[618] According to Galen, in his Commentary on this passage, the setting of the Pleiades takes place fifty days after the autumnal equinox. See the Argument to the treatise On Airs, etc.
[619] We have already stated that the ardent fevers or causi, of which repeated mention is made in the Hippocratic treatises, were fevers of the remittent type, in short that they were the same as the bilious remittent fevers of Pringle and Monro.
[620] I need scarcely say that the disease here described is cynanche parotidæa or parotitis. It is a remarkable proof of our author’s talent for observation, that he has pointed out the tendency of the disease to be complicated with swelling and inflammation of the testicles. Altogether the description of the disease here given is quite applicable to the mumps of modern times. As stated by him, the swelling of the testicles is generally painful. See the Commentary of Galen.
[621] On reference to Galen’s Commentary it will be seen that anciently the reading of this passage was reckoned equivocal. According to one of the readings, the meaning is that those who were sick did not require to come to the Iatrium for advice. See also Littré’s annotations on this passage.
[622] Galen thinks our author expresses himself confusedly in this place, but Littré justly defends him from this charge. According to Littré, Hippocrates means that those who had been long affected with consumption (the term used, ὑποφθειρομένων, rather signifies had obscure symptoms of consumption), then betook themselves to bed; but those who were in a doubtful state, then first manifested signs of confirmed phthisis; and, finally, that there were some who then for the first time felt the attack of phthisis, and that these were persons who were predisposed to it. According to Galen, the phthisical constitution is marked by a narrow and shallow chest, with the scapulæ protuberant behind like wings; and hence he says chests of this construction have been named alar. He further states that there are two forms of consumption, the one originating in a defluxion from the head, and the other being connected with the rupture of a vessel in the lungs. I may be allowed to mention in this place, in confirmation of our author’s accuracy of observation with regard to the connection of hemoptysis with phthisis, that Louis found hemoptysis to a greater or less extent in two thirds of his cases. (Researches on Phthisis, p. 166, Sydenham Society edition.) The same author relates several cases in which death occurred suddenly and unexpectedly, as Hippocrates states to have happened to some of his patients. (Ibid.)
[623] I am of opinion that the species of phthisis noticed in the latter part of this section was the acute form of phthisis described by Louis (p. 351). Our author, it will be remarked, states that his patients were mostly delirious when near death. Louis, in like manner, mentions delirium in, I believe, every one of the cases of acute phthisis which he relates. Galen justly remarks, that, in the ordinary forms of phthisis, delirium is not a common symptom. I would also call attention to our author’s observation regarding the inflamed state of the fauces, which is also amply confirmed by the observation of Louis in this form of phthisis.
[624] The nature of the continual fevers of the ancients is fully explained in the Commentary on the twenty-seventh section of the Second Book of Paulus Ægineta. Galen, in his Commentary on this passage, marks their nature very distinctly in few words. He says that such fevers as have an exacerbation of fever ending in complete apyrexia are called intermittents, whereas such as do not end in a complete remission of the fever are called continual. See further De Diff. Febr., ii., 2. In a word, the continual fevers were decidedly of the remittent type. See further Donald Monro’s work on Army Diseases, in the beginning of the chapter on the Bilious Remittent Fever.
[625] The introduction of phthisis in this place has created some difficulty in the interpretation, as may be seen on reference to Galen and Littré. Galen gives a very interesting account of the way in which interpolations often took place. (Opera, tom. v., p. 356.)
[626] The text of this last sentence is in an unsettled state. The following would be a translation of it as it stands in the Basle edition of Galen’s Works: “Of all the cases described under this constitution, those alone which were of a phthisical character proved fatal. But they (the phthisical affections?) did not supervene upon the other fevers.” Provided this be the true meaning of the passage, it would merit great attention, as seeming to contain a declaration that intermittent fevers superinduced an immunity to phthisis. I need not say that this supposed fact has been exciting a great deal of interest lately in the profession, more especially in France.
[627] It is to be borne in mind that the autumn began with the rising of Arcturus, and ended with the setting of the Pleiades. The setting of the Pleiades then indicated the commencement of winter. The classical reader will find the different seasons, strikingly defined by the rising and setting of the stars, in Virgil’s Georgics. See in particular Georg. i., 221.