The seventh book, as we have already remarked, is closely allied to the fifth. Galen pronounces it to be universally condemned as being spurious, and of more recent origin than the others; but Littré, although of course he does not stand up for its genuineness, justly contends that it is replete with valuable matter. Grimm holds, from the nature of its contents, that it must have derived its origin from the Cnidian school, whereas the fifth sprung from the Coan. I must say, however, that I cannot see any good grounds for this opinion. According to M. Littré, it is a recueil of particular facts superior to anything of the kind left to us by antiquity, and such that its equal can scarcely be found in modern times. The cases being for the most part of an isolated nature and not susceptible of any arrangement, it is not possible within my narrow limits to give any general idea of the contents of this book. I shall be content, therefore, with a very few extracts as a specimen of it. It opens with two very interesting cases of fever, accompanied with sweats, which were treated mildly by purgatives and clysters, and terminated favorably. It strikes me as singular in reading these cases, that the characters of the urine are not distinctly given, as in the cases related in the first and third Epid. All that is said on this score is, that “the urine was like that of chronic diseases.” The tenth is a case of ardent fever proving fatal by intestinal hemorrhage. Some of the fatal cases of dropsy following fever are very instructive, as §§ 20, 21. Two cases of empyema (so they are marked by M. Littré) would appear to have been phthisis with cavities in the lungs. In both, mention is made of râles. See §§ 26, 27, and also 93, 107. In the 29th and six following sections there are reports of cases of severe wounds. Apparently they must have occurred in the time of war. The 36th, 37th, and 38th, are cases of tetanus supervening upon very slight wounds. A good many cases of phthisis are reported, as at §§ 49, 50, 51; in the last of those the pectoral râles are particularly noticed. In the 48th the disease is ascribed to the woman having been injured by succussion in order to procure the expulsion of the afterbirth. (On this case see the interesting remarks of M. Littré, tom. v., p. 359.) At § 52 are the cases of two children who died of disorder of the bowels, complicated with an affection of the head, as indicated by their constantly pressing on the part with the hand; and it is remarked, that after death there was a hollow in the seat of the bregma. Every experienced physician must have met with such cases. M. Littré refers in illustration of the disease here treated of to an analysis of a work by M. Elsæsser, in the “Archives Générales de Médecine,” March, 1845, p. 346; on ramollissement of the occiput. The cases of phrenitis, here related, are evidently febrile affections, as at §§ 79, 80. At § 102 a case is related in which serious symptoms supervened on the eating of a raw mushroom. The patient being treated by emetics and the hot bath, recovered. At § 121 is related the case of a person who had convulsive laughter, connected, as was supposed, with a wound of the diaphragm.
And now, having concluded my review of these Books of Epidemics, I will venture to affirm, without fear of contradiction, that when we look to the importance and rarity of the matters contained in them, the work, even at the present day, is perfectly unrivalled. That the books are the composition of different hands must be admitted, but altogether the contents of them bear the imprint of the mind and spirit of Hippocrates, and evince a talent for the cultivation of medicine which has never been surpassed. What a noble people the Greeks must have been in the days of Themistocles and Pericles!
XXXIV. Περὶ χυμῶν—On the Humors.
It must be admitted that there are few treatises in the Hippocratic Collection which unite such a concurrence of high authorities, both ancient and modern, in their favor as this work, and yet there seems good reason for joining the later critics in refusing its claims to be received as genuine. In favor of it may be quoted Erotian, Palladius, and Galen, among the ancient, and Foës, Zuinger, and Haller, among the modern authorities. Against it are ranged several of the older authorities, namely, Zeuxis, Heraclides, and Glaucias, some of whom refer it to a younger Hippocrates, some to Thessalus, others to Polybus, and others again to Democritus.[236] Accordingly, the highest modern authorities, as Mercuriali, Gruner, Ackerman, Kühn, and Littré, refuse to receive it into the list of genuine works; and the last of these seems to make it out pretty clearly that the treatise is composed of detached observations extracted from the other Hippocratic works. After repeated perusals of it, what strikes myself is, that it bears a close resemblance to the treatise “On the Surgery,” that is to say, that it is a recapitulation of the conclusions arrived at in certain of the other works of Hippocrates. Perhaps, then, it must be admitted that there is some inconsistency in allowing the one a place among the genuine works of Hippocrates, and refusing the similar claims of the other. That the work in question contains a most interesting summary of what were regarded, in ancient times, as great medical truths, cannot be doubted. From the condensed form in which the subject matters of it are presented, it will readily be apprehended that they do not well admit of being given in the form of an abstract, and that any specimens of its contents will afford but a very imperfect idea of its value as a whole. I would remark, at the outset, that the title of the work, “On the Humors,” appears not very applicable, since very few of the paragraphs relate to the humors; in fact, as already hinted, the treatise may be said to be a recueil of various observations gathered out of other works. I also feel at a loss to account for M. Littré’s disposition to rank it as the eighth book of the Epidemics, as it bears no resemblance either in form or matter to that work; the one consisting of isolated observations and of particular facts, and the other of general principles; and the style of the one being comparatively full, whereas the other is remarkably succinct, so as to be nearly unintelligible in many places. Take the following as a specimen of it: “The earth is to trees what the stomach is to animals; it nourishes, heats, and cools; cools when emptied, heats when filled, as the earth when manured is hot in winter, so is it with the stomach.” This important observation, that the earth, in connection with the vegetable productions, is analogous to the stomach in animals, is repeated by Aristotle and other of the ancient philosophers.[237] The author makes the important remark, (§ 14,) that we ought to study the condition of the body previous to the season in which the disease broke out; in confirmation of which M. Littré, in his arguments, gives some very interesting observations by M. Forster.[238] In the paragraph on deposits, the author remarks, that in fevers attended with a feeling of lassitude, the deposits generally take place to the joints and jaws. It is afterwards stated—and if confirmed by experience, as I think I have observed it to be in many cases, it is an important remark—that “when the feet are hot, the depositions point downwards, but when cold, upwards.” § 7. In § 12 diseases are thus classified: “with regard to the modes of diseases, some are congenital, as may be learned upon inquiry; some are connected with the nature of the locality, (for many are affected, and therefore many are acquainted with them); some with the condition of the body and the diet, the constitution of the disease, and the seasons. The localities which are ill situated in respect to the seasons engender diseases similar to the season; in like manner, irregularities as to heat and cold in the same day when it has such effects, produce autumnal diseases in the locality, and in the other seasons likewise. The diseases which are engendered by fetid and marshy waters are calculus and splenic diseases, and such are influenced by good or bad winds.” Altogether, as will be readily seen, it is a work of great ability, and will amply repay a diligent perusal. Galen esteemed it very much, and did not hesitate to declare that, not only Plato, Aristotle, and Theophrastus, but also several of the most distinguished medical authors had copied freely from it.[239]
XXXV. Περὶ χρήσιος ὑγρῶν—On the Use of Liquids.
This would seem to be the work which appears in Erotian’s list under the title of “On Waters” (περὶ ὑδατῶν); and, contrary to what is stated by Foës and Gruner, it is quoted by Galen in two places;[240] and it is further referred to by Athenæus, under the same title as that given to it by Erotian.[241] Foës pronounces it to be a mutilated work, and one which is wanting in many of the MSS. of the Hippocratic treatises; and all the modern critics, from Lemos and Mercuriali down to Littré and Greenhill, regard it as spurious. Gruner speaks of it as being a work of little importance, and Ackerman as being a mere compilation from the Aphorisms.[242] Gruner further remarks, that the title does not suit well with its contents, and this is in so far correct, for undoubtedly the title given to it by Erotian is more suitable, as it treats almost exclusively of the medicinal properties of waters; and this it certainly does in a fuller and more interesting manner than they are treated of in any other ancient, and, I may almost venture to add, any modern work with which I am acquainted. I look upon its contents, then, as being extremely valuable, even as the work has come down to us, but it is to be regretted that the text is in a very unsatisfactory state. Water the author of the treatise recommends as a fomentation to the eyes, when applied with a sponge; and further, as a general or local fomentation, for producing relaxation of any part when contracted. When poured over the head, and other parts, it is said to induce sleep, is useful in convulsions, and relieves pains of the eyes and ears. Cold water inflames ulcers, except such as have a tendency to hemorrhage, and also fractures, luxations, etc. In applying water to the body, the author recommends the feelings of the patient to be consulted, unless he be in a state of paralysis or of stupor, or be suffering from exposure to great cold, or be in great pain. In these cases, he adds, the patient may be insensible, and instances have occurred of persons having their feet congealed by cold, which have dropped off upon the affusion of hot water. The immoderate use of hot water induces relaxation of the fleshy parts (muscles?), weakness of the nerves, torpor of the understanding, hemorrhage, and deliquum animi, so as even to prove fatal; and much cold water will occasion spasms, tetanus, lividity, and febrile rigors. The parts of the body which are usually covered endure the cold water worst, and are most refreshed by hot. Cold water disagrees with the brain and its processes, the bones, the teeth, and the nerves; and hence, it is added, convulsions, distentions, and febrile rigors, which are induced by cold, are relieved by hot water. Hot water occasions delight and determination (to the skin?); cold, on the other hand, pain and determination inwardly: wherefore the loins, the breast, the back, and the hypochondriac region, are injured by cold applications, but delight in warm. Cold water, thrown on the extremities, relieves lipothymia, the reason of which he states, but the text is so corrupt that I dare not undertake to translate the passage. Ulcers, excoriated parts of the body, and burns, bear cold ill. The extremities, the bladder, and the organs of generation, delight in warm water. Salt water is proper to itchy parts, and to parts affected with pungent humors, but disagrees with burns, and abraded surfaces. Vinegar is said to have much the same properties as salt water in the cure of these complaints. Warm water, in which salt has been melted, is beneficial in lichen, leprosy, alphos, and other complaints of a like nature. The lees of vinegar (caustic potass?) also answer in these cases. The astringency of cold water is increased by having beet leaves, ivy, bramble, sumach, sage, etc. boiled in it. Red pustules, like lentils, are benefited by cold things, but eruptions arising from cold, and resembling millet, are improved by hot. There are certain cases in which both hot and cold are applicable, such as gouty affections, and most sprains: in these, cold applications deaden the pain, and warm soothe it. Indurations and ankyloses of a joint are to be removed by pouring warm water out of a vessel upon it. Rheums of the eyes are relieved by rubbing them with some fatty substance, to obtund the acrimony of the tears. In pains, suppurations, pungent tears, and deep ulcers of the eyes, hot water is most expedient; when the eyes are merely red, and free of pain, cold is to be preferred. Cold does not agree with complaints of the rectum and uterus, nor with cases of bloody urine. Cold raises pain when it is applied to ulcers, hardens the skin, renders it painful, suppresses suppuration, renders parts livid and black, is injurious in febrile rigors, spasms, and tetanus. But he adds, sometimes in a robust young man, in the middle of summer, when laboring under tetanus not connected with a wound, the affusion of cold water brings back the heat. (See Aphor. v., 21, and Paulus Ægineta, B. III., 20). Hot water does the same. It promotes ulceration in all cases, softens the skin, attenuates it, is anodyne, and soothes rigors, spasms, and tetanus, and removes heaviness of the head. It is most particularly applicable in fractures, when the bone is laid bare, and especially in injuries of the head. Hot water agrees with all ulcerations, whether innate or produced by artificial means, in herpes exedens, in blackened parts, and in diseases of the ears, anus, and womb. But cold water is inimical in all these cases, except when hemorrhage is apprehended.
The above is a brief summary of the matters contained in this little treatise. That they are highly important, and evince an extraordinary talent for apprehending the true bearing of practical points in medicine, will hardly be denied by any person who is a competent judge. Many of the rules and observations contained in it are, no doubt, the same as those found in the Aphorisms (see Section v.), but there is also no lack of valuable matter in it, which is not to be found elsewhere. Though I am disposed, then, to agree with the authorities who exclude it from the list of genuine works, I do not hesitate to declare it as my decided opinion, that it is not unworthy of the reputation of the great Hippocrates, and that, if not written by him, it must be the production of some person who thoroughly apprehended his high principles and discriminating views. How much, then, is it to be regretted, that this treatise should have come down to us in so mutilated a state that the meaning, in many places, can only be guessed at with considerable hesitation!
XXXVI. Περὶ γονῆς—On Semen.
XXXVII. Περὶ φύσιος παιδίου—On the Nature of the Infant.
That these two treatises originally constituted one work, has been remarked by Foës, Gruner, Ackerman, Littré, and others. Indeed, this will be made sufficiently obvious, upon comparing the conclusion of the one with the beginning of the other. Galen, in one place,[243] quotes the former of these as if he held it to be a genuine work of Hippocrates, but elsewhere he mentions that it had been referred to Polybus.[244] Erotian mentions, among the works of Hippocrates, a treatise bearing the title of the latter, under which he probably comprehended both treatises. It is also noticed as a Hippocratic treatise by Palladius,[245] and by Macrobius.[246] Both are rejected by Haller, Gruner, Ackerman, Kühn, Littré, and Greenhill. Indeed the story of the female musician, whom the author gravely admits that he taught the way how to get rid of a conception,[247] is so alien to the morals of Hippocrates, as declared in “The Oath,” that it is impossible for a moment to suppose him guilty of such an act of flagitiousness. Moreover the treatise so abounds in little subtleties and conceits, especially in reference to the Pythagorean doctrine of numbers, that no competent judge will hesitate for a moment in pronouncing it not to be the production of the Great Hippocrates.[248] Without doubt, however, these treatises are of great antiquity, and are valuable as containing the hypotheses with regard to the origin of the fœtus which prevailed in the schools down to the days of Harvey; that is to say, that the embryo is formed from the male semen, into which the uterine vessels enter, and form the cotyledones (or placenta). It contains, moreover, an hypothesis adopted by Aristotle in several of his physiological works regarding the semen, namely, that it is collected from all parts of the body; and hence, if any part be mutilated in the parent, it is so likewise in the fœtus.[249] The author moreover holds, that the fœtus breathes, and is nourished by the umbilicus,[250] which may be looked upon as an anticipation of the modern doctrine, that the placenta performs the function both of a lung and of an intestine. It contains a statement regarding the incubation of the egg, which has been often repeated in modern times, but which, from personal observation, I can affirm not to be true; namely, that the hen chips the shell to let out the chick.[251] Presentations in delivery are divided into those by the head, the feet, and crossways. I would mention, in conclusion, that these works abound in repetitions, and are written in a diffuse style, very unlike that of Hippocrates. Altogether, then, I can have no hesitation in pronouncing both treatises to be spurious. From what has been stated of them above, it must be obvious, however, that to the student of ancient anatomy and physiology they are very interesting, and will repay a careful perusal. Although, probably, later productions than the age of Hippocrates, there can be no doubt that they are anterior to the memorable epoch of Herophilus and Erasistratus.