SECTION III.. On the Physical Philosophy of the Ancients, and More Especially

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

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

Now it will at once be perceived by any person who is at all acquainted with modern science, that if the ancient dogmata be as here represented, they are altogether destitute of any solid foundation in truth and nature, and we may well wonder that such a baseless structure should have endured for so long a period. But before passing this severe judgment on the tenets of our great forefathers in philosophy, it will be well to investigate their doctrines more accurately than Dr. Watson appears to have done in this instance.

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

THE PYTHAGOREANS.

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

“In that part of the universe where Nature and Generation exert their powers, it is necessary that there should be these three things: In the first place, that thing which being tangible furnishes a body to everything which comes into existence. This is the universal recipient and substance of impression for things generated, bearing the same relation to things which are generated from them that water does to juice, and silence to sound, and darkness to light, and materials to the things fabricated from them. For water is void of taste and quality, bearing the same relation to sweet and bitter, and to sharp and salt. The air is unformed as to sound, or speech, or melody. And darkness is devoid of color and shape, and bears the same relation towards bright, and yellow, and white. But white bears reference also both to the statuary art and that which forms figures of wax. But matter admits of another comparison with the art of statuary. For all things exist in it potentially before they are made, but actually after they are made and have received their nature. In order, therefore, that there should be generation, it is necessary that there should be some one substance as a substratum. In the second place there are the contraries, in order that they may be changes and transmutations, the primary matter undergoing passion and affection, in order that the qualities (or powers, δυναμεις), being mutually passive, may not destroy, nor be destroyed, by one another. These (the contraries) are, heat and cold, moisture and dryness. In the third place are those substances in which these powers reside, namely, fire and water, air and earth. For these differ from the powers (qualities?) For the substances are consumed in place by one another, but the powers are neither consumed nor formed, for they are the incorporeal reasons of these. Of these four, heat and cold are causes, and active; but dryness and humidity are as the materials, and passive. In the first place there is matter, the universal recipient, for it is the common subject (or substratum) of all things, so that it is the first sensible body in potentiality, and the original of all things: next are the contraries, such as heat and cold, moisture and dryness; and in the third place there are fire, water, earth, and air: these all change into one another, but the contraries do not change.”

The primary matter is afterwards defined to be “the subject body, that which receives all the changes, the universal recipient, and that which potentially is the first to the touch.”

“The first principles of all created things are the substratum, matter, and the reason of shape; namely, form. The bodies are their offspring, namely, fire, air, earth, water.”

“Pythagoras taught that the original of all things is the monad, that from the monad sprung the duad, which is the subject matter to the efficient monad: that from the monad and infinite duad were formed the numbers: from the numbers the points; from them the lines, from these figures of superficies; from the superficies the solid figures; from these the solid bodies, of which are the elements, fire, water, earth, air:--that from these, changed and converted into every shape, is formed the world, which is animated, intelligent, of a spherical shape, comprehending in its middle the earth, which also is spherical and inhabited all round.

“Pythagoras said, that none of the elements is pure, for that earth contains fire, and fire air, and water air, etc.”

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

THE PLATONISTS.

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

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

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

Plato taught “that God, matter, and form, are the originals of all things:--that matter is increate and incorruptible, neither fire, nor water, nor any of the principles nor elements, but a substance capable of form and subject to fabrication: that when rude and deprived of every quality of configuration, God, the artificer, formed the universe from it. He taught, that matter is the original of all bodies, that it was stamped with the impression of forms, and hence were produced the elements, namely, fire, water, earth, and air.”

“Earth contains water, and water, as some suppose, carries earth: air is formed from water, and from dense air fire is formed.”

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

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

“Concerning the receptacle of bodies this may be said. In the first place, that there must be a certain substratum to bodies different from themselves, is demonstrated by the transmutation of the elements into one another. For that which is changed is not altogether consumed, or, if it is, a substance is changed into a non-entity. And neither has that which is born come into existence from nothing, but it has undergone a change from one form into another. For something remains which has received the new form and cast off the other. And this is shown by destruction, for it applies only to a compound body; and, if this be true, every such body is compounded of matter and form. Induction bears testimony to the truth of this, by showing, that whatever is dissolved was compounded; and analysis in the same manner, as, for example, if a phial be resolved into gold, and gold into water; and water, in like manner, when it perishes, requires to be something analogous. But the elements must be either form, or primary matter, or a compound of form and matter. But they cannot be form, for without matter, how could they be possessed of bulk and magnitude? But they are not primary matter, for it is not consumed. It follows, then, that they must consist of form and the primary matter. But form regards quality and shape, but it (the primary matter) pertains to the subject which is indeterminate, (ἀόριστον or ἀόρατον) because it is not form.”

“Matter of itself is devoid of form, matter is the subject of all things.”

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

“Plato, wishing to prove that the elements have one common matter as a substratum to all, in his ‘Timæus,’ enters into a discussion regarding their transmutation into one another. But he being well acquainted with the art of demonstration, has treated properly of the change of the first bodies into one another. But Thales, Anaximenes, Anaximander, and Heraclitus, assuming each that there is some one element, endeavor to prove this from their changing into one another. Yet all these seem to me to have had an obscure idea (ὀνειράττειν) of some matter, which is a common substratum to all the elements, and seeing that it is single they supposed that there is but one element. But instead of saying that this is a common element from which the others, I mean air, fire, water, and earth, are formed, they passed it over altogether and endeavored to demonstrate the same thing of some one of the elements, all proceeding upon the same mode of demonstration, although they did not all make choice of the same element.”

“With regard to the old philosophers, called physical, it will be obvious to us when we read their writings on Nature, that they held the existence of a first matter which is increate and eternal, being the substratum to all created and perceptible things.”

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

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

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

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

“Nothing that is pure can be comprehended by the senses.”

“The elements are inanimate matter, of itself devoid of motion, and subjected to the artificer, by whom it is transformed into all kinds of shapes and qualities.”

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

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

THE PERIPATETICS.

Aristotle defines the first matter as follows: “I call matter the first subject of everything, all things being formed from it existing in them not accidentally; and when anything is destroyed, it comes to this at last.”

In his Logical work he thus defines his ideas regarding the first substances, namely, mind and matter. “The first substances being the subjects of all other things, and as every other thing may be predicated by them and exists in them, are called the prime substances. “We must distinguish the first bodies from matter, for we must suppose concerning them that they have a first principle and origin, namely, matter, which is inseparable from them, and is the subject of the contraries. For heat does not furnish the materials to cold, nor it to heat, but the subject to both. So that we have first the sensible body in potentiality, the first principle; then we have the contraries, I mean cold and heat; and thirdly, fire and water, and the like. These change into one another, and not as Empedocles and others say of them.

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

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

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

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

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

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

“Of the simple substances, fire has peculiar powers. For air, water, and earth, admit only of changes into one another, but none of them can produce itself.”

“The nature of those substances called simple is mixed, and existing in one another.”

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

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

THE STOICS.

“They are of opinion that the first principles of all things are two--the active and the passive: that the passive is matter, a being devoid of all qualities; the active, or efficient, is the reason (λόγος) residing in it, that is, God. That he, being eternal, fabricates all things from it all (all matter?). That there is a difference between the first principles and the elements--that the former are increate and indestructible, whilst the elements are destructible by burning (ἐκπύρωσιν).--That the first principles are bodies devoid of form, whereas the elements are possessed of form. That God and Mind, Fate and Jupiter, are one and the same being under different appellations; that he formed the four elements, fire, air, water, earth.”

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

“Some of our sect are of opinion that air, being changeable into fire and water, etc.”

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

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

Suidas says, regarding the first principles: “The first principles of all things are two, the efficient and the passive. The passive, then, is a being devoid of qualities--earth, matter. The efficient is the reason residing in it, namely, God. The principles and elements are different, inasmuch as the former are increate and indestructible, while the elements are destructible by burning. Besides, the first principles are without body and form, but the elements have form.”

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

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

“Always remember the saying of Heraclitus, that the dissolution of earth is to become water, and the dissolution of water to become earth; and the dissolution of air to become fire, and conversely.”

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

“Acquire the habit of contemplating the transmutation of all things into one another.”

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

THE EPICUREANS.

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

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

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

These extracts prove clearly that the great philosophers of antiquity stand acquitted of having held the erroneous opinions generally ascribed to them respecting the elements of things, and that nothing can be farther from the truth than the account of the Peripatetic doctrines given by Dr. Watson. Instead of maintaining, as he carelessly represents, that “earth, air, fire, and water are distinct, uncompounded, immutable principles;” they taught, on the contrary, as we have shown, that all the elements are modifications of one common substance called the primary matter, and consequently they held, like himself, that “the elements are different magnitudes, figures, and arrangements of particles of matter of the same kind.” This primary matter they demonstrated to be devoid of all quality and form, but susceptible of all forms and qualities. In the language of the Peripatetics, it is everything in capacity, but nothing in actuality. They held that there are two original principles, both increate and indestructible; the one matter, the universal passive principle--the material from which all things are formed; and the other, the efficient cause by which all things are made:--that the one is possessed of universal privation, and the other of universal energy:--that it is the one which impresses, and the other which receives the forms of all things. They maintained that the original materials out of which all objects in the universe are composed being the same, bodies owe their characteristic qualities not to their substance, but to their form. The elements, then, according to the notions of the ancient philosophers, are the first matter arranged into certain distinguishing forms by the efficient cause. That form with which solidity is associated they call earth, under which they ranged all metals, stones, and the like, for all these they held to be allied to one another in nature, as well as in the form under which they are presented to our senses. The next arrangement of created substances is that which constitutes fluidity, and is called water, under which term they comprehended not only the native element, but every other modification of matter which assumes a similar form, namely, all juices of vegetables and fluids of animals. Some of their earliest speculators in philosophy maintained that all the materials which compose the universe existed at one time in this form; and it is curious to reflect that modern geology has reproduced nearly the same doctrine. The third form of matter, as presented to our sense of touch, is air, under which the ancient philosophers comprehended all matter in an aërial state, such as water converted into vapor, and what are now called gases. Whether or not they believed the atmosphere which surrounds this earth to be a homogeneous substance, in nowise affects the general principles of their philosophy; for it is the same thing, as far as regards their classification, whether they held that the atmosphere consists of one or of several distinct combinations of the primary matter with form. As they were well aware that several distinct modifications of matter are comprehended under each of the other elements, it can hardly be doubted that they inferred the like of air; and, indeed, it is quite apparent from the works of Galen that he knew very well that some kinds of air are favorable, and others unfavorable to respiration and combustion. But those phenomena which we ascribe to oxygen gas, they, without doubt, would have attributed to the operations of some modification of the element fire. By fire, they meant matter in its extreme state of tenuity and refinement. Of this elementary principle, Plato and Theophrastus have enumerated many varieties, and have speculated regarding their nature with great precision and acuteness. The ancient philosophers believed that fire is universally diffused through the universe, being sometimes in a sensible, and sometimes in a latent state; or, as Aristotle expressed it, heat exists sometimes in capacity, and sometimes in energy. They attributed the phenomena of lightning to an unequal distribution of this elemental fire. This is the element with which they supposed life to be most intimately connected; and, indeed, some of them would appear to have considered fire as the very essence of the soul. “I am of opinion,” says the author of one of the Hippocratic treatises, “that what we call heat is immortal, and understands, sees, and hears all things that are or will be.” This doctrine, which, to say the least of it, is not very judiciously expressed in this passage, is thus corrected by the great master of logic and philosophy: “Some,” says Aristotle, “improperly call fire or some such power the soul; but it would be better to say that the soul subsists in such a body, because heat is, of all bodies, the one most obedient to the operations of the soul; for to nourish and move are the operations of the soul, and these she performs by the instrumentality of this power (or quality?). To say that the soul is fire, is as if one were to call a saw or a wimble the artisan or his art, because his work is accomplished in co-operation with these instruments. From this it appears why animals stand in need of heat.” And in like manner he says, in another of his works: “Some are of opinion that the nature of fire is plainly the cause of nourishment and of growth; for it appears to be the only body or element which nourishes and increases itself. Wherefore one might suppose that it is this that operates both in plants and in animals. Yet it is but the co-cause (συνάιτιον); for it is not, properly speaking, the cause, but rather the soul. For the increase of fire is indeterminate in so far as it is supplied with fuel. But of natural substances there is a certain limit and reason (λόγος) of magnitude and increase. This belongs to the soul rather than to fire, to the reason rather than to the matter.”

From these observations, coupled with the information supplied in the preceding extracts, it will be perceived that, although there be, at first sight, a great discrepancy among physical doctrines of the ancient philosophers, they differed, in fact, much less than they would appear to do, only that some of them expressed themselves more scientifically than others in handling the subject of the elements. Thus, although Thales seems to hold water, and Anaximander air, and Heraclitus fire, to be original principles, we have every reason to believe that, as Galen says (l. c.), even they had an idea that these are not simple substances, but merely modifications of one unformed principle, the first matter, from which they conceived that all bodies in the universe are constructed. Contrary, then, to what is very generally supposed, it would appear that there was at bottom no very great difference of opinion between the philosophers of the Ionic school and those of the other sects, namely, the Pythagoreans, Platonists, Peripatetics, Stoics, and Epicureans; and further, that, from the earliest dawn of philosophy, down to the time when it fell into neglect and came to be misunderstood, the physical doctrines of the philosophers underwent but little variation.

From the elements, then, constructed in the manner now explained, out of the primary matter, the ancient philosophers taught that all the secondary bodies in the universe are formed, and as they maintained the transmutability of the elements into one another, so, in like manner, they did not hesitate to proclaim it as a great general truth “that all things are convertible into all things.” The possibility, then, of such permutations will not, I presume, be questioned by any one who has formed correct ideas of the powers of the Great First Cause, and the capacities of the first subject, Matter, and that such permutations do actually take place in the course of Nature may be inferred from many phenomena of daily occurrence in the vegetable and animal world. It cannot have escaped the most careless observation what changes the great pabulum, water, undergoes in the process of vegetation--how it is converted into various woods, and barks, and leaves, and flowers, all of which are resolvable, by the process of decay, into air, or reducible into earth. It is also well known that, although a more unfrequent occurrence, all the solid parts of a tree may undergo a mutation into rock, that is to say, may become petrified. But it is in the higher classes of animals that these changes of simple matter admit of the greatest variety. Let us contemplate for a moment some of the most remarkable mutations which any article of food (as, for example, flour-bread), which has been presented to the stomach, is destined to undergo in the animal frame. We know that the vital powers of the stomach will convert the starch, of which it principally consists, into a fluid state, that is to say, into what is called first chyme, and afterwards, when it has undergone some further change, is denominated chyle by the physiologists. Having been thus changed, it passes, by a process about the nature of which physiologists are still strangely divided in opinion, into certain vessels; and then, in some manner still less understood, it is converted into a fluid sui generis, called blood, abounding in globules of a singular construction, all fabricated, no doubt, from the food, but, by some occult process, which has hitherto defied the skillful manipulation of the chemist, and the accurate observation of the microscopist, to explain in any satisfactory manner. And so complete is the transformation that scarcely one particle of the original food can be detected in the new product by all the vaunted tests of modern science. But blood is soon after converted into many other fluid and solid substances--into bones, cartilages, muscles, and vessels, and into bile, mucus, and other recrementitious matters, all differing greatly from one another, both in their appearances and in their properties. And when all the component parts of the animal frame are constructed, and each seems to have acquired a determinate structure, should the vital actions by which they are formed become deranged, we may see the fair fabric undergo the most wonderful mutations, so that arteries are converted into bones, and bones into flesh and jelly. So many and so extraordinary are the changes which a simple alimentary substance may undergo in the animal frame! And if we admit, with the ancient philosophers, that every such substance is resolvable into one or more of the elements, and that all the elements are but different modifications of one common matter, how wonderful a thing must Form be, since it imparts such varied appearances and qualities to one common substratum?

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In detailing these opinions of the ancient philosophers, it is not my present business to determine whether they be true or not; my task is fulfilled, if I have given a distinct and faithful exposition of them, so that their real import and meaning may be readily comprehended by the medical reader. I may be allowed to remark, however, that, strange although that Protean being, the primary matter, may appear to be to such men of science as are not disposed to recognize the existence of any substance which cannot be subjected to their senses, and who refuse to admit the legitimacy of every process of analysis, but what is conducted in the laboratory of the chemist, opinions similar to those of the ancient philosophers have been held by some of the most profound thinkers and distinguished experimentalists of modern times. Thus Lord Bacon, the reputed father of the inductive philosophy, appears to admit all the tenets of the ancients regarding the first matter, which, like them, he considers to have been embodied in the Homeric fable of Proteus. He says, in reference to it, “that under the person of Proteus is signified Matter, the most ancient of all things, next to the Deity; that the herd of Proteus was nothing else than the ordinary species of animals, plants, and metals, into which matter appears to diffuse, and, as it were, to consume itself; so that, after it has formed and finished those several species, (its task being, in a manner, complete,) it appears to sleep and be at rest, nor to labor at, attempt, or prepare any species farther.” That learned and accomplished scholar, Mr. Harris, in his work on “Philosophical Arrangements,” writes thus on the subject we are now treating of: “Here, then, we have an idea (such as it is) of that singular being, the Primary Matter, a Being which those philosophers who are immerged in sensible subjects know not well how to admit, though they cannot well do without it; a Being which flies the perception of every sense, and which is at best, even to the intellect, but a negative object, no otherwise comprehensible than either by analogy or abstraction.

“We gain a glimpse of it by abstraction, when we say that the first matter is not the lineaments and complexion which make the beautiful face; nor yet the flesh and blood which make these lineaments and that complexion; nor yet the liquid and solid aliments, which make that flesh and blood; nor yet the simple bodies of earth and water, which make those various aliments; but something which, being below all these, and supporting them all, is yet different from them all, and essential to their existence.

“We obtain a sight of it by analogy when we say that, as is the brass to the statue, the marble to the pillar, the timber to the ship, or any one secondary matter to any secondary form; so is the First and Original Matter to all forms in general.”

Nay, the illustrious Sir Isaac Newton would seem, in the following extract, to countenance the profound speculations of the ancient philosophers with respect to the elements, and the transmutations of these substances into one another. He says, “Are not gross bodies and light (or ether) convertible into one another?--and may not bodies receive much of their activity from the particles of light which enter into their composition? The changing of bodies into light and of light into bodies is very agreeable to the course of Nature, which seems delighted with permutations. Water, which is a very fluid tasteless salt, she changes by heat into vapor, a sort of air; and by cold into ice, which is a hard, pellucid, brittle, fusible stone, and this stone returns into water by heat, and vapor returns into water by cold. Earth, by heat, becomes fire, and by cold returns into earth.”

I may further mention that all the late researches of chemical philosophers have tended to confirm the tenets of the ancients regarding the Elements. Thus in that very singular performance “The Elements of Physiophilosophy,” by Dr. Lorenz Oken, the productions of the mineral kingdom are classified, very much in accordance with the ancient arrangement, into four classes, namely, into Earth-earths, Water-earths, Air-earths, and Fire-earths. It is also well known that chemical experiment has lately established that several animal and vegetable substances, such as albumen, fibrin, and casein, which were formerly looked upon as distinct substances, are all but modifications of one substance, which is now regarded as the original of all the tissues; and further, that protein, in every respect identical with that which forms the basis of the three aforesaid animal principles, may be obtained from similar elements in the vegetable kingdom. And if every step which we advance in the knowledge of the intimate structure of things leads us to contract the number of substances formerly held to be simple, I would not wonder if it should yet turn out that oxygen, carbon, hydrogen, and nitrogen are, like what the ancients held the elements to be--all nothing else but different modifications of one ever-changing matter. But I will not indulge further in such speculations, especially as I have reason to apprehend that I may be thought to be wandering from my own proper sphere in thus prosecuting researches which may be supposed to have but a distant bearing on the subject now in hand. I must, however, be allowed again to repeat my declaration that it is impossible to comprehend the theories contained in the Hippocratic treatises without a proper acquaintance with the Physical Philosophy of the ancients, and that these principles have been misapprehended and misrepresented most unaccountably by modern writers, so as to occasion corresponding mistakes with regard to ancient medicine. I trust, then, that my present labors will not be ineffectual in preventing such mistakes in future; though, at the same time, knowing, as I well do, the practical bent of British science at the present day, I cannot but be apprehensive that a certain portion of my readers will lend a deaf ear to speculative opinions, of which they cannot recognize the importance, and will be disposed to discard the doctrines of the ancient philosophers, before they have rightly comprehended their import:

“Nec mea dona tibi studio comporta fideli Intellecta prius quam sint, contempta relinquas.”

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

* * * * *

Before concluding, I will briefly recapitulate the results to which our present inquiry has conducted us:--

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

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

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

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

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

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

THE WORKS OF HIPPOCRATES.

ON ANCIENT MEDICINE.

THE ARGUMENT.

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

It contains, as M. Littré remarks, a polemic, a method, and a system. The polemic is directed against those of his predecessors who had corrupted medicine by introducing hypotheses into it as the causes of disease, such as heat, cold, moisture, and dryness. These it will be seen that he combats with great force of argument and clearness of illustration. The philosophical dogmas to which he is supposed to refer in this place are those of the section of Pythagoreans, called the Eleatic, who would appear to have held nearly the same opinions as Pythagoras himself with regard to the elements. But, in fact, as I trust I have clearly made out in the third section of the Preliminary Discourse, all the ancient philosophers held substantially the same opinion regarding the elements, although they did not all express themselves in the same terms. It is of little consequence, then, to attempt to find out what particular class of philosophers our author directs his attack against, it being sufficient to say that he decidedly condemns the practice of founding the rules of medical practice on hypothesis. I may here remark, that the censure thus bestowed on hypothetical systems applies to modern times as well as to ancient, to those who proclaim theories by which, like Broussais, they account for all diseases upon figments which they call inflammations, and those who, like Cullen, attribute most diseases to spasms. We may rest assured, from the sensible observations which Hippocrates makes on this subject in the present work, that the causes of all diseases are realities, provided we could find them out, and that they are not vague abstractions, as the authors of these hypotheses suppose.

His method of cultivating medicine is founded on an attentive examination of all the circumstances connected with real life, and his system consists in studying the condition of the humors in the body, their origin, their coction, and their disappearance.

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

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

The reflections on the origin of fevers and inflammations are very just and original, but would appear not to have been properly appreciated by his successors; for among all the ancient authors who have treated of fevers, there is, perhaps, no one but himself who has stated in decided terms that there is something more in a fever than a mere increase of the innate (or animal) heat. See the Commentary on PAULUS ÆGINETA, B. II., 1.

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

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

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

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

The style of this piece is certainly elegant and beautiful; and it is proper to mention that the text is remarkably improved in M. Littré’s edition. In all the previous editions it was more corrupt than that of almost any other of the Hippocratic treatises.

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

“En résumé, le livre de l’Ancienne Médecine donne une idée des problèmes agités du temps d’Hippocrate, et de la manière donts ils étaient débattus. Il s’agissait, dans la plus grande généralité de la pathologie de déterminer la cause des maladies ou, en d’autres termes, de poser les bases d’un système de médecine. Certains médecins disaient que cette cause, étant une, résidait dans une propriété unique du corps, propriété qu’ils spécifiaient. Hippocrate répétait qu’en fait, cela était en contradiction avec l’expérience, qu’en principe une hypothèse était suspecte et stérile, et qu’il n’y avait de sureté que dans l’études des faits et dans la tradition de la science qui y ramene. Ainsi, quatre cents ans avant J. C., on essayait de rattacher toute la médecine à une seule propriété hypothétique, comme on l’a essayé de nos jours; mais cette propriété était ou le chaud, ou le froid, ou l’humide, ou le sec. Quatre cents ans avant J. C., un esprit sévère et éclairé combattait de telles opinions au nom de l’expérience, montrait que les causes des maladies ne pouvant pas se ramener à une seule, le champ de la pathologie générale était bien plus vaste qu’on ne croyait; et formulait ce que l’observation lui avait permis de conclure; mais sa conclusion n’embrasse guère que la trouble dans le mélange des humeurs, que leur coction et leurs crises. Depuis lors, la méthode de ceux qu’Hippocrate avait combattus, et la méthode d’Hippocrate, l’hypothèse et l’observation se sont perpétuées, ainsi que le témoigne l’histoire de la médecine, mais ce ne sont plus ni l’ancienne hypothèse, ni l’ancienne observation.

“Il est certainement instructif d’étudier, dans le cours du temps, les problèmes tels qu’ils ont été posés, et les discussions qu’ils ont soulevées. On le voit, la science antique a de grandes ressemblances avec la science moderne; dès l’époque que nous sommes forcés de regarder comme l’aurore de la médecine, dès les premiers monuments que nous possédons, les questions fondamentales sont débattues, et les limites de l’esprit humain sont touchées. Mais en dedans de ces limites, la science trouve, dans une immensité inépuisable de combinaisons, les matériaux qui la font grandir; et il est impossible de ne pas reconnaître que, sur un sol et avec les aliments que lui fournissent les choses et l’expérience, elle se développe en vertu d’un principe interne de vie, qui reside dans l’enchaînement nécessaire de son développement successif.”

ON ANCIENT MEDICINE.

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

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

3. For the art of Medicine would not have been invented at first, nor would it have been made a subject of investigation (for there would have been no need of it), if when men are indisposed, the same food and other articles of regimen which they eat and drink when in good health were proper for them, and if no others were preferable to these. But now necessity itself made medicine to be sought out and discovered by men, since the same things when administered to the sick, which agreed with them when in good health, neither did nor do agree with them. But to go still further back, I hold that the diet and food which people in health now use would not have been discovered, provided it had suited with man to eat and drink in like manner as the ox, the horse, and all other animals, except man, do of the productions of the earth, such as fruits, weeds, and grass; for from such things these animals grow, live free of disease, and require no other kind of food. And, at first, I am of opinion that man used the same sort of food, and that the present articles of diet had been discovered and invented only after a long lapse of time. For when they suffered much and severely from this strong and brutish diet, swallowing things which were raw, unmixed, and possessing great strength, they became exposed to strong pains and diseases, and to early deaths. It is likely, indeed, that from habit they would suffer less from these things then than we would now, but still they would suffer severely even then; and it is likely that the greater number, and those who had weaker constitutions, would all perish; whereas the stronger would hold out for a longer time, as even nowadays some, in consequence of using strong articles of food, get off with little trouble, but others with much pain and suffering. From this necessity it appears to me that they would search out the food befitting their nature, and thus discover that which we now use: and that from wheat, by macerating it, stripping it of its hull, grinding it all down, sifting, toasting, and baking it, they formed bread; and from barley they formed cake (maza), performing many operations in regard to it; they boiled, they roasted, they mixed, they diluted those things which are strong and of intense qualities with weaker things, fashioning them to the nature and powers of man, and considering that the stronger things Nature would not be able to manage if administered, and that from such things pains, diseases, and death would arise, but such as Nature could manage, that from them food, growth, and health, would arise. To such a discovery and investigation what more suitable name could one give than that of Medicine? since it was discovered for the health of man, for his nourishment and safety, as a substitute for that kind of diet by which pains, diseases, and deaths were occasioned.

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

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

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

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

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

9. And if it were simply, as is laid down, that such things as are stronger prove injurious, but such as are weaker prove beneficial and nourishing, both to sick and healthy persons, it were an easy matter, for then the safest rule would be to circumscribe the diet to the lowest point. But then it is no less mistake, nor one that injures a man less, provided a deficient diet, or one consisting of weaker things than what are proper, be administered. For, in the constitution of man, abstinence may enervate, weaken, and kill. And there are many other ills, different from those of repletion, but no less dreadful, arising from deficiency of food; wherefore the practice in those cases is more varied, and requires greater accuracy. For one must aim at attaining a certain measure, and yet this measure admits neither weight nor calculation of any kind, by which it may be accurately determined, unless it be the sensation of the body; wherefore it is a task to learn this accurately, so as not to commit small blunders either on the one side or the other, and in fact I would give great praise to the physician whose mistakes are small, for perfect accuracy is seldom to be seen, since many physicians seem to me to be in the same plight as bad pilots, who, if they commit mistakes while conducting the ship in a calm do not expose themselves, but when a storm and violent hurricane overtake them, they then, from their ignorance and mistakes, are discovered to be what they are, by all men, namely, in losing their ship. And thus bad and commonplace physicians, when they treat men who have no serious illness, in which case one may commit great mistakes without producing any formidable mischief, (and such complaints occur much more frequently to men than dangerous ones); under these circumstances, when they commit mistakes, they do not expose themselves to ordinary men; but when they fall in with a great, a strong, and a dangerous disease, then their mistakes and want of skill are made apparent to all. Their punishment is not far off, but is swift in overtaking both the one and the other.

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

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

12. Wherefore, I say, that such constitutions as suffer quickly and strongly from errors in diet, are weaker than others that do not; and that a weak person is in a state very nearly approaching to one in disease; but a person in disease is the weaker, and it is, therefore, more likely that he should suffer if he encounters anything that is unseasonable. It is difficult, seeing that there is no such accuracy in the Art, to hit always upon what is most expedient, and yet many cases occur in medicine which would require this accuracy, as we shall explain. But on that account, I say, we ought not to reject the ancient Art, as if it were not, and had not been properly founded, because it did not attain accuracy in all things, but rather, since it is capable of reaching to the greatest exactitude by reasoning, to receive it and admire its discoveries, made from a state of great ignorance, and as having been well and properly made, and not from chance.

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

14. And this I know, moreover, that to the human body it makes a great difference whether the bread be fine or coarse; of wheat with or without the hull, whether mixed with much or little water, strongly wrought or scarcely at all, baked or raw--and a multitude of similar differences; and so, in like manner, with the cake (maza); the powers of each, too, are great, and the one nowise like the other. Whoever pays no attention to these things, or, paying attention, does not comprehend them, how can he understand the diseases which befall a man? For, by every one of these things, a man is affected and changed this way or that, and the whole of his life is subjected to them, whether in health, convalescence, or disease. Nothing else, then, can be more important or more necessary to know than these things. So that the first inventors, pursuing their investigations properly, and by a suitable train of reasoning, according to the nature of man, made their discoveries, and thought the Art worthy of being ascribed to a god, as is the established belief. For they did not suppose that the dry or the moist, the hot or the cold, or any of these, are either injurious to man, or that man stands in need of them; but whatever in each was strong, and more than a match for a man’s constitution, whatever he could not manage, that they held to be hurtful, and sought to remove. Now, of the sweet, the strongest is that which is intensely sweet; of the bitter, that which is intensely bitter; of the acid, that which is intensely acid; and of all things that which is extreme, for these things they saw both existing in man, and proving injurious to him. For there is in man the bitter and the salt, the sweet and the acid, the sour and the insipid, and a multitude of other things having all sorts of powers both as regards quantity and strength. These, when all mixed and mingled up with one another, are not apparent, neither do they hurt a man; but when any of them is separate, and stands by itself, then it becomes perceptible, and hurts a man. And thus, of articles of food, those which are unsuitable and hurtful to man when administered, every one is either bitter, or intensely so, or saltish or acid, or something else intense and strong, and therefore we are disordered by them in like manner as we are by the secretions in the body. But all those things of which a man eats and drinks are devoid of any such intense and well-marked quality, such as bread, cake, and many other things of a similar nature which man is accustomed to use for food, with the exception of condiments and confectionaries, which are made to gratify the palate and for luxury. And from those things, when received into the body abundantly, there is no disorder nor dissolution of the powers belonging to the body; but strength, growth, and nourishment result from them, and this for no other reason than because they are well mixed, have nothing in them of an immoderate character, nor anything strong, but the whole forms one simple and not strong substance.

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

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

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

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

19. But such defluxions as are determined to the eyes being possessed of strong and varied acrimonies, ulcerate the eyelids, and in some cases corrode the cheeks and parts below the eyes upon which the flow, and even occasion rupture and erosion of the tunic which surrounds the eyeball. But pain, heat, and extreme burning prevail until the defluxions are concocted and become thicker, and concretions form about the eyes, and the coction takes place from the fluids being mixed up, diluted, and digested together. And in defluxions upon the throat, from which are formed hoarseness, cynanche, erysipelas, and pneumonia, all these have at first saltish, watery, and acrid discharges, and with these the diseases gain strength. But when the discharges become thicker, more concocted, and are freed from all acrimony, then, indeed, the fevers pass away, and the other symptoms which annoyed the patient; for we must account those things the cause of each complaint, which, being present in a certain fashion, the complaint exists, but it ceases when they change to another combination. But those which originate from pure heat or cold, and do not participate in any other quality, will then cease when they undergo a change from cold to hot, and from hot to cold; and they change in the manner I have described before. Wherefore, all the other complaints to which man is subject arise from powers (qualities?). Thus, when there is an overflow of the bitter principle, which we call yellow bile, what anxiety, burning heat, and loss of strength prevail! but if relieved from it, either by being purged spontaneously, or by means of a medicine seasonably administered, the patient is decidedly relieved of the pains and heat; but while these things float on the stomach, unconcocted and undigested, no contrivance could make the pains and fever cease; and when there are acidities of an acrid and æruginous character, what varieties of frenzy, gnawing pains in the bowels and chest, and inquietude, prevail! and these do not cease until the acidities be purged away, or are calmed down and mixed with other fluids. The coction, change, attenuation, and thickening into the form of humors, take place through many and various forms; therefore the crises and calculations of time are of great importance in such matters; but to all such changes hot and cold are but little exposed, for these are neither liable to putrefaction nor thickening. What then shall we say of the change? that it is a combination (crasis) of these humors having different powers toward one another. But the hot does not lose its heat when mixed with any other thing except the cold; nor again, the cold, except when mixed with the hot. But all other things connected with man become the more mild and better in proportion as they are mixed with the more things besides. But a man is in the best possible state when they are concocted and at rest, exhibiting no one peculiar quality; but I think I have said enough in explanation of them.

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

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

22. And it appears to me that one ought also to know what diseases arise in man from the powers, and what from the structures. What do I mean by this? By powers, I mean intense and strong juices; and by structures, whatever conformations there are in man. For some are hollow, and from broad contracted into narrow; some expanded, some hard and round, some broad and suspended, some stretched, some long, some dense, some rare and succulent, some spongy and of loose texture. Now, then, which of these figures is the best calculated to suck to itself and attract humidity from another body? Whether what is hollow and expanded, or what is solid and round, or what is hollow, and from broad, gradually turning narrow? I think such as from hollow and broad are contracted into narrow: this may be ascertained otherwise from obvious facts: thus, if you gape wide with the mouth you cannot draw in any liquid; but by protruding, contracting, and compressing the lips, and still more by using a tube, you can readily draw in whatever you wish. And thus, too, the instruments which are used for cupping are broad below and gradually become narrow, and are so constructed in order to suck and draw in from the fleshy parts. The nature and construction of the parts within a man are of a like nature; the bladder, the head, the uterus in woman; these parts clearly attract, and are always filled with a juice which is foreign to them. Those parts which are hollow and expanded are most likely to receive any humidity flowing into them, but cannot attract it in like manner. Those parts which are solid and round could not attract a humidity, nor receive it when it flows to them, for it would glide past, and find no place of rest on them. But spongy and rare parts, such as the spleen, the lungs, and the breasts, drink up especially the juices around them, and become hardened and enlarged by the accession of juices. Such things happen to these organs especially. For it is not with the spleen as with the stomach, in which there is a liquid, which it contains and evacuates every day; but when it (the spleen) drinks up and receives a fluid into itself, the hollow and lax parts of it are filled, even the small interstices; and, instead of being rare and soft, it becomes hard and dense, and it can neither digest nor discharge its contents: these things it suffers, owing to the nature of its structure. Those things which engender flatulence or tormina in the body, naturally do so in the hollow and broad parts of the body, such as the stomach and chest, where they produce rumbling noises; for when they do not fill the parts so as to be stationary, but have changes of place and movements, there must necessarily be noise and apparent movements from them. But such parts as are fleshy and soft, in these there occur torpor and obstructions, such as happen in apoplexy. But when it (the flatus?) encounters a broad and resisting structure, and rushes against such a part, and this happens when it is by nature not strong so as to be able to withstand it without suffering injury; nor soft and rare, so as to receive or yield to it, but tender, juicy, full of blood, and dense, like the liver, owing to its density and broadness, it resists and does not yield. But flatus, when it obtains admission, increases and becomes stronger, and rushes toward any resisting object; but owing to its tenderness, and the quantity of blood which it (the liver) contains, it cannot be without uneasiness; and for these reasons the most acute and frequent pains occur in the region of it, along with suppurations and chronic tumors (phymata). These symptoms also occur in the site of the diaphragm, but much less frequently; for the diaphragm is a broad, expanded, and resisting substance, of a nervous (tendinous?) and strong nature, and therefore less susceptible of pain; and yet pains and chronic abscesses do occur about it.

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

24. And, as has been formerly stated, one ought to be acquainted with the powers of juices, and what action each of them has upon man, and their alliances towards one another. What I say is this: if a sweet juice change to another kind, net from any admixture, but because it has undergone a mutation within itself; what does it first become?--bitter? salt? austere? or acid? I think acid. And hence, an acid juice is the most improper of all things that can be administered in cases in which a sweet juice is the most proper. Thus, if one should succeed in his investigations of external things, he would be the better able always to select the best; for that is best which is farthest removed from that which is unwholesome.

ON AIRS, WATERS, AND PLACES.

THE ARGUMENT.

Dr. Coray, in his excellent edition of this treatise, divides it into six chapters, as follows: first, the Introduction (from § 1–3) comprehends some general observations on the importance of cultivating a knowledge of the effects which the different seasons, the winds, the various kinds of water, the situation of cities, the nature of soils and the modes of life, exercise upon the health, and the necessity of a physician’s making himself well acquainted with all these matters, if he would wish to practise his profession successfully. The author insists, with particular earnestness, on the utility of studying the constitution of the year and the nature of the seasons, and refutes the opinions of those persons, in his days, who held that a knowledge of all these things belongs to meteorology rather than to medicine. The second chapter (§ 3–7) treats of climate, and the diseases prevalent in localities characterized by their exposure to particular winds. Those winds being peculiar to Greece, their names occasion some trouble in order to understand them correctly, and we shall give below a summary of what the modern Greek Coray says in illustration of them. This part of the present treatise appears to have been highly elaborated, and contains much important information. The third chapter (§ 7–10) treats of the various kinds of water, and their effects in different states of the human constitution. The remarks contained here are of an eminently practical nature, and evidently must have been the results of patient observation and experiment, so that, even at the present day, it would be difficult to detect our author in a single error of judgment. In this place he has occasion to deliver his opinions on the formation of urinary calculi, which he does at considerable length; and I may be permitted to remark, whatever may be thought of his etiology of the disease, it will be admitted that his theory is plausible, and the best that could well have been framed in the state of knowledge which then prevailed on that subject. Indeed, even at the present day, it must be allowed that this is a dark subject; we have acquired, it is true, many new and curious facts connected with the minute structure of these concretions, but it can hardly be affirmed that we have been able to evolve from them any general principles, or certain rules of practice. In the fourth chapter (§ 10–12), the nature of the seasons is treated of, and their influence on the health circumstantially stated. Some of the observations contained in this part of the work are remarkable for their acuteness and originality, such as the following, that, in estimating the effects of a season on the health, we ought to take into account the seasons which preceded it. This is well expressed by Celsus, as follows: “neque solum interest quales dies sint sed etiam quales præcesserint.” (Præfat.) See also Hippocrates (de Humoribus, § 8); and Coray (ad h. 1. § cix.) It will be seen in our annotations that a considerable number of the Aphorisms are abstracted from this part of the present treatise. In the fifth chapter (§ 12–17), the effects of climate and the institutions of society on the inhabitants of Asia are treated of at considerable length. Our author, in this place, evinces a great acquaintance with human life, and a most philosophical spirit in contemplating the subject which he is handling. Indeed few works in any language display so much accurate observation and originality of thought. The varieties of disposition, and of intellectual and moral development among mankind, are set down as being derived, in a great measure, from differences of climate and modes of government. Thus the Asiatics are of an effeminate and slavish disposition, because they live in a soft climate, on a rich soil, where they are little exposed to hardships or labor, and under a despotic form of government, which arrests the development of their mental energies. This part also contains some interesting observations on the Macrocephali and the inhabitants of Phasis. In the sixth and last chapter (§ 17 to the end), the peculiar traits of the European character, as connected with climate and institutions, are described in a very interesting manner. Here the observations on the Amazons, Sauromatæ, and Scythians are well deserving of an attentive perusal, and more particularly the description of the disease induced by continual riding on horseback, the probable nature of which we shall consider presently. Here, too, are given our author’s remarks on diseases supposed to be divine, which, as we have stated in the Preliminary section on his life, evince a wonderful exemption from the superstitious belief of his age, and indicate an extraordinary depth of thought.

This is a general outline of the contents of this treatise, which is one of the most celebrated in the whole Collection. From what we have stated, it will at once be seen that it relates to a subject of commanding interest, and deserves to be carefully studied, as containing the oldest exposition which we possess of the opinions entertained by an original and enlightened mind on many important questions connected with Public Hygiene and Political Economy, two sciences which, of late years, have commanded a large amount of professional attention. Whether or not modern experience may confirm our author’s judgment in every particular case, it surely can neither be unprofitable nor uninteresting to ascertain what his opinions on these subjects actually were. Let us be thankful, then, that the destroying hand of time has spared us so valuable a relic of antiquity; and, instead of undervaluing our ancient instructor because he shows himself ignorant of many truths which we are now familiar with, let us be grateful to him for the amount of information which he has supplied to us, and for setting us an example which it must be both safe and profitable for us to follow. Surely great praise is due to the man who first mooted so many important questions, and stated their bearings in distinct terms, although he did not always succeed in solving them.

I may take the present opportunity of mentioning that M. Littré, with some appearance of truth, blames Hippocrates for having rather overrated the influence of climate and institutions, in producing military valor, which, as he justly remarks, has been proved by modern examples to be most intimately connected with discipline, and a knowledge of the arts of war. But if Hippocrates was wrong on this point, it was because he did not avail himself properly of the lights of his own age; for he might have learned from his contemporary, Socrates, the very doctrine which M. Littré here inculcates. “The question being put to him,” says Xenophon, “whether valor was a thing that could be taught, or was natural? I am of opinion, he said, that as one body is born with greater powers than another for enduring labor, so is one soul produced by nature stronger than another for enduring dangers. For I see persons brought up under the same institutions and habits differing much from one another in courage. But I think that every nature may be improved in valour by learning and discipline. For it is obvious that the Scythians and Thracians would not dare to contend with the Lacedemonians with bucklers and spears; and it is clear that, the Lacedemonians would not be willing to contend with the Thracians with small targets and javelins, or with the Scythians with bows and arrows.” (Memorab. iii., 9.) The same doctrine is taught with remarkable subtlety of argument and originality of thought in the “Protagoras” of Plato, (see § 97). If, then, Hippocrates was wrong on this head, (which, however, may be doubted), it is clear that he is not to be screened by the alleged ignorance of his age, and that he might have put himself right by attending to the instructions of a contemporary with whom he, in all probability, was familiar, and who undoubtedly was the greatest master of human nature that ever existed.

As there are certain matters connected with this treatise which will require a more lengthened discussion than can well suit with foot notes, I think it advisable to treat of them in this place:--

1. With regard to the seasons of the year, as indicated try the risings and settings of the stars. the following observations, taken in a great measure from Clifton’s Preface will supply, in as brief a space as possible, all the information that will be required; “As the reader will find frequent mention of seasons, equinoxes, solstices, risings and settings of the sun and stars (particularly Arcturus, the Dog-star, and the Pleiades), it may not be amiss to premise, in the first place, that a year was divided by the ancients into four parts, every one of these was distinguished astronomically.

“Thus, for instance, the winter began at the setting of the Pleiades, and continued to the vernal equinox.

“The spring began at the vernal equinox, and ended at the rising of the Pleiades.

“The summer began at the rising of the Pleiades, and ended at the rising of Arcturus.

“The autumn began at the rising of Arcturus, and ended at the setting of the Pleiades.

“The rising and setting of the stars is always to be understood of what astronomers call the heliacal rising or setting, i. e. when a star rises or sets with the sun.

“The rising and setting of the sun in summer or winter (an expression which often occurs in this treatise), implies those points of the compass the sun rises and sets at.”

II. On the winds, of which frequent mention is made by our author, Coray has treated with a degree of prolixity and earnestness for which it is difficult to recognize the necessity. The figure given above, if properly studied and understood, will supply the professional reader with all the information he will require on this head.

III. One of the most singular diseases noticed in this work is the effeminacy with which the Scythians are said to have been attacked in consequence of spending the greater part of their time on horseback. (See § 22.) As the subject has attracted a good deal of attention lately, I will give a summary of the information which has been collected respecting it. See Coray, etc., t. ii., p. 331; Littré, t. ii., p. 5, 6; and Avert., xxxix., p. 47; t. iv., p. 9.

In the first place, then, it can scarcely admit of doubt that the disease is the same as that which Herodotus describes in the following passage: “Venus inflicted upon the Scythians, who pillaged her temple at Ascalon, and on their descendants, the feminine disease; at least it is to this cause that they attribute their disease; and travellers that go to the land of Scythia see how these persons are affected whom the Scythians called accursed (ἐναρεες).”

All the opinions which have been entertained respecting this affection are referred by M. Littré to the three following categories:

I. A vice, namely (A), Pederasty, which, he says is the most ancient opinion we have respecting it, as indicated by Longinus (on the Sublime, 25), and defended by his commentators, Toll and Pearce, and by Casaubon and Coster. (B), Onanism, the opinion to which Sprengel inclines in his work on Hippocrates.

2. A bodily disease, to wit: (A), Hemorrhoids, as maintained by Paul Thomas de Girac, by Valkenäer, by Bayer, and by the Compilers of the ‘Universal History.’ (B), A true menstruation, as appears to be maintained by Lefevre and Dacier, and by others. (C), Blenorrhagia, as Guy Patin and others suppose. (D), A true impotence, as held by Mercuriali and others.

3. A mental disease, as maintained by Sauvages, Heyne, Coray, and others.

M. Rosenbaum is at great pains to make out that the affection in question was pederasty, and that the accursed (ἐνάρεες) of Herodotus were the same as the pathici of the Romans. I must say, that in my opinion Rosenbaum makes out a strong case in support of this opinion. In particular it will be remarked, that Herodotus says, the descendants of these Scythians were also afflicted with this complaint. Now Celsus Aurelianus says expressly, that the affection of the pathici was hereditary. Taking everything into account, I must say that my own opinion has always been that the disease in question must have been some variety of spermatorrhœa. I need scarcely remark that this affection induces a state, both of body and mind, analogous to that of the pathici, as described by ancient authors.

Before leaving this subject, however, I should mention that M. Littré, in the fourth volume of his Hippocrates (p. xi.), brings into view a thesis by M. Graff, the object of which is to prove that the disease of the Scythians was a true sort of impotence; and in illustration of it, he cites a passage from the memoirs of M. Larrey, containing a description of a species of impotence, attended with wasting of the testicle, which attacked the French army in Egypt. But, as far as I can see, this disease described by Larrey had nothing to do with riding on horseback, and I cannot see any relation between it and the diseases described by Herodotus and Hippocrates.

IV. Of all the legendary tales of antiquity, there is probably no one which was so long and so generally credited by the best informed historians, critics, geographers, poets, and philosophers, as the story of the Amazons. They are noticed historically by Homer (Iliad, iii., 186; vi., 152); Apollonius Rhodius (ii., 196); Pindar (Olymp. xiii., 84); Herodotus (ix., 27); Lysias (Epitaph. 3); Plato (Menex.); Isocrates (Panyg.); Ctesias (Persic.); Plutarch (Theseus); Strabo (Geogr. ix.); Pausanias (iv., 31, 6; vii., 2, 4); Arrian (Exped. Alexand.); Quintus Curtius (vi., 4). Now it is singular that in all this list of authorities, which, it will be remarked, comprehends the élite of ancient scholars, no one, with the exception of Strabo, ventures to express the slightest doubt respecting the actual existence of the Amazons. Some of them, indeed, admit that the race had become extinct in their time; but they all seem satisfied that the Amazons had truly existed in a bygone age, and consequently they acknowledge them as real historical personages. See, in particular, Arrian, who, although compelled by his respect for truth to acknowledge that they did not exist in the days of Alexander the Great, still does not hesitate to declare that it appeared incredible that this race of women, celebrated as they were by the most eminent authors, should never have existed at all. Yet, notwithstanding the mass of evidence in support of their actual existence, I suppose few scholars nowadays will hesitate to agree with Heyne (Apollodor. ii., 5, 9), and with Grote (Hist. of Greece, i., 2), in setting down the whole story as mere myth. But, considering how generally it had been believed, we need not wonder that Hippocrates in this treatise should appear to entertain no doubt of their actual existence. The reader will remark that he makes the locality of the Amazons to be in Europe, among the Sarmatians, on the north side of the Euxine. It is generally taken for granted, however, in the ancient myths, that their place of residence was on the banks of the Thermodon, in Cappadocia, and they are described as having afterwards crossed to the opposite side of the Euxine, when expelled from this locality. But, in fact, they are remarkable so much for nothing as their ubiquity, being sometimes located in Asia, sometimes in Africa, and at other times in Athens. I may remark, before concluding, that Mr. Payne Knight (Symbolical Language, etc., Classical Journal, 23), and Creuzer (Symbolik. etc.), give a symbolical interpretation to the story of the Amazons; but this mode of explaining the myths of antiquity is altogether fanciful and unsatisfactory. It seems safer and more judicious to deal with them as Mr. Grote has done, that is to say, to receive them as tales in which the ancients believed, without having any rational foundation for their faith. That there may have been a certain basis of truth in the story of the Amazons need not be denied; but in this, as in all the ancient myths, it is a hopeless task to attempt to separate truth from fiction.

ON AIRS, WATERS, AND PLACES.

1. Whoever wishes to investigate medicine properly, should proceed thus: in the first place to consider the seasons of the year, and what effects each of them produces (for they are not at all alike, but differ much from themselves in regard to their changes). Then the winds, the hot and the cold, especially such as are common to all countries, and then such as are peculiar to each locality. We must also consider the qualities of the waters, for as they differ from one another in taste and weight, so also do they differ much in their qualities. In the same manner, when one comes into a city to which he is a stranger, he ought to consider its situation, how it lies as to the winds and the rising of the sun; for its influence is not the same whether it lies to the north or the south, to the rising or to the setting sun. These things one ought to consider most attentively, and concerning the waters which the inhabitants use, whether they be marshy and soft, or hard, and running from elevated and rocky situations, and then if saltish and unfit for cooking; and the ground, whether it be naked and deficient in water, or wooded and well watered, and whether it lies in a hollow, confined situation, or is elevated and cold; and the mode in which the inhabitants live, and what are their pursuits, whether they are fond of drinking and eating to excess, and given to indolence, or are fond of exercise and labor, and not given to excess in eating and drinking.

2. From these things he must proceed to investigate everything else. For if one knows all these things well, or at least the greater part of them, he cannot miss knowing, when he comes into a strange city, either the diseases peculiar to the place, or the particular nature of common diseases, so that he will not be in doubt as to the treatment of the diseases, or commit mistakes, as is likely to be the case provided one had not previously considered these matters. And in particular, as the season and the year advances, he can tell what epidemic diseases will attack the city, either in summer or in winter, and what each individual will be in danger of experiencing from the change of regimen. For knowing the changes of the seasons, the risings and settings of the stars, how each of them takes place, he will be able to know beforehand what sort of a year is going to ensue. Having made these investigations, and knowing beforehand the seasons, such a one must be acquainted with each particular, and must succeed in the preservation of health, and be by no means unsuccessful in the practice of his art. And if it shall be thought that these things belong rather to meteorology, it will be admitted, on second thoughts, that astronomy contributes not a little, but a very great deal, indeed, to medicine. For with the seasons the digestive organs of men undergo a change.

3. But how each of the afore-mentioned things should be investigated and explained, I will now declare in a clear manner. A city that is exposed to hot winds (these are between the wintry rising, and the wintry setting of the sun), and to which these are peculiar, but which is sheltered from the north winds; in such a city the waters will be plenteous and saltish, and as they run from an elevated source, they are necessarily hot in summer, and cold in winter; the heads of the inhabitants are of a humid and pituitous constitution, and their bellies subject to frequent disorders, owing to the phlegm running down from the head; the forms of their bodies, for the most part, are rather flabby; they do not eat nor drink much; drinking wine in particular, and more especially if carried to intoxication, is oppressive to them; and the following diseases are peculiar to the district: in the first place, the women are sickly and subject to excessive menstruation; then many are unfruitful from disease, and not from nature, and they have frequent miscarriages; infants are subject to attacks of convulsions and asthma, which they consider to be connected with infancy, and hold to be a sacred disease (epilepsy). The men are subject to attacks of dysentery, diarrhœa, hepialus, chronic fevers in winter, of epinyctis, frequently, and of hemorrhoids about the anus. Pleurisies, peripneumonies, ardent fevers, and whatever diseases are reckoned acute, do not often occur, for such diseases are not apt to prevail where the bowels are loose. Ophthalmies occur of a humid character, but not of a serious nature, and of short duration, unless they attack epidemically from the change of the seasons. And when they pass their fiftieth year, defluxions supervening from the brain, render them paralytic when exposed suddenly to strokes of the sun, or to cold. These diseases are endemic to them, and, moreover, if any epidemic disease connected with the change of the seasons, prevail, they are also liable to it.

4. But the following is the condition of cities which have the opposite exposure, namely, to cold winds, between the summer settings and the summer risings of the sun, and to which these winds are peculiar, and which are sheltered from the south and the hot breezes. In the first place the waters are, for the most part, hard and cold. The men must necessarily be well braced and slender, and they must have the discharges downwards of the alimentary canal hard, and of difficult evacuation, while those upwards are more fluid, and rather bilious than pituitous. Their heads are sound and hard, and they are liable to burstings (of vessels?) for the most part. The diseases which prevail epidemically with them, are pleurisies, and those which are called acute diseases. This must be the case when the bowels are bound; and from any causes, many become affected with suppurations in the lungs, the cause of which is the tension of the body, and hardness of the bowels; for their dryness and the coldness of the water dispose them to ruptures (of vessels?). Such constitutions must be given to excess of eating, but not of drinking; for it is not possible to be gourmands and drunkards at the same time. Ophthalmies, too, at length supervene; these being of a hard and violent nature, and soon ending in rupture of the eyes; persons under thirty years of age are liable to severe bleedings at the nose in summer; attacks of epilepsy are rare but severe. Such people are likely to be rather long-lived; their ulcers are not attended with serous discharges, nor of a malignant character; in disposition they are rather ferocious than gentle. The diseases I have mentioned are peculiar to the men, and besides they are liable to any common complaint which may be prevailing from the changes of the seasons. But the women, in the first place, are of a hard constitution, from the waters being hard, indigestible, and cold; and their menstrual discharges are not regular, but in small quantity, and painful. Then they have difficult parturition, but are not very subject to abortions. And when they do bring forth children, they are unable to nurse them; for the hardness and indigestible nature of the water puts away their milk. Phthisis frequently supervenes after childbirth, for the efforts of it frequently bring on ruptures and strains. Children while still little are subject to dropsies in the testicle, which disappear as they grow older; in such a town they are late in attaining manhood. It is, as I have now stated, with regard to hot and cold winds and cities thus exposed.

5. Cities that are exposed to winds between the summer and the winter risings of the sun, and those the opposite to them, have the following characters:--Those which lie to the rising of the sun are all likely to be more healthy than such as are turned to the North, or those exposed to the hot winds, even if there should not be a furlong between them. In the first place, both the heat and cold are more moderate. Then such waters as flow to the rising sun, must necessarily be clear, fragrant, soft, and delightful to drink, in such a city. For the sun in rising and shining upon them purifies them, by dispelling the vapors which generally prevail in the morning. The persons of the inhabitants are, for the most part, well colored and blooming, unless some disease counteract. The inhabitants have clear voices, and in temper and intellect are superior to those, which are exposed to the north, and all the productions of the country in like manner are better. A city so situated resembles the spring as to moderation between heat and cold, and the diseases are few in number, and of a feeble kind, and bear a resemblance to the diseases which prevail in regions exposed to hot winds. The women there are very prolific, and have easy deliveries. Thus it is with regard to them.

6. But such cities as lie to the west, and which are sheltered from winds blowing from the east, and which the hot winds and the cold winds of the north scarcely touch, must necessarily be in a very unhealthy situation: in the first place the waters are not clear, the cause of which is, because the mist prevails commonly in the morning, and it is mixed up with the water and destroys its clearness, for the sun does not shine upon the water until he be considerably raised above the horizon. And in summer, cold breezes from the east blow and dews fall; and in the latter part of the day the setting sun particularly scorches the inhabitants, and therefore they are pale and enfeebled, and are partly subject to all the aforesaid diseases, but no one is peculiar to them. Their voices are rough and hoarse owing to the state of the air, which in such a situation is generally impure and unwholesome, for they have not the northern winds to purify it; and these winds they have are of a very humid character, such being the nature of the evening breezes. Such a situation of a city bears a great resemblance to autumn as regards the changes of the day, inasmuch as the difference between morning and evening is great. So it is with regard to the winds that are conducive to health, or the contrary.

7. And I wish to give an account of the other kinds of waters, namely, of such as are wholesome and such as are unwholesome, and what bad and what good effects may be derived from water; for water contributes much towards health. Such waters then as are marshy, stagnant, and belong to lakes, are necessarily hot in summer, thick, and have a strong smell, since they have no current; but being constantly supplied by rain-water, and the sun heating them, they necessarily want their proper color, are unwholesome and form bile; in winter, they become congealed, cold, and muddy with the snow and ice, so that they are most apt to engender phlegm, and bring on hoarseness; those who drink them have large and obstructed spleens, their bellies are hard, emaciated, and hot; and their shoulders, collar-bones, and faces are emaciated; for their flesh is melted down and taken up by the spleen, and hence they are slender; such persons then are voracious and thirsty; their bellies are very dry both above and below, so that they require the strongest medicines. This disease is habitual to them both in summer and in winter, and in addition they are very subject to dropsies of a most fatal character; and in summer dysenteries. diarrhœas, and protracted quartan fevers frequently seize them, and these diseases when prolonged dispose such constitutions to dropsies, and thus prove fatal. These are the diseases which attack them in summer; but in winter younger persons are liable to pneumonia, and maniacal affections; and older persons to ardent fevers, from hardness of the belly. Women are subject to œdema and leucophlegmasiæ; when pregand then during nursing they become wasted and sickly, and the lochial discharge after parturition does not proceed properly with the women. The children are particularly subject to hernia, and adults to varices and ulcers on their legs, so that persons with such constitutions cannot be long-lived, but before the usual period they fall into a state of premature old age. And further, the women appear to be with child, and when the time of parturition arrives, the fulness of the belly disappears, and this happens from dropsy of the uterus. Such waters then I reckon bad for every purpose. The next to them in badness are those which have their fountains in rocks, so that they must necessarily be hard, or come from a soil which produces thermal waters, such as those having iron, copper, silver, gold, sulphur, alum, bitumen, or nitre (soda) in them: for all these are formed by the force of heat. Good waters cannot proceed from such a soil, but those that are hard and of a heating nature, difficult to pass by urine, and of difficult evacuation by the bowels. The best are those which flow from elevated grounds, and hills of earth; these are sweet, clear, and can bear a little wine; they are hot in summer and cold in winter, for such necessarily must be the waters from deep wells. But those are most to be commended which run to the rising of the sun, and especially to the summer sun; for such are necessarily more clear, fragrant, and light. But all such as are saltish, crude, and hard, are not good for drink. But there are certain constitutions and diseases with which such waters agree when drunk, as I will explain presently. Their characters are as follows: the best are such as have their fountains to the east; the next, those between the summer risings and settings of the sun, and especially those to the risings; and third, those between the summer and winter settings; but the worst are those to the south, and the parts between the winter rising and setting, and those to the south are very bad, but those to the north are better. They are to be used as follows: whoever is in good health and strength need not mind, but may always drink whatever is at hand. But whoever wishes to drink the most suitable for any disease, may accomplish his purpose by attending to the following directions: To persons whose bellies are hard and easily burnt up, the sweetest, the lightest, and the most limpid waters will be proper; but those persons whose bellies are soft, loose, and pituitous, should choose the hardest, those kinds that are most crude, and the saltest, for thus will they be most readily dried up; for such waters as are adapted for boiling, and are of a very solvent nature, naturally loosen readily and melt down the bowels; but such as are intractable, hard, and by no means proper for boiling, these rather bind and dry up the bowels. People have deceived themselves with regard to salt waters, from inexperience, for they think these waters purgative, whereas they are the very reverse; for such waters are crude, and ill adapted for boiling, so that the belly is more likely to be bound up than loosened by them. And thus it is with regard to the waters of springs.

8. I will now tell how it is with respect to rain-water, and water from snow. Rain waters, then, are the lightest, the sweetest, the thinnest, and the clearest; for originally the sun raises and attracts the thinnest and lightest part of the water, as is obvious from the nature of salts; for the saltish part is left behind owing to its thickness and weight, and forms salts; but the sun attracts the thinnest part, owing to its lightness, and he abstracts this not only from the lakes, but also from the sea, and from all things which contain humidity, and there is humidity in everything; and from man himself the sun draws off the thinnest and lightest part of the juices. As a strong proof of this, when a man walks in the sun, or sits down having a garment on, whatever parts of the body the sun shines upon do not sweat, for the sun carries off whatever sweat makes its appearance; but those parts which are covered by the garment, or anything else, sweat, for the particles of sweat are drawn and forced out by the sun, and are preserved by the cover so as not to be dissipated by the sun; but when the person comes into the shade the whole body equally perspires, because the sun no longer shines upon it. Wherefore, of all kinds of water, these spoil the soonest; and rain water has a bad smell, because its particles are collected and mixed together from most objects, so as to spoil the soonest. And in addition to this, when attracted and raised up, being carried about and mixed with the air, whatever part of it is turbid and darkish is separated and removed from the other, and becomes cloud and mist, but the most attenuated and lightest part is left, and becomes sweet, being heated and concocted by the sun, for all other things when concocted become sweet. While dissipated then and not in a state of consistence it is carried aloft. But when collected and condensed by contrary winds, it falls down wherever it happens to be most condensed. For this is likely to happen when the clouds being carried along and moving with a wind which does not allow them to rest, suddenly encounters another wind and other clouds from the opposite direction: there it is first condensed, and what is behind is carried up to the spot, and thus it thickens, blackens, and is conglomerated, and by its weight it falls down and becomes rain. Such, to all appearance, are the best of waters, but they require to be boiled and strained; for otherwise they have a bad smell, and occasion hoarseness and thickness of the voice to those who drink them. Those from snow and ice are all bad, for when once congealed, they never again recover their former nature; for whatever is clear, light, and sweet in them, is separated and disappears; but the most turbid and weightiest part is left behind. You may ascertain this in the following manner: If in winter you will pour water by measure into a vessel and expose it to the open air until it is all frozen, and then on the following day bring it into a warm situation where the ice will thaw, if you will measure the water again when dissolved you will find it much less in quantity. This is a proof that the lightest and thinnest part is dissipated and dried up by the congelation, and not the heaviest and thickest, for that is impossible: wherefore I hold that waters from snow and ice, and those allied to them, are the worst of any for all purposes whatever. Such are the characters of rain-water, and those from ice and snow.

9. Men become affected with the stone, and are seized with diseases of the kidneys, strangury, sciatica, and become ruptured, when they drink all sorts of waters, and those from great rivers into which other rivulets run, or from a lake into which many streams of all sorts flow, and such as are brought from a considerable distance. For it is impossible that such waters can resemble one another, but one kind is sweet, another saltish and aluminous, and some flow from thermal springs; and these being all mixed up together disagree, and the strongest part always prevails; but the same kind is not always the strongest, but sometimes one and sometimes another, according to the winds, for the north wind imparts strength to this water, and the south to that, and so also with regard to the others. There must be deposits of mud and sand in the vessels from such waters, and the aforesaid diseases must be engendered by them when drunk, but why not to all I will now explain. When the bowels are loose and in a healthy state, and when the bladder is not hot, nor the neck of the bladder very contracted, all such persons pass water freely, and no concretion forms in the bladder; but those in whom the belly is hot, the bladder must be in the same condition; and when preternaturally heated, its neck becomes inflamed; and when these things happen, the bladder does not expel the urine, but raises its heat excessively. And the thinnest part of it is secreted, and the purest part is passed off in the form of urine, but the thickest and most turbid part is condensed and concreted, at first in small quantity, but afterwards in greater; for being rolled about in the urine, whatever is of a thick consistence it assimilates to itself, and thus it increases and becomes indurated. And when such persons make water, the stone forced down by the urine falls into the neck of the bladder and stops the urine, and occasions intense pain; so that calculous children rub their privy parts and tear at them, as supposing that the obstruction to the urine is situated there. As a proof that it is as I say, persons affected with calculus have very limpid urine, because the thickest and foulest part remains and is concreted. Thus it generally is in cases of calculus. It forms also in children from milk, when it is not wholesome, but very hot and bilious, for it heats the bowels and bladder, so that the urine being also heated undergoes the same change. And I hold that it is better to give children only the most diluted wine, for such will least burn up and dry the veins. Calculi do not form so readily in women, for in them the urethra is short and wide, so that in them the urine is easily expelled; neither do they rub the pudendum with their hands, nor handle the passage like males; for the urethra in women opens direct into the pudendum, which is not the case with men, neither in them is the urethra so wide, and they drink more than children do. Thus, or nearly so, is it with reward to them.

10. And respecting the seasons, one may judge whether the year will prove sickly or healthy from the following observations:--If the appearances connected with the rising and setting stars be as they should be; if there be rains in autumn; if the winter be mild, neither very tepid nor unseasonably cold, and if in spring the rains be seasonable, and so also in summer, the year is likely to prove healthy. But if the winter be dry and northerly, and the spring showery and southerly, the summer will necessarily be of a febrile character, and give rise to ophthalmies and dysenteries. For when suffocating heat sets in all of a sudden, while the earth is moistened by the vernal showers, and by the south wind, the heat is necessarily doubled from the earth, which is thus soaked by rain and heated by a burning sun, while, at the same time, men’s bellies are not in an orderly state, nor the brain properly dried; for it is impossible, after such a spring, but that the body and its flesh must be loaded with humors, so that very acute fevers will attack all, but especially those of a phlegmatic constitution. Dysenteries are also likely to occur to women and those of a very humid temperament. And if at the rising of the Dog-star rain and wintry storms supervene, and if the etesian winds blow, there is reason to hope that these diseases will cease, and that the autumn will be healthy; but if not, it is likely to be a fatal season to children and women, but least of all to old men; and that convalescents will pass into quartans, and from quartans into dropsies; but if the winter be southerly, showery and mild, but the spring northerly, dry, and of a wintry character, in the first place women who happen to be with child, and whose accouchement should take place in spring, are apt to miscarry; and such as bring forth, have feeble and sickly children, so that they either die presently or are tender, feeble, and sickly, if they live. Such is the case with the women. The others are subject to dysenteries and dry ophthalmies, and some have catarrhs beginning in the head and descending to the lungs. Men of a phlegmatic temperament are likely to have dysenteries; and women, also, from the humidity of their nature, the phlegm descending downwards from the brain; those who are bilious, too, have dry ophthalmies from the heat and dryness of their flesh; the aged, too, have catarrhs from their flabbiness and melting of the veins, so that some of them die suddenly and some become paralytic on the right side or the left. For when, the winter being southerly and the body hot, the blood and veins are not properly constringed; a spring that is northerly, dry, and cold, having come on, the brain when it should have been expanded and purged, by the coryza and hoarseness is then constringed and contracted, so that the summer and the heat occurring suddenly, and a change supervening, these diseases fall out. And such cities as lie well to the sun and winds, and use good waters, feel these changes less, but such as use marshy and pooly waters, and lie well both as regards the winds and the sun, these all feel it more. And if the summer be dry, those diseases soon cease, but if rainy, they are protracted; and there is danger of any sore that there is becoming phagedenic from any cause; and lienteries and dropsies supervene at the conclusion of diseases; for the bowels are not readily dried up. And if the summer be rainy and southerly, and next the autumn, the winter must, of necessity, be sickly, and ardent fevers are likely to attack those that are phlegmatic, and more elderly than forty years, and pleurisies and peripneumonies those that are bilious. But if the summer is parched and northerly, but the autumn rainy and southerly, headache and sphacelus of the brain are likely to occur; and in addition hoarseness, coryza, coughs, and in some cases, consumption. But if the season is northerly and without water, there being no rain, neither after the Dog-star nor Arcturus; this state agrees best with those who are naturally phlegmatic, with those who are of a humid temperament, and with women: but it is most inimical to the bilious; for they become much parched up, and ophthalmies of a dry nature supervene, fevers both acute and chronic, and in some cases melancholy; for the most humid and watery part of the bile being consumed, the thickest and most acrid portion is left, and of the blood likewise, whence these diseases come upon them. But all these are beneficial to the phlegmatic, for they are thereby dried up, and reach winter not oppressed with humors, but with them dried up.

11. Whoever studies and observes these things may be able to foresee most of the effects which will result from the changes of the seasons: and one ought to be particularly guarded during the greatest changes of the seasons, and neither willingly give medicines, nor apply the cautery to the belly, nor make incisions there until ten or more days be past. Now, the greatest and most dangerous are the two solstices, and especially the summer, and also the two equinoxes, but especially the autumnal. One ought also to be guarded about the rising of the stars, especially of the Dog-star, then of Arcturus, and then the setting of the Pleiades; for diseases are especially apt to prove critical in those days, and some prove fatal, some pass off, and all others change to another form and another constitution. So it is with regard to them.

12. I wish to show, respecting Asia and Europe, how, in all respects, they differ from one another, and concerning the figure of the inhabitants, for they are different, and do not at all resemble one another. To treat of all would be a long story, but I will tell you how I think it is with regard to the greatest and most marked differences. I say, then, that Asia differs very much from Europe as to the nature of all things, both with regard to the productions of the earth and the inhabitants, for everything is produced much more beautiful and large in Asia; the country is milder, and the dispositions of the inhabitants also are more gentle and affectionate. The cause of this is the temperature of the seasons, because it lies in the middle of the risings of the sun towards the east, and removed from the cold (and heat), for nothing tends to growth and mildness so much as when the climate has no predominant quality, but a general equality of temperature prevails. It is not everywhere the same with regard to Asia, but such parts of the country as lie intermediate between the heat and the cold, are the best supplied with fruits and trees, and have the most genial climate, and enjoy the purest waters, both celestial and terrestrial. For neither are they much burnt up by the heat, nor dried up by the drought and want of rain, nor do they suffer from the cold; since they are well watered from abundant showers and snow, and the fruits of the season, as might be supposed, grow in abundance, both such as are raised from seed that has been sown, and such plants as the earth produces of its own accord, the fruits of which the inhabitants make use of, training them from their wild state and transplanting them to a suitable soil; the cattle also which are reared there are vigorous, particularly prolific, and bring up young of the fairest description; the inhabitants too, are well fed, most beautiful in shape, of large stature, and differ little from one another either as to figure or size; and the country itself, both as regards its constitution and mildness of the seasons, may be said to bear a close resemblance to the spring. Manly courage, endurance of suffering, laborious enterprise, and high spirit, could not be produced in such a state of things either among the native inhabitants or those of a different country, for there pleasure necessarily reigns. For this reason, also, the forms of wild beasts there are much varied. Thus it is, as I think, with the Egyptians and Libyans.

13. But concerning those on the right hand of the summer risings of the sun as far as the Palus Mæotis (for this is the boundary of Europe and Asia), it is with them as follows: the inhabitants there differ far more from one another than those I have treated of above, owing to the differences of the seasons and the nature of the soil. But with regard to the country itself, matters are the same there as among all other men; for where the seasons undergo the greatest and most rapid changes, there the country is the wildest and most unequal; and you will find the greatest variety of mountains, forests, plains, and meadows; but where the seasons do not change much there the country is the most even; and, if one will consider it, so is it also with regard to the inhabitants; for the nature of some is like to a country covered with trees and well watered; of some, to a thin soil deficient in water; of others, to fenny and marshy places; and of some again, to a plain of bare and parched land. For the seasons which modify their natural frame of body are varied, and the greater the varieties of them the greater also will be the differences of their shapes.

14. I will pass over the smaller differences among the nations, but will now treat of such as are great either from nature, or custom; and, first, concerning the Macrocephali. There is no other race of men which have heads in the least resembling theirs. At first, usage was the principal cause of the length of their head, but now nature cooperates with usage. They think those the most noble who have the longest heads. It is thus with regard to the usage: immediately after the child is born, and while its head is still tender, they fashion it with their hands, and constrain it to assume a lengthened shape by applying bandages and other suitable contrivances whereby the spherical form of the head is destroyed, and it is made to increase in length. Thus, at first, usage operated, so that this constitution was the result of force: but, in the course of time, it was formed naturally; so that usage had nothing to do with it; for the semen comes from all parts of the body, sound from the sound parts, and unhealthy from the unhealthy parts. If, then, children with bald heads are born to parents with bald heads; and children with blue eyes to parents who have blue eyes; and if the children of parents having distorted eyes squint also for the most part; and if the same may be said of other forms of the body, what is to prevent it from happening that a child with a long head should be produced by a parent having a long head? But now these things do not happen as they did formerly, for the custom no longer prevails owing to their intercourse with other men. Thus it appears to me to be with regard to them.

15. As to the inhabitants of Phasis, their country is fenny, warm, humid, and wooded; copious and severe rains occur there at all seasons; and the life of the inhabitants is spent among the fens; for their dwellings are constructed of wood and reeds, and are erected amidst the waters; they seldom practise walking either to the city or the market, but sail about, up and down, in canoes constructed out of single trees, for there are many canals there. They drink the hot and stagnant waters, both when rendered putrid by the sun, and when swollen with rains. The Phasis itself is the most stagnant of all rivers, and runs the smoothest; all the fruits which spring there are unwholesome, of feeble and imperfect growth, owing to the redundance of water, and on this account they do not ripen, for much vapor from the waters overspreads the country. For these reasons the Phasians have shapes different from those of all other men; for they are large in stature, and of a very gross habit of body, so that not a joint nor vein is visible; in color they are sallow, as if affected with jaundice. Of all men they have the roughest voices, from their breathing an atmosphere which is not clear, but misty and humid; they are naturally rather languid in supporting bodily fatigue. The seasons undergo but little change either as to heat or cold; their winds for the most part are southerly, with the exception of one peculiar to the country, which sometimes blows strong, is violent and hot, and is called by them the wind cenchron. The north wind scarcely reaches them, and when it does blow it is weak and gentle. Thus it is with regard to the different nature and shape of the inhabitants of Asia and Europe.

16. And with regard to the pusillanimity and cowardice of the inhabitants, the principal reason why the Asiatics are more unwarlike and of more gentle disposition than the Europeans is, the nature of the seasons, which do not undergo any great changes either to heat or cold, or the like; for there is neither excitement of the understanding nor any strong change of the body by which the temper might be ruffled, and they be roused to inconsiderate emotion and passion, rather than living as they do always in the same state. It is changes of all kinds which arouse the understanding of mankind, and do not allow them to get into a torpid condition. For these reasons, it appears to me, the Asiatic race is feeble, and further, owing to their laws; for monarchy prevails in the greater part of Asia, and where men are not their own masters nor independent, but are the slaves of others, it is not a matter of consideration with them how they may acquire military discipline, but how they may seem not to be warlike, for the dangers are not equally shared, since they must serve as soldiers, perhaps endure fatigue, and die for their masters, far from their children, their wives, and other friends; and whatever noble and manly actions they may perform lead only to the aggrandizement of their masters, whilst the fruits which they reap are dangers and death; and, in addition to all this, the lands of such persons must be laid waste by the enemy and want of culture. Thus, then, if any one be naturally warlike and courageous, his disposition will be changed by the institutions. As a strong proof of all this, such Greeks or barbarians in Asia as are not under a despotic form of government, but are independent, and enjoy the fruits of their own labors, are of all others the most warlike; for these encounter dangers on their own account, bear the prizes of their own valor, and in like manner endure the punishment of their own cowardice. And you will find the Asiatics differing from one another, for some are better and others more dastardly; of these differences, as I stated before, the changes of the seasons are the cause. Thus it is with Asia.

17. In Europe there is a Scythian race, called Sauromatæ, which inhabits the confines of the Palus Mæotis, and is different from all other races. Their women mount on horseback, use the bow, and throw the javelin from their horses, and fight with their enemies as long as they are virgins; and they do not lay aside their virginity until they kill three of their enemies, nor have any connection with men until they perform the sacrifices according to law. Whoever takes to herself a husband, gives up riding on horseback unless the necessity of a general expedition obliges her. They have no right breast; for while still of a tender age their mothers heat strongly a copper instrument constructed for this very purpose, and apply it to the right breast, which is burnt up, and its development being arrested, all the strength and fullness are determined to the right shoulder and arm.

18. As the other Scythians have a peculiarity of shape, and do not resemble any other, the same observation applies to the Egyptians, only that the latter are oppressed by heat and the former by cold. What is called the Scythian desert is a prairie, abounding in meadows, high-lying, and well watered; for the rivers which carry off the water from the plains are large. There live those Scythians which are called Nomades, because they have no houses, but live in wagons. The smallest of these wagons have four wheels, but some have six; they are covered in with felt, and they are constructed in the manner of houses, some having but a single apartment, and some three; they are proof against rain, snow, and winds. The wagons are drawn by yokes of oxen, some of two and others of three, and all without horns, for they have no horns, owing to the cold. In these wagons the women live, but the men are carried about on horses, and the sheep, oxen, and horses accompany them; and they remain on any spot as long as there is provender for their cattle, and when that fails they migrate to some other place. They eat boiled meat, and drink the milk of mares, and also eat hippace, which is cheese prepared from the milk of the mare. Such is their mode of life and their customs.

19. In respect of the seasons and figure of body, the Scythian race, like the Egyptian, have a uniformity of resemblance, different from all other nations; they are by no means prolific, and the wild beasts which are indigenous there are small in size and few in number, for the country lies under the Northern Bears, and the Rhiphæan mountains, whence the north wind blows; the sun comes very near to them only when in the summer solstice, and warms them but for a short period, and not strongly; and the winds blowing from the hot regions of the earth do not reach them, or but seldom, and with little force; but the winds from the north always blow, congealed, as they are, by the snow, the ice, and much water, for these never leave the mountains, which are thereby rendered uninhabitable. A thick fog covers the plains during the day, and amidst it they live, so that winter may be said to be always present with them; or, if they have summer, it is only for a few days, and the heat is not very strong. Their plains are high-lying and naked, not crowned with mountains, but extending upwards under the Northern Bears. The wild beasts there are not large, but such as can be sheltered under-ground; for the cold of winter and the barrenness of the country prevent their growth, and because they have no covert nor shelter. The changes of the seasons, too, are not great nor violent, for, in fact, they change gradually; and therefore their figures resemble one another, as they all equally use the same food, and the same clothing summer and winter, respiring a humid and dense atmosphere, and drinking water from snow and ice; neither do they make any laborious exertions, for neither body nor mind is capable of enduring fatigue when the changes of the seasons are not great. For these reasons their shapes are gross and fleshy, with ill-marked joints, of a humid temperament, and deficient in tone: the internal cavities, and especially those of the intestines, are full of humors; for the belly cannot possibly be dry in such a country, with such a constitution and in such a climate; but owing to their fat, and the absence of hairs from their bodies, their shapes resemble one another, the males being all alike, and so also with the women: for the seasons being of an uniform temperature, no corruption or deterioration takes place in the concretion of the semen, unless from some violent cause, or from disease.

20. I will give you a strong proof of the humidity (laxity?) of their constitutions. You will find the greater part of the Scythians, and all the Nomades, with marks of the cautery on their shoulders, arms, wrists, breasts, hip-joints, and loins, and that for no other reason but the humidity and flabbiness of their constitution, for they can neither strain with their bows, nor launch the javelin from their shoulder owing to their humidity and atony: but when they are burnt, much of the humidity in their joints is dried up, and they become better braced, better fed, and their joints get into a more suitable condition. They are flabby and squat at first, because, as in Egypt, they are not swathed(?); and then they pay no attention to horsemanship, so that they may be adepts at it; and because of their sedentary mode of life; for the males, when they cannot be carried about on horseback, sit the most of their time in the wagon, and rarely practise walking, because of their frequent migrations and shiftings of situation; and as to the women, it is amazing how flabby and sluggish they are. The Scythian race are tawny from the cold, and not from the intense heat of the sun, for the whiteness of the skin is parched by the cold, and becomes tawny.

21. It is impossible that persons of such a constitution could be prolific, for, with the man, the sexual desires are not strong, owing to the laxity of his constitution, the softness and coldness of his belly, from all which causes it is little likely that a man should be given to venery; and besides, from being jaded by exercise on horseback, the men become weak in their desires. On the part of the men these are the causes; but on that of the women, they are embonpoint and humidity; for the womb cannot take in the semen, nor is the menstrual discharge such as it should be, but scanty and at too long intervals; and the mouth of the womb is shut up by fat and does not admit the semen; and, moreover, they themselves are indolent and fat, and their bellies cold and soft. From these causes the Scythian race is not prolific. Their female servants furnish a strong proof of this; for they no sooner have connection with a man than they prove with child, owing to their active course of life and the slenderness of body.

22. And, in addition to these, there are many eunuchs among the Scythians, who perform female work, and speak like women. Such persons are called effeminates. The inhabitants of the country attribute the cause of their impotence to a god, and venerate and worship such persons, every one dreading that the like might befall himself; but to me it appears that such affections are just as much divine as all others are, and that no one disease is either more divine or more human than another, but that all are alike divine, for that each has its own nature, and that no one arises without a natural cause. But I will explain how I think that the affection takes its rise. From continued exercise on horseback they are seized with chronic defluxions in their joints (kedmata) owing to their legs always hanging down below their horses; they afterwards become lame and stiff at the hip-joint, such of them, at least, as are severely attacked with it. They treat themselves in this way: when the disease is commencing, they open the vein behind either ear, and when the blood flows, sleep, from feebleness, seizes them, and afterwards they awaken, some in good health and others not. To me it appears that the semen is altered by this treatment, for there are veins behind the ears which, if cut, induce impotence; now, these veins would appear to me to be cut. Such persons afterwards, when they go in to women and cannot have connection with them, at first do not think much about it, but remain quiet; but when, after making the attempt two, three, or more times, they succeed no better, fancying they have committed some offence against the god whom they blame for the affection, they put on female attire, reproach themselves for effeminacy, play the part of women, and perform the same work as women do. This the rich among the Scythians endure, not the basest, but the most noble and powerful, owing to their riding on horseback; for the poor are less affected, as they do not ride on horses. And yet, if this disease had been more divine than the others, it ought not to have befallen the most noble and the richest of the Scythians alone, but all alike, or rather those who have little, as not being able to pay honors to the gods, if, indeed, they delight in being thus rewarded by men, and grant favors in return; for it is likely that the rich sacrifice more to the gods, and dedicate more votive offerings, inasmuch as they have wealth, and worship the gods; whereas the poor, from want, do less in this way, and, moreover, upbraid the gods for not giving them wealth, so that those who have few possessions were more likely to bear the punishments of these offences than the rich. But, as I formerly said, these affections are divine just as much as others, for each springs from a natural cause, and this disease arises among the Scythians from such a cause as I have stated. But it attacks other men in like manner, for whenever men ride much and very frequently on horseback, then many are affected with rheums in the joints, sciatica, and gout, and they are inept at venery. But these complaints befall the Scythian, and they are the most impotent of men for the aforesaid causes, and because they always wear breeches, and spend the most of their time on horseback, so as not to touch their privy parts with the hand, and from the cold and fatigue they forget the sexual desire, and do not make the attempt until after they have lost their virility. Thus it is with the race of the Scythians.

23. The other races in Europe differ from one another, both as to stature and shape, owing to the changes of the seasons, which are very great and frequent, and because the heat is strong, the winters severe, and there are frequent rains, and again protracted droughts, and winds, from which many and diversified changes are induced. These changes are likely to have an effect upon generation in the coagulation of the semen, as this process cannot be the same in summer as in winter, nor in rainy as in dry weather; wherefore, I think, that the figures of Europeans differ more than those of Asiatics; and they differ very much from one another as to stature in the same city; for vitiations of the semen occur in its coagulation more frequently during frequent changes of the seasons, than where they are alike and equable. And the same may be said of their dispositions, for the wild, and unsociable, and the passionate occur in such a constitution; for frequent excitement of the mind induces wildness, and extinguishes sociableness and mildness of disposition, and therefore I think the inhabitants of Europe more courageous than those of Asia; for a climate which is always the same induces indolence, but a changeable climate, laborious exertions both of body and mind; and from rest and indolence cowardice is engendered, and from laborious exertions and pains, courage. On this account the inhabitants of Europe are more warlike than the Asiatics, and also owing to their institutions, because they are not governed by kings like the latter, for where men are governed by kings there they must be very cowardly, as I have stated before; for their souls are enslaved, and they will not willingly, or readily undergo dangers in order to promote the power of another; but those that are free undertake dangers on their own account, and not for the sake of others; they court hazard and go out to meet it, for they themselves bear off the rewards of victory, and thus their institutions contribute not a little to their courage.

Such is the general character of Europe and Asia.

24. And there are in Europe other tribes, differing from one another in stature, shape, and courage: the differences are those I formerly mentioned, and will now explain more clearly. Such as inhabit a country which is mountainous, rugged, elevated, and well watered, and where the changes of the seasons are very great, are likely to have great variety of shapes among them, and to be naturally of an enterprising and warlike disposition; and such persons are apt to have no little of the savage and ferocious in their nature; but such as dwell in places which are low-lying, abounding in meadows and ill ventilated, and who have a larger proportion of hot than of cold winds, and who make use of warm waters--these are not likely to be of large stature nor well proportioned, but are of a broad make, fleshy, and have black hair; and they are rather of a dark than of a light complexion, and are less likely to be phlegmatic than bilious; courage and laborious enterprise are not naturally in them, but may be engendered in them by means of their institutions. And if there be rivers in the country which carry off the stagnant and rain water from it, these may be wholesome and clear; but if there be no rivers, but the inhabitants drink the waters of fountains, and such as are stagnant and marshy, they must necessarily have prominent bellies and enlarged spleens. But such as inhabit a high country, and one that is level, windy, and well-watered, will be large of stature, and like to one another; but their minds will be rather unmanly and gentle. Those who live on thin, ill-watered, and bare soils, and not well attempered in the changes of the seasons, in such a country they are likely to be in their persons rather hard and well braced, rather of a blond than a dark complexion, and in disposition and passions haughty and self-willed. For, where the changes of the seasons are most frequent, and where they differ most from one another, there you will find their forms, dispositions, and nature the most varied. These are the strongest of the natural causes of difference, and next the country in which one lives, and the waters; for, in general, you will find the forms and dispositions of mankind to correspond with the nature of the country; for where the land is fertile, soft, and well-watered, and supplied with waters from very elevated situations, so as to be hot in summer and cold in winter, and where the seasons are fine, there the men are fleshy, have ill-formed joints, and are of a humid temperament; they are not disposed to endure labor, and, for the most part, are base in spirit; indolence and sluggishness are visible in them, and to the arts they are dull, and not clever nor acute. When the country is bare, not fenced, and rugged, blasted by the winter and scorched by the sun, there you may see the men hardy, slender, with well-shaped joints, well-braced, and shaggy; sharp industry and vigilance accompany such a constitution; in morals and passions they are haughty and opinionative, inclining rather to the fierce than to the mild; and you will find them acute and ingenious as regards the arts, and excelling in military affairs; and likewise all the other productions of the earth corresponding to the earth itself. Thus it is with regard to the most opposite natures and shapes; drawing conclusions from them, you may judge of the rest without any risk of error.

ON THE PROGNOSTICS.

THE ARGUMENT.

Of the genuineness of this work I have treated in the Preliminary Discourse, and have also briefly touched upon its relation to two other important treatises in the Hippocratic collection, the “Prorrhetics” and the “Coacæ Prænotiones.” The latter subject I am now to resume, and in doing so I mean to avail myself of the talented dissertation of Dr. Ermerins, to which also I have already made allusion. Indeed I am persuaded that I cannot do a more acceptable service to my profession in Britain than by laying before them a brief exposition of the important views brought forward in this “Dissertatio Inauguralis.”

After some preliminary observations on the ancient Temples of Health, which are mainly derived from Sprengel’s “History of Medicine” he passes on to consider the opinion stated by this author and others before his time, that the first book of the “Prorrhetics” and the “Coacæ Prænotiones” are the results of isolated observations made upon the sick in the Asclepion of Cos. The probability of this opinion being well founded he shows to be very great; and he next endeavors to solve the question whether the first book of the “Prorrhetics” be derived from the “Coacæ Prænotiones,” or whether the latter be the more modern work of the two. He comes to the conclusion that the “Prorrhetics” is the more ancient work, for the following reasons: 1st. Because in it the names of the patients are frequently given, which is rarely the case in the “Coacæ Prænotiones.” 2d. Because queries and doubts are oftener found in this book than in the other, when one takes into account the number of presages. 3d. Because the number of observations which this book contains is much smaller than those which the “Coacæ” embrace. 4th. This is confirmed by the circumstance that the enunciations of the prognoses are far less extended in the “Prorrhetics,” whence it is clearly proved that they are not derived from so great a field of observations as those we meet with in the other work. He then gives a most lucid view of the parallelism which subsists between the “Prorrhetica” and the “Coacæ,” and, as the results of his observations upon them, he draws the following most important conclusions:

1. “By a most fortunate occurrence certain monuments of the medical art, as cultivated by the Asclepiadæ, are preserved to us in the first “Prorrhetics” and the “Prænotiones Coacæ” which books appear to be fragments and excerpts from the histories of diseases and cures which were formerly found on the votive tablets of the Coan temple.

2. This sacerdotal medicine was at first a certain medical divination, which, as it was the offspring of pure observation, so the system of prognostics of the Coans was altogether aloof from the theories and systems of the philosophers, and is therefore to be reckoned most worthy of our attention, both from the great love of observation which we admire in it, and from the exquisite and beautiful sense of the simple truth which it evinces.

3. We must keep in view the origin of these presages from individual observations gradually collected, in order that we may have a knowledge of this system of prognostic semeiology. Hence we comprehend how we meet with so many doubtful propositions, and so many uncertain and vague remarks, and that imperfect etiology which confounded causes with their effects, and again, the latter with the former.

4. The readers must particularly keep before their eyes this origin, and the antiquity of those writings, if they would pass a correct judgment on the merits of the Asclepiadæ towards the art of medicine. Whatever in their works we have the pleasure of possessing, all attest the infancy of the art; many things are imperfect, and not unfrequently do we see them, while in the pursuit of truth, groping, as it were, and proceeding with uncertain steps, like men wandering about in darkness; but yet the method which they applied, and to which they would seem to have betaken themselves of their own accord, was so excellent, that nothing could surpass it. It was the same method which Hippocrates himself always adopted, and which, in fine, Lord Bacon, many ages afterwards, commended as the only instrument by which truth in medicine can be found out.

5. As this method is founded on true induction, so are its dicta to be held the more worthy of admiration, the more they possess a universal signification. To give an example; what assiduous observation, and what abundance of rational experience, must have been required for enunciating the following admirable truth, and, as it were, law of nature: “Those things which bring alleviation with bad signs, and do not remit with good, are troublesome and difficult.”

6. Many passages bear reference to the condition of the vital powers, which they took into account at all times, both in making presages and in exercising the art. For, although they had not our theories of the vital force, they perceived its effects very well by observation; and for this very reason, that they did not search for the art in theories, but in observation alone, we owe so many excellent things to them, since they did not adapt their observation to theories, but related a trustworthy and faithful history of the operations of nature.

7. They sought after many things from a comparison of health with disease, in which also they rightly calculated the manners and customs of men. Thus they call that, in the first place, the best mode of reclining, which is adopted by the patient when in good health, and hence they estimate the other modes as being less good, or altogether unfavorable. Nor did they only compare health with disease, but they compared also the symptoms of diseases with one another, and interpreted the one from the other. Thus they first depict and pronounce a favorable opinion on the best kind of excretions, and then they described the other abnormal kinds, and pass an unfavorable judgment on them.

8. They particularly relate the operations of a natura medicatrix, which, in a region such as Greece is, and in athletic, strong bodies, on which they appear to have practised the art, and for the most part in acute diseases, and the few chronic ones derived from them which they have left described, might especially be looked for. Hence that doctrine of crises most deserving of attention, the rudiments, indeed, of which we only have here preserved, but a just notion of which we may easily draw from these fragments.

9. The Asclepiadæ would appear to have accommodated and directed their art to this natural Therapia. Hence the advice that convulsions arising from a great hemorrhage, forcibly stopped, should be cured by the abstraction of blood. It is to be regretted that but a few monuments of their practice remain; but these embrace admirable imitations of nature, and the most prudent caution in administering remedies.

10. Neither did they neglect surgery, but deliver many excellent remarks on things pertaining to wounds, ulcers, and fractures.

11. Although it cannot be made out for certain that everything which is preserved in these writings existed before Hippocrates, there can be no doubt that many of them are more ancient than he. And although we may attribute some things rather to Hippocrates himself, it is nevertheless certain that the method of deducing the art from observation and comparison had existed before him. Some may, perhaps, object that these books are to be attributed to the youth of Hippocrates, and that the others, more elaborate and perfect, had proceeded from the same person in his old age; but this supposition we may refute by a single argument, namely, that it would be absurd to ascribe so many observations about so many diseases to one man.

12. From the whole Coan system of cultivating medicine, the best hopes might justly have been expected; and from what follows it will be seen that the result did not disappoint this expectation.”

These deductions, I must say, appear to be most legitimately drawn; and having thus satisfactorily made out that the “Coacæ Prænotiones” are founded on the “Prorrhetics,” Dr. Ermerins proceeds to make an interesting comparison between the former and the book of “Prognostics.” Here again we can only find room for the general conclusions.

1. “We have compared together two monuments of antiquity embracing entirely the same doctrine, so that we may hold it as put out of all doubt that they must have derived their origin from the same school, only the one yields to the other in antiquity, as its more expanded mode of expression shows.

2. The more recent work is attributed to Hippocrates by all the critics and interpreters; the most ancient authors have made mention of it, and all the characteristic marks by which the genuine works of Hippocrates are distinguished from the spurious, without doubt, are found in it; for whether you look to the brevity and gravity of the language, or the paucity of the reasonings, the correctness of the observations, or the dialect in which they are expressed, or, in fine, its agreement with the whole Hippocratic doctrine,--all these attest that “the divine old man” is the author of this work.

3. From a comparison of the “Coacæ Prænotiones” with the “Prognostics,” it is as clear as the light of day that Hippocrates composed this work from them, in such a manner that he circumscribed many of the symptoms, limited the enunciations, and amplified them all by his own experience in the medical Art. Hence the Prognostics may not inaptly be called the Commentary of Hippocrates on the “Coacæ Prænotiones.”

4. With regard to the exquisite and artificial order, in which we see many things proposed in his book, we agree entirely with Sprengel, who thinks that they have proceeded from a more recent describer. This is confirmed by our comparison of both works.

5. This work exhibits the fundamental principles and originals of the Hippocratic doctrine, and although we hardly know anything as to the manlier in which Hippocrates composed his writings, and of the form which he gave them, it does not seem at all out of the way to hold this book to be the oldest of all the works which “the Father of Medicine” has left to us.

6. Inasmuch as this work is entitled the Book of Prognostics, so it turns on the prescience πρόνοια, that is to say, the foreknowledge of the physician, which Hippocrates recommends to physicians for three reasons: first, for the confidence of mankind, which it will conciliate to the physician; then because it will free the practitioner from all blame, if he has announced beforehand the fatal result of diseases; and further, as being a very great instrument in effecting the cure.

7. Like the Coan priests, Hippocrates drew his Prognostics from a comparison of disease with health. This he held to be of so great importance, that he first delivers physiological semeiotics, and then adds pathological.

8. In calculating and judging of signs he neglected neither age nor sex, and, in the first place, directed his mind to the power of habit on the human body.

9. Nor did Hippocrates stop here, but directed care to be had of the attack of epidemics, and the condition of the season.

10. The Prognostics of Hippocrates are not of one time or place, but extend through every age, and through the whole world; inasmuch as the prognostic signs have been proved to be true in Libya, in Delos, and in Scythia, and it should be well known that every year, and at every season of the year, bad symptoms bode ill, and good symptoms good.

11. But he who would wish to know properly beforehand those who will recover from a disease, and those who will die, and those in whom the disease will persevere for many days, and those in whom it will last for a few, should be able to comprehend and estimate the doctrine of all the signs, and weigh in his mind and compare together their strength. The Hippocratic foreknowledge rests not only on the observation of the signs, but also on the understanding of them.

12. The Book of Prognostics exhibits observations of acute diseases, and of chronic arising from them, in which Hippocrates has diligently noted the times and modes of the crises.

13. Such is the authority of critical days and signs, that in those fevers which cease without the symptoms of resolution, and not upon critical days, a relapse is to be expected.

14. The series of critical days which Hippocrates delivers, proceeds solely upon the observation of nature. Yet neither can any of them be exactly numbered by entire days, since neither the year nor the months are usually numbered by entire days.”

Dr. Ermerins, in the remaining part of his Essay, shows, in a very lucid manner, that the rules of Prognosis laid down in this treatise by Hippocrates, are manifestly those by which he is regulated in his other works, and more especially in the Epidemics and Aphorisms. We must not, however, occupy room with any further exposition of the contents of this important treatise, which does equal credit to the author himself, and to the medical system of education pursued in the learned university from which it emanated.

* * * * *

I will now give some remarks and reflections of my own on the treatise under consideration.

In this work, then, Hippocrates appears to have had for his object, to give such a general description of the phenomena of disease as would apply to all the disorders of the animal frame. With this intention he brings into review the state of the countenance, the position of the patient in bed, the movements of the hands, the respiration, the sweats, the state of the hypochondria, dropsies which are the consequences of acute diseases, the sleep, the urine, the alvine dejections, the vomitings, and the sputa. In doing this, his uniform practice is to contrast the healthy with the morbid appearances. Although M. Littré regards it as a treatise on special Pathology, it appears to me to be decidedly a general work on Semeiology. Certain it is that all the best commentators, such as Erotian and Stephanus, decidedly regard it as a semeiological work. The class of ancient writings with which it admits of being most closely compared, are the works on the prognostics of the weather. On this subject Greek literature contains several works of a very philosophical nature, such as the Phænomena of Aratus, and several of the minor tracts of Theophrastus. Now as the object of these authors was to connect the most striking phenomena in the sky, the earth, and the sea, with the changes in the weather, of which they are the precursors, so the intention of the medical writer of Prognostics was to point out the alterations in the animal frame, which certain preternatural symptoms usually indicate. And as the utility of an acquaintance with prognostics of the weather to the husbandman and sailor is sufficiently obvious, the benefit to be derived from a knowledge of medical prognostics by the physician is equally so. Our author, it will be seen in the Preface to this work, enumerates three objects to be attained by cultivating an acquaintance with prognostics; first, to attract the confidence of one’s patients; second, to free the physician from blame by enabling him to announce beforehand the issue of the disorder about which he is consulted; and, third, to give him a decided advantage in conducting the treatment by preparing him for remarkable changes in the diseases before they occur. And, in like manner, I may be allowed to remark, the master of a ship who shows himself prepared for all changes of the weather, will naturally attract the confidence of those intrusted to his charge; and whatever may be the result, he will be freed from blame if his ship should be damaged in a storm which he had previously predicted; and surely his knowledge of impending commotions in the sea and sky, will be of advantage to him by enabling him to make preparations for them.

Looking then to the importance of general Prognostics, I have often wondered why this branch of Semeiology is no longer cultivated by the profession. Did not the ancient physicians follow the best possible plan when they first described the general phenomena of diseased action, and then applied them to particular cases? Surely they did right in first taking a comprehensive view of the whole subject of disease before attempting to examine the different parts of it in detail. This, in fact, constitutes the great superiority of the ancient savans over the modern, that the former possessed a much greater talent for apprehending general truths than the latter, who confine their attention to particular facts, and too much neglect the observation of general appearances. I trust no one will be offended if I venture to pronounce regarding the present condition of our professional literature, that (to borrow an illustration from the Logic of Kant) it is altogether Cyclopic,--that is to say, it wants the eye of Philosophy, for, although we have learned to examine particular objects with greater accuracy than our forefathers did, the sphere of our mental vision, so to speak, is more confined than theirs, and cannot embrace the same enlarged views of general subjects. Surely then we might gain a useful lesson by endeavoring to combine their more comprehensive views with our own more accurate and minute observation.

Some people may be inclined to think that we have greatly detracted from the credit which Hippocrates has long enjoyed as being the undoubted author of this work, by showing that in composing it he was so much indebted to the labors of his predecessors. But I have long been impressed with the conviction that in compositions even of the highest order, there is much less originality than is generally supposed, and that true genius frequently is displayed more in its own felicitous way of dealing with materials formerly prepared and collected for its use than in searching out new matter to work upon, and hence it will be found upon examination that many of the most distinguished efforts of human intellect have consisted in the successful performance of tasks which had been frequently attempted by previous laborers in the same line. Many artists, before the time of Phidias, had acquired reputation by their attempts at making the statue of Jupiter; but this did not deter him from undertaking the same task: and we may well believe that he would avail himself of every practical lesson which he could draw from the success or failure of his predecessors, in perfecting that matchless performance which completely cast all others into the background. The sad misfortunes of Œdipus had been often represented on the Athenian stage before Sophocles made them the subject of those inimitable dramas, which still enjoy an unrivalled reputation, nor will it be often considered how much assistance he may have derived from the labors of those who had gone before him. It is well known that of all the literary performances of Aristotle, there is no one which gained him so enduring a reputation as his Categories, and yet it is admitted that his division of the subject into the ten Predicaments, was taken from the Pythagorean philosopher Archytas; in short, the great merit of Aristotle on this as on many other occasions, consisted in defining and arranging a subject on which much had been previously effected by the labors of his predecessors. And, to give one example more, long before the time of Galen, the temperaments, and the facts in physiology and pathology bearing upon Hygiene, had been frequently and successfully investigated, but he, by recasting all these subject-matters into his Ars Medica, composed a work which posterity regarded as his master-performance, and every word and tittle of which, for a succession ages, were commented upon and admired in the Schools of Medicine. And of all our Author’s admired performances, there is perhaps no one which has exerted so great an influence upon the literature of the profession as the present work, for all the Greek, Roman, and Arabian writers on medicine, subsequent to him, make use of his terms, and copy his descriptions of morbid phenomena.

THE BOOK OF PROGNOSTICS.

1. It appears to me a most excellent thing for the physician to cultivate Prognosis; for by foreseeing and foretelling, in the presence of the sick, the present, the past, and the future, and explaining the omissions which patients have been guilty of, he will be the more readily believed to be acquainted with the circumstances of the sick; so that men will have confidence to intrust themselves to such a physician. And he will manage the cure best who has foreseen what is to happen from the present state of matters. For it is impossible to make all the sick well; this, indeed, would have been better than to be able to foretell what is going to happen; but since men die, some even before calling the physician, from the violence of the disease, and some die immediately after calling him, having lived, perhaps, only one day or a little longer, and before the physician could bring his art to counteract the disease; it therefore becomes necessary to know the nature of such affections, how far they are above the powers of the constitution; and, moreover, if there be anything divine in the diseases, and to learn a foreknowledge of this also. Thus a man will be the more esteemed to be a good physician, for he will be the better able to treat those aright who can be saved, from having long anticipated everything; and by seeing and announcing beforehand those who will live and those who will die, he will thus escape censure.

2. He should observe thus in acute diseases: first, the countenance of the patient, if it be like those of persons in health, and more so, if like itself, for this is the best of all; whereas the most opposite to it is the worst, such as the following; a sharp nose, hollow eyes, collapsed temples; the ears cold, contracted, and their lobes turned out: the skin about the forehead being rough, distended, and parched; the color of the whole face being green, black, livid, or lead-colored. If the countenance be such at the commencement of the disease, and if this cannot be accounted for from the other symptoms, inquiry must be made whether the patient has long wanted sleep; whether his bowels have been very loose; and whether he has suffered from want of food; and if any of these causes be confessed to, the danger is to be reckoned so far less; and it becomes obvious, in the course of a day and a night, whether or not the appearance of the countenance proceeded from these causes. But if none of these be said to exist, and if the symptoms do not subside in the aforesaid time, it is to be known for certain that death is at hand. And, also, if the disease be in a more advanced stage either on the third or fourth day, and the countenance be such, the same inquiries as formerly directed are to be made, and the other symptoms are to be noted, those in the whole countenance, those on the body, and those in the eyes; for if they shun the light, or weep involuntarily, or squint, or if the one be less than the other, or if the white of them be red, livid, or has black veins in it; if there be a gum upon the eyes, if they are restless, protruding, or are become very hollow; and if the countenance be squalid and dark, or the color of the whole face be changed--all these are to be reckoned bad and fatal symptoms. The physician should also observe the appearance of the eyes from below the eyelids in sleep; for when a portion of the white appears, owing to the eyelids not being closed together, and when this is not connected with diarrhœa or purgation from medicine, or when the patient does not sleep thus from habit, it is to be reckoned an unfavorable and very deadly symptom; but if the eyelid be contracted, livid, or pale, or also the lip, or nose, along with some of the other symptoms, one may know for certain that death is close at hand. It is a mortal symptom, also, when the lips are relaxed, pendent, cold, and blanched.

3. It is well when the patient is found by his physician reclining upon either his right or his left side, having his hands, neck, and legs slightly bent, and the whole body lying in a relaxed state, for thus the most of persons in health recline, and these are the best of postures which most resemble those of healthy persons. But to lie upon one’s back, with the hands, neck, and the legs extended, is far less favorable. And if the patient incline forward, and sink down to the foot of the bed, it is a still more dangerous symptom; but if he be found with his feet naked and not sufficiently warm, and the hands, neck, and legs tossed about in a disorderly manner and naked, it is bad, for it indicates aberration of intellect. It is a deadly symptom, also, when the patient sleeps constantly with his mouth open, having his legs strongly bent and plaited together, while he lies upon his back; and to lie upon one’s belly, when not habitual to the patient to sleep thus while in good health, indicates delirium, or pain in the abdominal regions. And for the patient to wish to sit erect at the acme of a disease is a bad symptom in all acute diseases, but particularly so in pneumonia. To grind the teeth in fevers, when such has not been the custom of the patient from childhood, indicates madness and death, both which dangers are to be announced beforehand as likely to happen; and if a person in delirium do this it is a very deadly symptom. And if the patient had an ulcer previously, or if one has occurred in the course of the disease, it is to be observed; for if the man be about to die the sore will become livid and dry, or yellow and dry before death.

4. Respecting the movement of the hands I have these observations to make: When in acute fevers, pneumonia, phrenitis, or headache, the hands are waved before the face, hunting through empty space, as if gathering bits of straw, picking the nap from the coverlet, or tearing chaff from the wall--all such symptoms are bad and deadly.

5. Respiration, when frequent, indicates pain or inflammation in the parts above the diaphragm: a large respiration performed at a great interval announces delirium; but a cold respiration at nose or mouth is a very fatal symptom. Free respiration is to be looked upon as contributing much to the safety of the patient in all acute diseases, such as fevers, and those complaints which come to a crisis in forty days.

6. Those sweats are the best in all acute diseases which occur on the critical days, and completely carry off the fever. Those are favorable, too, which taking place over the whole body, show that the man is bearing the disease better. But those that do not produce this effect are not beneficial. The worst are cold sweats, confined to the head, face, and neck; these in an acute fever prognosticate death, or in a milder one, a prolongation of the disease; and sweats which occur over the whole body, with the characters of those confined to the neck, are in like manner bad. Sweats attended with a miliary eruption, and taking place about the neck, are bad; sweats in the form of drops and of vapour are good. One ought to know the entire character of sweats, for some are connected with prostration of strength in the body, and some with intensity of the inflammation.

7. That state of the hypochondrium is best when it is free from pain, soft, and of equal size on the right side and the left. But if inflamed, or painful, or distended; or when the right and left sides are of disproportionate sizes;--all these appearances are to be dreaded. And if there be also pulsation in the hypochondrium, it indicates perturbation or delirium; and the physician should examine the eyes of such persons; for if their pupils be in rapid motion, such persons may be expected to go mad. A swelling in the hypochondrium, that is hard and painful, is very bad, provided it occupy the whole hypochondrium; but if it be on either side, it is less dangerous when on the left. Such swellings at the commencement of the disease prognosticate speedy death; but if the fever has passed twenty days, and the swelling has not subsided, it turns to a suppuration. A discharge of blood from the nose occurs to such in the first period, and proves very useful; but inquiry should be made if they have headache or indistinct vision; for if there be such, the disease will be determined thither. The discharge of blood is rather to be expected in those who are younger than thirty-five years. Such swellings as are soft, free from pain, and yield to the finger, occasion more protracted crises, and are less dangerous than the others. But if the fever continue beyond sixty days, without any subsidence of the swelling, it indicates that empyema is about to take place; and a swelling in any other part of the cavity will terminate in like manner. Such, then, as are painful, hard, and large, indicate danger of speedy death; but such as are soft, free of pain, and yield when pressed with the finger, are more chronic than these. Swellings in the belly less frequently form abscesses than those in the hypochondrium; and seldomest of all, those below the navel are converted into suppuration; but you may rather expect a hemorrhage from the upper parts. But the suppuration of all protracted swellings about these parts is to be anticipated. The collections of matter there are to be thus judged of: such as are determined outwards are the best when they are small, when they protrude very much, and swell to a point; such as are large and broad, and which do not swell out to a sharp point, are the worst. Of such as break internally, the best are those which have no external communication, but are covered and indolent; and when the whole place is free from discoloration. That pus is best which is white, homogeneous, smooth, and not at all fetid; the contrary to this is the worst.

8. All dropsies arising from acute diseases are bad; for they do not remove the fever, and are very painful and fatal. The most of them commence from the flanks and loins, but some from the liver; in those which derive their origin from the flanks and loins the feet swell, protracted diarrhœas supervene, which neither remove the pains in the flanks and loins, nor soften the belly; but in dropsies which are connected with the liver there is a tickling cough, with scarcely any perceptible expectoration, and the feet swell; there are no evacuations from the bowels, unless such as are hard and forced; and there are swellings about the belly, sometimes on the one side and sometimes on the other, and these increase and diminish by turns.

9. It is a bad symptom when the head, hands, and feet are cold, while the belly and sides are hot; but it is a very good symptom when the whole body is equally hot. The patient ought to be able to turn round easily, and to be agile when raised up; but if he appear heavy in the rest of his body as well as in his hands and feet, it is more dangerous; and if, in addition to the weight, his nails and fingers become livid, immediate death may be anticipated; and if the hands and feet be black it is less dangerous than if they be livid, but the other symptoms must be attended to; for if he appear to bear the illness well, and if certain of the salutary symptoms appear along with these there may be hope that the disease will turn to a deposition, so that the man may recover; but the blackened parts of the body will drop off. When the testicles and members are retracted upwards, they indicate strong pains and danger of death.

10. With regard to sleep--as is usual with us in health, the patient should wake during the day and sleep during the night. If this rule be anywise altered it is so far worse: but there will be little harm provided he sleep in the morning for the third part of the day; such sleep as takes place after this time is more unfavorable; but the worst of all is to get no sleep either night or day; for it follows from this symptom that the insomnolency is connected with sorrow and pains, or that he is about to become delirious.

11. The excrement is best which is soft and consistent, is passed at the hour which was customary to the patient when in health, in quantity proportionate to the ingesta; for when the passages are such, the lower belly is in a healthy state. But if the discharges be fluid, it is favorable that they are not accompanied with a noise, nor are frequent, nor in great quantity; for the man being oppressed by frequently getting up, must be deprived of sleep; and if the evacuations be both frequent and large, there is danger of his falling into deliquium animi. But in proportion to the ingesta he should have evacuations twice or thrice in the day, once at night and more copiously in the morning, as is customary with a person in health. The fæces should become thicker when the disease is tending to a crisis; they ought to be yellowish and not very fetid. It is favorable that round worms be passed with the discharges when the disease is tending to a crisis. The belly, too, through the whole disease, should be soft and moderately distended; but excrements that are very watery, or white, or green, or very red, or frothy, are all bad. It is also bad when the discharge is small, and viscid, and white, and greenish, and smooth; but still more deadly appearances are the black, or fatty, or livid, or verdigris-green, or fetid. Such as are of varied characters indicate greater duration of the complaint, but are no less dangerous; such as those which resemble scrapings, those which are bilious, those resembling leeks, and the black; these being sometimes passed together, and sometimes singly. It is best when wind passes without noise, but it is better that flatulence should pass even thus than that it should be retained; and when it does pass thus, it indicates either that the man is in pain or in delirium, unless he gives vent to the wind spontaneously. Pains in the hypochondria, and swellings, if recent, and not accompanied with inflammation, are relieved by borborygmi supervening in the hypochondrium, more especially if it pass off with fæces, urine, and wind; but even although not, it will do good by passing along, and it also does good by descending to the lower part of the belly.

12. The urine is best when the sediment is white, smooth, and consistent during the whole time, until the disease come to a crisis, for it indicates freedom from danger, and an illness of short duration; but if deficient, and if it be sometimes passed clear, and sometimes with a white and smooth sediment, the disease will be more protracted, and not so void of danger. But if the urine be reddish, and the sediment consistent and smooth, the affection, in this case, will be more protracted than the former, but still not fatal. But farinaceous sediments in the urine are bad, and still worse are the leafy; the white and thin are very bad, but the furfuraceous are still worse than these. Clouds carried about in the urine are good when white, but bad if black. When the urine is yellow and thin, it indicates that the disease is unconcocted; and if it (the disease) should be protracted, there may be danger lest the patient should not hold out until the urine be concocted. But the most deadly of all kinds of urine are the fetid, watery, black, and thick; in adult men and women the black is of all kinds of urine the worst, but in children, the watery. In those who pass thin and crude urine for a length of time, if they have otherwise symptoms of convalescence, an abscess may be expected to form in the parts below the diaphragm. And fatty substances floating on the surface are to be dreaded, for they are indications of melting. And one should consider respecting the kinds of urine, which have clouds, whether they tend upwards or downwards, and the colors which they have and such as fall downwards, with the colors as described, are to be reckoned good and commended; but such as are carried upwards, with the colors as described, are to be held as bad, and are to be distrusted. But you must not allow yourself to be deceived if such urine be passed while the bladder is diseased; for then it is a symptom of the state, not of the general system, but of a particular viscus.

13. That vomiting is of most service which consists of phlegm and bile mixed together, and neither very thick nor in great quantity; but those vomitings which are more unmixed are worse. But if that which is vomited be of the color of leeks or livid, or black, whatever of these colors it be, it is to be reckoned bad; but if the same man vomit all these colors, it is to be reckoned a very fatal symptom. But of all the vomitings, the livid indicates the most imminent danger of death, provided it be of a fetid smell. But all the smells which are somewhat putrid and fetid, are bad in all vomitings.

14. The expectoration in all pains about the lungs and sides, should be quickly and easily brought up, and a certain degree of yellowness should appear strongly mixed up with the sputum. But if brought up long after the commencement of the pain, and of a yellow or ruddy color, or if it occasions much cough, or be not strongly mixed, it is worse; for that which is intensely yellow is dangerous, but the white, and viscid, and round, do no good. But that which is very green and frothy is bad; but if so intense as to appear black, it is still more dangerous than these; it is bad if nothing is expectorated, and the lungs discharge nothing, but are gorged with matters which boil (as it were) in the air-passages. It is bad when coryza and sneezing either precede or follow affections of the lungs, but in all other affections, even the most deadly, sneezing is a salutary symptom. A yellow spittle mixed up with not much blood in cases of pneumonia, is salutary and very beneficial if spit up at the commencement of the disease, but if on the seventh day, or still later, it is less favorable. And all sputa are bad which do not remove the pain. But the worst is the black, as has been described. Of all others the sputa which remove the pain are the best.

15. When the pains in these regions do not cease, either with the discharge of the sputa, nor with alvine evacuations, nor from venesection, purging with medicine, nor a suitable regimen, it is to be held that they will terminate in suppurations. Of empyemata such as are spit up while the sputum is still bilious, are very fatal, whether the bilious portion be expectorated separate, or along with the other; but more especially if the empyema begin to advance after this sputum on the seventh day of the disease. It is to be expected that a person with such an expectoration shall die on the fourteenth day, unless something favorable supervene. The following are favorable symptoms: to support the disease easily, to have free respiration, to be free from pain, to have the sputa readily brought up, the whole body to appear equally warm and soft, to have no thirst, the urine, and fæces, sleep, and sweats to be all favorable, as described before; when all these symptoms concur, the patient certainly will not die; but if some of these be present and some not, he will not survive longer than the fourteenth day. The bad symptoms are the opposite of these, namely, to bear the disease with difficulty, respiration large and dense, the pain not ceasing, the sputum scarcely coughed up, strong thirst, to have the body unequally affected by the febrile heat, the belly and sides intensely hot, the forehead, hands, and feet cold; the urine, and excrements, the sleep, and sweats, all bad, agreeably to the characters described above; if such a combination of symptoms accompany and either on the ninth or eleventh. Thus then one may conclude regarding this expectoration, that it is very deadly, and that the patient will not survive until the fourteenth day. It is by balancing the concomitant symptoms whether good or bad, that one is to form a prognosis; for thus it will most probably prove to be a true one. Most other suppurations burst, some on the twentieth, some on the thirtieth, some on the fortieth, and some as late as the sixtieth day.

16. One should estimate when the commencement of the suppuration will take place, by calculating from the day on which the patient was first seized with fever, or if he had a rigor, and if he says, that there is a weight in the place where he had pain formerly, for these symptoms occur in the commencement of suppurations. One then may expect the rupture of the abscesses to take place from these times according to the periods formerly stated. But if the empyema be only on either side, one should turn him and inquire if he has pain on the other side; and if the one side be hotter than the other, and when laid upon the sound side, one should inquire if he has the feeling of a weight hanging from above, for if so, the empyema will be upon the opposite side to that on which the weight was felt.

17. Empyema may be recognized in all cases by the following symptoms: In the first place, the fever does not go off, but is slight during the day, and increases at night, and copious sweats supervene, there is a desire to cough, and the patients expectorate nothing worth mentioning, the eyes become hollow, the cheeks have red spots on them, the nails of the hands are bent, the fingers are hot especially their extremities, there are swellings in the feet, they have no desire of food, and small blisters (phlyctænæ) occur over the body. These symptoms attend chronic empyemata, and may be much trusted to; and such as are of short standing are indicated by the same, provided they be accompanied by those signs which occur at the commencement, and if at the same time the patient has some difficulty of breathing. Whether they will break earlier or later may be determined by these symptoms; if there be pain at the commencement, and if the dyspnœa, cough, and ptyalism be severe, the rupture may be expected in the course of twenty days or still earlier; but if the pain be more mild, and all the other symptoms in proportion, you may expect from these the rupture to be later; but pain, dyspnœa, and ptyalism, must take place before the rupture of the abscess. Those patients recover most readily whom the fever leaves the same day that the abscess bursts,--when they recover their appetite speedily, and are freed from the thirst,--when the alvine discharges are small and consistent, the matter white, smooth, uniform in color, and free of phlegm, and if brought up without pain or strong coughing. Those die whom the fever does not leave, or when appearing to leave them it returns with an exacerbation; when they have thirst, but no desire of food, and there are watery discharges from the bowels; when the expectoration is green or livid, or pituitous and frothy; if all these occur they die, but if certain of these symptoms supervene, and others not, some patients die and some recover, after a long interval. But from all the symptoms taken together one should form a judgment, and so in all other cases.

18. When abscesses form about the ears, after peripneumonic affections, or depositions of matter take place in the inferior extremities and end in fistula, such persons recover. The following observations are to be made upon them: if the fever persist, and the pain do not cease, if the expectoration be not normal, and if the alvine discharges be neither bilious, nor free and unmixed; and if the urine be neither copious nor have its proper sediment, but if, on the other hand, all the other salutary symptoms be present, in such cases abscesses may be expected to take place. They form in the inferior parts when there is a collection of phlegm about the hypochondria; and in the upper when the hypochondria continue soft and free of pain, and when dyspnœa having been present for a certain time, ceases without any obvious cause. All deposits which take place in the legs after severe and dangerous attacks of pneumonia, are salutary, but the best are those which occur at the time when the sputa undergo a change; for if the swelling and pain take place while the sputa are changing from yellow and becoming of a purulent character, and are expectorated freely, under these circumstances the man will recover most favorably and the abscess becoming free of pain, will soon cease; but if the expectoration is not free, and the urine does not appear to have the proper sediment, there is danger lest the limb should be maimed, or that the case otherwise should give trouble. But if the abscesses disappear and go back, while expectoration does not take place, and fever prevails, it is a bad symptom; for there is danger that the man may get into a state of delirium and die. Of persons having empyema after peripneumonic affections, those that are advanced in life run the greatest risk of dying; but in the other kinds of empyema younger persons rather die. In cases of empyema treated by the cautery or incision, when the matter is pure, white, and not fetid, the patient recovers; but if of a bloody and dirty character, he dies.

19. Pains accompanied with fever which occur about the loins and lower parts, if they attack the diaphragm, and leave the parts below, are very fatal. Wherefore one ought to pay attention to the other symptoms, since if any unfavorable one supervene, the case is hopeless; but if while the disease is determined to the diaphragm, the other symptoms are not bad, there is great reason to expect that it will end in empyema. When the bladder is hard and painful, it is an extremely bad and mortal symptom, more especially in cases attended with continued fever; for the pains proceeding from the bladder alone are enough to kill the patient; and at such a time the bowels are not moved, or the discharges are hard and forced. But urine of a purulent character, and having a white and smooth sediment, relieves the patient. But if no amendment takes place in the characters of the urine, nor the bladder become soft, and the fever is of the continual type, it may be expected that the patient will die in the first stages of the complaint. This form attacks children more especially, from their seventh to their fifteenth year.

20. Fevers come to a crisis on the same days as to number on which men recover and die. For the mildest class of fevers, and those originating with the most favorable symptoms, cease on the fourth day or earlier; and the most malignant, and those setting in with the most dangerous symptoms, prove fatal on the fourth day or earlier. The first class of them as to violence ends thus: the second is protracted to the seventh day, the third to the eleventh, the fourth to the fourteenth, the fifth to the seventeenth, and the sixth to the twentieth. Thus these periods from the most acute disease ascend by fours up to twenty. But none of these can be truly calculated by whole days, for neither the year nor the months can be numbered by entire days. After these in the same manner, according to the same progression, the first period is of thirty-four days, the second of forty days, and the third of sixty days. In the commencement of these it is very difficult to determine those which will come to a crisis after a long interval; for these beginnings are very similar, but one should pay attention from the first day, and observe further at every additional tetrad, and then one cannot miss seeing how the disease will terminate. The constitution of quartans is agreeable to the same order. Those which will come to a crisis in the shortest space of time, are the easiest to be judged of; for the differences of them are greatest from the commencement, thus those who are going to recover breathe freely, and do not suffer pain, they sleep during the night, and have the other salutary symptoms, whereas those that are to die have difficult respiration, are delirious, troubled with insomnolency, and have other bad symptoms. Matters being thus, one may conjecture, according to the time, and each additional period of the diseases, as they proceed to a crisis. And in women, after parturition, the crises proceed agreeably to the same ratio.

21. Strong and continued headaches with fever, if any of the deadly symptoms be joined to them, are very fatal. But if without such symptoms the pain be prolonged beyond twenty days, a discharge of blood from the nose or some abscess in the inferior parts may be anticipated; but while the pain is recent, we may expect in like manner a discharge of blood from the nose, or a suppuration, especially if the pain be seated above the temples and forehead; but the hemorrhage is rather to be looked for in persons younger than thirty years, and the suppuration in more elderly persons.

22. Acute pain of the ear, with continual and strong fever, is to be dreaded; for there is danger that the man may become delirious and die. Since, then, this is a hazardous spot, one ought to pay particular attention to all these symptoms from the commencement. Younger persons die of this disease on the seventh day, or still earlier, but old persons much later; for the fevers and delirium less frequently supervene upon them, and on that account the ears previously come to a suppuration, but at these periods of life, relapses of the disease coming on generally prove fatal. Younger persons die before the ear suppurates; only if white matter run from the ear, there may be hope that a younger person will recover, provided any other favorable symptom be combined.

23. Ulceration of the throat with fever, is a serious affection, and if any other of the symptoms formerly described as being bad, be present, the physician ought to announce that his patient is in danger. Those quinsies are most dangerous, and most quickly prove fatal, which make no appearance in the fauces, nor in the neck, but occasion very great pain and difficulty of breathing; these induce suffocation on the first day, or on the second, the third, or the fourth. Such as, in like manner, are attended with pain, are swelled up, and have redness (erythema) in the throat, are indeed very fatal, but more protracted than the former, provided the redness be great. Those cases in which both the throat and the neck are red, are more protracted, and certain persons recover from them, especially if the neck and breast be affected with erythema, and the erysipelas be not determined inwardly. If neither the erysipelas disappear on the critical day, nor any abscess form outwardly, nor any pus be spit up, and if the patient fancy himself well, and be free from pain, death, or a relapse of the erythema is to be apprehended. It is much less hazardous when the swelling and redness are determined outwardly; but if determined to the lungs, they superinduce delirium, and frequently some of these cases terminate in empyema. It is very dangerous to cut off or scarify enlarged uvulæ while they are red and large, for inflammations and hemorrhages supervene; but one should try to reduce such swellings by some other means at this season. When the whole of it is converted into an abscess, which is called Uva, or when the extremity of the variety called Columella is larger and round, but the upper part thinner, at this time it will be safe to operate. But it will be better to open the bowels gently before proceeding to the operation, if time will permit, and the patient be not in danger of being suffocated.

24. When the fevers cease without any symptoms of resolution occurring, and not on the critical days, in such cases a relapse may be anticipated. When any of the fevers is protracted, although the man exhibits symptoms of recovery, and there is no longer pain from any inflammation, nor from any other visible cause, in such a case a deposit, with swelling and pain, may be expected in some one of the joints, and not improbably in those below. Such deposits occur more readily and in less time to persons under thirty years of age; and one should immediately suspect the formation of such a deposit, if the fever be protracted beyond twenty days; but to aged persons these less seldom happen, and not until the fever be much longer protracted. Such a deposit may be expected, when the fever is of a continual type, and that it will pass into a quartan, if it become intermittent, and its paroxysms come on in an irregular manner, and if in this form it approach autumn. As deposits form most readily in persons below thirty years of age, so quartans most commonly occur to persons beyond that age. It is proper to know that deposits occur most readily in winter, that then they are most protracted, but are less given to return. Whoever, in a fever that is not of a fatal character, says that he has pain in his head, and that something dark appears to be before his eyes, and that he has pain at the stomach, will be seized with vomiting of bile; but if rigor also attack him, and the inferior parts of the hypochondrium are cold, vomiting is still nearer at hand; and if he eat or drink anything at such a season, it will be quickly vomited. In these cases, when the pain commences on the first day, they are particularly oppressed on the fourth and the fifth; and they are relieved on the seventh, but the greater part of them begin to have pain on the third day, and are most especially tossed on the fifth, but are relieved on the ninth or eleventh; but in those who begin to have pains on the fifth day, and other matters proceed properly with them, the disease comes to a crisis on the fourteenth day. But when in such a fever persons affected with headache, instead of having a dark appearance before their eyes, have dimness of vision, or flashes of light appear before their eyes, and instead of pain at the pit of the stomach, they have in their hypochondrium a fulness stretching either to the right or left side, without either pain or inflammation, a hemorrhage from the nose is to be expected in such a case, rather than a vomiting. But it is in young persons particularly that the hemorrhage is to be expected, for in persons beyond the age of thirty-five, vomitings are rather to be anticipated. Convulsions occur to children if acute fever be present, and the belly be constipated, if they cannot sleep, are agitated, and moan, and change color, and become green, livid, or ruddy. These complaints occur most readily to children which are very young up to their seventh year; older children and adults are not equally liable to be seized with convulsions in fevers, unless some of the strongest and worst symptoms precede, such as those which occur in frenzy. One must judge of children as of others, which will die and which recover, from the whole of the symptoms, as they have been specially described. These things I say respecting acute diseases, and the affections which spring from them.

25. He who would know correctly beforehand those that will recover, and those that will die, and in what cases the disease will be protracted for many days, and in what cases for a shorter time, must be able to form a judgment from having made himself acquainted with all the symptoms, and estimating their powers in comparison with one another, as has been described, with regard to the others, and the urine and sputa, as when the patient coughs up pus and bile together. One ought also to consider promptly the influx of epidemical diseases and the constitution of the season. One should likewise be well acquainted with the particular signs and the other symptoms, and not be ignorant how that, in every year, and at every season, bad symptoms prognosticate ill, and favorable symptoms good, since the aforesaid symptoms appear to have held true in Libya, in Delos, and in Scythia; from which it may be known that, in the same regions, there is no difficulty in attaining a knowledge of many more things than these; if having learned them, one knows also how to judge and reason correctly of them. But you should not complain because the name of any disease may happen not to be described here, for you may know all such as come to a crisis in the afore-mentioned times, by the same symptoms.

APPENDIX

THE BOOK OF PROGNOSTICS.

As announced in the Preliminary Discourse (Sect. II., 18), I shall now proceed to give an abstract of the principal matters contained in the SECOND BOOK OF PRORRHETICS, which appear to me to be highly interesting, and as they relate to the subjects treated of in the Prognostics, they may be more suitably introduced here than in any other place.

The author commences the treatise with expressing his disapproval of certain modes of making prognostics which he had seen practiced. He says he had heard of many and famous predictions having been made by physicians, such as he himself did not pretend that he could make. Such, for example, as for a physician to call in upon a patient who was looked upon as being in a desperate condition by another physician, and predict that he would not die, but would lose his sight. Or to predict with regard to another patient supposed to be in a bad way, that he will recover, but will become lame of a hand. And of a third who, to all appearance, cannot recover, to predict that he will get well, but that his toes will blacken and putrefy. Similar predictions are related under this class. Another mode of prediction is to prophecy to buyers and traders, to one death, to another madness, and to the rest diseases, and that from what is now occurring, or has occurred before, and all the predictions to turn out true. Another kind of predictions relates to Athletæ, and those who practice gymnastic and laborious exercises for the cure of diseases, where the practitioner pretends to so much exactness, that if the patient is guilty of any act of omission or commission in regard to food, drink, or venery, the physician will detect it. He himself makes no pretensions to any such skill in divination, but announces it as his object to describe the symptoms by which it may be known whether a man will die or live, and whether his disease will be of short or of long duration. With regard to the predictions of abscesses, lameness, death, or madness, the author holds that they can only be made after the morbid conditions leading to them have fairly set in. He strongly disapproves of all ostentatious modes of making predictions, and gives it as his advice that in all such cases the greatest prudence and reserve should be observed, since if a man become an adept in this art of prognostications, he will gain great credit with his patient, whereas if he fall into mistakes, he will incur odium, and will be looked upon as being deranged.

With regard to the prognostics made by those who practice gymnastics, he recommends them not to be made in a charlatan manner, but with suitable caution, and directs minute attention to be paid to the circumstances of the patient, which one has superior advantages in observing under this system. He says, for example, that a physician who feels a patient’s belly and pulse, pays attention to the breathing at the nostrils, and listens to the speech, and sound of the respiration, will be less likely to be deceived in forming a prognostic on his patients than he who neglects these things. He expresses himself, however, as being incredulous as to the possibility of detecting any little transgressions of orders which a patient may commit, although greater departures from instructions may be suspected. After some general observations in respect to diet, and other matters relating to it, he proceeds to a more circumstantial description of the symptoms upon which a prognosis is to be founded. And first, with regard to the alvine dejections, those of persons who live a laborious life, and use food and drink sparingly, are small and hard, and are passed every day, every third day, or every fourth day, but if they pass the last period there is danger of the man’s being seized with fever or diarrhœa. When the stools are so liquid that they do not assume a shape, they are all of a worse character in these cases. The dejections of persons who lead an active life are less copious than those of the indolent, provided they use the same amount of food. Liquid dejections taking place on the seventh day, and quickly coming to a crisis, are beneficial, if they occur all at once, and are not repeated. But if accompanied with fever, or if the diarrhœa is prolonged, all such dejections are bad, whether bilious, pituitous, or of indigested matters, and require a particular regimen and mode of treatment.

With regard to the urine, it should be in proportion to the drink that is taken, and somewhat thicker than the fluid that is drunk. If it be more copious than natural, this indicates either that the patient has disobeyed orders as to the amount of his drink, or that his body is in a state of atrophy. If the urine is passed in deficient quantity, with a noise, it indicates either that the man stands in need of purging, or that the bladder is diseased. A small quantity of blood passed without fever and pain does not indicate anything bad, but proves a solution to a state of lassitude. But if in large quantity, with the addition of any of these symptoms, it is to be dreaded. But if the urine be passed with pain, and if pus be passed along with the urine in a fever, the physician should announce that the patient will thus be relieved of his complaints. Thick urine having a thin sediment indicates some pain and swelling about the joints. All the other sediments which occur in the urine of persons who practice exercises are connected with disease about the bladder; this will be clearly shown by the obstinate pains with which they are accompanied. The author, although he states that he had been conversant with the teachers of prognostics from urine, and their children and disciples, seems to express himself doubtful as to the possibility of acquiring a great degree of accuracy in regard to these matters.

Respecting dropsy, consumption, gout, and epilepsy, he states generally that if they are hereditary they are difficult to remove. A favorable prognosis is to be formed in dropsy when the patient’s viscera are sound, when his strength is firm, the digestion and respiration natural, when he is free of pain, the temperature of the body moderate, and when there is no wasting of the extremities. It is favorable when there is no cough, thirst, nor dryness of the tongue, when the bowels are easily moved by medicine, and when, at other times, the dejections are consistent. Dropsy, supervening, along with fever, upon a great discharge of blood, is of a most intractable nature, and the physician should intimate the danger to some other person beforehand. When great swellings suddenly subside and rise again, there is more hope in such a case than in dropsies connected with a discharge of blood. He concludes his observations on dropsies with the remark, that they are apt to deceive the patients, so that they desert their physicians and thus perish.

With regard to consumptive patients, he says, he has the same observations to make with regard to the sputa and cough as he had written with regard to empyema. If the patient is to recover, the sputa should be white, equable, of one color, without phlegm; the defluxion from the head should be determined to the nose; there should be no fever, nor anorexia, nor thirst; the alvine discharges firm, proportionate to the ingesta, and the patient should not get thin. The best form of the chest is when it is quadrangular and hairy, and when the cartilage is small, and covered with flesh. Young persons, who become affected with empyema from determination (metastasis?), or fistula, or from any other similar cause, or from the retrocession of an abscess, do not recover unless many of the favorable symptoms combine in the case. They die, most commonly, in autumn, which proves peculiarly fatal in protracted diseases. Of all others, virgins, and women suffering from amenorrhœa, seldomest recover; and in their cases there is no hope unless menstruation be restored. All sexes, he seems to say (but the meaning appears to me rather ambiguous), have a better chance of recovery, when there is a discharge of blood, especially in those cases in which there are pains in the back and chest, connected with black bile; and if, after the evacuation, there be a remission of the pain; if the cough and fever do not set in; and if the thirst be tolerable. He seems to state (but the text is in an unsatisfactory condition), that relapses take place unless there be deposits in the place, the best of which are those which contain most blood; and that in those cases in which there are pains in the chest, if the patients get emaciated, and cough, and a dyspnœa supervenes, without fever or empyema, they should be asked whether, when they cough, and have difficulty of breathing, the sputa be compact, and attended with little smell.

With regard to persons affected with the gout, those who are aged, have tofi in their joints, who have led a hard life, and whose bowels are constipated, are beyond the power of medicine to cure. But, the best natural remedy for them is an attack of dysentery, or other determination to the bowels. Persons, under opposite circumstances, may be cured by a skilful physician.

The prognosis in epilepsy is unfavorable when the disease is congenital, and when it endures to manhood, and when it occurs to a grown person, and without any obvious cause. When connected with the head it is particularly to be apprehended, but least so when it seems to be derived from the hands or feet. The cure may be attempted in young persons, but not in old.

In the case of children, he mentions various complaints, such as distortion of the eyes, tubercles about the neck, pain in the bowels, omental hernia, etc., which, upon inquiry, will be found to be the consequences of an attack of epilepsy.

The judgment to be formed in the case of ulcers is to be founded on the age of the patient, the situation of the sore, and its appearance.

Strumous tubercles, which end in suppuration, occur most frequently in young persons. Adults are subject to bad favi, internal cancers, and herpetic sores, after epinyetis, until they pass sixty. Old persons are subject to cancers, both deep-seated and superficial, which never leave them. They are particularly intractable when seated in the armpits, the loins, and the thighs.

Of affections of the joints, the most dangerous are those seated in the thumb and great toe. When there is a chronic sore on the side of the tongue the surgeon should examine whether it be not occasioned by the sharp edge of a tooth.

The most dangerous wounds are those which implicate the large veins (blood-vessels), in the neck and groin; then those of the brain and liver; next, those of the bowels and bladder. These cases are all dangerous, but not uniformly fatal, as some suppose. Much depends upon constitution, as to liability to fever and inflammation after a wound. Sometimes, also, the wounds of smaller vessels prove fatal by inducing hemorrhage, fever, or delirium. In all recent wounds, however, the physician should endeavor to afford assistance.

Of spreading ulcers, the most fatal are such mortifications as are very deep, black, and dry; and those are bad and dangerous which are accompanied with a black ichorous discharge. Those which are white and mucous are less dangerous, but are more subject to relapse, and become inveterate. Herpes is the least dangerous of the spreading sores, but is most difficult to remove about deep-seated cancers. An ephemeral fever, with very white and thick pus, is beneficial in such a case; also, sphacelus of a nerve, of a bone, or of both, in deep-seated and black mortifications. For a free discharge of pus takes place and carries off the mortification.

The prognostics in wounds of the head are given in nearly the same terms as laid down in the treatise on that subject, and therefore I need not enter minutely into an exposition of what is stated regarding them here. Those in the upper part of the head, more especially if they implicate a suture, are said to be particularly dangerous. The author directs the surgeon to inquire whether, at the time of the accident, the patient fell down or became comatose, as in this case greater danger is to be apprehended.

Large wounds of the joints, if they involve the connecting nerves, necessarily leave the limb maimed. Several other observations connected with these injuries are added, of which one of the most important is the direction to practice flexion and extension of the limb, frequently, with the view, no doubt, of preventing rigidity of the joint.

Large excisions in the arm becoming inflamed end in suppurations, which require to be evacuated by the knife or cautery. Injuries of the spinal marrow, whether from disease or accident, are attended with loss of motion and sensibility, retention of the alvine and urinary discharges; but, after a time, involuntary evacuations take place, which are soon followed by death. When the throat is frequently filled with blood, and there is no headache or cough, nor any other morbid symptoms, the physician should examine whether there be not an ulcer or a leech in the part.

With regard to the eyes, the prognostics are given with so much prolixity of detail that I must be content with a brief abstract of them. Much attention is paid to the characters of the discharge from the eyes in diseases of them, namely, of the glutinous matter and tears; thus, if the gum be white and soft, the tears mixed with it not very hot, and the swelling light and loose, under these circumstances the eyelids are glued up during the night, so that the eye is free of pain, and thus the disease is without danger, and of short duration. The other appearances of the eye, and the discharges, are also minutely given. When the discharge is green or livid, the tears copious and hot, a burning heat in the head, and pains darting through the head to the eye, there must necessarily be ulceration in the eye; and there is much reason to apprehend that it will burst. If, when one can get a sight of the eye, it should be found burst, and the pupil projecting above the rupture, it is bad and difficult to restore; and, if there be sloughing, the eye will be wholly useless. According to the form and depth of the ulcers must be the subsequent cicatrices. These are minutely described according to their different varieties. Mention is also made of the prognostics from the eyes in fevers, as described by the author in another work. It is most likely that allusion is here made to the first book of “Prorrhetics.” In conclusion, the surgeon is directed to pay great attention to the state of the urine in diseases of the eyes.

Dysenteries, when they set in with fever, alvine discharges of a mixed character, or with inflammation of the liver, or of the hypochondrium, or of the stomach, such as are painful, with retention of the food and thirst, all these are bad; and the more of these symptoms there are, the greater the danger; and the fewer, the more hope is there of recovery. Children from five to ten years of age are the most apt to die of this complaint; the other ages less so. Such dysenteries as are of a beneficial nature, and are attended with blood and scrapings of the bowels, cease on the seventh, or fourteenth, or twentieth, or thirtieth day, or within that period. In such cases even a pregnant woman may recover and not suffer abortion.

All cases of lientery are said to be of a bad character when they are continued and protracted, both day and night, and when the dejections are either very crude, or black, soft, and fetid; for they occasion thirst and determine the fluids otherwise than to the bladder, give rise to ulcerations (aphthæ?) in the mouth, redness and ephelis of all colors, and at the same time the belly is in a state of ferment, and has a foul, wrinkled appearance externally. This disease is most to be dreaded by old persons; it is formidable to men of middle age, but less so in the other ages. The indications of cure, it is acutely stated, are to determine the fluids to the urine, to relieve the body from its atrophy, and change the color of the skin.

All the other varieties of diarrhœa without fever are of short duration and mild; for they will all cease when washed out, or of their own accord. The discharge may be predicted as about to cease when, upon touching the belly, there is no movement, and flatulence passes with the discharge. Eversion of the gut takes place in the case of middle-aged persons having piles, of children affected with the stone, and in protracted and intense discharges from the bowels, and of old persons having mucous concretions (scybalæ?).

Women may be judged of whether they are in a fit state for conception or not by attending to the following circumstances:--In the first place to their shapes. Women of smaller stature more readily conceive than taller persons; the thin than the fat; the white than the ruddy; the dark than the pale; those who have prominent veins than the contrary. In oldish women it is bad to have much flesh, but a good thing to have swelled and large breasts. In addition, inquiry should be made whether or not the menstruation be regular as to time and quantity. And it should be ascertained whether the uterus be healthy, of a dry temperament, and soft; neither in a state of retraction nor prolapsus; and its mouth neither turned aside, nor too close, nor too open. When any of these obstructions come in the way, it is impossible that conception can take place.

Such women as cannot conceive, but appear green, without fever, and the viscera are not in fault; these will say that the head is pained, and that the menstrual discharge is vitiated and irregular. But such of these as have the proper color, are of a fat habit of body, the veins are inconspicuous, they have no pains, and the menses either never appear at all, or are scanty and intense, and this is one of the most difficult states of sterility to remove. In other cases the health is not to blame, but the fault lies in the position of the womb. The other contingencies in this place are attended with pains, discoloration, and wasting.

Ulceration in the womb from parturition, an abscess of a chronic nature, or from any other cause, is necessarily accompanied with fevers, buboes, and pains in the place; and if the lochial discharge be also suppressed, all these evils are more intense and inveterate, along with pains of the hypochondrium and head. And when the ulcer heals, the part necessarily is smoother and harder, and the woman is less adapted for conception. If, however, the ulceration be in the right side only, the woman may conceive of a female child, or if in the left, of a male. When a woman cannot conceive, and fever comes on with a slight cough, inquiry should be made whether she has any ulcer about the uterus, or any other of the complaints I have described; for if she has no complaint in that region to account for her loss of flesh and sterility, it may be expected that she will have vomiting of blood, and the catamenia will necessarily be suppressed. But if the fever be carried off by the evacuation of blood, and if the catamenia appear, she will then prove with child. But if looseness of the bowels having a bad character take place before there is an evacuation of blood, there is danger lest the woman perish before a vomiting of blood can take place.

In cases of false conception, in which women are deceived by the non-appearance of the menses, and by the increase of the belly and movement in it, they will be found to have had headache and pains about the neck and hypochondria, and there is no milk in the breasts except a little of a watery character. But when the swelling of the womb passes away they will conceive, unless there be any other impediment. For this affection is beneficial in so far as it produces a change in the uterus, so that afterwards the woman may prove with child. Women with child have not these pains unless the headache be habitual to them, and in addition they have milk in their breasts. Women affected with chronic discharges are to be asked whether they have pains in the head and loins, and in the lower part of the belly, and whether their teeth be set on edge, and if they have dimness of sight, and noises in their ears. Such women as vomit bile for several days while in a fasting state, though they are not with child nor have fever, are to be asked whether they have vomited up round lumbrici, and if they say not, they should be warned that this will happen to them. This affection happens principally to married women, then to virgins, and less seldom to other people.

Pains without fever are not deadly, but mostly prove protracted, and have many changes and relapses. Several varieties of headache are described, and the prognosis in each laid down. The natural cure of them is a coryza, a discharge of mucus from the nose, or sneezing. Pains spreading from the head to the neck and back, are relieved by abscesses, expectoration of pus, hemorrhoids, exanthemata on the body, or pityriasis on the head.

Heaviness and pruritus in the head, either in a part or through the whole of it, if, on inquiry, they extend to the tip of the tongue, indicate a confirmed disease, and one difficult to remove. They are best removed by the occurrence of an abscess. But those cases which are accompanied with vertigo are difficult to cure, and are apt to pass into mania. Other diseases in the head, of a very strong and protracted character, occur to both men and women, but especially to young persons, and virgins at the season of manhood, and especially at the catamenial period. Women, however, are less subject to pruritus and melancholic affections than the men, unless the menses have disappeared.

Both men and women who have long had a bad color, but not in the form of jaundice, are subject to headaches, eat stones and earth, and have piles. Those who have green colors, without decided jaundice, are affected in like manner, only instead of eating stones and earth, they are more subject to pains in the hypochondriac region. Persons who are pale for a length of time, and have the face tumid, will be found to have headache, or pains about the viscera, or some disease in the anus; and in most cases, not one, but many, or all these evils make their appearance.

Nyctalopia is most apt to attack young persons, either males or females, and to pass off spontaneously on the fortieth day or in seven months, and in some cases it endures for a whole year. Its duration may be estimated from the strength of the disease and the age of the patient. They are relieved by deposits which determine downwards, but these rarely occur in youth. Married women and virgins that have the menstrual discharge regular are not subject to the complaint. Persons having protracted defluxions of tears who are attacked with nyctalopia, are to be questioned whether they had any previous complaint in the head.

Such persons as have frequent pains in the vertex and temples, without fever or loss of color, unless they have some other obvious deposit in the face, or speak in a rough tone, or have pain in the teeth, may be expected to have a hemorrhage from the nose. Those who have bleeding at the nose, although they may appear to be otherwise in good health, will be found to have enlarged spleen, or pain in the head, or flashes of light before their eyes. Most of these patients have both headache and affection of the spleen.

The gums are diseased and the mouth fetid in persons who have enlarged spleens. But persons who, although they have enlarged spleens, are exempt from hemorrhages and fœtor of the mouth have malignant ulcers on the legs and black cicatrices. But if they have any obvious deposit in the countenance, or if their speech be rough, or if they have toothache, a hemorrhage from the nose may be expected. Those who have great swellings below the eyes will be found to have enlarged spleens. And if there come on swellings in the feet, and if they appear to be dropsical, the belly and loins must be attended to.

Distortions of the countenance, if not sympathetic with some other part of the body, quickly pass off either spontaneously or by remedial means. The others are of an apoplectic nature. In other cases, when the diseased part wastes from want of motion, there can be no relief afforded. But when wasting does not take place there may be recovery. With regard to the time when this may occur, it is to be prognosticated by attending to the severity of the disease, to its duration, to the age of the patient, and to the season, it being known that of all cases the inveterate, and such as are the consequences of repeated attacks, are the worst, and the most difficult to remove, and those in aged persons. Autumn and winter are more unfavorable seasons for such complaints than spring and summer.

Pains in the shoulder, which, passing down the arms, occasion torpor and pains, do not usually terminate in deposits, but the patients get better by vomiting black bile. But when the pains remain in the shoulders, or extend to the back, the patients are relieved by vomiting pus or black bile. They are to be judged of thus:--If their breathing be free, and if they be slender, it is rather to be expected that they will vomit black bile. But if they have more difficulty of breathing, and if there is any unusual color on the countenance, whether reddish or black, it is to be expected that they will rather spit blood. It should also be attended to whether there be swellings on the feet. This disease attacks men most violently from forty to sixty years of age. At this period of life ischiatic diseases are most troublesome.

Ischiatic diseases are to be thus judged of:--In the case of old persons, when the torpor and coldness of the loins and legs are very strong, and when they lose the power of erections, and the bowels are not moved, or with difficulty, and the fæces are passed with much mucus, the disease will be very protracted, and it should be announced beforehand that the disease will not last shorter time than a year from its commencement; and amendment is to be looked for in spring and summer. Ischiatic diseases are no less painful in young men, but are of shorter duration, for they pass off in forty days; and neither is the torpor great, nor is there coldness of the legs and loins. In those cases in which the disease is seated in the loins and leg, but the patient does not suffer so much as to be confined to bed, examine whether any concretions have taken place in the hip-joint, and make inquiry whether the pain extends to the groin; for if both these symptoms be present, the disease will be of long duration. And the physician should also inquire whether there be torpor in the thigh, and if it extend to the ham; and if he says so, he is to be again asked if it spreads along the leg to the ankle of the foot. Those who confess to the most of these symptoms are to be told that the limb will be sometimes hot and sometimes cold; but those persons in whom the pain leaves the loins, and is turned downwards, are to be encouraged; but when the disease does not leave the hip and loins, such persons are to be warned that it is to be dreaded. In those cases in which there are pains and swellings about the joints, and they do not pass off, after the manner of gout, you will find the bowels enlarged, and a white sediment in the urine; and, if you inquire, the patient will admit that the temples are often pained, and he will say that he has nightly sweats. If the urine have not this sediment, nor do the sweats take place, there is danger either that the joints will become lame, or that the tumor called meliceris will form in it. This disease forms in those persons who in their youth had epistaxis, and in whom it had ceased afterwards. They are to be interrogated whether they had discharges of blood in their youth, and if they have pruritus in the breast and back. And the same thing happens to those who have severe pains in the bowels, without disorder of them, or who have hemorrhoids. This is the origin of these complaints. But if the patients have a bad color, they are to be interrogated whether their head be pained, for they will say that it is. In those cases in which the bowels are pained on the right side, the pains are stronger, and especially when the pain terminates in the hypochondrium at the liver. Such pains are immediately relieved if borborygmi take place in the belly. But when the pain ceases, they pass thick and green urine. The disease is not deadly, but very protracted. But when the disease is already of long standing, the patients have dimness of sight in consequence of it. But they are to be interrogated whether, when young, they had a flow of blood, and regarding the dimness of vision, the greenness of the urinary discharge, and regarding the borborygmi, if they took place and gave relief; for they will confess to all these symptoms.

Lichen, leprosy, and leucè, when they occur in young children and infants, or when they appear at first small, and gradually increase in the course of a long time--in these cases the eruption is not to be regarded as a deposit, but as a disease; but when they set in rank and suddenly, this case is a deposit. Leucè also arises from the most fatal diseases, such as the disease called phthisis; but leprosy and lichen are connected with black bile. These complaints are the more easily cured the more recent they are, and the younger the patients, and the more soft and fleshy the parts of the body in which they occur.

ON REGIMEN IN ACUTE DISEASES.

THE ARGUMENT.

In this treatise two very important questions are discussed: first, a nosological question, regarding the proper distinction of diseases from one another; and secondly, a therapeutical, respecting the rules by which the regimen in acute diseases ought to be regulated. The former of these is of a polemical nature, being an attack directed against the physicians of the Cnidian school of medicine, who distinguished diseases from one another in an arbitrary manner, from incidental varieties in their constitution, and without proper attention to their true constitution and identity. As will be seen in the annotations, the Cnidians pretended to recognize several varieties of disease connected with bile,--several fanciful divisions of diseases of the bladder, and so forth; to which mode of distinguishing diseases there would obviously be no end, since of incidental varieties in any case there can be no limit. The other question discussed in this treatise relates to what may justly be pronounced to be one of the most important points connected with the practice of medicine, namely, the proper regimen in acute diseases; that is to say, in idiopathic fevers and febrile diseases, comprising most of those diseases now classed under the head of Zymotic, and which constitute by far the highest item in our bills of mortality at the present day. Our author distinguishes them by the names of pleurisy, pneumonia, phrenitis, lethargy, causus, and their cognate diseases, including fever of the continual type. Now it is to be borne in mind, that the phrenitis, lethargy, and causus of Hippocrates, were all epidemic fevers, so that, with the exception of pleurisy and pneumonia, all the diseases here treated of are fevers of the country in which Hippocrates resided. One, then, cannot well imagine a question which from the commencement of the medical Art must have been felt of higher importance than this,--how so numerous and formidable a class of diseases ought to be treated. In the attempt to solve it, every imaginable mode of treatment, as might have been expected beforehand, was tried, and its effects determined by experience. Herodicus, the master of Hippocrates in gymnastics, applied his panacea in the treatment of febrile diseases, and, as we are informed, with the most disastrous results. “Herodicus,” says the author of the sixth Book of Epidemics, “killed persons in fever by promenading, much wrestling, and fomentations.” (§ iii., 18.) It may now appear wonderful that so extraordinary a mode of practice should have ever been attempted in this case; but while men of all ranks continue to resort for the cure of all sorts of diseases to any individual who has got a single hobby with which he constantly works to his own profit, whether it be gymnastics, or shampooing, or the wet sheet, we may expect to hear that such rash experiments have been repeated. Truly mankind pay as dearly for their tame submission to the insane practices of professional chiefs, as the Greeks are represented by the poet to have suffered from the follies of their princes:

“Quicquid delirant Reges, plectuntur Achivi.”

And surely it is much to be desired that men would learn a lesson from the Past, and not allow every new page in the history of society and of the profession to furnish a repetition of the oft-told tale of supine credulity on the one side, and of audacious folly on the other. From what has been stated, it will readily be understood that it was soon settled that active exercise is inadmissible in febrile diseases. It would next come to be determined, what rule was to be followed with regard to the administration of food in fevers. On this point, as will be seen below in our annotations, the most diametrically opposite plans of treatment were essayed. One authority administered the most highly nutritious articles of food, namely, fleshes, to his patients, while, on the other hand, some wasted them by enforcing a total abstinence for several days. Experience, we may be well assured, was not long in deciding against both the starving and the glutting system: the palled appetite would soon refuse to accept of solids, and the parched tongue would speedily crave some allowance of liquids. Even before the days of Hippocrates, there is every reason to suppose that these extreme modes of treatment had been abandoned; but still he complains that in his time many important points in the treatment of acute diseases were wholly undetermined, such as the following: whether plain drink, that is to say water, was to be administered;--or, water seasoned by the admixture of something farinaceous, such as the decoction of barley;--whether the same should be given so thick as to constitute a nutritious gruel, or strained so as to form merely a drink;--whether wine should be given in small quantity, or more copiously;--whether any of these things should be given from the commencement of the disease, or not until after an interval of certain days. Hippocrates informs us that the most discordant opinions prevailed upon these points, and his professed object, in this treatise, is to reduce the rules of practice to certain fixed principles. How our author performs this task, the reader is left to judge for himself; it may be interesting, however, to know, that Galen with all his devoted admiration of Hippocrates, is not disposed to admit that his solution of the question at issue is quite lucid and satisfactory. This opinion Galen pronounces on two separate occasions; in his commentary on this treatise, and in his great Work “On the Tenets of Hippocrates and Plato.” As I look upon his observations contained in the latter Work to be of great importance toward understanding the bearing of this treatise, I shall not scruple to introduce a translation of the greater part of them in this place.

The ninth book of the Work we have mentioned opens with an elaborate disquisition on the logical principles which ought to guide us in deciding with regard to identity and difference, both in Philosophy and Medicine: on the former of these subjects he quotes freely from Plato, and on the other from Hippocrates. Coming, then, to the question in hand, he says:--“And thus Hippocrates proceeded in the work ‘On the Regimen of Acute Diseases,’ finding fault with the Cnidian physicians, as being ignorant of the differences of diseases with regard to genus and species; and he himself points out the definitions according to which that which appears to be one, being divided becomes many, not only in the case of diseases, but also in that of all other things; in which we find that many of the most celebrated physicians fall into mistakes, even with regard to the remedies. For some, coming to the particular use of them, have established a most immethodical method of instruction; whilst others, stating a very general precept, lay down a rule which at first sight appears very methodical, but in truth is very bad, and hence they disagree among themselves; some, as for example those treating of the remedy for a certain affection, such as pleurisy, declaring it to be venesection, others purging, some fomentations by means of sponges, and others of bags, or something of the like kind. And they differ, in the same manner, with regard to the use and disuse of the bath, of oxymel, of hydromel, and of water, of wine, and of ptisan, either giving of the strained juice only, or of the barley portion only; and some, with regard to food, giving discordant decisions as to the differences of the sick, and the indications which a pleuritic affection requires. And that he, as being the first discoverer, has handled these subjects in rather a confused manner, I have shown in my Commentary on the treatise which has been improperly entitled, ‘Against the Cnidian Sentences,’ and ‘On the Ptisan.’ But in order that those who are desirous of learning, may have a clear exposition of this question in a brief form, I shall not scruple to give here a summary of it. In the commencement of pleuritic attacks, when the side is just beginning to be pained, inasmuch as the nature of the disease is not yet obvious, he directs fomentations, otherwise called heating applications, to be tried, and he explains the materials of which they consist. And then, if the complaint is not removed, it is to be ascertained whether the patient took food recently, and whether the bowels have been moved, and he gives instructions what should be done in these cases. But if the disease does not yield to these means, he gives definitions of those cases which require venesection and purging, and those in which one should use hydromel for drink, or oxymel, or water until the crisis, without giving any food; and those in which the juice of ptisan is to be used, or the barley along with it, and when food is to be administered. In like manner, with regard to the administration of wine, it is determined in what cases it is to be given, and in what not, and when, and of what quality. And in like manner respecting baths, and other matters of the like kind. And as a twofold mistake is committed with regard to the divisions (of diseases), some doing it in a deficient manner, and others carrying this process to excess, Hippocrates, finding fault with both, expresses himself thus, in the beginning of the book: ‘Some of them, indeed, were not ignorant of the many varieties of each complaint, and their manifold division, but when they wish to tell clearly the members (species?) of each disease, they do not write correctly; for the species would be almost innumerable if every symptom experienced by the patients were held to constitute a disease, and receive a different name.’ And again, respecting the remedies, as being deficient, he writes thus: ‘And not only do I not give them credit on this account, but also because those they use are few in number.’ Afterwards, assuming what is of great importance to the question, he does not give a clear solution of it, and therefore the whole bearing of the question is misunderstood by many physicians. I have, therefore, given an exposition of the whole subject, in my first Commentary ‘On the Regimen of Acute Diseases;’ and it is necessary to show the import of it briefly. The question is given by Hippocrates in the following terms: ‘But it appears to me that those things are more especially deserving of being consigned to writing, which are undetermined by physicians, notwithstanding that they are of vital importance, and either do much good or much harm. By undetermined, I mean such as those: wherefore certain physicians, during their whole lives, are constantly administering untrained ptisans, and fancy they thus accomplish the cure properly, whereas others take great pains that the patient may not swallow a particle of the barley (thinking it would do much harm), but strain the juice through a cloth before giving it: others, again, will neither give thick ptisan nor the juice, some until the seventh day of the disease, and some until after the crisis. Physicians are not in the practice of mooting such questions, nor perhaps, if mooted, would a solution of them be readily found, although the whole Art is thereby exposed to much censure from the vulgar, who fancy that really there is no such science as Medicine, since, in acute diseases, practitioners differ so much among themselves, that those things which one administers, as thinking it the best that can be given, another holds to be bad.’ And a little afterwards: ‘I say, then, that this question is a most excellent one, and allied to very many others, and some of the most vital importance in the Art: for, that it can contribute much to the recovery of the sick, and to the preservation of health in the case of those who use it well, and that it promotes the strength of those who take gymnastic exercises, and is useful to whatever one may wish to apply it.’ The inquiry regarding the differences of opinion among practitioners, he says, is of the greatest consequence, not only to the sick, for the recovery of health, but also to those in health, for the preservation of it, and to those who practise it for the recovery and preservation of deportment. And he afterwards adds, ‘to whatever one may wish;’ as indicating that the solution of this inquiry is applicable not only to medicine but to all the other arts to which one may choose to apply it. For it is wonderful that physicians practising an art, in which the remedies applied may be determined by experience whether they are beneficial or hurtful, should yet make the most conflicting statements respecting those things which are beneficial and those which are prejudicial. For, in philosophy, it is not to be wondered at that there should be no end to most disputes, since these things cannot be clearly determined by experience; and therefore some hold that the world is uncreated, some that it was created, some that there is nothing beyond its boundary, some that there is, and some declaring what that which is contained is, and some pronouncing it to be a vacuum, having no substance in it, and some holding that worlds in inconceivable numbers, and infinite, exist. For such discrepancy of opinion cannot be set at rest by any clear appeal to the senses. But it is not so with respect to the benefit or injury derived from remedies administered to the body, since the differences among physicians, in this case, may be decided by experience, as to which of them are beneficial and which injurious. Wherefore the solution of this question is not very clearly stated by Hippocrates, and on that account it has excited the observation of almost all the commentators on this book. It is this: some of the sick require abstinence from food, until the disease come to a crisis, and some require food, and of these some require the unstrained ptisan, and some the strained, as also some require still more substantial food, and, moreover, some require oxmyel, or hydromel, and some water, or wine. Wherefore to those physicians who have cultivated the Art upon experience alone, that only appears beneficial which perchance has seemed useful in most cases. Neither do they venture to try the opposite mode of regimen, for fear of failure. He alone, then, who knows the constitution of the sick, and the nature of the disease, and the powers of the remedy which is administered, and the time in which it ought to be used, will be able rationally to devise the remedy to be applied, and confirm his expectation of it by experience.”

Galen gives other remarks, not devoid of interest, on the same subject, but these want of room obliges me to pass by. I may mention, however, that after giving, in the form of extract, the passage on wine (§ 12), he makes the remark, that if the question be put whether wine should be given to persons in fever, the proper answer to it would be, that it is to be given in some certain cases, and in others not. (See tom. v., p. 773, ed. Kühn.) Thus far Galen.

Before quitting this subject, I would beg leave to make a few remarks on some points of medical practice which are here treated of, and which appear to me to be either overlooked, or not satisfactorily determined at the present day; and also upon some modern innovations on the practice of the ancients. As far as I have observed, it is quite a common practice now to administer food, such as farinaceous gruels, or animal broths, without much reserve, after evacuation of the system either by purging or bleeding. Now it will be seen that Hippocrates forbids food to be administered at such a season, as the body, being weakened by the depletion, is unable to digest it properly, and consequently what is given as a support to the frame proves a load to it. To the reason here assigned for this practice, might be added that the vascular system, having been emptied, greedily absorbs the food before it is properly digested. I am not sure that this physiological principle is stated in any of the works of Hippocrates, but it is frequently to be met with in the works of Galen, and in those of the toxicologists, from Nicander to Actuarius. See PAULUS ÆGINETA,