[695] In Galen’s Commentary on this case there is not much of any great interest to the professional reader of the present day. He animadverts again on the omission of all mention of the treatment, although, as he states, venesection and the other usual means had no doubt been tried; indeed the report implies as much. Hippocrates, he repeats, never thinks of mentioning the usual routine of practice, as he takes it for granted that the reader will understand that it was not neglected. It is only on special occasions, then, that he thinks of making any particular reference to the treatment. Galen remarks, that ileus being an inflammation of the upper intestines, is a particularly dangerous affection.
[696] As remarked by Galen in his Commentary, this was no doubt a case of ardent fever or caucus, complicated with an incidental miscarriage. There is no reason for looking upon it as being a case of puerperal fever. Galen thinks that the last word (caucus) is an addition made by the copyists, having been transferred from the Glossarium to the text in the course of transcription. Galen, as usual, directs attention to the characters of the urine, which in this case are particularly unfavorable, being defective both in quantity and quality.
[697] Galen’s remarks on the circumstances of this case are sufficiently to the purpose, but there is nothing very striking in them. He states that the abortion may have been occasioned either by external causes—such as the application of pessaries for this purpose, and the like—or internal, such as hemorrhage from the neck of the uterus. and so forth. As in the former case, he pronounces the last word (phrenitis) to be an addition to the text, as Hippocrates never enters upon the diagnosis of diseases, as is done in the work On Diseases. I suppose he means that our author’s real works are all founded on Prognosis; whereas the other, being derived from the Cnidian school, is founded on Diagnosis. See our observations on this subject in the Preliminary Discourse, and the Argument to the Prognostics.
[698] Galen remarks, that with such a combination of fatal symptoms, namely, coldness of the extremities, fetid vomiting, etc., it is wonderful that this patient stood out until the fourteenth day. He thinks, however, that this is to be explained from her age and constitution. He justly remarks that the occurrence of the epistaxis could not be supposed sufficient to carry of such a combination of unfavorable symptoms. He once more protests against the last word of the report (causus) being admitted as genuine. He confesses himself unable to determine whether “The Liars’ Market” was in Athens or elsewhere.
[699] This is entitled the pestilential constitution by Galen. By constitution, he explains, is meant not only the preternatural state of the atmosphere, but also of everything else which influences the state of the general health.
[700] Galen remarks, that in the First Book of the Epidemics three constitutions of the year are described and also that others are described in the Second Book; but that these are not carefully drawn out for publication like those of the First and Third. He further remarks on this head, that the constitution of the season might prepare us for the putrid diseases, which are described below, as heat is the active, and humidity the material, cause of all putrefaction.
[701] Galen remarks that erysipelas is occasioned by a bilious defluxion, but that it is not always of a malignant and putrid nature; on the contrary, when the defluxion is mild, and the bile which produces it is natural, it is not attended with any considerable injury to the body, if properly managed; but that the humor which produced the erysipelas about to be described was not such, but of a malignant, corrosive, and septic nature, being engendered by the humid and calm state of the weather in such persons as were of a choleric constitution.
[702] According to Galen, aphthæ in general are superficial ulcerations in the mouth, produced by the acrimony of the nurse’s milk, and which are easily removed by an astringent application. But in the present instance the aphthæ were of a malignant nature.
[703] The carbuncle (anthrax), Galen says, is always dangerous, and the product of bad humors. See Paulus Ægineta, Vol. II., pp. 78, 79. Galen, in his excellent work On the Difference of Fevers, writes thus: “In constitutions of the year, similar to those which Hippocrates describes as taking place in Cranon (See Ep. ii.). I have known cases of anthrax prevailing epidemically in no few numbers, the formation and other symptoms of which were exactly as described by him.” (Tom. vii., p. 293; ed. Kühn.)
[704] Galen explains under this head that the term epidemic is not applied to any one disease, but that when many cases of any disease occur at the same time in a place, the disease is called an epidemic; and that when it is remarkably fatal it is called a plague.