Book Ii., 26.

M. Littré quotes the remark of an excellent English authority on fever, J. Johnson, that it is singular the effects of marsh effluvia should have escaped the observation of Hippocrates, more especially as the remittent and intermittent fevers, of which he treats so fully, are mostly derived from this source. Now I must say, that I am not aware of there being any passages in the works of Hippocrates where the effects of marsh effluvia in engendering such fevers are distinctly noticed; but if Hippocrates was ignorant of this fact, in the etiology of fevers, it was well known to Galen, as may be seen on reference to his very interesting work “On the Difference of Fevers.” The Arabians also were familiar with the fact. See Avicenna, iv., 1, 2, 1.

In the treatise “On Airs,” which, although not admitted by us into the list of genuine works, has considerable pretension to be so regarded, the causes of fever are treated of with great precision, and there the pestilential fevers are said to derive their origin from miasma, but whether or not under this term be included marsh effluvia, cannot be determined. But perhaps a better reason might be assigned for there being little or no allusion to malaria in the works of Hippocrates, namely, that after all, this was not the cause of the epidemical diseases which he describes. The following extract from a work of very high authority on fever is well deserving of consideration in this place: “A question has arisen as to whether or not the inflammatory states of fever, in warm countries, are caused by malaria, or by the other causes now instanced (excess of heat, etc.). There can be no doubt that malaria very frequently produces in the plethoric, young, and robust, who have recently arrived in a hot climate, fever of an inflammatory and continued kind; but it must also be conceded that this fever chiefly occurs, even in persons thus constituted, during the dry season, and at times and in places where the existence of malaria is doubtful, or, at least, by no means proved. It is notoriously admitted that the inflammatory states of continued fever, in both the East and West Indies, appear among those soldiers, sailors, and civilians, who have not been long in a warm country, and who have not suffered from disease since their arrival; and that they take place chiefly during the dry and warm seasons, and in situations where the usual affects of malaria are never observed. This is the result of the experience of Jackson, Annesley, Boyle, Twining, Conwell, and the other experienced practitioners in warm countries. It agrees with my own observations, and is even admitted by Dr. Fergusson, who has gone much further than any one else in assigning malaria as the cause of intertropical fevers.” I may mention, moreover, that Hippocrates and his contemporaries were evidently not ignorant of the fact, that the atmosphere in the vicinity of marshes and large rivers is unwholesome to the inhabitants of warm climates. See De Diæta, ii, 2.

The following are part of the conclusions which M. Littré draws from his investigations into the nature of the fevers described by Hippocrates. I quote them as being strongly confirmatory of the opinions delivered by me in the Commentary on the Second Book of PAULUS ÆGINETA.

“Les fièvres décrites dans les Epidémies d’Hippocrate différent de nos fièvres continués.

“Les fièvres décrites dans les Epidémies ont, dans leur apparence générale, une similitude très grande avec celles des pays chauds.

“La similitude n’est pas moins grande dans les détails que dans l’ensemble.

“Dans les unes comme dans les autres les hypochondres sont pour un tiers des cas, le siége d’une manifestation toute spéciale.

“Dans les unes comme dans les autres, il y a une forte tendence ou réfroidissement du corps, à la sueur froide et à la lividité des extrémités.”

On almost all the other diseases treated of in these books, M. Littré’s opinions, in like manner, exactly coincide with those delivered by me in the above-mentioned work. Thus he arrives at the conclusion, that the Phrenitis and Lethargus of Hippocrates were varieties of the Causus. Compare PAULUS ÆGINETA, Book III., 6, 9. He refers them to les fièvres pernicieuses comateuses pseudo-continués et les fièvres pernicieuses dolorantes pseudo-continués of M. Maillot. It would appear from the extracts which he quotes from a work of M. Roux, on the Diseases of Morea, that a similar tendency to pass into phrenitis and lethargy is still observable in the land of Greece. The fevers of the East Indies also, as described by Dr. Twining, appear to partake very much of the same character. In a word, the conclusions to which a patient study of modern authorities on the subject have brought me amount to this; that the fevers described by Hippocrates in his “Epidemics,” are exactly the same as those which are now described as still prevailing in the land of Greece: that they correspond very well with those described by Cleghorn as occurring in Majorca; differ but little from those described by Pringle, Monro, and Sylvius, as happening in the Low Countries, and differ from those described by Twining, as happening in Bengal, only in a few particulars.

From the analysis of their contents given above it will readily be understood that the subject-matters of these two books are not arranged methodically. Indeed it is quite obvious from the nature of the work that the matters which are treated of in it had never been methodized by the author. Certainly then, as proposed by Desmair, it would be a much more natural arrangement to give the four Constitutions of the season first, and then to give the forty-two cases together. But the present arrangement being of old standing, no editor has thought himself warranted to depart from it.

There are two important professional subjects of which it may appear surprising that there is no mention in the “Books of the Epidemics,” I mean sphygmology and contagion. Galen repeatedly declares it as his opinion, that Hippocrates paid no attention to the characters of the arterial pulse, and that the subject was not at all studied until after his time; and as far as I can see there is no ground for calling in question this opinion of Galen. Herophilus, in fact, would appear to have been the first person that made any progress in this study. It is more remarkable that Hippocrates should omit all allusion to the other subject, more especially as the contagiousness of certain diseases would appear to have been the popular belief of his age. Thus his contemporary, Thucydides, in describing the plague, expresses himself in such terms as puts it beyond a doubt that he regarded the disease as being of a contagious nature. And another contemporary, Isocrates, makes such observations on a certain case of empyema, by which he evidently means phthisis pulmonalis, as to show that it also was regarded as being communicable. How the omission is to be accounted for I do not know, but certain it is that not the least reference to contagion, in any shape, is to be found in any of the Hippocratic treatises.