Section Iii.--Constitution 2.[699]

The year was southerly, rainy; no winds throughout. Droughts having prevailed during the previous seasons of the year, the south winds towards the rising of Arcturus were attended with much rain. Autumn gloomy and cloudy, with copious rains. Winter southerly, damp, and soft. But long after the solstice, and near the equinox, much winterly weather out of season; and when now close to the equinox, northerly, and winterly weather for no long time. The spring again southerly, calm, much rain throughout until the dog-days. Summer fine and hot; great suffocating heats. The Etesian winds blew small and irregular; again, about the season of Arcturus, much rains with north winds. The year being southerly, damp, and soft towards winter, all were healthy, except those affected with phthisis, of whom we shall write afterwards.

3. Early in spring, along with the prevailing cold, there were many cases of erysipelas, some from a manifest cause, and some not. 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, tumors on the genital organs; of ophthalmia, 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 epidemic. There were patients affected with every one of the species which have been mentioned, and many died. The symptoms in each of these cases were as follows:

4. In many cases erysipelas, from some obvious cause, such as an accident, and sometimes from even a very small wound, broke out all over the body, especially, in persons about sixty years of age, about the head, if such an accident was neglected in the slightest degree; and this happened in some who were under treatment; great inflammation took place, and the erysipelas quickly spread all over. In the most of them the abscesses ended in suppurations, and there were great fallings off (sloughing) of the flesh, tendons, and bones; and the defluxion which seated in the part was not like pus, but a sort of putrefaction, and the running was large and of various characters. Those cases in which any of these things happened about the head were accompanied with falling off of the hairs of the head and chin, the bones were laid bare and separated, and there were excessive runnings; and these symptoms happened in fevers and without fevers. But these things were more formidable in appearance than dangerous; for when the concoction in these cases turned to a suppuration, most of them recovered; but when the inflammation and erysipelas disappeared, and when no abscess was formed, a great number of these died. In like manner, the same things happened to whatever part of the body the disease wandered, for in many cases both forearm and arm dropped off; and in those cases in which it fell upon the sides, the parts there, either before or behind, got into a bad state; and in some cases the whole femur and bones of the leg and whole foot were laid bare. But of all such cases, the most formidable were those which took place about the pubes and genital organs. Such was the nature of these cases when attended with sores, and proceeding from an external cause; but the same things occurred in fevers, before fevers, and after fevers. But those cases in which an abscess was formed, and turned to a suppuration, or a seasonable diarrhœa or discharge of good urine took place, were relieved thereby: but those cases in which none of these symptoms occurred, but they disappeared without a crisis, proved fatal. The greater number of these erysipelatous cases took place in the spring, but were prolonged through the summer and during autumn.

5. In certain cases there was much disorder, and tumors about the fauces, and inflammations of the tongue, and abscesses about the teeth. And many were attacked with impairment or loss of speech; at first, those in the commencement of phthisis, but also persons in ardent fever and in phrenitis.

6. The cases of ardent fever and phrenitis occurred early in spring after the cold set in, and great numbers were taken ill at that time, and these cases were attended with acute and fatal symptoms. The constitution of the ardent fevers which then occurred was as follows: at the commencement they were affected with coma, nausea, and rigors; fever not acute, not much thirst, nor delirium, slight epistaxis, the paroxysms for the most part on even days; and, about the time of the paroxysms, forgetfulness, loss of strength and of speech, the extremities, that is to say, the hands and feet, at all times, but more especially about the time of the paroxysms, were colder than natural; they slowly and imperfectly became warmed, and again recovered their recollection and speech. They were constantly affected either with coma, in which they got no sleep, or with insomnolency, attend 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 crisis, but in some instances after having lost their speech for a long time, and having had copious sweats. These were the symptoms which marked the fatal cases of ardent fever; similar symptoms occurred in the phrenitic cases; but these were particularly free from thirst, and none of these had wild delirium 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; fungous excrescences of the eyelids, externally and internally, 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 other affections, which are called “the putrefaction” (seps); also large ecthymata, and large tetters (herpetes) in many instances.

8. And many and serious complaints attacked many persons in the region of the belly. In the first place, tenesmus, accompanied with pain, attacked many, but more especially children, and all who had not attained to puberty; and the most of these died. There were many cases of lientery and of dysentery; but these were not attended with much pain. The evacuations were bilious, and fatty, and thin, and watery; in many instances the disease terminated in this way, with and without fever; there were painful tormina and volvuli of a malignant kind; copious evacuations of the contents of the guts, and yet much remained behind; and the passages did not carry off the pains, but yielded with difficulty to the means administered; for in most cases purgings were hurtful to those affected in this manner; many died speedily, but in many others they held out longer. In a word, all died, both those who had acute attacks and those who had chronic, most especially from affections of the belly, for it was the belly which carried them all off.

9. All persons had an aversion to food in all the afore-mentioned complaints to a degree such as I never met with before, and persons in these complaints most especially, and those recovering from them, and in all other diseases of a mortal nature. Some were troubled with thirst, and some not; and both in febrile complaints and in others no one drank unseasonably or disobeyed injunctions.

10. The urine in many cases was not in proportion to the drink administered, but greatly in excess; and the badness of the urine voided was great, for it had not the proper thickness, nor concoction, nor purged properly; for in many cases purgings by the bladder indicate favorably, but in the greatest number they indicated a melting of the body, disorder of the bowels, pains, and a want of crisis.

11. Persons laboring under phrenitis and causus were particularly disposed to coma; but also in all other great diseases which occurred along with fever. In the main, most cases were attended either by heavy coma, or by short and light sleep.

12. And many other forms of fevers were then epidemic, of tertian, of quartan, of nocturnal, of continual, of chronic, of erratic, of fevers attended with nausea, and of irregular fevers. All these were attended with much disorder, for the bowels in most cases were disordered, accompanied with rigors, sweats not of a critical character, and with the state of the urine as described. In most instances the disease was protracted, for neither did the deposits which took place prove critical as in other cases; for in all complaints and in all cases there was difficulty of crisis, want of crisis, and protraction of the disease, but most especially in these. A few had the crisis about the eightieth day, but in most instances it (the disease?) left them irregularly. A few of them died of dropsy without being confined to bed. And in many other diseases people were troubled with swelling, but more especially in phthisical cases.

13. The greatest and most dangerous disease, and the one that proved fatal to the greatest number, was the consumption. With many persons it commenced during the winter, and of these some were confined to bed, and others bore up on foot; the most of those died early in spring who were confined to bed; of the others, the cough left not a single person, but it became milder through the summer; during the autumn, all these were confined to bed, and many of them died, but in the greater number of cases the disease was long protracted. Most of these were suddenly attacked with these diseases, having frequent rigors, often continual and acute fevers; unseasonable, copious, and cold sweats throughout; great coldness, from which they had great difficulty in being restored to heat; the bowels variously constipated, and again immediately in a loose state, but towards the termination in all cases with violent looseness of the bowels; a determination downwards of all matters collected about the lungs; urine excessive, and not good; troublesome melting. The coughs throughout were frequent, and sputa copious, digested, and liquid, but not brought up with much pain; and even when they had some slight pain, in all cases the purging of the matters about the lungs went on mildly. The fauces were not very irritable, nor were they troubled with any saltish humors; but there were viscid, white, liquid, frothy, and copious defluxions from the head. But by far the greatest mischief attending these and the other complaints, was the aversion to food, as has been described. For neither had they any relish for drink along with their food, but continued without thirst. There was heaviness of the body, disposition to coma, in most cases swelling, which ended in dropsy; they had rigors, and were delirious towards death.

14. The form of body peculiarly subject to phthisical complaints was the smooth, the whitish, that resembling the lentil; the reddish, the blue-eyed, the leucophlegmatic, and that with the scapulæ having the appearance of wings: and women in like manner, with regard to the melancholic and subsanguineous, phrenitic and dysenteric affections principally attacked them. Tenesmus troubled young persons of a phlegmatic temperament. Chronic diarrhœa, acrid and viscid discharges from the bowels, attacked those who were troubled with bitter bile.

15. To all those which have been described, the season of spring was most inimical, and proved fatal to the greatest numbers: the summer was the most favorable to them, and the fewest died then; in autumn, and under the Pleiades, again there died great numbers. It appears to me, according to the reason of things, that the coming on of summer should have done good in these cases; for winter coming on cures the diseases of summer, and summer coming on removes the diseases of winter. And yet the summer in question was not of itself well constituted, for it became suddenly hot, southerly, and calm; but, notwithstanding, it proved beneficial by producing a change on the other constitution.

16. I look upon it as being a great part of the art to be able to judge properly of that which has been written. For he that knows and makes a proper use of these things, would appear to me not likely to commit any great mistake in the art. He ought to learn accurately the constitution of every one of the seasons, and of the diseases; whatever that is common in each constitution and disease is good, and whatever is bad; whatever disease will be protracted and end in death, and whatever will be protracted and end in recovery; which disease of an acute nature will end in death, and which in recovery. From these it is easy to know the order of the critical days, and prognosticate from them accordingly. And to a person who is skilled in these things, it is easy to know to whom, when, and how aliment ought to be administered.

SEC. 17. SIXTEEN CASES.

CASE I.--In Thasus, the Parian who lodged above the Temple of Diana was seized with an acute fever, at first of a continual and ardent type; thirsty, inclined to be comatose at first, and afterwards troubled with insomnolency; bowels disordered at the beginning, urine thin. On the sixth day, passed oily urine, was delirious. On the seventh, all the symptoms were exacerbated; had no sleep, but the urine of the same characters, and the understanding disordered; alvine dejections bilious and fatty. On the eighth, a slight epistaxis; small vomiting of verdigris-green matters; slept a little. On the ninth, in the same state. On the tenth, all the symptoms gave way. On the eleventh, he sweated, but not over the whole body; he became cold, but immediately recovered his heat again. On the fourteenth, acute fever; discharges bilious, thin, and copious; substances floating in the urine; he became incoherent. On the seventeenth, in a painful state, for he had no sleep, and the fever was more intense. On the twentieth, sweated all over; apyrexia, dejections bilious; aversion to food, comatose. On the twenty-fourth, had a relapse. On the thirty-fourth, apyrexia; bowels not confined; and he again recovered his heat. Fortieth, apyrexia, bowels confined for no long time, aversion to food; had again slight symptoms of fever, and throughout in an irregular form; apyrexia at times, and at others not; for if the fever intermitted, and was alleviated for a little, it immediately relapsed again; he used much and improper food; sleep bad; about the time of the relapse he was delirious; passed thick urine at that time, but troubled, and of bad characters; bowels at first confined, and again loose; slight fevers of a continual type; discharges copious and thin. On the hundred and twentieth day he died. In this patient the bowels were constantly from the first either loose, with bilious, liquid, and copious dejection, or constipated with hot and undigested fæces; the urine throughout bad; for the most part coma, or insomnolency with pain; continued aversion to food. Ardent fever.

Explanation of the characters. It is probable that the weakness produced by the fever, the phrenitis, and affection of the hypochondrium caused death on the hundred and twentieth day.

CASE II.--In Thasus, the woman who lodged near the Cold Water, on the third day after delivery of a daughter, the lochial discharge not taking place, was seized with acute fever, accompanied with rigors. But a considerable time before delivery she was feverish, confined to bed, and loathed her food. After the rigor which took place, continual and acute fevers, with rigors. On the eighth and following days, was very incoherent, and immediately afterwards became collected; bowels disordered, with copious, thin, watery, and bilious stools; no thirst. On the eleventh was collected, but disposed to coma; urine copious, thin, and black; no sleep. On the twentieth, slight chills, and immediately afterwards was warm; slight incoherence; no sleep; with regard to the bowels, in the same condition; urine watery, and copious. On the twenty-seventh, free from fever; bowels constipated; not long afterwards violent pain of the right hip-joint for a considerable time; fevers afterwards supervened; urine watery. On the fortieth, complaints about the hip-joint better; continued coughs, with copious, watery sputa; bowels constipated; aversion to food; urine the same; fever not leaving her entirely, but having paroxysms in an irregular form, sometimes present, sometimes not. On the sixtieth, the coughs left her without a crisis, for no concoction of the sputa took place, nor any of the usual abscesses; jaw on the right side convulsively retracted; comatose, was again incoherent, and immediately became collected; utter aversion to food; the jaw became relaxed; alvine discharges small, and bilious; fever more acute, affected with rigors; on the following days lost her speech, and again became collected, and talked. On the eightieth she died. In this case the urine throughout was black, thin, and watery; coma supervened; there was aversion to food, despondency, and insomnolency; irritability, restlessness; she was of a melancholic turn of mind.

Explanation of the characters. It is probable that the suppression of the lochial discharge caused death on the eightieth day.

CASE III.--In Thasus, Pythion, who was lodged above the Temple of Hercules, from labor, fatigue, and neglected diet, was seized with strong rigor and acute fever; tongue dry, thirsty, and bilious; had no sleep; urine darkish, eneorema floating on the top of the urine, did not subside. On the second day, about noon, coldness of the extremities, especially about the hands and head; loss of speech and of articulation; breathing short for a considerable time; recovered his heat; thirst; passed the night quietly; slight sweats about the head. On the third, passed the day in a composed state; in the evening, about sunset, slight chills; nausea, agitation; passed the night in a painful state; had no sleep; small stools of compact fæces passed from the bowels. On the fourth, in the morning, composed; about noon all the symptoms became exacerbated; coldness, loss of speech, and of articulation; became worse; recovered his heat after a time; passed black urine, having substances floating in it; the night quiet; slept. On the fifth, seemed to be lightened, but a painful weight about the belly; thirsty, passed the night in a painful state. On the sixth, in the morning, in a quiet state; in the evening the pains greater; had a paroxysm; in the evening the bowels properly opened by a small clyster; slept at night. On the seventh, during the day, in a state of nausea, somewhat disturbed; passed urine of the appearance of oil; at night, much agitation, was incoherent, did not sleep. On the eighth, in the morning, slept a little; but immediately coldness, loss of speech, respiration small and weak; but in the evening recovered his heat again; was delirious, but towards day was somewhat lightened; stools small, bilious, and unmixed. On the ninth, affected with coma, and with nausea when roused; not very thirsty; about sunset he became restless and incoherent; passed a bad night. On the tenth, in the morning, had become speechless; great coldness; acute fever; much perspiration; he died. His sufferings were on the even days.

Explanation of the characters. It is probable that the excessive sweats caused death on the tenth day.

CASE IV.--The patient affected with phrenitis, having taken to bed on the first day, vomited largely of verdigris-green and thin matters; fever, accompanied with rigors, copious and continued sweats all over; heaviness of the head and neck, with pain; urine thin, substances floating in the urine small, scattered, did not subside; had copious dejections from the bowels; very delirious; no sleep. On the second, in the morning, loss of speech; acute fever; he sweated, fever did not leave him; palpitations over the whole body, at night, convulsions. On the third, all the symptoms exacerbated; he died.

Explanation of the characters. It is probable that the sweats and convulsions caused death.

CASE V.--In Larissa, a man, who was bald, suddenly was seized with pain in the right thigh; none of the things which were administered did him any good. On the first day, fever acute, of the ardent type, not agitated, but the pains persisted. On the second, the pains in the thigh abated, but the fever increased; somewhat tossed about; did not sleep; extremities cold; passed a large quantity of urine, not of a good character. On the third, the pain of the thigh ceased; derangement of the intellect, confusion, and much tossing about. On the fourth, about noon, he died. An acute disease.

CASE VI.--In Abdera, Pericles was seized with a fever of the acute, continual type, with pain; much thirst, nausea, could not retain his drink; somewhat swelled about the spleen, with heaviness of the head. On the first day, had hemorrhage from the left nostril, but still the fever became more violent; passed much muddy, white urine, which when allowed to stand did not subside. On the second day, all the symptoms were exacerbated, yet the urine was thick, and more inclined to have a sediment; the nausea less; he slept. On the third, fever was milder; abundance of urine, which was concocted, and had a copious sediment; passed a quiet night. On the fourth, had a copious and warm sweat all over about noon; was free of fever, had a crisis, no relapse. An acute affection.

CASE VII.--In Abdera, the young woman who was lodged in the Sacred Walk was seized with an ardent fever. She was thirsty, and could not sleep; had menstruation for the first time. On the sixth, much nausea, flushing, was chilly, and tossed about. On the seventh, in the same state; urine thin, but of a good color; no disturbance about the bowels. On the eighth, deafness, acute fever, insomnolency, nausea, rigors, became collected; urine the same. On the ninth, in the same state, and also on the following days; thus the deafness persisted. On the fourteenth, disorder of the intellect; the fever abated. On the seventeenth, a copious hemorrhage from the nose; the deafness slightly better; and on the following days, nausea, deafness, and incoherence. On the twentieth, pain of the feet; deafness and delirium left her; a small hemorrhage from the nose; sweat, apyrexia. On the twenty-fourth, the fever returned, deafness again; pain of the feet remained; incoherence. On the twenty-seventh, had a copious sweat, apyrexia; the deafness left her; the pain of her feet partly remained; in other respects had a complete crisis.

Explanation of the characters. It is probable that the restoration of health on the twentieth day was the result of the evacuation of urine.

CASE VIII.--In Abdera, Anaxion, who was lodged near the Thracian Gates, was seized with an acute fever; continued pain of the right side; dry cough, without expectoration during the first days, thirst, insomnolency; urine well colored, copious, and thin. On the sixth, delirious; no relief from the warm applications. On the seventh, in a painful state, for the fever increased, while the pains did not abate, and the cough was troublesome, and attended with dyspnœa. On the eighth, I opened a vein at the elbow, and much blood, of a proper character, flowed; the pains were abated, but the dry coughs continued. On the eleventh, the fever diminished; slight sweats about the head; coughs, with more liquid sputa; he was relieved. On the twentieth, sweat, apyrexia; but after the crisis he was thirsty, and the expectorations were not good. On the twenty-seventh the fever relapsed; he coughed, and brought up much concocted sputa: sediment in the urine copious and white; he became free of thirst, and the respiration was good. On the thirty-fourth, sweated all over, apyrexia, general crisis.

Explanation of the characters. It is probable that the evacuation of the sputa brought about the recovery on the thirty-fourth day.

CASE IX.--In Abdera, Heropythus, while still on foot, had pain in the head, and not long afterwards he took to bed; he lived near the High Street. Was seized with acute fever of the ardent type; vomitings at first of much bilious matter; thirst; great restlessness; urine thin, black, substances sometimes floating high in it, and sometimes not; passed the night in a painful state; paroxysms of the fever diversified, and for the most part irregular. About the fourteenth day, deafness; the fever increased; urine the same. On the twentieth and following days, much delirium. On the thirtieth, copious hemorrhage from the nose, and became more collected; deafness continued, but less; the fever diminished; on the following days, frequent hemorrhages, at short intervals. About the sixtieth, the hemorrhages ceased, but violent pain of the hip-joint, and increase of fever. Not long afterwards, pains of all the inferior parts; it then became a rule, that either the fever and deafness increased, or, if these abated and were lightened, the pains of the inferior parts were increased. About the eightieth day, all the complaints gave way, without leaving any behind; for the urine was of a good color, and had a copious sediment, while the delirium became less. About the hundredth day, disorder of the bowels, with copious and bilious evacuations, and these continued for a considerable time, and again assumed the dysenteric form with pain; but relief of all the other complaints. On the whole, the fevers went off, and the deafness ceased. On the hundred and twentieth day, had a complete crisis. Ardent fever.

Explanation of the characters. It is probable that the bilious discharge brought about the recovery on the hundred and twentieth day.

CASE X.--In Abdera, Nicodemus was seized with fever from venery and drinking. At the commencement he was troubled with nausea and cardialgia; thirsty, tongue was parched; urine thin and dark. On the second day, the fever exacerbated; he was troubled with rigors and nausea; had no sleep; vomited yellow bile; urine the same; passed a quiet night, and slept. On the third, a general remission; amelioration; but about sunset felt again somewhat uncomfortable; passed an uneasy night. On the fourth, rigor, much fever, general pains; urine thin, with substances floating in it; again a quiet night. On the fifth, all the symptoms remained, but there was an amelioration. On the sixth, some general pains; substances floating in the urine; very incoherent. On the seventh, better. On the eighth, all the other symptoms abated. On the tenth, and following days, there were pains, but all less; in this case throughout, the paroxysms and pains were greater on the even days. On the twentieth, the urine white and thick, but when allowed to stand had no sediment; much sweat; seemed to be free from fever; but again in the evening he became hot, with the same pains, rigor, thirst, slightly incoherent. On the twenty-fourth, urine copious, white, with an abundant sediment; a copious and warm sweat all over; apyrexia; the fever came to its crisis.

Explanation of the characters. It is probable that the cure was owing to the bilious evacuations and the sweats.

CASE XI.--In Thasus, a woman, of a melancholic turn of mind, from some accidental cause of sorrow, while still going about, became affected with loss of sleep, aversion to food, and had thirst and nausea. She lived near the Pylades, upon the Plain. On the first, at the commencement of night, frights, much talking; despondency, slight fever; in the morning, frequent spasms, and when they ceased, she was incoherent and talked obscurely; pains frequent, great, and continued. On the second, in the same state; had no sleep; fever more acute. On the third, the spasms left her; but coma, and disposition to sleep, and again awake, started up, and could not contain herself; much incoherence; acute fever; on that night a copious sweat all over; apyrexia, slept, quite collected; had a crisis. About the third day, the urine black, thin, substances floating in it generally round, did not fall to the bottom; about the crisis a copious menstruation.

CASE XII.--In Larissa, a young unmarried woman was seized with a fever of the acute and ardent type; insomnolency, thirst; tongue sooty and dry; urine of a good color, but thin. On the second, in an uneasy state, did not sleep. On the third, alvine discharges copious, watery, and greenish, and on the following days passed such with relief. On the fourth, passed a small quantity of thin urine, having substances floating towards its surface, which did not subside; was delirious towards night. On the sixth, a great hemorrhage from the nose; a chill, with a copious and hot sweat all over; apyrexia, had a crisis. In the fever, and when it had passed the crisis, the menses took place for the first time, for she was a young woman. Throughout she was oppressed with nausea, and rigors; redness of the face; pain of the eyes; heaviness of the head; she had no relapse, but the fever came to a crisis. The pains were on the even days.

CASE XIII.--Apollonius, in Abdera, bore up (under the fever?) for some time, without betaking himself to bed. His viscera were enlarged, and for a considerable time there was a constant pain about the liver, and then he became affected with jaundice; he was flatulent, and of a whitish complexion. Having eaten beef, and drunk unseasonably, he became a little heated at first, and betook himself to bed, and having used large quantities of milk, that of goats and sheep, and both boiled and raw, with a bad diet otherwise, great mischief was occasioned by all these things; for the fever was exacerbated, and of the food taken scarcely any portion worth mentioning was passed from the bowels; the urine was thin and scanty; no sleep; troublesome meteorism; much thirst; disposition to coma; painful swelling of the right hypochondrium; extremities altogether coldish; slight incoherence, forgetfulness of everything he said; he was beside himself. About the fourteenth day after he betook himself to bed, had a rigor, became heated, and was seized with furious delirium; loud cries, much talking, again composed, and then coma came on; afterwards the bowels disordered, with copious, bilious, unmixed, and undigested stools; urine black, scanty, and thin; much restlessness; alvine evacuations of varied characters, either black, scanty, and verdigris-green, or fatty, undigested, and acrid; and at times the dejections resembled milk. About the twenty-fourth, enjoyed a calm; other matters in the same state; became somewhat collected; remembered nothing that had happened since he was confined to bed; immediately afterwards became delirious; every symptom rapidly getting worse. About the thirtieth, acute fever; stools copious and thin; was delirious; extremities cold; loss of speech. On the thirty-fourth he died. In this case, as far as I saw, the bowels were disordered; urine thin and black; disposition to coma; insomnolency; extremities cold; delirious throughout. Phrenitis.

CASE XIV.--In Cyzicus, a woman who had brought forth twin daughters, after a difficult labor, and in whom the lochial discharge was insufficient, at first was seized with an acute fever, attended with chills; heaviness of the head and neck, with pain; insomnolency from the commencement; she was silent, sullen, and disobedient; urine thin, and devoid of color; thirst, nausea for the most part; bowels irregularly disordered, and again constipated. On the sixth, towards night, talked much incoherently; had no sleep. About the eleventh day was seized with wild delirium, and again became collected; urine black, thin, and again deficient, and of an oily appearance; copious, thin, and disordered evacuations from the bowels. On the fourteenth, frequent convulsions; extremities cold; not in anywise collected; suppression of urine. On the sixteenth loss of speech. On the seventeenth, she died. Phrenitis.

Explanation of the characters. It is probable that death was caused, on the seventeenth day, by the affection of the brain consequent upon her accouchement.

CASE XV.--In Thasus, the wife of Dealces, who was lodged upon the Plain, from sorrow was seized with an acute fever, attended with chills. From first to last she wrapped herself up in her bedclothes; still silent, she fumbled, picked, bored, and gathered hairs (from them); tears, and again laughter; no sleep; bowels irritable, but passed nothing; when directed, drank a little; urine thin and scanty; to the touch of the hand the fever was slight; coldness of the extremities. On the ninth, talked much incoherently, and again became composed and silent. On the fourteenth, breathing rare, large, at intervals; and again hurried respiration. On the sixteenth, looseness of the bowels from a stimulant clyster; afterwards she passed her drink, nor could retain anything, for she was completely insensible; skin parched and tense. On the twentieth, much talk, and again became composed; loss of speech; respiration hurried. On the twenty-first she died. Her respiration throughout was rare and large; she was totally insensible; always wrapped up in her bedclothes; either much talk, or complete silence throughout. Phrenitis.

CASE XVI.--In Melibœa, a young man having become heated by drinking and much venery, was confined to bed; he was affected with rigors and nausea; insomnolency and absence of thirst. On the first day much fæces passed from the bowels along with a copious flux; and on the following days he passed many watery. stools of a green color; urine thin, scanty, and deficient in color; respiration rare, large, at long intervals; softish distention of the hypochondrium, of an oblong form, on both sides; continued palpitation in the epigastric region throughout; passed urine of an oily appearance. On the tenth, he had calm delirium, for he was naturally of an orderly and quiet disposition; skin parched and tense; dejections either copious and thin, or bilious and fatty. On the fourteenth, all the symptoms were exacerbated; he became delirious, and talked much incoherently. On the twentieth, wild delirium, jactitation, passed no urine; small drinks were retained. On the twenty-fourth he died. Phrenitis.

ON INJURIES OF THE HEAD.

THE ARGUMENT.

This treatise opens with a description of the bones of the head, which, although in most respects pretty accurate, is remarkable for containing an account of particular configurations of the cranium, and of certain varieties in the arrangement of the sutures, which it has puzzled modern authorities in anatomy to explain, otherwise than upon the supposition that the writer must have been but imperfectly acquainted with the subject. But as the work otherwise bears evidence that our author must have examined the bones of the head very carefully, and moreover, as in all his works he displays a wonderfully minute acquaintance with osteology, (to say nothing of the historical tradition, mentioned by Pausanias, that he was possessed of a skeleton, which at his death he bequeathed to the Temple of Apollo, at Delphi,) it seems incredible that he should have committed most glaring blunders in describing the prominent features of a part to which it is clear that he had paid very great attention. Moreover, the reputation of Hippocrates for accuracy stood so high, that an eminent authority does not hesitate to declare of him, that he was a man who knew not how to deceive or be deceived. An easy way of getting rid of the difficulty would no doubt be, to adopt the conjecture advanced by Scaliger, and in part approved of by Riolanus, that the treatise had suffered much in early times, from the interpolations of ignorant transcribers; or to hold, with M. Malgaigne, that the whole work is to be condemned as spurious. But it would be a dangerous practice in ancient criticism, to reject as spurious a work which has such unexceptionable evidence in its favor, although it may contain matter which appears to us derogatory to the reputation of its author, and it will be admitted, by any competent judge who examines the arguments by Scaliger, that the proofs which he brings forward of great interpolations in this treatise, are generally of a very fanciful nature.

On a point so obscure, and which has puzzled so many eminent scholars, it is to be feared that I shall not be able to throw much additional light, but as, consistently with my general plan, I cannot well avoid stating some opinion on the question I shall endeavor to elucidate it in so far by giving in the first place a brief sketch of the information supplied by all the other ancient authorities who have touched upon this subject. I shall begin, then, with Aristotle, the contemporary of our author, who, in his work “On the History of Animals,” gives the following very inaccurate description of the sutures of the human skull: “The female cranium has one circular suture, but men generally three, which unite in one point. But a male skull has been seen not having a suture.” Celsus describes the sutures in the following terms: “Ex ceteris, quo suturæ pauciores sunt, eo capitis valetudo commodior est. Neque enim certus eorum numerus est, sicut ne locus quidem. Ferè tamen duæ, super aures, tempora a superiori parte discernunt; tertia ad aures, occipitium a summo capite deducit; quarta, ab eodem vertice per medium caput ad frontem procedit; eaque modo sub imo capillo desinit, modo frontem ipsam secans inter supercilia finitur.” (viii., 1.) “Nam neque utique certa sedes, supra posui, suturarum est.” (viii., 4.) Pliny gives the following description of the head, which it is impossible not to recognize as having been borrowed from our author: “Vertices bini hominum tantum aliquibus. Capitis ossa plana, tenuia, sine medullis, serratis pectinatim structa compagibus.” Of Ruffus Ephesius I may just mention, that his descriptions of the human body are in general remarkable for their correctness, which is not to be wondered at, as he would appear to have followed, in general, Erasistratus and the other authorities belonging to the great Alexandrian period in anatomy; and that he has described very accurately all the sutures of the human cranium, but says not a word of the different configurations of the head, as here given by our author. We now come to Galen, who gives a very lengthy description of the various forms of the head, in nearly the same terms as our author, and after alluding to the uses of the sutures, the principal of which he holds to be to permit transpiration from the brain, he proceeds thus to describe the distribution of the sutures: “That there is one which runs straight along the middle of the head, (the sagittal?) and two transverse, (the coronal and lambdoid?) has been stated previously, and need not require many words in this place. For, the head being like an oblong sphere, one was justly made to extend straight through its middle from behind forwards, and two transverse sutures meet it, and the form of the three sutures is like the letter H. For the whole head being more elongated in this case than usual, and, as it were, compressed towards the ears, it was equitable that the number of the sutures should be unequal as to length and breadth, otherwise Nature would undeservedly have been named just, by Hippocrates, in thus giving equal gifts to the unequal. But it is not the case; for being most just, she formed the strongest suture which extends along the length of the head single, being thus proportionate to the width of the parts on both sides of it; namely, on the right and on the left; but she formed the transverse double in number, the one behind, as formerly said, called the lambdoid, and the other before, called the coronal, so that the bone of the head between these two sutures might be equal to those in the middle, on each side (the parietal bones?). The sutures of the head, in that configuration which is acuminated, furnish a very great example of the justness of Nature. For there are three principal figures of the head: the one entirely opposed to the natural configuration already described, when the head loses both its protuberances, that behind and the other before, and is equal on all hands, and like a true sphere; and two others, the one form having no protuberance in front, and the other none in the occiput. The sutures of the spherical head are like the letter χ, two only in number, and intersecting one another; the one extending transverse from the one ear to the other, and the other extending straight through the middle of the vertex to the middle of the forehead. For, as when one part of the head is excessive, being longer than the other, it was just that the longer form should have more sutures, so, when both are alike, Nature bestowed an equal number on both. But in the head which wants the protuberance at the occiput, the straight and the coronal sutures remain, but the lambdoid is wanting (it being near to the protuberance that is wanting), so that the figure of the two resembles the letter T; as also when the protuberance of the head in front is wanting, the coronal at the same time is wanting, but there remains the one running lengthways and joining the lambdoid, and this form of construction is made to resemble the letter T. A fourth species of acuminated (sugar-loaf) head might be imagined, but which does not occur, with the head more prominent at the two ears than in front and behind.” He goes on to state the reasons why there is no such construction of the head as this, and concludes as follows: “Wherefore Hippocrates described four configurations, and the sutures of each, in the manner we have now said that they exist, being justly distributed to each configuration by Nature as to position and number.” The description of the bones and sutures of the head, given in the Latin work “De Ossibus,” generally attributed to Galen, is to the same effect. The same number of distinct configurations of the head, and the same characters as regards the sutures, is also given by Avicenna, who professedly copies from Galen. (I., i., 5, 3.)

When examined together, these descriptions certainly must be admitted to have the appearance of being all derived from one original, namely, from our author, in this place; and taken literally, there can be no doubt that their meaning amounts to this: that the number of the sutures varies with the form of the head; that when there are protuberances both before and behind, the head in its upper part has two transverse sutures, namely, the coronal and the lambdoid, and one longitudinal, namely, the sagittal; that if the anterior protuberance be wanting, the coronal is wanting, and, if the posterior, the lambdoid. Now I need scarcely remark, that modern anatomists do not recognize such varieties in the configuration of the head nor in the numbers of the sutures, and that it is very rare indeed for either the coronal or the lambdoid suture to be found wanting. To all appearance, then, Galen was mistaken, and it only appears remarkable that, with all his knowledge of anatomy, theoretical and practical, and considering the opportunities which he must have possessed of examining human skeletons in Alexandria, he should have failed to observe and describe the bones of the cranium for himself.

Before stating my own conjectures on this question, it may be interesting to examine the solution of it attempted by authorities who lived about the period when the original study of human anatomy was revived in modern times. In the first place, then, I may mention that Ambrose Paré, who, I need scarcely say, was possessed of no mean talent for original observation, in treating of fractures of the head, adopts exactly the description given by Hippocrates; thus he describes “the bunches of the head” in nearly the same terms as our author, and adds, that such “bunches change the figure and site of the sutures,” and that “there be some skulls that want the foremost suture, and other some the hind, and sometimes none of the true sutures, but only the false, or spurious, remain.” Nay, it. cannot but appear remarkable, that Vesalius, the great antagonist of Galen and of the ancient authorities in general, in the present instance does not venture to call in question their opinion, but gives a description of the different forms of the head, and the varieties of the sutures, which scarcely at all differs from that given by Hippocrates. It is singular, also, that certain other authorities, who were much more disposed to show a leaning to antiquity, such as Columbus, Eustachius, Fallopius, and Riolanus, should, in the present instance, have manifested a more independent spirit in challenging the authority of Hippocrates, though, at the same time, they show a disposition to find out some mode of bringing him clear off. Thus, for example, Riolanus is compelled to admit that there is no such variety in the forms and numbers of the sutures as Hippocrates describes; but he attempts to free him from error, by suggesting that the cases in which Hippocrates found them wanting must have been those of old men. He also quotes some very extraordinary instances, in which something approaching the varieties described by our author had been remarked. Fallopius does not hesitate, in his great anatomical work, to express the surprise he felt that all the authorities should have assented to the descriptions of the protuberances and sutures of the head given by Hippocrates; for that he, after having examined large heaps of crania in the Musea of Ferrara and Florence, had not found that they agreed with the descriptions given by Hippocrates; that he had seen crania without a suture, and yet not wanting in the protuberances; and in like manner, that he had seen the coronal suture obliterated, and yet the skull possessed its anterior prominence, and the lambdoid wanting, although the posterior protuberance was as usual. Altogether, then, in this work he modestly ventures to impugn the authority of Hippocrates. In his work entitled “Expositio in Librum Galeni de Ossibus,” he adopts the same views, and there declares that he had never seen the sutures obliterated except from old age. But, in his work entitled “Expositio in Lib. Hippocrat. de Vulneribus Capitis,” he gives two suppositions, which he had devised in order to defend the authority of Hippocrates: first, that Hippocrates did not give these varieties of form as real, but as hypothetical; and second, that he merely described them as being the vulgar opinion, without pledging himself to the correctness of the description. These, as far as I am aware, are the only defences which have ever been set up for our author in this matter, and it must be admitted that they are not very satisfactory. I shall now present the reader with the conjectural explanation which has occurred to myself. I have imagined that what Hippocrates meant was to express himself to the following effect: when the forehead is remarkably prominent, and, at the same time, there is a great depression behind, the cranium, if looked upon from above, will show the coronal suture running across the fore part of the head, and the sagittal through its middle, while the lambdoid will be inconspicuous, from being below the level of the coronal. The two together, then, would form some resemblance to the letter T. When, on the other hand, the forehead is low, that is to say, wants its normal development, and the occiput is unusually prominent, the lambdoid suture joins the sagittal, so as to present some appearance of the same letter reversed. But in a square-built head, where the frontal and occipital regions have protuberances equally developed, the coronal and lambdoid sutures run nearly parallel to one another, and are joined in the middle by the sagittal, in which case the three sutures may be imagined to present some resemblance to the Greek letter Η. When there is no protuberance either before or behind, and the sagittal suture passes through the middle of the bone down to the nasal process, the coronal suture intersects it, so as to give them something like the shape of the Greek letter χ. I offer this explanation, however, merely as a conjecture, and wish the reader to judge of it accordingly.

I now proceed to give an analysis of the contents of this treatise, and to attempt to form a correct estimate of their value.

Injuries of the cranial bones are divided by our author into five orders, as follows: 1, simple fractures, or fissures of various kinds and sizes (§ 4); 2, contusion, without fracture or depression (§ 5); 3, fractures attended with depression (§ 6); 4, the hedra, that is to say, the indentation or cut in the outer table of the bone, and not necessarily attended either with fracture or contusion (§ 7); 5, the counter-fissure, or fracture par contre-coup fracture and the severe contusion, require the operation of trepanning; whereas neither the hedra (or simple cut) nor the depressed fracture require it, and the counter-fissure does not admit it, owing to the obscurity of the symptoms with which it is attended (§ 9).

In the first place, the surgeon is to ascertain the nature and situation of the wound, by a careful investigation of all the circumstances of the case, but so as to avoid the use of the sound, if possible (§§ 9, 10).

Next are described the various kind of injury which the different sorts of weapons are most likely to inflict, and from the consideration of them the surgeon is to form an estimate of the probable nature of the accident (§ 11).

The characters of the hedra, or superficial injury of the cranium, and the difficulty of forming a correct estimate of it, when complicated by the presence of a suture, are strongly insisted upon (§ 12).

The principles upon which the treatment of injuries situated in different parts of the head should be treated, are carefully defined and stated. Great, and as now would be thought, superfluous directions are given, for ascertaining whether or not a fissure exists in the bone. The treatment, as far as applications go, is to be mild and desiccant. When a fracture cannot be made to disappear by scraping, the trepan is to be applied (§§ 13, 14).

The dangers which the bone incurs of becoming affected from the soft parts, are strongly insisted upon, and applications of a drying nature are prescribed (§ 15).

The condition of a piece of bone which is going to exfoliate is correctly and strikingly described (§ 16).

The treatment of depression is laid down, and the danger of applying the trepan in this case is strongly insisted upon (§ 17).

The peculiarities in the case of children are pointed out. Under certain circumstances, when there is contusion combined with the fracture, he admits of perforating the skull with a small trepan (§ 18).

When, after a severe injury, symptoms of irritation and inflammation appear to be coming on, the surgeon is to lose no time in proceeding to the operation. Some correct observations are made on the consequences of injuries of the head on other parts of the body (§ 19).

The treatment of erysipelatous inflammation is distinctly laid down (§20).

The operation of trepanning the skull is circumstantially described, and an interesting description is given of a mode of doing the operation peculiar to our author (§ 21).

This, then, as far as I know, is the first exposition ever made of a highly important subject in surgery, upon which professional men are still greatly divided in opinion. I cannot, then, resist the temptation to offer some remarks on the views of practice here recommended, and to institute a comparison between them and certain methods of treatment which have been in vogue of late years.

I can scarcely doubt but it will be generally admitted that the exposition of the subject here given is remarkably lucid, that our author’s divisions of it are strongly marked, and his rules of practice, whether correct or not, distinctly laid down. At all events, it will not be affirmed that there is any confusion in his ideas, or that his principles of treatment are not properly defined. After all that has been written on injuries of the head, it would be difficult to point to any better arrangement of them than that of our author, into five orders: 1st, simple fractures without depression; 2d, contusions without fracture or depression; 3d, depression with fracture; 4th, simple incisions without fracture; 5th, fractures par contre-coup.

As regards the operation of trepanning the skull, then, our author’s rule of practice is sufficiently well defined: we are to operate in the first two of these cases, that is to say, in simple fractures and contusions, but not in the last three, that is to say, in fracture with depression, in simple incisions in the skull, and in the counter-fissure. To begin, then, with the examination of those cases in which the operation is proscribed: it is not to be had recourse to in the counter-fissure, because, from the nature of it, there is generally no rule by which its existence can be positively ascertained, and therefore the case is to be given up as hopeless.

In the simple incision of the bone, that is to say, in the slash or indentation, when the effects of the injury are not transmitted to the brain, it must be obvious that all instrumental interference must be strongly contraindicated.

At first sight it will appear remarkable to a surgeon, who approaches the subject with views exclusively modern, that our author should have interdicted the use of instruments in that class of injuries in which one would be inclined to suppose that they are most clearly indicated, namely, in a fracture of considerable extent, attended with depression of part of the bone from its natural level. Several questions present themselves here to be solved. Is the operation generally required? Has it been successful when it has been had recourse to? When it is to be performed, should it be done immediately, or not until the bad effects of the injury have manifested themselves?

With regard, then, to the necessity of the operation for depressed fractures, the most discordant opinions have prevailed in modern times, and even within a very recent period. Not to go farther back than Pott, it is well known that he established it as the general rule of practice, that in every case of fracture with depression, the skull should be perforated, and the depressed portion of the bone either raised to its level, or entirely removed. But since his time a great change of opinion has taken place on this subject, and of late it has become the general rule of practice (if rule can be predicated, where opinions are so vague and indeterminate) not to interfere, even in cases of depression, unless urgent symptoms have supervened. The late Mr. Abernethy took the lead in questioning the propriety of the rule laid down by Pott; and with the view of demonstrating that the operation may be often dispensed with in fractures complicated with depression, and in order, as he says, “to counteract in some degree the bias which long-accustomed modes of thinking and acting are apt to impress on the minds of practitioners,” he relates the histories of five cases of fracture with depression, which, in the space of twelve months, occurred under his own eyes in St. Bartholomew’s Hospital, and which all terminated favorably, although no operation was performed. These cases, supported by the authority of so great a name as Mr. Abernethy, made a deep impression on the profession, especially in this country, so that it became the established rule of practice in British surgery never to interfere in cases of fracture, unless with the view of removing urgent symptoms. See Cooper’s Surgical Dictionary, edit. 1825, and the previous edition. The old Hippocratic rule in regard to the trepan, when it is at all to be applied, namely, that of applying it as a preventive of bad consequences, was altogether eschewed, and it was held to be perfectly unwarrantable to perforate the skull, except with the intention of removing substances which were creating irritation and pressure of the brain. This practice, I say, was sanctioned by all the best army and hospital surgeons, from about the beginning of the present century, down to a very recent period. What, then, it will be asked, have been the results? Has experience confirmed the safety of this rule of practice, or has it not? To enable us to solve these queries, we have most elaborate and trustworthy statistics, published a few years ago by Dr. Laurie of Glasgow, which deserve to be seriously studied by every surgeon who may be called upon to discharge the duties of his profession in such cases. I cannot find room for long extracts from these valuable papers, but may be allowed to state a few of the more important results which are to be deduced from Dr. Laurie’s interesting investigation. Coming then at once to the point, it deserves to be remarked that Dr. Laurie’s ample experience has led him to reject decidedly the rule of practice, which, as I have stated, was established by Mr. Abernethy, about forty years ago, namely, that, in cases of depression, the symptoms of compression should be our guide to the employment of the trephine. He adds, “however well this rule may sound, when delivered ex cathedrá, it will be found of very little practical utility, for this reason, that if we limit interference to cases exhibiting symptoms of compression, we had much better not interfere at all, inasmuch as such cases prove almost invariably fatal. Such, at least, has been the experience of the Glasgow hospitals; for out of fifty-six cases operated upon, including, in point of time, a period little short of fifty years, there does not appear in our records a single unequivocal instance of profound insensibility, in which the mere operation of trepanning removed the coma and paralysis, or in any way conduced to the recovery of the patient. We wish to be clearly understood as speaking of the trephine used in reference to the state of the bone in cases of profound insensibility, not employed to remove extravasated blood. Nor does the cause of our want of success appear at all obscure. We believe that in practice the cases of urgent compression dependent on depressed bone alone are very few indeed; we are well aware that many such are on record, we do not presume to impugn their accuracy, we merely affirm that the records of the Glasgow Infirmary do not add to the number.” He thus states his views with regard to the principles by which the application of the trephine should be regulated. “From what we have said, it will appear that we coincide with these who, in using the trephine, in cases of compound fracture of the skull, look more to the state of the bone than to the general symptoms, and who employ it more as a preventive of inflammation and its consequences, than as a cure for urgent symptoms, the immediate result of the accident.” He goes on to state that “the details we have given are by no means in favor of the trephine. Of fifty-six cases operated upon, eleven recovered, and forty-five died. We feel assured that this affords too favorable a view of the actual results.”

* * * * *

From the extracts now given, it will readily be seen that this very able authority has rejected entirely the rule of practice established by Mr. Abernethy, and that, in so far, he has reverted to the principle upon which the use of the instruments in simple fractures of the skull was regulated by Hippocrates, namely, as a preventive of the bad consequences of fracture on the brain, rather than with the view of relieving them when established. It will further be seen that, in whatever way applied, the use of perforating instruments in the case of depressed fractures is attended with so unsatisfactory results, that it may be doubted if any other operation in surgery, recognized as legitimate, be equally fatal. Less than one fifth of the patients operated upon recovered. In fact, he very candidly admits “that it would not have been greatly to the disadvantage of the patients admitted into the Glasgow Infirmary, if the trephine had never found its way within its walls.” He further, in conclusion, adverts to the well-known fact that Desault, in the end, completely abandoned the operation, and that Mr. Lawrence states, “as far as the experience of this Hospital (St. Bartholomew’s) goes, he can cite very few instances in which the life of the patient had been saved by the operation of trephining.”

Altogether, then, it will be allowed to no very questionable whether, in general, the Hippocratic treatment, in cases of fracture with depression, would not be fully as successful as the modern practice of perforating the skull. Moreover, it is by no means well ascertained, as generally assumed by superficial observers of facts in medical practice, that depressed fractures are more dangerous than other injuries of the skull attended with less formidable appearances. Indeed, recent experience has shown, in confirmation of the opinion advanced by our author, that extensive fractures, with great depression, are frequently not followed by any very dangerous train of consequences. (See Thomson’s “Observations made in the Military Hospitals of Belgium,” pp. 59, 60; Hennen’s “Military Surgery,” p. 287; Cooper’s “Lectures,” xiii.; Mr. Guthrie’s “Lectures on Injuries of the Head,” p. 56.) All these, in substance, coincide with Mr. Guthrie, who mentions with approbation that “it has been stated from the earliest antiquity, that the greater the fracture, the less the concussion of the brain.” I may mention further, that I myself, in the course of my own experience, have known many instances in which fractures with considerable depression were not followed, either immediately or afterwards, by any bad consequences; while, on the other hand, I have known cases in which simple contusion of the bone, without fracture or extravasation, and without even very urgent symptoms of concussion at first, have proved fatal in the course of a day or two. Now, in such circumstances, Hippocrates would have operated by either perforating the skull at once, down to the meninx, and removing a piece of it, or by sawing it nearly through, and leaving the piece of bone to exfoliate. It will be asked here, what object can he have had in view by this procedure? This he has nowhere distinctly defined; but, judging from the whole tenor of this treatise, and that of his commentator, Galen, I can have no doubt in my mind that what he wished to accomplish was to loosen the bones of the head, and give greater room to the brain, which he conceived to be in a state of congestion and swelling brought on by the vibration, or trémoussement, communicated directly to the brain by the contusion. It is, in fact, an opinion which Hippocrates repeatedly inculcates, not only with regard to the brain, but also respecting injuries of the chest and joints, that severe contusions are, in general, more dangerous than fractures, the effects of the vibration in the former case being more violent than in the latter. Believing, then, that, in contusions, the internal structure of the brain is extensively injured, and that irritation, with hypertrophy, are the consequences, he advocated instrumental interference, in order as I have stated, to give more room to the brain, and relieve it from its state of compression. This, no doubt, was the rationale of his practice also in simple fractures, not attended with depression, that is to say, his object in perforating the skull was to remove tension, and furnish an outlet to the collection within, whether of a liquid or a gaseous nature.

There can be no doubt that our author also had it in view, by perforating the skull, to afford an issue to extravasated blood and other matters collected within the cranium. This clearly appears from what is stated in section 18, and the same rule of practice is distinctly described by Celsus in the following terms: “Raro, sed aliquando tamen evenit, ut os quidem totum integrum maneat, intus vero ex ictu vena aliqua in cerebri membrana rupta aliquid sanguinis mittat; isque ibi concretus magnos dolores moveat, et oculos quibusdam obcæcet.... Sed ferè contra id dolor est, et, eo loco cute incisa, pallidum os reperitur: ideoque id os quoque excidendum est.” (viii., 4.) It is quite certain, then, that one of the objects for which our author recommended trepanning, was to give issue to extravasated blood on the surface of the skull. This naturally leads me to compare the results of modern experience in the treatment of cases of contusion, with or without extravasation of blood.

All the earlier of our modern authorities on surgery, such as Theodoric, Pet. c. Largelata, Ambrose Paré, Wiseman, and Fallopius, distinctly held that contusions of the skull, even when not complicated with a fracture, are often of so formidable a nature as to require the use of perforating instruments. The same views are strenuously advocated by Pott, who has described the effects of contusion in very elegant and impressive language. See page 42; ed. Lond. 1780. The upshot is, that one of the consequences of a severe contusion of the bone frequently is separation of the pericranium, “which is almost always followed by a separation between the cranium and the dura mater; a circumstance extremely well worth attending to in fissures and undepressed fractures of the skull, because it is from this circumstance principally that the bad symptoms and the hazard in such cases arise.” (p. 50.) After insisting, in very strong terms, on the danger attending severe contusions of the, skull, he proceeds to lay down the rules of treatment, which, in a word, are comprehended in the two following intentions:--first, to prevent bad consequences by having recourse, at first, to depletion; and, second, to procure the discharge of matter collected under the cranium, which can be answered only by the perforation of it. He agrees with Archigenes that the operation is generally too long deferred, and that the sooner it is performed the better. Still, however, it is to be borne in mind that even Potts does not make it a general rule to operate at first, before the bad symptoms have come on, that is to say, during the first three days, and that he rather appears to have followed Celsus, who alludes to the method of Hippocrates, and describes his rule of practice in the following terms:

--“In omni vero fisso fractoque osse, protinus antiquiores medici ad ferramenta veniebant, quibus id exciderent. Sed multo melius est ante emplastra experiri, etc.... Si vero sub prima curatione febris intenditur, ... magni dolores sunt, cibique super hæc fastidium increseit; tum demum ad manum scalprumque veniendum est.” (viii., 4.) Pott then, it appears, follows the rule of Celsus, and does not operate until unpleasant effects have developed themselves; but, at the same time, he candidly admits that, although the course now described be all that our art is capable of doing in these melancholy cases, he wishes he could say that it was frequently successful. He then goes on to relate several cases: first, of simple contusion without a wound; second, of contusion with a wound; and, third, of contusion with extravasation. In all these classes of cases he operated with very equivocal results; but then it is to be borne in mind, that, as I have said, he operated, like Celsus, after the bad effects had come on, and not, like Hippocrates, at first, in order to prevent them. Even with all these discouraging results, he continued to adhere to this rule of treatment, which, under the sanction of his name, became the established practice of the profession. The late Mr. Abernethy, who took the lead in innovating upon Pott’s rules for the application of the trephine, did not venture to make any material change in this case when he supposed that there was any considerable extravasation of blood; and he delivered it as a test whereby we might judge whether or not a great vessel had been ruptured within the skull, to examine whether or no the bone bled, having generally found, as, indeed, had been clearly laid down by Celsus, that in these cases the bone does not bleed. The rule of practice, then, to operate in order to remove the coagula of blood and matters which form between the skull and the dura mater, was sanctioned by Sir Charles Bell and Sir Astley Cooper; but they, like Mr. Abernethy, generally condemn interference when the fluids are situated below the membrane. On this subject Mr. Guthrie remarks:--“The operation of incising the dura mater, to admit of the discharge of blood or matter from beneath, and even of puncturing the brain, is much more commonly performed in France than in Great Britain, where it is very rarely had recourse to, and which may be an error,” etc. (p. 125.)

After thirty years’ further experience, this practice has been tested by the recent statistics of Dr. Laurie, and the results, as stated by him, are very discouraging. In the Hospital of Glasgow, it was found in practice that there was no certain symptom whereby it could be determined at what part of the head the blood had been effused, nor, when discovered, could it, in general, be removed by trephining the skull. The results, in short, were the following: “We have thus thirty-nine cases in which extravasation existed as the principal lesion, or as an important complication, in only one of which extravasation existed as the principal lesion, or as an important complication; in only one of which could an operation have saved the patient; and of the seventeen cases operated upon, not one recovered after, or was benefited by, the removal of the coagula.”

Such, then, are the results of modern experience, as far as they are at present ascertained, in the use of the trephine for the treatment of contusion, and undepressed fracture, complicated with the effusion either of blood or of matter, from the days of Pott down to the present time. The reader, however, should bear in remembrance that the practice, of which the results have been shown to be so unsatisfactory, is not that of Hippocrates, but of Celsus; for, in the present instance, even Dr. Laurie repudiates the idea of operating “for the purpose of relieving the evil consequences which may follow concussion of the brain,” and holds distinctly in this case that one is not warranted in even entertaining the idea of operating, unless--“first, when the puffy tumor indicates the spot which probably has sustained the greatest amount of injury; second, such an inflamed and suppurating condition of the injured soft parts as renders it more than probable that the corresponding portion of the dura mater is in a similarly diseased condition; third, inflammatory fever, preceded or followed by rigors, and symptoms of compression.” From what has been stated, then, it must appear evident that the recent statistics furnish no test whatever of the results of the practice laid down by Hippocrates, which was founded upon an entirely different principle, namely, the preventive.

But, however anxious I may feel to prosecute further this comparison of the results of ancient and of modern experience on this highly interesting subject, my necessary limits compel me to bring this discussion to a close. Before doing so, however, I shall briefly state the inferences which I think may be drawn from a careful study of all the principle authorities who have written on injuries of the head from Hippocrates down to the present time:

1. All the serious injuries of the skull may be arranged conveniently under the classes of contusions, simple fractures and fractures with depressions.

2. Hippocrates recommended the operation of perforating the cranium, in cases of simple fractures and contusions, whenever he apprehended that these would be followed by serious consequences, such as inflammation, extravasation of blood, and the effusion of matter.

3. Hippocrates operated in these cases during the first three days, before any serious symptoms had come on, but Celsus rejected this rule, and postponed the operation until after these effects had been developed.

4. The objects which Hippocrates had in view by perforating the skull, either entirely through or nearly so, would appear to have been to slacken the tightness of the skull, and procure the evacuation of extravasated blood lying within it.

5. The object for which Celsus opened the skull would appear to have been solely to remove bodies which were creating irritation in the brain.

6. All the ancient authorities looked upon contusions and simple fractures as being very formidable injuries, which generally produce congestion in the brain, with inflammation and effusion.

7. In modern times, at least within the last hundred years, the trephine has never been applied in cases of contusion and simple fracture, upon the principle of the operation acting as a preventive of subsequent mischief, but only with the object of relieving effusion when it was supposed to have taken place within the cranium, that is to say, upon the plan recommended by Celsus.

8. The most contradictory accounts are given by modern authorities, especially by the French surgeons of the eighteenth century, as to the different results in cases of this description, when let alone, and when treated upon the Celsian principle; and the recent statistics of the operation are extremely unfavorable.

9. Hippocrates regarded fractures accompanied with depression and a considerable separation of the bones as being generally less dangerous than severe contusions and simple fractures, as in the former case the brain is usually less hurt by the vibration of the shock which inflicted the injury, and there is an outlet to any noxious matters which may get congested in the brain.

10. Hippocrates, as a general rule, did not operate in cases of depression, not even in cases of comminuted fracture, but in the latter case left the pieces of bone to separate gradually by suppuration.

11. Celsus, on the other hand, approved of removing spiculæ at once, of raising the depressed corner of a fractured bone, by sawing off the superincumbent part, and even of perforating the adjoining bone, and, in certain instances, of removing the whole of the depressed portion.

12. Pott laid it down as a general rule of practice, to operate with the trephine in all cases of fracture accompanied with any considerable degree of depression, and this formed the established practice in this country, until the late Mr. Abernethy, about forty years ago, introduced the rule of not interfering in such cases until urgent symptoms had come on.

13. Of late years a further innovation has taken place in this rule of practice in cases of depressed fracture, the operation being had recourse to by Dr. Laurie and others, on the principle of preventing the bad effects likely to result from the injury.

14. On whatever principle applied, the statistics of large hospitals exhibit the results of the operation in a most unfavorable light, insomuch that many of the most able and experienced surgeons of the day hesitate whether, as a general rule, the operation ought not to be abandoned altogether.

Finally, a careful study of the whole literature of the subject, from Hippocrates down to the present time, leads to the conclusion that what constitutes the great difficulty in the treatment of injuries of the head is, that the operation, to be successful, would require to be performed early, and rather with a view of preventing serious consequences, than of removing them after they have come on; and that these can seldom be estimated so correctly as could be wished, since they frequently bear no proportion to the apparent magnitude of the mischief which the cranium has sustained.

As the reader may find some difficulty in apprehending correctly the nature of the instruments and other apparatus used by the ancients in surgical operations, I have subjoined drawings of them, taken principally from the works of Vidus Vidius and Andreas à Cruce, who both lived at a time when these instruments must have been sufficiently common in the cabinets of learned physicians, so that there is every presumption that the figures which they give are sufficiently correct. The manner in which they were used will readily be comprehended from their shapes, assisted by the following lucid description of the ancient process of trepanning the skull, given by Mr. Pott. “If the piece of bone intended to be removed was larger than could be comprehended within the modiolus (trephine?) then in use, and which was a very defective instrument in many respects, the operation was thus performed by means of terebræ. The piece intended to be taken away was surrounded with perforations made at small distances from each other, and then either the scalper excisorius or the scalper lenticulatus was introduced, and, by means of repeated strokes with a heavy mallet, was driven through all the interspaces between each perforation. By these means the portion of bone so surrounded was removed, and the dura mater was laid bare.” That the modiolus of Celsus was a small circular saw with a pivot, exactly like the modern trephine, seems quite obvious from his own description of it; and that the instrument called by our author terebra serrata (πρίων χαρακτὸς) was identical with it, cannot admit of any doubt. See Foës, Œc. Hipp. in voce πρίων.

Before concluding, I must also say a few words on one important point connected with the constitutional treatment, which the modern reader may at first sight be surprised to find no mention made of in this treatise--I mean the use of venesection in the treatment of injuries of the head. Now certainly it does not appear that Hippocrates regarded bleeding as necessarily forming a portion of the system of treatment in injuries of the bones of the head any more than in those of other bones. But, although these were his views, it can be as little doubted, by any one who is acquainted with his general views of practice, that he bled whenever the abstraction of blood was indicated, either to produce evacuation or revulsion. We know, for example, that in pains of the back part of the head he opened the temporal vessels, and that in all inflammations and febrile diseases he abstracted blood freely, nay, perhaps, ad deliquium animi. And that Hippocrates enforced the depletory system of treatment in injuries of the head, when pain and inflammatory fever supervened, is quite obvious, from its having been the system pursued in such cases by all subsequent authorities, who looked up to him as their great guide in practice. See PAULUS ÆGINETA, Book VI., 90, Syd. Soc. Edit. I may mention further, as a proof that I am not straining a point in the present instance, in order, as might be supposed, to bring my author clear off in a case where he would appear to have been in fault, that Ambrose Paré, who is a great advocate for depletion in the treatment of fractures of the skull, is at great pains to show that he has Hippocrates on his side in support of this practice. But while it is maintained that our author did not omit venesection when properly indicated, I did not mean to say that he or any of the ancient authorities carried the abstraction of the blood to the extent practiced by Pott, or the members of the Royal Academy of Surgery in France, nor as was done by the army and hospital surgeons of this country during the late war. Whether or not this was a defect in ancient practice I shall not take it upon me to offer an opinion. Suffice it to say, that there is undoubted evidence that in injuries of the head the ancient surgeon, as is naively recommended by Avicenna, “bled his patient when he stood in need of being bled;” that is to say, according to special indications, and not in obedience to any general rule.

There is another point of practice in injuries of the head to which it is proper that I should draw attention--I mean cold applications. Now it is beyond a doubt that the application of cold in diseases of the brain is pointedly condemned by Hippocrates, and that he used hot applications instead; and, moreover, that most of the ancient authorities adhered to his rule on this point. At the same time it would appear, that in extreme cases certain of them did not scruple to apply ice to the shaved head. I shall only remark further, that in this case, as in diseases of the eyes, perhaps the safest rule is, to be guided very much by the feelings and habits of the patient.

ON INJURIES OF THE HEAD

1. Men’s heads are by no means all like to one another, nor are the sutures of the head of all men constructed in the same form. Thus, whoever has a prominence in the anterior part of the head (by prominence is meant the round protuberant part of the bone which projects beyond the rest of it), in him the sutures of the head take the form of the Greek letter tau, Τ; for the head has the shorter line running transverse before the prominence, while the other line runs through the middle of the head, all the way to the neck. But whoever has the prominence in the back part of the head, in him the sutures are constructed in quite the opposite form to the former; for in this case the shorter line runs in front of the prominence, while the longer runs through the middle all along to the forehead. But whoever has a prominence of the head both before and behind, in him the sutures resemble the Greek letter êta Η; for the long lines of the letter run transverse before each prominence while the short one runs through the middle and terminates in the long lines. But whoever has no prominence on either part he has the sutures of the head resembling the Greek letter χ; for the one line comes transverse to the temple while the other passes along the middle of the head. The bone at the middle of the head is double, the hardest and most compact part being the upper portion, where it is connected with the skin, and the lowest, where it is connected with the meninx (dura mater); and from the uppermost and lowermost parts the bone gradually becomes softer and less compact, till you come to the diploe. The diploe is the most porous, the softest, and most cavernous part. But the whole bone of the head, with the exception of a small portion of the uppermost and lowermost portions of it, is like a sponge; and the bone has in it many juicy substances, like caruncles; and if one will rub them with the fingers, some blood will issue from them. There are also in the bone certain very slender and hollow vessels full of blood. So it is with regard to hardness, softness, and porosity.

2. In respect to thickness and thinness; the thinnest and weakest part of the whole head is the part about the bregma; and the bone there has the smallest and thinnest covering of flesh upon it, and the largest proportion of brain is situated in that region of the head. And hence it happens that from similar or even smaller wounds and instruments, when a person is wounded to the same or a less degree, the bone of the head there is more contused, fractured, and depressed; and that injuries there are more deadly and more difficult to cure; and it is more difficult to save one’s life in injuries there than in any other part of the head; that from having sustained a similar or even a less wound a man will die, and that, too, in a shorter space of time than from a wound in any other part of the head. For the brain about the bregma feels more quickly and strongly any mischief that may occur to the flesh or the bone; for the brain about the bregma is in largest quantity, and is covered by the thinnest bone and the least flesh. Of the other portions, the weakest is that about the temples; for it is the conjunction of the lower jaw with the cranium, and there is motion there up and down as at a joint; and the organ of hearing is near it; and further, a hollow and important vein runs along the temple. But the whole bone of the head behind the vertex and the ear is stronger than the whole anterior part, and the bone itself has a larger and deeper covering of flesh upon it. And hence it follows, that when exposed to the same or even greater injuries from instruments of the same or greater size, the bone is less liable to be fractured and depressed than elsewhere; and that in a fatal accident the patient will live longer when the wound is in the posterior part of the head than when elsewhere; and that pus takes longer time to form and penetrate through the bone to the brain, owing to the thickness of the bone; and moreover, as there is less brain in that part of the head, more persons who are wounded in the back part of the head escape than of those who are wounded in the anterior part. And in fatal cases, a man will survive longer in winter than in summer, whatever be the part of the head in which the wound is situated.

3. As to the hædræ (dints or marks?) of sharp and light weapons, when they take place in the bone without fissure, contusion, or depression inwards (and these take place equally in the anterior and posterior part of the head), death, when it does occur, does not properly result from them. A suture appearing in a wound, when the bone is laid bare, on whatever part of the head the wound may have been inflicted, is the weakest point of the head to resist a blow or a weapon, when the weapon happens to be impinged into the suture itself; but more especially when this occurs in the bregma at the weakest part of the head, and the sutures happen to be situated near the wound, and the weapon has hit the sutures themselves.

4. The bone in the head is liable to be wounded in the following modes, and there are many varieties in each of these modes of fracture: When a wounded bone breaks, in the bone comprehending the fissure, contusion necessarily takes place where the bone is broken; for an instrument that breaks the bone occasions a contusion thereof more or less, both at the fracture and in the parts of the bone surrounding the fracture. This is the first mode. But there are all possible varieties of fissures; for some of them are fine, and so very fine that they cannot be discovered, either immediately after the injury, or during the period in which it would be of use to the patient if this could be ascertained. And some of these fissures are thicker and wider, certain of them being very wide. And some of them extend to a greater, and some to a smaller, distance. And some are more straight, nay, completely straight; and some are more curved, and that in a remarkable degree. And some are deep, so as to extend downwards and through the whole bone; and some are less so, and do not penetrate through the whole bone.

5. But a bone may be contused, and yet remain in its natural condition without any fracture in it; this is the second mode. And there are many varieties of contusion; for they occur to a greater and less degree, and to a greater depth, so as sometimes to extend through the whole bone; or to a less depth, so as not to extend through the whole bone; and to a greater and smaller length and breadth. But it is not possible to recognize any of these varieties by the sight, so as to determine their form and extent; neither, indeed, is it visible to the eyes when any mischief of this kind takes place, and immediately after the injury, whether or not the bone has been actually bruised, as is likewise the ease with certain fractures at a distance from the seat of injury.

6. And the bone being fractured, is sometimes depressed inwards from its natural level along with the fractures, otherwise there would be no depression; for the depressed portion being fractured and broken off, is pushed inwards, while the rest of the bone remains in its natural position; and in this manner a fracture is combined with the depression. This is the third mode. There are many varieties of depression, for it may comprehend a greater and a smaller extent of bone, and may either be to a greater depth, or less so, and more superficial.

7. When a hedra, or dint of a weapon, takes place in a bone, there may be a fracture combined with it; and provided there be a fracture, contusion must necessarily be joined, to a greater or less extent, in the seat of the dint and fracture, and in the bone which comprehends them. This is the fourth mode. And there may be a hedra, or indentation of the bone, along with contusion of the surrounding bone, but without any fracture either in the hedra or in the contusion inflicted by the weapon. But the indentation of a weapon takes place in a bone, and is called hedra, when the bone remaining in its natural state, the weapon which struck against the bone leaves its impression on the part which it struck. In each of these modes there are many varieties, with regard to the contusion and fracture, if both these be combined with the hedra, or if contusion alone, as it has been already stated that there are many varieties of contusion and fracture. And the hedra, or dint, of itself may be longer and shorter, crooked, straight, and circular; and there are many varieties of this mode, according to the shape of the weapon; and they may be more or less deep, and narrower or broader, and extremely broad. When a part is cleft, the cleft or notch which occurs in the bone, to whatever length or breadth, is a hedra, if the other bones comprehending the cleft remain in their natural position, and be not driven inwards; for in this case it would be a depression, and no longer a hedra.

8. A bone may be injured in a different part of the head from that on which the person has received the wound, and the bone has been laid bare. This is the fifth mode. And for this misfortune, when it occurs, there is no remedy; for when this mischief takes place, there is no means of ascertaining by any examination whether or not it has occurred, or on what part of the head.

9. Of these modes of fracture, the following require trepanning: the contusion, whether the bone be laid bare or not; and the fissure, whether apparent or not. And if, when an indentation (hedra) by a weapon takes place in a bone it be attended with fracture and contusion, and even if contusion alone, without fracture, be combined with the indentation, it requires trepanning. A bone depressed from its natural position rarely requires trepanning; and those which are most pressed and broken require trepanning the least; neither does an indentation (hedra) without fracture and contusion require trepanning; nor does a notch, provided it is large and wide; for a notch and a hedra are the same.

10. In the first place, one must examine the wounded person, in what part of the head the wound is situated, whether in the stronger or weaker parts; and ascertain respecting the hairs about the wound, whether they have been cut off by the instrument, and have gone into the wound; and if so, one should declare that the bone runs the risk of being denuded of flesh, and of having sustained some injury from the weapon. These things one should say from a distant inspection, and before laying a hand on the man; but on a close examination one should endeavor to ascertain clearly whether the bone be denuded of flesh or not; and if the denuded bone be visible to the eyes, this will be enough; but otherwise an examination must be made with the sound. And if you find the bone denuded of the flesh, and not safe from the wound, you must first ascertain the state of the bone, and the extent of the mischief, and what assistance it stands in need of. One should also inquire of the wounded person how and in what way he sustained the injury; and if it be not apparent whether the bone has sustained an injury or not, it will be still more necessary, provided the bone be denuded, to make inquiry how the wound occurred, and in what manner; for when contusions and fractures exist in the bone, but are not apparent, we must ascertain, in the first place from the patient’s answers, whether or not the bone has sustained any such injuries, and then find out the nature of the case by word and deed, with the exception of sounding. For sounding does not discover to us whether the bone has sustained any of these injuries or not; but sounding discovers to us an indentation inflicted by a weapon, and whether a bone be depressed from its natural position, and whether the bone be strongly fractured; all which may also be ascertained visibly with the eyes.

11. And a bone sustains fractures, either so fine as to escape the sight, or such as are apparent, and contusions which are not apparent, and depression from its natural position, especially when one person is intentionally wounded by another, or when, whether intentionally or not, a blow or stroke is received from an elevated place, and if the instrument in the hand, whether used in throwing or striking, be of a powerful nature, and if a stronger person wound a weaker. Of those who are wounded in the parts about the bone, or in the bone itself, by a fall, he who falls from a very high place upon a very hard and blunt object is in most danger of sustaining a fracture and contusion of the bone, and of having it depressed from its natural position; whereas he that falls upon more level ground, and upon a softer object, is likely to suffer less injury in the bone, or it may not be injured at all. Of those instruments which, falling upon the head, wound the parts about the bone, or the bone itself, that which falls from a very high place, and the least on a level with the person struck, and which is at the same time very hard, very blunt, and very heavy, and which is the least light, sharp, and soft, such an instrument would occasion a fracture and contusion of the bone. And there is most danger that the bone may sustain these injuries, under such circumstances, when the wound is direct and perpendicular to the bone, whether struck from the hand or from a throw, or when any object falls upon the person, or when he is wounded by falling, or in whatever way the bone sustains a direct wound from this instrument. Those weapons which graze the bone obliquely are less apt to fracture, contuse, or depress the bone, even when the bone is denuded of flesh; for in some of those wounds thus inflicted the bone is not laid bare of the flesh. Those instruments more especially produce fractures in the bone, whether apparent or not, and contusions, and inward depression of the bone, which are rounded, globular, smooth on all sides, blunt, heavy, and hard; and such weapons bruise, compress, and pound the flesh; and the wounds inflicted by such instruments, whether obliquely or circularly, are round, and are more disposed to suppurate, and to have a discharge, and take longer time to become clean; for the flesh which has been bruised and pounded must necessarily suppurate and slough away. But weapons of an oblong form, being, for the most part, slender, sharp, and light, penetrate the flesh rather than bruise it, and the bone in like manner; and such an instrument may occasion a hedra and a cut (for a hedra and a cut are same thing); but weapons of this description do not produce contusions, nor fractures, nor depressions inwardly. And in addition to the appearances in the bone, which you can detect by the sight, you should make inquiry as to all these particulars (for they are symptoms of a greater or less injury), whether the wounded person was stunned, and whether darkness was diffused over his eyes, and whether he had vertigo, and fell to the ground.

12. When the bone happens to be denuded of flesh by the weapon, and when the wound occurs upon the sutures, it is difficult to distinguish the indentation (hedra) of a weapon which is clearly recognized in other parts of the bone, whether it exist or not, and especially if the hedra be seated in the sutures themselves. For the suture being rougher than the rest of the bone occasions confusion, and it is not clear which is the suture, and which the mark inflicted by the instrument, unless the latter (hedra) be large. Fracture also for the most part is combined with the indentation when it occurs in the sutures; and this fracture is more difficult to discern when the bone is broken, on this account, that if there be a fracture, it is situated for the most part in the suture. For the bone is liable to be broken and slackened there, owing to the natural weakness of the bone there, and to its porosity, and from the suture being readily ruptured and slackened: but the other bones which surround the suture remain unbroken, because they are stronger than the suture. For the fracture which occurs at the suture is also a slackening of the suture, and it is not easy to detect whether the bone be broken and slackened by the indentation of a weapon occurring in the suture, or from a contusion of the bone at the sutures; but it is still more difficult to detect a fracture connected with contusion. For the sutures, having the appearance of fissures, elude the discernment and sight of the physician, as being rougher than the rest of the bone, unless the bone be strongly cut and slackened, (for a cut and a hedra are the same thing.) But it is necessary, if the wound has occurred at the sutures, and the weapon has impinged on the bone or the parts about it, to pay attention and find out what injury the bone has sustained. For a person wounded to the same, or a much smaller, extent, and by weapons of the same size and quality, and even much less, will sustain a much greater injury, provided he has received the blow at the sutures, than if it was elsewhere. And many of these require trepanning, but you must not apply the trepan to the sutures themselves, but on the adjoining bone.

13. And with regard to the cure of wounds in the head, and the mode of detecting injuries in the bone which are not apparent, the following is my opinion:--In a wound of the head, you must not apply anything liquid, not even wine, but as little as possible, nor a cataplasm, nor conduct the treatment with tents, nor apply a bandage to an ulcer on the head, unless it be situated on the forehead, in the part which is bare of hairs, or about the eyebrow and eye, for wounds occurring there require cataplasms and bandages more than upon any other part of the head. For the rest of the head surrounds the whole forehead, and the wounds wherever situated become inflamed and swelled, owing to an influx of blood from the surrounding parts. And neither must you apply cataplasms and bandages to the forehead at all times; but when the inflammation is stopped and the swelling has subsided, you must give up the cataplasms and bandages. A wound in any other part of the head must not be treated with tents, bandages, or cataplasms, unless it also requires incision. You must perform incision on wounds situated on the head and forehead, whenever the bone is denuded of flesh, and appears to have sustained some injury from the blow, but the wound has not sufficient length and breadth for the inspection of the bone, so that it may be seen whether it has received any mischief from the blow, and of what nature the injury is, and to what extent the flesh has been contused, and whether the bone has sustained any injury, or whether it be uninjured by the blow, and has suffered no mischief; and with regard to the treatment, what the wound, and the flesh, and the injury of the bone stand in need of. Ulcers of this description stand in need of incision; and, if the bone be denuded of the flesh, and if it be hollow, and extend far obliquely, we cut up the cavity wherever the medicine cannot penetrate readily, whatever medicine it may be; and wounds which are more inclined to be circular and hollow, and for the most part others of the like shape, are cut up by making a double incision in the circle lengthways, according to the figure of the man, so as to make the wound of a long form. Incisions may be practiced with impunity on other parts of the head, with the exception of the temple and the parts above it, where there is a vein that runs across the temple, in which region an incision is not to be made. For convulsions seize on a person who has been thus treated; and if the incision be on the left temple, the convulsions seize on the right side; and if the incision be on the right side, the convulsions take place on the left side.

14. When, then, you lay open a wound in the head on account of the bones having been denuded of the flesh, as wishing to ascertain whether or not the bone has received an injury from the blow, you must make an incision proportionate to the size of the wound, and as much as shall be judged necessary. And in making the incision you must separate the flesh from the bone where it is united to the membrane (pericranium?) and to the bone, and then fill the whole wound with a tent, which will expand the wound very wide next day with as little pain as possible; and along with the tents apply a cataplasm, consisting of a mass (maza) of fine flour pounded in vinegar, or boiled so as to render it as glutinous as possible. On the next day, when you remove the tent, having examined the bone to see what injury it has sustained, if the wound in the bone be not right seen by you, nor can you discover what mischief the bone itself has sustained, but the instrument seems to have penetrated to the bone so as to have injured it, you must scrape the bone with a raspatory to a depth and length proportionate to the suture of the patient, and again in a transverse direction, for the sake of the fractures which are not seen, and of the contusions which are not discovered, as not being accompanied with depression of the bone from its natural position. For the scraping discovers the mischief, if the injuries in the bone be not otherwise manifest. And if you perceive an indentation (hedra) left in the bone by the blow, you must scrape the dint itself and the surrounding bones, lest, as often happens, there should be a fracture and contusion, or a contusion alone, combined with the dint, and escape observation. And when you scrape the bone with the raspatory, and it appears that the wound in the bone requires the operation, you must not postpone it for three days, but do it during this period, more especially if the weather be hot, and you have had the management of the treatment from the commencement. If you suspect that the bone is broken or contused, or has sustained both these injuries, having formed your judgment from the severity of the wound, and from the information of the patient, as that the person who inflicted the wound, provided it was done by another person, was remarkably strong, and that the weapon by which he was wounded was of a dangerous description, and then that the man had been seized with vertigo, dimness of vision, and stupor, and fell to the ground,--under these circumstances, if you cannot discover whether the bone be broken, contused, or both the one and the other, nor can see the truth of the matter, you must dissolve the jet-black ointment, and fill the wound with it when thus dissolved, and apply a linen rag smeared with oil, and then a cataplasm of the maza with a bandage; and on the next day, having cleaned out the wound, scrape the bone with the raspatory. And if the bone is not sound, but fractured and contused, the rest of it which is scraped will be white; but the fracture and contusion, having imbibed the preparation, will appear black, while the rest of the bone is white. And you must again scrape more deeply the fracture where it appears black; and, if you thus remove the fissure, and cause it to disappear, you may conclude that there has been a contusion of the bone to a greater or less extent, which has occasioned the fracture that has disappeared under the raspatory; but it is less dangerous, and a matter of less consequence, when the fissure has been effaced. But if the fracture extend deep, and do not seem likely to disappear when scraped, such an accident requires trepanning. But having performed this operation, you must apply the other treatment to the wound.

15. You must be upon your guard lest the bone sustain any injury from the fleshy parts if not properly treated. When the bone has been sawed and otherwise denuded, whether it be actually sound, or only appears to be so, but has sustained some injury from the blow, there may be danger of its suppurating (although it would not otherwise have done so), if the flesh which surrounds the bone be ill cured, and become inflamed and strangled; for it gets into a febrile state, and becomes much inflamed. For the bone acquires heat and inflammation from the surrounding flesh, along with irritation and throbbing, and the other mischiefs which are in the flesh itself, and from these it gets into a state of suppuration. It is a bad thing for the flesh (granulations?) in an ulcer to be moist and mouldy, and to require a long time to become clean. But the wound should be made to suppurate as quickly as possible; for, thus the parts surrounding the wound would be the least disposed to inflammation, and would become the soonest clean; for the flesh which has been chopped and bruised by the blow, must necessarily suppurate and slough away. But when cleaned the wound must be dried, for thus the wound will most speedily become whole, when flesh devoid of humors grows up, and thus there will be no fungous flesh in the sore. The same thing applies to the membrane which surrounds the brain: for when, by sawing the bone, and removing it from the meninx, you lay the latter bare, you must make it clean and dry as quickly as possible, lest being in a moist state for a considerable time, it become soaked therewith and swelled; for when these things occur, there is danger of its mortifying.

16. A piece of bone that must separate from the rest of the bone, in consequence of a wound in the head, either from the indentation (hedra) of a blow in the bone, or from the bone being otherwise denuded for a long time, separates mostly by becoming exsanguous. For the bone becomes dried up and loses its blood by time and a multiplicity of medicines which are used; and the separation will take place most quickly, if one having cleaned the wound as quickly as possible will next dry it, and the piece of bone, whether larger or smaller. For a piece of bone which is quickly dried and converted, as it were, into a shell, is most readily separated from the rest of the bone which retains its blood and vitality; for, the part having become exsanguous and dry, more readily drops off from that which retains its blood and is alive.

17. Such pieces of bone as are depressed from their natural position, either being broken off or chopped off to a considerable extent, are attended with less danger, provided the membrane be safe; and bones which are broken by numerous and broader fractures are still less dangerous and more easily extracted. And you must not trepan any of them, nor run any risks in attempting to extract the pieces of bone, until they rise up of their own accord, upon the subsidence of the swelling. They rise up when the flesh (granulations) grows below, and it grows from the diploe of the bone, and from the sound portion, provided the upper table alone be in a state of necrosis. And the flesh will shoot up and grow below the more quickly, and the pieces of bone ascend, if one will get the wound to suppurate and make it clean as quickly as possible. And when both the tables of the bone are driven in upon the membrane, I mean the upper and lower, the wound, if treated in the same way, will very soon get well, and the depressed bones will quickly rise up.

18. The bones of children are thinner and softer, for this reason, that they contain more blood [than those of adults]; and they are porous and spongy, and neither dense nor hard. And when wounded to a similar or inferior degree by weapons of the same or even of an inferior power, the bone of a young person more readily and quickly suppurates, and that in less time than the bone of an older person; and in accidents, which are to prove fatal, the younger person will die sooner than the elder. But if the bone is laid bare of flesh, one must attend and try to find out, what even is not obvious to the sight, and discover whether the bone be broken and contused, or only contused; and if, when there is an indentation in the bone, whether contusion, or fracture, or both be joined to it; and if the bone has sustained any of these injuries, we must give issue to the blood by perforating the bone with a small trepan, observing the greatest precautions, for the bone of young persons is thinner and more superficial than that of elder persons.

19. When a person has sustained a mortal wound on the head, which cannot be cured, nor his life preserved, you may form an opinion of his approaching dissolution, and foretell what is to happen from the following symptoms which such a person experiences. When a bone is broken, or cleft, or contused, or otherwise injured, and when by mistake it has not been discovered, and neither the raspatory nor trepan has been applied as required, but the case has been neglected as if the bone were sound, fever will generally come on before the fourteenth day if in winter, and in summer the fever usually seizes after seven days. And when this happens, the wound loses its color, and the inflammation dies in it; and it becomes glutinous, and appears like a pickle, being of a tawny and somewhat livid color; and the bone then begins to sphacelate, and turns black where it was white before, and at last becomes pale and blanched. But when suppuration is fairly established in it, small blisters form on the tongue and he dies delirious. And, for the most part, convulsions seize the other side of the body; for, if the wound be situated on the left side, the convulsions will seize the right side of the body; or if the wound be on the right side of the head, the convulsion attacks the left side of the body. And some become apoplectic. And thus they die before the end of seven days, if in summer; and before fourteen, if in winter. And these symptoms indicate, in the same manner, whether the wound be older or more recent. But if you perceive that fever is coming on, and that any of these symptoms accompany it, you must not put off, but having sawed the bone to the membrane (meninx), or scraped it with a raspatory, (and it is then easily sawed or scraped,) you must apply the other treatment as may seem proper, attention being paid to circumstances.

20. When in any wound of the head, whether the man has been trepanned or not, but the bone has been laid bare, a red and erysipelatous swelling supervenes in the face, and in both eyes, or in either of them, and if the swelling be painful to the touch, and if fever and rigor come on, and if the wound look well, whether as regards the flesh or the bone, and if the parts surrounding the wound be well, except the swelling in the face, and if the swelling be not connected with any error in the regimen, you must purge the bowels in such a case with a medicine which will evacuate bile; and when thus purged the fever goes off, the swelling subsides, and the patient gets well. In giving the medicine you must pay attention to the strength of the patient.

21. With regard to trepanning, when there is a necessity for it, the following particulars should be known. If you have had the management of the case from the first, you must not at once saw the bone down to the meninx; for it is not proper that the membrane should be laid bare and exposed to injuries for a length of time, as in the end it may become fungous. And there is another danger if you saw the bone down to the meninx and remove it at once, lest in the act of sawing you should wound the meninx. But in trepanning, when only a very little of the bone remains to be sawed through, and the bone can be moved, you must desist from sawing, and leave the bone to fall out of itself. For to a bone not sawed through, and where a portion is left of the sawing, no mischief can happen; for the portion now left is sufficiently thin. In other respects you must conduct the treatment as may appear suitable to the wound. And in trepanning you must frequently remove the trepan, on account of the heat in the bone, and plunge it in cold water. For the trepan being heated by running round, and heating and drying the bone, burns it and makes a larger piece of bone around the sawing to drop off, than would otherwise do. And if you wish to saw at once down to the membrane, and then remove the bone, you must also, in like manner, frequently take out the trepan and dip it in cold water. But if you have not charge of the treatment from the first, but undertake it from another after a time, you must saw the bone at once down to the meninx with a serrated trepan, and in doing so must frequently take out the trepan and examine with a sound (specillum), and otherwise along the tract of the instrument. For the bone is much sooner sawn through, provided there be matter below it and in it, and it often happens that the bone is more superficial, especially if the wound is situated in that part of the head where the bone is rather thinner than in other parts. But you must take care where you apply the trepan, and see that you do so only where it appears to be particularly thick, and having fixed the instrument there, that you frequently make examinations and endeavor by moving the bone to bring it up. Having removed it, you must apply the other suitable remedies to the wound. And if, when you have the management of the treatment from the first, you wish to saw through the bone at once, and remove it from the membrane, you must, in like manner, examine the tract of the instrument frequently with the sound, and see that it is fixed on the thickest part of the bone, and endeavor to remove the bone by moving it about. But if you use a perforator (trepan?), you must not penetrate to the membrane, if you operate on a case which you have had the charge of from the first, but must leave a thin scale of bone, as described in the process of sawing.

END OF VOL. I.

EXPLANATION OF THE PLATES TO VOL. I.

FIG. 1. The Saw used by carpenters. (Taken from Chirurgia è Græco in Latinum conversa, Vido Vidio interprete Lutetiæ Parisiorum, p. 115.)

2. A small Saw. (Ibid.)

3. The Modiolus, or ancient Trephine. (Ibid.)

4. The Terebra, or Trepan, called Abaptiston. (Ibid. p. 116.)

5. The Auger used by carpenters. (Ibid. p. 116.)

6. The Terebra, or Trepan, which is turned round by a thong bound tight about its middle. (Ibid. p. 117.)

7. The Auger, or Trepan, which is turned round by a bow. (Ibid. p. 118.)

8. A Terebra, or Trepan, which is turned round by a thong on a cross-beam. (Ibid. p. 119.)

9. A Terebra, or Trepan, which has a ball in its upper end, by which it is turned round. (Ibid. p. 120.)

10. A Terebra, or Trepan, which is turned round by a cross piece of wood, or handle, on its upper end. (Ibid. p. 120.)]

FIG. 1. A Terebra, or Trepan, turned round by a handle in its middle. (Ibid. p. 122.) It resembles the centre-bit of modern artisans.

1. A hole into which the iron head is fixed. 2. Upright part, three inches long. 3. Cross part, one inch long. 4. The part which is grasped in turning the instrument. 5. Cross part, an inch long. 6. Upright part. 7. A ball fixed to the top. A. B. C. Different forms of the iron head fixed in the hole 1.

FIG. 2. Scalper rectus, or straight Raspatory. (Ibid. p. 123.)

3. Scalper in medio recurvatus, or bent Raspatory. (Ibid. p. 123.)

4, 5, 6. Ancient Modioli, as represented by Pott (Injuries of the Head, p. 153).]

FIGS. 1 and 2. A Scalper, or Raspatory, with which the moderns scrape the bone. (Chirurgia è Græco, &c., p. 125.)

3. Scalper cavus or scooped Raspatory. (Ibid. p. 126.)

4. A Lenticular. (Ibid. p. 127.)

5. A Malleolus, or Mallet. (Ibid. p. 126.)

6. A Lever, by which modern surgeons protect the dura mater, and raise a depressed bone. (Ibid. p. 128.)

7. The ancient Meningophylax. (Ibid. p. 128.)

8. Forfex excisoria, or Cutting Scissors. (Ibid. p. 129.)

9. A Forceps, used for extracting bones. (Ibid. p. 130.)]

FOOTNOTES:

It is necessary to inform my readers in this place, that, owing to its bulk, it has been judged expedient by the Council of the Sydenham Society to divide the work into two separate parts or volumes.

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

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

Plato, Menex.

Celsus mentions Pythagoras, Empedocles, and Democritus, as the most distinguished of the philosophers who cultivated medicine.--Præfat.

“Hippocrates primus ab studio sapientiæ disciplinam hanc separavit.”--Præfat.

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

Philostratus, Vita Apollonii, 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 Revelata.

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

Galen, de Administ, Anatom., ii.

Censura Operum Hippocrat., p. 184.

Hist. de la Méd., i., 5, p. 175, French edit. Schulze, in like manner, depreciates the anatomical knowledge of the Asclepiadæ, and holds that it had been overrated by Galen.--Hist. Med., i., 2, 5.

Comment, in Libr. de Artie, iii., 28; de Decret. Hippocrat. et Platon., viii., I.

Polit., iii., 399; ed. Tauchnitz.

Geograph., xiv., 2.

De Sanitate tuenda, i.

L. c.

Galen, Opera, tom. iv., ed. Basil, 35.

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.

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

Noctes Atticæ, xvii., 21.

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 Schulze, Hist. Med., i., 2, 8. The author of the VI. Epidem. condemns Herodicus for using exercises in the treatment of acute diseases. Herodicus is frequently mentioned in the Dialogues of Plato. See Protagoras, § 20; and de Repub., iii. Plato says, that being in ill health, he wore out first himself and afterwards many others, by combining gymnastics with medicine.

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

See Plato, Protagoras.

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 Commentary on PAULUS ÆGINETA, Vol. I., p. 274. There can be no doubt that it was the established practice of the profession in the days of Hippocrates. The names of Acron, Empedocles, and Hippocrates are particularly famous as having successfully adopted the practice. See Aëtius, v., 94; Paulus Ægineta, l. c.; Pliny, H. N., xxxvi., 69; and Plutarch, De Iside et Osiride.

Hist., iii., 87.

It deserves to be mentioned further, as adding probability to the present narrative, that it was quite common in ancient times for the Asclepiadæ to be publicly consulted by cities and States respecting the general health of the inhabitants, and this both for the prevention and cure of diseases. See Aristid. Opera, i., p. 81.

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

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

See Xenophon, Cyropæd., i. and viii.

Galen, Comment in libr. de Artic. iii.

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

See Thucyd., ii., 48.

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 works, it will be seen below that it possesses considerable evidence in its favor, and that beyond doubt it is very ancient.

Aphor., I., 1.

See Galen, Opera, tom. v., p. 488; ed. Basil.

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

This is the more remarkable, as it does not appear to have been the established creed of the greatest literary men and philosophers of the age, who still adhered or professed to adhere to the popular belief in the extraordinary interference of the gods with the works of Nature and the affairs of mankind. This at least was remarkably the case with Socrates, whose mind, like that of most men who make a great impression on the religious feelings of their age, had evidently a deep tinge of mysticism. See Xenoph. Memor., i., 1, 6–9; Ibid. iv., 7, 7; also Grote’s History of Greece, vol. i., p. 499. The latter remarks, “Physical and astronomical phenomena are classified by Socrates among the divine class, interdicted to human study.” (Mem., i. 1, 13.) He adds, in reference to Hippocrates, “On the other hand, Hippocrates, the contemporary of Socrates, denied the discrepancy, and merged into one the two classes of phenomena--the divine and the scientifically determinable,--which the latter had put asunder. Hippocrates treated all phenomena as at once both divine and scientifically determinable.” (p. 499.) He then quotes the memorable passage in the treatise “On Airs,” etc. It does not appear, however, that in ancient times the charge of Atheism was ever brought against him. It has been urged against him by modern fanatics, but scarcely deserves a serious refutation. See Schulze (Hist. Med., i., 3, 2), and Ackerman (Hist. Lit. Hippocr., pp. xii, xiii; ed. Kühn). By such persons, whoever does not join in their anthropomorphical notions of a first cause is held up for an Atheist.

For the medicine of the ancient Jews, Egyptians, and Babylonians, see the introductory chapters of Sprengel’s Hist. de la Méd. The medicine of the Hindoos, as given in the “Susruta” of D’Hanvantare, abounds in superstitious practices.

Epidem., vi.

Epidem., i.

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

See Galen, Oper. tom. v., p. 106; ed. Basil.

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

De Superfœt. et pluries.

De Ratione Victus in Acut. There is some doubt, however, whether the σκαμμώνιον of Dioscorides be the Convolvulus scammonia. Some rather take it for the C. sagittifolius.

De Superfœt. et alibi.

De Morb. Mulier.

De Fract., Aphor. et alibi.

Galen, Meth. Med., v., 3; Comment. in Libr. de Humor. See further in illustration, Œconom. Hippocrat. under Παροχετεύειν and 'Αντίσπασις; and Schulze, Hist. Med., i., 3, 4, 10.

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

See de Morbis, ii.; and Le Clerc, Hist. Med., 1, 3, 20.

See the work “On the Articulations,” pluries.

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

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

Coray, Traité de Hippocrat. des Airs, etc., Discours préliminaire, pp. l., lvii.

Dionysius Halicarnassensis de iis quæ Thucyd. propria sunt, et de Platon. judicium.

Opus supra laudatum, p. clxxiv.

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

See in Bentley’s Horace. The poet himself in several of his pieces, alludes to the separate publication of the various books, as i., 97; vi., 1; ii., præfat.; et pluries.

See Middleton’s Life of Cicero, pluries.

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

See the preliminary dissertation prefixed to Buhle’s edition; also Schneider’s edition of the Historia Animalium, Epimetrum iii.

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

See Galen, de Crisibus, i., 6.

Galen, Gloss., tom. v., p. 705; ed. Basil. As frequent mention of the commentators will occur in the course of this work, I will here subjoin a complete list of them, with a few brief notices of them, more especially of a chronological nature, derived principally from the following sources: Ackerman, Bibliotheca Græca; Dietz, Præfatio in Scholia Apollonii, etc.; Littré, Op. Hippocrat., tom. i., pp. 80–132; Daremberg, Cours sur l’Histoire et la Littérature des Sciences Médicales.

Herophilus, the famous anatomist of Alexandria; flourished about from 310–280 A.C.

Xenocrates of Cos, quoted by Erotian as an authority on the Prognostics; nearly contemporary with Herophilus.

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

Bacchius, contemporary with Philinus.

Glaucias immediately after Bacchius; flourished probably between 290–260 A.C.

Zeuxis the Empiric, immediately after Glaucias and before Zeno; probably from 270–240 A.C. See Daremberg.

Heraclides Tarentinus, somewhat later than Bacchius, probably between 260–240 A.C.

Zeno the Herophilean, the contemporary and rival of Heraclides; probably the same as Zeno of Laodicea.

Apollonius Biblas, the contemporary and rival of Zeno.

Callimachus, according to Daremberg, an immediate disciple of Herophilus.

Epiceleustus of Crete, of uncertain date.

Apollonius Ophis, of uncertain date.

Lysimachus of Cos, uncertain.

Euphorion, uncertain.

Heraclides the Erythrean, rather uncertain; but, according to Daremberg, a contemporary with Heraclides Tarentinus. The same as Heraclides the Herophilean. (Strabo, Geogr., xiv.)

Epicles, uncertain.

Eurycles, uncertain.

Philonides of Sicily, uncertain.

Ischomachus, uncertain.

Cydias, uncertain.

Cinesias, uncertain.

Demetrius, the Epicurean.

Diagoras, uncertain.

Nicander the Poet of Colophon, from 150–120 A.C.

Apollonius Citiensis; Daremberg places him between 80–52 A.C. See also Dietz and Littré.

Asclepiades of Bithynia, contemporary with Pompey the Great; about 60–40 A.C.

Thessalus, the famous Methodist; about 50–70 P.C.

Erotian flourished in the reign of Nero, from 50–70 P.C. His Glossary still preserved.

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

Metrodorus, disciple of Sabinus.

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

Marinus, the celebrated anatomist, about the beginning of the second century P.C.

Quintus, the Empiric, probably about from 110–130 P.C.

Lycus, the Macedonian, the disciple of Quintus; from 120–140 P.C. See Daremberg.

Lycus, of Naples, date rather uncertain.

Artemidorus, a favorite of the Emperor Hadrian; often blamed by Galen for his alterations of the text; about 120–140 P.C.

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

Numesianus, somewhat later than Dioscorides.

Dionysius, about the time of the last.

Pelops, the disciple of Numesianus.

Satyrus, the disciple of Quintus.

Phecianus, the disciple of Quintus.

Julian the Alexandrian, the immediate predecessor of Galen, who frequently animadverts on his writings.

GALEN, flourished between 150–190 P.C.; wrote Commentaries, still in existence, on the following works:--On the Nature of Man; on Regimen in Health; on Regimen in Acute Diseases; on the Prognostics; on the First Book of the Prorrhetics; on the Aphorisms; on the First, the Third, and the Sixth Books of the Epidemics; on the Treatise on Fractures; on the Articulations; on the Physicians’ Establishment or Surgery; on the Humours; fragments of the Commentaries on Airs, Waters, Places, and on the Aliment. Besides these, he wrote several other Commentaries, which are lost.

Domnus, of uncertain date, after Galen.

Attalion, like the last, cited in the Commentary attributed to Oribasius.

Philagrius, of uncertain date, quoted by Theophilus.

Gesius, of uncertain date.

Asclepius, of uncertain date, quoted by Theophilus. (Dietz, tom. ii., p. 458.)

Stephanus, the Athenian, supposed by Dietz to have lived in the reign of Heraclius, that is to say, in the earlier part of the seventh century. According to Dietz, not the same as Stephanus Alexandrinus.

Palladius, probably about the seventh century; his Commentary on the book “On Fractures,” published by Foës, and a considerable portion of his Commentary “On the Sixth Epidemic,” by Dietz.

Joannes Alexandrinus, probably near the time of Palladius; part of his Commentary “On the Nature of the Young Man,” published by Dietz.

Theophilus, or Philotheus, surnamed Protospatharius, probably flourished in the seventh century P.C. See the Annotations of Dr. Greenhill, in his excellent edition of the work “De Corporis Humani Fabrica;” Oxford, 1842. Several of his Commentaries on the Aphorisms, published by Dietz.

Meletius, of uncertain date; part of his Commentaries on the Aphorisms, published by Dietz. See also Anec. Gr., ed. Cramer.

Damascius, of uncertain date; a few of his Commentaries on the Aphorisms, published by Dietz.

Œuvres d’Hippocrat., tom. i., p. 171.

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

It will be proper to give this Class:--

1. De Aëre, Aquis, et Locis. 2. De Natura Hominis. 3. De Locis in Homine. 4. De Humoribus. 5. De Alimento. 6. De Morbis popularibus. 7. Prognosticon. 8. Prædictionum, ii. 9. De Victu Acutorum. 10. De Fracturis. 11. De Articulis. 12. Mochlicus. 13. De Vulneribus Capitis. 14. Officina Medici. 15. Aphorismi.

Censura Librorum Hippocrateorum, Vratislaviæ, 1772.

De Elementis, i., 9.

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

De Artic., i.

See his Historia Literaria Hippocratis, in the Bibliotheca Græca of Albertus Fabricius, or in vol. i. of Kühn’s edition of Hippocrates.

Galen, tom. v., p. 17; ed. Basil.

Apologie, etc.

Hippocratis nomine quæ circumferuntur scripta ad temporis rationes disposuit Christianus Petersen, p. prior. Hamburgi, 1839.

Prædict., i.; Coacæ Prænot.; de Loc. in Hom.

De Carne.; 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.; Præn.; Prædict., ii.; Aphor.; de Aëre, Locis, et Aq.; de Insom.; de Hæmorrh.; de Fistul.

De Nat. Puer.

De Prisca Med.

De Nat. Hom.; de Humor.; de Nat. Oss.; de Corde; de Corp. Sect.; de Gland.; de Visu; de Alim.; de Usu Liquid.; de Affect. Intern.; de Morb. Popul., ii., iv., etc.; de Morb., ii., iii.; de Morb. Mulier.; de Nat. Mulieb.; de his quæ ad Virg. Spect.; de Steril.; de Vulner.; de Judic.; de Dieb. Judic.

De Morb., iv.; de Genitura; de Remed. Purgant.

De Victu Sanor. libri tres.

Tom. ii., pp. 32, 33.

Œuvres d’Hippocrate, tom. i., p. 263.

See Stephanus, Comment. in Prognost. Hippocrat., tom. ii., p. 61, ed. Dietz.; and Galen, tom. v., p. 328, ed. Basil.

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

The death of Aristotle is referred to A.C. 321. Now this is just about the date of the foundation of the Royal Library at Alexandria, and very near the age when Herophilus flourished. These (M. Littré’s) positions clearly made out, it would follow that the dates of the treatises in the Collection come down very near to the foundation of the Alexandrian Library.

See Hengstenberg’s Commentary on the Psalms, pluries.

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

Prænotiones or Prognostica; Aphorismi; Epidemiorum, i., iii.; de Diæta Acutorum; de Aëre, Aquis, et Locis; de Capitis Vulneribus.

De Prisca Medicina; de Articulis; de Fracturis; Mochlicus; Jusjurandum; Lex; de Ulceribus; de Fistulis; de Hæmorrhoidibus; de Officina Medici; de Morbo Sacro.

Prorrhetica, i.; Coacæ Prænotiones.

De Natura Hominis; de Salubri Victus Ratione; de Natura Muliebri; de Morbis, ii., iii.; de Superfœtatione.

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

Epistolæ; Thessali Legati Oratio; Oratio ad Aram; Atheniensium Senatus-Consultum.

De Genitura; de Natura Pueri; de Morbis, iv.; de Mulierum Morbis; de Virginum Morbis; de Sterilibus.

Epidemiorum, v., vii.; de Corde; de Alimento; de Carnibus; de Septimanis; de Natura Ossium; de Glandulis; de Medico; de Decenti habitu; Præceptiones; de Anatomia; de Dentitione; de Exsectione Fœtus; de Visu; de Crisibus; de Diebus Criticis; de Medicamentis Purgativis.

Hippocrat. Coi Comment. etc., Theod. Zuingeri studio. Basil, 1579.

See his additions to Ackerman’s Dissertation, in his edition of the Works of Hippocrates.

§ 122, tom. i., p. 172 (ed. Bekker), where see the note of Heindorf.

Galeni Opera, tom. v., pp. 2, 16; ed. Basil.

Œuvres Complètes, etc., tom. i., p. 320.

The argument turns principally on the meaning of the expression, τι πότε λέγει Ἱπποκράτης τε καὶ ὁ ἀληθὴ λόγος, which M. Littré contends signifies, “ce qu’Hippocrate et la raison pourraient dire.” Now I must say that, to me, the words of Plato here quoted do not warrant the interpretation which M. Littré puts upon them; and, not satisfied with my own judgment on this point, which happens in the present instance to be an important one, I applied to one of the best authorities in Britain on the minutiæ of the Greek language for his opinion, and was happy to find that it entirely corresponded with my own. Having alluded in the text to the prolixity of the discussion which M. Littré enters into on this occasion, I trust that eminent scholar will not be offended (provided these pages ever meet his eyes) if I introduce here an anecdote of the celebrated Kuster. Having been shown a work in which the quantity of argumentation and reflection greatly over-balanced the amount of facts and references, he laid it aside with the remark, “I find nothing here but reasoning: non sic itur ad astra.”

Galeni Opera, tom. v., p. 119; ed. Basil.

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

See under Hippocrates in Smith’s Greek and Roman Biographical and Mythological Dictionary.

“In 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 be allowed, because the inward heat is stronger, which is the reason that a more plentiful food is necessary. This difference may be seen in such as are old, and in such as are lusty and well-grown bodies.”

“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 be nourished without danger.”

“When that which ought to be evacuated is discharged by spontaneous vomiting and diarrhœa, it is useful and easily endured; but when otherwise, the contrary. This is equally true with regard to every vessel,” etc.

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

“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 labor, 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 has been dry and cold, and the spring moist and warm, in summer acute fevers, ophthalmias, and dysenteries must necessarily occur, chiefly, however, among females and men of pituitous temperament.”

Tom. v., p. 399; ed, Basil.

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

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

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

“The extremities were generally very cold, there was seldom any heat in them.” (p 3.)

Præfat. 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., Comm. ii., Præf.

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.--Discours Préliminaire, etc., p. lvi.

De Placit. Hippocr., et Platon. ix.; de Diff. Resp., iii., 7.

Ap. Foës., p. 197.

Galeni Opera, tom. v., p. 652; ed. Basil.

Opera, tom. v., p, 578; ed. Basil.

Ibid., p. 170.

In Prædict. i., Comm. i., 4.

V. Galen, in Exeges. in vocibus ἐκλούσθω, σφάκερος, etc.

Præfat. Gloss. Hippocrat.

Gynæc., tom. i., P. I., p. 13.

In vita Hippocrat.

Ad Nepotian. de vita Cleric., Ep. ii., p. 13, tom. i.; ed. Paris, 1643.

Orat. Funebr., in Cæsarium Fratrem.

Sub voce Hippocrates.

Epist. ad C. Jal. Callistum.

Thesmophor., l. 240.

De Legg. iv., l. vi., p. 134; ed. Tauchnitz.

Tom. ii., p. xlviii.; Add. et Corrig.

Tom. v., p. 526; ed. Basil, etc. Elsewhere he quotes it as being undoubtedly genuine.--De Placit. Hippoc. etc., ix., 1.

Hist. Med., p. 283.

See Polybius, as quoted by Littré, l., c.; also section iii. of the Preliminary Discourse.

Saturnal., vii., 6.

Hist. Animal., iii., 3.

In Boerhaav., Meth. Stud. Med.

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

De Nat. Facult., tom. i., p. 87.

Opera, tom. v., p. 329; ed. Basil.

See English translation of PAULUS ÆGINETA, Book I., p. 549.

See Galen, tom. v., p. 2.

See further, under No. 1.

Opera, tom. v., pp. 17, 29.

See PAULUS ÆGINETA, I., 50.

I., 3.

Sect. ii., near the beginning.

Comment. in III. Epidem.

Ad Hippocrat. de Aëre, Aquis, Locis, § 65.

De Vulneribus superciliis allatis. Lips., 1741.

Lehre von den Augen-krankheiten. Wien, 1813.

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

Hist. Med., i., 3, 4, 60. His language is particularly strong: “Maximè genuinus ab omnibus judicatur.”

In his Commentary on this work.

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

Comment in Lib. de Nat. Human.

They are as follows: “Continuari cum libello de hæmorrhoidis manifeste spurio, ideoque ipsum esse spurium, Galenus jam notat in Gloss., s. v. πήρινα et στρυβλήν.” Now, as stated above, Galen does not say a word against the authenticity of these works.

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

Morb. Diuturn., i., 4.

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

See § 66, tom. vii., p. 359: ed. Bekker.

See all these authorities as quoted by Ackerman.

Hist. de la Méd., i., iii., 4.

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

“Dum terra fretum terramque levabit Aer.” Pharsal., i., 89.

And in like manner Ovid:

“Nec circumfuso pendebat in aere tellus Ponderibus librata suis.” Met., I., 11.

Bentley remarks, in his note on the passage in Lucan, “Omnis poetarum chorus hoc prædicat ut et philosophorum veterum.”

Morb. Chron., i.

Corp. Human. Appell., ii., 1.

See under θήριον and κρημνόι.

They refer apparently to Deipnos, ii., 7, where Athenæus quotes a treatise of Hippocrates περὶ τόπων, but he evidently means by it the work “de Aëre, Aquis, Locis.” It is to be borne in mind that Athenæus often makes his references in a loose manner.

De Facult. Natur., ii.

Censura Libr. Hippocrat., p. 115.

Comment. in Epidem., ii., 3. See also Le Clerc, Hist. de la Méd., iii., 17; and Sprengel, Hist. de la Méd., tom. i., p. 325, etc. A passage, which we shall see below, in the Prognostics (§ 15) puts it beyond a doubt that venesection was part of the routine of practice pursued by Hippocrates in cases of pneumonia. See also (and this passage is very decisive) de Diæta in Morb. Acut., § 5; and Galen’s Commentary, pluries.

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

See under Ἱππωκράτης. The meaning of the passage, however, is somewhat doubtful.

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

Zuinger, however, stands up for its genuineness. Hippocratis Vigenti duo Comment., etc., p. 386. He gives a most elaborate analysis of it.

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!”

Hist. de la Méd., 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.

Galen quotes it as a portion of the work on Diet. See Opera, tom. 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.

Zuinger points out a striking mark of the connection between it and the work ‘On Diet:’ op. sup. laud. p. 549.

Amstel., 1658.

Oneirocritica, etc. Lutetiæ, 1603.

Σκιᾱς ὄναρ ἄνθρωποι. Pind. Pyth., viii.

Comment. in Libr. de Diæt. Acut., i.

Tom. v., pp. 306, 614, etc.; ed. Basil.

See the Syd. Soc. edition of PAULUS ÆGINETA, Vol. I., p. 264.

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

See the Syd. Soc. edition of PAULUS ÆGINETA, Vol. I., p. 354.

I presume it was the rib itself that was perforated, and not the intercostal space. The term τρύπανον was generally applied to the trepan. The epithet τρυγλητήριον, or, as Foës proposes to read it, τρωλοδυτήριων, is probably derived from τρώγλη, a hole, and δύω, to penetrate; joined together, they would signify a trepan for boring holes.

Morb. Acut., iii., 17.

De Humor., Comment. in VI. Epidem.

Opera, tom. v., p. 456; ed. Basil.

The silphium, indeed, is mentioned among the remedies for this case in the treatise “On Regimen in Acute Diseases” (7), but not the other articles.

Ad Epidem., vi., 6, 27.

Hippocrat. Opera, i., p. 318.

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

I should mention that Zuinger pronounces, without the slightest hesitation, in favor of their genuineness: op. sup. laud. pp. 188, 199.

De Difficult. Respir., ii., 8; ibid., iii., 1.

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

Opera, tom. v., p. 24; ed. Basil.

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

VIII., 4.

Institut., Orat. iii.

De Perfect. in Virt.

§ 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 Hippocratis auctoritate decedit, quod in scriptis suis tot ægrotorum epiphonema ipsos mortuos esse legerem.”--Exer. v., de Utilitate Philosoph. Exper., p. 192. On the other hand, Mart. Lister justly defends Hippocrates: “A me sane absit illa quorundam nuperorum scriptorum jactantia, qui nihil exhibent, nisi quod bonum eventum habuit; errores et infortunia caute abscondunt, aliter autem nobis profuit magnus Hippocrates, apud quem fere non nisi casus funesti occurrunt, ac si iidem potioris doctrinæ essent.”--Exercit. de Hydrope.

Acut. Morb., iii., 17.

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 immaterial principle as the cause of the vital phenomena was not so well understood until after Plato and Aristotle had cultivated mental philosophy with so great success; for, as we shall see in the next section, Hippocrates seems to identify mind with heat, that is to say, he confounds the cause of motion and of change with its first instrument, or co-cause (συνάιτιον).

See the references given by Gruner, Ackerman, and Littré.

See Musonius, Ap. Stobæi Sentent., xviii. It occurs frequently in Galen.

Des Maladies de la France dans leurs Rapports avec les Saisons, p. 193. Paris, 1840.

Natural. Facult., ii., 8; de Placit. Plat. et Hippocrat., viii., 5.

Opera, tom. v., pp. 257, 479; ed. Basil.

Deipnos, ii., 46.

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

Ad Aphor. v., 37.

De Fœtus fabricat.

Comment. in Libr. de Fract. ap. Foës, p. 147.

Somnium Scipionis, i., 6.

Vol. i., p. 386; ed. Kühn.

Even Zuinger admits that, both in style and matter, these treatises are unlike the genuine works of Hippocrates.

Vol. i., p. 371; ed. Kühn.

Ibid., p. 387.

Ibid., p. 420.

In Gloss. in voce ἄλφιτα, etc.

See Foës, Œconom. Hippocrat. in voce κιών.

Bibl. Græc., ii., 24, p. 801.

Aristotle refers this opinion to Leophanes, De Generatione Animalium, v., 1.

De Placit. Hippocrat. et Plat., ix.

Comment., tom. xv., p. 224; ed. Kühn.

Noct. Attic., iii., 16.

Ap. Foës; ed. Hippocrat.

Comment. in Galen; ed. Dietz.

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

In Boerhaav. Meth. Stud. Med., i., 3, p. 594.

De Placit. Hippocrat. et Platon.

De Acut., i., 7; de Chron., i., 13.

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

In Epidem. Comm., iii., 29, etc.

See the remarks on this passage in the next section.

De Cosmopœa.

Opera, tom. v., p. 594; ed. Basil.

Καλὸν καὶ αγαθὸν. See the Annotations on Mitchell’s Aristophanes as to the import of this expression. I quote from memory.

I quote here from memory, not having leisure to search the passages in Galen’s works where this saying occurs. It is a maxim, however, which he frequently repeats.

One word (ἰχθύη) which occurs in this work is in the Glossaries of Galen and Erotian. This is likely to be an interpolation.

Tuscul. Disputat., v., 35.

In vita Platonis.

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

Scaliger, Menage, Gruner, and Littré, although they regard the Epistles as spurious, admit that they are “very ancient.”

See Diog. Lært. ix. Ælian. Var. Hist. iv., 20.

Chemical Essays, vol. iv., Essay 7.

Ocellus Lucanus, On the Universe.

Αόγοι γὰρ ἀσώματοι τυγχάνουσι τούτων.

Ocellus Lucanus, On the Universe.

Ibid.

Timæus Locrus, On the Soul of the Universe.

Diogenes Laertius, Life of Pythagoras. That Monad and Duad, in the symbolical language of Pythagoras, signified Mind and Matter, is positively stated by Philo Judæus. Ἑπόμενος δ' ἀκολουθίᾳ ύσεως κἀκεῖνο λέξω ὅτι μουὰς εἴκων αἰτίου πρώτου, δυὰς δε παθητῆς καὶ διαιρετῆς ὕλης.--De Specialibus Legibus. It may be proper to mention here that it is not true, as has been often stated in modern works, that Pythagoras himself taught the same system of the world as Copernicus; the first person who did so was Philolaus the Pythagorean philosopher. See Diogenes Laertius.

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

Ovid’s Metamorph., translated by Dryden, Book XV.

Plato, in his Timæus.

Ἐκμαγεῖον. Harris, in his Philosophical Arrangements, translates this word by “impression”; but it does not, strictly speaking, signify impression, but the substance which receives the impression. Wax, for example, is not the impression of the seal, but the substance which receives the impression. Matter, in like manner, is not the impression of forms, but the substance which receives the impression.

Plato, in his Timæus.

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

Apuleius the Platonic Philosopher, On Natural Philosophy.

Idem, On the Universe.

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

Plotinus, Ennead ii., 4.

Plotinus, Ennead ii., 6.

Proclus, Inst. Theol., 72.

Plutarch, On the Opinions of the Philosophers.

Galen, On the Elements, etc., ii.

Galen, Commentary on the Nature of Man.

Idem, On the Elements, etc.

Philo, on the Creation of the World.

On the Indestructibility of the Universe.

On the Creation.

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.

Simplicius, Comment. in Auscult. Nat., iv.

Ammonius, Comment. in Porphyr. Introd.

Ibid.

Theophrastus, On Fire.

Ibid.

Cicero, Quæd. Acad., i., 6.

Cicero, Quæd. Acad., i., 7.

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. Quæst., ii., 15.

Seneca, Nat. Quæst., iii., 10.

Lactantius, Div. Inst., iii., 3.

See under ἀρχαι.

Plutarch, Concerning the Opinions of the Philosophers.

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

Marcus Antoninus, iv., 46.

Ibid.

Ibid.

Manilius, Astron., iii., 53:--

“Principium rerum et custos natures latentûm Cum tantas strueret moles per inania mundi:

* * * * *

Aëraque et terras flammamque undamque natantem Mutua in alternum præbere alimenta juberet.”

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

Cicero, Acad. Quæst., i., 2; Galen, de Elementis.

Diogenes Laertius, Life of Democritus.

Ἡ ὔλη ἄποιος. Galen, de Element. ex Hippocrat.

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

“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.

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

Timæus.

De Igne.

De Partibus Animalium, ii., 2. His great commentator, Averrhoes the Arabian, states this distinction very correctly. See Cantic. Avicennæ, tr. v.

Lucan’s Pharsalia, i., 157, 606.

De Carnibus. (See the preceding section.) In like manner Phornutus says, “our souls are fire.” (De Nature Deorum, ap. Gale’s Opuscula Mythologica, p. 142.) Such is also said to have been the doctrine of Hippocrates and Democritus. See Macrobius (Somnium Scipionis, i., 14); and Nemesius (de Nat. Hominis). In the Hippocratic treatise De Septimadibus, which M. Littré has discovered in Latin, the essence of the soul is held to be heat. (Ed. Littré, i., p. 391.)

De Partibus Animalium, ii., 7.

De Anima, ii., 4.

Ὄτι πᾶν ἐκ πάντος γινέσθαι πέφυκε.--Aristot. de Ortu et Interitu. et Auscultationes Naturales, i.

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 à des transformations de fluides; et c’est dans la manière dont ces transformations s’opérent, que gît le véritable secret de cette admirable économie.”--Leçons d’Anatom. Comp. lib. i.

It will be readily understood that allusion is here made to the diseases ossification and osteosarcoma.

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

De Sapient. Vet., cap. xiii.

Op. cit., iv.

These opinions of Newton bear a strong resemblance to those of Strabo, as expressed in the following passage: “Since all things are in motion and undergoing great changes, it is to be supposed that neither does the earth always remain the same, so as neither to be augmented nor diminished; nor yet water; nor that either always possesses the same seat, for that a change of one thing into another seems very much according to nature. For that much earth is converted into water, and much water into earth.”--Geograph., xvii., 1.

See p. 120, Ray Society’s edition.

See Simon’s Chemistry, vol. i., p. 5; Sydenham Society’s edition. The etymology of the term protein is there given from πρωτέυω, I am first; but it may more properly be derived from Proteus, to which, as we have mentioned above, the first matter was likened.

Lucretius, de R. 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 Sirens I cannot but think that the poet meant to represent Philosophy and Melody, these being, as it were, the handmaids of Poetry. They assail the virtue of Ulysses with no vulgar temptations, by assuring him that they were well acquainted with all the martial exploits in which he had been engaged, and that he would leave them “much delighted, and with an increase of knowledge.”

Ἀλλ’ ὄγε τερψάμενος νεἰται καὶ πλέιονα ἐιδώς. Odyss, xii., 188.

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

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

Tom. i., p. 567.

See Note, p. 191.

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

The maza was a sort of pudding or cake made from barley-meal mixed up with water, oil, milk, oxymel, hydromel, or the like. It also was a very ancient invention, for it is mentioned in one of the works of Hesiod, which is universally allowed to be genuine, I mean the Opera et Dies, 1., 588.

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

He means both the pilot and physician.

Καθαρὸς ἄρτος ἢ συγκομιστός. There has been some difference of opinion regarding these two kinds of bread; but it appears to me probable that the former was made of flour from which the bran had been entirely excluded, and the other from flour containing the whole of the bran. Later authorities called the one siligo, and the other autopyrus. See PAULUS ÆGINETA, Vol. I., p. 121.

He alludes here to the secretions and humors in the body. See the Commentary of Heurnius.

See Littré, h. 1.

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

Meaning the mammæ, according to Heurnius.

Such as the spleen and lungs.

Although I shall touch cursorily on this subject in my annotations, I cannot deny myself the pleasure of setting down here the following passage from the treatise of Longinus “On the Sublime.” It is to be borne in mind that it was written by a noble-minded Greek, who lived at the court of an Oriental despot, and must have been a daily observer of the effects which he so feelingly depicts. Who does not lament to think of a generous mind placed under circumstances where cowardice is honored and courage debased? And what more melancholy picture of human misery can be imagined than that which is here exhibited of the bodily and mental powers in a state of arrested development from the effects of confinement?

Ἥμισυ γάρ τ' ἀρετῆς (κατὰ τὸν Ὅμηρον) ἀποαίνυται δύλιον ἦμαρ· ὥσπερ οὖν (εἴγε γησὶ, τοῦτο πιστόν ἐστι) ἀκούω τὰ γλωττόκομα, ἐν οἱς οἱ Πυγμαῖοι καλούμενοι νάνοι τρέφονται, οὐ μόνον κωγύει τῶν εγκεκλεισμένων τὰς αὐξήσεις, ἀλλὰ καὶ συνάγει διὰ τὸν περικείμενον τοῖς σώμασι δεσμόν· οὒ τως ἅπασαν δουλείαν, καὶ ἦ δικαιοτάτη, ψυχῆς γλωττόκομον, καὶ κοιόν δή τις ἀποφήναιτο δεσωπτήριον.--§ 39.

M. Littré thus states the four principal points to which Hippocrates here directs attention:

“1st. Il cherche quelle est, sur le maintein de la santé et la production des maladies, l’influence de l’exposition des villes par rapport au soleil et aux vents.

“2d. Il examine quelles sont les propriétés des eaux, bonnes ou mauvaises.

“3d. Il s’efforce de signaler les maladies qui prédominent suivant les saisons, et suivant les alternatives que chacune d’elles épreuve.

“4th. Enfin, il compare l’Europe et l’Asie, et it rattache les différences physiques et morales qui en séparent les habitants, aux différences du sol et du climat.”

He goes on, however, to state, that these four questions, although neatly put, are merely sketched, and half insinuates that it is a defect in the work, that it merely contains our author’s assertions, without the corresponding proofs. In a modern work, he remarks, the mode of procedure would be different; for it would be expected that the general truths should be supported by detailed and prolonged statistics on particular facts. It is to be borne in mind, however, that the work of Hippocrates was probably meant merely as a text-book, on which were grounded his public prelections, wherein would, no doubt, be given all the necessary proofs and illustrations. In this respect, it resembles the esoteric works of Aristotle, of which the author of them said that when they were published the contents of them, in one sense, were not communicated to the public, as they would be unintelligible without the illustrations by which they were accompanied when delivered in his school. In conclusion, I would beg leave to remark that, if the work of Hippocrates, in its present form, appear defective when compared with what a modern work on the same subject would be expected to be, it has also peculiar traits which would hardly be matched in a modern composition. In a modern work we might have a greater abundance of particular facts, and a more copious detail of individual observations, but would there be such an exuberance of general truths, of grand results, and of original reflections?

The classical reader is referred to Theophrastus’ treatise De Signis Aquarum et Ventorum, for much interesting information on this subject.--See also Galen, Op. tom. v., p. 346, 347, ed. Basil.

I. 105.

It appears to me, however, that the meaning of Longinus in this place is rather overstrained.

Coster, Défense des (Œvres de Voiture, etc., p. 194.

Réponse à l’Apologie de Voiture, par Coster, p. 54.

Memoria Scythica, in Comm. Petropol. p. 377–78.

P. vi., p. 35.

Notæ in Longinum.

Comment, in vetus Monument, p. 415.

Nosol. Meth. p. 365.

De maribus inter Scythas morbo effeminatis, etc., p. 28.

Hipp. de Aere, etc., t. ii., p. 326.

Morb. Târd. iv., 9.

Hist. of Greece, pluries.

The part in parenthesis is rather obscure. In the old French translation it is rendered thus: “Elles sont très différentes entre elles par leur nature, et il arrive d’ailleurs une infinité de changemens qui sont tous divers.” On these changes, see Aphor. iii., 2–15.

I have translated this passage agreeably to the reading suggested by Coray, that is to say, ὀυκ ἐδωδὸς, which appears to be a great improvement, although it is not adopted by Littré. Without the negation (ὀυκ) the contrast between the first and the last clause of the sentence is entirely lost. It will be remarked that I have translated ἀριστητάι, eating to excess. The ἄριστον, or dinner, was a meal which persons of regular habits seldom partook of, and hence Suetonius mentions it as an instance of Domitian’s gormandising propensities, that he was in the habit of taking dinner.--See Vita Domitiani; also PAULUS ÆGINETA, B. I., 109.

It will be remarked that our author uses meteorology and astronomy almost as synonymous terms. In his time meteorology was looked upon by practical men as a visionary subject of investigation, which had a tendency to make those who engaged in it atheists, and the enemies of Socrates took advantage of the prejudices then prevailing against it to represent him as a meteorologist. See Aristophanes (Nub. 225.) Aristophanes, who would appear to have been always too ready to pander to the popular prejudices of the day, also represents the physicians as being “meteorological impostors,”--μετεωροφένακας. (Ibid. 330.) The enlightened mind of Aristotle, however, regarded meteorology in a very different light, and accordingly he wrote a work on the subject replete with all the astronomical and geological knowledge of his time. In it he professes to treat of the heavenly bodies and atmospherical phenomena, including winds, earthquakes and the like; also of minerals, fossils, etc. See the introduction to his Meteorologica.

Upon reference to the editions of Coray, Clifton, and Littré, it will be seen that the text here is in a doubtful state. I shall not weary the reader by stating my reasons for adhering to the meaning which I have adopted.

In place of the common reading, παιδίον, Coray adopts θεῖον which certainly, at first sight, appears to be an improvement. But I admit, with Littré, that the authority of Galen (tom. v., p. 447, ed. Basil), is quite decisive in favour of παιδίον. It is also to be taken into account in this place that the author of the treatise on Dentition brings prominently into view the connection between infancy and convulsions, which adds probability to the supposition that in those days convulsions may have been called “the disease of infancy.”

The Hepialus is a species of intermittent fever, very common in warm climates. It would appear to be a variety of the quotidian. See PAULUS ÆGINETA, Vol. I., 252, Syd. Soc. edition.

Frequent mention of this disease of the skin occurs in the works of the ancient writers on medicine. See PAULUS ÆGINETA, Vol. II., 40. We have there stated that it would appear to have been some species of Eczema, with which we are now unacquainted. Coray has a very lengthy note on it, but arrives at no satisfactory conclusions on the subject. He brings into review three cutaneous diseases, namely, the bouton d’Alep.. (described, Mémoir. de la Société Royale de Médic., année 1777, 1778, t. i., p. 313;) the pelagre, (described, Toaldo, Essai Méteorolog., pp. 19, 20; Comment. de Rebus in Scient. Nat. et Médec. Gestis., tom. xxxi., p. 553; and Journ. de Médec. tom. lxxx., p. 272;) and the lepre des Asturies or mal de la rosa, (described by Thieri, Journ. de Médec., tom. ii., p. 337.)

Coups de soleil, or strokes of the sun, are often mentioned incidentally in the works of the ancient authors, but no one has treated of them in any very systematic manner, as far as I recollect. On the effects of exposure to cold and heat, see, however, PAULUS ÆGINETA, Vol. I., 49–51, Syd. Soc. edition.

Ῥηγματα καὶ σπάσματα. There has been much difference of opinion as to the exact import of these two terms. It would appear to me that they were intended to apply to a rupture or straining of the fibres, occasioned by external violence. M. Littré has a very interesting note on this subject, tom. v., p. 579. On these strainings see further Coacæ Prænotiones, 376, 418. M. Littré, l. c., relates a case of empyema brought on by lifting a heavy piece of wood. On these terms see further the Annotations on Demosthenes, Olynth. ii., 8, ed. Dobson; and Foës, Œc. Hippocr.

Clifton translates this clause of the sentence thus: “Even if there be but a small distance between them,” and, I think, correctly, although Coray is not quite satisfied with this interpretation. The stadium was nearly the eighth part of a Roman mile, that is to say, it consisted of 94½ French toises, or 625 English feet.

In another place, I have given a summary of the information supplied by the ancient authors on this subject, (PAULUS ÆGINATA, Vol. I., 66.) Upon the whole, none of them gives so much valuable matter on it as our author. Coray has some elaborate annotations on this passage.

It can scarcely admit of a doubt that our author here alludes to scurvy. (See Coray at this place, and Lind on Scurvy, iii., 1.) He also describes the disease distinctly in the second book of Prorrhetics, that is to say, if Hippocrates be actually the author of that book. See also Epidem. ii., 1; de Affection., de inter. affect.; Cælius Aurelianus, Tard. Pass. iii., 4; Celsus, iv., 9; Aëtius, x., 11; Pliny, H. N., xxv., 3; Aretæus, Morb. Diuturn, i., 14; and Paulus Ægineta, iii., 49; Marcellus, de Medic. ii.

The leucophlegmasia is treated of in different parts of the Hippocratic treatises, as Aphor. vii., 29; de Morb. ii. By it he evidently meant a species of dropsy, as Galen remarks in his commentary on the Aphorisms (l. c.). It occurs in Aretæus’s chapter on dropsy. Morb. Diuturn. ii., 1; Octavius Horatianus, v. Celsus makes it to be synonymous with anasarca, iii., 21. Our author would seem to notice these varieties of dropsy as being affections to which pregnant women are subject.

On hydrops uteri see the authorities quoted in the Commentary on PAULUS ÆGINATA, B. III., 48, Syd. Soc. edition. It may appear singular that hydatids of the womb should be particularly prevalent in the case of women that drink unwholesome water from marshes, and yet our author’s observation is confirmed by a modern authority as quoted by Coray: “Il a été également prouvé par les observations des Modernes, que les fausses grossesses produites par les hydatides; sont très-communes dans les pays marécageux, ou la plupart des habitans ont une constitution lâche, propre à l’affection scorbutique, qui y est presque endémique, qu’elles terminent plus ou moins tard par l’excrétion de ces hydatides.”--(Notes sur le Traité des Airs, &c., p. 106.) Sydenham, moreover, describes the symptoms of false pregnancy in much the same terms as our author. (Tract de Hydrop.)

On the Thermal waters of the ancients, see PAULUS ÆGINATA, Vol. I., 72. I have treated fully of the ancient alum and nitre under στυπτηρία and λίτρον, in the Third Volume. Coray, in his notes on this passage, does not throw much light on this subject. The opinion here delivered by our author, that these metallic substances are produced by the operation of heat, is adopted and followed out by Aristotle towards the end of the third book on Meteorologia.

Corny appears to me to be unnecessarily puzzled to account for our author’s statement, that saltish waters, although held to be purgative, are, in fact, astringent of the bowels. But, although their primary effect certainly be cathartic, is it not undeniable that their secondary effect is to induce or aggravate constipation of the bowels? Certain it is, moreover, that all the ancient authorities held salts to be possessed of desiccant and astringent powers. See PAULUS ÆGINETA, Vol. III., under ἂλες.

Aristotle discusses the subject in his Problems, ii., 9, 36, 37; ii., 15; i., 53; v., 34, and arrives at nearly the same conclusions as Hippocrates. See also Theophrastus de Sudoribus.

I cannot hesitate in adopting the emendation suggested by Coray (ἀποσήθεσθαι) in place of the common reading (ἀποσήπεσθαι), which evidently has no proper meaning in this place. I am surprised that M. Littré should have hesitated in admitting it into the text.

Athenæus, in like manner, praises rain water. Deipnos ii., 5.

It appears singular that Athenæus, who is undoubtedly a most learned and judicious authority on all matters relating to Dietetics, speaks as favorably of water from ice as he does of rain water. Both he praises for their lightness, (l. c.) Celsus gives the character of the different kinds of water with his characteristic terseness and accuracy: “Aqua levissima pluvialis est; deinde fontana; tum ex flumine; tum ex puteo: post hæc ex nive, aut glacie; gravior his ex lacu; gravissima ex palude,” (ii., 19.) Galen treats of the medicinal and dietetical properties of water in several of his works, and uniformly agrees with Hippocrates in the judgment he pronounces on them. See in particular, De Ptisana; De Sanit. tuend. ii.; Comment. ii. in Libr. de Ratione victus in Morb. acut.

Athenæus, on the other hand, argues from the fact that ice is lighter than water, that water formed from ice must be light. Pliny gives a lucid statement of the opinions of those who held that water from ice is light and wholesome, and those who, like Hippocrates, held it to be just the reverse. He says in the words of Hippocrates, literally translated, “nec vero pauci inter ipsos e contrario ex gelu ac nivibus insaluberrimos potius prædicant, quoniam exactum sit inde, quod tenuissimum fuerit.” (H.N. xxxi., 21.) See also Seneca, Quæst. Natural. iv. It would appear that iced liqueurs were greatly relished at the tables of gourmands in those days. I need scarcely remark that there has been great difference of opinion in modern times regarding the qualities of water from melted snow and ice. It was at one time generally believed that it is the cause of the goîtres to which the inhabitants of the valleys bordering on the Alps are subject. This opinion, however, is by no means generally held at the present time.

This is a most interesting chapter, as containing the most ancient observations which we possess on the important subject of urinary calculi. The ancients never improved the theory, nor added much to the facts which are here stated by our author. We have given the summary of their opinions in the Commentary on PAULUS ÆGINETA, B. III., 45. I would beg leave to remark that, notwithstanding the number of curious facts which modern chemistry has evolved regarding the composition of urinary calculi, the etiology of the disease is nearly as obscure now as it was in the days of Hippocrates.

Coray remarks that Prosper Martian, in his commentary on this passage, confirms the truth of the observation here made, that persons affected with calculus have the bowels constipated.

Theophilus, in his treatise De Urinis, would seem to contradict this observation of Hippocrates, when he states that the urine of calculous persons is thick and milky (8.) But, according to Prosper Martian, when the calculus is in the state of formation, its characters are as described by the latter, whereas, when the calculus is already formed, the urine is limpid, as described by Hippocrates.

It is worthy of remark that Celsus states just the reverse with regard to the practice of women laboring under the stone; he says: “Feminæ vero oras naturalium suorum manibus admotis scabere crebro coguntur.” (ii., 7.) Are we to suppose that he followed a different reading? Considering how well he shows himself acquainted with the works of Hippocrates, it cannot be thought that he had overlooked this passage.

Our author, it will be remarked, ascribes the comparative immunity from calculus which females enjoy to their freer use of liquids. Celsus, in laying down directions for the regimen of a calculous person, as preparatory for the operation, among other things, directs, “ut aquam bibat,” (vii., 26–2.) Coray collects the opinions of several modern authorities in favor of drinking water as a preventive of calculus. Thus Tissot states that the Chinese, who drink so much water with their tea, enjoy almost an immunity from the disease. (De la Santé des Gens de Lettres, p. 196,) Campfer, in like manner, affirms that calculus has become less common in Europe since the introduction of tea, which he justly attributes to the amount of water drunk with it, rather than to any virtues of the plant itself. (Comment de Reb. in scient. nat. et medic. gestis, vol. xvi., p. 594.) Metzger attributes the diminution of the number of calculous cases in Königsberg to the use of draughts of tepid water. (Journal de Médec., vol. lxvii., 348.) The Turks, according to Thevenot, owing to their free use of water, are almost exempt from the disease. (Voyage au Lévant, c. xxvii., p. 70.)

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.

See Aphorism iii., 11.

The celebrated Haller charges Hippocrates with inaccurate observation in stating that dysenteries are epidemic in spring, which, he contends, is contrary to modern experience. (Bibl. Med. Pract., vol. i., p. 61.) Hippocrates, however, is defended by Gruner (Cens. libr. Hippocrat. ii., 5, p. 51), and by Coray. (Notes, etc., p. 159.) The latter justly argues, that although dysentery may not prevail at that season in Germany, that is no reason for holding why it may not be so in Greece. He also refers to the works of Birnstiel and Stoll for descriptions of epidemical dysentery, occurring in the season of spring.

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 Commentary on PAULUS ÆGINETA, Vol. I., p. 365. See Coray’s lengthened note on this passage.

Aphorism, iii., 13.

Aphorism, iii., 14.

I have stated in my analysis of the short treatise “On Purgative Medicines,” that the author of it forbids the administration of these medicines, that is to say, of drastic purgatives, during excessive heat or cold.

One may see, upon consulting the editions of Clifton, Coray, and Littré, that there are great varieties of readings in regard to the word which I have translated “affectionate.” It will be remarked that I have followed Coray and Littré in reading εύοργητότερα. Clifton adopts ἀεργότερα, and translates it “unactive.”

This expression of our author is ambiguous. Coray explains it thus: “il entend le lever d’été, qu’il place à 45 degrés de l’Est au Nord, dans l’horizon de la Grece, et particulièrement celui de l’île de Cos; et le lever d’hiver qu’il place à 45 degrés de l’Est au Sud.”

The sense undoubtedly requires this addition, and therefore I have not scrupled to follow the reading of Cornarius, καὶ τοῡ θερμοῡ.

The term here used meant particularly the fructus horæi, or summer fruits; namely, cucumbers, gourds, and the like. (See PAULUS ÆGINETA, B. I., § 80.) Surely Coray forgot himself, when he wrote thus regarding the distinction between the summer and autumnal fruits of his country: “les Grecs entendoient particulièrement par ὡρᾱια les fruits de la fin de l’été, c’est-à-dire, de cette partie de l’année qu’ils appelloient ὀπώραν, etc.”

It is but too apparent that there is a lacuna in the text here. A chapter devoted to an examination of the peculiarities of the Egyptians and Libyans is evidently lost. As M. Littré has remarked, Galen appears to refer to the contents of the lost chapter. (Opera, tom. xvi., p. 392; ed. Kühn.)

That is to say, the Sea of Azoff. See Herodotus, iv., 86, who calls it Μαιῆτις. This was generally held to be the division between Europe and Asia, as stated by our author. As Coray remarks, its borders on the north-west are occupied by the inhabitants of Little Tartary: it has the Crimea on the south-west; the Tartars of Cuban and the Circassians on the south-east.

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 Harpocration in Μακροκέφαλοι; Pomponius Mela, i., 19; Strabo, xii.; Scholiast Apollon. Rhod., i.; Dionysius Periegetes.

The exact situation of the savage nation of the Macrocephali cannot be precisely determined, but it was evidently not far from the Palus Mæotis, and most probably in the vicinity of the Caucasus. Little is known of them, except what our author says respecting the practice which they had of disfiguring their heads by squeezing them, in early infancy, into an elongated shape. It is well known that the same absurd usage prevailed among the early inhabitants of MEXICO. I need scarcely say that much important information respecting them has been obtained of late years. M. Littré, in the fourth vol. of his edition of Hippocrates, supplies some very important information in illustration of this subject, from a recent publication of Dr. H. Rathke. Certain tumuli having been excavated at Kertch, in the Crimea, there were found in them, besides different utensils and statues, several skeletons, and it was most remarkable that the form of the head was greatly elongated, in the manner described by Hippocrates with regard to the Macrocephali. The author’s words are: “On y remarquait, en effet, un hauteur extraordinaire par rapport au diamètre de la base, et par là ils frappaient même les personnes qui n’avaient aucune connaissance de la structure du corps humain.”

The same theory respecting the secretion of the semen is given in the treatises “De Genitura” and “De Morbo Sacro.” It is espoused by Galen, in his little work. “Quod animal sit quod utero continetur.” Coray remarks that Hippocrates’s theory on the origin of the fœtus does not differ much from that of Buffon.

I need scarcely remark that both the river and city of this name are very celebrated in ancient mythology and history. See in particular Apollonius Rhodius, with his learned Scholiast, Arg. II.; Strabo, xi.; Pliny, H. N., vi., 4; Procopius, Pers., ii., 29; Mela, i., 85; Arrian, periplus. The river takes its rise in the Caucasus, and terminates in the Black Sea. It is called Rion by the inhabitants, and the river and a city situated upon it are called Fache by the Turks. See Coray at this place, and Mannert., Geograph., iv., 394.

Coray quotes from Lamberti, a modern traveller, a description of the Colchide and its inhabitants, which agrees wonderfully with the account of both given by our author. The following is part of his description: “Il sito della Colchide porta seco un’ aria tanto humida che forse in altro luogo non si è veduta la simile. E la ragione si è perchè venendo dall’ occidente bagnata, dall’ Eusino, et dall’ oriente cinta dal Caucaso, dal quale sorgano gran quantità di fiumi rende da per tutto l’aria humidissima affatto. A questo s’ aggiungono la frequenza de’ boschi, fra quali non viene agitata l’aria da’ venti, et li spessi venti marini apportatoi di pioggie et de’ vapori del mare. Questa humidità si grande genera poi gran quantità de’ vapori, che sollevati in alto si dissolvono in frequentissime pioggie.”--Relatione della Colchide, c. 27. He goes on to state that a great part of the inhabitants are fishers.

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.

The best practical proof of the justness of our author’s reflections in this place is the result of the battle of Salamis; and the noblest intellectual monument which ever the wit of man has raised to the triumph of freedom is the Persæ of Æschylus, in celebration of that event. A single line, descriptive of the Greeks, is sufficient to account for their superiority to the Asiatics:

Οὔ τινος δοῦλοι κέκληνται φωτὸς, οὐδ' ὑπήκοοι.--1., 240.

None seem to have felt the force of this great truth so much as the Persian despots themselves, or to have estimated the effects of civil liberty higher than they did. The younger Cyrus, before the battle of Cynaxa, addresses his Grecian soldiers in the following memorable words: Ὦ ἄνδρες Ἕλληνες, οὐκ ἀνθρώπων ἀπορῶν βαρβάρων συμμάχους ἡμᾶς ἄγω, ἀλλὰ νομίζων ἀμείνονας καὶ κρείττους πολλπῶν βαρβάρων ὑμᾶς εἶναι διὰ τοῦτο προσέλαβον ὅπως οὖν ἔσεσθε ἄνδρες ἄξιοι τῆς ἐλευθερίας, ἧς κέκτησθε, καὶ ὑπὲρ ἧς ὑμᾶς ἐγὼ εὐδαιμονίζω· εὖ γὰρ ἴστε, ὅτι τὴν ἐλευθερίαν ἑλοίμην ἂν ἀντὶ ὧν ἔχω πάντων καὶ ἄλλων πολλαπλασίων.--Anab., i., 7. Such being the established opinions of the intelligent portion of mankind in the days of Hippocrates, the sentiment here expressed would then be regarded as a self-evident truth. Plato, indeed, modifies this opinion in so far when he holds despotism to be the consequence and not the cause of servility.--De Repub., viii.

The name Sauromatæ or Sarmatæ was applied by the ancient geographers to certain inhabitants of that vast and, to them, nearly unexplored country, extending from the Sinus Codanus or Baltic Sea, to the Euxine or Black Sea. It comprehends, then, a large portion of Russia, Poland, and perhaps Prussia. (See Pomponius Mela, iii., 4; Ptolemy, Geograph.; and Maltebrun, Geograph., vol. i., p. 126.) That the Sarmatians and Scythians were the same race of men, although some of the authorities make a distinction between them, can scarcely admit of a doubt. Our author, it will be remarked, seems to restrict the name to a peculiar race of Scythians, who lived near the Palus Mæotis (or Sea of Asaph). From the account which he gives of them it is impossible to doubt that he alludes to the Amazonians, so celebrated in ancient legends. The opinion which I entertain of them is pretty fully stated in the Argument to this treatise. That our author should not have doubted the real existence of the Amazonians need excite no wonder, considering the very positive and very circumstantial account of them given by his contemporary Herodotus (iv., 110–18).

It may at first sight appear singular that our author should have mixed up his account of the Scythians with allusions to the Egyptians; but he probably had in view Herodotus (ii., 103–6), who connects the Egyptians with the Scythians, and more especially with the tribe of them called Colchians. He states in particular that the Colchians and Egyptians resembled one another in the fashion of their linen, their whole course of life, and in their language.

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 certainly Virgil (Georg., iii., 349–83), and perhaps Horace (Od. iii., 24), had it in view when they drew their pictures of the nomadic life of the Scythians. The extraordinary cold of that region, notwithstanding its southern latitude, has not been exaggerated by ancient authors; but to account for it, as the modern traveller, Clark, remarks, is still a problem which no one has solved. Strabo mentions that carts were driven across the Palus Mæotis (Geogr., vii., 3). The chariots covered in from the inclemency of the weather with a roof of felt, are described also by Strabo (Geogr., l. c.); and, according to Dr. Coray, similar contrivances are still to be found among the Kalmucs and other savage nations. (Notes sur le Traité des Airs, etc., h. 1.) A preparation from milk resembling the hippace is still used by the inhabitants of that region. On the people who lived upon this composition from milk, see in particular Strabo, vii., 3.

The following lines of Virgil, referred to above, may be almost said to be a translation of this passage:

“Semper hiems, semper spirantes frigora Cauri. Tum sol pallentes haud unquam discutit umbras;

* * * * *

Talis Hyperboreo septem subjecta trioni Gens effrena virûm Rhiphæo tunditur Euro.”

It was in this region of mist and cold that the celebrated race of the Cimmerians resided. See Herodot., i., 6, etc.; Homer, Odyss. x., 14. The montes Rhiphæi would appear to have been the Ural mountains which separate Russia from Siberia.

It is well known now that excessive cold has a tendency to retard the growth of animals. This opinion is confirmed in several instances by Pallas (Voy. en Russie, i., 197; iii., 431.) Strabo mentions, as the consequences of the cold which prevails in the country of the Getæ, that there are no asses in it, the cattle want horns, and the horses are small. (Geogr., vii., 3.)

Buffon, on the other hand, maintains that the Nomadic race are men of active habits. (Hist., Nat., tom. iii., p. 384.) Pallas, however, confirms the judgment of Hippocrates. (Voyag. en Russie, tom. i., p. 499.) See also Coray, ad. h. l.

It is to be borne in mind that Hippocrates, and after him most of the ancient authorities, held that the fœtus is formed from the male semen. This doctrine prevailed generally down to the days of Harvey. Some of the ancient physiologists, however, maintained that “omne animal est ab ovo.” See Plutarch, de Placit. Philos.

Ὑγρότης, when applied to the body, may signify both humidity and relaxation, in like manner as the adjective (ὑγρὸς) signifies humid and relaxed. We shall see an example of the latter signification in the Prognostics.

This practice came to be one of the regular operations of surgery, being performed with the view of correcting the tendency of a joint to dislocation. It is minutely described by Hippocrates (De Artic., xi.), Paulus Ægineta, (VI., 42), Albucasis (Chirurg., i., 27), Haly Abbas (Pract., ix., 78). See the Sydenham Society’s edition of PAULUS ÆGINETA, 1. c.

The meaning of this passage is ambiguous. I have followed Coray, who gives some very interesting annotations on it. He translates these words, “Ils sont naturellement d’une complexion lâche et trapus; premièrement, parceque dans leur enfance ils ne sont point emmaillotés, non plus que les Ægyptiens.” Clifton has given nearly the same meaning of the passage: “Their fluidness and breadth proceed first from their neglect of bandages, as in Egypt.” Littré, on the other hand, appears to give a different interpretation of the passage: “D’abord parceque on ne les emmaillotte pas, comme en Egypte.”

A fat condition of the body was also supposed adverse to conception in the case of cattle. Virgil alludes to this opinion, and the means used to counteract the effects of an excessively fat state of the body in the following verses, which have been always admired as an example how delicately a great genius can touch upon an indelicate subject:

“Ispa autem macie tenuant armenta volentes, Atque, ubi concubitus primos jam nota voluptas Sollicitat, frondesque negant, et fontibus arcent. Sæpe etiam cursu quatiunt et sole fatigunt; Hoc faciunt nimio ne luxu obtusior usus Sit genitali arvo, et sulcos oblimet inertes; Sed rapiat sitiens venerem, interiusque recondat.”

Georg., iii., 136.

On the nature of this affection see the Argument. There is a variety in the reading, most of the MSS. having ἀνανδριείς, but the one usually marked 2146, which is followed in the Aldine edition, reading ἀνδριεῖς. See a long discussion in Coray’s edition on this point. There seems to be no good reason for at all interfering with the text as it now stands.

Our author in this place, as in the treatise on the Sacred Disease, holds the philosophical opinion in opposition to the superstitious, that all diseases have natural causes, and that no one more than another is to be ascribed to the extraordinary interference of supernatural beings. Plato, his contemporary, would appear to have endeavored to steer a sort of middle course between the scientific and the popular belief. Thus he ascribes epilepsy, like all other diseases, to a natural cause, namely, in this instance, to a redundancy of black bile; but he qualifies this opinion by calling the passages of the brain (the ventricles?) most divine, and adds that the disease had been most appropriately denominated sacred. (Timæus, § 66.)

The origin and signification of this term are by no means well defined. See Galen (Exeges, etc.), Foës (Œcon. Hippocr.), and Coray (ad h. l.). It has been applied first, to certain varieties of morbus coxarius; secondly, to chronic buboes, superinduced by disease of the hip-joint; thirdly, to paralysis of the muscles about the genital organs; fourthly, aneurismal varix. (See Aretæus, Morb. Acut., ii., 8; and the note in Boerhaave’s edition.) I must own that I find some difficulty in deciding to which of these significations I should give the preference; I rather incline, however, to the first, from what our author says towards the end of this section, namely, that all men who ride much “are afflicted with rheums in the joints, sciatica and gout, and are inept at venery.”

This opinion of our author was no doubt founded on the erroneous notion regarding the distribution of the veins which prevailed in his time, and which we find advocated in the tract “on the Nature of Man,” and elsewhere. (See Aristot., H. N., iii., 3.) Coray strives hard, in his annotations on this passage, to make out that the fact may be as stated by his ancient countryman, although the hypothesis by which he explained it be false. It is singular, however, that, after the lapse of more than two thousand years, Phrenology should have come to the assistance of Hippocrates in this case. I need scarcely remark that Gall and his followers hold that the cerebellum is the seat of the animal appetites, so that, if this be really the fact, a close sympathy between the back of the head and the genital organs may be very legitimately inferred. At all events, this coincidence between ancient observation and modern hypothesis must be admitted to be very remarkable.

Aristotle, on the other hand, holds that the effects of equitation are aphrodisiac. (Probl. iv., 12.) Coray attempts to reconcile the discordant opinions of the physician and philosopher, by supposing that moderate exercises may excite the venereal appetite, whereas excessive extinguish them. Van Swieten agrees with Hippocrates that inordinate exercise in riding may induce impotence. (Comment. in Boerh. Aphor., § 1063.)

It is a singular idea of our author that the wearing of breeches by confining the development of the genital organs impairs the sexual desires. It is curious, as remarked by Coray, that the same opinion is advocated by Hunter in his treatise on the Venereal Disease. Coray also quotes the following passage from Lalement: “Sæpe audivimus pistores et cæteros quorum partes pudendæ subligaculis non obteguntur sed liberius pendent crassos et bene nutritos habere testiculos.”--Comment. in Hippocrat. de Aer., etc.

I trust I shall be excused in quoting entire Dr. Coray’s note on this section: “Trente mille Macédoniens (dit Pauw) ont conquis la Perse; quarante mille Mogols ont conquis les Indes; cinquante mille Tartares ont conquis la Chine, où l’on comptait alors plus de quarante millions d’habitans, qui abandonnèrent leurs souverains. On a vu de nos jours l’armée du grand Visir déserter presque complètement dans les environs de Varna; et jamais les Turcs n’eurent plus de bon sens qu’en cette occasion là; car leurs tyrans ne méritent pas qu’on verse une seule goutte de sang pour les maintenir sur le trône de ces contrées qu’ils ont dévastées en voleurs et en brigands. (Recherch. philosoph. sur les Grecs.)--Par ce dernier exemple on voit encore combien les causes politiques ou morales, et les causes naturelles, peuvent se modifier réciproquement. Les Russes, quoique soumis à un gouvernement despotique, ont cependant été la terreur des Turcs, à cause, sans doute de la différence du climat, de la discipline militaire, et des progrès dans la civilisation. Ces circonstances ont concouru à mitiger le despotisme Russe, et à le rendre si différent du despotisme brutal des Turcs. Il en est de même des autres peuples Septentrionaux de l’Europe. Quoique gouvernés par des loix qui ne sont point leur ouvrage, ils sont très belliqueux, et par la nature de leur climat, et par les lumières que les sciences et les arts ont répandues parmi eux.”

Aristotle, in drawing the traits of the European and Asiatic character, would appear to have borrowed freely from our author. He says the inhabitants of cold countries and of Europe are full of spirit, but deficient in intellect and skill; they therefore remain in a state of freedom, but without regular government, and they are incapable of governing their neighbors. The inhabitants of Asia are described by him as being intellectual and skilled in the arts, but deficient in courage, and therefore they are in constant subjection and slavery. The Greeks, he maintains, held an intermediate place between these two, have both courage and intellect, and therefore enjoy freedom and good government. (Polit., iii., 7.)

We have lately had a notable example of the warlike and independent spirit of mountaineers in the determined resistance which the Circassians have made to the colossal power of Russia. Great Britain, too, I may be permitted to remark, experienced disasters in contending with the mountaineers of Affganistan, such as she had never met with in the rich plains of India. And, by the way, the conqueror of Greece and of Persia was very nearly cut off by the same people. See Arrian, Exped. Alexandr., iv., 22, etc.

Ἄναρθροι. The meaning of this term seems to be, persons whose joints are indistinct 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 Thucydides ascribes the early civilization of the Athenians to the infertility of the soil. (Ἀττίκην λεπτόγεων, i., 2.) See Arnold’s Note, h., 1.; also the quotation from Aristotle at § 23; and Plato’s Timæus, tom. iii., p. 247; ed. Bekker. According to Coray (but perhaps he was partially disposed towards his adopted country), the characters of Provence and Marseilles are analogous to those of Attica and Athens, and the effects on the inhabitants similar. That Marseilles was at one time a flourishing seat of learning is undoubted; see Tacitus (Agricola) and Strabo (Geogr., iii.); but in literary celebrity it cannot surely aspire to be put on a level with the region which produced an Æschylus, a Thucydides, a Plato, and a Demosthenes! And it may be doubted whether even the Marseillais Hymn equals in masculine energy the war songs of Tyrtæus!

Its title is, Specimen Historico-Medicum Inaugurale de Hippocratis Doctrina a Prognostice Oriunda. Lugduni Batavorum, 1832.

Cap. v.

Comment. in Prognos. ap. Dietz.

The opinion here advanced is expressed with great precision by a French writer who has been making some figure in the political world of late. “Great men,” says Louis Blanc, “only govern society by means of a force which they themselves borrow. They enlighten the world only by a burning focus of all the scattered rays emanating from itself.”--Organization of Labor, p. 98, English edition.

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.

Galen, in his Commentary on this clause of the sentence, acutely remarks that patients are justly disposed to form a high opinion of a physician who points out to them symptoms of their complaint which they themselves had omitted to mention to him. And Stephanus further remarks that the patient naturally estimates highly the acumen of the physician who detects any errors in regimen which he has been guilty of, such as drinking water, or eating fruit when forbidden; (Ed. Dietz, p. 54;) or when he has some disease about him, such as bubo or inflammation, which he wishes to conceal. (Ibid., p. 63.)

It has puzzled all the commentators, ancient and modern, to explain satisfactorily why Hippocrates, in this place, seems to adopt the popular creed, and acknowledge that a certain class of diseases are of divine origin; whilst in his treatises “On Airs,” etc., and “On the Sacred Disease” he combats this doctrine as being utterly unfounded. Galen attempts to get over the difficulty by supposing that, in this place, by divine our author means diseases connected with the state of the atmosphere; this, however, would merely imply that, on the present occasion, he expressed himself in accordance with the popular belief. And, by the way, I would beg leave to remark that the plague which is described by Homer in the exordium to the Iliad, and is referred to the wrath of a god, that is to say, of Apollo, was at the same time held by Eustathius and other commentators to be connected with the state of the atmosphere; that is to say, agreeably to the vulgar belief, epidemical diseases were looked upon as divine. See also Stephanus, the commentator, t. i., p. 77; ed. Dietz. M. Littré has given, from a MS. in the Royal (National?) Library at Paris, a gloss never before published, which contains an interesting extract from one of the early Hippocratic commentators, Xenophon of Cos, bearing upon this passage. It is to this effect, that Bacchius, Callimachus, Philinus, and Heraclides Terentinus, supposed that by divine, in this place, was meant pestilential, because the pestilence was held to be from god; but that Xenophon, the acquaintance of Praxagoras, reckoned the nature of the critical days divine; for, as to persons in a storm, the appearance of the gods Dioscuri brings safety, so do the critical days bring life to men in disease. (Opera, tom. i., p. 76.) See some remarks on this scholium by Grote, Hist. of Greece, vol. i., p. 488. On the θεῖον of Hippocrates see further Berends, Lect. in Aphor., p. 349.

It will be remarked that, in his sketch of Prognosis (πρόνοια), in this place our author uses the term with considerable latitude; in fact, it comprehends the past, the present, and the future condition of the patient. Hippocrates, in a word, appears to have desired that the physician should be in his line what his contemporary, Thucydides, describes Themistocles to have been as a statesman: “Quod de instantibus (ut ait Thucydides), verissime judicabat, et de futuris callidissime conjiciebat.”--Cornelius Nepos, in vita Themistocles. See also Thucydides, i., 138. Probably both these writers had in his mind the character of the prophet as drawn by Homer: Ὃς ᾔδη τά τ' ἕοντα τά τ' ἐσσόμενα πρό τ' ἔοντα.. (Iliad i.)

The groundwork of the matters contained in this section is to be found in the Coacæ Prænotiones, 212; but it is greatly expanded and improved by our author. I need scarcely remark that the description of the features of a dying man is of classical celebrity. It is given in elegant prose by Celsus, ii., 6; and by Lucretius it is thus put into a poetical form:

“Item ad supremum denique tempus Compressæ nares, nasi primoris acumen Tenue, cavati oculi, cava tempora, frigida pellis Duraque, inhorrebat rictum, frons tenta minebat.” De Rerum Natura, vi., 1190.

Shakespeare’s description of the death of Falstaff, by the way, contains images which have always appeared to me to be borrowed (at second-hand, no doubt) from this and other passages of the present work: “For after I saw him fumble with the sheets, and play with flowers, and smile upon his fingers’-ends, I knew there was but one way: for his nose was as sharp as a pin, and he babbled of green fields.--So he bade me lay more clothes on his feet: I put my hand into the bed and felt them, and they were as cold as any stone,” etc.--Henry V., ii., 3. Although perhaps it may be thought rather hypercritical, I cannot omit the present opportunity of making the remark, that it appears to me rather out of character to make the wandering mind of a London debauchee dwell upon images “of green fields.” One would have thought that “the ruling passion strong in death” would have rather suggested stews and pot-houses to the imagination of such a person.

It will be remarked that our author modifies his judgment on the result of the ensemble of dangerous symptoms which he has just described, provided they be connected with want of food and of rest, or with looseness of the bowels. See Galen’s Commentary on this passage. Celsus renders this clause of the sentence as follows: “Si ita hæc sunt, ut neque vigilia præcesserit, neque ventris resolutio, neque inedia.”--ii., 6. I may briefly mention that both Galen and Stephanus seem to have understood this passage as I have translated it. Littré it will be seen has rendered it somewhat differently.

The prognostics, drawn from the position in which the patient is found reclining, are mostly taken from the Coacæ Prænotiones, 497. As usual, however, Hippocrates has improved very much the materials which he avails himself of.

I would here point out a mistake which most of the modern translators have committed respecting the meaning of an expression contained in this paragraph. It is καὶ τὸ ξύμπαν σῶμα ὑγρον κείμενον, which Clifton, Moffat, and even Littré understand as descriptive of the body’s being in a moist state with sweat. Littré’s translation is, “Le corps entier en moiteur.” The translators forget that the word ὑγρὸν is used by the best classical authors to signify “relaxed” or “soft.” Thus Pindar, in his celebrated description of the eagle perched upon the sceptre of Jupiter, and lulled asleep by the power of music (every English scholar will remember Gray’s version of it in his Ode on the Progress of Poesy), has the expression ὑγρὸν νῶτον, which Heyne interprets by flexile and lubricum. (Ad Pyth., 1.) See also the Scholiast, in h. 1. Galen apprehends the meaning of the term as I have stated it: thus he defines it as applying to the position intermediate between complete extension and complete flexion, that is to say, half-bent or relaxed. Foës also renders the expression correctly by “corpus molliter positum.” (Œconom. Hippocrat.) See also Stephanus (p. 96, ed. Dietz), who decidedly states that the epithet (ὑγρὸς), in this place, means slightly bent or relaxed. Heurnius explains ὑγρὸν as signifying “molliter decumbens,” p. 189. Celsus renders the words in question by “cruribus paulum reductis,” ii., 3.

This is taken pretty closely from the Coacæ Prænotiones, 235.

This sentence is thus translated by Celsus: “Ubi ulcus, quod aut ante, aut in ipso morbo natum est, aridum, et aut pallidum, aut lividum factum est.” (ii., 6.) It is imitated from the Coacæ Prænotiones, 496.

This graphic description of the movement of the hands in delirium is nearly original, being but slightly touched upon in the Coacæ Prænotiones, 76. The terms are copied by most of the ancient authors subsequent to Hippocrates, in their descriptions of phrenitis and febrile delirium. See in particular PAULUS ÆGINETA, Book III., 6. Stephanus, in his Commentary, has several very philosophical remarks on this passage, namely, upon the rationale of the ocular deception which leads to these extraordinary movements of the hands. (Ed. Dietz, t. i., pp. 103, 104.)

This is imitated pretty closely from the Coacæ Prænotiones, 260. Dr. Ermerins remarks that there is a greater number of symptoms in the Prænotiones than in the Prognostics. He therefore suggests the question whether there may not be a lacuna in the text. The description of the respiration preceding dissolution in the Prænotiones is certainly most graphic, and it appears wonderful that it should be omitted by Hippocrates in the Prognostics.

The paragraph on sweats is founded on the Coacæ Prænotiones, 572, 573; but the Prognostics is much fuller than the other. The cold sweats described in this paragraph were called syncoptic by the ancients, and were supposed to be connected with atony of the pores of the skin. See Galen, h. 1., and De Causis Sympt. iii., 9. Stephanus, with rather too much logical parade, gives a good many acute and interesting remarks on this passage. He says that cold sweats are connected with a complete prostration of the innate heat (calidum innatum). (p. 114.)

The characters of the hypochondriac region are copied in part from the Coacæ Prænotiones, 279, 280, 282; but they are much improved in the Prognostics. It will be remarked that in the Epidemics great attention is paid to the state of the hypochondria. Stephanus remarks that pulsation or palpitation in the hypochondria is caused by violent throbbing of the aorta as it passes through this region, which is occasioned by the effervescence and inflammation of the important parts which are situated in it, and with which the brain is apt to sympathize. (p. 118.) Meteorism of the hypochondriac region is often mentioned in the reports of the cases described in the Epidemics.

The author evidently alluded to hepatitis ending in abscess. This would seem to have been a very common termination of inflammation of the liver in Greece, as it is often described in the ancient medical works. See PAULUS ÆGINETA, B. III., 46, and the authorities quoted there in the Sydenham Society’s edition.

The paragraph on the prognostics relating to dropsies is founded in a great measure on the Coacæ Prænotiones, 454. The ancient writers who treat systematically of dropsy generally describe four varieties of it, namely, dropsy from disease of the liver, from disease of the spleen, from fever, and from a sudden draught of cold water. See De Morbis, and PAULUS ÆGINETA, B. III., 48, Sydenham Society’s edition.

On this variety I have remarked in the Comment. on Paulus Ægineta: “Hippocrates refers one species of dropsy to disease of the parts situated in the loins, by which Galen and Stephanus agree that he means the jejunum, mesaraic veins, and kidneys.” (Paulus Ægineta, l. c.) M. Littré accordingly holds it probable that allusion is made to granular degeneration of the kidneys, that is to say, to Bright’s disease. (Opera, etc., tom. ii., 388.)

Dr. Ermerins remarks that the species of dropsy here described was most probably connected with organic disease of the parts situated in the abdominal region, arising from inflammation with which they had been previously attacked.

This paragraph is pretty closely taken from the Coacæ Prænotiones, 492. A good deal of stress is laid upon the state of the temperature of the extremities in the reports of the febrile cases contained in the Epidemics. He announces it as a general truth that coldness of the extremities in acute diseases is bad. (Aphor. vii., 1.) Sprengel considers that he has stated this fact in too general terms, as there are many exceptions to it. (Hist. de la Méd., tom. i., 317.)

This is taken in part from the Coacæ Prænotiones, 493. Sprengel finds great fault with Hippocrates for laying it down as a rule, that in cases of gangrene a black color of the part is less dangerous than a livid. Dr. Ermerins, however, espouses the side of Hippocrates, and maintains that our author has acutely pointed out the difference between gangrene proving critical, and gangrene connected with weakness of the vital actions in the part. In the former case the part becomes perfectly black, whereas in the other it is livid. He mentions that he observed in an hospital at the same time a case of mortification from cold, and another of the same from want and congelation; that in the former the part was black, and the patient recovered; whilst in the other the arms were livid, and the patient soon died. (Specimen Hist. Med., p. 68.) Stephanus, by the way, gives nearly the same explanation of this remark. (p. 142.) Perhaps our author had in view the plague of Athens, in which the disease often terminated favorably in mortification of the fingers or toes. (Thucyd., ii., 49.)

A considerable portion of the Prognostics from Sleep are taken from the Coacæ Prænotiones, 497. This part is elegantly rendered by Celsus: “Ubi nocturna vigilia premitur, etiamsi interdiu somnus accedit; ex quo tamen pejor est, qui inter quartam horum et noctem est, quam qui matutino tempore ad quartam. Pessimum tamen est, si somnus neque noctu, neque interdiu accedit; id enim fere sine continuo dolore esse non potest.” (ii., 4.) Stephanus gives a philosophical disquisition on the nature and causes of sleep. (pp. 142–8.)

This is pretty closely taken from the Coacæ Prænotiones, 601.

A small part of this is to be found in the Coacæ Prænotiones, 609.

Part of this is borrowed from the Coacæ Prænotiones, 601.

Strigmentosa: that is to say, resembling the scrapings or strippings of the bowels.

This in part is borrowed from the Coacæ Prænotiones, 604, 631.

This is pretty closely copied from the Coacæ Prænotiones, 495.

This is taken from the Coacæ Prænotiones, 281. Several of the other ancient writers on medicine, both Greek and Arabian, have treated fully on the characters of the alvine discharges; but, upon the whole, have not added much to the information contained in the Coacæ Prænotiones and Prognostics. See the Commentary on PAULUS ÆGINETA, B. II., 13. Stephanus has many interesting observations on the prognostics from the urine. He remarks that the urine is a good index of the condition which the digestive process is in, and more especially the process of sanguification. (p. 162.)

This is closely copied from the Coacæ Prænotiones, 575.

According to Stephanus, both the farinaceous and leafy sediments are the products of a melting of the solid parts, as a consequence of inflammatory heat. (p. 165.)

A small portion of the above occurs in the Coacæ Prænotiones, 578.

For part of this our author is indebted to the Coacæ Prænotiones, 580.

See Coacæ Prænotiones, 582.

This is partly taken from the Coacæ Prænotiones, 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 discharges, it must be highly important to determine whether their characters be indicative of the condition of the general system, or of the viscus by which they are secreted. (Opera, v., p. 142; ed. Basil.) The ancients paid great attention to the characters of the urine in disease, and their knowledge of the subject will be admitted, even at the present day, to have been remarkable. The works of some of the later authorities, particularly of Theophilus and Actuarius, are well deserving of an attentive perusal. See PAULUS ÆGINETA, Vol. I., p. 225.

This is partly taken from the Coacæ Prænotiones, 556.

These characters of the sputa are partly borrowed from the Coacæ Prænotiones, 390, 399.

They are founded on the Coacæ Prænotiones, 390, 391.

This is taken in part from the Coacæ Prænotiones, 302, 304. The succeeding paragraphs on empyema are also partly derived from the Coacæ Prænotiones, 393, 402, 428. I may be allowed to remark in this place that modern pathologists are agreed that abscesses after pneumonia are of rare occurrence; at the same time, however, purulent infiltration and its natural consequence, expectoration of pus, are not so very uncommon results of the disease. True pulmonary abscess or empyema is commonly occasioned by chronic inflammation. I am inclined to think that the ancients applied the term also to the cavities in the lungs produced by the softening of tubercles. It is difficult otherwise to account for the frequent mention of empyemata in the works of the ancient authorities on medicine, especially in the Hippocratic treatises. See De Locis in Homine, p. 415, ed. Foës; and tom. i., p. 306, ed. Kühn, et alibi. M. Littré makes the following remarks on the descriptions of empyema which occur in the Hippocratic treatises: “On remarquera dans le Pronostic, et cette remarque s’étend à plusieurs autres des écrits Hippocratiques, qu’une très-large place est faite aux affections de la poitrine, péripneumonies et pleurésies. Il paraîtrait que, sous le climat de la Grèce, ces affections ont une grande fréquence, plus peut-être qu’elles n’en ont même dans notre climat. La description, fort abrégée il est vraie, qu’en donne Hippocrate, me porte à penser que, si cette description est exacte, elles ne suivent pas la même marche que parmi nous. En effet, que sont ces empyèmes que, suivant Hippocrate, se font jour an dehors sous forme d’expectoration purulente? On peut croire, que dans les dénominations d’empyèmes sont compris les épanchements pleurétiques; mais les épanchements pleurétiques ne se font pas jour au dehors, ils se guérissent par résorption; alors, que sont ces empyèmes signalés par Hippocrate, comme terminaison des péripneumonies, et ces expectorations qui en procurent l’evacuation? Il m’est impossible de répondre à ces questions: peut-être des observations faites dans la Grèce même, permettraient de résoudre la difficulté.” (Œuvres Complets d’Hippocrate, tom. ii., p. 97.) Perhaps, as I have hinted above, the most probable answer that could be returned to the questions put by M. Littré would be, that many of the cases of pneumonia terminating in empyema, which occur in the Hippocratic treatises, were what are now described as cases of acute phthisis. See Louis on Phthisis, ii., 2. In confirmation of my supposition that many of the cases of empyema described by the ancients were, in fact, cases of phthisis, I would refer to PAULUS ÆGINETA, B. III., 32, where it will be seen that the two diseases, phthisis and empyema, are treated of under the same head. See also the second book of the Prorrhetics, tom. i., pp. 198–201; ed. Kühn.

M. Littré reverts to this subject in the Argument to the Coacæ Prænotiones, tom. v., p. 576, where he relates, from two recent authorities, a case of empyema after pleurisy, and another after pneumonia, in both of which the pus was evacuated by the mouth. He also quotes the remark of an English writer, Dr. Twining, that, in and about Bengal, abscess of the lungs after pneumonia is by no means very rare. Still M. Littré admits that the paucity of such cases in modern works must lead to the conclusion either that Hippocrates had not observed correctly, or that this termination is more rare now than formerly. I leave the reader to judge whether my suggestion stated above does not remove this difficulty.

The observations of Andral have in some measure confirmed the opinion of Hippocrates and other authors, ancient and modern, that there are certain days in the duration of the disease in which there is a greater tendency to amelioration. Of ninety-three cases, he found twenty-three give way on the seventh, thirteen on the eleventh, eleven on the fourteenth, and nine on the twentieth days. The recoveries in the remaining cases commenced on twelve out of forty-two non-critical days, as many as eleven being ascribed to the tenth day. Thus the recoveries on critical days averaged as high as fourteen, while those on non-critical scarcely exceeded three. (Dr. C. J. B. Williams on Pneumonia, Cyclop. of Pract. Med., vol. iii., p. 405.) See also Andral, Clin. Med., c. ii., p. 365.

Stephanus has a lengthened and most important commentary on this passage, containing an elaborate disquisition on empyema. (pp. 184–91.)

This is taken pretty closely from the Coacæ Prænotiones, 395.

A part of this is copied from the Coacæ Prænotiones, 396.

It will be seen in our analysis of several of the Hippocratic treatises, such as De Affect. Intern., De Morbis, etc., that it was the common practice in such cases to evacuate the matter either by the cautery or the knife. See also Aphorism, vii., 44.

Part of this is borrowed from the Coacæ Prænotiones, 108.

This is in part derived from the Coacæ Prænotiones, 471. Galen, in his commentary, is at pains to explain that by a hard bladder Hippocrates means a bladder in a state of inflammation.

The subject of the critical days is not touched upon in the Coacæ Prænotiones, so that the contents of this section are either original or taken from some source with which we are totally unacquainted. Galen, indeed, does not hesitate to declare that Hippocrates himself was the first who treated of the critical days; but whether he had any competent authority for pronouncing this opinion cannot be satisfactorily determined. The critical days are incidentally treated of in the Epidemics and Aphorisms; but, as we have stated in our critique on the Hippocratic treatises in the Preliminary Discourse, the work “On Critical Days” is in all probability spurious. The system of the critical days taught by Hippocrates was adopted by almost all the ancient authorities, with the exception of Archigenes and his followers, who, however, were not numerous nor of any great name, with the exception of Celsus. See the Commentary on PAULUS ÆGINETA, B. II., 7, Syd. Soc. edition.

The contents of this section are borrowed in a great measure from the Coacæ Prænotiones, 160. Dr. Ermerins remarks that the headache here described is probably of a catarrhal or rheumatic nature. (Specimen Hist. Med. Inaug., etc., p. 84.)

This is taken in great measure from the Coacæ Prænotiones, 189. Galen in his commentary, remarks that patients die of violent pains of the ear, owing to the brain sympathizing, which brings on delirium, and sometimes occasions sudden death. I may be allowed to remark that every experienced physician must have met with such cases.

A considerable part of this section on ulcerated sore-throat is extracted from the Coacæ Prænotiones. The present sentence is from § 276. The medical reader will not fail to remark that Hippocrates displays a wonderfully accurate acquaintance with these affections.

This is founded on the contents of the Coacæ Prænotiones, 363. The disease here described is evidently angina laryngæa.

This is taken in part from the Coacæ Prænotiones, 364. As Dr. Ermerins remarks in his note on it, the disease here described is evidently angina pharyngæa.

This is closely copied from the Coacæ Prænotiones, 365. The danger of erythematous swelling being determined inwards, is well understood nowadays.

This is taken, with slight alterations, from the Coacæ Prænotiones, 365, 367. The latter clause is more fully expressed in the Coacæ Prænotiones than in the Prognostics. “In those cases in which cynanche is determined to the lungs, some die in seven days, and some escaping these get into a state of empyema, unless they have a pituitous expectoration.” This is evidently a correct description of the disease spreading to the lungs.

No part of this last clause is to be found in the Coacæ Prænotiones. The operations of excising and burning the diseased uvula are minutely described by Paulus Ægineta and other of the ancient authorities. See PAULUS ÆGINETA, B. VI., 31. I need scarcely remark that both these operations have been revived of late years.

This is taken with little variation from the Coacæ Prænotiones, 146.

A part of what precedes is taken from the Coacæ Prænotiones, 143; all that follows, with the exception of a short sentence, is original.

Our author here and elsewhere impresses it upon his readers that it is from the tout ensemble of the symptoms that a judgment is to be formed in every case. This is evidently a remark of the most vital importance in forming a prognosis. Galen’s observations in the succeeding commentary are very interesting, and deserve an attentive perusal.

That is to say, the physician ought to get speedily acquainted with the nature of the epidemics which prevail at every particular season. I need scarcely remark that this is a subject which is largely treated of in the works of our English Hippocrates, Sydenham. Hippocrates himself is very full on this head, more especially in his Epidemics and Aphorisms, as we shall see below.

It has excited a great deal of discussion and difference of opinion to determine what our author means by specifying these three places; but the explanation given by Galen in his Commentary seems to me quite satisfactory. According to him, the meaning of our author is that good and bad symptoms tell the same in all places, in the hot regions of Libya, the cold of Scythia, and the temperate of Delos. It is further to be borne in mind that Odessus in Scythia, and Cyrene in Libya, were the extremities of the Grecian world, whilst Delos may be regarded as its centre. It is proper to remark, however, that by the three places mentioned, Erotian understands the three quarters of the earth--Africa, Asia, and Europe. See under Λιβύη.

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.

See Epidem., i., and iii.

Empyema is treated of in the Prognostics, the first book of Prorrhetics, the Coacæ Prænotiones, and the work De Morbis. Which of these is here alluded to cannot be determined for certain; it seems probable, however, that it is to the preceding book of Prorrhetics.

This important observation is thus rendered by Celsus: “Quæ in latere linguæ ulcera nascuntur diutissimè durant. Videndumque est, num contra dens aliquis acutior sit, qui sanescere sæpe ulcus eo loco non sinit, ideoque limandus est.” (vi., 12.)

Allusion seems to be made to herpes exedens.

See PAULUS ÆGINETA, B. III., 25.

Foës inclines to think that the proper reading in this place is νοὔσος φοινικίη, and not φθινικὴ, and that Galen alludes to this passage in his Exegesis under the former of these terms, where he says that by φοινικίη νοῡσος was probably meant elephantiasis. The other reading, however, would seem quite applicable, for I have known phthisis and leprosy combined in the same case.

The phrenitis of Sydenham in like manner was an epidemical fever, and not an idiopathic inflammation of the brain. See Opera, p. 56; ed. Syd. Soc. That Hippocrates regarded phrenitis as a variety of causus, attended with determination to the brain, is obvious from Epidem. i. See Op. Galen., tom. v., p. 371; ed. Basil.

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, præcipueque ardente febre, ad discutiendam eam, gestatione dixit utendum: sed id pericolose fit; meliusque quiete ejusmodi impetus sustinetur.” (ii., 15.) A great modern authority on fever, Dr. R. Jackson, speaks favorably of this practice, although, as we see, it is so pointedly condemned by Celsus. Celsus, however, admits of gestation in that species of remittent fever which was called lethargus. (iii., 20.)

Observ. Med., vi., 3, 4.

The Cnidian Sentences in all probability were the results of the observations and theories made in the Temple of Health at Cnidos. We may reasonably conclude from what we know of them, that, like the Coacæ Prænotiones at Cos, the Cnidian Sentences at Cnidos were looked up to in the time of Hippocrates as the great guides to medical practice. How much, then, it is to be regretted that they have not come down to us like the other! It is clear, however, from Galen’s Commentary, that the work was extant in his time, and from it, as will be seen, we are enabled to draw a few particulars respecting the theoretical and practical views of the Cnidians. Le Clerc considers it likely that Euryphon was the author of the Cnidian Sentences (Hist. Phys., i., 3, 30); but it is evident, from the terms in which Hippocrates refers to them, that they were not the work of a single author. He makes mention, it will be remarked, of more than one person being concerned in remodelling them.

By this our author means that the Cnidians neglected Prorrhetics and Prognostics. This must be obvious to every person who had entered properly into the spirit of the Hippocratic system of medicine.

The text of this sentence is in a very unsatisfactory state, and much difference of opinion has prevailed respecting the meaning. See the annotations of Littré, and the remarks of Galen, as quoted in the Argument.

Galen, in his Commentary, mentions that the Cnidians described seven species of diseased bile, and twelve diseases of the bladder; and, again, four diseases of the kidneys; and, moreover, four species of strangury, four species of tetanus, and four of jaundice; and, again, three species of phthisis. Galen, having made this statement, remarks that they looked to the peculiarities of the body, instead of regarding the identity of the diatheses, as was done by Hippocrates. In other words, they split diseases into endless varieties, instead of attending to the essence or general nature of each. The system of Hippocrates, then, was founded on a rational prognosis, whereas that of the Cnidians was founded on mistaken principles of diagnosis. The principles of the Hippocratic system are admirably explained and developed in Galen’s great work On the Method of Cure, or Therapeutics.

Galen, in his Commentary on this passage, states that when a disease of a mild character prevailed generally, it was called an epidemic; and when of a malignant nature, it was called the plague. (See further PAULUS ÆGINETA, Book II., 36, Syd. Soc. edition.) It will be remarked that I have included the word (not) in brackets. This I have done because not only the reading, as given in the common editions of Galen, is in its favor, but because the sense appears to me to require it. Surely when diseases are of an epidemic character they are similar; but when they are sporadic, they are not similar. M. Littré, however, rejects it altogether.

The question here mooted is certainly one of the most important that can well be entertained, namely, whether or not a certain portion of nutriment ought to be given to persons laboring under fever. It would appear, from what is stated by Galen upon the authority of Erasistratus, that the most diametrically opposite modes of practice had been followed by different individuals--that some had starved their patients altogether for a considerable time; whereas, on the other hand, a physician of the name of Petronas allowed his patients flesh and wine. Our author, it will be remarked, does not allude to these extreme modes of practice in this place, but enters at great length into the question whether or not unstrained ptisan (or barley gruel) should be administered in fevers, and, if so, under what circumstances.

Galen, in his Commentary, has some very interesting remarks on the differences of opinion among the diviners. This, in fact, may well be supposed, since, as will now be pretty generally acknowledged, the whole art was founded upon conjecture and deception. The comparison of medicine to divination is therefore very discreditable to the former.

Our author now enters upon the consideration of one of his principal objects in the present work, namely, to describe the modes of preparing ptisan (or the decoction of barley), and its uses in acute diseases. He is so full on this subject that the present treatise is quoted by Athenæus (Deipnos. ii., 16), by the name of the work On the Ptisan. Galen states that, on the principle that diseases are to be cured by their contraries, as the essence of a febrile disease is combined of heat and dryness, the indication of cure is to use means of a cooling and moistening nature, and that the ptisan fulfils both these objects. I may be allowed to remark in this place, that probably there is not a more important rule in the whole practice of medicine than this, that fevers are to be treated by things of a cooling and diluent nature. I may mention further regarding the ptisan of the ancients, that it would appear to have been very little different from the decoction of barley, as now in use; that is to say, it was prepared from pearl-barley roughly pounded and boiled for a time in water. As will be seen by the text, it was given to the sick either strained or entire, according to circumstances. A similar decoction was prepared from wheat, and was called πτιαάνη πυρίνη. See Galen (De Aliment., i.) The simple term ptisan, however, is always to be understood as applying to the decoction of barley.

Galen gives the following illustration of what is meant by a disease of a peculiarly dry nature. In pneumonia, pleurisy, and in all the affections about the lungs and trachea, the disease is held to be of a dry nature when there is no expectoration from the parts affected; and in any complaints about the liver, the mesentery, the stomach, the small or great intestines, or spleen, when the belly is either entirely constipated, or when the discharges brought away by artificial means are dry and scybalous; and diseases of the arteries and veins are known to be dry by the dryness of the tongue, and the parched appearance of the whole body. In the same manner external ulcers are accounted dry when there is no discharge from them. And ophthalmies are held to be dry when there is no discharge from the eyes or nose. And, in short, all diseases are recognized as being dry which are not attended with any discharge.

It is curious to remark that a double charge was founded against our author on the ground of his treatment of febrile cases, as here laid down. The followers of Thessalus held that he gorged his patients with too much food, whereas Erasistratus and his followers held that he starved them. Galen, on the other hand, contends that the practice of Hippocrates is the juste milieu between these two extremes. (Opera, tom. v., p. 47; ed. Basil.)

This sentence shows that Hippocrates understood thoroughly the proper treatment of pleurisy. When the disease did not yield to fomentations, but the pain continued, either a vein was opened or the bowels moved; for without first using these means, it was reckoned fatal practice to administer ptisan. Galen relates that it was also considered an unsafe practice to give opium, mandragora, or hyoscyamus for the purpose of alleviating the pain, instead of having recourse to venesection or purging for the removal of it. This is a practical remark well deserving of the most serious consideration.

How briefly, and yet how graphically, our author has described the termination of pleurisy! It is singular that no succeeding author has written so learnedly of râles in affections of the breast as Hippocrates, down at least to the time of Laennec, who repeatedly acknowledges his obligations to our author.

I need scarcely remark that the seasonable administration of drink, and especially of water, is one of the most important points connected with the treatment of febrile diseases. This is so much the case that, as Galen remarks in his Commentary on this passage, fevers may often be extinguished at once by a large quantity of water given in due season. This subject is fully treated of by him in his Methodus Medendi.

The professional reader will not fail to remark, what is pointed out in strong language by Galen, how judiciously our author commences with the most gentle means, and gradually rises to the most powerful and dangerous; namely, bleeding and the administration of drastic purgatives. One cannot help being further struck with the rich supply of information which he has on the simple subject of fomentations.

By livid (πέλιον) is here meant the colour intermediate between red and black. See Galen, h. 1.

Probably the Helleborus niger. See PAULUS ÆGINETA, Vol. III., p. 108.

The Euphorbia peplus. See Ibid., Vol. III., p. 294.

Probably the Seseli tortuosum. See Ibid., Vol. III., p. 330; and Dierbach, Arzn. der Hipp. p. 186.

A species of asafœtida, probably the Laserpetium derias. PAULUS ÆGINETA, Vol. III., p. 339.

It is worthy of remark, that our author directs aromatics to be mixed with the purgatives. The reason for prescribing them, as Galen states, was to counteract the bad effects of the purgatives upon the stomach. The ancients, in my opinion, acted much more wisely in this respect than the moderns generally do, for the latter are constantly administering the most nauseous cathartics to their patients without taking any pains to obviate their bad effects upon the stomach. On the ancient modes of administering purgatives, see PAULUS ÆGINETA, B. VII., 4.

Galen, in his Commentary, remarks that the common herd of physicians followed the very opposite rule to that here laid down by Hippocrates, that is to say, they administered food copiously after evacuations. According to Galen, the object of Hippocrates in proscribing food of all descriptions at that season is, because the powers of the system, being then weakened, are unable either to bear food or to digest it.

See Celsus, I., 3.

The cyceon was a mixture of various articles of food, but generally contained cheese, honey, and wine. See Athenæus (Deipnos, ii.). It is described by Homer as the potion which Circe administered to the followers of Ulysses. (Odyss. x., 235). There is frequent mention of it in the Hippocratic treatises, as at De Diæta, ii.; de Muliebribus, ii.; and in the works of the other medical authors.

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.

There is considerable difficulty as to the text at this place. See Foës in his Annotations and Œconomica, and a very lengthy note by Littré.

The preternatural mode of respiration here described is several times adverted to by Galen, as at De Dyspnœa, iii.; Comment. in Aphor., iv., 68; and Comment. in h. 1. Galen seems to understand the meaning to be, that the breathing is intercepted in the inspiration. I should have rather been disposed to think that it is the expiration which is said to be interrupted. But I suppose we must bow to so great an authority as Galen! I may mention, by the way, that his Commentary on this and the collateral passages of our author is most interesting; but, as usual, too diffuse for my narrow limits. It relates to a most important point in medical practice, on which great ignorance and uncertainty prevail among us, even at the present day.

Galen finds the language in this last sentence so confused, that he does not hesitate to declare that he is convinced the work must have been left by Hippocrates in an unfinished state, and not published until after his death. He decides that ἐφθότης signifies a heated state connected with humors, and not with dryness; that is to say, a condition analogous to boiling, and not to roasting.

Galen, in his elaborate Commentary on this section, complains that our author’s account of wines is imperfect, inasmuch as several varieties are omitted; at the same time it must be admitted that his observations on this head are very much to the purpose, and highly judicious. For the other ancient authorities on this subject, see PAULUS ÆGINETA, Book I., 95, Syd. Soc. edit.

I need scarcely mention that hydromel was a drink prepared by boiling honey in a large proportion of water. It was of different degrees of strength; sometimes there were only two parts of water to one of honey, and at other times from seven to eight parts were used See PAULUS ÆGINETA, Book I., 96, Syd. Soc. edit.

Galen, in explanation, mentions that hydromel is of a detergent nature; and hence it clears out the air-passages, and thus promotes expectoration. When the sputa are thick and viscid, it cuts and attenuates them. (Opera, tom. v., pp. 75, 76; ed. Basil.)

Although, as we have shown in our analysis of the treatise on the Use of Liquids, Hippocrates and his followers were sufficiently liberal in the administration of water on proper occasions, it will be seen from the contents of this section that our author was by no means disposed to give water freely in febrile diseases, nor in affections of the chest. Whatever may now be thought of his observations on this point of practice, all must admit that they are deserving of high attention. Galen’s Commentary is also very interesting. It appears from it that he disapproved of giving water alone, but always added a small proportion of wine to it in order to give it a flavour. That the quantity of wine which was added to the water must have been small, is obvious from an anecdote which he relates in this place. He says that a certain physician, who saw the insignificant amount of the wine which was put into the water, said, bantering him, “Your patient will have the pleasure of seeing the wine indeed, but will not be able to taste it.” Galen, however, contends that, although the quantity thus added be small, it is sufficient to act as a stomachic, and to obviate the bad effects which the water would otherwise produce. (Opera, tom. v., p. 83; ed. Basil.) It will be perceived from the context, that Hippocrates intended to give a separate treatise on each particular disease, not considering the present work on general therapeutics sufficiently explicit, as Galen remarks.

The smegma was an abstergent composition used by the ancients in bathing for the purpose of cleansing the skin. For a full account of the smegmata, see PAULUS ÆGINETA, Vol. III., pp. 536–41.

Galen, in his Commentary, remarks that the physicians usually did not put their patients into the baths, but made use of the douche, or affusion of hot water. He adds, that persons in good health may leave the hot bath and plunge into the cold, but that this practice is not safe in the case of invalids. He recommends, then, that there should be at hand a good supply of baths of various temperatures, so that the patient may gradually pass from one of a high to others of a low temperature. By the way, I have often wondered that Dr. Currie, who certainly had no inconsiderable pretensions to classical scholarship, should have been so profoundly ignorant as he appears to have been of the use of the warm affusion by Hippocrates and Galen in the treatment of febrile diseases. His rival, Dr. Jackson, had a much more respectable acquaintance with the ancient authorities on medicine; and I have often thought it was to be regretted that the profession at that period, in giving a trial to the affusion of cold and hot water in fever, put itself under the leadership of Currie instead of Jackson.

Dr. Tweedie’s observations agree so well with those of Hippocrates, that I will give the reader an opportunity of comparing them together. “This organ (the stomach), in convalescence, partakes of the external or muscular debility, and the convalescent may as well expect to be able to carry a heavy load on his shoulders as to digest an undue quantity of food, even of a suitable kind.” (p. 215.)

The directions given by that excellent authority Alexander Trallian, for the regulation of the regimen in phrenitis, are to the same effect. Wine is to be given when there is much insomnolency, when the strength is reduced, when the fever is no longer strong and ardent, and when concoction appears already in the urine. The author makes the acute remark, that the remedy is attended with certain evil consequences, but that it is the part of a prudent physician to balance the good and bad effects, and administer the article in question when the good preponderate. (i., 13.)

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.

The causes of ardent fever of the ancients was decidedly the same as the bilious remittent fever of modern authors. See PAULUS ÆGINETA, Vol. I., p. 262. We shall find many cases of it related in the Epidemics. In fact the causus is the ordinary fever of Greece and other countries bordering upon the Mediterranean. Galen, in his Commentary on this section, mentions that he had known it generally superinduced by drinking wine after great fatigue in summer. There can be no doubt that this was the fever of which Alexander the Great died. The description of the disease in his case, as given by Arrian from the Royal Journals (βασίλειοι ἑφημερίδες), has so much the air of truth, and withal appears to me so interesting, that I shall be excused introducing it in this place. “And the Royal Journals ran thus: that he drank at a jollification in the house of Medius; then rising up and being bathed, slept, and again supped with Medius, and again drank until the night was far advanced; that giving over drinking he bathed; and having bathed, ate a little, and slept there, because he was already feverish; that being carried on a little to the sacrifices, he performed them according to his daily practice; that the sacrifices being performed, he reclined in the dining-room (ἀνδρὼν) until the dusk of evening, and there gave orders to the commander respecting the march and voyage, that those who had to proceed on foot should be prepared for marching on the fourth day, and those who were to sail on the fifth; that he was carried hence upon a couch to the river, and being placed in a boat was taken across the river to the garden, and then being again bathed, that he rested. Next day, that he again was bathed and performed the appointed sacrifices; and going into a chamber, that he reclined and conversed with Medius, and gave orders to the commanders to meet him in the morning. That having done these things, he took a little supper; and having been carried back to the chamber, that he was in a continued state of fever during the whole night; that next day he bathed, and after the bath performed the sacrifices; that he gave orders to Nearchus and the other commanders respecting the voyage, that it should take place on the third day; that next day he bathed again, and performed the appointed sacrifices; that the religious rites being over, he did not cease to be feverish, but that calling the commanders he gave orders for having every thing in readiness for the voyage; that he was bathed next day, and being bathed was already in a bad state. That next day being carried to the house adjoining the bath, he performed the appointed sacrifices; that he was in a bad state, but yet that he called to him the chiefs of his commanders, and again gave orders respecting the voyage; that the following day he was carried with difficulty to the religious rites and sacrificed, and that notwithstanding he gave orders to the commanders respecting the voyage. That next day, although already in a bad state, he performed the appointed sacrifices; that he gave orders that the commanders should watch in the saloon, and the chiliarchs and pentacosiarchs before the doors; and that being altogether now in a bad state, he was carried from the garden to the palace. That when the commanders came in he recognized them, but did not speak, being now speechless; that he was in a bad state of fever during that night and day, and during another night and day. Thus it is written in the Royal Journals.” Thus far the report is no doubt to be strictly depended upon; the historical embellishments added to it from other sources can have no interest to the professional reader. (Appiani Exped. Alexandr., vii., 37.) It deserves to be remarked, as a remarkable feature in this case, that the mind appears to have been pretty entire during the whole course of the fever. Now, this is one of the characteristics of causus as described by Aretæus (Morb. Acut., ii., 4). It is further one of the most marked features of the yellow fever, which, from all I can learn of it, would appear decidedly to be an aggravated form of causus.

Galen admits that he did not understand the exact import of this term.

This is a general rule of such importance that Galen wonders our author did not embody it in one of his Aphorisms. Galen’s observations on venesection in this commentary, and in his two treatises on this subject, are highly important. It will be remarked that three circumstances are held to form indications of the necessity for bleeding: first, if the disease be of a strong nature; second, if the patient be in the vigor of life; and, third, if his strength be entire.

This section, as Galen remarks, contains a list of the principal cases in which venesection is to be had recourse to.

I need scarcely point out to the professional reader that these symptoms are very descriptive of congestion in the brain, threatening an attack either of apoplexy or epilepsy. See the treatise on the Sacred Disease.

Meaning apparently the great vessels. See Galen’s Commentary.

The description here given of cynanche, more especially of the variety in which the ulceration spreads down to the trachea and produces engorgement of the lungs, is most characteristic, and bespeaks a great practical acquaintance with the disease. Judged of in a becoming spirit of candor, it must be admitted that even at the present day we have scarcely made any advancement in our knowledge of this subject. What are our descriptions of ulcerous sore-throat, diptherite, œdema glottidis, croup, and laryngismus stridulus, but reproductions in a divided and (may I be allowed to suggest?) a less accurate form, of the general views here presented by our author? For an abstract of the views of the other ancient authorities in medicine, see PAULUS ÆGINETA, Book III., 27. Aretæus deserves particularly to be consulted (Morb. Acut., i., 7). It will be remarked that our author speaks of a spontaneous determination to the skin, as being calculated to remove the urgent symptoms within. Galen, in commenting upon this clause, states that some physicians were in the practice of applying to the skin certain medicines possessed of ulcerative powers, in order to determine to the surface, and thus imitate Nature’s mode of cure.

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.

I would beg leave to direct the attention of the medical reader to the observations of our author in this and many other places on the characters of the urine in fevers. That in febrile diseases the sediment is wanting previous to the crisis, and that at and after the crisis, when favorable, the sediment becomes remarkably copious, I believe to be certain facts; and yet I question if, with all our boasted improvements in urology, they be generally known and attended to. I have called attention in the Argument to the important rule of practice which our author founds on the state of the urine at the crisis.

He means by this, that the disease is not of an intermittent type.

This seems the most appropriate meaning in this place, but the passage may also signify “a state of great emphysema or meteorism.” See Galen.

It is impossible not to recognize here a brief sketch of delirium tremens. The trembling hands from drinking, with the subsequent delirium, can leave no doubts on the subject. See further Littré, tom. ii., p. 382.

The fruit of the pinus pinaster. See PAULUS ÆGINETA, Vol. III., p. 301.

It will be remarked, that in this place the author directs that the bleeding should be carried to a greater extent than in the former part of this treatise. In general, the ancient authorities forbade the abstraction of blood until it induced lipothymia. This is decidedly the rule of practice laid down by Aretæus (De Curat. Morb. Acut., ii., 1).

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, etc., p. 131.

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. Very similar views are also laid down in the treatise On Ancient Medicine.

On the Dietetics of the ancients, see the Commentary on PAULUS ÆGINATA, Vol. I., pp. 106–86.

By dry cholera would seem to be meant flatulent colic. See Galen’s Commentary. It is also described below, and further with great accuracy by Alexander Trallian (vii., 16).

Galen, in his Commentary on this section, finds many things imperfectly stated, and therefore unworthy of his great author. For example, he remarks, only two varieties of dropsy are mentioned, namely, anasarca and tympanites; whereas there are three at least, and some even describe four varieties. By the three kinds of dropsy, Galen and the other ancient authorities meant anasarca, ascites, and tympanitis. (See PAULUS ÆGINETA, Book III., 48). That tympanites should have been ranked with dropsy need excite no wonder, when we consider the resemblance of this affection to ascites. In fact I have known cases of tympanites in which paracentesis was performed by inexperienced surgeons under the impression that they were cases of ascites. See some elaborate annotations on this head by Ermerins (Specimen Hist. Med., p. 125), and by Littré (Op. Hippocrat., tom. iv., p. 415). With regard to venesection in dropsy, Galen remarks that the rule of practice is not laid down here with sufficient precision; it is only when the dropsy is connected with the suppression of the hemorrhoidal or menstrual discharge, or when the patient is in a plethoric state, that blood can be abstracted with advantage. He also finds fault with the directions for the subsequent treatment, as not being accurately given. He justly remarks, that none but persons in the vigor of life and in good health would be able to digest dark-colored wine and pork after venesection. I may mention further that the text is faulty, that the words ἐγχειρέων γίνεσθαι ἄφυκτος should have been written ἀποκτέινει δ’ ἐυθὺς ὁ ὔδερος ἐφὴν γένηται. He attributes the mistake to the first amanuensis who wrote the words in question.

In reference to this practice Horace says:

“Si noles sanus curres hydropicus.” (Serm. I., 1.)

Galen finds many things in this section also carelessly and confusedly written, and therefore unworthy of Hippocrates. For example, the list of cases in which purging is inapplicable, Galen holds to be incomplete; and even in some of the cases specified by Hippocrates he demurs to admit his views to be correct; for example, in diseases of the spleen he contends that melanogogues are strongly indicated. Many more of the rules he considers to be vaguely and inaccurately stated. Altogether, then, he holds that it is a loss of time to devote much attention to writings of such a stamp; but, he shrewdly remarks, there is no persuading many people to study only such writings as are clear, and to leave such as are not so to the writers themselves; for it is just that, as they have paid no regard that we should understand what they have written, we should not be very anxious to find out and learn what they say.

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 suggests afterwards, they are meant to apply to general pains.

The Cantharis of the ancients was indisputably the Mylabris cichorii, or M. Fusselini. It continued to be used in ancient times as a diuretic, (see PAULUS ÆGINETA, Vol. III., p. 153;) and is well known in the East at the present day.

All the remaining part of this work evidently consists of fragments put together, without any method or arrangement. Though not devoid of interest, they decidedly have no connection with the treatise On Regimen in Acute Diseases. Indeed an impartial examination of the whole Appendix must satisfy any one that there are but too good grounds for holding with Galen, that the whole work is a disorderly compilation, which, although it may have been made up of notes written or dictated by Hippocrates, had certainly not been published by him.

It most probably is the Reseda mediterranea. See PAULUS ÆGINETA, Vol. III., 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 ÆGINETA, Vol. III., pp. 262, 269. M. Littré gives the following interesting observations on this passage by M. Malgaigne: “Quoiqu’il semble que l’auteur emploie deux fils, cependant il n’est fait mention que d’une aiguille. Il paraît bien indiqué que l’aiguille traverse deux plis transverseaux en marchant de haut en bas. Voici comment je traduirais le passage en question: pour le trichiasis, avec une aiguille armée d’un fil, traversé de haut en bas le point le plus élevé (ou la base); de la paupière supérieure, après lui avoir fait former un pli, et repasser l’aiguille de la même manière un peu plus bas (ou près du bord libre); rapprochez les extrémités du fil, et fixez-les par un nœud: puis laissez-les tomber d’eux-mêmes. Si cela réussit, c’est bien: si non, it faudra recommencer.” (Op. Hippocrat., tom. iii., p. xliv). In my Commentary on PAULUS ÆGINETA, (Vol. II., p. 163.) I have in so far fallen into the mistake of supposing this description to apply to the lower eyelid, and M. Ermerins would appear to have done the same. See Littré, l. c. The operation by the ligature on hemorrhoids will be found more circumstantially described in the treatise on that subject, of which a translation is given in this volume.

For the weights and measures mentioned here, and in other parts of our author’s works, see the Comment. on the last section of PAULUS ÆGINETA, Syd. Soc. edit.

A mineral, consisting principally of sulphate of copper. See PAULUS ÆGINETA, Vol. III., pp. 400–2.

The μηκώνιον was applied to three totally distinct substances; 1st, To a sort of opium, that is to say, the expressed juice of the poppy (see PAULUS ÆGINETA, Vol. III., p. 280); 2d, to the Euphorbia peplus, L., (see Appendix to Dunbar’s Greek Lexicon, under the name): and, 3d, to the excrement of new-born children. It is singular that the learned Foës, in his Œconomia Hippocratica, should apply it in this place to the last of these; for if Hippocrates had used such a substance medicinally, we may be well assured that it would not have been overlooked by Dioscorides and Galen. There is every reason, however, to suppose that it is the same as the πέπλος of Dioscorides and Galen, that is to say, the Euphorbia peplus, which was recommended as a drastic purgative by all the ancient authorities on the Materia Medica, and consequently would be a medicine very applicable either in coma or dropsy.

All the commentators admit that the last section is obscure. It would appear to me that Galen understands the expression τὸ ἀπὸ τῶν κοπρἰων as applying ἑδρικοῖς, that is to say, to affections of the anus. I have followed Littré in giving the passage a very different interpretation, but I am by no means sure that Galen may not be right.

De Diebus Decretoriis, i.

See the Argument of the Prognostics.

Μηδὲν εἰκῆ, μηδὲν ὑπερορῇν. (Epid. vi., 2, 12). Νούσων φύσιες ἰητροί· ἀνεθρίσκει ἡ φύσις αὐτὴ ἐωυτῇ τὰς ἐφόδους· ἀπαίδευτος ἡ φύσις ἐοῦσα καὶ οὐ μαθοῦσα τὰ δέοντα ποίει. (Ibid. vi., 5, 1.)

Galen, De Venesect. adv. Erasist., c. iii.

One cannot help being struck with the resemblance between this description and a passage in Aretæus’s chapter on Causus: Ψυχῆς κατάστασις, ἄισθησις σύμπασα καθαρὴ, διάνοια λεπτὴ, γνώμη μαντικὴ, κ. τ. λ. In the yellow fever of the West Indies, which would certainly appear to me to be a variety of the causus, the mind is said to be wonderfully entire to the last. Dr. Fergusson gives a very striking instance of this in describing the case of Sir James Leith, the British Governor of Guadaloupe.

Traité des Fièvres ou Irritations Cérébro-spinales intermittentes, d’après des Observations recueillies en France, en Corse et en Afrique. Paris, 1836.

Œuvres d’Hippocrate, etc., tom. ii., p. 565.

Prax. Med. nova Idea, i., 31.

Tom. ii., p. 565.

On the Influence of Tropical Climates.

Tom. vii., p. 290; ed. Kühn.

Copland’s Dictionary of Practical Medicine, P. iv., p. 974.

Clinical Observations on the more important Diseases of Bengal. Calcutta, 1835.

Epidém. d’Hippocrate.

See Ægineta. The narrative contains the most distinct and unequivocal traces of the belief in the contagiousness of consumption.

Thasus is an island in the Ægean sea, off the coast of Thrace, which bears the modern name of Thaso or Tasso. It was in a flourishing condition in the time of Hippocrates, and a tributary to Athens, but revolted from that power after its disasters in Sicily during the Peloponnesian war. See Herodot., vi., 47; Thucydid., i., 101; viii., 66. Galen states that it is cold, with a northerly exposure.

According to Galen, in his Commentary on this passage, the setting of the Pleiades takes place fifty days after the autumnal equinox. See the Argument to the treatise On Airs, etc.

We have already stated that the ardent fevers or causi, of which repeated mention is made in the Hippocratic treatises, were fevers of the remittent type, in short that they were the same as the bilious remittent fevers of Pringle and Monro.

I need scarcely say that the disease here described is cynanche parotidæa or parotitis. It is a remarkable proof of our author’s talent for observation, that he has pointed out the tendency of the disease to be complicated with swelling and inflammation of the testicles. Altogether the description of the disease here given is quite applicable to the mumps of modern times. As stated by him, the swelling of the testicles is generally painful. See the Commentary of Galen.

On reference to Galen’s Commentary it will be seen that anciently the reading of this passage was reckoned equivocal. According to one of the readings, the meaning is that those who were sick did not require to come to the Iatrium for advice. See also Littré’s annotations on this passage.

Galen thinks our author expresses himself confusedly in this place, but Littré justly defends him from this charge. According to Littré, Hippocrates means that those who had been long affected with consumption (the term used, ὑποφθειρομένων, rather signifies had obscure symptoms of consumption), then betook themselves to bed; but those who were in a doubtful state, then first manifested signs of confirmed phthisis; and, finally, that there were some who then for the first time felt the attack of phthisis, and that these were persons who were predisposed to it. According to Galen, the phthisical constitution is marked by a narrow and shallow chest, with the scapulæ protuberant behind like wings; and hence he says chests of this construction have been named alar. He further states that there are two forms of consumption, the one originating in a defluxion from the head, and the other being connected with the rupture of a vessel in the lungs. I may be allowed to mention in this place, in confirmation of our author’s accuracy of observation with regard to the connection of hemoptysis with phthisis, that Louis found hemoptysis to a greater or less extent in two thirds of his cases. (Researches on Phthisis, p. 166, Sydenham Society edition.) The same author relates several cases in which death occurred suddenly and unexpectedly, as Hippocrates states to have happened to some of his patients. (Ibid.)

I am of opinion that the species of phthisis noticed in the latter part of this section was the acute form of phthisis described by Louis (p. 351). Our author, it will be remarked, states that his patients were mostly delirious when near death. Louis, in like manner, mentions delirium in, I believe, every one of the cases of acute phthisis which he relates. Galen justly remarks, that, in the ordinary forms of phthisis, delirium is not a common symptom. I would also call attention to our author’s observation regarding the inflamed state of the fauces, which is also amply confirmed by the observation of Louis in this form of phthisis.

The nature of the continual fevers of the ancients is fully explained in the Commentary on the twenty-seventh section of the Second Book of PAULUS ÆGINETA. Galen, in his Commentary on this passage, marks their nature very distinctly in few words. He says that such fevers as have an exacerbation of fever ending in complete apyrexia are called intermittents, whereas such as do not end in a complete remission of the fever are called continual. See further De Diff. Febr., ii., 2. In a word, the continual fevers were decidedly of the remittent type. See further Donald Monro’s work on Army Diseases, in the beginning of the chapter on the Bilious Remittent Fever.

The introduction of phthisis in this place has created some difficulty in the interpretation, as may be seen on reference to Galen and Littré. Galen gives a very interesting account of the way in which interpolations often took place. (Opera, tom. v., p. 356.)

The text of this last sentence is in an unsettled state. The following would be a translation of it as it stands in the Basle edition of Galen’s Works: “Of all the cases described under this constitution, those alone which were of a phthisical character proved fatal. But they (the phthisical affections?) did not supervene upon the other fevers.” Provided this be the true meaning of the passage, it would merit great attention, as seeming to contain a declaration that intermittent fevers superinduced an immunity to phthisis. I need not say that this supposed fact has been exciting a great deal of interest lately in the profession, more especially in France.

It is to be borne in mind that the autumn began with the rising of Arcturus, and ended with the setting of the Pleiades. The setting of the Pleiades then indicated the commencement of winter. The classical reader will find the different seasons, strikingly defined by the rising and setting of the stars, in Virgil’s Georgics. See in particular Georg. i., 221.

Galen thus explains the origin of the ophthalmies. He says, the constitution of the air being not only cold and humid, but attended also with hurricanes. The eyes were thus injured, and consequently were the first part of the body to show symptoms of disease. The dysenteric and other alvine complaints which followed, he ascribes to the constriction of the skin induced by the cold, and to the humoursæ of the system aggravated and increased by the humid state of the season. These humours being thus shut up by the occlusion of the pores of the skin, part of them were determined to the intestines, occasioning diarrhœa, tenesmus, dysentery, etc.; some to the bladder, inducing strangury; and some to the mouth of the stomach, occasioning vomiting.

Galen states in his Commentary that the phrenitis is connected with inflammation of the parts about the brain. We have mentioned before that the phrenitis of the ancients was a febrile affection, and not idiopathic inflammation of the brain, as is generally supposed.

According to Galen, the causi or ardent fevers are occasioned by yellow bile collected about the vessels of the liver and stomach, and the tertians by the same diffused over the whole body.

Galen states in his Commentary that children are peculiarly subject to convulsions owing to the weakness of their nervous system. He adds, that in their case convulsions are not attended with so much danger as in other cases. See the Hippocratic treatise On Dentition.

The fever here described is evidently the semitertian. See PAULUS ÆGINETA, Book II., 34. “The true semitertian,” says M. Bartels, as quoted by M. Littré, “is a real complication of an intermittent fever with another fever of a continual type. It does not show itself but rarely in our countries; but it is more frequent in the hotter countries of Europe, although the false semitertian has oftener than once been confounded with the true. In the true, the intermittent fever is tertian; the non-intermittent is quotidian.” See also Galen, Opera, tom. v., p. 362; ed. Basil.

The text here is in an unsatisfactory state, and, as usual in such cases, no ingenuity nor pains can do much to mend it. See Foës and Littré. I have translated the disputed words “not resolved,” which seems to me to agree best with the sense. Every practical physician knows that swellings of the glands, which continue long and do not suppurate, are unfavorable in fevers.

The modern physician will not fail to be struck with this observation as to the termination of certain cases of fever in determination to the kidneys. Galen remarks in his Commentary on this passage, that as the general system is often purged by the bowels, so is it also sometimes by the kidneys and bladder. This, he adds, is a protracted and painful mode of resolution in fevers. The reader will remark the characters of the urine as stated below by our author. One cannot help being struck with his statement, that all these cases recovered. I am not aware of any modern observations bearing on this point.

There is considerable difficulty here in determining the reading. See Littré, 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 Hippocrates to lay it down as a rule of practice, that “the physician should do good to his patient, or at least no harm;” but that, after having seen a good deal of the practice of other physicians, and observed how often they were justly exposed to censure for having bled, or applied the bath, or given medicines, or wine unseasonably, he came to recognize the propriety and importance of the rule laid down by Hippocrates. The practice of certain physicians, Galen remarks, is like playing at the dice, when what turns up may occasion the greatest mischief to their patients. The last clause of this passage is very forcibly put. Galen, however, informs us that in some of the MSS. instead of “art” he found “nature;” that is to say, that the physician is “the minister (or servant) of nature.” Either of the readings, he remarks, will agree very well with the meaning of the passage.

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 be recollected that the rising of Arcturus 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 readily bring to his recollection the lines of Horace, which are descriptive of this season:

“Jam Procyon furit; Et stella vesani Leonis, Sole dies referente siccos.”

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 remittent fever has uniformly been found to be most aggravated in autumn, and hence it has been named by some authorities the autumnal remittent fever. See the works of Sydenham, Pringle, Monro, and Cleghorn. Monro mentions that he seldom saw it in spring, but that it is common in the neighborhood of London towards the end of summer and beginning of autumn. All these authorities are agreed that it is of a highly bilious nature.

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 unable to evacuate the bile, it is collected in the skin, and occasions jaundice. He adds, that the occurrence of the jaundice in this case was unfavorable, owing to its taking place before the seventh day. When occurring on the seventh day, jaundice was reckoned a favorable symptom. See On Crises, 3; Aphorism, iv., 62, 64.

The reader may feel interested to learn Galen’s hypothesis by which he accounts for the hemorrhage in this case. He says it is produced by the redundancy of yellow bile, which, being mixed up with the blood and heating it, is carried up to the head, where it produces rupture of the vessels and hemorrhage.

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.

I would again request the attention of my contemporaries to the characters of the urine before a crisis, as given by Hippocrates; and, in confirmation of them I will venture to introduce here an extract from Donald Monro’s admirable account of the autumnal remittent fever: “The urine in the beginning was commonly of a high color, though sometimes it was pale and limpid; but when the fever came to remit, there was often a small sediment after each paroxysm; and as the fever was going off, it let fall a sediment in all.” (Army Diseases, etc., p. 159.) The absence of the sediment in the urine before the crisis is an important fact in the history of febrile diseases, which I have reason to think is not now sufficiently adverted to.

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.

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.

This is perhaps the most striking account of an aggravated form of causus which is anywhere to be found. Although less finished than the celebrated picture of the disease given by Aretæus, it is evidently more original. In fact, any human production which is very original cannot well be finished, and consequently a very finished work can scarcely be expected to be very original.

It is impossible to overrate the importance of these observations on crises in fevers, provided they be correct and confirmed by general experience. Monro, without appearing to have our author in view, seems to give an ample confirmation of his doctrines on crises as here laid down.

From Galen’s Commentary it appears that the text here is in a doubtful state. See also Littré.

Allusion is here made to the symptoms of delirium as described in the fourth paragraph of the Prognostics. See Galen’s Commentary on this passage.

What an admirable and comprehensive enumeration of all the circumstances upon which the prognosis and diagnosis of diseases are to be founded! Here we find nothing either wanting or redundant; and with what conciseness and precision the whole is stated! Galen gives an elaborate and, upon the whole, a very interesting Commentary on this section, but does not supply any new views, and there are few terms in it requiring explanation.

Having already stated in this work, as well as in the Commentary on PAULUS ÆGINETA, Book II., 27, my opinion respecting the nature of the continual fevers, I need not enlarge on the subject in this place. Whoever wishes for more information may find much to interest him in the Commentary of Galen. Respecting the septans and nonans, he remarks, that, although conversant with fevers from his youth, he had never met with any cases of these.

Galen, in illustration, states that epilepsy is sometimes carried off by an attack of quartan fever.

The semitertian was always looked upon as a very formidable form of fever. See PAULUS ÆGINETA, Book II., 34. Galen gives a prolix, but not a very distinct account of it.

Galen, in his Commentary, states that he had often seen persons in consumption attacked with tertian and quotidian intermittents, but admits that he had no more experience of quintans than he had of septans and nonans. Avicenna. however, is not so sceptical as to the occurrence of these rare forms of intermittents. Indeed he says, he had often met with quintans, and that a trustworthy physician of great experience had assured him that he had met with nonans. (iii., 1, 3, 67.) Rhazes also would appear to acknowledge the occurrence of all these varieties of intermittent fever. (Contin., xxx., 10, 1, 409.)

The text is much improved in Littré’s edition, so that the meaning is pretty intelligible without any commentary. Galen states in explanation, that the three varieties of fever are thus marked and distinguished from one another: in the first, the fever attains its height at the commencement, and gradually diminishes until the crisis; in the second, it begins mild, and gradually reaches its height at the crisis; in the third, the fever begins mild, gradually attains its height, and then gradually subsides until the crisis.

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.

Galen, in his Commentary, remarks that the fatal issue of this case might have been anticipated after the return of the fever on the third day, with a complication of bad symptoms, such as great thirst, dry tongue, black urine, delirium, coldness of the extremities, and so forth. The modern reader will be struck with the description of the respiration, namely, that the patient seemed like a person who forgot for a time the besoin de respirer, and then, as it were, suddenly recollected himself. Such is the meaning of the expression as explained by Galen in his Commentary, and in his work On Difficulty of Breathing. By “rare” is always meant “few in number.” The reader will remark that this is a striking case of a fever having regular exacerbations on the even days, and slight remissions on the uneven.

This, it will be remarked, is a case of fever induced from obvious causes, namely, excessive fatigue and dissipation. We must take into account, however, the febrile constitution of the season. According to Galen, the fatal result could have been confidently foreseen from the seventh day. The distention in the hypochondriac region here described would appear to have been meteorism. The throbbing in this region was no doubt owing no the same cause. The rash was most probable miliary. It is described as resembling vari (ἴονθοι), by which was probably meant acne. See PAULUS ÆGINETA, Vol. I., p. 454. Upon reference to the Prognostics, it will be remarked that the characters of the urine are all bad, that is to say, it was either suppressed, or the sediment was either wanting or black and farinaceous. See Prognost. 12. By “black,” as applied to the urine, is to be understood “a dark-red color,” like that of wine.

There is nothing in this case very remarkable, or which stands in need of elucidation; but yet the reader may feel interested in Galen’s reflections upon it. The recovery he holds to have been unexpected, as a different result might have been anticipated from the characters of the alvine discharge, and of the urine at the commencement. The favorable change he attributes to the swelling of the spleen, whereby the peccant humors were attracted to it; and he further remarks, that as the swelling of the spleen diminished, the humors are described as having passed down to the extremities, after having first affected the groin of the side on which the spleen is situated. He further calls attention to the improved characters of the urine when the swelling of the spleen and pains of the limbs supervened. Still, however, he adds, there was a remnant of the cacochymy in the system which gave rise to the relapse on the fourteenth day, so that the complete crisis did not take place until the seventeenth day.

This is evidently a well-marked case of puerperal fever, or of fever complicated with the puerperal state. There is nothing particularly interesting in Galen’s commentary on it. He states that the application made in order to remove the suppression of the lochial discharge may either have been a pessary or a suppository. It seems most likely to have been the former. On the composition of the ancient pessaries, see PAULUS ÆGINETA, Book VII., 24. He remarks that the symptoms first stated are unfavorable, but not necessarily fatal, until we come to the coldness of the extremities, which is an extremely mortal symptom in the beginning of a disease when combined with a very violent fever. The modern reader will be struck with the expression that “the attendants seldom put her in mind” to make water; it is very descriptive, however, of the state of stupor the patient was in when she was so insensible that she did not attend to the calls of nature.

Galen remarks that it was reckoned very extraordinary for a rigor not to be followed by febrile heat. See Comment. et de Rigore; de Diff. Febr., ii.; and Foës’s long annotations on this passage.

It will be remarked that the characters of the urine throughout are favorable. Though darkish at first, this was reckoned not unfavorable, as being connected with the lochial discharge. (See Galen. Comment. 2, Epid. iii.) The sediments afterwards are all of good omen; but, as Galen remarks, its first characters indicated a prolonged fever.

On the Critical Days, see PAULUS ÆGINETA Book II., 7.

On comparing the symptoms here enumerated with the Prognostics, it will be remarked that none of them are of fatal omen. But the white sediment, and afterwards the reddish color of the urine, while they indicated recovery, at the same time prognosticated a protracted attack of fever. See Prognost., 12. The reader will further remark that there is an absence of all the decidedly fatal symptoms, such as delirium, coldness of the extremities at the commencement, and so forth.

The rapid recovery in this case would seem to be partly attributable to the decided plan of treatment, namely, the copious affusion of hot water on the head. Hippocrates probably had it in view when he wrote the forty-second Aphorism of the Seventh Book: “In fever not connected with bile, if a large quantity of hot water be poured over the head, it proves a resolution of the fever.” Galen points it out as a remarkable circumstance, that in this case the crisis took place without concoction of the urine, in consequence of the hemorrhage from the nose, and the sweating.

In this case, as Galen remarks, the continued sweats, unfavorable condition of the hypochondriac region, and the black urine, precluded all hopes of recovery. He thinks our author related the case as an instance of sudden death in fever, this patient having died on the fourth day after the attack (the first not being counted). See his Commentary. He also makes reflections upon this case in his work On Difficulty of Breathing, where he points out the danger of meteorism of the hypochondriac region as being necessarily accompanied with dyspnœa, and connected with inflammation (2).

This case, as Galen remarks, is interesting from the suddenness of the fatal result. We should not hesitate nowadays to set it down as a case of malignant erysipelas; the pain, swelling, and bullæ of the foot and ankle must have been of this nature. By the way, these bullæ, when not followed by suppuration, are represented in the Coacæ Prænotiones, as a fatal symptom. Galen thinks it strange that this patient was not bled, but accounts for it by supposing that Hippocrates had been called in too late. He remarks on this case in the Second Book of his work On Difficulty of Breathing.

Galen looks upon this patient as an example or paradigm of general principles in Prognostics. Thus, with regard to the characters of the urine, it is stated that on the eleventh day the urine was thin, of a good color, and having many substances floating about in it, but without sediment. Thus matters remained until the sixteenth, when the urine became somewhat thicker, and had a slight sediment. Now Galen remarks (as the reader will find on turning to the Book of Prognostics) that these characters of the urine are indicative of recovery after a protracted disease. Galen further points out that no one of the fatal symptoms are mentioned, and that swellings of the parotid glands and the dysenteric affections of the bowels indicated that the crisis would be distant. He also calls attention to the case as confirmatory of the doctrines of Critical Days. In the Second Book of his work On Difficulty of Breathing, he makes some remarks, of no great importance however, on the meteorism of the hypochondriac region, as noticed in this case.

In this case, as Galen remarks, the characters of the urine from the first were such as to indicate a fatal and speedy result. On the second day the urine was turbid, and without any sediment; on the third day the same, and consequently confirming the anticipation of the disease proving mortal; on the fourth, oily urine, with epistaxis, so that it was not to be wondered at that the patient died on the sixth. Indeed, when we further take into account the state of the breathing, the coldness of the extremities, the meteorism of the hypochondriac region, and the subsultus tendinum, it is difficult to imagine a more hopeless case of fever. Having mentioned “oily urine,” it may be well to state its characters, as fully given by one of the later authorities on urology, namely Theophilus. He says, when the urine in fevers assumes the color of oil, it indicates that the fat of the body is melting down; when the appearance of the urine still more resembles oil, it shows a still greater melting; and when the urine in consistence and color exactly resembles oil of a dark color, it prognosticates a fatal collapse. (De Urinis, 17; ed. Ideler.) On this subject, see further some very interesting observations by Foës, in his annotations on this passage (p. 988). With regard to the respiration in this case, see also the remarks of Galen in the Third Book of his work On Difficulty of Breathing (tom. vii., p. 932; ed. Kühn). As Galen here remarks, Hippocrates explains the meaning of this passage in one of his Aphorisms, where he writes thus: “In fevers, when the respiration stops, it is a bad symptom, for it prognosticates convulsion.”

According to Galen, this case is an instructive example of the danger of neglecting the diet at the commencement of complaints which appear unimportant. This man, having taken supper at the beginning of a fever which appeared slight, suffered therefrom as the result showed; that is to say, vomiting ensued, followed by serious symptoms, among which Galen particularizes, as indicating a fatal result, urine at first thick and without sediment, and afterwards oily. So much importance did the ancient physicians attach to observations on the urine in fevers! Galen further calls attention to the fact, that the patient died on a critical day, that is to say, on the eleventh.

Galen, in the commentary, makes a remark regarding this report, which appears more important to him than it will do to most modern readers, namely, that he wonders Hippocrates did not state the age of this patient. He adds, that it is very rare for a pregnant woman to have such a serious fever without parting with her child. He thinks the patient, in the present instance, owed her recovery to the strength of her constitution, as “urine white, and not of a good color,” in combination with the other bad symptoms, indicated an unfavorable result. By the way, upon reference to the Basle edition of Galen, and to Foës’s annotations on this case, it will be seen that there is a difference of reading in the words descriptive of the urine, that is to say, some read ἀχρόων, some εὑχρόων. Certainly it appears to me that Foës is right in preferring the latter. The decided crisis, it will be remarked, took place on a critical day, that is to say, the fourteenth, by a sweat.

Here again Galen calls attention principally to the characters of the urine, which is first described as being “of a good color, but thin.” Now, by a good color of the urine, Galen observes, was meant of a slightly yellow color. In this case, as usual, the crisis was marked by a sediment in the urine.

Œuvres d’Hippocrate, tom. iii., Arg., pp. xxxvi.-xlii. tom. v., pp. 57–70.

There is some doubt, however, even on this head; indeed Riolanus does not scruple to affirm, with a considerable degree of plausibility, that Ruffus must have lived after Galen, since he is nowhere mentioned by the latter. (Anthropographia, i., 5.)

In illustration, consult Plutarch (Placit. Philosoph., v., 29).

De Differ. Feb., i., 7; tom. vii., p. 296, ed. Kühn.

Commentary on PAULUS ÆGINETA, Book II., 16, 36; IV., 25, Syd. Soc. edition.

Disquisitio Historico-Medica de Natura Morbi Atheniensium. Stuttgart, 1831.

On this case Galen has left very lengthy and elaborate commentaries, containing much important and amusing matter, but not a little verbose trifling, to say the least. Our limits, as well as our tastes, dispose us to be very sparing in our extracts from them. Passing over his remarks on the solecism in syntax, with which the Report commences, and his observations on the absence of all mention of the exciting causes, as is the usual practice of our author, I shall proceed to state what Galen says on the apparent neglect of venesection in a case where it would certainly appear to have been clearly indicated. In this case, as Galen remarks, one or other of these suppositions may be made: either that bleeding was not practiced, or that the author did not think of mentioning the practice here, as supposing that it would be taken for granted that it was applied. Now, he adds, the former supposition is very improbable, considering how partial our author shows himself to this practice in his works which are unquestionably genuine, such as On the Regimen in Acute Diseases, the Aphorisms, the work On the Articulations, and even in this very book, where in one place he mentions that he abstracted blood copiously on the eighth day. If, then, he bled so late in febrile diseases, Galen contends that he was not likely to neglect the operation in an earlier stage, when so much more demanded. He argues further, that in many of the other reports of cases he neglects to mention that the usual routine of practice was followed: and therefore he inclines to the opinion that it is omitted to be mentioned here, because the author supposed there could be no question on this point, more especially as it was his universal rule to bleed in all great complaints, when not prevented by the age or powers of the patient. He afterwards insists strongly on venesection having been indicated in this case, in order to procure revulsion from the brain. As usual with the commentator, he calls attention to the characters of the urine, and explains the meaning of the term “cloudy,” as applied to the eneorema, or substances floating in the urine, by which he contends is to be understood a color intermediate between white and black. What follows in this very lengthy Commentary is very interesting in a general point of view as regards the views of some of the older commentators, but is not directly applicable to the present case. His observations on the characters affixed to this and many of the subsequent cases have been noticed in the Argument. The reader will further remark of this case that it is an instance of fever passing into a deposit (or abscess), and the latter into strangury, of which our author had made mention in the First Book of the Epidemics. I may further mention that the reader will find much interesting matter in Galen’s work On Trembling, in illustration of the nature of the attack under which the patient labored.

Galen, in his Commentary, communicates a singular notion which one of the earlier commentators maintained respecting the name of the place where this patient was laid, that is to say, that this new wall, having been recently washed with quicklime, had been the cause of this patient’s illness. Galen, however, rejects this paltry conceit. He says on his own authority, that there being three distinct classes of fever, namely, the ephemeral, the hectic, and those connected with putrid humors, the present case belongs to the last of these.

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 1843. In this epidemic, as in the present case, the fever was very subject to relapses and to jaundice at an early stage. Hippocrates, in one of his Aphorisms, pronounces jaundice in fevers before the seventh day to be a fatal symptom. (iv., 62, 64.) Galen justly thinks it somewhat singular that no further mention of the jaundice is made in the course of the report; but he inclines from this to draw the conclusion that it remained in the same state throughout. As there was no crisis by the stomach, the bowels, the urine, or sweat, he concludes that the jaundice could not have been carried off. From all that has been said, he adds, it is clear that the organ primarily affected was the liver. Galen, then, decidedly opposes the view taken in the Explanation of the Characters respecting the cause of this man’s death, which he contends was not connected with any suppression of the alvine discharges, but with the affection of the liver. On the Scotch Epidemic, see Ed. and Lond. Med. Journal, March, 1844.

Most of the ancient authorities regarded deafness as an unfavorable symptom in fevers. See PAULUS ÆGINETA, Book II., 4. The modern are divided in opinion on this point. Pringle and Huxham regard it as a favorable symptom, but Home looks upon it as unfavorable.

Here again Galen mentions the absurd notion of Sabinus the commentator, that this man’s disease was occasioned by the locality in which he was laid. Galen, on the other hand, thinks it likely that the patient was conveyed to the garden as being a favorable situation for a person ill of fever. He further alludes to this case in the Second Book of his work On Critical Days.

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.

Thus, as Galen remarks, after two ineffectual attempts, Nature accomplished a cure on the fortieth day.

There is not much to remark in this case. A modern reader will suspect that there had been cerebral disease before the attack of the fever, and that matters had been brought to a crisis by the drinking of wine. Indeed Galen, in his Commentary, remarks that the precursory symptoms indicate a congestion of humors in the brain, which of course would be much aggravated by the wine, the brain then being, as he says, in a bad state; and the patient having inflicted an additional injury to the organ, by means of the drink, brought on the acute attack, which proved fatal in five days. The deafness, delirium, spasms, and bilious vomitings all indicate a cerebral affection. The state of the hypochondria, as described in the report, Galen would seem to attribute to a spasmodic affection of the diaphragm, from sympathy with the brain. Retraction of the hypochondrium is pronounced to be a bad symptom in the First Book of the Prorrhetics. Galen justly contends that there is no reason in this case to suspect any inflammation in that region.

Galen’s remarks on this case are unusually brief; he attributes the fever to a bilious plethora, and states that the result was such as might have been anticipated from a knowledge of the critical days, and of the characters of the urine. Indeed the latter appear to me well deserving of attention.

This is in many respects an interesting case, and more especially, from its being stated that the disease was complicated with hereditary consumption. Galen, in his Commentary, remarks that some authorities denied that any disease is congenital, but this opinion he decidedly rejects. The phthisical affection, however, as he justly remarks, would not have occasioned so sudden an issue if it had not been complicated with a complete prostration of the natural powers. He insists strongly on the striking description here given of the total loss of the natural appetite, both in regard to food and drink. Of course, no worse state of the system can be imagined than that in which it is totally insensible to its own wants, nay, that it loathes the very articles which it stands most in need of. Galen properly remarks in another place (Comment. I., in Epid. i.), that it is an extremely unfavorable symptom when in an ardent fever there is no thirst. The small abscess about the nates would seem to have been an incidental complication. It would appear to be now settled by the best pathological authorities that there is no natural alliance between phthisis and fistula in ano, as was at one time suspected. See Andral (Cliniq. Médicale, tom. iv., p. 308), and Louis (On Phthisis, p. 89, Sydenham Society’s edition). The affection of the fauces and throat, which is described as having attacked the patient at “the commencement of the disease,” would appear to have been a common complication of that epidemic. It is noticed in the First Book of the Epidemics. Foës remarks, however, that some had referred it to that redness of the fauces to which persons laboring under consumption are liable. Compare Louis, l. c. p. ii., § 12. Galen makes mention of a difference of reading in the MSS. he used in reference to the Critical Days.

On this brief case Galen has left a lengthy and elaborate Commentary, abounding in most interesting matters on a variety of subjects; as, for example, the different readings and opinions of the more ancient commentators on the characters at the end of this and the other reports; on the formation of the Hippocratic Collection, and the extraordinary zeal of the Ptolemies in procuring books for their great Library at Alexandria, and so forth. There is not much in it, however, which bears directly on the present case, and therefore we shall give but a very brief abstract of it. It appears from Galen that there was a considerable diversity of readings in the latter part of it, more especially in regard to the number of days the patient lived; some of the old authorities having placed the death on the fifth, some on the seventh, and others on the eighth. Galen inclines to hold by the text as we now have it, and maintains, apparently with good reason, that under such a combination of fatal symptoms it was not likely that the patient’s strength should have stood out longer than the fourth day. Another curious subject connected with this case which Galen slightly touches upon, but without throwing any light upon it, is the omission of the treatment. He justly remarks, that if Hippocrates treated the patient himself, or superintended the treatment as managed by another, it is singular that there is no mention of a clyster having been administered, nor of a cataplasm having been applied, nor of venesection having been practiced. I shall not attempt to solve the question here propounded by Galen. See the Argument. His Commentary also contains an interesting discussion on the meaning of the expression “respiration elevated.” To give the sum of what has been advanced on this subject in a few words, it may signify laborious breathing so as to move the labia of the nose; or it may mean simply orthopnœa, or it may signify laborious respiration, attended with elevation of the chest. By the way, this is evidently the “sublimis anhelitus” of Horace, in his famous ode entitled “Nireus.” I have often wondered that such a learned physician as Julius Cæsar Scaliger, in his celebrated critique on Horace in his Poetics, should have remarked on this expression: “Ex toto Galeno non intelligo quid sit sublimis anhelitus.” Galen, in fact, treats fully of the “sublimis anhelitus” in various parts of his works. See in particular On Difficulty of Breathing.

Galen has given us a lengthy Commentary on this case, but a great part of it relates to the characters and to other matters not of any very great importance in this place. As he remarks, it is a striking example of an acute fever induced by immoderate fatigue. It appears from his Commentary, moreover, that some of the older authorities had added “drinking” to the excesses which induced his affection; that is to say, they proposed to read πότων instead of πόνων. The symptoms, upon reference to the Prognostics, are all such as indicated a fatal result, namely, the blackish and thin urine, “the fumbling with the bedclothes,” the coldness and lividity of the extremities, the meteorism, and so forth.

In Galen’s Commentary on this case there is not much of any great interest to the professional reader of the present day. He animadverts again on the omission of all mention of the treatment, although, as he states, venesection and the other usual means had no doubt been tried; indeed the report implies as much. Hippocrates, he repeats, never thinks of mentioning the usual routine of practice, as he takes it for granted that the reader will understand that it was not neglected. It is only on special occasions, then, that he thinks of making any particular reference to the treatment. Galen remarks, that ileus being an inflammation of the upper intestines, is a particularly dangerous affection.

As remarked by Galen in his Commentary, this was no doubt a case of ardent fever or caucus, complicated with an incidental miscarriage. There is no reason for looking upon it as being a case of puerperal fever. Galen thinks that the last word (caucus) is an addition made by the copyists, having been transferred from the Glossarium to the text in the course of transcription. Galen, as usual, directs attention to the characters of the urine, which in this case are particularly unfavorable, being defective both in quantity and quality.

Galen’s remarks on the circumstances of this case are sufficiently to the purpose, but there is nothing very striking in them. He states that the abortion may have been occasioned either by external causes--such as the application of pessaries for this purpose, and the like--or internal, such as hemorrhage from the neck of the uterus. and so forth. As in the former case, he pronounces the last word (phrenitis) to be an addition to the text, as Hippocrates never enters upon the diagnosis of diseases, as is done in the work On Diseases. I suppose he means that our author’s real works are all founded on Prognosis; whereas the other, being derived from the Cnidian school, is founded on Diagnosis. See our observations on this subject in the Preliminary Discourse, and the Argument to the Prognostics.

Galen remarks, that with such a combination of fatal symptoms, namely, coldness of the extremities, fetid vomiting, etc., it is wonderful that this patient stood out until the fourteenth day. He thinks, however, that this is to be explained from her age and constitution. He justly remarks that the occurrence of the epistaxis could not be supposed sufficient to carry of such a combination of unfavorable symptoms. He once more protests against the last word of the report (causus) being admitted as genuine. He confesses himself unable to determine whether “The Liars’ Market” was in Athens or elsewhere.

This is entitled the pestilential constitution by Galen. By constitution, he explains, is meant not only the preternatural state of the atmosphere, but also of everything else which influences the state of the general health.

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 defluxion, but that it is not always of a malignant and putrid nature; on the contrary, when the defluxion is mild, and the bile which produces it is natural, it is not attended with any considerable injury to the body, if properly managed; but that the humor which produced the erysipelas about to be described was not such, but of a malignant, corrosive, and septic nature, being engendered by the humid and calm state of the weather in such persons as were of a choleric constitution.

According to Galen, aphthæ in general are superficial ulcerations in the mouth, produced by the acrimony of the nurse’s milk, and which are easily removed by an astringent application. But in the present instance the aphthæ were of a malignant nature.

The carbuncle (anthrax), Galen says, is always dangerous, and the product of bad humors. See PAULUS ÆGINETA, Vol. II., pp. 78, 79. Galen, in his excellent work On the Difference of Fevers, writes thus: “In constitutions of the year, similar to those which Hippocrates describes as taking place in Cranon (See Ep. ii.). I have known cases of anthrax prevailing epidemically in no few numbers, the formation and other symptoms of which were exactly as described by him.” (Tom. vii., p. 293; ed. Kühn.)

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 locality where I am now writing, the one in 1823, and the other in 1846. As described by Hippocrates, the disease sometimes supervened upon a slight injury, and generally terminated in gangrene. On epidemical erysipelas, see De Haen (Ratio Medendi), Bartholinus (Hist. Anatom. Rat. Hist., 56), Wells (Transactions of a Society for the Improvement of Medical and Chirurgical Knowledge), Cooper’s Surgical Dictionary; and Cyclopædia of Practical Medicine, under Erysipelas.

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 Thucydides: “For the mischief, being at first seated in the head, spread over the whole body, and if one survived the most formidable symptoms, an attack on the extremities manifested itself; for it was determined to the genital organs and to the hands and feet, and many escaped with losing them, and some with the loss of their eyes.” (ii., 49.) The passage is thus rendered by Lucretius:

“tamen in nervos huic morbus et artus Ibat et in partes genitales corporis ipsas; Et graviter partim metuentes limina lethi Vivebant ferro privati parte virili: Et manibus sine nonnulli pedibusque manebant In vita tamen et perdebant lumina partim.” (vi., 1203.)

Lucretius, it will be remarked, understands the historian to mean that the mortified parts were amputated; and this opinion, although rejected by most of our non-professional editors of Thucydides, is confirmed by what Galen says in his Commentary on this passage, namely, that in erysipelas of the genital organs “we (meaning the physicians of his own time) are often obliged to excise the putrid parts, and apply the cautery to them.” I would here further point out a singular mistake into which Dr. Bloomfield falls in his note on this passage of Thucydides; he says that the words of the original (ἄκρας χεῑρας καὶ πόδας) “can only signify the ends of or lower joints of the fingers and toes.” No one who is acquainted with the language of our author will require to be told that this is an entire misconception. In the works of Hippocrates χεῖρες is often put for the arms, and χεῖρες ἄκραι are always applied to the hands.

Upon reference to the Glossary of Erotian, the Commentary of Galen, and the Annotations of Foës and Littré, the reader will see that there is great difficulty in determining the text in this place. After examining all that has been written on the subject, one cannot come to any satisfactory conclusion as to the true reading. I have adopted the meaning which seems to suit best with the passage. The professional reader will scarcely require to be reminded that in cases of phthisis there is often a notable impairment of the voice.

Galen makes the important remark on this word, that, in febrile diseases, epistaxis 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.” (l. c.)

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.

This description apparently can refer to nothing but pestilential buboes.

It is impossible not to recognize this as a description of purulent ophthalmia. Celsus thus describes the ficus: “Est etiam ulcus quod a fici similitudine σύκωσις Græcis nominatur, ubi caro excrescit; et id quidem generale est. Sub eo vero duæ species aunt. Alterum ulcus durum et rotundum est: alterum humidum et inæquale. Ex duro exiguum quoddam et glutinosum exit: ex humido plus, et mali odoris.” See the Lexicons of Hesychius and Phavorinus, and also PAULUS ÆGINETA, Book III., 3. It will be remarked that Hippocrates also makes mention of fungous excrescences about the pudenda. Were they syphilitic? In other words, did they derive their origin from elephantiasis? See the Annotations on PAULUS ÆGINETA, Book IV., 1, Sydenham Society’s edition.

The meaning of this term is not precisely determined. Galen’s account of it may apply both to exanthemata, and pustulæ. The description of the eruption in the Plague of Athens is likewise vague and indeterminate. (Thucyd, ii., 49.)

These intestinal complaints are all mentioned in the description of the Plague at Athens. (l. c.) Upon reference to the Commentary of Galen, the reader will remark that there is a question here respecting the reading.

Galen, in his Commentary, makes the remark that he observed the same symptom in the plague which raged in his time.

It will readily be understood that a colliquative diabetes would prove a very unfavorable complication of these complaints.

By nocturnal fevers, according to Galen, was meant quotidians, which had their paroxysms during the night. Foës inclines to think that diurnal should also be inserted in this place. These nocturnal fevers are thus described by D. Monro: “The sick were restless and uneasy at night; but commonly felt themselves cooler and lighter in the daytime: and although they had no cold fit, as the fever came on at nights, and many of them no breathing sweat, as they became cooler and freer from the fever in the morning; yet the fits were so remarkable, that many of the patients used to say that they had a regular fit of an ague every night, and some few that they had the fit every second night.” (Army Diseases, etc., p. 158.)

The account of the origin and progress of consumption here given is, upon the whole, wonderfully correct. Common experience seems to have decided that spring and autumn are the most fatal seasons to phthisical patients. Avicenna makes the remark, which is very important, and deserves to be kept in mind, that by phthisis, in this place, Hippocrates most probably meant hectic fever, connected with disease of the internal viscera, which had been in an inflamed state during the acute attack of the fever. (iii., 1, 3, 67.)

I shall not enter into a discussion of the different readings of this interesting passage. I may mention that our great pathological authority on phthisis, Dr. Louis, agrees with Hippocrates in deciding that the lymphatic temperament constitutes a more or less marked predisposition to the development of phthisis. (p. 483.) Galen describes the phlegmatic temperament as being attended with a soft and slightly tumid skin. He attributes the disease in their case to a cacochymy, that is to say, to cachexia. I need scarcely remark that this opinion is strongly advocated by one of the highest authorities of the day, I mean Sir James Clark. See his treatise on Tubercular Phthisis. Galen gives a discussion on the color of the eyes, about which there is some difficulty, as the ancient terms which relate to colors are not very well defined. The term here used (χαροπὸς) may signify either blue or gray. Galen considers this color of the eyes as a symptom of a cold and humid temperament.

There is an ambiguity in the part of the sentence which relates to women, as Galen states in his Commentary. Galen does not hesitate to declare that women are more subject to phthisis than men, an opinion upon which modern authorities are not at all agreed. See the recent publications of Louis and Clark on Phthisis.

The last paragraph, and the latter clause of the preceding one, were at first attached to the end of the subsequent cases, and were transferred to their present position by Dioscorides the commentator a short time before Galen. They evidently embody a most distinct and admirable enumeration of the general facts with which the practical physician ought to make himself acquainted.

We learn from the Commentary of Galen that some of the older critics supposed that the sixteen cases about to be related had been selected by Hippocrates in illustration of his doctrines, as laid down in the preceding description of what is generally entitled the Pestilential Season. Galen, however, does not incline to this opinion.

This is an example of one of those protracted fevers of an intermittent type, which, as I have been informed by an intelligent physician who practiced for several years in the Ionian Islands, are so common in the climate of Greece. There is not much of any particular value in Galen’s Commentary on this case. He informs us that one of the older commentators absurdly maintained the opinion that the country of this patient was given because, according to Asclepiades, the inhabitants of Paros were most especially benefited by bleeding. But, as Galen says, this remark is particularly out of place here, since no mention of venesection occurs in the report. Galen, and after him Foës, have given very lengthy and elaborate disquisitions on the nature of oily urine. The result is, that it is an unfavorable, but not necessarily a fatal, character. It is minutely described by the later authorities on urology, namely, Theophilus and Actuarius. See also the Commentary on PAULUS ÆGINETA, Book II., 14, Sydenham Society’s edition.

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.

Galen’s Commentary on this case is written in his usual light and diffuse style, but contains very little which is calculated to throw light on the text, or on the nature of the disease which is here described. If any one find difficulty in comprehending the characters of the respiration, as given in this narrative, he can turn to Galen’s work, On Difficulty of Breathing, where they are explained very fully. I may just mention that by shortness of breath (βραχύπνοος) was understood, by Hippocrates and Galen, frequency of the act of respiration.

This case, as Galen remarks, is an instance of the most acute form of phrenitis. He states that he himself had met with cases of phrenitis in which the patients had died on the fourth and fifth day, but that he had never seen a case which proved so suddenly fatal as the present one. He further makes some very interesting reflections on the suddenness of the attack in such cases, which is the more wonderful, as the exciting cause of them must be gradually collecting in the system, and acquiring strength and intensity, and it is singular that it should then be developed all at once, and cut off the patient in a very short time, as if he had swallowed poison, or had been stung by a venomous animal. He compares the latency of the febrile humor in the system to that of the mad dog, which will remain for a long time in the body of a person who had been bitten, and then all at once will manifest its effects, by inducing the rage. For the ancient views on the subject of Hydrophobia, see PAULUS ÆGINETA, Book V., 4, Sydenham Society’s edition.

Galen, in his Commentary on this case, enters into a train of reflections how a physician ought to proceed when called in to a patient so circumstanced. He ought, in the first place, as the Commentator properly remarks, to make careful inquiry, in order to find out whether the pain in the limb be occasioned by any external cause, as persons often meet with local injuries by sudden twisting and movements of their limbs, or even by laying a limb uncomfortably in bed, without being aware of it. When no such cause of the complaint can be discovered, Galen says the physician should try to ascertain whether or not it be connected with the regimen or temperament of the patient. If it shall turn out that the body is in a plethoric state, general bleeding must be had recourse to, before any local applications are made to the part. It is then to be fomented, and liquid and heating medicines applied to it. Whether or not this was the mode of treatment which Hippocrates adopted in this case, Galen cannot take upon himself to affirm, as no mention is made in the report of venesection, nor of the particular remedies which were used. I am of opinion that this is one of the most interesting cases in the whole Collection, for I believe it to be a faithful report of a disease which on three several occasions I have met with during an active professional practice of thirty years, and which I have not seen described elsewhere. In all my cases, indeed, the patients were from twelve to sixteen years old, but in other respects the symptoms were the same as here described by Hippocrates. In every one of the cases the patient was seized with pain and swelling of the thigh, attended with high fever, great jactitation, and partial delirium. They all proved fatal in the course of three or four days. Whether the disease be connected with diffuse inflammation of the areolar substance, or with inflammation of the veins, or whether it be a general fever complicated with a local affection of the limb, or what may be the exact nature of the affection, I have not been able to determine. From what is stated above, it will be clearly seen how justly Hippocrates deserves the compliment paid to him by Galen, of having been, of all medical authorities, the most careful in observing the phenomena of disease. (Opera Galeni, tom. vii., p. 829, ed. Kühn.)

Galen remarks, that this is one of those cases which appear formidable to the inexperienced, but which those who are practiced in the art judge of as being likely to come to a speedy crisis. He adverts to the slight swelling of the spleen and the characters of the urine, which soon showed a proper sediment, as being particularly favorable symptoms. The more that we study Hippocratic medicine, we shall be the more convinced that too little attention has been paid of late years to the physical characters of the urine in all febrile complaints.

Galen’s Commentary on this case is unusually brief. He holds it to be a case connected with general plethora, as indicated by the good color of the urine. He once more makes the remark that a favorable issue of the case might have been anticipated, from the characters of the urine.

Galen remarks in his Commentary, that of all the cases related in the First and Third Books of the Epidemics, this is the only one in which Hippocrates says that the patient was bled, not, he adds, that this was the only case in which venesection was adopted, but because, although the general rule was not to bleed after the fourth day, the patient, in the present instance, was bled on the eighth. Many others, he says, were no doubt bled on the second, third, and fourth days, but of these bleedings, and the other means used, Hippocrates in general takes no notice, except that he sometimes states, in order to render the malignity of the disease more apparent, that it was nowise benefited by the remedies applied. In other cases he adds, he would appear, from the words he uses (such as “as far as I am aware”), not to have attended the patient at the commencement. Galen further directs attention to the characters of the expectoration, the concoction of which he looks upon as having proved the means of carrying off this fever. Galen has reviewed the symptoms of this case very fully, and in a most interesting manner, in the Second Book of his work, On Difficulty of Breathing, see ed. Kühn, tom. vii., p. 854, etc. That it was a case of fever complicated with pleurisy seems clear, as Galen remarks. Galen further treats of the characters of the sputa in this case, in the First Book of his work, On Crises. Upon reference to the edition of Littré, it will be seen that unfortunately there is considerable variation in the readings of this passage.

On this case Galen makes the remark that this patient must have had a strong constitution, otherwise it could not have withstood such an affection. He adds that, moreover, his pulse must have possessed strength, but that, as formerly said by him, this department of prognostics is altogether omitted by Hippocrates, in his reports of febrile cases. He further remarks that the respiration and appetite were not to complain of, and the only bad symptom was the thinness and blackness of the urine, which therefore required a long time for nature to overcome, by occasioning hemorrhage, pain of the hip-joint, and determination downwards. He adds, that great diseases require decided crises, and that even with those now mentioned, the disease was not entirely removed in this case, until concoction in the urine took place.

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.

The only thing of importance in Galen’s Commentary on this case is the remark that this woman’s melancholy was most probably connected with suppression of the menses, and that to this cause the dark color of the urine in the present instance is most probably to be ascribed. To the critical evacuations by the sweat and menstruation he attributes the recovery.

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 occurred on the sixth day, there was no relapse. The recovery he ascribes to the copious menstruation which then took place for the first time. He also calls attention to the characters of the urine, which, he says, are those which usually accompany delirium, although this is omitted in the Prognostics.

Galen, in his Commentary, merely remarks that Hippocrates, at the conclusion of the report, briefly enumerates the more prominent symptoms from which a fatal result might have been confidently prognosticated. By enlarged viscera, in this case, we are informed by Galen in another place, that our author meant inflammation and swelling (Comment. in Rat. Vict. in Acut. c. iii.) There can be no doubt that by viscera Hippocrates meant the liver and spleen (see the work just referred to). Galen briefly remarks on this case towards the end of the Second Book of his work, On Difficulty of Breathing.

Cyzicus was a flourishing city on the Propontis. See Strabo, Geogr. xii.; and Pliny, H. N. v. 32.

Galen, in his Commentary, accounts for this fatal disease upon the supposition that the uterus was inflamed, and affected the brain by sympathy, hence maniacal delirium and convulsions were the consequence. Galen, both in his Commentary, and in his work On Crises, refers to this case, in confirmation of his doctrine of critical days.

I will venture to affirm, without much fear of contradiction, that in all the works on medicine, both ancient and modern, there is not to be found so vivid a delineation of the symptoms of fever, complicated with effusion on the brain. Those who have added new features to the picture, have thereby detracted from the general effect. Galen, in his Commentary, insists more especially on the character of the respiration, but there does not appear to me to be any particular obscurity about it. He also touches on this case towards the end of the Second Book, On Difficulty of Breathing. After reading all his prolix disquisition on the subject, one does not feel much better instructed on the subject. Galen, at times, nay, very frequently, seems to forget a favorite saying of his own, namely. that he who would wish to lay in a copious store of knowledge during life, should trouble himself little about words, and attend principally to things.

There were two Thessalian cities of this name, the one in Estiæotis, and the other in Magnesia. This would appear to be the latter. See Pliny, H. N. iv., 9; and Livy, xliv., 13.

Galen’s Commentary contains few observations of much interest, and which are not sufficiently obvious. Excesses in drinking and debauchery, he remarks, hurt the nerves and the origin of them, that is to say, the brain. Thus he accounts for the delirium with which this case of fever was attended. All the other prominent symptoms, such as the palpitation in the epigastric region, the swelling of the hypochondrium, and the like, were noticed previously. Galen also reviews the symptoms of this case in his work On Difficulty of Breathing, II.

“Hippocrates qui tam fallere quam falli nescit.” (Macrobius in Somn. Scipionis, i., 6.)

Hippocratis Coi de Cap. Vuln., etc., a Francisco Vertuniano. Ejusdem textus Græcus a J. Scalig. Castigatus, etc.

Comment. de Ossibus.

Hist. Animal., i., 7. In reference to this description, it is stated by Vesalius, who in the course of his life had examined a great number of crania, that it is very rare indeed to meet with a skull in which the sutures are wanting. He accounts for the statement made by Herodotus (Hist. ix.) and Aristotle (1. c.), respecting skulls without sutures, upon the supposition that the observations of these authors must have been made upon those of old persons, in whom the sutures are often very indistinct. (Chirurg. Magn., i., 17.)

H. N., xi., 48; ed. Hardouin.

De Partib. Animal., p. 34; ed. Londin.

Φοεός. The exact meaning of this term is well defined by Eustathius in his Commentary on Homer (ad Iliad., ii., 219), ό ἐις ὀξὺ λήγονσαν ἔχων τὴν κεφαλήν. It is excellently expressed by Damm as follows: “One whose head diminishes towards the top like a sugar-loaf.” (Lexicon Homericum in voce Φοεός.)

De Usu Partium, ix., 17.

Surgery, v., 4.

Chirurg. Mag., i., 17.

It is well known that in very advanced age the sutures get nearly effaced. See the Cyclopædia of Anatomy, vol. i., p. 745.

Comment. de Ossibus.

Obs. Anatom.

This letter was very varied in form. See Galen and Foës.

The operation consisted in sawing the bone nearly through, and leaving it in this state until it exfoliated, or until the bone could be separated from the dura mater without violence. See below.

It is no doubt true that a simple cut in the outer table of the bone, when accompanied with concussion or contusion, may produce fatal effects within, and this, in fact, is stated by our author; but, of itself, as he says, the simple incision or hedra cannot be of a dangerous nature, nor require any recourse to instruments. The cases related by M. Littré in the Argument were all evidently complicated with contusion, and are thus referable to the second class of these injuries. It is most worthy of remark, that in the very interesting account of “slicing cuts,” given in Mr. Guthrie’s excellent work, On Injuries of the Head, the result, without any operation, by the most simple system of treatment, was in general very favorable. (pp. 95, 96.) On these cuts and superficial injuries of the skull, see further Hennen (pp. 283, 284), Thomson (pp. 51, 52), and Chelius (vol. i., p. 388).

London and Edinburgh Medical Journal, 1844.

Although, as we have stated, Dr. Laurie’s rule of practice now be to use the trephine on the preventive principle, it is probable that most of his cases occurred at a period when the practice of Mr. Abernethy was universally followed. His statistics therefore are no test of the results of the operation, when performed on the preventive principle.

See Lawrence’s Clinical Lecture in the Medical Gazette, vol. xxi., p. 345; and Guthrie’s work, On Injuries of the Head, p. 113.

See De Articulis, § 50; and Mochlicus, § 36.

On hypertrophy and swelling of the brain after injuries, see the very interesting observations made by Mr. Guthrie, in his work on Injuries of the Head, p. 125.

It is proper to mention in this place that Quesnay, with great good sense, discusses the question, whether or nor the separation of the pericrunium in this case be a sure indication of matter being collected within the cranium. He decides in the negative. (p. 17, Syd. Soc. edition of Selected Mem. of the Acad. of Surgery.)

I ought to mention, however, in this place, that in simple undepressed fractures, Pott allows of the operation as a preventive; that, at least, is one of his objects in having recourse to the operation. (p. 130.)

Ambrose Paré expresses very strongly the difficulty of forming a correct prognosis in injuries of the head: “Ex quo intelligere licet, multos ab exiguis vulneribus mortem oppetere, alios ex ingentibus et penitus magnis desperatisque convalescere.” (Opera, ix., 9.)

Injuries of the Head, p. 148.

Aphor. v., 68.

See the Argument to the treatise, On Regimen in Acute Diseases.

Opera, ix., 10.

Sir Astley Cooper mentions an instance in which 208 ounces of blood were abstracted from a patient!! In Quesnay’s Memoir there is nothing more common than to find it reported that he had bled a patient three or four times in the course of a day. In one case 160 ounces were taken in nine days; “but,” it is gravely added, “two years elapsed before she was quite well again.”

IV., 5, 3, 1.

The principles upon which depletion by bleeding and purging should be regulated are fully stated and discussed by Galen, in the Fourth Book of his great work on Therapeutics. The rule is briefly given by Hippocrates in his Second Aphorism: “respect being paid to place, season, age, and the disease in which it is proper or not.”

See Aphor. v., 18, 22; and § 12 of this treatise. The professional authorities of the present day are not agreed as to the expediency of using poultices or cold lotions in injuries of the scalp. Guthrie and Hennen recommend the latter; but South, in the edition of Chelius, prefers the former.

This is related of Philagrius in a very interesting scholium on the Aphorism just quoted. See Scholia in Hippocrat. et Galen., tom. ii., p. 457; ed. Dietz.

Perhaps the meaning here is, that when the forehead is much elevated, and the occiput much depressed, if one looks down upon the skull from above, the sagittal and coronal sutures will present the appearance of the letter Τ.

The meaning, I suppose, may be, that when the forehead is very low, and when the occiput is protuberant, if one looks down upon the skull from above, the sagittal and lambdoidal sutures will present the appearance of the letter Τ reversed.

The meaning would appear to be, that in a square-built head, that is to say, when it is prominent both before and behind, the coronal and sagittal sutures run nearly parallel to one another, and the sagittal connects them together in the middle. In this case they would present the appearance of the letter Η reversed.

Perhaps this alludes to the form of the head in which the sagittal suture passes through the middle of the os frontis down to the nose, in which case we may imagine that the coronal suture intersects the lambdoidal in such a manner as to have some resemblance to the letter χ. It is to be borne in mind, that the character of this letter was very variable in ancient writing. Ruffus Ephesius describes the sagittal suture as sometimes passing down the middle of the frontal bone.

This passage was considered by Scaliger as a gloss, but as interpreted by M. Littré, whom I have followed, the meaning is quite suitable. See his note, h. 1.

It is difficult to say what can be meant by caruncles in this place, but still I agree with M. Littré that Scaliger was not warranted in proposing to eject the passage from the text as an interpolation. Unless the glandulæ Pacchioni are meant (and the description must be admitted not to be quite applicable to them), I cannot pretend to explain or account for the description.

I need scarcely remark, that if by this is strictly meant that wounds in the posterior part of the head are less dangerous than those in the anterior, the statement is at variance with the experience of certain modern authorities. See, in particular, Pott and Liston, p. 46. At the same time, it is, no doubt, anatomically correct, that the occipital bone can bear more violence, without being seriously fractured, than the frontal or parietal bones, and it is worthy of remark, that the views and experience of Mr. Guthrie are very consonant with those of Hippocrates. He says: “The result of my experience on this point is, that brain is more rarely lost from the fore part of the head with impunity, than from the middle part; and that a fracture of the skull, with even a lodgment of a foreign body, and a portion of the bone in the brain, may be sometimes borne without any great inconvenience in the back part.... I have never seen a person live with a foreign body lodged in the anterior lobe of the brain, although I have seen several recover with the loss of a portion of the brain at this part. My experience, then, leads me to believe, that an injury of apparently equal extent is more dangerous on the forehead than on the side or middle of the head, and much less so on the back part than on the side. A fracture of the vertex is of infinitely less importance than one of the base of the cranium, which, although not necessarily fatal, is always attended with the utmost danger.” (On Injuries of the Head, p. 3.) I feel difficulty in reconciling these discordant results of modern experience. Perhaps the fact of the matter is, that injuries on the upper part of the occipital region are the least dangerous of any, whereas those in the lower part of it, are particularly fatal.

Vidus Vidius thus explains the hedra or sedes: “Inciditur os ita ut teli vestigium remaneat, quod genus fracturæ appellatur a Hippocrate ἒδρα, id est sedes, quum (ut ipse inquit) appareat in osse qua telum insederit; fit autem ab acuto telo, quod et ipse in sequentibus, et Galenus, in Commentario, in librum memoriæ prodidit, quum sub telo acuto incidi os dixit. Requirit autem sedes ut incisum os nullo modo ad cerebri membranam inclinatur.” (Chirurg. Græc., p. 71.) Andreas à Cruce defines it thus: “Potissimum vero sedes vocatur ubi osse in suo statu remanente qua parte telum insederit apparet.” (De Vulneribus, 1. 2.) By hedra would appear to have been understood a dint, or impression, left in a bone by a blow which has not produced fracture or depression. It was also applied to a cut or slash affecting only the outer plate of the skull. Hippocrates, it will be remarked, pronounces this sort of injury not to be dangerous of itself, but M. Littré relates a case taken from the “Journal de Médecine,” in which a sabre-cut, which only penetrated through the external plate of the cranium, and did not touch the internal, proved fatal. (Op. Hippocrat. iii., p. 170.) Our author, in the latter part of this paragraph, mentions cursorily injury of the skull at a suture, and more circumstantially in the twelfth paragraph. This accident is very correctly described by the later writers, under the name of diastasis. See Heliodorus (ap. Chirurg. Veteres, p. 100), and Archigenes (ibid., p. 117). Pott declares that he did not remember having ever seen a single instance of recovery when there was separation of the bones at a suture. Morgagni, in like manner, represents the case as being of a particularly serious character. (De Caus. et Sed. Morb.) I once saw a strongly marked case in which there was a considerable separation of the bones at the upper part of the temporal suture, along with an extensive wound, unguardedly inflicted by the scalpel of a juvenile surgeon, in order to explore the nature of the accident. As might have been expected, under these circumstances, the case had a fatal issue. Mr. Guthrie writes thus of diastasis: “It is well known, that when a violent shock has been received on the head, particularly by a fall on the vertex, the sutures are often separated to a considerable extent; these cases usually terminate fatally.” (p. 135.)

The meaning here is somewhat obscure, but as Arantius states in his commentary on this tract, our author probably means that a fissure is necessarily complicated with a contusion, or, in other words, that there can be no fissure without contusion.

Arantius and Porralius, in their conjoined commentary on this treatise, mention that in contusion sometimes only the outer plate of the skull is contused, but the inner is depressed upon the dura mater. This is a case of which we have examples in modern surgery; but it does not appear clearly to be alluded to in this place by our author. Mr. Guthrie, indeed, understands the ἀπήχημα of the Greek authors, and resonitus of the Latin, to apply to this variety of fracture; but he appears to me to be mistaken, for these terms unquestionable refer to the contre-coup, of which we will treat presently. Quesnay, indeed, uses the term contre-coup in this double sense, but, as I think, very injudiciously, as it tends to introduce confusion of ideas; for assuredly the case of a fracture on a different part of the head from that which received the blow, and a fracture on the inner plate of the skull from an injury on the outer, are quite different cases. See Quesnay, etc., p. 20, Syd. Soc. edit.

The expressions in this place are somewhat confused, but the meaning evidently is, that without fracture there can be no depression.

This third mode of fracture is thus defined by Celsus: “At ubi medium desedit, eandem cerebri membranam os urget; interdum etiam ex fractura quibusdam velut aculeis pungentibus,” (viii., 4.) Hippocrates, it will be remarked, makes no mention of spiculæ in his description of depression. Galen describes two varieties of depression; in the one the depressed portion retains its situation, and in the other it rises again to its former level. (De Caus. Morb.) Hippocrates does not appear to have been acquainted with the latter. Modern experience has shown that it sometimes occurs in children.

It is almost impossible to know what to make of this passage, owing to the corrupt state of the text.

The nature of this mode of injury is explained in the annotations on the third paragraph. It does not appear clear why our author has given two separate descriptions of this injury. He describes, it will be remarked, several varieties of it, according as it is complicated or not with contusion and fracture. Galen uses hedra in one place. (Meth. Med. vi.) The term hedra is rendered teli sedes by the Latin translators of the Greek medical authors. (See Asellii Comment. in Hippocrat. de Vuln. Capit.) It is used also by Ambrose Paré, Wiseman, and all our earlier writers on surgery. Wiseman thinks the term most appropriate when applied to wounds inflicted by a pole-axe, halberd, or the like. (v. 9.) Paré applies it to a kind of injury, in which the bone is not broken through, but the print of the weapon is left on the skull. (xx., 7.) Fallopius gives an interesting discussion on it. (In librum Hippocrat. de Vuln. Capit.) The term incision, borrowed from Paulus Ægineta, has been since used in its stead. See Quesnay, on the Use of the Trepan, p. 29, Syd. Soc. edition; and on simple incisions or sabre-cuts, see, in particular, Mr. Guthrie, Injuries of the Head, p. 86.

This, it will readily be perceived, is the fractura per resonitum, that is to say, the fracture par contre-coup, or counter-fissure of modern authorities. Except Paulus Ægineta, I am not aware that any of the ancient authorities question the occurrence of this species of the accident, and with the exception of Vidus Vidius, Guido, Fallopius, and Dinus de Garbo, it is generally recognized by the best modern authorities, from Bertaphalia and Andreas à Cruce, down to Sir Astley Cooper and Mr. Liston. Mr. Guthrie, indeed, remarks, that in recent times there has been no well-authenticated instance of fracture on the one side of the head from a blow on the other. Such cases, however, are not wanting in the works of the earlier modern authorities. Quesnay writes thus: “We find in authors, also, many cases of fracture by contre-coup, from one part of the head to the part opposite: and in honor of the ancients we may cite the case related by Amatus, who applied the trepan to the part of the head opposite to the wound, when he found that the symptoms were not relieved by applying it on the side wounded, and that the patient suffered from severe pain on the other side. This second trepan proved very apropos, for it allowed the escape of pus, which had collected under the skull.” (On the use of the Trepan.) All our modern authorities, including Mr. Guthrie, admit the reality of the case in which fracture of the base of the skull is produced by a blow on the upper part of the head. In imitation of our author, this case was denominated “infortunium” by the earlier authorities, such as Asellius and Porralius, being accounted an irremediable misfortune, because its seat could not be detected; and it is noticed in the following terms by Sir Astley Cooper, who did not trouble himself much about the writings of his predecessors, but formed his opinions from actual observation: “When the basis of the skull is fractured from a high fall, from the whole pressure of the body resting upon that part, on opening the brain and tearing up the dura mater, extravasated blood is commonly observed; this kind of fracture must inevitably prove fatal, nor can it be discovered till after death.” (Lectures, xiii.)

Whatever opinion may now be formed of the rule of practice here laid down, all must admit that it is clearly stated and distinctly defined. We have seen above that our author describes five modes of injury in the skull, namely, the incision or indentation, confined to its outer table; the contusion; the direct fracture; the fracture par contre-coup; and the depression. He now states decidedly that it is only in the case of contusion and simple fracture, that the trepan can be applied with advantage. I have entered so fully into the rationale of this practice in the Argument, that I do not think it necessary to say more on the subject in this place.

This passage indicates strongly our author’s partiality for prognostics, or rather, I should say, for prorrhetics. It would appear to have been a primary consideration with him, in all cases, to secure the physician from blame, and to teach him how to gain the confidence of the patient and his attendants. Few who have practiced medicine for a great many years, will question the propriety of these rules of conduct, or doubt the importance of taking all honorable steps to ensure the confidence and good-will of patients and their friends.

There is a remark made by Arantius and Porralius on the latter part of this paragraph, which, although it appears to be scarcely warranted by anything in the text of our author, I quote for its importance, as showing that the earlier authorities were well aware of the danger and impropriety of treating injuries of the head in children by instruments: “Sed præ ceteris illud notandum quod dixerit (nudato osse) quasi dicat, eo non denudato quamvis calliso aut fisso, quod raro accidit, non esse tamen sectione denudandam calvariam: nam in pueris, ubi decidunt non raro accidit ut eorum collidatur calvaria, frangaturque, cute integra, quod etsi accidat, et tactu hoc probe precipiatur, sanguisque e venis effusus sub cute fluctua, abstinendum tamen a sectione est, neminem enim servatum vidi, cui sectio adhibita sit, propterea quod eorum calor facile dissipetur, eoque magis, quum gemitu et clamore caput valdè incelescat, et ad fluxiones suscipiendas proclive reddatur,” (Comm. in Hip. de Vuln. Cap.) It will be seen at § 18, that our author allowed the application of a small trepan in children when strongly indicated.

This passage is rendered as follows by Celsus: “Igitur, ubi ea percussa, protinus requirendum est, num bilem is homo vomuerit; num oculi ejus obcæcati sint; num obmutuerit; num per nores auresque sanguis ei effiuxerit: num conciderit, num sine sensu quasi dormiens jacuerit. Hæc enim non nisi osse fracto eveniunt; atque, ubi inciderunt, scire licet, necessariam, sed difficilem curationem esse.” (viii., 4.) Now, although it is no doubt true, as remarked by Pott (Injuries of the Head, § 4), that these symptoms sometimes take place, without there being any fracture of the skull, and that, on the other hand, as had been previously pointed out by Paré and Le Dran, fractures do sometimes take place without being accompanied by all these symptoms, still there can be no doubt that as a general rule the doctrine of Celsus is correct, and that, at all events, a case is to be treated as serious in which these symptoms occur. With regard to one of the characteristics of a fracture, thus noticed by Celsus, a modern authority of great experience, but little acquaintance with ancient learning, observes, “Blood flowing from the nose and ears is a symptom attending fracture of the skull. It may be consequent on mere concussion, a vibration which ruptures the membranes; but oftener it is a consequence of fissure across the bone.” (Institutes of Surgery, by Sir Charles Bell, vol., i, p. 173.)

The separation of the bones at a suture, usually called diastasis, is noticed in the annotations on § 8. I have also alluded, in my analysis of the Fifth Book of the Epidemics, to the case in which the author, generally supposed by ancient authorities to be Hippocrates, mistook a suture for a fracture of the skull. See Epidem. v., 14; and Celsus, viii., 4.

On the terms which occur parenthetically, the philological reader may consult the note of Stephanus, contained in the edition of Erotian by Franzius, under ἑδράιως. I may here remark, that it is difficult to account for the frequent repetition of these words in parentheses.

It will be remarked that, as a general rule, Hippocrates forbids us to apply the trepan at the sutures, but, notwithstanding this prohibition, it would appear to have been departed from in two cases related in the Sixth Book of the Epidemics. (See § 27 and 28.) The rule, however, to avoid the application of the trepan at the sutures, was generally observed by nearly all the modern authorities down to Pott, and even he admits that the sutures should be avoided when the trephine may with equal utility be set on any other part. Louis, in a paper lately reprinted from the Memoirs of the Royal Academy of Surgery, by the Sydenham Society, gives an interesting examination of the doctrine of the ancient and modern authors on this rule of practice. Most of the authorities quoted by him are averse to the application of the trepan over sutures, except when very urgently required. C. Porralius, in his marginal notes on Arantius’s Commentary on this work of Hippocrates, assigns three reasons for avoiding the sutures in this operation: 1st, because the bone is weak at that place; 2dly, because the membrane there being in close connection with the bone, is in danger of being injured; 3dly, because, by the contraction of the callus, the transpiration there will be stopped. The last of these reasons is based on the physiological doctrine of the ancient authorities respecting the uses of the sutures, one of which was, to permit transpiration from the brain. See Galen, de Usu Partium, ix., 1, 2.

Our author, it will be remarked, forbids liquid applications, tents, cataplasms, and bandages, in wounds of the head. He seems to have approved most of things of a drying nature. The other authorities would appear to differ considerably in their views regarding the proper principles upon which wounds on the head are to be treated. Celsus directs us, after laying bare the dura mater by trepanning, to apply strong vinegar to it, and when the membrane is inflamed, he approves of tepid rose-water. (viii., 4.) Paulus Ægineta, after the operation of trepanning, directs a piece of cloth, or small ball of wool dipped in oil, to be applied to the part. I believe they all agreed in rejecting sutures. See Galen, de Med. sec. Genera III.

Hippocrates would seem to hold the fanciful idea, that the forehead is environed by the rest of the head, and that afflux of blood takes place from the parts around to it. Scaliger rejects this passage as containing a doctrine wholly unworthy of our author.

The danger of incisions, in the temporal region, is adverted to in several parts of the Hippocratic Collection, as in the work On the Articulations, in the Prorrhetics, and the Coan Prænotions. Even at the present day, when the treatment of hemorrhage is better understood than in the days of the great Fathers of Grecian medicine, a large incision in that quarter is regarded with considerable apprehension. Convulsion, that is to say, tetanus, was supposed to be the frequent, if not the invariable, result of a wound in the temporal muscle. Pott, indeed, contends that lock-jaw is not necessarily produced by a wound there; he admits, however, that the application of the trepan to the temple is not often successful, but the reason of this he contends is, that in these fractures the breach generally extends to the base of the skull (§ 5). Quesnay, however, inclines to support the views of Hippocrates. (On the Use of the Trepan, p. 15, Syd. Soc. edit.) Scultet, in like manner, pronounces decidedly that a wound in the temple is a very dangerous affair. (Armam. Chirurg. Tabl. xxxi.)

The maza was evidently a poultice prepared with barley-meal and vinegar, or water. See the Annotations on the treatise On Ancient Medicine.

Celsus translates this passage as follows: “At si ne tum quidem rima manifesta est, inducendum supra os atramentum scriptorium est, deinde scalpro id deradendum; nigritiem enim continet, si quid fissum est.” (viii., 4.) Arantius properly remarks, that the ancient ink must not be confounded with the modern, which is composed principally of copperas and galls. It was, no doubt, the milder kind prepared from the soot of pines with gum which was used in this case. On the writing-ink of the ancients, see Dioscorides (M. M., v., 182) and Pliny (H. N., xxxv., 6).

The text in the beginning of this paragraph is in a very unsatisfactory state. It seems pretty clear, however, that in this place our author describes caries of the bone brought on by an unhealthy state of the integuments. The description--allowance being made for the corruption of the text--is sufficiently distinct, and most probably has reference to that condition of the parts which is so graphically described by Pott as forming “a puffy, circumscribed, indolent tumour of the scalp, and a spontaneous separation of the pericranium from the skull under such tumour.”

Our author in this place would appear to treat of incipient hernia cerebri, as immediately before he treats of fungous ulcers on the pericranium. Galen in like manner, praises powerfully dessicant medicines upon the authority of Meges the Sidonian, who, he says, had great experience in these cases. He speaks of the plaster called Isis as being a most efficacious application to the dura mater, when laid bare. Its principal ingredients are of an escharotic and detergent nature, such as squama æris, burnt copper, ammoniac salts, myrrh, aloes, and the like. See PAULUS ÆGINETA, Vol. III., p. 564. Galen concludes his remarks on this subject with stating that, before getting into an inflamed state, the dura mater, as being of a dry nature, endures the most powerful medicines. (Meth. Med., vi., at the end.)

This description of a piece of bone which is going to exfoliate, is remarkably correct. Compare it with the following narrative: “A girl of ten or twelve years of age was struck on the head by an iron rod falling on her; the blow caused no wound, and the young woman was soon well, with the exception of a fixed pain of no great extent, which remained over one of the parietal bones. The pain continued for several years. M. Mareschal, who was at last consulted, considered it necessary to trepan. He exposed the bone at the painful part, and applied one crown of a trepan; he observed, that the bone, when sawed, appeared dry, like a skull that had been buried.” (Quesnay, on the Use of the Trepan.) This agrees excellently with the description given by Hippocrates. It is to be regretted, however, that the text here; as far as regards one word ἀποστρακὸς, is in a very unsatisfactory state. The conjectural emendation of Schneider (ἀπεσκληκὸς) seems to be a plausible emendation, but it is not adopted by Littré.

Our author delivers the same doctrine in the work On the Articulations, and states that extensive fractures of the bones are often less dangerous than others which appear not so formidable. I need scarcely remark that modern experience has confirmed the truth of this position. How often has it been seen that one patient died from a slight injury to the skull, while another recovered from an extensive fracture of it? Mr. Guthrie appears in so far to agree in opinion with our author, that extensive fractures are less dangerous than they appear; he says, “Mr. Keate, who has had great opportunities for observation in St. George’s Hospital, has invariably remarked that the symptoms dependent on extravasation have been less severe in the first instance, in proportion as the separation of the edges of the fracture have been greater one from the other, or when the sutures have yielded to the shock and have been separated. It has been stated from the earliest antiquity, that the greater the fracture, the less the concussion of the brain.” (p. 56.) See the Argument.

It will be remarked as a striking feature in our author’s views of practice in injuries of the head, not to interfere with fractures attended with depression. See the Argument, where the rationale of this practice is fully discussed.

Although these directions of our author regarding the treatment of children be most important, I am not aware that any other of the ancient authorities has shown his sense of their value of them by repeating them. It is well known that in children there is but one table, and that it is very thin. Our author, as remarked above, does not entirely omit the operation in the case of children, but uses a small trepan.

The reader will again remark an instance of our author’s fondness for prognosis, and his observance of the rule at all times to prevent the surgeon from committing himself by attempting hopeless cases. Celsus, writing in the same spirit, says, “Ante omnia scire medicum oportere, quæ vulnera insanabilia sint, quæ difficilem curationem habeant; ... non attingere, nec subire speciem ejus, ut occisi, quem sors ipsius intermit.” (v., 26.)

This is an opinion held by all the ancient authorities. Some interesting cases in point are related in the First Book of the Continens of Rhazes. It was explained on the principle that the cerebral nerves decussate. (See Aretæus, on the Causes of Disease, i., 7.) Modern experience, in the main, is in accordance with the ancient on this point. Paralysis has generally been found on the opposite side to that which has received the injury. See Thomson’s Observations, etc., p. 52; Larrey’s Mem. de Chirurg., iv., p. 180; Hennen’s Principles, p. 301.

This passage is thus translated by Celsus: “Si sub prima curatione febris intenditur, brevesque somni, et iidem per summa tumultuosi sunt, ulcus madet, neque alitur, et in cervicibus glandulæ oriuntur, magni dolores sunt, cibique super hoc fastidium increscit, tum demum ad manum scalprumque veniendum est.” (vii., 4.)

The practice advocated in this paragraph is alluded to by Paulus Ægineta, in his chapter on Fractures of the Skull. (vi., 90.)

The operation here described by our author is the more deserving of attention, as it appears to have been peculiar to him. It is not described by Celsus, Paulus Ægineta, Albucasis, nor any one of the ancient authorities, as far as I can find; neither am I aware of its having been attempted in modern times. The object of it, however, seems to be very rational, namely, to avoid doing serious injury to the dura mater by tearing the bone forcibly from it at once.

The instrument here used is named πρίων χαρακτὸς; and, as far as I can see, was the same as the modiolus of Celsus, and the χοινικὶς of the later authorities. It would certainly appear to have been a circular saw, and consequently not unlike our modern trephine. See the figures and the Argument.

The following sentence, taken from Sir Charles Bell’s description of the operation, looks like a translation of this passage of Hippocrates; but it is well known that our English surgeon was not guilty of reading Greek! “Withdraw your trephine from time to time, brush it, and run the flat probe round the circular cut.” The specillum of the ancient surgeons was, in most respects, not unlike our modern probe.

The meaning here would seem to be, that the bone does not extend so deep as might be supposed. See Foës, Œcon. Hippoc., under ἐπιπολαιότερον ὀστέου.

Transcriber’s Notes:

1. Obvious printers’, punctuation and spelling errors have been corrected silently.

2. Where hyphenation is in doubt, it has been retained as in the original.

3. Some hyphenated and non-hyphenated versions of the same words have been retained as in the original.

4. Possible errors in Greek words or phrases have been retained as in original.

5. Italics are shown as xxx.