[470] This graphic description of the movement of the hands in delirium is nearly original, being but slightly touched upon in the Coacæ Prænotiones, 76. The terms are copied by most of the ancient authors subsequent to Hippocrates, in their descriptions of phrenitis and febrile delirium. See in particular Paulus Ægineta, Book III., 6. Stephanus, in his Commentary, has several very philosophical remarks on this passage, namely, upon the rationale of the ocular deception which leads to these extraordinary movements of the hands. (Ed. Dietz, t. i., pp. 103, 104.)
[471] This is imitated pretty closely from the Coacæ Prænotiones, 260. Dr. Ermerins remarks that there is a greater number of symptoms in the Prænotiones than in the Prognostics. He therefore suggests the question whether there may not be a lacuna in the text. The description of the respiration preceding dissolution in the Prænotiones is certainly most graphic, and it appears wonderful that it should be omitted by Hippocrates in the Prognostics.
[472] The paragraph on sweats is founded on the Coacæ Prænotiones, 572, 573; but the Prognostics is much fuller than the other. The cold sweats described in this paragraph were called syncoptic by the ancients, and were supposed to be connected with atony of the pores of the skin. See Galen, h. 1., and De Causis Sympt. iii., 9. Stephanus, with rather too much logical parade, gives a good many acute and interesting remarks on this passage. He says that cold sweats are connected with a complete prostration of the innate heat (calidum innatum). (p. 114.)
[473] The characters of the hypochondriac region are copied in part from the Coacæ Prænotiones, 279, 280, 282; but they are much improved in the Prognostics. It will be remarked that in the Epidemics great attention is paid to the state of the hypochondria. Stephanus remarks that pulsation or palpitation in the hypochondria is caused by violent throbbing of the aorta as it passes through this region, which is occasioned by the effervescence and inflammation of the important parts which are situated in it, and with which the brain is apt to sympathize. (p. 118.) Meteorism of the hypochondriac region is often mentioned in the reports of the cases described in the Epidemics.
[474] The author evidently alluded to hepatitis ending in abscess. This would seem to have been a very common termination of inflammation of the liver in Greece, as it is often described in the ancient medical works. See Paulus Ægineta, B. III., 46, and the authorities quoted there in the Sydenham Society’s edition.
[475] The paragraph on the prognostics relating to dropsies is founded in a great measure on the Coacæ Prænotiones, 454. The ancient writers who treat systematically of dropsy generally describe four varieties of it, namely, dropsy from disease of the liver, from disease of the spleen, from fever, and from a sudden draught of cold water. See De Morbis, and Paulus Ægineta, B. III., 48, Sydenham Society’s edition.
[476] On this variety I have remarked in the Comment. on Paulus Ægineta: “Hippocrates refers one species of dropsy to disease of the parts situated in the loins, by which Galen and Stephanus agree that he means the jejunum, mesaraic veins, and kidneys.” (Paulus Ægineta, l. c.) M. Littré accordingly holds it probable that allusion is made to granular degeneration of the kidneys, that is to say, to Bright’s disease. (Opera, etc., tom. ii., 388.)
[477] Dr. Ermerins remarks that the species of dropsy here described was most probably connected with organic disease of the parts situated in the abdominal region, arising from inflammation with which they had been previously attacked.
[478] This paragraph is pretty closely taken from the Coacæ Prænotiones, 492. A good deal of stress is laid upon the state of the temperature of the extremities in the reports of the febrile cases contained in the Epidemics. He announces it as a general truth that coldness of the extremities in acute diseases is bad. (Aphor. vii., 1.) Sprengel considers that he has stated this fact in too general terms, as there are many exceptions to it. (Hist. de la Méd., tom. i., 317.)
[479] This is taken in part from the Coacæ Prænotiones, 493. Sprengel finds great fault with Hippocrates for laying it down as a rule, that in cases of gangrene a black color of the part is less dangerous than a livid. Dr. Ermerins, however, espouses the side of Hippocrates, and maintains that our author has acutely pointed out the difference between gangrene proving critical, and gangrene connected with weakness of the vital actions in the part. In the former case the part becomes perfectly black, whereas in the other it is livid. He mentions that he observed in an hospital at the same time a case of mortification from cold, and another of the same from want and congelation; that in the former the part was black, and the patient recovered; whilst in the other the arms were livid, and the patient soon died. (Specimen Hist. Med., p. 68.) Stephanus, by the way, gives nearly the same explanation of this remark. (p. 142.) Perhaps our author had in view the plague of Athens, in which the disease often terminated favorably in mortification of the fingers or toes. (Thucyd., ii., 49.)