[717] Galen, in his Commentary, makes the remark that he observed the same symptom in the plague which raged in his time.
[718] It will readily be understood that a colliquative diabetes would prove a very unfavorable complication of these complaints.
[719] By nocturnal fevers, according to Galen, was meant quotidians, which had their paroxysms during the night. Foës inclines to think that diurnal should also be inserted in this place. These nocturnal fevers are thus described by D. Monro: “The sick were restless and uneasy at night; but commonly felt themselves cooler and lighter in the daytime: and although they had no cold fit, as the fever came on at nights, and many of them no breathing sweat, as they became cooler and freer from the fever in the morning; yet the fits were so remarkable, that many of the patients used to say that they had a regular fit of an ague every night, and some few that they had the fit every second night.” (Army Diseases, etc., p. 158.)
[720] The account of the origin and progress of consumption here given is, upon the whole, wonderfully correct. Common experience seems to have decided that spring and autumn are the most fatal seasons to phthisical patients. Avicenna makes the remark, which is very important, and deserves to be kept in mind, that by phthisis, in this place, Hippocrates most probably meant hectic fever, connected with disease of the internal viscera, which had been in an inflamed state during the acute attack of the fever. (iii., 1, 3, 67.)
[721] I shall not enter into a discussion of the different readings of this interesting passage. I may mention that our great pathological authority on phthisis, Dr. Louis, agrees with Hippocrates in deciding that the lymphatic temperament constitutes a more or less marked predisposition to the development of phthisis. (p. 483.) Galen describes the phlegmatic temperament as being attended with a soft and slightly tumid skin. He attributes the disease in their case to a cacochymy, that is to say, to cachexia. I need scarcely remark that this opinion is strongly advocated by one of the highest authorities of the day, I mean Sir James Clark. See his treatise on Tubercular Phthisis. Galen gives a discussion on the color of the eyes, about which there is some difficulty, as the ancient terms which relate to colors are not very well defined. The term here used (χαροπὸς) may signify either blue or gray. Galen considers this color of the eyes as a symptom of a cold and humid temperament.
[722] There is an ambiguity in the part of the sentence which relates to women, as Galen states in his Commentary. Galen does not hesitate to declare that women are more subject to phthisis than men, an opinion upon which modern authorities are not at all agreed. See the recent publications of Louis and Clark on Phthisis.
[723] The last paragraph, and the latter clause of the preceding one, were at first attached to the end of the subsequent cases, and were transferred to their present position by Dioscorides the commentator a short time before Galen. They evidently embody a most distinct and admirable enumeration of the general facts with which the practical physician ought to make himself acquainted.
[724] We learn from the Commentary of Galen that some of the older critics supposed that the sixteen cases about to be related had been selected by Hippocrates in illustration of his doctrines, as laid down in the preceding description of what is generally entitled the Pestilential Season. Galen, however, does not incline to this opinion.
[725] This is an example of one of those protracted fevers of an intermittent type, which, as I have been informed by an intelligent physician who practiced for several years in the Ionian Islands, are so common in the climate of Greece. There is not much of any particular value in Galen’s Commentary on this case. He informs us that one of the older commentators absurdly maintained the opinion that the country of this patient was given because, according to Asclepiades, the inhabitants of Paros were most especially benefited by bleeding. But, as Galen says, this remark is particularly out of place here, since no mention of venesection occurs in the report. Galen, and after him Foës, have given very lengthy and elaborate disquisitions on the nature of oily urine. The result is, that it is an unfavorable, but not necessarily a fatal, character. It is minutely described by the later authorities on urology, namely, Theophilus and Actuarius. See also the Commentary on Paulus Ægineta, Book II., 14, Sydenham Society’s edition.
[726] This appears clearly to be a case of fever, complicated with, but not produced by parturition. Galen, however, seems to ascribe the fever and its fatal results to the retention of the lochial discharge. The characters of the urine, he properly remarks, are unfavorable, being copious, thin, and black. He also calls attention to the want of proper concoction in the sputa, to which he attributes the fatal relapse.