This little piece is noticed by Erotian, and admitted as genuine by M. Littré, but Mercuriali, Gruner, Ackerman, Kühn, and Greenhill incline to reject it. It is well written, but the style is rather too scholastic for the age and taste of the great Father of Medicine. At the same time, it has so many points of accordance with “The Oath,” that it seems inconsistent to admit the one as authentic and reject the other as spurious.
XIII. Κατ' ἰητρεῖον—On the Surgery.
All the ancient commentators which have come down to us, such as Erotian, Galen, and Palladius, admit it to be genuine; but it would appear from Galen that some of the older commentators were not satisfied upon this point, some doubting whether it was the production of the great Hippocrates or of Thessalus, and some referring it to Hippocrates, the son of Gnosidicus.[157] It is received also by Foës, Gruner, and, after a good deal of hesitation, by M. Littré. Schulze expresses himself on this point doubtfully,[158] and the work is rejected by Grimm, Ackerman, and Kühn. Beyond all doubt, it is a compendium of the treatises “On Fractures” and “On the Articulations,” so that, whether the composition of Hippocrates himself or not, there can be no question that the subject-matter of it is derived from him. Galen appears to have been remarkably fond of this treatise, and makes frequent reference to it in his great work “On the Dogmata of Hippocrates and Plato.” It would appear that Diocles, Philotimus, and Mantias had written treatises bearing the same title.
There is some difficulty in determining accurately what was the nature of the ancient Iatrium ιητρεῖον. See an interesting disquisition on this subject in Littré’s edition of Hippocrates, t. v., p. 25. It most probably was an establishment kept by the physician, in which were contained not only all sorts of medicines, but also all kinds of surgical apparatus. Mention of the Iatrium is made by Plato (Legg. iv., p. 720, and i., p. 646; ed. Tauch.) Aristotle is said to have possessed an Iatrium, which, if the story be true, he had no doubt acquired from his father, who was a medical practitioner.[159] From what is stated by Plato, it would appear that the assistants were qualified to administer professional assistance in the absence of their superior, and were also called doctors. (Legg. iv.) So it appears that the modern abuse of this title was sanctioned by classical usage! It must be recollected that, in the time of Hippocrates, eminent physicians were periodeutæ, that is to say, wanderers from place to place, and consequently they would stand in need of such an establishment as we have described the Iatrium to be. See further the Argument to this work.
XIV. Περὶ φύσεως ἀνθρώπου—On the Nature of Man.
Erotian, Galen, Palladius, and Macrobius[160] do not hesitate to quote the doctrines contained in this treatise as being those of the great Hippocrates, but its authenticity has long been considered very questionable, owing to the circumstance that a passage in it of considerable length, relative to the anatomy of the venous system, is quoted by Aristotle[161] as being the production of Polybus, and it is accordingly received as such by Haller,[162] Gruner, Littré, and most of our recent authorities on ancient medicine. Galen, however, contends that the passage quoted by Aristotle is not the work either of Hippocrates or of Polybus, but an interpolation, and that the rest of the treatise is genuine.[163] But Galen, at the same time, admits that Dioscorides, the Commentator (he must not be confounded with the celebrated author of the Materia Medica), had marked the first part of this treatise with the sign of the obelisk, as indicating his suspicion of its being spurious, and that he held it to be the work of Hippocrates, the son of Thessalus, that is to say, of a grandson of the great Hippocrates. But, whatever may be decided regarding its authorship, a careful perusal of the treatise will satisfy any one that it is a piece of patchwork; made up of several fragments, which do not cohere properly together. It certainly also appears to me that many of the philosophical dogmata which are delivered in it do not accord well with the doctrines contained in those treatises which are universally admitted to be genuine.
After alluding briefly to the opinions of those philosophers who held that the human body is formed from the four elements, that is to say, fire, air, water, and earth, the writer proceeds to state his own doctrines regarding the four humors, namely, blood, phlegm, yellow and black bile, and the diseases which are occasioned by the prevalence of one or other of them, according to the seasons of the year, and other circumstances. The doctrines, as herein stated, are very hypothetical, and certainly, as already hinted, not in accordance with those delivered in the genuine works. It is proper to mention, however, that Galen, in several parts of his works, makes Hippocrates to be the author of the theories of the elements and of the humors.[164] The treatise contains certain general truths and rules of practice not unworthy of some consideration, such as this, that diseases are cured by their contraries, that is to say, that diseases arising from repletion are removed by evacuation, and vice versa; and that diseases in general are occasioned either by the food we eat, or the air we breathe, those which prevail epidemically being produced by the latter cause. All sudden changes of diet are held to be attended with danger, and to be avoided. It is also an important rule of practice that, in venesection, blood should be abstracted from a part as distant as possible from the seat of the pain and of the collection of blood. There can be no doubt, in a word, as we have stated in the preceding section, on the authority of Galen, that Hippocrates was well acquainted with the principle of revulsion in the practice of medicine. The natural heat, or, as it is now called, the animal heat, is stated to be greater the younger the body is—a physiological doctrine strenuously advocated by Galen in several parts of his works, but more especially in the treatise “Against Lycus.”[165] The theory of the formation of urinary calculi is also discussed. The same occurs in the treatise “De Aëre,” etc., and in the work “De Morbis” (iv., 28). Allusion is likewise made to the occurrence of substances in the urine resembling hairs.[166] The last fragment of which this treatise is composed relates to fevers, the greater part of which are held to be occasioned by bile. It is said that there are four varieties of them, namely, synochus, quotidian, tertian and quartan; that the synochus is formed from the most intense bile, and comes soonest to a crisis, and the others in the order we have stated them. This is very unlike the doctrines of fever laid down in the genuine works, and accordingly this portion of the treatise was a great stumbling-block to those among the ancient commentators who contended for the genuineness of the treatise.[167] Altogether, then, I must say, that a careful perusal of the work leads me to the conclusion that, notwithstanding the high authorities in its favor, it does not deserve to be received as a genuine production of Hippocrates.[168]
XV. Περὶ διαίτης ὑγιεινῆς—On Diet in Health.
This work is passed over unnoticed by Palladius and Erotian; and Galen, although he wrote a commentary on it which still remains, informs us that some of the elder commentators had assigned it to Polybus, the son-in-law to Hippocrates.[169] He further mentions that it had been variously referred to Euryphon, Phaon, Philistion, and others; ancient authority in its favor is, therefore, very equivocal. The modern critics are pretty unanimous in rejecting it; indeed, Littré, improving on the hint cast out by Galen, does not scruple to refer it and the preceding treatise to Polybus. Though the subject-matters of it are not, in the main, of much importance, it contains some directions for the regulation of the diet, which are by no means injudicious. One of his directions, with regard to clothing, is very different, however, from what we might have expected, considering the fondness of the ancients for the use of oil to counteract the effects of cold.[170] The author of this work directs oily garments to be used in summer, but clean ones in winter. Emetics are recommended to be taken by persons of a gross habit of body, but to be avoided by those who are slender. This rule is expressed by Celsus in the following terms: “Vomitus inutilis gracilibus et imbecillum stomachum habentibus, utilis plenis et biliosis omnibus, si vel nimium se repleverint vel parum concoxerint.”[171] The author of this treatise recommends hyssop as an emetic, and we find its use in this way not infrequently noticed in the Hippocratic treatises, but not in the works of subsequent authorities, as far as I am aware. The work concludes with a passage on diseases of the brain, which also occurs, “De Morbis” (ii.), and seems much out of place here. It is said that they are first manifested by stupor of the head, frequent passing of urine, and other symptoms of strangury; and it is added, that a discharge of water or of mucus by the nose or ears relieves these complaints.
Altogether, considering how slender the evidence is, both external and internal, in favor of the authenticity of this treatise, I can have no hesitation in rejecting it as spurious.