THE ARGUMENT.
The ancient physicians commonly used the term Epidemic in the same sense as it is understood now, that is to say, as applying to any disease which attacks a multitude of persons in a locality at any particular period. This, as will be seen in our annotations below, is nearly the definition which Galen gives of it; and it is generally used by Hippocrates, in the first and third books of the “Epidemics,” in pretty much the same sense as it is used by our great modern authority on epidemics, Sydenham. But, although this be the strict sense in which the ancient authorities use the term, it must be borne in mind that, as applied to the whole seven books of the “Epidemics,” it must be taken in a much wider signification; for there are many things treated of in them to which the term epidemic can by no means be thus applied, such as surgical cases, fragments of anatomical descriptions, philosophical speculations, empirical remedies, general reflections on various topics, and so forth. In fact, the work entitled “The Books of Epidemics” can be viewed in no other light than as an Adversaria, or Memorandum Book, in which is collected a variety of isolated facts and detached observations, to serve as the materials for more elaborate and finished works on professional subjects. Indeed, Galen does not hesitate to give it as his opinion, that some of the most celebrated of our author’s productions, such as the “Aphorisms” and “Prognostics,” are in a great measure made up from the materials originally laid up in this capacious repertory of observations;[602] and, with regard to the former of these works, there is no person familiarly acquainted with it but must admit the truth of Galen’s remark. But, respecting the other, although it must be obvious, upon a comparison of them, that there is a close connection between it and the “Epidemics,” there can be no doubt that, in composing the “Prognostics,” Hippocrates availed himself of other materials ready prepared for his use, in the “Prorrhetics” and “Coan Prænotions” of his predecessors, the Asclepiadæ;[603] so that, of all his admired productions, it, perhaps, is the one which has the least pretension to any originality of matter. If it be thought strange that the term epidemics should have been applied to a work composed of such heterogeneous materials, I would remark, in explanation, that, although the subject-matters of which it consists are not all of this nature, the most valuable portion of them refers to epidemics, and it is not to be wondered at that the whole collection should have got its appellation from the most prominent subject to which it relates.
I shall now proceed to give a succinct analysis of the various subjects which are contained in the First and Third Books of the “Epidemics.”
The first book opens with a description of the leading phenomena of a certain season, which is called the First Constitution; it was southerly, coldish, rainy, clouded and misty, with some intervals of drought. The most noted diseases of spring in this constitution were causus and an epidemical parotitis. But the most important subject which is handled under this head, is an epidemic phthisis, of which a very interesting description is given.
The Second Constitution is described as being northerly and humid; humid ophthalmies, dysenteries, and diarrhœas are described among the prevailing diseases of the season; but the most marked affection which is said to have occurred in this constitution, is a continual fever of a serious character, which did not come to a crisis until after it had run a long course. It is described as passing off by deposits, and principally by dropsies, and an affection of the urinary organs. One cannot help being struck with the remark which Hippocrates makes, that he never knew a case prove fatal in which the strangury supervened. The directions as to the treatment he condenses into one general rule, which well deserves to be engraved in letters of gold, that “the aim of the physician should be to do good to his patient, or, at least, to do no harm.” The description of this constitution concludes with some general reflections on the prognostics in causus and phrenitis.
The Third Constitution is described as being of a very variable character; winter stormy, spring rainy, summer hot, autumn cold and dry. The ardent fevers (or causi) began early in the season, but did not assume a fatal character until autumn. This disease came to a crisis in four modes—by an epistaxis, by a copious flow of urine, by a deposit, or by an alvine discharge. In women, there was also sometimes a crisis by menstruation.
The Fourth Constitution is one which, by Galen and the other authorities, has been entitled the pestilential, and has attracted great attention, as being supposed to have derived its peculiar characters from the great Plague which prevailed during the Peloponnesian war, and which is described in so interesting a manner by Thucydides. Galen, not only in his Commentary, but in various other parts of his works, advocates this opinion, and it will be seen from what is stated in our annotations, that there is in reality a striking resemblance between the features of the plague, as delineated by Thucydides, and the epidemical diseases which are noticed by Hippocrates as having prevailed during this constitution. Of all the diseases here described the most remarkable is the erysipelas, which, although not of a very fatal character, was still of a formidable nature, as it frequently terminated in gangrene. Causus, phrenitis, and anthrax are also described as being common under this constitution. The last of these being a well-known symptom of the Oriental plague, it has naturally excited a good deal of speculation to determine whether or not our author here refers to the glandular plague. See our remarks on Epidem. III.
In these books it is remarkable that phthisis is treated of as a febrile disease, and in particular as supervening upon attacks of the semitertian. There seems reason to suppose that our author means to describe a hectic fever succeeding to intermittents, which had caused organic derangement of the internal viscera, more especially of the liver and spleen. See Paulus Ægineta, Book II., 32.