XVI. Προρῥητικον, α’—First Book of Prorrhetics.
XVII. Κωακὰι προγνώσεις—Coan Prognostics.
These two works are so evidently allied to one another, that I have judged it expedient to treat of them together. The greatest difference of opinion has prevailed among the critics, both ancient and modern, with regard to them. Erotian declares expressly that the “Prorrhetics,” both first and second, are not genuine; and Galen, although he writes a commentary on the first book, complains of the difficulty he experienced in explaining certain vocables of dubious meaning contained in it,[172] and elsewhere states that the treatise is composed of extracts from the “Prognostics,” “Epidemics,” and “Aphorisms.” Foës is almost the only modern scholar of any note who stands up for the genuineness of the first book of the “Prorrhetics;” and it is decidedly rejected by Grimm, Ackerman, Haller, Littré and nearly all the other modern authorities. The “Coacæ Prænotiones” have very little ancient authority in their favor, and even Foës rejects the work with greater disdain than it would seem to merit. Of late years, the opinion has gained pretty general assent that these two treatises are more ancient than the days of Hippocrates;[173] that, in fact, they constitute the materials out of which he composed the “Prognostics,” and are the results of the observations made by the priest-physicians in the Asclepion, or Temple of Health, at Cos. This idea is followed out with great ability by Dr. Ermerius, in his “Specimen Historico-Medicum Inaugurale de Hippocratis doctrina a Prognostice oriunda,” where, by a most ingenious and convincing process of comparison, he appears clearly to make out that the “Coacæ Prænotiones” are formed from the first book of the “Prorrhetica,” and the “Prognostics” from the “Coacæ Prænotiones.” These positions, I repeat, he seems to me to have established most satisfactorily, and I cannot hesitate to declare it as my opinion that Dr. Ermerius has thereby thrown great light on this department of the Hippocratic literature. M. Littré has justly appreciated the labors of Dr. Ermerius, and adopted his views without reserve. (v. i., p. 351.) As I shall have occasion to compare the contents of these two treatises now under consideration with the subject-matters of the “Prognostics” in my Argument to the latter, I shall confine myself at present to a few observations, selected in a good measure from M. Littré’s argument to the “Coacæ Prænotiones.”
In the first place, M. Littré makes some interesting remarks on vomicæ of the chest after pneumonia and pleurisy; but this subject will come to be treated of in the notes on the “Prognostics.” He next gives some important observations on the following passage in the “Coacæ Prænotiones,” § 418: “All sprains are troublesome, and cause intense pains at the commencement, and in certain cases occasion after-consequences; the most troublesome are those about the breast, and the most dangerous are those in which there is vomiting of blood, much fever, and pain about the mammæ, chest, and back; when all these occur, the patients quickly die; but in those cases in which they do not all occur, nor are severe, they are longer protracted; the inflammation at farthest is protracted to forty days.” He relates, in illustration of this passage, a case very much in point, from the “Journal de Médecine,” Juillet, 1843, of a healthy person who, in lifting a log of wood, strained the parts about the chest so as to experience a cracking sensation about the breast; it was followed by intense inflammation, which, in spite of plentiful depletion, ended in an empyema which opened by the fifth intervertebral space. The patient recovered. This case is a good illustration of a species of accident frequently described in the Hippocratic Collection. He then briefly considers the question whether or not Hippocrates was acquainted with the croup, on which he does not give any decided opinion. In my opinion, the term croup is now used in a vague sense, being applied to cases of angina, in which the inflammation spreads down to the glottis and trachea, and also to cases of bronchitis attended with a croupy cough. I am confident that pure cynanche trachealis, that is to say, acute disease originating in the trachea, is of very rare occurrence, at least, it certainly is so in the north of Scotland. That the ancients were well acquainted with that species of cynanche in which the disease spreads down to the windpipe there can be no doubt. See the Commentary on §§ 26, 27, Book III., of Paulus Ægineta. It may reasonably be doubted whether they were not fully as well acquainted with diseases of the fauces and windpipe as the moderns are.
M. Littré’s observations on sphacelus of the brain do not at all accord with the opinions of Dr. Coray,[174] nor with those advanced in the Commentary on Paulus Ægineta, B. III., § 7. He thinks that Hippocrates meant by it necrosis of the cranium. Although I still so far adhere to my former opinion that by sphacelus was generally meant ramollissement of the brain, I must admit that some of the passages in the Hippocratic Collection, where it is described, would bear out M. Littré’s ideas regarding it. On the subject of sphacelus, see “De Morbis,” near the beginning.
M. Littré draws, from a variety of sources, much interesting matter in illustration of § 500 of the “Coacæ Prænotiones:” “Amaurosis is produced by wounds in the eyelash, and a little above it; the more recent the wound, they see the better; but when the cicatrix becomes older the amaurosis increases.” Plattner[175] held that in this case the amaurosis is connected with lesion of the frontal nerve. Beer[176] shows that the affection of the sight is not connected with injury of the nerve, but is rather the result of concussion of the ball of the eye. Walker, and Littré himself, are rather disposed to question altogether the truth of the statement made by Hippocrates.
M. Littré concludes his argument with some observations on the lethargus of the ancients, which he holds, and correctly, as I think, to be a pseudo-continual fever. My own opinion, as delivered in the Commentary on Book III., § 9, of Paulus Ægineta, will be found to be very similar. Lethargus is there stated to have been a species of remittent fever, resembling the causus. M. Littré, further in illustration of this subject, gives from the works of Mr. R. Clark, an English physician at Sierra Leone, an interesting account of a sleepy-dropsy, to which the Negroes there are subject.
The greater part of the contents of these treatises are mixed up by Clifton with his translation of the “Prognostics;” and Moffat gives a complete translation of this book of the “Prorrhetics.” The latter, like all the other translations by the same hand, is utterly worthless. Clifton is only culpable for having introduced confusion into the contents of works which had been so admirably arranged by Hippocrates.
XVIII. Προῤῥητικόν, β’—The Second Book of Prorrhetics.
The reception which this work has met with from the critics, ancient and modern, appears rather singular. Erotian and Galen, who, in general, are too facile in admitting the claims of suspected works, in the present instance reject a work which many modern authorities acknowledge as genuine; as, for example, Haller, Gruner, Grimm, and, with certain qualifications, Ackerman and Kühn. I must say, however, with Foës, Littré, and Greenhill, that I cannot see how we can consistently recognize as genuine a work which has so large an amount of ancient authority against it, and none in its favor. At the same time, all must admit that the treatise in question contains nothing unworthy of the name of Hippocrates, and that, if estimated by the value of its contents, it is one of the most important works in the whole Collection. I will, therefore, give an abstract of its contents, along with my translation of the “Prognostics.” It is deserving of much attention, as being the only work we possess which gives us an insight into the method taken by the ancient physicians to gain the confidence of their patients by their mode of conducting the preliminary examination of every case. In my younger days I knew an old physician, who was an adept in this art of conciliating the confidence of his patients by anticipating their histories of their own complaints.