CHAPTER VIII. Brief Extracts From Some of the Hippocratic Writings

BRIEF EXTRACTS FROM SOME OF THE HIPPOCRATIC WRITINGS

The statements which have thus far been made in these pages with regard to Hippocrates are only of a general character, and it may therefore be interesting for the reader to have placed before him a few selected extracts from the writings which have formed the basis of these statements. The English text here used is a translation of the German version of Robert Fuchs, to which reference has already been made. It would have been a pleasure to use for this purpose the admirable English translation of Frederick Adams, published in 1849 under the auspices of the Sydenham Society of Great Britain; but, unfortunately, this version contains only a part of the Hippocratic writings, and, besides, this writer did not at that time have the advantage of consulting the French and German versions which have been published since 1849.

It seems almost unnecessary to state here, by way of preface, that the small amount of space which may properly be devoted to these extracts renders it necessary to present many of them in a very fragmentary and disconnected form, merely enough text being furnished to give the reader some slight idea both of the manner in which Hippocrates and those associated with him handled certain medical topics, and also of the views which they entertained with regard to the same subjects.

BRIEF EXTRACTS FROM SOME OF THE HIPPOCRATIC WRITINGS

Aphorisms.--I.--1. Life is short, art is long, the right moment lasts but an instant, experience is often deceptive, a correct judgment is hard to reach.

6. For the most serious ills extreme measures cautiously employed are the best.

8. When an illness has reached its acme the lightest diet must be prescribed.

11. During the exacerbations nourishment should be withheld, for at these times the giving of food is harmful; and in illnesses which are characterized by periodic paroxysms it is also best not to give food during the paroxysms.

13. Old people bear fasting very well, and the same is almost true of persons of mature age; but young individuals do not bear abstinence from food so well, and this is particularly the case with children, especially with those of a lively disposition.

24. In acute illnesses laxative remedies should rarely be administered, and then only in the early stage of the malady and with great caution.

II.--2. When sleep puts an end to delirium it is a good sign.

3. When either sleep or wakefulness oversteps the proper limit it is harmful.

5. Causeless depression is an indication of some disorder.

19. In acute diseases the prognosis as regards either death or recovery, is very uncertain.

44. Corpulent persons are more likely than those who are slender to die a quick death.

V.--7. When epileptic attacks occur before the age of puberty, a change for the better may be looked for; but if the disease makes its first appearance when the individual has already reached his twenty-fifth year, he may be expected to carry the affliction with him to the time of his death.

9. Consumption most commonly attacks persons who are between the ages of eighteen and thirty-five.

14. When a consumptive person has attacks of diarrhoea, a fatal issue may be anticipated.

VII.--1. If in the course of an acute illness the extremities grow cold, it is an unfavorable sign.

14. If, after a blow upon the head, stupefaction or delirium manifests itself, the outlook is bad.

The Book of Prognoses.--1. I believe that it is best for a physician to acquire a certain degree of practice in the power to predict how the disease is likely to terminate; for if, when he is in the presence of his patient, he is able to state, not only what is going to take place in the future course of the malady, but also certain other facts which relate to the past behavior of the attack, but which were omitted from the account given to him of the previous history of the case, he will impress the patient with the belief that he is thoroughly familiar with the disease from which the latter is suffering, and that consequently he is a physician in whose knowledge and skill he can place entire confidence. Then, besides, he will be the gainer in another respect: his knowledge of what is likely to be the subsequent course of any given disease will enable him to treat it in the most effective manner. The ability to restore all his patients to health would of course be a greater power than that of correctly predicting the future behavior of a malady in any particular case. This ability, however, is clearly unattainable. One patient dies by reason of the severity of the disease itself, even before the physician is called in; a second one, shortly after the latter’s visit; and a third lingers on for a day or two after the doctor’s arrival, dying before the latter’s art has had time to produce a beneficial effect in hindering the advance of the malady. The observation of these different events should enable the physician to become acquainted with the nature of the diseases observed, and--more particularly--to learn to what extent, in individual instances, they manifest a strength greater than the patient’s power of resistance. At the same time, he must not forget that in many cases divine interference plays a part in directing the course of the disease. And thus, if he pays heed to all these things, the physician will merit the confidence of his patients and will gain the reputation of being a clever and skilful practitioner.

IV.--It is better when the physician, upon the occasion of his first visit, finds the patient lying upon one side, with his hands, neck and thighs slightly flexed, and the entire body placed in a perfectly natural position, like that which a man assumes in bed when he is in a state of health. It is not so well when the physician finds the patient lying upon his back, with his hands, neck and thighs extended. But if the latter is found curled up and sliding down toward the foot of the bed, this is an unfavorable sign. Finally, if he is found with rather cold feet projecting from under the bedclothes, and with his arms outstretched and his neck and thighs exposed, his condition may be considered dangerous, for this attitude of the body betokens an agitated state of the mind. If the patient sleeps with his mouth constantly open, lying upon his back and with his thighs strongly flexed and widely separated, it may be assumed that death is near at hand. If he lies upon his belly when it is known that he was not in the habit of sleeping in this manner before he was taken ill, the inference is warranted either that he is delirious or that he is suffering from pain in the lower part of his abdomen. Finally, if the patient shows an inclination to maintain a sitting posture while the malady is still in an active stage, this feature must be looked upon as a grave symptom and especially so in inflammation of the lungs.

XIV.--Pus that has a whitish color and a uniform consistency, that is smooth and free from clumps, and the odor of which is only slightly unpleasant, is the least harmful. On the other hand, a pus which possesses the opposite characteristics is very dangerous.

XL.--Severe pain in the ear, if associated with a persistent fever is dangerous, for the patient may become delirious and die.

The Epidemic Diseases.--VI.--4. The wife of Agasis had already as a young girl been troubled with shortness of breath. After she had reached womanhood, and soon after she had given birth to a child, she lifted a heavy weight. Immediately she heard, as she believed, a noise in her chest, and on the following day she experienced some difficulty in breathing and a certain amount of pain in her right hip. These two symptoms were so related to each other that, whenever the pain in the hip made its appearance, she immediately became conscious that she was short of breath, and, vice versa, whenever the pain ceased, she found that her breathing became easier. Her expectoration was of a foamy character and of a rather bright color, but, after it had been allowed to stand for a short time, it looked like diluted biliary matter that had been vomited. The pain in the hip troubled her chiefly when she performed manual work. She was advised to abstain from eating garlic, pork, mutton, and beef, and not to call loudly or to get excited while she was engaged in work.

VII.--7. The wife of Polycrates became feverish during the summer season, and about the time of the dog star. In the morning her breathing was somewhat embarrassed, but after mid-day it became more difficult and at the same time more rapid. From the very beginning of the illness she had a cough and expectorated purulent masses. In the throat and along the course of the trachea one could hear a hoarse whistling sound. The patient’s face had a healthy color, and over the two halves of the jaw there was some redness, not of a deep hue but rather fresh and bright. A little later her voice also became hoarse, she began to show some emaciation, raw spots developed over the fleshy parts of her hips, and the surface of the body grew more moist than it had been before. On the seventieth day the outward evidences of fever became much less noticeable, but the respiration grew more rapid; and from that day to the time of her death, five or six days later, she was obliged to remain in a sitting posture. Toward the end the tracheal râle grew louder, and dangerous sweats occurred, but the patient never lost her expression of intelligence.

Fractures.--II.--9. In the human body the foot, like the hand, is composed of a number of small bones. As they are not easily broken it may safely be assumed, when such a case of fracture comes under observation, that some pointed or unusually heavy object had caused the lesion, and that the surrounding soft parts must necessarily have been injured at the same time. (Injuries of this nature will be discussed in a later section.) But if any part of this bony framework is pushed out of its natural position--whether this take place in one of the toes, or in one of the tarsal bones, it makes no difference--the dislocated part should be forced back into position in the manner recommended in section XXIV. In its essential features the treatment consists in the employment of wax plaster, compresses, and bandages, exactly the same as is done in the treatment of fractures of the long bones, but without splints. The same rules hold good with regard to the degree of pressure to be applied, and every third day the dressings should be renewed. On each occasion of such renewal the patient should be questioned with regard to the sensations which he feels after the bandages have been applied, and if necessary they should be readjusted in accordance with the nature of the answers which he gives. The great majority of these injuries heal completely in twenty days. The exceptional cases are those in which the fracture] involves a bone that stands in immediate relation with the bones of the leg. It is advisable, however, that the patient should remain in bed during the period mentioned; for, in not a few instances, the persons thus affected, failing to appreciate the gravity of the injury, walk about before the parts have really healed; and then, for an indefinite period of time, they are frequently reminded in a painful manner of the injury which they received. There is nothing astonishing in this when the fact is recalled to mind that the feet support the entire weight of the body.

Wounds of the Head.--10. The physician should, first of all, before touching the patient’s head, inspect carefully the wound and surrounding parts. After noting whether the injury has been inflicted upon a strong or a weak portion of the head, he should ascertain whether the hair has been cut by the fall or the blow, and whether portions of it have penetrated into the wound. In the latter event he should express his fear that the skull at this point has been laid bare and has perhaps even received some material injury. He should make this statement before he has touched or probed the wound. Then afterward he should proceed to a physical examination of the injured parts, in order that he may learn positively whether the overlying soft tissues have or have not been separated from the bone. If simple inspection reveals the fact that the skull has been laid bare, well and good; but, if the real condition is not thus revealed, he should not hesitate to employ the probe. If he finds that the soft parts have been separated from the bone and that the latter has been more or less injured, he should continue this more minute exploration until he shall have ascertained to just what extent and in what manner the skull has been injured, and what measures are required to remedy the damage; in brief, he should make the diagnosis. At the same time, however, he should not neglect to question the patient very closely about the manner in which the wound was inflicted, for in this way he may be able to infer the existence of a contusion, or even a fracture of the skull, of which no material evidences are discoverable. Important information may also be gathered by passing the hand over the seat of injury in the bone,--information which the employment of the probe is not competent to convey.