This treatise is sustained as genuine by Erotian, and even by one of

the older commentators, Heraclides of Tarentum, but it is nowhere

noticed by Galen, and Suidas would appear to refer it to Hippocrates,

the son of Gnosidicus.[198] Mercuriali, Gruner, Haller, Ackerman, Kühn,

and most of the modern authorities hold it decidedly to be spurious.

Foës and Zuinger, however, do not object to its authenticity; and

Littré, although he excludes it from his list of the genuine works of

Hippocrates admits that it is very ancient, and formed a portion of the

Collection from the commencement. To me it appears that it is written

in too subtle and abstract a style to admit the supposition of its

being the work of a practical physician like Hippocrates. Although it

contains a good deal of original thought, there is not much in it which

would prove interesting to the medical reader of the present day. It

is an elaborate defense of the art of medicine against the attacks of

those who maintain that it is no art at all, or one of an uncertain

nature. According to the author’s definition, the aim of the physician

should be to remove the pains of the sick, to blunt the intensity

of diseases, and not to interfere with those that are mastered by

disease, as knowing that medicine can be of no avail in such a case. In

conclusion, I shall merely remark that the evidence, both internal and

external, is against the supposition of its being genuine, but still

there appears no good reason for doubting that it emanated from the

school of Cos.

XXVI. Περὶ διαιτης--_On Regimen_.

The evidence in favor of this large and interesting work,

unfortunately, is by no means strong. It is passed by unnoticed by

Erotian, and Galen expresses himself, in general, regarding the work in

very equivocal terms, mentioning that some had referred it to Euryphon,

some to Phaon, others to Philistion, and others, again, to Aristo.[199]

In other places, however, he expresses himself less unfavorably as to

the authenticity of the last two books. Haller, Gruner, Ackerman, Kühn,

and, in fact, nearly all the modern authorities, reject it.[200] M.

Littré, although he agrees with them, remarks justly that the work is

one of great value, and exhibits many evident traces of conformity with

the writings which are truly Hippocratic.

The nature of the work is as follows: The first book is altogether

made up of abstract principles, which savor very much of the dogmata

of Heraclitus. Thus, the author of it holds that there are in men,

and in all other animals, two principles, different in power but

consentaneous in use, namely, fire and water; that these together are

sufficient for all others, and for themselves; that the one contains

the principle of motion, and the other of nutrition; that these give

rise to the separate existence of seeds and animals, of all varieties,

shapes, and characters; that, in reality, none of those things which

exist either perish or are created, but they are altered by being mixed

together and separated from one another, but that men suppose that

the one passes from Hades to light, and the other again from light

to Hades. In a word, the contents of the first book savor more of

philosophy than of practical medicine. For example, it is said, “The

trainers of the athletæ instruct their pupils in this manner--to break

the law according to law, to commit injustice according to justice; to

deceive, to steal, to rob, to commit violence, in the most elegant and

disgraceful manner: he who cannot do these things is bad, he who can

do them is good; which is a proof of the folly of the many who, when

they behold these things decide that the one of these is good and the

others bad. Many wonder, but few are judges. Men going to the market

proceed thus: they deceive one another in buying and selling, he who

deceives most is admired. They execute these things--they drink and

become mad, they run, they wrestle, they fight, they steal, they cheat;

the one is preferred to all the others. Hypocrites and deceivers!

Before the spectators they say one thing. and think another.[201] The

same persons creep out, and they creep in not the same persons; to one

man they say one thing, and do another; the same person not always

the same--sometimes he has one mind, and sometimes another. In this

manner all the arts have communion with human nature.” All this is too

fanciful and recondite for the physician of whom Celsus says “primus ex

omnibus memoria dignis ab studio sapientiæ disciplinam hanc separavit.”

It is clearly the production of a philosopher and not of a practical

physician, such as we know Hippocrates to have been. The latter part of

this book, however, is of a more practical nature, and treats of many

things relating to regimen and dietetics, such as the arrangement of

meals, of exercises, etc.

The second book is a regular work on Dietetics, and exhibits this

branch of medicine in a more advanced state than might have been

expected, considering the time it was written. After some preliminary

observations on climate, which bear a great resemblance to those

contained in the treatise “On Airs,” etc., the author treats, in a

very scientific and methodical manner, of the various animal and

vegetable substances which are used as articles of food. It concludes

with a discussion on certain matters connected with regimen, such

as exercises, baths, sleep, and so forth. Foës remarks that a great

portion of the opinions advanced by Celsus on the head of Dietetics is

borrowed from this book.

The third book treats again of various subjects connected with

Dietetics, such as exercises, the arrangement of meals, the

administration of emetics, the use of venery, and the like. It is full

of important matter, but looks like a distinct treatise from the two

preceding books, for one cannot conceive that the author of one work

would have twice resumed the consideration of the same subject. Le

Clerc, with considerable appearance of reason, ascribes the book to

Herodicus, the master of Hippocrates in the gymnastic art.[202]

Altogether, the work is one of the highest importance in medical

literature, whether we ascribe it to Hippocrates or not. On this point

the evidence, both external and internal, we have seen to be very

inconclusive. The most probable conclusion that can be drawn regarding

it is, that the work is a compilation of important documents from a

variety of sources, but who the compiler was, whether Hippocrates or

one of his successors cannot be determined.[203]

XXVII. Περὶ ἐνυπνίον--_On Dreams_.

This little work is generally admitted to be a continuation of the

preceding one, and consequently stands upon much the same grounds as

regards its authorship.[204] As Le Clerc and Gruner have well remarked,

it is written with much acumen, and evinces great freedom of spirit,

and exemption from popular errors and superstitions. It commences in

the following strain:

“He who forms a correct judgment of those signs which occur in sleep,

will find that they have a great efficacy in all respects; for the mind

is awake when it ministers to the body, being distributed over many

parts; it is not then master of itself, but imparts a certain portion

of its influence to every part of the body, namely, to the senses,

to the hearing, seeing, touch, walking, acting, and to the whole

management of the body, and therefore its cogitations are not then in

its own power. But when the body is at rest, the soul, being in a state

of movement, steals over the organs of the body, manages its own abode,

and itself performs all the actions of the body; for the body, being

asleep, does not perceive, but the soul, being awake, beholds what is

visible, hears what is audible, walks, touches, is grieved, reflects,

and, in a word, whatever the offices of the soul or body are, all these

the soul performs in sleep.[205] Whoever, then, knows how to judge of

these correctly, will find it a great part of wisdom. But with regard

to such dreams as are divine, and prognosticate something, either

good or evil, to cities, or to a particular people, there are persons

who have the art of judging of them accurately, without falling into

mistakes. But such affections of the body as the soul prognosticates,

namely, such as are connected with repletion and evacuation, from

the excess of customary things or the change of unusual things, on

these also persons pronounce judgment, and sometimes they succeed,

and sometimes they err, and understand neither how this happens, that

is to say, how it comes that sometimes they are right, and sometimes

they fall into mistakes; but warning people to be upon their guard

lest some mischief befall them, they do not instruct them how to

guard themselves, but direct them to pray to the gods; and to offer

up prayers is no doubt becoming and good, but while praying to the

gods a man ought also to use his own exertions. With regard to these,

then, the matter stands thus: Such dreams as represent at night a man’s

actions through the day, and exhibit them in the manner in which they

occur, namely, as performed and justly deliberated, these are good to

a man, and prognosticate health, inasmuch as the soul perseveres in

its diurnal cogitations, and is not weighed down by any repletion,

evacuation, or any other external accident. But when the dreams are the

very opposite to the actions of the day, and when there is a conflict

between them--when this happens, I say, it indicates a disorder in the

body; when the contrast is great, the evil is great, and when the one

is small the other is small also.” For the cure of this state, as being

connected with repletion, he recommends evacuation by vomiting, active

exercise, and a restricted diet. The author of the treatise proceeds to

state the signification of dreams which relate to the sun, moon, and

stars, of which the last are said to be connected with the external

parts of the body, the sun with the middle, and the moon with the

cavities. This is the nearest approach to alchemy which I have met with

in the works of any of the ancient physicians. But I must not proceed

much further with my extracts from this work, which there is no reason

to suppose a genuine production of Hippocrates, and the substance of

which would not much interest the general reader nowadays, when the

interpretation of dreams has been entirely abandoned by the profession.

The work concludes as follows:

“He who observes these rules as laid down by us will be healthy through

life.... The regimen, also, as far as it was possible for a man to find

it out with the assistance of the gods, has been expounded by me.” This

looks like the conclusion of a large work, and gives probability to the

supposition that this treatise originally formed a part of the work “On

Diet,” as stated above.[206]

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_.

A work with this title is cited by Erotian, Cælius Aurelianus,[216] and

by Galen,[217] but so confusedly that we must come to the conclusion

regarding these Books, that the ancient authority in support of their

genuineness is by no means satisfactory. Galen evidently inclines to

the opinion of Dioscorides the Commentator, that the Second Book is

the work of the younger Hippocrates, this is to say, of a grandson of

our author. Almost all the modern authorities, as, for example, Foës,

Haller, Ackerman, Gruner, and Littré, concur in rejecting the whole

four as spurious. The Fourth Book in particular is separated by M.

Littré from the other three, as being a portion of the work “On the

Diseases of Women,” rather than of the work “On Diseases.” We shall

be better enabled to speak decidedly on this and the other questions

regarding the authenticity of these books, when we have examined the

nature of their contents.

After a very striking exordium, in which it is stated that the first

object of him who turns his attention to the healing art should be to

consider the causes of disease, and the natural tendencies of every one

of them, that is to say, of their dispositions to death, or to loss of

parts, the author proceeds to deliver his doctrine as to the causes

of them, which he assumes to be either internal, namely, bile and

phlegm; or external, such as labor, wounds and excess in heat, cold,

dryness, and humidity. The following accidents are said to be mortal:

a wound of the brain, of the spinal marrow, of the liver, of the

diaphragm, of the bladder, of a large blood-vessel, or of the heart.

He ranks the following as fatal diseases: phthisis, dropsy, and, when

they attack a pregnant woman, pneumonia, causus, pleurisy, phrenitis,

and erysipelas of the womb. The issue of the following is set down

as doubtful in ordinary circumstances: pneumonia, causus, phrenitis,

pleuritis, quinsy, enlargement of the uvula, hepatitis, splenitis,

nephritis, dysentery, menorrhagia. The following are not deadly:

chronic defluxions on the joints (κέδματα), melancholy, gout, ischiatic

disease, tenesmus, quartan and tertian fevers, strangury, ophthalmy,

leprosy, lichen, arthritis; yet even from these patients often become

maimed in particular members, such as in the limbs from arthritis, or

in the eyes from ophthalmy. Diseases also have a tendency to pass into

one another, as, for example, pleurisy into causus, phrenitis into

pneumonia, tenesmus into dysentery, and lientery; and pleurisy and

pneumonia into empyema. He makes the following curious observations

on the awkward mistakes which a physician may commit in the practice

of his profession: not to know when there is matter in an abscess or

tubercle; not to ascertain the existence of fractures or dislocations;

having probed the head in case of injury thereof, not to ascertain

that there is a fracture of the skull; not to be able to introduce an

instrument into the bladder, nor to be able to ascertain whether there

is a stone in it or not; in the case of empyema, not to ascertain the

existence of matter by succussion; and in using the knife or cautery,

to apply either of them to too great or too small an extent. The

treatise also contains many other general observations, which are very

ingeniously stated, as, for example, the following enumeration of the

untoward accidents which may occur to a medical practitioner: Having

administered an emetic for the purpose of evacuating bile or phlegm

upwards, to induce rupture of a vessel by the act of vomiting, although

the patient had previously been sensible of no pain in the region;

having given an emetic to a woman with child, to induce abortion

in consequence; in curing empyema, when looseness of the bowels is

superinduced, and cuts off the patient; in applying an ointment for

a disease of the eyes, when acute pains supervene, which end either

in rupture of the eye or amaurosis, the physician in such a case gets

the blame for having applied the ointment; and when a physician gives

anything to a woman in labor on account of pains in the bowels, and the

woman gets worse or dies, the physician incurs censure. And in diseases

and injuries, when there is a necessary succession of bad symptoms, the

physician gets the blame, as men do not perceive that the aggravation

of the symptoms is a necessary consequence of the nature of the

disease. And if a physician visits a patient in fever, or who has met

with an injury, and if the patient gets worse after the first medicine

that is administered, the physician is blamed; whereas he does not get

the same amount of credit if the patient improves, as the amendment

is attributed to the nature of the case. This book contains what I

believe is the most circumstantial detail of the phenomena of empyema

that is to be met with in any ancient work on medicine. The author

ascribes the disease principally to three causes: to the termination

of pneumonia, to a defluxion from the head, and to the consequences of

a ruptured vessel. Whoever is acquainted with the modern literature of

the subject, or possesses a practical knowledge of the disease, will

not fail, from the accompanying description of the last of these, to

recognize a case of cavity of the lungs produced by the ulceration

of tubercles. True empyema, however, as the result of chronic

inflammation, is also described in distinct terms. The never-failing

test by succussion is constantly adverted to in these cases. Distinct

mention is also made of the _râle_, by which the existence of

matter in the lungs is ascertained. Allusion is probably made here to

the well-known gurgling sound produced by matter in a cavity. There

is a good deal of other important matters in this book, but these my

necessary limits oblige me to pass over unnoticed. I shall merely

allude to the distinct mention which is made of _ruptures_, by

which was meant a severe sprain or other injury ending in suppuration,

or protracted pains in the part. Fever is said to be formed in this

manner: when bile or phlegm is heated, the whole of the body is heated,

and they are heated either by internal things, such as food or drink,

or by external, such as labor, wounds, excess of heat or cold; also

from the sight or hearing, but rarely from these. In the treatment of

pneumonia, venesection in the arm is recommended. Altogether this book

contains much valuable matter, but mixed up with hypothesis in a way

not usually met with in the genuine works of Hippocrates.

The second book, at the very commencement, betrays a strong

disposition to diagnosis. Eight diseases at the head are described, but

in such terms that we fail to recognize the distinguishing features

of each. Besides these, a little way further on the author describes

several other diseases of the head, including hydrocephalus, the

symptoms of which are given with great precision, namely, acute pain

about the bregma and temples, alternate rigor and fever, impairment

of the sight, double vision, vertigo, etc. He recommends errhines,

purgatives, and even trepanning of the skull. Even of this disease

several varieties are described in very striking terms; so that for

once at least we are tempted to question the correctness of the

judgment which Hippocrates pronounced against the rival school of

Cnidos, for cultivating diagnosis to an undue extent.

Several varieties of quinsy are likewise described, including various

diseases of the parts about the fauces, and among them the disease

named _hypoglottis_, by which appears to be meant an abscess below the

tongue, attended with swelling of that organ. Five varieties of polypus

nasi are next described, and suitable plans of treatment recommended,

namely, with the ligature, the knife, and the cautery. Pleurisy and

pneumonia are described, and their termination in empyema, the symptoms

of which are circumstantially described again; and, moreover, three

varieties of it are noticed. Here, again, we find mention made of the

diagnostic method, by succussion, and a recommendation of the operation

of _paracentesis thoracis_, to evacuate the fluid. Next are described

several varieties of phthisis, including the _tabes dorsalis_, of

which a curious description is given. An interesting account is also

given of _spermatorrhœa_. The treatment consists in abstinence from

immoderate drinking, venery, and excessive exercises, except walking,

_for a year_, avoiding cold and the sun, and taking the tepid bath. The

description of the varieties of pulmonic disease is most interesting,

although some of them are not sufficiently well defined. Hydrothorax is

also described, and paracentesis recommended in the treatment of it.

After describing lethargy, which was clearly a species of remittent

fever, he gives descriptions of certain diseases, under the names of

_morbus resiccatorius_ (ἀυαντή), _Febris mortifera_, _Lividus morbus_,

_morbus ructus ciens_, and _morbus pituitosus_. No one can fail to

recognize in these descriptions the spirit of the Cnidian school of

medicine, and one very different from that of Hippocrates. Indeed

we have positive authority for referring this work to the Cnidian

school, for Galen assigns the description of the _morbus lividus_ to

the Cnidian physician Euryphon.[218] The author describes a singular

species of melancholy, which, he says, is sometimes epidemic in spring;

he calls it _cura, morbus gravis_. It appears to have been a variety

of the lycanthropia. See PAULUS ÆGINETA, III., 16. The book concludes

with a description of two species of _melæna_, and of _sphacelotes_,

the latter being a variety of the other. Now what strikes one in going

over this book is, that it cannot be a portion of the same work as the

First Book, for we cannot conceive it probable that an author would

have treated twice of the very same subjects in one work. Moreover, as

we have stated, there are evidently many things in it which are not at

all in accordance with the principles of the Coan school.

In the third book very much the same ground is again gone over as

in the two preceding books. In the first place, diseases of the head

are described under the names of _tumor cerebri_, _plenitudo cerebri

dolorem inferens_, _sydere icti_, _sphacelismus_, _lethargus_ (then

intervenes a brief account of _Febris ardens_, quite out of place),

of _dolor capitis_, and _phrenitis_. Afterwards comes a description

of _cynanche_, and _paracynanche_, next of _icterus_, and afterwards

of _tetanus_, for the cure of which the author recommends the cold

affusion. (On the merits and demerits of this practice, see the English

edition of PAULUS ÆGINETA, III., 20.) For ileus, as in a preceding

book, among other modes of treatment, it is directed to inflate the

bowels by means of a pipe and bladder, and then to evacuate their

contents with a clyster. Afterward, pneumonia and pleurisy are most

circumstantially described, and the treatment of them laid down with

a degree of prolixity very unlike the usual manner of Hippocrates.

Thus, to promote the expectoration in pleurisy, he recommends the flos

æris, asafœtida, trefoil, pepper, etc.[219] I am not aware that any

other ancient authority recommends these medicines for the cure of

this disease. The symptoms and diagnosis of empyema as the consequence

of pleurisy, are given in much the same terms as in the preceding

book. Succussion is particularly alluded to. For empyema, burning and

incision are recommended. In performing paracentesis, he forbids all

the matter to be evacuated at once. Altogether, a perusal of this book

leads me to the positive inference that it is not the production of

the same author as the two preceding books; for what could induce the

author to go over the same ground three different times in one work?

The fourth book is manifestly the production of a different author

from the others, indeed, as appears evident from the conclusion

of the work, it is continuous with the treatise “On the Nature of

Women.” It commences with an elaborate discussion on the four humors,

blood, phlegm, water, and bile, from which all diseases are said to

derive their origin. The whole book is tinged with the exposition

of this doctrine; indeed all the contents of it are for the most

part hypothetical, and very unlike the matter contained in the

genuine compositions of Hippocrates. From first to last there is no

well-defined description of disease in it. The observations on lumbrici

and calculus are the portions of it which command the greatest interest.

I shall now briefly recapitulate the conclusions which I am prepared

to draw from a careful examination of the contents of this work. 1.

As the same diseases, for example, pleurisy, pneumonia, and empyema,

are all circumstantially treated of in each of the first three books,

it is impossible to suppose them all portions of the same work, or

even the productions of the same author. 2. In the fourth a different

hypothesis is advanced from that which is laid down in the first, and

from this circumstance, joined to many other considerations already

enumerated, there can be no doubt that it is the production of an

entirely different author. 3. Although all parts of these books

contain abundance of valuable materials, many of the principles and

rules of practice which are developed in them are not akin to those of

Hippocrates, but rather savor of the Cnidian school, which trusted too

much to a fanciful diagnosis, instead of cultivating prognosis as the

basis of its system, like the school of Hippocrates and his followers.

4. The internal evidence in the present instance against their

genuineness, more than counterbalances the small amount of ancient

authority which there is in support of these books.

XXXI. Περὶ ἑπταμήνου--_On the Seven Months’ Birth_.

XXXII. Περὶ ὀκταμήνου--_On the Eight Months’ Birth_.

Although the genuineness of these two works is admitted by Galen[220]

and by Foës,[221] they are not looked upon as the productions of

Hippocrates by almost any other of the authorities, whether ancient or

modern, and in particular, Palladius, Ackerman, Gruner, Littré, and

Greenhill reject them. Yet all admit them to be of very high antiquity,

so that, in this respect, they are not destitute of considerable

interest. The contents of them are altogether of a philosophical

nature, and such as we might expect the school of Democritus to

produce. The author of them holds that fœtuses born at the seventh

month survive, but not those of the eighth. It is clear that he was

imbued with the Pythagorean notions regarding the mystical power of the

number seven.[222] Altogether, the style and matter of these treatises

do not appear to me to accord well with the spirit which prevails in

the true Hippocratic works, but at the same time it must be admitted

that the preponderance of authority for or against their authenticity

is not decided.[223]

XXXIII. Ἐπιδημών, β’, δ’, ε’, ς’, ζ’--_The 2d, 4th, 5th,

6th, and 7th Books of the Epidemics_.

With the exception of Erotian, who admits the whole of the seven books

of Epidemics into his list of the works of Hippocrates, I am not aware

that any of the authorities, ancient or modern, recognize them as

genuine. Galen says that the seventh is allowed by all to be spurious;

that the fifth is the work of Hippocrates, the son of Draco, that is

to say, of a grandson of the great Hippocrates; and that the second,

fourth, and sixth were held by some to be the productions of a son of

Hippocrates, and by some they were looked upon as having been written,

indeed, by Hippocrates himself, but merely as notes or commentaries.

Galen himself inclines to the opinion that these four books are the

production of Thessalus, the son of Hippocrates.[224]

From what has been stated respecting these books, it will be clearly

seen that, although there is no reason whatever to suppose they were

published by Hippocrates, it is, at the same time, highly probable

that he had something to do with the composition of them, and that,

at all events, they emanated from the school upon which his name has

cast so much splendor. I think myself, therefore, called upon to give a

condensed view of their contents; and in doing so, I shall not scruple

to avail myself of the very important annotations made on them by

M. Littré, in his recent edition of this portion of the Hippocratic

treatises.

With regard to these books, in general, he observes that they are

naturally divided into two groups, the one containing the second,

fourth, and sixth books, the other the fifth and seventh. The

correctness of this division is quite evident from a comparison of

the contents of the different books, and, to a certain extent, it is

recognized by Galen.[225]

As to the locality of these observations, M. Littré shows that the spot

of their greatest activity is Thessaly and Thrace, although mention of

Athens, and of certain cities of the Peloponnesus occasionally occurs.

He traces with much minuteness the connection of these books with the

other works in the Hippocratic Collection. For example, he shows the

connection between those in the first group, with the “Aphorisms,”

in particular, but also with the treatises, “On Airs,” etc., “The

Mochlicus,” “The Surgery,” etc., and of those in the other group, with

the work “On Wounds of the Head” in particular. I will now offer a few

remarks on the contents of each of these books.

M. Littré, in his argument prefixed to the second book, treats of

various matters contained in it, the most interesting of which is his

elaborate disquisition on the nature of the carbuncles (ἄνθρακες)

described in his book, during the course of which he brings into review

various collateral passages from the works of subsequent authors, and

discusses the question at considerable length whether or not they

apply to smallpox. I am free to admit that it would have been to my

advantage if I had seen this part of the writings of M. Littré before

piling my commentary on PAULUS ÆGINETA, B. IV., 25. I must

be permitted to say, however, that I see no reason for changing my

opinions with regard to the anthrax of the Greek writers on medicine.

I certainly cannot agree with M. Theod. Kauser, in setting down the

ancient descriptions of the anthrax and plague (λοιμὸς) as applying

to the smallpox. Having diligently studied the minute descriptions

which the ancient medical authors give of the different varieties of

cutaneous disease, I am confident that if the smallpox had actually

existed in their days, they would not have passed over the disease with

a vague and casual notice, but would have given us such a sketch of its

appearances that no one could have failed to recognize its features.

The carbuncles, then, which are incidentally mentioned by Hippocrates

at the beginning of this book, I am disposed to look upon as one of

those anomalous phases of disease which are every now and then making

their appearance, and I cannot persuade myself that they had anything

to do with smallpox.

Among the important matters contained in this book may be noticed the

remarks on deposits, an interesting subject often alluded to in the

Hippocratic treatises, § 7. At § 22 a case is obscurely noticed, which

M. Littré concludes, but upon very slight grounds, to have been a case

of purulent infection. At § 24 spontaneous luxation of the cervical

vertebræ is described, as M. Littré, in his argument, remarks, with

admirable judgment. It is also alluded to at “Aphoris,” iii., 26, and

“De Articulis,” tom. iv., p. 179, ed. Littré. This affection, which

came afterwards to be overlooked, has been redescribed of late years.

In the third section there is given an interesting account of causus,

the remittent fever of hot climates, so admirably described afterward

by Aretæus. The fourth section is occupied with a description of the

veins of the body, which is certainly confused, and yet we find in it

the distinction between the nature of the arteries and veins clearly

pointed out. It is curious, moreover, that Galen, in one place, stands

up for this part as being genuine and accurate.[226] See also b.v. §

46. The last two sections treat professedly of physiognomy, but contain

other detached and unconnected observations on medical subjects.

Altogether, the impression which a careful perusal of this book conveys

to one is, that it is a compilation of the most incongruous matters,

strung together without any plan; but, at the same time, one cannot

fail to detect in it traces of no contemptible talent for observation

and description.

The fourth book, of the whole number, is the one which is written with

the least unity of design. Yet, as M. Littré remarks, it is interesting

as containing the history of an epidemical causus, complicated with

jaundice and ophthalmia, which would appear to have been very similar

to the febrile epidemic which prevailed in Scotland a few years ago.

With this opinion I entirely acquiesce, after having had a good deal

of experience in the treatment of that epidemic. It was decidedly of

the remittent type, was frequently accompanied with jaundice, and the

patients were very subject to relapses and affections of the eyes.[227]

For Hippocrates’s description of it see tom. v., p. 169, ed. Littré.

M. Littré also makes the important remark that, of late years, proper

attention has not been paid to the state of the urine at the epoch of

a crisis in fevers. He mentions that M. Martin Solon holds that, at

the resolution of diseases, the urine is apt to become albuminous;

but that, in a true crisis, the precipitate is generally composed of

urate of ammonia. M. Zimmerman found the urinary deposit composed of

the urate of ammonia, with the triple phosphates and the crystals of

uric acid. Certain observations on this critical deposit occur in this

book of the Epidemics, but they are met with more frequently and more

distinctly expressed in the genuine books, I mean the first and third.

It appears to me most remarkable that the important observations made

by Hippocrates on the state of the urine in febrile diseases should

have been lost sight of in an age when the chemical characters of the

urine have been so much studied; for I am fully satisfied, from my own

practical acquaintance with fevers, that in most cases the febrile

crisis is marked by a copious sediment in the urine. An interesting

case of empyema, which was treated by the cautery, is related at §

4. A case is related at § 19 of a singular affection of the mouth in

two children, attended with necrosis and exfoliation of the bones. At

§ 39 there is a case of metastasis of purulent matter from the hand

to the lungs. At § 11 a case is related of a child who sustained an

injury in the head from another child, was trepanned, and died on the

twenty-fourth day. We shall see in the work “On Injuries of the Head”

that the ancients were very free in the application of the trepan to

the skull. Cases of nyctalopia are alluded to at § 52, and at § 58 a

case is related of mania supervening on the cure of hemorrhoids. But,

upon the whole, the most interesting part of this book is that which

contains the narratives of febrile cases, and the remarks on relapses,

§ 28.

Though the fifth and seventh books of the Epidemics are pronounced by

Galen to be unworthy of the Great Hippocrates, they contain detached

observations of much interest, insomuch that Haller was almost disposed

to admit the genuineness of the fifth. Lemos and Mercuriali, on

the other hand, hold them to be wholly removed from all connection

with the genuine remains of Hippocrates. It is remarkable, however,

that the fifth is referred to by Celsus,[228] Quintilian,[229] and

Plutarch.[230] This, in fact, is the book which contains the memorable

passage in which the author admits, that in a case of injury of the

head he mistook a fracture for a suture of the skull,[231] and for

this candid admission Hippocrates is highly lauded by the authors we

have just quoted. The Hippocratic treatises also contain many other

instances in which the author admits having committed mistakes. How

much might the medical art not have advanced before this time, if

the example thus set of recording for the benefit of posterity, the

mistakes which one commits had been more generally followed?[232]

The first paragraph contains the case of a woman who had fever and

took medicine which did her no good; a hard swelling, accompanied

with severe pains, seized her below the navel, which were removed

by strongly rubbing in oil with the hands, after which she had a

copious discharge of blood downwards, and recovered. M. Littré, from

a comparison of this passage with Epidem. ii., 6, 26; iv., 45, 56,

draws the conclusion, that reference is here made to the practice

of compressing the bowels with the hands in cases of ileus, for

which Praxagoras, the master or Herophilus, is censured by Cælius

Aurelianus.[233] At § 9 there is the case of a man affected with

prurigo, and a condition of the skin resembling leprosy, which nobody

could remove. He then went to the hot baths in the island of Melos, and

was cured of his cutaneous affection, but soon after became dropsical

and died. In § 10 there is related a case of cholera, treated with

hellebore, which produced great evacuations upwards and downwards,

and the patient recovered. This mode of practice is animadverted upon

by Cælius Aurelianus. (Morb. Acut. iii., 20.) § 12th contains an

instructive history of headache in a woman, which nothing relieved

but free menstruation, and afterwards conception. At § 15, there is a

very interesting case of necrosis or caries at the hip-joint, for the

relief of which a large incision was made down to the bone and the

cautery applied; on the eleventh day tetanus supervened, and proved

fatal on the eighth day afterwards, although treated by embrocations,

fomentations, and strong purgatives. The author remarks in conclusion,

that the patient would have lived longer, if the purgative medicine

had not been administered. At § 16 there is a case of injury of the

head, where the surgeon at first sawed the bone down to the diploe, a

practice alluded to in the treatise “On Injuries of the Head,” § 21.

In this case erysipelas came on, and yet the patient recovered. It

is to be regretted that the text here is in a corrupt state. At § 18

there is a case of pregnancy in which the administration of a strong

purgative was followed by fatal results. At § 20 there is related a

case of hemorrhoids, seemingly _mali moris_, which proved fatal

in consequence of an operation having been performed upon them. § 24th

contains the history of a case of hæmoptysis, which ended in phthisis.

The author makes the shrewd remark that the patient was indisposed

before the vomiting of blood commenced. I may here remark, how well

this accords with the doctrine of Louis, that hæmoptysis is rather

the consequence than the cause of tubercular disease. At § 38 there

is another case of hæmoptysis in which the patient was choked by a

large quantity of blood which he was bringing up; the spleen also, in

this case, was affected, and there were bloody discharges downwards.

This book contains a great variety of serious cases connected with

accidents. At § 50 is a fatal case of concussion of the brain. At §

74 there is a fatal case of tetanus supervening upon a slight injury

of one of the fingers and in the following section there is a case of

tetanus arising from a strain of the thumb and proving fatal. In the

next section there is a case of fatal tetanus from the injudicious

healing of a sore on the leg.

Though Galen refuses to sustain the sixth book as genuine, he

has written an elaborate commentary upon it, and mentions at the

commencement that commentaries had been written upon it before his

time by Zeuxis of Tarentum, the Erythræan Heraclides, and before

them by Bacchius and Glaucis. It is a large work, being divided into

eight different sections, which have little or no connection with one

another. Upon the whole, as M. Littré remarks, the most interesting

portion of it is the part in which are described the phenomena

attending an epidemic cough, or influenza, which reigned in Perinthus.

See § vii. It broke out in winter about the solstice, and was preceded

by great changes of the winds. There was a great tendency to relapses,

and it was further complicated with pulmonic affections, nyctalopia,

angina, paralysis, etc. It was observed, that any member which was

much exposed to fatigue was the part most liable to be attacked. All

these complications occurred in the relapse, and never in the original

attack. Women were less liable to be affected than men, the reason of

which is supposed to have been, that they do not expose themselves

so much to the air as men do. In women, too, all the attacks were

mild; but in the men some were mild and others fatal. When a febrile

rigor supervened, the attack speedily was mortal. The usual remedies

were tried, namely, purging, venesection, bleeding by the renal vein,

and emetics; but none of them did any good. M. Littré remarks, that

in the course of his reading he has never met with an example of an

epidemic exactly resembling the one here described. It is, therefore,

an interesting picture of a disease not otherwise known. The sixth

section begins with the announcement of the physiological doctrine so

frequently quoted with approbation, namely, that “the fleshy parts

attract both from the bowels and from without, and that the whole body

inspires and expires.” This doctrine is fully expanded and illustrated

in an interesting volume by Abraham Kaau.[234] The fifth section

opens with another philosophical tenet, which Sydenham often quotes

with approbation, namely, that “Nature is the physician of diseases.”

“Nature,” the writer adds, “although untaught and uninstructed, does

what is proper.” Galen’s Commentary on this passage contains much

interesting matter, and is a fine specimen of the medical philosophy of

the ancients.[235]

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.

XXXVIII. Περὶ γυναικείων--_On the Diseases of Women_.

We have already stated in our critical remarks on the fourth book,

“On Diseases,” that it and the present treatise are evidently the

productions of the same author. Although Erotian and Galen[252]

make reference to it as if acknowledging it to be the production of

Hippocrates, its claim is rejected by Foës, Schulze, Gruner, and

Ackerman, and all the modern authorities of any note. Its connection

with the treatises “De Genitura” and “De Natura Pueri,” is pointed out

by Foës and Gruner; and Littré does not hesitate to refer to the same

author the whole of the following treatises, “De Genitum,” “De Natura

Pueri,” “De Morbis,” iv., “De Morbis Mulierum,” “De Morbis Virginum,”

“De Sterilibus.” Although not the composition of Hippocrates, all these

treatises are, without doubt, of high antiquity, and were anterior to

the age of Aristotle.

The work now under consideration contains much valuable matter, and

deserves a careful perusal. I feel rather at a loss what selections

to make from it, as a specimen of its contents, but shall be brief

on the present occasion, more especially as I have no difficulty in

establishing the point, that the treatise in question is not one of the

genuine works of Hippocrates.

The observations contained in the first part of it, on menstruation

and the causes of sterility, are ingenious. For the cure of sterility,

fumigation of the uterus is recommended, and a minute description

is given of the mode of performing this process, by means of a tube

introduced into the os uteri, and connected with a vessel which emits

aromatic fumes. When sterility is connected with the shutting up of

the os uteri, the author gives directions for expanding it by means of

a wooden or leaden pipe. We need scarcely remark, that this practice

has been revived of late years. A minute description is given of a

malformation of the vagina, in which the passage is nearly obliterated

by a membrane. Allusion is probably made here to a preternatural

rigidity of the hymen. The author directs the membrane to be fairly

torn, and the part dressed with wine and myrrh. In transverse and

footling presentations of the child it will be best, he says, to bring

it down by the head. Both cases are said to be dangerous, so that

either the mother or child is lost, and sometimes both. Treating of

retention of the placenta, the author remarks, that if it is not cast

off it becomes putrid, and thus comes away on the sixth or seventh

day, or later. To promote its expulsion, he recommends southernwood,

dittany, the flowers of the white violet, and asafœtida. The process

of abortion, and the unpleasant circumstances connected with retention

of the placenta in this case, are given with much accuracy. Hydrops

uteri is described at considerable length. For an account of it, see

PAULUS ÆGINETA, Vol I., p. 573, Syd. Soc. edition, and the

modern authorities there referred to. For ulcers of the womb, he

recommends applications consisting of many stimulating ingredients,

such as the flos argenti, etc. The subject of difficult delivery is

resumed; when the arm or leg of a living child is protruding, it is

directed to be pushed back, and the child turned to the head; and if

the fœtus be dead, either the same thing may be done, or the projecting

part may be cut off, and the head opened with a sharp knife, and the

bones thereof extracted, and the body brought along. The chest also

may be opened, if there be any difficulty in extracting the body.

The author expresses himself strongly in regard to the danger of

abortions. All abortions, he says, are attended with more danger than

deliveries at the full time. Artificial abortion never takes place

without violence, whether produced by medicine, a draught, or food, or

a suppository, or any other means.

The second book commences with a description of fluor albus, an

affection to which the old are stated to be more subject than the

young. It arises from suppression of the menses, from parturition,

or a fever. Among other means which he speaks of for the cure of it,

he mentions the application of cupping-instruments to the mammæ.

Astringents from the vegetable kingdom are to be administered, such

as sumach boiled in vinegar, mulberries, or the like. A full account

of the red fluor, _or_ uterine hemorrhage, is also given. It is

said to be connected principally with parturition. The treatment which

is recommended can scarcely be improved upon, even after the lapse

of two thousand years: a sponge is to be wetted and applied to the

pudenda; soft garments are to be moistened with cold water, and laid

on the belly; and _the foot of the bed is to be raised_. When the

hemorrhage is connected with putridity many women thus perish, indeed

few recover. A long description is given of hysterical convulsions

which is said principally to attack antiquated maids and widows. It is

remarked that hysterical complaints bring on cough, and other pectoral

complaints. A very striking and accurate description is given of

procidentia uteri. Inflation of the womb is also described. On it see

PAULUS ÆGINETA, Vol. I., p. 632, Syd. Soc. edition. There is

also a curious description of the mole. The clitoris is described under

the name of columna.[253]

From the extracts now given, it will be seen that these Books contain

a great variety of most important matter. Indeed, there are few

treatises in the Collection more deserving of an attentive perusal.

They furnish the most indubitable proofs that the obstetrical art had

been cultivated with most extraordinary ability at an early period.

Beyond all doubts the complaints of women, and the accidents attending

parturition, must at that time have come under the jurisdiction of

the male practitioner. But, considering the wandering life which

Hippocrates led, and that during the best part of it he must have been

what is now called a consulting physician, it is not at all likely

that he could have acquired that acquaintance with the minutiæ of

obstetrical practice which this work displays. It is not, then, at all

probable that he can be the author of it.

XXXIX. Περὶ ἀφόρων--_On Sterile Women_.

This treatise is closely connected with the preceding one, both in

matter and style. It relates to a subject which, as we have shown, is

also treated of in the other work, I mean sterility, the most common

cause of which is held to be the state of the os uteri, when it is

oblique to the passages of the vagina, constricted from cicatrices,

or otherwise diseased. Distinct directions are given for opening the

mouth of the womb, after which a cleansing application, composed of

cantharides and myrrh, is to be made to it. The mole, and procidentia

uteri, are described in nearly the same terms as in the preceding

treatise. Though it bears a great resemblance, then, to the work “On

the Diseases of Women,” it is not likely, as suggested by Albertus

Fabricius,[254] that it is an appendix to it, for why should an author

treat twice of the same subject in the same work?

XL. Περὶ παρθενίων--_On the Complaints of Young Women._

Foës looks upon this little tract as being the prelude to the greater

work “On the Diseases of Women.” It is destitute of all claims to

be held as genuine, and accordingly no critic, ancient or modern,

stands up for it. Gruner is inclined to ascribe it to the author of

the treatise “On the Sacred Disease,” but I see no grounds for this

opinion, except it be that, in the two treatises, there is a certain

similarity of views with regard to the nature of the hysterical

convulsion. This, however, is not a sufficient reason for deciding that

they both must have come from the same source, for all the ancient

authorities, from Hippocrates to Actuarius, held pretty much the same

ideas regarding the nature of “Uterine suffocation.” See PAULUS

ÆGINETA, III., 71. The author of this little fragment gives very

naïve advice to virgins who are subject to hysterics; instead of making

costly oblations of garments and the like to Diana, as recommended by

the prophets, he gravely advises them ὡς ταχίστα συνοικῆσαι ἀνδρασι.

XLI. Περὶ ἐπικυήσιος--_On Superfœtation._

This treatise, I believe, is not mentioned by any one of the ancient

authorities, and it is almost universally rejected by the modern.

I need scarcely remark that it relates to a very curious subject, and

that great doubts are now entertained whether or not superfœtation

in women ever actually takes place. I can state, however, that two

trustworthy persons, the one a surgeon and the other a _sage

femme_, informed me, some years ago, that they once attended

together a case in which a woman was first delivered of a fœtus about

four months old, and, about thirty-six hours afterwards, of a fully

grown child. The ancient _savants_ all believed in the occurrence

of superfœtation. See in particular Aristotle (Hist. Anim. vii., 5);

and Pliny, (H. N., vii., 11.)

The following are a few of the most interesting observations which

I have remarked in perusing this treatise. When the secundines are

evacuated before the child, they cause difficult parturition, and the

case is dangerous unless the head present. Presentations of the hand

and foot are directed to be replaced. When the placenta is retained

after the expulsion of the child, the child is to be laid upon wool,

or upon two bladders, filled with water, either of which is to be

pricked, so that the water may run off gradually, and thus draw down

the placenta. When there is a copious discharge of blood before labor,

there is a risk that the child may be dead, or at least not viable.

When women with child long for coals, the appearance of these things

is to be seen on the child’s head. (For the opinions of the ancients

on the effect of imagination on the fœtus in utero, see the commentary

on B. I., § 1, of PAULUS ÆGINETA, Syd. Soc. edition.) Some

ridiculous things are contained in this work, such as the following;

when a man wishes to beget a male child let his left testicle be tied,

and when a female the right.[255] The composition of suppositories

for cleansing the uterus is described at considerable length towards

the end of the treatise. Altogether, the work is by no means devoid

of interest, but, as I have already said, it is certainly not the

composition of Hippocrates. Littré, on the authority of the passage

quoted from Aristotle on this head, refers the treatise to Leophanes.

From the account which we have given of its contents, it will be

remarked that the title and contents of it do not well accord together.

This remark, however, applies to other of the Hippocratic treatises

besides the one we are now treating of.

XLII. Περὶ γυναικείης--_On the Female Nature_.

As Foës remarks, this work is mostly made up of excerpts from the

treatise “De Muliebribus.” I need not, therefore, occupy time in

discussing its claims to be regarded as genuine, nor in giving an

outline of its contents.

XLIII. Περὶ καρδίης--_On the Heart_.

Galen, in one place, appears to cite a passage in this treatise, but

without naming it.[256] It is not found in Erotian’s list, and all the

modern authorities, including even Foës, who is more disposed than

most of the others to deal leniently with the claims of the treatises

which bear the name of Hippocrates, concur in refusing to admit it

as genuine. Still, however, there can be no question as to its being

a work of very high antiquity. It is to be regretted, then, that the

text is in a very unsatisfactory state. It contains, upon the whole, a

wonderfully accurate description of all the parts about the heart--of

its substance, which is said to be a strong muscle; of its pericardium,

which is described as being a smooth tunic, containing a little fluid

resembling urine; of its ventricles (γαστέρες); of its auricles

(ὄυατα); of the origin of the veins from it; of its sigmoid valves; of

its office, to be, as it were, the fountain head, from which all parts

of the body are irrigated, and the seat of the understanding, which

is said to be in the left ventricle. The understanding, it is added,

is not nourished by the blood, but by a pure and luminous (φωτοειδὴς)

superfluity from it. Altogether, this little treatise bespeaks much

practical acquaintance with human anatomy, and, considering the age

in which it was written, must be the production of a very superior

mind. It contains an account of an experiment which has been much

animadverted upon, both by ancient and modern authorities. The writer

says, if a colored fluid be given to an animal, such as a sow, to

drink, and if its throat be cut while it is in the act of swallowing,

it will be found that part of the fluid has passed down by the gullet

to the lungs. See in particular Aulus Gellius (Noctes Atticæ, xvii.,

11); Macrobius (Saturnal. vii., 15); and Plutarch (Sympos. vii., 1.)

Aulus Gellius says decidedly that Plato had adopted this opinion from

Hippocrates. Aulus Gellius and Macrobius also quote Plutarch as having

stated, in his ‘Symposiacon,’ that Hippocrates is the author of this

opinion; but the text of Plutarch (l.c.) is in an unsatisfactory state.

See Schulze (Hist. Med. i., iii., vi., 12.)

XLIV. Περὶ τροφῆς--_On Aliment_.

It must be admitted that this treatise has very high authorities

in favor of its authenticity, such as Erotian, Galen,[257] Aulus

Gellius,[258] Palladius,[259] Stephanus;[260] and, in modern times,

Mercuriali, Foës, Haller, and Le Clerc.[261] It is rejected by Casper

Hoffman,[262] Gruner, Ackerman, Kühn, Littré, and Greenhill, though,

by the last two, not in decided terms. Considering the respectability

of the external evidence in its favor, I should certainly not have

hesitated in admitting it as genuine, had not a careful examination

of its contents led me to form the unbiassed decision that it

must be the production of some metaphysician, rather than of a

medical practitioner, such as we know Hippocrates to have been. The

physiological dogmata with which it abounds are announced in so

antithetical, not to say paradoxical, a manner, that I can conceive

nothing more foreign to the style and character of the true writings of

Hippocrates. I shall give a few specimens:--“The species of aliment is

one and many; all these (kinds of aliment?) are one nature and not one.

Purging is upwards and downwards, and neither upwards nor downwards.

Purging in aliment is excellent, purging in aliment is bad. Aliment

not aliment, unless it conveys nourishment; it is aliment in name but

not in deed; aliment in deed and no longer in name only. Sweet and

not sweet; sweet potentially, as water, sweet to the taste, as honey.

Things not animals are animated; animals are animated, the parts of

animals are animated. It (the embryo) is and is not.” Now, I must say,

that all this appears to me to savour more of the taste of Democritus

than of Hippocrates himself. It may be said, indeed, that the very

circumstance of Galen’s having admitted the work as genuine, and

having composed an elaborate commentary on it, is a most presumptive

proof of its authenticity; for where shall we find so excellent a

judge of the doctrines of Hippocrates as his great commentator? But

then it must be taken into account that Galen himself had a great

_penchant_ towards metaphysical subtleties, and this would lead

him to believe that what was in accordance with his own tastes must

have been in accordance with those of his great professional hero.

But, notwithstanding the doubts which hang over the question of its

authorship, it may be confidently affirmed regarding this treatise

that, illustrated as it is by Galen’s commentary (even although it has

come down to us in a mutilated state), few works in the Collection are

more suggestive than the present one. I shall merely give a few more

specimens of it:--“The root of the veins is the liver, and the root of

the arteries is the heart; and from them blood and spirits are carried

to all parts, and heat passes to the same.” This passage is frequently

quoted and commented upon by ancient authors; as by Galen,[263] and

Aretæus.[264] We have seen it stated in the preceding treatise that

the heart is the place from which both veins and arteries originate.

This seems a presumptive proof that these two treatises must have

had a distinct authorship. “The aliment reaches to the hairs, the

nails, and the outer surfaces from within; and aliment from without

passes from the most external to the most internal parts, there is one

conflux and one conspiration (ξύρροια μία, ξύμπνοια μία). All parts

sympathize throughout the whole frame, but in so far every part has

its own peculiar action.” This passage, also, is very celebrated and

frequently quoted.[265] I need scarcely remark that it embraces a

grand and most important view of the animal economy. “Milk is food to

some with whom it agrees, and to others not. To some wine is food, and

to others not; and so with flesh and many other kinds of aliment. We

must look to situation and habit. Humidity is the vehicle of food. The

natures (instincts?) of all things are untaught. Persons who perspire

freely are weak, more healthy, and have easier recoveries than others.

Those who perspire ill are stronger than others before they become

indisposed, but being indisposed have more difficult recoveries. These

remarks apply to the whole and to the parts.”

From these specimens it will be readily seen that the work abounds

in curious matters, but of a very different stamp from those which

the true Hippocratic treatises contain. Contrary, then, to my general

rule, I certainly feel disposed in the present instance to reject,

upon internal evidence, a treatise which has the most unexceptionable

external evidence in its favor.

XLV. Περὶ σαρκῶν, ἤ ἀρχῶν--_On Fleshes, or Principles_.

This treatise does not appear in Erotian’s list of the Hippocratic

works, and it is rejected by all the modern authorities, from

Mercuriali downwards. Galen is inconsistent in his notice of it.[266]

Some of the philosophical dogmata which it contains are curious, such

as the following specimen: “It appears to me that what we call heat

is immortal, and that it knows all, sees, hears, and perceives all

things that are and will be.[267] When things, then, were thrown into

confusion the greater part of this passed off to the highest circle,

and this it is which the ancients called ether.” The following extract

is held by Gruner, but probably without any good reason, to evince a

degree of anatomical knowledge in advance of the age of Hippocrates:

“There are two hollow veins from the heart, the one called the artery,

and the other the vena cava. The artery has more heat than the vein.”

The other veins are also described with considerable accuracy. It is

stated that the fœtus in utero sucks in fluid (liquor amnii?) by its

lips, and in proof of this the author remarks that the child voids

fæces soon after delivery, which, it is argued, must be derived from

food. The opinion thus stated has been often maintained in modern

times, but does not appear to be well founded. The author mentions

correctly that persons in attempting to commit suicide open the

trachea, in which case, he adds, the patient lives, but loses his voice

until the opening be closed. Conringius and Haller, with considerable

plausibility, but yet without any direct proof, attribute this treatise

to Democritus.

XLVI. Περὶ ἑβδομάδων--_On Hebdomads_.

This treatise exists now only in the Latin translation, which M.

Littré has discovered in the Royal (_National_, it is now called!)

Library in Paris, and will be published in his edition of the works

of Hippocrates. M. Littré gives an elaborate and most interesting

disquisition on it, and seems to make out clearly that it is the

production of the same author as the treatise “On Fleshes,” which we

last noticed. It is cited by Philo Judæus,[268] and several other

writers of antiquity. Galen, however, held it not to be the production

of Hippocrates. A considerable extract from it is contained in the

tract “On Critical Days,” and the eighth section of the Aphorisms,

which has always been looked upon as spurious, is said by M. Littré to

be mostly taken from this treatise.

XLVII. Περὶ ἀδένων--_On the Glands_.

Erotian makes no mention of this treatise, and Galen pronounces it to

be the work of the recent Hippocratists.[269] M. Littré remarks, and

with great truth, that it is difficult to find out the grounds upon

which the ancient critics have rejected this work. Certain it is that

it contains a goodly store of interesting matters, none of which, as

far as I can discover, are inconsistent with the true doctrines of

Hippocrates. In it a pretty correct description is given of the glands,

including those of the mesentery. The brain itself is said to be of

glandular nature, and also the kidneys. An ingenious account is also

given of the origin of scrofula, which is said to be produced by the

lodgment of humors in the glands of the neck, which get into a state

of slow inflammation. Glands, the author says, are seated mostly in

parts of the body which most abound in humidities, such as the armpits

and groins, and hence such parts produce hairs. In the case of the

mesentery, however, no hairs are produced, because the humidities here

are excessive, and choke up, as it were, the seeds of the hairs; in

like manner as seeds sown in marshy grounds perish. A very ingenious

account is given of the origin of phthisis, which is said to spring

from tubercles in the lungs and matter (pus), which corrodes the lungs

when “the patients do not readily recover.” A curious description is

next given of the tabes dorsalis, “in which disease the patient does

not wish to live.” How expressive this language is of the state of mind

in the case of the unfortunates who are subject to spermatorrhœa! The

treatise concludes with some striking remarks on the sympathy between

the mammæ and uterus, and on the influence which both exercise on the

development of the female character. Altogether the contents of this

treatise are most valuable, and may suggest important views to the

medical practitioner and physiologist, even at the present day. We need

have no hesitation in pronouncing, with regard to it, that it reflects

infinite credit on the school from which it emanated, and that it is

not unworthy of Hippocrates, although we have reason to believe that he

was not actually the author of it.

XLVIII. Περὶ φλεβῶν--_On the Veins_.

This is merely an excerpt from the treatise “On the Nature of the

Bones.”

XLIX. Περὶ ἰητροῦ--_On the Physician_.

I may mention in this place, generally, that the treatises which follow

have no ancient authority in support of them, and that, with very few

exceptions, they are also rejected by all the modern critics. Their

contents, moreover, are not of much practical importance, and therefore

I shall be very brief in my analysis of them.

The treatise in question is held to be genuine by no one critic, as

far as I know, with the exception of Foës, who appears, in part, to

sanction its claims. The object of the author is announced to be in

order to instruct the physician how to conduct matters connected

with the iatrium, that is to say, with his establishment or surgery.

Mercuriali, I may mention, is unjustly severe in his animadversions on

the exordium. (See Conringius, Introd. p. 120.) The physician should

have a healthy look himself, for the writer says, people fancy that

a person who does not keep himself in good health is not qualified

to take charge of the health of others. He should be of a prudent

disposition and a gentleman in morals.[270] Minute directions are given

respecting the site and other circumstances connected with the iatrium:

clean and soft towels are to be at hand, linen is to be used for the

eyes, and sponges for the sores. In supplying bandages, attention is

to be paid to utility rather than to display. The surgeon should pay

great attention to all matters connected with this operation: for it is

attended with much disgrace when any manual operation does not succeed.

Minute directions are given about the performance of venesection at

the arm, and mention is made of several untoward accidents connected

with it, such as the blowing up of the vein, whereby the flow of

blood is stopped; and suppuration following as a consequence of the

operation. In order to acquire dexterity in the treatment of accidents,

the author recommends the young physician to attach himself to some

foreign army; and from this Gruner infers, that the work cannot belong

to Hippocrates, as domestic wars were but too common in his time; and

there could have been no necessity for the surgeon’s seeking foreign

service in order to gain experience. It does not occur to me, however,

that there is much force in this argument; for intervals of peace were

just as common during the long life of Hippocrates, as during the

interval between his death and the time when the Collection was made.

But, in fact, there is no necessity to seek recondite reasons for

rejecting a treatise which has no proper authority in support of it.

L. Περὶ εὐσχημοσύνης--_On Decorum_.

This work, like the last, has not the slightest claim to be

looked upon as genuine. Moreover, it has come down to us in a very

unsatisfactory state as regards the text, so that the meaning is often

very dark and uncertain; and I must confess that, as a general rule, I

have little inclination to spend much time in searching out a meaning,

in obscure writings, when, after it is discovered, it is not likely

to repay the exertions made in discovering it. I am always disposed

to remember the advice which Galen repeatedly gives to the student of

medicine, “to concern himself more about things than about words.”[271]

The object of the author seems to be to give general directions with

regard to decorum in the physician’s communication with the sick. It

is evidently the production of some sophist, according to Bernard, of

some one belonging to the Stoical sect. I shall be brief in my abstract

of it. A philosophical physician is equal to a god. In the practice

of medicine all the virtues relating to wisdom are exercised; namely,

contempt of money, decency, modesty, simplicity in dress, character,

judgment, quietness, accessibility, purity of life, sententious maxims,

knowledge of the purifications which are proper and necessary in life,

abstinence from lucre, freedom from superstition, divine excellence.

The physician should keep himself aloof, and not hold much converse

with the common people, unless when necessary. The surgeon should

be well provided with all the means required in the practice of his

profession, such as dressings, medicines, instruments, and so forth,

as any deficiency in these might produce serious results. Minute

directions are given for the regulation of the physician’s address in

entering the chamber of the sick, and his conduct while there.

LI. Παραγγέλιαι--_Precepts_.

This little tract stands altogether in much the same circumstances as

the preceding one, that is to say, it is wholly destitute of all good

authority in its favor, and the nature of its contents is what might

rather be expected from a sophist than a practical physician. The text,

moreover, is in a most unsatisfactory state. I shall dismiss it then

with a very brief notice. It opens with an advice to the physician not

to trust to speculation but to rational experience. He ought to learn

remedies from all quarters, even from the vulgar, and not be avaricious

in his dealings with the sick, more especially if strangers and needy.

The author alludes, as Schulze thinks, to the practice then followed

by the physicians of migrating from one city to another, and of making

a public declaration of their pretensions at their first entry into

any place. These physicians were called _periodeutæ_. The author

of this tract advises the physician, in such a case, not to make any

vainglorious or inflated profession of his abilities. He also enjoins

the medical practitioner to look to the health of those who are free

from disease, as well as those who was indisposed.

LII. Περὶ ἀνατομῆς--_On Dissection_.

This small fragment of ancient anatomical science has no claim to be

regarded as the work of Hippocrates. Neither Erotian nor Galen, nor

any other ancient critic, holds it as such, and the modern authorities

are unanimous in rejecting it. That it may have been the composition

of Democritus, as suggested by Gruner, seems not unlikely. It abounds

in harsh and obsolete terms, which have never been satisfactorily

explained. Some parts of the anatomical description are difficult to

determine, as for example, “the large bronchia which extend from the

heart to the liver;” “the vena scalena, which extends from the liver to

the kidneys.” The latter passage, however, may be supposed to refer to

the emulgent vein.

LIII. Περὶ ὀδοντοφυίης--_On Dentition_.

This little tract is destitute of any competent evidence of its

authenticity. Some of the observations contained in it bespeak a

familiar acquaintance with the diseases of infancy. Thus it is

said, that when the bowels are loose at the term of dentition, if

the digestion be good, the children thrive, and are not subject to

convulsions. When children at the breast vomit up their food, the

bowels are constipated. When there is fever accompanying dentition,

children are seldom attacked with convulsions. But when there is heavy

sleep along with dentition, there is danger of convulsions. All the

children that are seized with convulsions at the time of dentition do

not die. Children that take food during dentition bear vomiting best.

Ulcers on the tonsils are attended with danger.

LIV. Περὶ ἐγκατοτὸμης άμβρύου--_On Excision of the Fœtus_.

No one stands up for the genuineness of this treatise,[272] which,

however, is not wanting in interesting matter relative to the

extraction of the fœtus in cross-presentations. For an abstract of the

practice there recommended, see PAULUS ÆGINETA, Vol. II., p.

389, Syd. Soc. edition. A circumstantial description is also given of

the process of _succussion_, the dangerous effects of which, in

certain cases, are related in the Epidemics.

LV. Περὶ ὄψιος--_On Vision_.

This little fragment is admitted by all the authorities to be

spurious. It contains a description of glaucoma, for which purging of

the head and the application of the actual cautery are recommended, and

also in certain cases venesection. In epidemic ophthalmy, purging both

of the head and bowels is recommended.

LVI. Περὶ ὀστέων φύσιος--_On the Nature of the Bones_.

M. Littré has very ingeniously shown that this work is a compilation

made up of fragments of other works, and thus he has announced his

intention of excluding it altogether from the Hippocratic Collection.

Certain it is, beyond all dispute, that the treatise is not the

production of Hippocrates himself. The following are a few of the most

notable things which I have observed in it. “It appears to me that what

we call heat is immortal, and that it understands, sees, hears, and

perceives all things that are and will be.” The heat, it is further

said, is the origin of all movement in animals. This will be recognized

as the original of the doctrine of the _Calidum innatum_, which

figures in the works of our earlier physiologists in modern times. See

the works of Harvey and the other physiologists of the seventeenth

century; also what is said on this subject in the next section. The

aorta and vena cava are correctly described, the one as an artery, the

other as a vein; and their origin from the ventricles of the heart is

noticed. The author states (p. 440, ed. Kühn), that he had known cases

of attempted suicide in which the windpipe had been opened, and yet

death did not ensue; only while the opening remained the person lost

the power of speaking. See No. XLV.

LVII. Περὶ κρισίων--_On the Crises_.

This tract has no ancient authority whatever in support of it, and

Foës, Gruner, and Littré concur in holding it to be a compilation

from other Hippocratic treatises, more especially the Aphorisms and

Prognostics. This, indeed, must be obvious to every person who reads it

with any attention.

LVIII. Περὶ κρισίμων--_On Critical Days_.

This treatise stands in the same predicament as the preceding one,

that is to say, it has no ancient authority in support of it; indeed

Galen declares against it when he says that Hippocrates had not given

any work on the Critical Days. (Tom. iii., p. 440; ed. Basil.) It is

manifestly a compilation from the other treatises, more especially from

those “On Internal Diseases” and “On Diseases.” Still it appears to

me to be an interesting and well-written compilation. For example, it

would be difficult to point out in any other work, ancient or modern,

a better description of pneumonia than is given towards the conclusion

of it. Tetanus also is accurately described. To be sure, Gruner

infers, from the circumstance that three varieties of this disease

are described, that the work in question must have emanated from the

Cnidian school. But Aretæus, and, indeed, all the ancient authorities

that treat of tetanus, describe three varieties of this disease; and

therefore this is no good reason for excluding it from the Coan school.

LIX. Περὶ φαρμάκων--_On Purgative Medicines_.

Though it must be admitted that this little fragment can boast of no

competent authorities to establish its claim to be placed among the

genuine works of Hippocrates, it bears undoubted marks of having been

written by some person well acquainted with his principles, and having

no ordinary acquaintance with professional matters. Thus the author

states very correctly the effects of idiosyncrasy in modifying the

operation both of purgatives and emetics, and advises the physician to

make inquiry beforehand what effects such medicines, if formerly taken,

had produced on the patient; for, he adds, it would be a disgraceful

casualty to occasion a man’s death by the administration of a purgative

medicine. He also interdicts the administration of purgatives during

the heat of a fever, and during the very hot seasons of the year.

These practical rules appear to me to be highly important, and yet how

frequently do we see them disregarded! At the time we have mentioned,

the author prudently remarks that it is safer to administer a clyster.

LX. Περὶ ἑλλεβορισμοῦ--_On the Administration of Hellebore_.

This little tract is usually published among the _Epistolæ_, and,

as a matter of course, it has no evidence in support of its genuineness

further than they have, which, as we shall presently see, is very

slender. It contains, however, very acute and important observations

on the administration of hellebore, to which it is well known that

the Hippocratists were very partial. But these are mostly extracted

from the Aphorisms, and need not be noticed in this place. The Book of

Prognostics also is quoted, but seemingly by mistake.

LXI. Ἐπιστολαι--_The Epistles_.

No scholar can require to be informed that, since the memorable

controversy in this country between the Honorable C. Boyle and the

celebrated Dr. Bentley, respecting the authenticity of the Epistles

which bear the name of Phalaris, the whole of the “Epistolæ Græcanicæ”

have been generally condemned as spurious. Against this judgment I

have no intention to protest; but I may be allowed to remark that

many ancient works which are usually acknowledged as genuine have not

so much external evidence in their favor as these Epistles possess.

The Epistles ascribed to Plato, for example, are quoted as genuine

by Cicero,[273] and by Diogenes Laertius.[274] Those of Hippocrates,

too, are quoted and recognized by Erotian, Soranus, and other ancient

authorities. Still, however, as I have stated, I have no intention to

stand up against the general opinion of scholars from the Scaligers

down to the present time, by which they have been condemned as

supposititious; only I contend that, as it is admitted on all hands

that they are very ancient,[275] that is to say, that they must have

been composed within less than a hundred years after the death of

Hippocrates, it is utterly incredible that the Sophists who wrote

them, whether for a fraudulent purpose that they might derive profit

from them by passing them off for the productions of the great name

they bear, or whether for the purpose of displaying their own skill

in sustaining an assumed character, should have made them turn upon

alleged occurrences in the life of Hippocrates which every person

at that early period must have been able to judge whether they were

fictitious or not. I see no reason, then, to doubt that the main

facts to which these Epistles relate are real, although the Epistles

themselves be supposititious.[276]

* * * * *

Having thus stated my opinion of these Epistles in general terms, I

shall now dismiss them with a very brief notice.

They are differently arranged by modern authorities; I shall follow M.

Littré in the few remarks which I have to offer upon them.

The first series of these Epistles relates to the services which

Hippocrates is said to have rendered to the people of Athens during

the time of the memorable plague. The spuriousness of these, it is

generally held, is proved beyond all doubt by the silence of Thucydides

with regard to any such professional services rendered by Hippocrates

on the occasion; and no doubt if it were maintained that these took

place at the outbreak of the disease in Greece, that is to say, at the

commencement of the Peloponnesian war, the inference would be most

legitimate. But if we be permitted to suppose that, as the plague

is known to have lurked about in different parts of Greece for a

considerable time, the services of Hippocrates did not take place until

several years afterwards, there is nothing in the story which bears the

slightest air of falsehood, even if we adhere to the common chronology

respecting the birth of our author. Indeed, I repeat, if the Sophist

who composed these letters had founded them on tales which everybody

knew to be false, he could never have hoped to impose upon the learned

men of the next generation, and make his forgeries pass for genuine.

The second series relates to Democritus, and these must be admitted

to be the most interesting of the whole group. Now that Hippocrates

visited Abdera, and that he was familiarly acquainted with Democritus,

are facts which the most sceptical critic will hardly venture to call

in question.[277] But that the Epistles themselves were not written by

the physician and philosopher whose name they bear, I readily admit to

be probable. Most undoubtedly the letter of Hippocrates, in which he

is made to describe his visit to Democritus, however full it may be

of curious matters, is written in a style and manner very unlike the

well-known characters of the true writings of Hippocrates.

Third. The short letter inscribed from Hippocrates to his son

Thessalus, contains nothing from which its authenticity or the contrary

could be legitimately inferred, only it is destitute of all ancient

authority in its favor. In it the father recommends to the son the

study of geometry and arithmetic, as a proper preparation to the study

of medicine.

Fourth. This series, consisting of “The Oration at the Altar,” “The

Decree of the Athenians,” and “The Oration of Thessalus, son of

Hippocrates,” although now generally regarded as spurious, possess

more direct evidence in their favor than any of the others. In fact,

they are decidedly recognized as genuine by Erotian. The documents

in question have all reference to the services of Hippocrates and

his disciples in the pestilence which pervaded Greece during the

Peloponnesian war. These services are alluded to by many ancient

authorities, as we have shown in the Commentary on PAULUS

ÆGINETA, Book II., § 35. In conclusion, I repeat that, supported

as the main facts referred to in these documents are by the highest

testimony which antiquity can furnish, I cannot but regard the facts as

true, although the documents themselves be given up as supposititious.

* * * * *

I will now briefly recapitulate the general results of the

investigations on which I have been occupied in the present section:

1. That all the authorities, ancient and modern, who have investigated

the question regarding the genuineness of the works which have

come down to us under the name of Hippocrates, are agreed that a

considerable portion of them are not the productions of the author

himself.

2. That it is almost universally admitted that the following treatises

are genuine, viz.:

The Prognostics.

On Airs, etc.

On Regimen in Acute Diseases.

Seven of the Books of Aphorisms.

Epidemics I. and III.

On the Articulations.

On Fractures.

On the Instruments of Reduction.

The Oath.

3. That the following treatises may be pretty confidently acknowledged

as genuine, although the evidence in their favor is not so strong as it

is with regard to the preceding list:--

On Ancient Medicine.

On the Surgery.

The Law.

On Ulcers.

On Fistulæ.

On Hemorrhoids.

On the Sacred Disease.

4. That as it certainly appears that the Book of Prognostics is

composed, in a great measure, from the contents of the First

“Prorrhetics” and the “Coacæ Prænotiones,” there can be little or

no doubt that these two treatises are more ancient than the time of

Hippocrates.

5. That although the exact time at which the Collection, as it now

stands, was made out has never been determined in a very satisfactory

manner, an examination of the contents of the different treatises leads

to the conclusion that most of them represent pretty faithfully the

opinions held by the family of Hippocrates and his immediate successors

in the Coan school of medicine.

6. That a few of them, and more especially the two important works “On

Internal Affections,” and “On Diseases,” would appear to bear distinct

traces of having emanated from the contemporary school of Cnidos.

7. That although the Epistles and certain public documents usually

published at the end of the Collection may justly be suspected of being

spurious, there is undoubted evidence that they are of very ancient

date, and were composed, most probably, within less than a hundred

years after the death of Hippocrates, so that there is every reason for

believing that they relate to real events in the life of our author,

and not to fictitious as some have supposed.