[490] A small portion of the above occurs in the Coacæ Prænotiones, 578.
[491] For part of this our author is indebted to the Coacæ Prænotiones, 580.
[492] See Coacæ Prænotiones, 582.
[493] This is partly taken from the Coacæ Prænotiones, 577.
[494] Galen, in his Commentary, justly praises Hippocrates for the acuteness of the remark contained in this sentence, since both with regard to the urinary and fecal discharges, it must be highly important to determine whether their characters be indicative of the condition of the general system, or of the viscus by which they are secreted. (Opera, v., p. 142; ed. Basil.) The ancients paid great attention to the characters of the urine in disease, and their knowledge of the subject will be admitted, even at the present day, to have been remarkable. The works of some of the later authorities, particularly of Theophilus and Actuarius, are well deserving of an attentive perusal. See Paulus Ægineta, Vol. I., p. 225.
[495] This is partly taken from the Coacæ Prænotiones, 556.
[496] These characters of the sputa are partly borrowed from the Coacæ Prænotiones, 390, 399.
[497] They are founded on the Coacæ Prænotiones, 390, 391.
[498] This is taken in part from the Coacæ Prænotiones, 302, 304. The succeeding paragraphs on empyema are also partly derived from the Coacæ Prænotiones, 393, 402, 428. I may be allowed to remark in this place that modern pathologists are agreed that abscesses after pneumonia are of rare occurrence; at the same time, however, purulent infiltration and its natural consequence, expectoration of pus, are not so very uncommon results of the disease. True pulmonary abscess or empyema is commonly occasioned by chronic inflammation. I am inclined to think that the ancients applied the term also to the cavities in the lungs produced by the softening of tubercles. It is difficult otherwise to account for the frequent mention of empyemata in the works of the ancient authorities on medicine, especially in the Hippocratic treatises. See De Locis in Homine, p. 415, ed. Foës; and tom. i., p. 306, ed. Kühn, et alibi. M. Littré makes the following remarks on the descriptions of empyema which occur in the Hippocratic treatises: “On remarquera dans le Pronostic, et cette remarque s’étend à plusieurs autres des écrits Hippocratiques, qu’une très-large place est faite aux affections de la poitrine, péripneumonies et pleurésies. Il paraîtrait que, sous le climat de la Grèce, ces affections ont une grande fréquence, plus peut-être qu’elles n’en ont même dans notre climat. La description, fort abrégée il est vraie, qu’en donne Hippocrate, me porte à penser que, si cette description est exacte, elles ne suivent pas la même marche que parmi nous. En effet, que sont ces empyèmes que, suivant Hippocrate, se font jour an dehors sous forme d’expectoration purulente? On peut croire, que dans les dénominations d’empyèmes sont compris les épanchements pleurétiques; mais les épanchements pleurétiques ne se font pas jour au dehors, ils se guérissent par résorption; alors, que sont ces empyèmes signalés par Hippocrate, comme terminaison des péripneumonies, et ces expectorations qui en procurent l’evacuation? Il m’est impossible de répondre à ces questions: peut-être des observations faites dans la Grèce même, permettraient de résoudre la difficulté.” (Œuvres Complets d’Hippocrate, tom. ii., p. 97.) Perhaps, as I have hinted above, the most probable answer that could be returned to the questions put by M. Littré would be, that many of the cases of pneumonia terminating in empyema, which occur in the Hippocratic treatises, were what are now described as cases of acute phthisis. See Louis on Phthisis, ii., 2. In confirmation of my supposition that many of the cases of empyema described by the ancients were, in fact, cases of phthisis, I would refer to Paulus Ægineta, B. III., 32, where it will be seen that the two diseases, phthisis and empyema, are treated of under the same head. See also the second book of the Prorrhetics, tom. i., pp. 198–201; ed. Kühn.
M. Littré reverts to this subject in the Argument to the Coacæ Prænotiones, tom. v., p. 576, where he relates, from two recent authorities, a case of empyema after pleurisy, and another after pneumonia, in both of which the pus was evacuated by the mouth. He also quotes the remark of an English writer, Dr. Twining, that, in and about Bengal, abscess of the lungs after pneumonia is by no means very rare. Still M. Littré admits that the paucity of such cases in modern works must lead to the conclusion either that Hippocrates had not observed correctly, or that this termination is more rare now than formerly. I leave the reader to judge whether my suggestion stated above does not remove this difficulty.