the drinks ought to be 
binding, of a vinous nature, and rather astringent. In cases 
of fever attended from the first with vertigo, throbbing of the 
head, and thin urine, you may expect the fever to be exacerbated 
at the crisis ; neither need it excite wonder, although there be 
delirium. When, at the commencement, the urine is cloudy 
or thick, it is proper to purge gently, provided this be other- 
wise proper ; but Avhen the mine at first is thin, do not purge 
such patients, but, if thought necessary, give a clyster : such 

' 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. 



320 REGIMEN IN ACUTE DISEASES. 

patients should be thus treated ; they should be kept in a quiet 
state, have unguents applied to them, and be covered up pro- 
perly with clothes, and they should use for drink a watery 
hydromel, and the juice of ptisan as a draught in the evening; 
clear out the bowels at first with a clyster, but give no purgative 
medicines to thera, for, if you move the bowels strongly, the 
urine is not concocted, but the fever remains long, without 
sweats and without a crisis. Do not give draughts when the 
time of the crisis is at hand, if there be agitation, but only 
when the fever abates and is alleviated. It is proper to be 
guarded at the crises of other fevers, and to withhold the 
draughts at that season. Fevers of this description are apt to 
be protracted, and to have determinations, if the inferior ex- 
tremities be cold, about the ears and neck, or, if these parts 
are not cold, to have other changes ; they have epistaxis, and 
disorder of the bowels. But in cases of fever attended with 
nausea, or distension of the hypochondria, when the patients 
cannot lie rechued in the same position, and the extremities 
are cold, the greatest care and precaution are necessary ; 
nothing should be given to them, except oxymel diluted with 
water; no draught should be administered, until the fever 
abate and the urine be concocted; the patient should be laid 
in a dark apartment, and recline upon the softest couch, and 
he should be kept as long as possible in the same position, so 
as not to toss about, for this is particularly beneficial to him. 
Apply to the hypochondrium linseed by inunction, taking care 
that he do not catch cold when the application is made ; let it 
be in a tepid state, and boiled in water and oil. One may 
judge from the urine what is to take place, for if the urine be 
thicker, and more yellowish, so much the better; but if it be 
thinner, and blacker, so much the worse ;^ but if it undergo 
changes, it indicates a prolongation of the disease, and the pa- 
tient, in like manner, must experience a change to the worse 

' I would beg leave to direct the attention of the medical reader to the observa- 
tions 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. 



APPENDIX. 321 

and the better. Irregular fevers should be let alone until they 
become settled, and, when they do settle, they are to be treated 
by a suitable diet and medicine, attending to the constitution of 
the patient. 

9. The aspects of the sick are various ; wherefore the phy- 
sician should pay attention, that he may not miss observing the 
exciting causes, as far as they can be ascertained by reasoning, 
nor such symptoms as should appear on an even or odd day, 
but he ought to be particularly guarded in observing the odd 
days, as it is in them, more especially, that changes take place 
in patients. He should mark, particularly, the first day on 
which the patient became ill, considering when and whence 
the disease commenced, for this is of primary importance to 
know. When you examine the patient, inquire into all par- 
ticulars ; first how the head is, and if there be no headache, nor 
heaviness in it ; then examine if the hypochondria and sides be 
free of pain ; for if the hypochondrium be painful, swelled, and 
unequal, with a sense of satiety, or if there be pain in the side, 
and, along with the pain, either cough, tormina, or belly-ache, 
if any of these symptoms be present in the hypochondrium, 
the bowels should be opened with clysters, and the patient 
should drink boiled hydromel in a hot state. The physician 
should ascertain whether the patient be apt to faint when he 
is raised up, and whether his breathing be free ; and examine 
the discharges from the bowels, whether they be very black, or 
of a proper colour, like those of persons in good health, and 
ascertain whether the fever has a paroxysm every third day, 
and look well to such persons on those days. And should the 
fourth day prove like the third, the patient is in a dangerous 
state.^ With regard to the symptoms, black stools prognosticate 
death ; but if they resemble the dischai'ges of a healthy person, 
and if such is their appearance every day, it is a favorable 
symptom ; but when the bowels do not yield to a suppository, 
and when, though the respiration be natural, the patient when 
raised to the night-table, or even in bed, be seized with deli- 
quium, you may expect that the patient, man or woman, who 
experiences these symptoms, is about to fall into a state of 
delirium. Attention also should be paid to the hands, for if 



He means by this, that the disease is not of an intermittent typo. 

21 



322 REGIMEN IN ACUTE DISEASES. 

they tremble, you may expect epistaxis ; and observe tbe nos- 
trils, whether the breath be drawn in equally by both ; and if 
expiration by the nostrils be large, a convulsion is apt to take 
place ; and sliould a convulsion occur to such a person, death 
may be anticipated, and it is well to announce it beforehand. 

10. If, in a Avinter fever, the tongue be rough, and if there 
be swoonings, it is likely to be the remission of the fever. 
Nevertheless such a person is to be kept upon a restricted diet, 
with water for drink, and hydromel, and the strained juices, 
not trusting to the remission of the fevers, as persons having 
these symptoms are in danger of dying ; when, therefore, you 
perceive these symptoms, announce this prognostic, if you shall 
judge proper, after making the suitable observations. When, 
in fevers, any dangerous symptom appears on the fifth day, 
when watery discharges suddenly take place from the bowels, 
when deliquium animi occurs, or the patient is attacked with 
loss of speech, convulsions, or hiccup, under such circumstances 
he is likely to be affected with nausea, and sweats break out 
under the nose and forehead, or on the back part of the neck 
and head, and patients Avith such symptoms shortly die, from 
stoppage of the respiration.^ When, in fevers, abscesses form 
about the legs, and, getting into a chronic state, are not con- 
cocted Avhile the fever persists, and if one is seized Avith a sense 
of suffocation in the throat, while the fauces are not swelled, 
and if it do not come to maturation, but is repressed, in such 
a case there is apt to be a floAV of blood from the nose : if this, 
then, be copious, it indicates a resolution of the disease, but if 
not, a prolongation of the complaint; and the less the discharge, 
so much worse the symptoms, and the more protracted the dis- 
ease ; but if the other symptoms are very favorable, expect in 
such a case that pains will fall upon the feet ; if then they 
attack the feet, and if these continue long in a very painful 
and inflamed state, and if there be no resolution, the pains will 
extend by degrees to the neck, to the clavicle, shoulder, breast, 
or to some articulation, in which an inflammatory tumour will 
necessarily form. When these are reduced, if the hands are 
contracted, and become trembling, convulsion and delirium 



' This seems the most appropriate meaning in this place, hut the passage may also 
signify " a state of great emphysema or meteorism." See Galen. 



APPENDIX. 323 

seize such a person ; but blisters break out on the eyebrow, 
erythema takes place, tlie one eyelid being tumefied overtops 
the other, a hard inflammation sets in, the eye becomes strongly 
swelled, and the delirium increases much, but makes its attacks 
rather at night than by day. These symptoms more frequently 
occur on odd than on even days, but, whether on the one or 
the other, they are of a fatal character. Should you determine 
to give purgative medicines in such cases, at the commencement, 
you should do so before the fifth day, if there be borborygmi 
in the bowels, or, if not, you should omit the medicines alto- 
gether. If there be borborygmi, with bilious stools, piu'ge 
moderately with scammony ; but with regard to the treatment 
otherwise, administer as few drinks and draughts as possible, 
until there be some amendment, and the disease is past the 
fourteenth day. When loss of speech seizes a person, on the 
fourteenth day of a fever, there is not usually a speedy reso- 
lution, nor any removal of the disease, for this symptom indi- 
cates a protracted disease ; and when it appears on that day, it 
will be still more prolonged. When, on the fourth day of a 
fever, the tongue articulates confusedly, and when there are 
watery and bilious discharges from the bowels, such a patient 
is apt to fall into a state of delirium ; the physician ought, 
therefore, to watch him, and attend to whatever symptoms may 
turn up. In the season of summer and autumn an epistaxis, 
suddenly occurring in acute diseases, indicates vehemence of 
the attack, and inflammation in the course of the veins, and on 
the day following, the discharge of thin urine ; and if the pa- 
tient be in the prime of life, and if his body be strong from 
exercise, and brawny, or of a melancholic temperament, or if 
from drinking he has trembling hands, it may be well to an- 
nounce beforehand either delirium or convulsion ;^ and if these 
symptoms occur on even days, so much the better ; but on 
critical days, they are of a deadly character. If, then, a copious 
discharge of blood procure an issue to the fulness thereof about 
the nose, or what is collected about the anus, there will be an 
abscess, or pains in the hypochondrium, or testicles, or in the 
limbs ; and when these are resolved, there will be a discharge 

' It is impossible not to recongise here a brief sketch of delirium tremens. The 
trembling hands from drinking, with the sul)sequent delirium, can leave no doubts 
on the subject. See further Littre, torn, ii, p. 382. 



324 REGIMEN IN ACUTE DISEASES. 

of thick sputa, and of smooth, thin urine. In fever attended 
with singultus, give assafcetida, oxymel, and carrot, triturated 
together, in a draught ; or gallianum in honey, and cumin in 
a hnctus, or the juice of ptisan. Such a person cannot escape, 
unless critical sweats and gentle sleep supervene, and thick and 
acrid urine be passed, or the disease terminate in an abscess : 
give pine-fruit^ and myrrh in a linctus, and further give a very 
little oxymel to drink; but if they are very thirsty, some 
barley-water. 

11. Peripneumonia, and pleuritic affections, are to be thus 
observed : If the fever be acute, and if there be pains on either 
side, or in both, and if expiration be attended with pain, if 
cough be present, and the sputa expectorated be of a blond or 
livid colour, or likewise thin, frothy, and florid, or having any 
other character different from the common, in such a case, the 
physician should proceed thus : if the pain pass upwards to the 
clavicle, or the breast, or the arm, the inner vein in the arm 
should be opened on the side affected, and blood abstracted 
according to the habit, age, and colour of the patient, and the 
season of the year, and that largely and boldly, if the pain be 
acute, so as to bring on deliquium animi,^ and afterwards a 
clyster is to be given. But if the pain be below the chest, and 
if very intense, purge the bowels gently in such an attack of 
pleurisy, and during the act of purging give nothing; but 
after the purging give oxymel. The medicine is to be adminis- 
tered on the fourth day ; on the first three days after the com- 
mencement, a clyster should be given, and if it does not relieve 
the patient, he should then be gently purged, but he is to be 
watched until the fever goes off, and till the seventh day ; then 
if he appear to be free from danger, give him some unstrained 
ptisan, in small quantity, and thin at first, mixing it with honey. 
If the expectoration be easy, and the breathing free, if his sides 
be free of pain, and if the fever be gone, he may take the 
ptisan thicker, and in larger quantity, twice a day. But if he 

' The fruit of the pinus pinaster. See Paulus /Egineta, Vol. Ill, p. 301. 

2 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. 
Tlus is decidedly the rule of practice laid down by Aretseus (De Curat. Morb. Acut., 
ii, 1). 



APPENDIX. 325 

do not progress favorabh^, he must get less of the drink, and of 
tlie draught, which should be thin, and only given once a dav, 
at whatever is judged to be the most favorable hour; this you 
will ascertain from the urine. The draught is not to be given 
to persons after fever, until you see that the urine and sputa 
are concocted, (if, indeed, after the administration of the medi- 
cine he be purged frequently, it may be necessary to give it, 
but it should be given in smaller quantities and thinner than 
usual, for from inanition he will be unable to sleep, or digest 
properly, or wait the crisis ;) but when the melting down of 
crude matters has taken place, and his system has cast off what 
is offensive, there will then be no objection. The sputa are con- 
cocted when they resemble pus, and the urine when it has 
reddish sediments like tares. But there is nothing to prevent 
fomentations and cerates being applied for the other pains of 
the sides ; and the legs and loins may be rubbed with hot oil, 
or anointed with fat ; linseed, too, in the form of a cataplasm, 
may be applied to the hypochondrium, and as far up as the 
breasts. When pneumonia is at its height, the case is beyond 
remedy if he is not purged, and it is bad if he has dyspnoia, 
and vnnne that is thin and acrid, and if sweats come out about 
the neck and head, for such sw;eats are bad, as proceeding from 
the suffocation, rales, and the violence of the disease which is 
obtaining the upper hand, unless there be a copious evacuation 
of thick urine, and the sputa be concocted ; when either of 
these come on spontaneously, that will carry off the disease. 
A linctus for pneumonia : Galbanum and pine-fruit in Attic 
honey ; and southernwood in oxymel ; make a decoction of 
pepper and l)lack hellebore, and give it in cases of pleurisy 
attended with violent pain at the commencement. It is also 
a good thing to boil opoponax in oxymel, and, having strained 
it, to give it to drink ; it answers well, also, in diseases of the 
liver, and in severe pains proceeding from the diaphragm, and 
in all cases in which it is beneficial to determine to the bowels 
or urinary organs, when given in wine and honey ; when given 
to act upon the bowels, it should be drunk in larger quantity, 
along with a watery hydromel. 

12. A dysentery, when stopped, will give rise to an apos- 
teme, or tumour, if it do not terminate in fevers with sweats. 



326 REGIMEN IN ACUTE DISEASES. 

or Avitli tliick and white urine, or in a tertian fever, or the pain 
fix upon a varix, or the testicle, or on the hip-joints.^ 

13. In a bilious fever, jaundice coming on with rigor before 
the seventh day carries off the fever, but if it occur without the 
fever, and not at the proper time, it is a fatal symptom. 

14. When the loins are in a tetanic state, and the spirits in 
the veins are obstructed by melancholic humours, venesection 
will afibrd relief.2 But when, on the other hand, the anterior 
tendons are strongly contracted, and if there be sweats about 
the neck and face, extorted by the violent pain of the parched 
and dried tendons of the sacral extremity (these are very thick, 
sustaining the spine, and giving rise to very great ligaments, 
which terminate in the feet), in such a case, imless fever and 
sleep come on, followed by concocted urine and critical sweats, 
give to drink a strong Cretan wdne, and boiled barley-meal for 
food; anoint and rub with ointments containing wax; bathe 
the legs and feet in hot water, and then cover them up ; and 
so in like manner the arms, as far as the hands, and the spine, 
from the neck to the sacrum, are to be wrapped in a skin 
smeared with wax ; this must extend to the parts beyond, and 
intervals are to be left for applying fomentations, by means of 
leather bottles filled with hot Avater, then, Avrapping him up in 
a linen cloth, lay him down in bed. Do not open the boAvels, 
unless by means of a suppository, when they have been long of 
being moved. If there be any remission of the disease, so far 
well, but otherwise, pound of the root of bryonia^ in fragrant 
wine, and that of the carrot, and give to the patient fasting early 
in the morning, before using the aff'usion, and immediately 
afterwards let him eat boiled barley-meal in a tepid state, and 
as much as he can take, and in addition let him drink, if he 
will, wine well diluted. If the disease yield to these means, so 
much the better, but, if otherwise, you must prognosticate 
accordingly. 

15. All diseases are resolved either by the mouth, the bowels, 

' Galen, in his Commentary, remarks that this account of dysentery is vague, the 
species of dysentery here alluded to not being properly defined. 

- 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. 

•* Bryonia dioica. See Dierbach, c&c. p. 131. 



APPENDIX. 327 

the bladder, or some other such organ. Sweat is a common 
form of resolution in all these cases. ^ 

16. You should put persons on a course of helleboi'e who 
are troubled with a defluxion from the head. But do not 
administer hellebore to such persons as are labouring under 
empyema connected with abscesses, haemoptysis, and intem- 
perameut, or any other strong cause, for it will do uo good ; 
and if anything unpleasant occur the hellebore will get the 
blame of it. But if the body have suddenly lost its powers, or 
if there be pain in the head, or obstruction of the ears and 
nose, or ptyalism, or heaviness of the limbs, or an extraordinary 
swelling of the body, you may administer the hellebore, pro- 
vided these symptoms be not connected with drinking, nor 
with immoderate venery, nor with sorrow, vexation, nor insom- 
nolency, for, if any of these causes exist, the treatment must 
have respect to it. 

17. From walking arise pains of the sides, of the back, of 
the loins, and of the hip-joint, and disorder of the respiration has 
often been from the same cause, for, after excesses of wine and 
flatulent food, pains shoot to the loins and hips, accompanied 
with dysuria.^ Walking is the cause of such complaints, and 
also of coryza and hoarseness. 

18. Disorders connected with regimen, for the most part, 
make their attack accordingly as any one has changed his 
habitual mode of diet.^ For persons who dine contrary to 
custom experience much swelling of the stomach, drowsiness, 
and fulness ; and if they take supper over and above, their 
belly is disordered ; such a person will be benefited by sleeping 
after taking the bath, and by walking slowly for a considerable 
time after sleep ; if, then, the bowels be moved, he may dine 
and drink a small quantity of wine not much diluted ; but if 
the bowels are not opened, he should get his body rubbed wdth 
hot oil, and, if thirsty, drink of some weak and white wine, or 
a sweet wine, and take repose; if he does not sleep he should 

' 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. 

^ The text is in a very unsettled state. 

^ 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. 
Verv similar views are also laid down in the treatise On Ancient Medicine. 



328 REGIMEN IN ACUTE DISEASES. 

repose the longer. In other respects he should observe the 
regimen laid down for those who have taken a debauch. With 
regard to the bad eflFects of drinks, such as are of a watery 
nature pass more slowly through the body, they regurgitate, 
as it were, and float about the hypochondria, and do not 
flow readily by urine ; when filled up with such a drink, he 
should not attempt any violent exertion, requiring either 
strength or swiftness, but should rest as much as possible until 
the drink has been digested along with the food ; but such drinks 
as are stronger or more austere, occasion palpitation in the body 
and throbbing in the head, and in this case the person affected 
will do well to sleep, and take some hot draught for which he 
feels disposed ; for abstinence is bad in headache and the effects 
of a surfeit. Those who, contraiy to usage, restrict themselves 
to one meal, feel empty and feeble, and pass hot urine in con- 
sequence of the emptiness of their vessels; they have a salt and 
bitter taste in the mouth ; they tremble at any work they 
attempt; their temples throb; and they cannot digest their 
supper so well as if they had previously taken their dinner. 
Such persons should take less supper than they are wont, and 
a pudding of barley-meal more moist than usual instead of 
bread, and of potherbs the dock, or mallow, and ptisan, or 
beets, and along with the food they should take wine in mode- 
ration, and diluted Avitli water; after supper they should take 
a short walk, until the urine descend and be passed ; and they 
may use boiled fish. 

Articles of food have generally such effects as the fol- 
lowing :^ Garhc occasions flatulence and heat about the chest, 
heaviness of the head, and nausea, and any other habitual pain 
is apt to be exasperated by it ; it is diuretic, Avhich, in so far, 
is a good property which it possesses : but it is best to eat it 
when one means to drink to excess, or when intoxicated. 
Cheese produces flatulence and constipation, and heats the 
other articles of food ; and it gives rise to crudities and indi- 
gestion, but it is worst of all to eat it along with drink after a 
full meal. Pulse of all kinds are flatulent, whether raw, boiled, 
or fried; least so when macerated in water, or in a green 

' On the Dietetics of the ancients, see the Commentary on Paulus /Egineta, 
Vol. I, pp. 106-86. 



APPENDIX. 329 

state ; they should not be used except along with food prepared 
from the cerealia. Each of these articles, however, has bad 
effects peculiar to itself. The vetch, whether raw or boiled, 
creates flatulence and pain. The lentil is astringent, and dis- 
orders the stomach if taken with its hull. The lupine has tlie 
fewest bad effects of all these things. The stalk and the juice 
of silphium {assafcetida), pass through some people's bowels 
very readily, but in others, not accustomed to them, they 
engender Avliat is called dry cholera -^ this complaint is more 
especially produced by it if mixed with much cheese, or eaten 
along with beef. Melancholic diseases are most particu- 
larly exacerbated by beef, for it is of an unmanageable nature, 
and requires no ordinary powers of stomach to digest it ; it 
will agree best with those who use it well boiled and pretty 
long kept. Goats' flesh has all the bad properties of beef; it 
is as indigestible, more flatulent, and engenders acid eructa- 
tions and cholera; such as has a fragrant smell, is firm, and 
sweet to the taste, is the best, when well baked and cooled ; but 
those kinds which are disagreeable to the taste, have a bad 
smell, and are hard, such are particularly bad, and especially if 
very fresh; it is best in summer and worst in autumn. The 
flesh of young pigs is bad, either when it is too raw or when it is 
over-roasted, for it engenders bile and disorders the bowels. 
Of all kinds of flesh, pork is the best ; it is best when neither 
very fat, nor, on the other hand, very lean, and the animal had 
not attained the age of what is reckoned an old victim ; it 
should be eaten without the skin, and in a coldish state. 

19. In dry cholera the belly is distended with wind, there 
is rumbling in the bowels, pain in the sides and loins, no 
dejections, but, on the contrary, the bowels are constipated. 
In such a case you should guard against vomiting, but endea- 
vour to get the bowels opened. As quickly as possible give a 
clyster of hot water with plenty of oil in it, and having rubbed 
the patient freely with unguents, put him into hot water, laying 
him down in the basin, and pouring the hot water iipon him 
by degrees ; and if, when heated in the bath, the bowels be 



' By dry cholera would seem to be meant flatulent colic. See Galen's Com- 
mentary. It is also described Ijelow, and further with great accuracy by Alexander 
Trallian (vii, IG). 



330 REGIMEN IN ACUTE DISEASES. 

moved, he will be freed from the complaint. To a person in 
such a complaint it will do good if he sleep, and drink a thin, 
old, and strong wine ; and you should give him oil, so that he 
may settle, and have his bowels moved, when he will be relieved. 
He must abstain from all other kinds of food; but when the 
pain remits, give him asses' milk to drink until he is purged. 
But if the bowels are loose, with bilious discharges, tormina, 
vomitings, a feeling of suffocation, and gnawiug pains, it is 
best to enjoin repose, and to drink hydromel, and avoid 
vomiting. 

20. There are two kinds of dropsy, the one anasarca, which, 
when formed, is incurable ; the other is accompanied with 
emphysema (tympanites ?) and requires much good fortune to 
enable one to triumph over it.^ Laborious exertion, fomenta- 
tion, and abstinence (are to be enjoined). The patient should 
eat dry and acrid things, for thus will he pass the more 
water, and his strength be kept up. If he labours under 
difficulty of breathing, if it is the summer season, and if he is 
in the prime of life, and is strong, blood should be abstracted 
from the arm, and then he should eat hot pieces of bread, 
dipped in dark wine and oil, drink very little, and labour much. 



' 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 tym- 
panitis. (See Paulus jEgineta, 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 tliis head by Ermerins (Specimen 
Hist. Med., p. 125), and by Littre (Op. Ilippocrat., 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 sup- 
pression 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 persous in the vigour of life and in good heahh would 
be able to digest dark-coloured wine and pork after venesection. I may mention 
further that the text is faulty, that the words iyx^'-P'^^^ yivE(r9ai d<pvKrog should 
have been written cnroKTiivsi S' iv9vc o vStpog inriv ykvi^Tcu. He attributes the 
mistake to the firpt amanuensis who wrote the words in question. 



APPENDIX. 331 

find live on well-fed pork^ boiled with vinegar^ so that he may 
be able to endure hard exercises.^ 

21. Those who have the inferior intestines hot, and who 
pass acrid and irregular stools of a colliquative nature, if they 
can bear it, should procure revulsion by vomiting with hellebore ; 
but if not, should get a thick decoction of summer wheat in a 
cold state, lentil soup, bread cooked with cinders, and fish, 
which should be taken boiled if they have fever, but roasted if 
not feverish ; and also dark-coloured wine if free of fever ; but 
otherwise they should take the water from medlars, myrtles, 
apples, services, dates, or wild vine. If there be no fever, and 
if there be tormina, the patient should drink hot asses' milk in 
small quantity at first, and gradually increase it, and linseed, 
and wheaten flour, and having removed the bitter part of 
Egyptian beans, and ground them, sprinkle on the milk and 
drink ; and let him eat eggs half-roasted, and fine flour, and 
millet, and perl-spelt (chondrus) boiled in milk ; — all these 
things should be eaten cold, and similar articles of food and 
drink should be administered. 

22. The most important point of regimen to observe and 
be guarded about in protracted diseases, is to pay attention to 
the exacerbations and remissions of fevers, so as to avoid the 
times when food should not be given, and to know Avhen it 
may be administered without danger ; this last season is at the 
greatest possible distance from the exacerbation. 

23. One should be able to recognise those who have headache 
from gymnastic exercises, or running, or walking, or hunting, 
or any other unseasonable labour, or from immoderate venery ; 
also those who are of a pale colour, or troubled with hoarseness ; 
those who have enlarged spleen, those who are in a state of 
ansemia, those who are suffering from tympanites, those having 
dry cough and thirst, those who are flatulent, and have the course 
of the blood in their veins intercepted ; those persons whose hy- 
pochondria, sides, and back are distended ; those having torpor ; 
those laliouring under amaurosis, or having noises in their ears; 
those suffering from incontinence of urine or jaundice, or 
whose food is passed undigested ; those who have discharges of 
blood from the nose or anus, or who have flatulence and intense 

' 111 reference to this practice Horace says : 

" Si noles sanus curres hydropicus." (Serm. I, 1.) 



332 REGIMEN IN ACUTE DISEASES. 

pain, and who cannot retain the wind. In these cases you 
may do mischief, but cannot possibly do any good by purging, 
but may interrupt the spontaneous remissions and crises of the 
complaints.^ 

24<. If you think it expedient to let blood, see that the 
bowels be previously settled, and then bleed ; enjoin abstinence, 
and forbid the use of wine ; and complete the cure by means 
of a suitable regimen, and wet fomentations.^ But if the 
bowels appear to be constipated, administer a soothing clyster. 

25.^ If you think it necessary to give medicines, you may 
safely purge upwards by hellebore, but none of those should be 
purged downwards. The most effectual mode of treatment is 
by the urine, sweats, and exercise ; and use gentle friction so 
as not to harden the constitution ; and if he be confined to bed 
let others rub him. When the pain is seated above the dia- 
phragm, place him erect for the most part, and let him be as 
little reclined as |)Ossible ; and when he is raised up let him be 
rubbed for a considerable time with plenty of hot oil. But if 
the pains be in the lower belly below the dia])liragm, it will be 
useful to lie reclined and make no motion, and to such a person 
nothing should be administered except the friction. Those 
pains which are dissolved by discharges from the bowels, by 
urine, or moderate sweats, cease spontaneously, if they are 
slight, but if strong they prove troublesome; for persons so 
affected either die, or at least do not recover without further 
mischief, for they terminate in abscesses. 

' 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 dis- 
eases of the spleen he contends that melanogogues are strongly indicated. Many 
more of the rules he considers to l)e vaguely and inaccurately stated. Altogether, 
then, he holds that it is a loss of time to devote much attention to WTitings 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. 

^ Galen correctly remarks that this rule is applicable in certain cases, but not 
in all. 

^ 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 sug- 
gests afterwards, they are meant to apply to general pains. 



APPENDIX. 333 

26. A draught for a droi^sical person. Take three cantliarides/ 
and removing their head, feet, and wings, triturate their bodies 
in three cupfuls (cyathi) of water, and when the person who 
lias drunk the draught complains of pain, let him have hot 
fomentations applied. The patient should be first anointed 
with oil, should take the draught fasting, and eat hot bread 
with oil. 

27". A styptic. Apply the juice of the fig inwardly to the 
vein; or having moulded biestings into a tent, introduce up 
tlic nostril, or push up some chalcitis with the finger, and 
press the cartilages of the nostrils together ; and open the bowels 
with the boiled milk of asses : or having shaved the head apply 
cold things to it if in the summer season. 

28, The sesamoides'^ purges upwards when pounded in 
oxymel to the amount of a drachm and a half, and drunk ; it 
is combined with the hellebores, to the amount of the third 
part, and thus it is less apt to produce suffocation. 

29. Trichiasis. Having introduced a thread into the eye of 
a needle push it through the upper part of the distended eye- 
lid, and do the same at the base of it ; having stretched the 
threads tie a knot on them, and bind up until they drop out : 
and, if this be sufficient, so far well ; but, if otherwise, you 
must do the same thing again.'* And hemorrhoids, in like 

' The caiitharis of the ancients was indisputably the Mylabris cichorii, or M, 
Fusselini. It continued to be used in ancient times as a diuretic, (see Pauids 
iEoiNETA, Vol. Ill, p. 153 ;) and is well known in the East at the present day. 

^ 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 connexion with the treatise On Regimen in Acute Diseases. Indeed an im- 
partial 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 com- 
pilation, which, although it may have been made up of notes written or dictated by 
Hippocrates, had certainly not been published by him. 

3 It most probably is the Reseda mediterranea. See Paulus ^gineta, Vol. Ill, 
p. 331. 

^ This description has always been regarded as very obscure. According to Galen 
it is the operation which was afterwards named anabrochismus. See Paulus 
/Egineta, Vol. Ill, pp. 262, 269. M. Littre gives the following interesting observa- 
tions on this passage by M. Malgaigne: " Quoiqu'il semble que I'auteur emploie deux 
fils, cependant il n'est fait mention que d'une aiguille. II parait bien indique que 
I'aiguille traverse deux plis transverseaux en marchant de haut en has. Voici com- 
ment je traduirais le passage en question : pour le trichiasis, avec nne aiguille armc'e 



334 REGIMEN IN ACUTE DISEASES. 

manner^ you may treat by transfixing them with a needle and 
tying them with a very thick and large woollen thread ; for 
thus the cure will be more certain. When you haA^e secured 
them, use a septic application, and do not foment until they 
drop off, and always leave one behind ; and when the patient 
recovers, let him be put upon a course of hellebore. Then let 
him be exercised and sweated ; the friction of the gymnasium 
and wrestling in the morning will be proper; but he must 
abstain from running, drinking, and all acrid substances, except 
marjoram ; let him take an emetic every seven days, or three 
times in a month; for thus will he enjoy the best bodily health. 
Let him take straw-coloured, austere, and watery wine, and use 
little drink. 

30. Fur perso7is affected with empyema. Having cut some 
bulbs of squill, boil in water, and when well boiled, throw this 
away, and having poured in more water, boil until it appear to 
the touch soft and well-boiled ; then triturate finely and mix 
roasted cumin, and white sesames, and young almonds pounded 
in honey, form into an electuary and give ; and afterwards 
sweet wine. In draughts, having pounded about a small aceta- 
bulum of the white poppy, moisten it with water in which 
summer wheat has been washed, add honey, and boil. Let him 
take this frequently during the day. And then taking into 
account what are to happen, give him supper. 

31. For dysentery. A fourth part of a pound of cleaned 
beans, and twelve shoots of madder ha\ing been triturated, 
are to be mixed together and boiled, and given as a linctus 
with some fatty substance. 

32. For diseases of the eyes. Washed spodium (tutty ?) 
mixed with grease, and not of a thinner consistence than dough. 



d'un fil, traverse de baut en bas le point le plus eleve (ou la base) de la paupiere 
superieure, apres lui avoir fait former un pli, et repasser I'aiguille de la niuine 
maniere un peu plus bas (ou pres du bord libre) ; rapprocbez les extremites du fil, 
et fixez-les par un nceud ; puis laissez-les tomber d'eiLx-memes. Si cela reussit, c'est 
bien : si non, il faudra recommencer." (Op. Ilippocrat., torn, iii, p. xliv.) In my 
Commentary on Paulus jEgineta (Vol. II, p. 162), I bave in so far fallen into tbe 
mistake of supposing tbis description to apply to tbe lower eyeUd, and M. Ermerins 
would appear to bave done the same. See Littre, 1. c. The operation by the liga- 
ture on hemorrhoids will be found more circumstantially described in tbe treatise on 
that subject, of which a translation is given in this volume. 



APPENDIX. 335 

is to be carefully triturated, and moistened with the juice of 
unripe raisins ; and having dried in the sun, moisten until it 
is of the consistence of an ointment. When it becomes again 
dry, let it be finely levigated, anoint the eyes with it, and dust 
it upon the angles of the eyes, 

33. For watery eyes. Take one drachm of ebenj^ and nine 
oboli of burnt copper, rub them upon a whetstone, add three 
oboli of saffron ; triturate all these things reduced to a fine 
powder, pour in an Attic hemina of sweet wine, and then place 
in the sun and cover up ; when sufficiently digested, use it.^ 

34. For violent pains of the eyes. Take of chalcitis,^ and of 
raisin, of each 1 dr., when digested for two days, strain ; and 
pounding myrrh and safiPron, and having mixed must, with 
these things, digest in the sun ; and with this anoint the eyes 
when in a state of severe pain. Let it be kept in a copper vessel. 

35. Mode of distinguishing jJer sons in an hysterical fit. Pinch 
them with your fingers, and if they feel, it is hysterical ; but 
if not, it is a convulsion. 

36. To persons in coma, (dropsy ?) give to drink meconium 
{euphorbia peplus ?) to the amount of a round Attic leciskion 
(small acetabulum^) . 

37. Of squama seris, as much as three specilla can contain, 
with the gluten of summer wlieat : levigate, pound, form into 
pills, and give ; it purges water downwards. 

38. A medicine for opening the bowels. Pour upon figs the 



' For the weights and measures mentioned here, and in other parts of our author's 
works, see the Comment, on the last section of Paulus jEgineta, Syd. Soc. edit. 

2 A mineral, consisting principally of sulphate of copper. See Paulus /Egineta, 
Vol. Ill, pp. 400-2. 

3 The jujj/cw i/iov was applied to three totally distinct suhstances : 1st, To a sort 
of opium, that is to say, the expressed juice of the poppy (see Paulus ^Egineta, 
Vol. Ill, p. 280) ; 2d, to the Euphorbia peplus, L. (see Appendix to Dunhar's Greek 
Lexicon, under the name) ; and, 3d, to the excrement of newborn children. It is 
singular that the learned Foes, in his CEconomia Ilippocratica, 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 
■KtirXoQ of Dioscorides and Galen, that is to say, the Eupliorhia 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. 



336 REGIMEN IN ACUTE DISEASES. 

juice of spurge, in the proportion of seven to one : then put 

into a new vessel and lay past when properly mixed. Give 
before food. 

39. Pounding meconium, pouring on it water, and straining, 
and mixing flour, and baking into a cake, with the addition of 
boiled honey, give in affections of the anus and in dropsy ; and 
after eating of it, let the patient drink of a sweet watery wine, 
and diluted hydromel prepared from Avax : or collecting meco- 
nium, lay it up for medicinal purposes.' 

• All the commentators admit that the last section is obscure. It would appear to 
me that Galen understands the expression to airb t&v KOTrp/wj/ as applying tSpiKolc, 
that is to say, to affections of the anus. I have followed Littre in giving the passage 
a very different interpretation, but I am by no means sure that Galea may not be 
right. 






FIRST AND THIRD BOOKS 



OF 



THE EPIDEMICS. 



22 



THE EPIDEMICS. 



BOOK I. 



THE ARGUMENT. 

The ancient physicians commonly used tlie term Epidemic 
in the same sense as it is understood now^ tliat is to say, as 
applying to any disease which attacks a multitude of persons 
in a locality at any particular period. This, as will be seen in 
our annotations below, is nearly the definition which Galen 
gives of it ; and it is generally used by Hippocrates, in the 
first and third books of the . ' Epidemics,^ in pretty much 
the same sense as it is used hy our great modern authority on 
epidemics, Sydenham. But, although this be the strict sense 
in which the ancient authorities use the terra, it must be 
borne in mind that, as applied to the whole seven books of 
the 'Epidemics,' it must be taken in a much wider significa- 
tion ; for there are many things treated of in them to which 
the terra epidemic can by no means be thus applied, such as 
surgical cases, fragments of anatomical descriptions, philoso- 
phical specidations, empirical remedies, general reflections on 
various topics, and so forth. In fact, the work entitled ' The 
Books of Epidemics' can be viewed in no other light than as 
an Adversaria, or Memorandum Book, in which is collected a 
variety of isolated facts and detached observations, to serve as 
the materials for more elaborate and finished works on profes- 
sional subjects. Indeed, Galen does not hesitate to give it as 
his opinion, that some of the most celebrated of our author's 
productions, such as the ' Aphorisms' and ' Prognostics,' are in a 
great measure made up from the materials originally laid up in 



340 EPIDEMICS— BOOK I. 

this capacious repertory of observations -^ nnd, with regard to 
the former of these Avorks, there is no person fjimiHarly 
acquainted with it but must admit the truth of Galen's remark. 
Butj respecting the other, aUhough it must be obvious, upon 
a comparison of them, that there is a close connexion between 
it and the ' Epidemics,' there can be no doubt that, in com- 
posing the ' Prognostics,' Hippocrates availed himself of other 
materials ready prepared for his use, in the ' Prorrhetics' and 
' Coan Prainotions' of his predecessors, the Asclepiadte ;" so 
that, of all his admired productions, it, perhaps, is the one 
which has the least pretension to any originality of matter. 
If it be thought strange that the term epidemics should have 
been applied to a work composed of such heterogeneous mate- 
rials, I would remark, in explanation, that, although the 
subject-matters of which it consists are not all of this nature, 
the most valuable portion of them refers to epidemics, and it 
is not to be wondered at that the whole collection should have 
got its appellation from the most prominent subject to which 
it relates. 

I shall now proceed to give a succinct analysis of the various 
subjects which are contained in the First and Third Books of 
the ' Epidemics.' 

The first book opens with a description of the leading 
phenomena of a certain season, which is called the First Con- 
stitution ; it was southerly, coldish, rainy, clouded and misty, 
with some intervals of drought. The most noted diseases of 
spring in this constitution were causus and an epidemical 
parotitis. But the most important subject which is handled 
under this head, is an epidemic phthisis, of which a very inte- 
resting description is given. 

The Second Constitution is described as being northerly and 
humid; humid ophthalmies, dysenteries, and diarrhoeas are 
described among the prevailing diseases of the season ; but the 
most marked affection which is said to have occurred in this 
constitution, is a continual fever of a serious character, which 
did not come to a crisis until after it had run a long course. 
It is described as passing off by deposits, and principally by 

' De Diebus Decretoriis, i. - See the Argument of the Prognostics. 



ARGUMENT. 341 

dropsies, and an affection of tlie urinary organs. One cannot 
help being struck with the remark which Hippocrates makes, 
that he never knew a case prove fatal in which the strangury 
supervened. The directions as to the treatment he condenses 
into one general rule, which well deserves to he engraved in 
letters of gold, that "the aim of the physician should be to do 
good to his patient, or, at least, to do no harm." The descrip- 
tion of this constitution concludes with some general reflections 
on the jTTognostics in causus and phrenitis. 

The Third Constitution is described as being of a ver}^ vari- 
able character; winter storm}-, spring rainy, summer hot, 
autumn cold and dry. The ardent fevers {or causi) began 
early in the season, but did not assuine a fatal character until 
autumn. This disease came to a crisis in four modes — by an 
epistaxis, by a copious flow of urine, by a deposit, or by an 
alvine discharge. In w^oraen, there was also sometimes a crisis 
by menstruation. 

The Fourth Constitution is one which, bv Galen and the 
other authorities, has been entitled the pestilential, and has 
attracted great attention, as being supposed to have derived its 
peculiar characters from the great Plague which prevailed 
during the Peloponnesian Avar, and which is described in so 
interesting a manner by Thucydides. Galen, not only in his 
Commentary, but in various other parts of his works, advocates 
this opinion, and it will be seen from what is stated in our 
annotations, that there is in reality a striking resemblance 
between the features of the plague, as delineated by Thucydides, 
and the epidemical diseases which are noticed by Hippocrates 
as having prevailed during this constitution. Of all the 
diseases here described the most remarkable is the erysipelas, 
which, although not of a very fatal character, was still of a 
formidable nature, as it frequently terminated in gangrene. 
Causus, phrenitis, and anthrax are also described as being 
common under this constitution. The last of these being a 
well-known symptom of the Oriental plague, it has naturally 
excited a good deal of speculation to determine whether or not 
our author here refers to the glandular plague. See our 
remarks on Epidem. III. 

In these books it is reuiarkalde that phthisis is treated of as 



312 EPIDEMICS— BOOK I. 

a febrile disease, and in particular as supervening upon attacks 
of the serai-tertian. There seems reason to suppose that our 
author means to describe a hectic fever succeeding to inter- 
mittents, which had caused organic derangement of the internal 
viscera, more especially of the liver and spleen. See Paulus 
^GiNETA, Book II, 32. 

In the first book, fourteen cases of disease are related, and 
in the beginning of the third twelve, and sixteen in the end ; 
thus making forty-two in all. It is worthy of remark, that in 
twenty-five of these the result was fatal. There is every reason, 
then, to suppose that they were selected for a purpose, but 
what that purpose was cannot now be easily determined. The 
most natural would no doubt have been to illustrate, by 
examples, the forms of the different diseases which are described 
as occurring during the Constitutions previously described. 
But there seems to be little or no reason to suppose that this 
is the object for which they are related. In proof of this, I 
may mention that there is not in the collection a single case 
of the epidemical erysipelas which is described as having been 
the prevailing disease during the fourth Constitution. Indeed 
it must strike everybody, who reads them carefully, as a sin- 
gular feature in these cases, that the lineaments of a particular 
disease are seldom to be recognised, and this perhaps may be 
regarded as a proof of the faithfulness with which they have 
been copied from nature. In short, we here recognise the 
features of disease in the concrete, and not in the abstract. 
And is not this what we should expect in all true copies from 
Nature ? How often does the candid physician find himself 
forced honestly to admit that he is at a loss what name to give 
to the combination of morbid actions which he is called upon 
to treat ! The common herd of mankind would seem to fancy, 
as in Nature there are certain types of all animal and vegetable 
substances, and the botanist has no difficulty in classing such 
a plant, for example, as the conium maculatum ; and the natural 
historian can readily pronounce that such a bird is the alcedo 
Isptda ; that the physician, in like manner, upon examining 
the characteristic features of any case, should have no difficulty 
in pronouncing that it is pleuritis, for example, or pneumonia, 
or the like. But how often does it happen, that the complaint 
in question is an aggregate of symptoms, produced by pecu- 



ARGUMENT. 343 

liarities of constitution, and incidental circumstances, Avhich, 
taken together, constitute an ensemble which does not well 
admit of being referred to any one of the general forms of dis- 
ease described in our nosological systems ? Now, I say the most 
wonderful feature in the cases related by Hippocrates, is that 
they are descriptive of the symptoms observed in certain dis- 
eased individuals, instead of being, what most modern cases 
are, symptoms drawn to correspond with certain ideal forms of 
disease. What, in my opinion, likewise adds very much to the 
value of these cases is, tliat (as Galen somewhere remarks in 
his Commentarv) the author never aimed to make his Books 
of Epidemics a work on Therapeutics, and hence, in noting 
morbid phenomena, his mind is not warped by any particular 
hypothesis, nor by any selfish interest, in order to place some 
favorite mode of practice, advocated by himself, in a favorable 
light. May I be permitted here to remark, that the reader 
will be much struck with our author^s admirable talent for de- 
scribing the phenomena of disease as they are actually presented 
to us, if he will compare the cases related by him in these two 
books with those of almost any modern authority whatever ; — 
for example, wdtli those related by the late Dr. James Hamilton, 
in his celebrated work on Purgative INIedicines ? In the latter, 
you look in vain for the strongly-marked features which present 
themselves in all the cases related by our author, — for a de- 
scription of the condition of the hypochondriac region, — of the 
state of the animal heat in the extremities, — of the minute 
characters of the alvine and urinary discharges, — of the respi- 
ration, — of the patient^s position in bed, — and many other 
symptoms, wdiich are invariably noticed by Hippocrates. And 
what reasonable person will venture to deny, that the symptoms 
I have just now mentioned are most important features in every 
febrile disease, and that no one can be said to have a sufficient 
view of such a case, who does not take these into account ? 
To confine our attention at present to only one of these sym- 
ptoms, — can it ever be a matter of indifference what are the 
physical characters of so important an excretion as the urine ? 
that is to say, whether the grosser particles of it, which usually 
fall to the bottom, be present in the urine or not ? Yet in all 
the seventeen cases related in the modern work just now re- 
ferred to, the characters of the urine arc not given iu a single 



344 EPIDEMICS— BOOK I. 

instance. And althoiigli the object of tlie writer is to enforce 
his own peculiar views, as to the utility of purgative medicines 
in this disease, he scarcely ever gives the minute characters of 
the alvine discharges, as is uniformly the case with Hippocrates; 
or if they are noticed at all, it is in so confused a manner that 
the reader is at a loss to determine whether they are produced 
by the disease, or by the medicines which have been adminis- 
tered. For the issue of the case no obvious cause is stated, 
but the reader is expected to draw the conclusion that, as pur- 
gatives were freely given, and a considerable proportion of the 
cases did well, — (agreeably to the hacknied rule, post quod, ergo 
propter quod,) — the purgatives brought about the fortunate re- 
sult. Had the cases been fully and circumstantially detailed, it 
might have been found that, as in those related by Hippocrates, 
the recovery was preceded by a critical discharge of urine, ac- 
companied with a copious sediment ; and then the more probable 
inference would have been, that the amendment was referable 
to it, and not to the purgative medicines which were adminis- 
tered. It is, I regret to say, a notable example of the want 
of logical training in the education of professional men, in the 
present age, that inferences regarding a peculiar method of 
practice were allowed to be founded upon narratives of obser- 
vations so defective, and one-sided, as those I refer to. 

I cannot quit the present subject of discussion, without 
saying a few words in reference to what must strike the reader 
as a singular feature in the cases related in the books of the 
Epidemics ; I mean the general omission of any mention of 
treatment. The reader will find in our annotations various 
remarks of Galen on this head, from which he will learn that 
the Great Commentator inclines to the opinion, that in all 
these cases the usual routine of practice was followed, but that 
no mention is made of medicines, unless when there was some 
deviation from the established rules. For example, in a certain 
febrile case, it is stated that the patient was bled on the eighth 
dav, and Galen contends that venesection is noticed in this in- 
stance, merely because it was contrary to the established rule 
of not bleeding after the fourth day ; for that if the practice 
had been in accordance with the general rule, it would not 
have been noticed at all. Now it must be admitted, that tliis 



ARGUMENT. 345 

supposition is by no means improhable, and tliat examples of 
this usage are not wanting, even in the modern literature of 
medicine. To give an example, which just occurs to me : 
in not a few of the cases of cerebral disease related by Dr. 
Abercrombie, in his work ' On the Brain/ there is no allusion 
whatever to remedies, although no one, who recollects the 
vigorous system of treatment then pursued by the profession in 
"Modern Athens," will doubt for a moment that they must have 
been applied. As this eminent authority, then, when he believed 
that the treatment had no perceptible effect on the course 
which the disease ran, thought himself warranted in omitting 
all mention of it, it might be supposed, in like manner, that 
Hippocrates may have passed over the remedies applied, from 
some such motive or consideration. But another reason for the 
absence of remedies in these Reports may be readily supposed. 
May not Hippocrates have been at first quite undecided what 
was the proper plan of treatment to be adopted in these cases, 
and thought it the wisest course to attempt nothing rashly, 
but to be for a season the quiet spectator of the course which 
the diseases in question Avere naturally disposed to run, before 
attempting to interfere in the struggle between morbific agents 
with which he was imperfectly acquainted, and their great 
physician, as he held Nature to be ? ^ And however much the 
advocates for a bold system of treating diseases may be disposed 
to deride this expectant method, which Asclepiades contemp- 
tuously denominated ^' the contemplation of death," " it does 
not want the sanction of a name which is second only to 
Hippocrates in the literature of epidemical fevers. Sydenham 
admits, that with all the diligence which he had applied to the 
study of these diseases, he was always greatly puzzled what plan 
of treatment to adopt at the first breaking out of a new epidemic, 
and that it was only "ingenti adhibita cautela intcntisque 
animi nervis," that he could make up his mind what course of 
treatment to adopt in such an emergency. Need it be wondered 
at, then, that two thousand years earlier the modest mind of 
our great author should have hesitated for a time, before de- 

' Mi]Stv hi:}], fir]Siv vinpopyv. (Epid. vi, 2, 12.) 'HovaMV (pv(nfQu]Tpoi' di'iv- 
plfTKEi ri (pvaiQ avry) iiovry tuq tfocovQ' dTraiStVTog r/ (pvaig iovaa kccI ou jxaQovaa 
rd SiovTU TToin. (Ibid, vi, 5, 1.) 

^ Galen, De Venesect, adv. Erasist., c. iii. 



346 EPIDEMICS— BOOK I. 

ciding how to act under similar circumstances ? I must own, 
therefore, that I have long inclined to the opinion, that, dis- 
tracted with the conflicting plans of treatment adopted by his 
contemporaries, Hippocrates at first did little or nothing in the 
treatment of epidemical fevers, and that it was only after a pa- 
tient study of their symptoms, and many cautious trials, that 
he ventured to lay down those excellent rules of treatment 
which he has described so admirably in his work ' On Regimen 
in Acute Diseases/ This, however, is merely my individual 
opinion, and the reader must receive it as such. 

M. Littre, in the Argument prefixed to his translation of 
the Epidemics, enters very fully into the discussion of the 
question regarding the nature of the diseases which are treated 
of in the course of this work. This is a task, however, which 
I deem it superfluous to undertake at any length, as I have 
stated my opinions on this subject, in the Commentaries on the 
Second Book of Paulus ^gineta, and after maturely weighing 
what has been elicited by subsequent inquirers, I find no cause 
to retract any of the opinions which are there advanced. That 
the causus of Hippocrates, and the other ancient authorities, was 
not the typhus of the more temperate parts of Europe, but a 
bilious fever, of the remittent type, must be quite apparent to 
every person at all acquainted with the medical literature of 
febrile diseases. M. Littre^s researches lead him to exactly the 
same conclusion, and much deference is due to his judgment 
in this case, as it must be admitted that a French physician 
is now very favorably situated for contrasting the diseases of 
temperate and hot climates, owing to the familiar intercourse 
which at present subsists between Paris and Algiers. Of all 
the materials which he has collected from the observations of 
French physicians in Algeria, the most interesting are those 
which he draws from a work on Fevers, by jNl. Maillot. The 
description which is there given of " la fievTC algide," is so 
strikinsr, and is so much calculated to illustrate the nature of 
the fevers which are treated of in this work of Hippocrates, 
that I shall not scruple to quote it entire. 

" La fievre algide (dit M. Maillot) n'est pas generalement, 
comme on le dit, la prolongation indefinie du stade de froid ; 
je I'ai vue rarement debuter de la sorte. H y a meme entre 
ces deux etats une contraste frappante. Dans le premier stade 



ARGUMENT. 347 

des fievres intermittentes, la sensation du froid est liors de toute 
proportion avec Tabaisseraent reel de la temperature de la peau, 
tandis que, dans la fievre algide, le froid n'est pas per9u par le 
malade, alors que la pcau est glacee. C^est ordinairement 
pendant la reaction que commencent les syraptomes qui la 
caracterisent ; souvent ils surviennent tout a coup au milieu 
d\ine reaction qui paraissait franclie. Au trouble de la 
circulation succede en pen d^instants et presque sans transition 
le ralentissement du pouls, qui devient bientot tres rare, fuit 
sous le doigt et disparait ; Tabaissement de la temperature du 
corps va vite et suit la progression promptement decroissante 
de la circulation ; les extremites, la face, le torse, se refroi- 
dissent successivement ; I'abdomeu seul conserve encore quelque 
temps un pen de clialeur ; le contact de la peau donne la sensa- 
tion de froid que procure le marbre. Les levres sont de- 
colorees, Fhaleine froide, la voix cassee, les battemens du coeur 
rares, incomplets, appreciables seulement par Pauscultation ; les 
facultes intellectuelles sont intactes, et le malade se complait 
dans cet etat de repos, surtout lorsqu'il succede h une fievre 
violente, la pliysionomie est sans mobilite, Pimpassibilite la plus 
grande est peinte sur son visage ; ses traits sont morts. La 
marclie de cette fievre est tres.insidieuse ; il n^est peut-etre per- 
sonne, dont elle n'ait surpris la vigilance ; avant d'etre fami- 
liarise avec Tobservation des accidens de cette nature, on prend 
souvent pour une tres grande amelioration due aux depletions 
sanguines, le calme qui succede aux accidents inflammatoires j 
et plus d'une fois, dans de semblables circonstances, on n'aete 
detrompe que par la mort soudaine du malade. Toutes les fois 
qu'a une reaction plus ou moins forte, on verra succeder tout k 
coup un ralentissement du pouls, avec paleur de la langue et 
decoloration des levres, on ne devra liesiter a diagnostiquer 
une fievre algide. La temporisation ici donne la mort, en 
quelques lieures. Dans quelques cas tres rares, j'ai cependant 
vu cet etat algide se prolouger trois ou quatre jours. Le malade 
expire en conservant toutes ses facultes intellectuelles,^ il s'eteint 

' One cannot help being struck with the resemblance between this description and 
a passage in Aretaeus's chapter on Causus : ''I'l'X'/C KaTucTTauiQ, aiuOijcng aiiiiiraaa 
KaOap)], Siavoia Xfun), ■yrojj.itf jiavTiK)), k. t. X. 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. 



348 EPIDEMICS- BOOK I. 

comme par un arret cle rinnervation. Lorsque la mort n'est 
pas le terme cle cet etat morbide si grave, le pouls se releve ; 
la peau reprend sa clialeur iiaturelle ; quelquefois alors la 
reaction determine une irritation de Tencepliale ou des voies 
digestives ; mais rarement elle est assez intense pour qu'on 
soit oblige de la combattre par des depletions sanguines/^^ 
I shall add a remark, wliicli J\I, Littre gives on the same au- 
thority : " J^ai tenu a mentionner ici I'impression qu'eprouva 
M. Maillot au debut de sa pratique en Algerie, et qui est si 
instructive ; car, aller subitement de France exercer la mede- 
cine dans un pays chaud, ou lire les observations d'Hippocrate, 
c'est tout un : Fimpression est la meme, le changement de scene 
est aussi grand/'" 

I cannot help remarking in this place, however, that it 
appears to me singular, that M. Littre should represent the 
febris algida as being confined to southern climates, and should 
speak of it as being unknown in Paris ; for, at all events, there 
seems to be no doubt that it prevails in a more northerly 
region, namely, in Holland. It is thus described by the cele- 
brated Franciscus de le Boe [07- Sylvius), who was professor of 
practical medicine at Leyden about the middle of the 17th 
century : " Febres algidse observantur nonnunquara, non 
tautum frigore prsesertim, sed frigore tantum molestse ; adeo ut 
aliquando et frequentius levis, aliquando et rarius nuUus 
scquatur calor. Tales, etiam semper algidas in Nosocomio 
academico habuimus ita manifestas, ut non tantum incipiente, 
atque augescente, sed etiam vigente et declinante, imocessante 
paroxysmo, id est, semper tum suo, tum adstantium, tum medi- 
corum sensu moleste ubique frigerent, nunquam teperent, 
minus calerent ullibi segri. Suntque hse algidas graviores 
semper forsan quotidians .•''" The febris algida is also named 
" rigor without heat,'' by the Greek authorities, and " frigus 
quod non calefit" by the Arabians, who, like Sylvius, as quoted 
above, regard it as a variety of the quotidian intermittent. 
See Paulus Egineta, Book II, 26. 

M. Littre^ quotes the remark of an excellent English 

' Traite des Fievres ou Irritations Cerebro-spinales intermittentes, d'apres des Ob- 
servations recueillies en France, en Corse et en Afrique. Paris, 1836. 
'■' (Euvres d'Hippocrate, &c., torn, ii, p. 565. 
^ Prax. Med. nova Idea, i, 31. '' Tom. ii, p. 565. 



ARGUMENT. 319 

authority on fever, J. Jolmson/ that it is singular the effects 
of marsh effluvia should have escaped the observation of Hip- 
pocrates, more especially as the remittent and intermittent 
fevers, of which he treats so fully, are mostly derived from this 
source. Now I must say, that I am not aware of there being 
any passage in the works of Hippocrates where the effects of 
marsh effluvia in engendering such fevers are distinctly noticed; 
but if Hippocrates was ignorant of this fact, in the etiology of 
fevers, it was well known to Galen, as may be seen on reference 
to his very interesting work 'On the Difference of Fevers.'" The 
Arabians also were familiar with the fact. See Avicenna,iv, 1, 2, 1 . 
In the treatise ' On Airs,' which, although not admitted by 
us into the list of genuine works, has considerable pretension 
to be so regarded, the causes of fever are treated of with great 
precision, and there the pestilential fevers are said to derive 
their origin from miasma, but whether or not under this term be 
included marsh effluvia, cannot be determined. But perhaps a 
better reason might be assigned for there being little or no 
allusion to malaria in the works of Hippocrates, namely, that 
after all, this was not the cause of the epidemical diseases which 
he describes. The following extract from a work of very high 
authority on fever is well deserving of consideration in this 
place : " A question has arisen as to whether or not the in- 
flammatory states of fever, in warm countries, are caused l)y 
malaria, or by the other causes now instanced (excess of heat, 
&c.) There can be no doubt that malaria very frequently 
produces in the plethoric, young, and robust, who have recently 
arrived in a hot climate, fever of an inflammatory and con- 
tinued kind; but it must also be conceded that this fever 
chiefly occurs, even in persons thus constituted, during the dry 
season, and at times and in places where the existence of 
malaria is doubtful, or, at least, by no means proved. It is 
notoriously admitted that the inflammatory states of continued 
fever, in both the East and West Indies, appear among those 
soldiers, sailors, and civilians, who have not been long in a 
warm countrv, and who have not suffered from disease since 
their arrival ; and that they take place chiefly during the dry 
and warm seasons, and in situations where the usual effects of 

' On the Influence of Tropical Climates. - Tom. vii, p. 290 ; ed. Kiihn. 



350 EPIDEMICS— BOOK I. 

malaria are never observed. This is the result of the experience 
of Jackson, Annesley, Boyle, Twining, Conwell, and the other 
experienced practitioners in warm countries. It agrees with 
my own observations, and is even admitted by Dr. Fergusson, 
who has gone much further than any one else in assigning 
malaria as the cause of intertropical fevers.'^ ^ I may mention, 
moreover, that Hippocrates and his contemporaries were evi- 
dently not ignorant of the fact, that the atmosphere in the 
vicinity of marshes and large rivers is unwholesome to the in- 
habitants of warm climates. See De Diaita, ii, 2. 

The following are part of the conclusions which M. Littre 
draws from his investigations into the nature of the fevers 
described by Hippocrates. I quote them as being strongly 
confirmatory of the opinions delivered by me in the Com- 
mentary on the Second Book of Paulus ^gineta. 

" Les fievres decrites dans les Epidemies d'Hippocrate 
different de nos fievres continues. 

" Les fievres decrites dans les Epidemies ont, dans leur ap- 
parence geuerale, une similitude tres grande avec celles des 
pays chauds. 

" La similitude n'est pas moins grande dans les details que 
dans I'ensemble. 

" Dans les unes comme dans les autres les hypochondres sont 
pour un tiers des cas, le siege d'une manifestation toute speciale. 

" Dans les unes comme dans les autres, il y a une forte ten- 
dence ou refroidissement du corps, Jl la sueur froide et a la 
lividite des extremites." 

On almost all the other diseases treated of in these books, 
M. Littre's opinions, in like manner, exactly coincide with those 
delivered by me in the above-mentioned work. Thus he arrives 
at the conclusion, that the Phreuitis and Lethargus of Hippo- 
crates were varieties of the Causus. Compare Paulus tEgineta, 
Book III, 6, 9. He refers them to les fievres pernicieuses 
comateuses pseudo-co7itinues, et les fievres pernicieiises dolor antes 
pseudo-continues of M. Maillot. It would appear from the extracts 
■which he quotes from a work of M. Boux, on the Diseases of 
Morea, that a similar tendenc}^ to pass into phrenitis and lethargy 
is still observable in the land of Greece. The fevers of the 

' Copland's Dictionary of Practical Medicine, P. iv, p. 974. 



ARGUMENT. 351 

East Indies also, as described by Dr. Twining,^ appear to 
partake very much of the same character. In a word, the 
conclusions to which a patient study of modern authorities on 
the subject have brought me amount to this ; that the fevers 
described by Hippocrates in his ' Epidemics/ are exactly the 
same as those which are now described as still prevailing in 
the land of Greece : that they correspond very well with those 
described by Cleghorn as occurring in Majorca ; differ but Httle 
from those described by Pringle, Monro, and Sylvius, as hap- 
pening in the Low Countries, and dift'er from those described 
by Twining, as happening in Bengal, only in a few particulars. 

From the analysis of their contents given above it will readily 
be understood that the subject-matters of these two books are 
not arranged methodically. Indeed it is quite obvious from 
the nature of the work that the matters which are treated of 
in it had never been methodised by the author. Certainly 
then, as proposed by Desmair,^ it would be a much more natural 
arrangement to give the four Constitvitions of the seasons first, 
and then to give the forty-two cases together. But the present 
arrangement being of old standing, no editor has thought him- 
self warranted to depart from it. 

There are two important professional subjects of which it may 
appear surprising that there is no mention in the ' Books of 
the Epidemics,^ I mean sphygmology and contagion. Galen 
repeatedly declares it as his opinion, that Hippocrates paid no 
attention to the characters of the arterial pulse, and that the 
subject was not at all studied until after his time ; and as far 
as I can see there is no ground for calling in question this 
opinion of Galen. Herophilus, in fact, would appear to have 
been the first person that made any progress in this study. 
It is more remarkable that Hippocrates should omit all allusion 
to the other subject, more especially as the contagiousness of 
certain diseases would appear to have been the popular belief 
of his age. Thus his contemporary, Thucydides, in describing 
the plague, expresses himself in such terms, as puts it beyond 
a doubt that he regarded the disease as being of a contagious 
nature. And another contemporary, Isocrates, makes such 

' Clinical Observations on the more important Diseases of Bengal. Calcutta, 
1835. 
" Epidem. d'Hippocrate. 



352 EPIDEMICS— BOOK I. 

observations on a certain case of empyema, by wliich he evi- 
dently means phthisis puhnonalis, as to show that it also was 
regarded as being communicable.^ How the omission is to 
be accounted for I do not know, but certain it is that not the 
least reference to contagion, in any shape, is to be found in 
any of the llippocratic treatises. 



BOOK I— OF THE EPIDEMICS. 

Sect. I. — Constitution First. 

1. In Thasus," about the autumnal equinox, and under the 
Pleiades,^ the rains were abundant, constant, and soft, with 
southerly winds ; the winter southerly, the northerly winds 
faint, droughts ; on the whole, the winter having the character 
of spring. The spring was southerh', cool, rains small in 
quantity. Summer, for the most part, cloudy, no rain, the 
Etesian winds, rare and small, blew in an irregular manner. 
The whole constitution of the season being thus inclined to the 
southerly, and with droughts early in the spring, from the pre- 
ceding opposite and northerly state, ardent fevers occurred in a 
few instances, and these very mild, being rarely attended 
with hemorrhage, and never proving fatal.* Swellings 
appeared about the ears, in many on either side, and in the 
greatest number on' both sides, being imaccompanied by fever 
so as not to confine the patient to ])ed ; in all cases they 

' See jEgineta. The narrative contains the most distinct and nnequivocal traces of 
the belief in the contagiousness of consumption. 

■■' Thasus is an island in the ^Egean sea, off the coast of Thrace, which bears the 
modern name of Thaso or Tasso. It was in a flourishing condition in the time of 
Hippocrates, and a tributary to Athens, but revolted from that power after its dis- 
asters 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. 

^ According to Galen, in his Commentary on this passage, the setting of the Pleiades 
takes jjlace fifty days after the autumnal equinox. See the Argument to the treatise 
On Airs, &c. 

'' We have already stated that the ardent fevers or causi, of which repeated men- 
tion is made in the llippocratic treatises, were fevers of the remittent type, in short 
that they were the same as the bilious remittent fevers of Pringle and Monro. 



EPIDEMICS— COOK I. 353 

disappeared witliout giving trouble, neither did any of them 
come to suppuration, as is common in swellings from other 
causes. They were of a lax, large, diffused character, without 
inflammation or pain, and they went away without any critical 
sign. They seized children, adults, and mostly those who 
were engaged in the exercises of the palestra and gymnasium, 
but seldom attacked women. Many had dry coughs without 
expectoration, and accompanied with hoarseness of voice. In 
some instances earlier, and in others later, inflammations with 
pain seized sometimes one of the testicles, and sometimes both -^ 
some of these cases were accompanied with fever and some not ; 
the greater part of these were attended with much suffering. 
In other respects they were free of disease, so as not to require 
medical assistance.^ 

2. Early in the beginning of spring, and through the 
summer, and towards winter, many of those who had been long- 
gradually declining, took to bed with symptoms of phthisis ; 
in many cases formerly of a doubtful character the disease then 
became confirmed ; in these the constitution inclined to the 
phthisical.^ Many, and, in fact, the most of them, died ; and 
of those confined to bed, I do not know if a single individual 
survived for any considerable time ; they died more suddenly 

' I need scarcely say that the disease here described is cynanche jjarotUcea, or 
parotitis. It is a remarkable proof of our author's talent for observation, that he 
has pointed out the tendency of the disease to be complicated with swelling and in- 
flammation of the testicles. Altogether the description of the disease here given is 
quite applicable to the mumps of modern times. As stated by him, the swelling of 
the testicles is generally painful. See the Commentary of Galen. 

2 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 latrium for 
advice. See also Littre's annotations on this passage. 

^ Galen thinks our author expresses himself confusedly in this place, but Littre 
justly defends him from this charge. According to Littre, Hippocrates means that 
those who had been long affected with consumption (the term used, viroipOdpoi.iei'wi', 
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 at- 
tack 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 scapulaj protuberant behind hke wings ; and hence he says chests of this con- 
struction have been named alar. He further states that there are two forms of 
consumption, the one originating in a defiuxion from tlie head, and the other being 

23 



354 EPIDEMICS— BOOK I. 

than is common in such cases. But other diseases, of a pro- 
tracted character, and attended with fever, were well supported, 
and did not prove fatal : of these we will give a description 
afterwards. Consumption was the most considerable of the 
diseases which then prevailed, and the only one which proved 
fatal to many persons. Most of them were affected by these 
diseases in the following manner : fevers accompanied with 
rigors, of the continual type, acute, having no complete inter- 
missions, but of the form of the semi-tertians, being milder the 
one day, and the next having an exacerbation, and increasing 
in violence ; constant sweats, but not diffused over the whole 
body; extremities very cold, and warmed with difficulty; 
bowels disordered, with bilious, scanty, unmixed, thin, pungent, 
and frequent dejections. The urine was thin, colourless, 
unconcocted, or thick with a deficient sediment, not settling 
favorably, but casting down a crude and unseasonable sedi- 
ment. Sputa small, dense, concocted, but brought up rarely 
and with diflficulty ; and in those who encoimtcred the most 
violent symptoms there was no concoction at all, but they con- 
tinued throughout spitting crude matters. Their fauces, in 
most of them, were painful from first to last, having redness 
with inflammation ; defluxions thin, small, and acrid ; they 
were soon wasted and became worse, having no appetite for 
any kind of food throughout ; no thirst ; most persons delirious 
when near death. So much concerning the phthisical affec- 
tions.-^ 

3. In the course of the summer and autumn many fevers of 

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 connexion of hemoptysis with phthisis, that Louis found hemoptysis to a greater 
or less extent in two thirds of his cases. (Researclies 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.) 

' 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 hke manner, mentions delirium in, I believe, eveiy 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. 



EPIDEMICS— BOOK I. 355 

tlie continual type, but not violent ;' they attacked persons 
who had been long indisposed, but who were otherwise not in 
an uncomfortable state. In most cases the bowels were dis- 
ordered in a very moderate degree, and they did not suffer 
thereby in any manner worth mentioning ; the urine was gene- 
rally well coloured, clear, thin, and after a time becoming 
concocted near the crisis. They had not much cough, nor 
was it troublesome ; they Avere not deficient in appetite, for it 
was necessary to give them food, (on tlie whole^ persons 
labouring under phthisis were not affected in the usual 
manner.) 2 They were affected with fevers, rigors, and defi- 
cient sweats, with varied and irregular paroxysms, in general 
not intermitting, but having exacerbations in the tertian form. 
The earliest crisis wliich occurred was about the twentieth day, 
in most about the fortieth, and in many about the eightieth. 
But there were cases in which it did not leave them thus at 
all, but in an irregular manner, and without any crisis ; in 
most of these the fevers, after a brief interval, relapsed again ; 
and from these relapses they came to a crisis in the same 
periods ; but in many they were prolonged so that the disease 
was not gone at the approach of winter. Of all those which 
are described under this constitution, the phthisical diseases 
alone were of a fatal character ; for in all the others the patients 
bore up Avell, and did not die of the other fevers."" 

' The nature of the continual fevers of the ancients is fully explained in the Com- 
mentary on the twenty-seventh section of the Second Book of Paulus jEgineta. 
Galen, in his Commentary on this passage, marks their nature very distinctly in few 
words. He says that such fevers as have an exacerbation of fever ending in complete 
apyrexia are called intermittents, whereas such as do not end in a complete remission 
of the fever are called continual. See further De Diflf. Febr., ii, 2. In a word, the con- 
tinual fevers were decidedly of the remittent type. See further Donald Monro's work 
on Army Diseases, in the beginning of the chapter on the Bilious Remittent Fever. 

- The introduction of phthisis in this place has created some ditficultyin the inter- 
pretation, as may be seen on reference to Galen and Littre. Galen gives a very interesting 
account of the way in which interpolations often took place. (Opera, tom. v, p. 356.) 

^ The text of this last sentence is in an unsettled state. The following would be 
a translation of it as it stands in the Basle edition of Galen's AVorks : " Of all the 
cases described under this constitution, those alone which were of a phthisical 
character proved fatal. But they (the phthisical atfections ?) did not supervene upon 
the other fevers." Provided this be the true meaning of the passage, it would merit 
great attention, as seeming to contain a declaration that intermittent fevers super- 
induced an immunity to phthisis. I need not say that this supposed fact has been 
exciting a great deal of interest lately in the profession, more especially in France. 



356 EPIDEMICS— BOOK I. 

Sect. II. — Constitution Second. 

1. In Thasus, early in autumn, the winter suddenly set in 
rainy before the usual time, with much northerly and southerly 
winds. These things all continued so during the season of the 
Pleiades, and until their setting.^ The winter was northerly, 
the rains frequent, in torrents, and large, with snow, but with 
a frequent mixture of fair weather. These things were all 
so, but the setting in of the cold was not much out of season. 
After the winter solstice, and at the time when the zephyr 
usually begins to blow, severe winterly storms, out of season, 
with much northerly wind, snow, continued and copious rains; 
the sky tempestuous and clouded ; these things were protracted, 
and did not remit until the equinox. The spring was cold, 
northerly, rainy, and clouded j the summer was not very sultry, 
the Etesian winds blew constant, but quicklj^ afterwards, about 
the rising of Arcturus, there were again many rains with north 
winds. The whole season being wet, cold, and northerly, 
people were, for the most part, healthy during winter; but 
early in the spring very many, indeed, the greater part, were 
valetudinary. At first ophthalmies set in, with rheums, pains, 
unconcocted discharges, small concretions, generally breaking 
with difficulty, in most instances they relapsed, and they did 
not cease until late in autumn.^ During summer and autumn 
there were dvsenteric affections, attacks of tenesmus and lien- 
tery, bilious diarrhoea, with thin, copious, undigested, and acrid 
dejections, and sometimes with watery stools ; many had copious 
defluxions, with pain, of a bilious, watery, slimy, purulent 

' It is to be borne in mind that the autumn began with the rising of Arcturus, 
and ended with the setting of the Pleiades. The setting of the Pleiades then indi- 
cated the commencement of winter. The classical reader will find the different 
seasons, strikingly defined by the rising and setting of the stars, in Virgil's Georgics. 
See in particular Georg. i, 221. 

'^ Galen thus explains the origin of the ophthalmies. He says, the constitution of 
the air being not only cold and humid, but attended also with hurricanes, the eyes 
were thus injured, and consequently were the first part of the body to show symptoms 
of disease. The dysenteric and other alvine complaints which followed, he ascribes 
to the constriction of the skin induced by the cold, and to the humours of the system 
aggravated and increased by the humid state of the season. These humours being 
thus shut up by the occlusion of the pores of the skin, part of them were determined 
to the intestines, occasioning diarrhoea, tenesmus, dysentery, &c. ; some to the bladder, 
inducing strangury ; and some to the mouth of the stomach, occasioning vomiting. 



EPIDEMICS— BOOK I. 357 

nature, attended with strangury, not connected with disease of 
the kidneys, but one complaint succeeding the other ; vomit- 
ings of bile, phlegm, and undigested food, sweats, in all cases 
a redundance of humours. In many instances these complaints 
were unattended with fever, and did not prevent the patients 
from walking about, but some cases were febrile, as will be 
described. In some all those described below occurred with 
pain. During autumn, and at the commencement of Avinter, 
there were phthisical complaints, continual fevers ; and, in a 
few cases, ardent ; some diurnal, others nocturnal, semi- 
tertians, true tertians, quartans, irregular fevers. All the fevers 
which are described attacked great numbers. The ardent fevers 
attacked the smallest numbers, and the patients suffered the 
least from them, for there were no hemorrhages, except a few 
and to a small amount, nor was there delirium ; all the other 
complaints were slight ; in these the crises were regular, in most 
instances, with the intermittents, in seventeen days ; and I 
know no instance of a person dying of causus, nor becoming 
phreuitic.^ The tertians were more numerous than the ardent 
fevers, and attended with more pain -^ but these all had four 
periods in regular succession from the first attack, and they 
had a complete crisis in seven, without a relapse in any 
instance. The quartans attacked many at first, in the form of 
regular quartans, but in no few cases a transition from other 
fevers and diseases into quartans took place ; they were pro- 
tracted, as is wont with them, indeed, more so than usual. 
Quotidian, nocturnal, and wandering fevers attacked many 
persons, some of whom continued to keep up, and others were 
confined to bed. In most instances these fevers were prolonged 
under the Pleiades and till winter. Many persons, and more 
especially children, had convulsions from the commencement f 

' Galen states in his Commentary that the phrenitis is connected with inflamma- 
tion of the parts about the brain. We have mentioned before that the phrenitis of 
the ancients was a febrile affection, and not idiopathic inflammation of the brain, as 
is generally supposed. 

^ According to Galen, the causi or ardent fevers are occasioned by yellow bile 
collected about the vessels of the liver and stomach, and the tertians by the same 
dilfused over the whole body. 

* Galen states in his Commentary that children are peculiarly subject to convul- 
sions owing to the weakness of their nervous system. He adds, that in their case 
convulsions are not attended with so much danger as in other cases. See the 
Hippocratic treatise On Deuliiioii. 



3o8 EPIDEMICS— BOOK I. 

and tliey had fever, and the convulsions supervened upon 
the fevers ; in most cases they were protracted, but free 
from danger, unless in those who were in a deadly state from 
other complaints. Those fevers which were continual in the 
main, and with no intermissions, but having exacerbations in 
the tertian form,' there being remissions the one day and 
exacerbations the next, were the most violent of all those which 
occurred at that time, and the most protracted, and occurring 
with the greatest pains, beginning mildly, always on the whole 
increasing, and being exacerbated, and always turning worse, 
having small remissions, and after an abatement having more 
violent paroxysms, and growing worse, for the most part, on 
the critical days. Rigors, in all cases, took place in an irre- 
gular and uncertain manner, very rare and weak in them, but 
greater in all other fevers ; frequent sweats, but most seldom 
in them, bringing no alleviation, but, on the contrary, doing 
mischief. Much cold of the extremities in them, and these 
were warmed with difficulty. Insomnolency, for the most 
part, especially in these fevers, and again a disposition to 
coma. The bowels, in all diseases, were disordered, and in a 
bad state, but worst of all in these. The urine, in most of 
them, was either thin and crude, yellow, and after a time with 
slight symptoms of concoction in a critical form, or having 
the proper thickness, but muddy, and neither settling nor 
subsiding ; or having small and bad, and crude sediments; 
these being the Avorst of all. Coughs attended these fevers, 
but I cannot state that any harm or good ever resulted from 
the cough. The most of these were protracted and trouble- 
some, went on in a very disorderly and irregular form, and, for 
the most part, did not end in a crisis, either in the fatal cases 
or in the others ; for if it left some of them for a season it 
soon returned again. In a few instances the fever terminated 
with a crisis ; in the earliest of these about the eightieth day, 
and some of these relapsed, so that most of them were not free 

• The fever here described is evidently the semitertian. See Paulus ^gineta, 
Book l[, 34. " The true semitertian," says M. Bartels, as quoted by M. Littre, " is a real 
comphcation of an intermittent fever with another fever of a continual type. It does 
not show itself but rarely in our countries ; but it is more frequent in the hotter 
countries of Europe, although the false semitertian has oftener than once been con- 
founded vtith the true. In the true, the intermittent fever is tertian ; the nou- 
interniittent is quotidian." See also Galen, Opera, toni. v, p. 362 ; ed. Basil. 



EPIDEMICS— BOOK I. 359 

from the fever during the winter; but the fever left most of 
them without a crisis, and these things happened alike to those 
who recovered and to those who did not. There being much 
want of crisis and much variety as to these diseases^ tlie greatest 
and worst symptom attended the most of them, namely, a 
loathing of all articles of food, more especially with those who 
had otherwise fatal symptoms ; but they were not unseasonably 
thirsty in such fevers. After a length of time, with much 
suffering and great wasting, abscesses were formed in these 
cases, either vmusually large, so that the patients could not 
support them, or unusually small, so that they did no good, 
but soon relapsed and speedily got worse. The diseases which 
attacked them were in the form of dysenteries, tenesmus, lien- 
ter}^ and fluxes ; but, in some cases, there were dropsies, 
with or without these complaints. AVhatcver attacked them 
violently speedily cut them off, or again, did them no good. 
Small rashes, and not corresponding to the violence of the 
disease, and quickly disappearing, or swellings occurred about 
the ears, which were not resolved, and brought on no crisis.^ 
In some they were determined to the joints, and especially to 
the hip-joint, terminating critically v/iili a few, and quickly 
again increasing to its original habit. Persons died of all 
these diseases, but mostly of these fevers, and especially infimts 
just weaned, and older children, until eight or ten years of 
age, and those before puberty. These things occurred to those 
affected with the complaints described above, and to many 
persons at first without them. The only favorable symptom, 
and the greatest of those which occurred, and what saved 
most of those who were in the greatest dangers, was the con- 
version of it to a strangury, and when, in addition to this, 
abscesses were formed." The strangury attacked, most especi- 
ally, persons of the ages I have mentioned, but it also occurred 

' The text here is iu an unsatisfactory state, and, as usual in snch cases, no in- 
genuity nor pains can do much to mend it. See Foes and Littre. I have translated 
the disputed words " not resolved," which seems to me to agree best with the sense. 
Every practical physician knows that swellings of the glands, which continue long 
and do not suppurate, are unfavorable in fevers. 

* The modern physician will not fail to be struck with this observation as to the 
termination of certain cases of fever in determination to the kidneys. Galen remarks 
in his Commentary on this passage, that as the general system is often purged by the 
bowels, so is it also sometimes by the Sidneys and bladder. Tliis, he adds, is a pro- 



360 EPIDEMICS— BOOK I. 

in many others, both of those who were not confined to bed 
and those who were. There was a speedy and great change 
in all these cases. For the bowels, if they happened previously 
to have watery discharges of a bad character, became regular, 
they got an appetite for food, and the fevers were mild after- 
wards. But, with regard to the strangury itself, the symptoms 
were protracted and painful. Their urine was copious, thick, 
of various characters, red, mixed with pus, and was passed with 
pain. These all recovered, and I did not see a single instance 
of death among them. 

5, With regard to the dangers of these cases, one must 
always attend to the seasonable concoction of all the evacua- 
tions, and to the favorable and critical abscesses. The con- 
coctions indicate a speedy crisis and recovery of health ; crude 
and undigested evacuations, and those which are converted 
into bad abscesses, indicate either want of crisis, or pains, or 
prolongation of the disease, or death, or relapses; which of these 
it is to be must be determined from other circumstances. TJie 
jihysician must be able to tell the antecedents, knoiv the present, and 
foretell the future — must meditate these things, and have tivo spe- 
cial objects in view with regard to diseases, namely, to do good or 
to do no harm. The art consists in three things — the disease, the 
patient, and the physician. The physician is the servant of the art, 
and the patient must combat the disease along with the physician? 

tracted and painful mode of resolution in fevers. The reader will remark the cha- 
racters of the urine as stated below by our author. One cannot help being struck 
with his statement, that all these cases recovered. I am not aware of any modern 
observations bearing on this point. 

' There is considerable difficulty here in determining the reading. See Littre, 
whom I have followed. 

* I need scarcely remark that this passage is of classical celebrity. Galen, in his 
Commentary, remarks that the first time he read it he thought it unworthy of Hip- 
pocrates to lay it down as a rule of practice, that " the physician should do good to 
his patient, or at least no harm ;" but that, after having seen a good deal of the 
practice of other physicians, and observed how often they were justly exposed to 
censure for having bled, or applied the bath, or given medicines, or wine unseasonably, 
*he came to recognise the propriety and importance of the rule laid down by Hippo- 
crates. The practice of certain physicians, Galen remarks, is like playing at the dice, 
when what turns up may occasion the greatest mischief to their patients. The last 
clause of this passage is very forcibly put. Galen, however, informs us that in some 
of the MSS. instead of " art" he found " nature ;" that is to say, that the physician 
is " the minister {or sei-vaut) of nature." Either of the readings, he remarks, will 
agree very well with the meaning of the passage. 



EPIDEMICS— BOOK I. 361 

6. Pains about the head and neck, and heaviness of the 
same along with pain, occur either without fevers or in fevers. 
Convulsions occurring in persons attacked with frenzy, and 
having vomitings of verdigris-green hile, in some cases quickly 
prove fatal. In ardent fevers, and in those other fevers in which 
there is pain of the neck, heaviness of the temples, mistiness 
about the eyes, and distension about the hypochondriac region, 
not unattended with pain, hemorrhage from the nose takes 
place,^ but those who have heaviness of the whole head, cardi- 
algia and nausea, vomit bilious and pituitous matters ; children, 
in such affections, are generally attacked with convulsions, and 
women have these and also pains of the uterus ; whereas, in 
elder persons, and those in whom the heat is already more 
subdued, these cases end in paralysis, mania, and loss of sight. 

Thikd Constitution. 

7. In Thasus, a little before and during the season of 
Arcturus," there were frequent and great rains, with northerly 
winds. About the equinox, and till the setting of the Pleiades, 
there were a few southerly rains : the winter northerly and 
parched, cold, with great winds and snow. Great storms about 
the equinox, the spring northerly, dryness, rains few and cold. 
About the summer solstice, scant}' rains, and great cold until 
near the season of the Dog-star.^ After the Dog-days, until the 
season of Arcturus, the summer hot, great droughts, not in 
intervals, but continued and severe : no rain ; the Etesian winds 
blew ; about the season of Arcturus southerly rains until the 
equinox. 

' The reader will find it interesting to refer here to the Prognostics. See also the 
Commentary of Galen. Let me here impress upon the reader the necessity of making 
frequent comparisons of the Prognostics with this work, if he would wish rightly to 
apprehend the bearing and meaning of the latter. That the Epidemics are entirely 
founded upon the principles of prognosis there can be no doubt. 

^ It is to he recollected that the rising of xVrcturus marked the beginning of autumn, 
and the setting of the Pleiades the end of it. See above. 

^ The season of the Dog-star was immediately after the summer solstice, namely, 
when the sun enters the constellation Leo. The classical reader will reachly bring to 
his recollection the hues of Horace, which are descriptive of this season : 

" Jam Pi-ocyon fnrit, 
Et Stella vesani Leonis, 
Sole dies referente siccos." 



362 EPIDEMICS— BOOK I. 

8. In this state of things^ during winter^ paraplegia set in, 
and attacked many, and some died speedily ; and otherwise the 
disease prevailed much in an epidemical form, but persons re- 
mained free from all other diseases.^ Early in the spring, 
ardent fevers commenced and continued through the summer 
until the equinox. Those then that were attacked immediately 
after the commencement of the spring and summer, for the 
most part recovered, and but few of them died. But when the 
autumn and the rains had set in, they were of a fatal character, 
and the greater part then died.^ When in these attacks of 
ardent fevers there was a proper and copious hemorrhage from 
the nose, they were generally saved by it, and I do not know 
a single person who had a proper hemorrhage who died in this 
constitution. Philiscus, Epaminon, and Silenus, indeed, Avho 
had a trifling epistaxis on the fourth and fifth day, died.^ The 
most of those seized with the disease had a rigor about the time 
of the crisis, and especially those who had no hemorrhage ; 
these had also the rigor associated. Some were attacked with 
jaundice on the sixth day,* but these were benefited either by 
an urinary purgation, or a disorder of the bowels, or a copious 
hemorrhage, as in the case of Heraclides, who was lodged with 
Aristocydes : this person, though he had the hemorrhage from 
the nose, the purgation by the bladder, and disorder of the 

' Galen, in his Commentary, remarks that the attacks of paraplegia (that is to 
say, of apoplexy) were brought on by the cold winds of the winter succeeding to a 
humid autumn. 

" The causi or ardent fevers, it is worthy of remark, began this season in spring? 
but were not of a fatal character until autumn. In modern times the bilious remit- 
tent fever has uniformly been found to lie most aggravated in autumn, and hence it 
has been named by some authorities the autumnal remittent fever. See the works 
of Sydenham, Pringle, Monro, and Cleghorn. Monro mentions that he seldom saw 
it in spring, but that it is common in the neighbourhood of London towards the end 
of summer and beginning of autumn. All these authorities are agreed tliat it is of a 
highly bilious nature. 

* Monro mentions epistaxis as occurring in the autumnal remittent fever; he says 
it did not prove a crisis in any case. 

"* The complication of the autumnal remittent fever with jaundice is noticed by 
Sir John Pringle (Obs. iii, 4), and by Monro (On Army Diseases, p. 161). Galen, 
in his Commentary, remarks that when nature is imable to evacuate the bile, it is 
collected in the skin, and occasions jaundice. He adds, that the occurrence of the 
jaundice in this case was unfavorable, owing to its taking place before the seventh 
day. When occurring on the seventh day, jaundice was reckoned a favorable symptom. 
See On Crises, 3; Aphorism, iv, G2, G4. 



EPIDEMICS— BOOK I. 363 

bowels, experienced a favorable crisis on the twentieth day, 
not like the servant of Plianagoras, wbo had none of these 
symptoms, and died. The hemorrhages attacked most persons, 
but especially young persons and those in the prime of life, and 
the greater part of those who had not the hemorrhage died •} 
elderly persons had jaundice or disorders of the bowels, such 
as Bion, who was lodged with Silenus. Dysenteries were epi- 
demical during the summer, and some of those cases in which 
the hemorrhage occurred, terminated in dysentery, as liappened 
to the slave of Eraton, and to Mullus, who had a copious 
hemorrhage, which settled down into dysentery, and they reco- 
vered. This humour was redundant in many cases, since in 
those who had not the hemorrhage about the crisis, but the 
risings about the ears disappeared, after their disappearance 
there was a sense of weight in the left flank extending to the 
extremity of the hip, and pain setting in after the crisis, with 
a discharge of thin urine; they began to have small hemorrhages 
about the twenty-fourth day, and the swelling was converted 
into the hemorrhage. In the case of Antiphon, the son of 
Critobulus,the fever ceased and came to a crisis about the fortieth 
day. Many Avonien were attacked, but fewer than of the men, 
and there were fewer deaths among them. But most of them 
had difficult parturition, and after labour they were taken ill, 
and these most especially died, as, for example, the daughter of 
Telebolus died on the sixth day after delivery.^ Most females 
had the menstrual discharge during the fever, and many girls 
had it then for the first time : in certain individuals, both the 
hemorrhage from the nose and the menses appeared; thus, in the 
case of the virgin daughter of Da^tharses, the menses then took 
place for the first time, and she had also a copious hemorrhage 
from the nose, and I knew no instance of any one dying when 
one or other of these took place properly. But ail those in the 
pregnant state that were attacked had abortions, as far as I 

' The reader may feel interested to learn Galen's hypothesis by which he accounts 
for the hemorrliage in this case. He says it is produced by the redundancy of yellow 
bile, which, being mixed up with the blood and heating it, is carried up to the head, 
where it produces rupture of the vessels and liemorrliage. 

* Modern observations have confirmed this account of the generally fatal issue of 
febrile diseases after parturition. In the Hippocratic work On Diseases, fever after 
delivery in a woman is reckoned among the cases which generally prove fatal. 



364 EPIDEMICS— BOOK I. 

observed. Tlie urine in most cases was of the proper colour, 
but tbin, and having scanty sediments •} in most the bowels 
were disordered with thin and bilious dejections; and many, 
after passing through the other crises, terminated in dysente- 
ries, as happened to Xenophanes and Critias. The urine was 
watery, copious, clear, and thin ; and even after the crisis, when 
the sediment was natural, and all the other critical symptoms 
were favorable, as I recollect having happened to Bion, who 
was lodged in the house of Silenus, and Critias, who lived with 
Xenoj)hanes, the slave of Areton, and the wife of Mnesistratus. 
But afterwards all these were attacked with dysentery. It 
would be worth while to inquire whether the watery urine was 
the cause of this.^ About the season of Arcturus many had 
the crisis on the eleventh day, and in them the regular re- 
lapses did not take place, but they became comatose about this 
time, especially children ; but there were fewest deaths of all 
among them. 

9. About the equinox, and until the season of the Pleiades, 
and at the approach of winter, many ardent fevers set in ; but 
great numbers at that season were seized with phrenitis, and 
many died j^ a few cases also occurred during the summer. 
These then made their attack at the commencement of ardent 
fevers, which were attended with fatal symptoms ; for immedi- 
ately upon their setting in, there were acute fever and small 
rigors, insomnolency, aberration, thirst, nausea, insignificant 
sweats about the forehead and clavicles, but no general per- 

' I would again request the attention of my contemporaries to the characters of 
the urine hefore a crisis, as given hy Hippocrates ; and, in confirmation of them, I will 
venture to introduce here an extract from Donald Monro's admirable account of the 
autumnal remittent fever : " The urine in the beginning was commonly of a high 
colour, though sometimes it was pale and limpid ; but when the fever came to remit, 
there was often a small sediment after each paroxysm ; and as the fever was going 
off, it let fall a sediment in all.'" (Army Diseases, &c., p. 159.J The absence of the 
sediment in the urine before the crisis is an important fact in the history of febrile 
diseases, which I have reason to think is not now sufficiently adverted to. 

^ Galen does not hesitate to give it as his opinion that the dysentery was owing to 
the bile not being properly purged off by the urine. 

3 The reader will find it interesting here to mark the alliance between the causus 
and phrenitis, to which we formerly adverted. Galen remarks that both arise from 
the same humour, that is to say, bile, which when it collects in the veins of the lower 
part of the body gives rise to causus ; but from the beginning of autumn to the 
equinox, produces phrenitis by being determined to the brain. 



EPIDEMICS— BOOK I. 365 

spiration ; they had much delirious talking, fears, despondency, 
great coldness of the extremities, in the feet, but more espe- 
cially in their hands : the paroxysms were on the even days ; 
and in most cases, on the fourth day, the most violent pains set 
in, with sweats, generally coldish, and the extremities could not 
be warmed, but were livid and rather cold, and they had then 
no thirst ; in them the urine was black, scanty, thin, and the 
bowels were constipated ; there was an hemorrhage from the 
nose in no case in which these symptoms occurred, but merely 
a trifling epistaxis ; and none of them had a relapse, but they 
died on the sixth day with sweats.^ In the phrenitic cases, all 
the symptoms which have been described did not occur, but in 
them the disease mostly came to a crisis on the eleventh day, 
and in some on the twentieth. In those cases in Avhich the 
phrenitis did not begin immediatel}^, but about the third or 
fourth day, the disease was moderate at the commencement, but 
assumed a violent character about the seventh day. There was 
a great number of diseases, and of those affected, they who died 
were principally infants, young persons, adults ha\dng smooth 
bodies, white skins, straight and black hair, dark eyes, those 
living recklessly and luxuriously ; persons with shrill, or 
rough voices, who stammered and were passionate, and women 
more especially died from this form. In this constitution, four 
symptoms in particular proved salutary ; either a hemorrhage 
from the nose, or a copious discharge by the bladder of urine, 
having an abundant and proper sediment, or a bilious disorder 
of the bowels at the proper time, or an attack of dysentery." 
And in many cases it happened, that the crisis did not take 
place by any one of the symptoms Avhich have been mentioned, 
but the patient passed through most of them, and appeared to 
be in an uncomfortable way, and yet all who were attacked with 
these symptoms recovered. All the symptoms which I have 

' This is perhaps the most striking account of an aggravated form of causus which 
is anywhere to be found. Although less finished than the celebrated picture of the 
disease given by Aretseus, it is evidently more original. In fact, any human produc- 
tion which is very original cannot well be finished, and consequently a very finished 
work can scarcely be expected to be very original. 

- It is impossible to overrate the importance of tliese observations on crises in 
fevers, provided they be correct and confirmed by general experience. Jlonro, with- 
out appearing to have our author in view, seems to give an ample confirmation of his 
doctrines on crises as here laid down. 



366 EPIDEMICS— BOOK I. 

described occurred also to women and girls ; and wlioeA'er of 
them had any of these symptoms in a favorable manner, or 
the menses appeared abundantly, were saved thereb}'^, and had 
a crisis, so that I do not know a single female who had any of 
these favorably that died. But the daughter of Philo, who 
had a copious hemorrhage from the nose, and took supper 
unseasonably on the seventh day, died. In those cases of 
acute, and more especially of ardent fevers, in which there is an 
involuntary discharge of tears, you may expect a hemorrhage 
from the nose, unless the other symptoms be of a fatal cha- 
racter, for in those of a bad description^ they do not indicate a 
hemorrhage, but death. Swellings about the ears, with pain 
in fevers, sometimes when the fever went off critically, neither 
subsided nor were converted into pus ; in these cases a bilious 
diarrhoea, or dysentery, or thick urine having a sediment, car- 
ried off the disease, as happened to Hermippus of Clazomense. 
The circumstances relating to crises, as far as we can recognise 
them, were so far similar and so far dissimilar. Thus two 
brothers became ill at the same hour (they were the brothers 
of Epigenes, and lodged near the theatre), of these the elder 
had a crisis on the sixth day, and the younger on the seventh, 
and both had a relapse at the same hour ; it then left them for 
five days, and from the return of the fever both had a crisis 
together on the seventeenth day. Most had a crisis on the 
sixth day ; it then left them for six days, and from the relapse 
there was a crisis on the fifth day.^ But those who had a crisis 
on the seventh day, had an intermission for seven days ; and 
the crisis took place on the third day after the relapse. Those 
who had a crisis on the sixth day, after an interval of six days 
were seized again on the third, and having left them for one day, 
the fever attacked them again on the next and came to a crisis, 
as happened to Evagon the son of Dsetharses. Those in whom 
the crisis happened on the sixth day, had an intermission of 
seven days, and from the relapse there was a crisis on the 
fourth, as happened to the daughter of Aglaidas. The greater 
part of those who were taken ill under this constitution of 
things, were affected in this manner, and I did not know a 
single case of recovery, in which there was not a relapse 

' From Galen's Commentary it appears that the text here is in a doubtful state. 
See also Littre. 



EPIDEMICS— BOOK I. 367 

agreeably to the stated order of relapses ; and all those reco- 
vered in which the relapses took place according to this form : 
nor did I know a single instance of those who then passed 
throngh the disease in this manner who had another relapse. 
In these diseases death generally happened on the sixth day, as 
happened to Epaminondas, Sileuus, and Philiscus the son of 
Antagoras. Those who had parotid swellings experienced a 
crisis on the twentieth day, hnt in all these cases the disease 
went oif without coming to a suppuration, and was turned upon 
the bladder. But in Cratistonax, who lived by the temple of 
Hercules, and in the maid servant of Scymnus the fuller, it 
turned to a suppuration, and they died. Those who had a 
crisis on the seventh day, had an intermission of nine days, and 
a relapse which came to a crisis on the fourth day from the 
return of the fever, as was the case with Pantacles, who resided 
close by the temple of Bacchus. Those who had a crisis on 
the seventh day, after an interval of six days had a relapse, from 
which they had a ci'isis on the seventh day, as happened to 
Phanocritus, who was lodged with Gnathon the painter. During 
the winter, about the winter solstices, and until the equinox, 
the ardent fevers and frenzies prevailed, and many died. The 
crises, however, changed, and happened to the greater number 
on the fifth day from the commencement, left them for four 
days and relapsed ; and after the return, there was a crisis on 
the fifth day, making in all fourteen days. The crisis took 
place thus in the case of most children, also in elder per- 
sons. Some had a crisis on the eleventh day, a relapse on the 
fourteenth, a complete crisis on the twentieth ; but certain per- 
sons, who had a rigor about the twentieth, had a crisis on the 
fortieth. The greater part had a rigor along with the original 
crisis, and these had also a rigor about the crisis in the relapse. 
There were fewest cases of rigor in the spring, more in summer, 
still more in autumn, but by far the most in winter ; then 
hemorrhages ceased. 



Sect. III. 

10. With regard to diseases, the circumstances from which 
we form a judgment of them are, — by attending to the general 
nature of all, and the peculiar nature of each individual, — to 



368 EPIDEMICS— BOOK I. 

the disease, the patient, and the applications, — to the person 
who applies tliera, as that makes a difference for hetter or for 
worse, — to the whole constitution of the season, and particu- 
larly to the state of the heavens, and the nature of each 
country ; — to the patient^s habits, regimen, and pursuits ; — 
to his conversation, manners, taciturnity, thoughts, sleep, or 
absence of sleep, and sometimes his dreams, what and when 
they occur ; — to his picking and scratching ; ' — to his tears ; — 
to the ahine discharges, urine, sputa, and vomitings ; and to the 
changes of diseases from the one into the other; — to the de- 
posits, whether of a deadly or critical character ; — to the sweat, 
coldness, rigor, cough, sneezing, hiccup, respiration, eructation, 
flatulence whether passed silently or with a noise ; — to hemor- 
rhages and hemorrhoids ; — from these, and their consequences, 
we must form our judgment." 

11. Fevers are, — the continual, some of which hold during 
the day and have a remission at night, and others hold during 
the night and have a remission during the day f semi-tertians, 
tertians, quartans, quintans, septans, nonans. The most acute, 
strongest, most dangerous, and fatal diseases, occur in the con- 
tinual fever. The least dangerous of all, and the mildest and 
most protracted, is the quartan, for it is not only such from 
itself, but it also carries off other great diseases.'^ In what is 
called the semi-tertian, other acute diseases are apt to occur, 
and it is the most fatal of all others, and moreover phthisical 
persons, and those labouring under other protracted diseases, 

' Allusion is here made to the symptoms of delirium as described in the fourth 
pai'agraph of the Prognostics. See Galen's Commentary on this passage. 

^ What an admirable and comprehensive enumeration of all the circumstances 
upon which the prognosis and diagnosis of diseases are to be founded ! Here we 
find nothing either wanting or redundant ; and with what conciseness and precision 
the whole is stated ! Galeu gives an elaborate and, upon the whole, a very interest- 
ing Commentary on this section, but does not supply any new views, and there are 
few terms in it requiring explanation. 

^ Having already stated in this work, as well as in the Commentary on Paulus 
^Egineta, Book 11,27, my opinion respecting the nature of the continual fevers, I 
need not enlarge on the subject in this place. Whoever wishes for more information 
may find much to interest him in the Commentary cf Galen. Respecting the septans 
and nonans, he remarks, that, although conversant with fevers from his youth, he 
had never met with any cases of these. 

* Galen, in illustration, states that epilepsy is sometimes carried off by an attack 
of quartan fever. 



EPIDEMICS— BOOK I. 369 

are apt to be attacked by it.^ The nocturnal fever is not verv 
fatal;, but protracted ; the diurnal is still more protracted, and 
in some cases passes into phthisis. The septan is protracted, 
but not fatal ; the nonan more protracted, and not fatal. The 
true tertian comes quickly to a crisis, and is not fatid ; but 
the quintan is the worst of all, for it proves fatal when it pre- 
cedes an attack of phthisis, and when it supervenes on persons 
who are already consumptive." There are peculiar modes, and 
constitutions, and paroxysms, in every one of these fevers ; for 
example, — the continual, in some cases at the very commence- 
ment, grows, as it were, and attains its full strength, and 
rises to its most dangerous pitch, but is diminished about and at 
the crisis ; in others it begins gentle and suppressed, but gains 
ground and is exacerliated every day, and bursts forth with all 
its heat about and at the crisis ; while in others, again, it com- 
mences mildly, increases, and is exacerbated until it reach its 
acme, and then remits until at and about the crisis.'^ These 
varieties occur in every fever, and in every disease. From these 
observations one must regidate the regimen accordingly. There 
are many other important symptoms allied to these, part of 
which have been alreadj^ noticed, and part will be described 
afterwards, from a consideration of which one may judge, and 
decide in each case, whether the disease be acute, and whether 
it will end in death or recoverv ; or Avhether it will l^e protracted, 

' The semitertian was alwaj's looked upon as a very formidable form of fever. See 
Paulus jEgineta, Book JI, 34. Galen gives a prolix, hut not a very distinct 
account of it. 

'^ Galen, in his Comment.iry, states that he had often seen persons in consumption 
attacked with tertian and quotidian Intermittents, but admits that he had no more 
experience of quintans than he had of septans and nonans. Avicenna, however, is 
not so sceptical as to the occurrence of these rare forms of intermittents. Indeed he 
says, he had often met with quintans, and that a trustworthy physician of great ex- 
perience had assured him that he had met with nonans. (iii, 1, .3, G/.) Rhazes also 
would appear to acknowledge the occurrence of all these varieties of intermittent 
fever. (Contin., xxx, 10, 1, 409.) 

^ The text is nuich improved in Littre's edition, so that the meaning is pretty in. 
telligible without any commentary. Galen states in explanation, that the three 
varieties of fever are thus marked and distinguished from one another: in the tirst, 
the fever attains its height at the commencement, and gradually diminishes until the 
crisis ; in the second, it begins mild, and gradually reaches its height at the crisis ; 
in the third, the fever begins mild, gradually attains its height, and then gradually 
subsides until the crisis. 

24 



370 EPIDEMICS— BOOK I. 

and will end in death or recovery ; and in what cases food is 
to be given, and in what not ; and when and to what amount, 
and what particular kind of food is to be administered. 

12. Those diseases wdiich have their paroxysms on even days 
have their crises on even days ; and those which have their 
paroxysms on uneven days have their crises on uneven days. 
The first period of those M'hich have the crisis on even days, is 
the 4th, 6th, 8th, 10th, 14th, 20th, 30th, 40th, GOth, 80th, lOOth; 
and the first period of those Avliich have their crises on uneven 
days, is the 1st, 3d, 5th, 7th, 9th, 11th, 17th, 21st, 27th, 31st. 
It should be known, that if the crisis take place on any other 
day than on those described, it indicates that there will be a 
relapse, which may prove fatal. But one ought to pay attention, 
and know in these seasons what crises will lead to recovery and 
what to death, or to changes for the better or the worse. 
Irregular fevers, quartans, quintans, septans, and nouans should 
be studied, in order to find out in what periods their crises 
take place. 

13. Fourteen Cases of Disease.^ 

Case I. — Philiscus, who lived by the Wall, took to bed on 
the first day of acute fever ; he sweated ; towards night was 
uneasy. On the second day all the symptoms were exacerbated ; 
late in the evening had a proper stool from a small clyster, the 
night quiet. On the third day, early in the morning and until 
noon, he appeared to be free from fever ; towards evening, acute 
fever, with sweating, thirst, tongue parched ; passed black urine; 
night uncomfortable, no sleep ; he was delirious on all subjects. 
On the fourth, all the symptoms exacerbated, urine black ; 
night more comfortable, urine of a better colour. On the fifth, 
about mid-day, had a slight trickling of pure blood from the 
nose; urine varied in character, having floating in it round 
bodies, resembling semen, and scattered, but which did not 
fall to the bottom ; a suppository having been applied, some 
scanty flatulent matters were passed; night uncomfortable, 
little sleep, talking incoherently; extremities altogether cold, 

' These are all febrile diseases, and for the most part of the ardent type. In 
order to enter properly into the spirit of them, the reader will find it necessary to 
revert frequently to the Prognostics, and compare the parallel passages. See also the 
Argument. 



EPIDEMICS— BOOK I. 371 

and could not be warmed ; urine black ; slept a little towards 
da}^ ; loss of speech, cold sweats ; extremities livid ; about tlie 
middle of the sixth day he died. The respiration throughout, 
like that of a person recollecting himself, Avas rare, and large, 
the spleen was SAvelled up in a roimd tumour, the sweats cold 
throughout, the paroxysms on the even days.^ 

Case II. — Silenus lived on the Broad-way, near the house 
of Evalcidas. From fatigue, drinking, and unseasonable exer- 
cises, he was seized with fever. He began with having pain 
in the loins ; he had heaviness of the head, and there was 
stifiPness of the neck. On the first day the alvine discharges 
were bilious, unmixed, frothy, high coloured, and copious ; 
urine black, having a black sediment ; he was thirsty, tongue 
dry; no sleep at night. On the second, acute fever, stools 
more copious, thinner, frothy ; urine black, an inicorafortalde 
night, slight delirium. On the third, all the symptoms exacer- 
bated ; an oblong distension, of a softish nature, from both 
sides of the hypochondrium to the navel ; stools thin, and 
darkish ; urine muddy, and darkish ; no sleep at night ; much 
talking, laughter, singing, he could not restrain himself. On 
the fourth, in the same state. • On the fifth, stools bilious, un- 
mixed, smooth, greasy ; urine thin, and transparent ; slight 
absence of delirium. On the sixth, slight perspiration about 
the head ; extremities cold, and livid ; much tossing about ; no 
passage from the bowels, urine suppressed, acute fever. On the 
seventh, loss of speech ; extremities could no longer be kept 
warm ; no discharge of urine. On the eighth, a cold sweat 
all over ; red rashes with sweat, of a round figure, small, like 
vari, persistent, not subsiding ; by means of a slight stimulus, 
a copious discharge from the bowels, of a thin and undigested 

' Galen, in his Comnientar}', remarks that tlie fatal issue of this case might have 
been anticipated after the return of the fever on the third day, with a complication 
of had s3'mptoms, such as great thirst, dry tongue, black urine, delirium, coldness 
of the extremities, and so forth. The modern reader will be struck with the 
description of the respiration, namely, that the patient seemed like a person who 
forgot for a time the lesoln cle respirer, and then, as it were, suddenly recollected 
himself. Such is the meaning of the expression as explained by Galen in his 
Commentary, and in his work On Difficulty of Breathing. By "rare" is always 
meant " few in number." The reader will remark that this is a striking case of a 
fever having regular exacerbations on the even days, and slight remissions on the uneven. 



372 EPIDEMICS— BOOK I. 

character, with pain ; urine acrid, and passed with pain ; ex- 
tremities slightly heated ; sleep slight, and comatose ; speechless; 
urine thin^ and transparent. On the ninth, in the same state. 
On the tenth, no drink taken; comatose, sleep slight; alvine 
discharges the same ; urine abundant, and thickish ; when al- 
lowed to stand, the sediment farinaceous and white ; extremities 
again cold. On the eleventh, he died. At the commencement, 
and throughout, the respiration was slow and large ; there was 
a constant throbbing in the hypochondrium ; his age was about 
twenty.^ 

Case III. — Herophon was seized with an acute fever; alvine 
discharges at first were scanty, and attended with tenesmus; 
but afterwards they were passed of a thin, bilious character, 
and frequent ; there was no sleep ; urine black, and thin. On 
the fifth, in the morning, deafness ; all the symptoms exacer- 
bated ; spleen swollen ; disteusion of the hypochondrium ; al- 
vine discharges scanty, and black ; he became delirious. On 
the sixth, delirious ; at night, sweating, coldness ; the delirium 
continued. On the seventh, he became cold, thirsty, was dis- 
ordered in mind ; at night recovered his senses ; slept. On 
the eighth, was feverish ; the spleen diminished in size ; quite 
collected ; had pain at first about the groin, on the same side 
as the spleen ; had pains in both legs ; night comfortable ; 
urine better coloured, had a scanty sediment. On the ninth, 
sweated ; the crisis took place ; fever remitted. On the fifth 
day afterwards, fever relapsed ; spleen immediately became 
swollen ; acute fever ; deafness again. On the third day after 
the relapse, the spleen diminished ; deafness less ; legs painful ; 



' This, it will be remarked, is a case of fever induced from obvious causes, namely, 
excessive fatigue and dissipation. We must take into account, however, the febrile 
constitution of the season. According to Galen, the fatal result could have been 
confidently foreseen from the seventh day. The distension in the hypochondriac 
region here described w-ould appear to have been meteorism. The throbbing in this 
region was no doubt owing to the same cause. The rash was most probably mihary. 
It is described as resembling vari ('lov9oi), by which was probably meant aciie. See 
Paui.us yEgineta, Vol. I, p. 454. Upon reference to the Prognostics, it will be 
remarked that the characters of the urine are all bad, that is to say, it was either 
suppressed, or the sediment was either wanting or black and farinaceous. See 
Prognost. 12. By " black," as applied to the urine, is to be understood " a dark-red 
colour," like that of wine. 



EPIDEMICS— BOOK I. 373 

sweated during the night ; crisis took place on the seventeenth 
day ; had no disorder of the senses during the relapse.^ 

Case IV. — In Thasus, the wife of Philinus^ having been 
delivered of a daughter, the lochial discharge being natural, 
and other matters going on mildly, on the fovirteenth day after 
delivery was seized with fever, attended with rigor ; was pained 
at first in the cardiac region of the stomach and right hypo- 
chondrium ; pain in the genital organs ; lochial discharge ceased. 
Upon the application of a pessary all these symptoms were al- 
leviated ; pains of the head, neck, and loins remained ; no 
sleep ; extremities cold ; thirst ; bowels in a hot state ; stools 
scanty ; urine thin, and colourless at first. On the sixth, 
towards night, senses much disordered, but again were restored. 
On the seventh, thirsty ; the evacuations bilious, and high 
coloured. On the eighth, had a rigor ; acute fever ; much 
spasm, with pain ; talked much, incoherently ; upon the appli- 
cation of a snppository, rose to stool, and passed copious dejec- 
tions, with a bilious flux; no sleep. On the ninth, spasms. 
On the tenth, slightly recollected. On the eleventh, slept ; 
had perfect recollection, l)ut again immediately wandered ; 
passed a large quantity of urine with spasms, (the attendants 
seldom putting her in mind,) it was thick, white, like urine 
which has been shaken after it has stood for a considerable 
time until it has subsided, but it had no sediment ; in colour 
and consistence, the urine resembled that of cattle, as far as I 
observed. About the fourteenth day, startings over the whole 
body ; talked much ; slightly collected, but presently became 

' There is nothing in this case very remarkable, or which stands in need of eUici- 
dation ; but yet the reader may feel interested in Galen's reflections upon it. The 
recovery he holds to have been unexpected, as a different result might have been 
anticipated from the characters of the alvine discharge, and of the urine at the com- 
mencement. The favorable change he attributes to the swelling of the spleen, 
whereby the peccant humours were attracted to it ; and lie fLU'ther remarks, that as 
the swelling of the spleen diminished, the humours are described as ha\ang passed 
down to the extremities, after having first affected the groin of the side on which the 
spleen is situated. He further calls attention to the improved characters of the urine 
when the swelling of the spleen and pains of the limbs supervened. Still, however, 
he adds, there was a remnant of the cacocbymy in the system which gave rise to 
the relapse on the fourteenth day, so that the complete crisis did not take place until 
the seventeenth day. 



374 EPIDEMICS— BOOK I. 

again delirious. About the seventeentli day became speechless, 
on the twentieth died.^ 

Case V. — The wife of Epi crates, who was lodged at the 
house of Archigetes^ being near the term of delivery, was seized 
with a violent rigor, and, as was said, she did not become heated ;" 
next day the same. On the third, she was delivered of a 
daughter, and everything went on properly. On the day fol- 
lowing her delivery, she was seized with acute fever, pain in 
the cardiac region of the stomach, and in the genital parts. 
Having had a suppository, was in so far relieved ; pain in the 
head, neck, and loins ; no sleep ; alvine discharges scanty, 
bilious, thin, and unmixed ; urine thin, and blackish. Towards 
the night of the sixth day from the time she was seized with 
the fever, became delirious. On the seventh, all the symptoms 
exacerbated ; insomnolency, delirium, thirst ; stools bilious, 
and high coloured. On the eighth, had a rigor ; slept more. 
On the ninth, the same. On the tenth, her limbs painfully 
affected ; pain again of the cardiac region of the stomach ; 
heaviness of the head ; no delii'ium ; slept more ; bowels con- 
stipated. On the eleventh, passed urine of a better colour, and 
having an abundant sediment, felt lighter. On the fourteenth, 
had a rigor; acute fever. On the fifteenth, had a copious vomit- 
ing of bilious and yellow matters; sweated; fever gone; at night 
acute fever ; urine thick, sediment white.^ On the seventeenth, 

' This is evidently a well-marked case of puerperal fever, or of fever complicated 
with the puerperal state. There is nothing particularly interesting in Galen's Com- 
mentary on it. He states that the application made in order to remove the suppression 
of the lochial discharge may either have been a pessary or a suppository. It seems 
most likely to have been the former. On the composition of the ancient pessaries, see 
Paulus iEciNETA, Book VII, 24. He i-emarks that the symptoms first stated are 
unfavorable, but not necessarily fatal, until we come to the coldness of the extre- 
mities, which is an extremely mortal symptom in the beginning of a disease when 
combined with a very violent fever. The modern reader will be struck with the 
expression that " the attendants seldom put her in mind" to make water; it is very 
descriptive, however, of the state of stupor the patient was in when she was so in- 
sensible that she did not attend to the calls of nature. 

- Galen remarks that it was reckoned very extraordinary for a rigor not to be 
followed by febrile heat. See Comment, et de Rigore ; dc Diff. Febr., ii ; and Foes's 
long annotations on this passage. 

■* It will be remarked that the characters of the urine throughout are favorable. 
Though darkish at first, this was reckoned not unfavorable, as being connected with 



EPIDEMICS— BOOK I. 375 

an exacerbation ; night uncomfortable ; no sleep ; delirium. On 
the eighteenth, thirsty ; tongue parched ; no sleep ; much de- 
lirium ; legs painfull}^ affected. About the twentieth, in the 
morning, had a slight rigor ; was comatose ; slept tran(|uilly ; 
had slight vomiting of bilious and black matters ; towards night 
deafness. About the twenty-first, weight generally in the left 
side, with pain ; slight cough ; urine thick, mudd}^, and reddish ; 
when allowed to stand, had no sediment ; in other respects felt 
lighter ; fever not gone ; fauces painful from the commence- 
ment, and red ; uvula retracted ; defluxion remained acrid, 
pungent, and saltish throughout. About the twenty-seventh, 
free of fever ; sediment in the urine ; pain in the side. About 
the thirty-first, was attacked with fever, bilious diarrhoea ; slight 
bilious vomiting on the fortieth. Had a complete crisis, and 
was freed from the fever on the eightieth day.^ 

Case VI. — Cleonactides, who was lodged above the Temple 
of Hercules, was seized with a fever in an irregular form ; was 
pained in the head and left side from the commencement, and 
had other pains resembling those produced b}^ fatigue ; 
paroxysms of the fevers inconstant and irregular; occasional 
sweats ; the paroxysms generally attacked on the critical days. 
About the twenty-fourth was cold in the extremities of the 
hands, vomitings bilious, yellow, and frequent, soon turning to 
a verdigris -green colour; general relief. About the thirtieth, 
began to have hemorrhage from both nostrils, and this con- 
tinued in an irregular manner until near the crisis ; did not 
loathe food, and had no thirst throughout, nor was troubled 
with insomnolenc}^ ; urine thin, and not devoid of colour. 
When about the thirtieth day, passed reddish urine, having a 
copious red sediment; was relieved; but afterwards the characters 
of the urine varied, sometimes having sediment, and sometimes 
not. On the sixtieth, the sediment in the urine copious, white, 
and smooth ; all the symptoms ameliorated ; intermission of the 
fever ; urine thin, and well coloured. On the seventieth, fever 
gone for ten days. On the eightieth had a rigor, was seized 

the locliial discharge. (See Galen, Comment. 2, Epid. iii.) The sediments afterwards 
are all of good omen ; but, as Galen remarks, its first characters indicated a prolonged 
fever. 

' On the Ci-itical Days, see Paulus yE(iiNnTA, Book II, 7. 



376 EPIDEMICS— BOOK 1. 

with acute fever, sweated much ; a redj smooth sediment in the 
urine ; had a perfect crisis.^ 

Case VII. — ]Mcton was seized with fever; there was a 
painful M'eight in tlie loins. Next day, after drinking water 
pretty copiously, had proper evacuations from the bowels. On 
the third, heaviness of the head, stools thin, bilious, and 
reddish. On the fourth, all the symptoms exacerbated ; had 
twice a scanty trickling of blood from the right nostril ; passed 
an uncomfortable night ; alvine discharges like those on the 
third da}' ; urine darkish, had a darkish cloud floating in it, 
of a scattered form, which did not subside. On the fifth, a 
copious hemorrhage of pure blood from the left nostril ; he 
sweated, and had a crisis. After the fever restless, and had 
some delirium ; urine thin, and darkish ; had an affusion of 
warm water on the head; slept, and recovered his senses. In 
this case there was no relapse, but there were frequent 
hemorrhasres after the crisis.^ 



'o^ 



Case VIII. — Erasinus, who lived near the Canal of Bootes, 
was seized with fever after supper; passed the night in an 
agitated state. During the first day quiet, but in pain at 
night. On the second, symptoms all exacerbated ; at night 
deUrious. On the third, was in a painful condition ; great 
incoherence. On the fourth, in a most uncomfortable state ; 
had no sound sleep at night, but dreaming and talking; 
then all the appearances worse, of a formidable and alarming 
character ; fear, impatience. On the morning of the fifth, was 
composed, and quite coherent, but long before noon was 

' On comparing the symptoms here enumerated ■with the Prognostics, it will be 
remarked that none of them are of fatal omen. But the white sediment, and after- 
wards the reddish colour of the urine, while they indicated recovery, at the same 
time prognosticated a protracted attack of fever. See Prognost., 12. The reader 
will further remark that there is an absence of all the decidedly fatal symptoms, such 
as delirium, coldness of the extremities at the commencement, and so forth. 

^ The rapid recovery in this case would seem to be partly attributable to the decided 
plan of treatment, namely, the copious affusion of hot water on the head. Hippocrates 
probably had it in view when he wrote the forty-second Aphorism of the Seventh 
Book : " In fever not connected with bile, if a large quantity of hot water be poured 
over the head, it proves a resolution of the fever." Galen points it out as a remark- 
aide circumstance, that in this case the crisis took place without concoction of the 
urine, in consequence of the hemorrhage from the nose, and the sweating. 



EPIDEMICS— BOOK I. 377 

furiously mad, so that he could not constrain himself; extre- 
mities cold, and somewhat livid; urine Avithout sediment; died 
about sunset. The fever in this case was accompanied by 
sweats throughout ; the hypochondria were in a state of 
meteorism, with distension and pain ; the urine was black, had 
round substances floating in it, which did not subside ; the 
alvine evacuations were not stopped ; thirst throughout not 
great ; much spasms with sweats about the time of death. ^ 

Case IX. — Criton, in Tliasus, while still on foot, and going 
about, was seized w^ith a violent pain in the great toe ; he took 
to bed the same day, had rigors and nausea, recovered his 
heat slightly, at night was delirious. On the second, swelling 
of the whole foot, and about the ankle erythema, with disten- 
sion, and small bulloe (phlycttenre) ; acute fever ; he became 
furiously deranged ; alvine discharges bilious, unmixed, and 
rather frequent. He died on the second day from the com- 
mencement.^ 

Case X. — The Clazomenian vvdio was lodged bv the Well of 
Phrynichides was seized with fever. He had pain in the head, 
neck, and loins from the beginning, and immediately after- 
wards deafness ; no sleep, acute fever, hypochondria elevated 
with a swelling, but not much distension ; tongue dr3^ On 
the fourth, towards night, he became delirious. On the fifth, 
in an uneasy state. On the sixth, all the symptoms exacer- 

' In this case, as Galen remarks, the continued sweats, unfavorable condition of 
the hypochondriac region, and the black urine, precluded all hopes of recovery. He 
thinks our author related the case as an instance of sudden death in fever, this 
patient having died on the fourth day after the attack (the first not being counted). 
See his Commentary. lie also makes reflections upon this case in his work On 
Difficulty of Breathing, wliere he points out the danger of meteorism of the hypo- 
chondriac region as being necessarily accompanied with dyspnoea, and connected with 
inflammation (2). 

- This case, as Galen i-emarks, is interesting from the suddenness of the fatal re- 
sult. We should not hesitate nowadays to set it down as a case of malignant 
erysipelas; the pain, swelling, and bulla", of the foot and ankle must have been of 
this nature. By the way, these bullae, when not followed by suppuration, are re- 
presented in the Coacse Pracnotiones, as a fatal symptom. Galen thinks it strange that 
this patient was not bled, but accounts for it by supposing that Hippocrates had been 
called ill too late. He remarks on this case in the Second Book of his work On 
Uithculty of Breathing. 



378 EPIDEMICS— BOOK I. 

bated. About the eleventh a slight remission ; from the com- 
mencement to the fourteenth day the alvine discharges thin, 
copious, and of the colour of water, but were well supported ; 
the bowels then became constipated. Urine throughout thin, 
and well coloured, and had many substances scattered through 
it, but no sediment. About the sixteenth, urine somewhat 
thicker, which had a slight sediment ; somewhat better, and 
more collected. On the seventeenth, urine again thin ; 
swellings about both his ears, with pain ; no sleep, some inco- 
herence ; legs painfully affected. On the twentieth, free of 
fever, had a crisis, no sweat, perfectly collected. About the 
twenty-seventh, violent pain of the right hip ; it speedily went 
off. The swellings about the ears subsided, and did not sup- 
purate, but were painful. About the thirty-first, a diarrhoea, 
attended with a copious discharge of watery matters, and 
symptoms of dysentery ; passed thick urine ; swellings about 
the ears gone. About the fortieth day, had pain in the right 
eye, sight dull. It went away.' 

Case XI. — The wife of Dromeades having been delivered of 
a female child, and all other matters going on properly, on the 
second day after was seized with rigor and acute fever. Began 
to have pain about the hypochondrium on the first day; had 
nausea and incoherence, and for some hours afterwards had no 
sleep ; respiration rare, large, and suddenly interrupted. On 
the day following that on which she had the rigor, alvine dis- 
charges proper; urine thick, Avhite, muddy, like urine which 
has been shaken after standing for some time, until the sedi- 

' Galen looks upon this patient as an example or paradigm of general principles in 
Prognostics. Thus, with regard to the characters of the urine, it is stated that on 
the eleventh day the urine was thin, of a good colour, and having many suhstances 
floating about in it, but without sediment. Thus matters remained until the sixteenth, 
when the urine became somewhat thicker, and had a slight sediment. Now Galen 
remarks (as the reader will find on turning to the Book of Prognostics) that these 
characters of the urine are indicative of recovery after a protracted disease. Galen 
further points out that no one of the fatal symptoms are mentioned, and that 
swellings of the parotid glands and the dysenteric affections of the bowels indicated 
that the crisis would be distant. He also calls attention to the case as confirmatory 
of the doctrines of Critical Days. In the Second Book of his work On Difficulty of 
Breathing, he makes some remarks, of no great importance however, on the 
meteorisra of the hypochondriac region, as noticed in this case. 



EPIDEMICS— BOOK I. 379 

ment had fallen to the bottom ; it had no sediment ; she did 
not sleep during the night. On the third day, about noon, 
had a rigor, acute fever ; urine the same ; pain of the hj^po- 
chondria, nausea, an ini comfortable night, no sleep ; a coldish 
sweat all over, but heat quickly restored. On the fourth, 
slight alleviation of the symptoms about the hypochondria; 
heaviness of the head, with pain ; somewhat comatose ; slight 
epistaxis, tongue dry, thirst, urine thin and oily ; slept a little, 
upon awaking was somewhat comatose ; slight coldness, slept 
during the night, was delirious. On the morning of the 
sixth had a rigor, but soon recovered her heat, sweated all 
over ; extremities cold, was delirious, respiration rare and 
large. Shortly afterwards spasms from the head began, and 
she immediately expired.^ 

Case XII. — A man, in a heated state, took supper, and 
drank more than enough ; he vomited the whole during the 
night ; acute fever, pain of the right hypochondrium, a softish 
inflammation from the inner part ; passed an uncomfortable 
night ; urine at the commencement thick, red, but when allowed 
to stand, had no sediment, tongue dry, and not very thirsty. 
On the fourth, acute fever, pains all over. On the fifth, urine 
smooth, oily, and copious ; acute fever. On the sixth, in the 

' In this case, as Galen remarks, the characters of the urine from the first were 
such as to indicate a fatal and speedy result. On the second day the urine was turliid, 
and without any sediment ; on the third day the same, and consequently confirming 
the anticipation of the disease proving mortal; on the fourth, oily urine, with 
epistaxis, so that it was not to be wondered at that the patient died on the sixth. 
Indeed, when we further take into account the state of the breathing, the coldness 
of the extremities, the meteorism of the hypochondriac region, and the subsultus 
tendinum, it is difficult to imagine a more hopeless case of fever. Having mentioned 
" oily lu'ine," it may be well to state its characters, as fully given by one of the later 
authorities on urology, namely, Theophilus. He says, when the urine in fevers as- 
sumes the colour of oil, it indicate's that the fat of the body is melting down ; when 
the appearance of the urine still more resembles oil, it shows a still greater melting ; 
and when the urine in consistence and colour exactly resembles oil of a dark colour, 
it pi-oguosticates a fatal collapse. (De Urinis, 17; ed. Ideler.) On this sul)ject, see 
further some very interesting observations by Foes, in his annotations on this passage 
(p. 988). With regard to the respiration in this case, see also the remarks of Galen 
in the Third Book of his work On Difficulty of Breathing (tom. vii, p. 932 ; ed. 
Kiihn). As Galen here remarks, Hippocrates explains the meaning of this passage 
in one of his Aphorisms, where he writes thus: "In fevers, when the respiration 
stops, it is a bad symptom, for it prognosticates convulsion." 



380 EPIDEMICS— BOOK I. 

evening, very incoherent, no sleep during the night. On the 
seventh, all the symptoms exacerbated; urine of the same 
characters; much talking, and he could not contain himself; 
the bowels being stimulated, passed a watery discharge Avith 
lumbrici : night equally painful. In the morning had a rigor ; 
acute fever, hot sweat, appeared to be free of fever ; did not 
sleep long ; after the sleep a chill, ptyalism ; in the evening, 
great incoherence; after a little, vomited a small quantity of 
dark bilious matters. On the ninth, coldness, much delirium, 
did not sleep. On the tenth, pains in the limbs, all the 
svmptoms exacerbated ; he was delirious. On the eleventh, he 
dled.i 

Case XIII. — A woman, Avho lodged on the Quay, being 
three months gone with child, Avas seized with fever, and 
immediately began to have pains in the loins. On the third 
day, pain of the head and neck, extending to the clavicle, 
and right hand ; she immediately lost the power of speech ; was 
paralysed in the right hand, with spasms, after the manner of 
paraplegia ; was quite incoherent ; passed an uncomfortable 
night ; did not sleep ; disorder of the bowels, attended witli 
bilious, unmixed, and scanty stools. On the fourth, recovered 
the use of her tongue ; spasms of the same parts, and general 
pains remained ; swelling in the hypochondrium, accompanied 
with pain ; did not sleep, was quite incoherent ; bowels dis- 
ordered, urine thin, and not of a good colour. On the fifth, 
acute fever ; pain of the hypochondrium, quite incoherent ; 
alvine evacuations bilious ; towards night had a sweat, and was 
freed from the fever. On the sixth, recovered her reason ; 
was every way relieved ; the pain remained about the left 
clavicle ; was thirsty, urine thin, had no sleep. On the seventh, 
trembling, slight coma, some incoherence, pains about the 

' According to Galen, this case is an instructive example of the danger of neglect- 
ing the diet at the commencement of complaints which appear unimportant. This 
man, having taken supper at the beginning of a fever which appeared slight, suffered 
therefrom as the result showed ; that is to say, vomiting ensued, followed by serious 
symptoms, among which Galen particularises, as indicating a fatal result, urine at 
first thick and without sediment, and afterwards oily. So much importance did the 
ancient physicians attach to observations on the urine in fevers 1 Galen further 
calls attention to the fact, that the patient died on a critical day, that is to say, on 
the eleventh. 



EPIDEMICS— BOOK I. 381 

clavicle and left arm remained ; in all other respects was alle- 
viated ; quite coherent. For three days remained free from 
fever. On the eleventh, had a relapse, with rigor and fever. 
Aliout the fourteenth day, vomited pretty abundantly bilious 
and yellow matters, had a sweat, the fever went off, by coming 
to a crisis.' 

Case XIV. — Melidia, who lodged near the Temple of Juno, 
began to feel a violent pain of the head, neck, and chest. 
She was straightway seized with acute fever ; a slight Appear- 
ance of the menses ; continued pains of all these parts. On 
the sixth, Avas affected with coma, nausea, and rigor; redness 
about the cheeks ; slight delirium. On the seventh, had a 
sweat; the fever intermitted, the pains remained. A relapse; 
little sleep ; urine throughout of a good colour, but thin ; the 
alvine evacuations were thin, bilious, acrid, very scanty, black, 
and fetid ; a white, smooth sediment in the urine ; had a sweat, 
and experienced a perfect crisis on the eleventh day.^ 

' Galeu, in the Commentary, makes a remark regarding tliis report, which appears 
more important to him than it will do to most modern readers, namely, that he 
wonders Hippocrates did not state the. age of this patient. He adds, that it is 
very rare for a pregnant woman to have such a serious fever without parting with 
her child. He thinks the patient, in the present instance, owed her recovery to the 
strength of her constitution, as " urine white, and not of a good colour," in comhi- 
nation with the other had symptoms, indicated an unfavorable result. By the way, 
upon reference to the Basle edition of Galen, and to Foes's annotations on this case, it 
will be seen that there is a difference of reading in the words descriptive of the 
mine, that is to say, some read axpoojv, some n''xp6cov. Certainly it appears to 
me tliat Foes is right in preferring the latter. The decided crisis, it will be remarked, 
took place on a critical day, that is to say, the fourteenth, by a sweat. 

■■^ Here again Galen calls attention principally to the characters of the urine, which 
is first described as being " of a good colour, but thin." Now, by a good colour of 
the urine, Galen observes, was meant of a slightly yellow colour. In this case, as 
usual, the crisis was marked by a sediment in the urine. 



382 



BOOK III— OF THE EPIDEMICS. 



THE AKGUMENT. 

Though in the Argument prefixed to tlie First Book of tlie 
Epidemics I have given a pretty full summary of the contents 
both of that book and the third, I have still a few observations 
to make on some important points^ Avhich were not sufficientlj'' 
considered on that occasion ; and this I do the more readily, 
as it will afford me an opportunit}^ of noticing a subject on 
which M. Littre has bestowed very extensive research. I allude 
to the origin of the Glandular Plague. As I make it a rule, 
in giving these my annotations, not to enter into any lengthy 
details, I shall now state, in a very succinct manner, the re- 
sult of my inquiries. The reader is referred, for a fuller dis- 
cussion of the subject, to the more ample disquisitions of M. 
Littre. 1 

The opinion has been pretty generally maintained by modern 
authorities, that the first description which we have of the 
glandular plague of the East is that given by the historian 
Procopius, in the sixth centmy ; and the inference drawn there- 
from is that the disease was unknown until his time. This 
opinion is still held, to a certain extent, by Hecker, Rosenbaum, 
Pariset, Naumau, and others of the most distinguished scholars 
of the day, but it appears to be untenable after the discovery 
of the 'Fragment' of Ruffus, published by Mai, Eome^ 1831. 
As the passage is very important, I shall give a translation of 
it in this place. It is as follows : " The buboes called pesti- 
lential are most fatal and acute, especially those which are seen 
occurring about Libya, Egjpt, and Syria, and which are men- 
tioned b}' Dionysius Curtus. Dioscorides and Posidonius 
make much mention of them in the plague which occurred in 
their time in Libya; they say it was accompanied by acute 

' CEuvres d'Hippocrate, torn, iii, Arg., pp. xxxvi-xlii; torn. \, pp. 57-70. 



ARGUMENT. 383 

fever, pain, and prostration of the whole body, delirium, and 
the appearance of large and hard buboes, which did not sup- 
purate, not only in the accustomed parts, but also in the groins 
and armpits/^ The only thing which detracts from the value 
of tills paragraph is the difficulty of determining exactly who 
the authorities are which are referred to in it. Of Dionysius 
Curtus nothing is known ; indeed it is more than probable, 
that there is some mistake in this name. There are several 
medical authors of the name of Dioscorides and Posidonius, and 
it is difficult to determine to which of them reference is here 
made. Still, however, there seems to be no reason for ques- 
tioning the authenticity of the passage. Ptuffus, I may add, is 
generally admitted to have flourished in the reign of Trajan.^ 

To this important document let me join an interesting ex- 
tract from Galen's work ' On Fevers.' Galen, treating pro- 
fessedly of Pestilential Fevers, which he maintains are all con- 
nected with a tendency to putridity, expresses himself as follows : 
" Moreover, as Hippocrates says, all fevers from buboes are bad, 
with the exception of epheraerals ; although the bubo is also of 
the class of phlegmons. And I agree in so far with what is 
said of putrefaction, for this is the cause of the fever in inflam- 
mations, and not as Erasistratus supposed." But yet there are 
certain fevers from buboes of the class of ephemerals, as certain 
others proclaim them to be ; diseases difficult to cure, which de- 
rive their origin from an inflammation, an ulcer, an abscess, or 
some other such affection in a viscus. But the ephemeral fevers 
from buboes differ from those connected with putrefactions, 
either in a certain viscus, or in the hollow and very large vessels, 
that in those from buboes, which always impart their heat to 
the surrounding parts, the heat is communicated to the heart, 
and the putrefactive fume does not reach it, but remains cir- 
cumscribed in the seat of the bubo, and the heat reaching the 
heart solely by a change in the connecting parts, in like manner 
as in those exposed to excessive heat and fatigue, the diffusion 
of the heat takes place from the parts first warmed to the source 
of vitality ; but in a putrefaction about the viscera and large 

' There is some doubt, however, even on this head ; indeed Riolanns does not 
scruple to affirm, with a considerable degree of plausibihty, that Ruffus must have 
lived after Galen, since he is nowhere mentioned by the latter. (Anthropographia, i, 5.) 

'■^ In illustration, consult Plutarch (Placit. Philosoph., v, 29). 



384 EPIDEMICS— BOOK III. 

vessels, a fume, as it were^ from the putrefying liumours reaches 
the cavities of the heart, &c.'^ ^ From these two passages alone, 
without taking into account several others of less importance, 
which might be gathered from other medical authorities,^ it 
must be quite obvious that the glandular plague was kuoAvn, 
at all events^ in the second century of the Christian era. 
Moreover it is equally clear, that Galen did not look upon it as 
a new disease^ but considered that it was noticed in the works 
of Hippocrates. To my mind, then^ there can be no doubt that 
the pestilence which prevailed during the Pcloponnesian war 
partook of the nature of the glandular plague. What has 
tended to create doubts on this subject, in the minds of many 
learned men, is the omission of any distinct mention of buboes 
in the graphic description of it given by Thucydides. But it 
should alwaj^s be taken into account that Thucydides was not 
a professional man^ and therefore there is a strong pre- 
sumption that his acquaintance v»^ith the disease, even although, 
as he states^ he himself had experienced an attack of itj must 
have been altogether of a general nature. Indeed Galen, both 
in the treatise fi'om Avhich I have quoted above and in many 
other parts of his works, does not hesitate to declare, that tlie 
historian describes the disease as a common, that is to sa}'^, a 
non-professional mau^ whereas Hippocrates gives its characters 
as a physician. It is also to be borne in mind, that the de- 
scription of it given by Thucydides applies to it only at its out- 
break in the city of Athens, and it is a well-known characteristic 
of pestilential epidemics that they change very much during 
their progress. This character of them was well illustrated in 
the Plague of Aleppo, so admirably described by Dr. Russel ; 
for although the glandular form of the disease prevailed in a 
large number of cases, a considerable proportion of them were 
unaffected with buboes. Indeed it appears to me to be too 
much the practice for the profession, as well as the public, to 
imagine to themselves a certain type or ideal of every disease, 
and when they do not recognise the exact characters which 
they fancy it should present, they immediately set down such 
cases as constituting an entirely different disease. This is an 

' De Differ. Feb., i, 7 ; torn, vii, p. 296, ed. Kiihn. 

- Coiimieiitary on Paulus iEciNETA, Book II, 16,30; IV, 2.'),Sy(l. Soc. edition. 



ARGUMENT. 385 

error that is constantly committed, and one wliicli I believe to 
be at the bottom of the discordant opinions which prevail among 
professional men, on the subject of the glandular plague. It 
would be well for the physician to bear in mind how many 
varieties of symptoms the fever designated as Typhus puts on, 
— some with the rash reckoned peculiar to this fever, and 
some without it, — some with petechie, and miliary eruptions, 
and others without them ; and many other complications of 
symptoms, which are sometimes present and sometimes not. 

With regard to the hypothesis lately advanced by M. Theod. 
Krause,^ and in so far countenanced by M. Littre, that the 
plague of Athens was an epidemical variola, I must say that I 
can see no probability in this supposition ; for that a disease so 
strongly marked as smallpox should have prevailed in ancient 
times, and yet not be distinctly noticed by the Greek and 
E-oman writers on medicine, I cannot conceive, more especially 
when we call to recollection the very accurate descriptions which 
they have left us of other cutaneous diseases, by no means at- 
tended with symptoms of so obvious a nature. Indeed it 
appears to me most wonderful, that such an opinion should 
have been entertained by any person at all acquainted with the 
Arabic writers on medicine, wlio describe most distinctly both 
the plague and the smallpox. Not to lose ourselves amidst a 
host of authorities, I would refer the reader, in particular, to 
Avicenna, iv, 1, 4, where the two diseases are treated of most 
distinctly, so that I cannot entertain a doubt that the Arabian 
physicians considered them to be essentially different. 

In a considerable number of the cases reported in this book, 
there are affixed to them in the original certain characters, the 
interpretation of which the reader will find given in the trans- 
lation. It will be necessary, then, to give the reader some 
account of the origin of these characters, regarding which our 
sole authority is Galen, who, in his Commentaries on this book, 
enters on the question in his usual elegant and attractive style. 
He admits that he derived his information principally from 
Zeuxis, one of his predecessors in the office of commenting 
upon the works of Hippocrates. (See § 2, of the Preliminary 
Discourse.) It appears that Ptolemy Philadelphus was so 

' Disquisitio Historico-Medica de Natura Morbi Atheniensiuni. Stuttgart, 1831. 

25 



386 EPIDEMICS-BOOK III. 

zealous in liis search for hooks to adorn his hbrary, in Alexandria, 
that he gave instructions to the masters of ships going on dis- 
tant voyages to collect all the books they could procure, and 
bring them back with them ; that he ordered copies to be taken 
of books brought to him in this way, and kept the originals, 
but returned the copies, along with large sums of money, in 
certain cases, to those who had lent them to him ; and that the 
works so obtained were preserved in a separate department of 
the library, with the inscription, " The Books of tlie Ships/^ 
Among these was found a copy of the Third Book of the 
Epidemics, with the inscription, " One of the Books of the 
Ships, according to the redacteur Memuon of Sida." Others 
say, that the term " redacteur" was wanting, and that the 
book bore simply the inscription of " Memnon •" and that the 
servants of the king inscribed the names of all the seamen who 
had brought these books, when they were installed on the 
shelves of the library. This, it would seem, was not done im- 
mediately after their arrival in Alexandria, but that at first 
they were collected together in certain houses. Memnon, the 
librarian, then, is generally supposed to have surreptitiously 
introduced the characters into one of the copies, in order that 
he might raise himself into importance by interpreting them. 
But whether or not this ruse was actually perpetrated by 
Memnon, the general belief of the commentators was, that 
Hippocrates himself had nothing to do with them. In fact, 
Zeno would appear to have been the only commentator who 
held them to be genuine, and ascribed the introduction of them 
to our author. The opinion thus advanced by Zeno led him 
into a violent controversy with the two ApoUonii, namely, the 
Empiric and Biblas, who strenuously maintained that the cha- 
racters were an interpolation executed by INIemnon. This came 
to be the settled opinion of the commentators, and among 
others of Galen, who, although he gives a key to the interpre- 
tation of the characters, maintains, on all occasions, that they 
are of no authority, and had in fact been forged by Memnon. 
The following is the key which Galen gives to the interpre- 
tation of the characters : a, signifies cnro(j)9opav, abortion, or 
aTrwKtiav, loss ; y, signifies yovoaritg ov^ou, urine resembling 
semen ; §, punctuated below, thus, S^^, signifies ISpwra, siveat, 
and ^la^ooiav, diarrhoea, and ^ia<l>o^n<nv, perspiration, or in fact 



ARGUMENT. 387 

any other evacuation which it is wished to express ; k, signifies 
kiroyjiv, retention, or t^oav, seat ; ^, signifies "CnTi^fxa, the object 
of research ; 6, signifies OavciToi', death; i, signifies 'i^p^jra, 
Siveat ; K, signifies Ko'iaiv, crisis, or KoiXiaKriv ciaOecriv ; /u, 
signifies fxaviuv, madness, or /(j/r^ov, the ivomb ; v, signifies 
veoT7]Ta, youth, or veKpio<rn>, mortification; t,, signifies ^ai'6i]v 
^oAj/)', yelloiv bile, or '^ivov ti kciI aTravioi', somethiny stranf/e 
and rare, or ^vajiiov, irritation, or ^»;oor>j-a, dryness ; o, signifies 
oSvvag, pains, or ovoov, urine (but some think that it is only 
when it has a v above it that it signifies urine) ; tt, signifies 
irXijOoQ, abundance, or tttu'eXoj', sputum, or ttvooi' [ttv^ooi'?), 
yellow, or irvoeTov, fever, or m'evf.ioi'o<; -aOoq, affection of the 
lungs ; TT, with a character t in its middle ( 7T or 7?) ), signifies 
TTiOavdu, probable ; p, signifies pvaiv, flux, or piyog, chill ; 
<p, signifies (ppsulrw, phrensy ; a, signifies aTrao-^tor, convulsion, 
or (jTOf.iay(ov rj (rro^tarog KaKixxnv, illness of tJiC stomach or mouth ; 
T, signifies tokov, accouchement ; v, signifies vyeiav, health, or 
vTrovoi'Soiov, hypochondriwn ; v, signifies ^oX)/i', bile, or -j^o- 
AwSfc, bilious ; xp, signifies ^v^iu, congealing ; w, signifies 
(J^torj^ra, crudity. See G-aleni Opera, t. v, p. 412, ed. Basil. ; 
and Littre's Hippocrates, t. iii, p. 33. 

According to this key, the characters at the end of the first 
case are thus explained by Galen : they are ^ IIOYMY. 
Here, then, 7?) signifies TriBavov, it is probable; IT, -rrXiiOog, 
that an abundance, ov, ovobjv, of urine; M, on the 40th day ; 
Y, vynav, brought health. It is more fully expressed thus by 
Galen : ttSuvov \ivai ^la to —Xi]9oq twv aKoiOevTcov oi»pwv avro 
XvOi]vai TO \>oai]fxa icai vyir] ytvkaQai tov avupioirov £v ry recro-o- 
paKoaTYi Twi> rj^itgowi', that is to say, " it is probable that, owing 
to the copious discharge of urine, the disease ivas resolved, and 
the patient became well on the fortieth day J" 



388 EPIDEMICS— BOOK III. 



BOOK III— OF THE EPIDEMICS. 

Sect. I. 

Case I. — Pythion, who lived by the Temple of the Earth : 
on the first day, trembling commencing from his hands ; 
acute fever, delirium. On the second, all the symptoms were 
exacerbated. On the third, the same. On the fourth, alvine 
discharges scanty, unmixed, and bilious. On the fifth, all the 
symptoms were exacerbated, the tremors remained ; little 
sleep, the bowels constipated. On the sixth, sputa mixed, 
reddish. On the seventh, mouth drawn aside. On the eighth, 
all the symptoms were exacerbated ; the tremblings were again 
constant ; urine, from the beginning to tlie eighth day, thin, and 
devoid of colour ; substances floating in it cloudy. On the tenth 
he sweated ; sputa somewhat digested, had a crisis ; urine thinish 
al)out the crisis ; but after the crisis, on the fortieth day, an 
abscess about the anus, which passed off by a strangury. 

Explanation of the characters. It is probable that the 
great discharge of urine brought about the resolution of the 
disease, and the cure of the patient on the fortieth day.i 

' On this case Galen has left very lengthy and elaborate commentaries, containing 
much important and amusing matter, but not a little verbose trifling, to say the least. 
Our limits, as well as our tastes, dispose us to be very sparing in our extracts from 
them. Passing over his remarks on the solecism in syntax, with which the 
Report commences, and his observations on the absence of all mention of the 
exciting causes, as is the usual practice of our author, I shall proceed to state what 
Galen says on the apparent neglect of venesection in a case where it would certainly 
appear to have been clearly indicated. In this case, as Galen remarks, one or other 
of these suppositions may be made: either that bleeding was not practised, or 
that the author did not think of mentioning the practice here, as supposing that 
it would be taken for granted that it was applied. Now, he adds, the former sup- 
position is very improbable, considering how partial our author shows himself to this 
practice in his works which are unquestionably genuine, such as On the Regimen 
in Acute Diseases, the Aphorisms, the work On the Articulations, and even in this 
very book, where in one place he mentions that he abstracted blood copiously on the 
eighth day. If, then, he bled so late in febrile diseases, Galen contends that he was 
not likely to neglect the operation in an eai-lier stage, when so much more demanded. 
He argues further, that in many of the other reports of cases he neglects to mention 
that the usual routine of practice was followed; and therefore he inclines to the 
opinion that it is omitted to be mentioned here, because the author supposed there 



EPIDEMICS— BOOK III. 389 

Case II. — Hermocrates, who lived by tlic New Wall/ was 
seized with fever. He began to have pain in the head and 
loins ; an empty distension of the Iwpochondrinm ; the tongue 
at first was parched ; deafness at the commencement ; there 
was no sleep ; not very thirsty ; urine thick and red, w hen 
allowed to stand it did not subside ; alvine discharge very dry, 
and not scanty. On the fifth, urine thin, had substances 
fioating in it which did not fall to the bottom ;" at night he was 
delirious. On the sixth, had jaundice f all the symptoms were 
exacerbated; had no recollection. On the seventh, in an 
uncomfortable state ; urine thin, as formerly ; on the following 
days the same. About the eleventh day, all the symptoms 

could be no question on this point, move especially as it was his universal rule to 
bleed in all great complaints, when not prevented by the age or powers of the patient. 
He afterwards insists strongly on venesection having been indicated in this case, in 
order to procure revulsion from the brain^'^s usual with the commentator, he calls 
attention to the characters of fTie^Tii-ine, and explains the meaning of the term 
" cloudy," as applied to the eneorema, or substances floating in the urine, by which he 
contends is to be understood a colour intermediate between white and black. What 
follows in this very lengthy Commentary is very interesting in a general point of 
view as regards the views of some of the older commentators, but is not directly 
applicable to the present case. His observations on the characters affixed to this 
and many of the subsequent cases have been noticed in the Argument. The reader 
will further remark of this case that it is an instance of fever passing into a deposit 
(or abscess), and the latter into strangury, of which our author had made mention 
in the First Book of the Epidemics. I may further mention that the reader will find 
much interesting matter in Galen's work On Trembling, in illustration of the nature 
of the attack under which the patient laboured. 

' Galen, in his Commentary, communicates a singular notion which one of the earher 
commentators maintained respecting the name of the place where this patient was 
laid, that is to say, that this new wall, having been recently washed with quicklime, 
had been the cause of this patient's illness. Galen, however, rejects this paltry con- 
ceit. He says on his own authority, that there being three distinct classes of fever, 
namely, the ephemeral, the hectic, and those connected with putrid humours, the 
present case belongs to the last of these. 

- Galen compares the characters of the urine with their indications as given in the 
Prognostics. None of them are favorable, although not decidedly fatal. 

'^ This complication cannot fail to attract attention, from its resemblance to an 
epidemic which prevailed in Scotland in the year 1813. In this epidemic, as in the 
present case, the fever was very subject to relapses and to jaundice at an early stage. 
Hippocrates, in one of his Aphorisms, pronounces jaundice in fevers before the 
seventh day to be a fatal symptom, (iv, G2, 61.) Galen justly thinks it somewhat 
singular that no further mention of the jaundice is made in tlie course of the report; 
but he inclines from this to draw the conclusion that it renuiincd in the same state 
throughout. As there was no crisis by the stomach, tlie Ijowels, the urine, or sweat, 



390 EPIDEMICS—BOOK III. 

appeared to be lightened. Coma set in ; urine tliicker^ reddish, 
thin substances below, liad no sediment ; by degrees he became 
collected. On the fourteenth, fever gone ; had no sweat ; 
slept, quite collected ; urine of the same characters. About 
the seventeenth, had a relapse, became hot. On the following 
days, acute fever, urine thin, Avas delirious. Again, on the 
twentieth, had a crisis ; free of fever ; had no sweat ; no 
appetite through the whole time ; was perfectly collected ; 
could not speak, tongue dry, without thirst ; deep sleep. About 
the twenty-fourth day he became heated ; bowels loose, with a 
thin, watery discharge; on the following days acute fever, 
tongue parched. On the twenty-seventh he died. In this 
patient deafness continued throughout j^ the urine either thick 
and red, without sediment, or thin, devoid of colour, and 
having substances floating in it ; he could taste nothing. 

ExpJanatio7i of the characters. It is probable that it was 
the suppression of the discharges from the bowels which occa- 
sioned death on the twenty- seventh day. 

Case III. — The man who was lodged in the Garden of 
Dealces :" had heaviness of the head and pain in the right 
temple for a considerable time, from some accidental cause, 
was seized with fever, and took to bed. On the second, there 
was a trickling of pure blood from the left nostril, but the 
ahdne discharges were proper, urine thin, mixed, having small 
substances floating in it, like coarse barleymeal, or semen. On 
the third, acute fever; stools black, thin, frothy, a livid sedi- 

he concludes that the jaundice could not have been carried oflf. From all that has 
been said, he adds, it is clear that the organ primarily affected was the liver. Galen, 
then, decidedly opposes the view taken in the Explanation of the Characters re- 
specting the cause of this man's death, which he contends was not connected with 
any suppression of the alvine discharges, but with the alfection of the liver. On the 
Scotch Epidemic, see Ed. and Lond. Med. Journal, March 1844. 

' Most of the ancient authorities regarded deafness as an unfavorable symptom in 
fevers. See Paulus jEgineta, Book II, 4. The modern are divided in opinion on 
this point. Pringle and Huxham regard it as a favorable symptom, but Home looks 
upon it as unfavorable. 

^ Here again Galen mentions the absurd notion of Sabinus the commentator, that 
this man's disease was occasioned by the locality in which he was laid. Galen, on 
the other hand, thinks it likely that the patient was conveyed to the garden as being 
a favorable situation for a person ill of fever. He further alludes to this case in the 
Second Book of his work On Critical Davs. 



EPIDEMICS-BOOK III. 391 

ment in the dejections; slight coma; uneasiness at the times 
he had to get up ; sediment iu the urine livid, and somewhat 
viscid. On the fourth, slight vomiting of bilious, yellow 
matters, and, after a short interval, of the colour of verdigris ; 
a few drops of pure blood ran from the left nostril ; stools the 
same ; urine the same ; sweated about the head and clavicles ; 
spleen enlarged, pain of the thigh on the same side; loose 
swelling of the right hypochondrium ; at night had no sleep, 
slight delirium. On the sixth, stools black, fatty, viscid, fetid ; 
slept, more collected. On the seventh, tongue dry, thirsty, 
did not sleep ; was somewhat delirious ; urine thin, not of a 
good colour. On the eighth, stools black, scanty, and com- 
pact ; slept, became collected ; not very thirsty. On the ninth 
had a rigor, acute fever, sweated, a chill, was delirious, strabis- 
mus of the right eye, tongue dry, thirsty, without sleep.^ On 
the tenth, much the same. On the eleventh, became quite 
collected; free from fever, slept, urine thin about the crisis. 
The two following days without fever ; it returned on the four- 
teenth, then immediately insomnolency and complete delirium. 
On the fifteenth, urine muddy, like that which has been shaken 
after the sediment has fallen to the bottom; acute fever, quite 
delirious, did not sleep ; knees and legs painful ; after a sup- 
pository, had alvine dejections of a black colour. On the six- 
teenth, urine thin, had a cloudy eneorema, was delirious. On the 
seventeenth, in the morning, extremities cold, was covered up 
with the bedclothes, acute fever, general sweat, felt relieved, 
more collected ; not free of fever, thirsty, vomited yellow bile, 
in small quantities ; formed faeces passed from the bowels, but 
soon afterwards black, scantj^, and thin ; urine thin, and not 
well coloured. On the eighteenth, not collected, comatose. 
On the nineteenth, in the same state. On the twentieth, 
slept ; quite collected, sweated, free from fever, not thirsty, but 
the urine thin. On the twenty-first, slight delirium; some- 
what thirsty, pain of the hypochondrium, and throbbing about 
the navel throughout. On the twenty -fourth, sediment in the 
urine, quite collected. Twenty-seventh, pain of the right hip- 
joint ; urine thin and bad, a sediment ; all the other symptoms 
milder. About the twenty-ninth, pain of the right eye ; urine 

' Galen remarks, that as there is no mention of a single favorable symptom up to 
this date, the patient would certainly have died if he had not been of a vigorous 
constitution. 



392 EPIDEMICS— BOOK III. 

thin. Fortieth, dejections pituitons, white, rather fi-eqiieut ; 
sweated abundantly all over ; had a complete crisis.^ 

Explanation of the characters. It is probable that, by 
means of the stools, the urine, and the sweat, this patient was 
cured in forty days. 

Sect. II. 

Case IV. — In Thasus, Philistes had headache of long con- 
tinuance, and sometimes was confined to bed, with a tendency 
to deep sleep ; having been seized with continual fevers from 
drinking, the pain was exacerbated ; during the night he, at 
first, became hot. On the first day, he vomited some bilious 
matters, at first yellow, but afterwards of a verdigris-green 
colour, and in greater quantity ; formed fgeces passed from the 
bowels ; passed the night uncomfortably. On the second, 
deafness, acute fever ; retraction of the right hypochondrium ; 
urine thin, transparent, had some small substances like semen 
floating in it ; delirium ferox about mid-day. On the third, 
in an imcomfortable state. On the fourth, convulsions ; all 
the symptoms exacerbated. On the fifth, early in the morning, 
died. 

Explanation of the characters. It is probable that the 
death of the patient on the fifth day is to be attributed to a 
phrenitis, with unfavorable evacuations.^ 

Case V. — Charion,whowas lodged at the house of Demsenetus, 
contracted a fever from drinking. Immediately he had a pain- 

' Thus, as Galen leiuai'ks, after two ineffectual attempts, Nature accomplished a 
cure on the fortieth day. 

2 There is not much to remark in this case. A modern reader will suspect that 
there had heen cerebral disease before the attack of the fever, and that matters had 
been brought to a crisis by the drinking of wine. Indeed Galen, in his Commentary, 
remarks that the precursory symptoms indicate a congestion of humours in the brain, 
which of course would be much aggravated by the wine, the brain then being, as he 
says, in a bad state ; and the patient having inflicted an additional injm^ to the 
organ, by means of the drink, brought on the acute attack, which proved fatal in five 
days. The deafness, delirium, spasms, and bilious vomitings all indicate a cerebral 
affection. The state of the hypochondria, as described in the report, Galen would 
seem to attribute to a spasmodic affection of the diaphragm, from sympathy with the 
brain. Retraction of the hypochondrium is pronounced to be a bad symptom in the 
First Book of the Prorrhetics. Galen justly contends that there is no reason in this 
case to suspect any inflammation in that region. 



EPIDEMICS— BOOK III. 393 

ful heaviness of the head ; did not sleep ; bowels disordered, 
with thin and somewhat bilious discharges. On the third day, 
acute fever; trembling of the head, bat especially of the lower 
lip ; after a little time a rigor, convulsions ; he was quite 
delirious ; passed the night uncomfortably. On the fourth, 
quiet, slept little, talked incoherently. On the fifth, in pain ; 
all the symptoms exacerbated ; delirium ; passed the night 
uncomfortably; did not sleep. On the sixth, in the same 
state. On the seventh had a rigor, acute fever, sweated all 
over his body ; had a crisis. Throughout the alvine discharges 
were bilious, scanty, and unmixed ; urine thin, well coloured, 
having cloudy substances floating in it. About the eighth 
day, passed urine of a better colour, having a white scanty 
sediment ; was collected, free from fever for a season. On the 
ninth it relapsed. About the fourteenth, acute fever. On the 
sixteenth, vomited pretty frequently yellow, bilious matters. 
On the seventeenth had a rigor, acute fever, sweated, free of 
fever ; had a crisis ; urine, after the relapse and the crisis, well 
coloured, having a sediment ; neither was he delirious in the 
relapse. On the eighteenth, became a little heated ; some 
thirst, urine thin, with cloudy, substances floating in it ; slight 
wandering in his mind. About the nineteenth, free of fever, 
had a pain in his neck ; a sediment in the urine. Had a com- 
plete crisis on the twentieth. 

Explanation of the characters. It is probable that the 
patient was cured in twenty days, b}' the abundance of bilious 
stools and urine. i 

Case VI. — The daughter of Euryanax, a maid, was taken 
ill of fever. She Avas free of thirst throughout, but had no 
relish for food. Alvine discharges small, urine thin, scanty, 
not well coloured. In the beginning of the fever, had a pain 
about the nates. On the sixth day, was free of fever, did not 
sweat, had a crisis ; the complaint about the nates came to a 
small suppuration, and burst at the crisis. After the crisis, on 
the seventh day, had a rigor, became slightly heated, sweated. 

' Galen's remarks on this case are unusually brief; he attriliutes the fever to a 
bilious plethora, and states that the result was such as might have been anticipated 
from a knowledge of the critical days, and of the characters of the uiiiie. Indeed 
the latter appear to me well deserving of attention. 



394 EPIDEMICS— BOOK III. 

On the eighth day after the rigor, had an inconsiderable rigor ; 
the extremities cokl ever after. About the tenth day, after a 
sweat which came on, she became delirious, and again imme- 
diately afterwards was collected ; these symptoms were said to 
have been brought on by eating grapes. After an intermis- 
sion of the twelfth day, she again talked much incoherently ; 
her bowels disordered with bilious, scanty, unmixed, thin, acrid 
discharges ; she required to get frequently up. She died on 
the seventh day after the return of the delirium. At the com- 
mencement of the disease she had pain in the throat, and it 
was red throughout ; uvula retracted ; defluxions abundant, 
thin, acrid; coughed, but had no concocted sputa; duinng the 
whole time loathed all kinds of food, nor had the least desire 
of anything ; had no thirst, nor drank anything worth men- 
tioning ; was silent, and never spoke a word ; despondency ; 
had no hopes of herself. She had a congenital tendency to 
phthisis.-^ 

Case VII. — The woman affected with quinsy, who lodged 
in the house of Aristion : her complaint began in the tongue ; 

' This is in many respects an interesting case, and more especially from its being 
stated that the disease was complicated with hereditary consumption. Galen, in his 
Commentary, remarks that some authorities denied that any disease is congenital, 
but this opinion he decidedly rejects. The phthisical affection, however, as he justly 
remarks, would not have occasioned so sudden an issue if it had not been compli- 
cated with a complete prostration of the natural powers. He insists strongly on the 
striking description here given of the total loss of the natural appetite, both in regard 
to food and drink. Of course, no worse state of the system can be imagined than 
that in which it is totally insensible to its own wants, nay, that it loathes the very 
articles which it stands most in need of. Galeu properly remarks in another place 
(Comment. I, in Epid, i), that it is an extremely unfavorable symptom when in an 
ardent fever there is no thirst. The small abscess about the nates would seem to 
have been an incidental complication. It would appear to be now settled by the 
best pathological authorities that there is no natural alliance between phthisis and ( 
fistula in ano, as was at one time suspected. See Andral (Cliuiq. Medicale, torn, iv, 
p. 308), and Louis (On Phthisis, p. 89, Sydenham Society's edition). The affection 
of the fauces and tliroat, which is described as having attacked the patient at " the 
commencement of the disease," would appear to have been a common complication 
of that epidemic. It is noticed in the First Book of the Epidemics. Foes remarks, 
however, that some had referred it to that redness of the fauces to which persons 
labouring under consumption are hable. Compare Louis, 1. c. p. ii, § 12. Galen 
makes mention of a difference of reading in the MSS. he used in reference to the 
Critical Days. 



EPIDEMICS— BOOK III. 395 

speech inarticulate ; tongue red and parched. On the first day, 
felt chilly, and afterwards became heated. On the third day, a 
rigor, acute fever ; a reddish and hard swelling on both sides 
of the neck and chest, extremities cold and livid ; respira- 
tion elevated ; the drink returned by the nose ; she could 
not swallow ; alviue and urinary discharges suppressed. On 
the fourth, all the symptoms were exacerbated. On the sixth 
she died of the quinsy. 

Explanation of the characters. It is probable that the 
cause of death on the sixth day Avas the suppression of the 
discharges.^ 

Case VIII. — The young man who was lodged by the Liars' 
Market was seized with fever from fatigue, labour, and running 

' On this Ijrief case Galen has left a leugtliyand elaborate Commentary, abounding 
in most interesting matters on a variety of subjects ; as, for example, the different 
readings and opinions of the more ancient commentators on the characters at the 
end of this and the other reports ; on the formation of the llippocratic Collection, 
and the extraordinary zeal of the Ptolemies in procuring books for their great Library 
at Alexandria, and so forth. There is not much in it, however, which bears directly 
on the present case, and therefore we shall give but a very brief abstract of it. It 
appears from Galen that there was a considerable diversity of readings in the latter 
part of it, more especially in regard to the number of days the patient lived ; some 
of the old authorities having placed the death on the fifth, some on the seventh, and 
others on the eighth. Galen inclines to hold by the text as we now have it, and 
maintains, apparently with good reason, that under such a comljination of fatal 
symptoms it was not likely that the patient's strength should have stood out longer 
than the fourth day. Another curious subject connected with this case which Galen 
slightly touches upon, but without throwing any light upon it, is the omission of 
the treatment. He justly remarks, that if Hippocrates treated the patient himself, 
or superintended the treatment as managed by another, it is singular that there is 
no mention of a clyster having been administered, nor of a cataplasm having been 
applied, nor of venesection having been practised. I shall not attempt to solve the 
question here propounded by Galen. See the Argument. His Commentary also con- 
tains an interesting discussion on the meaning of the expression " respiration elevated." 
To give the sum of what has been advanced on this subject in a few words, it may 
signify laborious breathing so as to move the labia of the nose ; or it may mean 
simply orthopnoea, or it may signify laborious respiration, attended with elevation 
of the chest. By the way, this is evidently the " sublimis anhelitus" of Horace, in 
his famous ode entitled " Nireus." I have often wondered that such a learned physi- 
cian as Julius CtEsar Scaliger, in his celebrated critique on Horace in his Poetics, 
should have remarked on this expression : " Ex toto Galeno non intelligo quid sit 
sublimis anhelitus." Galen, in fact, treats fully of the "sublimis anhelitus" in 
various parts of his works. See in particular On Difficulty of Breathing. 



396 EPIDEMICS— BOOK III. 

out of season. On tlie first day, the bowels disordered, with 
bilious, thin, and copious dejections ; urine thin and blackish ; 
had no sleep ; was thirsty. On the second all the symptoms 
were exacerbated ; dejections more copious and unseasonable ; 
he had no sleep ; disorder of the intellect ; slight sweat. On 
the third day, restless, thirst, nausea, much tossing about, 
bewilderment, delirium ; extremities livid and cold ; softish 
distension of the hypochondrium on both sides. On the 
fourth, did not sleep ; still worse. On the seventh he died. 
He was about twenty years of age. 

Exjjlanation of the characters. It is probable that the 
cause of his death on the seventh day was the unseasonable 
practices mentioned above. An acute affection.' 

Case IX. — The woman who lodged at the house of 
Tisamenas had a troublesome attack of iliac passion : much 
vomiting ; could not keep her drink ; pains about the hypo- 
chondria, and pains also in the lower part of the belly ; con- 
stant tormina ; not thirsty ; became hot ; extremities cold 
throughout, with nausea and insomnolency ; urine scanty and 
thin; dejections undigested, thin, scanty. Nothing could do 
her any good. She died.^ 

Case X. — A woman of those who lodged with Pantimides, 

' Galea has given us a lengthy Commentary on this case, but a great part of it 
relates to the characters and to other matters not of any very great importance in 
this place. As he remarks, it is a striking example of an acute fever induced by 
immoderate fatigue. It appears from his Commentary, moreover, that some of the 
older authorities had added "drinking" to the excesses which induced this affection; 
that is to say, they proposed to read Trorwv instead of TcorMv. The symptoms, upon 
reference to the Prognostics, are all such as indicated a fatal result, namely, the 
blackish and thin urine, " the fumbhng with the bedclothes," the coldness and 
lividity of the extremities, the meteorism, and so forth. 

'^ In Galen's Commentaiy on this case there is not much of any great interest to 
the professional reader of the present day. He animadverts again on the omission 
of all mention of the treatment, although, as he states, venesection and the other 
usual means had no doubt been tried ; indeed tlie report impUes as much. Hippo- 
crates, he repeats, never thinks of mentioning the usual routine of practice, as he 
takes it for granted that the reader will understand that it was not neglected. It is 
only on special occasions, then, that he thinks of making any particular reference to 
the treatment. Galen remarks, that ileus being an inflammation of the upper intes- 
tines, is a particularly dangerous aflectiou. 



EPIDEMICS— BOOK III. 397 

from a miscarriage^ was taken ill of fever. On the first day, 
tongue dry, thirst, nausea, insomnolency, belly disordered, 
with thin, copious, undigested dejections. On the second day, 
had a rigor, acute fever ; alvine discharges copious ; had no 
sleep. On the third, pains greater. On the fourth, delirious. 
On the seventh she died. Belly throughout loose, with 
copious, thin, undigested evacuations : urine scanty, thin. An 
ardent fever.^ 

Case XI. — Another woman, after a miscarriage about the 
fifth m.onth, the wife of Ocetes, was seized with fever. At first 
had sometimes coma and sometimes insomnolency ; pain of the 
loins ; heaviness of the head. On the second, the bowels 
were disordered, with scanty, thin, and at first unmixed dejec- 
tions. On the third, more copious, and worse; at night did 
not sleep. On the fourth was delirious ; frights, despondency ; 
strabismus of the right eye; a faint cold sweat about the head; 
extremities cold. On the fifth day, all the symptoms were 
exacerbated ; talked much incoherently, and again immediately 
became collected ; had no thirst ; laboured under insomno- 
lency ; alvine dejections copious^ and unseasonable throughout; 
urine scanty, thin, darkish ; extremities cold, somewhat livid. 
On the sixth day, in the same state. On the seventh she 
died. Phrenitis." 

' As remarked by Galen in his Commentary, this was no doubt a case of ardent 
fever or causus, complicated with an incidental miscarriage. There is no reason for 
looking upon it as being a case of puerperal fever. Galen thinks that the last word 
(causus) is an addition made by the copyists, having been transferred from the 
Glossarium to the text in the course of transcription. Galen, as usual, directs at- 
tention to the characters of the urine, which in this case are particularly unfavorable, 
being defective both in quantity and quality. 

^ Galen's remarks on the circumstances of this case are sufficiently to the purpose, 
but there is nothing very striking in them. He states that the abortion may have 
been occasioned either by external causes — such as the application of pessaries for 
this purpose, and the like — or internal, such as hemorrhage from the neck of the 
uterus, and so forth. As in the former case, he pronounces the last word (phrenitis) 
to be an addition to the text, as Hippocrates never enters upon the diagnosis of dis- 
eases, as is done in the work On Diseases. I suppose he means that our author's 
real works are all founded on Prognosis ; whereas the other, being derived from the 
Cnidian school, is founded on Diagnosis. See our observations on tliis subject in 
the Preliminary Discourse, and the Argument to the Prognostics. 



398 EPIDEMICS— BOOK III. 

Case XII. — A woman who lodged near the Liars' Market, 
having then brought forth a son in a first and difficult labour, 
was seized Avith fever. Immediately on the commencement had 
thirst, nausea, and cardialgia ; tongue dry ; bowels disordered, 
with thin and scanty dejections; had no sleep. On the second, 
had slight rigor, acute fever; a faint cold sweat about the 
head. On the third, painfully affected ; evacuations from the 
bowels undigested, thin, and copious. On the fourth, had a 
rigor ; all the symptoms exacerbated ; insomnolency. On 
the fifth, in a painful state. On the sixth, in the same 
state; discharges from the bowels liquid and copious. On 
the seventh, had a rigor, fever acute ; much thirst ; much 
tossing about ; towards evening a cold sweat over all ; extre- 
mities cold ; could no longer be kept warm ; and again at night 
had a rigor ; extremities could not be warmed ; she did not 
sleep ; was slightly delirious, and again speedily collected. On 
the eighth, about mid-day, she became warm, was thirsty, 
comatose, had nausea ; vomited small quantities of yellowish bile; 
restless at night, did not sleep ; passed frequently large quan- 
tities of urine without consciousness. On the ninth, all the 
symptoms gave way ; comatose, towards evening slight rigors ; 
small vomitings of bile. On the tenth, rigor ; exacerbation of 
the fever, did not sleep at all ; in the morning passed much 
urine having a sediment; extremities recovered their heat. On 
the eleventh, vomited bile of a verdigris-green colour ; not long 
after had a rigor, and again the extremities cold ; towards 
evening a rigor, a cold sweat, much vomiting ; passed a pain- 
ful night. On the twelfth, had copious black and fetid 
vomitings ; much hiccup, painful thirst. On the thirteenth, 
vomitings black, fetid, and copious ; rigor about mid-day, loss 
of speech. On the fourteenth, some blood ran from her nose, 
she died. In this case the bowels were loose throughout ; 
with rigors : her age about seventeen. An ardent fever. ^ 

' Galen remarks, that with such a combination of fatal symptoms, namely, cold- 
ness of the extremities, fetid vomiting, &c., it is wonderful that this patient stood 
out until the fourteenth day. He thinks, however, that this is to be explained from her 
age and constitution. He justly remarks that the occurrence of the epistaxis could 
not be supposed sufficient to carry off such a combination of unfavorable symptoms. 
He once more protests against the last word of the report (causus) being admitted 
as genuine. He confesses himself unable to determine whether " The Liars' Market" 
was in Athens or elsewhere. 



EPIDEMICS— BOOK III. 399 



Section III. — Constitution 2.^ 

The year was southerly, rainy ; no winds throughout." 
Draughts having prevailed during the previous seasons of the 
year, the south winds towards the rising of Arcturus were at- 
tended with much rain. Autumn gloomy and cloud)^, with 
copious rains. Winter southerly, damp, and soft. But long 
after the solstice, and near the equinox, much wintery weather 
out of season ; and when now close to the equinox, northerly, 
and winterly weather for no long time. The spring again 
southerlj^, calm, much rain throughout until the dog-days. 
Summer fine and hot; great suffocating heats. The Etesian 
winds blew small and irregular; again, about the season of 
Arcturus, much rains with north winds. The year being 
southerly, damp, and soft towards winter, all were healthy, ex- 
cept those affected with phthisis, of whom we shall write after- 
wards. 

3. Early in spring, along with the prevailing cold, there 
were many cases of erysipelas, some from a manifest cause, and 
some not.'^ They were of a malignant nature, and proved fatal 
to many ; many had sore-throat and loss of speech. There 
were many cases of ardent fever, phrensy, aphthous affections 
of the mouth,* tumours on the genital organs ; of ophthalmia, 

' Tills is entitled the pestilential constitution by Galen. By constitution, he ex- 
plains, is meant not only the preternatural state of the atmosphere, but also of every- 
thing else which influences the state of the general health. 

- Galen remarks, that in the First Book of the Epidemics three constitutions of 
the year are described, and also that others are described in the Second Book; but 
that these are not carefully drawn out for publication like those of the First and 
Third. He further remarks on this head, that the constitution of the season might 
prepare us for the putrid diseases, which are described below, as heat is the active, 
and humidity the material, cause of all putrefaction. 

^ Galen remarks that erysipelas is occasioned by a bilious detluxion, but that it is 
not always of a malignant and putrid nature ; on the contrary, when the defluxion is 
mild, and the bile which produces it is natural, it is not attended with any consider- 
able injury to the body, if properly managed; but that the humour wliich produced 
the erysipelas about to be described was not such, but of a malignant, corrosive, and 
septic nature, being engendered by the humid and calm state of the weather in such 
persons as were of a choleric constitution. 

■* According to Galen, aphthae in general are superficial ulcerations in the moutli, 
produced by the acrimony of the nurse's milk, and which are easily removed by an 
astringent application. But in the present instance the aphthae were of a malignant 
nature. 



400 EPIDEMICS— BOOK III. 

anthrax/ disorder of the bowels^ anorexia, with thirst and 
without it; of disordered urine, large in quantity, and bad in 
quality ; of persons affected with coma for a long time, and 
then falling into a state of insomnolency. There were many 
cases of failure of crisis, and many of unfavorable crisis ; many 
of dropsy and of phthisis. Such were the diseases then epi- 
demic. ~ There were patients affected with every one of the 
species Avhich have been mentioned, and many died. The 
symptoms in each of these cases were as follows : 

4. In many cases erysipelas, from some obvious cause, such 
as an accident, and sometimes from even a very small wound, 
broke out all over the body, especially, in persons about sixty 
years of age, about the head, if such an accident was neglected 
in the slightest degree ; and this happened in some who were 
under treatment : great inflammation took place, and the ery- 
sipelas quickly spread all over.^ In the most of them the 
abscesses ended in suppurations, and there were great fallings 
off (sloughing) of the flesh, tendons, and bones ; and the de- 
fluxion which seated in the part was not like pus, but a sort of 
putrefaction, and the running was large and of various cha- 
racters. Those cases in which any of these things happened 
about the head were accompanied with falling off" of the hairs 

' The carbuncle (anthrax), Galen says, is always dangerous, and the product of 
bad humours. See Paulus /Egineta, Vol. II, pp. 78, 79. Galeu, in his excellent 
work On the DifFerence of Fevers, writes thus : " In constitutions of the year, similar 
to those which Hippocrates describes as taking place in Cranon (see Ep. ii), I have 
known cases of anthrax pi-evailing epidemically in no few numbers, the formation 
and other symptoms of which were exactly as described by him." (Tom. vu, p. 293 ; 
ed. Kiihn.) 

2 Galen explains under this head that the term epidemic is not applied to any one 
disease, but that when many cases of any disease occur at the same time in a place, 
the disease is called an epidemic ; and that when it is remarkably fatal it is called a 
plague. 

' The history of the epidemical erysipelas here described cannot fail to prove 
interesting to the modern reader. I need scarcely remark that epidemics of a similar 
nature are occasionally met with in Great Britain at the present day. I myself have 
encountered two such epidemics in the locahty where I am now writing, the one in 
1823, and the other in 1846. As described by Hippocrates, the disease sometimes 
supervened upon a slight injury, and generally terminated in gangrene. On ejjide- 
mical erj'sipelas, see De Haen (Ratio Medendi), Bartholinus (Hist. Anatom. Rat. 
Hist., 56), Wells (Transactions of a Society for the Improvement of Medical and 
Chirurgical Knowledge), Cooper's Surgical Dictionary ; and Cyclopaedia of Practical 
Medicine, under Erysipelas. 



EPIDEMICS— BOOK III. 401 

of the head and chin, the bones were laid bare and separated, 
and there were excessive runnings ; and these symptoms hap- 
pened in fevers and without fevers. But these things Avere more 
formidable in appearance than dangerous ; for when the con- 
coction in these cases turned to a suppuration, most of them 
recovered ; but when the inflammation and erysipelas disap- 
peared, and when no abscess was formed, a great number of 
these died.' In like manner, the same things happened to 
whatever part of the body the disease wandered, for in many 
cases both forearm and arm dropped off; and in those cases 
in which it fell upon the sides, the parts there, either before or 
behind, got into a bad state ; and in some cases the whole femur 
and bones of the leg and whole foot were laid bare. But of 
all such cases, the most formidable were those which took place 
about tlie pubes and genital organs.^ Such was the nature of 

' Galen amply confirms this statement, that when erysipelas fixes on a particular 
part of the body it is more formidable in appearance than in reality, and that the 
disease is attended with most danger when it leaves an external member, and is 
determined inwardly. 

* The classical reader will here call to his recollection a striking passage in the 
celebrated description of the Plague of Athens, as given by Tluicydides : " For the 
mischief, being at first seated in the head, spread over the whole body, and if one sur- 
vived the most formidable symptoms, an attack on the extremities manifested itself; 
for it was determined to the genital organs and to the hands and feet, and many 
escaped with losing them, and some with the loss of their eyes." (ii, 49.) The passage 
is thus rendered by Lucretius : 

" tamen in nervos huic morbus et artus 
Ibat et in partes genitales corporis ipsas ; 
Et graviter partim metuentes limina lethi 
Vivebant ferro privati parte virili : 
Et manibus sine nonnuUi pedibusque manebant 
In vita tamen et perdebant lumina partim." (vi, 1203.) 

Lncretins, it will be I'emarked, understands the histoiian to mean that the mortified 
parts were amputated; and this opinion, although rejected by most of our non- 
professional editors of Thucydides, is confirmed by what Galen says in his Commentary 
on this passage, namely, that in erysipelas of the genital organs " we (meaning the 
physicians of his own time) are often obliged to excise the putrid parts, and apply 
the cautery to them." I would here further point ont a singular mistake into which 
Dr. Bloomfield falls in his note on this passage of Thucydides ; he says that the 
words of the original (aKpag xtipag Kal -rrSSag) " can only signify the ends of or 
lower joints of the fingers and toes." No one who is acquainted with the language 
of our author will require to be told that this is an entire misconception. In the 
works of Hippocrates %« t/jfc is often put for the arms, and x^^P^f uKpai are always 
applied to the hands. 

2G 



402 EPIDEMICS— BOOK III. 

these cases when attended with sores, and proceeding from an 
external cause ; but the same things occurred in fevers, before 
fevers, and after fevers. But those cases in wliich an abscess 
was formed, and turned to a suppuration, or a seasonable 
dianhoea or discharge of good urine took place, were relieved 
thereby ; but those cases in which none of these symptoms 
occurred, but they disappeared without a crisis, proved fatal. 
The greater number of these erysipelatous cases took place in 
the spring, but were prolonged through the summer and during 
autumn. 

5. In certain cases there was much disorder, and tumours 
about the fauces, and inflammations of the tongue, and ab- 
scesses about the teeth. And many were attacked with im- 
pairment or loss of speech ;^ at first, those in the commencement 
of phthisis, but also persons in ardent fever and in plirenitis. 

6. The cases of ardent fever and phrenitis occurred early in 
spring after the cold set in, and great numbers were taken ill 
at that time, and these cases were attended with acute and fatal 
symptoms. The constitution of the ardent fevers which then 
occurred was as follows : at the commencement they were af- 
fected with coma, nausea, and rigors ; fever not acute, not much 
thirst nor delirium, slight epistaxis,^ the paroxysms for the most 
part on even days ; and, al)out the time of the paroxysms, for- 
getfulness, loss of strength and of speech, the extremities, that 
is to sa}^, the hands and feet, at all times, but more especially 
about the time of the paroxysms, were colder than natural ; 
they slowly aud imperfectly became warmed, and again re- 
covered their recollection and speech.'^ They were constantly 
affected either with coma, in which they got no sleep, or with 

• Upon reference to the Glossary of Erotian, the Commentary of Galen, and the 
Annotations of Foes and Littre, the reader will see that there is great difficulty in 
determining the text in this place. After examining all that has been written on 
the subject, one cannot come to any satisfactory conclusion as to the tnie reading. 
I have adopted the meaning which seems to suit best with the passage. The pro- 
fessional reader will scarcely require to be reminded that in cases of phthisis there 
is often a notable impairment of the voice. 

^ Galen makes the important remark on this word, that, in febrile diseases, epis- 
taxis is always a bad symptom. 

^ This obliviousness is a feature of the plague, as described by Thucydides : " And 
some, when they first left their beds, were seized with an utter forgetfulness of all 
things, and knew not themselves nor their relatives." (1. c.) 



EPIDEMICS— BOOK III. 403 

insomnolency, attended with pains ;' most had disorders of the 
bowels, attended with undigested^ thin, and copious evacuations; 
urine copious, thin, having nothing critical nor favorable about 
it ; neither was there any other critical appearance in persons 
affected thus ; for neither was there any proper hemorrhage, 
nor any other of the accustomed evacuations, to prove a crisis. 
They died, as it happened, in an irregular manner, mostly 
about the crises, but in some instances after having lost their 
speech for a long time, and having had copious sweats. These 
were the symptoms which marked the fatal cases of ardent fever ; 
similar symptoms occurred in the phrenitic cases ; but these 
were particularly free from thirst, and none of these had wild 
delirium" as in other cases, but they died oppressed by a bad 
tendency to sleep, and stupor. 

7. But there were also other fevers, as will be described. 
Many had their mouths affected with aphthous ulcerations. 
There were also many defluxions about the genital parts, and 
ulcerations, boils (phymata), externally and internally, about 
the groins.'^ Watery ophthalmies of a chronic character, with 
pains j fungous excrescences of the eyelids, externally and in- 
ternally, called fici, which destroyed the sight of many persons.^ 
There were fungous growths, in many other instances, on ulcers, 
especially on those seated on the genital organs. There were 
many attacks of carbuncle (anthrax) through the summer, and 

' Our author alludes to the affection called coma vigil by the later authorities. In 
this affection, as Galen remarks, the patient lies with his eyes shut, but can get no 
sound sleep. This, of course, is so much more the case provided pain be present, as 
it necessarily will prevent the occurrence of sleep. See Galen's tract On Coma. 

- The low muttering delirium of typhoid fevers is here evidently alluded to. 
Galen, in his Commentary, guards the reader against supposing that the fever passed 
into lethargus. 

3 This description apparently can refer to nothing but pestilential buboes. 

■• It is impossible not to recognise this as a description of purulent ophthalmia. 
Celsus thus describes the ficus : " Est etiam ulcus quod a fici similitudine uvkiixjiq 
Gi lEcis nominatur, ubi caro excrescif; et id quidem generale est. Sub eo vero duae spe- 
cies sunt. Alterum ulcus durum et rotundum est : alteram humidum et insequale. 
Ex duro exiguum quoddam et glutinosum exit: ex humido plus, et mali odoi'is." 
See the Lexicons of Hesychhis and Phavorinus, and also Paulus ^gineta, Book 

III, 3. It will be remarked that Hippocrates also makes mention of fungous ex- 
crescences about the pudenda. Were they syphilitic .' In other words, did they derive 
their origin from elephantiasis .' See the Annotations on Pauhts yEaiNEXA, Book 

IV, ] , Sydenham Society's edition. 



404 EPIDEMICS— BOOK III. 

other affections, whicli are called " the putrefaction" [seps) ; 
also large ecthyraata/ and large tetters [herpetes) in many in- 
stances. 

8. And many and serious complaints attacked many persons 
in the region of the belly. In the first place, tenesmus, ac- 
companied with pain, attacked many, but more especially 
children, and all who had not attained to puberty ; and the 
most of these died. There were many cases of lientery and of 
dysentery ; but these were not attended with much pain.^ 
The evacuations were bilious, and fatty, and thin, and watery ; 
in many instances the disease terminated in this way, with and 
without fever; there were painful tormina and volvuli of a 
malignant kind; copious evacuations of the contents of the 
guts, and yet much remained behind ; and the passages did 
not carry off the pains, but yielded with difficulty to the means 
administered ; for in most cases purgings av ere hui'tful to those 
affected in this manner; many died speedily, but in many 
others they held out longer. In a word, all died, both those 
who had acute attacks and those who had chronic, most espe- 
cially from affections of the belly, for it was the belly which 
carried them all off. 

9. All persons had an aversion to food in all the afore- 
mentioned complaints to a degree such as I never met Avith 
before,^ and persons in these complaints most especially, and 
those recovering from them, and in all other diseases of a 
mortal nature. Some were troubled with thirst, and some not ; 
and both in febrile complaints and in others no one drank un- 
seasonably or disobeyed injunctions. 

10. The urine in many cases was not in proportion to the 
drink administered, but greatly in excess ; and the badness of 
the urine voided was great, for it had not the proper thickness, 
nor concoction, nor purged properly ; for in many cases purgings 
by the bladder indicate favorably, but in the greatest number 

' The meaning of this term is not precisely determined. Galen's account of it 
may apply both to exanthemata and pustulas. The description of the eruption in 
the Plague of Athens is likewise vague and indeterminate. (Thucyd. ii, 49.) 

^ These intestinal complaints are all mentioned in the description of the Plague at 
Athens. (1. c.) Upon reference to the Commentary of Galen, the reader will remark 
that there is a question here respecting the reading. 

^ Galen, in his Commentary, makes the remark that he observed the same symptom 
in the plague which raged in his time. 



EPIDEMICS— BOOK HI. 405 

they indicated a meltiug of the bod}', disorder of the bowels, 
pains, and a want of crisis. ' 

11. Persons labouring under phrenitis and causus were par- 
ticularly disposed to coma ; but also in all other great diseases 
which occurred along with fever. In the main, most cases 
were attended either by heavy coma, or by short and light sleep. 

12. And many other forms of fevers were then epidemic, 
of tertian, of quartan, of nocturnal," of continual, of chronic, 
of erratic, of fevers attended with nausea, and of irregular 
fevers. All these were attended with much disorder, for tlie 
bowels in most cases were disordered, accompanied with rigors, 
sweats not of a critical character, and with the state of the 
urine as described. In most instances the disease was pro- 
tracted, for neither did the deposits which took place prove 
critical as in other cases ; for in all complaints and in all cases 
there was difficulty of crisis, want of crisis, and protraction of 
the disease, but most especially in these. A few had the crisis 
about the eightieth day, but in most instances it (the disease?) 
left them irregularly. A few of them died of dropsy without 
being confined to bed. And in many other diseases people were 
troubled with swelling, but more especially in phthisical cases. 

13. The greatest and most dangerous disease, and the one 
that proved fatal to the greatest number, was the consumption.^ 
With many persons it commenced during the winter, and of 
these some were confined to bed, and others boi'e up on foot ; 

' It will readily be understood that a colliquative diabetes would prove a very un- 
favorable complication of these complaints. 

- By nocturnal fevers, according to Galen, was meant quotidians, which had their 
paroxysms during the night. Foes incUnes to think that diurnal should also be 
inserted in this place. These nocturnal fevers are tluis described by D. Monro : 
" The sick were restless and uneasy at night ; but commonly felt themselves cooler 
and hghter in the daytime ; and although they had no cold fit, as the fever came on 
at nights, and many of them no breatliing sweat, as they became cooler and freer 
from the fever in the morning ; yet the fits were so remarkable, that many of the 
patients used to say that they had a regular fit of an ague every night, and some few 
that they had the fit every second night." (Army Diseases, &c., p. 158.) 

^ The account of the origin and progress of consumption here given is, upon the 
whole, wonderfully correct. Common experience seems to have decided that spring 
and autumn are the most fatal seasons to phthisical patients. Avicenna makes tlie 
remark, which is very important, and deserves to be kept in mind, that by phthisis, 
in this place, Hippocrates most probably meant hectic fever, connected with disease 
of the internal viscera, which had been in an inflamed state during the acute attack 
of the fever, (iii, 1, 3, 67.) 



406 EPIDEMICS— BOOK III. 

the most of tliose died early in spring wlio were confined to bed; 
of the otherSj the cough left not a single person^ but it became 
milder through the summer ; during the autumn, all these were 
confined to bed, and many of them died, but in the greater 
number of cases the disease was long protracted. Most of these 
were suddenly attacked with these diseases, having frequent 
rigors, often continual and acute fevers ; unseasonable, copious, 
and cold sweats throughout ; great coldness, from which they 
had great difficulty in being restored to heat; the bowels 
variously constipated, and again immediately in a loose state, 
but towards the termination in all cases with violent looseness 
of the bowels ; a determination downwards of all matters col- 
lected about the lungs ; urine excessive, and not good; trouble- 
some melting. The coughs throughout were frequent, and 
sputa copious, digested, and liquid, but not brought up with 
much pain ; and even when they had some slight pain, in all 
cases the purging of the matters about the lungs went on 
mildly. The fauces were not very irritable, nor were they 
troubled with any saltish humours; but there were viscid, 
white, liquid, frothy, and copious defluxions from the head. 
But by far the greatest mischief attending these and the other 
complaints, was the aversion to food, as has been described. 
For neither had they any relish for drink along with their food, 
but continued without thirst. There was heaviness of the body, 
disposition to coma, in most cases swelling, which ended in 
dropsy ; they had rigors, and were delirious towards death. 

14. The form of body peculiarly subject to phthisical com- 
plaints was the smooth, the whitish, that resembling the lentil; 
the reddish, the blue-eyed, the leucophlegmatic,^ and that with 

' I shall not enter into a discussion of the different readings of this interesting 
passage. I mux mention that our great pathological authority on phthisis, Dr. 
Louis, agrees with Hippocrates in deciding that the lymphatic temperament consti- 
tutes a more or less marked predisposition to the development of phthisis, (p. 483.) 
Galen descrihes the phlegmatic temperament as being attended with a soft and 
shghtly tumid skin. He attributes the disease in their case to a cacochymy, that is 
to say, to cachexia. I need scarcely remark that this opinion is strongly advocated 
by one of the highest authorities of the day, I mean Sir James Clark. See his 
treatise on Tubercular Phthisis. Galen gives a discussion on the colour of the eyes, 
about which there is some difficulty, as the ancient terms which relate to colours are 
not verj' well defined. The term here used (xapoTrbg) may signify either bhie or 
gray. Galen considers thi& colour of the eyes as a symptom of a cold and humid 
temperament. 



EPIDEMICS— BOOK III. 407 

the scapuliTC having the appearance of wings : and women in hke 
manner/ with regard to the melanclioKc and subsanguineous, 
phrenitic and dysenteric aft'ections principally attacked them. 
Tenesmus troubled young persons of a phlegmatic temperament. 
Chronic diarrhoea^ acrid and viscid discharges from the bowels 
attacked those who were troubled with bitter bile. 

15. To all those which have been described, the season of 
spring was most inimical, and proved fatal to the greatest 
numbers : the summer was the most favorable to them, and 
the fewest died then ; in autumn, and under the Pleiades, 
again there died great numbers. It appears to me, accord- 
ing to the reason of things, that the coming on of summer 
should have done good in these cases ; for winter coming on 
cures the diseases of summer, and summer coming on removes 
the diseases of winter. And yet the summer in question was 
not of itself well constituted, for it became suddenly hot, south- 
erly, and calm ; but, notwithstanding, it proved beneficial by 
producing a change on the other constitution. 

16. I look upon it as being a great part of the art to be able 
to judge properly of that which has been written. For he that 
knows and makes a proper use of these things, would appear to 
me not likely to commit any great mistake in the art. He 
ought to learn accurately the constitution of every one of the 
seasons, and of the diseases ; whatever that is common in each 
constitution and disease is good, and whatever is bad ; whatever 
disease will be protracted and end in death, and whatever will 
be protracted and end in recovery ; which disease of an acute 
nature Avill end in death, and which in recovery. From these 
it is easy to know the order of the critical days, and prognosti- 
cate from them accordingly. And to a person who is skilled 
in these things, it is easy to know to whom, when, and how 
aliment ought to be administered.^ 

' There is an ambiguity in the part of the sentence which relates to women, as 
Galen states in his Commentary. Galen does not hesitate to declare that women are 
more subject to phthisis than men, an opinion upon wliicli modern authorities are 
not at all agreed. See the recent publications of Louis and Clark on Phthisis. 

^ The last paragraph, and the latter clause of the preceding one, were at first at- 
tached to the end of tlie subsequent cases, and wei'e transferred to their present 
position by Dioscorides the commentator a short time before Galen. They evidently 
embody a most distinct and admirable enumeration of the general facts with which 
the practical physician ought to make himself acquainted. 



408 EPIDEMICS— BOOK III. 

§ 17. Sixteen Cases.^ 

Case I. — In Thasus, the PariaB who lodged above the 
Temple of Diana was seized with an acute fever, at first 
of a continual and ardent type ; thirsty, inclined to be coma- 
tose at first, and afterwards troubled with insomnolency ; 
bowels disordered at the beginning, urine thin. On the sixth 
day, passed oily urine, was dehrious. On the seventh, all the 
symptoms were exacerbated ; had no sleep, but the urine of the 
same characters, and the understanding disordered ; alvine de- 
jections bilious and fatty. On the eighth, a slight epistaxis ; 
small vomiting of verdigris-green matters ; slept a little. On 
the ninth, in the same state. On the tenth, all the symptoms 
gave way. On the eleventh, he sweated, but not over the whole 
body; he became cold, but immediately recovered his heat 
again. On the fourteenth, acute fever ; discharges bihous, thin, 
and copious ; substances floating in the urine; he became inco- 
herent. On the seventeenth, in a painful state, for he had no 
sleep, and the fever was more intense. On the twentieth, 
sweated all over ; apyrexia, dejections bihous; aversion to food, 
comatose. On the twenty-fourth, had a relapse. On the 
thirty-fourth, apyrexia; bowels not confined; and he again reco- 
vered his heat. Fortieth, apyrexia, bowels confined for no long 
time, aversion to food ; had again slight symptoms of fever, and 
throughout in an irregular form; apyrexia at times, and at 
others not ; for if the fever intermitted, and was alleviated for 
a little, it immediately relapsed again ; he used much and im- 
proper food ; sleep bad ; about the time of the relapse he was 
delirious ; passed thick urine at that time, but troubled, and of 
bad characters ; bowels at first confined, and again loose ; slight 
fevers of a continual type; discharges copious and thin. On the 
hundred and twentieth day he died. In this patient the bowels 
were constantly from the first either loose, with bilious, liquid, 
and copious dejections, or constipated with hot and undigested 
fseces ; the urine throughout bad ; for the most part coma, or in- 
somnolency with pain; continued aversion to food. Ardent fever. 

' We learn from the Commentary of Galen that some of the older critics sup- 
posed that the sixteen cases about to be related had been selected by Hippocrates 
in illustration of his doctrines, as laid down in the preceding description of what 
is generally entitled the Pestilential Season. Galen, however, does not incline to 
this opinion. 



EPIDEMICS— BOOK III. !09 

ExpIanuHon of the characters. It is probable that the 
weakness produced by the fever, the phrenitis, and affection of 
the hypochondi'ium caused death on the hundred and twentieth 
dav.^ 

Case II. — In Thasus, the woman who was lodged near the 
Cold Water, on the third day after delivery of a daughter, the 
lochial discharge not taking place, was seized with acute fever, 
accompanied with rigors. But a considerable time before 
delivery she was feverish, confined to bed, and loathed her food. 
After the rigor which took place, continual and acute fevers, 
wdth rigors. On the eighth and following days, was very inco- 
herent, and immediately afterwards became collected ; bowels 
disordered, with copious, thin, watery, and bilious stools; no 
thirst. On the eleventh was collected, but disposed to coma; 
urine copious, thin, and black ; no sleep. On the twentieth, 
slight chills, and immediately afterwards was warm ; slight 
incoherence ; no sleep ; with regard to the bowels, in the same 
condition ; urine watery, and copious. On the twenty-seventh, 
free from fever ; bowels constipated ; not long afterwards vio- 
lent pain of the right hip-joint for a considerable time ; fevers 
afterwards supervened ; urine watery. On the fortieth, com- 
plaints about the hip-joint better; continued coughs, with 
copious, watery sputa ; bowels constipated ; aversion to food ; 
urine the same ; fever not leaving her entirely, but having 
paroxysms in an irregular form, sometimes present, sometimes 
not. On the sixtieth, the coughs left her without a crisis, for 
no concoction of the sputa took place, nor any of the usual 

' This is an example of one of those protracted fevers of an intermittent iyytQ, 
\vhich, as I have been informed by an intelligent physician who practised for several 
years in the Ionian Islands, are so common in the climate of Greece. There is not 
much of any particular value in Galen's Commentary on this case. He informs ns 
that one of the older commentators absurdly maintained the opinion that the country 
of this patient was given because, according to Asclepiades, the inhabitants of Paros 
were most especially benefited by bleeding. But, as Galen says, this remark is 
particularly out of place here, since no mention of venesection occurs in the report. 
Galen, and after him Foes, have given very lengthy and elaborate disquisitions on 
the nature of oily urine. The result is, that it is an unfavorable, but not necessarily 
a fatal, character. It is minutely described by the later authorities on urology, 
namely, Theophilus and Actuarius. See also the Commentary on Paulus /Egineta, 
Book II, 14, Sydenham Society's edition. 



410 EPIDEMICS— BOOK III. 

abscesses; jaw on the right side convulsively retracted; coma- 
tose, was again incoherent, and immediately became collected; 
utter aversion to food; the jaw became relaxed; alvine dis- 
charges small, and bilious ; fever more acute, affected with 
rigors ; on the following days lost her speech, and again became 
collected, and talked. On the eightieth she died. In this case 
the urine throughout Avas black, thin, and watery; coma 
supervened ; there was aversion to food, despondency, and insora- 
nolency ; irritability, restlessness ; she was of a melancholic 
turn of mind. 

Explanation of the characters. It is probable that the 
suppression of the lochial discharge caused death on the 
eightieth day.^ 

Case III. — In Thasus, Pythion, who was lodged above the 
Temple of Hercules, from labour, fatigue, and neglected diet, 
was seized with strong rigor and acute fever ; tongue dry, 
thirsty, and bilious ; had no sleep ; urine darkish, eneorema 
floating on the top of the urine, did not subside. On the 
second day, about noon, coldness of the extremities, especially 
about the hands and head ; loss of speech and of articulation ; 
breathing short for a considerable time ; recovered his heat ; 
thirst ; passed the night quietly ; slight sweats about the head. 
On the third, passed the day in a composed state ; in the even- 
ing, about sunset, slight chills ; nausea, agitation ; passed the 
night in a painful state ; had no sleep ; small stools of compact 
faeces passed from the bowels. On the fourth, in the morning, 
composed ; about noon all the symptoms became exacerbated ; 
coldness, loss of speech, and of articulation ; became worse ; 
recovered his heat after a time ; passed black urine, having 
substances floating in it ; the night quiet ; slept. On the 
fifth, seemed to be lightened, but a painful weight about the 
belly ; thirsty, passed the night in a painful state. On the 
sixth, in the morning, in a quiet state ; in the evening the 
pains greater ; had a paroxysm ; in the evening the bowels pro- 

' This appears clearly to be a case of fever, complicated with, but not produced by 
parturition. Galen, however, seems to ascribe the fever and its fatal results to the 
retention of the lochial discharge. The characters of the urine, he properly remarks, 
are unfavorable, being copious, thin, and black. He also calls attention to the want 
of proper concoction in the sputa, to which he attributes the fatal relapse. 



EPIDEMICS— BOOK III. 411 

perly opened by a small clyster; slept at night. On the 
seventh, during the day, in a state of nausea, somewhat dis- 
turbed ; passed urine of the appearance of oil ; at night, much 
agitation, was incoherent, did not sleep. On the eighth, in 
the morning, slept a little ; but immediately coldness, loss of 
speech, respiration small and weak ; but in the evening reco- 
vered his heat again ; was delirious, but towards day was some- 
what lightened ; stools small, bilious, and unmixed. On the 
ninth, aifected with coma, and with nausea when roused ; not 
very thirsty ; about sunset he became restless and incoherent ; 
passed a bad night. On the tenth, in the morning, had become 
speechless ; great coldness ; acute fever ; much perspiration ; he 
died. His sufferings were on the even davs. 

Explanatio7i of the characters. It is probable that the 
excessive sweats caused death on the tenth day.^ 

Case IV. — The patient aflFected with phrenitis, having taken 
to bed on the first day, vomited largely of verdigris-green and 
thin matters; fever, accompanied Avith rigors, copious and con- 
tinued sweats all over; heaviness of the head and neck, with 
pain ; urine thin, substances floating in the urine small, scat- 
tered, did not subside; had copious dejections from the bowels; 
very delirious ; no sleep. On the second, in the morning, loss 
of speech ; acute fever ; he sweated ; fever did not leave him ; 
palpitations over the Avhole body, at night, convulsions. On the 
third, all the symptoms exacerbated ; he died. 

Explanation of the characters. It is probable that the 
sweats and convulsions caused death.^ 

' Galen's Commentary on this case is written in his usual light and diffuse style^ 
Ijut contains very little which is calculated to throw light on the text, or on the 
nature of the disease which is here described. If any one find difficulty in compre- 
hending the characters of the respiration, as given in this narrative, he can turn to 
Galen's work. On Difficulty of Breathing, where they are explained very fully. I may 
just mention that by shortness of breath QSpaxvirvooQ) was understood, by Hippo- 
crates and Galen, frequency of the act of respiration. 

- This case, as Galen remarks, is an instance of the most acute form of phrenitis. 
lie states that he himself had met with cases of phrenitis in which the patients had 
died on tlie fourth and fifth day, but that he had never seen a case which proved so 
suddenly fatal as the present one. He further makes some vei-y interesting reflections 
on the suddenness of the attack in such cases, which is the more wonderful, as tlic 
exciting cause of them must be gradually collecting in the system, and acquiring 
strength and intensity, aud it is singular tliat it should then be developed all at once, 



412 EPIDEMICS—BOOK III. 

Case V. — In Larissa, a man, who was bald, suddenly was 
seized with pain in the right thigh ; none of the things whicli 
were administered did him any good. On the first day, fever 
acute, of the ardent type, not agitated, but the pains persisted. 
On the second, the pains in the thigh abated, but the fever in- 
creased ; somewhat tossed about ; did not sleep ; extremities 
cold ; passed a large quantity of urine, not of a good character. 
On the third, the pain of the thigh ceased ; derangement of the 
intellect, confusion, and much tossing about. On the fourth, 
about noon, he died. An acute disease.^ 

and cut off the patient in a very short time, as if he had swallowed poison, or had 
been stung by a venomous animal. He compares the latency of the febrile humour 
in the system to that of the mad dog, which will remain for a long time in the body 
of a person who has been bitten, and then all at once will manifest its effects, by 
inducing the rage. For the ancient views on the subject of Hydrophobia, see Paulus 
jEgineta, Book V, 4, Sydenham Society's edition. 

' Galen, in his Commentary on this case, enters into a train of reflections how a 
physician ought to proceed when called in to a patient so circumstanced. He ought, 
in the first place, as the Commentator properly remarks, to make careful inquiry, in 
order to find out whether the pain in the limb be occasioned by any external cause, 
as persons often meet with local injuries by sudden twisting and movements of 
their limbs, or even by laying a limb uncomfortably in bed, without being aware of 
it. When no such cause of the complaint can be discovered, Galen says the physician 
should try to ascertain whether or not it be connected with the regimen or tempera- 
ment of the patient. If it shall turn out that the body is in a plethoric state, general 
bleeding must be had recourse to, before any local applications are made to the part. 
It is then to be fomented, and liquid and heating medicines applied to it. Whether 
or not this was the mode of treatment which Hippocrates adopted in this case, Galen 
cannot take upon himself to affirm, as no mention is made in the report of venesection, 
nor of the particidar remedies which were used. I am of opinion that this is one of 
tlie most interesting cases in the whole Collection, for I believe it to be a faithful 
report of a disease Mhich on three several occasions I have met with during an active 
professional practice of thirty years, and which I have not seen described elsewhere. 
In all my cases, indeed, the patients were from twelve to sixteen years old, but in 
other respects the symptoms were the same as here described by Hippocrates. In 
every one of the cases the patient was seized with pain and swelling of the thigh, 
attended with high fever, great jactitation, and partial delirium. They all proved 
fatal in the course of three or four days. Whether the disease be connected with 
diffuse inflammation of the areolar substance, or with inflammation of the veins, 
or whether it be a general fever complicated with a local affection of the limb, or 
what may be the exact nature of the affection, I have not been able to determine. 
From what is stated above, it will be clearly seen how justly Hippocrates deserves 
the compliment paid to him by Galen, of having been, of all medical authorities, 
the most careful in observing the phenomena of disease. (Opera Galeni, tom. vii, 
p. 829, ed. Kiihn.) 



EPIDEMICS— BOOK III. 413 

Case VI. — In Abdera^ Pericles was seized with a fever of the 
acute^ continual type, with pain ; much thirst, nausea, could 
not retain his drink ; somewhat swelled about the spleen, with 
heaviness of the head. On the first da}^, had hemorrhage from 
the left nostril, but still the fever became more violent ; passed 
much muddy, white urine, which when allowed to stand did not 
subside. On the second day, all the symptoms were exacer- 
bated, yet the urine was thick, and more inclined to have a 
sediment; the nausea less; he slept. On the third, fever was 
milder; abundance of urine, which was concocted, and had a 
copious sediment ; passed a quiet night. On the fourth, had a 
copious and warm sweat all over about noon; was free of fever, 
had a crisis, no relapse. An acute affection.' 

Case VII. — In Abdera, the young woman who was lodged 
in the Sacred Walk was seized with an ardent fever. She was 
thirsty, and could not sleep ; had menstruation for the first time. 
On the sixth, much nausea, flushing, was chilly, and tossed 
about. On the seventh, in the same state ; urine thin, but of 
a good colour ; no disturbance about the bowels. On the eighth, 
deafness, acute fever, insomnolency, nausea, rigors, became 
collected ; urine the same. On the ninth, in the same state, and 
also on the following days ; thus the deafness persisted. On the 
fourteenth, disorder of the intellect ; the fever abated. On the 
seventeenth, a copious hemorrhage from the nose ; the deafness 
slightly better ; and on the following days, nausea, deafness, and 
incoherence. On the twentieth, pain of the feet ; deafness and 
delirium left her ; a small hemorrhage from the nose ; sweat, 
apyrexia. On the twenty-fourth, the fever returned, deafness 
again ; pain of the feet remained ; incoherence. On the tweut}' - 
seventh, had a copious sweat, apyrexia; the deafness left her; 
the pain of her feet partly remained ; in other respects had a 
complete crisis. 

Explanation of the characters. It is probable that the 

' Galen remarks, that tliis is one of those cases which appear forraitlahle to the 
inexperienced, but which those who are practised in the art judge of as being 
likely to come to a speedy crisis. He adverts to the slight swelling of the spleen 
and the characters of the urine, which soon showed a proper sediment, as being 
particularly favorable symptoms. The more that we study Hippocratic medicine, 
we shall be the more convinced that too little attention has been paid of late years to 
the physical characters of the urine in all febrile complaints. 



414 EPIDEMICS— BOOK III. 

restoration of health on the twentieth day was the result of the 
evacuation of urine.^ 

Case VIII. — In Abdera, Anaxion, who was lodged near the 
Thracian Gates, was seized with an acute fever ; continued pain 
of the right side ; dry cough, without expectoration during the 
first days, thirst, insomnolency ; urine well coloured, copious, 
and thin. On the sixth, delirious ; no relief from the warm 
applications. On the seventh, in a painful state, for the fever 
increased, while the pains did not abate, and the cough was 
troublesome, and attended with dyspnoea. On the eighth, I 
opened a vein at the elbow, and much blood, of a proper cha- 
racter, flowed; the pains were abated, but the diy coughs 
continued. On the eleventh, the fever diminished ; slight 
sweats about the head ; coughs, with more liquid sputa ; he was 
relieved. On the twentieth, sweat, apyrexia; but after the 
crisis he was thirsty, and the expectorations were not good. On 
the twenty-seventh the fever relapsed ; he coughed, and l)rought 
up much concocted sputa : sediment in the urine copious and 
white ; he became free of thirst, and the respiration was good. 
On the thirty-fourth, sweated all over, apyrexia, general crisis. 

Explanation of the characters. It is probable that the eva- 
cuation of the sputa brought about the recovery on the thirty- 
fourth day.'^ 

' Galen's Commentary on this case is unusually brief. He holds it to be a case 
connected with general plethora, as indicated by the good colour of the urine. He 
once more makes the remark that a favorable issue of the case might have been 
anticipated, from the characters of the urine. 

^ Galen remarks in his Commentary, that of all the cases related in the First and 
Third Books of the Epidemics, this is the only one in which Hippocrates says that 
the patient was bled, not, he adds, that this was the only case in which venesection 
was adopted, but because, although the general rule was not to bleed after the fourth 
day, the patient, in the present instance, was bled on the eighth. Many others, 
he says, were no doubt bled on the second, third, and fourth days, but of these 
bleedings, and the other means used, Hippocrates in general takes no notice, except 
that he sometimes states, in order to render the malignity of the disease more 
apparent, that it was nowise benefited by the remedies appUed. In other cases he 
adds, he would appear, from the words he uses (such as " as far as I am aware"), not 
to have attended the patient at the commencement. Galen further directs attention 
to the characters of the expectoration, the concoction of which be looks upon as 
having proved the means of carrying off this fever. Galen has reviewed the symptoms 
of this case very fully, and in a most interesting manner, in the Second Book of his 



EPIDEMICS-BOOK III. 415 

Case IX. — In Abdera, Heropytlms, while still on foot, had 
pain in the head, and not long afterwards he took to bed ; he 
lived near the High Street. Was seized with acute fever of 
the ardent type ; vomitings at first of much bilious matter ; 
thirst ; great restlessness ; urine thin, black, substances some- 
times floating high in it, and sometimes not ; passed the night 
in a painful state ; paroxysms of the fever diversified, and for 
the most part irregular. About the fourteenth day, deafness ; 
the fever increased ; urine the same. On the twentieth and 
following days, much delirium. On the thirtieth, copious 
hemorrhage from the nose, and became more collected; deaf- 
ness continued, but less ; the fever diminished ; on the following- 
days, frequent hemorrhages, at short intervals. About the 
sixtieth, the hemorrhages ceased, but violent pain of the 
hip-joint, and increase of fever. Not long afterwards, pains 
of all the inferior parts ; it then became a rule, that either the 
fever and deafness increased, or, if these abated and were light- 
ened, the pains of the inferior parts were increased. About 
the eightieth day, all the complaints gave way, without leaving 
any behind ; for the urine Avas of a good colour, and had a 
copious sediment, while the delirium became less. About the 
hundredth day, disorder of the bowels, with copious and bilious 
evacuations, and these continued for a considerable time, and 
again assumed the dysenteric form with pain ; but relief of all 
the other complaints. On the whole, the fevers went off, and 
the deafness ceased. On the hundred and twentieth day, had 
a complete crisis. Ardent fever. 

Explanation of the characters. It is probable that the bilious 
discharge ])rought about the recovery on the hundred and 
twentieth day.^ 

woi'k, On Difficulty of Breatliing, see ed. Kiihn, torn, vii, p. 854, &c. That it was a 
case of fever complicated with pleurisy seems clear, as Galen remarks. Galen 
further treats of the characters of the sputa in this case, in the First Book of his 
work, On Crises. Upon reference to the edition of Littre, it will be seen that 
unfortunately there is considerable variation in the readings of this passage. 

' On this case Galen makes the remark that this patient must have had a strong 
constitution, otherwise it could not have withstood such an affection. lie adds 
that, moreover; his pulse must have possessed strength, but that, as formerly said by 
him, this department of prognostics is altogether omitted by Hippocrates, in his 
reports of febrile cases. He further remarks that the respiration and appetite were 
not to complain of, and the only bad symptom was the thinness and blackness of the 



416 EPIDEMICS— BOOK III. 

Case X. — In Abdera, Nicodemus was seized with fever from 
venery and drinking. At the commencement he was troubled 
with nausea and cardialgia ; thirsty, tongue was parched ; urine 
thin and dark. On tlie second day, the fever exacerbated ; he 
was troubled with rigors and nausea ; had no sleep ; vomited 
yellow bile ; urine the same ; passed a quiet night, and slept. 
On the third, a general remission ; amelioration ; but about 
sunset felt again somewhat uncomfortable ; passed an uneasy 
night. On the fourth, rigor, much fever, general pains ; urine 
thin, with substances floating in it; again a quiet night. On 
the fifth, all the symptoms remained, but there was an ame- 
lioration. On the sixth, some general pains ; substances float- 
ing in the urine ; very incoherent. On the seventh, better. 
On the eighth, all the other symptoms abated. On the tenth, 
and following days, there were pains, but all less ; in this 
case throughout, the paroxysms and pains were greater on the 
even days. On the twentieth, the urine white and thick, but 
when allowed to stand had no sediment ; much sweat ; seemed 
to be free from fever ; but again in the evening he became 
hot, with the same pains, rigor, thirst, slightly incoherent. On 
the twenty-fourth, urine copious, white, with an abundant 
sediment ; a copious and warm sweat all over ; apyrexia ; the 
fever came to its crisis. 

Explanation of the characters. It is probable that the cure 
was owing to the bilious evacuations and the sweats.' 

Case XI. — In Thasus, a woman, of a melancholic turn of 
mind, from some accidental cause of sorrow, while still going 
about, became afi'ected with loss of sleep, aversion to food, and 
had thirst and nausea. She lived near the Pylades, upon the 
Plain. On the first, at the commencement of night, frights, 
much talking, despondency, slight fever; in the morning, fre- 
quent spasms, and when they ceased, she Avas incoherent and 

urine, which therefore required a long time for nature to overcome, by occasioning 
hemorrhage, pain of the hip-joint, and determination downwards. He adds, that great 
diseases require decided crises, and that even witli those now mentioned, the disease 
was not entirely removed in this case, until concoction in the urine took place. 

' Galen passes over this case without any remark worth mentioning. I cannot 
but think that the abundant sediment in the urine, which preceded the favorable 
crisis, is a fact in the case well deserving to be noticed. Galen, however, in the 
present instance, omits all notice of it, and ascribes the recovery to the profuse sweat. 



/ 



EPIDEMICS— BOOK III. 417 

tulked obscurely; pains frequent, great, and continued. On 
the second, in the same state ; had no sleep ; fever more acute. 
On the third, the spasms left her ; but coma, and disposition 
to sleep, and again awaked, started up, and could not contain 
herself ; much incoherence ; acute fever ; on that night a copious 
sweat all over ; apyrexia, slept, quite collected ; had a crisis. 
About the third day, the urine black, thin, substances floating 
in it generally round, did not fall to the bottom; about the 
crisis a copious menstruation.^ 

Case XTI. — In Larissa,^ a young unmarried Avoman was 
seized with a fever of the acute and ardent type ; insomno- 
leney, thirst ; tongue sooty and dry ; urine of a good colour, 
but thin. On the second, in an uneas}^ state, did not sleep. 
On the third, alvine discharges copious, watery, and greenish, 
and on the following days passed such with relief. On the 
fourth, passed a small quantity of thin urine, having substances 
floating towards its surface, which did not subside ; was delirious 
towards night. On the sixth, a great hemorrhage from the 
nose ; a chill, with a copious and hot sweat all over ; apyrexia, 
had a crisis. In the fever, and when it had passed the crisis, 
the menses took place for the first time, for she was a young 
woman. Throughout she was oppressed with nausea, and 
rigors ; redness of the face ; pain of the eyes ; heaviness of the 
head ; she had no relapse, but the fever came to a crisis. The 
pains Avere on the even days.^ 

Case XIII. — Apollonius, in Abdera, bore up (under the 

' The only thing of importance in Galen's Commentary on this case is the remark 
that this woman's melancholy was most prol)al)ly connected with suppression of the 
menses, and that to this cause the dark colour of the urine in the present instance is 
most probably to be ascribed. To the critical evacuations by the sweat and men- 
struation he attributes the recovery. 

2 There were several ancient cities of this name, but there can be no doubt that 
the one here referred to is the celebrated city of Thessaly. See Strabo, Geograph. ix. 

^ Galen considers it a remarkable feature in this case that although the crisis 
occun-ed on the sixth day, there was no relapse. The recovery he ascribes to the 
copious menstruation which then took place for the first time. He also calls attention 
to the characters of the urine, which, he says, are those which usually accompany 
delirium, although this is omitted in the Prognostics. 

27 



418 EPIDEMICS— BOOK III. 

fever?) for some time^ Avithout betaking himself to bed. His 
viscera were enlarged^ and for a considerable time tbere was a 
constant pain about the liver, and then he became affected with 
jaimdice; he was flatulent, and of a whitish complexion. Having 
eaten beef, and drunk unseasonably, he became a little heated 
at first, and betook himself to bed, and having used large 
quantities of milk, that of goats and sheep, and both boiled 
and raw, with a bad diet otherwise, great mischief was occa- 
sioned by all these things ; for the fever was exacerbated, and 
of the food taken scarcely any portion worth mentioning was 
passed from the bowels ; the urine was thin and scanty ; no 
sleep; troublesome meteorism ; much thirst; disposition to coma; 
painful swelling of the right hypochondrium ; extremities alto- 
gether coldish; slight incoherence, forgetfulness of everything 
he said; he was beside himself. About the fourteenth day 
after he betook himself to bed, had a rigor, became heated, and 
was seized with furious delirium ; loud cries, much talking, 
again composed, and then coma came on ; afterwards the bowels 
disordered, with copious, bilious, unmixed, and undigested 
stools ; urine black, scanty, and thin ; much restlessness ; alvine 
evacuations of varied characters, either black, scanty, and ver- 
digris-green, or fatty, undigested, and acrid; and at times the 
dejections resembled milk. About the twenty-fourth, enjoyed 
a calm ; other matters in the same state ; became somewhat 
collected ; remembered nothing that had happened since he 
was confined to bed ; immediately afterwards became delirious ; 
every symptom rapidly getting worse. About the thirtieth, 
acute fever ; stools copious and thin ; was delirious ; extremities 
cold; loss of speech. On the thirty-fourth he died. In this 
case, as far as I saw, the bowels were disordered ; urine thin 
and black ; disposition to coma ; insomnolency ; extremities 
cold; delirious throughout. Phrenitis.