Chapter V: Section II (3)

The nature of the work is as follows: The first book is altogether made up of abstract principles, which savor very much of the dogmata of Heraclitus. Thus, the author of it holds that there are in men, and in all other animals, two principles, different in power but consentaneous in use, namely, fire and water; that these together are sufficient for all others, and for themselves; that the one contains the principle of motion, and the other of nutrition; that these give rise to the separate existence of seeds and animals, of all varieties, shapes, and characters; that, in reality, none of those things which exist either perish or are created, but they are altered by being mixed together and separated from one another, but that men suppose that the one passes from Hades to light, and the other again from light to Hades. In a word, the contents of the first book savor more of philosophy than of practical medicine. For example, it is said, “The trainers of the athletæ instruct their pupils in this manner--to break the law according to law, to commit injustice according to justice; to deceive, to steal, to rob, to commit violence, in the most elegant and disgraceful manner: he who cannot do these things is bad, he who can do them is good; which is a proof of the folly of the many who, when they behold these things decide that the one of these is good and the others bad. Many wonder, but few are judges. Men going to the market proceed thus: they deceive one another in buying and selling, he who deceives most is admired. They execute these things--they drink and become mad, they run, they wrestle, they fight, they steal, they cheat; the one is preferred to all the others. Hypocrites and deceivers! Before the spectators they say one thing. and think another.[201] The same persons creep out, and they creep in not the same persons; to one man they say one thing, and do another; the same person not always the same--sometimes he has one mind, and sometimes another. In this manner all the arts have communion with human nature.” All this is too fanciful and recondite for the physician of whom Celsus says “primus ex omnibus memoria dignis ab studio sapientiæ disciplinam hanc separavit.” It is clearly the production of a philosopher and not of a practical physician, such as we know Hippocrates to have been. The latter part of this book, however, is of a more practical nature, and treats of many things relating to regimen and dietetics, such as the arrangement of meals, of exercises, etc.

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

The third book treats again of various subjects connected with Dietetics, such as exercises, the arrangement of meals, the administration of emetics, the use of venery, and the like. It is full of important matter, but looks like a distinct treatise from the two preceding books, for one cannot conceive that the author of one work would have twice resumed the consideration of the same subject. Le Clerc, with considerable appearance of reason, ascribes the book to Herodicus, the master of Hippocrates in the gymnastic art.[202]

Altogether, the work is one of the highest importance in medical literature, whether we ascribe it to Hippocrates or not. On this point the evidence, both external and internal, we have seen to be very inconclusive. The most probable conclusion that can be drawn regarding it is, that the work is a compilation of important documents from a variety of sources, but who the compiler was, whether Hippocrates or one of his successors cannot be determined.[203]

XXVII. Περὶ ἐνυπνίον--_On Dreams_.

This little work is generally admitted to be a continuation of the preceding one, and consequently stands upon much the same grounds as regards its authorship.[204] As Le Clerc and Gruner have well remarked, it is written with much acumen, and evinces great freedom of spirit, and exemption from popular errors and superstitions. It commences in the following strain:

“He who forms a correct judgment of those signs which occur in sleep, will find that they have a great efficacy in all respects; for the mind is awake when it ministers to the body, being distributed over many parts; it is not then master of itself, but imparts a certain portion of its influence to every part of the body, namely, to the senses, to the hearing, seeing, touch, walking, acting, and to the whole management of the body, and therefore its cogitations are not then in its own power. But when the body is at rest, the soul, being in a state of movement, steals over the organs of the body, manages its own abode, and itself performs all the actions of the body; for the body, being asleep, does not perceive, but the soul, being awake, beholds what is visible, hears what is audible, walks, touches, is grieved, reflects, and, in a word, whatever the offices of the soul or body are, all these the soul performs in sleep.[205] Whoever, then, knows how to judge of these correctly, will find it a great part of wisdom. But with regard to such dreams as are divine, and prognosticate something, either good or evil, to cities, or to a particular people, there are persons who have the art of judging of them accurately, without falling into mistakes. But such affections of the body as the soul prognosticates, namely, such as are connected with repletion and evacuation, from the excess of customary things or the change of unusual things, on these also persons pronounce judgment, and sometimes they succeed, and sometimes they err, and understand neither how this happens, that is to say, how it comes that sometimes they are right, and sometimes they fall into mistakes; but warning people to be upon their guard lest some mischief befall them, they do not instruct them how to guard themselves, but direct them to pray to the gods; and to offer up prayers is no doubt becoming and good, but while praying to the gods a man ought also to use his own exertions. With regard to these, then, the matter stands thus: Such dreams as represent at night a man’s actions through the day, and exhibit them in the manner in which they occur, namely, as performed and justly deliberated, these are good to a man, and prognosticate health, inasmuch as the soul perseveres in its diurnal cogitations, and is not weighed down by any repletion, evacuation, or any other external accident. But when the dreams are the very opposite to the actions of the day, and when there is a conflict between them--when this happens, I say, it indicates a disorder in the body; when the contrast is great, the evil is great, and when the one is small the other is small also.” For the cure of this state, as being connected with repletion, he recommends evacuation by vomiting, active exercise, and a restricted diet. The author of the treatise proceeds to state the signification of dreams which relate to the sun, moon, and stars, of which the last are said to be connected with the external parts of the body, the sun with the middle, and the moon with the cavities. This is the nearest approach to alchemy which I have met with in the works of any of the ancient physicians. But I must not proceed much further with my extracts from this work, which there is no reason to suppose a genuine production of Hippocrates, and the substance of which would not much interest the general reader nowadays, when the interpretation of dreams has been entirely abandoned by the profession. The work concludes as follows:

“He who observes these rules as laid down by us will be healthy through life.... The regimen, also, as far as it was possible for a man to find it out with the assistance of the gods, has been expounded by me.” This looks like the conclusion of a large work, and gives probability to the supposition that this treatise originally formed a part of the work “On Diet,” as stated above.[206]

It would appear that this work, although little regarded now, was highly esteemed two hundred years ago, for we find that the celebrated Julius Cæsar Scaliger wrote an elaborate commentary on it.[207] On the “Oneirocritica,” see further Vander Linden, “Manuductio ad Mediciam,” who refers to this treatise of Hippocrates, and also to the works of Scaliger, Ferrer, and Cardanus on the same subject. The only other ancient writers on this subject which have come down to us are Artemidorus, Achmet, Astrampsychus, and Nicephorus.[208] The work of Artemidorus is an elaborate production on the interpretation of all sorts of dreams; and to the sober judgment of the present generation it cannot but be regarded as a memorable instance of the misapplication of human intellect and industry. The whole subject of the “Oneirocritica,” however, may well deserve the serious consideration of the most learned philosopher as affording a most striking and lamentable proof how prone men, even of cultivated minds, are to view things exactly in the light in which they fancy them to exist. This truth is most strikingly illustrated by the work of Artemidorus, who first gives the theory, as it were, of dreams, and in the last book relates particular instances in confirmation of the principles previously laid down by him. No one, assuredly, can rise from the perusal of such a work without being strongly impressed with the great truth embodied in our author’s first aphorism, “Experience is fallacious, and decision is difficult.” The “Oneirocritica” of Achmet is the work of an Arabian, and is interesting as containing all the superstitious notions of the Orientals, that is to say, of the Persians, Egyptians, and Indians, on this subject. Allusion is also made to the dreams recorded in the Jewish Scripture. The author sets out with declaring that, from the interpretation of dreams one may acquire a certain foreknowledge of all the casualties of life, namely, of life or death, of poverty or riches, of disease or health, of joy or sorrow, of victory over one’s enemies or defeat, and this with far greater accuracy than from astronomy (astrology?), for that astronomers differed much in opinion among themselves, whereas about the interpretation of dreams there could be no doubt!!

The following list of writers on the “Oneirocritica” previous to Artemidorus will show the attention which has been paid to this subject in very early times: Artemon Milesius, Antiphon, Apollodorus Tellmissensis, Apollonius Atalensis, Aristander Telmissensis, Aristarchus, Alexander Myndius, Cratippus, Demetrius Phalereus, Dionysius Rhodius, Epicharmus, Geminus Tyrius, Hermippus, Nicostratus Ephesius, Phœbus Antiochenus, Philochorus, Panyasis Halicarnessensis, Serapion, Strabo. Mighty names once on a day! Now they are but “the dream of a shadow!”[209]

XXVIII. Περὶ παθῶν--_On Affections_.

This treatise being passed over in silence by Erotian, and rejected as unworthy of Hippocrates by Galen, although he acknowledges that it contains many fine things,[210] has been generally regarded as spurious by modern critics, as for example, Foës, Haller, Gruner, Ackerman, Littré, Greenhill, and others. The work is carefully written, but seemingly without a plan, or any well-defined object. It touches, in general terms, on most of the diseases to which the human body is subject, and concludes with some general observations on regimen. All diseases are said to be derived from phlegm or bile. This seems very unlike the etiology of diseases, as laid down in the true Hippocratic treatises. Pleurisy is to be treated by purgatives and soothing applications, but without any mention of bleeding. The termination of the disease in empyema is described. The symptoms of pneumonia are also given in brief but striking terms. The sputa, at first, are said to consist of phlegm, and are thick and pure, but on the sixth and seventh day they become somewhat bilious and sublivid. This disease is also said to terminate in empyema. Some of the general observations contained in this work are deserving of attention. Of all the diseases the acute are the most painful and the most fatal, and they require the greatest care and the most accurate treatment. No additional mischief should, at all events, be inflicted by the physician, but he must do the patient as much good as lies in his power; and if the physician treats the case properly, and the patient sinks under the weight of the disease, it will not be the physician’s fault; but if, while the physician does not treat nor understand the disease properly, the patient fall a victim to the disease, the physician will then be to blame. In treating ileus, when a clyster fails to relieve the bowels, they are to be inflated by means of a bladder attached to a pipe, and then the pipe is to be removed, and a clyster immediately injected, in which case, if the bowels admit the clyster, they will be opened, and the patient will recover, but if otherwise, he will die, especially on the seventh day. The treatise further contains some very interesting remarks on the causes and varieties of dropsy. When the water is not otherwise removed, an incision is to be made either at the navel, or behind at the loins. It deserves to be mentioned that, in this treatise, there are frequent references to a work of the author’s “On Medicines.” Whether it was the same as the treatise bearing that title which we possess cannot be determined. In the course of the work, the use of the cautery is freely recommended for the cure of diseases.

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

XXIX. Περὶ τῶν ἐντὸς παθῶν--_On Internal Affections_.

This treatise has but little ancient authority in support of it. Erotian has omitted it in his list of the works of Hippocrates; Palladius does not mention it; and Galen notices it in a confused manner under a variety of titles.[211] Foës, Schulze, and others, have referred it to the Cnidian school; and if this point could be made out satisfactorily, it would give the treatise a remarkable degree of interest, as furnishing us with a key to the opinions of one of the oldest sects in medicine. That the reader may be enabled to form his own opinion in this matter, we will now give a brief outline of its contents.

The work commences with a short description of hæmoptysis, which is said to originate either in ulceration or rupture of an artery of the lungs, the ordinary causes of which are held to be severe exercise, falls, blows, violent vomiting, or fevers. The symptoms are pretty well described, and a mild system of treatment recommended. Inflammation of the lungs is said to be produced principally by drinking wine, and an immoderate indulgence in eating mullets and eels. The treatment at first is like what we have described the Cnidian system to have been, consisting of milk, emetics, and purges; but if these do not answer, the actual cautery is to be applied to the breast. Erysipelas of the lungs is described in much the same terms as at “De Morbis,” i., 13; ii., 53.[212] A correct description is given of empyema as connected with tubercle of the side, for which draughts are recommended, with broth made from poppies, etc. When matter forms, it is to be let out either by the knife or the cautery.[213] Three species of phthisis are described, the first being derived from phlegm, the second from violent labor, and the third being the tabes dorsalis. The treatment in all these affections appears to be very empirical, and unlike the usual therapeutics of Hippocrates. Four diseases of the kidneys are described, of which the first is calculus, and the second abscess, in which case the writer recommends an incision to be made, in order to furnish an outlet to the pus. Now, it is deserving of remark, that, of all the ancient authorities which have come down to us, Ruffus Ephesius would appear to be the only other author who makes mention of this practice.[214] The author of the treatise states, that if the matter of the abscess find vent by the intestinum rectum the patient may recover. The disease altogether, he adds, is troublesome, and in many cases ends in renal tabes. He most probably here alludes to what is now called Bright’s disease. From disease of the kidneys is said to arise an affection of the venæ cavæ, which runs from the head near the jugulars, along the spine to the malleolus externus. He says it originates in bile and phlegm which collect in the veins. Varices, I suppose, are here meant to be described. If not cured by purging with hellebore and scammony, the actual cautery is to be applied at the shoulders, below the scapulæ, at the hip-joint, at the middle of the thigh, above the knee, and at the ankle. Now it is deserving of notice, that this disease is not mentioned by subsequent authors on medicine, so that we are warranted in concluding that the treatise was not looked upon by them as being a production of the Great Hippocrates: for if it had been so regarded, we are sure that Galen, Aretæus, Celsus, and all the worthies of the Arabian school, would not have overlooked this description. And, moreover, the description of the disease from first to last is vague and prolix, being the very reverse of that graphic style of delineation which we find in the genuine works of Hippocrates: and yet the work contains other matters of a different stamp. For example, treating of dropsy, the author says it is sometimes connected with tubercles of the lungs, which get filled with water and burst into the chest. In proof of this, he appeals to observations on cattle, sheep, and swine, which are said to be very subject to these tubercles (phymata); and he argues that men are still more liable to them. And in many cases, he adds, empyema originates in tubercles. In that case, when the collection protrudes externally, he directs that an opening should be made in it; but if not, he directs the patient to be shaken by the shoulders, when the sound of the fluid within will be heard. When the side in which the greater collection is situated has been ascertained, he recommends us to cut down to the third rib from the last, and then make a perforation with a trocar[215] (τρυπάνῳ τρυγλητηρίῳ), so as to give vent to a small portion of the fluid; the opening is then to be filled with a tent, and the remainder evacuated after twelve days. Four species of icterus are described: these would appear to be febrile affections. Five varieties of typhus are next noticed in rather vague terms; there can be little doubt that they were all cases of remittent fever. Several varieties of a disease which is called morbus crassus are described with much prolixity, and so vaguely as not convey to us a distinct idea of the disease. He says of two of the varieties, that they last for six years. Unless these were varieties of elephantiasis (and we have no evidence of its existence so early), I am at a loss to comprehend what disease is alluded to. The treatise concludes with an account of three species of tetanus.

From the analysis now given of its contents, it will be readily seen that this work abounds in interesting matter, but that, at the same time, it is clearly of a different stamp from what we find in the genuine works of Hippocrates, nay, that in all probability it does not belong to the Coan school. In conclusion, I have, then, to state that I think the presumption of its being a production of the Cnidian school is very strong.

XXX. Περὶ νοὐσων--_On Diseases_.

A work with this title is cited by Erotian, Cælius Aurelianus,[216] and by Galen,[217] but so confusedly that we must come to the conclusion regarding these Books, that the ancient authority in support of their genuineness is by no means satisfactory. Galen evidently inclines to the opinion of Dioscorides the Commentator, that the Second Book is the work of the younger Hippocrates, this is to say, of a grandson of our author. Almost all the modern authorities, as, for example, Foës, Haller, Ackerman, Gruner, and Littré, concur in rejecting the whole four as spurious. The Fourth Book in particular is separated by M. Littré from the other three, as being a portion of the work “On the Diseases of Women,” rather than of the work “On Diseases.” We shall be better enabled to speak decidedly on this and the other questions regarding the authenticity of these books, when we have examined the nature of their contents.

After a very striking exordium, in which it is stated that the first object of him who turns his attention to the healing art should be to consider the causes of disease, and the natural tendencies of every one of them, that is to say, of their dispositions to death, or to loss of parts, the author proceeds to deliver his doctrine as to the causes of them, which he assumes to be either internal, namely, bile and phlegm; or external, such as labor, wounds and excess in heat, cold, dryness, and humidity. The following accidents are said to be mortal: a wound of the brain, of the spinal marrow, of the liver, of the diaphragm, of the bladder, of a large blood-vessel, or of the heart. He ranks the following as fatal diseases: phthisis, dropsy, and, when they attack a pregnant woman, pneumonia, causus, pleurisy, phrenitis, and erysipelas of the womb. The issue of the following is set down as doubtful in ordinary circumstances: pneumonia, causus, phrenitis, pleuritis, quinsy, enlargement of the uvula, hepatitis, splenitis, nephritis, dysentery, menorrhagia. The following are not deadly: chronic defluxions on the joints (κέδματα), melancholy, gout, ischiatic disease, tenesmus, quartan and tertian fevers, strangury, ophthalmy, leprosy, lichen, arthritis; yet even from these patients often become maimed in particular members, such as in the limbs from arthritis, or in the eyes from ophthalmy. Diseases also have a tendency to pass into one another, as, for example, pleurisy into causus, phrenitis into pneumonia, tenesmus into dysentery, and lientery; and pleurisy and pneumonia into empyema. He makes the following curious observations on the awkward mistakes which a physician may commit in the practice of his profession: not to know when there is matter in an abscess or tubercle; not to ascertain the existence of fractures or dislocations; having probed the head in case of injury thereof, not to ascertain that there is a fracture of the skull; not to be able to introduce an instrument into the bladder, nor to be able to ascertain whether there is a stone in it or not; in the case of empyema, not to ascertain the existence of matter by succussion; and in using the knife or cautery, to apply either of them to too great or too small an extent. The treatise also contains many other general observations, which are very ingeniously stated, as, for example, the following enumeration of the untoward accidents which may occur to a medical practitioner: Having administered an emetic for the purpose of evacuating bile or phlegm upwards, to induce rupture of a vessel by the act of vomiting, although the patient had previously been sensible of no pain in the region; having given an emetic to a woman with child, to induce abortion in consequence; in curing empyema, when looseness of the bowels is superinduced, and cuts off the patient; in applying an ointment for a disease of the eyes, when acute pains supervene, which end either in rupture of the eye or amaurosis, the physician in such a case gets the blame for having applied the ointment; and when a physician gives anything to a woman in labor on account of pains in the bowels, and the woman gets worse or dies, the physician incurs censure. And in diseases and injuries, when there is a necessary succession of bad symptoms, the physician gets the blame, as men do not perceive that the aggravation of the symptoms is a necessary consequence of the nature of the disease. And if a physician visits a patient in fever, or who has met with an injury, and if the patient gets worse after the first medicine that is administered, the physician is blamed; whereas he does not get the same amount of credit if the patient improves, as the amendment is attributed to the nature of the case. This book contains what I believe is the most circumstantial detail of the phenomena of empyema that is to be met with in any ancient work on medicine. The author ascribes the disease principally to three causes: to the termination of pneumonia, to a defluxion from the head, and to the consequences of a ruptured vessel. Whoever is acquainted with the modern literature of the subject, or possesses a practical knowledge of the disease, will not fail, from the accompanying description of the last of these, to recognize a case of cavity of the lungs produced by the ulceration of tubercles. True empyema, however, as the result of chronic inflammation, is also described in distinct terms. The never-failing test by succussion is constantly adverted to in these cases. Distinct mention is also made of the _râle_, by which the existence of matter in the lungs is ascertained. Allusion is probably made here to the well-known gurgling sound produced by matter in a cavity. There is a good deal of other important matters in this book, but these my necessary limits oblige me to pass over unnoticed. I shall merely allude to the distinct mention which is made of _ruptures_, by which was meant a severe sprain or other injury ending in suppuration, or protracted pains in the part. Fever is said to be formed in this manner: when bile or phlegm is heated, the whole of the body is heated, and they are heated either by internal things, such as food or drink, or by external, such as labor, wounds, excess of heat or cold; also from the sight or hearing, but rarely from these. In the treatment of pneumonia, venesection in the arm is recommended. Altogether this book contains much valuable matter, but mixed up with hypothesis in a way not usually met with in the genuine works of Hippocrates.

The second book, at the very commencement, betrays a strong disposition to diagnosis. Eight diseases at the head are described, but in such terms that we fail to recognize the distinguishing features of each. Besides these, a little way further on the author describes several other diseases of the head, including hydrocephalus, the symptoms of which are given with great precision, namely, acute pain about the bregma and temples, alternate rigor and fever, impairment of the sight, double vision, vertigo, etc. He recommends errhines, purgatives, and even trepanning of the skull. Even of this disease several varieties are described in very striking terms; so that for once at least we are tempted to question the correctness of the judgment which Hippocrates pronounced against the rival school of Cnidos, for cultivating diagnosis to an undue extent.

Several varieties of quinsy are likewise described, including various diseases of the parts about the fauces, and among them the disease named _hypoglottis_, by which appears to be meant an abscess below the tongue, attended with swelling of that organ. Five varieties of polypus nasi are next described, and suitable plans of treatment recommended, namely, with the ligature, the knife, and the cautery. Pleurisy and pneumonia are described, and their termination in empyema, the symptoms of which are circumstantially described again; and, moreover, three varieties of it are noticed. Here, again, we find mention made of the diagnostic method, by succussion, and a recommendation of the operation of _paracentesis thoracis_, to evacuate the fluid. Next are described several varieties of phthisis, including the _tabes dorsalis_, of which a curious description is given. An interesting account is also given of _spermatorrhœa_. The treatment consists in abstinence from immoderate drinking, venery, and excessive exercises, except walking, _for a year_, avoiding cold and the sun, and taking the tepid bath. The description of the varieties of pulmonic disease is most interesting, although some of them are not sufficiently well defined. Hydrothorax is also described, and paracentesis recommended in the treatment of it. After describing lethargy, which was clearly a species of remittent fever, he gives descriptions of certain diseases, under the names of _morbus resiccatorius_ (ἀυαντή), _Febris mortifera_, _Lividus morbus_, _morbus ructus ciens_, and _morbus pituitosus_. No one can fail to recognize in these descriptions the spirit of the Cnidian school of medicine, and one very different from that of Hippocrates. Indeed we have positive authority for referring this work to the Cnidian school, for Galen assigns the description of the _morbus lividus_ to the Cnidian physician Euryphon.[218] The author describes a singular species of melancholy, which, he says, is sometimes epidemic in spring; he calls it _cura, morbus gravis_. It appears to have been a variety of the lycanthropia. See PAULUS ÆGINETA, III., 16. The book concludes with a description of two species of _melæna_, and of _sphacelotes_, the latter being a variety of the other. Now what strikes one in going over this book is, that it cannot be a portion of the same work as the First Book, for we cannot conceive it probable that an author would have treated twice of the very same subjects in one work. Moreover, as we have stated, there are evidently many things in it which are not at all in accordance with the principles of the Coan school.

In the third book very much the same ground is again gone over as in the two preceding books. In the first place, diseases of the head are described under the names of _tumor cerebri_, _plenitudo cerebri dolorem inferens_, _sydere icti_, _sphacelismus_, _lethargus_ (then intervenes a brief account of _Febris ardens_, quite out of place), of _dolor capitis_, and _phrenitis_. Afterwards comes a description of _cynanche_, and _paracynanche_, next of _icterus_, and afterwards of _tetanus_, for the cure of which the author recommends the cold affusion. (On the merits and demerits of this practice, see the English edition of PAULUS ÆGINETA, III., 20.) For ileus, as in a preceding book, among other modes of treatment, it is directed to inflate the bowels by means of a pipe and bladder, and then to evacuate their contents with a clyster. Afterward, pneumonia and pleurisy are most circumstantially described, and the treatment of them laid down with a degree of prolixity very unlike the usual manner of Hippocrates. Thus, to promote the expectoration in pleurisy, he recommends the flos æris, asafœtida, trefoil, pepper, etc.[219] I am not aware that any other ancient authority recommends these medicines for the cure of this disease. The symptoms and diagnosis of empyema as the consequence of pleurisy, are given in much the same terms as in the preceding book. Succussion is particularly alluded to. For empyema, burning and incision are recommended. In performing paracentesis, he forbids all the matter to be evacuated at once. Altogether, a perusal of this book leads me to the positive inference that it is not the production of the same author as the two preceding books; for what could induce the author to go over the same ground three different times in one work?

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

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

XXXI. Περὶ ἑπταμήνου--_On the Seven Months’ Birth_.

XXXII. Περὶ ὀκταμήνου--_On the Eight Months’ Birth_.

Although the genuineness of these two works is admitted by Galen[220] and by Foës,[221] they are not looked upon as the productions of Hippocrates by almost any other of the authorities, whether ancient or modern, and in particular, Palladius, Ackerman, Gruner, Littré, and Greenhill reject them. Yet all admit them to be of very high antiquity, so that, in this respect, they are not destitute of considerable interest. The contents of them are altogether of a philosophical nature, and such as we might expect the school of Democritus to produce. The author of them holds that fœtuses born at the seventh month survive, but not those of the eighth. It is clear that he was imbued with the Pythagorean notions regarding the mystical power of the number seven.[222] Altogether, the style and matter of these treatises do not appear to me to accord well with the spirit which prevails in the true Hippocratic works, but at the same time it must be admitted that the preponderance of authority for or against their authenticity is not decided.[223]

XXXIII. Ἐπιδημών, β’, δ’, ε’, ς’, ζ’--_The 2d, 4th, 5th,
6th, and 7th Books of the Epidemics_.

With the exception of Erotian, who admits the whole of the seven books of Epidemics into his list of the works of Hippocrates, I am not aware that any of the authorities, ancient or modern, recognize them as genuine. Galen says that the seventh is allowed by all to be spurious; that the fifth is the work of Hippocrates, the son of Draco, that is to say, of a grandson of the great Hippocrates; and that the second, fourth, and sixth were held by some to be the productions of a son of Hippocrates, and by some they were looked upon as having been written, indeed, by Hippocrates himself, but merely as notes or commentaries. Galen himself inclines to the opinion that these four books are the production of Thessalus, the son of Hippocrates.[224]

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

With regard to these books, in general, he observes that they are naturally divided into two groups, the one containing the second, fourth, and sixth books, the other the fifth and seventh. The correctness of this division is quite evident from a comparison of the contents of the different books, and, to a certain extent, it is recognized by Galen.[225]

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

M. Littré, in his argument prefixed to the second book, treats of various matters contained in it, the most interesting of which is his elaborate disquisition on the nature of the carbuncles (ἄνθρακες) described in his book, during the course of which he brings into review various collateral passages from the works of subsequent authors, and discusses the question at considerable length whether or not they apply to smallpox. I am free to admit that it would have been to my advantage if I had seen this part of the writings of M. Littré before piling my commentary on PAULUS ÆGINETA, B. IV., 25. I must be permitted to say, however, that I see no reason for changing my opinions with regard to the anthrax of the Greek writers on medicine. I certainly cannot agree with M. Theod. Kauser, in setting down the ancient descriptions of the anthrax and plague (λοιμὸς) as applying to the smallpox. Having diligently studied the minute descriptions which the ancient medical authors give of the different varieties of cutaneous disease, I am confident that if the smallpox had actually existed in their days, they would not have passed over the disease with a vague and casual notice, but would have given us such a sketch of its appearances that no one could have failed to recognize its features. The carbuncles, then, which are incidentally mentioned by Hippocrates at the beginning of this book, I am disposed to look upon as one of those anomalous phases of disease which are every now and then making their appearance, and I cannot persuade myself that they had anything to do with smallpox.

Among the important matters contained in this book may be noticed the remarks on deposits, an interesting subject often alluded to in the Hippocratic treatises, § 7. At § 22 a case is obscurely noticed, which M. Littré concludes, but upon very slight grounds, to have been a case of purulent infection. At § 24 spontaneous luxation of the cervical vertebræ is described, as M. Littré, in his argument, remarks, with admirable judgment. It is also alluded to at “Aphoris,” iii., 26, and “De Articulis,” tom. iv., p. 179, ed. Littré. This affection, which came afterwards to be overlooked, has been redescribed of late years. In the third section there is given an interesting account of causus, the remittent fever of hot climates, so admirably described afterward by Aretæus. The fourth section is occupied with a description of the veins of the body, which is certainly confused, and yet we find in it the distinction between the nature of the arteries and veins clearly pointed out. It is curious, moreover, that Galen, in one place, stands up for this part as being genuine and accurate.[226] See also b.v. § 46. The last two sections treat professedly of physiognomy, but contain other detached and unconnected observations on medical subjects. Altogether, the impression which a careful perusal of this book conveys to one is, that it is a compilation of the most incongruous matters, strung together without any plan; but, at the same time, one cannot fail to detect in it traces of no contemptible talent for observation and description.

The fourth book, of the whole number, is the one which is written with the least unity of design. Yet, as M. Littré remarks, it is interesting as containing the history of an epidemical causus, complicated with jaundice and ophthalmia, which would appear to have been very similar to the febrile epidemic which prevailed in Scotland a few years ago. With this opinion I entirely acquiesce, after having had a good deal of experience in the treatment of that epidemic. It was decidedly of the remittent type, was frequently accompanied with jaundice, and the patients were very subject to relapses and affections of the eyes.[227] For Hippocrates’s description of it see tom. v., p. 169, ed. Littré. M. Littré also makes the important remark that, of late years, proper attention has not been paid to the state of the urine at the epoch of a crisis in fevers. He mentions that M. Martin Solon holds that, at the resolution of diseases, the urine is apt to become albuminous; but that, in a true crisis, the precipitate is generally composed of urate of ammonia. M. Zimmerman found the urinary deposit composed of the urate of ammonia, with the triple phosphates and the crystals of uric acid. Certain observations on this critical deposit occur in this book of the Epidemics, but they are met with more frequently and more distinctly expressed in the genuine books, I mean the first and third. It appears to me most remarkable that the important observations made by Hippocrates on the state of the urine in febrile diseases should have been lost sight of in an age when the chemical characters of the urine have been so much studied; for I am fully satisfied, from my own practical acquaintance with fevers, that in most cases the febrile crisis is marked by a copious sediment in the urine. An interesting case of empyema, which was treated by the cautery, is related at § 4. A case is related at § 19 of a singular affection of the mouth in two children, attended with necrosis and exfoliation of the bones. At § 39 there is a case of metastasis of purulent matter from the hand to the lungs. At § 11 a case is related of a child who sustained an injury in the head from another child, was trepanned, and died on the twenty-fourth day. We shall see in the work “On Injuries of the Head” that the ancients were very free in the application of the trepan to the skull. Cases of nyctalopia are alluded to at § 52, and at § 58 a case is related of mania supervening on the cure of hemorrhoids. But, upon the whole, the most interesting part of this book is that which contains the narratives of febrile cases, and the remarks on relapses, § 28.

Though the fifth and seventh books of the Epidemics are pronounced by Galen to be unworthy of the Great Hippocrates, they contain detached observations of much interest, insomuch that Haller was almost disposed to admit the genuineness of the fifth. Lemos and Mercuriali, on the other hand, hold them to be wholly removed from all connection with the genuine remains of Hippocrates. It is remarkable, however, that the fifth is referred to by Celsus,[228] Quintilian,[229] and Plutarch.[230] This, in fact, is the book which contains the memorable passage in which the author admits, that in a case of injury of the head he mistook a fracture for a suture of the skull,[231] and for this candid admission Hippocrates is highly lauded by the authors we have just quoted. The Hippocratic treatises also contain many other instances in which the author admits having committed mistakes. How much might the medical art not have advanced before this time, if the example thus set of recording for the benefit of posterity, the mistakes which one commits had been more generally followed?[232] The first paragraph contains the case of a woman who had fever and took medicine which did her no good; a hard swelling, accompanied with severe pains, seized her below the navel, which were removed by strongly rubbing in oil with the hands, after which she had a copious discharge of blood downwards, and recovered. M. Littré, from a comparison of this passage with Epidem. ii., 6, 26; iv., 45, 56, draws the conclusion, that reference is here made to the practice of compressing the bowels with the hands in cases of ileus, for which Praxagoras, the master or Herophilus, is censured by Cælius Aurelianus.[233] At § 9 there is the case of a man affected with prurigo, and a condition of the skin resembling leprosy, which nobody could remove. He then went to the hot baths in the island of Melos, and was cured of his cutaneous affection, but soon after became dropsical and died. In § 10 there is related a case of cholera, treated with hellebore, which produced great evacuations upwards and downwards, and the patient recovered. This mode of practice is animadverted upon by Cælius Aurelianus. (Morb. Acut. iii., 20.) § 12th contains an instructive history of headache in a woman, which nothing relieved but free menstruation, and afterwards conception. At § 15, there is a very interesting case of necrosis or caries at the hip-joint, for the relief of which a large incision was made down to the bone and the cautery applied; on the eleventh day tetanus supervened, and proved fatal on the eighth day afterwards, although treated by embrocations, fomentations, and strong purgatives. The author remarks in conclusion, that the patient would have lived longer, if the purgative medicine had not been administered. At § 16 there is a case of injury of the head, where the surgeon at first sawed the bone down to the diploe, a practice alluded to in the treatise “On Injuries of the Head,” § 21. In this case erysipelas came on, and yet the patient recovered. It is to be regretted that the text here is in a corrupt state. At § 18 there is a case of pregnancy in which the administration of a strong purgative was followed by fatal results. At § 20 there is related a case of hemorrhoids, seemingly _mali moris_, which proved fatal in consequence of an operation having been performed upon them. § 24th contains the history of a case of hæmoptysis, which ended in phthisis. The author makes the shrewd remark that the patient was indisposed before the vomiting of blood commenced. I may here remark, how well this accords with the doctrine of Louis, that hæmoptysis is rather the consequence than the cause of tubercular disease. At § 38 there is another case of hæmoptysis in which the patient was choked by a large quantity of blood which he was bringing up; the spleen also, in this case, was affected, and there were bloody discharges downwards. This book contains a great variety of serious cases connected with accidents. At § 50 is a fatal case of concussion of the brain. At § 74 there is a fatal case of tetanus supervening upon a slight injury of one of the fingers and in the following section there is a case of tetanus arising from a strain of the thumb and proving fatal. In the next section there is a case of fatal tetanus from the injudicious healing of a sore on the leg.

Though Galen refuses to sustain the sixth book as genuine, he has written an elaborate commentary upon it, and mentions at the commencement that commentaries had been written upon it before his time by Zeuxis of Tarentum, the Erythræan Heraclides, and before them by Bacchius and Glaucis. It is a large work, being divided into eight different sections, which have little or no connection with one another. Upon the whole, as M. Littré remarks, the most interesting portion of it is the part in which are described the phenomena attending an epidemic cough, or influenza, which reigned in Perinthus. See § vii. It broke out in winter about the solstice, and was preceded by great changes of the winds. There was a great tendency to relapses, and it was further complicated with pulmonic affections, nyctalopia, angina, paralysis, etc. It was observed, that any member which was much exposed to fatigue was the part most liable to be attacked. All these complications occurred in the relapse, and never in the original attack. Women were less liable to be affected than men, the reason of which is supposed to have been, that they do not expose themselves so much to the air as men do. In women, too, all the attacks were mild; but in the men some were mild and others fatal. When a febrile rigor supervened, the attack speedily was mortal. The usual remedies were tried, namely, purging, venesection, bleeding by the renal vein, and emetics; but none of them did any good. M. Littré remarks, that in the course of his reading he has never met with an example of an epidemic exactly resembling the one here described. It is, therefore, an interesting picture of a disease not otherwise known. The sixth section begins with the announcement of the physiological doctrine so frequently quoted with approbation, namely, that “the fleshy parts attract both from the bowels and from without, and that the whole body inspires and expires.” This doctrine is fully expanded and illustrated in an interesting volume by Abraham Kaau.[234] The fifth section opens with another philosophical tenet, which Sydenham often quotes with approbation, namely, that “Nature is the physician of diseases.” “Nature,” the writer adds, “although untaught and uninstructed, does what is proper.” Galen’s Commentary on this passage contains much interesting matter, and is a fine specimen of the medical philosophy of the ancients.[235]