It would appear that this work, although little regarded now, was highly esteemed two hundred years ago, for we find that the celebrated Julius Cæsar Scaliger wrote an elaborate commentary on it.[207] On the “Oneirocritica,” see further Vander Linden, “Manuductio ad Mediciam,” who refers to this treatise of Hippocrates, and also to the works of Scaliger, Ferrer, and Cardanus on the same subject. The only other ancient writers on this subject which have come down to us are Artemidorus, Achmet, Astrampsychus, and Nicephorus.[208] The work of Artemidorus is an elaborate production on the interpretation of all sorts of dreams; and to the sober judgment of the present generation it cannot but be regarded as a memorable instance of the misapplication of human intellect and industry. The whole subject of the “Oneirocritica,” however, may well deserve the serious consideration of the most learned philosopher as affording a most striking and lamentable proof how prone men, even of cultivated minds, are to view things exactly in the light in which they fancy them to exist. This truth is most strikingly illustrated by the work of Artemidorus, who first gives the theory, as it were, of dreams, and in the last book relates particular instances in confirmation of the principles previously laid down by him. No one, assuredly, can rise from the perusal of such a work without being strongly impressed with the great truth embodied in our author’s first aphorism, “Experience is fallacious, and decision is difficult.” The “Oneirocritica” of Achmet is the work of an Arabian, and is interesting as containing all the superstitious notions of the Orientals, that is to say, of the Persians, Egyptians, and Indians, on this subject. Allusion is also made to the dreams recorded in the Jewish Scripture. The author sets out with declaring that, from the interpretation of dreams one may acquire a certain foreknowledge of all the casualties of life, namely, of life or death, of poverty or riches, of disease or health, of joy or sorrow, of victory over one’s enemies or defeat, and this with far greater accuracy than from astronomy (astrology?), for that astronomers differed much in opinion among themselves, whereas about the interpretation of dreams there could be no doubt!!
The following list of writers on the “Oneirocritica” previous to Artemidorus will show the attention which has been paid to this subject in very early times: Artemon Milesius, Antiphon, Apollodorus Tellmissensis, Apollonius Atalensis, Aristander Telmissensis, Aristarchus, Alexander Myndius, Cratippus, Demetrius Phalereus, Dionysius Rhodius, Epicharmus, Geminus Tyrius, Hermippus, Nicostratus Ephesius, Phœbus Antiochenus, Philochorus, Panyasis Halicarnessensis, Serapion, Strabo. Mighty names once on a day! Now they are but “the dream of a shadow!”[209]
XXVIII. Περὶ παθῶν—On Affections.
This treatise being passed over in silence by Erotian, and rejected as unworthy of Hippocrates by Galen, although he acknowledges that it contains many fine things,[210] has been generally regarded as spurious by modern critics, as for example, Foës, Haller, Gruner, Ackerman, Littré, Greenhill, and others. The work is carefully written, but seemingly without a plan, or any well-defined object. It touches, in general terms, on most of the diseases to which the human body is subject, and concludes with some general observations on regimen. All diseases are said to be derived from phlegm or bile. This seems very unlike the etiology of diseases, as laid down in the true Hippocratic treatises. Pleurisy is to be treated by purgatives and soothing applications, but without any mention of bleeding. The termination of the disease in empyema is described. The symptoms of pneumonia are also given in brief but striking terms. The sputa, at first, are said to consist of phlegm, and are thick and pure, but on the sixth and seventh day they become somewhat bilious and sublivid. This disease is also said to terminate in empyema. Some of the general observations contained in this work are deserving of attention. Of all the diseases the acute are the most painful and the most fatal, and they require the greatest care and the most accurate treatment. No additional mischief should, at all events, be inflicted by the physician, but he must do the patient as much good as lies in his power; and if the physician treats the case properly, and the patient sinks under the weight of the disease, it will not be the physician’s fault; but if, while the physician does not treat nor understand the disease properly, the patient fall a victim to the disease, the physician will then be to blame. In treating ileus, when a clyster fails to relieve the bowels, they are to be inflated by means of a bladder attached to a pipe, and then the pipe is to be removed, and a clyster immediately injected, in which case, if the bowels admit the clyster, they will be opened, and the patient will recover, but if otherwise, he will die, especially on the seventh day. The treatise further contains some very interesting remarks on the causes and varieties of dropsy. When the water is not otherwise removed, an incision is to be made either at the navel, or behind at the loins. It deserves to be mentioned that, in this treatise, there are frequent references to a work of the author’s “On Medicines.” Whether it was the same as the treatise bearing that title which we possess cannot be determined. In the course of the work, the use of the cautery is freely recommended for the cure of diseases.
From the account which we have given of this treatise, and the paucity of evidence in favor of its genuineness, it will readily be understood that we have no hesitation in deciding that it is not one of the genuine productions of Hippocrates.
XXIX. Περὶ τῶν ἐντὸς παθῶν—On Internal Affections.
This treatise has but little ancient authority in support of it. Erotian has omitted it in his list of the works of Hippocrates; Palladius does not mention it; and Galen notices it in a confused manner under a variety of titles.[211] Foës, Schulze, and others, have referred it to the Cnidian school; and if this point could be made out satisfactorily, it would give the treatise a remarkable degree of interest, as furnishing us with a key to the opinions of one of the oldest sects in medicine. That the reader may be enabled to form his own opinion in this matter, we will now give a brief outline of its contents.
The work commences with a short description of hæmoptysis, which is said to originate either in ulceration or rupture of an artery of the lungs, the ordinary causes of which are held to be severe exercise, falls, blows, violent vomiting, or fevers. The symptoms are pretty well described, and a mild system of treatment recommended. Inflammation of the lungs is said to be produced principally by drinking wine, and an immoderate indulgence in eating mullets and eels. The treatment at first is like what we have described the Cnidian system to have been, consisting of milk, emetics, and purges; but if these do not answer, the actual cautery is to be applied to the breast. Erysipelas of the lungs is described in much the same terms as at “De Morbis,” i., 13; ii., 53.[212] A correct description is given of empyema as connected with tubercle of the side, for which draughts are recommended, with broth made from poppies, etc. When matter forms, it is to be let out either by the knife or the cautery.[213] Three species of phthisis are described, the first being derived from phlegm, the second from violent labor, and the third being the tabes dorsalis. The treatment in all these affections appears to be very empirical, and unlike the usual therapeutics of Hippocrates. Four diseases of the kidneys are described, of which the first is calculus, and the second abscess, in which case the writer recommends an incision to be made, in order to furnish an outlet to the pus. Now, it is deserving of remark, that, of all the ancient authorities which have come down to us, Ruffus Ephesius would appear to be the only other author who makes mention of this practice.[214] The author of the treatise states, that if the matter of the abscess find vent by the intestinum rectum the patient may recover. The disease altogether, he adds, is troublesome, and in many cases ends in renal tabes. He most probably here alludes to what is now called Bright’s disease. From disease of the kidneys is said to arise an affection of the venæ cavæ, which runs from the head near the jugulars, along the spine to the malleolus externus. He says it originates in bile and phlegm which collect in the veins. Varices, I suppose, are here meant to be described. If not cured by purging with hellebore and scammony, the actual cautery is to be applied at the shoulders, below the scapulæ, at the hip-joint, at the middle of the thigh, above the knee, and at the ankle. Now it is deserving of notice, that this disease is not mentioned by subsequent authors on medicine, so that we are warranted in concluding that the treatise was not looked upon by them as being a production of the Great Hippocrates: for if it had been so regarded, we are sure that Galen, Aretæus, Celsus, and all the worthies of the Arabian school, would not have overlooked this description. And, moreover, the description of the disease from first to last is vague and prolix, being the very reverse of that graphic style of delineation which we find in the genuine works of Hippocrates: and yet the work contains other matters of a different stamp. For example, treating of dropsy, the author says it is sometimes connected with tubercles of the lungs, which get filled with water and burst into the chest. In proof of this, he appeals to observations on cattle, sheep, and swine, which are said to be very subject to these tubercles (phymata); and he argues that men are still more liable to them. And in many cases, he adds, empyema originates in tubercles. In that case, when the collection protrudes externally, he directs that an opening should be made in it; but if not, he directs the patient to be shaken by the shoulders, when the sound of the fluid within will be heard. When the side in which the greater collection is situated has been ascertained, he recommends us to cut down to the third rib from the last, and then make a perforation with a trocar[215] (τρυπάνῳ τρυγλητηρίῳ), so as to give vent to a small portion of the fluid; the opening is then to be filled with a tent, and the remainder evacuated after twelve days. Four species of icterus are described: these would appear to be febrile affections. Five varieties of typhus are next noticed in rather vague terms; there can be little doubt that they were all cases of remittent fever. Several varieties of a disease which is called morbus crassus are described with much prolixity, and so vaguely as not convey to us a distinct idea of the disease. He says of two of the varieties, that they last for six years. Unless these were varieties of elephantiasis (and we have no evidence of its existence so early), I am at a loss to comprehend what disease is alluded to. The treatise concludes with an account of three species of tetanus.
From the analysis now given of its contents, it will be readily seen that this work abounds in interesting matter, but that, at the same time, it is clearly of a different stamp from what we find in the genuine works of Hippocrates, nay, that in all probability it does not belong to the Coan school. In conclusion, I have, then, to state that I think the presumption of its being a production of the Cnidian school is very strong.
XXX. Περὶ νοὐσων—On Diseases.