The genuine works of Hippocrates, Vol. 1 · Hippocrates
[372] I. 105.
The exact situation of the savage nation of the Macrocephali cannot be precisely determined, but it was evidently not far from the Palus Mæotis, and most probably in the vicinity of the Caucasus. Little is known of them, except what our author says respecting the practice which they had of disfiguring their heads by squeezing them, in early infancy, into an elongated shape. It is well known that the same absurd usage prevailed among the early inhabitants of MEXICO. I need scarcely say that much important information respecting them has been obtained of late years. M. Littré, in the fourth vol. of his edition of Hippocrates, supplies some very important information in illustration of this subject, from a recent publication of Dr. H. Rathke. Certain tumuli having been excavated at Kertch, in the Crimea, there were found in them, besides different utensils and statues, several skeletons, and it was most remarkable that the form of the head was greatly elongated, in the manner described by Hippocrates with regard to the Macrocephali. The author’s words are: “On y remarquait, en effet, un hauteur extraordinaire par rapport au diamètre de la base, et par là ils frappaient même les personnes qui n’avaient aucune connaissance de la structure du corps humain.” [428] The same theory respecting the secretion of the semen is given in the treatises “De Genitura” and “De Morbo Sacro.” It is espoused by Galen, in his little work. “Quod animal sit quod utero continetur.” Coray remarks that Hippocrates’s theory on the origin of the fœtus does not differ much from that of Buffon.
“Semper hiems, semper spirantes frigora Cauri. Tum sol pallentes haud unquam discutit umbras; * * * * * Talis Hyperboreo septem subjecta trioni Gens effrena virûm Rhiphæo tunditur Euro.” It was in this region of mist and cold that the celebrated race of the Cimmerians resided. See Herodot., i., 6, etc.; Homer, Odyss. x., 14. The montes Rhiphæi would appear to have been the Ural mountains which separate Russia from Siberia. [438] It is well known now that excessive cold has a tendency to retard the growth of animals. This opinion is confirmed in several instances by Pallas (Voy. en Russie, i., 197; iii., 431.) Strabo mentions, as the consequences of the cold which prevails in the country of the Getæ, that there are no asses in it, the cattle want horns, and the horses are small. (Geogr., vii., 3.) [439] Buffon, on the other hand, maintains that the Nomadic race are men of active habits. (Hist., Nat., tom. iii., p. 384.) Pallas, however, confirms the judgment of Hippocrates. (Voyag. en Russie, tom. i., p. 499.) See also Coray, ad. h. l. [440] It is to be borne in mind that Hippocrates, and after him most of the ancient authorities, held that the fœtus is formed from the male semen. This doctrine prevailed generally down to the days of Harvey. Some of the ancient physiologists, however, maintained that “omne animal est ab ovo.” See Plutarch, de Placit. Philos.
“Ispa autem macie tenuant armenta volentes, Atque, ubi concubitus primos jam nota voluptas Sollicitat, frondesque negant, et fontibus arcent. Sæpe etiam cursu quatiunt et sole fatigunt; Hoc faciunt nimio ne luxu obtusior usus Sit genitali arvo, et sulcos oblimet inertes; Sed rapiat sitiens venerem, interiusque recondat.” Georg., iii., 136. [445] On the nature of this affection see the Argument. There is a variety in the reading, most of the MSS. having ἀνανδριείς, but the one usually marked 2146, which is followed in the Aldine edition, reading ἀνδριεῖς. See a long discussion in Coray’s edition on this point. There seems to be no good reason for at all interfering with the text as it now stands. [446] Our author in this place, as in the treatise on the Sacred Disease, holds the philosophical opinion in opposition to the superstitious, that all diseases have natural causes, and that no one more than another is to be ascribed to the extraordinary interference of supernatural beings. Plato, his contemporary, would appear to have endeavored to steer a sort of middle course between the scientific and the popular belief. Thus he ascribes epilepsy, like all other diseases, to a natural cause, namely, in this instance, to a redundancy of black bile; but he qualifies this opinion by calling the passages of the brain (the ventricles?) most divine, and adds that the disease had been most appropriately denominated sacred. (Timæus, § 66.)
Shakespeare’s description of the death of Falstaff, by the way, contains images which have always appeared to me to be borrowed (at second-hand, no doubt) from this and other passages of the present work: “For after I saw him fumble with the sheets, and play with flowers, and smile upon his fingers’-ends, I knew there was but one way: for his nose was as sharp as a pin, and he babbled of green fields.--So he bade me lay more clothes on his feet: I put my hand into the bed and felt them, and they were as cold as any stone,” etc.--Henry V., ii., 3. Although perhaps it may be thought rather hypercritical, I cannot omit the present opportunity of making the remark, that it appears to me rather out of character to make the wandering mind of a London debauchee dwell upon images “of green fields.” One would have thought that “the ruling passion strong in death” would have rather suggested stews and pot-houses to the imagination of such a person. [466] It will be remarked that our author modifies his judgment on the result of the _ensemble_ of dangerous symptoms which he has just described, provided they be connected with want of food and of rest, or with looseness of the bowels. See Galen’s Commentary on this passage. Celsus renders this clause of the sentence as follows: “Si ita hæc sunt, ut neque vigilia præcesserit, neque ventris resolutio, neque inedia.”--ii., 6. I may briefly mention that both Galen and Stephanus seem to have understood this passage as I have translated it. Littré it will be seen has rendered it somewhat differently.
Il paraîtrait que, sous le climat de la Grèce, ces affections ont une grande fréquence, plus peut-être qu’elles n’en ont même dans notre climat. La description, fort abrégée il est vraie, qu’en donne Hippocrate, me porte à penser que, si cette description est exacte, elles ne suivent pas la même marche que parmi nous. En effet, que sont ces empyèmes que, suivant Hippocrate, se font jour an dehors sous forme d’expectoration purulente? On peut croire, que dans les dénominations d’empyèmes sont compris les épanchements pleurétiques; mais les épanchements pleurétiques ne se font pas jour au dehors, ils se guérissent par résorption; alors, que sont ces empyèmes signalés par Hippocrate, comme terminaison des péripneumonies, et ces expectorations qui en procurent l’evacuation? Il m’est impossible de répondre à ces questions: peut-être des observations faites dans la Grèce même, permettraient de résoudre la difficulté.” (Œuvres Complets d’Hippocrate, tom. ii., p. 97.) Perhaps, as I have hinted above, the most probable answer that could be returned to the questions put by M. Littré would be, that many of the cases of pneumonia terminating in empyema, which occur in the Hippocratic treatises, were what are now described as cases of acute phthisis. See Louis on Phthisis, ii., 2. In confirmation of my supposition that many of the cases of empyema described by the ancients were, in fact, cases of phthisis, I would refer to PAULUS ÆGINETA, B. III., 32, where it will be seen that the two diseases, phthisis and empyema, are treated of under the same head. See also the second book of the Prorrhetics, tom. i., pp. 198–201; ed. Kühn.
M. Littré reverts to this subject in the Argument to the Coacæ Prænotiones, tom. v., p. 576, where he relates, from two recent authorities, a case of empyema after pleurisy, and another after pneumonia, in both of which the pus was evacuated by the mouth. He also quotes the remark of an English writer, Dr. Twining, that, in and about Bengal, abscess of the lungs after pneumonia is by no means very rare. Still M. Littré admits that the paucity of such cases in modern works must lead to the conclusion either that Hippocrates had not observed correctly, or that this termination is more rare now than formerly. I leave the reader to judge whether my suggestion stated above does not remove this difficulty. [499] The observations of Andral have in some measure confirmed the opinion of Hippocrates and other authors, ancient and modern, that there are certain days in the duration of the disease in which there is a greater tendency to amelioration. Of ninety-three cases, he found twenty-three give way on the seventh, thirteen on the eleventh, eleven on the fourteenth, and nine on the twentieth days. The recoveries in the remaining cases commenced on twelve out of forty-two non-critical days, as many as eleven being ascribed to the tenth day. Thus the recoveries on critical days averaged as high as fourteen, while those on non-critical scarcely exceeded three. (Dr. C. J. B. Williams on Pneumonia, Cyclop. of Pract. Med., vol. iii., p. 405.) See also Andral, Clin. Med., c. ii., p. 365.
“And the Royal Journals ran thus: that he drank at a jollification in the house of Medius; then rising up and being bathed, slept, and again supped with Medius, and again drank until the night was far advanced; that giving over drinking he bathed; and having bathed, ate a little, and slept there, because he was already feverish; that being carried on a little to the sacrifices, he performed them according to his daily practice; that the sacrifices being performed, he reclined in the dining-room (ἀνδρὼν) until the dusk of evening, and there gave orders to the commander respecting the march and voyage, that those who had to proceed on foot should be prepared for marching on the fourth day, and those who were to sail on the fifth; that he was carried hence upon a couch to the river, and being placed in a boat was taken across the river to the garden, and then being again bathed, that he rested. Next day, that he again was bathed and performed the appointed sacrifices; and going into a chamber, that he reclined and conversed with Medius, and gave orders to the commanders to meet him in the morning.
That having done these things, he took a little supper; and having been carried back to the chamber, that he was in a continued state of fever during the whole night; that next day he bathed, and after the bath performed the sacrifices; that he gave orders to Nearchus and the other commanders respecting the voyage, that it should take place on the third day; that next day he bathed again, and performed the appointed sacrifices; that the religious rites being over, he did not cease to be feverish, but that calling the commanders he gave orders for having every thing in readiness for the voyage; that he was bathed next day, and being bathed was already in a bad state. That next day being carried to the house adjoining the bath, he performed the appointed sacrifices; that he was in a bad state, but yet that he called to him the chiefs of his commanders, and again gave orders respecting the voyage; that the following day he was carried with difficulty to the religious rites and sacrificed, and that notwithstanding he gave orders to the commanders respecting the voyage.
That next day, although already in a bad state, he performed the appointed sacrifices; that he gave orders that the commanders should watch in the saloon, and the chiliarchs and pentacosiarchs before the doors; and that being altogether now in a bad state, he was carried from the garden to the palace. That when the commanders came in he recognized them, but did not speak, being now speechless; that he was in a bad state of fever during that night and day, and during another night and day. Thus it is written in the Royal Journals.” Thus far the report is no doubt to be strictly depended upon; the historical embellishments added to it from other sources can have no interest to the professional reader. (Appiani Exped. Alexandr., vii., 37.) It deserves to be remarked, as a remarkable feature in this case, that the mind appears to have been pretty entire during the whole course of the fever. Now, this is one of the characteristics of causus as described by Aretæus (Morb. Acut., ii., 4). It is further one of the most marked features of the yellow fever, which, from all I can learn of it, would appear decidedly to be an aggravated form of causus. [568] Galen admits that he did not understand the exact import of this term.
If, then, he bled so late in febrile diseases, Galen contends that he was not likely to neglect the operation in an earlier stage, when so much more demanded. He argues further, that in many of the other reports of cases he neglects to mention that the usual routine of practice was followed: and therefore he inclines to the opinion that it is omitted to be mentioned here, because the author supposed there could be no question on this point, more especially as it was his universal rule to bleed in all great complaints, when not prevented by the age or powers of the patient. He afterwards insists strongly on venesection having been indicated in this case, in order to procure revulsion from the brain. As usual with the commentator, he calls attention to the characters of the urine, and explains the meaning of the term “cloudy,” as applied to the _eneorema_, or substances floating in the urine, by which he contends is to be understood a color intermediate between white and black. What follows in this very lengthy Commentary is very interesting in a general point of view as regards the views of some of the older commentators, but is not directly applicable to the present case. His observations on the characters affixed to this and many of the subsequent cases have been noticed in the Argument. The reader will further remark of this case that it is an instance of fever passing into a deposit (_or_ abscess), and the latter into strangury, of which our author had made mention in the First Book of the Epidemics. I may further mention that the reader will find much interesting matter in Galen’s work On Trembling, in illustration of the nature of the attack under which the patient labored.
He justly remarks, that if Hippocrates treated the patient himself, or superintended the treatment as managed by another, it is singular that there is no mention of a clyster having been administered, nor of a cataplasm having been applied, nor of venesection having been practiced. I shall not attempt to solve the question here propounded by Galen. See the Argument. His Commentary also contains an interesting discussion on the meaning of the expression “respiration elevated.” To give the sum of what has been advanced on this subject in a few words, it may signify laborious breathing so as to move the labia of the nose; or it may mean simply orthopnœa, or it may signify laborious respiration, attended with elevation of the chest. By the way, this is evidently the “sublimis anhelitus” of Horace, in his famous ode entitled “Nireus.” I have often wondered that such a learned physician as Julius Cæsar Scaliger, in his celebrated critique on Horace in his Poetics, should have remarked on this expression: “Ex toto Galeno non intelligo quid sit sublimis anhelitus.” Galen, in fact, treats fully of the “sublimis anhelitus” in various parts of his works. See in particular On Difficulty of Breathing.
Lucretius, it will be remarked, understands the historian to mean that the mortified parts were amputated; and this opinion, although rejected by most of our non-professional editors of Thucydides, is confirmed by what Galen says in his Commentary on this passage, namely, that in erysipelas of the genital organs “we (meaning the physicians of his own time) are often obliged to excise the putrid parts, and apply the cautery to them.” I would here further point out a singular mistake into which Dr. Bloomfield falls in his note on this passage of Thucydides; he says that the words of the original (ἄκρας χεῑρας καὶ πόδας) “can only signify the ends of or lower joints of the fingers and toes.” No one who is acquainted with the language of our author will require to be told that this is an entire misconception. In the works of Hippocrates χεῖρες is often put for the arms, and χεῖρες ἄκραι are always applied to the hands. [708] Upon reference to the Glossary of Erotian, the Commentary of Galen, and the Annotations of Foës and Littré, the reader will see that there is great difficulty in determining the text in this place. After examining all that has been written on the subject, one cannot come to any satisfactory conclusion as to the true reading. I have adopted the meaning which seems to suit best with the passage. The professional reader will scarcely require to be reminded that in cases of phthisis there is often a notable impairment of the voice.
I am of opinion that this is one of the most interesting cases in the whole Collection, for I believe it to be a faithful report of a disease which on three several occasions I have met with during an active professional practice of thirty years, and which I have not seen described elsewhere. In all my cases, indeed, the patients were from twelve to sixteen years old, but in other respects the symptoms were the same as here described by Hippocrates. In every one of the cases the patient was seized with pain and swelling of the thigh, attended with high fever, great jactitation, and partial delirium. They all proved fatal in the course of three or four days. Whether the disease be connected with diffuse inflammation of the areolar substance, or with inflammation of the veins, or whether it be a general fever complicated with a local affection of the limb, or what may be the exact nature of the affection, I have not been able to determine. From what is stated above, it will be clearly seen how justly Hippocrates deserves the compliment paid to him by Galen, of having been, of all medical authorities, the most careful in observing the phenomena of disease. (Opera Galeni, tom. vii., p. 829, ed. Kühn.) [730] Galen remarks, that this is one of those cases which appear formidable to the inexperienced, but which those who are practiced in the art judge of as being likely to come to a speedy crisis. He adverts to the slight swelling of the spleen and the characters of the urine, which soon showed a proper sediment, as being particularly favorable symptoms. The more that we study Hippocratic medicine, we shall be the more convinced that too little attention has been paid of late years to the physical characters of the urine in all febrile complaints.
Text from Project Gutenberg, public domain in the United States.