THE ARGUMENT.
Though in the Argument prefixed to the First Book of the Epidemics I have given a pretty full summary of the contents both of that book and the third, I have still a few observations to make on some important points, which were not sufficiently considered on that occasion; and this I do the more readily, as it will afford me an opportunity of noticing a subject on which M. Littré has bestowed very extensive research. I allude to the origin of the Glandular Plague. As I make it a rule, in giving these my annotations, not to enter into any lengthy details, I shall now state, in a very succinct manner, the result of my inquiries. The reader is referred, for a fuller discussion of the subject, to the more ample disquisitions of M. Littré.[676]
The opinion has been pretty generally maintained by modern authorities, that the first description which we have of the glandular plague of the East is that given by the historian Procopius, in the sixth century; and the inference drawn therefrom is that the disease was unknown until his time. This opinion is still held, to a certain extent, by Hecker, Rosenbaum, Pariset, Nauman, and others of the most distinguished scholars of the day, but it appears to be untenable after the discovery of the “Fragment” of Ruffus, published by Mai, Rome, 1831. As the passage is very important, I shall give a translation of it in this place. It is as follows: “The buboes called pestilential are most fatal and acute, especially those which are seen occurring about Libya, Egypt, and Syria, and which are mentioned by Dionysius Curtus. Dioscorides and Posidonius make much mention of them in the plague which occurred in their time in Libya; they say it was accompanied by acute fever, pain, and prostration of the whole body, delirium, and the appearance of large and hard buboes, which did not suppurate, not only in the accustomed parts, but also in the groins and armpits.” The only thing which detracts from the value of this paragraph is the difficulty of determining exactly who the authorities are which are referred to in it. Of Dionysius Curtus nothing is known; indeed it is more than probable, that there is some mistake in this name. There are several medical authors of the name of Dioscorides and Posidonius, and it is difficult to determine to which of them reference is here made. Still, however, there seems to be no reason for questioning the authenticity of the passage. Ruffus, I may add, is generally admitted to have flourished in the reign of Trajan.[677]
To this important document let me join an interesting extract from Galen’s work “On Fevers.” Galen, treating professedly of Pestilential Fevers, which he maintains are all connected with a tendency to putridity, expresses himself as follows: “Moreover, as Hippocrates says, all fevers from buboes are bad, with the exception of ephemerals; although the bubo is also of the class of phlegmons. And I agree in so far with what is said of putrefaction, for this is the cause of the fever in inflammations, and not as Erasistratus supposed.[678] But yet there are certain fevers from buboes of the class of ephemerals, as certain others proclaim them to be; diseases difficult to cure, which derive their origin from an inflammation, an ulcer, an abscess, or some other such affection in a viscus. But the ephemeral fevers from buboes differ from those connected with putrefactions, either in a certain viscus, or in the hollow and very large vessels, that in those from buboes, which always impart their heat to the surrounding parts, the heat is communicated to the heart, and the putrefactive fume does not reach it, but remains circumscribed in the seat of the bubo, and the heat reaching the heart solely by a change in the connecting parts, in like manner as in those exposed to excessive heat and fatigue, the diffusion of the heat takes place from the parts first warmed to the source of vitality; but in a putrefaction about the viscera and large vessels, a fume, as it were, from the putrefying humors reaches the cavities of the heart, etc.”[679] From these two passages alone, without taking into account several others of less importance, which might be gathered from other medical authorities,[680] it must be quite obvious that the glandular plague was known, at all events, in the second century of the Christian era. Moreover it is equally clear, that Galen did not look upon it as a new disease, but considered that it was noticed in the works of Hippocrates. To my mind, then, there can be no doubt that the pestilence which prevailed during the Peloponnesian war partook of the nature of the glandular plague. What has tended to create doubts on this subject, in the minds of many learned men, is the omission of any distinct mention of buboes in the graphic description of it given by Thucydides. But it should always be taken into account that Thucydides was not a professional man, and therefore there is a strong presumption that his acquaintance with the disease, even although, as he states, he himself had experienced an attack of it, must have been altogether of a general nature. Indeed Galen, both in the treatise from which I have quoted above and in many other parts of his works, does not hesitate to declare, that the historian describes the disease as a common, that is to say, a non-professional man, whereas Hippocrates gives its characters as a physician. It is also to be borne in mind, that the description of it given by Thucydides applies to it only at its outbreak in the city of Athens, and it is a well-known characteristic of pestilential epidemics that they change very much during their progress. This character of them was well illustrated in the Plague of Aleppo, so admirably described by Dr. Russel; for although the glandular form of the disease prevailed in a large number of cases, a considerable proportion of them were unaffected with buboes. Indeed it appears to me to be too much the practice for the profession, as well as the public, to imagine to themselves a certain type or ideal of every disease, and when they do not recognize the exact characters which they fancy it should present, they immediately set down such cases as constituting an entirely different disease. This is an error that is constantly committed, and one which I believe to be at the bottom of the discordant opinions which prevail among professional men, on the subject of the glandular plague. It would be well for the physician to bear in mind how many varieties of symptoms the fever designated as Typhus puts on,—some with the rash reckoned peculiar to this fever, and some without it,—some with petechiæ, and miliary eruptions, and others without them; and many other complications of symptoms, which are sometimes present and sometimes not.
With regard to the hypothesis lately advanced by Mr. Theod. Krause,[681] and in so far countenanced by M. Littré, that the plague of Athens was an epidemical variola, I must say that I can see no probability in this supposition; for that a disease so strongly marked as smallpox should have prevailed in ancient times, and yet not be distinctly noticed by the Greek and Roman writers on medicine, I cannot conceive, more especially when we call to recollection the very accurate descriptions which they have left us of other cutaneous diseases, by no means attended with symptoms of so obvious a nature. Indeed it appears to me most wonderful, that such an opinion should have been entertained by any person at all acquainted with the Arabic writers on medicine, who described most distinctly both the plague and the smallpox. Not to lose ourselves amidst a host of authorities, I would refer the reader, in particular, to Avicenna, iv., 1, 4, where the two diseases are treated of most distinctly, so that I cannot entertain a doubt that the Arabian physicians considered them to be essentially different.
In a considerable number of the cases reported in this book, there are affixed to them in the original certain characters, the interpretation of which the reader will find given in the translation. It will be necessary, then, to give the reader some account of the origin of these characters, regarding which our sole authority is Galen, who, in his Commentaries on this book, enters on the question in his usual elegant and attractive style. He admits that he derived his information principally from Zeuxis, one of his predecessors in the office of commenting upon the works of Hippocrates. (See § 2, of the Preliminary Discourse.) It appears that Ptolemy Philadelphus was so zealous in his search for books to adorn his library, in Alexandria, that he gave instructions to the masters of ships going on distant voyages to collect all the books they could procure, and bring them back with them; that he ordered copies to be taken of books brought to him in this way, and kept the originals, but returned the copies, along with large sums of money, in certain cases, to those who had lent them to him; and that the works so obtained were preserved in a separate department of the library, with the inscription, “The Books of the Ships.” Among these was found a copy of the Third Book of the Epidemics, with the inscription, “One of the Books of the Ships, according to the redacteur Memnon of Sida.” Others say, that the term “redacteur” was wanting, and that the book bore simply the inscription of “Memnon;” and that the servants of the king inscribed the names of all the seamen who had brought these books, when they were installed on the shelves of the library. This, it would seem, was not done immediately after their arrival in Alexandria, but that at first they were collected together in certain houses. Memnon, the librarian, then, is generally supposed to have surreptitiously introduced the characters into one of the copies, in order that he might raise himself into importance by interpreting them. But whether or not this ruse was actually perpetrated by Memnon, the general belief of the commentators was, that Hippocrates himself had nothing to do with them. In fact, Zeno would appear to have been the only commentator who held them to be genuine, and ascribed the introduction of them to our author. The opinion thus advanced by Zeno led him into a violent controversy with the two Apollonii, namely, the Empiric and Biblas, who strenuously maintained that the characters were an interpolation executed by Memnon. This came to be the settled opinion of the commentators, and among others of Galen, who, although he gives a key to the interpretation of the characters, maintains, on all occasions, that they are of no authority, and had in fact been forged by Memnon.
The following is the key which Galen gives to the interpretation of the characters: α, signifies ἀποφθορὰν, abortion, or ἀπώλειαν, loss; γ, signifies γονοειδὲς ὁυρον, urine resembling semen; δ, punctuated below, thus, δ, signifies ἱδρῶτα, sweat, and διάρροιαν, diarrhœa, and διαφόρησιν, perspiration, or in fact any other evacuation which it is wished to express; ἐ, signifies ἐποχὴν, retention, or ἒδραν, seat; ζ, signifies ζήτημα, the object of research; θ, signifies θάνατον, death; ι, signifies ἱδρῶτα, sweat; κ, signifies κρίσιν, crisis, or κοιλιακὴν διάθεσιν; μ, signifies μανίαν, madness, or μήτραν, the womb; ν, signifies νεότητα, youth, or νέκρωσιν, mortification; x, signifies ξανθὴν χολὴν, yellow bile, or ξένον τι καὶ σπάνιον, something strange and rare, or ξυσμὸν, irritation, or ξηρότητα, dryness; ο, signifies ὀδύνας, pains, or οὖρον, urine (but some think that it is only when it has a ὐ above it that it signifies urine); π signifies πλῆθος, abundance, or πτύελον, sputum, or πυρὸν (πυρρὸν?), yellow, or πυρετὸν, fever, or πνεύμονος τάθος, affection of the lungs; π, with a character ι in its middle
or
